Abstract: Stroke is a common cause of disability, but not all subjects who survive a stroke are left with debilitating sequelae. The human brain is able to self-repair and adapt after injury through neuroplasticity, which is crucial for stroke recovery. At present, recovery cannot be completely predicted from clinical stroke variables. A promising theory suggests that the health status of the stroke host is as important as stroke severity for recovery. Within the neurological system, health is reflected by the integrity of the brain tissue and its neuronal environment, which provide the neuroplastic potential that is necessary for recovery. The potential for neuroplasticity is likely variable across individuals and possibly accounts for some of the differences in outcome that cannot be explained by other clinical factors.
A better understanding of the relationship between stroke outcomes, host brain tissue integrity and recovery environment would have immense potential to address stroke related disabilities. Our group combines experts in research involving brain tissue integrity using neuroimaging and recovery environment using community based participation approaches involving nurse-guided community health workers (CHWs).
This research project will evaluate the relationship between cardiovascular risk factors, degrees of physical and mental activity prior to the stroke, brain tissue integrity, post-stroke community participation and neurological recovery after the stroke. We will recruit and study a biracial cohort, gaining insight into the possible mechanisms that explain why the adverse risk profile, which is more commonly present in African-Americans than non-Hispanic Whites in the stroke belt, is translated into a less favorable recovery post stroke. If a better understanding of the underlying reasons for this observation can be defined, an important first step toward eliminating this disparity can be achieved.
This research which encompasses a relatively new area of study that uses the Ecological Model to frame investigation is significant because it will help: (a) understand how patient, family, and community level factors impact stroke recovery and account for disparities in post stroke recovery between AA and Whites; (b) engage community members (AA, Health Provider, Families) and (c) integrate this knowledge and the interplay of socio-environmental and behavioral factors so as to develop a multi-level community based intervention with community dwelling AA in the acute post-stroke recovery period. In this model of care, the nurse guides the CHW in evidence-based interventions and the CHW links with community members to deliver the interventions to individuals. It uses nurse teleHealth guidance of the CHW and home based CHW-patient training in self-management. Together they work to disseminate and integrate the successful interventions into health and community systems. These activities will complement and build upon the growing literature related to environment guided lifestyle and self -management programs and will lead to effective socio-culturally tailored stroke recovery interventions that improve long term outcomes by directly addressing factors associated with existing disparities in recovery.