Stroke最新文献

{"title":"Perioperative Stroke: Mechanisms, Risk Stratification, and Management.","authors":"Liqi Shu, Yasmin N Aziz, Adam de Havenon, Steven R Messe, Thanh N Nguyen, Nicole B Sur, Lize Xiong, Shadi Yaghi","doi":"10.1161/STROKEAHA.125.051673","DOIUrl":"https://doi.org/10.1161/STROKEAHA.125.051673","url":null,"abstract":"<p><p>Perioperative stroke, defined as a cerebrovascular event occurring during surgery or within 30 days postoperatively, remains a devastating complication associated with substantial morbidity, disability, mortality, and increased healthcare utilization. Although overall incidence is relatively low-up to 1% in most surgical populations-it is significantly elevated in cardiac, major vascular, and neurosurgical procedures, often exceeding 5%. The rising prevalence of perioperative stroke, primarily driven by an aging surgical population burdened by multiple chronic vascular conditions and increasingly eligible for high-risk surgical interventions, underscores the urgency of optimizing preventive and management strategies. This review synthesizes insights into patient- and procedure-related risk factors, highlighting the intricate interplay of embolic, thrombotic, and hypoperfusion mechanisms underpinning perioperative ischemic strokes. Key patient-specific risks include advanced age, recent cerebrovascular events, atrial fibrillation, carotid stenosis, and chronic cardiovascular comorbidities. Procedural factors, such as the type and complexity of surgery, intraoperative hypotension, and vascular manipulations, further modulate stroke risk. Emphasizing an evidence-based approach to risk mitigation, this review examines preoperative risk stratification, intraoperative techniques designed to minimize cerebral embolization and preserve adequate perfusion, and structured postoperative protocols aimed at rapid stroke detection. Acute management complexities are also discussed, with careful consideration of intravenous thrombolysis and mechanical thrombectomy in the postoperative setting. Finally, gaps in current guidelines and promising areas for future research are identified, advocating a multidisciplinary approach involving neurology, surgery, anesthesiology, and allied specialties to enhance patient outcomes and reduce the perioperative stroke burden.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation and Feasibility of PETS-Stroke: A Patient-Reported Measure of Treatment Burden After Stroke.","authors":"Martin Taylor-Rowan, David T Eton, Hamish J McLeod, Jala Rizeq, Lisa Kidd, Grace Currie, Terry J Quinn, Frances S Mair, Katie I Gallacher","doi":"10.1161/STROKEAHA.125.051398","DOIUrl":"https://doi.org/10.1161/STROKEAHA.125.051398","url":null,"abstract":"<p><strong>Background: </strong>Treatment burden is the workload of health care for people with long-term conditions and the impact on wellbeing. A validated measure of treatment burden for use as an outcome measure in stroke trials is needed. We adapted a patient-reported measure of treatment burden in multimorbidity, Patient Experience With Treatment and Self-Management (PETS), version 2.0, to create a stroke-specific measure, PETS-stroke, and examined its psychometric properties.</p><p><strong>Methods: </strong>We conducted an observational cohort study. Stroke and transient ischemic attack survivors were recruited between February 2022 to June 2023 from 10 hospitals in the United Kingdom and through the Scottish Health Research Register. Participants completed the PETS-stroke questionnaire along with 3 other patient-reported measures (the Stroke Southampton Self-Management Questionnaire, the Satisfaction With Stroke Care Measure, and the Shortened Stroke Impact Scale). We performed confirmatory factor analysis to test the factor structure of the PETS-stroke. We assessed Spearman rank correlations between PETS-stroke and other patient-reported measures to determine convergent validity. An intraclass correlation coefficient was performed to assess test-retest reliability. Proportions of missing data along with feedback from qualitative interviews were used to determine feasibility. T-tests were conducted to examine variations in PETS-stroke scores based on multimorbidity and socioeconomic factors.</p><p><strong>Results: </strong>Three hundred eighty-one participants were included (mean age, 68.2 [SD, 11.2] years; female, 43.3%). The best fit was achieved with a 9-factor structure, and internal consistency was good (Omega values, 0.729-0.921). The factor loadings for the individual indicator items across 8 of the 9 domains were moderate to strong. All domains of PETS-stroke showed moderate to strong correlations with at least one other patient-reported measure. Test-retest reliability was good for all domains (intraclass correlation coefficient >0.7). Qualitative feedback on feasibility was positive: participants found the questionnaire to be easy and quick to complete, and missing data were within acceptable limits for 7 domains. PETS-stroke scores significantly differed based on multimorbidity in 3 domains and in 8 domains based on socioeconomic status.</p><p><strong>Conclusions: </strong>Psychometric performance suggests that PETS-stroke is a valid and feasible measure of treatment burden after stroke.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Amyloid Presence in Acute Ischemic Stroke Thrombi: Observational Evidence for Fibrinolytic Resistance.","authors":"Justine M Grixti, Arun Chandran, Jan-Hendrik Pretorius, Melanie Walker, Alakendu Sekhar, Etheresia Pretorius, Douglas B Kell","doi":"10.1161/STROKEAHA.124.050033","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.050033","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144151873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multicenter SPAN Trial of Fasudil in Ischemic Stroke.","authors":"Takahiko Imai, Andreia Lopes de Morais, Xuyan Jin, Tao Qin, Jessica Lamb, Karisma Nagarkatti, Mu-Hsun Chen, Ligia S B Boisserand, Rakesh B Patel, Mariia Kumskova, Anjali Chauhan, Krishnan M Dhandapani, Mohammad B Khan, Pradip K Kamat, Yanrong Shi, Suyi Cao, Basavaraju G Sanganahalli, Joseph B Mandeville, Patrick D Lyden, David C Hess, Enrique C Leira, Anil K Chauhan, Jaroslaw Aronowski, Louise D McCullough, Raymond Koehler, Lauren H Sansing, Márcio A Diniz, Cenk Ayata","doi":"10.1161/STROKEAHA.125.050977","DOIUrl":"https://doi.org/10.1161/STROKEAHA.125.050977","url":null,"abstract":"<p><strong>Background: </strong>The SPAN (Stroke Preclinical Assessment Network) is a confirmatory multicenter trial network to test cerebroprotective interventions in experimental acute stroke. In a first-of-its-kind trial, SPAN tested 6 interventions in a rodent model of transient focal ischemic stroke. Here, we report the efficacy of fasudil, an isoform-nonselective rho-associated kinase inhibitor, on primary and secondary outcomes in the SPAN trial.</p><p><strong>Methods: </strong>Fasudil was administered at 10 mg/kg intraperitoneally every 12 hours for 6 doses starting 5 minutes before reperfusion in a 60-minute endovascular filament middle cerebral artery occlusion model. The active treatment arm (n=345) was compared with the pooled intraperitoneal and intravenous vehicle arms (n=344). In addition to healthy young mice, the trial included aging mice (16±1 months), diet-induced obese mice, and spontaneously hypertensive rats. The a priori fasudil substudy design stipulated the modified corner test performance on day 28 as the primary end point and separate analyses for mice and spontaneously hypertensive rats using the modified intention-to-treat cohort.</p><p><strong>Results: </strong>Fasudil improved the primary outcome end point in mice (probabilistic index point estimate, 0.57; <i>P</i>=0.022). The effect appeared stronger in aging mice and when ischemia was induced during the active circadian stage. Fasudil did not show any benefit in the spontaneously hypertensive rats. Alternative analyses using the per-protocol population and imputation generally yielded similar conclusions.</p><p><strong>Conclusions: </strong>Our results reveal a favorable therapeutic profile for fasudil, supporting future translational development of rho-associated kinase inhibitors in ischemic stroke.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144151876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laminin Receptors in the CNS and Vasculature.","authors":"Yao Yao","doi":"10.1161/STROKEAHA.125.051560","DOIUrl":"https://doi.org/10.1161/STROKEAHA.125.051560","url":null,"abstract":"<p><p>Laminin exerts a variety of important functions via binding to its receptors, including integrins and dystroglycan. With the advance in gene-targeting technology, many integrin/dystroglycan knockout/mutant mice were generated in the past 3 decades. These mutants enable loss-of-function studies and have substantially enriched our knowledge of integrin/dystroglycan functions. In this review, we summarize the functions of laminin receptors during embryonic development and in the CNS and vasculature. First, the biochemical properties of integrins and dystroglycan are briefly introduced. Next, we discuss loss-of-function studies on laminin receptors, including integrin-α3, integrin-α6, integrin-α7, integrin-β1, integrin-β4, and dystroglycan, focusing on embryonic development, the CNS, and vasculature. The phenotypes of compound knockout mice are described and compared with that of single mutants. Last, important questions and challenges in the field as well as potential future directions are discussed. Our goal is to provide a synthetic review on loss-of-function studies of laminin receptors in the CNS and vasculature, which could serve as a reference for future research, encourage the formation of new hypotheses, and stimulate new research in this field.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144151874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inhibition of Ipsilesional M1 β Oscillations by Contralesional M1 Following Acute Ischemic Stroke: A TMS-EEG Study.","authors":"Weili Jia, Yijun Zhou, Jiawen Mao, Jinru Feng, Ying Han, Feng Xu, Xinjuan Wang, Tao Liu, Zixiao Li","doi":"10.1161/STROKEAHA.124.050376","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.050376","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to investigate neurophysiological mechanisms underlying functional impairment and recovery after acute ischemic stroke using transcranial magnetic stimulation combined with electroencephalography, focusing on interhemispheric interactions and oscillatory dynamics.</p><p><strong>Methods: </strong>This single-center case-control study (December 2022 to May 2024) included 19 ischemic stroke patients within 14 days of symptom onset (mean age, 47.95±12.41 years; 15 [79%] males) with 3-month poststroke follow-up. Sixteen age-matched healthy controls (53.56±9.83 years; 12 [80%] males) were included. Transcranial magnetic stimulation-evoked electroencephalography potentials, local mean field power during 25 ms and 35 ms (local mean field power₂₅_{-35 ms}), and power spectral density of the ipsilesional primary motor cortex (ilM1) were calculated when single-pulse transcranial magnetic stimulation was sequentially applied to the contralesional M1 (clM1) and ilM1. Spearman correlation analysis evaluated associations between transcranial magnetic stimulation combined with electroencephalography parameters and clinical outcomes: Fugl-Meyer assessment, Fugl-Meyer assessment-upper extremity subscale, National Institutes of Health Stroke Scale, and National Institutes of Health Stroke Scale changes from baseline to 3 months poststroke.</p><p><strong>Results: </strong>Stroke patients exhibited simplified transcranial magnetic stimulation-evoked electroencephalography potential waveforms with reduced amplitudes compared with healthy controls. The contralesional resting motor threshold of stroke patients was significantly lower compared with healthy controls (<i>t</i>=-2.79; <i>P</i>=0.009). The contralesional resting motor threshold was positively associated with the local mean field power₂₅_{-35 ms} of ilM1 with stimulation on ilM1 (<i>r</i>=0.482; <i>P</i>=0.018). The power and power spectral density of β oscillations were negatively associated with the Fugl-Meyer assessment (<i>r</i>=-0.557, <i>P</i>=0.014; <i>r</i>=-0.417, <i>P</i>=0.038, respectively) and Fugl-Meyer assessment-upper extremity (<i>r</i>=-0.503, <i>P</i>=0.014; <i>r</i>=-0.389, <i>P</i>=0.05, respectively), but the power of β oscillations was positively associated with changes in the National Institutes of Health Stroke Scale (<i>r</i>=0.507; <i>P</i>=0.027) with stimulation on clM1.</p><p><strong>Conclusions: </strong>Increased excitability of the clM1 is associated with decreased excitability of the ilM1. The inhibition of β oscillations in the ilM1 by the clM1 serves as a biomarker for poststroke functional impairment and recovery. Neuromodulation of the clM1 to enhance the β oscillations of ilM1 may be a promising treatment strategy.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"StrokeCog-15 Is an Efficient Neuropsychological Battery to Screen for Cognitive Impairment in Chronic Stroke.","authors":"Lauren L Drag, Michael Mlynash, Alperen Aslan, Muhith Musabbir, Amy Bradley, Maarten G Lansberg, Stuart M Allan, Nima Aghaeepour, Craig Smith, Marion S Buckwalter","doi":"10.1161/STROKEAHA.124.049217","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.049217","url":null,"abstract":"<p><strong>Background: </strong>Poststroke cognitive impairment can significantly impact functional outcomes and quality of life. While comprehensive neuropsychological evaluations are valuable in characterizing this impairment, their time-intensive nature is not always feasible. Thus, we set out to develop a brief cognitive battery that is sensitive to poststroke cognitive impairment.</p><p><strong>Methods: </strong>Neuropsychological testing was completed in a validation sample of 126 participants with chronic ischemic stroke (median days since stroke, 337 [interquartile range, 235-1057]) as part of StrokeCog, a prospective observational cohort study. This comprehensive 60-minute cognitive battery contained 9 tests covering 5 cognitive domains. A partial least square regression analysis informed the selection of a brief, 15-minute battery of 4 tests (StrokeCog-15) covering 4 cognitive domains: language, memory, working memory, and processing speed/executive functioning. We then compared StrokeCog-15 with Montreal Cognitive Assessment and an established 30-minute battery in its ability to detect cognitive impairment as identified by the comprehensive battery. Finally, we assessed the utility of StrokeCog-15 in an external validation sample of 61 participants (median days since stroke, 210 [interquartile range, 193-230]) enrolled in the parallel Stroke-IMPaCT study.</p><p><strong>Results: </strong>Cognitive impairment was common, occurring in 50% (n=61) and 66% (n=40) of the 2 cohorts. Deficits occurred most frequently in the memory and processing speed/executive functioning domains. In the derivation sample, StrokeCog-15 demonstrated high sensitivity (0.97) and adequate specificity (0.78) in detecting cognitive impairment on the comprehensive battery, outperforming both Montreal Cognitive Assessment (sensitivity, 0.77; specificity, 0.73) and the 30-minute battery (sensitivity, 0.97; specificity, 0.35). StrokeCog-15 similarly demonstrated high sensitivity (0.93) and adequate specificity (0.67) in the validation sample.</p><p><strong>Conclusions: </strong>A brief 15-minute battery of tests has high sensitivity to detect cognitive impairment as identified on a longer neuropsychological test battery. StrokeCog-15 assesses multiple cognitive domains commonly impacted by stroke and represents an efficient yet effective means to identify chronic poststroke cognitive impairment.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular Therapy for Late-Window M2-Segment Middle Cerebral Artery Occlusion: Analysis of the CLEAR Study.","authors":"Simon Winzer, Daniel P O Kaiser, Muhammad M Qureshi, Alicia C Castonguay, Daniel Strbian, Raul G Nogueira, Simon Nagel, Jean Raymond, Mohamad Abdalkader, Jelle Demeestere, João Pedro Marto, Hiroshi Yamagami, Kanta Tanaka, Sunil A Sheth, Anne Dusart, Patrik Michel, Marta Olive Gadea, Marc Ribo, Osama O Zaidat, Diogo C Haussen, Hilde Henon, Mahmoud H Mohammaden, Markus A Möhlenbruch, James E Siegler, Ajit S Puri, Johannes Kaesmacher, Piers Klein, Liisa Tomppo, Francois Caparros, João Nuno Ramos, Mouhammad Jumaa, Syed Zaidi, Nicolas Martinez-Majander, Stefania Nannoni, Lieselotte Vandewalle, Flavio Bellante, Milagros Galecio-Castillo, Sergio Salazar-Marioni, Pekka Virtanen, Anke Wouters, Rita Ventura, Jessica Jesser, Adnan Mujanovic, Liqi Shu, Abiya Qureshi, Zhongming Qiu, Hesham E Masoud, Manuel Requena, Mikko Sillanpää, Wei Hu, Eugene Lin, Charlotte Cordonnier, Daniel Roy, Shadi Yaghi, Davide Strambo, Urs Fischer, Santiago Ortega-Gutierrez, Robin Lemmens, Peter A Ringleb, Thanh N Nguyen, Volker Puetz","doi":"10.1161/STROKEAHA.124.048840","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.048840","url":null,"abstract":"<p><strong>Background: </strong>There is uncertainty about whether patients with M2 occlusion benefit from endovascular therapy (EVT) in the late (6-24-hour) time window. We evaluated the clinical outcomes of patients with M2 occlusion selected for EVT compared with those who received medical management (MM) in the late window.</p><p><strong>Methods: </strong>This multinational cohort study was conducted at 66 sites across 10 countries (January 2014 to May 2022). We included consecutive patients with late-window stroke due to M2 occlusion, baseline National Institutes of Health Stroke Scale score of ≥5, and premorbid modified Rankin Scale score of ≤2 who received EVT or MM alone. The primary end point was 90-day ordinal shift in the modified Rankin Scale score. Safety end points were symptomatic intracranial hemorrhage and 90-day mortality. Differences in outcomes were determined using inverse probability of treatment weighting-adjusted logistic regression models.</p><p><strong>Results: </strong>Among 5098 patients, 496 met inclusion criteria (median [interquartile range] age, 74 years [62-81 years]; baseline National Institutes of Health Stroke Scale score, 12 [8-17]), of whom 394 (79.4%) received EVT and 102 (20.6%) MM. In inverse probability of treatment weighting adjusted analyses, there was no favorable 90-day ordinal modified Rankin Scale shift (odds ratio, 1.39 [95% CI, 0.92-2.12]) and no difference of functional independence rates (modified Rankin Scale score of 0-2; odds ratio, 1.72 [95% CI, 0.93-3.15]) with EVT compared with MM. Moreover, symptomatic intracranial hemorrhage risk (odds ratio, 3.46 [95% CI, 0.50-23.92]) and 90-day mortality (odds ratio, 1.11 [95% CI, 0.66-1.87]) were not statistically different between treatment groups.</p><p><strong>Conclusions: </strong>In patients with M2 occlusion in the 6- to 24-hour time window, there was no difference in disability outcomes or symptomatic intracranial hemorrhage risk between patients treated with EVT compared with MM. Results of ongoing randomized trials will provide further insight.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT04096248.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biofeedback Training for 3-Dimensional Finger Force Control to Improve Upper Limb Function Poststroke: An RCT.","authors":"Na Jin Seo, Christian Schranz, Kristen Coupland, Jenna Blaschke, Gabrielle Scronce, Christian Finetto, Adam Baker, Ja'Quann Gallant, Arianna Alston, Keith Howard, Devin Thompson, Viswanathan Ramakrishnan, Christine A Holmstedt, Derek G Kamper","doi":"10.1161/STROKEAHA.125.050965","DOIUrl":"https://doi.org/10.1161/STROKEAHA.125.050965","url":null,"abstract":"<p><strong>Background: </strong>After stroke, impairment of hand sensorimotor control leads to improperly scaled and directed fingertip forces that disrupt object manipulation. The objective of this study was to determine the efficacy of finger force magnitude and direction training using 3-dimensional versus 1-dimensional biofeedback to enhance poststroke upper extremity motor recovery.</p><p><strong>Methods: </strong>A double-blind randomized controlled trial took place in the Veterans Affairs laboratory from 2020 to 2023. Forty-five stroke survivors were randomly assigned to the experimental or control group. Both groups received 18 training sessions to generate digit force in the target magnitude and direction. The experimental group trained with visual feedback on the digit force magnitude in 3 dimensions. The control group trained with 1-dimensional visual feedback on the digit force magnitude along the target direction only. The primary outcome was the change in upper extremity function assessed using the Action Research Arm Test post-intervention.</p><p><strong>Results: </strong>Baseline characteristics were comparable between the groups (mean age, 59 years, 60% male, 40% Black). The change between pretraining and posttraining Action Research Arm Test scores was significantly greater for the experimental group than for the control group (experimental mean, 3.5 [CI, 2.2-4.8] versus control mean, 0.8 [CI, -0.5 to 2.1]; <i>P</i>=0.005). This difference was maintained at 1-month follow-up. Secondary analysis showed that individuals in the experimental group whose stroke occurred within a year prior improved more (mean, 6.1 [CI, 4.0-8.3]) than others (<i>P</i><0.003).</p><p><strong>Conclusions: </strong>Force direction feedback led to improved upper extremity motor recovery in stroke survivors. This biofeedback-based treatment may provide the needed explicit training in force direction control for more effective hand rehabilitation.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT03995069.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Innovative Hydrogel-Based Treatments for Neonatal Stroke.","authors":"Victor Mondal, Emily Ross-Munro, Kate Firipis, Gayathri K Balasuriya, Ritu Kumari, Md Munnaf Hossen, David R Nisbet, Glenn F King, Richard J Williams, David W Walker, Mary Tolcos, Bobbi Fleiss","doi":"10.1161/STROKEAHA.124.050139","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.050139","url":null,"abstract":"<p><p>Neonatal stroke, occurring within the first 28 days after birth, affects >1 in every 2500 newborns. The weekly adjusted risk of stroke in a term newborn is 3-fold greater than for a male smoker aged 50 to 59 years with diabetes and hypertension. Neonatal stroke has profound clinical and socioeconomic implications, causing cerebral palsy, epilepsy, and various motor, sensory, and cognitive disabilities. Currently, there is no treatment for the brain damage that neonatal stroke causes. Hydrogels, with their tunable elasticity and stiffness, shear-thinning properties, and ability to deliver therapeutic agents locally in a controlled manner, offer significant potential for tissue repair and regeneration. In this review, we synthesize the current knowledge on biocompatible hydrogels, providing insights into how they can be engineered to address the pathophysiology of neonatal stroke and their previous use in repairing severe focal lesions in the adult central nervous system. By exploring cutting-edge hydrogel therapies, this review aims to provide a comprehensive perspective on the potential of hydrogel therapy to improve outcomes for infants suffering from severe brain injury due to neonatal stroke.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}