Abstract TP37: Negative Diffusion-Weighted Imaging in Mild Ischemic Stroke Patients: An Exploratory Analysis of a Single-Center Six-Year Cohort

Background: DWI-negativity was observed in nearly one third of patients with non-disabling ischemic stroke in a recent study and complete reversal of DWI-positivity was reported in 2% of mild-moderate strokes after IV rtPA treatment. We sought to identify acute DWI-negativity and DWI reversal rates in an independent cohort treated with IV rtPA because of mild stroke symptoms (defined as NIHSS 0-5). Methods: We reviewed a prospective single-center registry of consecutive, IV rtPA-treated patients at Aarhus University Hospital from 2004 to 2010 with a substantial number of strokes with low (0-5) NIHSS scores and reviewed their acute (<4.5 hours) and 24-hour MRI characteristics. Acute MRI is standard stroke work-up imaging at our center (except for patients with MRI contraindications). The local practice was to prefer IV rtPA treatment in mild stroke patients if clinical suspicion was supported by either MRI DWI positivity or other imaging data (MRI-perfusion lesions or visualized arterial occlusions on MRA). Only patients with final diagnoses of ischemic stroke upon hospital discharge were included in this analysis. Results: Among 694 patients treated with IV rtPA from 2004-2010, 266 (38.3%) had NIHSS 0-5. Among these mild stroke patients, 238 received acute MRI and 107 had 24-hour follow-up MRI. Acute DWI-negativity was observed in 32/238 (13.5%; 95% CI 9.4-18.4) patients prior to IV rtPA treatment. Among the cohort with both acute and 24-hour MRIs, acute DWI-negativity was present in 15/107 (14.0%) patients and persisted in 8/15 (53.3%; 95% CI 26.6-78.7). Of 92 DWI-positive patients, only 2/92 (2.1%) became DWI-negative at 24 hours. An association of acute DWI-negativity with younger age (OR 0.98; 95% CI 0.96-1.01) or lower NIHSS (OR 0.90; 95% CI 0.69-1.18) was not found in this cohort. Conclusions: Acute DWI-negativity was observed in ~14% of ischemic strokes with NIHSS 0-5, and half remained negative at 24 hours following IV rtPA. DWI reversal from positive to negative, possibly representing an averted infarction, occurred in 2% of patients. These rates may be lower than the true rate of DWI-negativity and reversal in mild stroke, given limitations of this analysis, including DWI-positivity influencing the initial IV rtPA decision.

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Predictors of the functional outcome after thrombolysis in an Egyptian patients’ sample

The Egyptian Journal of Neurology Psychiatry and Neurosurgery ◽

10.1186/s41983-020-00261-5 ◽

2021 ◽

Vol 57 (1) ◽

Author(s):

H. M. Eldeeb ◽

D. H. Elsalamawy ◽

A. M. Elabd ◽

H. S. Abdelraheem

Keyword(s):

Ischemic Stroke ◽

Hospital Stay ◽

Functional Outcome ◽

Arterial Occlusion ◽

University Hospital ◽

Stroke Severity ◽

Stroke Patients ◽

Predicting Factors ◽

Egyptian Patients ◽

Cerebrovascular Stroke

Abstract Background About 6.2 million individuals worldwide and approximately 200 Egyptians/100,000 citizens have cerebrovascular stroke annually, and only less than 1% of stroke patients received intravenous (IV) thrombolysis in 2014. Outcome of the ischemic stroke after IV thrombolysis varies, and there is lack of data about the predicting factors that contributes to the outcome of ischemic strokes after IV thrombolysis in Egypt. Objective The aim of this work is to study the predictors of the functional outcome of ischemic cerebrovascular stroke after IV thrombolysis in Egyptian patients. Patients and methods This is a prospective study that includes acute ischemic stroke patients who received IV thrombolysis at the Alexandria University Hospital during the year from February 2017 to February 2018, and they were evaluated initially by Rapid Arterial Occlusion Evaluation (RACE) scale and followed-up serially for 6 months after thrombolysis using the National Institutes of Health Stroke Scale (NIHSS) and modified ranking score (mRS). Results Forty-five patients are included; 56% had favorable functional outcome (mRS 0–2) after 6 months, 68% had ≥ 4 points improvement in NIHSS after 6 months, and 13% had hemorrhagic conversion with 18% mortality rate. High initial RACE scale and long hospital stay are associated with poor functional outcome 6 months after thrombolysis. Conclusion Stroke severity demonstrated by high initial RACE and the duration of hospital stay are the two most significant predictors with an impact on the functional outcome of ischemic cerebrovascular stroke after thrombolysis.

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Supplemental Oxygen Use in Ischemic Stroke Patients, Does Utilization Correspond to Need for Oxygen Therapy?

Stroke ◽

10.1161/str.32.suppl_1.382-b ◽

2001 ◽

Vol 32 (suppl_1) ◽

pp. 382-382

Author(s):

Arthur M Pancioli ◽

Mark J Bullard ◽

Mary E Grulee ◽

Edward C Jauch ◽

David F Perkis

Keyword(s):

Ischemic Stroke ◽

Oxygen Therapy ◽

Supplemental Oxygen ◽

University Hospital ◽

Extensive Literature ◽

Oxygen Utilization ◽

Stroke Patients ◽

Co Morbidity ◽

History Of ◽

Explicit Criteria

P236 Background: In 1994, the American Heart Association Stroke Council stated that there is no data to support routine use of supplemental oxygen in stroke patients. The purpose of this study was to determine the degree of supplemental oxygen use in ischemic stroke and whether patients receiving oxygen met criteria for therapy. Methods: An extensive literature search was performed to generate a comprehensive list of explicit criteria for supplemental oxygen use. When the literature disagreed, criteria were included in the list to overestimate rather than underestimate the justification for oxygen use. A retrospective chart review of 169 consecutive, non-intubated, ischemic stroke patients admitted to a university hospital during calendar year 1998 was performed. Two patients were excluded due to missing data yielding a sample of 167 patients. Data included demographic and co-morbidity information as well as a check of each inpatient day for documentation of any of the explicit criteria for supplemental oxygen use. Results: A total of 167 patient charts were reviewed yielding a total of 600 inpatient days abstracted. Of the 167 patients, 102 (61.1%) received oxygen accounting for 322 patient days. Of the 322 inpatient days that patients received oxygen, 147 (45.6%) met at least one criteria for oxygen utilization. Of the 278 inpatient days that patients did not receive oxygen 69 (24.8%) would have met at least one of the criteria for oxygen use. For the entire population, statistically significant factors associated with patients receiving oxygen included: presence of at least one justifying criteria, increasing age, white race, male gender, history of atrial fibrillation, and a history of hypertension. Conclusion: We developed a comprehensive, literature-based list of criteria for supplemental oxygen therapy that was designed to overestimate rather than underestimate the justification of oxygen utilization. Using this explicit list, only 45.6% of days of oxygen therapy were justified in our ischemic stroke population. This study demonstrates that oxygen therapy is commonly given to ischemic stroke victims without clear indication.

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Analysis of microRNA signatures in ischemic stroke thrombus

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2021-017597 ◽

2021 ◽

pp. neurintsurg-2021-017597

Author(s):

Jeong-Min Kim ◽

Jun-Soo Byun ◽

Jiah Kim ◽

Moo-Seok Park ◽

Soon Auck Hong ◽

...

Keyword(s):

Ischemic Stroke ◽

Expression Pattern ◽

Microarray Analysis ◽

Laboratory Data ◽

Microrna Expression ◽

University Hospital ◽

Large Artery ◽

Stroke Patients ◽

Qrt Pcr ◽

Functional Relevance

BackgroundWe investigated the microRNA expression pattern from thrombus retrieved by mechanical thrombectomy in acute stroke patients to understand the stroke mechanism.MethodsThis study included acute ischemic stroke patients who had undergone intra-arterial thrombectomy at Chung-Ang University Hospital in Seoul, Korea between February 2016 and March 2019. The thrombus was retrieved and stored at −70℃ after obtaining informed consent. MicroRNA microarray analysis was performed for the patients with identified stroke mechanisms including (1) large artery atherosclerosis, (2) cardioembolism with atrial fibrillation, and (3) cardioembolism with valvular heart disease. The microRNAs derived from microarray analysis were validated by quantitative real-time polymerase chain reaction (qRT-PCR) from different patient populations. The correlation analysis was performed between microRNA levels and laboratory data to understand the functional relevance of the altered microRNA.ResultsIn total, 55 thrombi were obtained from 74 patients, and the microRNAs were analyzed in 45 samples. Microarray analysis of 2578 microRNAs revealed that 50 microRNAs were significantly altered among the three groups. Validation using qRT-PCR showed that miR-378f and miR-450b-5p were significantly elevated among the cardioembolic thrombi; both microRNAs were inversely correlated with the ejection fraction from echocardiography. Thrombi from patients with early neurological deterioration exhibited higher levels of miR-93-5p and lower levels of miR-629-5p than those from neurologically stable patients.ConclusionsThe microRNA expression pattern can provide information regarding the mechanism of stroke by reflecting the underlying pathological status of the organ from which the thrombus was derived.

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Incidence and predictors of left atrium thrombus in acute ischemic stroke patients without atrial fibrillation: a single center cohort study

European Heart Journal ◽

10.1093/ehjci/ehaa946.0076 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

T Cinar ◽

M.I Hayiroglu ◽

V Cicek ◽

S Asal ◽

M.M Atmaca ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cohort Study ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Left Atrium ◽

Characteristic Curve ◽

Multivariate Logistic Regression Analysis ◽

Single Center ◽

Stroke Patients ◽

Previous Diagnosis

Abstract Introduction The present study aimed to determine independent predictors of left atrial thrombus (LAT) in acute ischemic stroke patients without atrial fibrillation (AF) using transesophageal echocardiography (TEE). Material and methods In this single center, retrospective cohort study, we enrolled 149 consecutive acute ischemic stroke patients. All of the patients underwent TEE examination to detect LAT within 10 days following admission. Multivariate logistic regression analysis was performed to assess independent predictors of LAT. Results Among all cases, 14 patients (9.3%) had a diagnosis of LAT on TEE examination. In a multivariate analysis; a previous diagnosis of cerebrovascular accident, elevated mean platelet volume (MPV), low left ventricle ejection fraction (EF) and a reduced left atrium appendix (LAA) peak emptying velocity were independent predictors of LAT. The area of MPV under the receiver operating characteristic curve analysis was 0.70 (95% CI: 0.57–0.83; p=0.011). With the optimal cut-off value of 9.45, MPV had a sensitivity of 71.4% and a specificity of 63% to predict LAT. Conclusion Patients with low ventricle EF and elevated MPV should undergo further TEE examination for the possibility of cardio-embolic source. In addition, this research may provide novel information with respect to the applicability of MPV to predict LAT in acute ischemic stroke patients without AF. Figure 1 Funding Acknowledgement Type of funding source: None

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Trends in the seeking of emergency service for ischemic stroke and its risk factors during the COVID-19 pandemic, a study from Taiwan

Neurology Asia ◽

10.54029/2021axy ◽

2021 ◽

Vol 26 (3) ◽

pp. 441-447

Author(s):

Yi Te Tsai ◽

Yachung Jeng ◽

Hsiu-Hsi Chen ◽

Kai-Chieh Chang

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Emergency Services ◽

Stroke Care ◽

University Hospital ◽

Minor Stroke ◽

Stroke Severity ◽

Health Seeking ◽

Stroke Patients ◽

Ich Score

Background & Objectives: COVID-19 may influence the health seeking behavior of acute ischemic stroke patients. This study aimed to determine the characteristics of the patients who visited the emergency room in a centre designated for stroke care in Taiwan. Methods: This was a retrospective database-based study comparing the severity of ischemic stroke, intracerebral hemorrhage (ICH), and risk factors of patients seen between 2019 and 2020 in the National Taiwan University Hospital Yunlin Branch. Patients with or without thrombolysis therapy were analysed. Results: The median NIHSS of ischemic stroke patients were lower in 2019 than in 2020 (p = 0.015). The difference was seen in non-thrombolysis patients (2019: 3[1-6] vs. 4 [2-7.5], p = 0.012) but not in thrombolysis patients. The frequency of minor stroke was higher in 2019 (45.1%) than in 2020 (37.9%, p = 0.038). The discharge mRS was lower overall (p = 0.004) and in non-thrombolysis patients (0.003), but not in thrombolysis patients in 2019. As for the ICH patients, the severity of ICH score (p = 0.021) and discharge mRS (p = 0.001) were also lower in 2019. The frequencies of risk factors of stroke were higher in 2019 than in 2020, including smoking (24% vs. 18.2%, p = 0.046), alcohol (11.9% vs. 7.5%, p = 0.039), hypertension (72.9% vs. 66.2%, p = 0.039), history of stroke (16.5% vs. 11.6%, p = 0.047), and atrial fibrillation (11.9% vs. 7.5%, p = 0.039). Conclusions: This study in Taiwan revealed a decline in the willingness to seek emergency services under the influence of COVID-19 among patients with lower stroke severity, especially those with more risk factors.

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Stroke subtypes in southern Iran

Galen Medical Journal ◽

10.31661/gmj.v4i1.359 ◽

2015 ◽

Vol 4 (1) ◽

pp. 47-49

Author(s):

Rasool Safari ◽

Afshin Borhanihaghighi ◽

Seyed Taghi Heydari ◽

Anahid Safari ◽

Salvador Cruz-Flores

Keyword(s):

Ischemic Stroke ◽

Subarachnoid Hemorrhage ◽

Intracerebral Hemorrhage ◽

Single Center ◽

Stroke Patients ◽

Stroke Subtype ◽

Younger Patients ◽

Single Center Study ◽

Length Of Hospitalization ◽

Center Study

Objective: To investigate about frequency of different subtypes of stroke in south of IranMethods: This is a retrospective, single-center study conducted at Namazi Hospital, Shiraz, south of Iran. Age, sex, length of hospitalization and mortality of stroke patients were recorded by reviewing hospital medical records.Results: 16 351 patients (53.6% male, 46.4%female) were recruited. Ischemic stroke (10750 patients, 65.7%), intracerebral hemorrhage(3282 patients,20.1%) and subarachnoid hemorrhage(1057 patients,6.5%) were the most common subtypes of stroke, respectively. In 1262 patients (7.7%) the stroke subtype could not been specified. Ischemic stroke and intracerebral hemorrhage were more common in men but subarachnoid hemorrhage was more common in women. Subarachnoid hemorrhage occurred significantly in younger patients. Mortality was significantly higher in intracerebral hemorrhage. Hospital stay was significantly longer in subarachnoid hemorrhage group.Conclusion: the distribution of the different subtypes of stroke in Iran is similar to Caucasians.

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STROKE PATIENTS

The Professional Medical Journal ◽

10.29309/tpmj/2015.22.07.1178 ◽

2015 ◽

Vol 22 (07) ◽

pp. 887-895

Author(s):

Santosh Kumar ◽

Muhammad Aslam ◽

Maria Maria ◽

Saleem Saleem

Keyword(s):

Ischemic Stroke ◽

Hemorrhagic Stroke ◽

University Hospital ◽

P Value ◽

Stroke Patients ◽

Chi Square ◽

Aged Patients ◽

Chi Square Test ◽

Bed Sores ◽

Medical Wards

Stroke is one of the leading factors of morbidity and mortality worldwide. Toreduce the incidences of stroke, it is essential to identify and modify the risk factors for stroke.Risk factors can be modifiable and non modifiable. The aim of study was to ascertain theoutcome of stroke patient admitted in all Medical Wards in Liaquat University Hospital HyderabadObjective: To see the mortality, morbidity, disability and co-infection in stroke patients. StudyDesign: Prospective study. Period: One year. Setting: Medical Wards of Liaquat UniversityHospital Hyderabad / Jamshoro. Material and Methods: 200 Patients were enrolled in ourstudy to see the excepted outcome like mortality, Disability, Bed Sores, UTI & Pneumonia andDehydration in Stroke patients. All the patients were Young Adults, greater than 12 years inage and old aged patients, with Ischemic & Hemorrhagic stroke. On categorical variable suchas sex, mortality, morbidity chi-square test was applied at 95% confidence interval and the P-value ≤0.05 was considered as statically significant while the mean ±SD will be calculated forquantitative variables. Results: Mean age of the patient in our study was 57.03 years with thestandard deviation of ±7.35 years. Gender distribution shows most of the patients in our studywere male, i.e. 75% while, only 25% of the patients were female. Ischemic Stroke was foundin 126(63%) patients while, hemorrhagic stroke was found in 74(37%) patients. Regardingoutcome, mortality was found in 5% patients, disability 2%, UTI 2%, pneumonia 15%, Coinfection4%, Bed Sores 21.5% and dehydration was present in 50.5% patients. Conclusion:The study concludes that maximum patients had Ischemic Stroke. Among these patientsdehydration was the most common entity followed by bed Sores, pneumonia, mortality, Coinfection,disability and UTI.

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Abstract 2268: Trends In Reasons For Non-eligibility For tPA

Stroke ◽

10.1161/str.43.suppl_1.a2268 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Xin Tong ◽

Mary G George

Keyword(s):

Ischemic Stroke ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Advanced Age ◽

Stroke Patients ◽

Rapid Improvement ◽

Nihss Score ◽

Mild Stroke ◽

Over Time ◽

Iv Tpa

Background: Use of IV tPA has increased over time, as has the adherence to the NQF endorsed performance measure for receipt of IV tPA within 3 hours. Little is known about trends in the reasons for patient ineligibility for IV tPA. This study examines trends in reasons for not providing IV tPA over time and by race and gender among acute ischemic stroke patients in the Paul Coverdell National Acute Stroke Registry (PCNASR), a quality improvement program for acute stroke implemented by state health departments. Methods: There were 13,164 PCNASR patients enrolled from 2008- 2010 with a clinical diagnosis of acute ischemic stroke with documentation of LKW and who arrived within 2 hours of LKW. Cochran-Armitage tests were used to test for trend on accepted reasons for not providing IV tPA within 3 hours of time last known well (LKW). Chi-square tests were used to test for differences among reasons between men and women and between non-Hispanic whites and minorities. Multiple reasons for not giving tPA could be selected. Results: Among 13,164 acute ischemic patients admitted between 2008 and 2010 with documentation of LKW and who arrived within 2 hours of LKW, 3781 (28.7%) received IV tPA, 7284 (55.3%) had documented reasons for not receiving IV tPA, and 2099 (16.0%) did not receive IV tPA. Contraindications to IV tPA, advanced age, rapid improvement and inability to determine eligibility increased over time. Mild stroke decreased over time. Conditions with warning, advanced age, limited life expectancy and family refusal were more common in women; mild stroke and rapid improvement were more common in men. Contraindications were more common in minorities; advanced age, mild stroke and rapid improvement, and family refusal were more common in non-Hispanic whites. When advanced age was selected, 46.6% of patients were over age 90 and 3.4% were under age 80. When stroke too mild was selected, 44.8% of patients had missing NIHSS scores, 42.1% of scores were 0-4, 8.8% were 5-9, and 4.3% were ≥ 10. The three most common reasons for not providing tPA were rapid improvement (40.9%), mild stroke (33.0%), and contraindications (29.2%) in 2010. Conclusions: More than half of ischemic stroke patients arriving within 2 hours of LKW were ineligible to receive IV tPA. There was little use of advanced age for patients under age 80. Documentation of stroke too mild was not substantiated by an NIHSS score in nearly half of patients. Better documentation of NIHSS score should be provided.

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Abstract WP32: Good Reperfusion Can Rescue Acute Ischemic Stroke Patients Treated With Endovascular Therapy Beyond 6 Hours After Onset.

Stroke ◽

10.1161/str.48.suppl_1.wp32 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

KENTARO SUZUKI ◽

Junya Aoki ◽

Yohei Takayama ◽

Arata Abe ◽

Satoshi Suda ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Endovascular Therapy ◽

Onset Time ◽

Favorable Outcome ◽

Modified Rankin Scale ◽

Single Center ◽

Stroke Patients ◽

Tissue Plasminogen ◽

Improve Patient

Objective: Endovascular therapy (EVT) within 6 hours from ischemic stroke onset were recommended by 2015 AHA/ASA guideline. Effectiveness and factors for favorable outcome for EVT beyond 6 hours are unclear. We investigated whether onset to puncture time (O2P) beyond 6 hours is associated with outcome at 3 months and what is the favorable factors in patients treated with EVT beyond 6 hours. Methods: We performed a retrospective, single center analysis of patients with acute ischemic stroke who underwent EVT. The O2P, risk factors, reperfusion success rate and outcome at 3 month were assessed. First, all patients were classified into the two groups with EVT beyond 6 hours or not. Second, we compared any characteristics and favorable outcome between two groups. Finally, we investigated independent factors for favorable outcome in patients treated with EVT beyond 6 hours. Favorable outcome and good reperfusion were defined by modified Rankin scale ≤ 2 and thrombolysis in cerebral infarction (TICI) score ≥ 2B, respectively. Results: Of the 130 EVT cases, 124 cases with known onset time were enrolled (age; 75 [66-83] and 74 (60.5%) men). 98 (79%) were treated with EVT within 6 hours and 26 (21%) patients were beyond 6 hours. Absence of atrial fibrillation (11[42%] vs. 70[71%], p=0.01), high DWI-ASPECTS (9 [7-10] vs. 7 [6-9], p=0.01), no use of intravenous tissue plasminogen (1[4%] vs. 50[51%], p<0.01) and low achievement of good reperfusion (14[54%] vs. 77[79%], p=0.01) were more frequently observed in beyond 6 hours group than within 6 hours group. However, favorable outcome was not different between two groups (beyond 6 hours group ;10(38%) vs. within 6 hours group; 43(44%), p = 0.66). In beyond 6 hours group, good reperfusion (9[90%] vs. 5[31%], p=0.01) and presence of hyperlipidemia (7[70%] vs. 3[19], p=0.02) were associated with favorable outcome. On multivariate analysis, only good reperfusion (OR 45.6, 95%CI 3.7-2271.4, p<0.01) was the independent factor associated with favorable outcome. Conclusions: The frequency of favorable outcome in beyond 6 hours group was not lower than within 6 hours group. Good reperfusion can improve patient outcome in O2P within 6 hours as well as beyond 6 hours.

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Abstract P382: Assessing the Impact of Damage to Brainstem Tracts on Motor Ability in Ischemic Stroke Patients

Stroke ◽

10.1161/str.52.suppl_1.p382 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Emily Olafson ◽

Keith Jamison ◽

Hesheng Liu ◽

Danhong Wang ◽

Joel Bruss ◽

...

Keyword(s):

Ischemic Stroke ◽

Motor Impairment ◽

Principal Component ◽

First Episode ◽

Imaging Data ◽

Stroke Patients ◽

Fiber Tracts ◽

Brainstem Stroke ◽

Cortical Regions ◽

The Impact

The extent of disruption to the corticospinal tract has been associated with motor impairment and worse recovery, but the role of other motor and sensorimotor tracts in impairment following brainstem stroke is poorly understood. Additionally, the impact of brainstem strokes on connectivity to distal cortical regions innervated by these tracts has not been well established. In 23 first-episode unilateral brainstem ischemic stroke patients, the extent of disruption to brainstem pathways was determined using the Dice score between binarized lesion masks obtained from T1 images and each of 23 brainstem tracts defined using a recently published high-resolution atlas of the brainstem based on connectome imaging data. Motor impairment was determined using the Fugl-Meyer assessment. White matter disruption due to the stroke was estimated using the Network Modification Tool 2.0 (NeMo) tool, which calculates the proportion of fiber tracts disrupted by the lesion in each voxel. Principal components analysis (PCA) was used to determine disruption patterns across patients. PCA of Dice scores identified one component which explained 65% of the variance, which corresponded to overlap with the corticospinal (CST), frontopontine (FPT), and parieto-occipito-temporo-pontine (POTPT) tracts, as well as the middle cerebellar peduncle. Component scores significantly correlated with Fugl-Meyer scores (corr. = -0.82, p < 0.01). PCA of cortical disconnectivity revealed one principal component which explained 75% of the variance, which correlated most highly with cortical regions connected to the CST, FPT, and the POTPT and whose scores also significantly correlated with Fugl-Meyer scores (corr. = -0.65, p < 0.01).

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