OBJECTIVE: Investigate preferences of stroke survivors and caregivers for mobile applications (apps) to facilitate post-stroke care/needs. BACKGROUND: Mobile technology has been rapidly entering the medical field. However, it is underutilized in patient-centered healthcare. Mobile apps may allow stroke survivors/caregivers to actively participate in care/management. DESIGN/METHODS: Nationwide population-based survey consisting of 17 questions was distributed to 11,720 stroke survivors and caregivers identified from National Stroke Association’s database via email and postal mail, including an introduction letter and IRB-approved informed consent. The survey was developed using formative focus groups in Brooklyn, NY and Centennial, CO. Qualitative information about current smartphone usage and interest in health-related apps was collected. Preferences were explored by gender, race/ethnicity, age, and education using χ2. RESULTS: 1,221 survivors and 396 caregivers responded. App for scheduling doctor/rehab appointments was preferred by survivors and caregivers of all ethnicities, with doctor appointments, medication reminder, and blood pressure tracking as the most favored in both groups. For how-to information app, there were no differences in caregiver preferences based on demographics, except that app usefulness declined with age (χ2=19.7, p=0.02). While, app with rehab exercises was more often cited by younger survivors, older ones wanted trustworthy medical information (χ2=41.4, p < 0.001). App to find local stroke-related resources was preferred by the majority of caregivers and stroke survivors. More Afro-Caribbean/American survivors (42[percnt]) preferred use of stroke support groups compared to Hispanics (36[percnt]) or Caucasians (28[percnt]), χ2=45.1, p< 0.001 as did younger age (χ2=41.3, p< 0.001). App tracking fitness/diet was more desired by the majority of stroke survivors than caregivers. App facilitating stroke survivors’ communication was highly favored by survivors while not considered useful by the majority of caregivers. CONCLUSIONS: Building relevant apps requires feedback from users. We identified useful key features reported by stroke survivors and caregivers to build a stroke-dedicated app. Disclosure: Dr. Nadege has nothing to disclose. Dr. Zelonis has nothing to disclose. Dr. Beving has nothing to disclose. Dr. Burton has nothing to disclose. Dr. Ventura-DiPersia has nothing to disclose. Dr. Kunnakkat has nothing to disclose. Dr. Balucani has nothing to disclose. Dr. Jensen has nothing to disclose. Dr. Levine has received personal compensation for activities with NCME and as a medical legal consultant. Dr. Levine has received personal compensation in an editorial capacity for Medlink, and for editing a book on TIAs.

BACKGROUND:Perinatal and childhood stroke result in neurological impairment in the majority of survivors, but less is known about patient and parent perception of function following stroke in children. Our aim was to characterize parent-proxy and child-reported health status in children following unilateral arterial ischemic stroke or intraparenchymal hemorrhage.METHODS:Fifty-nine children 2-18 years (30 girls, 29 boys) with unilateral arterial ischemic stroke or spontaneous intraparenchymal hemorrhage at least 6 months before evaluation were enrolled from a single center. The PedsQL version 4.0 Generic Short Form and PedsQL version 3.0 Cerebral Palsy Module were administered to childhood stroke subjects and parents. Generic PedsQL Inventory scores were compared between children with stroke and published data from healthy children. Reported health status scores for children with varying degrees of hemiparesis were compared.RESULTS:Children with stroke had lower reported health status scores on the Generic PedsQL Inventory than healthy children. Children with moderate-severe hemiparesis had worse scores than children without hemiparesis on several measures of the Cerebral Palsy Module as reported by both parents and children. The parents of children with epilepsy reported worse scores on several measures compared with children without epilepsy, and the parent scores were lower on several measures for children with lower intelligence quotients. Agreement between parent and child scores was better on the Cerebral Palsy Module than on the Generic Inventory.CONCLUSIONS:Children with stroke have worse reported health status than healthy controls. Degree of hemiparesis, epilepsy, and lower intelligence quotient affect reported health status on some measures. Agreement between parent-proxy and child scores ranges from slight to good which suggests that both provide useful information.

Objective Few data regarding causes and outcomes of haemorrhagic stroke (HS) in term neonates are available. We characterised risk factors, mechanism and short-term outcomes in term and late preterm neonates with acute HS.Design Prospective cohort.Setting Single-centre tertiary care stroke registry.Subjects Term and late preterm neonates (>= 34 weeks gestation), born 2004-2010, with acute HS <= 28 days of life were identified, and clinical information was abstracted. Short-term outcomes were assessed via standardised neurological exam and rated using the Paediatric Stroke Outcome Measure (PSOM).Results Among 42 neonates, median gestational age was 39.7 weeks (IQR 38-40.7 weeks). Diagnosis occurred at a median of 1 day (IQR 0-7 days) after delivery. Twenty-seven (64%) had intraparenchymal and intraventricular haemorrhage. Mechanism was haemorrhagic transformation of venous or arterial infarction in 22 (53%). Major risk factors included congenital heart disease (CHD), fetal distress and haemostatic abnormalities. Common presentations included seizure, apnoea, and poor feeding or vomiting. Acute hydrocephalus was common. Mortality was 12%. Follow-up occurred in 36/37 survivors at a median of 1 year (IQR 0.5-2.0 years). Among 17/36 survivors evaluated in stroke clinic, 47% demonstrated neurologic deficits. Deficits were mild (PSOM 0.5-1.5) in 9/36 (25%), and moderate-to-severe (PSOM >= 2.0) in 8/36 (22%).Conclusions In our cohort with acute HS, most presented with seizures, apnoea and/or poor feeding. Fetal distress and CHD were common. Nearly two-thirds had intraparenchymal with intraventricular haemorrhage. Over half were due to haemorrhagic transformation of infarction. Short-term neurologic deficits were present in 47% of survivors.

Numbers are conceptualized spatially along a horizontal mental line. This view is supported by mounting evidence from healthy adults and patients with unilateral spatial neglect. Little is known about children's representation of numbers with respect to space. This study investigated elementary school children's directional biases in physical and numerical space to better understand the relation between space and number. We also examined the nature of spatial organization in numerical space. In two separate tasks, children (n = 57) were asked to bisect a physical line and verbally estimate the midpoint of number pairs. In general, results indicated leftward biases in both tasks, but the degree of deviation did not correlate between the tasks. In the number bisection task, leftward bias (underestimating the midpoint) increased as a function of numerical magnitude and interval between number pairs. In contrast, a rightward deviation was found for smaller number pairs. These findings suggest that different underlying spatial attentional mechanisms might be directed in physical and numerical space in young school children, which would be integrated in adulthood.

Visual search plays an important role in guiding behavior. Children have more difficulty performing conjunction search tasks than adults. The present research evaluates whether developmental differences in children's ability to organize serial visual search (i.e., search organization skills) contribute to performance limitations in a typical conjunction search task. We evaluated 134 children between the ages of 2 and 17 on separate tasks measuring search for targets defined by a conjunction of features or by distinct features. Our results demonstrated that children organize their visual search better as they get older. As children's skills at organizing visual search improve they become more accurate at locating targets with conjunction of features amongst distractors, but not for targets with distinct features. Developmental limitations in children's abilities to organize their visual search of the environment are an important component of poor conjunction search in young children. In addition, our findings provide preliminary evidence that, like other visuospatial tasks, exposure to reading may influence children's spatial orientation to the visual environment when performing a visual search.

OBJECTIVE: Although acute seizures are common among neonates with arterial ischemic stroke (AIS), the incidence of subsequent seizures is unknown. The goals of this study were to determine the incidence of seizures following hospital discharge after perinatal acute AIS, and to assess lesion characteristics associated with later seizure occurrence. METHODS: Neonates with confirmed acute AIS on MRI were identified through a prospective stroke registry. Clinic visits and telephone follow-up identified occurrence of seizures after hospital discharge. MRI scans were graded for size and characteristics of infarct, and associations with seizures after stroke were analyzed. RESULTS: At a mean (SD) follow-up of 31.3 (16.1) months, 11 of 46 (23.9%) patients with perinatal AIS had at least 1 seizure. Five patients had a single episode of seizure, and 6 developed epilepsy. The Kaplan-Meier probability of remaining seizure-free at 3 years was 73%. Stroke size on MRI was significantly associated with development of later seizures, with an incidence rate of later seizures 6.2 times higher among those with larger stroke size. CONCLUSIONS: Seizures occurred in <25% of patients during initial follow-up after perinatal AIS. Of those with seizures, nearly half had a single episode of seizure and not early epilepsy. Larger stroke size was associated with higher risk of seizure. These data suggest that prolonged treatment with anticonvulsant agents may not be indicated for seizure prophylaxis after perinatal AIS. These findings may help guide clinicians in counseling families and could form the basis for much-needed future research in this area.