Search Results (603)

Objectives: In patients presenting to the emergency department with acute ischemic stroke (AIS), there is a growing need for practical and rapid biomarkers that can effectively predict prognosis and infarct volume, complementing neurological examination and imaging methods. Methods: This study retrospectively evaluates patients diagnosed with AIS at the emergency department of Bilecik Training and Research Hospital between 1 March 2022, and 30 September 2023. Patients who were transferred for reperfusion therapy were excluded, as thrombolysis and mechanical thrombectomy were not available at our institution during the study period. The systemic immune–inflammation index (SII) and the systemic inflammation response index (SIRI) scores were calculated based on patients’ laboratory values. Additionally, infarct volumes were independently assessed by two experienced radiologists and calculated by multiplying the hyperintense areas on diffusion-weighted magnetic resonance imaging by slice thickness. Results: Of the 349 patients diagnosed with AIS during this study period, 257 who met the inclusion criteria were analyzed. The median age was 76 years (IQR: 66–83), and 130 (51%) patients were female. Lacunar infarction was present in 109 patients (42.4%), while 148 (57.6%) had non-lacunar infarction. The all-cause mortality rates at 1 month, 1 year, and 2 years were 7.8%, 21.4%, and 29.6%, respectively. SII and SIRI scores were significantly higher in deceased patients compared to survivors across all time points for mortality. Conclusions: The findings of this study suggest that SII and SIRI values, derived from complete blood count parameters, may contribute to the early identification and management of high-risk AIS patients. 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

Objectives: Stroke predominantly affects older adults and is accompanied by age-related declines in balance and mobility. Given the inter-individual variability in post-stroke functional capacity, identifying the most effective dual-task training modalities for specific patient profiles is essential for precision-based stroke rehabilitation. This systematic review and meta-analysis aimed to investigate the differential effectiveness of motor dual-task training (MDT) and cognitive dual-task training (CDT) on gait performance, balance control, and motor function while exploring other moderating factors. Methods: The study followed the PRISMA guidelines. A comprehensive search of six English databases (Web of Science, PubMed, Medline, Embase, Cochrane Library, CINAHL) and one Chinese database (CNKI) was conducted from November 2023 to June 2025. Randomized controlled trials involving adult stroke survivors were included. Outcomes included gait, balance, and lower-extremity motor function. Random-effects meta-analysis, subgroup analyses, and meta-regression were performed to evaluate modality-specific effects and moderating factors. Results: Twenty-one RCTs (n = 786) were included. Dual-task training demonstrated moderate improvements in both temporal (SMD = 0.50, p = 0.03) and spatial (SMD = 0.5, p = 0.04) gait performance and balance control (SMD = 0.71, p = 0.02), but not motor function. MDT demonstrated superior effects on gait speed and stride length (SMD = 1.15, p = 0.01; SMD = 0.89, p < 0.01), whereas CDT showed greater benefits for balance (SMD = 0.59, p < 0.01). Greater balance improvements were observed in individuals at high fall risk, and subacute patients showed enhanced responsiveness. Conclusions: These findings provide guidance for tailoring dual-task modality and timing to individual patient profiles, though high heterogeneity and the lack of direct comparisons between MDT and CDT limit definitive conclusions. Full article

Background/Objectives: In the past few years increasing attention has been given to the application of dry needling (DN) for spasticity in stroke survivors. Nevertheless, the underlying mechanisms of this technique have not yet been confirmed. The aim of this systematic review was to distinguish the effects of DN in post-stroke spasticity on both structural–mechanical muscle properties (SMMPs) and neurophysiological properties to address these mechanisms. Methods: A literature search was performed in Web of Science, PubMed, Scopus and Embase following PRISMA guidelines (PROSPERO ID: 1163064). Randomized controlled trials and case–control studies involving adults with post-stroke spasticity treated with DN were included. Outcomes were categorized as SMMPs (e.g., muscle architecture, passive stiffness, PROM) or neurophysiological measures (e.g., H-reflex, H/M ratio). Standardized effect sizes (Hedges’ g) were calculated when possible; however, heterogeneity in outcomes and incomplete variance reporting precluded meta-analysis. Results: Twelve studies met the inclusion criteria. Most of these studies assessed passive range of motion, reporting a significant increase following the intervention. Only two of the included studies examined structural characteristics, and five studies included neurophysiological outcomes. Correlations between mechanistic outcomes and clinical spasticity grading (MAS/MMAS) were weak. Emerging evidence suggests DN may additionally modulate local inflammatory mediators, indicating a potential neuroimmune contribution to its effects. Conclusions: DN appears to improve structural–mechanical muscle properties and produce moderate reductions in reflex excitability in individuals with post-stroke spasticity. Mechanical adaptations are more consistently demonstrated than neural changes, and neither domain is proportionally reflected in clinical spasticity scales. Evidence remains limited by small samples, methodological variability, and incomplete reporting. Further mechanistic research is needed to clarify how DN influences the complex pathophysiology of post-stroke spasticity. Full article

Background/Objectives: Post-stroke gait impairment is highly heterogeneous, which limits the effectiveness of standardized exoskeleton control strategies. Deep reinforcement learning offers a route to adaptive assistance, but its use in stroke rehabilitation is constrained by limited pathological gait data and the lack of interpretable transfer frameworks. We developed a data-efficient, pathology-informed reinforcement learning framework for personalized exoskeleton assistance under limited clinical gait data. Methods: The framework combines neuromuscular-inspired parametric augmentation (NIPA) with parameter-efficient transfer learning. NIPA synthesizes pathological gait trajectories by modeling weakness, stiffness or contracture, and abnormal synergies. A policy is first pretrained in simulation and then adapted to clinical gait data by freezing a shared feature extractor and fine-tuning the output heads. The framework was evaluated on a public clinical gait dataset of 50 stroke survivors using tracking error, reward, smoothness, generalization, and data efficiency as main outcomes. Results: The proposed method outperformed zero assistance, rule-based control, and reinforcement learning from scratch on the test set. Compared with scratch, it reduced total MSE from 14.8681 to 11.9369 ($p=5.96\times {10}^{-8}$) and improved reward from −21.2264 to −18.4798 ($p=3.76\times {10}^{-4}$). Hip MSE decreased from 5.9544 to 4.0143 ($p=7.51\times {10}^{-8}$) and knee MSE decreased from 6.5507 to 5.4507 ($p=1.51\times {10}^{-5}$), with significant improvements in repeated experiments. Conclusions: The proposed framework reduces reliance on large pathological training datasets and improves offline trajectory-level personalization under limited clinical data. It also provides an interpretable basis for quantitative characterization of post-stroke gait heterogeneity and may support individualized rehabilitation assessment and assistance planning. Full article

Background/Objectives: This study longitudinally assessed cognitive–motor control deficits in the ipsilesional upper limb following stroke and, secondarily, examined the effect of lesion laterality on these deficits. Methods: Forty-one participants (mean [SD] age: 64.6 [14.4] years; 24 with right-hemisphere lesion; 38 right-handed) were assessed using the KINARM Exoskeleton Lab at approximately 4 weeks (T1), 10 weeks (T2), and 29 weeks (T3) post-stroke. They completed the Visually Guided Reaching (VGR) and Reverse Visually Guided Reaching (RVGR; where the cursor moved in the opposite direction to the subject’s hand movement) tasks with their ipsilesional limb to assess motor control and cognitive–motor control, respectively. Global Task-scores and Z-scores for specific variables derived from normative data were used to determine the occurrence of deficits within each task. Linear mixed-effects models examined time and lesion-side effects. Results: About 88% and 56% of participants were impaired on the RVGR global Task-score, at T1 and T3, respectively. In contrast, only 12% and 9% of participants were impaired on the VGR Task-score, at T1 and T3, respectively. Performance on the RVGR task improved over time. Interestingly, deficits were significantly more severe for right-hemisphere lesions on several variables, except for the feedforward variables. Performance on the VGR task remained unchanged with no lesion-side effect. Conclusions: Stroke survivors exhibited significant impairments in cognitive–motor control of the ipsilesional upper limb, independent of pure motor deficits, persisting into the chronic stage. Right-hemisphere lesions were associated with greater impairments, indicating a potential hemispheric specialization for such cognitive–motor control task. Full article

Background: Refractory cardiac arrest, cardiogenic shock, and severe acute respiratory failure remain associated with substantial mortality despite advances in advanced life support and extracorporeal membrane oxygenation (ECMO). Transportable ECMO platforms may enable rapid deployment, uninterrupted extracorporeal support, and safer in-hospital transport, but early real-world experience with newer systems remains limited. Methods: We conducted a retrospective single-center observational cohort study including all VitalFlow veno-arterial ECMO (VA-ECMO) and veno-venous ECMO (VV-ECMO) deployments performed between November 2025 and March 2026 at a high-volume tertiary cardiac surgery center. Fifteen cases were analyzed, comprising 12 VA-ECMO and 3 VV-ECMO deployments. Data were extracted from electronic health records, perfusion protocols, and ICU documentation. Outcomes included survival to hospital discharge, 30-day survival, neurological outcomes, and complications. Analyses were descriptive. Results: The cohort was exclusively male and clinically unstable at implantation, with high lactate and low pH levels consistent with severe hypoperfusion. Median time-to-flow was 33 min, and median ECMO duration was 8 days. Survival to discharge was 60% overall (66.7% VA-ECMO, 33.3% VV-ECMO), with ECMO weaning success in 86.7% and the primary death cause being multiorgan failure (83.3% of non-survivors). All survivors achieving a favorable neurologic outcome (CPC 1). Thirty-day survival was 73.3%. No major bleeding or stroke occurred. Limb ischemia was observed in 4 patients, with 2 patients requiring fasciotomy, all in the VA-ECMO group. Bronchial infection occurred in 3 patients. Lactate levels improved within the first 24 h, and survivors showed a more pronounced metabolic response. Conclusions: In this early single-center experience, VitalFlow ECMO was feasible and associated with rapid flow establishment, survival to discharge of 60% of patients, and good neurologic outcome among survivors. The complication profile was acceptable, with limb ischemia as the main adverse event. These findings support further evaluation of this transportable ECMO platform in larger multicenter cohorts. Full article

Stroke causes approximately 12.2 million new cases and 6.5 million deaths annually, with survivors requiring coordinated care across pre-hospital, acute, rehabilitative, and preventive phases. Mobile health (mHealth) technologies, including smartphone applications, wearable sensors, and tablet-based platforms, have shown clinical potential across these contexts, yet a structured mapping of their distribution across the full stroke care continuum is lacking. We searched PubMed, Scopus, and Web of Science for publications from January 2019 to March 2025. Studies evaluated mHealth interventions in which the mobile platform directly performed diagnostic, therapeutic, or rehabilitative functions in stroke populations. Of 4524 records identified, 17 met the inclusion criteria. Studies originated from eight countries and used heterogeneous designs: five randomized controlled trials, five non-randomized studies, four cohort studies, and three diagnostic accuracy studies. Median sample size was 37 participants (range 10–2249). Evidence concentrated at two poles: six studies addressed acute diagnosis and ten addressed rehabilitation, predominantly in the chronic phase. One study addressed secondary prevention; two targeted early rehabilitation, the period of maximum neuroplasticity after discharge. All seventeen studies covered a single care phase. Smartphone platforms dominated acute contexts; wearable and mixed-modality systems were confined to rehabilitation. The mHealth stroke landscape is fragmented and phase-specific, exhibiting a silo effect in which interventions operate as isolated tools rather than components of an integrated care system. An important gap is the near-absence of research in early rehabilitation. Future priorities include cross-continuum design, expansion into cognitive and secondary prevention domains, and progression toward adequately powered trials. Full article

Post-stroke depression (PSD) is the most prevalent neuropsychological disorder among stroke survivors, affecting over 30% of patients. It significantly impairs patients’ quality of life and imposes a substantial burden on individuals, families, and society. Currently, the primary treatment for PSD focuses on conventional antidepressant therapies, with a lack of innovative approaches. Therefore, there is an urgent need to develop novel targeted therapies for PSD. This review synthesizes PSD pathogenesis as a multi-system network disorder involving monoamine deficits, neuroinflammation, HPA axis dysfunction, and neurotrophic imbalance. Within this framework, mesenchymal stem cells (MSCs) transplantation, as an emerging therapeutic strategy, may exert beneficial effects through anti-inflammatory, neuroprotective mechanisms, and the provision of neurotrophic factors. This review provides a preclinical framework that highlights the potential of MSC-based strategies, while emphasizing the need for further validation in PSD-specific models before clinical translation. Full article

Background/Objectives: Psychological resilience is associated with improved quality of life after stroke, yet less is known about how resilience and mindfulness interact over time in long-term recovery. This qualitative instrumental case study aimed to describe how psychological resilience and mindfulness unfolded in one stroke survivor with high psychological resilience and to identify processes that may inform future research on long-term stroke rehabilitation. Method: We conducted an instrumental qualitative case study involving a stroke survivor and his spouse (carepartner), using an in-depth interview framework for data collection and grounded theory procedures to support analysis. Data sources included interview transcripts and contextual artifacts, such as personal and professional websites, emails, and informal conversations. Findings: Three interrelated themes described how resilience unfolded in this case: (a) antecedents to poststroke resilience: personality traits, values, behavioral modeling, and environmental factors; (b) the obstacle is the way to posttraumatic growth; and (c) poststroke resilience: mindfulness embodied. Together, these themes suggest how prestroke strengths, responses to adversity, and mindfulness practice interacted in this participant’s long-term recovery. Conclusions: This exploratory case study offers a detailed account of how resilience and mindfulness may interact after stroke in one highly resilient individual. The findings are hypothesis-generating and may help guide future research on mindfulness-based and holistic approaches to long-term stroke recovery in larger and more diverse populations. Full article

Background/Objectives: Robot-assisted therapy (RAT) can deliver repetitive, feedback-enriched upper-limb practice after stroke, but evidence comparing RAT with dose-matched conventional occupational therapy (COT) under routine inpatient conditions—and concurrent neurocognitive data—remains limited. We compared motor recovery between an end-effector RAT-based program (30 min RAT plus 30 min COT) and dose-matched COT alone in subacute stroke survivors, with neurocognitive outcomes prespecified as exploratory endpoints. Methods: In this single-center retrospective non-randomized cohort study, adults with first-ever ischemic or hemorrhagic stroke who completed routine baseline and week−4 assessments received 4 weeks of upper-limb rehabilitation: combined RAT plus COT (60 min daily) or COT alone (60 min daily). The primary outcome was the week-4 Fugl–Meyer Assessment–Upper Extremity (FMA-UE) motor score adjusted for baseline. Primary inference used covariate-adjusted linear regression on outcome-specific complete cases, with a prespecified stabilized inverse probability of treatment weighting (IPTW) average treatment effect analysis as the sensitivity test. Secondary and exploratory endpoints were interpreted descriptively; Benjamini–Hochberg false discovery rate (FDR) control and multiple imputation were applied as supportive analyses. Results: The analytic cohort comprised 65 patients (RAT, n = 33; COT alone, n = 32). Both groups improved over 4 weeks, but the RAT group had worse baseline upper-limb motor status. The adjusted between-group difference for the week-4 FMA-UE motor score was non-significant (adjusted mean difference, 4.39; 95% confidence interval (CI), −2.43 to 11.21; p = 0.203), and the stabilized IPTW estimate was concordant (β = 2.17; 95% CI, −3.63 to 7.98; p = 0.464). In unadjusted analyses, the FMA-UE motor gain was larger after RAT than COT alone (14.70 ± 15.53 vs. 7.91 ± 9.42), and only the RAT group exceeded the prespecified 12.4-point clinically important threshold; this signal attenuated after adjustment. No secondary or exploratory endpoint remained significant after FDR control. Multiple imputation for the primary endpoint was concordant with the complete-case result (pooled β = 4.52; 95% CI, −1.91 to 10.94; p = 0.168). Conclusions: End-effector RAT did not demonstrate adjusted superiority over dose-matched COT alone for upper-limb motor recovery. The larger unadjusted FMA-UE gain should be interpreted as a descriptive impairment-level signal rather than as evidence of comparative efficacy. Neurocognitive results were exploratory; the retrospective non-randomized design, baseline imbalance, differential missingness, and unavailable confounder data require cautious interpretation. Full article

Clonal hematopoiesis of indeterminate potential (CHIP) is an age-related condition affecting over 10–20% of individuals older than 70 years, characterized by the expansion of hematopoietic stem cell clones carrying somatic mutations in leukemia-associated driver genes in the absence of overt hematologic disease. Initially recognized as a precursor to hematologic malignancies, CHIP has since been implicated in diverse non-malignant disorders, notably increasing the risk of cardiovascular events by 40%. Recent epidemiological and experimental evidence suggests a potential disease-modifying influence of CHIP in neurodegenerative diseases, particularly Alzheimer’s disease (AD), although findings remain heterogeneous and sometimes contradictory. This review synthesizes recent evidence linking CHIP to AD risk, neuropathology, and disease progression. In this study, we summarize population-based cohort studies reporting a 36 to 54% reduction in the odds of clinical AD among CHIP carriers, alongside emerging data indicating that DNMT3A and TET2 mutations may exert divergent effects on neurodegeneration. Mechanistic insights from experimental models are examined, highlighting the ability of mutated myeloid cells to infiltrate the central nervous system and modulate neuroinflammation and amyloid clearance. We discuss conflicting findings and analyze how CHIP-driven vascular disease and stroke confound neuroprotective signals. We propose that CHIP may differentially influence AD and vascular contributions to cognitive impairment and dementia, shaping mixed dementia phenotypes. Methodological challenges, including survivor bias, competing risks, variable mutation detection thresholds, and incomplete Apolipoprotein E stratification, are discussed. Ultimately, our review clarifies that CHIP is not a simple protective factor, but a complex systemic modulator that reshapes the neurodegenerative and vascular drivers of cognitive decline, necessitating cross-disciplinary neuro-hematology collaboration to establish its role as a novel risk stratificator for improving diagnostic precision and personalizing clinical outcomes in Alzheimer’s disease. Full article

Background: Lower limb arterial calcification (LLAC) is a robust imaging biomarker of peripheral artery disease (PAD) severity. Vitamin K antagonists are presumed to accelerate cardiovascular calcification. Direct oral anticoagulants (DOACs) may influence vascular calcification differently, but lower limb data are limited. Methods: We performed a single-center retrospective cross-sectional study comparing LLAC on clinically acquired non-contrast CT between DOAC users and controls without anticoagulation. Patients were propensity score-matched 1:1 (48 DOAC vs. 48 control; n = 96) using baseline clinical covariates. Associations between LLAC scores and perioperative or cardiovascular events were assessed. Segment-specific LLAC was quantified on non-contrast CT and normalized for arterial segment length. A prespecified exposure–duration sensitivity analysis compared the outcomes in patients with ≥5 years of continuous DOAC therapy (n = 22) versus matched controls. Results: In the matched cohort, total LLAC scores did not differ significantly between DOAC and control groups (infrarenal aorta: median 7596.0 vs. 8637.0 (p = 0.487), iliac segment: median 5689.5 vs. 5193.5 (p = 0.602). However, in patients with ≥5 years of DOAC use, LLAC scores were significantly lower in proximal segments: infrarenal aorta median 5593.5 vs. 11,185.0 (p = 0.001997) and iliac arteries 5624.5 vs. 11,501.0 (p = 0.001867)). Higher LLAC was associated with major adverse cardiovascular events (such as myocardial infarction, stroke, or significant bleeding) in controls (p = 0.0023) but not in DOAC-treated patients. Conclusions: In this propensity-matched, cross-sectional CT study, long-term DOAC exposure was associated with lower proximal LLAC scores in a small duration-defined subgroup, while the primary matched analysis showed no overall difference in total LLAC scores. Because baseline (pre-DOAC) imaging was unavailable and residual confounding/survivor bias is possible, these findings should be considered hypothesis-generating and require prospective validation. The cohort reflected a mixed lower-extremity vascular population rather than exclusively classic chronic atherosclerotic PAD, which may limit biological interpretation and generalizability. Full article

Background: Upper-limb impairment is a major contributor to chronic disability after stroke. Conventional recovery protocols frequently suffer from poor adherence, limited accessibility, and insufficient intensity for prolonged rehabilitation. Methods: We performed a systematic analysis of randomized controlled trials (RCTs) and non-randomized designs published between 2019 and 2024, assessing virtual reality (VR) interventions for upper-limb stroke rehabilitation. Participant characteristics, VR intervention details, primary and secondary outcomes, and adherence rates were analyzed in accordance with PRISMA guidelines. The review is registered in PROSPERO (CRD420251150877). We searched PubMed, Embase, Wiley, Scopus, and Cochrane databases. Study quality was assessed using the RoB 2 and ROBINS-I tools. This review received no funding. Results: Forty-one trials met the inclusion criteria. High variability in study methodology, VR devices, intervention protocols, and outcome measures limited direct comparability. Dropout rates were low and were frequently attributed to factors unrelated to the VR intervention. Adverse events were uncommon, supporting the feasibility and safety of VR-based rehabilitation. Conclusions: While VR is a safe and feasible modality, large-scale, multicenter clinical trials with standardized protocols and long-term follow-up are essential to define the role of VR in routine stroke care. Full article