Stroke Rehabilitation Research Articles

Exploring cerebellar transcranial magnetic stimulation in post-stroke limb dysfunction rehabilitation: a narrative review

This review delves into the emerging field of cerebellar Transcranial Magnetic Stimulation (TMS) in the rehabilitation of limb dysfunction following a stroke. It synthesizes findings from randomized controlled trials and case studies, examining the efficacy, safety, and underlying mechanisms of cerebellar TMS. The review outlines advancements in TMS technologies, such as low-frequency repetitive TMS, intermittent Theta Burst Stimulation, and Cerebello-Motor Paired Associative Stimulation, and their integration with physiotherapy. The role of the cerebellum in motor control, the theoretical underpinnings of cerebellar stimulation on motor cortex excitability, and the indirect effects on cognition and motor learning are explored. Additionally, the review discusses current challenges, including coil types, safety, and optimal timing and modes of stimulation, and suggests future research directions. This comprehensive analysis highlights cerebellar TMS as a promising, though complex, approach in stroke rehabilitation, offering insights for its clinical optimization.

Supporting Long-Term Meaningful Outcomes in Stroke Rehabilitation.

Rehabilitation is the mainstay of recovery after stroke, but key recommendations focused on delivering 'as much therapy as possible' and stroke survivor outcome measures have remained relatively unchanged for decades. Traditional therapy approaches focus on maximum improvement of physical impairments while a stroke survivor is in hospital to ensure that community discharge can be deemed 'safe'. This narrow approach sidelines the outcomes that are meaningful to the stroke survivor in the long term and the challenges they may face within their social context. In this article, we highlight the importance of the whole-person approach and review recent research introducing novel considerations to optimise outcomes after stroke. Psychosocial well-being is a major component of health but is poorly acknowledged and managed for stroke survivors. Evidence supports the use of self-management interventions, peer befriending, and culturally - responsive methods, including deep engagement with Indigenous and cultural knowledge. Cultural safety and involvement of a stroke survivor's important personal connections are also vital for achieving truly person-centred care and equity in rehabilitation outcomes. Outcomes in rehabilitation will be optimised if we shift our mindsets from a sole focus on improving physical impairments to a broader scope of delivering whole-person care.

Visual Impairment in Stroke Patients: a Two-Part Review. Part II — Rehabilitation Methods

INTRODUCTION. The search and development of optimal rehabilitation programs for patients who have suffered acute cerebrovascular accident (OMNA) is an urgent problem of modern medicine. The development of scientific and technical capabilities leads to the active introduction of the latest technologies at different stages of medical rehabilitation of cerebral stroke. This article is the second part of a two-part review devoted to the problem of visual impairment in patients with acute cerebrovascular accident, which provides an overview of the methods of rehabilitation of patients in this category. MAIN CONTENT OF THE REWIEW. This overview of rehabilitation methods for patients with impaired visual functions who have undergone OMNA is based on publications in international and domestic databases OpenAlex, Scilit, Lens, PubMed, Cyberleninka and eLibrary available for analysis by 15.08.2024, with a search depth of mainly 15 years. As a result of the search, 66 articles on a given topic were reviewed. In addition, 6 sources dated from an earlier period (1989–2005) were used, as they contain the necessary information within the framework of this review. The rehabilitation methods considered in the review correspond to the accepted basic strategies for restoring impaired visual functions, including those caused by cerebral stroke. Two main strategies include the use of optical devices to adapt to the environment and training of intact structures of the visual analyzer aimed at compensating for lost functions. The third strategy is aimed at increasing the processing of visual information in areas of residual vision. CONCLUSION. The variety of types of visual disorders, the degree of influence on the quality of life of stroke patients, necessitates the search and development of optimal rehabilitation programs. This will significantly expand the choice of recovery options after a cerebral stroke in this category of patients.

Coming to my own wisdom: A qualitative study exploring the role of the Take Charge intervention in stroke recovery.

The Take Charge intervention, delivered early after hospital discharge following acute stroke, is effective at improving 12-month health status, independence and advanced activities of daily living. This study aims to provide a deeper understanding of the experiences of receiving Take Charge. This was a qualitative study nested within a large randomised control trial, the Taking Charge After Stroke (TaCAS) study. Data were analysed using thematic analysis, and we describe our findings using interpretive description. People with stroke aged over 18 years, who were participants in the TaCAS study conducted in Aotearoa New Zealand. Take Charge, a person-centred conversation delivered face-to-face, designed to explore a person's identity and priorities, conducted by a trained facilitator and guided by a workbook. We interviewed nine participants, three from each of the three arms of the TaCAS trial - each would have received one, two, or zero Take Charge sessions (the control group). The overall theme of 'Doing things my way/coming to know my own wisdom and expertise' was enabled by 'being listened to and feeling heard' and 'focusing on the goals which were important to me', both strongly expressed by people who received the Take Charge intervention, and hindered by 'medical paternalism' and 'loss of sense of self/"not me"' most commonly expressed by people in the control arm. The Take Charge intervention empowers people with stroke by enhancing intrinsic motivation. A trusting, therapeutic relationship and non-judgemental facilitation are essential to ensure that the person feels heard.

Abstract 24: Iron deposition changes of ipsilateral ventral posterolateral nuclei correlate with central post-stroke pain after thalamic infarction

Objectives: To investigate the correlation between iron deposition changes in the lesioned thalamic nuclei and the presence and severity of central post-stroke pain (CPSP) after thalamic infarction using quantitative susceptibility mapping (QSM) technique. Methods: We consecutively enrolled patients with unilateral chronic thalamic infarction with radiological examination conformed . Detailed and multidimensional pain characteristics measured as follows: Douleur Neuropathique 4 (DN4) questionnaire for validation of neuropathic pain diagnosis, Short-Form McGill Pain Questionnaire (SF-MPQ) for comprehensive representation of pain experience, Present Pain Intensity index (PPI) for current pain severity upon examination, and Visual Analogue Scale (VAS) for overall pain feeling since symptom onset. Age- and sex-matched stoke-free healthy controls were recruited simultaneously. High resolution structural image 3D-T1 BRAVO and QSM sequences were obtained with 3.0T MRI. The voxel-lesion-symptom-mapping (VLSM) was used to determine lesioned thalamic nuclei at the high risk for CPSP. Then ipsilateral QSM values of the whole thalamus and subregions were compared with contralateral side and healthy controls. Partial correlation analysis were performed to explore the relationship between QSM value and pain severity. Results: Finally, 28 CPSP patients, 33 non-CPSP patients and 55 healthy controls were included in the study. Our results indicated no significant difference in overall QSM values of the whole thalamus among the groups. The VLSM results showed lesion involving ventral posterolateral nuclei (VPL) was highly orrelaed with occurance of CPSP ( p FWE =0.0092.). The QSM values of each subnuclei in the thalamus ipsilateral to infarction were lower compared with the contralateral side and healthy controls ( p <0.001). Nonetheless, the QSM values in ipsilateral VPL were higher in CPSP patients campared with non-CPSP patients( p =0.003). Notably, the QSM values in the ipsilateral VPL were significantly correlated to pain severity (all p <0.05). Conclusions: The study showed that altered iron deposition in the VPL nuclei is associated with the occurrence and severity of CPSP following thalamic infarction. Aberrant iron deposition after ischemic thalamus stroke may play an important role in the pathogenesis of CPSP. Key words: Thalamic infarction; Central post-stoke pain; Iron deposition; VLSM; Quantitative susceptibility mapping

Abstract TP351: Evidence of sustained monocytosis during chronic stroke recovery

An acute ischemic stroke (AIS) triggers rapid mobilization of immune cells from bone marrow, leading to the infiltration of circulating immune cells into the brain. Among these immune cells, monocytes, which are pivotal in both adaptive and innate immune responses, play a crucial role in stroke injury and recovery in a temporal manner. Previous research indicates that tissue injury such as AIS causes acute monocytosis. However, it remains unclear if this upregulation persists during the recovery phase. Given the diverse roles of monocytes during post-stroke recovery, we hypothesize that their numbers remain elevated during chronic recovery. In this study, we will analyze the effect of stroke duration on monocytosis and the factors affecting this process after AIS. We recruited consecutive AIS patients (58-90 years) undergoing endovascular clot retrieval and age-matched healthy control subjects of both sexes, with informed consent obtained from all participants. Flow cytometric analysis of whole blood-derived immune cells, including monocytes, was performed at 0–2 days (acute, n=20), 3–7 days (subacute, n=20), and 65±20 days (chronic, n=14) after stroke onset. These were compared with healthy subjects (n=20 per age group). A pure monocyte population was isolated using a side and forward scatter plot with cell-surface markers, such as HLA-DR, CD45, CD11b, CD14, and CD16, along with a negative gating strategy. Plasma samples were analyzed for various secreted cytokine levels using the Millipore multiplex array. scRNA-seq analysis was employed to support the evidence of monocytosis using total immune cells of these subjects. We found that the total monocyte count (% of total immune cells) progressively increased during recovery in AIS patients (P<0.05), which was corroborated by unbiased scRNA-seq analysis data. Cytokine analysis indicated that the levels of M-CSF and G-CSF also progressively increased, further supporting the evidence of monocytosis after stroke. Subclassification of monocyte clusters from RNA-seq data suggested that specific monocyte subsets are the major contributors to monocytosis. In summary, our data support the evidence of continued monocytosis after ischemic stroke, indicating diverse roles for monocytes beyond the acute inflammatory response. Detailed molecular characterization of monocytes, their subpopulations, and their genetic composition over time may provide novel insights into their pathophysiological roles during stroke recovery.

Patient preferences for gender-concordant physiotherapists in stroke rehabilitation: a cross-sectional study

ObjectivesTo investigate patient perspectives on the gender of physiotherapists in stroke rehabilitation. MethodsA cross-sectional study was conducted among a diverse group of patients with stroke (N=143) who required manual assistance with transfer and ambulation. Participants were asked about their preferences for the gender of their physiotherapist and responses were categorized as male physiotherapist, female physiotherapist, or gender doesn't matter. ResultsA significant proportion of participants (24-38%) showed a preference for gender-concordant physiotherapists (p < 0.01). Women had a higher preference for gender-concordant physiotherapists compared to men. Specifically, 3 to 4 out of 10 women (32-38%) preferred physiotherapists of the same gender, while 5 to 6 out of 10 (51-57%) indicated that the gender of the physiotherapist didn’t matter to them (p < 0.01). ConclusionsThis study highlights the diverse perspectives on the importance of physiotherapist gender among patients with stroke. While gender preferences may influence patient comfort and engagement in therapy, these preferences are not universal and should be considered within a broader context of patient-centered care.Practice Implications:Rehabilitation programs should strive to be sensitive to patient preferences while balancing these preferences with the availability of skilled therapists and the operational constraints of clinical settings

Abstract TP104: Bridging the Education Gap: Strengthening Stroke Rehabilitation in the Midwest

Introduction: Post-acute care (PAC) facilities across Iowa, Montana, Nebraska, and North Dakota are engaged in the American Heart Association’s Mission: Lifeline Stroke PAC Initiative, a quality improvement initiative focused on enhancing stroke rehabilitation through evidence-based practice. Participants across these states collaborate to improve patient care, identify gaps in current practices, and enhance stroke specific education. Purpose: In a 2023 survey of healthcare professionals (HCPs) in Iowa, 48% (n=120) of respondents identified professional education as a missing resource that could help them provide rehabilitation care to stroke survivors. Through the initiative, education was developed to address this identified need. Methods: A variety of free educational opportunities were offered throughout the Mission: Lifeline Stroke Initiatives. These included in-person stroke conferences and workshops, virtual learning modules, online courses, and discipline specific rehabilitation certifications. 760 HCPs participated in 12 different educational offerings across Midwest states. Attendees were surveyed to assess the perceived benefits of the offerings, utility to their current role, and improvements in knowledge and confidence providing rehabilitation care to stroke patients. Results: Following the completion of the educational offerings, 93 attendees completed a post-survey. The large majority of respondents reported they were extremely or mostly confident in identifying signs of a stroke (95%), describing common deficits after a stroke (96%), and implementing evidenced-based practices to address these deficits (90%). Most respondents agreed the trainings improved their knowledge of the relationship between treatment and stroke rehab patient outcomes (91%) and their understanding about key issues related to working with stroke rehab patients (91%). Overall, 78% of respondents reported they always or often use the knowledge and skills learned from the trainings and 95% were satisfied with the content of the trainings. Respondents also identified additional educational needs for cognitive rehabilitation strategies, aphasia interventions, caregiver education, community integration, and general stroke rehabilitation. Conclusions: Mission: Lifeline Stroke educational offerings benefitted HCPs by improving their knowledge and confidence to provide care to stroke patients. Education on additional stroke specific topics were also identified.

Development and validation of clinical prediction model for functional independence measure following stroke rehabilitation.

To develop and internally validate a clinical prediction model that includes balance ability and nutritional indices for the motor-functional independence measure (M-FIM) at 90 days post-stroke stroke. This retrospective, single-center study included 566 patients with stroke undergoing rehabilitation at our rehabilitation hospital. The primary outcome was the M-FIM score of >61 at 3 months post-strokes onset. Stepwise conditional forward selection was first used to identify predictors for the achievement of M-FIM>61 at 90 days post-stroke, from 25 potential predictors at admission. The selected predictors were dichotomized with cut-off values to establish scoring systems, resulting in the B-ADL model, which includes postural balance (B), albumin level, age, arm function (A), days since stroke onset (D), and level of activities of daily living (ADL) (L). For internal validation, we corrected the optimism of the area under the curve of receiver operating characteristic curve (AUROC) induced by overfitting the original data using the bootstrap validation method. Calibration capacity was assessed using a calibration plot. We developed a clinical model to predict the M-FIM at 90 days post-stroke onset. The AUROC of the B-ADL model was 0.92 (sensitivity, 93.7%; specificity, 89.7%). The B-ADL model showed high accuracy with an AUROC of 0.970 in the internal validation. The scoring system in the validation cohort had a cut-off value of 5.5/12 points to predict the achievement of M-FIM>61 (AUROC: 0.950; 95% CI 0.930-0.970). The B-ADL model accurately predicted M-FIM >61 at 90 days post-stroke on the day of admission to the recovery rehabilitation ward. The B-ADL model is useful for optimizing rehabilitation programs and resource allocation, allowing for targeted interventions after stroke.

Abstract TP113: Cerebellar Intermittent Theta Burst Stimulation in Post-Stroke Gait Impairment: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background: Persistent gait impairments affect nearly half of stroke survivors six months post-stroke, despite standard rehabilitation. Intermittent theta burst stimulation (iTBS), a specialized form of repetitive transcranial magnetic stimulation (TMS), has shown promise in enhancing neural circuit activity and promoting long-term potentiation. While traditionally targeting the primary motor cortex, recent studies suggest that cerebellar iTBS may further improve gait and balance by modulating cerebello-cortical pathways. Aim: This meta-analysis aims to evaluate the efficacy of cerebellar iTBS in improving gait and balance in stroke patients. Methods: We conducted a systematic search in PubMed, Embase, and the Cochrane Library until August 2024, following the recommendations in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Included studies were peer-reviewed randomized controlled trials (RCTs) that assessed the effects of cerebellar iTBS on balance, assessed using the Berg Balance Scale; gait, measured through 3D gait analysis and the Timed Up and Go (TUG) test; and activities of daily living, assessed via the Barthel Index, in post-stroke patients with persistent gait and balance impairments. Meta-analyses were performed using a random-effects model. Results: Seven RCTs involving a total of 230 post-stroke patients (iTBS group, n=115) were included in this meta-analysis. The analysis revealed a significant improvement in balance (standardized mean difference [SMD] = 1.20, 95% confidence interval [CI] 0.12 to 2.29, p = 0.03). However, the TUG test did not demonstrate a significant change (SMD = 0.04, 95% CI: -0.37–0.46, p = 0.83), potentially reflecting variability in baseline gait performance. The 3D gait analysis showed a favorable but non-significant trend towards step length improvement (SMD = 0.71, 95% CI: -0.82–2.23, p = 0.37). Notably, a significant enhancement was observed in activities of daily living (SMD = 1.24, 95% CI: 0.49–1.98, p = 0.001). Conclusions: This meta-analysis suggests that cerebellar iTBS significantly enhances activities of daily living in post-stroke patients, with a potential but less consistent impact on balance and gait. These findings highlight the promise of cerebellar iTBS as an adjunctive therapy in stroke rehabilitation, though further high-quality RCTs are needed to clarify its specific therapeutic benefits.

Abstract TP110: Impact of High-Intensity Training on Cardiopulmonary and Lipid Profiles in Stroke Rehabilitation: A Systematic Review and Meta-Analysis

Introduction: Cardiovascular comorbidities are highly prevalent in patients who suffer from cerebrovascular disease. Peak oxygen uptake (VO 2 peak) is a well-established, independent predictor of cardiovascular health and premature mortality. Dyslipidemia also contributes significantly to cardiovascular disease risk. Although previous studies have demonstrated improvements in these parameters with any exercise, the evidence remains inconclusive regarding which exercise intensity offers the greatest benefit. This systematic review and meta-analysis aims to compare the effects of high-intensity training (HIT) with other exercise intensities, including moderate intensity (MIT) and usual activity (UA). Methods: We systematically searched the PubMed, Cochrane, Embase, and Scopus databases for studies comparing HIT with MIT or UA in stroke patients. We evaluated changes from baseline in VO 2 peak, serum LDL, and HDL levels. Additionally, a separate analysis comparing HIT with MIT and UA was conducted for VO 2 peak. Results: A total of eight studies, involving 338 patients, were included in our analysis, with 163 (48%) of these patients undergoing HIT. The pooled analysis revealed that VO 2 peak was significantly higher in the control group compared to the HIT group, with a mean difference (MD) of 2.01 ml/kg/min (95% CI: 0.85-3.18, p &lt; 0.01). Further analysis of four studies comparing HIT with MIT and three studies comparing HIT with UA showed that VO 2 peak was significantly higher following MIT (MD 2.03; 95% CI: 0.70-3.35; p &lt; 0.01) and UA (MD 3.73; 95% CI: 0.87-6.59; p = 0.01). A separate analysis of three studies involving 148 patients showed no significant difference in serum LDL levels (MD 0.51; 95% CI: -0.46-1.49; p = 0.30) or serum HDL levels (MD -0.02; 95% CI: -0.16-0.13; p = 0.83). Conclusion: High-intensity training, based on a moderate sized pooled sample, does not offer superior advantages in changes from baseline in cardiopulmonary parameters compared to different exercise intensities. Future well-structured randomized controlled trials are needed to evaluate different exercise intensities and durations for more definitive conclusions. Nevertheless, the early data seems to indicate that there are no differences between exercise modalities.

Abstract TP105: Non-invasive Brain Stimulation Alters Resting-State Brain Activity in Ischemic Stroke

Stroke is the leading cause of serious long-term disability in the United States. Stroke recovery is greatly varied since the long term effect is determined by the site and size of the initial lesion. Specifically, post stroke motor impairments occur due to damage to the corticospinal tract and maladaptive upregulation of the cortico-reticulospinal tract. Transcranial direct current stimulation (tDCS) may be an effective treatment for stroke rehabilitation. However, conventional tDCS is limited by spatial resolution to precisely target a specific brain region. To improve its spatial resolution, this study used targeted high-definition tDCS (HD-tDCS) navigated by paired-pulse transcranial magnetic stimulation. In a double-blind randomized crossover study, stroke participants (n=12) had three visits 1) anodal HD-tDCS stimulation of the arm region of the primary motor cortex (M1) to improve function of the corticospinal tract in the lesioned hemisphere, 2) cathodal stimulation of the arm region of the dorsal premotor (PM) cortex to inhibit maladaptive use of the cortico-reticulospinal tract in the contralesional hemisphere, and 3) sham. The effect was measured by quantitative electroencephalogram (qEEG) metrics delta alpha ratio (DAR) and delta theta alpha beta ratio (DTABR), calculated from a pre and post 3-minute EEG. Acute changes in brain activity of these power bands have been associated with the severity of motor impairment post stroke. The results demonstrate that anodal (p=0.026) and cathodal (p=0.0108) stimulation significantly decreased the DAR compared to the sham. The reducation of DAR value is associated with the improvement of Fugl-Meyer Upper Extremity score. However, there were no significant differences found in the DTABR. These results indicate that both anodal and cathodal HD-tDCS may improve brain function following stimulation. However, future work is required on the use of qEEG metrics and its use as a marker of stroke recovery. This work is important as qEEG could be used as a more objective method, compared to clinical assessments, to track stroke rehabilitation.

Abstract WP128: A Comparative Meta-Analysis of Functional Outcomes Following Various Exercise Intensities in Stroke Rehabilitation.

Abstract WP128: A Comparative Meta-Analysis of Functional Outcomes Following Various Exercise Intensities in Stroke Rehabilitation.

Abstract TP103: Exploring the experience of engaging in a visual arts-based intervention on promoting psychosocial functioning among community-dwelling stroke survivors: Qualitative insights from a randomized controlled trial

Introduction: A visual arts-based intervention was developed and implemented for community-dwelling stroke survivors. Purpose: This study aimed to explore the participants’ experience of engaging in a visual arts-based intervention. Methods: Stroke survivors were recruited and randomly allocated to receive visual arts-based intervention or usual stroke care in the community settings. This intervention is a four-week group intervention with six activities guided by Bandura’ principles of self-efficacy, including warm-up activity, art-making activity, break, discussion, workbook review, and end-up activity. Semi-structured interviews were conducted with the participants after completing the intervention. Participants were invited to share their experience of engaging in the intervention, including comments, primary concerns, and difficulties encountered. Interview data were audio-recorded and transcribed as well as analyzed by thematic analysis. Results: Sixty-one participants (age range: 49 to 93) were interviewed. The results showed that most participants were satisfied with the intervention and appreciated the facilitator’s encouraging attitude. They appreciated the theme of each session, all of which enabled them to recall their memories to draw on meaningful values from their stroke recovery journey. Furthermore, over half of participants acknowledged that the intervention addressed their psychosocial concerns, which added values to address gaps in the traditional stroke rehabilitation. Specifically, they considered the creative approach in art-making activities and discussions enhanced their verbal and non-verbal expression, explored and expressed their inner emotions, and encouraged them to engage in group interactions. However, participation in the intervention was challenging for some participants. They pointed out some stroke-related barriers, such as blurred vision, slow reaction, lack of imagination, and limitation in hand movement, affecting their performances in group. Additionally, a lack of familiarity with art-making activity and tool for drawing also contributed to their difficulties in engaging in the intervention. To ensure the intervention implementation, participants suggested modifying the intervention to minimize barriers that hinder participants and establishing a more inclusive intervention environment in future. Conclusion: The qualitative results provided valuable insights of the impact of the visual arts-based intervention for stroke recovery.

Abstract TMP51: Association between genetic variation and acute stroke characteristics

Introduction: Strokes lead to acute deficits with wide-ranging severity. Genetic variation may explain some of these inter-subject differences. The current report examined the relationship that candidate genetic variants have with acute injury and acute behavioral deficits. We hypothesized that variants known to be associated with poorer stroke recovery would also be associated with more a severe acute presentation. Methods: Infarcts were outlined on clinical scans acquired during acute stroke admission as part of the STRONG (“Stroke, sTress, RehabilitatiON, and Genetics”) study and resampled to MNI152 brain standard space. Multivariable linear regression modeling was used to examine association with genetic measures known to be related to stroke outcome: 3 single nucleotide polymorphisms (SNPs): BDNF (rs6265), ACE (rs4291), and FAAH (rs324420), plus ApoE e4 and ApoE e2; a dopamine polygene score was also explored. Acute injury (infarct volume) and acute deficits (NIHSS score, grip strength, and acute stress disorder inventory (ASDI)) were each examined as the dependent measure in separate models that used age, gender, and ancestry as covariates. To understand where in the brain these relationships occurred, voxel lesion symptom mapping (VLSM) was used to test for associations between acute injury and each genetic measure. Results: In 448 subjects (age 63.4±14.4 yr (mean±SD), 43.1% females), lesion volume ranged from 0.46 to 535.13 cc and involved cortical grey matter in 63% of patients. Larger lesion volume was associated with presence of the ACE SNP (β=8.77, p=0.03); lower NIHSS score, with ApoE e4 (β=-1.69, p=0.04); greater grip strength, with ApoE e2 SNPs (β=6.78, p=0.03); and higher ASDI, with the ACE SNP (β=0.56, p=0.05). VLSM revealed that acute injury to the postcentral gyrus was significantly more likely in the presence of the ACE SNP (z=-3.5), and that acute injury to the calcarine fissure was significantly more likely in the presence of the BDNF SNP (z=-2.53). Conclusions: Genetic variants known to be associated with differences in stroke recovery are also related to acute stroke deficits and injury. In particular, a common variant in the gene for ACE was associated with differences in lesion volume and location, findings that may suggest a personalized medicine approach to acute therapy. Measures of genetic variability may be useful to understand inter-subject differences in acute injury and symptom severity, and may have therapeutic implications.

Associations between non-verbal cognitive assessment and stroke recovery via screening test for aphasia and dysarthria

Associations between non-verbal cognitive assessment and stroke recovery via screening test for aphasia and dysarthria

Abstract TP102: Exploring the Role of Podcasts in Stroke Recovery and Prevention

The recovery process for stroke patients requires ongoing reinforcement of critical health information. Traditional education methods of written handouts often fail to adequately meet patient needs, particularly for those with limited literacy, or busy lifestyles. Podcasts are emerging as a powerful tool in patient education, offering a flexible, accessible, and engaging format that can be accessed anytime, anywhere. The hypothesis was that by prescribing podcasts, we could ensure patients have continuous access to vital information, allowing for repeated exposure and improved retention of key concepts. Studies have shown that podcasts can significantly enhance knowledge retention and listener engagement, even when listeners are engaged in other activities, as verified by EEG. This makes podcasts a practical solution for reinforcing key health messages and catering to diverse learning preferences, offering an alternative for patients who may struggle with written materials. Since neurological patients struggle to retain complex medical information provided during brief consultations, this can lead to gaps in understanding, and consequently suboptimal outcomes. Putting this hypothesis to the test, our method was to create a podcast with episode topics selected by a multidisciplinary stroke team, focusing on the frequently asked questions posed by stroke survivors and caregivers. Each podcast episode features interviews with expert guests or stroke survivors who discuss strategies and resources relevant to the topic. To enhance accessibility, links to printable information and specialist directories are provided in the show notes of each episode. The results demonstrate global demand for access to such specialized information, with regular listeners in 56 countries, all 50 of the United States and over 1600 downloads in outlying US territories. Each new episode consistently averages 300 audio downloads or video views in the first week they are released. In conclusion, neurology providers are encouraged to incorporate podcasts as a standard component of their stroke patient education strategy. Also, future research should focus on developing specialized neurological podcasts tailored to community needs, providing insight into how to aid them to better understand and manage their conditions, ultimately contributing to improved adherence to treatment plans and better quality of life.

Abstract WP305: Childhood Trauma Exposure, Loneliness, Mental Health, and Stroke Recovery: Findings From The STRONG Study

Abstract WP305: Childhood Trauma Exposure, Loneliness, Mental Health, and Stroke Recovery: Findings From The STRONG Study

Abstract TP394: Electrical Stimulation Therapy Improves Mitochondrial Calcium Uptake in Induced Neurons under Hypoxic Conditions

Introduction: Electrical stimulation has proven itself to be a powerful and novel tool in stroke recovery. However, it is unknown why this therapy significantly improves behavioral outcomes in rodent models of stroke. In a hypoxic environment, neural cells lack the proper glucose and oxygen to survive leading to many cell death pathways like Ca 2+ toxicity. Healthy neural cells can uptake excess intracellular Ca 2+ through the mitochondria as mitochondrial membrane potential increases. Neural cells under hypoxic conditions, however, are unable to uptake as much calcium due to mitochondrial dysfunction. We hypothesize that electrical stimulation therapy increases mitochondrial membrane potential in neural cells under hypoxia leading to increased Ca 2+ uptake and less Ca 2+ toxicity in the cell. Methods: To test our hypothesis, we used two innovative methodologies: (1) neuron conversion from induced pluripotent stem cells (iPSCs) with neurogenin-2 (Ngn2) overexpressed for a period of 28 days developed in the Wernig Lab, and (2) a custom in vitro stimulation setup consisted of a gold layer sputtered onto cell culture inserts and a copper sheet placed below the 24-well plate creating an electric field across the iN cells (Figure 1). Induced neurons (iN) underwent oxygen glucose deprivation (5% CO 2, 10% H 2 , and 85% N 2 ) for a period of four hours in glucose deprived media. One hour after exposure, iN cells were electrically stimulated at 50mV, 100Hz, and a 20% duty cycle for 20 minutes at 37°C. One day after stimulation, iN cells were stained with Rhod-2, a labeled calcium indicator that increases in fluorescence as a function of mitochondrial Ca 2+ , and DAPI to confirm cell presence. Results and Conclusions: Stimulation significantly increased mitochondrial Ca 2+ concentration in healthy iN cells seen in Figure 2 (N = 5, p = 0.014). In Figure 3, stimulation also significantly increased mitochondrial Ca 2+ in hypoxic cells (N = 5, p = 0.0024). Increased mitochondrial Ca 2+ in both cases indicates that mitochondrial calcium uptake appears to be improving. Electrical stimulation increasing mitochondrial membrane potential and improving calcium uptake could be a mechanism by which electrical stimulation facilitates stroke recovery. Future work will include additional staining for cytosolic calcium concentration (Calcium Green) and mitochondrial membrane potential (TMRM) to better track the relationship between the two.

Abstract 25: Discovery of Serum Biomarkers to Inform Early Rehabilitation after Acute Ischemic Stroke

Background: Rehabilitation therapy is an important component of acute ischemic stroke (AIS) recovery. A major hinderance is the inability to predict which patients benefit from mobilization during the first 24 hours (ERehab). We hypothesize serum biomarker analyses during the hyperacute phase can bridge the gap. Methods: This is a single center study of 20 AIS patients&amp;14 age/sex matched controls enrolled from 3/2022-6/2023. Serum samples were collected at 4 time points – angiography suite before cerebral reperfusion or Neuro ICU at hospital admission, 12, 24&amp;72 hours. Biomarker candidates were identified using a DisGeNET search for AIS associated proteins; 70% achieved an Evidence Index cutoff score of 1, indicating all publications support human gene-disease or variant-disease associations. Time course of serum proteome changes was evaluated using aptamer-based SomaScan assay, measuring 1500 proteins. NIH Database for Annotation, Visualization&amp;Integrated Discovery (DAVID) Gene Functional Classification Tool compared shared genes and biomarkers for stroke (vs healthy controls)&amp;unfavorable (vs favorable) outcome, characterized by modified Rankin Scale (mRS) score of 3-6 (vs 0-2), at hospital discharge&amp;90 days (90d). Results: The mean age of AIS patients was 59 years, 65% were male. Median NIHSS score was 11, Charlson Comorbidity Index score was 5.5 and the median last known well to hospital admission was 6.6 hrs. The average time to first mobilization was 39 hrs, 25% received ERehab. The mean rehab duration during AIS hospitalization was 438 min; median length of stay was 8.4 days, 40% received post-acute rehabilitation. Median AIS volume was 36mL, 65% of patients had ICA or M1/MCA involvement. Approximately 65% received IV thrombolysis, 80% underwent cerebral reperfusion therapy, 94% achieved modified thrombolysis in Cerebral Infarction score ≥ 2b. The median mRS was 4 at hospital discharge, 3 at 90d. Mortality rate was 10%. DAVID analyses resulted in 22 biomarkers at hospital discharge&amp;35 biomarkers at 90d associated with favorable outcome. Gene expression differences were present at each time point (Figure). Conclusions: We identified multiple serum biomarkers and gene clusters associated with favorable outcomes at hospital discharge and 90d in AIS patients, indicating a need for several biologic targets to predict ERehab response during the hyperacute phase. These findings provide an early framework for tailored stroke recovery interventions.