Task-Based Mapping of Compensatory Strategies and Movement Kinematics After Stroke: A Systematic Scoping Review Pedro Henrique Sousa de Andrade, Caroline Rodrigues Osawa, Maria Eduarda Salum Aveiro, Clara Rezende Rocha, Rodrigo Bazan, et al. Physiotherapy Research International, 2026 Although compensatory motor strategies are widely described after stroke, there is still no structured synthesis integrating their kinematic characteristics across core functional tasks. This scoping review aimed to map compensatory strategies and movement kinematics in mobility, postural control, and upper‐limb tasks after stroke. The review followed the Joanna Briggs Institute methodology and was registered on the Open Science Framework. Ten databases were searched through August 2024. Studies including individuals post‐stroke that used motion analysis to characterize compensatory strategies during sit‐to‐stand and stand‐to‐sit transfers, gait, step up/down, postural control, and upper‐limb tasks (reaching, grasping, and manipulation) were included. Compensatory strategies were defined as alternative task‐oriented motor patterns involving redistribution of movement to preserved segments or substitution of impaired motor elements to maintain functional performance. Movement kinematics comprised spatiotemporal parameters and joint‐level kinematic variables derived from motion analysis. Data were extracted and synthesized according to task category. A total of 101 studies were included. In mobility tasks, the most frequently reported compensatory strategies involved asymmetrical weight‐bearing, reduced step length and cadence, prolonged movement time, and reduced joint excursion at the hip, knee, and ankle. During postural control tasks, common findings included weight‐bearing asymmetry, increased mediolateral displacement of the center of pressure, and reduced weight‐shifting capacity. In upper‐limb tasks, compensatory patterns were characterized by prolonged movement time, reduced elbow extension, and increased trunk and shoulder contribution. In conclusion, this review provides a structured task‐based mapping of compensatory motor behavior and its associated kinematic parameters in individuals after stroke.
Development of a Laser Device for the Assessment of Trunk Position Sense: Normative Data and Concurrent Validation With Verticality Perception Tests in Healthy Individuals Flávia Guirro Zuliani, Leandro Ribeiro Alves, Fabio Somera Junior, Andressa Rastrelo Rezende, Jussara Almeida de Oliveira Baggio, et al. Perceptual and Motor Skills, 2026 This cross-sectional study aimed to examine the participants’ ability to perceive trunk positions by comparing the trunk position sense (TPS) and subjective vertical test results. The effect of age on the perception of trunk position was also evaluated. Verticality perception was measured in the sitting position using the subjective vertical visual (SVV) bucket test and the subjective vertical postural (SVP) test with an automatic chair in the frontal plane. The repositioning accuracy of the trunk joint perception was measured using the TPS and assessed using a 3D-printed laser point support fixed to the xiphoid process during 30° of trunk lateral flexion in sitting and standing positions. Subsequently, the absolute angular deviation was calculated. The TPS data of the groups were compared using the Mann-Whitney U test. The Bland-Altman test was used to calculate the agreement between the evaluation methods. In addition, the sensitivity and specificity of the TPS sitting , TPS standing , and verticality tests were compared using a receiver operating characteristic curve. A total of 26 young and 26 older adults were included in this study. Older adults had a greater absolute angular deviation in the TPS standing in the counterclockwise and total directions than the young adults. Agreement was greater between TPS sitting and TPS standing with SVV in young and older adults and between TPS standing and SVP in older adults. TPS standing has a greater sensitivity for clinical application in older adults. Therefore, the TPS is a viable instrument for assessing active trunk proprioception in young and older adults and has greater agreement with verticality tests.
Stroke Severity and Nursing Care Complexity Natália Cristina Ferreira, Luis Cuadrado Martin, Alini Correa, Simone Cristina Paixão Dias Baptista, Fabiana Tomé Ramos, et al. Dimensions of Critical Care Nursing, 2026 Background: Nursing care complexity is a critical determinant of safety and quality of care in stroke management. Objectives: This retrospective cross-sectional study evaluated the care complexity and its association with neurological impairment among patients admitted to a comprehensive stroke unit. Methods: This study analyzed a database of patients with stroke. Care complexity was assessed using the Fugulin scale. Occupancy rate and required nursing staff were calculated according to the Fugulin scale care profile. Neurological impairment was measured at admission using the National Institutes of Health Stroke Scale (NIHSS). A multiple regression model was used to test the association between Fugulin and NIHSS scores across 3 models: model 1 (NIHSS only), model 2 (NIHSS, age, sex, and treatment), and model 3 (NIHSS, age, sex, stroke type, and treatment). Results: Most patients required high-dependency care. Optimal care delivery demanded 5 nurses and 8 nursing technicians. NIHSS score was positively associated with Fugulin score in all models ( P <.001). Age was also positively associated with care complexity ( P <.001). In contrast, reperfusion therapy with combined thrombolysis and thrombectomy was negatively associated with Fugulin score (model 2: P =.016; model 3: P =.035). Conclusions: Nursing care complexity exceeded national recommendations. Stroke severity and older age increased demands, whereas cerebral reperfusion reduced them.
Impact of Palliative Care Training for Neurology Residents on Stroke Unit Outcomes: A Retrospective Matched Study Ana Claudia Pires Carvalho, Maiara Silva Tramonte, Marcos Christiano Lange, Marcos Ferreira Minicucci, Danilo Assis Pereira, et al. American Journal of Hospice and Palliative Medicine, 2026 Background Neurologists frequently care for patients with serious neurological illnesses such as stroke, yet formal training in palliative care (PC) during neurology residency remains limited. Educational interventions may improve patient-centered care in acute neurological settings. Objective To evaluate whether integrating structured PC training into neurology residency is associated with changes in clinical outcomes of patients admitted to a stroke unit. Methods We conducted a retrospective matched case-control study analyzing medical records of stroke patients admitted to a Stroke Unit in Brazil before (2018-2019) and after (2020-2021) implementation of a structured PC training program for neurology residents. Patients were matched using coarsened exact matching based on age, sex, admission NIHSS, and pre-stroke modified Rankin Scale (mRS). Primary outcomes included total hospital and Stroke Unit length of stay (LOS). Secondary outcomes included opioid use, discontinuation of clinically-assisted nutrition and hydration (CANH), family meeting documentation, and PC consultation. Results Among 270 matched patients (141 pre-training; 129 post-training), patients treated by residents who had completed PC training had shorter total hospital LOS (median 6 vs 8 days, P = 0.002) and shorter Stroke Unit LOS (median 6 vs 7 days, P < 0.001). No significant differences were observed in opioid use, discontinuation of CANH, or PC consultations. Among patients with unfavorable outcomes (mRS 4-6), PC training remained associated with reduced Stroke Unit LOS. Conclusions Palliative care training was associated with shorter hospital stays among stroke patients but limited differences in specific PC practices. These findings suggest that primary PC education may influence care processes in acute neurological settings.
Effect of an aerobic exercise program on cardiac remodeling and functional capacity in patients with stroke: CRONuS trial Josiela Cristina da Silva Rodrigues, Gustavo José Luvizutto, Vitor Mendes Pereira, Rafael Dalle Molle da Costa, Robson Aparecido Prudente, et al. Topics in Stroke Rehabilitation, 2026 BACKGROUND Aerobic exercise training leads to cardiovascular changes and improves cardiovascular performance and functional capacity after a stroke. However, the effect of aerobic exercise on cardiac remodeling in patients with stroke has been poorly explored. This study aimed to investigate the effects of a physical exercise program on morphofunctional echocardiographic variables and the functional capacity of post-stroke patients. METHODS This randomized, controlled clinical trial included patients with stroke, categorized into the control group (CG), conventional physiotherapeutic care, and intervention group (IG). The IG underwent a cardiovascular rehabilitation program consisting of warm-up, aerobic exercise, and muscle cooling. Both conventional and test interventions lasted 45 min, three times a week for 16 weeks. The patients underwent transthoracic echocardiography, a 6-minute walk test, neurological and nutritional evaluation, laboratory tests, and QoL assessment initially and at 16 weeks after the intervention. RESULTS The IG showed significant reduction in the following morphological echocardiographic variables compared to the CG after intervention: diastolic thicknesses of the posterior wall (p = 0.0001) and interventricular septum (p = 0.004), relative wall thickness (p = 0.001), left ventricular mass (LVM, p < 0.001), LVM index (p < 0.0001), and left atrial diameter (p = 0.003). Regarding systolic and diastolic functions, the IG showed a significant increase in LV ejection fraction (p = 0.001) and tricuspid ring systolic excursion (p = 0.0002), and a reduction in the left atrial volume index (p = 0.001) and E/E' ratio (p = 0.01) compared to the CG. In addition, the IG showed an increase in the distance covered compared to the CG after the intervention (p = 0.04). CONCLUSIONS The cardiovascular rehabilitation program improved the cardiac morphological and functional parameters and had a positive impact on the functional capacity of patients with chronic ischemic stroke. TRIAL REGISTRATION REBEC, RBR-4wk4b3. Registered on 19 September 2016.
Assessing the Quality of Stroke Services in Brazil Using the World Stroke Organization Roadmap Aline Palmeira Pires, Kelin Cristine Martin, Thaís L. Secchi, Gisele Sampaio Silva, Letícia Costa Rebello, et al. Cerebrovascular Diseases, 2026 Introduction: Organizing acute stroke care effectively reduces disability and mortality. Since the Ministry of Health in Brazil established the National Stroke Policy in 2012, stroke care has improved significantly. However, despite the increase in stroke centers, some hospitals have not fully implemented the recommended structure and protocols. This study aims to evaluate the quality of stroke services in Brazil based on the World Stroke Organization (WSO) Roadmap, marking the first step towards the Certification of Stroke Centers in Latin America. Method: From 2020 to 2022, we assessed the structure of stroke centers in Brazil via an online survey based on the WSO Roadmap. When multiple responses came from the same hospital, we checked for consistency and contacted the stroke center coordinator if needed. We then compared these findings to the structure of stroke centers available in 2008, before the national stroke plan began. Results: The number of stroke centers in Brazil increased from 35 in 2008 to 246 in 2022, with 216 centers assessed in this study (102 Essential, 114 Advanced). Advanced centers were mostly private (69%). Of all hospitals, 51% serve public health patients, 75% as Essential centers. The southeast and south region have the highest number of stroke centers (77%). All hospitals provided essential blood tests, CT scans, and thrombolytic therapy, with 97% having pre-hospital emergency services. Neurologists were available 24/7 in 85% of centers (49% on-call, 35% on duty, 16% via telemedicine), and 46% of hospitals had stroke units. Nearly 90% had acute neurosurgical care, and 47% offered endovascular thrombectomy 24/7. Advanced centers implemented 85% of the WSO Roadmap items, and Essential centers 76%. According to WSO/SIECV Certification, 39 centers were prepared for certification, and 18 were certified (6 private - Advanced, 12 public - 4 Advanced, 8 Essential). Conclusion: Brazil has significantly improved its stroke care structure, but disparities and areas for further enhancement remain, particularly in equity, resource access, and best practices implementation. Certification programs could help address these issues and improve outcomes for stroke patients.
Thrombolysis With Tenecteplase for Minor Disabling Stroke: Secondary Analysis of the TEMPO-2 Randomized Clinical Trial Yiran Zhang, Brian H. Buck, Philip A. Barber, Kausik Chatterjee, Brian Clarke, et al. JAMA Neurology, 2025 Importance Outcomes following intravenous thrombolysis for minor ischemic stroke may vary based on the presence of disabling deficits. Objective To determine whether intravenous tenecteplase improves outcomes according to US National Institutes of Health Stroke Scale (NIHSS) score–based definitions of pretreatment disabling deficits. Design, Setting, and Participants This is a secondary analysis of the TEMPO-2 (Tenecteplase vs Standard of Care for Minor Ischemic Stroke With Proven Occlusion) randomized clinical trial, conducted between April 27, 2015, and January 19, 2024. Patients were followed up for 90 days. The TEMPO-2 trial was conducted across 48 sites globally among patients with minor ischemic stroke (NIHSS 0-5) and proven intracranial occlusion within 12 hours of onset. Patients were divided into having nondisabling vs disabling syndromes at presentation as per the TREAT Task Force consensus. Other established definitions of disabling stroke from the ARAMIS trial and the National Institute of Neurological Disorders and Stroke trial were explored. Data analysis was completed from July 2024 to September 2024. Interventions Intravenous tenecteplase (0.25 mg/kg) vs nonthrombolytic standard of care. Main Outcomes and Measures The primary outcome was a return to baseline modified Rankin scale score at 90 days. Results Among 886 enrolled patients, 2 withdrew consent and 884 were included in the secondary analysis. Among 884 patients analyzed (369 women [41.7%]; median [IQR] age, 72 [61-80] years), 100 (11.3%) had disabling and 784 (88.7%) had nondisabling deficits. Patients with disabling deficits had higher median (IQR) baseline NIHSS scores (4 [3-5] vs 2 [1-3]), later presentations (onset to hospital arrival time: 288 [153-412] minutes vs 133 [70-310] minutes), and longer onset to treatment time (411 [307-560] minutes vs 278 [170-462] minutes) than those with nondisabling deficits. In the disabling group, the primary outcome following tenecteplase, compared with standard of care, occurred in 29 patients (54.7%) vs 32 patients (68.1%) (adjusted risk ratio [aRR], 0.81; 95% CI, 0.60-1.10). This neutral treatment effect was consistent in patients without disabling deficits (280 [73.9%] vs 306 [75.6%]; aRR, 0.98; 95% CI, 0.91-1.07; P for interaction = .32). Conclusions and Relevance In this secondary analysis of the TEMPO-2 randomized clinical trial, current definitions of disabling symptoms based on NIHSS score at baseline did not modify the neutral treatment effect of intravenous tenecteplase in patients with minor stroke and intracranial occlusion. Together with converging evidence comparing intravenous thrombolysis to nonthrombolytic standard of care, this analysis suggests the need to reevaluate thrombolysis in minor disabling stroke. Trial Registration ClinicalTrials.gov Identifier: NCT02398656
Hypertrophic cardiomyopathy: A review Silméia Garcia Zanati Bazan, Gilberto Ornellas de Oliveira, Caroline Ferreira da Silva Mazeto Pupo da Silveira, Fabrício Moreira Reis, Karina Nogueira Dias Secco Malagutte, et al. Arquivos Brasileiros De Cardiologia, 2020
Cerebral ischemia as initial neurological manifestation of atrial myxoma: Case report Arquivos De Neuro Psiquiatria, 2006
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