RELATIONSHIPS BETWEEN CARDIORESPIRATORY FITNESS, PHYSICAL ACTIVITY PRACTICES AND FUNCTIONAL OUTCOMES ONE-YEAR POST-STROKE IN NORTHERN BENIN: A CASE-CONTROL STUDY

Abstract

Conclusions: An adapted virtual ICAP delivered by SLP student clini-cians resulted in improved communication outcomes in individuals with chronic aphasia. This type of service delivery model may be a feasible alternative for university-based clinics and other rehabilitation centres to provide programming in a cost-effective manner within a short time frame. Background and Aims: The structural integrity of the corticospinal tract (CST) is an important biomarker of poststroke upper limb recovery. Injured CST undergoes Wallerian degeneration rostrocaudally during the first few months. This study aimed to determine the measurement accuracy of the structural integrity of the CST. Methods: This study included 50 patients with middle cerebral artery stroke who underwent diffusion tensor imaging upon transfer from the acute stroke unit to the inpatient rehabilitation facility. We evaluated hemi-plegic upper limb function using Shoulder Abduction and Finger Extension (SAFE) scores. Fractional anisotropy values of the CST were evaluated using four region of interest-based and two tract-based measurements, including the posterior_limb_of_internal_capsule, cerebral_peduncle, pons, pontomedullary_junction, entire_CST, and CST_in_the_brainstem. Multivariate linear regression models and the area under the receiver operating characteristic curve (AUC) were used to determine measurement accuracy for hemiplegic upper limb function. Results: The structural integrity of the CST at the pontomedullary junction showed the highest explanatory power, followed by the entire CST, in the multivariate linear regression models (adjusted R 2 =0.459 and 0.425, respectively). The structural integrity of the CST at the pontomedullary junction also showed the highest AUC, followed by the entire CST, in discriminating patients with a SAFE score of less than 8 or 5 from those with SAFE>=8 or 5 (SAFE< 8: AUC 0.90[95% CI 0.80-1.00]; AUC 0.83[0.66-0.99]; SAFE< 5: AUC 0.87[0.77-0.96]; AUC 0.83[0.72-0.95], respectively). Conclusions: The structural integrity of the CST measured at the pon-tomedullary junction or entire CST demonstrated the highest accuracy for hemiplegic upper limb function in the subacute phase of stroke. makes mobile app(mAPP) based educational intervention an attractive strategy. A pilot on mAPP based study showed significant reduction in post stroke complications. MOBILITY will test efficacy of mobile app based strategy in reducing post stroke complications in a large multi-center randomised trial. Aims: To compare impact of use of medical application-based care in addition to routine post stroke care versus routine post stroke care alone in preventing post stroke complications. Methods: A multicenter Prospective Randomized Open-labeled with Blinded End-point assessment (PROBE) design will assess efficacy of mAPP based stratagem. Major Inclusions are patients ⩾18 years with recent (<3month) ischemic/haemorrhagic stroke, significant disability (mRS>3), caregivers willing to provide care, caregivers/patients with smartphone/tablet with internet connectivity. Major Exclusions are Stroke survivors with no caregiver or hired caregiver/illiterate caregiver, unable to use app. Patients will be randomized into either control arm (care booklet) or intervention arm (MOBILITY app and care booklet). Results: Primary outcome-Incidence of reduction of composite of complications (Aspiration pneumonia, catheter associated urinary tract infection (CAUTI), shoulder pain (>=5 score on Numerical rating scale (NRS>=5)), deep vein thrombosis (DVT) at 3 months. To detect a difference between groups for reduction in the composite endpoint by 10% with a two sided alpha error of 0.05, 90% power and 20% loss to follow-up, 2636 patients need to be enrolled. Background and Aims: Intensive Comprehensive Aphasia Programs (ICAPs) employ a variety of treatment approaches in 1:1 and group settings , for several hours a day over several weeks. Although ICAPs have been shown to result in positive outcomes for people with aphasia (PWA), they are resource intensive to deliver and financial costs to PWA make them inaccessible and difficult to launch and sustain. University training clinics for speech-language pathology (SLP) graduate students is one way in which ICAPs can be made more accessible for PWA. The purpose of this study was to explore communication and quality of life outcomes in PWA following participation in an adapted virtual ICAP. Methods: Participants were 11 PWA (5M/6F) who participated in 36 hours of therapy delivered virtually by SLP graduate students over 3 weeks. Programming comprised a combination of group-based and individual treatments. Assessments of aphasia severity, discourse, communication confidence and overall communication were administered pre-treatment, post-treatment and at 4-week follow-up. Results: The vast majority of participants demonstrated improvements across the various outcome measures, particularly on overall aphasia severity and communication confidence. High levels of satisfaction with the adapted virtual ICAP were reported and all participants unanimously agreed it was very important to continue offering such an ICAP in the future.