Search Results (2,067)

Background: Endothelial dysfunction and renal injury are emerging as a common feature of long COVID, especially in those with hypertension. It is not yet well characterised whether SARS-CoV-2 infection exacerbates podocyte dysfunction, fibrotic signalling and renal hemodynamic remodelling, over and above the effects of hypertension alone and there are no reliable early biomarkers in this population. Methods: We conducted a comparative cross-sectional study with prospective 6-month treatment response follow-up in 120 adult patients (aged 30–60 years) with essential hypertension (Stage I, II or III; n = 40 per stage), at Bukhara Regional Multidisciplinary Hospital. Each stage subgroup was further divided into post-COVID (3–6 months after recovery; n = 20) and non-COVID (n = 20) strata. Patients with diabetes, known chronic kidney disease, previous myocardial infarction or stroke and other major comorbidities were excluded. Serum cystatin-C, creatinine, aldosterone, TGF-β1 and VEGF-A; urinary nephrin and microalbumin; cystatin-C-derived eGFR (CKD-EPI) and oral protein-loaded renal functional reserve (RFR); and renal Doppler indices (Vps, Ved, RI, PI) of the main, segmental and interlobar arteries were assessed before and after 6 months of guideline-based renin–angiotensin–aldosterone system (RAAS) blockade (enalapril 5–10 mg or azilsartan 40–80 mg, ±eplerenone). Comparisons were made by Student’s t-test—associations by Pearson correlation. Results: At baseline, post-COVID hypertensive patients exhibited consistently higher endothelial–podocyte injury markers than non-COVID counterparts. Urinary nephrin was elevated across all stages (Stage I: 126.5 ± 9.1 vs. 91.9 ± 8.3 pg/mL, p < 0.01; Stage III: 203.3 ± 11.2 vs. 164.5 ± 9.7 pg/mL, p < 0.05), as were VEGF-A (Stage III: 286.1 ± 16.4 vs. 223.2 ± 12.6 pg/mL, p < 0.01) and TGF-β1 (Stage III: 186.4 ± 10.1 pg/mL, 1.3-fold higher; p < 0.01). The detection of microalbuminuria was 100% in Stage III post-COVID patients and 85% in non-COVID controls. The post-COVID groups had selective loss of renal functional reserve (7.8 ± 1.1% in Stage III compared to 12.5 ± 1.6% in non-COVID controls, p < 0.001). Nephrinuria correlated strongly with RFR (r = −0.824, p < 0.001), eGFR (r = −0.797, p < 0.001) and aldosterone (r = 0.613, p < 0.001). Six months of RAAS blockade reduced nephrinuria, microalbuminuria and TGF-β1 in both arms but the magnitude of biomarker reduction appeared smaller in the post-COVID group, particularly in Stage III. Conclusions: Long COVID appears to be associated with persistent endothelial dysfunction and podocyte injury in hypertensive patients. These results indicate that nephrinuria, VEGF-A, TGF-β1 and renal functional reserve are potential exploratory markers of endothelial and renal abnormalities in hypertensive patients following COVID-19. Before clinical utility can be determined, larger studies with multivariable modelling, diagnostic-performance analyses and correction for multiple testing are needed. The differences in biomarker response between groups observed in this study need to be confirmed in larger prospective studies with multivariable modelling and formal interaction analyses. Full article

Background: Cognitive impairment is a common complication after ischemic stroke and affects patients’ quality of life. Elevated glial fibrillary acidic protein (GFAP) and low vitamin D levels may contribute to neuroinflammation and impaired neuroplasticity, but their association with post-stroke cognitive impairment remains unclear. This study aimed to determine whether high serum GFAP and low vitamin D levels are risk factors for cognitive impairment in ischemic stroke patients. Methods: A prospective cohort study was conducted in patients with acute ischemic stroke. Serum GFAP and vitamin D levels were measured on the third day after stroke onset using an enzyme-linked immunosorbent assay (ELISA). Cognitive function was assessed two weeks after stroke onset using the Indonesian version of the Montreal Cognitive Assessment (MoCA-Ina). Data were analyzed using the chi-square test and multivariate logistic regression. Results: Seventy-six subjects were included in this study, of which 55 (72.4%) developed cognitive impairment. High serum GFAP (≥1.885 ng/mL) (RR = 1.755; 95% CI: 1.252–2.459; p = 0.001) and low vitamin D levels (<16.185 ng/mL) (RR = 1.773; 95% CI: 1.234–2.547; p = 0.001) were both associated with cognitive impairment. Multivariate analysis showed that high GFAP (AOR = 10.039; 95% CI: 2.484–40.569; p = 0.001) and low vitamin D levels (AOR = 6.640; 95% CI: 1.798–24.518; p = 0.005) were independent risk factors. Conclusions: Elevated serum GFAP and low vitamin D levels were independently associated with cognitive impairment after ischemic stroke and may serve as potential biomarkers for early risk stratification. Full article

Background: Prolonged cardiac monitoring increases atrial fibrillation (AF) detection after ischemic stroke or transient ischemic attack (TIA). The AS5F score was developed to identify patients at higher risk of post-stroke AF, but its performance in real-world populations remains incompletely characterized. We aimed to externally validate the AS5F score and to evaluate whether left atrial dilatation (LAD) improves risk prediction. Methods: We conducted a retrospective single-center study including 410 patients with ischemic stroke or TIA who underwent prolonged Holter monitoring between 2021 and 2025. Logistic regression and receiver operating characteristic (ROC) curve analyses were used to assess discrimination. Model calibration was evaluated using the Hosmer–Lemeshow test. Results: AF was detected in 33 patients (8.0%). The AS5F score was significantly associated with AF detection (OR 1.07 per point; 95% CI 1.03–1.11; p < 0.001), showing modest discrimination (AUC 0.69). Age alone demonstrated similar performance (AUC 0.69). LAD was strongly associated with AF (OR 4.00; 95% CI 1.79–8.93; p = 0.001) but had lower discriminatory ability (AUC 0.61). In patients with available echocardiographic data (n = 369), a combined age + LAD model achieved an AUC of 0.73 with adequate calibration. The improvement compared with AS5F was not statistically significant. Conclusions: In this external real-world cohort, AS5F demonstrated moderate discrimination for post-stroke AF detection. A simplified model combining age and left atrial dilatation showed numerically higher performance and may represent a pragmatic strategy for risk stratification in clinical practice. Full article

Background/Objectives: The accurate prediction of postprocedural mortality is critical for clinical decision-making; however, research on mortality risk models for patients undergoing mechanical thrombectomy remains limited. This study aimed to develop and validate machine learning models for predicting 90-day post-mechanical thrombectomy mortality. Methods: A retrospective-prospective cohort study involving 699 retrospective patients (January 2019–December 2022) and 274 prospective patients (January 2023–June 2024) from a single institution in Sichuan was conducted. The primary outcome was all-cause mortality within 90 days, ascertained via telephone follow-up. Predictors were identified using univariate analysis and LASSO regression. Eight predictive models were developed and evaluated using existing machine learning methods via 10-fold cross-validation. Model performance was assessed through discrimination, calibration, decision curve analysis, and interpretability via Shapley additive explanations. Results: The final dataset included 593 patients in the modeling set and 247 in the validation set. The 90-day mortality rates were 25.6% and 32.0%, respectively. Key predictors included age, hyperlipidemia, atrial fibrillation, pre-stroke statin use, antiplatelet/anticoagulant therapy within 48 h of onset, dysphagia, D-dimer levels, and activities of daily living scores. Logistic regression demonstrated superior performance in the modeling cohort (AUC = 0.87), whereas the multilayer perceptron model exhibited the greatest efficacy in the validation cohort (AUC = 0.77). Conclusions: Machine learning algorithms can accurately predict 90-day mortality among patients undergoing mechanical thrombectomy. The multilayer perceptron model demonstrated robust validation performance and offers a potential tool for personalized risk assessment and optimization of clinical decision-making. Full article

Acute ischemic stroke is one of the leading causes of mortality and disability globally, characterized by a complex and temporally structured cascade of cellular and molecular events. Although reperfusion therapies have improved outcomes, their narrow therapeutic window and limited availability leave many patients without effective treatment, highlighting the need for effective neuroprotective strategies capable of targeting multiple interconnected pathways. Melatonin has been proposed as a potential adjunctive neuroprotective agent based on its pleiotropic properties, modulating cellular signaling networks including antioxidant, anti-inflammatory, mitochondrial stabilizing, and BBB-preserving effects. Melatonin regulates key signaling pathways, thereby coordinating cellular responses to injury in multiple stages of ischemic pathophysiology, positioning it as a potential adjunctive therapy. Preclinical studies consistently demonstrate reductions in infarct volume, preservation of neuronal architecture, and improvements in neurological outcomes. However, clinical evidence remains limited to a small number of clinical trials, which suggest safety and possible early neurological benefit but are underpowered to determine long-term efficacy. Importantly, translational gaps persist regarding optimal dosing, duration of administration, and alignment with the temporal dynamics of post-ischemic injury. This review integrates current knowledge on the cellular and molecular mechanisms underlying the potential neuroprotective actions and its role as a pleiotropic modulator of ischemic injury. Full article

Background: Acute focal neurological deficits require rapid differentiation between ischemic stroke and stroke mimics to avoid treatment delays and inappropriate therapy. Seizures, including ictal deficits, status epilepticus, and post-ictal/Todd’s phenomena, are among the most challenging mimics. This review summarizes the role of multimodal neuroimaging in distinguishing acute ischemic stroke from seizure-related deficits. Methods: We performed a focused narrative review of neuroimaging findings in acute stroke mimics, emphasizing non-contrast computed tomography (CT), CT angiography, CT perfusion, magnetic resonance imaging (MRI), including diffusion weighted imaging (DWI), apparent diffusion coefficient (ADC), fluid attenuated inversion recovery (FLAIR), and arterial spin labeling (ASL) sequences. Imaging patterns, diagnostic pitfalls, and practical clues for hyperacute stroke pathways were synthesized. Results: Acute ischemic stroke is typically suggested by vascular-territorial abnormalities, including arterial occlusion or stenosis, territorial hypoperfusion, and congruent DWI/ADC restriction. Seizure-related deficits more often show non-territorial cortical perfusion changes, ictal or status-related hyperperfusion, reversible MRI abnormalities, and absence of arterial occlusion. However, post-ictal hypoperfusion, peri-ictal diffusion restriction, and reperfusion-related hyperperfusion may overlap with ischemic patterns. Conclusions: A multimodal approach integrating vascular imaging, perfusion distribution, DWI/ADC, ASL, clinical timing, and EEG findings can improve diagnostic accuracy in the stroke–seizure differential without delaying treatment in true acute ischemic stroke. Full article

Background: The study aims to compare the short-term clinical outcomes of transcatheter aortic valve implantation (TAVI) with the novel self-expandable, intra-annular Navitor valve (NAV) and the balloon-expandable, intra-annular Sapien 3 Ultra valve (S3U). Methods: From a single-center TAVI database, patients receiving NAV and S3U were identified. We applied 1:2 propensity score matching for the selected variables (gender, age, aortic valve perimeter, area, diameter, mean aortic valve gradient, EuroScore2, coronary artery disease (CAD), previous stroke and previous pacemaker implantation), resulting in 153 patients. Results: Clinical outcomes at 30 days of 51 patients with NAV [mean age: 80.4 ± 6.7 years; 51% female; mean annulus diameter: 24.1 ± 1.40 mm; EuroScore2: 3.4 ± 3.1%] and 102 patients with S3U [mean age: 79.9 ± 6.5 years (p = 0.7); 51% female (p > 0.99); mean annulus diameter: 24.1 ± 1.4 mm (p > 0.99); EuroScore2: 3.2 ± 2.7 (p = 0.7)] were analyzed according to VARC-3 recommendations. Post-TAVI aortic valve mean (S3U: 11.0 [3–27] mmHg; NAV: 7 [3–15] mmHg; p < 0.001) and maximum (S3U: 22 [6–44] mmHg; NAV: 12 [5–28] mmHg; p < 0.001) gradients at discharge were significantly lower with NAV, whereas the effective orifice area (EOA) of the aortic valve measured significantly larger with NAV (S3U: 1.5 [0.8–3.8] cm²; NAV: 2.1 [0.9–3.5] cm²; p < 0.001). Rates of no to mild paravalvular regurgitation (PVL) were 92.1% after NAV and 91.2% after S3U implantation (p = 0.15), mild to moderate PVL were 2.0% after NAV vs. 2.9% after S3U (p = 0.1) and moderate PVL were 2% after NAV and 1% after S3U (p = 0.07). None of the patients had a severe regurgitation. Severe patient–prosthesis mismatch (PPM) occurred significantly less with NAV (S3U: 14.7%; NAV: 7.8%; p = 0.002). One (1%) non-disabling stroke occurred within the S3U group and none occurred within the NAV group (p = 0.1). Life-threatening (S3U: 2.9%; NAV= 1%; p > 0.99) and major (S3U: n = 2.9; NAV: 0%; p = 0.55) bleeding events were comparable between both groups. The incidence of major (S3U: 2.9%; NAV: 2.0%; p > 0.99) vascular complications and the need for permanent pacemaker implantation (S3U: 9.8%; NAV: 11.8%; p = 0.8) were comparable in both groups. The 30-day mortality rate was 0.7% [1 in NAV group (2%), none in S3U; p = 0.3]. Conclusions: In conclusion, at 30-day follow-up, the self-expanding intra-annular Navitor valve demonstrated excellent acute safety and superior early hemodynamic performance, characterized by significantly lower transvalvular gradients and lower rates of severe PPM compared to the balloon-expandable Sapien 3 Ultra. However, whether these acute hemodynamic advantages translate into superior long-term clinical outcomes remains to be determined in long-term follow-up studies. Full article

Post-rotation jacking is a critical construction stage for load-path reconstruction and alignment adjustment in rotation-constructed bridges, particularly for ultra-wide double-deck composite girder systems. Taking a two-span continuous steel truss–concrete composite girder bridge with spans of 2 × 85 m as the engineering background, this study investigates the mechanical behavior during post-rotation jacking through theoretical derivation, finite element simulation, and on-site monitoring. Based on the force method of structural mechanics, a linear relationship between vertical synchronous jacking force and displacement is derived, and an analytical formulation for bearing reaction redistribution under laterally asynchronous jacking is established by considering the coupling effects of vertical bending, torsion, and transverse multi-bearing support. A full-bridge spatial finite element model was developed in MIDAS Civil NX 2024 V1.1 to analyze the redistribution of bearing reactions and the stress response of the concrete crossbeam under different jacking conditions. The results show that, for the investigated bridge, the jacking force–displacement response remains highly linear during synchronous jacking. The B-axis middle bearing is more sensitive to jacking displacement than the two side bearings, with its fitted stiffness being approximately 2.19 times the average stiffness of the side bearings. Eccentric jacking causes reaction concentration at the jacked point and reaction reduction at adjacent supports, and the magnitude of reaction variation increases approximately linearly with jacking displacement. When the transverse non-uniform jacking magnitude reaches 20 mm, a tensile stress of 0.3 MPa appears at the bottom flange of the concrete crossbeam; therefore, a project-specific stroke-difference limit of 20 mm is recommended for this bridge, while the actual construction achieved a stroke control accuracy of ±0.5 mm and a transverse elevation difference within 1 mm. Field monitoring results validate the proposed analytical and numerical methods. The Pearson correlation coefficients of the measured jacking forces with the finite element and theoretical results are 0.9987 and 0.9988, respectively, and the corresponding mean relative errors are 3.84% and 4.23%. For stress responses, the measured and calculated values show a strong correlation, with a Pearson correlation coefficient of 0.9980 and a mean relative error of 12.77%; the critical mid-span monitoring point shows a relative error of only 0.65%. The final bridge alignment deviation is controlled within ±3 cm. The overall mean verification coefficient is 0.968, with a 95% empirical agreement range of [0.888, 1.048], indicating that the proposed mechanical analysis framework and combined force–displacement control strategy can provide a useful reference for refined construction control of similar ultra-wide double-deck composite girder bridges with comparable span arrangement and transverse bearing layout. Full article

Background and Objectives: Central facial paralysis following stroke may affect oral motor control and swallowing function; however, its role in dysphagia-related impairments remains unclear. This study aimed to investigate the relationship between facial motor impairment, swallowing function, and oral motor dysfunction in patients with post-stroke central facial paralysis. Methods: This cross-sectional observational study included 80 patients with ischemic or hemorrhagic stroke accompanied by central facial paralysis. Facial motor function was evaluated using the Sunnybrook Facial Grading System. Swallowing function was assessed using the Eating Assessment Tool-10 (EAT-10), Repetitive Saliva Swallowing Test (RSST), and Functional Oral Intake Scale (FOIS). Oral motor dysfunction was evaluated using a clinician-based oral motor assessment form. Correlation and exploratory regression analyses were performed. Results: Significant associations were identified between facial motor function, swallowing measures, and oral motor parameters (all p < 0.001). Sunnybrook scores showed strong negative correlations with EAT-10 scores (r = −0.954) and positive correlations with RSST (r = 0.914) and FOIS scores (r = 0.915). In exploratory regression analyses, NIHSS emerged as an important contributor to swallowing-related outcomes. Labial and tongue functions were independently associated with RSST performance, whereas labial, velar, and buccal functions were independently associated with EAT-10 scores. Velar function was the only oral motor variable independently associated with FOIS levels. Conclusions: Facial motor function, oral motor dysfunction, and swallowing-related measures were significantly associated in individuals with post-stroke central facial paralysis. Overall, neurological severity also contributed substantially to swallowing-related outcomes. These findings may suggest a potential association between oral motor dysfunction and swallowing-related outcomes and may warrant consideration in comprehensive dysphagia evaluation. However, the observed relationships should be interpreted as exploratory and require confirmation in future studies using validated assessment tools and instrumental swallowing measures. Full article

Virtual reality (VR)-based rehabilitation is an established modality for upper extremity motor recovery; however, existing systems frequently rely on fixed, random, or therapist-tuned target placement that disregards patient-specific motor capacity and population-level priors. This study proposes a cross-patient collaborative swarm intelligence framework that derives zone-based patient profiles from real VR trajectories and augments them with a similarity-weighted cohort prior distilled from clinically similar patients’ successful trajectory clouds and zone-transition graphs. A hybrid Ant Colony Optimization (ACO)–Particle Swarm Optimization (PSO) algorithm optimizes 12 targets per session across a 27-zone ($3\times 3\times 3$) workspace using a five-component fitness function encompassing reachability, zone balance, movement efficiency, heatmap-guided challenge coverage, and swarm-flow consistency. The framework was evaluated retrospectively on a single-center cohort of 36 post-stroke patients and 6373 sessions under a leakage-safe simulation protocol with 70/30 chronological splits; outcomes are model-based proxy success rates derived from each patient’s profile rather than directly observed task success. The hybrid strategy achieved a mean simulated success rate of 85.5% ± 5.5%, a 36.4% relative improvement over random placement (Wilcoxon $p<{10}^{-7}$, Cohen’s $d=4.91$); the leakage-safe split yielded 80.1% on the held-out segment versus 61.1% for random, with no statistically significant train–test gap ($p=0.470$). Ablation confirmed both PSO and ACO are individually necessary ($\mathsf{\Delta }\ge 2.7$ pp, $p<0.001$). Total session-start computation is 78 ms on standard CPU hardware. These findings constitute a proof-of-concept that collaborative personalized swarm optimization can substantially outperform heuristic target placement under in silico evaluation; clinical efficacy in terms of standardized motor outcome measures remains to be established in a prospective randomized controlled trial, and the findings should be replicated across centers, task modes, and a larger cohort before generalization. Full article

Postoperative atrial fibrillation (POAF) is the most frequent post-cardiac surgical arrhythmia and is associated with haemodynamic instability, longer hospital stays, higher healthcare utilisation, stroke and adverse long-term outcomes. Conventional models of POAF focus on advancing age, pre-existing atrial substrate, increasing operative complexity, inflammatory responses related to cardiopulmonary bypass, disturbances in autonomic balance, and acute metabolic insults during the perioperative period. Although these explanations are important, they may be incomplete. Malignancy and the cancer-associated systemic environment involve biological processes potentially relevant to postoperative atrial vulnerability, such as chronic inflammation, oxidative stress, impaired vascular function, hypercoagulability, altered immune response, frailty, and treatment-related myocardial, pericardial, or conduction-system injury. This review assesses whether malignancy should be regarded as an underrecognised modifier of susceptibility rather than as a coincidental comorbidity. Most available data are extrapolated from cardio-oncology and thoracic oncology studies or general studies related to atrial fibrillation (AF) rather than studies focused on cardiac surgery. While malignancy cannot be dismissed as irrelevant to the generation of POAF, it also does not permit causal inference. Future studies should move beyond binary cancer status and incorporate cancer activity, treatment exposures, biomarker profiles, and atrial substrate measures to determine whether malignancy improves perioperative POAF risk stratification. Full article

Background: Cardiovascular complications are increasingly recognized in patients undergoing hematopoietic stem cell transplantation (HSCT). Early detection of subclinical myocardial dysfunction may improve risk stratification, and global longitudinal strain (GLS) is emerging as a sensitive marker of early cardiac impairment. Methods: We conducted a single-center observational cohort study including 518 adult patients undergoing autologous (n = 64) or allogeneic (n = 454) HSCT between 2004 and 2025. Baseline cardiovascular risk factors, transplant characteristics, and echocardiographic parameters—including GLS in a subset—were recorded. Abnormal GLS was defined as less negative than −20%. The primary outcome was the occurrence of cardiovascular events (composite of cardiovascular death, myocardial infarction, stroke, atrial fibrillation/flutter, pericardial effusion, pulmonary embolism, and left ventricular systolic dysfunction). Multivariable logistic regression was used to identify independent predictors. Results: Median age was 53 years; 58% were male. Cardiovascular events were predominantly atrial fibrillation, pericardial effusion, and reduced left ventricular function, whereas ischemic events were rare. Over 90% of events occurred within 100 days post-transplant. Multivariable analysis identified older age (OR 1.28 per 10-year increment; 95% CI 1.10–1.48; p = 0.002), chronic kidney disease (OR 2.44; 95% CI 1.18–5.02; p = 0.01), pre-transplant atrial fibrillation (OR 2.12; 95% CI 1.04–4.31; p = 0.03), and abnormal baseline GLS (OR 1.89; 95% CI 1.02–3.52; p = 0.04) as independent predictors. Importantly, the prognostic value of GLS remained significant after excluding clinically insignificant pericardial effusions from the composite endpoint. GLS deterioration during follow-up occurred more frequently in patients receiving reduced-intensity conditioning compared with myeloablative conditioning (25% vs. 12.7%; p = 0.006). Conclusions: Subclinical myocardial dysfunction detected by GLS identifies HSCT recipients at increased cardiovascular risk. These findings support the incorporation of strain imaging into routine pre- and post-transplant cardiovascular evaluation to enable earlier detection and guide targeted interventions. Full article

Ischemic stroke elicits a rapid and sustained innate immune response that critically contributes to blood–brain barrier (BBB) breakdown and secondary neuronal injury. Among the cellular mediators involved, neutrophil extracellular traps (NETs) have emerged as potent effectors of neurovascular damage. However, the regulatory mechanisms governing NET formation and their prolonged impact on BBB integrity remain incompletely understood. Increasing evidence indicates that NET formation is an epigenetically regulated process, requiring chromatin remodeling, histone modifications, DNA methylation changes and non-coding RNA-mediated control within neutrophils under ischemic conditions. These epigenetic events license the extrusion of DNA–histone–enzyme complexes that directly injure endothelial cells, degrade tight junction proteins, activate innate immune signaling pathways and amplify neuroinflammatory cascades at the neurovascular unit. Moreover, NET-derived chromatin and associated mediators can induce transcriptional and epigenetic alterations in BBB cells, thereby sustaining barrier permeability and impairing vascular repair mechanisms. In this review, we synthesize current knowledge on the epigenetic regulation of NET formation and delineate how epigenetically regulated NETs function as key disruptors of BBB integrity in ischemic stroke. Understanding this NETosis–epigenetics–BBB axis may uncover novel therapeutic strategies aimed at preserving neurovascular integrity and limiting post-stroke brain injury. Full article

Ankle dorsiflexion plays a vital role in ensuring safe and effective walking post-stroke, yet the best methods for assessing it and their clinical significance are still uncertain. This research compiles the existing sensor-based technologies used to measure ankle dorsiflexion in adults who have experienced a stroke and examines how these measurements correlate with walking performance. It also compares these findings with traditional clinical evaluation methods like manual muscle testing (MMT). We conducted a systematic search of PubMed, IEEE Xplore, and the Cochrane Library (2000–2025) for both observational and experimental studies that utilized sensor-based techniques (such as handheld or isokinetic dynamometry, load cells, and proprioceptive devices) to quantify ankle dorsiflexion and reported their relationship with gait outcomes. Additionally, studies employing conventional, non-instrumented clinical grading (e.g., ankle-dorsiflexor MMT) were included if they explored the connection between ankle function and gait, although these were not included in the quantitative analysis. Eighteen studies involving 783 stroke survivors met the inclusion criteria and were evaluated using the Newcastle–Ottawa Scale. Generally, individual studies found a positive association between ankle-dorsiflexor strength and both gait speed and endurance, although some negative correlations were noted. The strength and sometimes direction of these associations varied depending on the sensing technology, dorsiflexion index, gait outcome, and stroke chronicity. Overall, the current evidence indicates a generally positive but highly variable relationship between ankle dorsiflexion measurements and gait post-stroke, emphasizing the need to identify sources of variability and to create standardized, clinically applicable sensor-based assessment protocols. Full article

Stroke-related gait impairments are frequently associated with deficits in trunk control, movement coordination, and dynamic stability. Although robotic-assisted gait rehabilitation has shown promising clinical benefits, phase-specific biomechanical adaptations following rehabilitation remain incompletely understood. This study investigated phase-specific biomechanical adaptations following robotic-assisted gait rehabilitation in individuals with stroke using sensor-derived waveform analysis. Rehabilitation was performed three times per week over approximately 5–6 weeks using treadmill-based robotic gait training under dynamic body-weight support conditions. Pre- and post-intervention kinematic data were collected using a sensor-based motion analysis system. Joint kinematics, trunk motion, and center of gravity (COG) displacement were analyzed across the normalized gait cycle using waveform-based effect size analysis, statistical parametric mapping, principal component analysis, and k-means clustering to explore inter-individual adaptation patterns. Thirteen post-stroke hemiplegia patients (10 males; age = 63.9 ± 13.8 years), including six subacute and seven chronic stroke survivors, completed 16 rehabilitation sessions. The most prominent improvements were observed in trunk lateral flexion, particularly during loading response (d = 0.47, p < 0.01), indicating enhanced frontal plane trunk stability. Trunk flexion–extension showed reduced compensatory motion, whereas hip and knee adaptations were smaller and phase-dependent. COG displacement decreased across the gait cycle, reflecting improved dynamic stability. Step length increased significantly on both hemiplegic (Δ = +5.73 cm, p = 0.024) and intact sides (Δ = +8.83 cm, p = 0.007), while cadence and load symmetry remained unchanged. Clustering analysis revealed heterogeneous adaptation profiles rather than distinct responder groups. Chronic participants demonstrated greater variability within the Principal Component Analysis space compared to subacute participants, suggesting more variable and individualized biomechanical reorganization patterns rather than clearly separable recovery categories. Overall, robotic rehabilitation induced inter-individual biomechanical adaptations, predominantly involving proximal trunk control and stabilization strategies. Full article