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We examined the impact of stroke severity and timing to inpatient rehabilitation admission on length of stay (LOS), functional gains, and discharge destination.Alberta inpatient stroke rehabilitation data between April 2013 and March 2017 were analyzed. We evaluated the impact of stroke severity, as measured by the Functional Independence Measure (FIM), on timing to inpatient rehabilitation, functional gains, LOS, and discharge destination. Further, we examined whether timing to inpatient rehabilitation impacted the latter three factors.The 2404 adults were subcategorized as mild (1237), moderate (1031), or severe (136) based on FIM at inpatient rehabilitation admission. Length of time to rehabilitation admission was not significantly (p = 0.232) different between stroke severities. Mean length of time (days) to rehabilitation admission was 19.79 (20.3 SD) for mild, 27.7 (35.7 SD) for moderate, and 37.70 (56.8 SD) for severe stroke. Mean FIM change for mild (M = 16.3, 9.9 SD) differed significantly (p = 5.1 × 10-9) from moderate (M = 30.4, 16.4 SD) and severe (M = 31.0, 25.7 SD) stroke. The mean LOS for mild stroke (M = 41.3, 31.9 SD) was significantly (p = 5.1 × 10-9) different from moderate stroke (M = 86.8, 76.4 SD) and severe stroke (M = 126.1, 104.2 SD). Time to inpatient rehabilitation admission showed a small, significant impact on FIM change (p = 1.4 × 10-9, partial η2 0.022) and LOS (p = 1.1 × 10-19, partial η2 0.042). Shorter times to rehabilitation admission and mild stroke were associated with discharging home without needing homecare.Stroke severity has a significant impact on the conduct of inpatient rehabilitation. Yet, despite suggestions shortening timing to rehabilitation should improve outcomes, the impact on functional gains and rehabilitation LOS was small.Les soins de réadaptation prodigués à des patients albertains hospitalisés: quelle est l’importance de la gravité des AVC et des délais d’admission en matière de réadaptation? Contexte: Nous nous sommes penchés sur l’impact que la gravité des AVC et les délais d’admission à des soins de réadaptation peuvent avoir sur la durée de séjour de patients hospitalisés, sur leurs gains fonctionnels et sur leur lieu de destination à la suite de leur congé. Méthodes: Nous avons analysé les données portant sur la réadaptation de patients albertains hospitalisés à la suite d’un AVC. Ces données couvraient la période allant d’avril 2013 à mars 2017. À l’aide de la mesure de l’indépendance fonctionnelle (MIF), nous avons ainsi évalué l’impact de la gravité des AVC sur les délais d’admission de patients hospitalisés à des soins de réadaptation, sur leurs gains fonctionnels, sur la durée de leur séjour et sur leur lieu de destination à la suite de leur congé. De plus, nous avons examiné dans quelle mesure les délais d’admission à des soins de réadaptation avaient un impact sur ces trois dernières variables. Résultats: Au total, 2 404 adultes ont été répartis en trois catégories en fonction de leur résultat à la MIF: AVC légers (1237), modérés (1031) ou graves (136). Mentionnons que les délais avant d’être admis à des soins de réadaptation ne se sont pas révélés notablement différents (p = 0,232) selon les niveaux de gravité des AVC. Les délais moyens (en jours) avant d’être admis à des soins de réadaptation ont été de 19,79 (σ 20,3) pour les AVC légers; de 27,7 (σ 35,7) pour les AVC modérés; et de 37,70 (σ 56,8) pour les AVC graves. En se basant sur la MIF, les changements moyens pour les AVC légers (M = 16,3; σ 9,9) ont différé de façon notable (p = 5,1 x 10-9) par rapport à ceux des AVC modérés (M = 30,4; σ 16,4) et des AVC graves (M = 31,0; σ 25,7). La durée moyenne de séjour dans le cas des AVC légers (M = 41,3; σ 31,9) s’est par ailleurs révélée significativement (p = 5,1 x 10-9) différente si on la compare aux autres catégories (AVC modérés M = 86,8; σ 76,4 ou AVC graves M = 126,1; σ 104,2). Les délais d’admission à des soins de réadaptation ont donné à voir un faible, quoique notable, impact sur les changements révélés par la MIF (p = 1,4 x 10-9, eta-carré partiel 0,022) et sur la durée des séjours (p = 1,1 x 10-19, eta-carré partiel 0,042). Enfin, des délais d’admission plus courts à des soins de réadaptation et des AVC légers ont été associés, à la suite d’un congé, à un retour à la maison sans devoir recourir à des soins à domicile. Conclusion: La gravité des AVC a un impact considérable sur la réadaptation de patients ayant été hospitalisés. Bien qu’il ait été suggéré que la réduction des délais d’admission à des soins de réadaptation devrait améliorer l’évolution de leur état de santé, l’impact quant à leurs gains fonctionnels et leur durée de séjour en réadaptation a toutefois été mineur.

Background and Purpose— We aimed to evaluate the current practice patterns, safety and outcomes of patients who receive endovascular therapy (EVT) having mild neurological symptoms. Methods— From Jan 2010 to Jan 2018, 127,794 ischemic stroke patients were enrolled in the Florida-Puerto Rico Stroke Registry. Patients presenting within 24 hours of symptoms who received EVT were classified into mild (National Institutes of Health Stroke Scale [NIHSS] ≤5) or moderate/severe (NIHSS>5) categories. Differences in clinical characteristics and outcomes were evaluated using multivariable logistic regression. Results— Among 4110 EVT patients (median age, 73 [interquartile range=20] years; 50% women), 446 (11%) had NIHSS ≤5. Compared with NIHSS >5, those with NIHSS ≤5 arrived later to the hospital (median, 138 versus 101 minutes), were less likely to receive intravenous alteplase (30% versus 43%), had a longer door-to-puncture time (median, 167 versus 115 minutes) and more likely treated in South Florida (64% versus 53%). In multivariable analysis younger age, private insurance (versus Medicare), history of hypertension, prior independent ambulation and hospital size were independent characteristics associated with NIHSS ≤5. Among EVT patients with NIHSS ≤5, 76% were discharged home/rehabilitation and 64% were able to ambulate independently at discharge as compared with 53% and 32% of patients with NIHSS >5. Symptomatic intracerebral hemorrhage occurred in 4% of mild stroke EVT patients and 6.4% in those with NIHSS >5. Conclusions— Despite lack of evidence-based recommendations, 11% of patients receiving EVT in clinical practice have mild neurological presentations. Individual, hospital and geographic disparities are observed among endovascularly treated patients based on the severity of clinical symptoms. Our data suggest safety and overall favorable outcomes for EVT patients with mild stroke.

Background: Mild stroke occurrences are rising and in order to comprehensively understand the experience of this health phenomenon, the context in which people with mild stroke live must be explore...

[Purpose] The aim of this study was to clarify whether the motor imagery of walking and physical function are related in mild hemiplegic stroke patients. [Participants and Methods] Sixteen mild hemiplegic stroke patients were included in this study. We evaluated motor imagery with a 10-m walking, the estimation error and the kinesthetic and visual imagery questionnaire. Physical function was evaluated with the actual 10-m walk test time, Brunnstrom recovery stage, stroke impairment assessment set, and functional independent measure. The correlation coefficient was calculated using Spearman's correlation coefficient for all evaluation methods. [Results] The 10-m walking motor imagery took an average of 23.36 ± 22.14 s. The actual 10-m walk test averaged 24.87 ± 21.41 s. The 10-m walking motor imagery and the 10-m walking speed were significantly correlated. There was a significant correlation between the 10-m walking motor imagery and the Brunnstrom recovery stage, stroke impairment assessment set, and functional independent measure. There were no significant correlations between the estimation error and all the assessments. [Conclusion] These results show that the motor imagery of walking is related to physical function in mild hemiplegic stroke patients.

Introduction: Patients without prior functional deficits who suffer mild stroke (NIHSS Methods: Hospitalized strokes from the Greater Cincinnati Northern Kentucky Stroke Study were used. Included patients had an initial NIHSS Results: Of 1268 ischemic strokes, 353 (28%) were functionally dependent at discharge. Increased baseline NIHSS was associated with worse outcome on the mRS. Leg, LOC questions, and sensation NIHSS subscores were the best predictors of outcome. Multivariable analysis identified age, race, hypertension, chronic kidney disease, heart failure, and post-stroke dysphagia as independently associated with discharge mRS ≥3. Discussion: Our results agree with and complement the results of prior studies. They are not limited by inclusion/exclusion criteria or referral bias. Rather, our major limitation is the retrospective estimation of NIHSS and mRS based on physician descriptive documentation rather than direct score assessment. Our results may allow for modeling to better predict outcome which in turn can inform clinical decision making and trial design.

Introduction: To evaluate overall ischemic stroke rates, specific subtypes, and clinical presentation during the COVID-19 pandemic in a multicenter observational study from eight states across US. Methods: We compared all ischemic strokes admitted between January 2019 and May 2020, grouped as; March-May 2020 (COVID-19 period), March-May 2019 (seasonal pre-COVID period) and November 2019-January 2020 (immediate pre-COVID-19 period). Primary outcome was stroke severity at admission measured by NIHSS stratified as mild (0-7), moderate (8-14), and severe (>14) symptoms. Secondary outcomes were number of large vessel occlusions (LVOs), stroke etiology, IV-tPA rates, and disposition. Results: Of the 7,969 patients diagnosed with acute stroke during the study period, 933 (12%) presented in the COVID-19 period, 1319 (17%), and 1254 (16%) presented in the seasonal pre-COVID-19 and immediate pre-COVID-19 periods, respectively. Significant decline was observed in the weekly mean volume of newly diagnosed strokes (98±7.3 vs 50±20, p Conclusions: We observed a decrease in newly diagnosed stroke cases and rates of IV-tPA administration, while the LVO frequency remained unchanged during the COVID-19 pandemic. Additionally, these stroke patients had more severe presentations.

Objective: The term ‘mild stroke’ is used to describe stroke patients with a NIHSS score of 0 to 6. There is still no clear decision regarding the application of iv recombinant tissue plasminogen activator (iv-tPA) to patients who is admitted with an acute ischemic stroke and is in the mild stroke category. In our study, we aimed to analyze the data of patients who applied to our stroke center with an acute mild stroke clinic and received iv-tPA treatment and their three-month follow-up. Methods: A total of 47 (age 69.1 ± 14.1, 28 female) mild stroke patients were included out of 350 patients receiving thrombolytic therapy. Intravenous thrombolysis was initiated with a maximum delay of 4.5 hours in all patients. Patients had a NIHS score less than 6. NIHSS scores immediately before starting thrombolytic therapy and scores 24 hours after treatment were recorded. Modified Rankin Scale scores (mRS) at admission, 1 and 3 months were recorded. Results: NIHSS scores of the patients who received tPA decreased significantly after the treatment (p = 0.001). The patients’ 1st and 3rd month mRS scores were statistically significantly decreased according to the mRS scores when they entered the treatment (p = 0.001). Conclusions: This study highlights the efficacy of iv-tPA in acute ischemic stroke patients with mild symptoms and demonstrates the low risk profile of this therapy.

Patients who are victims of a mild stroke are vulnerable to several invisible and neglected neurological sequelae. In parallel, it is known that fatigue and neuropsychiatric symptoms are common complications after a stroke in general. Our aim was to describe the prevalence and the factors associated with these two outcomes after a minor stroke.We conducted a prospective observational cohort study that included consecutive patients diagnosed with minor ischemic stroke between 2015 and 2019. Minor stroke was defined as NIHSS 4 and modified Rankin Scale (mRS) 2. Patients were followed for 12 months after the index stroke. The primary endpoints included fatigue and neuropsychiatric impairment, which were evaluated with the Fatigue Severity Scale (FSS) and the Hospital Anxiety Depression Scale (HADS), respectively.A total of sixty patients were followed in our cohort. The mean age was 53.0 (SD 15.0) and 51.7% were male. There were 32 (53.3%) and 25 (41.7%) patients who developed PSF and post-stroke neuropsychiatric symptoms, respectively. The use of antidepressants and statins were associated with post-stroke fatigue, while women and younger patients were more likely to develop neuropsychiatric symptoms after the stroke (p 0.05). Eighteen (30.0%) patients were diagnosed with both post-stroke fatigue and psychiatric disorders.Post-stroke fatigue and neuropsychiatric symptoms are prevalent in minor stroke and should be independently addressed as a part of the recovery goal.

With the increase in the number of stroke patients in China and the rehabilitation service requirements, the conventional hospital rehabilitation model can no longer cater to the individual needs of patients. Upper limb motor dysfunction is the most prevalent symptom leading to reduced capacity of patients. Therefore, rehabilitation training is vital to the recovery of limb motor function in stroke hemiplegia patients. The authors conduct research on the upper limb recovery in mild stroke patients in China. During the research, the authors adopt methods including literature review, case study, field research, interviews, and so on, to observe and study the medical treatment and life patterns of mild-stroke patients, also to explore their needs through multiple iterations. The research utilizes the human-centered design principle and ergonomics paradigms and finally produces a home-based rehab service system design.

Background: The COVID-19 pandemic might affect health care resources and alter patient admission to hospital in case of stroke or transient ischemic attack (TIA). We aim to determine whether the COVID-19 pandemic is affecting utilization of recanalization procedures and numbers of patients with stroke and TIA admitted to a primary care stroke center.Methods: In this retrospective observational study, we compared patients admitted from January 2019 until February 2020 with patients admitted during the COVID-19 pandemic (March/April 2020) in Germany. We included patients with stroke (hemorrhagic or ischemic) or TIA as classified by International Statistical Classification of Diseases and Related Health Problems version 10 (ICD-10).Results: The number of patients per month with ischemic stroke or TIA was found to have significantly decreased from January 2019 until February 2020 compared to the COVID-19 pandemic (March/April 2020) (ischemic stroke 69.1 ± 4.5 vs. 55 ± 5.7, p < 0.001, TIA 22.1 ± 4.1 vs. 14.5 ± 6.4, p < 0.034). Contrarily, percentages and numbers of recanalization procedures per month were not influenced by the COVID-19 pandemic (intravenous thrombolysis [iv-tPA] 9.4 ± 3.7 vs. 10.5 ± 0.5, p = 0.697, mechanical thrombectomy [MT] 13.1 ± 3.1 vs. 14.5 ± 3.5, p = 0.580, iv-TPA or MT 19.4 ± 4.1 vs. 19.0 ± 0.0, p = 0.889).Conclusions: During the COVID-19 pandemic, resources of the healthcare system in a primary care university hospital in Germany still allowed for unchanged numbers of recanalization procedures due to ischemic stroke. However, the numbers of patients admitted to the hospital specifically due to ischemic stroke or TIA decreased, suggesting that the awareness for non-disabling stroke symptoms has to be increased.

Cognitive impairment usually occurs in the acute phase after stroke, but most stroke survivors experience some form of long-term cognitive deficit. The aim of this study was to establish the cutoff point of the Montreal Cognitive Assessment (MoCA-Beijing) in screening for cognitive impairment (CI) at 6 months of ischemic stroke or transient ischemic attack (TIA).A total of 301 stroke patients and 15 TIA patients were recruited. Patients were assessed at six months by the MoCA-Beijing and a formal neuropsychological battery. The 1.5 SD below the level of the norm on several tests indicated cognitive impairment (CI).Most stroke and TIA patients were in their 60s (61.23 ± 10.60 years old). The optimal cutoff point for MoCA-Beijing in discriminating patients with CI from those with no cognitive impairment (NCI) was 24/25 (sensitivity 63.28%, specificity 71.22%, PPV = 73.68%, NPV = 60.37%, classification accuracy = 66.72%). The predominant cognitive deficits were visuospatial ability (84.85%), and then attention/executive function (79.27%).The MoCA-Beijing cutoff score for differentiating CI from NCI after stroke and TIA at six months was at 24/25, and it is important for routine clinical practice.

Objective To determine the frequency of, and factors associated with, physical inactivity 6 months post-stroke. Design Prospective longitudinal cohort. Patients A total of 215 consecutively included individuals with mild acute stroke from the Fall Study of Gothenburg. Methods Physical activity level was assessed using the 4-level Saltin-Grimby Physical Activity Scale. Associations between independent variables and the dependent variable physical inactivity 6 months post-stroke were identified using univariable and multivariable logistic regression analyses. Results At 6 months post-stroke, 81 individuals (37.7%) reported physical inactivity. Physical inactivity at 6 months after a mild stroke were associated with: stroke severity, odds ratio (OR) 1.29 (95% confidence interval (95% CI) 1.01-1.66, p = 0.043); physical inactivity prior to stroke, OR 2.89 (95% CI 1.39-6.04, p = 0.0046); moderate postural control, OR 6.71 (95% CI 2.48-18.16, p = 0.0002); poor postural control, OR 2.55 (95% CI 1.19-5.48, p = 0.016); and number of drugs in acute stroke, OR 1.20 (95% CI 1.06-1.35, p = 0.0046). Conclusion In this exploratory study, almost 40% of subjects reported physical inactivity 6 months after an acute mild stroke. Predictors of physical inactivity were physical inactivity before stroke and greater stroke severity, impaired postural control and a higher number of drugs in acute stroke.

Pendahuluan: Pasien stroke iskemik memiliki risiko menderita gangguan kognitif. Derajat gangguan kognitif antara lain dipengaruhi tingkat defisit neurologis. Derajat gangguan kognitif juga dipengaruhi oleh kadar kolesterol non-high density lipoprotein (non-HDL) yang abnormal karena mengandung semua lipid aterogenik yang menyebabkan terjadinya aterosklerosis. Tujuan: Mengetahui hubungan kadar kolesterol non-HDL terhadap gangguan kognitif pasien stroke iskemik terhadap defisit neurologis ringan di Rumah Sakit Atma Jaya pada tahun 2014-2018. Metode: Penelitian potong lintang dengan menganalisis rekam medis pasien (115 subjek). Analisis data menggunakan uji Chi-square dan uji Fisher. Hasil: Jumlah sampel pada penelitian ini adalah 115 orang. Rerata usia adalah 58±11,286 tahun. Tingkat pendidikan dengan proporsi tertinggi adalah Sekolah Menengah Atas (SMA), yaitu 30,4%. Berdasarkan Mini Mental State Examination (MMSE), 44 sampel (38,3%) mempunyai gangguan kognitif, dan 79,5% di antaranya memiliki kadar kolesterol non-HDL abnormal. Sementara itu, berdasarkan Montreal Cognitive Assessment Versi Indonesia (MoCA-Ina), 81 sampel (70,4%) mempunyai gangguan kognitif, dan 76,5% di antaranya memiliki kadar kolesterol non-HDL abnormal. Kolesterol non-HDL tidak berhubungan signifikan dengan fungsi kognitif yang diukur baik dengan MMSE maupun MoCA-Ina. Diskusi: Penelitian ini bertentangan dengan penelitian sebelumnya. Hal ini disebabkan oleh tidak ada hubungan secara langsung antara kolesterol non-HDL dan fungsi kognitif. Selain itu, kolesterol berperan sebagai antioksidan yang membantu transmisi sinyal saraf dan bersifat neuroprotektor. Kata kunci: Defisit neurologis ringan, fungsi kognitif, kolesterol non-HDL, stroke iskemik

At present, there is controversy regarding whether thrombolysis is beneficial for patients suffering from a mild stroke. In this study, we therefore sought to determine whether the therapeutic benefit of thrombolysis is dependent upon stroke subtype for those with mild stroke. We conducted a retrospective analysis of data from consecutive mild stroke patients (National Institutes of Health Stroke Scale ≤5) with and without recombinant tissue plasminogen activator (rt-PA) therapy. The TOAST (Trial of Org 10172 in acute stroke treatment) criteria was used to determine stroke subtypes. Patients suffering from large-artery atherosclerosis (LAA) were subdivided based upon whether or not they exhibited tandem steno-occlusion, as defined by the association of a proximal intracranial occlusion and a cervical internal carotid artery lesion (complete occlusion or severe stenosis ≥ 90%). For this study, favorable outcomes at 90 days of onset (modified Rankin Scale Score [mRS] of 0-1) were the primary measured outcome. Three hundred thirty-nine patients were included in the study. For patients with non-LAA, there were not statistically significant improvements in favorable outcomes for rt-PA treatment (p = 0.889, 0.929, 0.708; respectively). For patients with LAA, compared with non-treated group, rt-PA-treated patients had a significant in the rate of favorable outcomes at 90 days (82.8 vs. 64.9%; OR 2.59; 95%CI, 1.13-5.92; P = 0.024). Among LAA patients exhibiting tandem lesions, favorable outcomes were observed in 66.7% of rt-PA-treated patients, with no significant differences to those observed in untreated patients (OR 1.00; 95%CI, 0.23-4.28; p = 1.000). Among LAA patients without tandem lesions, compared with non-treated group, we found that rt-PA treatment was associated with a significant beneficial impact on favorable outcomes after 90 days (64.4 vs. 88.4%; OR 4.20; 95%CI, 1.43-12.30; p = 0.009). Our findings suggest that intravenous rt-PA is only beneficial in mild stroke patients with LAA-type strokes that do not exhibit tandem steno-occlusion.

Introduction Little is known about the relationship between smoking and clinical outcomes in acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy (MT). The outcomes could depend on different stroke subtypes. The aim of this study was to investigate whether smoking affected differently the outcomes in patients with different stroke subtypes who received MT. Methods AIS patients who underwent MT were prospectively enrolled from three hospitals between January 2014 and December 2018. Smokers were defined as current users of cigarettes. The stroke subtypes were classified according to TOAST criteria. Outcome measurements included treatment effects, intracerebral hemorrhage (ICH), and functional outcomes at 3 months. The effects of smoking on outcomes were assessed by logistic regression analysis. Results A total of 128 AIS patients with MT were enrolled, including 64 smokers and 64 non-smokers. Logistic regression analysis indicated that smoking was related to higher risk of In-hospital ICH (OR=4.31; 95% CI: 1.10–16.96; p=0.036) in patients with cardioembolism subtype. Furthermore, smoking was also associated with lower rates of mild stroke at discharge (OR=0.07; 95% CI: 0.02–0.31; p

Intravenous thrombolysis (IVT) in patients with a low National Institutes of Health Stroke Scale (NIHSS) score of 0&ndash, 5 remains controversial. IVT should be used in patients with mild but nevertheless disabling symptoms. We hypothesize that response to IVT of patients with &ldquo, mild stroke&rdquo, may depend on their level of functional dependence (FD) at hospital admission. The aims of our study were to investigate the effect of IVT and to explore the role of FD in influencing the response to IVT. This study was a retrospective analysis of a prospectively collected database, including 389 patients stratified into patients receiving IVT (IVT+) and not receiving IVT (IVT &minus, ) just because of mild symptoms. Barthel index (BI) at admission was used to assess FD, dividing subjects with BI score &lt, 80 (FD+) and with BI score &gt, 80 (FD&minus, ). The efficacy endpoints were the rate of positive disability outcome (DO+) (3-month mRS score of 0 or 1), and the rate of positive functional outcome (FO+) (mRS score of zero or one, plus BI score of 95 or 100 at 3 months). At the multivariate analysis, IVT treatment was an independent predictor of DO+ (OR 3.12, 95% CI 1.34&minus, 7.27, p = 0.008) and FO+ (OR: 4.70, 95% CI 2.38&minus, 9.26, p = 0.001). However, FD+ IVT+ patients had a significantly higher prevalence of DO+ and FO+ than those FD+ IVT&ndash, Differently, IVT treatment did not influence DO+ and FO+ in FD&ndash, patients. In FD+ patients, IVT treatment represented the strongest independent predictor of DO+ (OR 6.01, 95% CI 2.59&ndash, 13.92, p = 0.001) and FO+ (OR 4.73, 95% CI 2.29&ndash, 9.76, p = 0.001). In conclusion, alteplase seems to improve functional outcome in patients with &ldquo, However, in our experience, this beneficial effect is strongly influenced by FD at admission.

Introduction: We investigated the effectiveness of intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) patients with large vessel occlusion (LVO) and mild neurological deficits defined as National Institutes of Health Stroke Scale scores Methods: The primary efficacy outcome was three-month functional independence (FI; mRS-scores of 0-2) that was compared between patients with and without IVT treatment. Other efficacy outcomes of interest included three-month favorable functional outcome (FFO; mRS-scores of 0-1) and mRS-scores distribution at discharge and at 3 months. The safety outcomes comprised all-cause 3-month mortality, symptomatic intracranial hemorrhage (ICH), asymptomatic ICH and severe systemic bleeding. Results: We evaluated 336 AIS patients with mELVO (mean age: 63±15 years, 45% women). Patients treated with IVT (n=162) had higher FI (85.6% vs. 74.8%, p=0.027) with lower mRS scores at hospital discharge (p=0.034) compared to the rest. Three-month mRS-scores tended to be lower in the IVT group (p=0.069). No differences were detected in any of the safety outcomes including symptomatic ICH, asymptomatic ICH, severe systemic bleeding and 3-month mortality (p>0.1). IVT was associated with higher likelihood of 3-month FI (OR=2.19, 95%CI: 1.09-4.42), 3-month FFO (OR=1.99, 95%CI: 1.10-3.57) and functional improvement at discharge [cOR (per 1-point decrease in mRS-score)=2.94, 95%CI: 1.67-5.26] and at 3 months (cOR=1.72, 95%CI: 1.06-2.86) on multivariable logistic regression models adjusting for potential confounders including mechanical thrombectomy. Conclusion: IVT is independently associated with higher odds of improved discharge and three-month functional outcomes in AIS patients with mELVO. IVT does not increase the risk of systemic or intracranial bleeding.

Background: A significant proportion of patients are unable to return to work (RTW) post stroke. While post-stroke depression and fatigue have been linked to patients’ RTW status, the role of discharge NIHSS has not been studied. Objective: To evaluate role of stroke severity, depression, fatigue, and cognitive impairment on patients’ ability to RTW. Methods: A retrospective study was conducted using a survey completed by a convenience sample of patients during follow-up in stroke clinic. The survey included PHQ-9, Fatigue Assessment Scale (FAS), and the Montreal Cognitive Assessment (MoCA). Demographic, work status, and clinical data (discharge NIHSS, mRS, medical history) were also collected. NIHSS was evaluated both continuously and dichotomized ( < 1, > 1). Patients who did and did not RTW were compared using chi square tests of proportions and Wilcox Ranked Sum tests; independence of factors was explored using logistic regression predicting RTW. Results: Out of 135 patients surveyed, 41% (N=56) reported employment at the time of their stroke. Of those, a significant percentage of patients were unable to RTW post stroke (57.1%); 39.3% (N=22) were unable to RTW due to physical limitations. Further analysis revealed patients who did not RTW were more likely to suffer from fatigue (p=0.026), have higher rates of cognitive impairment (p=0.027) and a higher NIHSS at discharge (p Conclusions: For patients with mild stroke, NIHSS at discharge indicating minimal to no disability is a strong independent predictor for RTW status. For patients with greater deficit, depression, fatigue and cognitive impairment could play a greater role; additional studies of patients with greater variety of stroke severity would be needed.

Background: Stroke impacts several aspects of patients’ lives and sexual dysfunction post stroke has been reported in 40%-50% of patients. Current investigations have revealed links to depression, however this has not been examined specifically in mild stroke. Objective: To determine prevalence and factors associated with sexual dysfunction after mild stroke Design/methods: A retrospective study was conducted on a self-report questionnaire completed by a convenience sample of patients during a hospital follow-up appointment in the stroke clinic. Patients were asked about sexual dysfunction after stroke and if yes, to specify the cause: safety concern, physical limitation, consequence or change in libido. In addition, patients completed a PHQ-9 to measure depression, Fatigue Assessment Scale (FAS), and the Montreal Cognitive Assessment (MoCA). A thorough review of clinical history including NIHSS, mRS and demographics was completed by researchers. Descriptive statistics were used to identify and understand the patient population. Mild stroke was defined as NIHSS ≤ 5. Results: In our study of 135 patients, 21 (16%) did not respond to the sexual dysfunction question. Of the 114 who responded, only 11 (9.6%) reported sexual dysfunction and 9 (81%) attributed their sexual dysfunction to physical limitations. Descriptive statistics of the respondent subgroup indicate that the cohort was 59% male with a median (IQR) age of 64 (57,75) and that 52% were living with someone at the time. The mean NIHSS on discharge was 1 (IQR 0-3) and 77% were ischemic strokes. Few patients experienced post stroke depression (21.9%, N=25), and the cohort reported low levels of fatigue (median FAS=19). Low incidence and response rates precluded an analysis of specific predictors in this cohort. Conclusion: Physical limitations are reported to be the main cause of post stroke sexual dysfunction. Roughly 1 in 10 patients with mild stroke reported experiencing sexual dysfunction, however twice as many did not respond to the question. Therefore, the true incidence is unclear, prompting the need for further investigation on post stroke sexual dysfunction in mild stroke.

Intro: Guidelines advocate screening all acute stroke patients for dysphagia. However, limited data are available regarding how many patients with mild presentation fail initial screening. We sought to evaluate the rates and predictors of dysphagia screening failure in mild acute ischemic stroke patients (NIHSS < 5). Methods: Using GWTG stroke registry data from three large comprehensive stroke centers in the Northeast, South and West, we analyzed 8,687 stroke admissions from 06/2008 - 12/2018. Patients with mild stroke (NIHSS Results: Of the 8,687 patients, 3,614 (41%) had NIHSS < 5. Dysphagia screening failure was seen in 30.2% in the entire cohort while only 10.3% (373/3,614) in patients with NIHSS < 5. Mild stroke patients who failed dysphagia screening were older, more often had stroke risk factors of hypertension, hyperlipidemia, CAD/MI. They had higher median NIHSS and more often had language disturbance on presentation. Patients who failed dysphagia screening were less likely to be discharged home. On MV analysis, age (1.01, 95% 1.00, 1.02), hypertension (1.45, 95% 1.10, 1.91), NIHSS (1.62 95% 1.48, 1.77) and language disturbance at presentation (1.89 95% 1.13, 2.32) were significantly associated with initial dysphagia. Conclusion: Dysphagia screen failure rates are significantly less frequent in patients with mild symptoms and even lower for those with NIHSS of 0-1 at presentation. Factors associated with failure - older age, higher NIHSS and language disturbance at presentation may help focus efforts to avoid complications in these patients who might otherwise do well. This focused approach of screening patients all patients but targeting mild patients with dysphagia may hold potential for improved outcomes.

Perivascular spaces are fluid-filled tubular spaces that follow the course of cerebral penetrating vessels, thought to be a key part in the brain’s circulation and glymphatic drainage system. Their enlargement and abundance have been found associated with cerebral small vessel disease. Thus, their quantification is essential for establishing their relationship with neurological diseases. Previous works in the field have designed visual rating scales for assessing the presence of perivascular spaces and proposed segmentation techniques to reduce flooring and ceiling effects of qualitative visual scales, processing times, and inter-observer variability. Nonetheless, their application depends on the acquisition quality. In this paper, we propose a framework for improving perivascular spaces quantification using both texture analysis and total variation filtering. Texture features were considered for evaluating the image quality and determining automatically whether filtering was needed. We tested our work using data from a cohort of patients with mild stroke (\(n=60\)) with different extents of small vessel disease features and image quality. Our results demonstrate the potential of our proposal for improving perivascular spaces assessments.

Introduction The aim of this study was to explore how women of working age who have had a mild stroke resulting in cognitive impairment experience and manage their everyday lives. Method Data were collected using semi-structured interviews. The participants consisted of 10 women of working age who had sustained cognitive impairment after a mild stroke. The interviews were analysed using qualitative content analysis. Results Three main categories appeared: The everyday is affected by the symptoms, Living strategies, and The social environment effects and changes. Participants feel insecure about their abilities and capabilities, experience anxiety and fear in relation to work, and find it hard to live up to demands and expectations. They are required to plan their daily activities in a new way and to prioritise chores that benefit the family, rather than follow their own interests and social activities. In order to cope with everyday life, they need to allocate chores to other family members. Conclusions The constant impact of fatigue and cognitive impairments affects everyday life. The women said that they had to learn to continuously manage their limitations through their experience of everyday life, something that can be facilitated with occupational therapy.

The purposes of this cross-sectional descriptive study were to describe early neurological recovery in patients with acute ischemic stroke and to identify the statistical predictors of early neurological recovery at 24 h and 3 days after admission. A purposive random sampling was employed to recruit 220 AIS patients from 8 hospitals in the southern region of Thailand from January to May 2016, and the data was analyzed by using multivariate logistic regression analysis. The results revealed that moderate and severe stroke severity decreased neurological recovery at 24 h (OR = .095, p < .001, and OR = .126, p < .01, respectively), compared with mild stroke severity. In addition, onset time to rt-PA within 3 h and 3.0 - 4.5 h increased the neurological recovery at 24 h (OR = 22.22, P < .001, and OR = 17.28, P < .01, respectively), compared with those who did not receive rt-PA treatment. Lastly, age > 80 years decreased neurological recovery at 24 h after admission (OR=.361, P < .05). Neurological recovery at 3 days showed that moderate and severe stroke severity decreased neurological recovery (OR = .10, p < .001, and OR = .09, p < .001, respectively), compared with mild stroke severity. Stroke patients who had onset time to rt-PA within 3 h and within 3.0 - 4.5 h increased neurological recovery at 3 days (OR=16.95, P < .05, and OR = 14.43, P < .01, respectively), compared with those who did not receive rt-PA treatment. The findings of this study show that stroke severity and onset time to rt-PA influence early neurological recovery in AIS patients.

Stroke Transient Ischemic Attack (TIA ) adalah kondisi stroke ringan. Stroke ringan diakibatkan oleh berkurangnya suplai darah menuju otak. Kelumpuhan disebabkan oleh kurangnya aliran darah ke otak, sehingga sisi tubuh akan mengalami kelumpuhan terutama pada siku dan lutut. Fisioterapi pada pasien pasca stroke ringan dilakukan dengan metode terapi gerakan antara lain seperti penggunaan alat bantu fisioterapi pasien pasca stroke menggunakan sensor MPU6050 melalui media transmisi Bluetooth. Sistem rancangan ini membantu latihan pada pasien berbentuk sensor MPU6050 yang digunakan untuk mendeteksi sudut serta banyaknya gerakan rehabilitasi pasien pasca stroke. Sensor gyroscope menghasilkan deteksi sudut pada siku sebesar 150 dan sudut pada lutut sebesar 135 . Data yang didapatkan diproses oleh arduino nano menggunakan metode I2C. Penelitian ini bertujuan untuk merancang alat bantu fisioterapi pasien pasca stroke berbasis mikrokontroler guna memperoleh hasil yang maksimal karena bentuk alat ini yang portable. Stroke Transient Ischemic Attack (TIA) is a mild stroke condition that can be caused by reduced blood supply to the brain due to blocked blood vessels. Lack of blood flow to the brain can cause paralysis, usually only on one side of the body such as the elbows and knees. Physiotherapy in post-stroke patients is carried out using movement therapy methods, including elbow and knee flexion. Currently, patients come to the therapist or vice versa to perform therapeutic movements, so a telemonitoring system for post-stroke patient physiotherapy tools is made using the MPU6050 sensor which is connected to ESP 232 and the internet network and can be monitored by therapists and clinic admins where the therapy is done. This system helps monitor elbow and knew flexion exercises using the MPU6050 sensor which is used to detect the angle and number of rehabilitation movements of post-stroke patients. . From the results of testing the accuracy of this sensor is able to detect the angle of elbow movement from 00-1500 and knee flexion angle of 00-1350 by 99%.The telemonitoring application for physiotherapy tools for post-stroke patients based on Android is equipped with a therapist menu so that the number of movements and the average angle of movement of the knees and elbows can be monitored by the therapist, this tool can also be used anywhere and anytime due to the portable form of this tool.

A new serious game for post-stroke rehabilitation with six different levels of exercises.This solution allows to assist the traditional therapy and motivate the patient to execute his/her rehabilitation program, under health professional supervision.A preliminary study show good results in user preferences.This approach supports first- and third-person point of views and virtual reality devices, like head-mounted displays and motion sensors. Background and objectiveRecent researches about games for post-stroke rehabilitation have been increasing, focusing in upper limb, lower limb and balance situations, and showing good experiences and results. With this in mind, this paper presents Motion Rehab AVE 3D, a serious game for post-stroke rehabilitation of patients with mild stroke. The aim is offer a new technology in order to assist the traditional therapy and motivate the patient to execute his/her rehabilitation program, under health professional supervision. MethodsThe game was developed with Unity game engine, supporting Kinect motion sensing input device and display devices like Smart TV 3D and Oculus Rift. It contemplates six activities considering exercises in a tridimensional space: flexion, abduction, shoulder adduction, horizontal shoulder adduction and abduction, elbow extension, wrist extension, knee flexion, and hip flexion and abduction. Motion Rehab AVE 3D also report about hits and errors to the physiotherapist evaluate the patient's progress. ResultsA pilot study with 10 healthy participants (6175 years old) tested one of the game levels. They experienced the 3D user interface in third-person. Our initial goal was to map a basic and comfortable setup of equipment in order to adopt later. All the participants (100%) classified the interaction process as interesting and amazing for the age, presenting a good acceptance. ConclusionsOur evaluation showed that the game could be used as a useful tool to motivate the patients during rehabilitation sessions. Next step is to evaluate its effectiveness for stroke patients, in order to verify if the interface and game exercises contribute into the motor rehabilitation treatment progress.