Nuanced effects of music interventions on rehabilitation outcomes after stroke: a systematic review

Background: Music is affordable and easily integrated in rehabilitation exercises, and has demonstrated different effects on the brain. We hypothesized that music interventions could improve rehabilitation outcomes after stroke.

Objective: the aim of our review is to determine the effectiveness of different types of music interventions according to the rehabilitation objectives after stroke.

Method: A systematic review of randomized controlled trials, clinical controlled trials and cross-over design performed on PubMed and PEDro in May 2018. All of these studies focus on acute, sub-acute or chronic stroke rehabilitation with music or rhythmic auditory stimulation intervention in adults during clinical outcomes. Two independent reviewers extracted the data and assessed the risk of bias before bringing it together.

Results: Twenty-seven studies were included and analyzed. Our review found positive effects on physical status (upper-limb activity; gait parameters, balance), on cognition (neglect, attention, communication) and mood. The analysis of the quality of the evidence showed that a majority of the studies had a high risk of bias.

Conclusion: Focusing on high to moderate level evidence, our review highlighted that rhythmic auditory stimulation has a positive effect on gait and balance; that receptive music therapy improves mood as well as some cognitive functions; that there is not enough evidence to determine the effectiveness of active music therapy and melodic intonation therapy. High-quality trials with large samples would be necessary to further assess and/or recommend these interventions.     

Psychometric properties of an Arabic version of the fatigue severity scale in patients with stroke

Background: Post-stroke fatigue is a common symptom which needs to be assessed by a psychometrically sound tool.

Objectives: To investigate the psychometric properties of an Arabic version of the fatigue severity scale (FSS-A) in patients with stroke.

Methods: An observational, cross-sectional design was applied to 147 survivors of first-time stroke and 70 healthy participants. Internal consistency was measured by Cronbach’s α, while test-retest reliability was measured by intraclass correlation coefficients (ICCs). To assess validity, the FSS-A was correlated with the Fatigue Visual Analogue Scale (VAS-F), the Short Form 36 (SF-36) and its vitality domain (SF-36V), the stroke specific quality of life (SSQOL-A) and its energy domain (SSQOL-A-E), and the Beck Depression Inventory II (BDI-II).

Results: The FSS-A showed excellent internal consistency (Cronbach’s α = 0.934) and test-retest reliability (ICC = 0.920, 95% confidence interval (CI): 0.85–0.96). Exploratory factor analysis confirmed that the FSS-A is unidimensional. The FSS-A had high positive correlation with VAS-F, moderate positive correlation with BDI-II, high negative correlation with SSQOL-A-E and moderate negative correlations with SF-36, SF-36V, and SSQOL-A. It differentiated patients from healthy participants with a sensitivity of 78.4% and a specificity of 77.1%. The minimal detectable change with 95% CI was 1.02 (22.4%).

Conclusions: The FSS-A showed good psychometric properties suggesting its usefulness as a fatigue evaluation tool in patients diagnosed with stroke.     

Development and feasibility of a sedentary behavior intervention for stroke: a case series

Background and Objective: High levels of sedentary behavior are prevalent among people with stroke and contribute to elevated risk for recurrent stroke. Few interventions reduce sedentary behavior post-stroke. The ABLE intervention aims to reduce sedentary behavior using activity monitoring, activity scheduling, problem-solving, and self-assessment to promote engagement in meaningful daily activities. The purpose of this study was to assess the feasibility (tolerability, acceptability, reliability, safety) of the ABLE intervention after stroke and describe trends in sedentary behavior at baseline and 4 weeks.

Clinical Presentation: Participants (n = 5) who were 6 months to 2 years post-stroke, ambulatory, and reported ≥6 h of daily sitting time.

Intervention: Twelve ABLE intervention sessions (3x/week for 4 weeks) conducted in participants’ homes. The ABLE intervention includes activity monitoring, activity scheduling, self-assessment, and collaborative problem-solving.

Results: All feasibility benchmarks were met for three participants. Two participants met tolerability and safety benchmarks but did not meet acceptability and reliability benchmarks. Variability in feasibility and sedentary behavior outcomes may be related to baseline levels of sedentary behavior and social support.

Conclusions: The ABLE intervention was tolerable and safe. The intervention protocol was refined to enhance reliability and acceptability. Future studies should estimate the effects of the ABLE intervention.     

Working memory profiles of patients with multiple sclerosis: Where does the impairment lie?

Introduction: Previous studies have mostly provided general estimations regarding Working Memory impairment in patients with Multiple Sclerosis. The aim of the present study was to investigate the relative degree of impairment in the four Working Memory components in Multiple Sclerosis.

Method: Thirty-eight patients diagnosed with MS and 27 matched controls were assessed using 12 different cognitive tasks of the four components, i.e. phonological loop, visuospatial sketchpad, central executive and episodic buffer. More precisely, Greek translated and adapted versions of the following tasks were administered: Digit recall, Word recall, Non-word recall, Block recall, Mazes recall, Visual Patterns recall, Backward Digit recall, Backward Block recall, Listening recall, Logical Memory I-Immediate Story recall and Greek Verbal Learning Test, which is based on the California Verbal Learning Test.

Results: The phonological loop, the central executive and the spatial subcomponent of the visuospatial sketchpad were found to be equally disrupted in MS patients. The episodic buffer was found to be more heavily affected. On the other hand, the visual subcomponent of the visuospatial sketchpad proved to be preserved.

Conclusions: WM subcomponents are differentially affected in patients with MS. This novel finding is discussed within the framework of existing knowledge regarding WM impairment in MS.     

Surviving a stroke in South Africa: outcomes of home-based care in a low-resource rural setting

Background: Little is known of stroke outcomes in low- and middle-income countries with limited formal stroke rehabilitation services and of homebased-stroke services delivered within the primary health care (PHC) context by community health workers (CHWs).

Objectives: To describe and analyze the outcomes of patients with stroke from a rural PHC setting in the Western Cape, South Africa.

Methods: In a longitudinal survey, 93 stroke patients, referred to home and community-based care services (HCBC) between June 2015 and December 2017, were assessed at baseline, one month and three months. Changes in function (Barthel Index (BI)), caregiver strain (Caregiver Strain Index (CSI)), impact of environmental factors and satisfaction with stroke care were measured.

Results: HCBC was delayed, fragmented and brief (median session duration 20 minutes (IQR 15.0–30.0)). Although function improved significantly, dependence remained high: median BI score changed from 40.0 (IQR 15.0–70.0) to 62.5 (IQR 30.0–81.25) (p = .019). A third (33.0% (30/91)) of caregivers initially experienced strain and the median CSI score remained 3.0 (IQR 0.0–7.0) (p = .672). Overall, patient and caregiver satisfaction with HCBC was low with only 46.9% (31/66) of caregivers and 17.4% (12/69) of patients satisfied with all aspects of care. Only 47.6% of assistive product needs were met. Environmental factors negatively impacted on patient function and caregiving.

Conclusions: Clinical practice pathways and referral guidelines should be developed for the HCBC platform. Specific training of CHWs, focusing on how to educate, support and train family caregivers, provide assistive devices and refer to health services is needed.     

A short bout of high-intensity exercise alters ipsilesional motor cortical excitability post-stroke

Background: Acute exercise can increase motor cortical excitability and enhance motor learning in healthy individuals, an effect known as exercise priming. Whether it has the same effects in people with stroke is unclear.

Objectives: The objective of this study was to investigate whether a short, clinically-feasible high-intensity exercise protocol can increase motor cortical excitability in non-exercised muscles of chronic stroke survivors.

Methods: Thirteen participants with chronic, unilateral stroke participated in two sessions, at least one week apart, in a crossover design. In each session, they underwent either high-intensity lower extremity exercise or quiet rest. Motor cortical excitability of the extensor carpi radialis muscles was measured bilaterally with transcranial magnetic stimulation before and immediately after either exercise or rest. Motor cortical excitability changes (post-exercise or rest measures normalized to pre-test measures) were compared between exercise vs. rest conditions.

Results: All participants were able to reach the target high-intensity exercise level. Blood lactate levels increased significantly after exercise (p < .001, d = 2.85). Resting motor evoked potentials from the lesioned hemisphere increased after exercise (mean 1.66; 95% CI: 1.19, 2.13) compared to the rest condition (mean 1.23; 95% CI: 0.64, 1.82), p = .046, d = 2.76, but this was not the case for the non-lesioned hemisphere (p = .406, d = 0.25).

Conclusions: High-intensity exercise can increase lesioned hemisphere motor cortical excitability in a non-exercised muscle post-stroke. Our short and clinically-advantageous exercise protocol shows promise as a potential priming method in stroke rehabilitation.     

Utility of the Structured Interview of Reported Symptoms (SIRS-2) in detecting feigned adult attention-deficit/hyperactivity disorder

Introduction: The Structured Interview of Reported Symptoms (SIRS-2) utilizes various strategies in the detection of simulated psychiatric disorders. The present study aimed to examine which of these strategies proves most useful in uncovering feigned attention deficit hyperactivity disorder (ADHD) in adulthood.

Method: One-hundred seventy-one individuals instructed to feign ADHD were compared to 46 genuine patients with ADHD as well as 99 neurotypical controls in their reports provided on the SIRS-2.

Results: Responses provided by simulators resembled those of genuine patients with ADHD on all SIRS-2 subscales with the exception of a supplementary scale tapping Overly Specified symptom reports, where a moderate effect emerged (d = 0.88). Classification accuracy remained low, with particularly poor sensitivity (sensitivity = 19.30%). Sensitivity was higher when the decision rules postulated in the first edition SIRS were applied instead of its successor’s decision model, yet this increase in sensitivity came at the price of unacceptably low specificity.

Conclusion: The present results call for a disorder-specific instrument for the detection of simulated ADHD and offer starting points for the development of such a tool.     

Sound design for auditory biofeedback and motor performance in participants with stroke: a pilot study

Background: Although auditory biofeedback (ABF) has proved to be effective in stroke rehabilitation, there are a variety of means by which to present information through sound.

Objectives: To examine if ABF sound design influences the motor performance of patients with stroke.

Methods: A total of four people with chronic stroke participated . They were asked to track target signals by their paretic ankle dorsiflexion. Half of the participants were assigned to one of the two groups. Those in the Error ABF group heard ABF that alerted them to the error between the target and the joint angle. Those in the Full ABF group heard ABF that presented both the target and the angle separately by modulating the frequencies of two sounds. Therefore, when there was no error, no sound or two sounds with the identical frequency were heard in the Error and Full ABF sessions, respectively. The same visual BF (VBF) was always present regardless of the group. The accuracy of the task was quantified via an accuracy index (AI, ranging from ?100 to 100). All participants were trained by repeating tracking, and the pre- and post-training AIs were obtained.

Results: The AIs of all participants increased after training, but the increase was greater for the Error ABF group (mean increase = 8.9 and 14.9 for the Full and Error groups, respectively).

Conclusions: The Full ABF was less effective than the Error ABF, probably because the VBF was present, and the information provided by the Full ABF was therefore redundant.     

Methodological considerations for kinematic analysis of upper limbs in healthy and poststroke adults Part II: a systematic review of motion capture systems and kinematic metrics

Background and purpose: To review the methods used to analyze the kinematics of upper limbs (ULs) of healthy and poststroke adults, namely the motion capture systems and kinematic metrics.

Summary of review: A database of articles published in the last decade was compiled using the following search terms combinations: (“upper extremity” OR “upper limb” OR arm) AND (kinematic OR motion OR movement) AND (analysis OR assessment OR measurement). The articles included in this review: (1) had the purpose to analyze objectively three-dimension kinematics of ULs, (2) studied functional movements or activities of daily living involving ULs, and (3) studied healthy and/or poststroke adults. Fourteen articles were included (four studied a healthy sample, three analyzed poststroke patients, and seven examined both poststroke and healthy participants).

Conclusion: Most articles used optoelectronic systems with markers; however, the presentation of laboratory and task-specific errors is missing. Markerless systems, used in some studies, seem to be promising alternatives for implementation of kinematic analysis in hospitals and clinics, but the literature proving their validity is scarce. Most articles analyzed “joint kinematics” and “end-point kinematics,” mainly related with reaching. The different stroke locations of the samples were not considered in their analysis and only three articles described their psychometric properties.

Implication of key findings: Future research should validate portable motion capture systems, document their specific error at the acquisition place and for the studied task, include grasping and manipulation analysis, and describe psychometric properties.     

Relationship between pharyngeal response time and lateralized brain lesion in stroke

Objectives: To analyze the relationship between pharyngeal response time (PRT) and lateralization of brain lesions.

Methods: A Cross-sectional study. 73 videofluoroscopic swallow studies (VFSS)were conducted on patients after stroke The study subjects were divided into : group 1 (G1) consisting of 39 individuals with left cortical lesion and group 2 (G2) consisting of 34 individuals with right cortical lesions. The VFSS of G1 and G2 subjects were analyzed using puree (A) and liquid (B) consistencies, and were also subdivided into young adults and older persons. . The mean PRT was divided into times shorter and longer than 250 ms.

Results: No statistically significant difference was observed between G1 and G2 for the A and B consistencies, being obtained : G1 (A mean: 56.6 ms; B mean: 99.5 ms; A mean: 3627 ms; B mean: 1712 ms) and G2 (A mean: 79.6 ms; B mean: 110.7 ms; A mean: 2040 ms, B mean: 1529 ms), for PRT shorter (A:p = .673; B: p = 1.000) and longer (A: p = .435; B: p = .847) than 250 ms, respectively. No statistically significant difference was found regarding the variable age in the comparison between young and old adults for mean PRT according to the A and B consistencies in G1 (A: p = .260; B: p = .732) and G2 (A: p = .586; B: p = .104).

Conclusion: No relationship between PRT and lateralization of brain lesion was observed with respect to subject age and to the swallowing of different food consistencies.     

Gait quality and velocity influences activity tracker accuracy in individuals post-stroke

Objective: Fitbit Zip? (FBZ) is a low-cost user-friendly device that could help motivate individuals post-stroke to increase their physical activity. However, inaccuracy in step counts from altered gait variables could cause dissatisfaction and reduce compliance. The aim of this study was to determine the influence of gait variables on the concurrent validity of the FBZ.

Method: In a cross-sectional study, 19 community-dwelling stroke survivors (mean 66 (SD 8) years) wore a FBZ at the non-paretic hip, and were videoed completing a six minute walk test (6MWT). Steps recorded by the FBZ were compared against the criterion standard of manually counted steps from video-recordings. Spatio-temporal gait parameters were calculated, and gait quality was assessed using the Wisconsin Gait Analysis (WGA) tool. Concurrent validity of FBZ was determined using Kendall’s Tau correlation coefficient. Linear regression analysis determined the association between gait parameters, quality, and FBZ accuracy.

Results: A very strong correlation was observed between the FBZ steps and manual counting (τ = 0.80, p < .001). Step difference demonstrated significant negative association with gait velocity (R² = 0.35, B = ?59.94, p = .007), and positive association with WGA score (R² = 0.69, B = 4.59, p < .001), indicating poor FBZ accuracy in participants with lower speed (≤0.8m/s) and poor gait quality (WGA score>16).

Conclusions: FBZ is an accurate measure of step activity in independent ambulators with stroke walking at speeds > 0.8m/s, but accuracy can be compromised with lower speed and poor gait quality. Clinicians should consider gait velocity and quality before advising FBZ as a motivational tool to increase physical activity in individuals post-stroke.     

Visuospatial functioning is associated with sleep disturbance and hallucinations in nondemented patients with Parkinson’s disease

Introduction: Cognitive impairment is a common symptom of Parkinson’s disease (PD) associated with reduced quality of life and a more severe disease state. Previous research has shown an association between visuospatial dysfunction and worse disease course; however, it is not clear whether this is separable from executive dysfunction and/or dementia. This study sought to determine whether distinct cognitive factors could be measured in a large PD cohort, and if those factors were differentially associated with other PD-related features, specifically to provide insight into visuospatial dysfunction.

Methods: Non-demented participants with PD from the Pacific Udall Center were enrolled (n = 197). Co-participants (n = 104) completed questionnaires when available. Principal components factor analysis (PCFA) was utilized to group the neuropsychological test scores into independent factors by considering those with big factor loading (≥.40). Linear and logistic regression analyses were performed to examine the relationship between the cognitive factors identified in the PCFA and other clinical features of PD.

Results: Six factors were extracted from the PCFA: 1) executive/processing speed, 2) visual learning & memory/visuospatial, 3) auditory working memory, 4) contextual verbal memory, 5) semantic learning & memory, and 6) visuospatial. Motor severity (p = 0.001), mood (p < 0.001), and performance on activities of daily living scores (informant: p < 0.001, patient: p = 0.009) were primarily associated with frontal and executive factors. General sleep disturbance (p < 0.006) and hallucinations (p = 0.002) were primarily associated with visuospatial functioning and visual learning/memory.

Conclusions: Motor symptoms, mood, and performance on activities of daily living were primarily associated with frontal/executive factors. Sleep disturbance and hallucinations were associated with visuospatial functioning and visual learning/memory only, over and above executive functioning and regardless of cognitive disease severity. These findings support that visuospatial function in PD may indicate a more severe disease course, and that symptom management should be guided accordingly.     

Motor difficulties are associated with impaired perception of interactive human movement in autism spectrum disorder: A pilot study

Introduction: The ability to accurately perceive human movement is fundamental to social functioning and known to be influenced by one’s own motor skills. In Autism Spectrum Disorder (ASD), there is ongoing debate about whether human movement perception is impaired. Given that motor skills vary considerably among these individuals, it may be that human movement perception is differentially affected as a function of motor proficiency. The aim of the current study was, thus, to explore whether individuals with ASD with and without motor difficulties differ in the way they visually attend to and perceive human movement.

Method: Three groups of children aged 6 to 14 completed the study: an ASD group with motor difficulties (ASD_MD), an ASD group without motor difficulties (ASD_NMD), and a typically-developing control group (TD). All participants (N = 31) underwent eye-tracking while they viewed communicative interactions performed by two point-light actors. Primary analyses considered group differences in perceptual accuracy and gaze patterns.

Results: Results revealed poorer perceptual accuracy in the ASD_MD group compared to the ASD_NMD and TD groups. Both ASD groups also exhibited gaze anomalies. Unlike the ASD_NMD and TD groups who preferentially allocated their gaze to the actor initiating the interaction, the ASD_MD group gazed at both actors equally. In contrast, the ASD_NMD group shifted their gaze between the actors more frequently than the other groups.

Conclusions: These preliminary findings suggest that individuals with ASD and co-occurring motor difficulties employ an atypical attentional style that may hinder accurate human movement perception, whereas those without motor difficulties may employ a compensatory attentional style that facilitates typical perception. Improving our understanding of how attention and perception are affected across the ASD spectrum has the potential to provide insight into the mechanisms that underlie the core social deficits that define this disorder.     

Stroke survivor cognitive decline and psychological wellbeing of family caregivers five years post-stroke: a cross-sectional analysis

Background: Family members frequently provide long-term care for stroke survivors, which can lead to psychological strain, particularly in the presence of cognitive decline.

Objectives: To profile anxious and depressive symptoms of family caregivers at 5 years post-stroke, and to explore associations with stroke survivor cognitive decline.

Methods: As part of a 5-year follow-up of the Action on Secondary Prevention Interventions and Rehabilitation in Stroke (ASPIRE-S) cohort of stroke survivors, family members completed a self-report questionnaire. Symptoms of anxiety and depression were assessed using the HADS-A and CES-D. Cognitive decline in stroke survivors was assessed from the caregiver’s perspective using the IQCODE, with cognitive performance assessed by the MoCA. Data were analyzed using logistic regression models.

Results: 78 family members participated; 25.5% exhibited depressive symptoms, 19.4% had symptoms of anxiety. Eleven stroke survivors (16.7%) had evidence of cognitive decline according to both the IQCODE and MoCA. Family members of stroke survivors with cognitive decline were significantly more likely to report symptoms of depression [age-adjusted OR (95% CI): 5.94 (1.14, 30.89)] or anxiety [age-adjusted OR (95% CI): 5.64 (1.24, 25.54)] than family members of stroke survivors without cognitive decline.

Conclusions: One-fifth of family caregivers exhibited symptoms of anxiety and one-quarter symptoms of depression at 5 years post-stroke. Stroke survivor cognitive decline was significantly associated with both depressive and anxious symptoms of family caregivers. Family members play a key role in the care and rehabilitation of stroke patients; enhancing their psychological wellbeing and identifying unmet needs are essential to improving outcomes for stroke survivors and families.     

Factors affecting rehabilitation and use of upper limb after stroke: views from healthcare professionals and stroke survivors

Background: Training of the upper limb (UL) is limited in stroke rehabilitation, and about 50% of stroke survivors do not regain useful function in their upper limb.

Objectives: This study explored what factors affect rehabilitation and use of upper limb after stroke from a stroke survivor and healthcare professional perspective to better understand low engagement in UL rehabilitation in the chronic stages of stroke.

Method: Eight chronic stroke survivors and 21 healthcare professionals took part in semi-structured interviews or in one of three focus groups, respectively.

Results: Thematic analysis revealed three main themes: Availability of resources, Healthcare professional–patient relationship, and Psychosocial factors. Availability of resources and Healthcare professional–patient relationship indicated that due to resource pressures and a lack of communication and education, positive upper limb rehabilitation behaviors (e.g. engaging and integrating the upper limb in daily activity) were not always established in the early stages post-stroke. Psychosocial factors illustrated the cognitive and psychological barriers to sustained engagement with upper limb rehabilitation.

Conclusion: The findings indicate that stroke survivors and healthcare professionals have very similar understandings of barriers to UL activity, and positive upper limb rehabilitation behaviors are not always established early in recovery post-stroke. Increased resources and healthcare professional–patient relationships seem key factors to establishing positive perceptions of UL rehabilitation. Addressing psychosocial issues and resource limitations may help sustain engagement with UL rehabilitation.     

Physical activity pre- and post-dementia: English Longitudinal Study of Ageing

Background: To inform public health interventions, further investigation is needed to identify: (1) frequency/intensity of everyday physical activity (PA) needed to reduce dementia risk; (2) whether post-diagnosis reduction in PA is associated with cognitive outcomes in people with dementia.

Methods: Data from 11,391 men and women (aged ≥50) were obtained from the English Longitudinal Study of Ageing cohort. Assessments were carried out at baseline (2002–2003) and at biannual follow-ups (2004–2013).

Results: Older adults who carried out moderate to vigorous activity at least once per week had a 34%–50% lower risk for cognitive decline and dementia over an 8–10 year follow-up period. From pre- to post-dementia diagnosis, those who decreased PA levels had a larger decrease in immediate recall scores, compared to those who maintained or increased PA levels (analyses were adjusted for changes in physical function).

Conclusion: PA was associated with cognitive outcomes in a dose-dependent manner. Reduction in PA after diagnosis was associated with accelerated cognitive decline and maintaining PA may reduce symptom progression in dementia.     

Intellectual,educational, and situation-based social outcome in adult survivors of childhood medulloblastoma

Purpose: To investigate intellectual and situation-based social outcome and educational achievement in adult survivors of childhood medulloblastoma and analyse factors influencing outcome

Methods: We collected demographic, medical and cognitive data, and social and educational outcome at a mean time since the end of treatments of 14.9 years in 58 adults, aged 19–35 years, consecutively treated in a single cancer center between 1989 and 2005.

Results: Ten survivors had severe intellectual disability, 12 were still studying, 23 had a regular employment and 13 were unemployed. Full Scale Intellectual Quotient, assessed 6.6 years after the end of treatments, ranged from 46 to 131. It was strongly associated with educational achievement and significantly lower in patients who experienced postoperative cerebellar mutism, and when parental education level was low.

Conclusion: These factors should be systematically considered at diagnosis in order to offer adequate and timely assessments and interventions.     

Tedium vitae in stroke survivors: a comparative cross-sectional study

Objectives: Suicide is best studied by deconstructing the psychological experiences preceding suicidal death. We assessed the characteristics of tedium vitae (feeling tired of life) after first ever stroke in Nigerian survivors.

Methods: Using the Schedule for Clinical Assessment in Neuropsychiatry, tedium vitae was assessed in 130 stroke survivors attending rehabilitation in a large Nigerian university hospital. Global cognitive and executive dysfunctions were evaluated, respectively, using the Mini Mental State Examination and the modi?ed Indiana University Token test. All participants had their index stroke 3 to 24 months before recruitment into the study. We also examined a comparative group of 130 age, gender, and education matched apparently normal persons who were unrelated to the stroke survivors. Associations were explored using univariate and multivariate logistic regression analyses.

Results: Tedium vitae was experienced by 16 (12.3%) stroke survivors compared with 5 (3.9%) in the comparative group (O. R = 3.5, 95% C. I = 1.3–9.9, p = 0.018). Among stroke survivors, those who were retired were more likely to experience tedium vitae (56.2%, p = 0.045). In analyses adjusting for the effect of systemic hypertension, cognitive dysfunction, retirement and marital separation, there was a 3.5-fold increase in the odds of experiencing tedium vitae after surviving a stroke (O. R = 3.5, 95% C. I = 1.1–11.6, p = 0.042).

Conclusions: Tedium vitae is a common suicidal experience after stroke and may be among the earliest perceptible pointer to impending poststroke suicide. It is easy to assess and may be less costly to obtain an adequate sample size in studies aiming to understand the phenomenon of suicide in the stroke population.