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Latest & greatest articles for stroke
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Stride management assist exoskeleton vs functional gait training in stroke: A randomized trial To test the hypothesis that gait training with a hip-assistive robotic exoskeleton improves clinical outcomes and strengthens the descending corticospinal drive to the lower limb muscles in persons with chronic stroke.Fifty participants completed the randomized, single-blind, parallel study. Participants received over-ground gait training with the Honda Stride Management Assist (SMA) exoskeleton (...) had greater improvement in walking endurance (46.0% ± 27.4% vs 35.7% ± 20.8%, p = 0.033), took more steps during therapy days (4,366 ± 2,426 vs 3,028 ± 1,510; p = 0.013), and demonstrated larger changes in CME of the paretic rectus femoris (178% ± 75% vs 33% ± 32%, p = 0.010). Participants with hemorrhagic stroke demonstrated greater improvement in balance when using the SMA (24.7% ± 20% vs 6.8% ± 6.7%, p = 0.029).Gait training with the SMA improved walking speed in persons with chronic stroke
-related ischemic stroke.We included 2229 participants from the ARIC study (Atherosclerosis Risk in Communities) and 700 participants from MESA (Multi-Ethnic Study of Atherosclerosis) with incident AF who were not on anticoagulants within 1 year of AF diagnosis. PWIs were obtained from study visit ECGs before development of AF. AF was ascertained using study visit ECGs and hospital records. Ischemicstroke cases were based on physician adjudication of hospital records. We used Cox proportional hazards (...) models to estimate hazard ratios and 95% CIs of PWIs for ischemicstroke. Improvement in 1-year stroke prediction was assessed by C-statistic, categorical net reclassification improvement, and relative integrated discrimination improvement.Abnormal P-wave axis was the only PWI associated with increased ischemicstroke risk (hazard ratio, 1.84; 95% CI, 1.33-2.55) independent of CHA2DS2-VASc variables, and that resulted in meaningful improvement in stroke prediction. The β estimate was approximately
. Physical Inactivity e99 5. Nutrition e119 6. Overweight and Obesity e138 Health Factors and Other Risk Factors 7. High Blood Cholesterol and Other Lipids e161 8. High Blood Pressure e174 9. Diabetes Mellitus e193 10. Metabolic Syndrome e212 11. Kidney Disease e233 12. Sleep e249 Cardiovascular Conditions/Diseases 13. Total Cardiovascular Diseases e257 14. Stroke (Cerebrovascular Disease) e281 15. Congenital Cardiovascular Defects and Kawasaki Disease e327 16. Disorders of Heart Rhythm e346 17. Sudden (...) (95% CI, 17.3–18.1 million) deaths were attributed to CVD globally, which amounted to an increase of 14.5% (95% CI, 12.1%–17.1%) from 2006. The age-adjusted death rate per 100 000 population was 277.9 (95% CI, 272.1–284.6), which represents a decrease of 14.5% (95% CI, −16.2% to −12.5%) from 2006. Stroke (Cerebrovascular Disease) (Chapter 14) An estimated 7.0 million Americans ≥20 years of age self-report having had a stroke, and the overall stroke prevalence was an estimated 2.5%. In the National
Effects of Electromechanical Exoskeleton-Assisted Gait Training on Walking Ability of Stroke Patients: A Randomized Controlled Trial To assess the efficacy of electromechanical exoskeleton-assisted gait training on walking ability of stroke patients based on ambulatory function, muscle strength, balance, gait speed, and capacity.Randomized controlled trial.University rehabilitation hospital.Individuals (N=40) with stroke who could stand alone.Patients were randomly assigned to control (...) significant in the experimental group alone. Most secondary outcomes in both groups also showed improvement after gait training. However, the differential outcomes were not varied between the 2 groups after adjusting the data for age and stroke duration. We did not exclude patients based on time since stroke onset. The average stroke duration was 530.11±389.21 days in the experimental group. The changes in FAC of the experimental group were negatively correlated with stroke duration. No adverse events
neurology center.Adult patients with acute middle cerebral artery territory ischemicstroke.60 patients were randomized into three groups of 20 each: TBS+PT; FES+PT; and PT alone. TBS group received intermittent TBS of ipsilesional hemisphere and continuous TBS of contralesional hemisphere while FES group received FES of paretic limb, both for four weeks. All groups received supervised physical therapy for four weeks followed by home physiotherapy for one year.Fugl Meyer Assessment upper limb score (FMA (...) The comparative efficacy of theta burst stimulation or functional electrical stimulation when combined with physical therapy after stroke: a randomized controlled trial To study the long-term effectiveness of Theta Burst Stimulation (TBS) or Functional Electrical Stimulation (FES) combined with Physical therapy (PT) as compared to PT alone for improving arm functions in patients with acute stroke.Single blind randomized controlled trial.Outpatient clinics and inpatient wards at tertiary care
Canagliflozin and Stroke in Type 2 Diabetes Mellitus Background and Purpose- This study reports the detailed effects of canagliflozin on stroke, stroke subtypes, and vascular outcomes in participants with and without cerebrovascular disease (stroke or transientischemicattack) at baseline from the CANVAS (Canagliflozin Cardiovascular Assessment Study) Program. Methods- The CANVAS Program, comprising 2 similarly designed and conducted clinical trials, randomly assigned 10 142 participants (...) with type 2 diabetes mellitus and high cardiovascular risk to canagliflozin or placebo. Its primary outcome was a composite of major adverse cardiovascular events. The main outcome of interest for this report was fatal or nonfatal stroke. Additional exploratory outcomes were stroke subtypes and other vascular outcomes defined according to standard criteria. Results- There were 1 958 (19%) participants with prior stroke or transientischemicattack at baseline. These individuals were older, more
Impact and sustainability of centralising acute stroke services in English metropolitan areas: retrospective analysis of hospital episode statistics and stroke national audit data. To investigate whether further centralisation of acute stroke services in Greater Manchester in 2015 was associated with changes in outcomes and whether the effects of centralisation of acute stroke services in London in 2010 were sustained.Retrospective analyses of patient level data from the Hospital Episode (...) Statistics (HES) database linked to mortality data from the Office for National Statistics, and the Sentinel Stroke National Audit Programme (SSNAP).Acute stroke services in Greater Manchester and London, England.509 182 stroke patients in HES living in urban areas admitted between January 2008 and March 2016; 218 120 stroke patients in SSNAP between April 2013 and March 2016.Hub and spoke models for acute stroke care.Mortality at 90 days after hospital admission; length of acute hospital stay; treatment
Unilateral Strength Training and Mirror Therapy in Patients With Chronic Stroke: A Pilot Randomized Trial. The aim of the study was to investigate the feasibility and potential effectiveness of mirror-aided cross-education compared with cross-education alone in poststroke upper limb recovery.A pilot randomized controlled parallel group study was carried out. Thirty-two patients with chronic stroke followed a 4-wk isometric strength training program performed with the less-affected upper limb (...) Inventory.Compliance was high with no adverse effects. The use of the Biodex Dynamometer must be reviewed. Mirror therapy did not augment the cross-education effect (P > 0.05) in patients with chronic stroke when training isometrically.This pilot trial established the feasibility of a randomized controlled trial comparing mirror-aided cross-education with cross-education alone for poststroke upper limb recovery. Mirror therapy did not augment cross-education when training isometrically. However, results indicate
It is safe to use transdermal glyceryl trinitrate to lower blood pressure in patients with acute ischaemicstroke with carotid stenosis. There is concern that blood pressure (BP) lowering in acute stroke may compromise cerebral perfusion and worsen outcome in the presence of carotid stenosis. We assessed the effect of glyceryl trinitrate (GTN) in patients with carotid stenosis using data from the Efficacy of Nitric Oxide in Stroke (ENOS) Trial.ENOS randomised 4011 patients with acute stroke (...) and raised systolic BP (140-220 mm Hg) to transdermal GTN or no GTN within 48 hours of onset. Those on prestroke antihypertensives were also randomised to stop or continue their medication for 7 days. The primary outcome was the modified Rankin Scale (mRS) at day 90. Ipsilateral carotid stenosis was split: <30%; 30-<50%; 50-<70%; ≥70%. Data are ORs with 95% CIs adjusted for baseline prognostic factors.2023 (60.5%) ischaemicstroke participants had carotid imaging. As compared with <30%, ≥70% ipsilateral
Cryotherapy Reduces Muscle Spasticity But Does Not Affect Proprioception in IschemicStroke: A Randomized Sham-Controlled Crossover Study. The aim of the study was to evaluate the immediate effects of cryotherapy (using an ice pack) on ankle joint position sense and the degree of spasticity after chronic hemiparetic stroke.We used a sham-controlled crossover design. Sixteen chronic hemiparetic patients were randomly assigned to two groups: (1) those who received cryotherapy followed
Comparative Effects of Different Assistance Force During Robot-Assisted Gait Training on Locomotor Functions in Patients With Subacute Stroke: An Assessor-Blind, Randomized Controlled Trial. The aim of the study was to compare the effects of progressive reducing assistance force versus full assistance force controlled robot-assisted gait training combined with conventional physiotherapy on locomotor functions in patients with subacute stroke.Inpatients with subacute stroke (N = 29; 16 men (...) to the full assistance force group, both at postintervention and at follow-up.Progressive reducing assistance force control during robot-assisted gait training combined with conventional physiotherapy may be more beneficial for improving locomotor functions in patients with subacute stroke.
Early CT score. MCA = middle cerebral artery. Thrombectomy provision and population size A recent study developed a decision-tree model based on data from international RCTs and national registries to estimate the number of ischaemicstroke patients eligible for mechanical thrombectomy each year in the UK 40 . Patients were excluded from the eligible population based on criteria such as small artery occlusion rather than large artery occlusion, mild stroke, presentation more than 12 hours after (...) ://www.stroke.org.uk/system/files/sotn_2018.pdf. 2. World Health Organization. Stroke, cerebrovascularaccident. [cited 2018 Oct 11]; Available from: http://www.who.int/topics/cerebrovascular_accident/en/. 3. Scottish Intercollegiate Guidelines Network. Management of patients with stroke or TIA: assessment, investigation, immediate management and secondary prevention. 2008 [cited 2018]; Available from: https://www.sign.ac.uk/assets/sign108.pdf. 4. EUnetHTA. Endovascular therapy using mechanical thrombectomy
Development and validation of a score to detect paroxysmal atrial fibrillation after stroke Prolonged monitoring times (72 hours) are recommended to detect paroxysmal atrial fibrillation (pAF) after ischemicstroke but this is not yet clinical practice; therefore, an individual patient selection for prolonged ECG monitoring might increase the diagnostic yield of pAF in a resource-saving manner.We used individual patient data from 3 prospective studies (ntotal = 1,556) performing prolonged (...) Holter-ECG monitoring (at least 72 hours) and centralized data evaluation after TIA or stroke in patients with sinus rhythm. Based on the TRIPOD (Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis) guideline, a clinical score was developed on one cohort, internally validated by bootstrapping, and externally validated on 2 other studies.pAF was detected in 77 of 1,556 patients (4.9%) during 72 hours of Holter monitoring. After logistic regression analysis
Rate of peri-procedural stroke observed with cerebral embolic protection during transcatheter aortic valve replacement: a patient-level propensity-matched analysis The role of cerebral embolic protection (CEP) in transcatheter aortic valve replacement (TAVR) remains controversial. Randomized trials have not been powered to demonstrate a reduction in stroke rates. The aim of this patient level pooled analysis was to validate the impact of the dual-filter CEP device (Claret Medical Inc., CA, USA (...) ) on peri-procedural stroke in a large number of TAVR patients.Patients from the SENTINEL US IDE trial were combined with the CLEAN-TAVI and SENTINEL-Ulm study in a patient level pooled analysis (N = 1306). Propensity score matching was performed to adjust for possible confounders. The primary endpoint was procedural stroke within 72 h post-TAVR according to Valve Academic Research Consortium-2 criteria. The secondary endpoint was the combination of all-cause mortality or all-stroke within 72 h after
on outcome across the 2-year duration of support.MOMENTUM 3 is a randomized controlled trial of the HM3 centrifugal-flow pump versus the HMII axial-flow pump in patients with advanced heart failure, regardless of the intended goal of support (bridge to transplantation or destination therapy). Baseline and postimplantation clinical correlates of stroke events were assessed with multivariable analyses. Longitudinal patterns, including device association, type of stroke (hemorrhagic versus ischemic (...) ), changing severity of impairment assessed with the modified Rankin Scale (disabling [modified Rankin Scale score >3] versus nondisabling [modified Rankin Scale score ≤3]) over time, and association with outcome, were determined.In 361 patients with the intended implant (189 HM3 and 172 HMII), 65 strokes (40 ischemicstrokes and 25 hemorrhagic strokes) occurred in 52 patients at a median of 131 (range, 1-733) days. No difference in stroke rate was noted between 0 and 180 days of follow-up between devices
started within 7 days after symptom onset to detect improvement in functional outcomes and cardiovascular protection in nondepressed, first-ever ischemicstroke. Study medication was given as add-on to standard medical care and treatment duration and follow-up was 6 months. There were 2 coprimary outcomes: changes in functional disability from 1 to 6 months on the modified Rankin Scale, and a composite vascular end point of transientischemicattack/stroke, myocardial infarction, or vascular mortality (...) Neuroregeneration and Vascular Protection by Citalopram in Acute IschemicStroke (TALOS) Background and Purpose- Recent studies indicate a possible beneficial effect on neuroregeneration and vascular protection of selective serotonin reuptake inhibitors after stroke. We conducted a national multicentre study to explore these effects. Methods- The TALOS study (The Efficacy of Citalopram Treatment in Acute Stroke) is a Danish placebo-controlled, randomized, double-blind study of citalopram
Relation of the CHA2DS2-VASc Score to Risk of Thrombotic and Embolic Stroke in Community-Dwelling Individuals Without Atrial Fibrillation (From The Atherosclerosis Risk in Communities [ARIC] Study) Recent hospital-based cohort studies found the CHA2DS2-VASc score to be associated with ischemicstroke in individuals without atrial fibrillation (AF). Our aim was to determine the distribution of embolic and thrombotic strokes and association with the CHA2DS2-VASc score, among community-dwelling (...) individuals without AF. We included participants from the Atherosclerosis Risk in Communities (ARIC) Study who attended visit 4 (1996 to 1998) and had no previous AF, stroke, or anticoagulant use (n = 10,671). During follow-up through 2008, incident AF cases (n = 760) and participants who started warfarin were censored. Incident AF was ascertained from study electrocardiograms and hospital discharge diagnosis codes, and stroke was physician-adjudicated. After 10 years of follow-up, 280 ischemicstrokes
Effects of Home-Based Versus Clinic-Based Rehabilitation Combining Mirror Therapy and Task-Specific Training for Patients With Stroke: A Randomized Crossover Trial We investigated the treatment effects of a home-based rehabilitation program compared with clinic-based rehabilitation in patients with stroke.A single-blinded, 2-sequence, 2-period, crossover-designed study.Rehabilitation clinics and participant's home environment.Individuals with disabilities poststroke.During each intervention
Validation of the Simplified Stroke-Thrombolytic Predictive Instrument to Predict Functional Outcomes in Chinese Patients Background and Purpose- The simplified stroke-thrombolytic predictive instrument (s-Stroke-TPI) is useful for predicting the outcomes in thrombolysis-treated patients in Western populations. We aimed to validate its predictive value in Chinese patients. Methods- Data from thrombolysis implementation and monitor of acute ischemicstroke in China were analyzed. Patients (...) with acute ischemicstroke and treated with thrombolysis within 4.5 hours of symptom onset were included. The 3-month functional outcomes were assessed with the modified Rankin Scale (mRS). Model discrimination was quantified by calculating the area under receiver operating characteristic curve. s-Stroke-TPI was compared with dense artery sign, mRS score, age, glucose, onset to treatment time, and National Institutes of Health Stroke Scale or stroke prognostication using age and National Institutes
to calculate the cumulative lifetime risks of first stroke, ischemicstroke, or hemorrhagic stroke among adults 25 years of age or older. Estimates of the lifetime risks in the years 1990 and 2016 were compared. Countries were categorized into quintiles of the sociodemographic index (SDI) used in the GBD Study, and the risks were compared across quintiles. Comparisons were made with the use of point estimates and uncertainty intervals representing the 2.5th and 97.5th percentiles around the estimate.The (...) estimated global lifetime risk of stroke from the age of 25 years onward was 24.9% (95% uncertainty interval, 23.5 to 26.2); the risk among men was 24.7% (95% uncertainty interval, 23.3 to 26.0), and the risk among women was 25.1% (95% uncertainty interval, 23.7 to 26.5). The risk of ischemicstroke was 18.3%, and the risk of hemorrhagic stroke was 8.2%. In high-SDI, high-middle-SDI, and low-SDI countries, the estimated lifetime risk of stroke was 23.5%, 31.1% (highest risk), and 13.2% (lowest risk