Stroke Lesion Volume and Injury to Motor Cortex Output Determines Extent of Contralesional Motor Cortex Reorganization

 This has nothing useful for stroke recovery. I'd fire everyone involved. Where the fuck is stroke leadership directing the strategy to solve stroke to 100% recovery?

Stroke Lesion Volume and Injury to Motor Cortex Output Determines Extent of Contralesional Motor Cortex Reorganization

Cathrin M. Buetefisch, MD, PhD https://orcid.org/0000-0001-6473-7800 cathrin.buetefisch@emory.edu, Marc W. Haut, PhD https://orcid.org/0000-0003-0235-362X, […], and Kirk Easley, PhD https://orcid.org/0000-0003-4419-2617+7View all authors and affiliations

Volume 37, Issue 2-3

https://doi.org/10.1177/15459683231152816

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Abstract

Background

After stroke, increases in contralesional primary motor cortex (M1_CL) activity and excitability have been reported. In pre-clinical studies, M1_CL reorganization is related to the extent of ipsilesional M1 (M1_IL) injury, but this has yet to be tested clinically.

Objectives

We tested the hypothesis that the extent of damage to the ipsilesional M1 and/or its corticospinal tract (CST) determines the magnitude of M1_CL reorganization and its relationship to affected hand function in humans recovering from stroke.

Methods

Thirty-five participants with a single subacute ischemic stroke affecting M1 or CST and hand paresis underwent MRI scans of the brain to measure lesion volume and CST lesion load. Transcranial magnetic stimulation (TMS) of M1_IL was used to determine the presence of an electromyographic response (motor evoked potential (MEP+ and MEP−)). M1_CL reorganization was determined by TMS applied to M1_CL at increasing intensities. Hand function was quantified with the Jebsen Taylor Hand Function Test.

Results

The extent of M1_CL reorganization was related to greater lesion volume in the MEP− group, but not in the MEP+ group. Greater M1_CL reorganization was associated with more impaired hand function in MEP− but not MEP+ participants. Absence of an MEP (MEP−), larger lesion volumes and higher lesion loads in CST, particularly in CST fibers originating in M1 were associated with greater impairment of hand function.

Conclusions

In the subacute post-stroke period, stroke volume and M1_IL output determine the extent of M1_CL reorganization and its relationship to affected hand function, consistent with pre-clinical evidence.

ClinicalTrials.gov Identifier: NCT02544503

Stroke Prognostication Obeys the Same Rules as Real Estate Location, Location, Location!

Will you please just stop with the useless prognostication and just give us EXACT REHAB PROTOCOLS  for each location. I know you thought this was a cute way to get published but I'd fire your ass for  not doing one damn thing here to solve stroke!

Stroke Prognostication Obeys the Same Rules as Real Estate Location, Location, Location!

View ORCID ProfileAdrien Guenego, View ORCID ProfileRobert Fahed

First published January 31, 2022, DOI: https://doi.org/10.1212/WNL.0000000000200168

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In patients with acute ischemic stroke (AIS) with large vessel occlusion (LVO), baseline ischemic core extent is one of the main criteria needed before a decision is made for mechanical thrombectomy (MT).¹ The measurement method and the thresholds depend on the time from symptom onset. According to the selection criteria used in most positive MT trials within 6 to 12 hours after onset,² it is currently recommended to offer MT to patients with stroke within 6 hours from onset if their Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is ≥6.¹ More recent trials for patients with stroke with an unknown onset or a late onset (i.e., >6 hours) have also shown benefits of MT if the core infarct volume was below a certain threshold.^3,4 Both of these algorithms imply that, ischemic lesions being irreversible, the initial infarct core can only remain the same or grow bigger, and a large initial infarct can only lead to a final infarct that will be at least as large. Final infarct volume is ultimately what shows the extent of brain lesions, and its size has been shown to be correlated with the clinical outcome.⁵

 

Robot-assisted gait training for balance and lower extremity function in patients with infratentorial stroke: a single-blinded randomized controlled trial

Did your doctor even tell you where your stroke was located? And show you a 3d picture of it? Mine didn't even tell me I had a stroke, I had a CVA. With no objective description or location of the damage area your doctor can never prescribe appropriate protocols that will address such damage. Yes I know this doesn't exist today, and until it does stroke rehab will stay in the dark ages. Which is why full recovery from stroke is only 10% rather than the expected 100%.  I expect a lot from our stroke doctors and as of right now they are complete failures.  That comment should get me flamed by thousands of doctors. I look forward to their justification for only getting 10% of survivors fully recovered.

In anatomy, the infratentorial region of the brain is the area located below the tentorium cerebelli. The area of the brain above the tentorium cerebelli is the supratentorial region. The infratentorial region contains the cerebellum, while the supratentorial region contains the cerebrum.

Robot-assisted gait training for balance and lower extremity function in patients with infratentorial stroke: a single-blinded randomized controlled trial

• Ha Yeon Kim,
• Joon-Ho Shin,
• Sung Phil Yang,
• Min A. Shin &
• Stephanie Hyeyoung Lee 

Journal of NeuroEngineering and Rehabilitation volume 16, Article number: 99 (2019) | Download Citation

Abstract

Background

Balance impairments are common in patients with infratentorial stroke. Although robot-assisted gait training (RAGT) exerts positive effects on balance among patients with stroke, it remains unclear whether such training is superior to conventional physical therapy (CPT). Therefore, we aimed to investigate the effects of RAGT combined with CPT and compared them with the effects of CPT only on balance and lower extremity function among survivors of infratentorial stroke.(You'll have to ask your doctor what robot-assisted gait training is and whether your hospital has it.)

Methods

This study was a single-blinded, randomized controlled trial with a crossover design conducted at a single rehabilitation hospital. Patients (n = 19; 16 men, three women; mean age: 47.4 ± 11.6 years) with infratentorial stroke were randomly allocated to either group A (4 weeks of RAGT+CPT, followed by 4 weeks of CPT+CPT) or group B (4 weeks of CPT+CPT followed by 4 weeks of RAGT+CPT). Changes in dynamic and static balance as indicated by Berg Balance Scale scores were regarded as the primary outcome measure. Outcome measures were evaluated for each participant at baseline and after each 4-week intervention period.

Results

No significant differences in outcome-related variables were observed between group A and B at baseline. In addition, no significant time-by-group interactions were observed for any variables, indicating that intervention order had no effect on lower extremity function or balance. Significantly greater improvements in secondary functional outcomes such as lower extremity Fugl-Meyer assessment (FMA-LE) and scale for the assessment and rating of ataxia (SARA) were observed following the RAGT+CPT intervention than following the CPT+CPT intervention.

Conclusion

RAGT produces clinically significant improvements in balance and lower extremity function in individuals with infratentorial stroke. Thus, RAGT may be useful for patients with balance impairments secondary to other pathologies.

Trial registration

ClinicalTrials.gov Identifier NCT02680691. Registered 09 February 2016; retrospectively registered.

Impact of infarct location on functional outcome following endovascular therapy for stroke

You mean we might finally get infarct location mapped to functional disability? And that could mean objective damage diagnosis rather than the subjective crapola of the Rankin scale.  Progress might finally be made.  

Impact of infarct location on functional outcome following endovascular therapy for stroke

1. Charlotte Rosso1,2,
2. Raphael Blanc3,
3. Julien Ly1,2,
4. Yves Samson1,2,
5. Stéphane Lehéricy1,4,
6. Benjamin Gory5,
7. Gautier Marnat6,
8. Mikael Mazighi3,
9. Arturo Consoli7,
10. Julien Labreuche8,
11. Suzana Saleme9,
12. Vincent Costalat10,
13. Serge Bracard5,
14. Hubert Desal11,
15. Michel Piotin3,
16. Bertrand Lapergue7
17. on behalf of the ASTER Trial and Pitié-Salpêtrière Investigators

Author affiliations

Abstract

Objectives The relationship between stroke topography (ie, the regions damaged by the infarct) and functional outcome can aid clinicians in their decision-making at the acute and later stages. However, the side (left or right) of the stroke may also influence the identification of clinically relevant regions. We sought to determine which brain regions are associated with good functional outcome at 3 months in patients with left-sided and right-sided stroke treated by endovascular treatment using the diffusion-weighted imaging-Alberta Stroke Program Early CT Score (DWI-ASPECTS).

Methods Patients with ischaemic stroke (n = 405) were included from the ASTER trial and Pitié-Salpêtrière registry. Blinded readers rated ASPECTS on day 1 DWI. Stepwise logistic regression analyses were performed to identify the regions related to 3-month outcome in left (n = 190) and right (n = 215) sided strokes with the modified Rankin scale (0–2) as a binary independent variable and with the 10 regions-of-interest of the DWI-ASPECTS as independent variables.

Results Median National Institute of Health Stroke Scale (NIHSS) at baseline was 17 (IQR: 12–20), median age was 70 years (IQR: 58–80) and median day-one NIHSS 9 (IQR: 4–18). Not all brain regions have the same weight in predicting good outcome at 3 months; moreover, these regions depend on the affected hemisphere. In left-sided strokes, the multivariate analysis revealed that preservation of the caudate nucleus, the internal capsule and the cortical M5 region were independent predictors of good outcome. In right-sided strokes, the cortical M3 and M6 regions were found to be clinically relevant.

Conclusion Cortical non-motors areas related to outcome differed between left-sided and right-sided strokes. This difference might reflect the specialisation of the dominant and non-dominant hemispheres for language and attention, respectively. These results may influence decision-making at the acute and later stages.

Trial registration number NCT02523261.

http://dx.doi.org/10.1136/jnnp-2018-318869

Impaired Callosal Motor Fiber Integrity and Upper Extremity Motor Impairment Are Associated With Stroke Lesion Location

Oh god, another problem description, NO SOLUTION though. You're all fired!

Impaired Callosal Motor Fiber Integrity and Upper Extremity Motor Impairment Are Associated With Stroke Lesion Location

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Chia-Lin Koh, PhD, Pei-Fang Tang, PhD, Hsiu-I Chen, PhD, , , ...

First Published July 18, 2018 Research Article

Article information

Abstract

Background. Damage to the callosal motor fibers (CMFs) may affect motor recovery in patients with stroke. However, whether the severity of CMF impairment varies with lesion locations remains unclear.  
Objective. To investigate (1) whether CMF impairment occurs after stroke and whether the impairment varies with lesion locations and (2) the associations of CMF impairment and upper extremity (UE) motor impairment.  
Methods. Twenty-nine patients with lesions involving the corticospinal tract (CST) were categorized into 2 groups: lesions involving the CMFs (CMF group, n = 15), and lesions not involving the CMFs (non-CMF group, n = 14). Thirteen healthy adults served as the control group. Tract integrity, assessed by the mean generalized fractional anisotropy (mGFA) using diffusion spectrum imaging, of the CMFs and the CST above the internal capsule (CST_ABOVE) of the ipsilesional hemisphere were compared.  
Results. After accounting for the effect of lesion load on the CST, the CMF group exhibited a significantly lower mGFA of the CMFs than did the control and non-CMF groups (post hoc P = .005 and .001, respectively). No significant difference was observed between the non-CMF and control groups (post hoc P = .999). The CST and CMF impairment accounted for 56% of the variance of UE motor impairment in the CMF group (P = .007), whereas no significant association was observed in the non-CMF group (P = .570).  
Conclusions. CMF impairment after stroke depends on lesion locations and CMF integrity has an incremental contribution to the severity of UE motor impairment in the CMF group.

3D model showcasing the anatomy and functional aspects of the brain.

At a minimum your doctor should show you the exact location and size of your stroke. 
https://www.facebook.com/NeuroNewsResearch/videos/1684974291521322/

Size Doesn’t Matter: Cortical Stroke Lesion Volume is Not Associated with Upper Extremity Motor Impairment and Function in Mild, Chronic, Hemiparesis

My god, why the hell would volume have much to do with impairment of upper extremity? It is location, location, location. Waste of research dollars and time. 

Size Doesn’t Matter: Cortical Stroke Lesion Volume is Not Associated with Upper Extremity Motor Impairment and Function in Mild, Chronic, Hemiparesis

Stephen J. Page, Ph.D., M.S., M.O.T., OTR/L, F.A.H.A., Lynne Gauthier, Ph.D., and Susan White, Ph.D.

Author information ► Copyright and License information ►

The publisher's final edited version of this article is available at Arch Phys Med Rehabil

See other articles in PMC that cite the published article.

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Abstract

Objective

To determine: (a) the relationship between lesion volume and upper extremity (UE) motor impairment using the UE section of the Fugl-Meyer (FM); and (b) the relationship between lesion volume and UE functional outcomes using the Arm Motor Ability Test (AMAT) Functional Ability (FA) and Time scales.

Design

Secondary, retrospective analysis of randomized controlled trial data

Setting

Not applicable

Participants

139 subjects with chronic stroke (83 males; mean age of all subjects = 56.7 ± 11.2 years; mean time since stroke onset = 59.6 ± 65.6 months; 90 subjects with right hemiparesis) and stable, active, distal UE movement.

Intervention

Data were collected related to subjects’ lesion volum and UE movement prior to their participation in a multicenter randomized controlled trial.

Main Outcome Measures

The FM and the AMAT.

Results

Neither age nor lesion volume was related to FM performance. The p-value for the regression coefficient of lesion volume was 0.045 in the AMAT FA model and 0.016 in the AMAT Time model. Lesion volume accounted for only an additional 1.7% (AMAT FA) to 3.1% (AMAT Time) of the variability in motor function, and was not clinically meaningful.

Conclusions

Data suggest no relationship between lesion volume and UE impairment, and a small, clinically insignificant relationship between lesion volume and UE motor function. Stroke affects metabolic changes in intact regions, and causes diffuse structural loss in anatomically remote regions from the infarction. These other factors may account for variance in motor outcomes following stroke.

Stroke Lesions in a Large Upper Limb Rehabilitation Trial Cohort Rarely Match Lesions in Common Preclinical Models

Only 86 references of which I'm sure your doctor has not read a single one.  No clue what use this will be in your stroke rehab protocols.

http://journals.sagepub.com/doi/abs/10.1177/1545968316688799

Show all authors

Matthew A. Edwardson, MD, Ximing Wang, MS, Brent Liu, PhD, Li Ding, MD, Christianne J. Lane, PhD, Caron Park, MS, Monica A. Nelsen, Theresa A. Jones, PhD, Steven L. Wolf, PhD, Carolee J. Winstein, PhD, Alexander W. Dromerick, MD

First Published January 1, 2017 research-article

Abstract

Background. Stroke patients with mild-moderate upper extremity motor impairments and minimal sensory and cognitive deficits provide a useful model to study recovery and improve rehabilitation. Laboratory-based investigators use lesioning techniques for similar goals.  
Objective. To determine whether stroke lesions in an upper extremity rehabilitation trial cohort match lesions from the preclinical stroke recovery models used to drive translational research. Methods. Clinical neuroimages from 297 participants enrolled in the Interdisciplinary Comprehensive Arm Rehabilitation Evaluation (ICARE) study were reviewed. Images were characterized based on lesion type (ischemic or hemorrhagic), volume, vascular territory, depth (cortical gray matter, cortical white matter, subcortical), old strokes, and leukoaraiosis. Lesions were compared with those of preclinical stroke models commonly used to study upper limb recovery. Results. Among the ischemic stroke participants, median infarct volume was 1.8 mL, with most lesions confined to subcortical structures (61%) including the anterior choroidal artery territory (30%) and the pons (23%). Of ICARE participants, <1% had lesions resembling proximal middle cerebral artery or surface vessel occlusion models. Preclinical models of subcortical white matter injury best resembled the ICARE population (33%). Intracranial hemorrhage participants had small (median 12.5 mL) lesions that best matched the capsular hematoma preclinical model.  
Conclusions. ICARE subjects are not representative of all stroke patients, but they represent a clinically and scientifically important subgroup. Compared with lesions in general stroke populations and widely studied animal models of recovery, ICARE participants had smaller, more subcortically based strokes. Improved preclinical-clinical translational efforts may require better alignment of lesions between preclinical and human stroke recovery models.

Association between Severe Upper Limb Spasticity and Brain Lesion Location in Stroke Patients

Wow, trying to find cause and effect, must be a first for our stroke researchers. Only 30% get spasticity. A  wonderful research question; 'What is the common cause for that group to get spasticity?' But we'll never know because we have fucking failures of stroke associations. And NO stroke leadership or strategy.

Association between Severe Upper Limb Spasticity and Brain Lesion Location in Stroke Patients

Alessandro Picelli,1 Stefano Tamburin,2 Francesca Gajofatto,1 Giampietro Zanette,3 Marialuigia Praitano,3 Leopold Saltuari,4,5 Claudio Corradini,5,6 and Nicola Smania1,7

1Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurological and Movement Sciences, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy
2Neurology Section, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
3Neurology Unit, Pederzoli Hospital, Peschiera del Garda, Italy
4Department of Neurology, Hochzirl Hospital, Zirl, Austria
5Research Unit of Neurorehabilitation, South Tyrol, Bolzano, Italy
6Department of Rehabilitation, Brunico Hospital, Brunico, Italy
7Neurorehabilitation Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy

Received 10 April 2014; Revised 12 May 2014; Accepted 12 May 2014; Published 25 May 2014

Academic Editor: Lucio Marinelli

Copyright © 2014 Alessandro Picelli et al. 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

Association between the site of brain injury and poststroke spasticity is poorly understood. The present study investigated whether lesion analysis could document brain regions associated with the development of severe upper limb poststroke spasticity. A retrospective analysis was conducted on 39 chronic stroke patients. Spasticity was assessed at the affected upper limb with the modified Ashworth scale (shoulder, elbow, wrist, and fingers). Brain lesions were traced from magnetic resonance imaging performed within the first 7 days after stroke and region of interest images were generated. The association between severe upper limb spasticity (modified Ashworth scale ≥2) and lesion location was determined with the voxel-based lesion-symptom mapping method implemented in MRIcro software. Colored maps representing the statistics were generated and overlaid onto the automated anatomical labeling and the Johns Hopkins University white matter templates provided with MRIcron. Thalamic nuclei were identified with the Talairach Daemon software. Injuries to the insula, the thalamus, the basal ganglia, and white matter tracts (internal capsule, corona radiata, external capsule, and superior longitudinal fasciculus) were significantly associated with severe upper limb poststroke spasticity. Further advances in our understanding of the neural correlates of spasticity may lead to early targeted rehabilitation when key regions are damaged.

Upright activity within the first week after stroke is associated with better functional outcome and health-related quality of life: A Norwegian multi-site study

Impossible to tell if this is a valid conclusion at all. Nothing mentioned about what the objective damage diagnosis was - location and size.  If you can get patients out of bed early then they probably had a less damaging stroke. Damn these people don't understand cause and effect at all. 

Upright activity within the first week after stroke is associated with better functional outcome and health-related quality of life: A Norwegian multi-site study

Hokstad A¹, Indredavik B, Bernhardt J, Langhammer B, Gunnes M, Lundemo C, Bovim MR, Askim T.

Author information

Abstract

OBJECTIVE:

To assess the amount of early upright activity of patients managed in Norwegian stroke units and its association with functional outcome and health-related quality of life 3 months later.

DESIGN:

A prospective observational multi-centre study.

SUBJECTS:

A total of 390 acute stroke patients, mean age 76.8 years, 48.1% men, less than14 days post-stroke, recruited from 11 Norwegian stroke units.

METHODS:

Time spent in different activity categories (in bed, sitting out of bed, upright) was observed with a standard method. Outcome was assessed by modified Rankin Scale (mRS), and health-related quality of life by EuroQol-5 Dimension 5 level (EQ-5D-5L) 3 months later. Ordinal logistic and linear regression analyses were used to examine the association between activity categories and mRS and EQ-5D-5L, respectively. Age, National Institute of Health Stroke Scale (NIHSS) score, premorbid mRS, sex, and hospital-site were added as covariates.

RESULTS:

The odds ratio (OR) (95% confidence interval (CI)) for poorer functional outcome (higher mRS) decreased as time spent in upright activities increased (OR 0.97 (95% CI 0.94-1.00)). There was also a significant positive association between time in upright activity and higher EQ-5D-5L, Beta 0.184 (95% CI 0.001- 0.008) 3 months later.

CONCLUSION:

This study confirms the beneficial effect of upright activity applied during hospital stay in Norwegian stroke units.

Getting out of the hospital bed for short periods soon after stroke has the potential to improve outcomes

Impossible to tell if this is a valid conclusion at all. Nothing mentioned about what the objective damage diagnosis was - location and size.  If you can get patients out of bed early then they probably had a less damaging stroke. Damn these people don't understand cause and effect at all.
http://www.alphagalileo.org/ViewItem.aspx?ItemId=160926&CultureCode=en
In their aim to provide a guideline for healthcare providers about the timing, frequency and amount of in-hospital mobilization of stroke patients, researchers studied the care and recovery of more than 2,100 patients admitted to a hospital stroke unit, according to research presented at the American Stroke Association’s International Stroke Conference 2016.
About half of those patients received frequent, early and higher amounts of mobilization, starting within 24 hours of their stroke. The other half received usual care, which involved lower-dose, and early mobilization. The researchers followed up with those patients three months later.
In the first study (abstract 76), researchers found that 46 percent of the early, higher dose-mobilizers experienced a good outcome compared with just over half of those receiving usual care, so higher dose mobilizing didn’t improve outcome. Usual care shifted 28 minutes earlier each year with patients being encouraged to move out of bed sooner. The question of moving stroke patients out of bed earlier has been met with hesitation due to concern of harming the patient, but researchers found no overall differences in serious adverse effects. They also found that early, frequent out of bed activity helped prevent serious complications in those aged 65-80 years.
In another analysis (abstract 153), the researchers found that getting hospitalized stroke patients out of bed for frequent, but short bouts of movement helped increase the odds that they’ll regain independence three months after their stroke. In this analysis they found:

• A consistent pattern of improved odds of favorable short-term stroke recovery with the use of more frequent out-of-bed sessions.
• Increasing the amount of time spent mobilizing in each session didn’t work in the patients’ favor, with higher amounts of time actually reducing the odds of patients’ being independent at three months.

Session frequency appears to be important, but too much too soon may interfere with recovery.
Additional Resources:

• Any available multimedia related to these tips are on the right column of this linkhttp://newsroom.heart.org/news/isc-16-wednesday-news-tips?preview=0a5ba41ae6d06babec5f52bf7f717541
• Stroke Caregiver Resources
• Emotional and Behavioral Conditions After Stroke
• Join the AHA/ASA Support Network to talk with others going through similar journeys including depression after stroke. 
• Follow news from the American Stroke Association’s International Stroke Conference 2016 via Twitter: @HeartNews #ISC16.

http://newsroom.heart.org/news/isc-16-wednesday-news-tips?preview=0a5ba41ae6d06babec5f52bf7f717541

Stroke Location Is an Independent Predictor of Cognitive Outcome

DUH! Do you have to be smarter than a fifth grader to know that? My stroke blew out my motor and premotor cortex, so I would expect my cognition not to be affected. 

Stroke Location Is an Independent Predictor of Cognitive Outcome

1. Fanny Munsch, MSc*;
2. Sharmila Sagnier, MD*;
3. Julien Asselineau, PhD;
4. Antoine Bigourdan, MD;
5. Charles. R. Guttmann, MD;
6. Sabrina Debruxelles, MD;
7. Mathilde Poli, MD;
8. Pauline Renou, MD;
9. Paul Perez, MD, PhD;
10. Vincent Dousset, MD, PhD;
11. Igor Sibon, MD, PhD†;
12. Thomas Tourdias, MD, PhD†

+ Author Affiliations

1. From the Université de Bordeaux, Bordeaux, France (F.M., C.R.G., V.D., I.S., T.T.); Neuroimagerie diagnostique et thérapeutique (F.M., A.B., V.D., T.T.), Unité neurovasculaire (S.S., S.D., M.P., P.R., I.S.), and Pôle de santé publique, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique (J.A., P.P.), CHU de Bordeaux, Bordeaux, France; INSERM, U862, Neurocentre Magendie, Bordeaux, France (F.M., V.D., T.T.); Center for Neurological Imaging, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (C.R.G.); and INCIA, Bordeaux, France (I.S.).

1. Correspondence to Thomas Tourdias, MD, PhD, Neuroradiology, CHU de Bordeaux, Bordeaux University Hospital, Place Amélie Raba-Léon, Bordeaux F-33076, France. E-mail thomas.tourdias@chu-bordeaux.fr

Abstract

Background and Purpose—On top of functional outcome, accurate prediction of cognitive outcome for stroke patients is an unmet need with major implications for clinical management. We investigated whether stroke location may contribute independent prognostic value to multifactorial predictive models of functional and cognitive outcomes.

Methods—Four hundred twenty-eight consecutive patients with ischemic stroke were prospectively assessed with magnetic resonance imaging at 24 to 72 hours and at 3 months for functional outcome using the modified Rankin Scale and cognitive outcome using the Montreal Cognitive Assessment (MoCA). Statistical maps of functional and cognitive eloquent regions were derived from the first 215 patients (development sample) using voxel-based lesion-symptom mapping. We used multivariate logistic regression models to study the influence of stroke location (number of eloquent voxels from voxel-based lesion-symptom mapping maps), age, initial National Institutes of Health Stroke Scale and stroke volume on modified Rankin Scale and MoCA. The second part of our cohort was used as an independent replication sample.

Results—In univariate analyses, stroke location, age, initial National Institutes of Health Stroke Scale, and stroke volume were all predictive of poor modified Rankin Scale and MoCA. In multivariable analyses, stroke location remained the strongest independent predictor of MoCA and significantly improved the prediction compared with using only age, initial National Institutes of Health Stroke Scale, and stroke volume (area under the curve increased from 0.697–0.771; difference=0.073; 95% confidence interval, 0.008–0.155). In contrast, stroke location did not persist as independent predictor of modified Rankin Scale that was mainly driven by initial National Institutes of Health Stroke Scale (area under the curve going from 0.840 to 0.835). Similar results were obtained in the replication sample.

Conclusions—Stroke location is an independent predictor of cognitive outcome (MoCA) at 3 months post stroke.

Use of a standardized assessment to predict rehabilitation care after acute stroke

This is not really worthwhile data since currently there is no objective basis for classifying damage. Standardized measures of stroke severity and function do not correlate to any measurement of cubic cm. of dead brain and its location or any measure of penumbra damage. Until we get to size and location to describe stroke damage we can't make any comparisons at all.  Use of the word 'care' MEANS YOU ARE A FUCKING FAILURE AT RECOVERY!

Use of a standardized assessment to predict rehabilitation care after acute stroke

Archives of Physical Medicine and Rehabilitation , Volume 96(2) , Pgs. 210-217.

NARIC Accession Number: J70666.  What's this?
ISSN: 0003-9993.
Author(s): Stein, Joel; Bettger, Janet P.; Sicklick, Alyse; Hedeman, Robin; Magdon-Ismail, Zainab; Schwamm, Lee H..
Publication Year: 2015.
Number of Pages: 8.
Abstract: Study implemented a formal assessment of rehabilitation needs that included standardized measures of function and sociodemographic factors known to influence referral and utilization of rehabilitation after an acute stroke. The following standardized measures of stroke severity and function were collected on 736 individuals with acute ischemic and hemorrhagic stroke: National Institutes of Health Stroke Scale, premorbid modified Rankin scale, Short Portable Mental Status Questionnaire, and Barthel Index (BI). These were collected in addition to routine data in the Get With The Guidelines-Stroke registry. The main outcome of interest was discharge disposition location. Logistic regression was used to examine predictors of referral to any institution-based rehabilitation versus discharge home and referral to an inpatient rehabilitation facility (IRF) versus a skilled nursing facility (SNF). In multivariable analyses, a higher BI score (85-100) was the only factor associated with return home versus need for institution-based rehabilitation. Among patients discharged to IRF versus SNF, discharge to IRF was less likely in older patients and in those with prestroke disability and more likely in those with moderate-severe (BI score 25-40) or moderate (BI score, 45-60) activities of daily living (ADL) impairment. Formal standardized assessment of rehabilitation needs was feasible in this pilot project. Patients’ sociodemographic characteristics, premorbid function, and ADL impairment discriminated better between discharge home and institution-based rehabilitation than between IRF and SNF. Selection of IRF versus SNF appears to be influenced either by unmeasured clinical characteristics of individuals with stroke or by nonclinical factors, such as cost, geography, referral relationships, or IRF availability.
Descriptor Terms: FEASIBILITY STUDIES, MEASUREMENTS, NEEDS ASSESSMENT, OUTCOMES, REHABILITATION, STROKE.

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

Citation: Stein, Joel, Bettger, Janet P., Sicklick, Alyse, Hedeman, Robin, Magdon-Ismail, Zainab, Schwamm, Lee H.. (2015). Use of a standardized assessment to predict rehabilitation care after acute stroke. Archives of Physical Medicine and Rehabilitation, 96(2), Pgs. 210-217. Retrieved 5/13/2015, from REHABDATA database.

Early inpatient rehabilitation admission and stroke patient outcomes

This is not really worthwhile data since currently there is no objective basis for classifying damage. Mild, moderate and severe do not correlate to any measurement of cubic cm. of dead brain and its location or any measure of penumbra damage. Until we get to size and location to describe stroke damage we can't make any comparisons at all.
http://search.naric.com/research/rehab/redesign_record.cfm?search=2&type=all&criteria=J70730&phrase=no&rec=127154
 American Journal of Physical Medicine and Rehabilitation , Volume 94(2) , Pgs. 85-100.

NARIC Accession Number: J70730.  What's this?
ISSN: 0894-9115.
Author(s): Wang, Hua; Camicia, Michelle; Divita, Magaret; Mix, Jacqueline; Niewczyk, Paulette.
Publication Year: 2015.
Number of Pages: 16.
Abstract: Study examined the relationship between the time from stroke onset to inpatient rehabilitation facility (IRF) admission (onset days) and patient outcomes, using nationally representative data. A secondary data analysis was conducted on a random sample of stroke patients discharged from IRFs in the United States between 2009 and 2011, including 649 mildly, 2,185 moderately, and 2,390 severely impaired patients. The rehabilitation outcomes of interest include Functional Independence Measure (FIM) gain, discharge destination, and IRF length of stay (LOS). The onset day variable was analyzed as a continuous variable and a categorical variable (0 to 2, 3 to 7, 8 to 14, and 15 to 365 days). The median of onset days for the total study sample was 5.5, with an interquartile range of 4 to 9 days. Severely impaired patients had a higher cognition gain and were more likely to be discharged to the community when admitted within 7 days, a greater motor gain when admitted within 14 days, and a lower risk for acute hospital transfer when admitted 3 to 7 days. Moderately impaired patients had a greater motor gain when admitted within 7 days. Early IRF admission was also associated with a shorter LOS. The results indicated that earlier IRF admission was beneficial among severely and moderately impaired patients. IRF admission within 7 days is recommended for stroke patients who achieved medical stability.
Descriptor Terms: EARLY INTERVENTION, FUNCTIONAL STATUS, OUTCOMES, REHABILITATION FACILITIES, STROKE.

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Citation: Wang, Hua, Camicia, Michelle, Divita, Magaret, Mix, Jacqueline, Niewczyk, Paulette. (2015). Early inpatient rehabilitation admission and stroke patient outcomes. American Journal of Physical Medicine and Rehabilitation, 94(2), Pgs. 85-100. Retrieved 5/13/2015, from REHABDATA database.