EEG microstate as a biomarker of post-stroke depression with acupuncture treatment

 We don't need useless depression biomarker research! Survivors want you to prevent depression and you do that by 100% RECOVERY PROTOCOLS! Do you not understand what survivors want? 

EEG microstate as a biomarker of post-stroke depression with acupuncture treatment

Conghui WeiQu YangJinling ChenXiuqin RaoQingsong LiJun Luo^*

• Department of Rehabilitation Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China

Background: Post-stroke depression (PSD) is a prevalent psychiatric complication among stroke survivors. The PSD researches focus on pathogenesis, new treatment methods and efficacy prediction. This study explored the electroencephalography (EEG) microstates in PSD and assessed their changes after acupuncture treatment, aiming to find the biological characteristics and the predictors of treatment efficacy of PSD.

Methods: A 64-channel resting EEG data was collected from 70 PSD patients (PSD group) and 40 healthy controls (HC group) to explore the neuro-electrophysiological mechanism of PSD. The PSD patients received 6 weeks of acupuncture treatment. EEG data was collected from 60 PSD patients after acupuncture treatment (MA group) to verify whether acupuncture had a modulating effect on abnormal EEG microstates. Finally, the MA group was divided into two groups: the remission prediction group (RP group) and the non-remission prediction group (NRP group) according to the 24-Item Hamilton Depression Scale (HAMD-24) reduction rate. A prediction model for acupuncture treatment was established by baseline EEG microstates.

Results: The duration of microstate D along with the occurrence and contribution of microstate C were reduced in PSD patients. Acupuncture treatment partially normalized abnormal EEG microstates in PSD patients. Baseline EEG microstates predicted the efficacy of acupuncture treatment with an area under the curve (AUC) of 0.964.

Conclusion: This study provides a novel viewpoint on the neurophysiological mechanisms of PSD and emphasizes the potential of EEG microstates as a functional biomarker. Additionally, we anticipated the therapeutic outcomes of acupuncture by analyzing the baseline microstates, which holds significant practical implication for the PSD treatment.

Introduction

PSD is an abnormal manifestation of mood depression, loneliness, and sleep disturbance in stroke patients (1, 2). Epidemiological studies indicate that approximately 31% of stroke patients experience varying degrees of depressive symptoms (3, 4). The mental status of PSD patients can significantly affect their physical recovery and life quality. Additionally, the severity of depression correlates with stroke severity and mortality rates (5). In clinical practice, depressive symptoms are commonly alleviated by taking monoamine oxidase inhibitors, 5-hydroxytryptamine (5-HT) reuptake inhibitors and tricyclic antidepressants (6). However, the complex pathogenesis and susceptible recurrence of PSD, combined with potential toxic side effects from prolonged medication use, often undermine patients’ adherence to treatment (7). Therefore, it is imperative to employ alternative methods to more effectively manage depressive symptoms in PSD patients.

Various viable alternatives have been investigated for the treatment of PSD, among which acupuncture has been widely adopted globally for its efficacy and safety (8). In China, acupuncture is recommended as a complementary therapy for both PSD and post-stroke insomnia (PSI) (9). Functional magnetic resonance imaging (fMRI) studies have demonstrated that acupuncture modulates the interconnected dysfunctions associated with depressive symptoms, thereby facilitating sustained clinical improvement (10).

Individual differences in resting-state brain functional connectivity are associated with different types of depression, which shown by previous fMRI examinations (11, 12). Recent research indicates that EEG microstates can distinguish between depressive subtypes (13). EEG microstates can reflect dynamic changes in large-scale brain networks, characterized as semi-stable, transient voltage topographies that recur during resting-state EEG recordings (14). Persistent repetitive microstates likely arise from repeated co-activation of interconnected brain regions, each lasting approximately 80 ms before transitioning to another temporarily stable pattern. The four typical microstates (A-D) were present in almost all subjects, representing the synchronized activity within large-scale network nodes (15).

On the relationship between EEG microstates and the treatment of depression, Damborsk et al. (16) demonstrated a significant positive correlation between the microstates occurrence and medication amount. The usage of antipsychotics, antidepressants, and mood stabilizers was markedly associated with the occurrence of microstate E. Additionally, another study indicated that variations in the duration of microstate C and microstate D were strongly predictors of the response to electroconvulsive therapy (ECT) (17). Therefore, EEG microstates hold promise as biomarkers for assessing the effectiveness of therapeutic interventions in various neurological disorders.

Previous studies have primarily examined the differences between PSD patients and normal subjects, with limited focus on the prediction of depression efficacy (18, 19). Therefore, we investigated the EEG microstates of PSD patients and evaluated the changes of EEG microstates after acupuncture treatment to identify the biological characteristics and the predictors of PSD treatment efficacy.

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Effectiveness of the Dyadic Coping Intervention of Social Participation (DCISP) for stroke survivors: study protocol for a randomized controlled trial

You wouldn't have to solve this secondary problem if you solved the primary problem of 100% recovery! DO YOU NOT UNDERSTAND?

Effectiveness of the Dyadic Coping Intervention of Social Participation (DCISP) for stroke survivors: study protocol for a randomized controlled trial

• Xiaoxuan Qiao,
• Zhuoyun Wu,
• Yahao Ren &
• Yuxia Li 

BMC Psychology volume 12, Article number: 500 (2024) Cite this article

• Metrics details

Abstract

Background

Enhancing social participation is not only the main goal of stroke survivors' community rehabilitation but also a protective factor affecting their physical and emotional health. The current state of stroke survivors' social participation is not encouraging due to the high disability incidence of stroke. Spouses may play a facilitating role in the social participation of patients by providing them with support and assistance. However, there remains a lack of evidence specifically regarding dyadic coping interventions of social participation for stroke survivors, and the intervention strategies are still underdeveloped without clear theoretical frameworks. Therefore, this proposed study aims to develop and evaluate the effectiveness of the Dyadic Coping Intervention of Social Participation (DCISP) for survivors of first-episode homebound stroke.

Methods

A single-blind (assessor-blinded), randomized controlled trial will be conducted to verify the effectiveness of DCISP. The randomized controlled trial will be preceded by a feasibility study (N = 20) of DCISP in stroke survivors. Stroke survivors will be randomly classified (1:1) into either a control (N = 50) or an experimental group (N = 50). In addition to routine care, participants in the experimental group will receive six 40 ~ 45 min sessions of guidance, once every two weeks. The primary outcome is social participation of stroke survivors, measured using Impact on Participation and Autonomy Questionnaire (IPA) and Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P), and the secondary outcomes will be measured by Knowledge Questionnaire for Stroke Patients (SPKQ), Stroke-specific Quality of Life Scale (SS-QOL), Dyadic Coping Inventory (DCI), Modified Rankin Scale (mRS) and Zarit Caregiver Burden Interview (ZBI-22). These will be measured at baseline(T0), during the intervention (T1 = 1 month), and after intervention completion (T2 = 3 months, T3 = 6 months).

Discussion

Findings from the study will provide evidence of the effects of DCISP on improving the social participation of first-episode homebound stroke survivors. The results of this study may support the implementation of survivor–spouse dyads care support in stroke survivors and provide a reference for clinical rehabilitation nursing practice, offering new insights into nursing interventions for stroke patients.

Trial registration

Chinese Clinical Trial Registry (ChiCTR) ChiCTR2400083072. Registered on 20 July 2023.

Peer Review reports

Background

Stroke is the second leading cause of disability and death worldwide, and it is also the primary cause of death and disability among Chinese adults [1]. China ranks first globally with an overall lifetime risk of stroke at 39.9%. In China, the burden of stroke is increasing due to the accelerated aging and urbanization processes. Stroke patients frequently have varied degrees of functional impairments, such as swallowing, speech, motor, sensory, cognitive, and mental health problems, which have a major impact on their daily lives and hinder their normal social participation [2, 3]. Even in stroke patients without functional impairments, the degree of social participation may drop [4]. Therefore, it is necessary to develop effective rehabilitation interventions, which can reduce the degree of disability, improve social participation and reduce social burden.

Definition of social participation and its importance for stroke survivors

In 2001, the World Health Organization (WHO) introduced the International Classification of Functioning, Disability and Health (ICF), which defines "social participation" as "the individual's involvement in different aspects of real-life social environments [5]." Social participation reflects the rehabilitative outcomes of chronic disease patients in a disabled state, representing their recovery and health status [6]. Several studies had shown a positive correlation between social participation and physical function. Furthermore, social participation can impact the quality of life and emotional state [7, 8], predict life satisfaction among patients, and enhance the well-being of older adults [9]. Therefore, improving social participation is crucial for the rehabilitation of stroke patients.

Research on the needs of stroke patients related to social participation had shown that stroke patients require nurses' assistance in engaging in social activities of interest, managing relationships with spouses, and handling family relationships [10]. Although stroke patients express a desire to join in social activities, their degree of engagement is far from encouraging. Studies have found that post-discharge stroke patients face moderate difficulties in carrying out daily tasks and engaging in social activities [11]. Even patients without physical impairments may experience a decline in their capacity for social participation [4].

Limited research on interventions for social participation among stroke survivors

Current research on social participation among stroke survivors primarily included improving patients' physical activity limitations, cognitive impairments, and language difficulties, as well as directing social participation interventions such as group activities, teaching social participation skills, and vocational rehabilitation. Comprehensive rehabilitation interventions were also conducted to enhance patients' social participation. The "Improving Participation After Stroke Self-Management Program" (IPASS), created by Wolf et al. [12], is one instance of a self-management program for stroke survivors. The result showed that among young and middle-aged stroke patients, a 12-week intervention improved the understanding of the relationship between health, participation, environmental support, and personal barriers. It also improved their short-term self-efficacy and made it easier for them to participate in activities, leading to a rise in their level of involvement in social, familial, and community activities. Another self-management intervention involves a 16-week program including aerobic exercise, exercise health education, energy conservation management, and prevention of recurrence showed significant improvement in social participation, with long-term effects observed during follow-up [13]. Mayo combined the Mission possible© program with exercise components, and the result showed a three-hour weekly increase in meaningful activities of patients and improved reintegration into normal life [14]. However, most research in China focuses on the current level of social participation among stroke patients and the influencing factors, and the guidelines do not explicitly present intervention strategies for improving social participation.

Positive dyadic coping can promote survivor–spouse dyads to deal with stress

Most intervention studies in stroke patients have concentrated on patient-centered approaches, ignoring the importance of spouses and families in stroke rehabilitation. Spouses as primary caregivers for stroke patients in homebound rehabilitation have a direct impact on the patient's recovery through their caregiving abilities, coping skills, and attitudes toward the illness [15]. The dyadic coping method utilizes the unique strengths of spouses, encouraging partners to cope with the illness together, support each other, and help patients feel more confident about their treatment and have a better prognosis [16]. Campbell [17] et al. used a training manual developed by medical psychologists to give intervention providers uniform instruction. The intervention providers conducted a 6-week symptom management skills training program for 12 couples consisting of prostate cancer patients and their spouses. The training sessions occurred once a week for one hour each. The training manual included six sections covering disease information, problem-solving skills, cognitive and behavioral coping skills (such as communication skills, relaxation training, and exercise pacing). The results showed that this intervention improved the patients' quality of life and alleviated the stress, depression, and fatigue experienced by their spouses. However, the role of dyadic coping in social participation among stroke survivors has not been further validated.

Therefore, this study develops a Dyadic Coping Intervention for Social Participation (DCISP), which is an intervention that focuses on social participation and involves the active participation of stroke survivor couples. In the preliminary phase, the research team conducted a literature review and qualitative interviews to learn more about the variables impacting stroke patients' social participation. Three main conclusions were drawn: (1) barriers to participation: self-care limitations, unsatisfactory rehabilitation outcomes, fear of falling, negative emotions, illness stigma, and concerns about burdening others, (2) facilitators of participation: acceptance of the illness, belief in rehabilitation, social support, and perceived benefits of participation, (3) multidimensional needs of patients: psychological care and professional rehabilitation counseling. Based on these findings, modifiable intervention targets were identified. The Information-Motivation-Behavioral Skills (IMB) theory was used as the theoretical framework to develop the DCISP. The intervention included information interventions through health education, motivation interventions through social support and spousal supervision, and skill-based interventions to enhance participation abilities. The intervention was further refined using the Delphi method.

In this study, a feasibility study will be carried out in order to assess acceptability and feasibility indicators, including patient compliance, recruitment rate, and participant feedback. Next, the effectiveness of DCISP will be evaluated through a randomized controlled study. Outcome measures include social participation, stroke knowledge, quality of life level of stroke survivors, caregiver burden of spouses, and dyadic coping of survivor-spouse dyads.

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Dynamics of perceived social isolation, secondary conditions, and daily activity patterns among individuals with stroke: A network analysis of ecological momentary assessment data

All of these problems are easily solved by creating EXACT 100% RECOVERY PROTOCOLS! You then don't need to work on these secondary problems! Or do you NOT UNDERSTAND HOW TO SOLVE STROKE?

 Dynamics of perceived social isolation, secondary conditions, and daily activity patterns among individuals with stroke: A network analysis of ecological momentary assessment data

Archives of Physical Medicine and Rehabilitation. Volume 105(7), Pgs. 1314-1321.

NARIC Accession Number: J94136. What's this?
Author(s): Shi, Yun, Fong, Mandy W. M., Metts, Christopher L., LaVela, Sherri L., Bombardier, Charles, Hu, Lu, Wong, Alex W. K..
Publication Year: 2024.
Abstract: Study assessed the dynamic relationships among perceived social isolation (PSI), secondary conditions, and daily activity patterns in 202 individuals with mild-to-moderate chronic stroke. Dynamic network analyses (contemporaneous and temporal) were applied to ecological momentary assessment (EMA) data to investigate the longitudinal relationships among these factors. EMA survey questions measured PSI, secondary conditions (pain, tiredness, stress, anxiety, worthlessness, difficulty concentrating, and cheerfulness), and daily activity patterns (being at home, being alone, and participating in productive activities). The median EMA response rate was 84 percent. Results indicated that PSI was contemporaneously related to all symptoms (fatigue; negative emotions (worthlessness, concentration difficulty, cheerlessness, stress, and anxiety) except pain, and being at home and alone. The temporal model revealed a pathway indicating that feelings of worthlessness predicted PSI, and then PSI predicted stress. After this chain, feeling stressed was followed by a tendency not to be at home. These findings suggest that engaging in out-of-home or outdoor activities may mitigate PSI and negative emotions.
Descriptor Terms: DAILY LIVING, DEPRESSION, EMOTIONS, INTERPERSONAL RELATIONS, MENTAL STRESS, SECONDARY CONDITIONS, SELF CONCEPT, SOCIAL SKILLS, STROKE.


Can this document be ordered through NARIC's document delivery service*?: Request Information.

Citation: Shi, Yun, Fong, Mandy W. M., Metts, Christopher L., LaVela, Sherri L., Bombardier, Charles, Hu, Lu, Wong, Alex W. K.. (2024.) Dynamics of perceived social isolation, secondary conditions, and daily activity patterns among individuals with stroke: A network analysis of ecological momentary assessment data. Archives of Physical Medicine and Rehabilitation., 105(7), Pgs. 1314-1321. Retrieved 9/14/2024, from REHABDATA database.

Finding Positivity Through Adversity in Poststroke Care: Harmony Sierens, MD

 I'm not wasting 4 minutes when this is about acceptance!

The first line of stroke treatment seems to always be "Acceptance" which is fucking bullshit!

Send me hate mail on this: oc1dean@gmail.com. Especially you:Harmony Sierens, MD, 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? I need an explanation of why you are putting out acceptance as your first line instead of recovery?

Finding Positivity Through Adversity in Poststroke Care: Harmony Sierens, MD

The medical director of the Inpatient Rehabilitation Unit at Ascension Genesys Hospital discussed the importance of early intervention, sustained care, and rehabilitation in managing poststroke patients. [WATCH TIME: 4 minutes]

Current Time 1:05

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Duration 4:35

 

"Stroke is common, many people are living with poststroke and have different levels of deficits. I think in stroke, we know early intervention is important, and there's a lot of information out there. There are all these mnemonics that help remember, ‘this could be a stroke, get emergency care, get to the hospital, there's intervention’ and that's wonderful. But I think we don't do a good job of talking about the management(NO, SURVIVORS WANT RECOVERY! DO YOU NOT UNDERSTAND?), poststroke, and how it changes lives and how it changes everybody's life that is involved with a person who's had a stroke.”

Stroke, a widespread disease, greatly impacts the quality of life of an individual, mostly through disability and physical changes, which can bring about different psychological and cognitive processes.¹ Although stroke mortality has declined, research shows that the annual incidence of stroke in the general population is increasing.² As more patients are living poststroke, practicing clinicians practice have the ability to optimize treatment management for their patients to improve outcomes and reduce the risk of other complications of the disease.

According to a review published in the Singapore Medical Journal, researchers recommend that clinicians institute secondary prevention and attention to bowel and bladder problems to reduce medical complications and readmissions.² The researchers also suggested that adequate analgesia, positioning/splinting of limbs, and physiotherapy can also reduce any discomfort and preventable pain in patients.² Stroke clinicians can help patients treat poststroke moods with psychological counseling and can provide additional support for patients by helping them have a more positive outlook on life.

In a recent conversation with NeurologyLive®, Harmony Sierens, MD, a physiatrist and medical director at Ascension Genesys Inpatient Rehab Unit, discussed how society can better address the long-term management and care needs of patients living poststroke(WRONG, WRONG, WRONG!You need to create protocols for 100% recovery. Survivors don't want 'care' and 'management'. They want to get back to their old life! You haven't even defined the problem you need to solve correctly! Talk to me, I can help with that.) She talked about the role that physiatrists play in optimizing rehabilitation for these patients, and how early intervention gaps can be closed. In addition, Sierens spoke about how clinicians can shift the narrative surrounding strokes, from being solely devastating events to opportunities for positive life changes for patients.(So acceptance? I'd scream my head off at any stroke medical person who gives me this crapola!)

ESOC 2024: “Cognition and Vascular Cognitive Impairment”

 Great research but useless for getting survivors recovered! The goal of stroke research is survivor recovery! DO YOU NOT UNDERSTAND?

What do survivors need to do to prevent this cognitive decline? That's the research needed!

ESOC 2024: “Cognition and Vascular Cognitive Impairment”

• Bastien Rioux, MD, MSc @B_Rioux

Originally published May 31, 2024 10.1161/blog.20240531.611984

European Stroke Organisation Conference
May 15–17, 2024

Session: Cognition and Vascular Cognitive Impairment

Seven researchers shared their work during this well-attended session on cognition and vascular cognitive impairment co-chaired by Sandra Billinger (University of Kansas Medical Center, Kansas City, United States) and Aleksandra M. Pavlovic (University of Belgrade, Belgrade, Serbia) at ESOC 2024. In this blog post, I comment on three take-home messages that are relevant to researchers and clinicians in stroke medicine.

Two researchers presented results that support a role for “strategic” white matter lesions in cognition using data from the Meta VCI Map consortium. Floor De Kort (UMC Utrecht, Utrecht, the Netherlands) first presented on the clinical relevance of white matter hyperintensity location in poststroke cognitive function. In this work integrating nine ischemic stroke cohorts and a total of 1,568 patients, De Kort identified certain locations, such as the left anterior thalamic radiation, which have differential associations with cognitive performance. Marvin Petersen (UMC Hamburg-Eppendorf, Hamburg, Germany) next presented a prediction model of cognitive performance using white matter hyperintensity dysconnectivity. In this study, Petersen used lesion network mapping in 3,485 individuals attending a memory clinic to improve the prediction of cognitive performance. Lesion network mapping was performed to quantify dysconnectivity, and Ridge regression was used to predict cognition across four cognitive domains. Lesion network mapping improved prediction of attention, processing speed, and verbal memory (but not language) over other available clinical variables. In summary, these two projects used large data sets of brain imaging and cognitive tests to demonstrate the clinical relevance of the location — and not just raw volume — of white matter lesions.

Marion Buckwalter (Stanford School of Medicine, Stanford, United States) next presented a coherent story on the effect of blocking the VCAM1-VLA4 axis on cognitive decline in a mouse model of infarct-induced neurodegeneration. Buckwalter presented data from a mouse model of infarct-induced neurodegeneration which is associated with lymphocytic infiltrates, blood-brain barrier leakiness, and loss of pericyte coverage. The use of VCAM1 and VLA4 blocking antibodies in this animal model prevented infarct-induced neurodegeneration, reduced blood-brain barrier leakiness, and improved pericyte coverage. These results support the promising role of blocking lymphocyte trafficking across the blood-brain barrier to prevent poststroke cognitive impairment,(Solve this problem, don't just tell us it exists!) and underline the need for additional studies in clinical trials after further exploration in translational studies.

Joanna Wardlaw (Centre for Clinical Brain Sciences, Edinburgh, United Kingdom) finally presented on the incidence, risk factors, and trajectories of cognitive impairment after stroke in the R4VaD study. Wardlaw summarized the R4VaD study, a UK-wide prospective longitudinal observational cohort of patients presenting at hospital stroke services within six weeks of stroke or transient ischemic attack. Participants were assessed through blinded central follow-up for up to two years, and cognition was rated on the Diagnostic and Statistical Manual of Mental Disorders (DSM)-V ordinal cognitive impairment scale. Age, pre-morbid modified Rankin Scale (mRS) score, baseline Montreal Cognitive Assessment (MoCA) score, and hypertension were among the top predictors of cognition at two years. These results are important as they may be used to stratify the risk of cognitive decline(Why aren't you solving this problem? Describing it does nothing.) after stroke in future interventional studies.

Measurement properties of movement smoothness metrics for upper limb reaching movements in people with moderate to severe subacute stroke

 You do realize how fucking useless 'measurements' are to getting survivors recovered?  Or do you not understand what survivors want? They want recovery; not some useless measurement you therapists have to do to get paid.

Measurement properties of movement smoothness metrics for upper limb reaching movements in people with moderate to severe subacute stroke

• Gwenaël Cornec,
• Mathieu Lempereur,
• Johanne Mensah-Gourmel,
• Johanna Robertson,
• Ludovic Miramand,
• Beatrice Medee,
• Soline Bellaiche,
• Raphael Gross,
• Jean-Michel Gracies,
• Olivier Remy-Neris &
• Nicolas Bayle 

Journal of NeuroEngineering and Rehabilitation volume 21, Article number: 90 (2024) Cite this article

• Metrics details

Abstract

Background

Movement smoothness is a potential kinematic biomarker of upper extremity (UE) movement quality and recovery after stroke; however, the measurement properties of available smoothness metrics have been poorly assessed in this group. We aimed to measure the reliability, responsiveness and construct validity of several smoothness metrics.

Methods

This ancillary study of the REM-AVC trial included 31 participants with hemiparesis in the subacute phase of stroke (median time since stroke: 38 days). Assessments performed at inclusion (Day 0, D0) and at the end of a rehabilitation program (Day 30, D30) included the UE Fugl Meyer Assessment (UE-FMA), the Action Research Arm Test (ARAT), and 3D motion analysis of the UE during three reach-to-point movements at a self-selected speed to a target located in front at shoulder height and at 90% of arm length. Four smoothness metrics were computed: a frequency domain smoothness metric, spectral arc length metric (SPARC); and three temporal domain smoothness metrics (TDSM): log dimensionless jerk (LDLJ); number of submovements (nSUB); and normalized average rectified jerk (NARJ).

Results

At D30, large clinical and kinematic improvements were observed. Only SPARC and LDLJ had an excellent reliability (intra-class correlation > 0.9) and a low measurement error (coefficient of variation < 10%). SPARC was responsive to changes in movement straightness (r_Spearman=0.64) and to a lesser extent to changes in movement duration (r_Spearman=0.51) while TDSM were very responsive to changes in movement duration (r_Spearman>0.8) and not to changes in movement straightness (non-significant correlations). Most construct validity hypotheses tested were verified except for TDSM with low correlations with clinical metrics at D0 (r_Spearman<0.5), ensuing low predictive validity with clinical metrics at D30 (non-significant correlations).

Conclusions

Responsiveness and construct validity of TDSM were hindered by movement duration and/or noise-sensitivity. Based on the present results and concordant literature, we recommend using SPARC rather than TDSM in reaching movements of uncontrolled duration in individuals with spastic paresis after stroke.

Trial Registration

NCT01383512, https://clinicaltrials.gov/, June 27, 2011.

Highlights

Reliability, responsiveness and construct validity of SPARC were satisfactory.

Responsiveness and construct validity of LDLJ, NARJ and nSUB were highly related to movement duration.

LDLJ had an excellent reliability and a low measurement error, but not NARJ and nSUB.

Introduction

Spastic paresis of the upper extremity (UE) was reported in 48% of survivors at 1 week after stroke in a community-based population (n = 421), with full UE function achieved at discharge by 79% of those with mild paresis but only 18% of those with severe paresis [1]. Three main symptoms are well described in spastic paresis syndrome [2]: structural alterations relating to immobility (spastic myopathy, leading to muscle contractures) [3, 4], impaired motor control (stretch-sensitive paresis) of the agonist muscles [5, 6], and overactivity of antagonist muscles [7, 8], (including spasticity [8,9,10], spastic dystonia [11] and spastic cocontractions [12,13,14,15]).

Spastic paresis directly alters the movement trajectories and velocity with spatial (poor movement control, less efficient trajectories) and temporal (longer movement duration) discontinuities, resulting in a lack of smoothness [16,17,18]. Changes in the smoothness of the hand trajectory after stroke have been studied during reaching, grasping, and pointing movements [19], and the evaluation of smoothness has been suggested as a valid indicator of the quality of spontaneous motor recovery [20,21,22,23] and rehabilitation-induced recovery [18, 24,25,26].

The assessment of measurement properties of smoothness metrics is needed for the evaluation of changes in the poststroke spastic paretic UE. To date, many metrics have been used to explore movement recovery after stroke [27]. Research involving robotic rehabilitation systems in the last fifteen years has particularly contributed to the development of kinematic metrics, including smoothness, as potential biomarkers for movement recovery [24, 25, 27,28,29]. However, the use of smoothness metrics in clinical research remains limited, as those metrics require particular instrumentation and expertise that might be an obstacle for multicentric studies, are often insufficiently defined mathematically (some are even robot-specific metrics) and validated, and are often non-reproducible, non-dimensionless (i.e. highly relying on movement time), poorly robust against measurement noise, or are not related to the intermittency of movement [19, 27, 30].

New smoothness metrics that attempt to avoid those limitations have been developed and used to assess point-to-reach and point-to-grasp movement in healthy subjects and individuals after stroke [23, 31,32,33], namely the log dimensionless jerk (LDLJ), a smoothness metric conceived in the temporal domain and the spectral arc length metric (SPARC). The SPARC was conceived in the frequency domain by Balasubramanian and colleagues, notably to overcome the bias of movement duration and noise-sensitivity in previously developed smoothness metrics, who tested its content validity and described it as a robust to noise, sensitive, reliable, and practical metric after tests on mathematical models [30, 34].

In an earlier study, we compared the properties of four smoothness metrics currently used in the literature (SPARC, and three temporal domain smoothness metrics (TDSM): LDLJ, number of zero-crossings in the acceleration profile also called number of submovements (nSUB) and normalized average rectified jerk (NARJ)) during UE reaching movements in 32 middle-aged healthy participants [33]. In this setting, the SPARC had the lowest measurement error, and seemed independent of movement duration whereas the TDSM were highly time-dependent. A better understanding of the measurement properties of these metrics is still needed for patients with poststroke UE impairment. An international consensus was reached on the taxonomy, terminology and definitions of measurement properties within the COSMIN initiative (COnsensus-based Standards for the selection of health Measurement INstruments) setting a framework for the present study [35].

This study aimed to assess the measurement properties (reliability, responsiveness and construct validity) of the SPARC and three TDSM (NARJ, LDLJ and nSUB) for point-to-reach movements in people with moderate to severe impairment in the subacute phase of stroke, before and after a rehabilitation program.

Based on our previous work in healthy subjects [33] and literature, we hypothesized that the three TDSM would be more associated with movement duration while the SPARC would be more associated with movement straightness in the present context.

Risk of Recurrent Stroke and Mortality Among Black and White Patients With Poststroke Depression

 FYI. You prevent depression by having 100% recovery protocols. Do you not understand?

Risk of Recurrent Stroke and Mortality Among Black and White Patients With Poststroke Depression

Jack Gomberg,

Laura K. Stein and

Mandip S. Dhamoon

Originally published3 Apr 2024https://doi.org/10.1161/STROKEAHA.123.045743Stroke. 2024;0

Abstract

BACKGROUND:

Poststroke depression (PSD) is a treatable(Well, you wouldn't need to treat it if you had 100% recovery protocols! Solve the correct problem, not the secondary problem! Are you that blitheringly stupid?) and common complication of stroke that is underdiagnosed and undertreated in minority populations. We compared outcomes of Black and White patients with PSD in the United States to assess whether race is independently associated with the risk of recurrent stroke and mortality.

METHODS:

We used deidentified Medicare data from inpatient, outpatient, and subacute nursing facilities for Black and White US patients from January 1, 2016, to December 31, 2019, to perform this retrospective cohort analysis. International Classification of Diseases, Tenth Revision codes were used to identify patients diagnosed with depression within 6 months of index stroke with no depression diagnosis 1-year preceding index stroke. We performed an unadjusted Kaplan-Meier analysis of the cumulative risk of recurrent stroke up to 3 years after index acute ischemic stroke admission and all-cause mortality following acute ischemic stroke stratified by Black and White race. We performed adjusted and reduced Cox regression to calculate hazard ratios for the main predictor of race (Black versus White), for recurrent stroke and all-cause mortality, adjusting for sociodemographic characteristics, comorbidities, characteristics of the hospitalization, and acute stroke interventions.

RESULTS:

Of 474 770 Medicare patients admitted with acute index stroke, 443 486 were categorized as either Black or White race and 35 604 fulfilled our criteria for PSD. Within the PSD cohort, 25 451 (71.5%) had no death or recurrent stroke within 6 months and 5592 (15.7%) had no death or readmission of any cause within 6 months. Black patients with PSD had a persistently elevated cumulative risk of recurrent stroke compared with White patients with PSD up to 3 years following acute ischemic stroke (log-rank P=0.0011). In our reduced multivariable model, Black patients had a 19.8% (hazard ratio, 1.198 [95% CI, 1.022–1.405]; P=0.0259) greater risk of recurrent stroke than White patients. The unadjusted cumulative risk of all-cause mortality was higher in this cohort of older White patients with PSD compared with Black patients; however, this difference disappeared with adjustment for age and other cofactors.

CONCLUSIONS:

Black patients with PSD face a persistently elevated risk of recurrent stroke compared with White patients but a similar risk of all-cause mortality. Our findings support that black race is an independent predictor of recurrent stroke in patients with PSD and highlight the need to address social determinants of health and systemic racism that impact poststroke outcomes among racial minorities.

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