Stroke

Stroke is a leading cause of disability across the developed world, affecting an increasing number of younger people. In this article, we seek to understand the experience of stroke as a disabling life situation among young people and the strategies that they use to recover and cope. Directed content analysis was conducted from interviews with 17 community-dwelling stroke survivors aged 55 years and younger across the United Kingdom. The sample was drawn from a larger maximum variation sample of stroke survivors. Using the sociological concepts of biographical disruption and biographical repair as a guide, excerpts from the interviews pertaining to aspects of the patients' life that were interrupted, in addition to how they coped with the changes, were selected and analysed. All individuals described an ''altered sense of self,'' a theme that included loss of identity, family disruption, and/or loss of valued activities. Individuals sought to adapt their sense of self by seeking external support, by restoring normality, and/or through positive reflection. Despite the adapted self that emerged, most individuals continued to experience impairments. While young stroke survivors adapt to their illness over time, they continue to experience impairments and disruptions in their personal and work lives. A holistic model of rehabilitation that helps individuals regain the capacity for everyday activities related to work, family life, and leisure can begin to address the emotional ramifications of diseases such as stroke, restore wellness, and work towards minimizing the burden felt by family caregivers and children.

Background-Transcranial Doppler ultrasonography (TCD) is used to predict stroke risk in children with sickle cell anemia (SCA), but has not been adequately studied in children under age 2 years. Procedure-TCD was performed on infants with SCA enrolled in the BABY HUG trial. Subjects were 7-17 months of age (mean 12.6 months). TCD examinations were successfully performed in 94% of subjects (n=192). Results-No patient had an abnormal TCD as defined in the older child (time averaged maximum mean velocity ≥ 200cm/sec) and only 4 subjects (2%) had velocities in the conditional range (170-199cm/sec). TCD velocities were inversely related to hemoglobin concentration and directly related to increasing age. Conclusion-Determination of whether the TCD values in this very young cohort of infants with SCA can be used to predict stroke risk later in childhood will require analysis of exit TCD's and long-term follow-up, which is ongoing. (ClinicalTrials.gov number, NCT00006400

This review summarizes the current state-of-the-art regarding the endovascular management of acute ischemic stroke. Beginning with intravenous tissue plasminogen activator, this paper traces the gradual shift of systemic thrombolysis from a competing to complementary treatment modality. Intra-arterial thrombolysis, mechanical thrombectomy with the Merci (Concentric Medical, Mountain View, California) and Penumbra (Penumbra, Inc., Alameda, California) systems, angioplasty, primary intracranial stenting, and emerging stentriever devices are sequentially reviewed. Ultimately, this paper lays the foundation for current endovascular stroke management and considers future areas of progress and research.

Purpose: The performance quality rating scale (PQRS) is an observational measure of performance quality of client-selected, personally meaningful activities. It has been used inconsistently with different scoring systems, and there have been no formal publications on its psychometric properties. The purpose of this study was to test and compare the psychometric properties of two PQRS scoring systems in two populations. Methods: A secondary analysis of video recorded participant-selected activities from previous studies involving either adults living with stroke or children diagnosed with developmental coordination disorder (DCD) was conducted. Three pairs of raters scored the video recorded performances with PQRS operational definitions (PQRS-OD) and a generic rating system (PQRS-G). Results: For interrater reliability, PQRS-OD ICCs were substantial, ranging from 0.83 to 0.93; while the PQRS-G ICCs were moderate, ranging from 0.71 to 0.77. Test-retest reliability was substantial, 40.80 (ICC), for both rating systems across all rater pairs. Internal responsiveness was high for both rating systems. Convergent validity with the Canadian Occupational Performance Measure (COPM) was inconsistent, with scores ranging from low to moderate. Conclusion: Both scoring systems have demonstrated they are reliable and have good internal responsiveness. The PQRS-OD demonstrated greater consistency across raters and is more sensitive to clinically important change than the PQRS-G and should be used when greater accuracy is required. Further exploration of validity with actual rather than perceived performance measures is required.

Recent experimental evidence indicates that progesterone (PROG) protects against various models of brain injury, including ischemic stroke. Most human studies of pharmacologic treatments for acute cerebral stroke have failed despite initial success in animal models. To simulate better the typical human stroke without reperfusion, the present study was conducted to examine the efficacy of PROG on infarct volume and functional outcome in a permanent model of stroke, using direct cauterization of the middle cerebral artery (MCA). Twenty-four male adult Sprague-Dawley rats underwent pMCAO by electro-coagulation and sham operation. After induction of permanent MCA occlusion (pMCAO), the rats received an initial intraperitoneal injection of PROG (8 mg/kg) or vehicle at 1h post-occlusion followed by subcutaneous injections at 6, 24 and 48 h. Functional deficits were tested on the rotarod and grip strength meter at 24, 48 and 72 h after pMCAO. The rats were killed 72 h after surgery and isolated brain was sectioned into coronal slices and stained with 2, 3, 5triphenyltetrazolium chloride (TTC). PROG-treated rats showed a substantial reduction (54.05%) in the volume of the infarct (% contralateral hemisphere) compared to vehicle controls. In addition there was a significant improvement in ability to remain on an accelerating rotarod and increased grip strength observed in the pMCAO rats treated with PROG compared to vehicle. Taken together, these data indicate that PROG is beneficial in one of the best-characterized models of stroke, and may warrant further testing in future clinical trials for human stroke.

Background: Over fifty percent of stroke patients experience chronic arm hand performance problems, compromising independence in daily life activities and quality of life. Task-oriented training may improve arm hand performance after stroke, whereby augmented therapy may lead to a better treatment outcome. Technology-supported training holds opportunities for increasing training intensity. However, the effects of robot-supported task-oriented training with real life objects in stroke patients are not known to date. The aim of the present study was to investigate the effectiveness and added value of the Haptic Master robot combined with task-oriented arm hand training in chronic stroke patients.

Electronic patient record systems serve many purposes for many different kinds of users. Four case studies are reported of the use made by health-care staff of electronic patient record systems that supported healthcare pathways. The results demonstrate that the systems fit the purposes of strategic and managerial users of the record, but they are problematic as tools for use by the frontline staff delivering care. As a result, these staff frequently resort to workarounds to accomplish their work goals. An analysis of the design processes that created these systems shows that the specification of the systems was based on strategic and managerial requirements and there was no formal assessment of the needs of frontline users. Efforts to address the needs of frontline staff in the provisions of electronic systems were most often made after the main system was implemented.

BACKGROUND Recent studies have focused on mechanical thrombectomy as a means to reduce the time required for revascularization and increase the revascularization rate in acute stroke. To date no systematic evaluation has been made of the different mechanical devices in this novel and fast-developing field of endovascular interventions. To facilitate such evaluations, we developed a specific in vivo model for mechanical thrombectomy that allows visualization of dislocation or fragmentation of the thrombus during angiographic manipulation. METHODS Angiography and embolization with a preformed thrombus was performed in 8 swine. The thrombus was generated by mixing 25 IU bovine thrombin and 10 mL autologous blood. For visualization during angiography, 1 g barium sulfate was added. RESULTS The preformed thrombus exhibited mechanical stability, reproducibility, and high radiographic absorption, providing excellent visibility during angiography. The setting allowed selective embolization o...

Introduction: Based on the positive results observed in experimental animal models, adipose tissue-derived mesenchymal stem cells (AD-MSCs) constitute a promising therapy for stroke treatment. However, several aspects need to be clarified to identify the optimal conditions for successful clinical translation. Areas covered: This review focuses on AD-MSC treatment for ischemic and hemorrhagic stroke in experimental animal models. In addition, we will explore the optimization of treatment conditions including AD-MSC production, administration routes and therapeutic windows for their appropriate use in patients, and we will provide an update on clinical trials on this therapy. Expert opinion: Compared with other cell types, AD-MSCs have been less investigated in stroke studies. Currently, experimental animal models have shown safety and efficacy with this treatment after stroke. Due to several advantages of AD-MSCs, such as their abundance and accessibility, they can be considered a promising strategy for use in patients. However, many questions are still to be resolved regarding their mechanisms of action, immune system modulation and the effects of AD-MSCs on all components of the brain that may be affected after ischemic and hemorrhagic strokes.

Background A core outcome set (COS; an agreed, minimum set of outcomes) was needed to address the heterogeneous measurement of outcomes in aphasia treatment research and to facilitate the production of transparent, meaningful, and efficient outcome data. Objective The Research Outcome Measurement in Aphasia (ROMA) consensus statement provides evidence-based recommendations for the measurement of outcomes for adults with post-stroke aphasia within phases I-IV aphasia treatment studies. Methods This statement was informed by a four-year program of research, which comprised investigation of stakeholder-important outcomes using consensus processes, a scoping review of aphasia outcome measurement instruments, and an international consensus meeting. This paper provides an overview of this process and presents the results and recommendations arising from the international consensus meeting. Results Five essential outcome constructs were identified: Language, communication, patient-reported...

The National Quality Forum (NQF) recently endorsed a performance measure for time to intravenous thrombolytic therapy which allows exclusions for circumstances in which fast alteplase treatment may not be possible. However, the frequency and impact of unavoidable patient reasons for long door-to-needle time (DNT), such as need for medical stabilization, are largely unknown in clinical practice. As part of the Hurry Acute Stroke Treatment and Evaluation-2 (HASTE-2) project, we sought to identify patient and systems reasons associated with longer DNT. From 06/2012 to 06/2013 we collected data on DNT and potential reasons for delays from 102 consecutive patients presenting directly to the ED who were treated with alteplase within 4.5 hours of symptom onset. Mean age was 71, 56/113 (54%) were women, median NIH Stroke Scale score was 13 and median DNT was 53 minutes. Potential delays were noted in 59/102 (58%), of which 31/102 (31%) were unavoidable patient-related or eligibility reasons...

Background. Chronic obstructive pulmonary disease (COPD) is commonly managed in primary care but there is poor awareness of evidence-based guidelines and the quality and interpretation of spirometry is suboptimal. Objectives. The aims of this qualitative study were to explore how an intervention involving case finding and management of COPD was implemented, and the extent to which the GPs and practice nurses (PNs) worked in partnership to diagnose and manage COPD. Methods. Semi-structured interviews with PNs (n = 7), GPs (n = 4) and patients (n = 26) who had participated in the Primary care EarLy Intervention for Copd mANagement (PELICAN) study. The Theoretical Domains Framework was used to guide the coding and analysis of the interviews with PN and GPs. The patient interviews were analysed thematically. Results. PNs developed technical skills and understood the requirements for good-quality spirometry. However, many lacked confidence in its interpretation and felt this was not part of their professional role. This was reflected in responses from the GPs. Once COPD was diagnosed, the GPs tended to manage the patients with the PNs less involved. This was in contrast with PNs' active role in managing patients with other chronic diseases such as diabetes. The extent to which the GPs and PNs worked in partnership to manage COPD varied. Conclusions. PNs improved their skills and confidence in performing spirometry. Beliefs about their professional role, identity and confidence influenced the extent to which PNs were involved in interpretation of the spirometry results and managing the patient in partnership with the GP.

We read with great interest the imaging vignette by Gurudevan et al. (1), presenting 3 patients in whom a thrombus was seen adherent to the septal left atrium (LA), potentially attributed to a recently described novel atrial structure, the left atrial septal pouch (LASP). Krishnan et al.

Recombinant mouse protein C was cloned, expressed, purified, and activated by Protac or thrombin. The anticoagulant activities of mouse and human activated protein C (APC) were compared using mouse and human plasma and the neuroprotective properties of murine APC were studied in an ischemic stroke model. Both human APC and mouse APC prolonged the activated partial thromboplastin time in a dose-dependent manner, but mouse APC was sixfold more effective than human APC as an anticoagulant in mouse plasma. Human protein S enhanced prolongation of the APTT clotting time of human plasma by human APC, but not by mouse APC. Hydrolysis of the S-2366 chromogenic substrate by murine APC was essentially identical to human APC. Mouse plasma contains 75 nM protein C. In a murine ischemic stroke model based on middle cerebral artery occlusion, murine APC was highly neuroprotective. The results show that recombinant murine APC is functionally similar to human APC both in vitro and in vivo and that it displays significant species specificity. The results imply that murine APC is notably superior to human APC for studies of murine disease models, including thrombosis and ischemic brain injury.

Background: Stroke recovery is a dynamic process for stroke survivors, and shorter lengths of stay in healthcare settings shift the care of the survivors to family caregivers. The physical and mental sequelae after stroke and the family's response to this catastrophic event may have deleterious effects on caregivers.

Controversy continues regarding the safety and efficacy of tissue plasminogen activator (tPA) for stroke outside major centers. We reviewed charts from 1998 to 2004 of 493 patients admitted with TIA or stroke to our small rural hospital. There was a 4% tPA treatment rate with no symptomatic intracranial hemorrhage and zero mortality. IV tPA can be safe and effective in the treatment of acute stroke despite the size of the institution.

Morris DM, Uswatte G, Crago JE, Cook EW III, Taub E. The reliability of the Wolf Motor Function Test for assessing upper extremity function after stroke. Arch Phys Med Rehabil 2001;82:750-5. Objective: To examine the reliability of the Wolf Motor Function Test (WMFT) for assessing upper extremity motor function in adults with hemiplegia. Design: Interrater and test-retest reliability. Setting: A clinical research laboratory at a university medical center. Patients: A sample of convenience of 24 subjects with chronic hemiplegia (onset Ͼ1yr), showing moderate motor impairment.

The development of an innovative functional assessment procedure based on the combination of electroencephalography (EEG) and robot-assisted upper limb devices may provide new insights into the dynamics of cortical reorganization promoted by rehabilitation. The aim of this study was to evaluate changes in event-related synchronization/desynchronization (ERS/ERD) in alpha and beta bands in a patient with pure sensory stroke who underwent a specific rehabilitation program for somatic sensation recovery. A 49-year-old, right-handed woman (time since stroke, 12 months) with severe upper limb somatic sensation deficits was tested using validated clinical scales and a standardized video-EEG system combined with the Bi-Manu-Track robotassisted arm trainer protocol. The patient underwent a 3-month home-based rehabilitation program for promoting upper limb recovery (1 hour a day for 5 days a week). She was tested before treatment, at 1-month, and at 3-month during treatment. Results showed progressive recovery of upper limb function over time. These effects were associated with specific changes in the modulation of alpha and beta event-related synchronization/desynchronization. This unique study provides new perspectives for the assessment of functional deficits and changes in cortical activity promoted by rehabilitation in poststroke patients.

Background: We wished to examine the impact of antiplatelet
drug discontinuation on recurrent stroke and all-cause
mortality. Methods: We identified a cohort of incident ischaemic
stroke patients in a Danish stroke registry, 2007–2011.
Using population-based registries we assessed subjects’
drug use and followed them up for stroke recurrence, or allcause
death. Person-time was classified by antiplatelet drug
use into current use, recent use ( ≤ 150 days after last use),
and non-use (>150 days after last use). Lipid-lowering drug
(LLD) use was classified by the same rules. We used Cox proportional
hazard models to calculate the adjusted hazard ratio
(HR) and corresponding 95% confidence intervals (CIs) for
the risk of recurrent stroke or death associated with discontinuation
of antiplatelet or LLD drugs. Results: Among 4,670
stroke patients followed up for up a median of 1.5 years, 237
experienced a second stroke and 600 died. Compared with
current antiplatelet drug use, both recent use (1.3 (0.8–2.0)),
and non-use (1.3 (0.8–1.9)) were associated with increased
recurrent stroke risk. The corresponding HRs of death were
1.9 (1.4–2.5) for recent and 1.8 (1.4–2.3) for non-use of antiplatelet
drugs. Recent statin use was associated with markedly
increased risk of death (2.1 (1.7–2.6)), and only marginally
with recurrent stroke (1.2 (0.9–1.6)). Conclusions: Antiplatelet
drug discontinuation may be associated with an
increased recurrent stroke risk. Our results on death risk indicate
that non-pharmacological biases, such as ‘sick stopper’,
may threaten the validity of this risk estimate.

Posture control appears deeply impaired in patients with severe Acquired Brain Injury (ABI). One of the main goals of neurorehabilitation specialists is to try to assess this neural function in a standardized manner. However, the tests available to evaluate posture control recovery after brain damage were developed for patients with focal neurological signs. We therefore developed a new test, the Trunk Recovery Scale (TRS). To evaluate the inter-rater reliability, internal consistency, external validity, and sensitivity of TRS in patients with ABI. Validation study. We examined 59 patients hospitalized after a brain injury in the Intensive and the Extensive Rehabilitation Units of our hospital. Patients with diagnosis of severe ABI with the capacity to respond to simple verbal orders and with a Level of Cognitive Functioning Scale (LCF scale) ≥ 4. Three raters independently assessed 20 subjects. One of the raters also assessed 39 additional subjects using TRS, Trunk Control Test (TC...

Strength training is recommended for children with cerebral palsy. However, it is difficult for moderately impaired children with cerebral palsy, who require crutches for ambulation, to participate in this type of training. The purpose of this study was to investigate whether whole-body vibration training is an effective method of strengthening in a moderately impaired child with cerebral palsy. [Subject and Methods] This report describes an 8-year-old Japanese boy with cerebral palsy, who was ambulatory with crutches. The subject participated in physical therapy twice a week for 5 weeks. Whole-body vibration training was selected to complement the standing practice. The patient's crutch-walking ability, gross motor function, and spasticity were evaluated. [Results] The number of steps and walking duration were reduced in a 5-m walk test with crutches and gross motor function was improved. Further, the spasticity was reduced. [Conclusion] Whole-body vibration training is an effective physical therapy intervention in moderately impaired children with cerebral palsy, who are unable to walk without crutches.

Stroke is defined as an abnormality in brain function resulting from disruption of cerebral circulation. It is the third leading cause of death in the United States and the primary cause of long-term disability. The economic burden of stroke will only increase as the population ages, making prevention and treatment of stroke one of the most important public health issues

Background: Apparent diffusion coefficient (ADC) thresholds are used to determine acute stroke lesion volume, but the reliability of this approach and comparability to the volume of the magnetic resonance diffusion-weighted imaging (MR-DWI) hyperintense lesion is unclear. Methods: We prospectively recruited and clinically assessed patients who had experienced acute ischemic stroke and performed DWI less than 24 hours and at 3 to 7 days after stroke. We compared the volume of the manually outlined DW hyperintense lesion (reference standard) with lesion volumes derived from 3 commonly used ADC thresholds: .55 3 10 23 /mm 2 /second 21 , .65 3 10 23 /mm 2 /second 21 , and .75 3 10 23 /mm 2 /second 21 , with and without ''editing'' of erroneous tissue. We compared the volumes obtained by reference standard, ''raw,'' and ''edited'' thresholds. Results: Among 33 representative patients, From the

Major pathological stroke types (ischemic stroke [IS], primary intracerebral hemorrhage [ICH], and subarachnoid hemorrhage) and IS subtypes, have differing risk factors, management, and prognosis. We report changes in major stroke types and IS subtypes incidence during 10 years using data from the ARCOS (Auckland Regional Community Stroke Study) III performed during 12 months in 2002 to 2003 and the fourth ARCOS study (ARCOS-IV) performed in 2011 to 2012. ARCOS-III and ARCOS-IV were population-based registers of all new strokes in the greater Auckland region (population aged >15 years, 1 119 192). Strokes were classified into major pathological types (IS, ICH, subarachnoid hemorrhage, and undetermined type). Crude annual age-, sex-, and ethnic-specific stroke incidence with 95% confidence intervals was calculated. ISs were subclassified using TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria into 5 etiologic groups. Rate ratios with 95% confidence intervals were calcu...

Cerebral ischemia initiates a cascade of detrimental events including glutamate-associated excitotoxicity, intracellular calcium accumulation, formation of Reactive oxygen species (ROS), membrane lipid degradation, and DNA damage, which lead to the disruption of cellular homeostasis and structural damage of ischemic brain tissue. Cerebral ischemia also triggers acute inflammation, which exacerbates primary brain damage. Therefore, reducing oxidative stress (OS) and downregulating the inflammatory response are options that merit consideration as potential therapeutic targets for ischemic stroke. Consequently, agents capable of modulating both elements will constitute promising therapeutic solutions because clinically effective neuroprotectants have not yet been discovered and no specific therapy for stroke is available to date. Because of their ability to modulate both oxidative stress and the inflammatory response, much attention has been focused on the role of nitric oxide donors (...

V ertigo and dizziness account for 2.6 million US emergency department (ED) visits per year, ≈4% attributable to stroke. 1 Roughly 250 to 500 000 involve a high-risk-for-stroke clinical presentation known as acute vestibular syndrome (AVS). 2 AVS is a well-defined clinical syndrome of severe, continuous vertigo, or dizziness, nausea or vomiting, gait instability, head motion intolerance, and nystagmus lasting days to weeks. 2-4 Most AVS patients have a benign peripheral vestibular cause (vestibular neuritis or nonbacterial labyrinthitis), but ≈25% have brain stem or cerebellar strokes. 2 Other central causes, such as multiple sclerosis, are uncommon. 2 Distinguishing dangerous central from benign peripheral vestibular causes can be challenging. Half of stroke patients presenting with AVS have no focal neurological signs. 2 In the first 24 hours after onset of symptoms, computed tomography accurately detects cerebellar hemorrhages but not ischemic strokes (16% sensitivity). 5 Even magnetic resonance imaging of the brain with diffusion-weighted imaging (MRI-DWI) identifies only ≈80% of posterior fossa infarctions in the first day. 2 Three bedside eye movement findings (Head Impulse test, Nystagmus, Test-of-Skew [HINTS]) differentiate central from peripheral causes of AVS, even outperforming early MRI (Table I in the online-only Data Supplement). 2 This is not Background and Purpose-Strokes can be distinguished from benign peripheral causes of acute vestibular syndrome using bedside oculomotor tests (head impulse test, nystagmus, test-of-skew). Using head impulse test, nystagmus, test-ofskew is more sensitive and less costly than early magnetic resonance imaging for stroke diagnosis in acute vestibular syndrome but requires expertise not routinely available in emergency departments. We sought to begin standardizing the head impulse test, nystagmus, test-of-skew diagnostic approach for eventual emergency department use through the novel application of a portable video-oculography device measuring vestibular physiology in real time. This approach is conceptually similar to ECG to diagnose acute cardiac ischemia. Methods-Proof-of-concept study (August 2011 to June 2012). We recruited adult emergency department patients with acute vestibular syndrome defined as new, persistent vertigo/dizziness, nystagmus, and (1) nausea/vomiting, (2) head motion intolerance, or (3) new gait unsteadiness. We recorded eye movements, including quantitative horizontal head impulse testing of vestibulo-ocular-reflex function. Two masked vestibular experts rated vestibular findings, which were compared with final radiographic gold-standard diagnoses. Masked neuroimaging raters determined stroke or no stroke using magnetic resonance imaging of the brain with diffusion-weighted imaging obtained 48 hours to 7 days after symptom onset. Results-We enrolled 12 consecutive patients who underwent confirmatory magnetic resonance imaging. Mean age was 61 years (range 30-73), and 10 were men. Expert-rated video-oculography-based head impulse test, nystagmus, test-ofskew examination was 100% accurate (6 strokes, 6 peripheral vestibular). Conclusions-Device-based physiological diagnosis of vertebrobasilar stroke in acute vestibular syndrome should soon be possible. If confirmed in a larger sample, this bedside eye ECG approach could eventually help fulfill a critical need for timely, accurate, efficient diagnosis in emergency department patients with vertigo or dizziness who are at high risk for stroke. (Stroke. 2013;44:1158-1161.) Key Words: diagnosis ■ diagnostic techniques, neurological ■ dizziness ■ sensitivity and specificity ■ vertigo

Abstract: Background and Objective Stroke patients with severe leg paralysis are often bedridden in the acute and subacute phase, which increases the risk of disuse muscle atrophy in the chronic phase. The evidence to date indicates that oxidative stress plays an ...

Background and Purpose— Tirofiban is a highly selective, fast-acting nonpeptide glycoprotein IIb/IIIa platelet receptor antagonist with a short half-life time. Glycoprotein IIb/IIIa antagonists are effective for the treatment of acute coronary syndromes proven in large clinical trials. Safety and efficacy in patients with ischemic stroke are uncertain. This was addressed in the Safety of Tirofiban in acute Ischemic Stroke (SaTIS) trial. Methods— Two hundred sixty patients with acute ischemic stroke were randomized in a placebo-controlled, prospective, open-label treatment, blinded outcome reading multicenter trial. Subjects with a National Institutes of Health Stroke Scale between 4 and 18 received intravenously either tirofiban or placebo within 3 to 22 hours after symptom onset for 48 hours. The primary end point was the rate of cerebral bleeding as measured in follow-up CT scans 2 to 7 days after inclusion. The secondary end point was clinical efficacy within 1 week (National Ins...

Objectives: to estimate levels of disability, handicap and health-related quality of life (HRQOL) up to 3 years after stroke and examine the relationships between these domains. Design: a longitudinal, observational study Setting: population-based register of first-ever strokes Methods: subjects, registered between 1 January 1995 and 31 December 1997, were assessed at 1 year (n = 490) and 3 years (n = 342) post-stroke for disability [Barthel index (BI)], handicap [Frenchay activity index (FAI)] and HRQOL (SF-36). BI was categorised as severe, moderate, mild and independent (0-9, 10-14, 15-19 and 20); FAI was categorised as inactive, moderately active and very active (0-15, 16-30 and 31-45). SF-36 domains include: Physical Functioning (PF), Role Physical (RP), Bodily Pain (BP), General Health (GH), Vitality (VT), Social Functioning (SF), Role Emotional (RE) and Mental Health (MH). Physical (PHSS) and Mental Health (MHSS) Summary Scores were computed. Results: at 1 and 3 years, 26.1 and 26.3%, respectively, were disabled (BI <15); 55 and 51%, respectively, were handicapped (FAI = 0-15); and survivors had low mean PHSS (37.1 and 37.9), but satisfactory mean MHSS (46.6 and 47.7). There was a graded positive relationship between all SF-36 domains and the categories of BI and FAI. Spearman rank correlations were significant between BI and all SF-36 domains at both time points: strong (r>0.70) with PF, moderate (r = 0.31-0.70) with RP, SF and PHSS, but weak (r<0.30) with other domains. Correlations between FAI and SF-36 domains were strong with PF, weak with BP, RE and MHSS, and moderate with other domains. Conclusions: disability and handicap remain highly prevalent up to 3 years after stroke. Patients' perception of physical health is persistently low, but mental health perception is satisfactory up to 3 years. Due to variable correlations between different HRQOL domains with disability and handicap, it is suggested that disability, handicap and HRQOL should all be assessed to acquire a broader measure of stroke outcome.

Functional outcome in acute stroke trials among others is usually measured on the modified Rankin Scale. However, new onset of depression, cognitive decline, and communication deficits alone or in combination affect more than 25% of patients. This report summarizes the findings and conclusions of a workshop by the European Stroke Organization held in February 2011 We propose that assessment of mood disorders, cognitive impairment/dementia, language or communication dysfunction, and quality of life should supplement outcome measures after acute stroke.

; for the Stroke Outcome Research Canada (SORCan) Working Group Background and Purpose-Hemiparesis resulting in functional limitation of an upper extremity is common among stroke survivors. Although existing evidence suggests that increasing intensity of stroke rehabilitation therapy results in better motor recovery, limited evidence is available on the efficacy of virtual reality for stroke rehabilitation. Methods-In this pilot, randomized, single-blinded clinical trial with 2 parallel groups involving stroke patients within 2 months, we compared the feasibility, safety, and efficacy of virtual reality using the Nintendo Wii gaming system (VRWii) versus recreational therapy (playing cards, bingo, or "Jenga") among those receiving standard rehabilitation to evaluate arm motor improvement. The primary feasibility outcome was the total time receiving the intervention. The primary safety outcome was the proportion of patients experiencing intervention-related adverse events during the study period. Efficacy, a secondary outcome measure, was evaluated with the Wolf Motor Function Test, Box and Block Test, and Stroke Impact Scale at 4 weeks after intervention. Results-Overall, 22 of 110 (20%) of screened patients were randomized. The mean age (range) was 61.3 (41 to 83) years. Two participants dropped out after a training session. The interventions were successfully delivered in 9 of 10 participants in the VRWii and 8 of 10 in the recreational therapy arm. The mean total session time was 388 minutes in the recreational therapy group compared with 364 minutes in the VRWii group (Pϭ0.75). There were no serious adverse events in any group. Relative to the recreational therapy group, participants in the VRWii arm had a significant improvement in mean motor function of 7 seconds (Wolf Motor Function Test, 7.4 seconds; 95% CI, Ϫ14.5, Ϫ0.2) after adjustment for age, baseline functional status (Wolf Motor Function Test), and stroke severity. Conclusions-VRWii gaming technology represents a safe, feasible, and potentially effective alternative to facilitate rehabilitation therapy and promote motor recovery after stroke. (Stroke. 2010;41:1477-1484.

Embolism is responsible for half of cerebral infarctions, yet few animal models were developed due to the unpredictability of the embolus-induced infarcts. We manufactured artificial embolic particles by blending chitin and poly(D,L-Lactide-co-glycolide) (chitin/PLGA) for their good biocompatibility and rapid hydration expansion property. We subdivided the chitin/PLGA microparticles into 10 size groups (from 38e45 mm to 255e350 mm) and injected them through the external carotid artery toward the bifurcation of the common carotid artery in the rat. Reduced blood flow of the ipsilateral hemisphere was evident immediately after the injection of particles. The spherical appearance of the particle was critical in occluding the cerebral vessels. Particle 212e250mm produced the greatest diffuse infarction in the ipsilateral hemisphere, including the cortex, hippocampus, basal ganglion, thalamus, midbrain and cerebellum. Particle 75-90mm induced single or sparse isolated infarcts mainly located in the subcortical region, resembling lacunar stroke observed in humans. Particle 38e45mm frequently crossed to the contralateral hemisphere and induced diffuse infarctions in both hemispheres. The cortex infarct volumes were positively correlated to neurologic score and seizure incidence. In conclusion, we have established embolic stroke animal models, including a novel model that mainly expresses lacunar infarction, by intravenous injection of chitin/PLGA microparticles.

Life table analysis is a powerful statistical tool that has become the preferred technique for studying both the natural history of and the effect of treatment on disease outcome. We have found only one report using life table analysis to study rehabilitation outcome after stroke. We assessed the recovery of both independent ambulation and overall self-care function in 95 consecutive patients with unilateral hemispheric stroke using life table analysis. Our results support the segregation of patients into the following prognostic subgroups at the time of entry into the rehabilitation program (mean±SD 5±3 weeks after stroke): 1) motor deficit only, 2) motor deficit plus somatic sensory deficit, and 3) motor deficit plus somatic sensory deficit plus homonymous visual deficit. The probabilities of reaching independence in ambulation, being able to walk 150 feet with assistance, reaching independence in self-care function, and reaching a point of assisted self care (Barthel Index score of ^60) are highly significantly different among subgroups. The interval after stroke required to reach the plateau phase of recovery is also significantly different among subgroups. We propose that life table analysis can be used 1) to define patient outcome goals, 2) to define the time required to reach such goals, 3) to identify patients with medical or behavioral comorbidity who are functioning below their expected level, and 4) to assess the effect of alternative treatment regimens on both final outcome and time to reach that outcome.

Аннотация. В профилактике инсультов и борьбе с их последствиями важна не только работа системы здравоохранения, но и самосохранительное поведение населения, которое в значимой мере обусловлено компетентностью в данном вопросе. Изучение информированности населения об инсульте и выработка рекомендаций по информационной политике – основные задачи данного исследования. Проведено 2 опроса в Москве в октябре-декабре 2019 г., выборка каждого – 800 человек. Исследование обнаружило рост между волнами числа тех, кто считает, что знает признаки инсульта (до 65%). Несмотря на большинство правильных ответов, данная самооценка не всегда подтверждается реальными знаниями, в т.ч. инсульт путают с ишемической болезнью сердца, инфарктом и эпилепсией. Меньшую компетентность демонстрируют мужчины и люди с начальным/средним образованием, более молодые респонденты. 94% респондентов при появлении признаков инсульта вызовут скорую помощь, 16% начнут самостоятельно оказывать помощь, в основном их действия будут корректными, хотя встречается ряд заблуждений. Среди основных факторов риска инсульта респонденты называют наличие вредных привычек. Население чаще обращается к таким источникам информации, как родственники/знакомые (25%) и интернет (22%). Исследование выявило запрос населения на корректную информацию об инсультах. Желательна большая представленность экспертно рецензируемых материалов в информационном поле.

Scene text recognition brings various new challenges occurs in recent years. Detecting and recognizing text in scenes entails some of the equivalent problems as document processing, but there are also numerous novel problems to face for recognizing text in natural scene images. Recent research in these regions has exposed several promise but present is motionless much effort to be entire in these regions. Most existing techniques have focused on detecting horizontal or near-horizontal texts. In this paper, we propose a new scheme which detects texts of arbitrary directions in natural scene images. Our algorithm is equipped with two sets of characteristics specially designed for capturing both the natural characteristics of texts using MSER regions using Otsu method. To better estimate our algorithm and compare it with other existing algorithms, we are using existing MSRA Dataset, ICDAR Dataset, and our new dataset, which includes various texts in various real-world situations. Experiments results on these standard datasets and the proposed dataset shows that our algorithm compares positively with the modern algorithms when using horizontal texts and accomplishes significantly improved performance on texts of random orientations in composite natural scenes images.

Intractable central post-stroke pain (CPSP) is one of the most common sequelae of stroke, but has been inadequately studied to date. In this study, we first determined the relationship between the lesion site and changes in mechanical or thermal pain sensitivity in a rat CPSP model with experimental thalamic hemorrhage produced by unilateral intra-thalamic collagenase IV (ITC) injection. Then, we evaluated the efficacy of gabapentin (GBP), an anticonvulsant that binds the voltage-gated Ca(2+) channel α2δ and a commonly used anti-neuropathic pain medication. Histological case-by-case analysis showed that only lesions confined to the medial lemniscus and the ventroposterior lateral/medial nuclei of the thalamus and/or the posterior thalamic nucleus resulted in bilateral mechanical pain hypersensitivity. All of the animals displaying CPSP also had impaired motor coordination, while control rats with intra-thalamic saline developed no central pain or motor deficits. GBP had a dose-relat...

This series of articles for rehabilitation in practice aims to cover a knowledge element of the rehabilitation medicine curriculum. Nevertheless they are intended to be of interest to a multidisciplinary audience. The competency addressed in this article is the neuropsychologist.

l e t t e r s Saccular intracranial aneurysms are balloon-like dilations of the intracranial arterial wall; their hemorrhage commonly results in severe neurologic impairment and death. We report a second genome-wide association study with discovery and replication cohorts from Europe and Japan comprising 5,89 cases and 4,8 controls with 832,000 genotyped and imputed SNPs across discovery cohorts. We identified three new loci showing strong evidence for association with intracranial aneurysms in the combined dataset, including intervals near RBBP8 on 8q.2 (odds ratio (OR) = .22, P = . × 0 −2 ), STARD13-KL on 3q3. (OR = .20, P = 2.5 × 0 −9 ) and a gene-rich region on 0q24.32 (OR = .29, P = .2 × 0 −9 ). We also confirmed prior associations near SOX17 (8q.23-q2.; OR = .28, P = .3 × 0 −2 ) and CDKN2A-CDKN2B (9p2.3; OR = .3, P = .5 × 0 −22 ). It is noteworthy that several putative risk genes play a role in cell-cycle progression, potentially affecting the proliferation and senescence of progenitor-cell populations that are responsible for vascular formation and repair.