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Functional Impairment Evaluation and Personalized Treatment in Stroke Patients

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A special issue of Journal of Personalized Medicine (ISSN 2075-4426). This special issue belongs to the section "Methodology, Drug and Device Discovery".

Deadline for manuscript submissions: closed (28 February 2022) | Viewed by 40500

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Prof. Dr. Won Hyuk Chang

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Department of Physical & Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
Interests: neurorehabilitation; neuroplasticity; non-invasive brain stimulation; stroke rehabilitation; Parkinson’s disease rehabilitation

Special Issue Information

Dear Colleagues,

Stroke patients commonly have functional impairments even after proper acute management, and disability after stroke can be a significant burden on patients, caregivers, and society. Many efforts have been made to improve the function in stroke patients. Unlike other diseases, each stroke patient can show different impairments in various functional domains, and a wide variety of factors affect disability in stroke patients. Therefore, it is necessary to apply accurate evaluation for functions and personalized treatment methods in consideration of various characteristics of each stroke patient to improve function. This Special Issue of the Journal of Personalized Medicine aims to highlight the current state of the science and clinical research of the latest findings in the field of stroke rehabilitation. Studies include those that explore new assessment tools using advance technology, and clinical and patient-based approaches. Scientific advances in the field of neuroscience and stroke rehabilitation will continue to pave the path toward personalized evaluation and treatment for optimal management.

Dr. Won Hyuk Chang
Guest Editor

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Personalized Medicine is an international peer-reviewed open access monthly journal published by MDPI.

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Keywords

Personalized approaches
Precision medicine
Biomarkers
Genomics
Recovery of function
Stroke rehabilitation
Neuroplasticity

Published Papers (12 papers)

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Editorial

Jump to: Research, Review

3 pages, 197 KiB

Open AccessEditorial

Personalized Approaches to Stroke: One Step Forward for Functional Recovery of Stroke Patients

by Won Hyuk Chang

J. Pers. Med. 2022, 12(5), 822; https://0-doi-org.brum.beds.ac.uk/10.3390/jpm12050822 - 19 May 2022

Cited by 3 | Viewed by 1426

Abstract

Recent advances in diagnoses, management, and rehabilitation have had a significant impact to reduce mortality and functional recovery in stroke patients. In spite of these medical advances, many stroke survivors still suffer from significant disabilities. Stroke is a complex disease caused by a combination of multiple risk factors. Therefore, personalized medicine is more important than any other field to overcome the limitations of current stroke management and rehabilitation. It is necessary to apply accurate evaluation for functions and a personalized approach in consideration of various characteristics of each stroke patient to improve function. The objective of this Special Issue is to inform the recent scientific knowledge, current limitations, and challenges for an individually tailored strategy in the areas of diagnosis, treatment, and rehabilitation of stroke. A multidisciplinary approach and research will be strongly encouraged for personalized medicine in the field of stroke treatment and rehabilitation. Full article

(This article belongs to the Special Issue Functional Impairment Evaluation and Personalized Treatment in Stroke Patients)

Research

Jump to: Editorial, Review

13 pages, 1611 KiB

Open AccessArticle

Role of Catechol-O-methyltransferase Val158Met Polymorphism on Transcranial Direct Current Stimulation in Swallowing

by Hyemi Hwang, Yeonjae Han, Geun-Young Park, Soohwan Lee, Hae-Yeon Park and Sun Im

J. Pers. Med. 2022, 12(3), 488; https://0-doi-org.brum.beds.ac.uk/10.3390/jpm12030488 - 17 Mar 2022

Cited by 2 | Viewed by 1963

Abstract

Transcranial direct current stimulation (tDCS) is one of the latest post-stroke dysphagia treatment modalities, and the effect of tDCS is known to be affected by various factors including genetic polymorphisms. However, the role of catechol-O-methyltransferase (COMT) polymorphisms on tDCS in swallowing is unclear. In this prospective pilot study, we aim to explore the effect of tDCS on the swallowing cortex and subsequent swallowing motor function according to COMT polymorphism. Twenty-four healthy participants received either anodal tDCS or sham mode tDCS on the mylohyoid motor cortex at random order, after inhibitory repetitive transcranial magnetic stimulation (rTMS) for preconditioning. The primary outcome was the changes of mylohyoid-motor-evoked potentials (MH-MEP) amplitude in each COMT polymorphism group, from the post-inhibitory rTMS baseline state to immediate, 30, and 60 min after tDCS. The secondary outcomes were the changes in swallowing function. The results showed that COMT Val/Val polymorphism showed improvement across time in the MH-MEP amplitudes and triggering time of swallowing after tDCS, whereas COMT Met carrier group did not show significant changes of MH-MEP or swallowing function across time. This therapeutic response variability of tDCS in the mylohyoid motor system according to COMT polymorphism support the importance of genetic analysis in individualized dysphagia treatment. Full article

(This article belongs to the Special Issue Functional Impairment Evaluation and Personalized Treatment in Stroke Patients)

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7 pages, 1127 KiB

Open AccessArticle

Changes in Bihemispheric Structural Connectivity Following Middle Cerebral Artery Infarction

by Dae Hyun Kim and Hyunkoo Kang

J. Pers. Med. 2022, 12(1), 81; https://0-doi-org.brum.beds.ac.uk/10.3390/jpm12010081 - 10 Jan 2022

Cited by 2 | Viewed by 1222

Abstract

This study investigated the changes in the structural connectivity of the bilateral hemispheres over time following a middle cerebral artery infarction. Eighteen patients in the subacute group and nine patients in the chronic group with mild upper extremity motor impairment (Fugl-Meyer motor assessment score for the upper limb > 43) following middle cerebral artery infarction were retrospectively evaluated in this study. All the patients underwent T1-weighted and diffusion tensor imaging. Tract-based statistical analyses of fractional anisotropy were used to compare the changes in the bilateral structural connectivity with those of age-matched normal controls. The corticospinal tract pathway of the affected hemisphere, corpus callosum, and corona radiata of the unaffected hemisphere had decreased structural connectivity in the subacute group, while the motor association area and anterior corpus callosum in the bilateral frontal lobes had increased structural connectivity in the chronic group. The bilateral hemispheres were influenced even in patients with mild motor impairment following middle cerebral artery infarction, and the structural connectivity of the bilateral hemispheres changed according to the time following the stroke. Full article

(This article belongs to the Special Issue Functional Impairment Evaluation and Personalized Treatment in Stroke Patients)

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12 pages, 734 KiB

Open AccessArticle

Virtual Reality and Physiotherapy in Post-Stroke Functional Re-Education of the Lower Extremity: A Controlled Clinical Trial on a New Approach

by Carlos Luque-Moreno, Pawel Kiper, Ignacio Solís-Marcos, Michela Agostini, Andrea Polli, Andrea Turolla and Angel Oliva-Pascual-Vaca

J. Pers. Med. 2021, 11(11), 1210; https://0-doi-org.brum.beds.ac.uk/10.3390/jpm11111210 - 16 Nov 2021

Cited by 11 | Viewed by 5033

Abstract

Numerous Virtual Reality (VR) systems address post-stroke functional recovery of the lower extremity (LE), most of them with low early applicability due to the gait autonomy they require. The aim of the present study was to evaluate the feasibility of a specific VR treatment and its clinical effect on LE functionality, gait, balance, and trunk control post-stroke. A controlled, prospective, clinical trial was carried out with 20 stroke patients, who were divided into two groups: the first group (VR + CP; n = 10) received combined therapy of 1 h VR and 1 h of conventional physiotherapy (CP) and the second group (CP; n = 10) received 2 h of CP (5 days/week, for 3 weeks). The following pre-post-intervention measuring scales were used: Functional Ambulatory Scale (FAC), Functional Independence Measure (FIM), Fugl-Meyer Assessment (FM), Berg Balance Scale (BBS), and Trunk Control Test (TCT). Only VR + CP showed a significant improvement in FAC. In FIM, CP presented a tendency to significance, whereas VR + CP showed significance. Both groups improved significantly in FM (especially in amplitude/pain in VR + CP and in sensitivity in CP) and in BBS. In TCT, there was a non-significant improvement in both groups. The results indicate that the intervention with VR is a feasible treatment in the post-stroke functional re-education of the LE, with the potential to be an optimal complement of CP. Full article

(This article belongs to the Special Issue Functional Impairment Evaluation and Personalized Treatment in Stroke Patients)

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14 pages, 1039 KiB

Open AccessArticle

Risk of Re-Rupture, Vasospasm, or Re-Stroke after Clipping or Coiling of Ruptured Intracranial Aneurysms: Long-Term Follow-Up with a Propensity Score-Matched, Population-Based Cohort Study

by Jiaqiang Zhang, Yang-Lan Lo, Ming-Chang Li, Ying-Hui Yu and Szu-Yuan Wu

J. Pers. Med. 2021, 11(11), 1209; https://0-doi-org.brum.beds.ac.uk/10.3390/jpm11111209 - 16 Nov 2021

Cited by 3 | Viewed by 2509

Abstract

Scarce evidence is available in Asia for estimating the long-term risk and prognostic factors of major complications such as re-rupture, vasospasm, or re-stroke for patients with aneurysmal subarachnoid hemorrhage (SAH) undergoing endovascular coil embolization or surgical clipping. This is the first head-to-head propensity score-matched study in an Asian population to demonstrate that endovascular coil embolization for aneurysmal SAH treatment is riskier than surgical clipping in terms of re-rupture, vasospasm, or re-stroke. In addition, the independent poor prognostic factors of vasospasm or re-stroke were endovascular coil embolization, male sex, older age (≥65 years; the risk of vasospasm increases with age), hypertension, congestive heart failure, diabetes, previous transient ischemic attack, or stroke in aneurysmal SAH treatment. Background: To estimate the long-term complications and prognostic factors of endovascular coil embolization or surgical clipping for patients with ruptured aneurysmal subarachnoid hemorrhage (SAH). Methods: We selected patients diagnosed with aneurysmal SAH between 1 January 2011 and 31 December 2017. Propensity score matching was performed, and Cox proportional hazards model curves were used to analyze the risk of re-rupture, vasospasm, and re-stroke in patients undergoing the different treatments. Findings: Multivariate Cox regression analysis revealed that the adjusted hazard ratio (aHR) of re-rupture for endovascular coil embolization compared with surgical clipping was 1.36 (95% confidence interval [CI]: 1.17–1.57; p < 0.0001). The aHRs of the secondary endpoints of vasospasm and re-stroke (delayed cerebral ischemia) for endovascular coil embolization compared with surgical clipping were 1.14 (1.02–1.27; p = 0.0214) and 2.04 (1.83–2.29; p < 0.0001), respectively. The independent poor prognostic factors for vasospasm and re-stroke were endovascular coil embolization, male sex, older age (≥65 years; risk increases with age), hypertension, congestive heart failure, diabetes, and previous transient ischemic attack or stroke. Interpretation: Endovascular coil embolization for aneurysmal SAH carries a higher risk than surgical clipping of both short- and long-term complications including re-rupture, vasospasm, and re-stroke. Full article

(This article belongs to the Special Issue Functional Impairment Evaluation and Personalized Treatment in Stroke Patients)

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10 pages, 1738 KiB

Open AccessArticle

Corticoreticular Pathway in Post-Stroke Spasticity: A Diffusion Tensor Imaging Study

by Sung-Hwa Ko, Taehyung Kim, Ji Hong Min, Musu Kim, Hyun-Yoon Ko and Yong-Il Shin

J. Pers. Med. 2021, 11(11), 1151; https://0-doi-org.brum.beds.ac.uk/10.3390/jpm11111151 - 04 Nov 2021

Cited by 9 | Viewed by 1965

Abstract

One of the pathophysiologies of post-stroke spasticity (PSS) is the imbalance of the reticulospinal tract (RST) caused by injury to the corticoreticular pathway (CRP) after stroke. We investigated the relationship between injuries of the CRP and PSS using MR diffusion tensor imaging (DTI). The subjects were divided into spasticity and control groups. We measured the ipsilesional fractional anisotropy (iFA) and contralesional fractional anisotropy (cFA) values on the reticular formation (RF) of the CRP were on the DTI images. We carried out a retrospective analysis of 70 patients with ischemic stroke. The cFA values of CRP in the spasticity group were lower than those in the control group (p = 0.04). In the sub-ROI analysis of CRP, the iFA values of pontine RF were lower than the cFA values in both groups (p < 0.05). The cFA values of medullary RF in the spasticity group were lower than the iFA values within groups, and also lower than the cFA values in the control group (p < 0.05). This results showed the CRP injury and that imbalance of RST caused by CRP injury was associated with PSS. DTI analysis of CRP could provide imaging evidence for the pathophysiology of PSS. Full article

(This article belongs to the Special Issue Functional Impairment Evaluation and Personalized Treatment in Stroke Patients)

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7 pages, 510 KiB

Open AccessArticle

Probable Factors Associated with Response to Mesenchymal Stem Cell Therapy in Stroke Patients: A Post Hoc Analysis of the STARTING-2 Trial

by Won Hyuk Chang, Jungsoo Lee, Jong-Won Chung, Yun-Hee Kim, Oh Young Bang and The STARTING-2 Collaborators

J. Pers. Med. 2021, 11(11), 1137; https://0-doi-org.brum.beds.ac.uk/10.3390/jpm11111137 - 02 Nov 2021

Cited by 8 | Viewed by 1782

Abstract

The aim of this study was to identify factors associated with improved motor function of the lower extremities in response to mesenchymal stem cell (MSC) therapy in patients with ischemic stroke. This study was a post hoc analysis of data from a prospective, open-label, randomized controlled trial of MSC therapy for patients with ischemic stroke patients associated with severe middle cerebral artery territory (STARTING-2 trial). Lower limb motor function was scored based on the lower limb of Fugl–Meyer assessment (FMA-LL) score before MSC therapy and at 3 months after stroke. All FMA-LL changes greater than or equal to six points were considered clinically significant. Univariate and multivariate binary logistic regression models were used to determine possible predictors of clinically significant lower limb motor response to MSC therapy. Twelve (33%) of the thirty-six patients receiving MSC therapy reached a minimal clinically important difference (MCID) of FMA-LL. The two independent factors with the greatest impact on response to MSC therapy for achieving an MCID in FMA-LL score were: (1) the time from stroke onset to MSC therapy, and (2) age (p < 0.05). In addition, obese stroke patients responded better to MSC therapy than stroke patients with normal weight. In conclusion, this post hoc analysis might suggest the need for recruiting stroke patients at younger and early after stroke onset in future clinical trials of MSC therapy for stroke. Full article

(This article belongs to the Special Issue Functional Impairment Evaluation and Personalized Treatment in Stroke Patients)

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11 pages, 1807 KiB

Open AccessArticle

Machine Learning-Based Classification of Dependence in Ambulation in Stroke Patients Using Smartphone Video Data

by Jong Taek Lee, Eunhee Park and Tae-Du Jung

J. Pers. Med. 2021, 11(11), 1080; https://0-doi-org.brum.beds.ac.uk/10.3390/jpm11111080 - 25 Oct 2021

Cited by 8 | Viewed by 2294

Abstract

The goal of this study was to develop a framework to classify dependence in ambulation by employing a deep model in a 3D convolutional neural network (3D-CNN) using video data recorded by a smartphone during inpatient rehabilitation therapy in stroke patients. Among 2311 video clips, 1218 walk action cases were collected from 206 stroke patients receiving inpatient rehabilitation therapy (63.24 ± 14.36 years old). As ground truth, the dependence in ambulation was assessed and labeled using the functional ambulatory categories (FACs) and Berg balance scale (BBS). The dependent ambulation was defined as a FAC score less than 4 or a BBS score less than 45. We extracted patient-centered video and patient-centered pose of the target from the tracked target’s posture keypoint location information. Then, the extracted patient-centered video was input in the 3D-CNN, and the extracted patient-centered pose was used to measure swing time asymmetry. Finally, we evaluated the classification of dependence in ambulation using video data via fivefold cross-validation. When training the 3D-CNN based on FACs and BBS, the model performed with 86.3% accuracy, 87.4% precision, 94.0% recall, and 90.5% F1 score. When the 3D-CNN based on FACs and BBS was combined with swing time asymmetry, the model exhibited improved performance (88.7% accuracy, 89.1% precision, 95.7% recall, and 92.2% F1 score). The proposed framework for dependence in ambulation can be useful, as it alerts clinicians or caregivers when stroke patients with dependent ambulatory move alone without assistance. In addition, monitoring dependence in ambulation can facilitate the design of individualized rehabilitation strategies for stroke patients with impaired mobility and balance function. Full article

(This article belongs to the Special Issue Functional Impairment Evaluation and Personalized Treatment in Stroke Patients)

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16 pages, 942 KiB

Open AccessArticle

Comparative Assessment of Robotic versus Classical Physical Therapy Using Muscle Strength and Ranges of Motion Testing in Neurological Diseases

by Zoltán Zsigmond Major, Calin Vaida, Kinga Andrea Major, Paul Tucan, Emanuela Brusturean, Bogdan Gherman, Iosif Birlescu, Raul Craciunaș, Ionut Ulinici, Gábor Simori, Alexandru Banica, Nicoleta Pop, Alin Burz, Giuseppe Carbone and Doina Pisla

J. Pers. Med. 2021, 11(10), 953; https://0-doi-org.brum.beds.ac.uk/10.3390/jpm11100953 - 25 Sep 2021

Cited by 10 | Viewed by 3491

Abstract

The use of robotic systems in physical rehabilitation protocols has become increasingly attractive and has been given more focus in the last decade as a result of the high prevalence of motor deficits in the population, which is linked to an overburdened healthcare system. In accordance with current trends, three robotic devices have been designed, called ParReEx Elbow, ParReEx Wrist, and ASPIRE, which were designed to improve upper-limb medical recovery (shoulder, elbow, forearm, and wrist). The three automated systems were tested in a hospital setting with 23 patients (12 men and 11 women) suffering from motor deficits caused by various neurological diseases such as stroke, Parkinson’s disease, and amyotrophic lateral sclerosis (ALS). The patients were divided into three groups based on their pathology (vascular, extrapyramidal, and neuromuscular). Objective clinical measures, such as the Medical Research Council (MRC) scale, goniometry, and dynamometry, were used to compare pre- and post-rehabilitation assessments for both robotic-aided and manual physical rehabilitation therapy. The results of these tests showed that, with the exception of a few minor differences in muscular strength recovery, the robotic-assisted rehabilitation methods performed equally as well as the manual techniques, though only minor improvements were validated during short-term rehabilitation. The greatest achievements were obtained in the goniometric analysis where some rehabilitation amplitudes increased by over 40% in the vascular group, but the same analysis returned regressions in the neuromuscular group. The MRC scale analysis returned no significant differences, with most regressions occurring in the neuromuscular group. The dynamometric analysis mostly returned improvements, but the highest value evolution was 19.07%, which also in the vascular group. While the results were encouraging, more research is needed with a larger sample size and a longer study period in order to provide more information regarding the efficacy of both rehabilitation methods in neurological illnesses. Full article

(This article belongs to the Special Issue Functional Impairment Evaluation and Personalized Treatment in Stroke Patients)

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15 pages, 2575 KiB

Open AccessFeature PaperArticle

Cerebrolysin Combined with Rehabilitation Enhances Motor Recovery and Prevents Neural Network Degeneration in Ischemic Stroke Patients with Severe Motor Deficits

by Won Hyuk Chang, Jungsoo Lee, Yong-Il Shin, Myoung-Hwan Ko, Deog Young Kim, Min Kyun Sohn, Jinuk Kim and Yun-Hee Kim

J. Pers. Med. 2021, 11(6), 545; https://0-doi-org.brum.beds.ac.uk/10.3390/jpm11060545 - 11 Jun 2021

Cited by 11 | Viewed by 2823

Abstract

The objective of this study was to evaluate whether Cerebrolysin combined with rehabilitation therapy supports additional motor recovery in stroke patients with severe motor impairment. This study analyzed the combined data from the two phase IV prospective, multicenter, randomized, double-blind, placebo-controlled trials. Stroke patients were included within seven days after stroke onset and were randomized to receive a 21-day treatment course of either Cerebrolysin or placebo with standardized rehabilitation therapy. Assessments were performed at baseline, immediately after the treatment course, and 90 days after stroke onset. The plasticity of the motor system was assessed by diffusion tensor imaging and resting state fMRI. In total, 110 stroke patients were included for the full analysis set (Cerebrolysin n = 59, placebo n = 51). Both groups showed significant motor recovery over time. Repeated-measures analysis of varianceshowed a significant interaction between time and type of intervention as measured by the Fugl–Meyer Assessment (p < 0.05). The Cerebrolysin group demonstrated less degenerative changes in the major motor-related white matter tracts over time than the placebo group. In conclusion, Cerebrolysin treatment as an add-on to a rehabilitation program is a promising pharmacologic approach that is worth considering in order to enhance motor recovery in ischemic stroke patients with severe motor impairment. Full article

(This article belongs to the Special Issue Functional Impairment Evaluation and Personalized Treatment in Stroke Patients)

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8 pages, 3676 KiB

Open AccessArticle

Alteration of White Matter in Patients with Central Post-Stroke Pain

by Jung Geun Park, Bo Young Hong, Hae-Yeon Park, Yeun Jie Yoo, Mi-Jeong Yoon, Joon-Sung Kim and Seong Hoon Lim

J. Pers. Med. 2021, 11(5), 417; https://0-doi-org.brum.beds.ac.uk/10.3390/jpm11050417 - 15 May 2021

Cited by 7 | Viewed by 2183

Abstract

A stroke may be followed by central post-stroke pain (CPSP), which is characterized by chronic neuropathic pain. The exact mechanism has not yet been fully uncovered. We investigated alterations in the white matters in patients with CPSP, compared with stroke patients without CPSP and normal controls. Our retrospective cross-sectional, case-control study participants were assigned to three groups: CPSP (stroke patients with CPSP (n = 17)); stroke control (stroke patients without CPSP (n = 26)); and normal control (normal subjects (n = 34)). The investigation of white matter for CPSP was focused on the values of fiber numbers (FN) and fractional anisotrophy (FA) for spinothalamic tract (STT), anterior thalamic radiation (ATR), superior thalamic radiation (STR) and posterior thalamic radiation (PTR), and corticospinal tract (CST) was measured. The FA for the STT and STR of the CPSP group were lower than those for the stroke control and normal control groups. The FA of CST and ATR did not differ between the CPSP and stroke groups, but both differed from the normal control. The FA of PTR in the stroke control group differed from the normal control group, but not from the CPSP group. The FN of CST, STT, ATR, and STR for the CPSP and stroke control groups did not differ from each other, but both differed from those of normal controls. FN of PTR did not differ between the CPSP and normal control groups. The alterations in the spinothalamic tract and superior thalamic radiation after stroke would play a role in the pathogenesis of CPSP. Full article

(This article belongs to the Special Issue Functional Impairment Evaluation and Personalized Treatment in Stroke Patients)

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Review

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17 pages, 2338 KiB

Open AccessReview

Effectiveness of Stretching in Post-Stroke Spasticity and Range of Motion: Systematic Review and Meta-Analysis

by Laura Gomez-Cuaresma, David Lucena-Anton, Gloria Gonzalez-Medina, Francisco Javier Martin-Vega, Alejandro Galan-Mercant and Carlos Luque-Moreno

J. Pers. Med. 2021, 11(11), 1074; https://0-doi-org.brum.beds.ac.uk/10.3390/jpm11111074 - 24 Oct 2021

Cited by 14 | Viewed by 11643

Abstract

Spasticity is one of the most frequent and disabling clinical manifestations of patients with stroke. In clinical practice, stretching is the most widely used physiotherapeutic intervention for this population. However, there is no solid evidence for its effectiveness. The aim of this study was to evaluate the effectiveness of different types of stretching in reducing post-stroke spasticity. Research was carried out until March 2021 in the following scientific databases: PubMed, CINAHL, Scopus, Cochrane Library, Web of Science, and PEDro. The PEDro scale and the Cochrane collaboration tool were used to assess the methodological quality and risk of bias of the studies. Eight articles were selected for qualitative analysis; six of them contributed information to the meta-analysis. No conclusive evidence was obtained on the effectiveness of stretching in terms of treating spasticity and range of motion in patients with stroke. Further research is necessary in order to determine the effectiveness of the use of stretching in this population, considering the different types of stretching (static and dynamic), the time of application, the measurement of the different components of spasticity, and the extrapolation of functional results. Full article

(This article belongs to the Special Issue Functional Impairment Evaluation and Personalized Treatment in Stroke Patients)

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