Frontiers in stroke最新文献

{"title":"Stroke survivors' and carers' experiences of nutritional care after stroke: a qualitative study.","authors":"Alex Lang, Sharon Geva, Nicholas R Evans, Francesca Cavallerio, Débora Vasconcelos E Sá, Ali Ali, Simon Nichols, Sanjoy K Deb","doi":"10.3389/fstro.2026.1733430","DOIUrl":"10.3389/fstro.2026.1733430","url":null,"abstract":"<p><strong>Introduction: </strong>Impaired nutritional status is commonly reported following stroke and is associated with poor clinical outcomes. More than 60% of stroke survivors in the UK are supported by informal, unpaid carers who commonly report one or more unmet care needs. This qualitative study explores stroke survivors' and informal carers' experiences of nutritional care across the pathway of stroke rehabilitation and recovery.</p><p><strong>Methods: </strong>Twelve stroke survivors and 12 informal carers were recruited via voluntary stroke organizations. Twelve participants were male. Thirteen were aged 18-34, five were aged 35-54, six were aged 55-74. Ten were of Black British ethnicity, nine White British, two Black other, two Asian and one mixed ethnicity. Median time since stroke was 2 years (range: 4 months to >10 years). Individual, online, semi-structured interviews explored the impact of stroke on nutrition, perceptions of nutritional care received, and suggested improvements. Interviews were transcribed and analyzed using reflexive thematic analysis within a critical realist framework.</p><p><strong>Results: </strong>Four themes were generated from the data: (1) \"overlooked stroke-specific and co-morbid challenges,\" recognizing the clinical complexity of post-stroke nutrition (2) \"the case for personalized, context-sensitive nutrition,\" highlighting the importance of personalized nutrition and consideration of cultural factors (3) \"preparedness for discharge home,\" which recognizes the importance of the multidisciplinary team in preparing stroke survivors and carers for returning home, (4) \"a lack of nutritional information and support,\" articulating a strong desire for nutritional information and lack of consistent dietetic support after discharge.</p><p><strong>Conclusion: </strong>Findings highlight the importance of preparing stroke survivors and carers effectively prior to discharge through improved access to personalized, culturally sensitive nutrition information, and more consistent dietetic support. Six recommendations are made for improved nutritional care across the stroke pathway. Strategies are needed to identify and address unmet need in relation to post-stroke nutrition and support recovery of stroke survivors.</p>","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"5 ","pages":"1733430"},"PeriodicalIF":1.2,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13193854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148019241","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":"Real-world characteristics and outcomes of ischemic stroke: a Peruvian multicenter analysis from the RES-Q registry.","authors":"Marla Gallo-Guerrero, Wilfor Aguirre-Quispe, Camila Nicole Gallo-Lazarte, Sofía Stefanie Sanchez-Boluarte, Antero Peralta-Mestas, Liliana E Rodriguez Kadota, Ivan José Aliaga Cordova, William Bayona Pancorbo, Manuel Moquillaza-Valle","doi":"10.3389/fstro.2026.1783830","DOIUrl":"10.3389/fstro.2026.1783830","url":null,"abstract":"<p><strong>Objective: </strong>To characterize and compare clinical profiles, care times, and functional outcomes between thrombolyzed and non-thrombolyzed patients with acute ischemic stroke (IS) within the Peruvian healthcare system using real-world data from the RES-Q registry.</p><p><strong>Methods: </strong>A retrospective multicenter cohort study was conducted. Data from adult patients with acute IS registered between January 2023 and June 2025 across five hospital centers in Peru (Lima, Arequipa, Cusco) were analyzed. The primary exposure was intravenous thrombolysis (IVT). Primary outcomes were functional independence [modified Rankin Scale (mRS) 0-2] at discharge, symptomatic intracranial hemorrhage (sICH), and in-hospital mortality. Multivariable logistic regression was used to identify independent predictors of poor functional outcome and mortality.</p><p><strong>Results: </strong>Of 1,780 patients with IS, 252 (14.2%) received IVT. Despite presenting with more severe strokes (higher median NIHSS, <i>p</i> < 0.001), the IVT group had a significantly higher rate of functional independence at discharge (50.7% vs. 38.3%, <i>p</i> < 0.001). In multivariable analysis, IVT remained an independent predictor of good functional outcome (adjusted odds ratio for poor outcome: 1.30 for non-IVT group). The median door-to-needle time was 68 minutes. In-hospital mortality did not differ significantly between groups (7.14% vs. 5.76%, <i>p</i> = 0.389). Key independent predictors of poor functional outcome were higher NIHSS (aOR 1.20 per point, 95% CI 1.16-1.24, <i>p</i> < 0.001), age (aOR 1.01 per year, 95% CI 1.00-1.02, <i>p</i> = 0.017), and diabetes (aOR 1.45, 95% CI 1.05-1.99, <i>p</i> = 0.022). For mortality, significant predictors were NIHSS (aOR 1.25, 95% CI 1.19-1.32, <i>p</i> < 0.001) and diabetes (aOR 2.21, 95% CI 1.12-4.38, <i>p</i> = 0.022).</p><p><strong>Conclusion: </strong>This real-world multicenter study in Peru demonstrates that IVT is feasible and effective, associating with significantly better functional outcomes despite treatment of a more severely affected cohort. The study validates the safety profile of IVT in this setting and identifies critical areas for quality improvement, particularly in reducing door-to-needle times and addressing disparities in access to mechanical thrombectomy. Our findings support the expansion and optimization of acute stroke reperfusion protocols in Peru and similar resource-limited healthcare systems.</p>","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"5 ","pages":"1783830"},"PeriodicalIF":1.2,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13160787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147935650","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":"NIH Stroke Scale and age predict early post-stroke cognitive impairment.","authors":"Faddi Saleh Velez, Cameron D Owens, Jennifer Hotson, Andrea Loggini, Ana Luyza Oliveira Santos, Demian Rudyk, Daniela Mercado Pena, Melba Zuniga-Gutierrez, Maria Cedeno-Bruzual, Laura Boada Robayo, Cheyenne Gutierrez, Kate Singleton, Zyanna Stuart, Evgeny Sidorov, Andriy Yabluchanskiy, Camila Bonin Pinto","doi":"10.3389/fstro.2026.1762758","DOIUrl":"10.3389/fstro.2026.1762758","url":null,"abstract":"<p><strong>Introduction: </strong>Acute post-stroke cognitive deficits, which may precede formal post-stroke cognitive impairment (PSCI), lacks evidence-based interventions or guidelines. Up to one-third of PSCI patients progress to dementia within 5 years. Deficits often emerge within 2 weeks, underscoring the need for early recognition of risk factors to guide prevention and management. However, predictive value of demographic, clinical, and stroke-specific factors remains inconsistent. We evaluated cognitive outcomes (Montreal Cognitive Assessment) at discharge and identified predictors of low function.</p><p><strong>Methods: </strong>In this retrospective study at the University of Oklahoma Medical Center, we reviewed 964 stroke patients, with 168 meeting inclusion criteria. Early PSCI was defined as Montreal Cognitive Assessment < 26 at hospital discharge post-stroke. We calculated prevalence, performed univariable logistic regression, and developed multivariable logistic regression models with and without interaction terms.</p><p><strong>Results: </strong>Patients with Montreal Cognitive Assessment < 26 were older, had longer hospital stays, higher NIH Stroke Scale, and more often discharged to non-home settings. Prevalence of early PSCI was higher with age, longer stays, non-white race, higher NIH Stroke Scale, and non-home discharge. Univariable analyses revealed length of stay, discharge disposition, NIH Stroke Scale, and race as strongest associations. Final multivariable model (NIH Stroke Scale, age, length of stay, discharge disposition) demonstrated NIH Stroke Scale and age as significant predictors, with good discrimination [Receiver Operating Characteristic-Area Under the Curve (ROC-AUC) = 0.79]. Models including interaction terms performed similarly (ROC-AUC = 0.78).</p><p><strong>Conclusion: </strong>Consistent with prior work, NIH Stroke Scale and age emerged as the most robust predictors of early PSCI. Length of stay, discharge disposition, and race were associated with early PSCI in univariable analyses and warrant further evaluation in larger prospective studies.</p>","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"5 ","pages":"1762758"},"PeriodicalIF":1.2,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13160796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147935607","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":"Collateral status predicts functional outcome in early-treated large-core anterior circulation stroke.","authors":"Andrés Gallardo, Pablo M Lavados, Pablo Albiña-Palmarola, Gabriel Cavada, Andrés Roldán, Verónica V Olavarría","doi":"10.3389/fstro.2026.1755828","DOIUrl":"10.3389/fstro.2026.1755828","url":null,"abstract":"<p><strong>Background and purpose: </strong>Endovascular therapy (EVT) is increasingly offered to patients with large-core acute ischemic stroke (AIS), yet outcomes remain highly heterogeneous. Collateral circulation may be a key determinant of infarct evolution and recovery, but its role in early-window large-core stroke is not fully defined.</p><p><strong>Methods: </strong>We retrospectively analyzed consecutive adults from a prospective stroke registry who presented within 6 h with anterior-circulation large-vessel occlusion, NIHSS ≥6, and a large ischemic core (MRI core >50 mL or CT perfusion core >70 mL, up to 150 mL). All patients received reperfusion therapy (intravenous thrombolysis, EVT, or both). Collateral status on baseline single-phase CTA was graded using the Tan scale (0-3); no patients had grade 3. The primary outcome was 90-day modified Rankin Scale (mRS); secondary outcome was NIHSS at discharge.</p><p><strong>Results: </strong>Fifty-four patients met inclusion criteria (Tan 0: <i>n</i> = 24; Tan 1: <i>n</i> = 14; Tan 2: <i>n</i> = 16). Baseline NIHSS, ASPECTS, and core volume were similar across groups. Patients without collaterals (Tan 0) had worse 90-day outcomes (median mRS 4 [IQR 3-6]) compared with those with Tan 1 (2 [IQR 1-3]) or Tan 2 (1 [IQR 1-2]) collaterals (both p < 0.001), whereas Tan 1 and Tan 2 did not differ significantly (<i>p</i> = 0.27). NIHSS at discharge showed a similar gradient. In proportional-odds logistic regression, each one-grade increase in collateral status was associated with lower odds of worse 90-day mRS (adjusted per-grade OR 0.32; 95% CI 0.15-0.68; <i>p</i> = 0.003).</p><p><strong>Conclusion: </strong>In early-treated large-core AIS, even simple CTA-based collateral assessment strongly predicts recovery. Patients with absent collaterals follow a distinctly poorer trajectory, while those with any collateral filling behave more favorably. Incorporating collateral status into routine evaluation may improve prognostic accuracy and support treatment decisions in this challenging subgroup.</p>","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"5 ","pages":"1755828"},"PeriodicalIF":1.2,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13121057/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791181","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":"Comparison of primary and secondary stroke outcomes between government and private healthcare institutions: insights from the SPRINT India trial.","authors":"Shweta Jain Verma, Bhavya Nanda, Paramdeep Kaur, Arya Devi K S, Deepti Arora, Aneesh Dhasan, P N Sylaja, Dheeraj Khurana, Vijaya Pamidimukkala, Biman Kanti Ray, Vivek Nambiar, Sanjith Aaron, Gaurav Mittal, Aparna R Pai, Sankar Prasad Gorthi, Somasundaram Kumaravelu, Yerasu Muralidhar Reddy, Sunil Narayan, Nomal Chandra Borah, Rupjyoti Das, Girish Baburao Kulkarni, Vikram Huded, Thomas Mathew, Rohit Bhatia, Pawan Kumar Ojha, Jayanta Roy, Anand Girish Vaishnav, Arvind Sharma, Abhishek Pathak, Sanjeev Kumar Bhoi, Sudhir Sharma, Sulena Sulena, Aralikatte Onkarappa Saroja, Neetu Ramrakhiani, Madhusudhan Byadarahalli Kempegowda, Mahesh Kate, Tina George, Ivy Sebastian, Meenakshi Sharma, Rupinder Dhaliwal, Jeyaraj D Pandian","doi":"10.3389/fstro.2026.1805422","DOIUrl":"10.3389/fstro.2026.1805422","url":null,"abstract":"<p><strong>Introduction: </strong>Stroke recurrence and vascular events remain major contributors to post-stroke mortality in India, where care is delivered through heterogeneous government and private healthcare systems. This <i>post-hoc</i> analysis of the Secondary Prevention with a Structured Semi-Interactive Stroke Prevention Package in India (SPRINT INDIA) trial compared primary and secondary stroke outcomes between government and private hospitals.</p><p><strong>Methods: </strong>SPRINT INDIA was a multicentre randomized controlled trial conducted across 31 centers (18 private, 13 government) within the Indian Stroke Clinical Trial Network (INSTRuCT). Adults with sub-acute stroke were randomized to a structured mHealth-supported secondary prevention intervention or standard care and followed for 1 year. The primary outcome was a composite of recurrent stroke, high-risk transient ischemic attack, acute coronary syndrome, and all-cause mortality. Secondary outcomes included functional status (modified Rankin Scale), behavioral risk factors, medication adherence, body mass index, physical activity, and laboratory measures of vascular risk. Outcomes were compared between government and private hospitals using adjusted regression models.</p><p><strong>Results: </strong>Among 4,298 randomized patients, 3,038 completed 1-year follow-up (59.8% private; 40.2% government). There was no significant difference was observed in the composite primary outcome between private and government institutions (2.8 vs. 3.7%; <i>p</i> = 0.215). Private hospitals demonstrated non-significantly lower adjusted odds of the primary outcome and higher odds of good functional recovery. The intervention was associated with improved functional outcomes and reductions in systolic blood pressure and fasting blood glucose in government hospitals, while private hospitals showed greater improvements in medication adherence, smoking and alcohol cessation, and body mass index.</p><p><strong>Conclusions: </strong>Stroke outcomes at 1 year were broadly comparable across healthcare sectors; however, the intervention demonstrated context-specific benefits, improving risk factors and functional recovery in government hospitals and reinforcing behavioral adherence in private hospitals. These findings highlight the importance of tailoring secondary stroke prevention strategies to healthcare system context.</p><p><strong>Clinical trial registration: </strong>http://ctri.nic.in, identifier: CTRI/2017/09/009600.</p>","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"5 ","pages":"1805422"},"PeriodicalIF":1.2,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13111008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791192","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":"Identifying wakeup stroke routine treatments in the emergency departments.","authors":"Mehari Gebreyohanns, Sidarrth Prasad, Kim D Barker, Joshua D E Amos, Erica M Jones, Lindsay M Riskey, Daiwai M Olson, Asmiet K Techan, Ty A Johnson, Nneka L Ifejika","doi":"10.3389/fstro.2026.1814085","DOIUrl":"10.3389/fstro.2026.1814085","url":null,"abstract":"<p><strong>Background: </strong>The term wake-up stroke refers to an acute ischemic stroke with an unknown time of onset, typically discovered when a patient awakens with symptoms. Wake-up strokes account for up to 25% of all acute ischemic strokes. There is limited understanding of how hospitals vary in their evaluation and treatment of these cases, and institutional protocols, imaging strategies, and therapeutic decision-making for wake-up stroke remain inconsistently defined.</p><p><strong>Methods: </strong>In this prospective observational study, we surveyed hospitals in Texas and Louisiana to assess institutional approaches to wake-up stroke care including hospital characteristics, imaging protocols, treatment pathways, and decision-making criteria for acute ischemic stroke with unknown onset time.</p><p><strong>Results: </strong>Among 54 hospitals in Louisiana (29), and Texas (25), representing 48 unique zip codes, >80% followed a standardized institutional protocol when making decisions for wake-up strokes. Additionally, 75.5% of hospitals ordered MRIs for these cases in the acute setting.</p><p><strong>Conclusion: </strong>A coordinated, systems-level approach to wake-up stroke care that integrates a standardized protocol may be valuable in promoting workflow processes.</p>","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"5 ","pages":"1814085"},"PeriodicalIF":1.2,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13110991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790590","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":"Study protocol for the Vivistim GRASP registry: capturing real-world outcomes of paired vagus nerve stimulation in the chronic stroke population.","authors":"Shannon J Doherty, Cecília N Prudente, Reema Adham Hinds, David Pierce, Navzer D Engineer, John Carrithers, Diana Hansen, W Brent Tarver","doi":"10.3389/fstro.2026.1751659","DOIUrl":"10.3389/fstro.2026.1751659","url":null,"abstract":"<p><strong>Objective: </strong>To capture real-world use and outcomes from chronic stroke survivors with arm and hand impairment implanted with a paired vagus nerve stimulation (Paired VNS) device. The FDA-approved Vivistim Paired VNS System combines VNS with upper limb rehabilitation to reduce upper-extremity motor deficits and improve function in chronic stroke survivors.</p><p><strong>Design: </strong>Observational, postmarket patient registry collecting outcomes data from individuals who receive Vivistim for stroke recovery. Assessments will be conducted at baseline and at scheduled assessment timepoints over a period of up to 3 years.</p><p><strong>Participants: </strong>Adults aged 18 years or older with a history of stroke with moderate-to-severe upper limb deficits and clinically evaluated as appropriate candidates for Paired VNS Therapy.</p><p><strong>Outcome measures: </strong>Motor outcome assessments include the Fugl-Meyer Assessment-Upper Extremity, the Nine Hole Peg Test, and the Wolf Motor Function Test (optional). Patient-reported outcome assessments include a global quality of life questionnaire, Stroke Impact Scale, Motor Activity Log, and Beck Depression Inventory.</p><p><strong>Conclusions: </strong>The registry is designed to provide real-world evidence on the use and outcomes of Paired VNS. These data will characterize functional changes, patient experiences, and therapy utilization in a heterogeneous chronic stroke population, supporting optimization and broader integration of Paired VNS into stroke recovery pathways.</p><p><strong>Clinical trial registration: </strong>https://clinicaltrials.gov/study/NCT05301140, identifier NCT05301140.</p>","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"5 ","pages":"1751659"},"PeriodicalIF":1.2,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13076104/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694014","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":"Implementing and sustaining 6-month post-stroke reviews: a complexity-informed, context-sensitive programme theory for clinical practice.","authors":"Rich Holmes, Suzanne Ackerley, Dawn Goodwin, Louise A Connell","doi":"10.3389/fstro.2026.1780242","DOIUrl":"10.3389/fstro.2026.1780242","url":null,"abstract":"<p><strong>Introduction: </strong>Stroke is a leading cause of long-term disability. Six-month post-stroke reviews are recommended in multiple guidelines to identify the ongoing needs of stroke survivors and facilitate follow-up care. However, guidance on how to deliver these reviews optimally is limited. This study developed a complexity-informed, context-sensitive programme theory for the 6-month post-stroke review, clarifying its core components and producing actionable recommendations to guide implementation and sustainability across diverse contexts.</p><p><strong>Methods: </strong>The programme theory was developed from empirically derived patterns identified in a multiple case study in England, based on data collected from interest-holder interviews, observations, and documentary analysis. Context-mechanism-outcome configurations were developed heuristically through a pragmatic approach. These informed the structure and content of the programme theory and logic model. A complexity theory lens facilitated identification of multi-level system dynamics, supporting applicability across diverse contexts. The model was iteratively refined by the research team and adjusted following validation feedback from international stroke rehabilitation experts and 6-month post-stroke review interest-holders.</p><p><strong>Results: </strong>Fourteen context-mechanism-outcome configurations informed 13 core components nested within four core domains of the 6-month review: <i>Access & Inclusion; Identifying & Addressing Needs; Maintaining Quality;</i> and <i>System Integration</i>. The real-world logic model illustrates how patient-, provider-, and service-level outcomes emerge from interactions between the 6-month review and the context in which it is delivered. The resulting actionable recommendations provide guidance for implementing and sustaining 6-month post-stroke reviews in clinical practice, including flexible delivery formats, person-centered tailoring, integration across services, and strategies to enhance quality and equity.</p><p><strong>Conclusions: </strong>This study presents the first complexity-informed, context-sensitive programme theory for the 6-month post-stroke review. By translating empirically driven theory into actionable recommendations, it supports clinicians and service planners in delivering person-centered, contextually adaptable follow-up care. It also provides a foundation for future evaluation of post-stroke services internationally, enabling systematic testing of its hypothesized outcomes and adaptation across diverse healthcare settings.</p>","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"5 ","pages":"1780242"},"PeriodicalIF":1.2,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13045055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147624712","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":"Impact of left vs. right hemisphere stroke on driving: lateralized attention deficits and executive dysfunction linked to impaired driving.","authors":"Krista Schendel, Isabella Santavicca, Timothy J Herron, Sandy J Lwi, Brian C Curran, Jas M Chok, Juliana Baldo","doi":"10.3389/fstro.2026.1679668","DOIUrl":"10.3389/fstro.2026.1679668","url":null,"abstract":"<p><strong>Introduction: </strong>For many people, driving is essential to quality of life because it facilitates social integration and community participation. Indeed, many stroke survivors return to driving within months post-stroke. Few studies, however, have specifically characterized post-stroke driving errors as a function of affected hemisphere (LH vs. RH) and cognitive impairment.</p><p><strong>Methods: </strong>This study examined driving performance in LH and RH stroke survivors and age-matched controls using a fully interactive driving simulator.</p><p><strong>Results: </strong>Analysis revealed that the direction and severity of visuospatial attention deficits were significant predictors of post-stroke driving performance and executive dysfunction correlated with specific types of driving errors. Moreover, the cerebral hemisphere affected by stroke had a significant impact on lane positioning errors, with RH stroke survivors experiencing more difficulty maintaining lane position. In addition, a higher incidence of lane departures on the contralesional side of the lane was observed after stroke. Notably, neither age, months post-stroke, nor simple reaction time were reliably associated with scores or pass/fail ratings on the simulated driving assessment.</p><p><strong>Discussion: </strong>This work highlights how LH and RH strokes differentially impact driving and suggests that driving assessment and rehabilitation efforts should consider both the direction and severity of visuospatial attention deficits as well as the degree of executive dysfunction in stroke survivors who wish to continue driving.</p>","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"5 ","pages":"1679668"},"PeriodicalIF":1.2,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13038550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147610754","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":"Neighborhood economic and demographic landscape as predictors of 90-day outcomes post-stroke hospitalization.","authors":"Farya Fakoori, Karlon H Johnson, Hannah Gardener, Carolina M Gutierrez, Negar Asdaghi, Lauri Bishop, Scott C Brown, Iszet Campo-Bustillo, Gillian Gordon Perue, Emir Veledar, Hao Ying, Lili Zhou, Jose G Romano, Tatjana Rundek, Erika Marulanda","doi":"10.3389/fstro.2026.1738822","DOIUrl":"10.3389/fstro.2026.1738822","url":null,"abstract":"<p><strong>Objective: </strong>An in-depth exploration of neighborhood environmental impact on post-discharge stroke outcomes is lacking yet essential for identifying populations at high risk. We assess neighborhood economic and demographic characteristics associated with 90-day death or readmission post-stroke hospitalization.</p><p><strong>Methods: </strong>We prospectively analyzed 1,329 acute stroke survivors in the Florida Stroke Registry's Transition of Care Stroke Disparities Study (91% ischemic, 56% male, 52% non-Hispanic White, 23% non-Hispanic Black, 22% Hispanic, median age 64). Neighborhood characteristics at the ZIP+4 level, including socioeconomic status (NSES), racial/ethnic composition, and business densities (food, tobacco/alcohol, gyms, medical services), were analyzed using factor analysis to generate four factors with eigenvalues greater than 1. Outcomes (death or readmission) were assessed through structured telephone interviews 90 days post-discharge. Logistic regression evaluated associations between neighborhood characteristics and outcomes, adjusting for demographics (race/ethnicity, sex, age), vascular risk factors, stroke severity from Get With The Guidelines-Stroke^®, and social or economic conditions such as insurance, support, and living arrangements.</p><p><strong>Results: </strong>Within 90 days, 208 patients experienced death or readmission. Four factors explained 59% of the variance in 24 neighborhood characteristics. Factor 1, defined by lower NSES, higher population density, and urbanization (RUCA code 1, greater densities of tobacco/alcohol outlets, restaurants, grocery stores, gyms, and pharmacies), was associated with a 20% increased risk.</p><p><strong>Conclusions: </strong>Living in densely populated, highly urbanized neighborhoods with lower SES and greater commercial density predicted poor stroke outcomes independent of individual health or SES. These findings can guide community interventions to reduce stroke mortality and readmission.</p>","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"5 ","pages":"1738822"},"PeriodicalIF":1.2,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13017339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147576968","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}