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What? Two previous large clinical trials (ATTEND, RECOVER) did not find task-shifting completely to a family caregiver and nurse to be superior to conventional therapy. Appropriate therapy intensity and duration were not delivered due to lack of continued professional supervision after discharge. Tele-stroke rehabilitation was widely adopted during and after the COVID-19 pandemic for motor, sensory, cognitive, pulmonary and functional rehabilitation, to avoid person-to-person contact and spread of the pandemic (DBC et al 2021, Surya N et al 2021). This mode of rehabilitation has developed into an effective service delivery system, in rehabilitating gait and mobility impairments and upper limb deficits post-stroke and has also proven to be suitable among geriatric population (Ciortea et al 2020, English C et al 2022). Cramer S et al (2019) reported non-inferior improvements in arm deficits among stroke patients with synchronous telerehab through an adequately powered trial. So we combine the advantages of home-based rehabilitation and intense-supervised rehabilitation into a structured tele-stroke rehabilitation program customized for patients with upper limb & mobility deficits after stroke. Why? The current apps providing tele-stroke rehab in India are limited and do not have the features required to make them effective in improve stroke related deficits. For example the Careforstroke app (Suresh et al, 2015) proved to be a feasible and acceptable mode of rehabilitation delivery in South India, although this app does not deliver a customized rehabilitation program to each patient. Similarly the Strokehelp app (Menon B et al) which is a commercial and widely used app, does not deliver tailor-made rehabilitation plans and does not have the feature of rehabilitation-progression with changing needs and changing physical status of patients over time. A small sample study in Southern India established the need and effectiveness of use of a set of adherence strategies to improve patient adherence to home-based rehab (Mahmood A et al, BMJ Open 2021). A handful of small feasibility studies on the use of telehealth in India show potential (Mahmood A 2021, Garg D 2020), however there have been no adequately powered randomized controlled trials (RCTs) to test effectiveness or an implementation study.  The ATTEND-2 app is designed to be socio-culturally specific, allows for continued monitoring via provision of exercise logs with a reward system and allows the supervising Physiotherapist to modify treatment regimes remotely as per patient need and changing sensorimotor status after discharge. Potential impact? 1) Longer periods of supervised rehabilitation post discharge 2) Improved patient follow-ups 3) Socio-culturally relevant exercise regimens that include locally specific ADL training 4) Inclusion of clinical decision making tool-kit for clinicians and package of adherence strategies for patients to help improve use of the app and adherence to rehab regime respectively 5) Building capacity among stroke rehab professionals Where we are? We have developed a complete design of the app with centralised web-console through which the health professional can access the exercise library and recruited patient details. This is a preliminary design awaiting funding for development and use in Phases 1 & 2 of the trial. Where we need to be The development of the app will the first step towards this trial. Through this trial that fulfills digital Health Recommendations put forth by the Indian government, World Heart Federation and World Health Organization Let's Get Proof Project Link https://www.letsgetproof.com/project/app-based-tele-stroke-rehabilitation-in-india-16-2

STROKE REHAB IN INDIA

Support Stroke Action Nigeria's Life After Stroke Centre (LASC) Program 
 
   The prevalence of stroke in Nigeria is 1.14 per 1000 4,5  while the 30-day case fatality rate is as high as 40%. Therefore, in a country with 200 million populations, stroke affects over 200,000 people a year  within an age range of 18 – 85 years . Stroke is the leading cause of disability in the country and continues to have a very high mortality in the range of 21% - 45% . Most deaths attributed to stroke in Nigeria occur within the first week of stroke occurrence . However t he burden of stroke does not lie in the high mortality figures, but in the high morbidity because  up to 50% of stroke survivors are chronically disabled . These stroke survivors are entitled to stroke rehabilitation and support to enable them to cope with life after stroke, an opportunity offered within Stroke Action Nigeria's service provision blue print. The Life After Stroke Centre (LASC) Onitsha, established by Stroke Action Nigeria provides community-based rehabilitation, secondary prevention, psychosocial, and return to work support to stroke survivors. The program is tailored for each stroke survivor, and includes assessments, goal setting, stroke education, secondary prevention, self-management strategies, group and individual functional rehabilitation and exercise training aimed at changing health behaviours and enabling stroke survivors to cope with life after a stroke. Let's Get Proof Project Link https://www.letsgetproof.com/project/determining-the-effectiveness-of-the-nigerian-life 
 
 Alternative ways to give: 
 
 For gifts by check: Write your check to KBFUS, write " STROKE ACTION NIGERIA - Let's get proof " in the memo section of the check, and send it to KBFUS, 551 Fifth Avenue, Suite 2400, New York, NY 10176. Gifts by wire transfer or to contribute other types of property: Email KBFUS at:  info@kbfus.org  or phone (212) 713 7660.

STROKE ACTION NIGERIA

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