Frontiers in stroke最新文献

Background: High-intensity gait training (HIGT) has emerged as a promising intervention to improve walking outcomes post-stroke. This quality improvement project aimed to increase the intensity of gait training for patients post-stroke in inpatient rehabilitation and evaluate HIGT's effects on functional mobility and discharge outcomes.

Methods: Eighty-four patients post-stroke admitted to inpatient rehabilitation (2019-2021) were divided into HIGT (n = 32) and standard of care (SoC; n = 52) groups. Baseline characteristics were compared using t-tests or χ² tests. Linear mixed-effects models evaluated changes in Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) (total and item-level) and secondary outcomes (6-min walk test (6 MWT), 10-Meter Walk Test (10 MWT), berg balance scale (BBS), Functional Gait Assessment, Five Times Sit to Stand Test, and Activities-Specific Balance Confidence Scale). Logistic regression examined predictors of discharge destination.

Results: Groups were similar at baseline except for length of stay, which was longer for HIGT (16.6 vs. 11.1 days; p < 0.01). IRF-PAI Mobility improved significantly across all patients (p < 0.001), with a significant time × group interaction (p = 0.035) favoring HIGT. Item-level differences favored HIGT for "Chair/Bed-to-Chair Transfer" (p = 0.007), "Sit to Stand" (p = 0.005), and "Walk 10 Feet" (p = 0.008). Secondary outcomes improved within groups (p < 0.05) but did not differ significantly between groups. HIGT participants were more likely to discharge home (adjusted OR = 8.0, 95% CI [2.26-39.1], p = 0.003).

Conclusion: Patients receiving HIGT demonstrated greater functional mobility gains and were more likely to discharge home than those receiving standard care. HIGT may enhance post-stroke recovery and support independent living. Further research should assess fidelity, long-term outcomes, and broader implementation.

Background: Stroke remains the second leading cause of disability and death worldwide, with hypertension as its principal risk factor. Evidence from high-income countries indicates that blood pressure variability (BPV) is an independent predictor of outcomes during the acute phase, but data from African populations are limited despite the rising burden of cardiovascular disease. Understanding BPV patterns in this context is crucial for designing interventions to improve stroke outcomes.

Objectives: To determine 24-h BPV patterns in acute stroke patients and assess their impact on 30-day functional outcomes.

Methods: This multicenter prospective cohort study enrolled adults with acute stroke presenting within 72 h of symptom onset at two tertiary hospitals in Dar es Salaam. BPV patterns were measured using 24-h ambulatory monitoring, and demographic, clinical, and stroke subtype data were collected. Functional outcomes were evaluated using the modified Rankin Scale (mRS) and Barthel Index at admission, day 7, and day 30. Associations were examined using logistic regression.

Results: Of 52 patients enrolled, 48 (92.3%) completed follow-up. Most were male (n = 31; 64.6%), middle-aged (47-60 years, n = 19; 39.6%), and hypertensive (n = 43; 91.5%). Hemorrhagic strokes (n = 27; 56.3%) demonstrated higher systolic and diastolic BP variability than ischemic strokes, though differences were not statistically significant. Impaired nocturnal dipping (day/night systolic BP ratio) was linked to poor outcomes in univariate analysis (p = 0.019) but lost significance in multivariate testing (p = 0.16). Functional outcomes improved significantly by day 30: the Barthel Index increased, and mRS scores decreased. NIHSS score at day 7 emerged as the strongest independent predictor of poor outcome (mRS: p = 0.027, OR = 3.04, 95% CI: 1.13-8.15). Higher education level was also associated with better functional outcomes (p = 0.03).

Conclusion: In this Tanzanian cohort, reduced nocturnal dipping and elevated morning pressures were the most frequent BPV patterns, especially in hemorrhagic strokes, though not independently associated with outcomes at 30 days. Neurological severity at day 7 (NIHSS) was the strongest predictor of recovery, and lower education levels negatively influenced outcomes. The Barthel Index was more sensitive than the mRS in detecting functional gains.

Background: Etiologic subtyping of ischemic stroke is crucial for determining its treatment, prognosis, and prevention. However, data on the widely utilized TOAST and ASCOD criteria remain scarce in the East African region.

Aims: The study aimed to compare the performance of the TOAST and ASCOD systems in subtyping ischemic stroke among stroke patients at a tertiary hospital in Tanzania.

Methods: This was an institutional cross-sectional study. All adults (≥18 years) admitted with a diagnosis of stroke over a six-year period were selected from the registry, and their clinical details reviewed retrospectively. One hundred and thirty (130) patients with first- or second-time acute stroke (as defined by the World Health Organization) were included. Acute stroke was confirmed as ischemic by magnetic resonance imaging. For each index stroke, TOAST and ASCOD criteria were applied. The discordance and level of agreement between the approaches were assessed using McNemar's test χ² (P-value) and Cohen's kappa coefficient (κ), respectively. The value of κ was interpreted as moderate (0.41-0.6), good (0.61-0.8), very good (0.81-0.9), or excellent (0.91-1.0). Statistical significance was set at P < 0.05.

Results: There was no significant discordance between TOAST and the grade 1 level of evidence of ASCOD (ASCOD1) in assigning stroke to all subtypes, except for undetermined etiology χ² (P = 0.023). Agreement between these systems was good to very good (κ = 0.601 to 0.843, P < 0.01) across the subtypes. TOAST and ASCOD1 failed to determine a definitive etiology in 34.6% and 48.5% of strokes, respectively. On comparing TOAST vs. combined grade of evidence 1 and 2 of ASCOD (ASCOD1,2), there was a discordance in allocation of strokes to the cardioembolic subtype χ² (P < 0.001), and agreement was moderate (κ = 0.471, P = 0.001). However, the agreement across other identified subtypes was good to very good (κ = 0.601 to 0.875, P ≤ 0.001).

Conclusion: There was a good to very good agreement between TOAST and ASCOD1 in etiologic subtyping of ischemic stroke. Further research is warranted to evaluate their consistency across diverse local settings and to explore factors influencing their performance.

Background: Mechanical thrombectomy is the standard of care for Acute Ischemic Stroke caused by proximal large-vessel occlusion in the anterior circulation. In the stent retriever approach, a nitinol stent engages the clot via outward radial force to enable removal. However, current procedures lack direct clot visualization under fluoroscopy, which can reduce retrieval efficacy and often require multiple passes. Improving first-pass success is critical given the time-sensitive nature of stroke intervention.

Methods: This study presents a clot visualization method using the spatial arrangement of radio-opaque markers on the Medtronic Solitaire™ stent. A deep learning model, Clot[U]-Net, based on the U-Net architecture, was trained on 800 anteroposterior and lateral in-vitro images and evaluated on a separate test set.

Results: The Clot[U]-Net model achieved strong performance in clot boundary prediction, with a mean Intersection over Union (IOU) of 87.9% and an AUROC of 89.9%, and standard deviations of 2.2 and 3.16, respectively.

Conclusion: The proposed method enables clot visualization during stent retriever thrombectomy without altering existing clinical workflows. With further pre-clinical and clinical validation, this approach may support real-time decision-making and improve procedural outcomes.

Introduction: Female stroke survivors experience considerable vulnerabilities and existential concerns, shaped by sociocultural factors and gender roles, which heighten stroke morbidity and limit community reintegration. Yet, the existential concerns of female stroke survivors in Nigeria, and their relationships with psychological depression and community reintegration have not been explored.

Methods: A mixed-methods study was conducted among female stroke survivors recruited from selected hospitals in South-west, Nigeria. Community integration questionnaire, Existential concerns questionnaire, and the depression subscale of the Hospital anxiety and depression scale were used to assess community reintegration, existential concerns, and psychological depression, respectively. Six purposively selected female stroke survivors participated in a focus group discussion (FGD). Quantitative data were analyzed using Chi-square test at p < 0.05, while qualitative data were thematically analyzed.

Results: Seventy-five female stroke survivors aged 64.07 ± 14.03 years participated in the survey. The mean community reintegration, existential concerns and psychological depression scores were 12.24 ± 2.95, 9.77 ± 5.52, and 13.84 ± 4.71, respectively. The majority (n = 61; 81.3%) of the participants had a low level of community integration. Forty-seven (62.7%) reported a moderate level of existential concerns, while 32(42.7%) had psychological depression. There was a significant association between community reintegration and psychological depression (p = 0.02), and between existential concerns and psychological depression (p < 0.01). However, there was no association between community reintegration and existential concerns (p = 0.08). The five emergent themes from the FGD were: perception of stroke as a devastating condition; role disruption and loss of autonomy in the home, isolation and stigmatization in society, inadequate spousal support and sexual intimacy, work-related and financial concerns.

Conclusion: Existential concerns among participants were mostly related to social and family roles and were associated with poor emotional and mental wellbeing. Addressing these concerns through integrated care, delivered by a coordinated multidisciplinary team, could enhance emotional and mental wellbeing, and promote community reintegration among female stroke survivors.

Heart disease (HD) and stroke risk can be reduced with adequate cardiovascular disease (CVD) disease prevention as outlined in the American Heart Association's Life's Essential 8 guidelines for modifiable health behaviors. This scoping review examines the roles of community health workers (CHWs) in CVD prevention trials across the United States. In the 24 clinical trials identified, our review emphasizes the effectiveness of CHWs in improving health behaviors and outcomes, particularly for underserved populations with limited access to health care. CHWs were actively engaged in implementing interventions, providing culturally sensitive education, offering health coaching, and supporting lifestyle modifications, such as increased physical activity and medication compliance. Notably, while most studies focused on HD, only three specifically targeted secondary stroke prevention. Beyond their role of delivering behavioral interventions, CHWs supported research efforts by collecting data and maintaining participant involvement. However, their integration into academic teams was inconsistent in terms of scope of practice and level of interprofessional engagement. Furthermore, CHW research contributions were rarely recognized, with a handful acknowledged in publications. Training for CHWs generally included disease-specific knowledge and communication skills. CHW training programs varied considerably in their scope and standards, with unclear role definitions and insufficient collaboration with academic institutions. To enhance CHW-led preventive health care, developing standardized training frameworks, defining CHW responsibilities in clinical and research collaborations and building sustainable community-academic partnerships are suggested. These actions could significantly increase CHWs' role in reducing CVD disparities, thereby promoting more equitable health care across the United States.

Introduction: Dysphagia or disordered swallowing is a post-stroke condition that requires early intervention to improve stroke recovery. Individuals with dysphagia require specialized services to support nutrition and reduce the likelihood of pneumonia after stroke. This study was designed to utilize Medicare claims data to better understand the acute and post-acute pathways of stroke patients with dysphagia.

Methods: Data included 100% of fee-for-service (FFS) Medicare claims for home health agency (HHA), skilled nursing facility (SNF), inpatient, outpatient, and carrier files. The sample included Medicare beneficiaries who incurred an inpatient claim between January 1, 2016, and October 1, 2019, with ischemic or hemorrhagic stroke as the primary diagnosis.

Results: We identified 745,917 unique FFS Medicare beneficiaries with a primary stroke diagnosis; 90% were over age 65. Approximately 79% were non-Hispanic White, 12% were Black/African American, and 6% were Hispanic. Among those identified stroke survivors, 32.5% were diagnosed with dysphagia within 90 days, with slight racial/ethnic variations. Between 68% and 73% of people with dysphagia (PWD) had their initial service encounter in an inpatient hospital facility, 15%-16% in an SNF, and 4%-5% in an outpatient facility, and there was little variation across race/ethnicity. Approximately 10%-12% of PWD were discharged directly home, 32%-36% were discharged to an SNF, and 33%-36% were discharged to a long-term care or rehabilitation facility.

Discussion: In this study of Medicare data, the rate of dysphagia after stroke among Medicare beneficiaries was ~33%. This rate showed only slight variation across racial and ethnic groups. Approximately 70% of PWD were identified in inpatient settings. Only a small percentage (10%) were discharged home, with ~80% moving to facilities offering rehabilitative services (SNF, long-term care, or rehabilitation facility).

Background: The prevalence of stroke is increasing in Africa, yet resources remain limited in managing the disease. Whilst there are international guidelines on how to set up and manage stroke services, even in resource-limited settings, the uptake remains low. We describe here the opportunities and challenges we faced whilst setting up a stroke care pathway of international standards in a regional referral hospital in East Africa.

Methods: We describe how we adapted international stroke care guidelines for acute primary stroke (including both ischemic and hemorrhagic stroke), and used these to inform our stroke care pathway. We highlight opportunities of leveraging on multi-disciplinary involvement, as well as challenges of implementing the pathway.

Results: Our hospital was accredited by the Joint Commission International with a Clinical Care Programme Certification in May 2021. However, there were strategic improvement plans recommended that needed to be addressed for future re-accreditations, including having a dedicated stroke unit and addressing shortfalls in thrombolysis and thrombectomy timelines. We discuss the challenges faced with these and other relevant findings from the accreditation process.

Conclusion: International accreditation of our hospital provides an example of how to adapt international guidelines to local contexts. The description of our experience may be useful for other healthcare institutions from resource-limited settings who strive to improve the quality of stroke care they provide.

The 2024 ICORR-SASNET Ghana Neurorehabilitation Robotics workshop, convened on March 15-16, 2024, in Accra, Ghana, brought together 22 speakers and 27 attendees from nine countries to address the pressing need for enhanced access to neurorehabilitation services and rehabilitation robotics in Africa. Low- and Middle-Income Countries (LMICs) face substantial challenges in providing adequate rehabilitation services. This exacerbates the burden of disability and impedes the recovery and quality of life of individuals with stroke and other neurological conditions. The workshop aimed to: (1) discuss current trends, challenges in neurorehabilitation services and rehabilitation robotics in Africa; (2) identify gaps in access to rehabilitation services and assistive technologies in LMICs; (3) develop strategies for improving access to these services; and (4) promote collaborative efforts and knowledge sharing among health professionals and stakeholders. A purposive sampling method was employed to recruit a diverse cohort of practicing health professionals, policy makers, and a stroke survivor/advocate. The workshop featured expert presentations and discussions centered on three key questions: (1) the current status of stroke rehabilitation in Africa and driving policies, (2) the role of assistive technology and rehabilitation devices in Africa, and (3) strategies for inclusive implementation culminated into 10 targeted recommendations for integrating rehabilitation robotics into conventional therapies. A roadmap was developed, featuring future initiatives, awareness campaigns, and technology transfer programs, with a planned second workshop in 2026, aiming to enhance access and promote sustainable solutions.