10 Years Observation and Rehabilitation of Stroke Disability

Despite significant advances in the treatment and rehabilitation of stroke, level of post-stroke disability remains at a fairly high level. Recent innovative developments in the rehabilitation of these patients provide good results in terms of functional outcome. One of such developments is method of virtual reality (VR), which affects not only the speed and volume of regaining movement, as well as coordination, but also normalizes the psycho-emotional background, increasing the motivation of patients to improve the recovery process. This article provides a literature review of the use of the VR method in the rehabilitation of post-stroke patients, neurophysiological aspects of recovery of lost functions using this method are considered.

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Societal Cost of Ischemic Stroke in Romania: Results from a Retrospective County-Level Study

Brain Sciences ◽

10.3390/brainsci11060689 ◽

2021 ◽

Vol 11 (6) ◽

pp. 689

Author(s):

Stefan Strilciuc ◽

Diana Alecsandra Grad ◽

Vlad Mixich ◽

Adina Stan ◽

Anca Dana Buzoianu ◽

...

Keyword(s):

Ischemic Stroke ◽

Indirect Costs ◽

First Year ◽

Hospital Level ◽

Economic Burden Of Disease ◽

Outpatient Cost ◽

Patient Pathways ◽

Stroke Disability ◽

Access To Data ◽

The Cost

Background: Health policies in transitioning health systems are rarely informed by the economic burden of disease due to scanty access to data. This study aimed to estimate direct and indirect costs for first-ever acute ischemic stroke (AIS) during the first year for patients residing in Cluj, Romania, and hospitalized in 2019 at the County Emergency Hospital (CEH). Methods: The study was conducted using a mixed, retrospective costing methodology from a societal perspective to measure the cost of first-ever AIS in the first year after onset. Patient pathways for AIS were reconstructed to aid in mapping inpatient and outpatient cost items. We used anonymized administrative and clinical data at the hospital level and publicly available databases. Results: The average cost per patient in the first year after stroke onset was RON 25,297.83 (EUR 5226.82), out of which 80.87% were direct costs. The total cost in Cluj, Romania in 2019 was RON 17,455,502.7 (EUR 3,606,505.8). Conclusions: Our costing exercise uncovered shortcomings of stroke management in Romania, particularly related to acute care and neurorehabilitation service provision. Romania spends significantly less on healthcare than other countries (5.5% of GDP vs. 9.8% European Union average), exposing stroke survivors to a disproportionately high risk for preventable and treatable post-stroke disability.

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Abstract 170: Impact of Eloquent Motor Cortex-Tissue Reperfusion Beyond the Traditional TICI Scoring After Thrombectomy

Stroke ◽

10.1161/str.51.suppl_1.170 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Radoslav I Raychev ◽

Jeffrey Saver ◽

Scott Brown ◽

Gary Duckwiler ◽

Reza Jahan ◽

...

Keyword(s):

Multivariate Analysis ◽

Motor Cortex ◽

Primary Motor Cortex ◽

Multivariable Analysis ◽

Functional Independence ◽

Digital Subtraction ◽

Anterior Circulation ◽

Endovascular Thrombectomy ◽

Stroke Disability ◽

The Impact

Background: Targeted eloquence-based tissue reperfusion within the primary motor cortex may have differential effect on disability as compared to the traditional volume-based (TICI) reperfusion after endovascular thrombectomy (EVT) in setting of acute ischemic stroke (AIS). Methods: We explored the impact of eloquent reperfusion (ER) within primary motor cortex (PMC) on clinical outcome (mRS) in AIS patients undergoing EVT. ER was defined as presence of flow on final digital subtraction angiography (DSA) within four main cortical branches, supplying the PMC (MCA - precentral, central, anterior parietal; ACA- pericallosal) and graded as absent (0), partial (1), and complete (2). Prospectively collected data from two centers were analyzed. Multivariable analysis was conducted to assess the impact of ER on 90-day disability (mRS) among patients with anterior circulation occlusion who achieved partial reperfusion (TICI 2 a and b). Results: Among the 125 patients who met study criteria, median age was 73, median NIHSS was 16, median ASPECTS was 7, 48% (60/125) were female, and 36.8% achieved functional independence (mRS 0-2) at 90 days. ER distribution was: Absent (0) in 19/125 (15.2%); Partial (1) in 52/125 (41.6%), and Complete (2) in 54/125 (43.2%). TICI 2b was achieved in 102/125 (81.6%) and ER was substantially higher in those patients (p<0.001). In multivariate analysis, in addition to age and sICH, ER had a profound independent impact on 90-day disability (OR 6.10, p=0.001 for ER 1 vs 0; and OR 9.87, p<0.001 for ER 2 vs 0). In contrast, extent of total partial reperfusion (TICI 2b vs 2a) was not related to 90-day disability. Conclusions: Our findings support that eloquent PMC-tissue reperfusion is a major determinant of functional outcome, more impactful than volume-based degree of partial reperfusion. More aggressive, PMC-targeted revascularization among patients with non-eloquent partial reperfusion may further improve post-stroke disability after EVT.

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Racial and ethnic disparities in stroke outcomes: a scoping review of post-stroke disability assessment tools

Disability and Rehabilitation ◽

10.1080/09638288.2018.1448467 ◽

2018 ◽

Vol 41 (15) ◽

pp. 1835-1845 ◽

Cited By ~ 4

Author(s):

Suzanne Perea Burns ◽

Brandi M. White ◽

Gayenell Magwood ◽

Charles Ellis ◽

Ayaba Logan ◽

...

Keyword(s):

Scoping Review ◽

Ethnic Disparities ◽

Assessment Tools ◽

Disability Assessment ◽

Racial And Ethnic Disparities ◽

Stroke Outcomes ◽

Post Stroke ◽

Stroke Disability

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Abstract TP372: Outcomes of the Extended Ischemic Stroke Treatment Window

Stroke ◽

10.1161/str.51.suppl_1.tp372 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Michele J Patterson ◽

Tracy Moore ◽

Paula Cline ◽

Lee Birnbaum

Keyword(s):

Ischemic Stroke ◽

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Community Education ◽

Stroke Severity ◽

Complication Rates ◽

Stroke Treatment ◽

Stroke Disability ◽

Treatment Window

Background: After clinical practice guidelines extended the mechanical endovascular reperfusion [MER] window, our Comprehensive Stroke Program expanded its stroke alert [SA] to include last known well [LKW] 6-24 hours [h]. Expansion included implementation of a standardized large vessel screen, RAPID brain imaging software, revised algorithm, EMS and community education, and regional transfer guidelines. Purpose: Evaluate outcomes of the extended window [EW] for ischemic stroke treatment. Method: We reviewed ischemic strokes over a 2 year period and categorized them into two groups: 2017 pre-guideline [PG] and 2018 EW post-guideline [PostG]. Each group was divided into all-MERs and MERs 6-24h. Groups were compared by LKW, NIHSS, TICI scores, complications, discharge [DC] disposition and Modified Rankin Score [mRS] at DC and 90 days [90d]. Outcomes were evaluated to identify the EW impact. Results: Of 744 strokes reviewed, 365 were PG and 379 were EW PostG. LKW 6-24h was greater PostG [22%=PG versus [v] 30%=EW], in all-MERs [19%=PG v 31%=EW] and MERs 6-24h [69%=PG v 83%=EW]. Stroke severity [NIHSS>7] was higher PostG [41%=PG v 45%=EW], in all-MERs [88%=PG v 91%=EW] and MERs 6-24h [85%=PG v 96%=EW]. MER treatment rates increased PostG [13%=PG v 17%=EW]. Post-MER TICI 2b/3 reperfusion rates were higher PostG in all-MERs [63%=PG v 77%=EW] and MERs 6-24h [38%=PG v 71%=EW]. Any complication was lower PostG [27%=PG v 22%=EW] with higher complication rates in MERs 6-24h [15%=PG v 17%=EW]. More patients were DC home PostG [42%=PG v 46%=EW], in all-MERs [25%=PG v 30%=EW], and MERs 6-24h [8%=PG v 29%=EW]. mRS 0-2 at DC was increased PostG [20%=PG v 29%=EW], in all-MERs [12%=PG v 27%=EW], and MERs 6-24h [8%=PG v 34%=EW]. mRS at 90d was increased PostG for all-MERs [25%=PG v 34%=EW] with decreased deaths [15%=PG v 10%=EW]. Conclusion: The EW has increased patients treated and improved overall outcomes. Patients arriving with LKW 6-24h has increased along with stroke severity. Reperfusion rates improved and overall complications were lower, however higher rates were seen in MERs 6-24h. Patients treated in the EW had reductions in post stroke disability, increases in DC to home, and improvements in mRS at DC and 90d.

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Developing an ICF core set for post-stroke disability assessment and verification in Taiwan: a preliminary study

Disability and Rehabilitation ◽

10.3109/09638288.2011.638033 ◽

2011 ◽

Vol 34 (15) ◽

pp. 1254-1261 ◽

Cited By ~ 13

Author(s):

Kwang-Hwa Chang ◽

Hung-Chou Chen ◽

Yennung Lin ◽

Shih-Ching Chen ◽

Hung-Yi Chiou ◽

...

Keyword(s):

Disability Assessment ◽

Icf Core Set ◽

Post Stroke ◽

Core Set ◽

Stroke Disability ◽

Preliminary Study

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Reliability of the modified Rankin Scale applied by telephone

Neurology International ◽

10.4081/ni.2013.e2 ◽

2013 ◽

Vol 5 (1) ◽

pp. 2 ◽

Cited By ~ 29

Author(s):

Katia Savio ◽

Gian Luca Della Pietra ◽

Elodie Oddone ◽

Monica Reggiani ◽

Maurizio A. Leone

Keyword(s):

Confidence Interval ◽

Acute Stroke ◽

Scale Score ◽

Weighted Kappa ◽

Hospitalized Patients ◽

The Other ◽

Modified Rankin Scale ◽

Face To Face ◽

The Face ◽

Stroke Disability

We aimed to evaluate the reliability of the modified Rankin Scale applied telephonically compared with face-to-face assessment in clinically stable hospitalized patients with acute stroke. One hundred and thirty-one patients were interviewed twice by 2 certified nurses (unstructured interview). Half of the patients were randomized to be interviewed by telephone followed by the face-to-face assessment, and half in the reverse order. The median value of the modified Rankin Scale score was 4 (first to third interquartile range 3-5) by telephone as well as by face-to-face assessment (P=0.8). The weighted kappa between the two methods was 0.82 (95% confidence interval: 0.77-0.88). Sensitivity of the telephone assessment was lower for scores 2 and 3 (17% and 46%, respectively) than for the other scores (range 67-90%). Telephone assessment of stroke disability with the modified Rankin Scale is reliable in comparison to direct face- to-face assessment.

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