Packard, Laurel

Abstract Background and aims Rural communities have a high incidence of stroke driven by high prevalence of risk factors. We hypothesize that patient centric stroke prevention education can be delivered in rural communities. Methods High risk patients defined as Atherosclerotic Cardiovascular Disease (ASCVD) 10-year risk of ≥ 20% cardio-cerebrovascular events were identified through electronic medical records receiving primary care in Greenville and Lakeview (intervention sites) and Muskegon (control site) were included. Education material included lifestyle modification and stroke signs-symptoms information. Patients completed a pre-intervention survey, recieved standardized stroke education, and were assessed for knowledge retention through quarterly telephone follow-ups and completed a 12-month post-intervention survey. Total study cost is 130,000$ over 18 months. Results High ASCVD score was identified in 758 (Intervention) and 1128 (Control) patients. 70 intervention and 73 control patients were enrolled. Time spent consenting patients and delivering education is 5 minutes with additional 10-15 minutes at each 3-month follow-up call. 65 intervention patients completed 12 month follow up. Intervention vs. Control; Median: IQR: Age [74 (68-76) vs. 73(68-75) years; p=0.20]; Initial ASCVD [24.5 (22-30) vs. 28.6 (26-37); p<0.001], 12-month ASCVD [25(21-30) vs. 30(24-39); p=0.002). Post-intervention survey showed significant improvement in recognition of stroke risk factors (p<0.001) and stroke signs-symptoms (p<0.001). 49 (75%) patients adopted healthy lifestyle at 12-month follow up. Conclusions A primary stroke prevention cost-effective education program can be successfully implemented in a high-risk rural population, demonstrating improved stroke literacy and healthy lifestyle adoption. Conflict of interest

ABSTRACT Background and Purpose Corticospinal tract (CST) integrity is an imaging biomarker for predicting upper extremity motor recovery, but data are limited in acute ischemic stroke patients. Our study aimed to assess the impact of CST disruption on upper extremity motor recovery after acute ischemic stroke. Methods We enrolled patients with upper extremity motor deficits within 7 days of stroke onset. Patients’ clinical status was assessed for the upper extremity Fugl–Meyer assessment motor component (UE‐FM) within 7 days of stroke and at 15, 30, and 90 days. MRI with tractography was performed within 7 days of stroke. Diffusion tensor images (DTI) were processed to produce maps of fractional anisotropy (FA), apparent diffusion, axial, radial, and mean diffusivity. FA maps were used to assess CST asymmetry index (CST‐AI). Fisher's exact tests for categorical variables, two‐sample t ‐tests for normally distributed numerical data, and Wilcoxon rank sums for non‐normally distributed numeric data were used. Results A total of 21 patients were enrolled in the study with a mean age of 66 (±14) years and median baseline upper extremity motor component score (UE‐FM) of 42 (median) [range: 23, 53]. Baseline UE‐FM was not predictive of a 10‐point change at 90 days ( p = 0.4469). CST‐AI was predictive of recovery at 15 days ( p = 0.0373), and axial diffusivity was predictive of recovery at 90 days ( p = 0.0402). All other imaging variables did not predict recovery. Conclusion Our data suggest that upper extremity motor recovery after acute ischemic stroke is impacted by CST integrity. Further studies are needed to validate our findings.