The impact of injuries below the knee joint on the long-term functional outcome following polytrauma

IntroductionThe mechanism linking childhood trauma (CT) to the functional deficits observed in early psychosis (EP) patients is as yet unknown.ObjectivesTo examine the potential mediating effect of depressive symptoms in this well-established association.MethodsTwo hundred nine EP subjects aged 18-35 were assessed for functioning and psychopathology after 2, 6, 12, 18, 24, 30, and 36 months of treatment. Patients were classified into early-trauma if they had faced at least one experience of abuse (physical, sexual, or emotional) or neglect (physical or emotional) before age 12, and late-trauma if the exposure had occurred between ages 12 and 16. Psychopathology was assessed with the Positive and Negative Syndrome Scale and the Montgomery-Asberg Depression Rating Scale. Functioning was measured with the Global Assessment of Functioning (GAF) and the Social and Occupational Functioning Assessment Scale (SOFAS). Mediation analyses were performed in order to study whether the relationship between CT and functioning was mediated by depressive symptoms.ResultsWhen compared with nonexposed patients, early but not late trauma patients showed lower levels of GAF and SOFAS scores over all the time points, excepting after the first assessment. After 30 and 36 months, the effect of early trauma on functioning was completely mediated by depressive symptoms. No mediating effect of positive or negative symptoms was highlighted at those time points.ConclusionMild depressive symptoms mediated the impact of early trauma on long-term functional outcome. Intensifying pharmacologic and/or psychotherapeutic treatment, focused on the depressive dimension, may help traumatized EP patients to improve their functioning.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Direct reprogramming of astrocytes to neurons leads to functional recovery after stroke

10.1101/2020.02.02.929091 ◽

2020 ◽

Author(s):

Jessica Livingston ◽

Tina Lee ◽

Emerson Daniele ◽

Clara Phillips ◽

Alexandra Krassikova ◽

...

Keyword(s):

Functional Outcome ◽

Functional Outcomes ◽

Treatment Options ◽

Brain Repair ◽

Novel Approach ◽

Regenerative Approach ◽

Cortical Stroke ◽

The Impact

AbstractStroke is the leading cause of adult disability with few treatment options for stroke survivors. Astrocyte reprogramming to neurons enables the targeted in vivo generation of new cells at the site of injury and represents a novel approach for brain repair. A number of studies have demonstrated successful conversion of astrocytes to neurons in various models of brain injury and disease; however, the impact of this strategy on tissue and functional outcome following stroke is not well established. Using AAV delivery of the transcription factor NeuroD1, we reprogrammed astrocytes 7 days after endothelin-1 induced cortical stroke, and studied the long-term cellular and functional outcomes. We found that by 63 days post-stroke, 20% of neurons in the perilesional cortex were reprogrammed. Furthermore, reprogrammed neurons had matured into regionally appropriate neuronal subtypes. Importantly, this treatment was associated with improved functional outcome using the foot fault test and gait analysis. Together, our findings indicate that in vivo reprogramming is a promising regenerative approach for stroke repair.

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Abstract TMP45: Predicting Long-term Body Function, Activity & Participation After Stroke: The Prevailing Role of Cognition in Determining Functional Outcome

Stroke ◽

10.1161/str.48.suppl_1.tmp45 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Arunima Kapoor ◽

Krista Lanctot ◽

Mark Bayley ◽

Alex Kiss ◽

Richard Swartz

Keyword(s):

Cognitive Impairment ◽

Functional Outcome ◽

Stroke Severity ◽

Post Stroke ◽

Body Function ◽

Multiple Levels ◽

Multiple Domains ◽

Levels Of Functioning ◽

The Impact

Background: Stroke can impact multiple levels of function and result in complex disability. Few studies have examined limitations across the range of functions from body function to social participation, or explored the impact of post-stroke comorbidities, such as depression, obstructive sleep apnea (OSA) and cognition, on function, especially in the long-term. We aimed to determine post-stroke predictors of multiple levels of functioning approximately 2 years after a stroke, and to specifically evaluate the impact of depressive symptoms, OSA and cognitive impairment on outcome. Hypothesis: We hypothesized that in addition to traditional predictors of outcome–age and stroke severity–depression, OSA and cognitive impairment will predict functional outcome in multiple domains. Methods: Baseline assessment of depression, apnea and cognitive impairment with 2-year follow-up assessment of functional outcome to evaluate each of the three levels of functioning as stated in the WHO International Classification of Functioning: Body Function (Montreal Cognitive Assessment), Activity (modified Rankin) and Participation (Reintegration to Normal Living Index). Results: A total of 162 patients were enrolled at approximately 2 years and 5 months post-stroke. Forty one percent had activity limitations, 58% were cognitively impaired and 68% had restrictions in participation. Long-term activity limitation was predicted by greater age (OR = 0.95), stroke severity (OR = 1.69) and cognitive impairment (OR = 1.28) at baseline. Body function impairment was predicted by greater age (OR = 0.96), and cognitive impairment (OR = 1.49). Participation restriction was predicted by cognitive impairment (OR = 1.26). Conclusion: Baseline cognition predicts long-term function in multiple domains and is a better predictor of long-term participation than age or baseline stroke severity. In view of the widespread impact of post-stroke cognitive impairment on every level of functioning, routine post-stroke cognitive screening and target interventions are warranted. Greater attention to functional domains beyond activity could further optimize recovery and enhance outcome after stroke.

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Long-term health-related quality of life, survival and costs by different levels of functional outcome six months after stroke

European Stroke Journal ◽

10.1177/2396987317753444 ◽

2018 ◽

Vol 3 (2) ◽

pp. 157-164 ◽

Cited By ~ 3

Author(s):

Ann-Sofie Rudberg ◽

Eivind Berge ◽

Anders Gustavsson ◽

Per Näsman ◽

Erik Lundström

Keyword(s):

Quality Of Life ◽

Functional Outcome ◽

Economic Evaluations ◽

Health Related Quality ◽

Term Survival ◽

Related Quality ◽

Health Related ◽

The Impact

Introduction Information about the impact of functional outcome after stroke is currently missing on health-related quality of life, survival and costs. This information would be valuable for health economic evaluations and for allocation of resources in stroke health care. Patients and methods Data on 297 Swedish patients included in the Third International Stroke Trial were analysed including functional outcome at six months (measured by Oxford Handicap Scale), health-related quality of life up to 18 months (EQ-5D-3L) and survival up to 36 months. We used record linkage to collect data on costs up to 36 months, using national patient registers. Results Patients with a better functional outcome level at six months had a significantly better health-related quality of life at 18 months ( p < 0.05), better long-term survival ( p < 0.05) and lower costs ( p < 0.001), for all time points up to 36 months. The difference in costs was mainly due to differences in days spent in hospital ( p < 0.005). Discussion This study showed an association between functional outcome at six months and health-related quality of life up to 18 months, and costs up to 36 months. Conclusion Functional outcome six months after stroke is an important determinant of health-related quality of life, survival and costs over 36 months. Effective interventions aimed at reducing short-term disability levels are therefore also expected to reduce the overall burden of stroke.

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Serum Anti-NMDA (N-Methyl-D-Aspartate)-Receptor Antibodies and Long-Term Clinical Outcome After Stroke (PROSCIS-B)

Stroke ◽

10.1161/strokeaha.119.026100 ◽

2019 ◽

Vol 50 (11) ◽

pp. 3213-3219 ◽

Cited By ~ 5

Author(s):

Pia S. Sperber ◽

Bob Siegerink ◽

Shufan Huo ◽

Jessica L. Rohmann ◽

Sophie K. Piper ◽

...

Keyword(s):

Functional Outcome ◽

Odds Ratio ◽

Vascular Event ◽

Vascular Events ◽

Aspartate Receptor ◽

Hazard Ratios ◽

Increased Risk ◽

One Year ◽

The Impact

Background and Purpose— NMDAR1-abs (anti-N-Methyl-D-Aspartate receptor GluN1 antibodies), predominantly known in the context of autoimmune encephalitis, have been observed in serum of healthy individuals. A previous study found smaller stroke magnetic resonance imaging lesion growth in seropositive patients, suggesting a neuroprotective effect of these antibodies. The impact of NMDAR1-abs seropositivity on long-term functional outcome and recurrent vascular events and death after first-ever stroke remains unclear. Methods— Data from the Prospective Cohort with Incident Stroke—Berlin were used. NMDAR1-abs (ie, IgM, IgA, and IgG) were measured in serum within 7 days after first stroke. Outcomes of interest included modified Rankin Scale at one year and the time-to-event of a combined end point (recurrent stroke, myocardial infarction, and all-cause mortality) within 3 years. We calculated odds ratios from adjusted partial proportional odds models and subsequently compared outcome of patients with low titers (1:10; 1:32; and 1:100), and high titers (1:320; 1:1000) to seronegative patients. Furthermore, we estimated hazard ratios for a secondary vascular event or death in NMDAR1-abs seropositive compared to seronegative patients in models adjusted for confounders. Results— The analyses included 583 patients with antibody measurements (39% female, median National Institutes of Health Stroke Scale:2, IQR:1-4), and NMDAR1-abs were observed in 76 (13%) patients. NMDAR1-abs seroprevalence was not associated with functional outcome (odds ratio=1.27; 95% CI, 0.77–2.09); sub-group analyses, however, showed worse outcome in patients with high titers (odds ratio=3.47; 95% CI, 1.54–7.80). Seropositive patients had an increased risk for a secondary vascular event or death (hazard ratios =1.83, 95% CI, 1.10–3.05). Conclusions— In our study, NMDAR1-abs seropositivity was not associated with functional outcome at one year after stroke, however, high titers (≥1:320) were associated with poor functional outcome. Furthermore, NMDAR1-abs seropositivity was associated with increased cardiovascular risk within 3 years after first stroke, independently from other risk factors. Clinical Trial Registration— URL: https://www.clinicaltrials.gov . Unique identifier: NCT01363856.

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Simulating the Effects of Anthropometry on the Contralateral Limb of Transtibial Amputees

Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care ◽

10.1177/2327857921101031 ◽

2021 ◽

Vol 10 (1) ◽

pp. 76-82

Author(s):

Ninad Mahajan ◽

Pratima Saravanan ◽

Jessica Menold

Keyword(s):

Inverse Dynamics ◽

Reaction Force ◽

Joint Damage ◽

Contralateral Limb ◽

Below The Knee ◽

Ankle Joints ◽

Transtibial Amputees ◽

The Impact ◽

Force Data

Gait analysis is a clinically relevant method to assess walking patterns in rehabilitating patients, especially transtibial amputees. Prior work in biomechanics has detailed the impacts of below-the-knee amputation and anthropometric characteristics on patient gait, but little work has been done in the intersection of these fields, particularly with consideration towards the contralateral (intact) limb. This study utilizes OpenSim, a biomechanics simulation package, to investigate the impact of anthropometry on the stresses and response behavior of the hip, knee, and ankle joints in the contralateral limb of transtibial amputees. Musculoskeletal geometry, gait, and ground reaction force data for models were sourced from a healthy subject and appropriately adjusted based on amputation status and anthropometry. Inverse dynamics operations were performed on each model. Results indicate the need for special clinical focus on the ankle of heavier, taller amputees, along with the prescription of appropriate prosthetic componentry with a sufficient range of motion, to prevent long-term joint damage within the lower extremities. Initial data is preliminary, but serves as a foundation for additional simulations and related work in biomechanics simulations.

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Abstract P179: Impact of Transportation Mode on Outcome of Mechanical Thrombectomy

Stroke ◽

10.1161/str.52.suppl_1.p179 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Colin Smith ◽

Eyad Almallouhi ◽

Cassie Nankee ◽

Habiba Fayyaz ◽

Sami Al Kasab ◽

...

Keyword(s):

Logistic Regression ◽

Functional Outcome ◽

Mechanical Thrombectomy ◽

Univariate Analysis ◽

Air Transportation ◽

Transportation Mode ◽

Interhospital Transfer ◽

The Impact

Introduction: It is well established that mechanical thrombectomy (MT) improves functional outcome in stroke patients with a large vessel occlusion and salvageable brain tissue. In this study, we evaluate the impact of transportation mode on outcomes of patients undergoing MT. Methods: The prospectively maintained data from medical charts of consecutive patients transferred to a single comprehensive stroke center (CSC) for thrombectomy from January 2017 to December 2019 was reviewed. Clinical outcome was measured at a 90-day follow up with National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS). Multivariate logistic regression analysis was used to assess the relationship between helicopter transportation and favorable 90-day outcome in MT patients. Results: A total of 135 MT patients underwent the procedure following interhospital transfer by helicopter or ground ambulance. 60/135 (44%) of the patients were transferred by air. On univariate analysis there was no significant differences in age (median of 66 vs. 68 years; p=0.23), sex (31% vs. 36% men; p=0.605) or race (31% vs. 44% white; p=0.344) between the air vs. ground groups. Also, baseline NIHSS did not differ (95% CI 12.0-15.69 vs. 14.06-17.31; p=0.136). Total of 56 (41.5%) patients received tissue plasminogen activator (tPA) (25 air vs. 31 ground; p=0.97) and the overall door to groin time was similar in both groups (85.17 vs. 83.96 minutes; p=0.86). NIHSS at 90-day follow up was significantly lower in those taken by helicopter compared to ground transit (95% CI 4.60-11.26 vs. 11.50-17.61; p=0.015). Air transportation was independently associated with good long-term functional outcome on multivariable logistic regression after controlling for age, sex, race, tPA and transportation time (OR 3.757 95% CI 1.23-11.4; p=0.02). Conclusions: Air transportation in MT patients was independently associated with better long-term functional outcome. The association between helicopter transit and long-term function is shown to be independent of transit time.

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Long term Post-Stroke Functional Outcomes: a comparison of diabetics and non-diabetics

Cerebrovascular Diseases Extra ◽

10.1159/000521442 ◽

2021 ◽

Author(s):

Deidre Anne de Silva ◽

Kaavya Narasimhalu ◽

Ian Wang Huang ◽

Fung Peng Woon ◽

John C. Allen ◽

...

Keyword(s):

Ischemic Stroke ◽

Functional Outcome ◽

Functional Outcomes ◽

Age Group ◽

Stroke Patients ◽

Poor Functional Outcome ◽

Post Stroke ◽

The Impact

Introduction: Diabetes mellitus (DM) is known to influence outcomes in the short-term following stroke. However, the impact of DM on long-term functional outcomes after stroke is unclear. We compared functional outcomes periodically over 7 years between diabetic and non-diabetic ischemic stroke patients and investigated the impact of DM on the long-term trajectory of post-stroke functional outcomes. We also studied the influence of age on the diabetes-functional outcome association. Methods: This is a longitudinal observational cohort study of 802 acute ischemic stroke patients admitted to the Singapore General Hospital from 2005 to 2007. Functional outcomes were assessed using the modified Rankin Scale (mRS) with poor functional outcome defined as mRS≥3. Follow-up data was determined at 6 months and at median follow-up durations of 29 and 86 months. Results: Among the 802 ischemic stroke patients studied (mean age 64 ± 12 years, male 63%), 42% had DM. In regression analyses adjusting for covariates, diabetic patients were more likely to have poor functional outcomes at 6 months (OR=2.12, 95% CI: 1.23–3.67) and at median follow-up durations of 29 months (OR=1.96, 95% CI: 1.37–2.81) and 86 months (OR=2.27, 95% CI: 1.58–3.25). In addition, age modulated the effect of DM, with younger stroke patients (≤65 years) more likely to have long term poor functional outcome at the 29-month (p=0.0179) and 86-month (p=0.0144) time points. Conclusions: DM was associated with poor functional outcomes following ischemic stroke in the long term with the effect remaining consistent throughout the 7-year follow-up period. Age modified the effect of DM in the long term, with an observed increase in risk in the ≤65 age group but not in the >65 age group.

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Abstract TP36: Impact of Intracranial Hemorrhage After Endovascular Treatment on Long-Term Functional Outcomes in Patients With Acute Large Vessel Occlusion: Insights From RESCUE- Japan Registry-2

Stroke ◽

10.1161/str.51.suppl_1.tp36 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Norito Kinjo ◽

Kazutaka Uchida ◽

Shinichi Yoshimura ◽

Nobuyuki Sakai ◽

Hiroshi Yamagami ◽

...

Keyword(s):

Functional Outcome ◽

Intracranial Hemorrhage ◽

Functional Outcomes ◽

Large Vessel ◽

Prognostic Impact ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Good Outcome ◽

The Impact

Background and Purpose: Endovascular therapy (EVT) for acute large vessel occlusion (LVO) is currently standard therapy, but it was associated with a higher incidence of intracranial hemorrhage (ICH) compared to conservative therapy. We investigated the impact of ICH within 72 hours on functional outcome at 90 days in patients with EVT for acute LVO. Methods: RESCUE-Japan Registry-2 was a multicenter registry enrolled 2420 consecutive patients with acute LVO within 24 hours of onset. We analyzed patients who received EVT and compared the functional outcomes between those with ICH (ICH group) and without ICH (No-ICH group) within 72 hours after onset. We estimated the adjusted odds ratio (OR) for good functional outcome as mRS 0-2 and mortality. We also explored the prognostic impact of symptomatic ICH (SICH) among those with ICH. Results: Among 2420 patients in the registry, 1281 received EVT and mean age was 75 years, and 759 (59.2%) were men. ICH occurred in 332 patients (25.9%). Good outcome was observed 80 patients (24.0%) and 454 patients (47.9%) in the ICH and No-ICH group, respectively, and the adjusted OR for good outcome of ICH group compared to No-ICH group was 0.30 (95% CI 0.22-0.42, p<0.0001). However, the mortalities within 90 days were not significantly different between groups (adjusted OR 1.13; 95% CI 0.72-1.76, p=0.59). SICH was observed in 35 patients (10.5%) among 332 patients with ICH, and the good outcomes were 8.6% and 25.9 % in patients with SICH and asymptomatic ICH (AICH), respectively (p=0.02). Mortality at 90 days were 31.4% and 7.0% in patients with SICH and AICH, respectively (p<0.0001). Conclusion: The functional outcomes at 90 days after onset was significantly worse in patients suffered ICH than the counterparts after EVT for acute LVO. However, the mortality rates were generally similar between those with and without ICH. Among patients with ICH, mortality was higher in patients with SICH, but mortality of the patients with AICH was similar to those without ICH.

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Abstract TMP4: Impact of Bridging Therapy With Intravenous Thrombolysis Prior to Mechanical Thrombectomy in Patients With Large Vessel Occlusion- Insights From the STAR Registry

Stroke ◽

10.1161/str.51.suppl_1.tmp4 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Sami Al Kasab ◽

Eyad Almallouhi ◽

Ali Alawieh ◽

Christine A Holmstedt ◽

Reda M Chalhub ◽

...

Keyword(s):

Functional Outcome ◽

Mechanical Thrombectomy ◽

Group Versus ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Bridging Therapy ◽

Vessel Occlusion ◽

Procedural Time ◽

The Impact

Introduction: Clinical trials have proven the safety and efficacy of mechanical thrombectomy (MT) with intravenous alteplase (tPA) compared to tPA alone in patients presenting with large vessel occlusion (LVO). The impact of tPA prior to MT on procedural metrics, successful revascularization, symptomatic hemorrhage and long-term functional outcome has not been established from large scale real-world studies. In this study we evaluate the impact of tPA prior to MT on procedural times, immediate and long-term outcomes. Methods: The STAR registry combined prospectively maintained databases of 11 thrombectomy-capable stroke centers in the US, Europe and Asia. Patients who received mechanical thrombectomy with or without intravenous tPA prior to MT were included in these analyses. Baseline characteristics, procedural time, successful revascularization (TICI ≥ 2B), symptomatic intracranial hemorrhage (PH2), and long-term functional outcomes were compared between the two groups. Results: Total of 1869 patients were included in this analysis. Of those, 907 received tPA prior to MT. Baseline features and outcomes are summarized in table 1. There were more white patients in the non-tPA group, and more patients in this group had atrial fibrillation and hyperlipidemia; otherwise there were no differences in baseline features between the two groups. Median NIHSS on admission was 16 in both groups, median ASPECTS was 9 in the tPA group versus 8 in the non-tPA group, p=0.208. Patients in the tPA group had higher rate of successful revascularization, lower number of revascularizations attempts and were more likely to achieve excellent long-term functional outcome. There was no difference in procedural time, rate of symptomatic hemorrhage or length of hospital stay. Conclusion: Bridging therapy with intravenous tPA prior to mechanical thrombectomy may facilitate MT and yield to better long-term functional outcome.

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