Displaying One Session

Scientific Communications
Session Type
Scientific Communications
Room
Hall M
Date
07.11.2020, Saturday
Session Time
08:30 AM - 10:00 AM

ACUTE PHASE BLOOD PRESSURE PROFILES AFTER TIA AND STROKE IN RELATION TO SEVERITY AND AETIOLOGICAL SUBTYPE: POPULATION-BASED STUDY

Session Type
Scientific Communications
Date
07.11.2020, Saturday
Session Time
08:30 AM - 10:00 AM
Room
Hall M
Lecture Time
08:40 AM - 08:50 AM

Abstract

Group Name

The Oxford Vascular Study

Background And Aims

Blood pressure (BP) is increased in 60-80% of patients with acute stroke. Although post-stroke hypertension is widely considered to be at least partly a physiological response to the event, its exact cause(s) are uncertain. We aimed to gain insights into aetiology by comparing post-event BP across the full range of acute TIA and stroke.

Methods

Acute-phase, post-event BP readings in a population-based study (Oxford Vascular Study) were recorded from all patients with acute TIA or stroke from 2002-2019 and related to severity, aetiology and subtype of event.

Results

BP was recorded within 24 hours of incident TIA/stroke in 2438, of whom 793 (32.5%) had measurements within 90 minutes. Mean first 90-minute SBP was substantially higher after intracerebral haemorrhage than after major (NIHSS≥3) ischaemic stroke (180.7 vs 155.5 mmHg, p<0.0001), and was lower after major stroke than after TIA/minor stroke (155.5 vs 160.1 mmHg, p=0.044). Indeed, mean first SBP within 24 hours after major stroke was no higher than after transient ocular ischaemic events (155.4 vs 153.2 mmHg; p=0.71). Among TOAST categories of ischaemic stroke, post-event SBP was lowest in cardioembolic strokes, being 8.7 mmHg (95% CI 6.1–11.4, p<0.0001) below that in large artery disease/small vessel disease/undetermined subtypes after adjusting for age/sex/medications/timing. Results for DBP were similar.

Conclusions

Although acute-phase BP was higher after ICH than ischaemic stroke, there was no evidence in ischaemic events that it was driven by the severity of brain injury. If anything, severity of post-stroke hypertension was inversely related to severity of ischaemia.

Trial Registration Number

Not applicable

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LONG-TERM OUTCOMES ASSOCIATED WITH DISCHARGE DESTINATION AFTER ACUTE STROKE IN AUSTRALIA: ARE PATIENTS DISCHARGED DIRECTLY HOME AT A DISADVANTAGE?

Session Type
Scientific Communications
Date
07.11.2020, Saturday
Session Time
08:30 AM - 10:00 AM
Room
Hall M
Lecture Time
09:00 AM - 09:10 AM

Abstract

Background And Aims

Little is known about long-term outcomes associated with access to inpatient rehabilitation after stroke.

Aim: to compare long-term outcomes for patients discharged directly home with those discharged to inpatient rehabilitation after stroke.

Methods

Data collected in the Australian Stroke Clinical Registry (2010-2013) were linked to hospital admission records and the national death index as part of the Stroke123 study. Multilevel multivariable regression analyses were conducted, adjusting for patient and hospital factors. Outcomes were death and hospital readmissions up to 365-days and health-related quality of life (HRQoL) at 90-180days.

Results

7,847 patients were included (median age 71 years, 59% male, 83% ischemic stroke); 4405 (56%) were discharged home and 3,442 (44%) to inpatient rehabilitation.

Patients discharged directly home were more likely to be aged under 65 years and to walk independently at hospital admission. Patients discharged to inpatient rehabilitation had more comorbidities and greater odds of having dementia.

Hazard of death was not significantly different between the two groups.

Patients discharged directly home were more likely to be readmitted to hospital than patients discharged to inpatient rehabilitation (adjusted subhazard ratio [aSHR]:90-days 0.54, 95%CI 0.49, 0.61; aSHR:180-days 0.74, 95%CI 0.67, 0.82; aSHR:365-days 0.85, 95%CI 0.78, 0.93).

Patients discharged directly home had higher HRQoL scores, but were more likely to report mobility problems (adjusted OR 0.54, 95%CI 0.47, 0.63).

Conclusions

Patients discharged directly home have higher risks of readmission and self-reported mobility problems than patients discharged to inpatient rehabilitation. To reduce this disadvantage, better support is indicated for people who are discharged directly home after stroke.

Trial Registration Number

Not applicable

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Shared and distinct anatomical correlates for phonemic and semantic fluency: a large multicenter lesion-symptom mapping study in 1208 patients with ischemic stroke

Session Type
Scientific Communications
Date
07.11.2020, Saturday
Session Time
08:30 AM - 10:00 AM
Room
Hall M
Lecture Time
09:10 AM - 09:20 AM

Abstract

Background And Aims

Disturbances of semantic (i.e. generating words according to a semantic category) and phonemic (i.e. generating words starting with a specific phoneme) fluency are common after stroke, as a manifestation of language, executive, or memory dysfunction. Lesion-symptom mapping (LSM) studies can help to understand which patients suffer from these deficits and can also provide fundamental insights in shared and distinct anatomical correlates of these cognitive functions. We performed a large-scale LSM study on semantic and phonemic fluency in patients with ischemic stroke.

Methods

1208 patients with ischemic stroke were included from two Korean cohorts. Hypothesis-free voxel-based and region of interest-based LSM was performed using support vector regression to relate infarct location to semantic (category animals) and phonemic (three phonemes) fluency

Results

With the largest-ever sample size for LSM on fluency we could achieve almost complete lesion coverage, ensuring that our analyses on anatomical correlates could address nearly the entire brain (Figure 1A). Lower performance on both types of fluency was related to left hemispheric frontotemporal cortical regions and subcortical regions centering on the left thalamus. Unique correlates for phonemic fluency were mostly located in left perisylvian frontoparietal regions, whereas unique correlates for semantic fluency were located in the left posterior temporal lobe.

figure final.png

Conclusions

Our results demonstrate that semantic and phonemic fluency depend on left subcortical and perisylvian structures, likely forming a cortical-subcortical network predominantly involving more widely distributed perisylvian regions for phonemic and posterior temporal regions for semantic fluency.

Trial Registration Number

Not applicable

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A PANEL COMPRISING SERUM AMYLOID A, WHITE BLOOD CELLS AND NIHSS FOR THE TRIAGE OF PATIENTS AT LOW RISK OF POST-STROKE INFECTION

Session Type
Scientific Communications
Date
07.11.2020, Saturday
Session Time
08:30 AM - 10:00 AM
Room
Hall M
Lecture Time
09:20 AM - 09:30 AM

Abstract

Background And Aims

Accurate and early prediction of post stroke infections is important to improve antibiotic therapy guidance and avoid unnecessary antibiotic treatment. We hypothesized that the iterative combination of blood biomarkers with clinical parameters could help to optimize risk stratification during hospitalization.

Methods

In this prospective observational study, blood samples of 283 ischemic stroke patients were collected at hospital admission within 72 hours from symptom onset. Prediction performances of blood biomarkers (Serum Amyloid-A, C-reactive protein, procalcitonin, white blood cells (WBC), creatinine) and clinical parameters (NIHSS, age, temperature) were evaluated using receiver operating characteristics curves. An algorithm that uses the iterative combination of biomarkers and clinical parameters the so called threshold method (ICBT) was utilized to evaluate the best panel combination.

Results

Among the 283 included patients, 60 developed an infection during the first 5 days of hospitalization. Comparing clinical parameters and blood biomarkers, the panel including SAA, WBC and the NIHSS had a sensitivity of 97% and a specificity of 45% to identify those patients who did not develop an infection.

Conclusions

The use of SAA combined with WBC and NIHSS at hospital admission may correctly stratify half of the ischemic stroke patients with low risk of infection to avoid unnecessary antibiotic (AB) treatment and thus the formation of AB resistance. A rapid Point-of-Care test (CompliCheckTM) is under development to be used at the bedside in a prospective study.

*L. Azurmendi Gil and L. Krattinger-Turbatu have equally contributed to this work.

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IN-HOSPITAL VENOUS THROMBOEMBOLISM IS ASSOCIATED WITH POOR OUTCOME IN SPONTANEOUS INTRACEREBRAL HEMORRHAGE PATIENTS: A MULTICENTER, PROSPECTIVE STUDY

Session Type
Scientific Communications
Date
07.11.2020, Saturday
Session Time
08:30 AM - 10:00 AM
Room
Hall M
Lecture Time
09:30 AM - 09:40 AM
Presenter

Abstract

Background And Aims

Patients with spontaneous intracerebral hemorrhage (ICH) are susceptible to venous thromboembolic (VTE) complications, but the relationship between VTE and outcome is largely unknown. We aime to investigate the effects of in-hospital VTE on functional outcome in ICH patients.

Methods

From September 2014 through August 2016, we conducted a hospital-based, prospective study by consecutively recruiting eligible first-ever acute spontaneous ICH patients. In-hospital VTE was defined as any observation of deep vein thrombosis or pulmonary embolism during initial hospitalization. The primary end point was death or disability (modified Rankin Scale, mRS 3 to 6) at discharge, 3-month and 1-year follow-up. Logistic analysis was performed to evaluate the association between VTE and poor functional outcome.

Results

Among 637 participants included in the analysis, the prevalence of VTE was 22.6%. After adjusting for confounding factors, VTE independently predicted death or disability at discharge (odds ratio [OR] 2.09, 95% confidence interval [CI] 1.12-3.85), 3-month follow-up (OR 2.00, 95% CI 1.12-3.54) and 1-year follow-up (OR 2.00, 95% CI 1.14-3.49). VTE was also an independent indicator of disability (mRS 3-5) among ICH survivors, with ORs ranging from 1.93 to 2.08 (all P<0.05). The relationship was stronger in patients with hematoma volume <10ml (OR 3.31, 95% CI 1.08-10.15) and ≥30ml (OR 2.92, 95% CI 1.09-7.86) (P for interaction=0.002) at 1-year follow-up. The results were confirmed by sensitivity analysis.

Conclusions

In-hospital VTE is independently associated with poor outcome at discharge, 3-month and 1-year in ICH patients.

Trial Registration Number

Not applicable.

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SENSORIMOTOR VERSUS MOTOR UPPER LIMB THERAPY IN THE EARLY REHABILITATION PHASE AFTER STROKE: A RANDOMIZED CONTROLLED TRIAL

Session Type
Scientific Communications
Date
07.11.2020, Saturday
Session Time
08:30 AM - 10:00 AM
Room
Hall M
Lecture Time
09:40 AM - 09:50 AM

Abstract

Background And Aims

Somatosensory impairments in the upper limb (UL) are common after stroke and significantly associated with motor impairments. Evidence of the effect of sensorimotor UL therapy is scarce.

Aim: To compare the effect of sensorimotor versus motor UL therapy on behaviour and brain imaging outcomes.

Methods

An assessor-blinded multicentre randomized controlled trial was conducted including 40 first-ever stroke patients with UL sensorimotor impairments recruited on admission to the rehabilitation centre and allocated to either sensorimotor (N=21) or motor (N=19) UL therapy using block randomization stratified for motor severity, type of stroke and presence of neglect. Both groups received 16 hours of additional therapy over four weeks. Assessments were completed at baseline, post-intervention and after four weeks follow-up including Action Research Arm Test (ARAT) as primary outcome measure, motor and somatosensory UL measures as well as resting-state functional magnetic resonance imaging. Between-group analyses will be performed for clinical data, and region-of interest (ROI) to ROI analysis and mixed models for resting state data.

Results

Result are still in progress and will be added before first of april

Conclusions

Since the results are still in progress, conclusion can't be drawn yet. Conclusion will be added before first of april

Trial Registration Number

The trial is registered at clinicaltrials.gov NCT03236376

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DESIGN GUIDELINES FOR PLANNING MOBILITY-SUPPORTING REHABILITATION CLINICS FOR STROKE PATIENTS

Session Type
Scientific Communications
Date
07.11.2020, Saturday
Session Time
08:30 AM - 10:00 AM
Room
Hall M
Lecture Time
09:50 AM - 10:00 AM

Abstract

Background And Aims

Physical environment of healthcare facilities influences patients’ recovery and contributes to the quality of provided care. Stroke inpatients in rehabilitation clinics are generally inactive during their rehabilitation stay and often encounter barriers in the built environment. The aim of this PhD research study was to identify and examine architectural features that hinder, facilitate and motivate independent mobility of stroke inpatients.

Methods

Comparative floor plan analysis and post-occupancy evaluation, including patient shadowing (70), patient questionnaire (60), and staff questionnaire (59), were used in seven German rehabilitation clinics. Ten stroke patients were shadowed per rehabilitation clinic, each for 12 consecutive hours (840 observation hours); with their paths, time logs and interactions with the built environment recorded on the floor plans. Questionnaires addressed the experience of the built environment from two perspectives.

Results

The results include the identification of five major categories of barriers in the built environment: wayfinding issues, widths of corridors, physical obstacles, floor surfaces and long distances, with their exact spatial properties; identification and examination of architectural features that act as mobility facilitators; as well as behavioural patterns of patients during scheduled therapies and voluntary activities, with the characteristics of spaces they visit during their free time.

These obtained study results were synthesized into a directly applicable catalogue of architectural guidelines for designing mobility-supporting rehabilitation clinics.

guidelines example.jpg

Conclusions

Built environment of rehabilitation clinics greatly hinders independent mobility of stroke patients during rehabilitation. The proposed design guidelines are intended for all professionals involved in the planning process of building new or renovating existing rehabilitation clinics.

Trial Registration Number

Not applicable

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