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Cummock JS, Wong KK, Volpi JJ, Wong ST. Reliability of the National Institutes of Health (NIH) Stroke Scale Between Emergency Room and Neurology Physicians for Initial Stroke Severity Scoring. Cureus 2023; 15:e37595. [PMID: 37197099 PMCID: PMC10183481 DOI: 10.7759/cureus.37595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2023] [Indexed: 05/19/2023] Open
Abstract
INTRODUCTION In patients with acute ischemic stroke (AIS), the National Institutes of Health Stroke Scale (NIHSS) is essential to establishing a patient's initial stroke severity. While previous research has validated NIHSS scoring reliability between neurologists and other clinicians, it has not specifically evaluated NIHSS scoring reliability between emergency room (ER) and neurology physicians within the same clinical scenario and timeframe in a large cohort of patients. This study specifically addresses the key question: does an ER physician's NIHSS score agree with the neurologist's NIHSS score in the same patient at the same time in a real-world context? METHODS Data was retrospectively collected from 1,946 patients being evaluated for AIS at Houston Methodist Hospital from 05/2016 - 04/2018. Triage NIHSS scores assessed by both the ER and neurology providers within one hour of each other under the same clinical context were evaluated for comparison. Ultimately, 129 patients were included in the analysis. All providers in this study were NIHSS rater-certified. RESULTS The distribution of the NIHSS score differences (ER score - neurology score) had a mean of -0.46 and a standard deviation of 2.11. The score difference between provider teams ranged ±5 points. The intraclass correlation coefficient (ICC) for the NIHSS scores between the ER and neurology teams was 0.95 (95% CI, 0.93 - 0.97) with an F-test of 42.41 and a p-value of 4.43E-69. Overall reliability was excellent between the ER and neurology teams. CONCLUSION We evaluated triage NIHSS scores performed by ER and neurology providers under matching time and treatment conditions and found excellent interrater reliability. The excellent score agreement has important implications for treatment decision-making during patient handoff and further in stroke modeling, prediction, and clinical trial registries where missing NIHSS scores may be equivalently substituted from either provider team.
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Affiliation(s)
- Jonathon S Cummock
- Systems Medicine and Bioengineering, Houston Methodist Hospital, Houston, USA
- Department of Translational Medical Sciences, Texas A&M University School of Medicine, Bryan, USA
| | - Kelvin K Wong
- Systems Medicine and Bioengineering, Houston Methodist Hospital, Houston, USA
- Department of Radiology, Weill Cornell Medicine, Houston, USA
- The Ting Tsung and Wei Fong Chao Center for BRAIN, Houston Methodist Hospital, Houston, USA
- Department of Radiology, Houston Methodist Academic Institute, Houston, USA
| | - John J Volpi
- Department of Neurology, Houston Methodist Neurological Institute, Houston, USA
| | - Stephen T Wong
- Systems Medicine and Bioengineering, Houston Methodist Hospital, Houston, USA
- Department of Radiology, Weill Cornell Medicine, Houston, USA
- The Ting Tsung and Wei Fong Chao Center for BRAIN, Houston Methodist Hospital, Houston, USA
- Department of Radiology, Houston Methodist Academic Institute, Houston, USA
- Department of Neuroscience and Experimental Therapeutics, Texas A&M University School of Medicine, Bryan, USA
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Muacevic A, Adler JR, Sirala Jagadesh N. Functional Ability and Health Problems of Stroke Survivors: An Explorative Study. Cureus 2023; 15:e33375. [PMID: 36751244 PMCID: PMC9898797 DOI: 10.7759/cureus.33375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2022] [Indexed: 01/06/2023] Open
Abstract
Background A stroke is an emergency medical condition that needs to be treated promptly. Patients who suffer from stroke frequently experience varying degrees of impairment, necessitating emergency hospital treatment and prolonged home care. It can lower the quality of life which leads to social isolation and makes it harder to function independently. The purpose of this research was to assess the health issues and functional capacity of individuals living with stroke. Methodology An exploratory study was conducted in the neurological outpatient department of tertiary care hospitals in Chennai. A total of 30 post-stroke participants were selected using a convenient sampling technique. Data were collected by structured interviews using the Post-Stroke Checklist and Barthel Index. The data were analyzed through descriptive and inferential statistics. Results The majority of the patients were (86.7%) men in the age group of 55-65 years. Regarding the health problems identified with the Post-Stroke Checklist, the activities of daily living (80%) were the most common, and spasticity (48%) and pain (34%) were the least common. However, 60% of the participants had new problems related to vision, 66% had problems with hearing, 76% had problems with getting around inside or outside, and 60% had a history of a recent fall. Further, 52% had problems with remembering and concentrating on things, 72% had problems sleeping, and 45% were worried about their relationship with their spouse after the stroke. The median Barthel Index score was 43.5. Conclusions More than half of all stroke survivors were dependent on others for everyday activities. We recommend that a well-designed and focused assessment is needed to identify the functional ability and stroke-related health problems among individuals by all healthcare professionals for the successful rehabilitation of stroke survivors.
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Scott SH, Lowrey CR, Brown IE, Dukelow SP. Assessment of Neurological Impairment and Recovery Using Statistical Models of Neurologically Healthy Behavior. Neurorehabil Neural Repair 2022:15459683221115413. [PMID: 35932111 DOI: 10.1177/15459683221115413] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
While many areas of medicine have benefited from the development of objective assessment tools and biomarkers, there have been comparatively few improvements in techniques used to assess brain function and dysfunction. Brain functions such as perception, cognition, and motor control are commonly measured using criteria-based, ordinal scales which can be coarse, have floor/ceiling effects, and often lack the precision to detect change. There is growing recognition that kinematic and kinetic-based measures are needed to quantify impairments following neurological injury such as stroke, in particular for clinical research and clinical trials. This paper will first consider the challenges with using criteria-based ordinal scales to quantify impairment and recovery. We then describe how kinematic-based measures can overcome many of these challenges and highlight a statistical approach to quantify kinematic measures of behavior based on performance of neurologically healthy individuals. We illustrate this approach with a visually-guided reaching task to highlight measures of impairment for individuals following stroke. Finally, there has been considerable controversy about the calculation of motor recovery following stroke. Here, we highlight how our statistical-based approach can provide an effective estimate of impairment and recovery.
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Affiliation(s)
- Stephen H Scott
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.,Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Catherine R Lowrey
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Ian E Brown
- Kinarm, BKIN Technologies Ltd. Kingston, ON, Canada
| | - Sean P Dukelow
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Mihandoust S, Joseph A, Madathil KC, Rogers H, Jafarifiroozabadi R, Ahmadshahi S, Holmstedt C, McElligott J. Comparing Sources of Disruptions to Telemedicine-Enabled Stroke Care in an Ambulance. HERD 2021; 15:96-115. [PMID: 34763545 PMCID: PMC10398637 DOI: 10.1177/19375867211054759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this study is to understand the nature and source of disruptions in an ambulance during the telemedicine-based caregiving process for stroke patients to enhance the ambulance design for supporting telemedicine-based care. BACKGROUND Telemedicine is emerging as an efficient approach to provide timely remote assessment of patients experiencing acute stroke in an ambulance. These consults are facilitated by connecting the patient and paramedic with a remotely located neurologist and nurse using cameras, audio systems, and computers. However, ambulances are typically retrofitted to support telemedicine-enabled care, and the placement of these systems inside the ambulance might lead to spatial challenges and disruptions during patient evaluation. METHOD Video recordings of 13 simulated telemedicine-based stroke consults were coded and analyzed using an existing systems-based flow disruption (FD) taxonomy. For each observed disruption-the type, severity or impact, location in the ambulance, and equipment involved in the disruption were recorded. RESULTS Seat size, arrangement of assessment equipment, location of telemedicine equipment (computer workstation), and design of telemedicine camera were among the factors that impacted telemedicine-related disruptions. The left ambulance seat zone and head of the patient bed were more involved in environmental hazard-related disruptions, while the right zone of the ambulance was more prone to interruptions and communication-related disruptions. CONCLUSION Adequate evaluation space for the paramedic, proper placement of evaluation equipment, and telemedicine computer location could facilitate the stroke care evaluation process and reduce FDs in the ambulance.
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Affiliation(s)
- Sahar Mihandoust
- Center for Health Facilities, Design and Testing, Clemson University, SC, USA
| | - Anjali Joseph
- Center for Health Facilities, Design and Testing, Clemson University, SC, USA
| | | | - Hunter Rogers
- Air Force Research Laboratory, Wright-Patterson Air Force Base, Dayton, OH, USA
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Wiśniewski A, Filipska K, Piec K, Jaskólski F, Ślusarz R. Introducing Adam's Scale of Posterior Stroke (ASPOS): A Novel Validated Tool to Assess and Predict Posterior Circulation Strokes. Brain Sci 2021; 11:424. [PMID: 33810516 DOI: 10.3390/brainsci11040424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/15/2021] [Accepted: 03/24/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Assessing the severity of posterior circulation strokes, due to the variety of symptoms, is a significant clinical problem. Current clinimetric scales show lower accuracy in the measurement of posterior stroke severity, compared with that of anterior strokes. The aim of the study was to design a validated tool, termed Adam's Scale of Posterior Stroke (ASPOS), for better assessment and prediction of posterior stroke. METHODS This prospective, observational study involved 126 posterior circulation ischemic stroke subjects. Four researchers, previously trained in ASPOS, randomized the stroke severity using a novel tool and other appropriate stroke scales (The National Institute of Health Stroke Scale-NIHSS, modified Rankin Scale-mRS, Glasgow Coma Scale, Barthel Index, or Israeli Vertebrobasilar Stroke Scale-IVBSS) to assess the psychometric properties, reliability, and validity of ASPOS and investigate its predictive value. RESULTS ASPOS reached a Cronbach's alpha coefficient of 0.7449, indicating good internal consistency. The Bland-Altman analysis showed a good coefficient of repeatability (CR) of 0.46, a 95% confidence interval (CI) of 0.41-0.53, and excellent intraclass correlation coefficients or weighted kappa values (>0.90), reflecting high reliability and reproducibility. Highly significant correlations with other scales confirmed the construct and predictive validity of ASPOS. A total ASPOS score of three points indicated a significantly increased probability of severe stroke based on the NIHSS, compared to a total ASPOS of 1-2 points (odds ratio (OR) 141; 95% CI: 6.72-2977.66; p = 0.0014). CONCLUSIONS We developed a novel, valid, and reliable tool to assess posterior circulation strokes. This can contribute to a more comprehensive estimation of posterior stroke and, additionally, due to its predictive properties, it can be used to more accurately select candidates for specific treatments.
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Duarte E, Messaggi-Sartor M, Grau-Sánchez J, Ramírez-Fuentes C, Neira N, Guillén-Solà A, Sánchez-Rodríguez D, Duran X, Boza R, Marco E. Cerebral infarct site and affected vascular territory as factors in breathing weakness in patients with subacute stroke. J Rehabil Med 2020; 52:jrm00116. [PMID: 33043382 DOI: 10.2340/16501977-2751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE A better understanding of factors influencing breathing weakness in stroke survivors would help in planning rehabilitation therapies. The main objective of this study was to determine whether the location of cerebral infarct is associated with breathing weakness in patients with subacute stroke. DESIGN Cross-sectional analysis of a prospective cohort. PATIENTS Consecutive patients admitted to a neurology rehabilitation unit with first-time ischaemic stroke (n?=?170). METHODS Breathing weakness was defined as >?70% reduction in maximal inspiratory and expiratory pressures (PImax and PEmax, respectively) compared with reference values. Computed tomography and magnetic resonance imaging were used to locate stroke lesions, which were classified as cortical, subcortical, cortico-subcortical, brainstem, or cerebellum. The affected cerebrovascular territory was identified to classify stroke subtype. The association between maximal respiratory pressure and affected brain area was studied using median regression analysis. RESULTS Breathing weakness was detected in 151 (88.8%) patients. Those with cortical and cortico-subcortical stroke location had the lowest PImax and PEmax values (median 33 cmH2O). This value differed significantly from maximal respiratory pressures of patients with strokes located in the brainstem and the cerebellum, with PImax median differences (?) of 16 cmH2O (95% confidence interval (95% CI) 4.127.9) and 27 cmH2O (95% CI 7.846.2), respectively, and PEmax median differences of 27 cmH2O (95% CI 11.442.7) and 49 cmH2O (95% CI 23.774.3), respectively, both of which remained significant after adjustments. CONCLUSION The prevalence of breathing weakness was very high in stroke patients admitted to a neurorehabilitation ward, being more severe in cortical or cortico-subcortical stroke.
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Affiliation(s)
- Esther Duarte
- Physical Medicine and Rehabilitation Dpt. Rehabilitation Research Group., Parc de Salut Mar (Hospital del Mar - Hospital de l'Esperança). Rehabilitation Research Group, Hospital del Mar Medical Research Institute (IMIM). Universitat Autònoma de Barcelona, Barcelona, Spain
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Friedman N, Chan V, Reinkensmeyer AN, Beroukhim A, Zambrano GJ, Bachman M, Reinkensmeyer DJ. Retraining and assessing hand movement after stroke using the MusicGlove: comparison with conventional hand therapy and isometric grip training. J Neuroeng Rehabil 2014; 11:76. [PMID: 24885076 PMCID: PMC4022276 DOI: 10.1186/1743-0003-11-76] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Accepted: 03/17/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND It is thought that therapy should be functional, be highly repetitive, and promote afferent input to best stimulate hand motor recovery after stroke, yet patients struggle to access such therapy. We developed the MusicGlove, an instrumented glove that requires the user to practice gripping-like movements and thumb-finger opposition to play a highly engaging, music-based, video game. The purpose of this study was to 1) compare the effect of training with MusicGlove to conventional hand therapy 2) determine if MusicGlove training was more effective than a matched form of isometric hand movement training; and 3) determine if MusicGlove game scores predict clinical outcomes. METHODS 12 chronic stroke survivors with moderate hemiparesis were randomly assigned to receive MusicGlove, isometric, and conventional hand therapy in a within-subjects design. Each subject participated in six one-hour treatment sessions three times per week for two weeks, for each training type, for a total of 18 treatment sessions. A blinded rater assessed hand impairment before and after each training type and at one-month follow-up including the Box and Blocks (B & B) test as the primary outcome measure. Subjects also completed the Intrinsic Motivation Inventory (IMI). RESULTS Subjects improved hand function related to grasping small objects more after MusicGlove compared to conventional training, as measured by the B & B score (improvement of 3.21±3.82 vs. -0.29±2.27 blocks; P=0.010) and the 9 Hole Peg test (improvement of 2.14±2.98 vs. -0.85±1.29 pegs/minute; P=0.005). There was no significant difference between training types in the broader assessment batteries of hand function. Subjects benefited less from isometric therapy than MusicGlove training, but the difference was not significant (P>0.09). Subjects sustained improvements in hand function at a one month follow-up, and found the MusicGlove more motivating than the other two therapies, as measured by the IMI. MusicGlove games scores correlated strongly with the B & B score. CONCLUSIONS These results support the hypothesis that hand therapy that is engaging, incorporates high numbers of repetitions of gripping and thumb-finger opposition movements, and promotes afferent input is a promising approach to improving an individual's ability to manipulate small objects. The MusicGlove provides a simple way to access such therapy.
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Affiliation(s)
- Nizan Friedman
- Department of Biomedical Engineering, University of California, Irvine, USA
| | - Vicky Chan
- Rehabilitation Services, Irvine Medical Center, Irvine, USA
| | | | - Ariel Beroukhim
- Department of Biomedical Engineering, University of California, Irvine, USA
| | - Gregory J Zambrano
- Department of Mechanical and Aerospace Engineering, University of California, Irvine, USA
| | - Mark Bachman
- Department of Biomedical Engineering, University of California, Irvine, USA
- Department of Electrical Engineering and Computer Science, University of California, Irvine, USA
| | - David J Reinkensmeyer
- Department of Biomedical Engineering, University of California, Irvine, USA
- Department of Mechanical and Aerospace Engineering, University of California, Irvine, USA
- Department of Anatomy and Neurobiology, University of California, Irvine, USA
- Department of Physical Medicine and Rehabilitation, University of California, Irvine, USA
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Chan L, Sandel ME, Jette AM, Appelman J, Brandt DE, Cheng P, Teselle M, Delmonico R, Terdiman JF, Rasch EK. Does postacute care site matter? A longitudinal study assessing functional recovery after a stroke. Arch Phys Med Rehabil 2013; 94:622-9. [PMID: 23124133 PMCID: PMC3584186 DOI: 10.1016/j.apmr.2012.09.033] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 09/12/2012] [Accepted: 09/30/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To determine the impact of postacute care site on stroke outcomes. DESIGN Prospective cohort study. SETTING Four northern California hospitals that are part of a single health maintenance organization. PARTICIPANTS Patients with stroke (N=222) enrolled between February 2008 and July 2010. INTERVENTION Not applicable. MAIN OUTCOME MEASURE Baseline and 6-month assessments were performed using the Activity Measure for Post Acute Care (AM-PAC), a test of self-reported function in 3 domains: Basic Mobility, Daily Activities, and Applied Cognition. RESULTS Of the 222 patients analyzed, 36% went home with no treatment, 22% received home health/outpatient care, 30% included an inpatient rehabilitation facility (IRF) in their care trajectory, and 13% included a skilled nursing facility (but not IRF) in their care trajectory. At 6 months, after controlling for important variables such as age, functional status at acute care discharge, and total hours of rehabilitation, patients who went to an IRF had functional scores that were at least 8 points higher (twice the minimally detectable change for the AM-PAC) than those who went to a skilled nursing facility in all 3 domains and in 2 of 3 functional domains compared with those who received home health/outpatient care. CONCLUSIONS Patients with stroke may make more functional gains if their postacute care includes an IRF. This finding may have important implications as postacute care delivery is reshaped through health care reform.
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Affiliation(s)
- Leighton Chan
- National Institutes of Health, Mark O. Hatfield Clinical Research Center, Rehabilitation Medicine Department, Bethesda, MD 20892, USA.
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