Predictors of Clinically Important Changes in Actual and Perceived Functional Arm Use of the Affected Upper Limb After Rehabilitative Therapy in Chronic Stroke

 Predictions DO NOTHING TO GET SURVIVORS RECOVERED! I'd fire all of you.

Predictors of Clinically Important Changes in Actual and Perceived Functional Arm Use of the Affected Upper Limb After Rehabilitative Therapy in Chronic Stroke

Yi-chun Li, MS^a ∙ Wan-wen Liao, PhD^a ∙ Yu-wei Hsieh, PhD^b,c,d ∙ Keh-chung Lin, ScD, OTR^a,e kehchunglin@ntu.edu.tw ∙ Chia-ling Chen, PhD, MD^d,f

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Abstract

Objective

To identify the predictors of minimal clinically important changes in actual and perceived functional arm use of the affected upper limb after rehabilitative therapy.

Design

Retrospective, observational cohort study.

Setting

Outpatient rehabilitation settings.

Participants

A cohort of 94 patients with chronic stroke.

Interventions

Patients received robot-assisted therapy, mirror therapy, or combined therapy for 4 weeks.

Main Outcome Measures

The primary outcome measures, assessed pre- and post intervention, included actual functional arm use measured by an accelerometer and perceived functional arm use measured by the Motor Activity Log (MAL). Candidate predictors included age, sex, time after stroke, side of stroke, and scores on the Fugl-Meyer Assessment, Modified Ashworth Scale, Medical Research Council scale, Wolf Motor Function Test, MAL (quality of movement), and Nottingham Extended Activities of Daily Living.

Results

Being male (odds ratio [OR], 3.17; 95% CI, 1.13-8.87) and having a higher than median Medical Research Council score (OR, 2.68; 95% CI, 1.12-6.41) significantly predicted minimal clinically important changes assessed by an accelerometer. Fugl-Meyer Assessment scores (odds ratio, 1.06; 95% CI, 1.02-1.11) were a significant predictor of achieving clinically important changes in MAL amount of use. Wolf Motor Function Test (quality) scores (OR, 3.05; 95% CI, 1.38-6.77) could predict clinically important improvements in MAL quality of movement.

Conclusions

Predictors of clinically important changes in the use of the affected upper limb after robot-assisted therapy, mirror therapy, or combined therapy in patients with chronic stroke for 4 weeks differ for actual vs perceived use. Further studies are recommended to validate these findings in a larger sample.

Predictors of Clinically Important Changes in Actual and Perceived Functional Arm Use of the Affected Upper Limb After Rehabilitative Therapy in Chronic Stroke

 

Why are you predicting outcome rather than delivering research that results in great functional outcome? I'd fire you all for missing the whole point of stroke research. SURVIVOR RECOVERY!

Even Ph.D.s are stupid in this regard!

Send me hate mail on this: oc1dean@gmail.com. I'll print your complete statement with your name and my response in my blog. Or are you afraid to engage with my stroke-addled mind? No excuses are allowed! You're medically trained; it should be simple to precisely state EXACTLY WHAT GOOD does knowing this get survivors recovered with NO EXCUSES! Your definition of competence in stroke is obviously much lower than stroke survivors' definition of your competence! Swearing at me is allowed, I'll return the favor. Don't even attempt to use the excuse that brain research is hard.

Predictors of Clinically Important Changes in Actual and Perceived Functional Arm Use of the Affected Upper Limb After Rehabilitative Therapy in Chronic Stroke

Yi-chun Li, MS^a ∙ Wan-wen Liao, PhD^a ∙ Yu-wei Hsieh, PhD^b,c,d ∙ Keh-chung Lin, ScD, OTR^a,e kehchunglin@ntu.edu.tw ∙ Chia-ling Chen, PhD, MD^d,f

Cite

• Set Alert
• Get Rights
• Reprints

• Previous articleNext article

Abstract

Objective

To identify the predictors of minimal clinically important changes in actual and perceived functional arm use of the affected upper limb after rehabilitative therapy.

Design

Retrospective, observational cohort study.

Setting

Outpatient rehabilitation settings.

Participants

A cohort of 94 patients with chronic stroke.

Interventions

Patients received robot-assisted therapy, mirror therapy, or combined therapy for 4 weeks.

Main Outcome Measures

The primary outcome measures, assessed pre- and post intervention, included actual functional arm use measured by an accelerometer and perceived functional arm use measured by the Motor Activity Log (MAL). Candidate predictors included age, sex, time after stroke, side of stroke, and scores on the Fugl-Meyer Assessment, Modified Ashworth Scale, Medical Research Council scale, Wolf Motor Function Test, MAL (quality of movement), and Nottingham Extended Activities of Daily Living.

Results

Being male (odds ratio [OR], 3.17; 95% CI, 1.13-8.87) and having a higher than median Medical Research Council score (OR, 2.68; 95% CI, 1.12-6.41) significantly predicted minimal clinically important changes assessed by an accelerometer. Fugl-Meyer Assessment scores (odds ratio, 1.06; 95% CI, 1.02-1.11) were a significant predictor of achieving clinically important changes in MAL amount of use. Wolf Motor Function Test (quality) scores (OR, 3.05; 95% CI, 1.38-6.77) could predict clinically important improvements in MAL quality of movement.

Conclusions

Predictors of clinically important changes in the use of the affected upper limb after robot-assisted therapy, mirror therapy, or combined therapy in patients with chronic stroke for 4 weeks differ for actual vs perceived use. Further studies are recommended to validate these findings in a larger sample.

Predictors of Good Functional Outcomes in Posterior Circulation Stroke After Mechanical Thrombectomy With Stent Retrievers: An Individual Patient‐Data Pooled Analysis From the TRACK and NASA Registries

Is this a 'good functional outcome' as described by the patients? By definition a good functional outcome for a survivor is 100%  recovery. DON'T YOU DARE SUGGEST ANYTHING LESS IS GOOD!

Predictors of Good Functional Outcomes in Posterior Circulation Stroke After Mechanical Thrombectomy With Stent Retrievers: An Individual Patient‐Data Pooled Analysis From the TRACK and NASA Registries

Yazan K. Ashouri,

Alexandra R. Paul,

Thanh N. Nguyen,

Alicia Castonguay,

Mohammad AlMajali,

Ahmad Armouti,

Raul G. Nogueira,

Jaafar Kashef Al‐Ghetaa,

Joey D. English,

… See all authors

Originally published19 Feb 2024https://doi.org/10.1161/SVIN.123.001017Stroke: Vascular and Interventional Neurology. 2024;0:e001017

Abstract

BACKGROUND

Recent randomized clinical trials have demonstrated that endovascular therapy for basilar artery occlusion is safe and potentially effective, predominantly in the non‐White population. The aim of this study was to identify predictors of good functional outcome in posterior circulation strokes in US population after mechanical thrombectomy from the TRACK (Trevo Stent‐Retriever Acute Stroke) and the NASA (North American Solitaire Stent Retriever Acute Stroke) registries from North America.

METHODS

Patient‐level data from the TRACK and NASA registries were pooled, and patients with posterior circulation stroke were included in this analysis. Patients were dichotomized into those with 90‐day good functional outcome (modified Rankin scale [mRS] score 0–2) and poor functional outcome (mRS score ≥3). Baseline and procedural data were compared between the 2 cohorts. Multivariate logistic regression was performed to identify predictors of functional outcome. P < 0.05 was considered significant.

RESULTS

Of 119 posterior stroke patients (99 [83.2%] basilar artery, 16 [13.4%] vertebral artery, and 4 [3.4%] posterior cerebral artery), 110 patients had 90‐day mRS data available on follow‐up. Good functional outcome was observed in 44 patients (40%). Patients with mRS score 0–2 were less likely to have hypertension (61.4% versus 83.3%; P = 0.01), hyperlipidemia (38.6% versus 62.1%; P = 0.016), and diabetes (18.2% versus 36.4%; P = 0.040). Patients with mRS score 0–2 had a lower mean presentation National Institutes of Health Stroke Scale score (15.2±9.95 versus 22.6±9.50; P < 0.001) and more likelihood of achieving Thrombolysis in Cerebral Infarction 3 (79.5% versus 42.2%; P < 0.001). There was no difference between 2 cohorts in time to puncture, use of balloon guide catheter, use of general anesthesia, and number of passes. On multivariate analysis, higher presentation National Institutes of Health Stroke Scale and hypertension were associated with worse functional outcomes. Complete recanalization and the receipt of intravenous tissue‐type plasminogen activator were associated with higher odds of achieving good functional outcomes.

CONCLUSION

In this pooled analysis of the NASA and TRACK registries, patients with posterior circulation stroke achieving good outcomes were more likely to have lower presentation National Institutes of Health Stroke Scale and fewer comorbidities. Use of intravenous tissue‐type plasminogen activator, hypertension, final Thrombolysis in Cerebral Infarction 3, and lower baseline National Institutes of Health Stroke Scale score were independent predictors of functional outcome.

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Application of quantitative electroencephalography in predicting early cerebral ischemia in patients undergoing carotid endarterectomy

 Useless. Survivors don't want predictions, they want concrete results that cure or prevent cerebral damage from stroke. Do the research that GETS THERE! I see nothing here that suggests testing to see if the Circle of Willis is complete and then you wouldn't need this work. But obviously since I'm not medically trained, I know nothing, so don't listen to me.  The stroke rates after carotid endarterectomy are too high for me, so I'd test to see if the Circle of Willis is complete and if so then close up the offending artery so it can never throw a clot. My right carotid artery completely closed up after my stroke and thus I didn't have to worry about it. Now collaterals have formed around it. I never had any issues from lack of blood flow with only three arteries feeding my Circle of Willis.

Application of quantitative electroencephalography in predicting early cerebral ischemia in patients undergoing carotid endarterectomy

Guanxu Zhao^†, Guang Feng^†, Lei Zhao, Shuai Feng, Yi An, Cuicui Kong and Tianlong Wang^*

• Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China

Background: Quantitative electroencephalography (QEEG) has emerged as a promising monitoring method in cerebral ischemia, but the feasibility of QEEG in intraoperative cerebral perfusion-related ischemia monitoring is still uncertain. The purpose of this study was to investigate the value of QEEG monitoring in Carotid Endarterectomy (CEA) and the thresholds for intraoperative cerebral perfusion-related ischemia monitoring.

Methods: Sixty-three patients who underwent carotid endarterectomy with continuous Transcranial Doppler ultrasound (TCD) monitoring and QEEG monitoring at Xuanwu Hospital Capital Medical University from January 2021 to August 2021 were enrolled in this study. Each patient received total intravenous anesthesia. Middle cerebral artery blood flow velocity (V-MCA) was obtained by TCD. Relative alpha percentage (RA) and alpha-delta ratio (ADR) were obtained by QEEG monitoring. Patients were divided into ischemic and non-ischemic groups using a decline of more than 50% in the V-MCA monitored by TCD as the gold standard.

Results: Of the 63 patients, twenty patients were divided into the ischemic group, and forty-three patients into the non-ischemic group. Ipsilateral post-clamp RA and ADR values of QEEG were decreased for all patients in the ischemic group. The optimal threshold for RA and ADR to predict cerebral ischemia was a 14% decrease from baseline (sensitivity 90.0%, specificity 90.7%, Kappa value 0.786), a 21% decrease from baseline (sensitivity 85.0%, specificity 81.4%, Kappa value 0.622), respectively, indicated by TCD monitoring.

Conclusions: Our study demonstrated that QEEG is a promising monitoring method undergoing CEA under general anesthesia and has good consistency with TCD.

Introduction

Worldwide, ischemic stroke accounts for about 68% and hemorrhagic stroke about 32%, while in China, the proportion of ischemic stroke is even more significant with 84%. Stroke is the second leading cause of death worldwide and the first leading cause of death in China (1–4). Stroke imposes a heavy burden on patients, families, and society. Therefore, prevention and treatment of stroke are of great importance.

About 10–20% of stroke is caused by carotid artery diseases, so timely intervention is crucial for the secondary or even primary prevention of stroke. Among the many factors leading to stroke, the degree of carotid artery stenosis is the most important determinant. Carotid endarterectomy (CEA) is a surgical method for reconstructing carotid blood flow and reducing the risk of stroke by removing calcified plaques inside vessels. Previous studies have confirmed that CEA has high benefits for patients with non-disabling stroke and severe carotid artery stenosis (70–99%), as well as patients with recent hemispheric and retina-related transient ischemic attack (TIA) (5–8). Although there are benefits for patients with severe stenosis, CEA requires temporary blocking of blood flow in one side of the carotid artery, which will lead to a significant reduction of cerebral blood flow at the clamping side of the hemisphere during CEA, and even ischemic stroke and other neurological adverse events. Previous studies have shown that 30 days perioperative stroke rates after CEA range between 2 and 6% (5, 9, 10). These make the benefits of patients dependent on the perioperative safety of CEA. In order to reduce the incidence of neurological adverse events during CEA and maximize the benefit of patients, intraoperative cerebral perfusion-related ischemia monitoring is essential. Intraoperative monitoring (IOM) can guide the surgeon to optimize surgical strategy and provide recommendations for shunting.

Many centers have used transcranial doppler (TCD) for IOM due to its convenient and non-invasive characteristics. However, TCD monitored the brain region with the middle cerebral artery as the blood supply and lack of monitoring in other areas. Besides, some patients don't have the appropriate temporal insonation window to be monitored with TCD. In recent years, Quantitative EEG (QEEG) has been attracting more and more attention as a new monitoring method (11, 12). QEEG uses Fourier transforms to quantify the raw EEG based on its amplitude, power, frequency, and rhythmicity to show numerical values, ratios or percentages, and a graphical display array or trend. It is now possible to calculate the ratio or percentage of α, β, θ, and δ power in a particular frequency band, such as relative alpha percentage (RA) and alpha-delta ratio (ADR), and these values can be compared between different regions, such as electrode pair channels. RA is the power of α wave as a percentage of power in 1–20 Hz band. ADR is the ratio of α wave power to δ wave power. Compared with raw EEG, one advantage of QEEG is that it allows for a more visual display of cerebral perfusion monitoring, another is that QEEG can monitor the whole brain perfusion, rather than only partial brain areas as TCD and cerebral oxygenation do. Laman et al. analyzed the value of QEEG parameters such as spectral edge frequency (SEF) and relative band power in predicting shunt in CEA. Kamitaki et al. evaluated the value of QEEG according to the responses of different QEEG parameters after carotid artery clamping during CEA under general anesthesia. Both of them obtained good results (13, 14). However, the two studies were retrospective, using EEG data from a database, and in Kamitaki's study, the grouping of patients is a subjective judgment by EEG physicians. At present, no specific threshold for QEEG changes in CEA has been proposed and there is no study on the combination of QEEG and TCD for cerebral perfusion during CEA.

The aim of the present study was to use a combination of QEEG and TCD to evaluate the feasibility of the new QEEG monitoring to monitor cerebral perfusion status during CEA, reducing the incidence of perioperative cerebral ischemia events.

More at link.

Association of Perfusion Lesion Variables With Functional Outcome in Patients With Mild Stroke and Large Vessel Occlusion Managed Medically

 Why are you predicting poor functional outcome rather than delivering research that results in great functional outcome? I'd fire you all for missing the whole point of stroke research. SURVIVOR RECOVERY!

Association of Perfusion Lesion Variables With Functional Outcome in Patients With Mild Stroke and Large Vessel Occlusion Managed Medically

Peng Wang, Wenhuo Chen, View ORCID ProfileChushuang Chen, View ORCID ProfileAndrew Bivard, Geng Yu, Mark W. Parsons, View ORCID ProfileLongting Lin, on behalf of INSPIRE

First published October 28, 2022, DOI: https://doi.org/10.1212/WNL.0000000000201498

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Abstract

Background and Objectives The best management of patients with mild stroke and large vessel occlusion (LVO) remains unclear. This study aimed to identify perfusion imaging predictors of poor functional outcome in such patients.

Methods This cohort study retrospectively selected patients enrolled in the International Stroke Perfusion Imaging Registry between August 2011 and April 2022. The registry enrolled patients with acute ischemic stroke and with baseline CT perfusion scanned within 24 hours of stroke onset. This study identified patients with mild symptoms, defined by an NIH Stroke Scale score of ≤5. Patients with LVO of anterior circulation were selected. This study further selected patients who received medical management and excluded patients who received endovascular treatment. The primary outcome was poor functional outcome defined as a modified Rankin Scale of 3–6 at 3 months. Perfusion lesion was defined by delay time > 3 seconds on CTP. Regression analyses were used to identify clinical and imaging variables that predicted poor functional outcome.

Results A total of 139 patients with mild stroke were included, of whom 27 (19%) had poor functional outcome. Patients with poor outcome, compared with those with good outcome, had much larger perfusion lesion volume (median 80 mL vs 41 mL, p < 0.001). Perfusion lesion was a significant predictor of poor outcome in either univariable regression (crude OR = 1.02, 95% CI = [1.01–1.03]) or multivariable regression model (adjusted OR = 1.01, 95% CI = [1.01–1.02]), adjusting for occlusion site, good collaterals, baseline stroke severity, age, IV thrombolysis (IVT), and onset to scan time. A perfusion lesion of 65 mL was the optimal cutpoint to identify poor functional outcome (sensitivity = 59%, specificity = 77%). Patients with perfusion lesion ≥65 mL, compared with patients with perfusion lesion <65 mL, showed a much higher rate of poor functional outcome (38% vs 11%, p < 0.001). Of the 139 patients in this study, 95 received IVT. Patients treated with or without IVT did not influence their outcomes (crude OR = 0.74, 95% CI = [0.31–1.78]).

Discussion A perfusion lesion of ≥65 mL predicted poor functional outcome in mild stroke patients with LVO.

Glossary

ASPECTS=

Alberta Stroke Program Early CT Score;

CBF=

cerebral blood flow;

CTP=

CT perfusion;

DT=

delay time;

EVT=

endovascular thrombectomy;

INSPIRE=

International Stroke Perfusion Imaging Registry;

IVT=

IV thrombolysis;

LVO=

large vessel occlusion;

NCCT=

noncontrast CT;

NIHSS=

NIH Stroke Scale;

PH=

parenchymal hemorrhage;

sICH=

symptomatic intracerebral hemorrhage

Footnotes

• Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

• ↵* These authors contributed equally to this work as first authors.

• ↵† These authors contributed equally to this work as senior authors.

• Submitted and externally peer reviewed. The handling editor was José Merino, MD, MPhil, FAAN.

• CME Course: NPub.org/cmelist

• Received February 20, 2022.
• Accepted in final form September 15, 2022.

Outcome prediction in large vessel occlusion ischemic stroke with or without endovascular stroke treatment: THRIVE-EVT

 

And you really think predicting failure to recover is of ANY FUCKING USE AT ALL TO SURVIVORS?

Outcome prediction in large vessel occlusion ischemic stroke with or without endovascular stroke treatment: THRIVE-EVT

Show all authors

Alexander C Flint, Shelia L Chan, Nancy J Edwards, ...

First Published March 23, 2022 Research Article

https://doi.org/10.1177/17474930221092262

Article information

Abstract

Introduction: 

The THRIVE score and the THRIVE-c calculation are validated ischemic stroke outcome prediction tools based on patient variables that are readily available at initial presentation. Randomized controlled trials (RCTs) have demonstrated the benefit of endovascular treatment (EVT) for many patients with large vessel occlusion (LVO), and pooled data from these trials allow for adaptation of the THRIVE-c calculation for use in shared clinical decision making regarding EVT.

Methods: 

To extend THRIVE-c for use in the context of EVT, we extracted data from the Virtual International Stroke Trials Archive (VISTA) from 7 RCTs of EVT. Models were built in a randomly selected development cohort using logistic regression that included the predictors from THRIVE-c: age, NIH Stroke Scale (NIHSS) score, presence of hypertension, diabetes mellitus, and/or atrial fibrillation, as well as randomization to EVT and, where available, the Alberta Stroke Program Early CT Score (ASPECTS).

Results: Good outcome( I 'm sure the suvivors defintion of 'good outcome' is vastly different that yours.) was achieved in 366/787 (46.5%) of subjects randomized to EVT and in 236/795 (29.7%) of subjects randomized to control (P<0.001), and the improvement in outcome with EVT was seen across age, NIHSS, and THRIVE-c good outcome prediction. Models to predict outcome using THRIVE elements (age, NIHSS, and comorbidities) together with EVT, with or without ASPECTS, had similar performance by ROC analysis in the development and validation cohorts (THRIVE-EVT ROC area under the curve [AUC] = 0.716 in development, 0.727 in validation, P=0.30; THRIVE-EVT+ASPECTS ROC AUC = 0.718 in development, 0.718 in validation, P=0.12).

Conclusion: 

THRIVE-EVT may be used alongside the original THRIVE-c calculation to improve outcome probability estimation for patients with acute ischemic stroke, including patients with or without LVO, and to model the potential improvement in outcomes with EVT for an individual patient based on variables that are available at initial presentation. Online calculators for THRIVE-c estimation are available at www.thrivescore.org and www.mdcalc.com/thrive-score-for-stroke-outcome.

Keywords

Acute stroke therapy, Outcome Prediction, THRIVE Score, ASPECTS, Endovascular Therapy, Shared decision-making

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