scholarly journals Fatal and non-fatal events within 14 days after early, intensive mobilization post stroke

Neurology ◽  
2020 ◽  
pp. 10.1212/WNL.0000000000011106
Author(s):  
Julie Bernhardt ◽  
Karen Borschmann ◽  
Janice M. Collier ◽  
Amanda G. Thrift ◽  
Peter Langhorne ◽  
...  
Keyword(s):  
Usual Care ◽  
Case Fatality ◽  
Early Mobilization ◽  
Haemorrhagic Stroke ◽  
High Dose ◽  
Stroke Severity ◽  
Serious Adverse Events ◽  
Significant Treatment ◽  
Intensive Training ◽  
Post Stroke

ObjectiveThis tertiary analysis from AVERT examined fatal and non-fatal Serious Adverse Events (SAEs) at 14 days.MethodAVERT was a prospective, parallel group, assessor blinded, randomized international clinical trial comparing mobility training commenced <24 hours post stroke, termed very early mobilization (VEM) to usual care (UC). Primary outcome was assessed at 3 months. Included: Patients with ischaemic and haemorrhagic stroke within 24 hours of onset. Treatment with thrombolytics allowed. Excluded: Patients with severe premorbid disability and/or comorbidities. Interventions continued for 14 days or hospital discharge if less. The primary early safety outcome was fatal SAEs within 14 days. Secondary outcomes were non-fatal SAEs classified as neurologic, immobility-related, and other. Mortality influences were assessed using binary logistic regression adjusted for baseline stroke severity (NIHSS) and age.Results2,104 participants were randomized to VEM (n = 1,054) or UC (n = 1,050) with a median age of 72 years (IQR 63–80) and NIHSS 7 (IQR 4–12). By 14 days, 48 had died in VEM, 32 in UC, age and stroke severity adjusted Odds Ratio of 1.76 (95% CI 1.06–2.92, p = 0.029). Stroke progression was more common in VEM. Exploratory subgroup analyses showed higher odds of death in intracerebral haemorrhage and >80 years subgroups, but there was no significant treatment by subgroup interaction. No difference in non-fatal SAEs found.ConclusionWhile the overall case fatality at 14 days post-stroke was only 3.8%, mortality adjusted for age and stroke severity was increased with high dose, intensive training compared to usual care. Stroke progression was more common in VEM.Classification of evidenceThis study provides Class I evidence that very early mobilization increases mortality at 14 days post stroke.Trial registrationAustralian New Zealand Clinical Trials Registry, ACTRN12606000185561.

scholarly journals Early Mobilization with Virtual Reality Head Mounted Display and Adapted Software is Likely Safe and Feasible for Children in the Pediatric Intensive Care Unit: A Brief Case Report (Preprint)

2021 ◽  
Author(s):  
Byron Lai ◽  
Maegen Powell ◽  
Anne Grace Clement ◽  
Drew Davis ◽  
Erin Swanson ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Virtual Reality ◽  
Intensive Care ◽  
Usual Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Early Mobilization ◽  
Adaptive Software ◽  
Serious Adverse Events ◽  
Head Mounted Display

BACKGROUND Early rehabilitative mobilization for children is safe and feasible. However, there is a lack of published rehabilitation strategies and treatments that can maximize engagement and outcomes among children in the pediatric intensive care unit (PICU). Virtual reality (VR) gaming using a head mounted display (HMD) and adaptive software can allow active and non-active gameplay at the bedside for people with limited arm mobility, making it a potentially inclusive and enjoyable treatment modality for children in the PICU. OBJECTIVE The purpose of this brief case study is to report on the preliminary feasibility of incorporating adaptive VR gaming using a HMD with two children who received early mobility treatment within the PICU. METHODS This study was a mini-ethnographic investigation of two children (15 years, m / 13 years, m) in the PICU who underwent VR gaming sessions as part of their early mobilization care, using an Oculus Rift HMD and adaptive software (WalkinVR) that promoted full gameplay in bed. The Rift was plugged into a gaming laptop that was setup on a table within the patient’s room prior to each session. The intervention was delivered by an adapted exercise professional and supervised by a physical therapist. Patients had access to a variety of active (e.g., boxing, rhythmic movement-to-music, and exploratory adventure) and non-active games (e.g., racing and narrative adventure). Gaming sessions were scheduled between usual care, when tolerable and requested by the participant. The interventionist and therapists took audio recorded and written notes after completing each gaming session. These data were analyzed and presented in a narrative format from the perspective of the research team. RESULTS Case 1 participated in four gaming sessions with an average of 18 minutes per session. Case 2 participated in two sessions, an average of 35 minutes per session. Both cases were capable of performing active gaming at a moderate level of exercise intensity, as indicated by their heart rate. However, their health and symptoms fluctuated on a daily basis, which prompted gameplay of adventure or non-active games. Gameplay appeared to improve participants affect and alertness and motivate them to be more engaged in early mobilization therapy. Gameplay without the WalkinVR software caused several usability issues. There were no serious adverse events, but both cases experienced symptomology from their conditions. CONCLUSIONS Study findings suggested that VR gaming with HMDs and adaptive software is likely a feasible supplement to usual care for children within the PICU, and these findings warrant further investigation. Recommendations for future studies aiming to incorporate VR gaming within early mobilization are presented herein.

scholarly journals Supporting wellbeing through peer-befriending (SUPERB) for people with aphasia: A feasibility randomised controlled trial

2021 ◽  
pp. 026921552199567 ◽  
Author(s):  
Katerina Hilari ◽  
Nicholas Behn ◽  
Kirsty James ◽  
Sarah Northcott ◽  
Jane Marshall ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Usual Care ◽  
Controlled Trial ◽  
Significant Others ◽  
Community Services ◽  
Serious Adverse Events ◽  
Post Stroke ◽  
Feasibility Randomised Controlled Trial ◽  
Low Levels ◽  
Randomised Controlled

Objective: To determine the feasibility and acceptability of peer-befriending, for people with aphasia. Design: Single-blind, parallel-group feasibility randomised controlled trial comparing usual care to usual care + peer-befriending. Participants and setting: People with aphasia post-stroke and low levels of distress, recruited from 5 NHS Hospitals and linked community services; their significant others; and 10 befrienders recruited from community. Intervention: Six 1-hour peer-befriending visits over three months. Main measures: Feasibility parameters included proportion eligible of those screened; proportion consented; missing data; consent and attrition rates. Acceptability was explored through qualitative interviews. Outcomes for participants and significant others were measured at baseline, 4- and 10-months; for peer-befrienders before training and after one/two cycles of befriending. Results: Of 738 patients identified, 75 were eligible of 89 fully screened (84%), 62 consented (83% of eligible) and 56 randomised. Attrition was 16%. Adherence was high (93% attended ⩾2 sessions, 81% all six). The difference at 10 months on the GHQ-12 was 1.23 points on average lower/better in the intervention arm (95% CI 0.17, −2.63). There was an 88% decrease in the odds of GHQ-12 caseness (95% CI 0.01, 1.01). Fourty-eight significant others and 10 peer-befrienders took part. Procedures and outcome measures were acceptable. Serious adverse events were few ( n = 10, none for significant others and peer-befrienders) and unrelated. Conclusions: SUPERB peer-befriending for people with aphasia post-stroke experiencing low levels of distress was feasible. There was preliminary evidence of benefit in terms of depression. Peer-befriending is a suitable intervention to explore further in a definitive trial. Clinical trial registration-URL: http://www.clinicaltrials.gov Unique identifier: NCT02947776 Subject terms: Translational research, mental health, rehabilitation, quality and outcomes, stroke

scholarly journals Stroke in young adults in Malaysia: 1 year outcome and functional status

2021 ◽  
Vol 26 (4) ◽  
pp. 657-664
Author(s):  
Yean Koon Chan ◽  
Kay Sin Tan ◽  
Lydia Abdul Latif
Keyword(s):  
Small Vessel Disease ◽  
Case Fatality ◽  
Haemorrhagic Stroke ◽  
Education Level ◽  
Stroke Recurrence ◽  
Stroke Survivors ◽  
Large Artery ◽  
Stroke Registry ◽  
Young Stroke ◽  
Post Stroke

Background & Objectives: Young stroke has socioeconomic implications. We aim to describe the demography and evaluate the long-term functional outcomes of young stroke survivors in Malaysia. Methods: First-ever Malaysian young stroke patients (18-50 years) from 1st October 2016 until 30th June 2018 were recruited from the University of Malaya Medical Centre Young Stroke Registry and other sources. Participants were interviewed in person or via telephone at one year post-stroke. Demographic information collected were age, sex, ethnicity, and education level. Results: Out of 120 eligible cases, there were 6 deaths (5%) and 7 recurrent strokes (5.8%) within 1 year. Seventy five patients were recruited for the study with mean assessment time at 14.8 months. Survivors are predominantly male (69.2%), aged ≥41 years old (73%) with racial profile representative of the locality. Ischaemic stroke (IS) is the commonest stroke type (72%) with majority TOAST classified as large-artery atherosclerosis and small-vessel disease. Hypertension and smoking are the leading risk factors. Greater than half are independent and returned to work (RTW); comparatively IS has better outcomes than haemorrhagic stroke (HS). Lesser educated survivors (≤secondary school education, 56%) are more likely to not RTW (OR 5, p = 0.005). There is no significant change in marital status and residence post stroke. Conclusion: In a single centre study in Malaysia, major findings for young stroke survivors, mainly male in their 40s, at 1 year are case fatality of 5%, stroke recurrence of 5.8%, and more than half achieved independence and RTW (IS > HS) with education level influencing RTW.

High-dose statin therapy and the risk of haemorrhagic stroke in Asian patients with stable coronary artery disease: insights from the REAL-CAD study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Takahashi ◽  
K Tsuchida ◽  
Y Sato ◽  
S Iimuro ◽  
K Kario ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Dose Group ◽  
Low Dose ◽  
Japanese Patients ◽  
Haemorrhagic Stroke ◽  
High Dose ◽  
The Real ◽  
Artery Disease ◽  
Stable Cad ◽  
Bleeding Score

Abstract Background/Introduction The REAL-CAD study identified that aggressive lipid lowering with high-dose statin reduced cardiovascular events also in Japanese patients with coronary artery disease (CAD). However, data from the SPARCL trial found that the benefits of high-dose atorvastatin treatment were partially offset by an increase in haemorrhagic stroke (HS). Although meta-analysis showed statin does not increase HS in Western countries, the evidence about the relation between statin and HS in Asian countries is still conflicting. In addition, the CREDO-Kyoto score is one of the prediction scorings for bleeding after coronary revascularization and might be a useful tool for the prediction of HS in this cohort. Recognizing the risk of HS and predicting of HS in the Asian cohort is clinically important. Purpose This study examined the factors associated with HS using the REAL-CAD cohort. Furthermore, we evaluated the performance of the CREDO-Kyoto bleeding risk score to predict HS in this cohort. We also performed the corresponding analysis of ischaemic stroke for reference purposes. Methods We sub-analysed the REAL-CAD study, prospective, multicentre, randomized, open-label, blinded endpoint study, in which 13,054 Japanese patients with stable CAD were randomized to high-dose (4 mg/day) or low-dose (1 mg/day) pitavastatin. Associations for stroke were determined using competing risk models: the Fine and Gray subdistribution hazards model accounting for the competing risk of death in models of haemorrhagic and ischaemic stroke in REAL-CAD trial. Patients were categorized to low (score 0), moderate (score 1–2), and high (score&gt;3) according to CREDO-Kyoto bleeding score for predicting of HS. Results The HS events in high-dose group tended to be higher than low-dose group (4mg vs. 1mg: 43 (0.7%) vs. 30 (0.5%)). The associated factors of HS on univariate analysis were non-prior myocardial (hazard ratio (HR): 0.62, 95% CI: 0.39–0.99) and non-prior cerebral (HR: 0.25, 95% CI: 0.09–0.70) infarction, atrial fibrillation (HR: 2.4, 95% CI: 1.2–4.7), prior HS (HR: 4.2, 95% CI: 1.5–11.8), anaemia (HR: 2.4, 95% CI: 1.4–4.1), and non-statins use before run-in period (HR: 0.52, 95% CI: 0.28–0.99). High-dose pitavastatin was not a correlate with HS. The multivariate analysis revealed anaemia might have a relation with HS (HR: 4.3, 95% CI: 0.90–20.6). The number of HS was the highest in the high CREDO-Kyoto bleeding score group (Figure 1, HR: 2.4, 95% CI: 1.3–4.6), whereas there was no significant difference in the number of HS between the moderate- and low-risk groups (HR: 1.4, 95% CI: 0.84–2.3). Conclusions High-dose pitavastatin was not associated with the incidence of HS in this large Japanese cohort with stable CAD. High CREDO-Kyoto bleeding score was associated with HS as compared with low or moderate scores, even each of the variables consisting of CREDO-Kyoto score was not associated with HS. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Genetic variation at the IGF1 locus shows association with post-stroke outcome and to circulating IGF1

2013 ◽  
Vol 169 (6) ◽  
pp. 759-765 ◽  
Author(s):  
N David Åberg ◽  
Sandra Olsson ◽  
Daniel Åberg ◽  
Katarina Jood ◽  
Tara M Stanne ◽  
...  
Keyword(s):  
Genetic Variation ◽  
Ischemic Stroke ◽  
Stroke Severity ◽  
Stroke Outcome ◽  
Nucleotide Polymorphisms ◽  
Post Stroke ◽  
Index Stroke ◽  
Genetic Impact ◽  
Major Allele ◽  
Community Controls

ObjectiveIn humans, serum IGF1 (s-IGF1) is associated with outcome after ischemic stroke (IS). Therefore variation at the IGF1 locus could also associate with both IS and s-IGF1. We investigated whether genetic variation at the IGF1 locus is associated with i) s-IGF1, ii) IS occurrence, iii) IS severity, and iv) post-stroke outcome.Design/methodsPatients (n=844; 66% males, mean age 56 years) and community controls (n=668) were included from the Sahlgrenska Academy Study on Ischemic Stroke (SAHLSIS). Post-stroke outcome was evaluated with the modified Rankin Scale at 3 and 24 months after index stroke, and baseline stroke severity with the Scandinavian Stroke Scale. s-IGF1 was determined in patients and after random selection in 40 of the controls.ResultsEleven single nucleotide polymorphisms (SNPs) were selected in the IGF1 gene. In healthy controls the major allele of rs7136446 was associated with higher s-IGF1, whereas in patients no such association was found. No SNP was associated with IS, nor with stroke severity. After multivariate correction for presence of diabetes, smoking, and hypertension, the major allele of rs7136446 was associated with favorable functional outcome 24-months post-stroke (odds ratio 1.46; 95% CI 1.09–1.96).ConclusionVariation in rs7136446 of the IGF1 gene associates with post-stroke outcome in relatively young IS patients. Also, rs7136446 associates with s-IGF1 in controls but not in IS, which indicates that IS perturbs a normal genetic impact on s-IGF1 levels.

A longitudinal study investigating how stroke severity, disability, and physical function the first week post-stroke are associated with walking speed six months post-stroke

2017 ◽  
Vol 33 (12) ◽  
pp. 932-942 ◽  
Author(s):  
Mona Kristin Aaslund ◽  
Rolf Moe-Nilssen ◽  
Bente Bassøe Gjelsvik ◽  
Bård Bogen ◽  
Halvor Næss ◽  
...  
Keyword(s):  
Longitudinal Study ◽  
Physical Function ◽  
Walking Speed ◽  
Stroke Severity ◽  
Post Stroke

scholarly journals Study on outcome of ischemic stroke patient with atrial fibrillation

KYAMC Journal ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. 8-12
Author(s):  
Achinta Kumar Mallick ◽  
Md Ahmed Ali ◽  
Md Kafiluddin ◽  
Md Parvez Amin ◽  
Pijus Kumar Kundu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Case Fatality ◽  
The Elderly ◽  
Clinical Deterioration ◽  
Stroke Recurrence ◽  
Stroke Severity ◽  
Ischemic Stroke Patient ◽  
Fold Excess

Background: Atrial fibrillation (AF) is a common arrhythmia and a major risk factor for ischemic stroke, especially in the elderly patients. Patients with non-valvular AF have a 5-fold excess risk of stroke recurrence and case-fatality rate.Objectives: This study was to evaluate the prevalence of AF and its influence on prognosis in patients with ischemic stroke.Materials & Methods: Total 125 patients with ischaemic stroke were enrolled in this study. Initially they were divided into two groups by ECG - those with AF and those without AF. They were followed up after one month, three months and six months. Comparison was done between the two groups in term of recurrence, mortality and clinical improvement which were assessed by Modified Rankin Score (MRS).Results: Among 125 patients, 22 patients had AF. Those with AF were more frequently male, aged more than 45 years. Recurrence was significantly higher in AF group during one month follow up (p<0.05). The presence of AF was associated with higher mortality in 3 months (p<0.05) and 6 months (p<0.05) follow up. At 3 months follow up clinical deterioration was noted in 9.1% patient with AF compared to 2.9% patients without AF (p<0.01) and at 6 months follow up clinical deterioration was noted in 18.2% patient with AF compared to 4.9% patients without AF (p<0.01).Conclusion: Patients who had an ischemic stroke with accompanying AF had higher mortality, graver stroke severity, more recurrences and poorer functional status than those without AF.KYAMC Journal Vol. 8, No.-2, Jan 2018, Page 8-12

scholarly journals Case fatality of patients with stroke over a 12-month period post stroke

2012 ◽  
Vol 102 (9) ◽  
pp. 765 ◽  
Author(s):  
W Mudzi ◽  
A Stewart ◽  
E Musenge
Keyword(s):  
Case Fatality ◽  
Post Stroke
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