Early functional factors for predicting outcome of independence in daily living after stroke: a decision tree analysis.

OBJECTIVE: This study aimed to investigate the predictive functional factors influencing the acquisition of basic activities of daily living performance abilities during the early stages of stroke rehabilitation using classification and regression analysis trees. METHODS: The clinical data of 289 stroke patients who underwent rehabilitation during hospitalization (164 males; mean age: 62.2 ± 13.9 years) were retrospectively collected and analysed. The follow-up period between admission and discharge was approximately 6 weeks. Medical records, including demographic characteristics and various functional assessments with item scores, were extracted. The modified Barthel Index on discharge served as the target outcome for analysis. A "good outcome" was defined as a modified Barthel Index score ≥ 75 on discharge, while a modified Barthel Index score < 75 was classified as a "poor outcome." RESULTS: Two classification and regression analysis tree models were developed. The first model, predicting activities of daily living outcomes based on early motor functions, achieved an accuracy of 92.4%. Among patients with a "good outcome", 70.9% exhibited (i) ≥ 4 points in the "sitting-to-standing" category in the motor assessment scale and (ii) 32 points on the Berg Balance Scale score. The second model, predicting activities of daily living outcome based on early cognitive functions, achieved an accuracy of 82.7%. Within the "poor outcome" group, 52.2% had (i) ≤ 21 points in the "visuomotor organization" category of Lowenstein Occupational Therapy Cognitive Assessment, (ii) ≤ 1 point in the "time orientation" category of the Mini Mental State Examination. CONCLUSION: The ability to perform "sitting-to-standing" and visuomotor organization functions at the beginning of rehabilitation emerged as the most significant predictors for achieving successful basic activities of daily living on discharge after stroke.

Comparison of biomechanical parameters in lower limb joints of stroke patients according to conventional evaluation scores during level walking.

Objective: Patients with chronic stroke capable of independent gait were classified into functional ambulation category (FAC) 4 or 5, and the kinetic and kinematic data on their lower limb joints on the affected and unaffected sides were compared with that of healthy individuals. Finally, the qualitative changes in the gait of patients with stroke were investigated based on the differences in FAC scores. Methods: Twelve healthy participants and 19 patients with stroke capable of independent gait were included. The three-dimensional (3D) motion analysis and conventional assessment were conducted for all patients with stroke. Results: The FAC 5 group exhibited a larger range of motion (ROM) than the FAC 4 group in knee and hip joints on the affected side and only in the hip on the unaffected side. In the FAC 5 group, ROM differences in the healthy group on either the affected or unaffected side were absent. The peak of the hip flexion moment on the affected side in both the FAC 4 and 5 groups was smaller than that in the healthy group and in the FAC 4 group on the unaffected side. The absorption power minimum on the affected side was smaller only in the FAC 4 group than that in the healthy group and was larger in the FAC 5 group than that in the FAC 4 group. On the unaffected side, the absorption power minimum was smaller only in the FAC 4 group than that in the healthy group. Conclusion: Functional differences in gait were found in patients classified based on conventional evaluation capable of independent gait after post-stroke rehabilitation. Patients may not exhibit complete recovery in the kinetic indices even if they are judged to be normal in the conventional evaluation, and the kinematic gait indices indicate recovery. Evaluating kinetic indices in addition to kinematic indices is necessary, and joint power may be an especially useful index.

Brain-computer interface in critical care and rehabilitation.

This comprehensive review explores the broad landscape of brain-computer interface (BCI) technology and its potential use in intensive care units (ICUs), particularly for patients with motor impairments such as quadriplegia or severe brain injury. By employing brain signals from various sensing techniques, BCIs offer enhanced communication and motor rehabilitation strategies for patients. This review underscores the concept and efficacy of noninvasive, electroencephalogram-based BCIs in facilitating both communicative interactions and motor function recovery. Additionally, it highlights the current research gap in intuitive "stop" mechanisms within motor rehabilitation protocols, emphasizing the need for advancements that prioritize patient safety and individualized responsiveness. Furthermore, it advocates for more focused research that considers the unique requirements of ICU environments to address the challenges arising from patient variability, fatigue, and limited applicability of current BCI systems outside of experimental settings.

HyperOptoNet: a MATLAB-based toolbox for inter-brain neuronal synchrony analysis using fNIRS hyperscanning.

Significance: We developed a MATLAB-based toolbox for the analysis of inter-brain synchrony (IBS) and performed an experimental study to confirm its performance. To the best of our knowledge, this is the first toolbox for IBS based on functional near-infrared spectroscopy (fNIRS) hyperscanning data that visually shows the results on two three-dimensional (3D) head models. Aim: Research on IBS using fNIRS hyperscanning is a nascent but expanding field. Although various analysis toolboxes for fNIRS exist, none can show inter-brain neuronal synchrony on a 3D head model. In 2019 and 2020, we released two MATLAB toolboxes named OptoNet I and II, which have helped researchers to analyze functional brain networks using fNIRS. We developed a MATLAB-based toolbox named HyperOptoNet to overcome the limitation of the previous OptoNet series. Approach: The developed HyperOptoNet can easily analyze inter-brain cortical connectivity using fNIRS hyperscanning signals simultaneously measured from two people at the same time. The connectivity results can be easily recognized by representing inter-brain neuronal synchrony with colored lines that are visually expressed on two standard head models. Results: To evaluate the performance of the developed toolbox, we conducted an fNIRS hyperscanning study of 32 healthy adults. The fNIRS hyperscanning data were measured while the subjects performed traditional, paper-and-pencil-based, cognitive tasks or interactive, computer-assisted, cognitive tasks (ICT). The results visualized different inter-brain synchronization patterns according to the interactive nature of the given tasks; a more extensive inter-brain network was seen with the ICT. Conclusions: The developed toolbox has good performance of IBS analysis and helps even unskilled researchers to easily analyze fNIRS hyperscanning data.

Effect of interactive multitouch game-based cognitive intervention on cognitive function in older adults: A randomized controlled trial.

Purpose: This study investigated the effects of an interactive multitouch game-based cognitive intervention (ICI) on cognitive function in community-dwelling older adults. Methods: Thirty-two older adults (19 women) between 65 and 84 years of age (mean age, 74.47 ± 4.30 years) without a history of neurological disease participated. They were randomized into two groups: intervention and control. The intervention group took part in ICI sessions using HAPPYTABLE® (Spring Soft Co. Ltd, Seoul, Korea) (ICI group), and the control group underwent a traditional paper-and-pencil-based cognitive intervention (TCI group). Both groups completed 10 intervention sessions over four consecutive weeks. Cognitive function was assessed before (pre-intervention) and after (post-intervention) intervention. Executive function was evaluated through the Color-Word Stroop Test (CWST) and Controlled Oral Word Association Test (COWAT). Memory was assessed through the Verbal Learning Test (VLT) and Rey Complex Figure Test (RCFT). Results: The ICI and TCI groups showed significant improvements in some cognitive functions after the intervention. Both groups showed substantial improvements in VLT and RCFT (P < 0.05), reflecting memory function. Regarding the executive role, the ICI group showed significant post-intervention improvements in the conditions of the CWST incongruent (ICI 76.31 ± 23.82; P = 0.004) compared to the pre-intervention scores. ANCOVA with pre-intervention scores and gender as covariates revealed improved results in the ICI group compared with the VLT delayed (ICI 9.18 ± 1.68, TCI 7.56 ± 2.13; P = 0.015) and VLT recognition task (ICI 22.81 ± 1.22, TCI 21.38 ± 1.09; P = 0.035). Conclusions: These findings revealed that both ICI and TCI helped increase cognitive performance in community-dwelling older persons; nevertheless, ICI showed better improvement in memory function than TCI. Thus, the ICI can be used to improve cognitive performance among older adults living in the community.

Clustering and prediction of long-term functional recovery patterns in first-time stroke patients.

Objectives: The purpose of this study was to cluster long-term multifaceted functional recovery patterns and to establish prediction models for functional outcome in first-time stroke patients using unsupervised machine learning. Methods: This study is an interim analysis of the dataset from the Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO), a long-term, prospective, multicenter cohort study of first-time stroke patients. The KOSCO screened 10,636 first-time stroke patients admitted to nine representative hospitals in Korea during a three-year recruitment period, and 7,858 patients agreed to enroll. Early clinical and demographic features of stroke patients and six multifaceted functional assessment scores measured from 7 days to 24 months after stroke onset were used as input variables. K-means clustering analysis was performed, and prediction models were generated and validated using machine learning. Results: A total of 5,534 stroke patients (4,388 ischemic and 1,146 hemorrhagic; mean age 63·31 ± 12·86; 3,253 [58.78%] male) completed functional assessments 24 months after stroke onset. Through K-means clustering, ischemic stroke (IS) patients were clustered into five groups and hemorrhagic stroke (HS) patients into four groups. Each cluster had distinct clinical characteristics and functional recovery patterns. The final prediction models for IS and HS patients achieved relatively high prediction accuracies of 0.926 and 0.887, respectively. Conclusions: The longitudinal, multi-dimensional, functional assessment data of first-time stroke patients were successfully clustered, and the prediction models showed relatively good accuracies. Early identification and prediction of long-term functional outcomes will help clinicians develop customized treatment strategies.

Gender differences in mortality and long-term functional outcomes after first-ever ischemic stroke: A prospective cohort study.

BACKGROUND: Although many studies about survival rates and functional outcomes after stroke have been published, studies on gender differences have reported conflicting results. AIMS: To determine whether there are differences in mortality and functional outcomes during the first 5 years after a first-ever ischemic stroke in Korean males and females. METHOD: This is an interim analysis of the Korean Stroke Cohort for Functioning and Rehabilitation, a prospective multicenter cohort study. Multifaceted functional assessments were performed repeatedly from 7 days to 60 months after stroke onset to test motor, ambulatory, cognitive, language, and swallowing functions as well as activities of daily living (ADLs) in patients with first-ever stroke. Of 10,636 first-ever-stroke patients admitted to nine representative hospitals in Korea, 8210 were ischemic stroke patients included in the mortality analysis. Among them, 6258 patients provided informed consent and 3508 completed functional assessments for 60 months. Gender-related differences in 5-year mortality and functional recovery were analyzed. RESULT: Women showed a significantly higher 5-year mortality rate than men after correction for possible covariates (p < 0.05). In terms of functional outcomes, women showed worse ambulatory, cognitive, language, and ADL outcomes than men after adjusting for covariates (all p < 0.05). The 5-year recovery pattern differed significantly between genders only for ADL function (ß-coefficient estimate = 0.34; p = 0.03). CONCLUSION: Five-year mortality rate, functional outcomes, and recovery patterns after first-ever ischemic stroke differed significantly by gender. These results suggest the need for gender-specific stroke care and long-term management strategies.

A Smart Glove Digital System Promotes Restoration of Upper Limb Motor Function and Enhances Cortical Hemodynamic Changes in Subacute Stroke Patients with Mild to Moderate Weakness: A Randomized Controlled Trial.

This study was a randomized controlled trial to examine the effects of the RAPAEL® Smart Glove digital training system on upper extremity function and cortical hemodynamic changes in subacute stroke patients. Of 48 patients, 20 experimental and 16 controls completed the study. In addition to conventional occupational therapy (OT), the experimental group received game-based digital hand motor training with the RAPAEL® Smart Glove digital system, while the control group received extra OT for 30 min. The Fugl-Meyer assessment (UFMA) and Jebsen-Tayler hand function test (JTT) were assessed before (T0), immediately after (T1), and four weeks after intervention (T2). Cortical hemodynamics (oxyhemoglobin [OxyHb] concentration) were measured by functional near-infrared spectroscopy. The experimental group had significantly better improvements in UFMA (T1-T0 mean [SD]; Experimental 13.50 [7.49]; Control 8.00 [4.44]; p = 0.014) and JTT (Experimental 21.10 [20.84]; Control 5.63 [5.06]; p = 0.012). The OxyHb concentration change over the ipsilesional primary sensorimotor cortex during the affected wrist movement was greater in the experimental group (T1, Experimental 0.7943 × 10-4 µmol/L; Control -0.3269 × 10-4 µmol/L; p = 0.025). This study demonstrated a beneficial effect of game-based virtual reality training with the RAPAEL® Smart Glove digital system with conventional OT on upper extremity motor function in subacute stroke patients.

Multifaceted Assessment of Functional Outcomes in Survivors of First-time Stroke.

Importance: Because stroke causes diverse functional deficits, understanding the long-term recovery pattern of each functional domain may inform prognosis and therapeutic strategies. Objective: To observe long-term changes in functional status and residual disability in survivors of first-time stroke. Design, Setting, and Participants: This cohort study was an interim analysis of the Korean Stroke Cohort for Functioning and Rehabilitation. Between August 2012 and May 2015, 7858 of 10 636 screened patients with first-time strokes from 9 district hospitals in Korea provided informed consent to participate. Data were analyzed from September 2021 through February 2022. Exposure: First-time stroke. Main Outcomes and Measures: Study data include multifaceted face-to-face functional assessments obtained at 8 to 9 points until 60 months after stroke onset. The Korean Mini-Mental State Examination (K-MMSE), Fugl-Meyer Assessment, Functional Ambulatory Category, American Speech-Language-Hearing Association National Outcome Measurement System Swallowing Scale, and Short Korean version of the Frenchay Aphasia Screening Test were performed from 7 days to 60 months after stroke. The Korean Modified Barthel Index was measured from 3 months to 60 months after stroke. Results: A total of 4443 patients (2649 men [59.62%]; mean [SD] age 62.13 [12.43] years) who underwent repeated functional assessments for 60 months after stroke (3508 patients with ischemic and 935 patients with hemorrhagic stroke) were included. Overall, functions plateaued between 12 and 18 months after stroke and declined after 30 months; for example, mean (SD) K-MMSE improved from 7 days (22.89 [7.89]) to 12 months (26.03 [5.48]) (P < .001), plateaued until 36 months (26.03 [5.84]), and decreased to 48 months (26.02 [5.82]) (P < .001). Interaction associations were found between time after stroke and age, stroke severity, and stroke type in functional assessment outcomes. For example, mean (SE) FMA for ages 65 years or younger vs older than 65 years was 81.64 (0.63) vs 80.69 (0.68) at 7 days and 91.28 (0.47) vs 88.46 (0.58) at 6 months (P for interaction < .001), and for IS vs HS, it was 84.46 (0.47) vs 69.02 (1.24) at 7 days and 91.20 (0.38) vs 85.51 (0.98) at 6 months (P for interaction < .001). Mean (SE) FMA was 94.39 (0.21) at 7 days and 97.57 (0.14) at 6 months for mild stroke, 44.69 (1.18) at 7 days and 70.43 (1.21) at 6 months for moderate stroke, and 13.22 (0.99) at 7 days and 48.07 (2.62) at 6 months for severe stroke (P for interaction < .001). Factors associated with activities of daily living independence at 60 months included older age (ß per 1-year increase = -0.35; standard error [SE], 0.03; P < .001), male sex (ß = 2.12; SE, 0.73; P = .004), and hemorrhagic stroke type (ß vs ischemic stroke = 2.35; SE, 0.81; P = .004). Conclusions and Relevance: This study found that long-term recovery patterns in multifaceted functional domains differed from one another and varied by patient age, stroke severity, and stroke type. Understanding the diversity of long-term functional recovery patterns and factors associated with these outcomes in survivors of stroke may help clinicians develop strategies for effective stroke care and rehabilitation.

Post-Stroke Depression and Cognitive Aging: A Multicenter, Prospective Cohort Study.

Background: This study investigated the impact of post-stroke depression (PSD) on cognitive aging in elderly stroke patients. Methods: This study was an interim analysis of the Korean Stroke Cohort for Functioning and Rehabilitation. Among 10,636 patients with first-ever stroke, a total of 3215 patients with normal cognitive function three months post-stroke were included in the analysis. PSD was defined using the Korean Geriatric Depression Scale Short Form (K-GDS-SF) at three months. Cognitive aging was defined as a decline in the Korean version of the Mini-Mental Status Examination (K-MMSE) score to less than the second percentile. Results: The hazard ratio (HR) of PSD for cognitive decline was 2.16 (95% CI, 1.34−3.50, p < 0.01) in the older group (age ≥65 years), and 1.02 (95% CI, 0.50−2.07, n.s.) in the younger group (age <65 years). When the older group was divided by sex, the HR was 2.50 (95% CI, 1.26−4.96, p < 0.01) in male patients and 1.80 (95% CI, 0.93−3.51, n.s.) in female patients. However, women showed a higher incidence of cognitive decline in both the PSD and no PSD groups. Among K-GDS-SF factors, "Negative judgment about the past, present, and future" increased the HR of PSD in older male patients. Conclusions: Early PSD increased the HR for cognitive decline in older stroke patients, mainly in males. Specifically, older male patients with negative thinking were at increased risk of cognitive decline. The findings also suggest that older women may be at risk for cognitive decline. Therefore, preventive interventions for cognitive decline should be tailored differently for men and women.

Sonographic Evaluation of the Optimal Needle Insertion Site in the Biceps Femoris Short Head.

OBJECTIVE: The aim of the study was to identify the optimal needle placement for electromyographic examination of the biceps femoris short head muscle in relation to the biceps femoris long head tendon through sonographic evaluation. DESIGN: This cross-sectional observational study involved 36 lower limbs of 18 healthy volunteers. The distances and angles indicating the relationships between the common fibular nerve and the medial or lateral border of the biceps femoris long head tendon were measured at 5 and 7 cm proximal to the tip of the fibular head (P1 and P2, respectively) using ultrasonography. RESULTS: The median values of the distance between the biceps femoris long head tendon and the common fibular nerve were significantly longer in the lateral approach than in the medial approach at the P1 and P2 levels. The median values of the angles between the vertical line to the biceps femoris long head tendon and the common fibular nerve were significantly larger in the lateral approach than in the medial approach at both levels. CONCLUSIONS: The common fibular nerve is located just below the medial border of the biceps femoris long head tendon at a near-vertical degree from the skin. It is strongly recommended that the needle should be inserted on the lateral side of the biceps femoris long head tendon during needle electromyographic examination of the biceps femoris short head muscle.

Optimal Trapezius Electrophysiological Recording Site.

BACKGROUND: Various active recording electrode positions for the trapezius motor nerve conduction study have been suggested. OBJECTIVE: To determine the optimal recording site of the trapezius muscles in a spinal accessory nerve conduction study. DESIGN: Retrospective descriptive study. SETTING: Department of physical medicine and rehabilitation in a tertiary clinic center. PARTICIPANTS: Thirty-four patients between 33 and 82 years of age with preoperative head and neck cancer (68 upper and middle trapezius muscles). INTERVENTIONS: Analysis of compound muscle action potentials (CMAPs) of upper and middle trapezius. MAIN OUTCOME MEASUREMENTS: CMAP latency and amplitudes were obtained at five and four recording points with constant intervals on the horizontal line of the upper and middle trapezius, respectively. RESULTS: The maximum CMAP amplitude of the upper trapezius was (mean ± SD) 8.5 ± 1.4 mV with the recording at the midpoint between the C7 spinous process and the lateral margin of the acromion. The maximum CMAP amplitude of the middle trapezius was 4.2 ± 1.4 mV, recorded on the horizontal line at the junction of the middle and lateral thirds between the root of the scapular spine and the vertebral spinous process. CONCLUSION: The optimal recording site in motor nerve conduction study of the trapezius is the midpoint between the C7 spinous process and the acromion for the upper trapezius, and the junction of middle and lateral thirds of the line between the root of scapular spine and the vertebral spine for the middle trapezius.

Rapid detection of S. mutans surface antigen I/II using a sensitive monoclonal anti-Ag I/II antibody by ELISA.

The cell-surface protein antigen I/II (Ag I/II) is expressed in oral streptococci, which are known as the causative agent of a number of diseases including dental caries, endocarditis, gingivitis, and periodontal disease. Consequently, monoclonal antibodies (MAb) capable of recognizing the streptococcal Ag I/II protein could be a useful tool for the diagnosis and cure of these diseases. In this study, a previously generated monoclonal anti-Ag I/II antibody, ckAg I/II, was used to detect a small amount of Streptococcus mutans (S. mutans) surface antigen Ag I/II. The ckAg I/II was proved to be very sensitive and able to detect as little as 1 ng of recombinant Ag I/II protein within 5 min and Ag I/II in saliva within 10 min, as well as native Ag I/II in 20 µL of culture supernatant by ELISA. These results suggest that ckAg I/II can be used as a fast and efficient diagnostic tool to detect Ag I/II.

Characteristics of tin oxide-based thin film transistors prepared by DC magnetron sputtering.

Here we demonstrate the fabrication of SnO(x) thin-film transistors (TFTs), where SnO(x) thin films are deposited as an active channel layer by DC magnetron sputtering. We analyzed the effects of the oxygen partial pressure ratio and post-deposition heat treatment (PDHT) on the characteristics of the SnO(x) thin films. We found improved performance of the TFTs obtained by using interface modification with the optimized deposition condition of SnO(x) thin films. These results are helpful for fabricating oxide-TFTs, including simple binary oxide semiconductors, as an active channel layer.