Risultati per: Stroke

Introduction
Across different populations, listening difficulties have been shown to adversely impact social interactions and work performance, and substantively contribute to poorer quality of life. Following a stroke, people also report listening difficulties in noisy, everyday environments such as cafes and workplaces. Despite the prevalence of these challenges, there is limited understanding of this issue, which means the listening needs of stroke survivors remain under-recognised and unmet. The aim of this scoping review is to map the breadth and depth of the existing literature on stroke survivors’ experiences of listening in noisy environments, encompassing qualitative descriptions and quantitative assessments of listening-in-noise abilities, to identify contributing factors, knowledge gaps and potential intervention strategies.

Methods and analysis
This protocol has been registered with the Open Science Framework (protocol number: 39TCA) and follows the Joanna Briggs Institute guidelines for scoping reviews. The protocol was developed by a multidisciplinary and multiprofessional team, led by a survivor of stroke and informed by additional patient input. A mixed-methods approach will be used to generate independent narrative summaries of qualitative and quantitative studies, followed by an integrated narrative of findings across data types. We will first conduct a comprehensive search using Medline, Embase, PsycInfo, Scopus, Cumulated Index in Nursing and Allied Health Literature and Web of Science databases in February 2025. Eligible studies will include stroke survivors as participants and focus on listening-in-noise experiences or abilities. Qualitative studies must explore personal experiences or perceptions related to listening in noisy environments, and quantitative studies must assess listening-in-noise performance. Studies addressing mediating factors, such as cognition, comorbidities (eg, hearing loss, aphasia), environmental factors and intervention strategies (eg, auditory training, assistive devices) will also be included. Two independent reviewers will assess the studies for eligibility. In cases of disagreement, a third reviewer will independently compare and resolve any discrepancies, ensuring a consensus is reached. This approach aims to minimise bias and enhance the validity of the review findings. The data extraction and synthesis will adhere to established guidelines, ensuring a robust and transparent analysis.

Ethics and dissemination
Ethical approval is not required as this review will analyse the existing literature. The results will be published in an open-access peer-reviewed journal and presented at local and international conferences. This dissemination strategy aims to reach a wide audience, including clinicians, researchers, policymakers and people with lived experience of stroke.

Trial registration number
Open Science Framework (https://osf.io; protocol number: 39TCA).

Introduction
There is currently insufficient high-quality evidence to make general recommendations about high-dose high-intensity upper-limb rehabilitation programmes. Here we describe a randomised controlled trial that will determine the efficacy of two forms of high-dose, high-intensity upper-limb rehabilitation provided in a rehabilitation unit setting.

Methods and analysis
Patients with moderate upper-limb impairment (n=105, at least 6 months after stroke) will be randomised to either (1) high-dose high-intensity conventional upper-limb rehabilitation, (2) high-dose high-intensity virtual reality-based upper-limb rehabilitation and (3) usual care (a waiting list control group). Groups 1 and 2 will receive a minimum of 45 hours of active time on task over 3 weeks. Outcome measures will be collected at (T1) baseline; (T2) immediately post intervention and (T3) 3 months after the intervention has finished. The primary outcome measure will be the Fugl-Meyer Upper Extremity Assessment at 3 months after the intervention. Secondary outcome measures will be clinical, kinematic and neurophysiological using transcranial magnetic stimulation and electroencephalography. Explanatory measures will include MRI-based markers for integrity of the corticospinal tract, dorsal column-medial lemniscal pathway, grey and white matter and lesion load. The aim is to detect a difference of 7.25 points on the Fugl-Meyer Upper Extremity Assessment between each treatment group and the waitlist control group, with a power of 0.9 and significance of 0.025 (to account for two primary analyses). Analysis of change in the primary and secondary outcome measures will be performed using mulitple regression analysis.

Ethics and dissemination
The study protocol (V.1) has been approved by the Wales Research Ethics Committee 2 Cardiff (Rec reference: 22/WA/0065) on 15 March 2022. All recruited participants will provide informed consent. Trial results will be disseminated through peer-reviewed publications, presentations at major stroke/neurorehabilitation conferences and outreach to relevant stakeholder communities.

Trial registration number
NCT05527262.

Every year in the US, 800 000 people experience strokes, and although most survive, current treatment plans fail to adequately address their physical, emotional, psychosocial, and spiritual distress, according to a new scientific statement from the American Heart Association. Palliative care could aid in the quality of life for both patients and their families by helping during all stages of poststroke care, including adapting to functional changes, navigating complex health care systems, and preparing for death when necessary. However, such care is often underused.

An ever-increasing number of acute ischemic stroke patients are being treated with intra-arterial thrombectomy, which aims to remove an embolic occlusion from a major intracranial artery with a catheter-based device. However, despite its proven efficacy, more than half of all patients do not achieve a satisfactory outcome and remain functionally dependent despite successful reperfusion. Research groups around the world are studying the potential of adjunctive treatments to further improve patient outcomes after thrombectomy. These additions range from antiplatelet and antithrombotic agents during the procedure, which are likely harmful, to neuroprotective agents, which have not been proven effective in humans.

This randomized clinical trial investigates whether intra-arterial urokinase following near-complete to complete reperfusion by endovascular thrombectomy increases the likelihood of survival without disability in patients with acute ischemic stroke due to large vessel occlusion.

This randomized clinical trial assesses the effect of adjunctive intra-arterial tenecteplase on freedom from disability at 90 days in patients with large vessel occlusion stroke with near-complete to complete reperfusion.

Our work suggested a potential association between brain ischemic lesion pattern on MR images and underlying AF. Furthermore, with additional validation, the AI model we developed may serve as a rapid screening tool for AF in clinical practice of stroke units.

Stroke, Ahead of Print. BACKGROUND:Stroke-induced aphasia significantly impacts communication and quality of life. Despite the standard treatment being speech and language therapy, outcomes vary, highlighting the need for additional therapies. Cerebrolysin, a neuroprotective and neurotrophic agent, has shown potential in stroke management. This study addresses the notable gap in research about the combined use of Cerebrolysin and speech therapy, evaluating their synergistic potential in the treatment of aphasia.METHODS:The ESCAS trial (The Efficacy and Safety of Cerebrolysin in the Treatment of Aphasia After Acute Ischemic Stroke), a prospective, randomized-controlled, double-blinded study was conducted in 2 Romanian stroke centers. Participants included those with left middle cerebral artery territory ischemic stroke and nonfluent aphasia, enrolled 3 to 5 days poststroke. Inclusion criteria were right-handedness and Romanian as the mother tongue. Participants received Cerebrolysin or a placebo combined with speech and language therapy in 10-day cycles over 3 intervals, and evaluations were done at baseline, 30, 60, and 90 days respectively. The main outcome measure was Western Aphasia Battery for language function. Changes at days 30, 60, and 90 compared with baseline were quantified, and the effect estimand used was the difference in means between groups. Secondary outcome measurements were the National Institutes of Health Stroke Scale for neurological deficit, the modified Rankin Scale for global disability, and the Barthel Index for activities of daily living.RESULTS:Out of 132 enrolled patients, 123 were included in the intention-to-treat analysis, and 120 in the per-protocol analysis. Overall, both groups showed improvement at subsequent visits compared with the baseline for Western Aphasia Battery and the National Institutes of Health Stroke Scale. The Cerebrolysin group showed greater improvements in Western Aphasia Battery (visit 4 mean increase of 35.579±16.316 [95% CI, 31.289–39.869] points;P

New England Journal of Medicine, Volume 392, Issue 7, Page 719-721, February 2025.

A population-based cohort study suggests that the threshold for anticoagulation should not be adjusted in patients with cancer.

In a randomized trial, use of intra-arterial tenecteplase following thrombectomy was not associated with an improved outcome.

Stroke, Ahead of Print. BACKGROUND:Infarct growth rate is remarkably heterogeneous in acute ischemic stroke, reflecting diverse clinical-physiological phenotypes. We compared different methods of estimating infarct growth rate in patients with acute ischemic stroke undergoing thrombectomy using multimodal computed tomography (CT) stroke imaging.METHODS:Secondary analysis of the international ESCAPE-NA1 trial (Efficacy and Safety of Nerinetide for the Treatment of Acute Ischemic Stroke) which evaluated the effect of nerinetide in patients with large vessel occlusion undergoing thrombectomy. Infarct growth rate was estimated leveraging each component of multimodal stroke CT imaging: (1) 10 minus baseline Alberta Stroke Program Early CT Score (ASPECTS) divided by hours elapsed from symptom onset on noncontrast CT (ASPECTS decay per hour); (2) collateral status on multiphase CT angiography (mCTA), and (3) hypoperfusion intensity ratio on CT perfusion. Patients were dichotomized into intermediate and slow progressors (since fast progressors were likely to be excluded from ESCAPE-NA1 based on trial enrollment criteria) according to median ASPECTS decay, presence of good versus moderate/poor mCTA collaterals, and median hypoperfusion intensity ratio, respectively. Associations between progressor phenotypes and 90-day modified Rankin Scale score were assessed across neuroimaging modalities using adjusted logistic regression analyses.RESULTS:Among 1105 patients enrolled in ESCAPE-NA1 between 2017 and 2019, 619 (56.0%) were assessed for progressor phenotypes using noncontrast CT, 1084 (98.1%) with mCTA, and 415 (37.6%) with CT perfusion. Median ASPECTS decay per hour was 1.05 (interquartile range, 0.05–1.85), 188/1084 (17%) patients had good collateral status on mCTA, and the median hypoperfusion intensity ratio was 0.44 (interquartile range, 0.28–0.59). Intermediate progressors showed worse functional outcomes compared with slow progressors only in CT perfusion strata: adjusted common odds ratio for modified Rankin Scale ordinal shift analysis of 1.69 (95% CI, 1.14–2.49). No significant association between progressor phenotypes and 90-day modified Rankin Scale was seen when the noncontrast CT and the mCTA approaches were used.CONCLUSIONS:Stroke progressor phenotypes based on CT perfusion criteria (using the hypoperfusion intensity ratio approach) were associated with clinical outcomes, while stroke progressor phenotypes based on noncontrast CT (ASPECTS decay) and mCTA (collateral status) criteria were not.

Objectives
To test the feasibility and acceptability of a text-message-delivered behavioural intervention to promote and maintain physical activity and recovery after stroke rehabilitation.

Design
A single-arm acceptability and feasibility study.

Setting
Community rehabilitation services in two Health Board areas in Scotland.

Participants
People with stroke who could participate in physical activities and use a mobile phone were recruited during rehabilitation and community rehabilitation.

Intervention
Keeping Active with Texting after Stroke (KATS) is an automated text message-delivered intervention informed by behaviour change theory. It delivers a structured sequence of 103 messages over 14 weeks to support the uptake and maintenance of physical activities following stroke rehabilitation.

Outcomes
Data on recruitment, retention and satisfaction were collected. Semistructured interviews explored intervention acceptability. Preintervention and postintervention measures provided preliminary information on step count, functional independence, mental well-being, self-efficacy and quality of life.

Results
18 men and 13 women were recruited; three withdrew before intervention commencement. All 28 participants who received at least one text message completed the study, indicating 100% retention. Median satisfaction score was 23/25 (range 12–25). All but one participant read and responded to texts, indicating good engagement. Effect sizes (Cohen’s d; per cent change) were demonstrated in step count (0.2; 13%), extended activities of daily living (0.24; 8.3%) and mental well-being (0.35; 7%). Participants perceived KATS as acceptable, valuing messages and motivational prompts, but personalised tailoring was desired by some.

Conclusions
Recruitment, retention and outcome measure completion were feasible, and KATS was perceived as acceptable. Findings suggest some modifications of messages and goal-setting processes are required to accommodate participants with diverse physical activity capabilities before a definitive trial. Promising indicators of effects were detected, although interpretation must be cautious because the study was not powered to determine efficacy, and there was no control group. Based on these findings, KATS will be further optimised before evaluating effectiveness in a randomised controlled trial.

Trial registration number and protocol availability
ISRCTN 13704805 https://www.hra.nhs.uk/planning-and-improving-research/application-summaries/research-summaries/keeping-active-with-texting-after-stroke-kats/
Protocol available https://www.isrctn.com/ISRCTN13704805?q=13704805&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10

Introduction
Individuals with stroke are at risk of long-term overweight and obesity due to biopsychosocial factors. Being overweight and obese is associated with an increased risk of numerous chronic conditions, including recurrent stroke. Unfortunately, recommendations for nutritional interventions vary. The objective of this scoping review is to identify and map the body of literature on professional nutritional interventions aimed at preventing or reducing overweight and obesity during postacute stroke rehabilitation.

Methods and analysis
The review follows the Joanna Briggs Institute methodology for scoping reviews. A three-step librarian-assisted search strategy will be conducted using the bibliographic databases MEDLINE (PubMed), Embase, CINAHL and Web of Science. Indexed and grey literature in English and Scandinavian languages, from January 2010 to the present, will be considered for inclusion. The scoping review will include materials such as research articles, methodological papers and clinical guidelines that report on nutritional interventions aimed at preventing or reducing overweight and obesity among individuals with stroke (aged ≥18 years) from admission to rehabilitation hospitals. We will map and identify any kind of nutritional intervention in rehabilitation hospitals, nursing homes or their own environments in high-income countries. Two independent reviewers will conduct an iterative process for screening the identified literature, paper selection and data extraction. Disagreements will be resolved through discussion or with an additional reviewer. A data extraction form will be used to guide the data extraction.

Ethics and dissemination
This review will involve the collection and analysis of secondary sources that have been published and/or are publicly available. Therefore, ethical approval is not required. The results will be published in an international peer-reviewed journal, presented at scientific conferences and disseminated through digital science communication platforms.

Trial registration number
The protocol is registered in the Open Science Framework: https://osf.io/ga63n/view_only=ee07beace7bb48d6b9c82cbf79cf2e95.

Stroke, Ahead of Print. Background:Stroke remains a leading cause of death and disability, underscoring the urgent need for treatments that enhance recovery. Growth Differentiation Factor 11 (GDF11), a member of the TGF-β superfamily, is a circulating protein involved in cellular development and tissue repair. GDF11 has gained attention for its potential regenerative properties in aging and disease contexts, making it a candidate for stroke recovery therapies.Methods:The therapeutic benefits of recombinant GDF11 (rGDF11) were evaluated using a rat ischemic stroke model, in which focal cerebral infarcts were induced in 8 –10 week-old young adult male Sprague-Dawley rats by permanently occluding the proximal right middle cerebral artery. Rats received single or multiple doses of rGDF11 (0.1-4 mg/kg) or vehicle 24-72 hours post-injury. Sensorimotor functions were evaluated, and brain and serum samples were examined to determine mechanism of action and identify biomarkers, using immunofluorescence, target-specific ELISAs, and an aptamer-based proteomics platform.Results:We confirmed rGDF11 activity in vitro and in established in vivo mouse models of cardiac hypertrophy and glucose metabolism and assessed the efficacy of rGDF11 treatment in six preclinical stroke studies, using independent Contract Research Organizations with all study animals and treatment groups blinded. All six studies revealed consistent improvement of sensorimotor outcomes with rGDF11. rGDF11-treated rats showed increased cortical vascularization and radial glia in the ventricular zone. Serum analysis revealed rGDF11 dose-dependent decreases in C-reactive protein and identified novel pharmacodynamic biomarkers and pathways associated with potential mechanisms of action of rGDF11.Conclusion:These results demonstrate that systemically delivered rGDF11 enhances neovascularization, reduces inflammation, promotes neurogenesis, and improves sensorimotor function post-injury in a rat model of ischemic stroke. More importantly, these data define an optimized and clinically-feasible rGDF11 dosing regimen for therapeutic development in ischemic stroke and identify a panel of candidate pharmacodynamic and mechanistic biomarkers to support clinical translation.

Stroke, Ahead of Print. BACKGROUND:Communicative ability after stroke influences patient outcomes. Limited research has explored the impact of aphasia when it intersects with cultural or linguistic differences on receiving stroke care and patient outcomes. We investigated associations between requiring an interpreter and the provision of evidence-based stroke care and outcomes for people with aphasia in the inpatient rehabilitation setting.METHODS:Retrospective patient-level data from people with aphasia were aggregated from the Australian Stroke Foundation National Stroke Audit–Rehabilitation Services (2016–2020). Multivariable regression models compared adherence to processes of care (eg, home assessment complete, type of aphasia management) and in-hospital outcomes (eg, length of stay, discharge destination) by the requirement of an interpreter. Outcome models were adjusted for sex, stroke type, hospital size, year, and stroke severity factors.RESULTS:Among 3160 people with aphasia (median age, 76 years; 56% male), 208 (7%) required an interpreter (median age, 77 years; 52% male). The interpreter group had a more severe disability on admission, reflected by reduced cognitive (6% versus 12%,P=0.009) and motor Functional Independence Measure scores (6% versus 12%,P=0.010). The interpreter group were less likely to have phonological and semantic interventions for their aphasia (odds ratio, 0.57 [95% CI, 0.40–0.80]) compared with people not requiring an interpreter. They more often had a carer (68% versus 48%,P