Stroke Victims Research Articles

Helicopter Emergency Medical Services (HEMS) Transportation Utilization for Acute Ischemic Strokes at a Community-Based Hospital in South Florida

Background: A comprehensive stroke center (CSC) servicing remote areas in South Florida became HEMS direct-from-field capable on October 15, 2020. This analysis reviews the utilization of this service and compares it to ground EMS (GEMS). Methods: This is a retrospective cohort study from October 15, 2020, to July 31, 2021, that collected HEMS adult stroke alert data and compared it to the prior year's summary GEMS stroke alert data. Using HEMS transportation logs, presenting stroke symptoms and prehospital assessment were abstracted, in addition to initial NIHSS, downgrade rate, stroke diagnosis percentage, treatment rate, and times. Results: The analysis included a total of 52 direct transport HEMS stroke alerts. Assessment tools utilized by HEMS included the Cincinnati stroke scale (4%) and the FAST-ED (37%); most cases (59%) did not document a stroke assessment tool. The median NIHSS was 10, with 37% presenting a score <6. Cases were downgraded upon arrival in 27% and after CT imaging in 15% of cases. Significantly (p<.001), more HEMS cases were diagnosed as stroke (69%) compared to GEMS (57%). Stroke treatment rates remained similar (HEMS=23%; GEMS=24%). Median door-to-needle times were significantly faster for HEMS (15 min) than GEMS (25 min) (p<.05). Median door-to-puncture times were clinically faster for HEMS (61mins) than GEMS (66 mins). Conclusion: Prehospital triage could be improved to better detect the 77% of patients who are not eligible for acute stroke reperfusion treatments and may benefit from ground as opposed to air transportation. The current HEMS triage, although not consistently documented, appropriately selects stroke victims, but not necessarily those who need air transport to a higher care level. Patients arriving via HEMS receive similar access to stroke treatment and, if treated, significantly faster treatment times.

Nursing Care For Patients With Stroke Victims: An Integrative Review

The study aims to analyze the nursing care offered to patients who have suffered a stroke; identify the main risk factors and forms of prevention; describe the main conducts adopted by the nursing team to patients suffering from a stroke. As a method, it is characterized as an integrative literature review study. The search was carried out during the months of July and August 2024, in the databases: Medical Literature Analysis and Retrieval Online System (Medline), Latin American and Caribbean Literature in Health Sciences ( Lilacs ), Scientific Electronic Library Online (SciELO), Nursing Database (BDENF), National Library of Medicine (NLM/ PubMed ) and ScienceDirect . Using the combination of descriptors contained in the Health Sciences Descriptors ( DeCS ), the following descriptors were used in English, Portuguese and Spanish: “Stroke Vascular Accident” AND “Nursing Care” AND “Cerebrovascular Accident” in conjunction with the Boolean operator OR. Ten articles were selected. As a result, three categories were highlighted according to thematic similarity: Stroke (CVA) and risk factors; nursing care offered to patients who are victims of Stroke and the conduct adopted by the nursing team in the care of patients with Stroke. Finally, it is of great relevance to highlight the assistance to patients affected by Stroke, thus emphasizing that the nursing area is composed of professionals dedicated to offering assistance and care that aim at both the prevention of the disease, treatment, cure, and the rehabilitation of patients, providing quality assistance, applying conducts based on scientific knowledge

The Contribution of the Triage Nurse in the Optimisation of Door-to-Computed-Tomography Time in Stroke.

A stroke is a time-sensitive emergency, so diagnosing and treating the victim promptly is extremely important. Therefore, the purpose of this study was to identify the influence of the Stroke Code Protocol's activation on the door-to-computed-tomography (door-to-CT) time and determine whether factors such as previous Modified Rankin Scale (mRS), age, and gender influence its activation. A retrospective study was conducted in a Medical-Surgical Emergency Department in the centre of Portugal from 1 January 2021 to 31 December 2022. The sample was selected according to the diagnosis assigned at the time of clinical discharge from the Emergency Department and the Stroke Code Protocol activation criteria. It was observed that 113 (50%) suspected stroke victims who met the activation criteria for the Stroke Code Protocol did not have the protocol activated, which had a highly significant influence (p < 0.001) on door-to-CT time. It was determined that activation at triage has an average door-to-CT time of 35 ± 18 min, post-triage activation has an average door-to-CT time of 38 ± 26 min, and non-activation has an average door-to-CT time of 1 h 04 ± 45 min. The need to implement an institutional protocol for activating the Stroke Code Protocol and provide specialised training for the multidisciplinary team is reiterated.

Bioinformatics Analysis Reveals HIST1H2BH as a Novel Diagnostic Biomarker for Atrial Fibrillation-Related Cardiogenic Thromboembolic Stroke.

Atrial fibrillation (AF) is a significant precursor to cerebral embolism. Our study sought to unearth new diagnostic biomarkers for atrial fibrillation-related cerebral embolism (AF-CE) by meticulously examining multiple GEO datasets and meta-analysis. The gene expression omnibus (GEO) database provided RNA sequencing data associated with AF and stroke. We began by pinpointing genes with varied expressions in AF-CE patient blood samples. A meta-analysis was subsequently undertaken using several RNA sequencing datasets to verify these genes. LASSO regression discerned key genes for AF-CE, with their diagnostic prowess verified through ROC curve examination. Active signaling pathways within stroke patients were discerned via GO and KEGG enrichment, with PPI interactions detailing gene interplay. Differential gene analysis revealed an upregulation of sixteen genes and a downregulation of four in stroke patient blood samples. Eight genes showcased varied expression in the meta-analysis. LASSO regression zeroed in on five of these, culminating in HIST1H2BH's identification as a characteristic gene. HIST1H2BH's prowess in predicting AF-CE was confirmed through ROC. Integrin signaling, platelet activation, ECM interactions, and the PI3K-Akt pathway were found active in stroke victims. HIST1H2BH's interaction with the notably upregulated ITGA2B was spotlighted by PPI. Additionally, HIST1H2BH exhibited links with NK cells and eosinophils. HIST1H2BH emerges as an insightful diagnostic beacon for AF-CE. Its presence, post AF, potentially modulates pathways, accentuating platelet activation and consequent thrombus generation, leading to cerebral embolism.

Stroke Transition of Care Intervention with Stroke Nurse Navigators and Early Stroke Clinic Follow-up Reduces Readmissions for Stroke at 12 Months

Background One in four strokes occur in stroke victims, with hospital readmissions contributing to high-cost care. Transition of care programs have been successful in reducing hospital readmissions in other diseases, but the data on such programs for stroke are mixed. A transition of care program was implemented with the goal of reducing recurrent strokes and hospital readmissions. Methods We implemented a transition of care program using nurse navigators and early outpatient follow-up with a vascular neurologist. Data were obtained on: Rate of recurrent stroke admissions within one-year, all-cause readmission within one-year, all-cause readmission within 30 days, initial follow-up scheduled within 7-10 days, compliance with follow up, and compliance rates with provision of two-day post-hospital discharge phone calls. Results An improvement was seen in process measures reflecting adherence to the intervention across all 3 years. The rate of readmission for stroke at 12 months was 8.5%, 9.0%, 6.6%, and 4.2% for year 0, 1, 2, and 3, respectively, representing a 50% reduction from baseline year 0. All-cause readmission remained unchanged, at 38.9%, 42.6%, 36.6%, and 37.4% for year 0, 1, 2, and 3 respectively. Conclusions Our nurse navigator led stroke transition intervention was associated with significant reduction in readmissions for stroke but did not impact all cause readmission at one year or 30 days. Our focus on Centers for Medicare/Medicaid intervention compliance has produced a sustainable program capable of now expanding to support other important patient needs.

Metabolic dysfunction in the myocardium three months after exertional heat stroke in mice

In humans, exposure to heat stroke has proven to be a risk factor for development of cardiovascular disease later in life. We hypothesized that exposure to exertional heat stroke (EHS) would result in the development of similar long-term cardiac disease in mice. In this study we followed mice for three months after EHS, using ultrasound imaging of the heart, metabolomics and histological analysis of ventricular tissue and biomarker analysis after 4 weeks of recovery. Methods: Mice were instrumented with temperature telemetry devices and were trained to run on forced running wheels using an incremental exercise protocol. EHS mice ran in an temperature elevated environmental chamber; females 37.5°C; males 34°C; whereas, matched exercise control mice (EXC) ran in 22-23°C. Running stopped when EHS mice reached symptom limitation (unconsciousness). The mice were followed for 12 wks post EHS, with two ultrasound measures at 2 and 10 wks of recovery. At the end of the study, mice were anesthetized, a blood sample drawn, and ventricular tissue collected for metabolomics. RESULTS: Male but not female EHS mice gained ~10% greater body mass compared to EXC over the course of recovery ( P&lt;0.01). Hearts from male but not female EHS mice exhibited elevations in heart mass per tibia length ( P&lt;0.01). At three months, metabolomics in male EHS hearts revealed significant elevations in glucose and glucose metabolites and significant decreases in acylcarnitines consistent with a metabolic shift toward glucose and away from lipid metabolism. In contrast, female hearts exhibited fewer abnormalities but with significant elevations in lipid and arachidonate metabolites. At two weeks post, there were no differences in male ultrasound measures between EHS and EXC mice but in females there was a reduced posterior wall velocity ( P=0.012) and a trend towards narrower posterior wall thickness ( P= 0.06) . Between 2 and 12 wks post EHS, there were significant elevations in fractional shortening in males ( P&lt;0.05) and elevations in posterior wall velocity ( P&lt;0.01). In contrast, females exhibited significant reductions posterior wall velocity. From blood samples, male EHS mice had increased HDL and females exhibited decreased HDL (p&lt;0.01 in both). LDL increased only in males P&lt;0.05. Vascular adhesion molecules sICAM ( P&lt;0.01) and Pecam1 ( P&lt;0.01) were significantly decreased in EHS males and females and e-Selectin was decreased in EHS males only ( P&lt;0.001). Total serum protein was significantly reduced in both male and females ( P&lt;0.01). Male EHS mice also exhibited significant elevations in white blood cell count and total lymphocytes ( P=0.01) suggesting ongoing activation of the immune system . CONCLUSIONS: In this controlled preclinical model of EHS, both male and female mice exhibited long-lasting cardiovascular and systemic disorders that could account for the lingering incidence of cardiovascular disease and poor overall health in heat stroke victims. Supported by US Army Med. Research and Devel. Command BA180078 and the BK and Betty Stevens Endowment. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Global tele-music therapy program reduces pain, discomfort and stress with enduring effects during COVID – 19: A pilot study

Abstract: Of particular need was access to easily applied modalities to improve recovery during the COVID-19 pandemic. The current state of knowledge regarding music therapy has allowed improvements among victims of stroke, dementia, spinal cord injuries, and so forth. The goal of this pilot study was to provide individuals with symptom reduction such as perceived pain, discomfort and anxiety, improved emotional processing, improved relaxation and well-being for participants with current, recent case or long haul COVID-19; those who had lost a loved one to COVID; those experiencing workplace burnt out, or symptoms related to getting the vaccine. Sixty-one individuals participated in a follow-up survey out of one hundred seventy one participants from twelve countries who were treated using one to one zoom sessions following a 30 minute protocol of live music using instruments chosen for soothing or activating energy. Recipients responded to assessment questions showing decrease in pain, anxiety and stress, sustained effect, most effective instruments, spontaneous imagery and open-ended narrative responses. The totality of all instruments were considered most helpful with the drum and Native American style flute considered the most beneficial. Many participants reported spontaneous healing imagery without any guidance demonstrating the power of sound and music to evoke individualized visualization.

Improving Time to Angioembolization for Trauma Care: Novel Smartphone Application.

Timely angiographic embolization of abdominopelvic injuries is a hallmark of a high-functioning trauma center. Yet, the process depends on the timely mobilization of interventional radiology staff. Smartphone technology to notify and mobilize staff may be a viable option. To describe the incorporation of a smartphone application into our trauma workflow process previously developed for stroke care. In 2022, our Level I trauma center implemented a smartphone application with three simultaneously occurring functions: (a) high-definition image viewing on the phone; (b) text messaging thread for all parties; and (c) a single-call activation system for staff mobilization. The application was initially developed to notify interventional radiologists of large-vessel occlusions in victims of stroke and, at our request, was modified to fit our trauma workflow process. The smartphone application company developed a new program, installed the application on trauma service smartphones, and provided educational in-services over a 1-month period. The application was then integrated into our trauma workflow process. The trauma surgeon and the interventional radiologist can now simultaneously view high-definition images on their smartphones. Text messages are accessible to all team members. The staff is notified and mobilized with the singlecall smartphone application, preventing the placing and returning of phone calls. Smartphone technology enhances timely interventional radiology staff response for hemorrhagic patients requiring emergent angioembolization.

A Single Case Study in Management of Pakshaghat with Ayurveda

In the Sharira, Vata is seen as the controller of all things. Vatavyadhi is the term for the influence of vitiated vata on the Dusyas, which permeate the whole body or a portion of it and give rise to various sorts of illness. One of the significant illnesses that fits this description is pakshaghata, also referred to as hemiplegia. One Vataj Nanatmaja Vyadhi who is regarded as a Mahavatavyadhi is Pakshaghata. There is a correlation between pakshaghata and hemiplegia, a condition caused by a cerebrovascular accident or stroke. Hemiplegia, which results in both mental and physical instability. In the world’s population, there are around 9 instances per 1000 people. A stroke is described as an abrupt onset of vascular mechanism-related neurologic impairment. 15% are initial hemorrhages, and 85% are ischemic. The World Health Organization estimates that 15 million stroke victims globally experience a stroke each year, of whom 5 million die and another 5 million become permanently incapacitated. According to current scientific theory, brain injuries that are too severe for treatment to reverse can result in lifelong neurological impairment. As a result, the prognosis for the illness is dismal, leaving the crippled individual dependent. The current research aims to provide baseline data for student physicians to cope with this terrible condition by identifying the etiopathogenesis, clinical aspects, and therapy of the disease from Ayurvedic classics.

Abstract TMP58: Neuroimaging Markers of Patient-Reported Outcomes in Acute Ischemic Stroke

Objectives: To determine the relationship between patient-reported outcome measures (PROMs) and volumetric biomarkers assessed on clinical imaging in acute ischemic stroke (AIS). Background: AIS is a leading cause of long-term disability. White matter hyperintensity (V_WMH), brain (V_Brain) and stroke lesion volume (V_Lesion) have been linked as potential determinants of functional outcomes after stroke. Recently, there has been surging attention to PROMs, which allow for direct, patient-centered health assessments of stroke victims. However, the link between neuroimaging biomarkers and PROMs is not well studied. Methods: Patients presenting to the Emergency Department at Massachusetts General Hospital between February 2017 and February 2020 with a confirmed AIS on MRI were eligible and underwent a follow-up telephone interview, including PROM-10 questionnaires. V_WMH and V_Brain were automatically determined from clinical MRI. V_Lesion was manually segmented. Regression analyses were performed to identify associations of brain volumetrics and clinical variables with PROM-10 subscores and global mental and physical summary scores. Results: Utilizing data from 150 patients (mean age: 64.7; 41.9% female), higher V_WMH was associated with worse global mental (β = -0.65), global physical (β = -0.60), social activities (OR = 0.59), physical health (OR = 0.68), fatigue (OR = 0.69) and social satisfaction (OR = 0.66) scores. V_Lesions were associated with poorer global mental (β = -0.79), social (OR = 0.55) and physical (OR = 0.66) activities, mental health (OR = 0.68) and emotional distress (OR = 0.68) scores. Higher V_Brain was linked to better global mental (β = 0.93), global physical (β = 0.79), physical activities (OR = 1.72) and mental health (OR = 1.54) scores. Conclusions: Imaging biomarkers were significantly associated with PROMs. The inclusion of these markers with PROMs in routine post-stroke assessment can enhance our understanding of recovery.

Massage Therapy Research: A Narrative Review

This narrative review on the massage therapy literature from the years 2020 to 2023 includes 49 studies. Many of these are focused on massage reducing prenatal depression and anxiety, increasing brain maturation in preterm neonates and on reducing jaundice in full-term newborns. Pediatric massage research has been focused on cerebral palsy and adult research on arthritis pain. Studies on older adults include the reduction of anxiety and depression in victims of stroke, Parkinson’s and Alzheimer’s. Other studies found positive effects of self-massage as well as couples’ massage that suggests that both the massager and “massagee” experience reduced stress. Surprisingly, most of the entries in the literature have been proposed protocols for studies and only one has involved potential underlying mechanisms for the positive effects of massage therapy.

Public knowledge of risk factors and warning signs of heart attack and stroke

BackgroundKnowledge of the predisposing risk factors and prompt recognition of the warning signs for heart attack and stroke is fundamental in modification of lifestyle behaviors and an imperative precursor to health-seeking behavior. In view of an existing knowledge gap amidst increasing incidence of heart attack and stroke in Tanzania, we conducted this community-based cross-sectional study among residents of Dar es Salaam city.ResultsA total of 1759 respondents were enrolled in this study. The mean age was 45.4 years, females constituted over a half of participants and over two-thirds had attained at least secondary school education. Regarding risk factors, just over 2% of participants displayed satisfactory awareness and only stress was recognized by at least half of participants. With regard to warning signs, barely 1% of participants had satisfactory knowledge for either of the conditions while nearly three-quarters of participants failed to mention even a single warning sign for heart attack. Recognized by about two-thirds of respondents, sudden numbness or weakness in face, arm or leg was the most acknowledged stroke symptom; however, other symptoms were familiar to less than a third of participants. Although over a half of respondents acknowledged going to a hospital as their first resort, over one-tenth of respondents expressed inappropriate reactions towards heart attack and stroke victims. Old age, higher level of education, positive history of heart attack or stroke, high blood pressure and history of dyslipidemia showed association with both risk factors and warning signs knowledge during bivariate analyses.ConclusionsPublic knowledge of common risk factors and typical warning signs for heart attack and stroke was critically suboptimal. These findings herald an utmost need for public health efforts to increase community awareness of risk factors and typical signs of the two conditions to curb the rising prevalence and associated morbimortality.

Emergency and Urgent Care Network: Analysis of the Stroke Care Line According to Care Times and Outcomes

Background: Given the importance of acute stroke care for public health in terms of its burden and consequences like disability and death, evidence-based practice has directed the development of clinical protocols and operational guidelines to care of the populations affected by this pathology.&#x0D; Aim: To evaluate the impact of implementing the stroke care line in the Urgency and Emergency Care Network of a large Brazilian municipality.&#x0D; Methods: This is a retrospective study, conducted between 2014 and 2019 in public health services in Ribeirao Preto, SP, a large municipality of Brazil. Data was collected through secondary sources. A total of 403 patients were included in the study, of which: 172 were treated between 2014 and 2016 and 231 between 2017 and 2019; 118 were served by the mobile pre-hospital care services and 285 by the fixed pre-hospital care services. Data comprise clinical, epidemiological characteristics and severity of cases, as well as stroke care times and outcomes and were analyzed using descriptive techniques, Mann-Whitney and Chi-squared tests.&#x0D; Results: First care provided by a mobile pre-hospital care unit increased from 16.9% to 38.5%. The service times for people undergoing thrombolysis were shorter in the period from 2017 to 2019 compared to 2014 to 2016 in the door-to-needle, stroke onset-to-call, stroke onset-to-ambulance dispatch and regulation-to-door times. Stroke victims treated first by a mobile (ambulance) unit had shorter care times when compared to those who received care in a fixed unit, except in ambulance dispatch-to-door time. No difference was identified in the percentage of outcomes studied in the period from 2017 to 2019 compared to the period from 2014 to 2016. There was a higher craniectomy occurrence in people treated at home than in those attended in health services. The percentage of unfavorable stroke outcomes increased depending on the case severity.&#x0D; Conclusion: The care flow organization with defined responsibilities for each care point through the creation of a care line and the use of pre-established protocols reduced pre- and in-hospital care times; however, they did not have a significative influence on the case outcomes.

Acute Ischaemic Stroke in the Context of Neurosyphilis: How Does Antibiotic Therapy Help, and When Should It Be Given?

Neurosyphilis (NS) refers to a central nervous system infection caused by Treponema pallidum. In recent years, there has been an increasing incidence of syphilis; however, NS is uncommon compared to the era before the discovery of penicillin. Manifestations are usually non-specific, ranging from asymptomatic cases to syphilitic meningitis, meningovascular syphilis, general paresis and tabes dorsalis. Meningovascular syphilis can cause an inflammatory arteritis of cerebral arteries, leading to vascular occlusion and cerebral infarction. We report a case of an ischaemic stroke in a patient with several vascular risk factors, presenting with right hemiparesis, hemihypesthesia and dysarthria. Initial computed tomography with angiography of the head and neck was normal; however, magnetic resonance imaging of the brain revealed a thalamic and internal capsule infarct. Serum T. pallidum antibodies were positive, as well as a rapid plasma reagin test. Cerebrospinal fluid analysis confirmed the diagnosis of neurosyphilis, and the patient was treated with ceftriaxone for 14 days due to a penicillin allergy. Although there is a high prevalence of stroke in patients with NS, this condition is typically underdiagnosed. Untreated NS carries a higher risk of stroke recurrence compared to other risk factors. Therefore, early diagnosis and treatment are essential. This case highlights the importance of considering NS in stroke victims, even in older patients with several additional vascular risk factors, to prevent recurrence and other complications. Neurosyphilis (NS) can occur at any stage of syphilis infection, and it can be asymptomatic or symptomatic, presenting as syphilitic meningitis, meningovascular syphilis, general paresis or tabes dorsalis.Ischaemic strokes are a frequent complication of NS, occurring in 14% of the cases. However, only 19% of the cases are correctly diagnosed.NS should be considered as a potential cause of stroke, even in older patients with several other vascular risk factors. This is essential to prevent future strokes, as well as dementia and other complications.

Evaluation of Gait Parameters after Cerebrovascular Accident

One of the main issues for stroke victims is restoring normal walking function, which necessitates a large amount of time being devoted to relearning how to walk. The aim of the study was to evaluate the walking efficiency of patients who Cerebrovascular accident (CVA) post of 2 months of Stroke by using specialized camera program to take angles during walking. The study was focus on patients who have Cerebrovascular accident (CVA) two months prior to the study and have received the international protocol for physical therapy in this period, 7 patients were undergo examination using the Kinovea capture system, and they were analyze the data generated from the system, the results issued by two physical therapists were be evaluated, and after completing this examination, the 7 patients were be given a Stroke Specific Quality Of Life Scale (SS-QOL) and filled out. The results were be achieved in the routine methods by checking some variables. Then we were come up with the results to achieve the aim of this study. According to the study, (57%) of the patients were female and (43%) were male. The results of the capture system are shown there are no significant statistical differences in limb swing time between the affected lower extremity and the intact lower extremity (p = 0.082), and, there are no significant statistical differences in limb stance time between the affected lower extremity and the intact lower extremity (p=0.141), and, there are no significant statistical differences in step length between the affected lower extremity and the intact lower extremity in patients with cerebrovascular accident (p = 0.383) , and, there are no significant statistical differences in stride length between patients with cerebrovascular accident (CVA) after 2 months of regular physical therapy sessions and normal stride length (p = 0.176).

Maximizing stroke recovery with advanced technologies: A comprehensive assessment of robot-assisted, EMG-Controlled robotics, virtual reality, and mirror therapy interventions

Inconvenience caused by stroke brings physical disability found in many people which restricts their daily life activities. Globally, it was predicted that the prevalence of stroke will rise to 21.9 % by 2030. To improve the sensory and motor recovery of the stroke survivors, they required high attention for their controllability and adaptability. About 80 % of stroke victims have upper-limb motor deficits which affects their daily living activities. Due to technological advancement in rehabilitation engineering with new interventions, traditional physical therapy for stroke patients now translates into new rehabilitation strategies which help in fast recovery of motor tasks with intention motions. Electromyography (EMG) based stroke rehabilitation now being developed for enhancement and assessment of motion control in clinical settings. The integration of EMG-based intervention provides the feasibility to use the concept of myoelectric control with therapeutic settings. In this paper, the use of EMG-based robot aided therapy has been discussed and highlights the contribution of interventions for stroke rehabilitation. Furthermore, discussion also emphasis on virtual reality and mirror therapy and their latest interventions and approaches carried out by different investigators for the evaluations and assessment of stroke rehabilitation in lieu of considerations for improved functional motor task. The most widely used functional outcome measures for conducting clinical assessment of stroke patients in randomized control trials (RCTs) are Fugl-meyer assessment-upper extremity (FMA-UE), a score range from 0 to 66points, Fugl-meyer assessment for lower extremity (FMA-LE) has a score from 0 to 34 points, the Action Research Arm Test (ARAT), a scale from 0 to 57 points, the Functional independence measure (FIM) has a scale of 18–126 points, Modified Ashworth Scale (MAS), a scale from 0 to 5 points and Box and block test (BBT). Furthermore, in most of the RCTs the statistical significance was set at p < 0.05 (95 % confidence interval). Moreover, future directions suggested that for real time autonomous detection of motion intentions, the EMG-based machine learning must be involved with robots, virtual reality and mirror therapy-based interventions to achieve 95 % accuracy that could leads to the development of intelligent rehabilitation interventions for stroke survivors.

Value of the stroke 1-2-0 prehospital stroke education system: the experience of a general practitioner team

BackgroundStroke is one of the leading causes of death worldwide, especially in developing countries. In China, there is an urgent need to educate people about stroke awareness and the importance of using emergency medical services (EMS) quickly after a stroke has occurred.ObjectiveWe sought to explore the effects of the Stroke 1-2-0 Prehospital Stroke Education System based on the experience of a general practitioner team.MethodWe prospectively enrolled 119 community general practitioners to be trained in the procedures advocated by the Stroke 1-2-0 Prehospital Stroke Education System. The training content included early detection of ischemic stroke, first aid for stroke, and intravenous thrombolysis; The effects of the training were later evaluated via a before-and-after comparison. The 119 enrolled physicians formed a Stroke 1-2-0 lecturer group and taught stroke knowledge to community residents. The group remained active for 6 months, during which the medical treatment data of stroke patients (i.e., stroke onset time, prehospital delay, whether an ambulance was called, and whether thrombolytic therapy was performed) in each of 5 jurisdictions were recorded for the month before (January 2021) and that after (August 2021) the 6-month community education program. Finally, the effects of the community education program were evaluated.ResultsThe participants’ understanding of intravenous thrombolysis in the treatment of acute ischemic stroke improved significantly after the training as compared with their earlier understanding (96% vs. 78.99%; P < .001), and their understanding of the time window for intravenous thrombolysis increased from 26.05% before to 72% (P < .001) after the training. Most of the participants (90% vs. 67.23%; P < .001) said that they would immediately call the 120 emergency number of China’s emergency phone system if they encountered individuals who appeared to be victims of acute stroke. A total of 82 stroke patients were seen before and 67 after the community education program. As for the use of the emergency call system, more patients with stroke activated that system after the program versus before (21.95% vs. 37.31%; P = .04). The 3-hour arrival rate after the program was nearly three times higher than that before the program (62.69% vs. 19.51%; P < .001). Also, regarding receiving thrombolysis after the occurrence of a stroke, the program triggered a substantial increase compared with the total earlier (19.4% vs. 6.1%; P = .013).ConclusionWe found that the Stroke 1-2-0 Prehospital Stroke Education System significantly improved community residents’ knowledge regarding stroke.

A Prospective-Comparative Study on Extremity of Stroke in Patients with and Without Atrial Fibrillation as a Clinical Predictor

Background: Atrial fibrillation (AF) is a leading cause of ischemic stroke. It is critical to confirm the impact of AF on stroke outcomes. Objective: To assess the risk factors for stroke in conditions with or without atrial fibrillation. • To compare stroke severity and outcomes in stroke patients with or without atrial fibrillation. • To assess the vascular risk factors and co-morbid conditions Method: Analysis of the patient's medical information, such as age, gender, kind of stroke, location, mode of therapy, severity, and results. antithrombotic therapy) on 100 stroke victims (50 of them who exhibited AF and the other 50 without). Results: Age 61 to 80 were associated with a greater risk of strokes (33% non-AF, 14% AF), while age groups 81 and above were associated with a higher chance of atrial fibrillation (2% AF).men and females had the same incidence of AF (12% each), with the exception that females were more common in the non-AF group (47%) than men (29%). Patients with ischemic stroke were more prevalent (73%), but patients with hemorrhagic stroke (6% AF, 9% non-AF) were more likely to have it. The CHAD2DS2-VASc SCORE and AH showed that hypertensive people had a greater risk of stroke in both the AF (10%) and non-AF (46%) groups. Overall, the AF (10%) and non-AF (46%) groups had hypertension as the most common co-morbid disease, with antihypertensive medications being the commonest prescribed medicine (23% AF, 59% non-AF). Conclusion: The study concluded that if treatment methods for atrial fibrillation and stroke are given, patient outcomes can be improved with sufficient assessment and strict adherence.

Efficacy and safety of vagus nerve stimulation on upper extremity motor function in patients with stroke: A meta-analysis of randomized controlled trials.

In 2021, the U.S. Food and Drug Administration (FDA) approved paired vagus nerve stimulation (VNS) for patients with moderate-to-severe upper extremity motor impairments following chronic ischemic stroke. Previous meta-analyses have shown that VNS may impact stroke rehabilitation, but each has some limitations. PubMed, Ovid, Cochrane Library, ScienceDirect, Web of Science and WHO ICTRP databases were searched until July 14, 2022 for randomized controlled trials (RCTs). We defined primary outcomes as Fugl-Meyer Assessment for Upper Extremity (FMA-UE) and Wolf Motor Function Test (WMFT). Subgroup analyses included types of VNS, time since onset and long-term effects. Secondary outcomes included adverse events of VNS. Eight RCTs involving 266 patients were analyzed, of which five used direct VNS and three transcutaneous auricular VNS. The results revealed that VNS enhanced upper extremity function via FMA-UE (SMD = 0.73; 95% CI: 0.48 to 0.99; P < 0.00001) and WMFT (SMD = 0.82; 95% CI:0.52 to 1.13; P < 0.00001) in comparison to the control group, but showed no significant change on long-term effects of FMA-UE (SMD = 0.69; 95% CI: - 0.06 to 1.44; P = 0.07). There was no difference in adverse events between the VNS and control groups (RR = 1.16; 95% CI: 0.46 to 2.92; P = 0.74). For stroke victims with upper limb disabilities, VNS paired with rehabilitation was significantly safe and effective. More high-quality multicentric RCTs are needed to validate this conclusion.

Anatomical features of PFO in patients with cryptogenic stroke in comparison to autopsy results

Abstract Background In young patients suffering a stroke, well over 30% is considered cryptogenic stroke and may be associated with a PFO. The anatomical characteristics of stroke-related PFOs that allow right-to-left shunting can be assessed with TEE. The prevalence of a PFO in autopsy studies is approximately 25%, suggesting that the a priori chance of finding a possible "bystander-PFO" in young stroke victims is substantial. Purpose To assess the anatomical characteristics of PFO in patients with cryptogenic stroke and compare these with previously published results from autopsy in the general population. Methods Data on all consecutive patients that underwent PFO closure from 2016 to 2022 were collected. Anatomical PFO characteristics, including PFO diameter, tunnel length and the presence of atrial septal aneurysm, were measured with TEE during the closure procedure and analyzed by two cardiologists. Results In total 228 patients were enrolled. The mean age was 43±11 years, 116 patients (50.9%) were male, the mean RoPE-score was 7.0±1.4. The most frequent shunt grade measured with contrast bubble study during Valsalva maneuver was 3 (&amp;gt;25 bubbles, without opacification). Patients were divided in two groups depending on how the PFO diameter was measured, unstretched (n=119) and stretched (n=109). The mean PFO diameter was 5.4±2.6mm in the unstretched group and 10.9±3.6mm in the stretched group compared to 4.9±2.6mm in previous autopsy (p=0.192 and p&amp;lt;0.001, respectively). The percentage of patients with a PFO size larger than 10mm was 2% in autopsy compared to 6% in the unstretched group (p=0.109) and 52% in the stretched group (p&amp;lt;0.001). The mean PFO tunnel length in our combined cohort was 7.8±2.9mm. Conclusion The difference in PFO diameter found in this study indicates that PFOs found during published autopsy series, which are present in approximately 25% of the population, are significantly smaller than those related to a cryptogenic stroke. The exact prevalence of PFOs in the population that are comparable to those in cryptogenic stroke patients remains thus unknown. Future studies should define which characteristics could classify or rule out a PFO prone for associated clinical conditions, such as cryptogenic stroke.Distribution of PFO size