Stroke Subjects Research Articles

Time profile of kinematic synergies of stroke gait.

BackgroundIn stroke subjects, the motor skills differ between sides and among subjects with different levels of motor recovery, impacting inter-joint coordination. How these factors can affect the kinematic synergies over time during gait has not been investigated yet. This work aimed to determine the time profile of kinematic synergies of stroke patients throughout the single support phase of gait. MethodsKinematic data from 17 stroke and 11 healthy individuals was recorded using a Vicon System. The Uncontrolled Manifold approach was employed to determine the distribution of components of variability and the synergy index. To analyze the time profile of kinematic synergies, we applied the statistical parametric mapping method. Comparisons were made within the stroke group (paretic and non-paretic limbs) and between groups (stroke and healthy). The stroke group was also subdivided into subgroups with worse and better motor recovery. FindingsThere are significant differences in synergy index at the end of the single support phase between stroke and healthy subjects; paretic and non-paretic limbs; and paretic limb according to the motor recovery. Comparisons of mean values showed significantly larger values of synergy index for the paretic limb compared to the non-paretic and healthy. InterpretationDespite the sensory-motor deficits and the atypical kinematic behavior, stroke patients can produce joint covariations to control the center of mass trajectory in the forward progression plane, but the modulation of the synergy is impaired, reflecting altered adjustments, especially in the paretic limb of subjects with worse levels of motor recovery.

Corticomuscular and intermuscular coherence are correlated after stroke: a simplified motor control?

During movement, corticomuscular coherence is a measure of central-peripheral communication, while intermuscular coherence is a measure of the amount of common central drive to the muscles. Although these two measures are modified in stroke subjects, no author has explored a correlation between them, neither in stroke subjects nor in healthy subjects. Twenty-four chronic stroke subjects and 22 healthy control subjects were included in this cohort study, and they performed 20 active elbow extension movements. The electroencephalographic and electromyographic activity of the elbow flexors and extensors were recorded. Corticomuscular and intermuscular coherence were calculated in the time-frequency domain for each limb of stroke and control subjects. Partial rank correlations were performed to study the link between these two variables. Our results showed a positive correlation between corticomuscular and intermuscular coherence only for stroke subjects, for their paretic and non-paretic limbs (P < 0.022; Rho > 0.50). These results suggest, beyond the cortical and spinal hypotheses to explain them, that stroke subjects present a form of simplification of motor control. When central-peripheral communication increases, it is less modulated and more common to the muscles involved in the active movement. This motor control simplification suggests a new way of understanding the plasticity of the neuromuscular system after stroke.

Effects of cortico-cortical paired associative stimulation based on multisensory integration to brain network connectivity in stroke patients: study protocol for a randomized doubled blind clinical trial

Introduction: Brain has a spontaneous recovery after stroke, reflecting the plasticity of the brain. Currently, TMS is used for studies of single-target brain region modulation, which lacks consideration of brain networks and functional connectivity. Cortico-cortical paired associative stimulation (ccPAS) promotes recovery of motor function. Multisensory effects in primary visual cortex(V1) directly influence behavior and perception, which facilitate motor functional recovery in stroke patients. Therefore, in this study, dual-targeted precise stimulation of V1 and primary motor cortex(M1) on the affected hemisphere of stroke patients will be used for cortical visuomotor multisensory integration to improve motor function.MethodThis study is a randomized, double-blind controlled clinical trial over a 14-week period. 69 stroke subjects will be enrolled and divided into sham stimulation group, ccPAS low frequency group, and ccPAS high frequency group. All groups will receive conventional rehabilitation. The intervention lasted for two weeks, five times a week. Assessments will be performed before the intervention, at the end of the intervention, and followed up at 6 and 14 weeks. The primary assessment indicator is the ‘Fugl-Meyer Assessment of the Upper Extremity ’, secondary outcomes were ‘The line bisection test’, ‘Modified Taylor Complex Figure’, ‘NIHSS’ and neuroimaging assessments. All adverse events will be recorded.DiscussionCurrently, ccPAS is used for the modulation of neural circuits. Based on spike-timing dependent plasticity theory, we can precisely intervene in the connections between different cortices to promote the recovery of functional connectivity on damaged brain networks after stroke. We hope to achieve the modulation of cortical visuomotor interaction by combining ccPAS with the concept of multisensory integration. We will further analyze the correlation between analyzing visual and motor circuits and explore the alteration of neuroplasticity by the interactions between different brain networks. This study will provide us with a new clinical treatment strategy to achieve precise rehabilitation for patient with motor dysfunction after stroke.Trial registrationThis trial was registered in the Chinese Clinical Trial Registry with code ChiCTR2300067422 and was approved on January 16, 2023.

Financial Burden of Acute Cerebrovascular Disease in United States Healthcare During 1993–2019 (P6-5.025)

<h3>Objective:</h3> To determine the financial burden of stroke on the national healthcare system for the past three decades. <h3>Background:</h3> Stroke is a leading cause of morbidity and mortality in the United States and has implications on the financial health of patients, families, and healthcare systems. <h3>Design/Methods:</h3> This is a retrospective study of inpatient subjects from 1993–2019 with cerebrovascular disease that was collected from the Healthcare Cost and Utilization Project (HCUP). Patients were evaluated for demographics, length of stay (LOS), mortality, and hospital charges. Statistical Z-testing was conducted for the analysis. <h3>Results:</h3> During the study period, 17,041,026 stroke subjects were studied, with 52.6% female and mean age of 70.62 (± 0.16) years old. The mean rate of stroke discharges per 100,000 persons was 194.46 (± 3.74), with an increase from 203 to 209 during the study (p = 0.22). The mean percentage of deaths was 9.52% (± 0.17), which decreased from 12.87% to 5.52% (p = 0.00). The mean LOS was 6.63 days (± 0.08), decreased from 9.54 to 6.90 during the study (p = 0.00). During the study period, the aggregated national bill was $710 billion. The mean hospital charges per patient were $43,954.23 (± 1,185.90) with an increase from $14,392.06 to $111,279.50 during the study period (p = 0.00). <h3>Conclusions:</h3> Our data show that the rate, LOS, and mortality of stroke have decreased, but its charges are increasing. The improvement in outcomes could be multifactorial such as establishment of comprehensive stroke centers and evolving treatment modalities. Ironically, the charges-per-patient increased nearly eight-fold with a national bill almost equal to the annual Medicare budget. Thus, the significance of preventive medicine, such as controlling hypertension, diabetes, and smoking cessation, cannot be understated. With such a dramatically increasing financial burden, improvements in mitigating risk factors, educational programs, and access to care may be a more cost-effective option. <b>Disclosure:</b> Miss Lorio has nothing to disclose. Miss Malone has nothing to disclose. Dr. Garcia Rodriguez has nothing to disclose. Ali Seifi has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Chiesi. Ali Seifi has received intellectual property interests from a discovery or technology relating to health care.

Stroke Care Pathway ensures high-quality stroke management in the COVID-19 pandemic

The aim of our study was to assess whether a well-established federal state-wide Stroke Care Pathway delivering high quality stroke care can cope with the COVID-19 pandemic and associated measures to contain the virus spread. The retrospective analysis is based on a prospective, quality-controlled, population-based registry of all stroke patients in the Tyrol, a federal state of Austria and one of the early hot-spots of COVID-19 in Europe. Patient characteristics, pre-hospital management, intra-hospital management and post-hospital were analysed. All residents of the Tyrol suffering ischemic stroke in 2020 (n = 1160) and four pre-COVID-19 years (n = 4321) were evaluated. In 2020, the annual number of stroke patients was the highest in this population-based registry. When local hospitals were overwhelmed with SARS-CoV-2-patients, stroke subjects were temporarily allocated to the comprehensive stroke centre. Stroke severity, quality metrics of stroke management, serious complications, and post-stroke mortality did not differ between 2020 and the four comparator years. Notably, iv. thrombolysis-rate was similar (19.9% versus 17.4%, P = 0.25) and endovascular stroke treatment even better (5.9% versus 3.9%, P = 0.003) but resources for in-patient rehabilitation were limited (25.8% versus 29.8%, P = 0.009). Concluding, a well-established Stroke Care Pathway was able to maintain high-quality acute stroke care even when challenged by a global pandemic.

MP52-11 MICTURITION-ASSOCIATED BRAIN ACTIVITY IN HEALTHY PATIENTS COMPARED TO STROKE SURVIVORS BEFORE AND AFTER TRANSCUTANEOUS SPINAL CORD STIMULATION

You have accessJournal of UrologyCME1 Apr 2023MP52-11 MICTURITION-ASSOCIATED BRAIN ACTIVITY IN HEALTHY PATIENTS COMPARED TO STROKE SURVIVORS BEFORE AND AFTER TRANSCUTANEOUS SPINAL CORD STIMULATION Sarah Ponce, Veronica Stefania Montero Arcila, Luis Alejandro Morales Ojeda, David Chapman, Rita Jen, Nhi Tuyet Ha, Parag Gad, V. Reggie Edgerton, Evgeniy Kreydin, Kay Jann, and Aidin Abedi Sarah PonceSarah Ponce More articles by this author , Veronica Stefania Montero ArcilaVeronica Stefania Montero Arcila More articles by this author , Luis Alejandro Morales OjedaLuis Alejandro Morales Ojeda More articles by this author , David ChapmanDavid Chapman More articles by this author , Rita JenRita Jen More articles by this author , Nhi Tuyet HaNhi Tuyet Ha More articles by this author , Parag GadParag Gad More articles by this author , V. Reggie EdgertonV. Reggie Edgerton More articles by this author , Evgeniy KreydinEvgeniy Kreydin More articles by this author , Kay JannKay Jann More articles by this author , and Aidin AbediAidin Abedi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003300.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Compared to healthy individuals, stroke survivors with neurogenic lower urinary tract dysfunction (NLUTD) exhibit decreased cortical activity in response to bladder filling and emptying. The use of transcutaneous spinal cord stimulation (TSCS) has been shown to reduce frequency, urgency and incontinence episodes in these individuals. The objective of this study was to determine whether TSCS also leads to normalization of micturition-related brain activity, as compared to healthy controls. METHODS: Twelve stroke patients with post-stroke NLUTD received 12 weeks of TSCS. Each subject also completed simultaneous urodynamics (UDS) and blood-oxygen-level-dependent (BOLD) fMRI before initiation of TSCS and within 72 hours of completing the final TSCS session. Healthy subjects without LUTS completed an identical fMRI-UDS protocol. BOLD signal during the period of maximum urgency (10 seconds preceding a detrusor contraction) was determined using statistical parametric mapping (SPM) and compared between healthy controls and stroke patients before and after TSCS (p<0.01, cluster size ⋝25 voxels). The SPM models were adjusted for age and sex. RESULTS: Compared to healthy controls, stroke survivors prior to TSCS exhibited diminished activation in the right cerebellum, left putamen, right insula, right anterior cingulate gyrus, right precuneus, bilateral medial frontal gyri, and right superior frontal gyrus compared to healthy controls. Following TSCS, there was no significant difference in BOLD signal in these regions between stroke survivors and healthy controls. However, healthy controls continued to exhibit increased activation in the right precentral (motor cortex) and left postcentral (sensory cortex) gyri, left posterior cingulate and left middle temporal gyrus even after TSCS. CONCLUSIONS: Micturition-related brain activity appears to partially revert to the healthy phenotype in stroke survivors following TSCS. Regions, where differences in BOLD signal between healthy controls and stroke subjects diminish following treatment, are known to be involved in LUT control. As expected, the neurosignature of stroke patients did not revert to the healthy phenotype entirely, as indicated by significant remaining differences in BOLD signal in several brain regions following TSCS. Source of Funding: Urology Care Foundation © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e706 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sarah Ponce More articles by this author Veronica Stefania Montero Arcila More articles by this author Luis Alejandro Morales Ojeda More articles by this author David Chapman More articles by this author Rita Jen More articles by this author Nhi Tuyet Ha More articles by this author Parag Gad More articles by this author V. Reggie Edgerton More articles by this author Evgeniy Kreydin More articles by this author Kay Jann More articles by this author Aidin Abedi More articles by this author Expand All Advertisement PDF downloadLoading ...

Whole‐exome sequencing analyses in a Saudi Ischemic Stroke Cohort reveal association signals, and shows polygenic risk scores are related to Modified Rankin Scale Risk

Ischemic stroke represents a significant societal burden across the globe. Rare high penetrant monogenic variants and less pathogenic common single nucleotide polymorphisms (SNPs) have been described as being associated with risk of diseases. Genetic studies in Saudi Arabian patients offer a greater opportunity to detect rare high penetrant mutations enriched in these consanguineous populations. We performed whole exome sequencing on 387 ischemic stroke subjects from Saudi Arabian hospital networks with up to 20,230 controls from the Saudi Human Genome Project and performed gene burden analyses of variants in 177 a priori loci derived from knowledge-driven curation of monogenic and genome-wide association studies of stroke. Using gene-burden analyses, we observed significant associations in numerous loci under autosomal dominant and/or recessive modelling. Stroke subjects with modified Rankin Scale (mRSs) above 3 were found to carry greater cumulative polygenic risk score (PRS) from rare variants in stroke genes (standardized PRS mean > 0) compared to the population average (standardized PRS mean = 0). However, patients with mRS of 3 or lower had lower cumulative genetic risk from rare variants in stroke genes (OR (95%CI) = 1.79 (1.29–2.49), p = 0.0005), with the means of standardized PRS at or lower than 0. In conclusion, gene burden testing in Saudi stroke populations reveals a number of statistically significant signals under different disease inheritance models. However, interestingly, stroke subjects with mRS of 3 or lower had lower cumulative genetic risk from rare variants in stroke genes and therefore, determining the potential mRS cutoffs to use for clinical significance may allow risk stratification of this population.

A Novel Telerehabilitation Approach for Cognitive-Language Therapy in Chronic Stroke Subjects With Aphasia: Neurocognitive Intervention Through Neurorehabilitation Exercises and Assessments

By stating “All people, everywhere, deserve the right care, right in their community,” <xref ref-type="bibr" rid="ref21" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">[21]</xref> . the World Health Organization sets, in an exhortative way, the fundamental assumption for primary health care. Under these premises, we developed an augmented and extended approach to a home-rehabilitation system to provide intensive care to chronic stroke patients with aphasia. The system proposes neurocognitive intervention based on an information and communication technologies ecosystem through neurorehabilitation exercises and assessments. In this study, we analyzed the feasibility, satisfaction, and motivation of patients, and the clinical effect of the intervention using this complex platform which, among other functions, allows the administration of speech and language home therapy. Eight patients conducted a therapeutic plan, including speech therapy, using the remote asynchronous rehabilitation system; seven patients were included in the control group (CG) and followed a traditional speech-therapy program. The analysis of usage revealed that participants made continuous and intensive use of the platform. The results confirmed the acceptability, perceived usefulness, and ease of use of the proposed platform. Clinical assessments showed that the system administers speech and language rehabilitation as effectively as traditional therapy, allowing one to consider such an approach as a valid alternative to standard face-to-face speech therapy.

“Neural Tension Among Hemiplegic Subjects”- A Cross-Sectional Study

AIM: This study was performed with the aim to know if there will be any change in the neural tension of the peripheral nerves following hemiplegia. The study analyzed the status of neural tension in radial, median, ulnar nerves following stroke METHODOLOGY: 30 individuals in post-stroke condition were selected based on inclusion and exclusion criteria. Detailed procedure was explained in the subject’s words and those who are interested; informed consent was obtained from all the participants. Complete neurological assessment was done. The subject was positioned in a supine position at lateral end of the couch in a diagonal manner. Upper limb tension testing 2 and 3 was tested on both the upper limbs of the subject. The positive and negative test results of the ULTT will be analyzed for the three major nerve of upper limb. RESULT: There were seven subjects positive with neural tension in upper limb out of thirty samples taken. There were 4 subjects with positive ULTT2a, 2 subjects with ULTT2b and 3 patients with ULTT3 positive. CONCLUSION: From this study, we conclude that neural tension is not a regular phenomenon in stroke hence it can be generalized as a treatment protocol for all the stroke subjects. This study also concludes that median nerve and ulnar nerve are the mostly affected in subjects tested positive for neural tension. Keywords: Neural Tension, Hemiplegia, Stroke.

Forearm Muscles Electromyography Analysis for Cylindrical Grip Sizes in Stroke

Purpose: To analyze the electrical activity of Flexor digitorum superficialis and extensor digitorum communis for cylindrical grip sizes of 30 mm and 40 mm in stroke patients. Methodology: 10 MCA affected stroke subjects and 10 normal subjects of same dominance, age and occupation were taken by purposeful sampling from physiotherapy department of M.M. Institute of Physiotherapy &amp; Rehabilitation. They were asked to grip two wooden cylinders of size 30mm and 40mm and electrical activity of Flexor digitorum superficialis and extensor digitorum communis i.e. amplitude and duration were analyzed during maximal contraction. The readings were statistically analyzed to compare the difference of activity in the proposed muscles for two different cylinders. Results: The statistical tests revealed that the differences between the amplitude and duration of the proposed muscles in hemiplegic and normal subjects are statistically significant. However, the difference of amplitude and duration of “Flexor digitorum superficialis” and “Extensor digitorum communis” are not statistically significant within the hemiplegic subjects for both the cylindrical diameters but the prolonged duration of Extensor digitorum communis in 40 mm cylinder was significant statistically. Conclusion: There is a significant difference in the amplitude and duration of forearm muscles i.e. flexor digitorum superficialis and extensor digitorum communis when compared with normals. However, only duration of extensor digitorum communis show significant change among the hemiplegic subjects with the change in grip size. The amplitude and duration of flexor digitorum superficialis and amplitude of extensor digitorum communis does not change significantly.

Characterization of Functional Connectivity in Chronic Stroke Subjects after Augmented Reality Training

Augmented reality (AR) tools have been investigated with promising outcomes in rehabilitation. Recently, some studies have addressed the neuroplasticity effects induced by this type of therapy using functional connectivity obtained from resting-state functional magnetic resonance imaging (rs-fMRI). This work aims to perform an initial assessment of possible changes in brain functional connectivity associated with the use of NeuroR, an AR system for upper limb motor rehabilitation of poststroke participants. An experimental study with a case series is presented. Three chronic stroke participants with left hemiparesis were enrolled in the study. They received eight sessions with NeuroR to provide shoulder rehabilitation exercises. Measurements of range of motion (ROM) were obtained at the beginning and end of each session, and rs-fMRI data were acquired at baseline (pretest) and after the last training session (post-test). Functional connectivity analyses of the rs-fMRI data were performed using a seed placed at the noninjured motor cortex. ROM increased in two patients who presented spastic hemiparesis in the left upper limb, with a change in muscle tone, and stayed the same (at zero angles) in one of the patients, who had the highest degree of impairment, showing flaccid hemiplegia. All participants had higher mean connectivity values in the ipsilesional brain regions associated with motor function at post-test than at pretest. Our findings show the potential of the NeuroR system to promote neuroplasticity related to AR-based therapy for motor rehabilitation in stroke participants.

The frequency and determinants of executive dysfunction among patients with subacute phase of ischemic stroke in West Nusa Tenggara, Indonesia

Background: Executive dysfunction is a common form of intellectual weakening that interferes with the functional activity of the stroke survivors. Detection of executive dysfunction in the subacute segment of ischemic stroke allows the patients to receive appropriate interventions for optimal clinical outcomes. This study aims to investigate the frequency and determinants of executive dysfunction among subacute ischemic stroke patients in West Nusa Tenggara. Methods: This study involved 192 subjects divided into two groups: ischemic stroke (n=96) and control groups (n=96). Categorical data collected from both ischemic stroke and control subjects were age, gender, education level, occupation, hypertension, diabetes mellitus, Trail Making Test Part B, verbal fluency test, backward digit span scores and executive function status. Besides the data previously mentioned, clinical data that were also collected in ischemic stroke subjects was infarct size. The significant difference in the frequency of executive dysfunction between ischemic stroke and control groups was analyzed using chi-square test. The association between the determinants of executive dysfunction and the frequency of this executive dysfunction was analyzed using logistic regression. Results: This study discovered that the frequency of executive dysfunction among subjects with subacute phase of ischemic stroke was 52.1% and it was significantly higher compared with controls (p&lt;0.0001). Further, lower education level was the only determinant significantly correlated with the increased risk of executive dysfunction in the subjects (Odds ratio [OR] =3.47; 95% confidence interval [CI] = 1.47 – 10.26). Conclusion: There was high frequency of subacute ischemic stroke-associated executive dysfunction associated with lower education level.

Evident lower blood levels of multiple nutritional compounds and highly prevalent malnutrition in sub-acute stroke patients with or without dysphagia.

Malnutrition is prevalent after stroke, particularly if post-stroke oropharyngeal dysphagia (OD) reduces nutritional intake. To further understand stroke-related malnutrition, a thorough nutritional assessment was performed in ischemic stroke patients with or without OD during sub-acute inpatient rehabilitation. In this exploratory, observational, cross-sectional, multi-center study in Germany (NTR6802), ischemic stroke patients with (N = 36) or without (N = 49) OD were age- and sex-matched to healthy reference subjects. Presence of (risk of) malnutrition (MNA-SF), blood concentration of stroke-relevant nutritional compounds and metabolites, nutritional intake, quality of life (EQ-5D-5L), and activities of daily living (Barthel index) were assessed. More than half of the stroke patients displayed (risk of) malnutrition, with higher prevalence in patient with OD vs. without OD. Fasted blood concentrations of vitamins B1, B2, B6, A, D, and E, selenium, choline, coenzyme Q10, albumin, pre-albumin, transferrin, docosahexaenoic acid, and eicosapentaenoic acid were all lower in stroke patients compared to their matched healthy reference subjects, irrespective of OD status. Reported energy, macronutrient, and water intake were lower in stroke patients vs. healthy reference subjects. As expected, quality of life and activities of daily living scores were lower in stroke vs. healthy reference subjects, with OD scoring worse than non-OD patients. This study shows that malnutrition is highly prevalent in sub-acute stroke patients during rehabilitation. Even though patients with OD were more likely to be malnourished, blood levels of specific nutritional compounds were similarly lower in stroke patients with or without OD compared to healthy reference subjects. Furthermore, subgroup analysis showed similarly lower blood levels of specific nutritional compounds in patients that are normal nourished vs. patients with (risk of) malnutrition. This might imply disease-specific changes in blood levels on top of overall protein-energy malnutrition. The results of the current study underline that it is important to screen for nutritional impairments in every stroke patient, either with or without OD.

A Comparison of Sit to Stand Movement between Stroke Subjects and Healthy Subjects

The sit to stand (STS) movement is a vital part of the activities of daily living (ADL). Due to the influence of the decreasing balance ability, patients with stroke would have high risk of falling when conducting this common movement. This essay had explored and compared the difference of the STS movement between patients with stroke and healthy adults from angular displacements of the trunk and lower limbs, muscular activation, postural control, weight bearing distribution and time aspects in kinematics and kinetics views, which aims to provide reference on reducing the risk of falls and improve the motor function for stroke survivors.

Reviewing factors that predict community reintegration among the community-dwelling subacute stroke subjects: a cross-sectional study.

Reviewing factors that predict community reintegration among the community-dwelling subacute stroke subjects: a cross-sectional study.

Effect of Motor Relearning Program with Obstacle Walking on Dynamic Gait Performance and Functional Mobility in Subacute Stroke Subjects

Background: Gait difficulties are common post-stroke due to muscle weakness and postural imbalance. Motorrelearning program is known to improve motor skills through task oriented practice, appropriate feedback andactive participation of subjects. Obstacle walking helps in improving gait parameters, stepping over objects,walking endurance and reduces fall risk.Objectives: To determine effect of Motor Relearning Program with obstacle walking on dynamic gait performanceand functional mobility in sub-acute stroke subjects.Materials and Methods: 30 sub-acute stroke subjects were assigned to one of the two groups. Group-A receivedMotor Relearning Program and Group-B received Motor Relearning Program with obstacle walking for 30 minutes,5 days a week for 4 weeks. Both groups received 15 minutes of conventional exercises for upper limb. Dynamicgait performance and functional mobility were assessed pre- and post-intervention at 4 weeks using Dynamic GaitIndex and Motor Assessment Scale.Results: Pre-test scores of DGI and MAS were 11.53±3.53 and 3.83±0.48 in Group-A, 12.43±4.12 and 3.67±0.81in Group-B which improved to 15.80±3.82 and 4.07±0.59 in Group-A, 18.67±4.86 and 4.73±0.96 in Group-B, postintervention.Within group comparison of pre to post-test scores of DGI and MAS was found to be statisticallysignificant in both groups. When post-test scores of DGI and MAS were compared in between groups, Group-Bwas found to be statistically significant than Group-A (p&lt;0.05).Conclusion: Both interventions were individually effective but Motor Relearning Program with obstacle walkingwas better than Motor Relearning Program alone to improve dynamic gait performance and functional mobilityin sub-acute stroke subjects.

The contribution of walking speed versus recent stroke to temporospatial gait variability

BackgroundInconsistent results have been reported for temporospatial gait variability after stroke. Given the large differences in gait speed across stroke subjects and relative to healthy controls, it is not clear which changes in temporospatial gait variability can be ascribed to the walking speed during gait evaluation versus the consequences of stroke. Research questionsDoes temporospatial gait variability differ between (1) stroke subjects grouped in clinically-relevant functional ambulation classes, (2) the paretic and non-paretic legs within each class, and (3) stroke and healthy subjects after controlling for gait speed? MethodsStroke subjects were evaluated at their comfortable speed < 2 months post-onset and classified into the household (<40 cm/s, n = 38), limited-community (40–80 cm/s, n = 35), and full-community (>80 cm/s, n = 14) walkers. Coefficients of variation (CVs) for paretic and non-paretic stance, initial double-support, and single-support times, step length, step cadence, and step width were compared across the stroke ambulation classes and between the two legs. For the parameters with significantly different CVs between stroke subjects and 33 age-matched controls walking at very-slow and free speeds, a 1-way ANCOVA was used with the gait speed as a covariate. ResultsFor most step parameters, CVs were greater in slower stroke ambulation classes except for the smaller step width CV. The differences between the paretic and non-paretic legs emerged in slower walkers only. After controlling for the gait speed, CVs of stroke subjects no longer significantly differed from controls walking at very-slow speed. With controls walking at free speed, however, CVs for the paretic and non-paretic single-support times and the non-paretic step time remained significantly different. SignificanceGait is more variable at slower speeds both in stroke subjects and healthy controls. After accounting for the free gait speed, the increased variability of only a few temporal parameters may be attributed to a recent stroke.

Performing a shortened version of the Action Research Arm Test in immersive virtual reality to assess post-stroke upper limb activity

BackgroundTo plan treatment and measure post-stroke recovery, frequent and time-bounded functional assessments are recommended. With increasing needs for neurorehabilitation advances, new technology based methods, such as virtual reality (VR) have emerged. Here, we developed an immersive VR version of the Action Research Arm Test (ARAT-VR) to complement neurorehabilitation.ObjectiveThis study aimed to assess the validity, usability and test–retest reliability of the ARAT-VR among individuals with stroke, healthcare professionals and healthy control subjects (HCS).MethodsAmong the 19 items of the ARAT, 13 items were selected and developed in immersive VR. 11 healthcare professionals, 30 individuals with stroke, and 25 HCS were recruited. Content validity was assessed by asking healthcare professionals to rate the difficulty of performing each item of the ARAT-VR in comparison to the classical Action Research Arm Test (ARAT-19). Concurrent validity was first measured using correlation (Spearman tests) between the ARAT-VR and ARAT-19 scores for the individuals with stroke, and second through correlation and comparison between the scores of the ARAT-VR and the reduced version of the ARAT (ARAT-13) for both individuals with stroke and HCS (Wilcoxon signed rank tests and Bland–Altman plots). Usability was measured using the System Usability Scale. A part of individuals with stroke and HCS were re-tested following a convenient delay to measure test–retest reliability (Intra-class correlation and Wilcoxon tests).ResultsRegarding the content validity, median difficulty of the 13 ARAT-VR items (0[0 to − 1] to 0[0–1]) evaluated by healthcare professionals was rated as equivalent to the classical ARAT for all tasks except those involving the marbles. For these, the difficulty was rated as superior to the real tasks (1[0–1] when pinching with the thumb-index and thumb-middle fingers, and 1[0–2] when pinching with thumb-ring finger). Regarding the concurrent validity, for paretic hand scores, there were strong correlations between the ARAT-VR and ARAT-13 (r = 0.84), and between the ARAT-VR and ARAT-19 (r = 0.83). Usability (SUS = 82.5[75–90]) and test–retest reliability (ICC = 0.99; p < 0.001) were excellent.ConclusionThe ARAT-VR is a valid, usable and reliable tool that can be used to assess upper limb activity among individuals with stroke, providing potential to increase assessment frequency, remote evaluation, and improve neurorehabilitation.Trial registrationhttps://clinicaltrials.gov/ct2/show/NCT04694833; Unique identifier: NCT04694833, Date of registration: 11/24/2020.

Cholesteryl Ester Transfer Protein (CETP) I405V (rs5882) Polymorphism Affects Plasma Lipid Parameters and Lipoprotein Ratio in Hyperlipidemic Ischemic Stroke Patients

Background: High-density lipoprotein cholesterol (HDL-C) and other lipoproteins are metabolized in part by the cholesteryl ester transport protein (CETP). Cardiovascular risk and the occurrence of ischemic stroke are linked to polymorphism in the CETP gene.&#x0D; Methodology: For the study, 100 ischemic stroke patients and 100 controls with matched sexes and ages ranging from 46 to 87 were chosen. Lipoprotein ratios were computed using Excel software, and lipid parameters were evaluated using Randox diagnostic kits. Polymerase Chain Reaction and Restriction Fragment Length Polymorphism (PCR-RFLP) and 2% gel electrophoresis were used to genotype the CETP gene. The genotyping of the CETP gene were performed by Polymerase Chain Reaction and Restriction Fragment Length Polymorphism (PCR-RFLP) combined with 2% gel electrophoresis.&#x0D; Results: There were significant difference (P&lt;0.0001) in the genotypic and allelic frequencies of CETP SNP between the healthy and patients with ischemic stroke. The frequencies of I/I, I/V and V/V genotypes of the CETP gene were 48%, 37% and 15% for the control and 17%, 33% and 50%, for the stroke subjects, respectively. The frequencies of I and V alleles were 67% and 33% for the control and 37.5% and 62.5% for the stroke subjects, respectively. The V allele carriers of CETP gene had higher plasma TC, TG, VLDL-C, LDL-C, Non-HDL-C, defective HDL-C, HDL2-C and HDL3-C when compared to the I allele carriers for both subjects. The V allele carriers were responsible for the increase in dyslipidemia for both subjects.&#x0D; Conclusion: The results of this study show that mutation of CETP I405V (rs5882) polymorphism causes an increased in plasma TC, TG, VLDL-C, LDL-C, Non-HDL-C, defective HDL-C, HDL2-C and HDL3-C concentration and is associated with an increased risk of ischemic stroke.

Individual electric field predicts functional connectivity changes after anodal transcranial direct-current stimulation in chronic stroke

The neuromodulation effect of anodal tDCS is not thoroughly studied, and the heterogeneous profile of stroke individuals with brain lesions would further complicate the stimulation outcomes. This study aimed to investigate the functional changes in sensorimotor areas induced by anodal tDCS and whether individual electric field could predict the functional outcomes. Twenty-five chronic stroke survivors were recruited and divided into tDCS group (n = 12) and sham group (n = 13). Increased functional connectivity (FC) within the surrounding areas of ipsilesional primary motor cortex (M1) was only observed after anodal tDCS. Averaged FC among the ipsilesional sensorimotor regions was observed to be increased after anodal tDCS (t(11) = 2.57, p = 0.026), but not after sham tDCS (t(12) = 0.69, p = 0.50). Partial least square analysis identified positive correlations between electric field (EF) strength normal to the ipsilesional M1 surface and individual FC changes in tDCS group (r = 0.84, p < 0.001) but not in sham group (r = 0.21, p = 0.5). Our results indicated anodal tDCS facilitates the FC within the ipsilesional sensorimotor network in chronic stroke subjects, and individual electric field predicts the functional outcomes.