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Singh A, Bonnell G, De Prey J, Buchwald N, Eskander K, Kincaid KJ, Wilson CA. Small-vessel disease in the brain. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2023; 27:100277. [PMID: 38511094 PMCID: PMC10945899 DOI: 10.1016/j.ahjo.2023.100277] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 03/22/2024]
Abstract
Cerebral small-vessels are generally located in the brain at branch points from major cerebral blood vessels and perfuse subcortical structures such as the white matter tracts, basal ganglia, thalamus, and pons. Cerebral small-vessel disease (CSVD) can lead to several different clinical manifestations including ischemic lacunar stroke, intracerebral hemorrhage, and vascular dementia. Risk factors for CSVD overlap with conventional vascular risk factors including hypertension, diabetes mellitus, and hypercholesterolemia, as well as genetic causes. As in cardiovascular disease, treatment of CSVD involves both primary and secondary prevention. Aspirin has not been established as a primary prevention strategy for CSVD among the general population; however, long-term antiplatelet therapy with aspirin alone continues to be the mainstay of secondary stroke prevention for non-cardioembolic ischemic stroke and high-risk TIA.
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Affiliation(s)
- Amita Singh
- Department of Neurology, University of Florida, Gainesville, FL, United States of America
| | - Gabriel Bonnell
- Department of Neurology, University of Florida, Gainesville, FL, United States of America
| | - Justin De Prey
- Department of Neurology, University of Florida, Gainesville, FL, United States of America
| | - Natalie Buchwald
- Department of Neurology, University of Florida, Gainesville, FL, United States of America
| | - Kyrillos Eskander
- Department of Neurology, University of Florida, Gainesville, FL, United States of America
| | - Keith J. Kincaid
- Department of Neurology, University of Florida, Gainesville, FL, United States of America
| | - Christina A. Wilson
- Department of Neurology, University of Florida, Gainesville, FL, United States of America
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Lee H, Heo J, Lee IH, Kim YD, Nam HS. Association between blood viscosity and early neurological deterioration in lacunar infarction. Front Neurol 2022; 13:979073. [PMID: 36203995 PMCID: PMC9530465 DOI: 10.3389/fneur.2022.979073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background Understanding the factors related to early neurologic deterioration (END) is crucial in the management of patients with lacunar infarction. Blood viscosity is a significant factor for microvascular perfusion. We investigated the association between blood viscosity and occurrence of END in lacunar infarction. Methods We included consecutive patients admitted for lacunar infarction within 72 h from symptoms onset. END was defined as an increase in the National Institute of Health Stroke Scale (NIHSS) score ≥2 within 24 h of admission. Viscosity was measured within 24 h of hospitalization with a scanning capillary tube viscometer. Viscosity measured at a shear rate of 300 s−1 was defined as systolic blood viscosity (SBV), whereas that measured at a shear rate of 5 s−1 as diastolic blood viscosity (DBV). Results Of the 178 patients included (median age, 65.5; interquartile range [IQR], 56.0, 76.0], END occurred in 33 (18.5%). DBV was significantly higher in patients with END than those without END (13.3 mPa·s [IQR 11.8, 16.0] vs. 12.3 mPa·s [IQR11.0, 13.5]; P = 0.023). In the multivariate analysis, DBV was independently associated with the occurrence of END (odds ratio 1.17; 95% confidence interval 1.01–1.36; P = 0.043). Subgroup analysis showed no heterogeneity in the effect of viscosity on the occurrence of END. Conclusions Blood viscosity at a low shear rate (DBV) was associated with the occurrence of END in patients with lacunar infarction. Blood rheology may be important in pathophysiology of END in patients with lacunar infarction.
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Affiliation(s)
- Hyungwoo Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - JoonNyung Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Il Hyung Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, South Korea
- *Correspondence: Hyo Suk Nam
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Moving from traditional to more advanced treatments in stroke care is cost-effective: A case study from Greece. J Stroke Cerebrovasc Dis 2022; 31:106764. [PMID: 36095859 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 09/04/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Stroke is the most common cause of disability in high-income countries. Several countries offer a limited range of advanced treatments with implications for outcomes, disability and costs. This study estimates the burden of disability that could have been avoided through the transition from traditional (no intravenous thrombolytic therapy (IVT), or endovascular thrombectomy (EVT)) to modern stroke treatments (treatment in stroke units, IVT and EVT). We perform a cost-effectiveness analysis comparing best practice with traditional stroke care, using Greece as a case study. MATERIALS AND METHODS A Markov model was used to calculate costs and Quality Adjusted Life Years (QALYs) for each treatment strategy, using a lifetime horizon. Data for model inputs were derived from meta-analyses of trials, and national and international cost databases. Sensitivity analyses were also performed to address potential uncertainty and test the robustness of the findings. RESULTS Incremental effectiveness comprised 0.22 QALYs per patient and year. Best practice was cost-effective for more than 90% of all iterations (ICER for the baseline scenario: €2,109.25/QALY). Sensitivity analysis demonstrated that the findings remain robust. Considering the stroke incidence in Greece, the annual additional cost to implement best practice was calculated to be between 0.07%-0.15% of the total health expenditure. CONCLUSION Best practice stroke treatment was cost-effective and affordable in a case study based on Greece. The results could be leveraged by including effects of preventive policies and rehabilitation. They also highlight the importance of adopting modern treatment strategies from a cost-effectiveness perspective, apart from the improved clinical outcomes.
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Xingnao Kaiqiao Acupuncture Method Combined with Temporal Three-Needle in the Treatment of Acute Ischemic Stroke: A Randomized Controlled Trial. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:8145374. [PMID: 35814561 PMCID: PMC9259275 DOI: 10.1155/2022/8145374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/01/2022] [Accepted: 06/06/2022] [Indexed: 11/17/2022]
Abstract
Objective. The objective of this study was to investigate the difference between the clinical effectiveness of two acupuncture methods in the treatment of acute ischemic stroke (AIS) and provide more evidence-based medical evidence of acupuncture’s effectiveness in stroke rehabilitation. Methods. We conducted an outcome assessor-and data analyst-blinded, randomized, and controlled trial. Seventy-two participants were randomly allocated to the observation group and control group with a 1 : 1 allocation ratio by the generating of a random number table.The observation group received the “Xingnao kaiqiao” acupuncture method combined with “Temporal three needles,” and the control group received conventional acupuncture “Scalp acupuncture” combined with the traditional “body acupuncture” method. The acupuncture treatment was performed once per day for one week by trained acupuncturists. Both groups underwent secondary prevention of cerebral infarction and received a 3-months’ followup. After a 1-week acupuncture intervention, the changes of NIHSS (National Institutes of Health Stroke Scale) scores, Percent Change and Absolute Change of NIHSS scores, MBI (Modified Barthel Index), and the rate of MBI ≥ 80 in two groups were observed. After 3 months’ followup, the mRS (Modified Ranking Scale) and the clinical efficacy of the two groups were compared. Results. The apparent efficiency rate of the observation group was 63.9%, higher than 19.4% of the control group, and the difference was significant (
). After treatment, NIHSS scores, Percent Change, and Absolute Change of NIHSS scores in the observation group had a significant reduction than the control group (all
). MBI in the observation group increased significantly more than in the control group (
), but the rate of MBI ≥ 80 in the two groups was not significantly different (
). After 3 months’ of followup, the mRS score frequencies of the observation group were not statistically different from the control group (
). The rate of mRS scores of 0–1 in the observation and control group were 55.6% and 38.9%, and there was no significant difference either (
). Conclusion. Compared with “Scalp acupuncture” combined with “body acupuncture,” “Xingnao kaiqiao” acupuncture method combined with “Temporal three-needle” had superiority in the improvement of neurological deficit, potential functional disability, and score of basic activities of daily living. As to the independent rate to basic activities of daily living and good prognosis of 3 months, there were no statistical differences.
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Ballester BR, Ward NS, Brander F, Maier M, Kelly K, Verschure PFMJ. Relationship between intensity and recovery in post-stroke rehabilitation: a retrospective analysis. J Neurol Neurosurg Psychiatry 2022; 93:226-228. [PMID: 34168083 PMCID: PMC8784991 DOI: 10.1136/jnnp-2021-326948] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/14/2021] [Indexed: 12/22/2022]
Affiliation(s)
- Belén Rubio Ballester
- Synthetic, Perceptive, Emotive and Cognitive Systems Laboratory, Institute for Bioengineering in Catalonia, Barcelona, Catalunya, Spain
| | - Nick S Ward
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK.,National Hospital for Neurology and Neurosurgery, London, UK
| | - Fran Brander
- National Hospital for Neurology and Neurosurgery, London, UK
| | - Martina Maier
- Synthetic, Perceptive, Emotive and Cognitive Systems Laboratory, Institute for Bioengineering in Catalonia, Barcelona, Catalunya, Spain
| | - Kate Kelly
- Therapy and Rehabilitation, National Hospital for Neurology and Neurosurgery, London, UK
| | - Paul F M J Verschure
- Synthetic, Perceptive, Emotive and Cognitive Systems Laboratory, Institute for Bioengineering in Catalonia, Barcelona, Catalunya, Spain .,Institucio Catalana de Recerca i Estudis Avancats, Barcelona, Catalunya, Spain
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Ganesh A, Ospel JM, Marko M, van Zwam WH, Roos YBWEM, Majoie CBLM, Goyal M. From Three-Months to Five-Years: Sustaining Long-Term Benefits of Endovascular Therapy for Ischemic Stroke. Front Neurol 2021; 12:713738. [PMID: 34381418 PMCID: PMC8350336 DOI: 10.3389/fneur.2021.713738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/28/2021] [Indexed: 11/28/2022] Open
Abstract
Background and Purpose: During the months and years post-stroke, treatment benefits from endovascular therapy (EVT) may be magnified by disability-related differences in morbidity/mortality or may be eroded by recurrent strokes and non-stroke-related disability/mortality. Understanding the extent to which EVT benefits may be sustained at 5 years, and the factors influencing this outcome, may help us better promote the sustenance of EVT benefits until 5 years post-stroke and beyond. Methods: In this review, undertaken 5 years after EVT became the standard of care, we searched PubMed and EMBASE to examine the current state of the literature on 5-year post-stroke outcomes, with particular attention to modifiable factors that influence outcomes between 3 months and 5 years post-EVT. Results: Prospective cohorts and follow-up data from EVT trials indicate that 3-month EVT benefits will likely translate into lower 5-year disability, mortality, institutionalization, and care costs and higher quality of life. However, these group-level data by no means guarantee maintenance of 3-month benefits for individual patients. We identify factors and associated “action items” for stroke teams/systems at three specific levels (medical care, individual psychosocioeconomic, and larger societal/environmental levels) that influence the long-term EVT outcome of a patient. Medical action items include optimizing stroke rehabilitation, clinical follow-up, secondary stroke prevention, infection prevention/control, and post-stroke depression care. Psychosocioeconomic aspects include addressing access to primary care, specialist clinics, and rehabilitation; affordability of healthy lifestyle choices and preventative therapies; and optimization of family/social support and return-to-work options. High-level societal efforts include improving accessibility of public/private spaces and transportation, empowering/engaging persons with disability in society, and investing in treatments/technologies to mitigate consequences of post-stroke disability. Conclusions: In the longtime horizon from 3 months to 5 years, several factors in the medical and societal spheres could negate EVT benefits. However, many factors can be leveraged to preserve or magnify treatment benefits, with opportunities to share responsibility with widening circles of care around the patient.
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Affiliation(s)
- Aravind Ganesh
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | | | - Martha Marko
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Wim H van Zwam
- Department of Radiology, Maastricht University Medical Centre, Maastricht, Netherlands
| | | | | | - Mayank Goyal
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Department of Radiology, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
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Walford I, Rondina JM, Ward N. Patient-specific prediction of long-term outcomes will change stroke rehabilitation for the better. J Neurol Neurosurg Psychiatry 2021; 92:jnnp-2020-325981. [PMID: 33789925 DOI: 10.1136/jnnp-2020-325981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 11/04/2022]
Affiliation(s)
- India Walford
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - Jane Maryam Rondina
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
| | - Nick Ward
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
- Department of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
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8
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Ganesh A, Luengo-Fernandez R, Rothwell PM. Late functional improvement and 5-year poststroke outcomes: a population-based cohort study. J Neurol Neurosurg Psychiatry 2020; 91:831-839. [PMID: 32576613 PMCID: PMC7402458 DOI: 10.1136/jnnp-2019-322365] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 03/24/2020] [Accepted: 05/27/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Late functional improvement between 3 and 12 months poststroke occurs in about one in four patients with ischaemic stroke, more commonly in lacunar strokes. It is unknown whether this late improvement is associated with better long-term clinical or health economic outcomes. METHODS In a prospective, population-based cohort of 1-year ischaemic stroke survivors (Oxford Vascular Study; 2002-2014), we examined changes in functional status (modified Rankin Scale (mRS), Rivermead Mobility Index (RMI), Barthel Index (BI)) from 3 to 12 months poststroke. We used Cox regressions adjusted for age, sex, 3-month disability and stroke subtype (lacunar vs non-lacunar) to examine the association of late improvement (by ≥1 mRS grades, ≥1 RMI points and/or ≥2 BI points between 3 and 12 months) with 5-year mortality and institutionalisation. We used similarly adjusted generalised linear models to examine association with 5-year healthcare/social-care costs. RESULTS Among 1288 one-year survivors, 1135 (88.1%) had 3-month mRS >0, of whom 319 (28.1%) demonstrated late functional improvement between 3 and 12 months poststroke. Late improvers had lower 5-year mortality (aHR per mRS=0.68, 95% CI 0.51 to 0.91, p=0.009), institutionalisation (aHR 0.48, 0.33 to 0.72, p<0.001) and healthcare/social care costs (margin US$17 524, -24 763 to -10 284, p<0.001). These associations remained on excluding patients with recurrent strokes during follow-up (eg, 5-year mortality/institutionalisation: aHR 0.59, 0.44 to 0.79, p<0.001) and on examining late improvement per RMI and/or BI (eg, 5-year mortality/institutionalisation with RMI/BI: aHR 0.73, 0.58 to 0.92, p=0.008). CONCLUSION Late functional improvement poststroke is associated with lower 5-year mortality, institutionalisation rates and healthcare/social care costs. These findings should motivate patients and clinicians to maximise late recovery in routine practice, and to consider extending access to proven rehabilitative therapies during the first year poststroke.
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Affiliation(s)
- Aravind Ganesh
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Ramon Luengo-Fernandez
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Peter Malcolm Rothwell
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Hammer A, Ranaie G, Yakubov E, Erbguth F, Holtmannspoetter M, Steiner HH, Janssen H. Dynamics of outcome after aneurysmal subarachnoid hemorrhage. Aging (Albany NY) 2020; 12:7207-7217. [PMID: 32312942 PMCID: PMC7202490 DOI: 10.18632/aging.103069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 03/29/2020] [Indexed: 02/07/2023]
Abstract
In this observational study, we analyzed and described the dynamics of the outcome after aneurysmal subarachnoid hemorrhage (SAH) in a collective of 203 cases. We detected a significant improvement of the mean aggregate modified Rankin Score (mRS) in every time interval from discharge to 6 months and up to 1 year. Every forth to fifth patient with potential of recovery (mRS 1-5) at discharge improved by 1 mRS point in the time interval from 6 month to 1 year (22.6%). Patients with mRS 3 at discharge had a remarkable late recovery rate (73.3%, p = 0.000085). Multivariate analysis revealed age ≤ 65 years (odds ratio 4.93; p = 0.0045) and "World Federation of Neurological Surgeons" (WFNS) grades I and II (odds ratio 4.77; p = 0.0077) as significant predictors of early improvement (discharge to 6 months). Absence of a shunting procedure (odds ratio 8.32; p = 0.0049) was a significant predictor of late improvement (6 months to 1 year), but not age ≤ 65 years (p = 0.54) and WFNS grades I and II (p = 0.92). Thus, late recovery (6 month to 1 year) is significant and independent from age and WFNS grade.
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Affiliation(s)
- Alexander Hammer
- Department of Neurosurgery, Paracelsus Medical University, Nuremberg 90471, Bavaria, Germany
| | - Gholamreza Ranaie
- Department of Neurosurgery, Paracelsus Medical University, Nuremberg 90471, Bavaria, Germany
| | - Eduard Yakubov
- Department of Neurosurgery, Paracelsus Medical University, Nuremberg 90471, Bavaria, Germany
| | - Frank Erbguth
- Department of Neurology, Paracelsus Medical University, Nuremberg 90471, Bavaria, Germany
| | | | - Hans-Herbert Steiner
- Department of Neurosurgery, Paracelsus Medical University, Nuremberg 90471, Bavaria, Germany
| | - Hendrik Janssen
- Department of Neuroradiology, Ingolstadt General Hospital, Ingolstadt 85049, Bavaria, Germany
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Ward NS, Brander F, Kelly K. Intensive upper limb neurorehabilitation in chronic stroke: outcomes from the Queen Square programme. J Neurol Neurosurg Psychiatry 2019; 90:498-506. [PMID: 30770457 DOI: 10.1136/jnnp-2018-319954] [Citation(s) in RCA: 167] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/21/2019] [Accepted: 01/28/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Persistent difficulty in using the upper limb remains a major contributor to physical disability post-stroke. There is a nihilistic view about what clinically relevant changes are possible after the early post-stroke phase. The Queen Square Upper Limb Neurorehabilitation programme delivers high-quality, high-dose, high-intensity upper limb neurorehabilitation during a 3-week (90 hours) programme. Here, we report clinical changes made by the chronic stroke patients treated on the programme, factors that might predict responsiveness to therapy and the relationship between changes in impairment and activity. METHODS Upper limb impairment and activity were assessed on admission, discharge, 6 weeks and 6 months after treatment, with modified upper limb Fugl-Meyer (FM-UL, max-54), Action Research Arm Test (ARAT, max-57) and Chedoke Arm and Hand Activity Inventory (CAHAI, max-91). Patient-reported outcome measures were recorded with the Arm Activity Measure (ArmA) parts A (0-32) and B (0-52), where lower scores are better. RESULTS 224 patients (median time post-stroke 18 months) completed the 6-month programme. Median scores on admission were as follows: FM-UL = 26 (IQR 16-37), ARAT=18 (IQR 7-33), CAHAI=40 (28-55), ArmA-A=8 (IQR 4.5-12) and ArmA-B=38 (IQR 24-46). The median scores 6 months after the programme were as follows: FM-UL=37 (IQR 24-48), ARAT=27 (IQR 12-45), CAHAI=52 (IQR 35-77), ArmA-A=3 (IQR 1-6.5) and ArmA-B=19 (IQR 8.5-32). We found no predictors of treatment response beyond admission scores. CONCLUSION With intensive upper limb rehabilitation, chronic stroke patients can change by clinically important differences in measures of impairment and activity. Crucially, clinical gains continued during the 6-month follow-up period.
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Affiliation(s)
- Nick S Ward
- Department of Clinical and Motor Neuroscience, UCL Institute of Neurology, London, UK .,The National Hospital for Neurology and Neurosurgery, London, UK.,UCLP Centre for Neurorehabilitation, London, UK
| | - Fran Brander
- The National Hospital for Neurology and Neurosurgery, London, UK.,UCLP Centre for Neurorehabilitation, London, UK
| | - Kate Kelly
- The National Hospital for Neurology and Neurosurgery, London, UK.,UCLP Centre for Neurorehabilitation, London, UK
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Hayward KS, Lohse KR, Bernhardt J, Lang CE, Boyd LA. Characterising Arm Recovery in People with Severe Stroke (CARPSS): protocol for a 12-month observational study of clinical, neuroimaging and neurophysiological biomarkers. BMJ Open 2018; 8:e026435. [PMID: 30478130 PMCID: PMC6254492 DOI: 10.1136/bmjopen-2018-026435] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION In individuals with early (indexed ≤7 days poststroke) and severe upper limb paresis (shoulder abduction and finger extension score of <5 out of 10), our objectives are to: (1) determine if biomarkers of brain structure and function collected at <1 month poststroke explain who will experience clinically important recovery over the first 12 months poststroke; (2) compare stroke survivors' perceptions of personally meaningful recovery to clinically important recovery; and (3) characterise the trajectory of change in measures of motor function, brain structure and function. METHODS AND ANALYSIS Prospective observational study with an inception cohort of 78 first-time stroke survivors. Participants will be recruited from a single, large tertiary stroke referral centre. Clinical and biomarker assessments will be completed at four follow-up time points: 2 to 4 weeks and 3, 6 and 12 months poststroke. Our primary outcome is achievement of clinically important improvement on two out of three measures that span impairment (Fugl-Meyer Upper Limb, change ≥10 points), activity (Motor Assessment Scale item 6, change ≥1 point) and participation (Rating of Everyday Arm-use in the Community and Home, change ≥1 point). Brain biomarkers of structure and function will be indexed using transcranial magnetic stimulation and MRI. Multilevel modelling will be performed to examine the relationship between clinically important recovery achieved (yes/no) and a priori defined brain biomarkers related to the corticospinal tract and corpus callosum. Secondary analyses will compare stroke survivor's perception of recovery, as well as real-world arm use via accelerometry, to the proposed metric of clinically meaningful recovery; and model trajectory of recovery across clinical, a priori defined biomarkers and exploratory variables related to functional connectivity. ETHICS AND DISSEMINATION Approved by the hospital and university ethics review boards. Results will be disseminated through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER NCT02464085.
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Affiliation(s)
- Kathryn S Hayward
- Brain Behaviour Laboratory, Physical Therapy, University of British Columbia, Vancouver, BC, Canada
- AVERT Early Rehabilitation Research Group, Stroke Theme, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, Victoria, Australia
| | - Keith R Lohse
- Department of Health, Kinesiology, Recreation; Department of Physical Therapy and Athletic Training, University of Utah, Utah, Salt Lake City, USA
| | - Julie Bernhardt
- AVERT Early Rehabilitation Research Group, Stroke Theme, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, Victoria, Australia
| | - Catherine E Lang
- Physical Therapy, Occupational Therapy, and Neurology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Lara A Boyd
- Brain Behaviour Laboratory, Physical Therapy, University of British Columbia, Vancouver, BC, Canada
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