{"title":"The Effects of Stroke and Stroke Gait Rehabilitation on Behavioral and Neurophysiological Outcomes:: Challenges and Opportunities for Future Research.","authors":"Trisha Kesar","doi":"10.32481/djph.2023.08.013","DOIUrl":"https://doi.org/10.32481/djph.2023.08.013","url":null,"abstract":"<p><p>Stroke continues to be a leading cause of adult disability, contributing to immense healthcare costs. Even after discharge from rehabilitation, post-stroke individuals continue to have persistent gait impairments, which in turn adversely affect functional mobility and quality of life. Multiple factors, including biomechanics, energy cost, psychosocial variables, as well as the physiological function of corticospinal neural pathways influence stroke gait function and training-induced gait improvements. As a step toward addressing this challenge, the objective of the current perspective paper is to outline knowledge gaps pertinent to the measurement and retraining of stroke gait dysfunction. The paper also has recommendations for future research directions to address important knowledge gaps, especially related to the measurement and rehabilitation-induced modulation of biomechanical and neural processes underlying stroke gait dysfunction. We posit that there is a need for leveraging emerging technologies to develop innovative, comprehensive, methods to measure gait patterns quantitatively, to provide clinicians with objective measure of gait quality that can supplement conventional clinical outcomes of walking function. Additionally, we posit that there is a need for more research on how the stroke lesion affects multiple parts of the nervous system, and to understand the neuroplasticity correlates of gait training and gait recovery. Multi-modal clinical research studies that can combine clinical, biomechanical, neural, and computational modeling data provide promise for gaining new information about stroke gait dysfunction as well as the multitude of factors affecting recovery and treatment response in people with post-stroke hemiparesis.</p>","PeriodicalId":72774,"journal":{"name":"Delaware journal of public health","volume":"9 3","pages":"76-81"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/82/28/djph-93-013.PMC10494801.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10232601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Medical Management of Acute Cerebral Ischemia.","authors":"Usman Shehzad","doi":"10.32481/djph.2023.08.006","DOIUrl":"https://doi.org/10.32481/djph.2023.08.006","url":null,"abstract":"<p><p>This review article discusses medical management of acute cerebral ischemia including recent advances. Expansion of the thrombolysis eligibility criteria are discussed. Tenecteplase as a promising new thrombolytic is explored and the evidence supporting the use of Mobile Stroke Units is presented.</p>","PeriodicalId":72774,"journal":{"name":"Delaware journal of public health","volume":"9 3","pages":"20-26"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/83/62/djph-93-006.PMC10494791.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10241097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Artificial Intelligence and the Evaluation and Treatment of Stroke.","authors":"Lee P Dresser, Michael Anders Kohn","doi":"10.32481/djph.2023.08.014","DOIUrl":"https://doi.org/10.32481/djph.2023.08.014","url":null,"abstract":"<p><p>Stroke affects close to 800,000 Americans every year and is a major cause of disability and mortality. Prompt, accurate diagnosis and treatment of stroke is of critical importance in minimizing these deleterious effects. Recent advances in computer technology have allowed the development artificial intelligence technology that can be applied to the diagnosis, treatment and rehabilitation of victims of stroke.</p>","PeriodicalId":72774,"journal":{"name":"Delaware journal of public health","volume":"9 3","pages":"82-84"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e9/64/djph-93-014.PMC10494798.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10239206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Stroke Prevention.","authors":"Bruce Dopler","doi":"10.32481/djph.2023.08.003","DOIUrl":"https://doi.org/10.32481/djph.2023.08.003","url":null,"abstract":"<p><p>Stroke has three main subtypes - ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. The most common stroke subtype is ischemic stroke, making up about 88% of strokes. Many of these strokes may be prevented by lifestyle modifications. These lifestyle modifications include engaging in physical activity, dietary changes such as the Mediterranean diet, smoking cessation, and avoiding substance abuse. Addressing medical conditions such as diabetes, hypertension, lipid management, sleep apnea, and atrial fibrillation will also have a major impact on stroke prevention. In addition to stroke prevention, these strategies help with overall brain health, which may also have an impact on neurological degenerative diseases such as Alzheimer's disease.</p>","PeriodicalId":72774,"journal":{"name":"Delaware journal of public health","volume":"9 3","pages":"6-10"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a1/78/djph-93-003.PMC10494800.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10239210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Nursing Care of Delaware's Stroke Patients.","authors":"Reina W McAndrew, Mary Ciechanowski","doi":"10.32481/djph.2023.08.008","DOIUrl":"https://doi.org/10.32481/djph.2023.08.008","url":null,"abstract":"<p><p>This article will highlight essential nursing care in each aspect of the continuum of stroke care. Nursing interventions will be covered from primary stroke prevention through the transitions needed for healthy return to the community and secondary stroke prevention.</p>","PeriodicalId":72774,"journal":{"name":"Delaware journal of public health","volume":"9 3","pages":"34-37"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1e/cd/djph-93-008.PMC10494796.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10239213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Stroke Systems of Care:: A Systematic Approach to Saving Neurons.","authors":"Kim Gannon","doi":"10.32481/djph.2023.08.005","DOIUrl":"https://doi.org/10.32481/djph.2023.08.005","url":null,"abstract":"<p><p>Stroke continues to be a major public health concern, accounting for more than 800,000 strokes per year and remains the leading cause of disability. Stroke systems of care are comprehensive frameworks designed to ensure efficient and effective management of stroke patients. This article provides a brief overview of the coordinated network of healthcare providers, emergency medical services, and hospitals working together to deliver timely and specialized care including pre-hospital care, acute hospital care, rehabilitation, and community reintegration.</p>","PeriodicalId":72774,"journal":{"name":"Delaware journal of public health","volume":"9 3","pages":"16-19"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/56/a3/djph-93-005.PMC10494794.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10232603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"In This Issue","authors":"O. Khan, Tim Gibbs","doi":"10.32481/djph.2023.08.001","DOIUrl":"https://doi.org/10.32481/djph.2023.08.001","url":null,"abstract":"","PeriodicalId":72774,"journal":{"name":"Delaware journal of public health","volume":"9 1","pages":"3 - 3"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43362719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Evaluation & Treatment of Psychological Effects of Stroke.","authors":"Nancy Devereux, Ashley M Berns","doi":"10.32481/djph.2023.08.011","DOIUrl":"https://doi.org/10.32481/djph.2023.08.011","url":null,"abstract":"<p><p>Strokes are a common medical condition in the United States, including in Delaware. An under-recognized effect of stroke is the impact on mood that often occurs. Many individuals develop depression, anxiety, PTSD, and other psychological sequelae. These disorders can significantly affect their lives and their relationships. The emotional effects of stroke pose a public health problem for our residents, leading to devastating decreases in the quality of life for the patient and the family. These challenges negatively impact the community due to the associated healthcare and economic burdens. The population of the State of Delaware is growing, and the proportion of senior residents, who are also at greater risk for strokes, is also increasing. Strokes will remain an ongoing important clinical concern for our healthcare providers. Emotional changes after a stroke will occur in many Delaware residents who suffer a stroke. The emotional sequelae of stroke are under-treated. It is critical for healthcare professionals to be trained to recognize, assess, and treat the psychological disorders that can result from having a stroke. This article provides an overview of the major psychological effects of stroke, recommended assessment tools, promising treatment trends, and directions for further research. Improving our ability to detect and treat these difficult emotional challenges can facilitate effective treatment and prevention strategies and increase quality of life for stroke survivors, their loved ones, and their communities.</p>","PeriodicalId":72774,"journal":{"name":"Delaware journal of public health","volume":"9 3","pages":"62-69"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8a/21/djph-93-011.PMC10494802.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10241092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Lessons on Health Literacy and Communication in Post-Stroke Rehabilitation:: A Primer and Proposal.","authors":"Christine V Cook, Rebecca Hunting Pompon","doi":"10.32481/djph.2023.08.010","DOIUrl":"https://doi.org/10.32481/djph.2023.08.010","url":null,"abstract":"<p><p>Health literacy, or the ability to find, understand, and use information to make well-informed health decisions, has been linked to post-stroke rehabilitation outcomes. Importantly, barriers to health literacy stem from stroke survivor characteristics, clinician practices, institutional norms, as well as systemic variables. These barriers impact recovery and rehabilitation outcomes. To address these obstacles, clinicians can learn from the evidence-based practices used by speech-language pathologists in their work with stroke survivors with aphasia, a language impairment that can follow stroke. These methods to overcome communication barriers are appropriate and recommended for patients and family members regardless of stroke impairment, and include a transdisciplinary care model, multimodal approaches to patient education, along with consistent engagement with patients and their care partners. These strategies may be adopted for both personal and organizational health literacy efforts and help optimize the rehabilitation and recovery outcomes of stroke survivors with and without aphasia.</p>","PeriodicalId":72774,"journal":{"name":"Delaware journal of public health","volume":"9 3","pages":"44-49"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/bf/8e/djph-93-010.PMC10494792.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10241096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Atrial Fibrillation:: A Common Cause of Stroke.","authors":"Waimei Tai","doi":"10.32481/djph.2023.08.004","DOIUrl":"https://doi.org/10.32481/djph.2023.08.004","url":null,"abstract":"<p><p>Atrial fibrillation is the culprit causal mechanism of twenty percent of acute ischemic strokes. As the population of Delaware ages, atrial fibrillation is a growing cause of stroke. Thus, the detection of atrial fibrillation and treatment of this cardioembolic risk factor of stroke is paramount.</p>","PeriodicalId":72774,"journal":{"name":"Delaware journal of public health","volume":"9 3","pages":"12-15"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a7/38/djph-93-004.PMC10494795.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10232602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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