Abstract WP173: Mexican Americans Less Likely to Return to Work Following Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Lesli Skolarus ◽  
Jeffrey J Wing ◽  
Lewis B Morgenstern ◽  
Lynda D Lisabeth
Keyword(s):  
High School ◽  
Return To Work ◽  
Ethnic Differences ◽  
Mexican Americans ◽  
Ethnic Difference ◽  
Public Health Problem ◽  
Stroke Recovery ◽  
Stroke Severity ◽  
Stroke Survivors ◽  
Post Stroke

Introduction: Lost earnings are the largest driver of the projected $2.2 trillion in stroke costs over the next 4 decades. Mexican Americans (MA) are more likely to have a working age stroke and suffer greater post-stroke disability than non-Hispanic whites (NHW). Thus, we explored ethnic differences in post-stroke return to work and whether sociodemographics and stroke severity contribute to ethnic differences. Methods: Ischemic stroke patients were identified from the population-based Brain Attack Surveillance in Corpus Christi (BASIC) study from August 2011-December 2013. Employment status was obtained at baseline and 90-day interviews conducted with patients or proxies. Sequential logistic regression models were built to assess ethnic difference in return to work after accounting for: 1) age (<65 vs ≥65), sex; 2) 90-day NIH stroke score, and 3) education (<high school vs. ≥high school). Results: Of the 729 MA and NHW stroke survivors who completed the baseline interview, 197 (27%) were working at the time of their stroke of which 125 completed the 90-day outcome interview. There were no ethnic differences in sex or the proportion over the age of 65. MAs had less education (5% vs. 24% college graduate, p<0.01) and greater median 90-day stroke severity (2 vs. 1, p=0.02) than NHWs. Forty-nine (40%) stroke survivors returned to work. MAs were less likely to return to work (OR= 0.45, 95% CI 0.22-0.94) than NHWs. This difference remained after accounting for age and sex (OR=0.45, 95% CI 0.21-0.94). The ethnic difference was attenuated and became non-significant after adjusting for stroke severity (0.59, 95%CI 0.24-1.24) and further attenuated after accounting for education (0.85, 95% CI 0.32, 2.22). In the fully adjusted model, lower stroke severity and higher education were associated with return to work. Conclusion: MAs are less likely to return to work after stroke than NHWs. This finding is important given that MAs are younger and poorer at the time of their stroke suggesting a crucial public health problem. Future work should consider including return to work as part of patient centered outcomes and efforts to optimize stroke recovery.

Abstract T P128: Ethnicity and the Availability of Rehabilitation Facilities in the Brain Attack Surveillance in Corpus Christi Project

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Sarah Reeves ◽  
Micah Aaron ◽  
Michael Fuentes ◽  
Lewis Morgenstern ◽  
Lynda Lisabeth
Keyword(s):  
Ethnic Differences ◽  
Mexican Americans ◽  
Stroke Rehabilitation ◽  
Inpatient Rehabilitation ◽  
Population Based ◽  
Stroke Survivors ◽  
Market Area ◽  
Post Stroke ◽  
Corpus Christi ◽  
Rehabilitation Facilities

Background: Mexican Americans (MAs) have worse stroke outcomes than non-Hispanic whites (NHWs). One explanation may be ethnic differences in post-stroke rehabilitation; despite its effectiveness, non-clinical factors such as geographic availability may influence use of certain rehabilitation venues. We investigated ethnic differences in availability of stroke rehabilitation venues in a bi-ethnic community. Methods: Stroke survivors were identified through the population-based Brain Attack Surveillance in Corpus Christi (BASIC) Project from 2011-2013 in Nueces County, a bi-ethnic, mostly urban community in southeast Texas with a population of 340,000. Addresses of inpatient rehabilitation facilities (IRFs) and skilled nursing facilities (SNFs) providing stroke rehabilitation were identified by phone/internet and geocoded. Availability was defined as distance to and supply of each type of venue in relation to the survivor’s home. Supply was calculated as the count of each type of venue within a given radius (defined as the 90th percentile of distribution of distances to reflect a reasonable market area). Associations between availability and ethnicity were modeled using linear regression adjusted for census tract-level median household income, proportion <65 years, and population density as obtained from the 2012 American Community Survey. Results: A total of 942 survivors were eligible (62% MA, 38% NHW); 3 IRFs and 21 SNFs were identified. The average distances from the survivors’ homes to an IRF or SNF were 5 miles (SD=6) and 2 miles (SD=3), respectively. Supply was calculated within radii of 16 miles for IRFs and 4 miles for SNFs. The average count of rehabilitation venues within these radii was 2.6 IRFs (SD=0.9) and 7.9 SNFs (SD=4.7). There were no ethnic differences in the distance or supply of IRFs; however, MAs were on average 1 mile (CI:0.6-1.5) closer to and had 0.8 (CI:0.2,1.3) more SNFs within the radius than NHWs. Conclusions: Availability of rehabilitation venues was high for both ethnic groups; however, MAs have greater availability of SNFs compared to NHWs. Additional study is necessary to understand how the availability and quality of services within rehabilitation venues impact post-stroke rehabilitation among MA stroke survivors.

Ethnic Differences in Informal Caregiving After Stroke

Stroke ◽  
2021 ◽  
Author(s):  
Lewis B. Morgenstern ◽  
Cecilia N. Hollenhorst ◽  
Linda C. Gallo ◽  
Chia-Wei Hsu ◽  
Sehee Kim ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Activities Of Daily Living ◽  
Informal Care ◽  
Ethnic Differences ◽  
Mexican Americans ◽  
Daily Living ◽  
Logistic Models ◽  
Stroke Care ◽  
Informal Caregiving ◽  
Stroke Severity

Background and Purpose: Informal (unpaid) caregiving usually provided by family is important poststroke. We studied whether the prevalence of informal caregiving after stroke differs between Mexican Americans (MAs) and non-Hispanic Whites (NHWs). Methods: Between October 2014 and December 2018, participants in the BASIC (Brain Attack Surveillance in Corpus Christi) project in Nueces County, Texas, were interviewed 90 days after stroke to determine which activities of daily living they required help with and whether family provided informal caregiving. Ethnic differences between MAs and NHWs were determined by logistic regression. The logistic models were stratified by formal (paid) care status. Odds ratios (95% CIs) are reported with NHW as the referent group. Fisher exact tests were used to assess the association of ethnicity with relationship of caregiver and with individual activities of daily living. Results: Eight hundred thirty-one patients answered the caregiving questions. Of these, 242 (29%) received family caregiving (33% of MAs and 23% of NHWs), and 142 (17%) received paid caregiving (21% of MAs and 10% of NHWs). There were no ethnic differences in stroke severity. In logistic regression analyses, among those without formal, paid care, MAs were more likely to have informal caregiving (odds ratio, 1.75 [95% CI, 1.12–2.73]) adjusted for age, National Institutes of Health Stroke Scale, prestroke modified Rankin Scale, and insurance. No ethnic differences in informal care were found among those who had formal care. There were no differences between ethnic groups in which family members provided the informal care. MAs were more likely to require help compared with NHWs for walking ( P <0.0001), bathing ( P <0.0001), hygiene ( P =0.0012), eating ( P =0.0004), dressing ( P <0.0001), ambulating ( P =0.0304), and toileting ( P =0.0003). Conclusions: MAs required more help poststroke than NHWs for assistance with activities of daily living. MAs received more help for activities of daily living through informal, unpaid caregiving than NHWs if they were not also receiving formal, paid care. Efforts to help minority and low-resource populations provide stroke care are needed.

scholarly journals Return to Work Among Stroke Survivors

2019 ◽  
Vol 67 (2) ◽  
pp. 87-94 ◽  
Author(s):  
Kristin D. Ashley ◽  
Loretta T. Lee ◽  
Karen Heaton
Keyword(s):  
Occupational Health ◽  
Return To Work ◽  
Quantitative Research ◽  
Stroke Severity ◽  
Stroke Survivors ◽  
Factors Affecting ◽  
Work And Employment ◽  
Subsequent Failure

Despite improvements in the treatment of stroke, many individuals still face cognitive, emotional, and physical impairments. Stroke is a leading cause of serious long-term disability and subsequent failure to return to work (RTW). The purpose of this literature review was to synthesize and discuss the literature relevant to factors affecting RTW for stroke survivors, summarize the identified gaps, and discuss steps occupational health nurses can take to facilitate RTW among stroke survivors. A literature search was conducted using the keywords: “stroke,” “cerebrovascular disease,” “return to work,” and “employment.” After excluding articles based on inclusion/exclusion criteria, 19 quantitative research articles were reviewed. Consistent themes found in the literature affecting RTW following stroke included physical, social, and cognitive factors. One of the most consistent predictors of RTW found was stroke severity. Individuals who experienced a mild to moderate stroke, those of Caucasian ethnicity, and higher socioeconomic levels were more likely to RTW. Findings suggest the importance of future studies to examine factors among African American stroke survivors that predict RTW and the role of occupational health nurses.

scholarly journals β-Oscillations Reflect Recovery of the Paretic Upper Limb in Subacute Stroke

2020 ◽  
Vol 34 (5) ◽  
pp. 450-462 ◽  
Author(s):  
Chih-Wei Tang ◽  
Fu-Jung Hsiao ◽  
Po-Lei Lee ◽  
Yun-An Tsai ◽  
Ya-Fang Hsu ◽  
...  
Keyword(s):  
Motor Function ◽  
Upper Limb ◽  
Primary Motor Cortex ◽  
Hand Movement ◽  
Stroke Recovery ◽  
Stroke Survivors ◽  
Healthy Controls ◽  
Functional Changes ◽  
Post Stroke ◽  
Subacute Stroke

Background. Recovery of upper limb function post-stroke can be partly predicted by initial motor function, but the mechanisms underpinning these improvements have yet to be determined. Here, we sought to identify neural correlates of post-stroke recovery using longitudinal magnetoencephalography (MEG) assessments in subacute stroke survivors. Methods. First-ever, subcortical ischemic stroke survivors with unilateral mild to moderate hand paresis were evaluated at 3, 5, and 12 weeks after stroke using a finger-lifting task in the MEG. Cortical activity patterns in the β-band (16-30 Hz) were compared with matched healthy controls. Results. All stroke survivors (n=22; 17 males) had improvements in action research arm test (ARAT) and Fugl-Meyer upper extremity (FM-UE) scores between 3 and 12 weeks. At 3 weeks post-stroke the peak amplitudes of the movement-related ipsilesional β-band event-related desynchronization (β-ERD) and synchronization (β-ERS) in primary motor cortex (M1) were significantly lower than the healthy controls (p<0.001) and were correlated with both the FM-UE and ARAT scores (r=0.51-0.69, p<0.017). The decreased β-ERS peak amplitudes were observed both in paretic and non-paretic hand movement particularly at 3 weeks post-stroke, suggesting a generalized disinhibition status. The peak amplitudes of ipsilesional β-ERS at week 3 post-stroke correlated with the FM-UE score at 12 weeks (r=0.54, p=0.03) but no longer significant when controlling for the FM-UE score at 3 weeks post-stroke. Conclusions. Although early β-band activity does not independently predict outcome at 3 months after stroke, it mirrors functional changes, giving a potential insight into the mechanisms underpinning recovery of motor function in subacute stroke.

scholarly journals Changes in PHQ-9 depression scores in acute stroke patients shortly after returning home

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259806
Author(s):  
Brent Strong ◽  
Michele C. Fritz ◽  
Liming Dong ◽  
Lynda D. Lisabeth ◽  
Mathew J. Reeves
Keyword(s):  
Depressive Symptoms ◽  
Acute Stroke ◽  
Recovery Period ◽  
Stroke Severity ◽  
Stroke Survivors ◽  
Stroke Patients ◽  
Early Recovery ◽  
Post Stroke ◽  
Early Recovery Period ◽  
Over Time

Introduction Post-stroke depression is a disabling condition that occurs in approximately one-third of stroke survivors. There is limited information on changes in depressive symptoms shortly after stroke survivors return home. To identify factors associated with changes in post-stroke depressive symptoms during the early recovery period, we conducted a secondary analysis of patients enrolled in a clinical trial conducted during the transition period shortly after patients returned home (MISTT). Methods The Michigan Stroke Transitions Trial (MISTT) tested the efficacy of social worker case management and access to online information to improve patient-reported outcomes following an acute stroke. Patient Health Questionnaire-9 (PHQ-9) scores were collected via telephone interviews conducted at 7 and 90 days post-discharge; higher scores indicate more depressive symptoms. Generalized estimating equations were used to identify independent predictors of baseline PHQ-9 score at 7 days and of changes over time to 90 days. Results Of 265 patients, 193 and 185 completed the PHQ-9 survey at 7 and 90 days, respectively. The mean PHQ-9 score was 5.9 at 7 days and 5.1 at 90 days. Older age, being unmarried, and having moderate stroke severity (versus mild) were significantly associated with lower 7-day PHQ-9 scores (indicating fewer depressive symptoms). However, at 90 days, both unmarried patients and those with moderate or high stroke severity had significant increases in depressive symptoms over time. Conclusions In stroke patients who recently returned home, both marital status and stroke severity were associated with depressive symptom scores; however, the relationships were complex. Being unmarried and having higher stroke severity was associated with fewer depressive symptoms at baseline, but both factors were associated with worsening depressive symptoms over time. Identifying risk factors for changes in depressive symptoms may help guide effective management strategies during the early recovery period.

scholarly journals Post-stroke fatigue is linked to resting state posterior hypoactivity and prefrontal hyperactivity

2021 ◽  
Author(s):  
Georgia Mary Cotter ◽  
Mohamed Salah Khlif ◽  
Laura Bird ◽  
Mark E Howard ◽  
Amy Brodtmann ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Resting State ◽  
Large Scale ◽  
Brain Activity ◽  
Low Frequency ◽  
Resting State Fmri ◽  
Stroke Severity ◽  
Stroke Survivors ◽  
Whole Brain ◽  
Post Stroke

Background and Purpose. Fatigue is associated with poor functional outcomes and increased mortality following stroke. Survivors identify fatigue as one of their key unmet needs. Despite the growing body of research into post-stroke fatigue, the specific neural mechanisms remain largely unknown. Methods. This observational study included 63 stroke survivors (22 women; age 30-89 years; mean 67.5 years) from the Cognition And Neocortical Volume After Stroke (CANVAS) study, a cohort study examining cognition, mood, and brain volume in stroke survivors following ischaemic stroke. Participants underwent brain imaging 3 months post-stroke, including a 7-minute resting state fMRI echoplanar sequence. We calculated the fractional amplitude of low-frequency fluctuations, a measure of resting state brain activity at the whole-brain level. Results. Forty-five participants reported experiencing post-stroke fatigue as measured by an item on the Patient Health Questionnaire-9. A generalised linear regression model analysis with age, sex, and stroke severity covariates was conducted to compare resting state brain activity in the 0.01-0.08 Hz range, as well as its subcomponents - slow-5 (0.01-0.027 Hz), and slow-4 (0.027-0.073 Hz) frequency bands between fatigued and non-fatigued participants. We found no significant associations between post-stroke fatigue and ischaemic stroke lesion location or stroke volume. However, in the overall 0.01-0.08 Hz band, participants with post-stroke fatigue demonstrated significantly lower resting-state activity in the calcarine cortex (p<0.001, cluster-corrected pFDR=0.009, k=63) and lingual gyrus (p<0.001, cluster-corrected pFDR=0.025, k=42) and significantly higher activity in the medial prefrontal cortex (p<0.001, cluster-corrected pFDR=0.03, k=45), attributed to slow-4 and slow-5 oscillations, respectively. Conclusions. Post-stroke fatigue is associated with posterior hypoactivity and prefrontal hyperactivity, reflecting dysfunction within large-scale brain systems such as fronto-striatal-thalamic and frontal-occipital networks. These systems in turn might reflect a relationship between post-stroke fatigue and abnormalities in executive and visual functioning. This first whole-brain resting-state study provides new targets for further investigation of post-stroke fatigue beyond the lesion approach.

Abstract TP210: Examining the Role of Context: Neighborhood Socioeconomic Status Shaping Post-Stroke Outcomes

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Eric Stulberg ◽  
Erica Twardzik ◽  
Chia-Wei Hsu ◽  
Sehee Kim ◽  
Philippa Clarke ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Neighborhood Context ◽  
Stroke Recovery ◽  
Future Research ◽  
Stroke Severity ◽  
Stroke Outcomes ◽  
Neighborhood Socioeconomic Status ◽  
Post Stroke

Introduction: Neighborhoods may influence post-stroke recovery. We examined the association between neighborhood socioeconomic status (nSES) and 90-day post-stroke function, depression, cognition, and quality of life (QoL). Methods: Stroke survivors (N=782) were identified from the population-based Brain Attack Surveillance in Corpus Christi (BASIC) Project. An nSES index – composite of 2010 census-tract level income, wealth, education, employment – was the exposure; higher values indicate higher nSES (median -4.56; IQR: -7.48 to -0.46). Function was measured with 22 self-reported activities of daily living/instrumental activities of daily living, depression with Patient Health Questionnaire-8, QoL with the Stroke Specific QoL Scale, and cognition with the Modified Mini Mental State Examination. Confounder-adjusted generalized estimating equations were used to estimate associations between nSES (comparing 75 th to 25 th percentile) and 90-day outcomes. We tested for effect modification by initial stroke severity (NIH Stroke Scale (NIHSS) ≤ 5 or >5) by including interaction terms in adjusted models. Results: Higher nSES was associated with significantly better function, better QoL, and less depression after adjusting for person-level confounders in those with NIHSS >5. Higher nSES was associated with better cognition, but this result was not significant. In those with NIHSS ≤5, higher nSES had a statistically significant (though attenuated) association with function and cognition. Conclusions: Future research should identify features of higher nSES neighborhoods that contribute to more favorable stroke outcomes. Our findings highlight the need for examining the individual and joint influence of neighborhood context and stroke severity on post-stroke recovery.

Abstract W MP105: Long Term Stroke Outcome and Caregiving Among Mexican Americans (MA) and Non-Hispanic Whites (NHW): The Population-Based Brain Attack Surveillance in Corpus Christi (BASIC) Study

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Brisa N Sanchez ◽  
Lynda Lisabeth ◽  
Darin Zahuranec ◽  
Melinda A Cox ◽  
Nelda Garcia ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Repeated Measures ◽  
Mexican Americans ◽  
Caregiver Strain ◽  
Stroke Survivors ◽  
Basic Study ◽  
Long Term Outcome ◽  
Post Stroke

Background: Long term stroke outcomes in MA are understudied, and the role of informal caregiving and caregiver strain in this population is unknown. We report a pilot study of long-term outcomes in BASIC. Methods: Patients previously interviewed at 90 days post-stroke were invited to participate in a telephone survey related to their 6 or 12 month post-stroke activities of daily living (ADLs) during March-May 2013. ADL score (average of 7 items, range 1-4) was analyzed by self-reported ethnicity using repeated measures models. In a separate sample interviewed at 90 days, patients were asked about willingness to participate in longer term follow-up and a subset of caregivers responded to the caregiver strain index (CSI, range 1-13, higher is worse). Results: Among patients alive at the time of interview, 87% of 39 MA and 74% of 19 NHW participated in the 6 month interview, and 84% of 32 MA and 88% of 8 NHW participated in the 12 month interview. No patients refused at either time point; the remainder could not be contacted. The figure shows trajectories of ADL score by ethnicity, and worsening scores among MA over time. Interest in longer-term follow-up was high (96% of 25 NHWs and 97% of 38 MAs). Caregivers of MA stroke survivors were most often children (41%) followed by spouses (36%), but were spouses (43%) followed by children (29%) for NHWs. Of 29 caregivers interviewed, 54% of MA and 57% of NHW reported being strained (CSI≥7). Caregiver strain was associated with 90-day ADL score: prevalence ratio = 1.34, 95%CI (1.01, 1.76) for 1 unit increase in ADL score. Conclusions: Our data demonstrate the feasibility of recruiting MA stroke survivors for long-term outcome assessments and suggests that MAs have worse functional outcome and greater functional declines than NHWs. The informal caregiver burden is related to functional outcome and is high in both ethnic groups.

Abstract WP233: Unraveling the Profile and Risk Factors of Post-Stroke Cognitive Impairment Among West African Stroke Survivors: Data From the SIREN Study

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Rufus Akinyemi ◽  
Bruce Ovbiagele ◽  
Onoja Akpa ◽  
Fred Sarfo ◽  
Joshua Akinyemi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Conditional Logistic Regression ◽  
Leafy Vegetables ◽  
Stroke Severity ◽  
Stroke Survivors ◽  
Community Screening ◽  
Post Stroke ◽  
Green Leafy Vegetables ◽  
Education Network

Background: There is paucity of data on the epidemiology of post-stroke cognitive impairment among African stroke survivors. The aim of this study is to report the profile and risk factors of post- stroke cognitive impairment among stroke survivors participating in the Stroke Investigative Research and Education Network (SIREN) Study. Methods: 1566 were evaluated with the Montreal Cognitive Assessment (MoCA) tool, the Community Screening Instrument for Dementia (CSID) and the Stick Design Test three months after the index stroke. Domain scores were derived for executive function, language memory and visuo-constructive/visuospatial domains. Cut off scores were derived from normative cognitive data obtained from comparable healthy stroke-free control subjects. We used conditional logistic regression to estimate odds ratios (OR) with 95% CIs. Results: Of 1566 stroke survivors [mean age 57.7 (13.4) years] who were assessed 3 months after stroke, 37% were impaired in global cognition and 18-43% were impaired in different domains of cognition (executive, memory, language and visuo-constructive). Stroke severity measured by modified NIHSS score had a strong significant negative association with cognitive function in all domains OR 1.96(1.32-2.91). Older age 1.04 (1.02-2.05), male gender 0.69 (0.50 -0.96), low intake of green leafy vegetables 2.83 (2.03 -3.95) and cardiac disease 1.86 (1.31 -2.75) were associated with poorer cognitive performance in different cognitive domains. Conclusion: The frequency of post-stroke cognitive impairment was high among African stroke survivors three months after the ictus. Diet low in green leafy vegetables is a potentially modifiable risk factor for post-stroke cognitive impairment among West Africans.

STROKE PATIENTS AND THEIR PARTNER’S PERCEPTIONS OF SURVIVOR FUNCTIONING

2017 ◽  
Vol 15 (2) ◽  
pp. 0-0 ◽  
Author(s):  
Chloe Witty ◽  
Thomas Heffernan ◽  
Leigh Riby
Keyword(s):  
Verbal Memory ◽  
Digit Span ◽  
Qualitative Interviews ◽  
Stroke Survivor ◽  
Self Report ◽  
Stroke Recovery ◽  
Step Test ◽  
Stroke Survivors ◽  
Post Stroke ◽  
Significant Difference

[b]Background: [/b]Research into stroke survivors and their partners have shown that the partner frequently rates the stroke survivor as less capable than the survivors rate themselves through self-report questionnaires or qualitative interviews; however, no research to date has used cognitive tasks as a method for in vestigation. This paper aims to investigate if the stroke survivor or the partner rate the stroke survivor as worse across all cognitive domains. [b]Material/ Methods:[/b]This research aimed to observe the incongruence of stroke survivors and their spouse’s perception of survivor functioning by rating their confidence on Picture Memory, Verbal Memory, Digit Span, Luria’s Three Step Test, NART and Raven’s Matrices. Participants, and to compare these score to see if either could predict the actual score. [b]Results: [/b]Showed that neither the stroke survivor nor the partner consistently rated functioning as worse, but there was a significant difference between the dyad. Further, the stroke survivor and the partner’s confidence had no relationship with raw scores. A thematic analysis was also conducted and themes emerged from the data. These were “Confidence,” “Insight into Ability,” and “Post-Stroke Changes.”[b]Conclusions:[/b]These themes were shown to interlink with the scores provided in the qualitative analysis, and implied that low self-efficacy may be crucial in post stroke recovery. Limitations and implications are discussed in full.

Sign in / Sign up

Export Citation Format

Share Document