Stroke rehabilitation in coastal Eastern England: a qualitative study of intersectional inequalities

My conclusion is, YOU DON'T UNDERSTAND THE BASIC PROBLEM!

You don't have 100% recovery protocols and AREN'T EVEN WORKING TOWARDS THAT!

 Stroke rehabilitation in coastal Eastern England: aqualitative study of intersectional inequalities

Katie Chadd , Doofan Udendeh , Ahang Kareem , Julia Vlahovic & Reza Majdzadeh To cite this article: Katie Chadd , Doofan Udendeh , Ahang Kareem , Julia Vlahovic & Reza Majdzadeh (28 Apr 2026): Stroke rehabilitation in coastal Eastern England: a qualitative study of intersectional inequalities, Disability and Rehabilitation, DOI: 10.1080/09638288.2026.2659555 To link to this article: https://doi.org/10.1080/09638288.2026.265955

ABSTRACT 

Purpose: Disparities in stroke incidence, outcomes and access to healthcare are increasingly reported—including in relation coastal status—yet a health-systems perspective is rarely applied to examine root causes. This study utilises a health-systems approach to explore how rehabilitation models of care may exacerbate or mitigate health inequalities, in an organisation serving rural and coastal communities in England. 

Methods: A multi-faceted theoretical framework drawing on seminal health-systems concepts was derived, to guide this qualitative study. Focus group discussions with stroke professionals were conducted. Data were analysed thematically, and iteratively, via operationalisation of the theoretical framework. 

Results: Rehabilitation systems exacerbated health inequalities, which was related to unresponsiveness to personal and social determinants, geographical factors and system-level factors. Bottlenecks were identified in accessibility and effective health coverage, which were associated with multiple aspects of a health system, including service delivery, financing, workforce, health information systems and leadership/ governance. Four recurrent intersectional high-risk profiles emerged. 

Conclusion: There are significant, system-derived challenges in the current stroke rehabilitation and life-after-stroke provision in the region studied, which may exacerbate health inequalities for those who are already marginalised by society. Applying an intersectional framework to develop solutions for equality in rehabilitation systems is required. (Equality in failure to recover IS THE HEIGHT OF STUPIDITY! Solve the correct problem! 100% recovery!)

IMPLICATIONS FOR REHABILITATION • In England, stroke rehabilitation is delivered via the publicly funded national health service (NHS) which is mostly free at the point of use for all residents, centring equity. • Stroke rehabilitation systems should be commissioned, designed and implemented according to patient needs and local population characteristics, with explicit attention to the intersections of coastal and socio-economic deprivation and across multiple axes including, transport barriers, cultural and linguistic diversity and disability status across the lifespan. • Improving the quality and collection of patient data is an important step in enabling intersectional analyses for understanding interactions between patient and population characteristics, needs and outcomes which can inform the design of equitable systems. 

Stroke Patients in Post-Acute Stage Had Improved Quality of Life While in Hospital-Based Rehab

But they didn't get to 100% recovery, did they? So you failed them.

Stroke Patients in Post-Acute Stage Had Improved Quality of Life While in Hospital-Based Rehab 

Stroke patients treated in home-based and hospital-based rehabilitation had mean scores of QOL assessment improved significantly after intervention. Though, the hospital-based group had better improvement than the home-based group in mobility, self-care, pain/ discomfort and depression/anxiety.

Hospital-based rehabilitation for stroke patients in the post-acute stage responded with better quality of life (QOL) outcomes than home-based patients, based on findings from a study conducted by researchers of Tainan Chi Mei Medical Center in Taiwan.

Published in the Journal of the Formosan Medical Association in May, researchers sought to examine the satisfaction with life quality in patients that received home-based rehab care and others that received hospital-based care. Researchers were also searching for QOL outcomes and comparing the advantages and disadvantages in the post-acute care (PAC) setting.

The retrospective study took place from January 1, 2019 to June 30, 2021. It consisted of 112 post-acute stroke patients who met the criteria for the PAC program from the southern Taiwan hospital – 39 patients belonged to the home-based group and 73 to the hospital-based group.

Patients met participation criteria for the program if the onset time of stroke was less than one month, were in stable medical condition without any complications within three days from enrolling, had a Modified Rankin Scale (MRS) score of 3-4, and had the potential for functional recovery after their rehabilitation.

The home-based group received rehab for one to two weeks, and two to four sessions per week. The hospital-based group received rehab for three to six weeks, and 15 sessions per week. The home-based group mainly received the training and guidance of daily activities at the patients’ residence. The hospital-based group mainly received physical facilitation and functional training in the hospital setting.

In each group, the mean scores of QOL assessment improved significantly after intervention. Though, the hospital-based group had better improvement than the home-based group in mobility, self-care, pain/ discomfort and depression/anxiety.

The Lawton Brody Instrumental Activity Daily Living scale (IADL) counts were high in the hospitalized group than the homed-based group. The homed-based group only showed some significant improvement in the overall IADL score. The hospitalized group showed significant improvement in housekeeping, ability to handle finances, modes of transportation, and ability to use the telephone.

The reasoning behind these results likely points to home-based rehab’s lower intensity and duration compared to hospital-based rehab. Though, improvements in QOL and the functions of stroke patients can still be reached in home-based care.

Among the hospital-based rehab, there were more and longer treatment sessions. Researchers claim the primary causes for these outcomes are that the patients and their families have more immediate access to medical professional in hospital-based care, receive more guidance in health education, can pursue rehab in higher concentration and at higher intensities, and can arrange an appropriate plan for discharge from the hospital.

Endovascular Treatment Combined With Standard Medical Treatment Improves Outcomes of Posterior Circulation Stroke: A Systematic Review and Meta-Analysis

 If all it did was 'improve outcomes', you're discussing failure. WHAT THE FUCK ARE YOU DOING TO PREVENT THAT FAILURE?

Endovascular Treatment Combined With Standard Medical Treatment Improves Outcomes of Posterior Circulation Stroke: A Systematic Review and Meta-Analysis

Shuju Dong^†, Yanbo Li^†, Jian Guo, Yaxi Luo, Jinghuan Fang, Li Tang and Li He^*

• Department of Neurology, West China Hospital, Sichuan University, Chengdu, China

Aims: Whether endovascular treatment (EVT) can further improve the prognosis of patients with posterior circulation ischemic stroke (PCIS) is unclear. This meta-analysis aims to compare the efficacy and safety of PCIS patients treated with EVT plus standard medical treatment (SMT) and SMT alone.

Methods: We systematically searched for relevant randomized controlled trials (RCTs) and prospective cohort trials in MEDLINE, EMBASE, and the Cochrane Library up to February 2022. The primary outcome was favorable functional outcome of the modified Rankin Scale (mRS) with scores of 0–2 or 0–3; secondary outcomes included successful recanalization rate, intracranial hemorrhage (ICH), or symptomatic intracranial hemorrhage (sICH) after treatment and 90-day mortality.

Results: We identified six studies including 1, 385 PCIS patients (957 with EVT plus SMT; 428 with SMT alone). EVT plus SMT substantially improved 90-day functional outcomes compared with SMT alone [mRS score of 0–2: RR=1.95, 95% CI (1.52 – 2.51), P < 0.001; mRS score of 0–3: RR = 1.85, 95% CI (1.49 – 2.30), P < 0.001, respectively]. Moreover, compared with SMT, combined treatment significantly improved the rate of successful recanalization [RR = 5.03, 95% CI (3.96–6.40), P < 0.001] and reduced 90-day mortality [RR = 0.71, 95% CI (0.63–0.79), P < 0.001] despite a higher risk of ICH [RR = 6.13, 95% CI (2.50–15.02), P < 0.001] and sICH [RR = 10.47, 95% CI [2.79–39.32), P = 0.001].

Conclusion: Low-to-moderate evidence from RCTs and non-RCTs showed that increased ICH and sICH risk of EVT plus SMT did not translate to a higher risk of unfavorable outcomes compared with SMT and could even promote independence at 90 days in a real-world cohort.

Introduction

Posterior circulation ischemic stroke (PCIS) is caused by blood interruption of the vertebrobasilar arterial system and accounts for approximately 20–25% of all ischemic strokes (1). The most common mechanisms responsible for PCIS are embolism (40%), followed by atherosclerosis (32–35%), and other causes of PCIS include dissection, penetrating small-artery diseases, and other identified or unknown etiologies (2). PCIS represents only 1% of all strokes and 5% of large vessel occlusion (LVO) strokes (3, 4). Despite that, PCIS patients with LVO have an extremely poor prognosis, with a 90-day mortality rate of approximately 35–50%, and the majority of deaths (83%) occur in the hospital (5, 6). PCIS patients have higher mortality than anterior circulation stroke (ACS) patients despite successful revascularization (7, 8).

For PCIS patients, successful recanalization is an independent predictor of a good prognosis (9). Although intravenous thrombolysis (IVT) has been shown to be effective and safe, recanalization rates with IVT remain suboptimal in the setting of LVO (10, 11). Evidence in the ACS suggests that endovascular therapy (EVT) can improve recanalization rates or functional outcomes compared with IVT alone (12–14). And application to patients with PCIS patients appears to similarly improve prognosis in these patients (15–17). However, conclusions regarding the benefit of EVT compared with the conservative treatment in improving the clinical outcome of PCIS patients are still unconfirmed.

Several clinical studies (18–24) and subsequent meta-analyses (25) have shown that the benefits of EVT in patients with PCIS are comparable to those in patients with ACS. Similarly, evidence from several recent studies suggested that patients with PCIS treated with EVT may have higher recanalization rates and better outcomes compared to conservative treatment alone (26, 27). In contrast, other studies have shown that PCIS patients receiving EVT have poorer functional outcomes at 90 days, with a mortality rate of 41.9% (28–30).

Although several meta-analyses have attempted to confirm the additional benefit of EVT on basis of SMT in patients with acute BAO (15, 16, 26), the efficacy and safety of EVT in patients with PCIS remain uncertain due to design and methodological flaws (26, 31). Therefore, we aimed to include the latest research evidence to further evaluate the effectiveness and safety of EVT plus standard medical treatment (SMT) over SMT alone in patients with PCIS and to provide more reliable evidence for clinical decision making in PCIS (6, 24, 32, 33).

More at link.

 

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

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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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Plasma Calprotectin Is Predictive for Short-Term Functional Outcomes of Acute Ischemic Stroke

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

 

Plasma Calprotectin Is Predictive for Short-Term Functional Outcomes of Acute Ischemic Stroke

Zicheng Hu¹, Haihua Li¹, Yongping Zhu¹, Jun Zhang¹, Xiao Yang², Rongzhong Huang³, Yongyong Li³, Haitao Ran^4* and Tingting Shang^4*

• ¹Department of Neurology, People's Hospital of Chongqing Hechuan (PHHC), Chongqing, China
• ²Neuroscience Center, General Hospital of Ningxia Medical University, Yinchuan, China
• ³Department of Gerontology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
• ⁴Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China

Background: Blood-based prognostic biomarkers of acute ischemic stroke (AIS) are limiting. Calprotectin is suggested to be involved in directing post-stroke inflammatory conditions. However, the pathological alteration of circulating calprotectin in AIS is yet to be thoroughly elucidated. Therefore, this study aimed to investigate the levels and clinical relevance of calprotectin in AIS.

Methods: This study recruited 271 patients with AIS within 24 h since symptom onset and 145 non-stroke healthy controls (HC) from February 1, 2018, to Dec 31, 2020. Patients were followed up for 2 weeks for observation of functional outcomes, as determined by the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS). Plasma calprotectin concentrations were determined by ELISA.

Results: Plasma calprotectin concentrations were significantly higher in patients with AIS compared with controls [patients vs. control: median (IQR) 54.2 (39.01–99.04) vs. 50.04 (35.42–61.22), p < 0.001]. Besides, patients with poor prognosis, as defined by mRS ≥ 3, had significantly higher calprotectin levels than patients with good prognosis [poor prognosis patients vs. good prognosis patients: median (IQR) 61.99 (47.52–108) vs. 43.36 (33.39–60.2), p < 0.001]. Plasma calprotectin levels were positively associated with the disease severity of AIS, as reflected by infarction volume and NIHSS score at baseline. Furthermore, baseline calprotectin was found to be independently associated with poor prognosis [odds ratio (OR): 1.02, 95% CI: 1.01–1.03] and disease progression (OR: 1.03, 95% CI: 1.02–1.04) of AIS during a 2-week follow-up, with adjustment of possible confounding factors.

Conclusion: Plasma calprotectin is associated with short-term functional outcomes of AIS.

Introduction

Acute ischemic stroke (AIS) is one of the leading causes of mortality and disability worldwide (1). Over the next years, the global AIS burden is expected to increase steadily because of population aging. The pathophysiology of brain ischemia and post-ischemia changes in the brain are not yet fully understood. Inflammation is increasingly recognized as an important element in the pathogenesis of ischemic stroke. Brain ischemia leads to an immediate local inflammatory reaction with activation of microglia, astrocytes, and endothelial cells, as well as the further release of pro-inflammatory cytokines (2). These non-specific alterations post-ischemia could result in blood-brain barrier dysfunction and infiltration of peripheral inflammatory cells and cytokines into the brain, which may further increase tissue injury (3).

A panel of inflammatory molecules are predictive markers of severity and functional outcomes of AIS; such molecules are proposed as potential therapeutic targets in AIS (4). Calprotectin, which is formed by S100A8 and S100A9 heterodimer, plays a pivotal role in promoting inflammation and atherosclerosis progression. Plasma calprotectin is associated with the risk of coronary artery events (5) and peripheral artery diseases (6). Moreover, circulating calprotectin has been demonstrated to be elevated in AIS (7), and inhibition of S100A9 has been found to suppress thrombus formation in experimental models of AIS (8). However, there is limited evidence currently about the predictive effects of calprotectin on short-term functional outcomes of AIS. Therefore, this study aimed to investigate the potential of circulating calprotectin as a short-term prognostic biomarker of AIS.

 More at link.

Video-Game-Based Stroke Therapy is as Effective as In-Person Rehab

So in other more truthful words it is also a complete failure at getting to 100% recovery. Tell the truth when you write titles. 

Video-Game-Based Stroke Therapy is as Effective as In-Person Rehab

After a stroke, patients may lose feeling in an arm or experience weakness and reduced movement that limits their ability to complete basic daily activities.

Traditional rehabilitation therapy is very intensive, time-consuming, and can be both expensive and inconvenient, especially for rural patients travelling long distances to in-person therapy appointments.

That’s why a team of researchers, including one at the University of Missouri, utilized a motion-sensor video game, Recovery Rapids, to allow patients recovering from a stroke to improve their motor skills and affected arm movements at home while checking in periodically with a therapist via telehealth.

The researchers found the game-based therapy led to improved outcomes similar to a highly regarded form of in-person therapy, known as constraint-induced therapy, while only requiring one-fifth of the therapist hours. This approach saves time and money while increasing convenience and safety as telehealth has boomed in popularity during the COVID-19 pandemic.

“As an occupational therapist, I have seen patients from rural areas drive more than an hour to come to an in-person clinic three to four days a week, where the rehab is very intensive, taking three to four hours per session, and the therapist must be there the whole time,” said Rachel Proffitt, assistant professor in the MU School of Health Professions.

“With this new at-home gaming approach, we are cutting costs for the patient and reducing time for the therapist while still improving convenience and overall health outcomes, so it’s a win-win. By saving time for the therapists, we can also now serve more patients and make a broader impact on our communities.”

MORE: Coffee and Tea Drinking May be Associated With Reduced Rates of Stroke and Dementia

Traditional rehab home exercises tend to be very repetitive and monotonous, and patients rarely adhere to them. The Recovery Rapids game helps patients look forward to rehabilitation by completing various challenges in a fun, interactive environment, and the researchers found that the patients adhered well to their prescribed exercises.

“The patient is virtually placed in a kayak, and as they go down the river, they perform arm motions simulating paddling, rowing, scooping up trash, swaying from side to side to steer, and reaching overhead to clear out spider webs and bats, so it’s making the exercises fun,” Proffitt said. “As they progress, the challenges get harder, and we conduct check-ins with the participants via telehealth to adjust goals, provide feedback and discuss the daily activities they want to resume as they improve.”

Nearly 800,000 Americans have a stroke each year according to the CDC, and two-thirds of stroke survivors report they cannot use their affected limbs to do normal daily activities, including making a cup of coffee, cooking a meal or playing with one’s grandchildren.

RELATED: In Learning to Use Her Left Hand Following a Stroke 60-Year Old Chen Lie Discovers She’s an Expert Painter

“I am passionate about helping patients get back to all the activities they love to do in their daily life,” Proffitt said. “Anything we can do as therapists to help in a creative way while saving time and money is the ultimate goal.”

This research was recently published in eClinicalMedicine, an open-access journal from The Lancet.

Source: University of Missouri

 

Brain–Computer Interface Training Based on Brain Activity Can Induce Motor Recovery in Patients With Stroke: A Meta-Analysis

Where did this irrational belief come from that writing in a journal will induce doctors and hospitals to create and bring in such therapy? Haven't you heard of resistance to change? Keep the status quo even though it is a complete failure at getting survivors recovered?

Brain–Computer Interface Training Based on Brain Activity Can Induce Motor Recovery in Patients With Stroke: A Meta-Analysis

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Ippei Nojima, PT, PhD, Hisato Sugata, PT, PhD, Hiroki Takeuchi, MD, PhD, ...

First Published December 27, 2021 Review Article Find in PubMed 

https://doi.org/10.1177/15459683211062895

Article information

Abstract

Background

Brain–computer interface (BCI) is a procedure involving brain activity in which neural status is provided to the participants for self-regulation. The current review aims to evaluate the effect sizes of clinical studies investigating the use of BCI-based rehabilitation interventions in restoring upper extremity function and effective methods to detect brain activity for motor recovery.

Methods

A computerized search of MEDLINE, CENTRAL, Web of Science, and PEDro was performed to identify relevant articles. We selected clinical trials that used BCI-based training for post-stroke patients and provided motor assessment scores before and after the intervention. The pooled standardized mean differences of BCI-based training were calculated using the random-effects model.

Results

We initially identified 655 potentially relevant articles; finally, 16 articles fulfilled the inclusion criteria, involving 382 participants. A significant effect of neurofeedback intervention for the paretic upper limb was observed (standardized mean difference = .48, [.16-.80], P = .006). However, the effect estimates were moderately heterogeneous among the studies (I² = 45%, P = .03). Subgroup analysis of the method of measurement of brain activity indicated the effectiveness of the algorithm focusing on sensorimotor rhythm.

Conclusion

This meta-analysis suggested that BCI-based training was superior to conventional interventions for motor recovery of the upper limbs in patients with stroke. However, the results are not conclusive because of a high risk of bias and a large degree of heterogeneity due to the differences in the BCI interventions and the participants; therefore, further studies involving larger cohorts are required to confirm these results.

Keywords

Brain–computer interface, stroke, brain activity, motor function

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Multimodal Imaging Biomarker-Based Model Using Stratification Strategies for Predicting Upper Extremity Motor Recovery in Severe Stroke Patients

 And you really think predicting failure to recover is of ANY FUCKING USE AT ALL TO SURVIVORS? Do you have any usable brain cells at all?

 

Multimodal Imaging Biomarker-Based Model Using Stratification Strategies for Predicting Upper Extremity Motor Recovery in Severe Stroke Patients

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Jungsoo Lee, PhD, Heegoo Kim, BS, Jinuk Kim, MS, ...

First Published December 31, 2021 Research Article 

https://doi.org/10.1177/15459683211070278

Article information

Abstract

Background. 

 Various prognostic biomarkers for upper extremity (UE) motor recovery after stroke have been reported. However, most have relatively low predictive accuracy in severe stroke patients.

Objective. 

This study suggests an imaging biomarker-based model for effectively predicting UE recovery in severe stroke patients.

Methods. 

 Of 104 ischemic stroke patients screened, 42 with severe motor impairment were included. All patients underwent structural, diffusion, and functional magnetic resonance imaging at 2 weeks and underwent motor function assessments at 2 weeks and 3 months after stroke onset. According to motor function recovery at 3 months, patients were divided into good and poor subgroups. The value of multimodal imaging biomarkers of lesion load, lesion volume, white matter integrity, and cortical functional connectivity for motor recovery prediction was investigated in each subgroup.

Results. 

Imaging biomarkers varied depending on recovery pattern. The integrity of the cerebellar tract (P = .005, R² = .432) was the primary biomarker in the good recovery group. In contrast, the sensory-related corpus callosum tract (P = .026, R² = .332) and sensory-related functional connectivity (P = .001, R² = .531) were primary biomarkers in the poor recovery group. A prediction model was proposed by applying each biomarker in the subgroup to patients with different motor evoked potential responses (P < .001, R² = .853, root mean square error = 5.28).

Conclusions. 

 Our results suggest an optimized imaging biomarker model for predicting UE motor recovery after stroke. This model can contribute to individualized management of severe stroke in a clinical setting.

Keywords

stroke, recovery, multimodal imaging, prediction

Introduction

Understanding the recovery mechanisms and predicting recovery patterns are important for establishing individually tailored rehabilitation strategies and allowing patients to set realistic goals in clinics.¹ Previous studies have reported diverse prognostic factors related to upper extremity (UE) recovery, such as injury of the corticospinal tract (CST).^1,2 A previous neuroimaging study used CST lesion load, which measures damage to the CST, to predict UE motor recovery after events including severe stroke.³ However, the predictive accuracy of CST lesion load tended to decline when applied in severe stroke patients.³ Another factor with prognostic value for motor recovery is motor evoked potential (MEP). The positive predictive value for MEP status is high, but the negative predictive value is low.¹ Because patients with severe motor impairments have a higher rate of negative MEP response, predicting UE motor recovery in these patients is challenging.

Therefore, there is a need among clinicians and investigators to identify novel neuroimaging biomarkers with better recovery prediction of UE motor function among patients with severe stroke. Multimodal neuroimaging data such as magnetic resonance imaging (MRI) images have been useful for predicting motor recovery of severe stroke patients.¹ Considering that severe stroke patients exhibit a large degree of inter-individual variability in functional recovery,⁴ it is conceivable that different neuroimaging biomarkers contribute to good or poor recovery. Various imaging biomarkers have been reported. In anatomical imaging, the CST lesion load is a representative biomarker, as mentioned above, and lesion volume is a well-known biomarker even though it is not the most predictive.⁵ In diffusion tensor imaging (DTI), the integrity of the CST or partial regions of the CST is a predictive neuroimaging biomarker with the greatest consensus among experts.⁶ Also, the integrity of the cortico-cerebellar tract and that of the corpus callosum are worth noting as predictive biomarkers.^7-9 The cerebellum is connected densely to motor areas and is involved in motor learning and control.^10,11 The corpus callosum is the largest white matter structure that plays an important role in the transfer of motor and sensory information.¹² In resting-state functional magnetic resonance imaging (rs-fMRI), interhemispheric connectivity is related to prediction of motor outcomes.^13-16 Disruption of interhemispheric connectivity is the most noticeable characteristic and a good indicator of bihemispheric imbalance after stroke.^14,17 We hypothesized that there are distinct neuroimaging biomarkers predicting good and poor recovery. We examined neuroimaging biomarkers in patients who showed good or poor recovery, and these biomarkers were applied to patients with a positive or negative response to MEP.^18,19 Then, we examined whether certain neuroimaging biomarkers could improve the predictive accuracy of UE motor recovery compared to previously established neuroimaging biomarkers and MEP response alone.

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Posterior National Institutes of Health Stroke Scale Improves Prognostic Accuracy in Posterior Circulation Stroke

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

Posterior National Institutes of Health Stroke Scale Improves Prognostic Accuracy in Posterior Circulation Stroke

Fana Alemseged

,

Alessandro Rocco

,

Francesco Arba

,

Jaroslava Paulasova Schwabova

,

Teddy Wu

,

Leone Cavicchia

,

Felix Ng

,

Jo Lyn Ng

,

Henry Zhao

,

Cameron Williams

,

Fabrizio Sallustio

, … See all authors

and on behalf of the Basilar Artery Treatment and Management (BATMAN) Collaboration Investigators

Originally published15 Dec 2021https://doi.org/10.1161/STROKEAHA.120.034019Stroke. 2021;0:STROKEAHA.120.034019

Abstract

Background and Purpose:

The National Institutes of Health Stroke Scale (NIHSS) underestimates clinical severity in posterior circulation stroke and patients presenting with low NIHSS may be considered ineligible for reperfusion therapies. This study aimed to develop a modified version of the NIHSS, the Posterior NIHSS (POST-NIHSS), to improve NIHSS prognostic accuracy for posterior circulation stroke patients with mild-moderate symptoms.

Methods:

Clinical data of consecutive posterior circulation stroke patients with mild-moderate symptoms (NIHSS <10), who were conservatively managed, were retrospectively analyzed from the Basilar Artery Treatment and Management registry. Clinical features were assessed within 24 hours of symptom onset; dysphagia was assessed by a speech therapist within 48 hours of symptom onset. Random forest classification algorithm and constrained optimization were used to develop the POST-NIHSS in the derivation cohort. The POST-NIHSS was then validated in a prospective cohort. Poor outcome was defined as modified Rankin Scale score ≥3 at 3 months.

Results:

We included 202 patients (mean [SD] age 63 [14] years, median NIHSS 3 [interquartile range, 1–5]) in the derivation cohort and 65 patients (mean [SD] age 63 [16] years, median NIHSS 2 [interquartile range, 1–4]) in the validation cohort. In the derivation cohort, age, NIHSS, abnormal cough, dysphagia and gait/truncal ataxia were ranked as the most important predictors of functional outcome. POST-NIHSS was calculated by adding 5 points for abnormal cough, 4 points for dysphagia, and 3 points for gait/truncal ataxia to the baseline NIHSS. In receiver operating characteristic analysis adjusted for age, POST-NIHSS area under receiver operating characteristic curve was 0.80 (95% CI, 0.73–0.87) versus NIHSS area under receiver operating characteristic curve, 0.73 (95% CI, 0.64–0.83), P=0.03. In the validation cohort, POST-NIHSS area under receiver operating characteristic curve was 0.82 (95% CI, 0.69–0.94) versus NIHSS area under receiver operating characteristic curve 0.73 (95% CI, 0.58–0.87), P=0.04.

Conclusions:

POST-NIHSS showed higher prognostic accuracy than NIHSS and may be useful to identify posterior circulation stroke patients with NIHSS <10 at higher risk of poor outcome.

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Machine Learning for Predicting Motor Improvement After Acute Subcortical Infarction Using Baseline Whole Brain Volumes

Will you please think! What the fuck good does predicting failure to recover do for survivors?

Machine Learning for Predicting Motor Improvement After Acute Subcortical Infarction Using Baseline Whole Brain Volumes

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Gang Liu, MD PhD*, Jiewei Wu, MS*, Chao Dang, MD PhD, ...

First Published November 1, 2021 Research Article Find in PubMed 

https://doi.org/10.1177/15459683211054178

Article information

Abstract

Background. 

Neuroimaging biomarkers are valuable predictors of motor improvement after stroke, but there is a gap between published evidence and clinical usage.  

Objective. 

In this work, we aimed to investigate whether machine learning techniques, when applied to a combination of baseline whole brain volumes and clinical data, can accurately predict individual motor outcome after stroke.  

Methods. Upper extremity Fugl-Meyer Assessments (FMA-UE) were conducted 1 week and 12 weeks, and structural MRI was performed 1 week, after onset in 56 patients with subcortical infarction. Proportional recovery model residuals were employed to assign patients to proportional and poor recovery groups (34 vs 22). A sophisticated machine learning scheme, consisting of conditional infomax feature extraction, synthetic minority over-sampling technique for nominal and continuous, and bagging classification, was employed to predict motor outcomes, with the input features being a combination of baseline whole brain volumes and clinical data (FMA-UE scores).  

Results. 

The proposed machine learning scheme yielded an overall balanced accuracy of 87.71% in predicting proportional vs poor recovery outcomes, a sensitivity of 93.77% in correctly identifying poor recovery outcomes, and a ROC AUC of 89.74%. Compared with only using clinical data, adding whole brain volumes can significantly improve the classification performance, especially in terms of the overall balanced accuracy (from 80.88% to 87.71%) and the sensitivity (from 92.23% to 93.77%).  

Conclusions. 

Experimental results suggest that a combination of baseline whole brain volumes and clinical data, when equipped with appropriate machine learning techniques, may provide valuable information for personalized rehabilitation planning after subcortical infarction.

Keywords

acute subcortical infarction, machine learning, T1-weighted image, whole brain volume, clinical data

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