Tag: Stroke and TAVR procedures

Speech Accessibility Project begins recruiting people who have had a stroke

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BYLINE: Meg Dickinson

Newswise — The Speech Accessibility Project has begun recruiting U.S. and Puerto Rican adults who have had a stroke.

Those interested can sign up online.

Funded by Big Tech companies Amazon, Apple, Google, Meta, and Microsoft, the University of Illinois Urbana-Champaign aims to train voice recognition technologies to understand people with diverse speech patterns and disabilities. The project is also recruiting adults with Parkinson’s disease, Down syndrome, cerebral palsy, and amyotrophic lateral sclerosis.

“A stroke can cause big changes, including changes to your ability to speak,” said Mark Hasegawa-Johnson, the project’s leader and a professor of electrical and computer engineering at Illinois. “Our goal is to teach AI to understand you the way you speak right now, so that you can use AI to help you on the job or in activities of daily life. The Speech Accessibility Project is about empowerment; the potential for empowerment of people post-stroke is huge and wonderful.”

The project has partnered with Lingraphica’s research team to recruit people who have had a stroke. Mentors will connect with those who want to participate, screen their speech, and help them understand and consent to participate.

Shawnise Carter, Lingraphica’s senior research manager and a speech language pathologist, said she’s thrilled to join the project and called it “ambitious and necessary.”

“It is essential for individuals with communication impairments to have access to technology in a way that can suit their needs,” Carter said. “The hope is that it will allow people who have had a stroke to access smart devices and smart technology while decreasing frustration resulting from voice recognition technology not recognizing impaired speech.”

Such technology doesn’t currently account for people with speech impairments, she said.

“Creating a database that considers this is a huge contribution to the field of communication sciences and disorders and more research of this nature should continue,” she said.

Clarion Mendes, a clinical assistant professor of speech and hearing science at Illinois and a speech language pathologist, added that the Speech Accessibility Project could also improve quality of life for family members and loved ones of people who have had a stroke.

“Communication difficulties associated with a cerebrovascular accident, commonly known as stroke, are diverse in both their severity and how they impact individuals and their families. Speech, language, and cognitive processes may be affected,” Mendes said. “Including stroke survivors with aphasia and their caregivers in the Speech Accessibility Project is an exciting new chapter. There’s outstanding potential for increasing quality of life for stroke survivors and decreasing caregiver burden.”

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Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign

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February 2, 2024
Bernadette Boden-Albala to be honored for contributions in addressing stroke inequities

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Newswise — Irvine, Calif., Jan. 30, 2024 — Bernadette Boden-Albala, M.P.H., Dr.P.H., director of the University of California, Irvine Program in Public Health and founding dean of the planned School of Population and Public Health, has been selected to receive the prestigious Edgar J. Kenton III Lecture Award from the American Stroke Association, a division of the American Heart Association, just prior to its annual International Stroke Conference. She is being recognized for her lifetime achievement of contributions to investigation, management, mentorship and community service in the field of stroke inequities or related disciplines.

“It’s a great honor to be acknowledged by the American Heart Association’s leadership at such an important event,” Boden-Albala said. “Stroke exhibits significant racial and ethnic inequalities, encompassing differences in incidence, prevalence, treatment and outcomes. This award and lecture provide me with a valuable platform to highlight the crucial role of community-based research, particularly in addressing stroke disparities among diverse communities.”

An internationally renowned expert in the social epidemiology of stroke and cardiovascular disease, Boden-Albala has authored or co-authored 170 publications that have become a blueprint for community-based stroke and heart disease prevention. Her robust research portfolio spans more than 25 years, with a focus on the roles of sex, race/ethnicity, socioeconomic status, social support, social networks and stress. Her work has significantly contributed to the understanding of inequalities and patterns of disparity across the U.S. and globally.

The American Heart Association will host its 2024 International Stroke Conference on Feb. 7 to 9 at the Phoenix Convention Center. Boden-Albala will present her lecture Feb. 6 at a pre-conference symposium called Health Equity and Actionable Disparities in Stroke: Understanding and Problem Solving. Held at the same site, HEADS-UP is recognized internationally as the premier meeting dedicated to the science and treatment of cerebrovascular disease and brain health. This annual gathering brings together a vast network of professionals to gain insights into the physiological processes associated with stroke, explore more effective therapies for brain health and stroke recovery, and collectively strive to reduce the burden of stroke worldwide.

About the University of California, Irvine: Founded in 1965, UCI is a member of the prestigious Association of American Universities and is ranked among the nation’s top 10 public universities by U.S. News & World Report. The campus has produced five Nobel laureates and is known for its academic achievement, premier research, innovation and anteater mascot. Led by Chancellor Howard Gillman, UCI has more than 36,000 students and offers 224 degree programs. It’s located in one of the world’s safest and most economically vibrant communities and is Orange County’s second-largest employer, contributing $7 billion annually to the local economy and $8 billion statewide. For more on UCI, visit www.uci.edu.

Media access: Radio programs/stations may, for a fee, use an on-campus ISDN line to interview UCI faculty and experts, subject to availability and university approval. For more UCI news, visit news.uci.edu. Additional resources for journalists may be found at https://news.uci.edu/media-resources.

NOTE TO EDITORS: PHOTO AVAILABLE AT
https://news.uci.edu/2024/01/30/bernadette-boden-albala-to-be-honored-for-contributions-in-addressing-stroke-inequities/

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University of California, Irvine

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January 30, 2024
Rapid Telehealth Consults Improve Care for Rural Patients With Stroke

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Newswise — Minutes matter when a patient may have had a stroke, but being far from a physician with advanced training in neurology no longer needs to be a barrier to rapid diagnosis and intervention.

Telestroke programs are designed to improve access to the limited number of specialists, regardless of the geographic isolation of patients who may have experienced a stroke. Telestroke, or stroke telemedicine, is a form of telehealth in which physicians with advanced training in stroke care use technology to provide immediate consultation to a local healthcare professional to recommend diagnostic imaging and treatment for patients with stroke at an originating site. Patients who present within 4.5 hours of when they were last known to be well may be eligible for thrombolytic drug therapy or endovascular intervention, often measured as door-to-needle time.

After launching a telestroke consultation program, Essentia Health, an integrated health system serving patients in Minnesota, Wisconsin and North Dakota, increased the percentage of patients receiving thrombolytics in less than 60 minutes and decreased the average door-to-needle time.

“Use of Telestroke to Improve Access to Care for Rural Patients With Stroke Symptoms” describes how Essentia Health’s program ensures that patients are evaluated rapidly to expedite decisions about their course of treatment. The article is published in the October issue of Critical Care Nurse (CCN).

Essentia Health initiated the telestroke program in fall 2019, with coverage provided by a team of four interventional neurologists, three of whom work in the system’s Comprehensive Stroke Center in Fargo, North Dakota. In addition to this center, telestroke services are provided to five other acute stroke-ready hospitals throughout rural areas in the upper Midwest.

Through the telestroke program, neurology consultations are available to all of the sites 24 hours a day, every day of the year, and can be used for both inpatient and emergency department stroke activations at each of the facilities.

The team developed a tiered stroke alert algorithm and telestroke workflow chart to help healthcare professionals at rural sites determine eligibility for telestroke consultation to decide the treatment plan.

The algorithm categorized strokes as level I to III according to the symptoms and time when the patient was last known to be well. Telestroke consults were most often used for patients with level I stroke alerts since they were within the timeframe when they may be eligible for thrombolytic drug therapy or endovascular intervention.

Once staff members determine whether a telestroke consultation will be initiated, they refer to the step-by-step workflow chart, which specifies actions needed for each member of the multidisciplinary team.

Co-author Chelsey Kuznia, BSN, RN, SCRN, is the stroke program manager for Essentia Health’s Comprehensive Stroke Center in Fargo, one of only two such facilities in North Dakota.

“Regardless of the type of stroke, rapid diagnosis and intervention are critical for improving survival rates and reducing the long-term effects of stroke,” she said. “People living in rural areas not only have increased stroke risk factors, but they also face challenges to getting the advanced care they need in a timely way, which leads to higher rates of disability and death.”

In 2022, telestroke connections for 42 patients were completed, with a stroke diagnosis confirmed in 25 of them (61%). Fourteen of the patients with confirmed stroke received thrombolytic therapy while others were not eligible, either because of patient-related contraindications or because more than 4.5 hours had elapsed since their last-known well time.

Of the 25 patients with confirmed stroke, 18 (72%) were discharged home, while three were discharged to skilled nursing facilities, one to an inpatient rehabilitation unit, one to hospice and two died.

The year prior to implementation of the telestroke program, 11 of 15 eligible patients (73%) received thrombolytic therapy in less than 60 minutes, with a mean door-to-needle time of 61 minutes. During the year after implementation, the results improved: 11 of 12 eligible patients (92%) received thrombolytic therapy in less than 60 minutes, and the mean door-to-needle time decreased to 38 minutes.

As the American Association of Critical-Care Nurses’ bimonthly clinical practice journal for acute and critical care nurses, CCN is a trusted source of information related to the bedside care of critically and acutely ill patients. Access the article abstract and full-text PDF by visiting the CCN website at http://ccn.aacnjournals.org.

About Critical Care Nurse: Critical Care Nurse (CCN), a bimonthly clinical practice journal published by the American Association of Critical-Care Nurses, provides current, relevant and useful information about the bedside care of critically and acutely ill patients. The award-winning journal also offers columns on traditional and emerging issues across the spectrum of critical care, keeping critical care nurses informed on topics that affect their practice in acute, progressive and critical care settings. CCN enjoys a circulation of about 130,000 and can be accessed at http://ccn.aacnjournals.org/.

About the American Association of Critical-Care Nurses: For more than 50 years, the American Association of Critical-Care Nurses (AACN) has been dedicated to acute and critical care nursing excellence. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. AACN is the world’s largest specialty nursing organization, with about 130,000 members and nearly 200 chapters in the United States.

American Association of Critical-Care Nurses, 27071 Aliso Creek Road, Aliso Viejo, CA 92656; 949-362-2000; www.aacn.org; facebook.com/aacnface; twitter.com/aacnme

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American Association of Critical-Care Nurses (AACN)

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October 1, 2023
Clinical Trial Aims to Reduce Depression, Improve Quality of Life After Stroke

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BYLINE: Julie Kiefer

Newswise — Following up on positive results from preliminary research, scientists at University of Utah Health are evaluating whether an eight-week program based on positive psychology techniques can improve the mood and well-being of people who have had a stroke and those who care for them. The National Institutes of Health-funded ReStoreD (Resilience in Stroke survivor-care partner Dyads) clinical trial involves both the stroke survivor and their spouse or care partner. Together, the couple takes part in planned activities that can be done at home.

The study will recruit 200 couples in which one partner has had a stroke within the past three months to three years. Couples must have lived together for at least six months and may reside anywhere in the U.S.

“This approach is different from others that address pathology or things that are wrong,” says Alexandra Terrill, Ph.D., leader of the new clinical trial and associate professor of occupational and recreational therapies at U of U Health. “Instead, we’re taking a ‘building what’s strong’ approach.”

In the eight-week program, couples coping with stroke learn and practice goal setting, communication strategies, and positive psychology activities, such as expressing gratitude, finding meaning, and fostering connections. As a part of each module, participants view educational videos or read materials to learn about topics, such as resilience, coping, and well-being, that relate to adjusting to life after stroke. Then, they carry out activities related to the week’s theme.

Activities can be as simple as writing a thank you note, performing a good deed, or reflecting on an enjoyable experience.

“We’re very good at prescribing blood pressure medicines and anti-thrombotics to help prevent the next stroke,” says Jennifer Majersik, M.D., a neurologist and stroke specialist at U of U Health who is a collaborator on the study. “But stroke survivors need something beyond just a pill to really help them reintegrate into their family lives and the community.”

Addressing post stroke depression and resilience

Preliminary research with 34 couples showed that the intervention decreased post stroke depression and improved resilience in stroke survivors, and these changes were maintained for at least three months after the program ended. Resilience is having the ability to adapt and cope when faced with challenges. Findings were more mixed for care partners, but those who had depressive symptoms and lower resilience also saw improvements. The studies’ results were based on self-report questionnaires and standardized measures.

The new trial seeks to confirm these results on a larger scale and provide additional evidence that the behavioral intervention lowers emotional distress in both partners. The trial will also examine effects on relationship quality, stroke-related stress, and engagement in meaningful activities.

“There is a common assumption that feeling depressed or anxious is to be expected after sustaining a stroke and that mental health issues will resolve spontaneously once a person returns home,” Terrill says. “Unfortunately, this is often not the case.”

Stroke is a leading cause of long-term disability, affecting nearly 800,000 people in the U.S. every year. The life-changing event can alter speech, movement, or cognition, causing a stroke survivor to lose their independence. As a result, 30 to 50 percent of people coping with stroke, along with their partners, experience depression or emotional distress.

Positive psychology could be a relatively simple, cost-effective solution to this problem, Terrill says. She is a clinical psychologist with specialized training in rehabilitation. More broadly, she researches the role of relationships and positive psychology in managing chronic conditions. If successful, the novel approach being tested in ReStoreD could become a sustainable and accessible means to improve recovery and quality of life.

“I’ve seen it affect patients and their partners in a positive way,” Majersik says. “It’s shown me that we can continue to bend the curve of stroke recovery, not just by medicines or technology but also by using what I consider to be pretty simple tools. And that matters.”

Watch this video to learn more about the research.

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University of Utah Health

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August 8, 2023
Women less likely to be routed to comprehensive stroke centers for large vessel acute ischemic stroke, according to UTHealth Houston research

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Newswise — Despite having worse stroke symptoms and living within comparable distances to comprehensive stroke centers, women with large vessel occlusion acute ischemic stroke are less likely to be routed to the centers compared to men, according to a new study from UTHealth Houston.

Led by corresponding author Sunil Sheth, MD, associate professor of neurology and director of the vascular neurology program with McGovern Medical School at UTHealth Houston, and senior author Youngran Kim, PhD, assistant professor of management, policy, and community health with UTHealth Houston School of Public Health, the study was published today in the Journal of the American Heart Association.

Large vessel occlusion stroke occurs when a major artery in the brain is blocked. They are considered one of the more severe kinds of strokes, accounting for an estimated 24% to 46% of acute ischemic strokes.

“Timely treatment of stroke is incredibly important; the faster a doctor is able to get the vessel open, the better the patient’s chance of having a good outcome. These routing systems in hospitals are designed to get patients to the best care as quickly as possible,” Sheth said. “We don’t know exactly why women were less likely than men to be routed to comprehensive stroke centers, but we do know that gender is an implicit bias. Getting to the granular level of what went into a hospital’s routing decision will be very important for future studies.”

Researchers identified consecutive patients with large vessel occlusion acute ischemic stroke from a prospectively collected multi-hospital registry for the Greater Houston area from January 2019 to June 2020. They compared prehospital routing of men and women to centers capable of performing endovascular therapy to remove the clot blocking the artery. Among 503 patients, 82% were routed to comprehensive stroke centers. Women made up 46% of the study participants.

Compared with men, women with large vessel occlusion acute ischemic stroke were older (73 versus 65) and presented with a greater National Institutes of Health Stroke Scale (NIHSS) Score (14 versus 12), meaning their symptoms were worse. After adjusting for differences in stroke type, age, travel distance, and other relevant factors, women with large vessel occlusion acute ischemic stroke were approximately 9% less likely than men to be routed to comprehensive stroke centers.

“The greater NIHSS score in women may be partially attributed to their older age, as age itself is a known contributing factor to sex differences in stroke severity,” Kim said. “Moreover, elderly women are more likely to live alone and experience social isolation, which can result in delayed recognition of stroke symptoms and subsequent delays in seeking medical attention.”

Additionally, patients living within a 10-mile distance to the nearest comprehensive stroke center were 38% more likely to be routed to one.

Stroke is the fifth-leading cause of death for women, according to the Centers for Disease Control and Prevention, and because women generally live longer than men, more women have strokes over their lifetimes.

Previous studies have shown that women with acute ischemic stroke were less likely than men to receive the clot-busting intravenous tissue-plasminogen activator (tPA) treatment, and that women with stroke are 33% more likely to be misdiagnosed with non-stroke related issues, such as headache or dizziness.

“Older age at onset and severe stroke in women, compounded by a higher likelihood of age-related risk factors, can contribute to the higher rate of death from stroke and higher risk for disability after stroke in women,” Kim said. “Therefore, appropriate triage and prehospital routing can be even more critical for women. Whether large vessel occlusions in women are less likely to be identified using current screening tools due to older age, premorbidity, or nontraditional symptoms needs to be investigated.”

Muhammad Tariq, MD, chief resident in the Department of Neurology at McGovern Medical School, was first author on the study. Other co-authors with McGovern Medical School’s neurology department included student Iman Ali, BS; resident Sergio Salazar-Marioni, MD; research coordinator Ananya Iyyangar, BSA; research coordinator Hussain Azeem, BS; resident Swapnil Khose, MD; research assistant Rania Abdelkhaleq, MPH; and Louise McCullough, MD, PhD, professor and chair of the department and the Roy M. and Phyllis Gough Huffington Distinguished Chair at McGovern Medical School. Abdelkhaleq is also a student at UTHealth Houston School of Public Health. McCullough is a member of The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences.

Also co-authoring the study was Victor Lopez, MD, a resident at Emory School of Medicine.

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University of Texas Health Science Center at Houston

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July 18, 2023
Poststroke Recovery Hinges on Physical Activity, Study Finds

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Newswise — After a stroke, physical activity can be pivotal to successful recovery. People who spend four hours a week exercising after their stroke achieve better functional recovery within six months than those who do not, a University of Gothenburg study shows.

The study, now published in the scientific journal JAMA Network Open, is based on data concerning 1,500 stroke patients in 35 Swedish hospitals. The participants were grouped according to their poststroke patterns of physical activity.

The results show that increased or maintained physical activity, with four hours’ exercise weekly, doubled the patients’ chances of recovering well by six months after a stroke. Men and people with normal cognition kept up an active life relatively more often, with better recovery as a result.

Positive programming from exercise

The researchers have previously succeeded in demonstrating a clear inverse association between physical activity and the severity of stroke symptoms at the actual onset of the condition. These new findings highlight the importance of maintaining a healthy, active lifestyle after a stroke.

The first and corresponding author of the study, Dongni Buvarp, is a researcher in clinical neuroscience at Sahlgrenska Academy, University of Gothenburg. Besides her research internship, she is a resident doctor at an initial stage of specialist training at Sahlgrenska University Hospital.

“Physical activity reprograms both the brain and the body favorably after a stroke. Exercise improves the body’s recovery at the cellular level, boosts muscle strength and well-being, and reduces the risk of falls, depression, and cardiovascular disease. Regardless of how severe the stroke has been, those affected can derive benefits from exercising more,” she says.

Knowledge and support vital

“Being physically active is hugely important, especially after a stroke. That’s a message that health professionals, stroke victims and their loved ones should all know. Women and people with impaired cognition seem to become less active after stroke. The study results indicate that these groups need more support to get going with physical activity,” Buvarp says.

One weakness of the study is that, with a few exceptions, the researchers were unable to study the participants’ degree of activity before the stroke. The patients included were treated in Sweden in the period from 2014 to 2019.

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University of Gothenburg

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May 8, 2023
Music Therapy: Relief for Chronic Pain Sufferers

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Newswise — In Sörmland, Sweden, music therapy is offered as a method of treatment for people living with chronic pain. Currently, the effects of what is known as the FMT method are being investigated through a research project at Mälardalen University (MDU).

In the FMT method, (Functionally oriented Music Therapy), music experiences and movement are combined with the purpose of contributing to a person’s well-being and recuperation. During the treatment, a therapist assesses what basic functions the participant needs to develop, and with the help of musical instruments such as drums and cymbals in various formations, different movements in the body are stimulated. Today, the treatment is given through a healthcare agreement in Sörmland.

In a current research project which has been launched at MDU, researchers wish to investigate whether it is possible to find scientific evidence that the FMT method is effective in increasing well-being, improving quality of life, and if and in what way it can relieve suffering and pain in people who live with chronic pain.

“I believe it is essential to evaluate health-promoting alternative methods in the area of chronic pain, as many people in society suffer from this. This project aims to explore and evaluate an up until now unexplored treatment method for people living with long standing pain,” says Helena Lööf, Associate Professor and Senior Lecturer in Health Sciences at MDU.

The method contributed to recovery
The backdrop to the project is a pilot study which showed that the FMT method helped people affected by stroke and Parkinson’s disease to recover better.

“Pain is the most common reason for seeking primary care services. Therefore in this way, many people are affected and from a societal standpoint it is good to have a variety of support efforts. This is in line with person-centred healthcare.”

Scientific evaluation needed
“Through a care agreement with a FMT treatment centre in Eskilstuna, this method is already being used in primary care in Sörmland. But the method is not evidence-based, which is why a scientific evaluation is needed. We will evaluate the effects of FMT in people suffering from chronic pain in comparison with the standard care that is provided in local healthcare. We also wish to create a deeper understanding of the importance of music and movement in recovery.”

Today, FMT is used in habilitation, rehabilitation and psychiatric healthcare.

“If the results of the project are positive, that is, if evidence can be found that various aspects of health are affected or improved, these can be used as evidence-based support for health promotion purposes for people suffering with chronic pain.”

“And on the other hand, if the results show that FMT has no or only a minor effect, this is in itself an important contribution to new knowledge about treatment and recovery for these people. Our research team is looking forward to investigating this over the next few years,” says Helena Lööf.

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Malardalen University

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May 5, 2023
Hackensack Meridian Mountainside Medical Center Awarded Spring 2023 ‘A’ Hospital Grade from Leapfrog Group

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Newswise — Montclair, NJ – (May 3, 2023) – Hackensack Meridian Mountainside Medical Center received an “A” Hospital Safety Grade from The Leapfrog Group, a national nonprofit upholding the standard of patient safety in hospitals and ambulatory surgery centers. This national distinction celebrates Mountainside Medical Center’s achievements in prioritizing patient safety by protecting patients from preventable harm and errors. The new grades reflect performance primarily during the height of the pandemic.

“The past few years have been a challenge, but at Mountainside Medical Center never wavered in our commitment to providing safe patient care,” said Tim O’Brien, chief executive officer at Mountainside Medical Center. “I am proud of the Mountainside team, who understand and work hard to implement patient-first practices.

The Leapfrog Group, an independent national watchdog organization, assigns an “A,” “B,” “C,” “D” or “F” grade to general hospitals across the country based on over 30 national performance measures reflecting errors, accidents, injuries and infections, as well as systems hospitals have in place to prevent harm.

“This new update of Hospital Safety Grades shows that, at the national level, we saw deterioration in patient safety with the pandemic,” said Leah Binder, president and CEO of The Leapfrog Group. “But this hospital received an ‘A’ despite those challenges. I congratulate all the leaders, staff, volunteers, and clinicians who together made that possible.”

The Leapfrog Hospital Safety Grade is the only hospital ratings program based exclusively on hospital prevention of medical errors and harm to patients. The grading system is peer-reviewed, fully transparent and free to the public. Grades are updated twice annually, in the fall and spring.

About Hackensack Meridian Mountainside Medical Center

Newswise — Hackensack Meridian Mountainside Medical Center has been serving Montclair and its surrounding New Jersey communities since 1891. The hospital provides patients access to innovative and effective treatment in specialized centers within the hospital focused on radiology, women’s health, oncology, surgery, bariatrics, neurosciences, stroke, and cardiovascular services. Mountainside is designated as a Primary Stroke Center by The Joint Commission and The NJ State Department of Health and Senior Services and is one of only a few community hospitals licensed by the State to perform emergency cardiac angioplasty and emergency neuroendovascular procedures. To learn more about Hackensack Meridian Health Mountainside Medical Center visit www.mountainsidehosp.com.

About The Leapfrog Group

Founded in 2000 by large employers and other purchasers, The Leapfrog Group is a national nonprofit organization driving a movement for giant leaps for patient safety. The flagship Leapfrog Hospital Survey and new Leapfrog Ambulatory Surgery Center (ASC) Survey collect and transparently report hospital and ASC performance, empowering purchasers to find the highest-value care and giving consumers the lifesaving information they need to make informed decisions. The Leapfrog Hospital Safety Grade, Leapfrog’s other main initiative, assigns letter grades to hospitals based on their record of patient safety, helping consumers protect themselves and their families from errors, injuries, accidents and infections. For more, follow us on Twitter and Facebook, and sign up for our newsletter.

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Hackensack Meridian Health (Mountainside Medical Center)

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May 2, 2023
ENRICH Trial Findings Debuts at the 2023 American Association of Neurological Surgeons Annual Scientific Meeting

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Newswise — The latest science and trial results were unveiled during the 2023 American Association of Neurological Surgeons (AANS) Annual Scientific Meeting in Los Angeles. The late-breaking abstract “Efficacy and Safety of Early Minimally Invasive Removal of Intracerebral Hemorrhage (ENRICH): a Multicenter Randomized Adaptive Trial,” was showcased Saturday, April 22.

The abstract was authored by Gustavo Pradilla, Jonathan J. Ratcliff, Alex J. Hall, Benjamin R. Saville, Jason W. Allen, Michael Frankel, David W. Wright, Daniel L. Barrow, and for the ENRICH Investigators.

Supratentorial intracerebral hemorrhage (ICH) accounts for 10-15% of all strokes and results in significant morbidity and mortality. The ENRICH Trial evaluated a Minimally Invasive trans-sulcal, Parafascicular Surgery (MIPS) approach. Between December 1, 2016, and August 24, 2022, eligible patients were randomized to either MM or MIPS at 37 centers in the United States. At the second interim analysis (175 enrolled), a pre-specified stopping criterion was met for the ABG location resulting in a study adaptation. Per design, the ABG location was halted and all subsequent participants were enrolled (enriched) meeting lobar location criteria. The trial randomized 300 participants, with 92 (30.7%) in the ABG location and 198 (69.3%) in the lobar location. There were no observed baseline differences between groups for age, ICH volume, GCS or NIHSS.

Overall mortality at 6 months was 21.3% (22.7% in the MM group and 20.7% in the MIPS group). In the MIPS group, median extent of hematoma evacuation was 87.7% with a median end-of-treatment volume (EOTV) of 7.2mL. Goal EOTV <15mL was reached in 72.7%. An mRS at 6 months was obtained in 286 participants (95.3%): 139 in the MM group (40 ABG and 99 lobar) and 147 in the MIPS group (47 ABG and 100 Lobar).

The Bayesian primary analysis compared the mean UWmRS at 6 months between treatment groups, with an estimated mean UWmRS of 0.376 for the control and 0.456 for the MIPS group, with a difference of 0.0793. The Bayesian posterior probability of superiority of the intervention was 0.9762, which exceeded the pre-specified 0.975 threshold to claim superiority of MIPS versus MM. The observed difference in mean UWmRS was -0.0488 in the ABG location, 0.1386 in the lobar location. Differences greater than 0 correspond to improved outcomes in the treatment group.

This is the first clinical trial to demonstrate the functional benefit of surgical clot evacuation among participants with supratentorial ICH presenting within 24 hours of LKN. MIPS was deemed safe, resulted in substantial clot evacuation and improved the UWmRS at 6 months relative to standard management. The overall benefit of MIPS appears to be from the strong positive effect observed for participants with lobar ICH.

About the 2023 AANS Annual Scientific Meeting:

From April 21-24, 2023, in in Los Angeles, California, neurosurgeons, neurosurgical residents, medical students, neuroscience nurses, clinical specialists, physician assistants, allied health professionals and other medical professionals will join together for the 2023 AANS Annual Scientific Meeting. The annual meeting is the largest gathering of neurosurgeons in the nation, with an emphasis on the field’s latest research and technological advances. The scientific presentations scheduled for the 2023 event represent cutting-edge examples of the incredible developments taking place within the field of neurosurgery.

About the AANS:

Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 13,000 members worldwide. The AANS promotes the highest quality of patient care and advances the specialty of neurological surgery. Fellows of the AANS are board-certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons of Canada or the Mexican Council of Neurological Surgery, A.C. Neurosurgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the spinal column, spinal cord, brain, nervous system and peripheral nerves.

For more information, visit www.AANS.org.

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American Association of Neurological Surgeons (AANS)

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April 22, 2023
Is the Language You Speak Tied to Outcome After Stroke?

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EMBARGOED FOR RELEASE UNTIL 4 P.M. ET, WEDNESDAY, APRIL 12, 2023

Newswise — MINNEAPOLIS – Studies have shown that Mexican Americans have worse outcomes after a stroke than non-Hispanic white Americans. A new study looks at whether the language Mexican American people speak is linked to how well they recover after a stroke. The study is published in the April 12, 2023, online issue of Neurology^®, the medical journal of the American Academy of Neurology.

“Our study found that Mexican American people who spoke only Spanish had worse neurologic outcomes three months after having a stroke than Mexican American people who spoke only English or were bilingual,” said study author Lewis B. Morgenstern, MD, of the University of Michigan in Ann Arbor and a Fellow of the American Academy of Neurology. “More research is needed into what factors and barriers may influence these worse outcomes.”

The study involved 1,096 Mexican American people in Corpus Christi, Texas, who had a stroke over a 10-year period. Researchers looked at results three months after the stroke in three areas: neurologic, functional and thinking and memory skills. Neurologic results cover areas such as muscle strength and coordination and problems with speech or vision. Functional results look at how well people can complete their daily activities such as showering and preparing meals.

The 170 people who spoke Spanish only were compared to the 926 people who spoke English only or were bilingual. Those who spoke Spanish only were older, had received less education and had worse neurologic scores at the time of the stroke than those in the other group.

Three months after the stroke, the Spanish-only speakers had average neurologic scores of seven, where scores of five to 14 indicate moderate effects from a stroke. The English-only and bilingual speakers had average scores of four, where scores of one to four indicate mild effects. The results remained after researchers adjusted for the differences between the two groups and other factors that could affect stroke risk, such as high blood pressure and diabetes.

The study found no difference between the two groups in how well they recovered their ability to complete their daily activities or in their thinking and memory skills.

“We conducted an earlier study in this same community finding that the language people spoke was not associated with any delay in their getting to the hospital or using emergency medical services after an ischemic stroke, so we definitely need more information to determine what is driving the differences in outcomes between these two groups,” Morgenstern said.

A limitation of the study was that there was a low number of Spanish-only speakers. Also, the majority of Mexican Americans in Corpus Christi are born in the United States, so these results may not be applicable to areas with a larger population of people born outside the United States.

The study was supported by the National Institutes of Health and the TRANSCENDS (Training in Research for Academic Neurologists to Sustain Careers and Enhance the Numbers of Diverse Scholars) program funded by the National Institutes of Health.

Learn more about stroke at BrainandLife.org, home of the American Academy of Neurology’s free patient and caregiver magazine focused on the intersection of neurologic disease and brain health. Follow Brain & Life^® on Facebook, Twitter and Instagram.

When posting to social media channels about this research, we encourage you to use the hashtags #Neurology and #AANscience.

The American Academy of Neurology is the world’s largest association of neurologists and neuroscience professionals, with over 40,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, concussion, Parkinson’s disease and epilepsy.

For more information about the American Academy of Neurology, visit AAN.com or find us on Facebook, Twitter, Instagram, LinkedIn and YouTube.

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April 12, 2023
Daily rhythm detected for cerebral blood flow in stroke patients

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Newswise — Strokes are a leading cause of morbidity and mortality in the United States, as well as around the world. Various environmental and biological factors are known to affect the risks and outcomes of strokes. A new study led by investigators from Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system, analyzed the cerebral blood flow (CBF) regulation of individuals who had experienced strokes. The team found that cerebral autoregulation (CA) — one of the key processes to maintain sufficient blood supply to the brain — displayed a daily rhythm in stroke patients, with more degraded regulation during nighttime and morning hours, as compared to that in the afternoon hours. Their results, which are published in the Journal of Cerebral Blood Flow and Metabolism, are relevant for health care planning during stroke recovery.

“The care and course of actions done after a stroke are essential for optimal rehabilitation. Our study suggests that the daily rhythm of CBF regulation in stroke patients may be highly relevant to managing an individual’s activity and stroke recovery,” said senior author, Kun Hu, PhD, of the Medical Biodynamics Program in the Brigham’s Division of Sleep and Circadian Disorders. “Exercise and surgery post-stroke could be more optimal when scheduled during afternoon hours, as this is when dynamic CA functions more effectively. These results may improve our understanding of a vulnerable time window for the cerebrovascular system and help guide daily activity and personal care during stroke recovery, which could improve health outcomes for patients who have had a stroke.”

Stable CBF is a necessary component for normal brain function. Dramatic changes in CBF can cause increased cranial pressure and brain tissue damage. Thus, a process like CA, which helps maintain relatively stable CBF through constriction and dilation of blood vessels in the brain, particularly during changes in an individual’s blood pressure (BP), is crucial. Currently, there is a gap in knowledge concerning the daily variance of CA in stroke patients. Generally, the daily rhythms of physiological functions can be controlled by external behaviors like food intake, sleep, and exercise, as well as the internal circadian clock. This study is among the first to examine the potential variation of CA in the stroke population.

The research team observationally studied 28 participants being treated in a hospital in São Paulo, Brazil after experiencing a stroke. They received thrombolysis within 5 hours of the onset of their symptoms. After undergoing this procedure, the participants’ CA was assessed over the course of 48 hours at various time points by examining the relationship between temporal changes in blood pressure and cerebral blood flow velocity of the middle cerebral artery.

Analysis of the results showed evidence of differing cerebral blood flow regulation during various times of the day, especially when cerebral blood flow and pressure fluctuated at large time scales or low frequencies < 0.05 Hz. In particular, a more degraded regulation motif was seen during the nighttime and morning hours when compared to the afternoon. This dysregulation interval coincides with the increased prevalence of recurrent and first-ever stroke events during morning times.

While these results are promising, the researchers identified future avenues to assist in creating a greater understanding of the regulation mechanism.

“Interestingly, the daily rhythm of CA was present in both stroke and non-stroke sides of the brain, suggesting the factor(s) driving the rhythm should affect CBF regulation globally,” said first author Daniel Abadjiev, of the Medical Biodynamics Program in the Brigham’s Division of Sleep and Circadian Disorders. “To better understand underlying mechanisms, future studies should consider more frequent assessments across the 24-hour cycle, an increase in patient sample size, inclusion of non-stroke controls, and monitoring of the daily activity rhythms like sleep and exercise as well as intrinsic circadian rhythm among the participants.”

“This study demonstrates that a daily rhythm does exist for stroke patients,” said Hu. “Rehab plans should look to identify the daily rhythm and design a strategy that makes use of optimal CA. The long-term goal is to see if we can further control the rhythm of CA by manipulating an individual’s daily behavioral cycles or endogenous circadian clock in order to deliver more personalized medicine and improve their recovery.”

Disclosures: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: KH was partially supported by the National Institutes of Health grants (RF1AG059867 and RF1AG064312). ET-D was supported by the São Paulo Research Foundation (FAPESP, # 2021/03076-4) and by the National Council for Scientific and Technological Development (CNPq, # 307434/2021-4).

Paper Cited: Abadjiev, D et al. “Daily rhythm of dynamic cerebral autoregulation in patients after stroke”. Journal of Cerebral Blood Flow & Metabolism. DOI: 10.1177/0271678X231153750.

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February 17, 2023
A handy lesson about pain and the brain in stroke survivors

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Newswise — A world-first study of stroke survivors shows how chronic pain can alter body perception, with the brain tricking patients into believing their affected hand is a different size, increasing the risk of accidents.

Australian and US researchers found there’s a strong likelihood in stroke patients with persistent pain to mistakenly believe their stroke-affected hand is either bigger or smaller than it really is. The findings are published in a landmark paper in Brain Sciences.

Researchers, including international pain expert Professor Lorimer Moseley AO from the University of South Australia, surveyed 523 stroke survivors, finding that those living with chronic pain were almost three times as likely as pain free survivors to experience altered body perception.

The results suggest that rehabilitation to address distorted body perception in stroke survivors may improve outcomes, given that stroke is a leading cause of disability worldwide and accurate perception of hand size is critical to holding or manipulating objects.

“There are two striking findings in our study,” Professor Moseley says.

“First, that three out of five stroke sufferers are living with chronic pain, which is up to 300 per cent higher than in the general population.

“Second, that those with pain are also more likely to perceive major changes in how their body feels to them. This is a potential double whammy, making daily activities more difficult and affecting quality of life,” Prof Moseley says.

Both stroke and persistent pain (lasting longer than three months) are associated with impaired cognition, more fatigue, anxiety and depression, and distortions in body perception might amplify these conditions, he says.

Distorted body perception has been reported in a range of conditions – after amputation, severe chronic pain and eating disorders – but has not previously been linked to pain after stroke.

“The next step is to identify whether body perception disturbance is contributing to pain in these patients. If it is, we need to devise treatments to address this.”

Distorted body perception was twice as likely when post-stroke pain was in the hand, which is consistent with other chronic pain populations such as knee osteoarthritis, where up to 30 per cent of people believe their knee is swollen when it isn’t.

“These remarkable findings show us that we are perhaps more complex creatures than we previously thought,” Prof Moseley says.

The researchers did not find any link between chronic pain and strokes occurring on a specific side of the body.

Notes for editors

“My Hand is Different”: Altered body perception in stroke survivors with chronic pain” is published in Brain Sciences. It is authored by researchers from the University of Melbourne, La Trobe University, the University of South Australia and University of California, San Francisco.

The paper is available at: https://www.mdpi.com/2076-3425/12/10/1331

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December 12, 2022
Vitamin D fails to reduce statin-associated muscle pain
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- About 30 to 35 million Americans are prescribed statins to lower cholesterol
- It’s common for patients to complain of muscle pain when taking statins
- Some doctors recommend vitamin D to ease these muscle aches, but new study found no benefit
Newswise — CHICAGO — Patients who take statins to lower high cholesterol levels often complain of muscle pains, which can lead them to stop taking the highly effective medication and put them at greater risk of heart attack or stroke.

Some clinicians have recommended vitamin D supplements to ease the muscle aches of patients taking a statin, but a new study from scientists at Northwestern University, Harvard University and Stanford University shows the vitamin appears to have no substantial impact.

The study will be published Nov. 23 in JAMA Cardiology.

Although non-randomized studies have reported vitamin D to be an effective treatment for statin-associated muscle symptoms, the new study, which is the first randomized clinical trial to look at the effect of vitamin D on statin-associated muscle symptoms, was large enough to rule out any important benefits.

In the randomized, double-blind trial, 2,083 participants ingested either 2,000 units of vitamin D supplements daily or a placebo. The study found participants in both categories were equally likely to develop muscle symptoms and discontinue statin therapy.

Over 4.8 years of follow-up, statin-related muscle pain was reported by 31% of the participants assigned vitamin D and 31% assigned a placebo.

“We had high hopes that vitamin D would be effective because in our clinic and across the country, statin-associated muscle symptoms were a major reason why so many patients stopped taking their statin medication,” said senior author Dr. Neil Stone, professor of medicine in cardiology and preventive medicine at Northwestern University Feinberg School of Medicine and a Northwestern Medicine cardiologist. “So, it was very disappointing that vitamin D failed a rigorous test. Nevertheless, it’s important to avoid using ineffective treatments and instead focus on research that can provide an answer.”

Statins and vitamin D supplements are two of the most commonly used medications in American adults. About 30 to 35 million Americans are prescribed statins, and about half of the population aged 60 and older take a vitamin D supplement.

“We took advantage of a large placebo-controlled randomized trial to test whether vitamin D would reduce statin-associated muscle symptoms and help patients keep taking their statins,” said lead study author Dr. Mark Hlatky, a professor of health policy and cardiovascular medicine at Stanford. “The placebo control in the study was important because if people think vitamin D is supposed to reduce their muscle pains, they just might feel better while taking it, even if vitamin D has no specific effect.”

Trial was a sub study within a larger clinical trial

The 2,083 patients were among the larger cohort of participants in the VITamin D and Omega-3 Trial (VITAL), which randomized nearly 26,000 participants to double-blind vitamin D supplementation to determine whether it would prevent cardiovascular disease and cancer. This provided researchers a unique opportunity to test whether vitamin D reduces muscle symptoms among participants who initiated statins during the follow-up period of the larger VITAL trial. The mean age of the study participants was 67, and 51% were women.

“Randomized clinical trials are important because many very good ideas don’t work as well as we had hoped when they are put to the test,” Hlatky said. “Statistical associations do not prove a cause-and-effect relationship. Low levels of vitamin D are associated with many medical problems, but it turns out that giving people vitamin D does not generally fix those problems.”

For patients who report statin-associated muscle pains

Dr. Stone noted that sometimes the secret for understanding patients who have difficulty with statins is analyzing other medications they’re taking, determining whether or not they have associated metabolic or inflammatory conditions, counseling them on their ability to hydrate adequately and, importantly, discussing “pill anxiety.”

“For those who have difficulties with statins, a systematic appraisal by a physician with experience in dealing with these matters is still very important,” Stone said.

The idea for this sub study arose out of conversations between study co-author Dr. Pedro Gonzalez, then a resident at Northwestern Memorial Hospital, and Dr. Stone, who runs a large lipid clinic at Northwestern.

Other authors of the study include JoAnn E. Manson and the VITAL study group at Brigham and Women’s Hospital, Harvard Medical School and the Harvard T. H. Chan School of Public Health.
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November 23, 2022
Exámenes de detección guiados por inteligencia artificial usan datos de electrocardiogramas para detectar factores de riesgo ocultos de accidente cerebrovascular

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Newswise — ROCHESTER, Minnesota —Los investigadores de Mayo Clinic utilizaron inteligencia artificial para evaluar electrocardiogramas de pacientes en el marco de una estrategia dirigida para detectar fibrilación auricular, un trastorno frecuente del ritmo cardíaco. La fibrilación auricular es un latido cardíaco irregular que puede provocar coágulos sanguíneos que podrían viajar al cerebro y causar un accidente cerebrovascular, y suele ser difícil de diagnosticar. En el estudio descentralizado realizado a través de medios digitales, la inteligencia artificial identificó nuevos casos de fibrilación auricular que no se habrían observado clínicamente en la atención médica de rutina.

En investigaciones anteriores, ya se había desarrollado un algoritmo de inteligencia artificial para identificar a los pacientes con una probabilidad alta de tener fibrilación auricular previamente desconocida. nference y Mayo Clinic otorgaron la licencia del algoritmo para detectar la fibrilación auricular en un ritmo sinusal normal a partir de un electrocardiograma a Anumana Inc., una empresa de tecnología médica impulsada por inteligencia artificial.

El Dr. Peter Noseworthy, cardiólogo electrofisiólogo en Mayo Clinic y autor principal del estudio, declaró: “Creemos que los exámenes de detección de la fibrilación auricular tienen mucho potencial, pero actualmente los resultados son muy pocos, y los costos son muy altos como para posibilitar la detección generalizada. El estudio demuestra que un algoritmo de inteligencia artificial aplicado a un electrocardiograma puede ayudar a dirigir los exámenes de detección a los pacientes que tengan más probabilidades de beneficiarse con ellos”.

Del estudio participaron 1003 pacientes, a quienes se les realizaron controles constantes, y otros 1003 pacientes de atención médica habitual funcionaron como controles del mundo real. Los hallazgos, que se publicaron en The Lancet, mostraron que la inteligencia artificial puede identificar un subgrupo de pacientes de alto riesgo que recibirían más beneficios al hacerse controles cardíacos intensivos adicionales para detectar fibrilación auricular, lo que apoyó la estrategia de detección dirigida y guiada por inteligencia artificial.

Habitualmente, los electrocardiogramas se hacen para diagnosticar una variedad de trastornos, pero como la fibrilación auricular puede durar poco, es baja la posibilidad de detectar un episodio durante un rastreo por electrocardiograma de 10 segundos. Los pacientes pueden someterse a enfoques de control cardíaco intermitentes o continuos que tienen tasas de detección más altas, pero se requieren muchos recursos para aplicarlos a todo el mundo, y los controles pueden ser molestos y costosos para los pacientes.

En este punto, puede ser útil el electrocardiograma guiado por inteligencia artificial. El algoritmo de inteligencia artificial puede identificar pacientes que, aunque tengan un ritmo cardiaco normal el día en que se hacen el electrocardiograma, puedan tener un riesgo mayor de episodios de fibrilación auricular no detectada en otros momentos. Luego, estos pacientes pueden hacerse controles adicionales para confirmar el diagnóstico.

“Los programas de exámenes de detección tradicionales seleccionan pacientes según la edad (mayores de 65 años) o la presencia de afecciones como la hipertensión arterial. Estos enfoques tienen sentido porque la edad avanzada es uno de los factores de riesgo de fibrilación auricular más importantes. Sin embargo, no es factible realizar controles cardíacos intensivos de manera reiterada a más de 50 millones de adultos mayores en todo el país”, señaló la Dra. Xiaoxi Yao, investigadora de resultados médicos del Departamento de Medicina Cardiovascular y del Centro Robert D. y Patricia E. Kern para la Ciencia de Brindar Atención Médica de Mayo Clinic. La Dra. Yao es autora sénior del estudio.

“El estudio muestra que un algoritmo de inteligencia artificial puede seleccionar un subgrupo de adultos mayores a los que los controles intensivos podrían beneficiar más. Si esta nueva estrategia se implementara de forma generalizada, podría reducir la fibrilación auricular sin diagnosticar y prevenir accidentes cerebrovasculares y la muerte de millones de pacientes alrededor del mundo”, indicó la Dra. Yao.

El próximo paso en esta investigación es un ensayo híbrido multicéntrico enfocado en la eficacia de la implementación del proceso de trabajo del electrocardiograma guiado por inteligencia artificial en diversos entornos clínicos y poblaciones de pacientes.

“Esperamos que este enfoque sea especialmente valioso en entornos de pocos recursos, en los que las tasas de fibrilación auricular sin diagnosticar pueden ser particularmente altas y pueden ser limitados los recursos para detectarla. Sin embargo, hace falta más trabajo para superar los obstáculos de implementación, y los estudios futuros deben evaluar las estrategias de exámenes de detección dirigidos en estos entornos”, expresó el Dr. Noseworthy.

“Ahora que demostramos que son posibles los exámenes de detección de fibrilación auricular dirigidos por inteligencia artificial, también debemos mostrar que los pacientes con fibrilación auricular detectada mediante exámenes se benefician del tratamiento para prevenir accidentes cerebrovasculares”, señaló el Dr. Noseworthy. “Nuestro objetivo final es prevenir los accidentes cerebrovasculares. Creo que el estudio actual nos ha llevado un paso más cerca”.

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November 21, 2022