Intervention Design for Individual Behavior Change in Stroke Prevention Trials

 This is simple! You don't HAVE EXACT PROTOCOLS!

Your survivors know you don't have any clue what you are doing by just having guidelines/suggestions!

Intervention Design for Individual Behavior Change in Stroke Prevention Trials

Imama A. Naqvi, MD, MS https://orcid.org/0000-0002-4228-7500 ian2108@cumc.columbia.edu, Seyyed Reza Ebadi, MD https://orcid.org/0000-0003-1825-4255, Sapana R. Patel, PhD, Maureen George, RN, PhD https://orcid.org/0000-0001-9234-7842, Ying Kuen Cheung, PhD https://orcid.org/0000-0001-8530-035X, and Ian M. Kronish, MD, MPH https://orcid.org/0000-0003-0945-2380Author Info & Affiliations

Stroke

New online

https://doi.org/10.1161/STROKEAHA.126.056667

 

Abstract

Stroke prevention requires that patients follow recommended health behaviors. However, few stroke behavioral interventions have been shown to produce clinically significant behavior change in clinical trials, likely thwarted in the design process by limited application of behavioral theoretical models and insight into mechanistic underpinnings during intervention testing. The National Institutes of Health Stage Model for Behavioral Intervention Development provides a systematic, nonlinear, iterative framework for advancing behavioral interventions from theory to practice. Here, we provide an overview of methods from behavioral medicine research that can be applied to improve the development of successful stroke preventive behavioral interventions. Behavioral change theories can provide a conceptual basis for theoretical frameworks for behavioral interventions as they identify individual-level influences on health behaviors using specified constructs tied to underlying psychosocial mechanisms. For example, interventions targeting self-efficacy behaviors for self-management after stroke may be guided by Social Cognitive Theory to deliver patient-centered care. Mixed methods that integrate qualitative and quantitative findings can be useful for identifying key patient barriers to target while designing behavioral interventions, and for evaluating intervention effects, including the extent to which they target putative behavioral mechanisms. Adaptive clinical trial methods such as SMART (Sequential Multiple Assignment Randomized Trials) for identifying optimal intervention sequences and JITAI (Just-in-Time Adaptive Interventions) that leverage real-time contextual data to tailor components can improve potency and personalization of theoretically supported behavioral interventions. Overall, in accordance with the National Institutes of Health Stage Model, successful behavioral trials to advance stroke prevention should be grounded in behavioral theory for intervention development, informed by design methods that enable assessment of behavioral mechanistic targets, and conducted with adaptive clinical trial methodologies to tailor interventions.

Graphical Abstract

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New injectable treatment helps the brain rebuild after stroke

 Have your competent? doctor and hospital ensure that human testing occurs and EXACT PROTOCOLS ARE CREATED!  

Not doing so IS PURE INCOMPETENCE!

New injectable treatment helps the brain rebuild after stroke

Date:

September 3, 2026

Source:

Duke University

Summary:

Duke researchers developed an injectable scaffold that helped stroke-damaged brains grow new blood vessels, support nerve regrowth, and recover movement in mice. The treatment appears to work partly by recruiting the body’s own immune cells, including neutrophils that may switch from damaging to helpful under the right conditions.

A Clinical Trial of Trontinemab in Participants With Early Symptomatic Alzheimer's Disease

 With your extra risk of Alzheimers is your competent? doctor knowledgeable about this? 

NO? So, PURE INCOMPETENCE! 

Good to know to get rid of him/her now!

1. A documented 33% dementia chance post-stroke from an Australian study?   May 2012.

2. Then this study came out and seems to have a range from 17-66%. December 2013.`    

3. A 20% chance in this research.   July 2013.

4. Dementia Risk Doubled in Patients Following Stroke September 2018 

The latest here:

A Clinical Trial of Trontinemab in Participants With Early Symptomatic Alzheimer's Disease 

Study Overview

Brief Summary

The purpose of this study is to assess the efficacy and safety of trontinemab in participants with early symptomatic Alzheimer's disease (AD) (mild cognitive impairment [MCI] to mild dementia due to AD).

Official Title

A Phase III, Multicenter, Randomized, Double-Blind, Placebo-Controlled, Parallel-Group Efficacy and Safety Study of Trontinemab in Participants With Early Symptomatic Alzheimer's Disease (MCI to Mild Dementia Due to AD)

Conditions

Alzheimers Disease

Intervention/Treatment

• Drug: Trontinemab
• Other: Placebo

Other Study ID Numbers

• WN45447

Study Start (Actual)

2025-11-12

Primary Completion (Estimated)

2028-06-07

Study Completion (Estimated)

2028-06-07

Enrollment (Estimated)

800

Study Type

Interventional

Phase

Phase 3

MedlinePlus related topics:  Mild Cognitive Impairment  Alzheimer's Caregivers 

FDA Drug and Device Resources

Contacts and Locations

This section provides contact details for people who can answer questions about joining this study, and information on where this study is taking place.

To learn more, please see the Contacts and Locations section in How to Read a Study Record.

Study Contact

Name: Reference Study ID Number: WN45447 https://forpatients.roche.com/ No attachments to email below.

Phone Number: 888-662-6728

Email: global-roche-genentech-trials@gene.com

Study Contact Backup

Name: Fastest response: use the inquiry form. https://www.gene.com/contact-us/submit-medical-inquiry

This study has 150 locations

Utility-Weighted Analysis of the Modified Rankin Scale: An Updated Review of Methods, Challenges, and Future Directions

 

mRS and the Berthel Index ARE NOT DAMAGE DIAGNOSES, they do not give you the 3d location of your dead and damaged neurons. In my opinion, they are FUCKING WORTHLESS to getting you recovered! 

I consider the Rankin scale useless, not objective except for #6, dead? You can't use it to objectively point to the EXACT STROKE PROTOCOLS  needed.  The exact same deficit could have 9 causes.

See this example of nine reasons for a movement disability:

 

You can't tell me these all have the same solution, I'm not that stupid.
1. Penumbra damage to the motor cortex.
2. Dead brain in the motor cortex.
3. Penumbra damage in the pre-motor cortex.
4. Dead brain in the pre-motor cortex.
5. Penumbra damage in the executive control area.
6. Dead brain in the executive control area.
7. Penumbra damage in the white matter underlying any of these three.
8. Dead brain in the white matter underlying any of these three.
9. Spasticity preventing movement from occurring.

The latest here: 

Utility-Weighted Analysis of the Modified Rankin Scale: An Updated Review of Methods, Challenges, and Future Directions

Paul M. Wechsler, MD https://orcid.org/0000-0002-0314-1867 wechslpl@ucmail.uc.edu, Joseph P. Broderick, MD https://orcid.org/0000-0002-7323-7709, Jeffrey L. Saver, MD https://orcid.org/0000-0001-9141-2251, and Eva A. Mistry, MBBS, MSCI https://orcid.org/0000-0002-7426-3650Author Info & Affiliations

Stroke

New online

https://doi.org/10.1161/STROKEAHA.126.056638

 

Abstract

The utility-weighted approach to analyzing the modified Rankin Scale (mRS) is increasingly being utilized in acute stroke clinical trials. This analytic approach assigns a patient-centered utility weight—the desirability or value of a health state to patients—to each level of the mRS. The utility-weighted-mRS analysis converts the mRS from a scale reflecting only the rank order of functional outcome after stroke into one that quantifies the value of each poststroke mRS health state from patients’ perspectives. The ability of the utility-weighted-mRS analysis to capture the unequal difference in patient health-related quality of life between each level of the mRS makes it an appealing patient-centered end point for acute stroke clinical trials. However, several concerns have historically raised skepticism regarding its value as a trial end point. Unfamiliarity with how utility weights are derived and used poses challenges to its use for shared decision-making between patients and clinicians. There are valid concerns that social, geographic, and demographic factors that differ between countries influence the mRS utility weights, so that use of uniform weights across all settings mildly reduces the precision of utility quantification, particularly in multinational stroke clinical trials. This narrative review aims to provide the clinical and research stroke community with a practical overview of key methodology in the utility-weighted-mRS analysis to aid in its interpretation, considers the advantages and challenges of using the utility-weighted-mRS analysis, and suggests future areas of study.

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Meditation May Slow the Aging Process and More by Super Age

 Of course your incompetent? doctor failed at providing meditation protocols for well over a decade! 

FIREABLE INCOMPETENCE!

meditation (67 posts to January 2012)

Meditation May Slow the Aging Process and More

Novel Nutritional Formulations for Post-Stroke Rehabilitation: Scientific Potential and Clinical Application

All this earlier research on diet AND NO ONE HAS THE BRAINS TO CREATE A PROTOCOL!

food (40 posts to December 2011)

diet protocol (219 posts to July 2015)

diet supplements (13 posts to August 2013)

 Novel Nutritional Formulations for Post-Stroke Rehabilitation: Scientific Potential and Clinical Application

Citation: Christina Rahm. “Novel Nutritional Formulations for Post-Stroke Rehabilitation: Scientific Potential and Clinical Applications". PriMera Scientific Surgical Research and Practice 8.3 (2026): 21-28. Copyright: © 2026 Christina Rahm. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Abstract 

 

Stroke is a major cause of mortality and long-term disability in most countries of the world, with about 795,000 Americans developing stroke every year. The conventional post-stroke re habilitation has been based on the use of pharmaceuticals and physical therapy. However, major gaps still exist to maximize the outcomes of neurological recovery and functional outcomes. This white paper will discuss a new patent-pending treatment protocol that utilizes three proprietary nutritional formulations that are being used under a structured dosing schedule to treat post-stroke rehabilitation. The strategy combines zeolite extracts, amino acids, polyphenolic compounds, and the use of different bioactive components, which may stimulate neural repair, lower inflammation, and functional restoration. This paper assesses the scientific rationale of every element of the formulation, the possible action mechanisms, and the prospects of making contributions to the development of stroke rehabilitation research and clinical practice.

More at link.

Application of artificial intelligence in prediction and management of stroke rehabilitation

Until 100%recovery research is out there, artificial intelligence isn't going to do much good. Wrong goal: the only goal in stroke is 100% recovery! GET THERE! Predictions and 'management' DO NOTHING FOR RECOVERY! If you are that fucking stupid; you need to be fired!

 Application of artificial intelligence in prediction and management of stroke rehabilitation

Weihua Song1,#, Shuai Si2,#, Yinghui Wang3, Hong Chang1,*, Xiaoying Tang2,* 1. Department of Neurology, Beijing Municipal Geriatric Medical Research Center, Xuanwu Hospital, Capital Medical University, Beijing, China 2. School of Medical Technology, Zhengzhou Academy of Intelligent Technology, Beijing Institute of Technology, Beijing, China 3. Luohe Orthopedic Hospital, Luohe, China Corresponding author: Hong Chang (changhong@xwhosp.org); Xiaoying Tang (xiaoying@bit.edu.cn) # Those authors contributed equally to this work

Abstract: 

Artificial intelligence (AI) is being studied across the stroke care pathway, but evidence from acute diagnosis, early prognosis, rehabilitation-outcome prediction, and long-term management is often discussed without clearly separating these clinical tasks. This structured narrative review adds an integrated framework that maps each application to its decision point, relevance to rehabilitation, validation level, and readiness for clinical use. Unlike previous technology-centred reviews, it explicitly separates acute prognostic evidence from rehabilitation-specific evidence and distinguishes technical performance from transportability, clinical impact, and rehabilitation benefit. Acute imaging and prognostic models may provide baseline information for later rehabilitation planning, but their diagnostic or prognostic performance does not establish rehabilitation efficacy. Most rehabilitation models and robotic, virtual-reality, brain-computer interface, wearable, and home-monitoring applications remain supported mainly by internal validation or early exploratory studies. Small or selected datasets, limited external and prospective validation, uncertain workflow effects, and sparse patient-centred outcomes continue to constrain clinical interpretation

Gait Speed Changes in Stroke Rehabilitation Motor Lower Extremity Randomized Controlled Trials by Intervention and Time Post-Stroke: A Meta-Analysis

 You uselessly described something; but created no protocols for recovery! YOU'RE FIRED! Your comeuppance/screaming when you are the 1 in 4 per WHO that has a stroke  will be soul satisfying. 

Gait Speed Changes in Stroke Rehabilitation Motor Lower Extremity Randomized Controlled Trials by Intervention and Time Post-Stroke: A Meta-Analysis

Author links open overlay panel, , , , , , , , 

https://doi.org/10.1016/j.apmr.2026.08.017Get rights and content

Under a Creative Commons license

Open access

Abstract

Objective

To examine gait speed changes in randomized controlled trials (RCTs) of motor lower extremity (LE) stroke rehabilitation across various interventions, compared to conventional care or sham controls, at different time points post-stroke.

Data Sources

A meta-analysis was conducted, in accordance with PRISMA guidelines. Systematic searches in MEDLINE, Embase, CINAHL and PsycINFO, were conducted for RCTs published in English, up to December 2024.

Study Selection

RCTs were included if they examined a LE motor rehabilitation intervention in adults with stroke, used conventional care or sham as control group, and evaluated gait speed.

Data Extraction

Two independent reviewers performed the screening of title/abstract, full-text screening and data extraction, with an independent reviewer available for conflict resolution.

Data Synthesis

A total of 106 RCTs met the inclusion criteria; 63.2% were conducted in the chronic phase post-stroke. Five interventions were evaluated in both the acute/subacute and chronic phases, of which, three, treadmill training, body weight-supported treadmill training, and training with exoskeletons, showed significant benefits in the acute/subacute phases, compared to conventional care, however, none showed any significant benefit in the chronic phase. Of the interventions evaluated solely in the chronic phase, overground walking training, trunk training, mirror therapy, and virtual reality demonstrated significant benefits compared to conventional care. Interventions studied during the acute/subacute phases post-stroke demonstrated significantly greater magnitude of improvement in gait speed compared to those in the chronic phase.

Conclusions

Overall, interventions for LE motor function post stroke evaluated in the acute/subacute phase demonstrated a greater magnitude of effect on gait speed compared to those assessed in the chronic phase, although more RCTs are being conducted in the chronic phase.

Ending the single versus multi-bedroom debate: Hybrid rooms meet stroke rehabilitation needs

 Multi-bedrooms should NOT BE USED! The morning vampires came almost every morning way too early and woke everyone up! Social interactions never occurred; differing rehab schedules and extreme fatigue prevented any interaction. And Julie Bernhardt is a rock star stroke researcher, which shows you that even rock stars can't know everything without consulting stroke survivors!

Ending the single versus multi-bedroom debate: Hybrid rooms meet stroke rehabilitation needs

• Marcus White ,
• Mark Huen Choong Lam,
• Tianyi Yang,
• Ruby Lipson-Smith,
• Juan Pablo Saa,
• 
  
• 
  
• 
  
• 
   
• Aaron Davis,
• Mehrnoush Latifi Khorasgani,
• Julie Bernhardt,
• on behalf of NOVELL Redesign 

• Published: September 3, 2026
• https://doi.org/10.1371/journal.pone.0356623

Abstract

Stroke is a leading cause of disability worldwide, and stroke rehabilitation plays a critical role in recovery. Early rehabilitation often occurs in a hospital setting, but the hospital built environment is rarely designed to support the specific needs and priorities of people who have had a stroke. In recent decades, there has been an ongoing debate regarding the benefits of single versus multi-bed rooms in healthcare settings. This debate centres around balancing privacy and rest, with social interaction and safety. While single rooms may be beneficial for some people, multi-bed rooms may be better for others. Both options, however, come with their own set of drawbacks in the context of stroke rehabilitation. In this study, we conducted a collaborative Living Lab to design a series of provocative-prototype hybrid room typologies that merged different aspects of single and multi-bed rooms to provide options specific for stroke rehabilitation. These typologies were used to generate four alternative bedroom designs which were modelled in virtual reality. The designs were informed by a values-based brief, outlining a set of predefined key criteria for optimising stroke rehabilitation environments: opportunities for activity and rest, wellbeing, safety, efficiency, flexibility, personal control, access to outdoors and green space, and access to a positive and stimulating environment. Twenty lived-experience and professional experts evaluated these virtual designs against the predefined values-based criteria. Evaluation revealed two preferred hybrid hospital room designs that incorporated beneficial features of both multi-bed and single-bed rooms. Our approach of values-based design and evaluation within a virtual environment proved an effective means of generating and evaluating design options with meaningful input from a wide range of stakeholders. These findings highlight the potential for flexible and adaptable room design to meet the specific needs and priorities of people participating in early-stage rehabilitation after stroke.

Figures

      

Citation: White M, Lam MHC, Yang T, Lipson-Smith R, Saa JP, Davis A, et al. (2026) Ending the single versus multi-bedroom debate: Hybrid rooms meet stroke rehabilitation needs. PLoS One 21(9): e0356623. https://doi.org/10.1371/journal.pone.0356623

Editor: Ruixin Liang, The Hong Kong Polytechnic University, HONG KONG

Received: December 2, 2025; Accepted: August 5, 2026; Published: September 3, 2026