Neurología Vascular.pósters

SmartRehab: Enhancing Stroke Recovery through Automated Telerehabilitation (P7-14.011)

2025-04-07T00:00:00Z

SmartRehab: Enhancing Stroke Recovery through Automated Telerehabilitation (P7-14.011) Velez, Faddi Saleh; Yeung, Elton; Bonin Pinto, Camila; Ling, Tsei Mei; Alet, Matías Javier; Carbonera, Leonardo; Ciopleias, Bogdan; khan, Abdul; Law, Zhe Kang; Lotlikar, Radhika; Liu, Roxanna; So, Adrian; Chan, Yin; Poon, Gloria; Boada Robayo, Laura; Rudyk, Demian; Kiper, Pawel; Yabluchanskiy, Andriy; Savitz, Sean; Luo, Louis Objective: We tested the SmartRehab efficacy, usability, and feasibility for stroke rehabilitation across seven countries. Background: Stroke is a major cause of disability worldwide. Timely and personalized rehabilitation is critical for recovery, yet current methods are limited by medical shortages, overwhelmed healthcare systems, and insurance constraints. Telerehabilitation has emerged as a promising solution to address these gaps. The SmartRehab app, developed to tackle these issues, uses an Artificial Intelligence powered, computer vision-based pose estimation algorithm to track patient movements, providing precise performance assessment, immediate feedback, and tailored adjustments. The app operates autonomously, allowing patients to complete sessions without a physical therapist (PT) being present, while a single PT can remotely track progress and monitor dozens of patients offline at their convenience. Design/Methods: This ongoing prospective single-arm international multicenter study spans four continents, testing SmartRehab's feasibility and efficacy for post-stroke motor disability. Participants enrolled receive a 4-week automated telerehabilitation program, prescribed by PTs using the SmartRehab platform. Motor improvements are assessed with the Fugl-Meyer Assessment (FMA) for upper and lower extremities. Usability and satisfaction are measured using the Telehealth Usability Questionnaire (TUQ). Results: This ongoing multicenter study has enrolled 30 subjects to date, with 15 stroke survivors completing telerehabilitation (mean age 57.6±16.97; 75% male). Preliminary analysis of patients with complete FMA (n=11) revealed a statistically significant improvement in upper extremity motor function (mean change [Baseline-Follow-up: −10.8±6.8; p<0.001]) and a trend toward improvement in lower extremities (mean change: −4.571±4.9; p=0.052). Usability feedback showed high ratings on TUQ (1-poor,7-great, mean 5.87±1.1). Therapists reported high satisfaction, ease of use, and benefits for patients, while adherence rates varied across countries (19%–95%, average 48%), with lower compliance linked to technology challenges Conclusions: SmartRehab is a feasible and effective telerehabilitation platform for stroke recovery, with high user satisfaction. Significant motor function improvements were observed. Addressing technological barriers may enhance adherence and outcome

EE277 Cost of Stroke in Latin America: A Multicentric Time-Driven Activity-Based Costing Study

2024-12-01T00:00:00Z

EE277 Cost of Stroke in Latin America: A Multicentric Time-Driven Activity-Based Costing Study Dittrich, L.; Etges, A.P.; Souza, J.S.; Marcolino, M.A.Z.; Rocha, E.; Amaya, P.; Barboza, M.; Saavedra, A.G.; Hornos, G.P.; Abanto, C.; Castillo-Soto, A.L.; Llanos-Leyton, N.; Pujol Lereis, Virginia Andrea; Rodríguez Pérez, María Soledad; Alet, Matías Javier; Navia, V.; Lopez, S.; Arauz, A.; Serrano, F.; Chwal, B. Objectives Given the significant global health challenge posed by stroke, this study aims to measure stroke costs in Latin American countries by analyzing the precise costs of acute ischemic stroke and their regional variabilities using accurate microcosting techniques. Methods A comprehensive international multicenter study evaluated the direct costs of patients admitted with acute ischemic stroke from December 2021 to December 2022. Data were collected from stroke centers in Argentina, Brazil, Chile, Colombia, Costa Rica, Mexico, Peru, and Uruguay. Direct costs were assessed using a microcosting method. Factors considered included favorable outcomes (modified Rankin Scale (mRS) 0-2), clinical risk levels (age and stroke severity), and treatment interventions (medical treatment alone, intravenous thrombolysis, and mechanical thrombectomy). Purchasing power parity adjustments and international dollar conversions facilitated cross-country comparisons. Descriptive analyses were performed stratified by country and Generalized Estimating Equation models assessed the relationship between clinical variables and total cost per patient. Results The study included 1,106 patients. Among them, 74% received medical treatment alone, 18% received IVT, 4% underwent MT, and 3% received combined IVT and MT. Costs increased with patients clinical risk, outcomes, and treatment options. MT incurred costs 3.1 times higher than medical treatment alone, with an incremental cost of I$20,418 per patient (p < 0.001). Treating high-risk patients incurred substantial cost increases of I$7,512 compared to medium-risk patients (p < 0.0001) and I$7,866 compared to low-risk patients (p < 0.0001). Patients in the mRS 5-6 categories had costs twice as high as those in the mRS 0-2 categories. Conclusions The study reveals disparities in stroke costs across Latin America, offering a comprehensive understanding into the economic landscape and cost variations factors, particularly in under-researched regions. Continued investment in evidence-based research and value-based care models is essential to ensure equitable access and reduce disabilities and deaths.

Abstract WP131: Global Landscape of Stroke Rehabilitation: Access and Challenges

2025-01-30T00:00:00Z

Abstract WP131: Global Landscape of Stroke Rehabilitation: Access and Challenges Velez, Faddi Saleh; Yeung, Elton Hau Lam; Pinto, Camila Bonin; Ling, Tse Mei; Carbonera, Leonardo; Alet, Matías Javier; Ciopleias, Bogdan; Khan, Abdul Hanif Khan Yusof; Law, Zhe Kang; Lotlikar, Radhika; Ramage, Emily; Xiong, Carol; Zuurbier, Susanna; Li, Linxin; Mares, Kathryn; Kiper, Pawel; Heldner, Mirjam; Matuja, Sarah; Johnson, Louise; Caso, Valeria Background: Stroke is a leading cause of long-term disability worldwide. Timely and adequate rehabilitation is crucial for post-stroke recovery, but access is limited due to an overburdened healthcare system, medical personnel shortages, and insurance barriers. Rehabilitation access is especially limited for stroke survivors in rural and low-income regions. Innovative solutions like telerehabilitation are needed to expand access. This study examines current rehabilitation practices, costs, and global telerehabilitation models, as well as barriers to rehabilitation utilization. Methods: We conducted an online survey aimed at stroke care providers, affiliated societies, and partner organizations to collect comprehensive data on the availability and practices of post-stroke rehabilitation and telerehabilitation across various regions. Results: A total of 523 responses were collected from 62 different countries (Fig1), with the majority of respondents being physicians (66.7%), followed by physiotherapists (15.7%). Most respondents reported working in urban areas (82.9%) and were primarily employed in public community hospitals (40.5%), with a significant portion also working in academic institutions (35.3%). Regarding experience, 45.1% of respondents had over 10 years of experience in the stroke field. Telerehabilitation services for stroke were not offered by most of the surveyed sites (71.1%). Among those that did provide telerehabilitation, most sessions were individualized for a single patient (34.7%), followed by sessions involving two patients (24.8%). Notably, 18.36% of the sites offered sessions for groups of more than 10 patients at a time. The frequency of sessions varied, with the majority offering a single session per week (30.6%), followed by two sessions per week (20%), while only 8% provided sessions five days a week. On average, the duration of these sessions ranged from 31 to 60 minutes (53.1%). The most reported barriers to providing adequate telerehabilitation services included the availability of electronic hardware devices (12.9%) and internet access (12.9%). Other significant barriers included poor video call quality (10.4%) and the lack of clear guidelines and protocols (9.2%). Conclusion: The survey results provide a comprehensive overview of current practices and availability of post-stroke rehabilitation and telerehabilitation, highlighting the global burden of post-stroke disability due to limited access to rehabilitation.

Abstract 147: Telestroke Network Mapping: An Update of the World Landscape for Remote Stroke Care

2025-01-30T00:00:00Z

Abstract 147: Telestroke Network Mapping: An Update of the World Landscape for Remote Stroke Care Velez, Faddi Saleh; Tunkl, Christine; Agarwal, Ayush; Roushdy, Tamer; Ullberg, Teresa; Carbonera, Leonardo; Ciopleias, Bogdan; Khan, Abdul Hanif Khan Yusof; Heldner, Mirjam; Khan, Maria; Alet, Matías Javier; Matuja, Sarah; Ramage, Emily; Lagos, Javier; Mosconi, Maria Giulia; Katsanos, Aristeidis; Li, Linxin; Gerner, Stefan; Zuurbier, Susanna; Law, Zhe Kang Background: Telestroke has proven efficacy in improving clinical outcomes by providing rapid access to specialized stroke care, particularly in remote areas. However, the global implementation of telestroke networks remains uneven, with limited data on their structure and coverage outside of high-income countries (HICs). Objective: This study aimed to provide a comprehensive overview of the global landscape of telestroke networks, highlighting disparities and underscoring the need for universal guidelines. We aimed to map the global telestroke landscape, characterize existing networks, and identify disparities in access, technological adoption, and quality monitoring practices across different regions. Methods: We conducted a three-tiered identification process involving engagement with national stroke experts, stroke societies, and international authorities, supplemented by extensive literature and internet searches to identify providers involved in telestroke networks worldwide. A detailed 39-question survey was distributed to the leaders of identified telestroke networks, assessing their structural characteristics, operational processes, and quality monitoring practices. Results: A total of 254 telestroke networks were identified across 67 countries (Figure 1), with 69% located in HICs. The response rate to our survey was 34%, with 88 networks from 31 countries providing detailed data. Our findings reveal significant disparities in the establishment and operation of telestroke networks. HICs predominantly host large, well-established networks, with robust technological infrastructures and comprehensive quality monitoring. In contrast, networks in low- and middle-income countries (LMICs) are fewer, smaller, and often lack advanced technology and standardized quality assurance measures. Notably, 87% of networks established within the last three years are located in non-HIC regions, signaling a shift toward broader global implementation. Conclusion: This study provides one of the most comprehensive global mappings of telestroke networks to date, uncovering significant disparities in access, resources availability (Figure 2) and quality monitoring practices. While telestroke networks are expanding into LMICs, there remains a critical need for universally applicable guidelines that can be adapted to diverse resource settings.