The Effect of Robot-Assisted Gait Training on Balance, Gait and Kinesiophobia in Individuals With Post-Stroke Hemiparesis: A Randomized Controlled Trial

 Get mental help if you think this will ever reach your hospital, they haven't even gotten music therapy installed! HOW MUCH MORE FUCKING INCOMPETENCE DO YOU NEED DISPLAYED BEFORE YOU REALIZE YOUR STROKE HOSPITAL DOESN'T KNOW ANYTHING ABOUT 100% STROKE RECOVERY?

The Effect of Robot-Assisted Gait Training on Balance, Gait and Kinesiophobia in Individuals With Post-Stroke Hemiparesis: A Randomized Controlled Trial

Ezgi Güçlü, Nuray Girgin

First published: 05 September 2026

https://doi.org/10.1002/pri.70340Digital Object Identifier (DOI)
 

ABSTRACT

Background and Purpose

Robot-assisted gait training (RAGT) is well established for post-stroke gait rehabilitation, but its potential effects on psychological and behavioral outcomes are less clear. This study investigated the effects of adding RAGT to conventional rehabilitation on balance, gait, kinesiophobia, and movement confidence in individuals with post-stroke hemiparesis.

Methods

This single-blind, parallel-group randomized controlled trial included 60 individuals with post-stroke hemiparesis (50–75 years), randomly allocated to an RAGT group (n = 30) or control group (n = 30). Ethical approval was obtained from the Clinical Research Ethics Committee of Istanbul Yeni Yüzyıl University (Approval No. 20.01.2022/05; approval date: 20 January 2022). Both groups received conventional rehabilitation for 8 weeks; the RAGT group additionally received 24 sessions of RAGT. Kinesiophobia was a prespecified study outcome assessed using the Kinesiophobia Causes Scale (KCS); balance, gait, and balance confidence were also assessed. All 60 randomized participants completed follow-up and were analyzed in their assigned groups.

Results

Significant group × time interactions were observed for several outcomes, including BBS, TUG duration, 10MWT walking speed, ABC, and KCS total score (p < 0.05). The between-group difference in change for KCS total score was −0.36 (95% CI: −0.51 to −0.21; partial eta squared = 0.292). In post hoc analyses adjusting each outcome for its baseline value, significant group effects remained for BBS, TUG duration, 10MWT walking speed, ABC, KCS biological domain, and KCS total score (p< = 0.031), whereas 10MWT step count and the KCS psychological domain were no longer statistically significant.

Discussion

Adding RAGT to conventional rehabilitation was associated with greater improvements in several balance, mobility, walking-speed, balance-confidence, and kinesiophobia outcomes compared with conventional rehabilitation alone. These findings suggest potential additional physical and psychological benefits of incorporating RAGT into post-stroke rehabilitation. However, because the RAGT group received greater overall treatment exposure, the observed between-group differences cannot be attributed solely to the robotic component. The principal contribution of this study is the concurrent evaluation of kinesiophobia and movement confidence alongside physical outcomes.

Conflicts of Interest

The authors declare that they have no financial, commercial, personal, or institutional relationships that could have influenced this work. The RoboGait device was already available as part of routine clinical practice and was not provided, loaned, or funded by BAMA Technology or its distributor for this study. Neither the manufacturer nor any distributor had any role in study design, participant recruitment, data collection, analysis, interpretation, manuscript preparation, or the decision to submit the manuscript. The authors have no commercial, financial, or institutional affiliation with the manufacturer or distributor.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request. Due to ethical restrictions related to patient confidentiality, the data are not publicly available.

A simple stair workout for longevity, recommended by a personal trainer

 Did your competent? doctor and therapist get you recovered correctly in climbing stairs by pointing out EXACTLY how it should be done? Like  this? 

With this series of images from Nathan Nicholson I finally got the understanding that you don't just lift the foot straight up, you  engage your hamstring to pull your leg up behind you at the same time pointing your toes down(plantarflexion) to clear the lip of the step. I have to plan this all out on my own since most of my premotor cortex is dead. This currently is a very slow process. My therapists DID NOTHING for me on this!
1. Engage the hamstring
2. Point the toes down - plantarflexion
3. Clear the step
4. Dorsiflexion to lift the toe up
5. Straighten the leg 

NO, SO PURE INCOMPETENCE? Haven't you gotten them all fired yet?

A simple stair workout for longevity, recommended by a personal trainer

• Why this matters: VO2 max measures how effectively your body uses oxygen during exercise. Stair climbing can improve your VO2 max.
• What you can do: Start with one or two sessions per week. Alternate four minutes of hard effort with a slow recovery period.
• The payoff: Higher levels of cardiorespiratory fitness are associated with a lower risk of premature death.

The stairs don’t have to be just something to get you from one place to another. They can also be a really effective workout tool—one that boosts your VO2 max. VO2 max measures the maximum amount of oxygen your body can use during exercise. Turns out, VO2 max is also a predictor of longevity. The higher your VO2 max, the more likely you may be to live longer. Here’s what you need to know about a stair workout so you can start increasing your VO2 max and, in turn, your longevity.

How To Do the Workout

There are different stair-related methods to increase your VO2 max, but a simple one you can implement is a 4x4 interval. Here’s how it works: 

1. Climb stairs for 4 minutes straight: The key is to do it at a pace that leaves you near exhaustion by the end. You can approximate this pace by asking yourself, “Could I keep going at this pace for more than four minutes?” If the answer is no, you’re on target. 
2. Recover for 4 minutes: Walk slowly on a flat surface or slowly climb the stairs. 
3. Repeat: Once you again complete four minutes at the fast pace and four minutes at the recovery pace, you’re done.

How Often Should You Do It?

For most adults, two 4×4 interval sessions per week is the best starting target for improving VO2 max. Research comparing weekly frequencies suggests that two to three sessions can improve VO2 max, but there is no clear extra benefit from doing three instead of two for recreational exercisers. Classic 4×4 studies often used three weekly sessions, but that volume may be harder for you to recover from.

 Related video: Study finds strength training sweet spot for longevity (KYTX-TV Tyler-Longview)

How To Progress

As you get comfortable doing your stair climbing workouts, a practical progression might look like the following:

• If you’re new to intervals: Once weekly for two to three weeks
• If you exercise regularly: Twice weekly
• If you’re well-trained and recovering well: Up to three times weekly, provided these are your only very hard cardio sessions

How To Adjust the Workout

Everybody has different physical needs and health implications, so by no means do you have to follow this prescription exactly to improve your VO2 max using stairs.

If using stairs hurts your knees or other lower body joints, feel free to do a 4x4 workout on a more suitable tool. You can still replicate four minutes on and four minutes of recovery using a workout tool of your choice, such as a stationary bike or elliptical. The key is to work at a strenuous pace for four minutes, recover slowly, and repeat.

If four minutes is too challenging, you can shorten the interval as needed to match your current capacity, then work up from there.

Stair Workout Safety Tips

Before starting a stair climbing exercise routine, keep these three safety points in mind:

• Warm up: Especially with interval work, warming up beforehand is a good idea. Take a few minutes to loosen up and get the blood flowing before starting your first interval.
• Stop if you feel unwell: If you develop chest pain, dizziness, faintness, or an irregular or pounding heartbeat when you start your intervals, stop immediately. 
• Talk with your doctor: Check with a healthcare provider before trying vigorous stair intervals if you have heart or lung disease, frequent falls, unexplained dizziness, a recent injury or surgery, or joint symptoms that make stairs difficult. Adults with chronic conditions should consider how those conditions affect their ability to exercise safely.

How Much of an Impact Can the Workout Have?

Stair climbing should be part of a larger fitness plan. But workouts like it that target VO2 can have a big impact on health over time.

A 2018 study showed that participants with extreme cardiorespiratory fitness—which VO2 measures—had a lower risk of all-cause mortality compared to people of any other level of cardiorespiratory fitness.

You don’t have to be an elite athlete with extreme cardiorespiratory fitness to get the benefits. The study also showed that improving cardiorespiratory fitness from low to even just below average was associated with a 50% reduction in all-cause mortality. When you go from low to above average, the risk reduction is about 70%. The results suggest that the better your cardiorespiratory fitness, the longer you may be able to live. Stair climbing may be able to play a part in this.

Read the original article on Health

PNF-based robot therapy boosts poststroke arm function and reduces spasticity

 Still a failure at 100% recovery! The only goal in stroke for survivors!

Check out how long your doctor is incompetent in not having protocols on PNF!

• PNF (14 posts to April 2011)

PNF-based robot therapy boosts poststroke arm function and reduces spasticity

OBJECTIVES

The effects of combining robot-assisted therapy (RAT) with other physiotherapy approaches in stroke rehabilitation are of current interest. The aim of this study was to investigate the effect of proprioceptive neuromuscular facilitation (PNF)-based RAT on upper extremity (UE) motor performance, spasticity, activities of daily living (ADL), and quality of life (QoL) in individuals with stroke.

DESIGN

Single-blind randomized controlled trial.

SETTING

Neurologic rehabilitation unit at a university.

PARTICIPANTS

Thirty-nine individuals with stroke were enrolled in the study (RAT, n=20; Control group [CG], n=19).

INTERVENTIONS

Both groups received 30 minutes of conventional rehabilitation per session; in addition, RAT completed 30 minutes of PNF and commonly used daily movement patterns with a robotic device, whereas CG performed the same exercises manually. All interventions were delivered 3 days per week for 8 weeks (60 min/session).

MAIN OUTCOME MEASURES

Participants' UE performance was assessed using the Fugl-Meyer Upper Extremity Scale, Action Research Arm Test, Box and Block Test, and Nine-Hole Peg Test. Spasticity severity was assessed using the Modified Ashworth Scale, and ADL, QOL were assessed using ACTIVLIM, ABILHAND, Stroke Impact Scale (SIS).

RESULTS

Mean age was 58.40±14.95 years in the RAT and 54.79±16.47 years in the CG. Fugl-Meyer Upper Extremity Scale, ACTIVLIM, ABILHAND, and SIS significantly increased in all groups after treatment (P<.05). At posttreatment, RAT showed significantly greater improvements than CG in Fugl-Meyer Upper Extremity Scale, Action Research Arm Test, Box and Block Test, Nine-Hole Peg Test, and muscle spasticity. In addition, decreases in wrist flexor and elbow flexor measurements were associated with 8.065- and 5.051-fold higher odds of being in the RAT, respectively.

CONCLUSIONS

Conventional treatment combined with PNF-based RAT application has been shown to be more effective than traditional training in improving(NOT RECOVERY!) spasticity, motor performance, ADL, and QoL of patients with stroke.

REFERENCES

1. The Efficacy of Proprioceptive Neuromuscular Facilitation-Based Robot-Assisted Therapy in Individuals With Stroke: A Randomized Controlled Trial.

   Demirhan İ, Ayvat E, Ayvat F, Onursal Ö, Navruz-Çelebi Ö, Aksu-Yıldırım S, Kurşun O, Kılınç M.

   Arch Phys Med Rehabil. 2026 Sep; 107(9): 2468-2480

Parkinson's Risk and Carbon Monoxide: What a New Study Found

 

Will your competent? doctor be doing something with this because of your risk of Parkinsons post stroke? Oh NO, NOTHING DOING! So, INCOMPETENCE REIGNS AGAIN! Your doctor is becoming an expert at incompetence and your board of directors is so incompetent they can't recognize it in their hospital! 

Of course your fuckingly incompetent? doctor did nothing with this earlier carbon monoxide research, right!

• carbon monoxide (13 posts to February 2012)

Parkinson’s Disease May Have Link to Stroke March 2017 

The latest here:

Parkinson's Risk and Carbon Monoxide: What a New Study Found

Key Takeaways

• Nicotine was long thought to fuel the inverse relationship between smoking and Parkinson's disease.
• In this study, nonsmokers with high carbon monoxide (CO) levels had less Parkinson's risk, suggesting CO may underlie smoking's neuroprotective effects.
• The study followed more than 500,000 people for 12 years, measuring exhaled CO at baseline.

Non-smokers with higher exhaled carbon monoxide (CO) levels had a lower risk of Parkinson's disease, a prospective study of more than 500,000 people in China showed.

Among people who never smoked, exhaled CO levels of 3 ppm or greater were associated with an approximately 30% lower risk of Parkinson's (HR 0.71, 95% CI 0.59-0.84) compared with exhaled levels under 3 ppm, reported Andri Iona, DPhil, of the Nuffield Department of Population Health at the University of Oxford in England, and co-authors.

Regular smoking also was tied to a reduced risk of Parkinson's disease (HR 0.70, 95% CI 0.62-0.79) but unlike CO measurements, was significantly associated with higher risks of lung cancer, ischemic heart disease, stroke, and all-cause mortality, the researchers wrote in JAMA Neurology.

"For the first time, this study provides robust evidence in humans supporting a potentially protective role for CO in Parkinson's," co-author Clara Bueno Lopez, MSc, also of Oxford, told MedPage Today.

Epidemiology research has repeatedly documented lower Parkinson's risks among people who smoke, a finding highlighted in a study that followed 30,000 British doctors for 65 years. Nicotine was long thought to be fueling this link.

In recent years, researchers have investigated other tobacco constituents and smoking by-products. Of these, CO has emerged as a promising candidate, noted Sirwan Darweesh, MD, PhD, of Radboud University Medical Center in Nijmegen, the Netherlands, and colleagues in an accompanying editorial.

"Carbon monoxide is formed during the burning process of cigarette smoking, as well as via incomplete combustion of carbon-containing fuels, such as gasoline," Darweesh and colleagues explained. "Exposure to CO in the context of smoking or air pollution has been associated with multiple harmful effects on health, and individuals who smoke have markedly higher levels of carboxyhemoglobin in their blood," they noted.

Conversely, CO is an essential signaling molecule that provides protection against oxidative damage and supports immune response and cell proliferation, survival, and death, the editorialists pointed out. "Preclinical studies and animal experiments have shown neuroprotective effects of small concentrations of CO, raising the hypothesis that CO may underlie the apparent neuroprotective effects of smoking in Parkinson's disease."

Studies also have investigated associations between air pollution -- another leading source of environmental CO -- and Parkinson's, but these exposures are "inevitably confounded by the effects of other gases, particles, and chemicals with well-known adverse health consequences," Iona and colleagues observed.

In the present study, the researchers assessed data from 512,701 adults in the China Kadoorie Biobank recruited between 2004 and 2008. Mean age was 52 years and 58.9% were women. Smoking status was self-reported and exhaled CO was measured at baseline.

Overall, 74.5% of men and 3.3% of women had ever smoked regularly. Mean exhaled CO levels were higher among those who regularly smoked (11.1 ppm) compared with those who never smoked (3.5 ppm), those who occasionally smoked (3.8 ppm), and those who formerly smoked regularly (3.7 ppm).

The median follow-up period was 12.1 years; in that time, 1,131 people with Parkinson's disease and 2,949 with other neurodegenerative diseases were identified. Findings were adjusted for sociodemographic characteristics, lifestyle factors, and confounding variables like solid fuel use and passive smoking exposure.

In non-smokers, higher exhaled CO levels showed a broad dose-dependent inverse relationship with Parkinson's risk, decreasing from HR 1.00 (95% CI 0.85-1.18) for levels under 2.0 ppm to HR 0.65 (95% CI 0.45-0.92) for levels of 11.5 ppm or more. Passive smoke exposure among never-smokers showed no clear relationship with Parkinson's risk.

The study had several limitations, Iona and colleagues acknowledged. Participants were relatively young at baseline, and a single measurement of exhaled CO may not fully capture long-term CO exposure, they said. The possibility that nicotine or other tobacco components contributed to the association between smoking and Parkinson's could not be excluded.

An ongoing phase IIa trial is investigating the effects of a low-dose oral CO liquid drug product in people with Parkinson's disease, the researchers noted.

Associations between essential trace elements and Alzheimer's disease and related dementias

 Ask your doctors about the benefits of selenium and iron as described in the following posts. Then get AN EXACT PROTOCOL from them on all trace minerals.

• selenium (15 posts to May 2015)
• iron (13 posts to December 2012)

Associations between essential trace elements and Alzheimer's disease and related dementias

Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring

Xin Wang,Roger L. Albin,Bruno Giordani,Bhramar Mukherjee,Henry L. Paulson,Kelly M. Bakulski

First published: 26 August 2026

https://doi.org/10.1002/dad2.70467Digital Object Identifier (DOI)

 

Abstract

INTRODUCTION

 Dysregulation of essential trace elements has been implicated in Alzheimer's disease (AD) pathogenesis, yet comprehensive epidemiologic evidence remains limited. We investigated associations of seven plasma essential trace elements, including manganese, iron, cobalt, copper, zinc, selenium, and molybdenum, with AD and all-cause dementia risk.

METHODS

We analyzed 1,737 participants from the National Alzheimer's Coordinating Center. Cross-sectional analyses assessed prevalent disease; longitudinal analyses evaluated incident cases among 1,101 initially dementia-free participants (median follow-up: 2.05 years). Multivariable logistic regression, Cox proportional hazards models, and quantile-based g-computation evaluated individual and mixture effects.

RESULTS

A simultaneous one-quartile increase in the seven-element mixture was associated with lower prevalent AD (odds ratio [OR] = 0.69; 95% confidence interval [CI]: 0.52–0.91). Longitudinally, higher plasma iron was associated with lower incident AD (hazard ratio [HR] = 0.41; 95% CI: 0.19–0.92, Q4 vs. Q1), while selenium predicted higher incident AD risk (HR = 2.42; 95% CI: 1.11–5.27, Q4 vs. Q1).

DISCUSSION

Lower plasma iron and higher plasma selenium were each associated with greater dementia risk, identifying iron and selenium as potentially modifiable factors for dementia prevention, especially in selenium-replete populations.

Highlights

• Higher plasma iron consistently associated with lower dementia risk.

• Plasma selenium paradoxically linked to higher incident Alzheimer's disease (AD) risk.

• Seven-element mixture associated with 30% lower odds of prevalent AD.(Your competent? doctor needs to create AN EXAXT PROTOCOL for these! Can't do that? PURE INCOMPETENCE!)

Lifestyle Changes May Improve Cognition 55 Percent More Than Basic Health Guidance: Study

 Then have your competent? doctor WRITE THESE UP IN EXACT PROTOCOLS! Can't do that: 

PURE INCOMPETENCE! Fire them!

Lifestyle Changes May Improve Cognition 55 Percent More Than Basic Health Guidance: Study

Stem Cell Therapy Shows Promise for Stroke Recovery

 The promise has been out there for well over a decade, WHOM will actually solve the problem? NO leadership and NO strategy is the result of our fucking failures of stroke associations!

• stem cells (409 posts to April 2011)

Stem Cell Therapy Shows Promise for Stroke Recovery

University of Miami Miller School of Medicine

Researchers from the University of Miami Miller School of Medicine and collaborating institutions have published a comprehensive review examining the rapidly evolving field of intra-arterial stem cell therapy for ischemic stroke, highlighting its potential to improve recovery for patients who continue to face disability despite major advances in stroke treatment.

Published in the American Heart Association Journal Stroke: Vascular and Interventional Neurology, the review, titled "Progress in Intra-arterial Stem Cell Therapy for Ischemic Stroke – A Review," examines decades of preclinical and clinical research and outlines a roadmap for translating regenerative therapies from the laboratory to the bedside.

Ischemic Stroke, in which blood supply to a part of the brain is cut off by suddenly by a clot blockage, remains one of the leading causes of death and long-term disability worldwide. While clot-busting medications and mechanical thrombectomy have transformed care for acute ischemic stroke, many patients are left with significant neurological deficits despite successful restoration of blood flow. The authors argue that stem cell therapies delivered directly into the brain's circulation via minimally invasive and widely available catheter angiographic techniques may complement existing treatments. The stem cells targeted this way to the stroke injured brain area work by promoting brain repair, reducing inflammation, and enhancing recovery.

"Mechanical thrombectomy has revolutionized stroke treatment, but half of the treated or more patients still do not regain full independence," said Dileep R. Yavagal, M.D., professor of clinical neurology and neurosurgery at the University of Miami Miller School of Medicine and senior author of the review. "Stem cell therapy represents a promising strategy to help the brain recover after injury and may become an important next step in improving outcomes(NOT GOOD ENOUGH!) for stroke patients."

(Likely a much better approach to full recovery is stopping the 5 causes of the neuronal cascade of death in the first week and thus saving hundreds of millions to billions of neurons! So you aren't even thinking of this properly!)

A Targeted Approach

Stem cells can be delivered through several different routes and optimal route in Stroke treatment is not yet established. The review focuses on intra-arterial delivery, an approach in which stem cells are infused directly into arteries supplying the injured region of the brain. Unlike intravenous administration, in which much of the cells are trapped in organs such as the lungs and liver, intra-arterial delivery into the affected artery allow a greater concentration of therapeutic cells to reach stroke-affected tissue. Surgical approaches such through a small hole in the skull are more invasive.

Researchers note that intra-arterial delivery is particularly attractive because it can potentially be performed during the same minimally invasive endovascular procedures and techniques used now as standard of care treatment, mechanical thrombectomy, avoiding the need for a new surgical access or additional intervention.

Preclinical studies, including from Dr. Yavagal's laboratory at the University of Miami Miller School of Medicine Interdisciplinary Stem Cell Institute, reviewed by the authors demonstrate that stem cells may reduce inflammation, promote formation of new blood vessels, support neural repair, and improve neurological outcomes following stroke. Multiple early-stage clinical trials have also established the feasibility and safety of stem cell administration across several delivery routes.

Strong safety record, more research needed

The review analyzes more than two decades of clinical development and notes that more than 40 randomized clinical trials have investigated stem cell therapies for stroke via many different routes of delivery. While safety has been consistently demonstrated, evidence for definitive functional benefit remains under investigation. Several ongoing studies are working to determine optimal cell type, dosing, timing, and patient selection strategies.

"The safety of IA stem cell therapy has been established by several preclinical and clinical studies and will continue to remain a critical endpoint for all future studies," said Roshni Thakkar, Ph.D., co-first author and research assistant professor in the Department of Neurology at the University of Miami. "The next challenge that the field is taking on is to identify the right cells, the right dose, the right patients, and the right time to intervene in order to maximize stroke recovery."

The authors emphasize that future studies should integrate advanced imaging, biological markers, and immune profiling to better understand how stem cells interact with the post-stroke brain and to identify patients most likely to benefit.

"Regenerative medicine has the potential to fundamentally reshape stroke treatment," said Nadia McMillan, M.D., Ph.D., co-first author, senior neuro-endovascular fellow and instructor . "The goal is not only to save brain tissue during a stroke but to help patients regain function and quality of life afterward."

Looking toward the future

According to the review, emerging therapies may eventually include bioengineered stem cells, extracellular vesicles and exosomes, and combination approaches that pair thrombectomy with regenerative treatments. Continued advances could ultimately transform stroke care from a model focused primarily on restoring blood flow to one that also actively promotes brain repair and recovery.

The authors conclude that while significant challenges remain, ongoing clinical trials and rapid advances in regenerative neuroscience provide reason for optimism that stem cell-based therapies may one day become an important adjunct to standard stroke treatment and achieve an outcome free of disability for the vast majority of stroke patients.

Public Release. This material from the originating organization/author(s) might be of the point-in-time nature, and edited for clarity, style and length. Mirage.News does not take institutional positions or sides, and all views, positions, and conclusions expressed herein are solely those of the author(s).View in full here.

Tags: regenerative medicine , america , investigation , american , Administration , Miami , biological , neuroscience , clinical trials , neurosurgery , University of Miami , blood vessels , inflammation , cell therapy , American Heart Association , quality of life

Early prediction of post-stroke depression using polysomnography parameters: a prospective cohort study

 Competent persons would research preventing depression by have EXACT 100% RECOVERY PROTOCOLS! But there seems to be no functioning brains anywhere in stroke! Not solving stroke is the absolute stupidity out there! Your comeuppance/screaming when you are the 1 in 4 per WHO that has a stroke  will be soul satisfying. 

Early prediction of post-stroke depression using polysomnography parameters: a prospective cohort study

• L

  Lan Chen 1

• B

  Bin Wang 1

• D

  Dan Kuang 1

• 

  Lei Chen 2*

• 1. Department of Child Psychiatry, Shaoxing Seventh People’s Hospital, Affiliated Mental Health Center, Shaoxing University, Shaoxing, Zhejiang, China

• 2. Department of Neurology, Shaoxing People’s Hospital, The First Affiliated Hospital, Shaoxing University, Shaoxing, Zhejiang, China

Abstract

Background: 

Post-stroke depression (PSD) affects approximately one-third of stroke survivors and significantly impacts functional recovery. This study aimed to develop and validate a prediction model for PSD using polysomnography (PSG) parameters combined with clinical characteristics.

Methods: 

We conducted a prospective cohort study enrolling 437 acute ischemic stroke patients who underwent PSG assessment within 7 days of stroke onset between January 2022 and December 2024. The primary outcome was PSD at 3-month follow-up, defined as Patient Health Questionnaire-9 (PHQ-9) score ≥10. Multivariate logistic regression identified independent predictors, and machine learning algorithms were compared for model performance.

Results: 

Among 390 patients completing follow-up, 139 (35.6%) developed PSD. Independent predictors included sleep latency (OR = 2.14, 95% CI: 1.68–2.73), arousal index (OR = 2.13, 95% CI: 1.65–2.94), sleep efficiency (OR = 0.74, 95% CI: 0.55–0.96), heart rate variability RMSSD (OR = 0.77, 95% CI: 0.61–0.96), NIHSS score (OR = 1.35, 95% CI: 1.04–1.76), and prior stroke history (OR = 1.35, 95% CI: 1.09–1.71). The gradient boosting model achieved the highest discriminative performance (AUC = 0.763; bootstrap-validated AUC = 0.738, 95% CI: 0.682–0.794). Risk stratification demonstrated a five-fold gradient in PSD rates across probability categories (14.3 to 70.3%).

Conclusion: 

PSG parameters, particularly sleep efficiency, sleep latency, and arousal index, are significant independent predictors of PSD. Integrating objective sleep assessment into early stroke management may facilitate identification of high-risk patients for targeted preventive interventions.

More at link.