Welcome to the WSC 2022 Interactive Program

Background and Aims

MLC901 is a combination of herbal ingredients proven to be safe and effective for stroke recovery.It is considered an add-on to standard stroke care. Cerebral venous sinus thrombosis (CVST) is treated with anticoagulation therapy, with subcutaneous low-molecular weight heparin (LMWH) and/or oral anticoagulants (vitamin K antagonists or direct oral anticoagulants (DOACs).Evidence from direct observational data can help assess safety.

Methods

NeuroAiD Safe Therapy (NeST) is designed to evaluate the safety and use of MLC901 (NeuroAiD) in clinical practice. It prospectively collects clinical data from baseline to the first to third months.Patients were given NeuroAiD taken at 2 capsules 3x a day. The primary outcome of the assessment was safety by reporting serious and non-serious adverse events. Patients who were diagnosed with CVST were retrospectively analyzed with focus on the reported side effects while on NeuroAiD.

Results

A total of 3 female patients with CVST were given MLC901 and anticoagulation therapy.Two patients developed post-partum CVST and one patient had ulcerative colitis as a risk factor. They were treated with LMWH in a therapeutic dose at the beginning and than switched to Rivaroxaban 20mg/day and 15mg/day respectively. Mean age of the patients was 29 (±4) years. All patients were compliant with the medications. During the treatment period, improvement of neurological status (measured by NIHSS, mRS) was observed, as well as improvement of cognitive functions (measured by Short-Orientation-Memory test).No side effects were seen during the treatment.

Conclusions

Concomitant use of MLC 901 and anticoagulation therapy in patients with CVST is safe and effective.

Background and Aims

Stroke is second leading cause of disability with 113 million DALY. Marketed hand robots offer 1 degree of freedom (DOF) for a single movement. The objective is to design a piezoelectric hand glove in functional hand position for upper limb post stroke. This glove will be assisted with brain stimulation techniques in pilot and randomised protocols.

Methods

Softwares and algorithms will be run. A search for material, design, sensors and actuators will be made. The hand will have wrist extended at 35 degrees, thumb abducted at 70 degrees, flexed at 45 degrees, DIP and PIP flexed at 30 degrees with total 12 linear actuators.

Results

(Components of the glove (material, sensors and actuators): The table 1 depict the components required for the glove. Of all the materials required, LZR racer swim suit was the best chosen. a preprotype design will look like fig 2.

Conclusions

We tend to devise an optimized and clinically validated robotic piezoelectric glove, with the following features: lightweight, low cost, compact and portable, modular and flexible which can work in different modes with patients having different clinical presentations. Pilot and randomised trials with brain stimulation techniques and growth factor (BDNF) upregulation will be futuristic models. Mobile based neuro-rehabilitation regime guidance for hand glove with training modules.

Background and Aims

Movement analysis of the human body is often used as a clinical tool not only by Neurologists for diagnosis but also by rehabilitation professionals for therapy supervision, assessment and outcome prediction. However existing clinical methods are highly subjective, lengthy, and insensitive. Leveraging the recent developments of computer vision, we have developed a simple system (MIRA – Machine Vision for Therapy) for therapy monitoring using a single camera for (a) tracking upper-limb and trunk kinematics of a subject, and (b) tracking any objects used for therapy. Aim: To develop and validate a camera-based system for automatic monitoring and quantifying of therapy in-clinic.

Methods

Methododology: Design: Cross sectional observational study

Results

Primary outcomes:

1. A custom questionnaire will be used to evaluate the quality of the therapy summary provided by MIRA.

2. Pittsburg Rehabilitation Participation score will be assigned by the Physiotherapists for videos.

Plan of data analysis: A non-parametric test will be carried out to test if the scores from the clinicians are above 0. A linear regression model will be developed using the different parameters extracted by MIRA to predict the Pittsburg Rehabilitation Participation score. Simple correlation analysis will be carried out between the different measures extracted by MIRA and the different clinical scores.

Conclusions

Most physical assessments employed by rehabilitationists are lengthy and often only quantify simple constructs. Such indices may not be sufficient to detail complex motor performances like that of the upper limb, hand functions, posture, gait, etc. Validating MIRA would help in automatic monitoring and quantifying of therapy in-clinic.

Background and Aims

Motor impairment is frequently affected after stroke. However, a full assessment of motor function is often not feasible in the acute setting. We assessed the association between a motor assessment based on the baseline NIHSS limb motor score (b-NIHSS-LMS) and functional recovery assessed with modified Rankin Score (mRS).

Methods

Data from a placebo-controlled clinical trial in subjects with acute ischemic stroke (AIS) and baseline-NIHSS score of 8-14 within the previous 72 hours assessing functional recovery (mRS 0-1 vs 2 -6) was included in the analysis. The association between b-NIHSS-LMS and the favourable outcome [defined as mRS 0-1 (0) vs. 2-6 (1)] was evaluated by using nested logistic regression model The odds-ratio (OR) of favourable outcome (mRS 0-1) at month (M) 3 between MLC601 and placebo was provided.

Results

The analysis of 533 subjects included in this exploratory study showed (i) that b-NIHSS-LMS (OR 0 .84; 95% confidence interval 0.76 to 0.92; p<0.001) was independently associated with mRS 0-1 at M3, and (ii) that its addition to the full NIHSS improved model fit for association with functional recovery (mRS 0-1). The best results between MLC601 and placebo were achieved in subjects with b-NIHSS-LMS≥3 compared to the overall analysis population (b-NIHSS 8-14) from M3 to M24.

Conclusions

In subjects with AIS of intermediate severity, b-NIHSS-LMS is independently associated with functional recovery. A practical implication is that the baseline-NIHSS-LMS can be used as a simple selection criterion to improve the study design of long-term recovery and rehabilitation after stroke.

Background and Aims

Stroke is the leading cause of long-term disability. Stroke is an unexpected medical emergency requiring immediate medical attention to save life. After surviving stroke, quality rehabilitation is an imperative to help minimize or eliminate disability and improve overall quality of life. Understanding the complex nature of post stroke requirements, a systematic and comprehensive rehabilitation program is required to achieve desired outcomes. There are multiple key determinants for a successful stroke recovery program.

Methods

At Transition Care Centers in India, program by name STRONG is introduced with key components of strength training, defining team, recovery care plan, exploring opportunities to improve recovery, tracking the net impact and making over all process engaging by introducing games.

STRONG - post stoke rehabilitation & recovery program was designed with the following key components

Strength Training – Focussed effort to improve strength across physical, mental & social aspects

Team - Defined multi-disciplinary rehabilitation members

Recovery care plan - Recovery care plan with defined goals & timelines

Opportunities - actively seek opportunities to improve recovery (from individual, family & friends)

Net Impact – reflect the progress made regularly

Gaming - engaging activities for motivation and adherence

Results

When STRONG (Strength training, Team, Recovery Plan, Opportunities, Net Impact and Gaming) approach is taken to design stroke rehabilitation, efforts are comprehensive, adherence is longer and possibilities of acheiving desired outcomes are high.

Conclusions

As stroke can leave lasting impact on individual, entire family and immediate community, there is a need for approaches like STRONG that can provide comprehensive post stroke recovery program to achieve desired rehabilitation outcomes.

Background and Aims

Reduced upper limb use after stroke results from a combination of motor, sensory, and cognitive impairments. So far, their longitudinal evolution, interactions, and effect on the use of the upper limb and quality of life has not been comprehensively described.

We designed a longitudinal observational study to gather a multi-modal database on the time-course of upper limb recovery in Asian adults after stroke, and characterize the longitudinal relationship between upper limb recovery, common post-stroke impairments, as well as quality of life. Here we present the study protocol and preliminary results.

Methods

Up to 400 participants with stroke will be recruited at Tan Tock Seng Hospital in Singapore and tested at up to 8 assessment time points, from subacute stages until 3 years post-stroke. We will perform a battery of clinical and neurophysiological assessments to describe the impairments most likely to influence upper limb recovery. Further, we will gather digital health metrics from technology-based assessments to sensitively characterize technology-based assessments and daily life limb usage. Also, health-related quality of life will be described using questionnaires and semi-structured interviews.

Results

Overall, this study will likely yield 1) a comprehensive documentation of upper limb recovery, 2) clinically important information on early prognostic factors for rehabilitation outcomes, and 3) identify different recovery profiles of subgroups of stroke survivors.

Conclusions

This study is expected to provide evidence to inform clinical decision making in Asian stroke survivors and help establishing personalized therapy programs.

Background and Aims

Recent studies had shown that inflammasome included NLRP3, ASC and caspase-1 was a key factor in the initiation of inflammation which caused brain injury and neuronal death after ischemic stroke. Dl-3-n-butylphthalide, an active ingredient found in celery seeds, had been shown to reduce inflammation during the acute phase of stroke. However, the relationship between Dl-3-n-butylphthalide and inflammasome was still unclear. In our study, we determined to explore whether the anti-inflammatory effects of Dl-3-n-butylphthalide by inhibiting the expression of NLRP3 inflammasome.

Methods

Adult male ICR mice underwent 90-min middle cerebral artery occlusion. These mice were randomly separated to two groups: NBP group administrated 100mg/kg bw Dl-3-n-butylphthalide immediately, 1 day and 2 days after ischemia in mice by gavage and OIL group administrated equal volume of oil at the same time. The expression of NLRP3 inflammasome and neuronal death were examined to explore the relationship between the effect of Dl-3-n-butylphthalide and expression of NLRP3 inflammasome.

Results

We found that Dl-3-n-butylphthalide treatment inhibited the expression of NLRP3 inflammasome (p<0.05). On day 3 after stroke, the number of ASC positive microglia (p<0.01) and caspase-1 and TUNEL double positive neurons was significantly decrease (p<0.05).

Conclusions

Our results suggested that Dl-3-n-butylphthalide may act on NLRP3 inflammasome of microglia to reduce neuronal apoptosis.

Background and Aims

Virtual Reality (VR) technology has emerged as a promising approach in the rehabilitation domain. Its improvisation and role in post-stroke rehabilitation is a research area of high priority. A library of VR-tasks was developed for targeted distal upper-limb rehabilitation. The primary objective of the pilot-study was to develop and to evaluate the rehabilitation potential of the VR-framework on a 42-year-old female stroke-patient having chronicity of 21 months. Furthermore, we aim to obtain subjective feedback from the patient to further enhance the VR-setup for a patient-specific approach.

Methods

Subjective trajectory plots along with three quantitative performance measures – Time taken to complete the task (TCT), Smoothness of trajectory, and relative percentage error were defined. Similar dataset for forty healthy subjects was first obtained and was used as a healthy reference for analysis of patient dataset. The patient was given twenty days of VR-sessions of 45-minutes each. Clinical scales – Fugl-Meyer Assesment (FMA-UE), Modified Ashworth Scale (MAS), and Barthel Index (BI) were acquired pre- and post-therapy.

Results

No adverse effect were observed. Post-therapy improvements were observed with increment in Wrist/hand component of FMA-UE (2units), BI (5units), and reduction in MAS at wrist (1+ to 1). TCT, smoothness of trajectory and relative percentage error values relatively reduced from pre-to post-therapy (Figure 1).

Conclusions

The developed VR-setup has shown its potential in targeted distal upper-limb rehabilitation. The obtained subjective feedback will help to further customize the VR-framework for a future clinical study with a large patient-cohort.

Background and Aims

Stroke is often considered as an aging disease; however, around 30% of stroke admissions were adults aged below 65 according to Hospital Authority, Hong Kong (2016). Day Rehabilitation Management (DRM) program, a multi-disciplinary day rehabilitation program, of our hospital has filled the service gap for limited resources designated for young-age neuro-rehabilitation and promoted early discharge. Occupational Therapy (OT) service in DRM has strived to achieve a seamless training program for young stroke patients from in-patient to community reintegration.

Aims

To review the functional outcomes in DRM program of Tuen Mun Hospital, Hong Kong.

Methods

Stroke patients aged below 65 discharged from DRM from 1 April to 30 September 2021 were reviewed. Outcome measures included Modified Barthel-Index (MBI), adapted Lawton-IADL, Functional Test for the Hemiplegic-Upper-Extremity (FTHUE), Action-Research-Arm Test (ARAT), Nine-Hole Peg Test (9-HPT) and Montreal-Cognitive-Assessment Hong Kong Version (HK-MoCA).

Results

42 stroke patients (mean age 50.5) were discharged from DRM after average 11.5 sessions. Significant improvements were found in functional status (p<0.001; mean MBI 90.9 to 95.0; adapted Lawton 12.7 to 16.4), upper limb function (p<0.05 in FTHUE, ARAT and 9-HPT) and cognitive function (p<0.001 in HK-MoCA).

Among 42 patients, 81.0% were working before stroke. 32.4% of them directly resumed previous job after DRM in 5.43 weeks. 44.1% continued OT rehabilitation in out-patient settings. 20.6% were referred to non-governmental organizations for further rehabilitation and job exploration.

Conclusions

The findings showed promising rehabilitative outcomes for OT service in DRM. Seamless rehabilitation was achieved from hospital to early community reintegration which is essential for young stroke patients.

Background and Aims

Cell therapy of ischemic stroke (IS) is a new and rapidly developing method. As a whole experimental direction, it originated in the 90s, when several successful attempts were made to transplant neural stem cells (NSCs) in neurodegenerative diseases and chronic cerebral infarctions in the basal nuclei.

Methods

The procedure for preparing the cell concentrate is performed by hardware leukocytapheresis after the stage of mobilization of hematopoietic cells. Cell stimulation is carried out by daily administration of colony stimulating factors (G-CSF) for 3-5 days at the rate of 5-10 mg / kg, resulting in the release of hematopoietic cells from the bone marrow into peripheral blood.

Results

The results of the study will allow us to further develop a route for personalized rehabilitation of ischemic stroke in solving the problems of active longevity, which will undoubtedly lead to a decrease in disability and a significant improvement in the quality of life of these patients. All this, ultimately, will reduce the human and economic losses of society.In the future, the development of an innovative method of rehabilitation of ischemic stroke, as a finished scientific and technical product, can be promoted to foreign markets.

Conclusions

The tasks to be solved in the project will create the foundation for further research designed to significantly improve the effectiveness of rehabilitation of patients with ischemic stroke.

Background and Aims

Spinal cord ischemia is an uncommon type of stroke accounting for 0.3 – 1% of all strokes. In spite of its rareness it very often leads to severe disability. The stroke mechanism is either a thromboembolic event or hypoperfusion after dissection. Developed spinal cord ischemia leads to neuroinflammatory response, NMDA-mediated neuronal excitotoxicity and finaly to neuronal death mostly due to apoptosis.

Medical management of spinal cord stroke is still controversial and includes thrombolytic therapy and antithrombotic drugs. However, both methods lack evidence based data. Neuroprotective agents have been investigated in spinal cord injury and spinal cord stroke. In spinal cord injury, add-on treatment with neuropeptide Cerebrolysin showed some benefitial effects in reducing neural injury, blood-spinal cord barrier breakdown and edema formation.

Methods

We present our experience with Cerebrolysin as add-on therapy in three patients with spinal cord stroke discussing clinical picture, neuroimaging appearance, diagnostic work-up and therapeutic approach to our patients as well as their functional outcome measured with modified Rankin scale 30 and 90 days after beginning of their illness.

Results

We did not experience any side effects of Cerebrolysin and all three patients improved significantly on the last follow-up visit. Although the variety of symptoms, ethiology and localization of spinal cord stroke in our patients does not allow any final conclusion, the results encourage for further studies.

Conclusions

Cerebrolysin according to our results is a safe add-on drug in patients with spinal cord stroke with promising results which warrant further investigations in this type of stroke.

Background and Aims

Physiotherapy, emphasising high intensity, individually tailored, and person‐centered treatment, is an effective route for recovery after a stroke. No single approach has been deemed paramount, and there is limited knowledge about patient experiences of assessment, goal‐setting, and treatment. In this study, we seek to report patient experiences of I‐CoreDIST -a new physiotherapy intervention targeting recovery and usual care. The purpose is to investigate how individuals with stroke experience the bodily and interactive course of physiotherapy during their recovery process.

Methods

A qualitative study, nested within a randomized controlled trial, consisting of interviews with 19 stroke survivors receiving either I‐CoreDIST or usual care. Data were analyzed using systematic text condensation, the analysis was informed by enactive theory.

Results

Interaction with the physiotherapist, guided by perceived bodily changes, fluctuated between being formal/explicit and tacit/implicit. The experiences of participants in the intervention group and the usual care group differed predominantly with regards to the content in therapy and the means of measuring progress; divergences in levels of satisfaction were less pronounced. Perceiving positive bodily changes, and tailoring of difficulty and intensity, were essential in generating meaning and motivation. An embodied approach seemed to facilitate sense‐making. In the interaction between the participants and their physiotherapists, trust and engagement were important and multifaceted, involving both interpersonal skills and professional expertise.

Conclusions

The embodied nature of physiotherapy practice is a source for sense‐ making and meaning‐construction for patients after a stroke. Trust in the physiotherapist, along with emotional support, is considered essential. Experiencing progress and individualizing approaches are decisive motivators.

Background and Aims

Community organizations often employ nonregulated health professionals to provide support and recovery services to people impacted by stroke. At March of Dimes Canada, the After Stroke Coordinators provide personalized system navigation and case management to stroke survivors and caregivers. They also provide support and education, link to community resources, and connect clients to opportunities for community participation. Outside of healthcare settings, there are no widely accepted competency frameworks for this type of community-based system navigator role. Project Aim: To create and validate a competency framework and performance indicators for a community stroke navigator role.

Methods

First we reviewed published competency documents of comparable roles, followed by drafting the competenices and indicators for each of the domains. We completed a survey of staff and external experts to validate and rank the importance of each to the community stroke coordinator role. Finally, we completed a pilot test of the framework before finalizing.

Results

The resulting competency framework has 13 domains; each with a set of corresponding indicators. It contains a coordinator self-rating and a manager rating component. Based on feedback the initial framework was made more concise, language was simplified, the number of indicators were condensed, and preliminary data has been used to develop training modules.

Conclusions

Implementation of a competency framework demonstrates a commitment to provide consistency in high quality service to clients and supports the staff in learning and development opportunities. This novel competency framework developed for community-based stroke coordinators could be useful for other stroke support organizations.

Background and Aims

Globally, the incidence of stroke is on the rise, so well-organized and managed informal care is needed. Informal caregivers provide a large amount of assistance and are crucial for the ability of survivors to recover and adapt to life after stroke. Informal caregivers need to be educated on the care process, but in order to do so, it is necessary to identify their needs.

Aim of this study was to find out the experience and needs of informal caregivers and stroke survivors about patient care in the first six months after stroke.

Methods

15 samples from stroke survivors and their informal caregivers were analyzed. Data were collected by interviewing patients and their caregivers 6 months after stroke

Results

Informal caregivers are not prepared to start the care process of stroke patients in the first months. Access to information and education in collaboration with health professionals is not always sufficiently organized and does not meet the needs of informal careers. The availability of technical aids to all persons after a stroke is not provided in a timely manner and significantly affects participation in daily functional activities, as well as complicates the care process.

Conclusions

The care process is hampered by the lack of competence of informal stroke caregivers in caring tasks. Informal caregivers want to get an education, but there is a lack of clarity about access to services and support, so they use self-education and practice care. Sometimes informal caregivers do not understand healthcare professionals due to ther use of medical terminology.

Background and Aims

Orthographic (written) cues are often incorporated into word-finding therapy in clinical practice, but their evidence base is surprisingly limited. This is in spite of recent findings by independent laboratories that orthographic cueing appeared to be particularly effective in aphasia rehabilitation (Brogan et al., 2020; Sze et al., 2021). In this study, salient research gaps are targeted, specifically, we investigated the optimal unit for a written cue and the duration of the effects.

Methods

Three adults with chronic aphasia (more than six months) post-stroke participated in two online orthographic cueing therapies (10 daily sessions) in a crossover design. Each therapy utilised the single-word picture-naming paradigm and focused on either the first letter or the entire word as its orthographic cue.

Results

WEighted STatistics (WEST), designed for small-n statistical analyses (Howard et al., 2015), revealed that whole word cues improved naming accuracies and response times for two participants, with effects lasting up to four weeks post-therapy. The results were robust, remaining significant even after comparing against corresponding outcomes for control items representing repeated exposure (i.e., items that were untreated but encountered during therapy). In contrast, first letter cues failed to elicit any significant improvement, after effects from repeated exposure were accounted for.

Conclusions

Overall, the results suggested that the whole word was an effective unit for orthographic cueing and its effects could be durable. Clinical implications include the efficacy of anomia therapy conducted online, scheduling of booster sessions, and the importance of measuring naming performance beyond a single accuracy dimension.

Background and Aims

Central post stroke pain (CPSP) is a chronic central neuropathic pain syndrome due to stroke lesions . Pain that occurs either with a stimulus or spontaneously, appears 1-6 months after an ischemic or hemorrhagic stroke. CPSP can cause anxiety, depression, sleep disturbances that lead to a decrease in the patient's quality of life . Transcranial Magnetic Stimulation (TMS) is a non-pharmacological and non-invasive intervention therapy that is used to relieve chronic pain and anxiety disorders by using a magnetic field through a coil placed on the skull bone, which is useful for realigning intracranial structures and functions disturbed by stroke lesions.

Methods

A 49 year-old patient came to clinic with pain in the left arm and leg, suffered since 5 months before admission, occurred with or without stimulus, reduced with analgetic drug but it came again soon 3-4 hours after drug consumption. She felt a continuous stabbing and burning sensation with neurological pain rating scale (NPRS) : 6-7. Stroke history 3 years ago with left side hemiparesis and dysarthria and routinely control to neurologist for medication. She felt difficult to sleep and anxiety because this pain. She got a gabapentin, paracetamol, clozapine, diazepam, amlodipine, and atorvastatin orally as her daily medication. Hamilton Anxiety Rating Scale (HARS) before rTMS scored 25 (moderate anxiety), and after rTMS was 4 (no anxiety).

Results

Improvement in HARS and NPRS score was noted after rTMS, thought to occur due to reorganization of neurotransmitters involved in chronic pain pathophysiology.

Conclusions

rTMS helped to improve quality of life in patient with CPSP

Background and Aims

Subluxation of the iliosacral joint will lead to instability of balance and abnormal walking posture.There is no relevant study on whether the correction of iliosacral subluxation can improve the core stability and walking ability of stroke patients.

Methods

13 patients with stroke hemiplegia in chronic stage (course of disease more than 6 months) hospitalized in the neurological rehabilitation center of Baotou Central Hospital from May 2021 to December 2021 were selected. 13 patients with iliosacral subluxation were treated with manual correction. Berg balance scale, timed up and go test, Holden walking ability, 10 meter walking timing test and pelvic positive X-ray were performed and compared before and after treatment.

Results

13 patients with chronic stroke hemiplegia with iliac sacroiliac joint subluxation were selected. According to the gonstead analysis system, the pelvic positive X-ray was measured, including 8 cases of iliac asin deviation, 2 cases of iliac asex deviation, 1 case of iliac PIIN deviation, 1 case of iliac Piex deviation and 1 case of iliac in deviation. In the course of treatment, 2 cases fell off, 1 case was transferred to another department and 1 case was discharged automatically. 11 patients who completed the whole treatment cycle were directly treated with manual correction. The scores were scored before and after 3 weeks of treatment and statistically analyzed. All scores were improved after treatment (P < 0.05).

Conclusions

For patients with chronic stroke hemiplegia with iliosacral subluxation, the correction of iliosacral subluxation is helpful to improve their walking ability and balance function.

Background and Aims

Spasticity is considered a 'positive' sign of upper motor neuron syndrome, which occurs after central nervous system damage and manifests as a velocity-dependent increase in resistance during the passive stretch, resulting from hyperexcitability of the stretch reflex. The weakening of the inhibitory influence of the motor cortex, on the spinal α-motoneuron via the brainstem originating lateral reticulospinal tract seems to play a crucial role in spasticity occurrence. Evidence suggests that spinal cord stimulation (SCS) may be effective in reducing spasticity. The present pilot study aims to examine whether resting-state functional connectivity (RS-FC) modifies after a short course (1-7 days) of SCS-therapy in patients with left-sided brain damage (due to stroke and TBI) and whether these changes are related to improved regulation of stretch reflex as assessed by the Ashworth scale (AS).

Methods

Eight right-handed patients (19-66 years old) with right-sided spasticity in the arm and leg underwent test epidural spinal cord stimulation at the C3-C5 level. Before and after SCS, patients were assessed with AS and RS-fMRI.

Results

There was a significant increase in FC between the brainstem and the leg area of the right motor cortex following SCS. Correlation analysis showed that decreasing connectivity of this motor cortex with the nearest right-sided cortex is associated with greater anti-spastic outcome in the leg (p_{FDR-corrected}<0.05).

Conclusions

Our preliminary data contribute to the understanding of adaptive neuroplasticity associated with spasticity elimination. However, confirmation of the causality of SCS in the occurrence of these rearrangements will be possible once the effect of spontaneous recovery is controlled.

Background and Aims

Smartphone apps have been identified as a method of supporting physical activity post-stroke; however, the content and quality of existing apps have not been examined. This study systematically identified commercial apps that promote physical activity post-stroke, assessed content for behavior change techniques (BCTs), and evaluated their quality.

Methods

The Google Play and iTunes stores were searched in March 2021. Results were screened by two reviewers. A content analysis was conducted by two coders using the Behavior Change Technique Taxonomy v1. Quality was assessed by three raters with the User Version of the Mobile Application Rating Scale (uMARS). Spearman correlations were conducted to explore the relationship between BCTs and app quality.

Results

The search identified 2,051 apps and seven were included in the final analysis. A mean of 8.3 BCTs was identified per app, though this ranged from 3 to 20. The mean app quality score was 3.27 on a five-point scale (SD = 1.04). Within subscales of the uMARS, aesthetics received the highest score (mean=3.62, SD=1.15), while engagement received the lowest (mean=3.2, SD= .1). A strong positive relationship was noted between the number of identified BCTs and overall app quality (rho = .815, p < 0.01).

Conclusions

This study provided the first content analysis and quality appraisal of apps targeting physical activity post-stroke. The high aesthetics scores indicated that app developers prioritized this aspect of app design. Two apps warrant evaluation of their impact on improving activity post-stroke. Lower-quality apps did not employ a systematic or evidence-based approach to app design.