A5008968693- Stroke Rehabilitation and Recovery
- Acute Ischemic Stroke Management
- Botulinum Toxin and Related Neurological Disorders
- Venous Thromboembolism Diagnosis and Management
- Cerebral Palsy and Movement Disorders
- Cerebrovascular and Carotid Artery Diseases
- Intracerebral and Subarachnoid Hemorrhage Research
- Transcranial Magnetic Stimulation Studies
- Nutritional Studies and Diet
- Traumatic Brain Injury and Neurovascular Disturbances
- Hemophilia Treatment and Research
- Atrial Fibrillation Management and Outcomes
- Trauma and Emergency Care Studies
- Dysphagia Assessment and Management
- Vascular Malformations Diagnosis and Treatment
- Climate Change and Health Impacts
- Geriatric Care and Nursing Homes
- Patient Satisfaction in Healthcare
- Mobile Health and mHealth Applications
- Esophageal and GI Pathology
- Healthcare Systems and Public Health
- Balance, Gait, and Falls Prevention
- Blood donation and transfusion practices
- Healthcare Systems and Practices
- Clinical practice guidelines implementation
The University of Texas Health Science Center at Houston
2006-2021
Memorial Hermann
2011-2015
The University of Texas at Austin
2004-2015
Houston Medical Center
2015
University of Houston
2009-2014
University of California, Irvine
2009-2014
University of California, Los Angeles
2009-2014
Research Triangle Park Foundation
2009-2014
GlaxoSmithKline (United States)
2009-2014
Texas Medical Center
2012
Mobile stroke units (MSUs) are ambulances with staff and a computed tomographic scanner that may enable faster treatment tissue plasminogen activator (t-PA) than standard management by emergency medical services (EMS). Whether how much MSUs alter outcomes has not been extensively studied.In an observational, prospective, multicenter, alternating-week trial, we assessed from MSU or EMS within 4.5 hours after onset of acute symptoms. The primary outcome was the score on utility-weighted...
Limited data are available about the effectiveness of early rehabilitation after stroke.This is 1st randomized controlled trial constraint-induced movement therapy (CIMT) in subacute stroke to investigate neurophysiologic mechanisms and long-term outcome.Within 2 weeks stroke, 23 patients with upper extremity (UE) weakness were CIMT or traditional at an equal frequency up 3 h/day. Motor function affected UE was blindly assessed before treatment, months stroke. Transcranial magnetic...
Background and Purpose— This study evaluated the safety efficacy of aggressive mechanical clot disruption (AMCD) in acute stroke patients with persisting middle cerebral artery (MCA) or internal carotid (ICA) occlusion after thrombolytic therapy. Methods— Retrospective case series were used from a prospectively collected database on consecutive ischemic treated intra-arterial (IA) thrombolytics during 5-year interval. Thrombolytic dosage, endovascular techniques, immediate final...
<b>Background: </b> Spontaneous intracerebral hemorrhage (ICH) is frequently associated with intraventricular (IVH), which an independent predictor of poor outcome. The purpose this study was to examine the relationship between ICH volume and anatomic location IVH, determine if decompression into ventricle truly beneficial. <b>Methods: We retrospectively analyzed CT scans charts all patients admitted our stroke center over a 3-year period. Outcome data were collected using prospective...
Faster treatment with intravenous tissue-type plasminogen activator (tPA) is likely to improve outcomes. Optimizing prehospital triage by mobile stroke units (MSUs) may speed times. The Benefits of Stroke Treatment Delivered Using a Mobile Unit (BEST-MSU) study was launched in May 2014 using the first MSU United States compare management an versus standard (SM). Herein, we describe results prespecified, nonrandomized run-in phase designed obtain preliminary data on logistics.The consisted 8...
Recently, the Mobile Stroke Unit (MSU) concept was introduced in Germany demonstrating prehospital treatment of more patients within first hour symptom onset. However, details and complexities establishing such a program United States are unknown. We describe steps involved setting up MSU States.Implementation included leadership, fund-raising, purchase build-out, knitting collaborative consortium community stakeholders, writing protocols to ensure accountability, radiation safety,...
Constraint-induced movement therapy improves outcome after chronic stroke, conforms experimental observations of neuronal plasticity, and proves the efficacy intensive occupational therapy. More acutely instituted constraint-induced has both practical theoretic risks benefits that deserve further careful evaluation.
Background and Purpose— We routinely perform an urgent bedside neurovascular ultrasound examination (NVUE) with carotid/vertebral duplex transcranial Doppler (TCD) in patients acute cerebral ischemia. aimed to determine the yield accuracy of NVUE identify lesions amenable for interventional treatment (LAITs). Methods— was performed portable carotid TCD using standardized fast-track (<15 minutes) insonation protocols. Digital subtraction angiography (DSA) gold standard identifying LAIT....
The optimal approach for acute ischemic stroke patients who do not respond to intravenous recombinant tissue plasminogen activator (IV rt-PA) is uncertain. This study evaluated the safety and response intra-arterial thrombolytics (IATs) in unresponsive full-dose IV rt-PA.A case series from a prospectively collected database on consecutive treated with IATs after 0.9 mg/kg rt-PA during 7-year interval was collected. Primary outcome measures included symptomatic intracranial hemorrhage...
Background and Purpose— Studies have established a relation between recanalization improved clinical outcome in acute ischemic stroke patients; however, intra-arterial clot size has not been routinely assessed. The aim of the study was to determine impact thrombus burden on treatment (IAT) outcome. Methods— A retrospective review our IAT database included procedure time, recanalization, symptomatic intracranial hemorrhage, poor (modified Rankin Scale score ≥4 at discharge), mortality....
Purpose: The purpose was to compare the effectiveness of robotic-assisted body weight supported treadmill training using Lokomat® over-ground gait (OGT) in adults with chronic stroke. Methods: Participants were randomly assigned or OGT interventions. Both protocols included 40 sessions over 8 weeks. Primary outcome measures 10-meter walk test and 6-minute distance. Secondary Functional Independence MeasureTM locomotion score, Fugl-Meyer Lower Extremity Motor Score (FM-LE), Barthel Index,...
Preliminary assessments of the feasibility, safety, and effects on neuronal reorganization measured with transcranial magnetic stimulation (TMS) from Constraint-Induced Movement Therapy (CIMT) upper extremity were made in eight cases subacute stroke. Within fourteen days their stroke, patients randomly assigned to two weeks CIMT or traditional therapy. Baseline motor performance cortical/subcortical representation for movement TMS assessed before treatment. Post-treatment at end treatment...
Background and Purpose— Evidence suggests the potential to improve motor status in patients with stroke by modifying brain catecholaminergic tone. The current study hypothesized that increased dopaminergic tone via dopamine agonist ropinirole, when combined physiotherapy (PT), would significantly safely increase gait velocity. Methods— Patients moderate deficits due 1 12 months prior were randomized (double blinded) 9 weeks of immediate-release ropinirole or placebo, each PT, followed up for...
Behavioral measures are often used to distinguish subgroups of patients with stroke (eg, predict treatment gains, stratify clinical trial enrollees, or select rehabilitation therapy). In studies the upper extremity, brain function using functional magnetic resonance imaging (fMRI) have also been found useful, but this approach has not examined for lower extremity. The current study hypothesized that an fMRI-based measure cortical would significantly improve prediction treatment-induced...
<h3>Background</h3> Most patients with cardioembolic stroke require long-term anticoagulation. Still, uncertainty exists regarding the best mode of starting <h3>Design, Setting, and Patients</h3> We conducted a retrospective review all admitted to our center from April 1, 2004, June 30, 2006, not treated tissue plasminogen activator. Patients were grouped by treatment: no treatment, aspirin only, followed warfarin sodium, intravenous heparin sodium in acute phase (heparin bridging),...
Background Minorities have an increased incidence of early-onset, obesity-related cerebrovascular disease. Unfortunately, effective weight management in this vulnerable population has significant barriers. Objective Our objective was to determine the feasibility and preliminary treatment effects a smartphone-based loss intervention versus food journals monitor dietary patterns minority stroke patients. Methods Swipe out Stroke pilot prospective randomized controlled trial with open blinded...
We report the case of a 16-year-old Caucasian girl who developed acute onset left hemiplegia, hemisensory deficit, and dysarthria. After negative computed tomographic scan brain, patient was given intravenous recombinant tissue plasminogen activator according to established adult guidelines. The experienced marked improvement within 24 hours. Stroke etiology determined be paradoxical embolus via patent foramen ovale associated with pelvic vein thrombosis. This illustrates importance early...
Swipe out Stroke (SOS) examines the use of a smartphone-based mobile application to reduce obesity in high-risk minority stroke patients. At record-high levels United States, disproportionately affects minorities and is highly correlated with cerebrovascular disease. Unfortunately, structured weight loss programs are expensive, compliance significantly decreases upon program completion. Mobile health (mHealth) technology an innovative, cost-effective way bridge this gap. Minorities spend...
This study aimed to evaluate factors that help determine the post-acute level of care for stroke patients with aspiration pneumonia (ASPNA).This was a retrospective observational admitted University Texas at Houston Medical School Stroke Service between July 2004 and October 2009 discharge dispositions home, inpatient rehabilitation, skilled nursing facility, or subacute (n = 3511). Demographics, risk factors, National Institutes Health Scale (NIHSS) values were collected. Interactions...
We report myocardial injury in 20 recombinant factor VIIa (rFVIIa) treated and 110 nontreated patients with intracerebral hemorrhage. Patients were or received standard medical management. All EKG cardiac enzyme testing. Elevated troponin occurred 20% vs 3% (p = 0.02). Myocardial infarction 10% 1% 0.01). found a significant increase rFVIIa patients.
Acute ischemic stroke patients who receive recombinant tissue plasminogen activator (rt-PA) within 3 hours of symptom onset are 30% more likely to have minimal no disability at months. During hospitalization, short-term is subjectively measured by discharge disposition, whether home, inpatient rehabilitation, a skilled nursing facility, or subacute care. There studies assessing the role use as predictor poststroke disposition.
Objective To test the role of hospital‐acquired symptomatic urinary tract infection (SUTI) as an independent predictor discharge disposition in acute stroke patient. Study Design A retrospective study data collected from a registry service. The is maintained by Specialized Programs Translational Research Acute Stroke Data Core. national network 8 centers that perform early phase clinical projects, share data, and promote new approaches to therapy for stroke. Setting single university‐based...