IMAS Optimization and Applicability in Acute and Subacute Stroke.

Inclusion Criteria

• Providing informed consent to participate in the study.
• Age 18 to 85 years old.
• Clinical presentation and neuroimaging (CTA-CTP/ MRI-MRA) consistent with the diagnosis of Acute Ischemic or Hemorrhagic Stroke.
• Preserved mental status (Glasgow coma score >12: E(4), V(5), M (4-6)).
• Presence of upper limb weakness per the NIHSS (1-2 points in the arm) and ability to perform testing (i.e., NIHSS motor score 1-2 at elbow, wrist, and finger flexion-extension) within 30 days from stroke. (Note that individuals with a prior ischemic or hemorrhagic stroke with available information pertaining superior extremity baseline strength after their previous stroke would qualify).
• Presence of upper limb weakness per the NIHSS (2 points in the arm) and ability to perform testing (i.e., NIHSS motor score 2 at elbow, wrist, and finger flexion-extension) in subacute stroke. (Note that individuals with a prior ischemic or hemorrhagic stroke with available information pertaining superior extremity baseline strength after their previous stroke would qualify).
• Baseline Modified Rankin score <4.

Exclusion Criteria

• History of dementia per relative/ medical records.
• Presence of receptive aphasia at baseline or after the current acute stroke.
• Need for rapid clinical response due to conditions such as psychosis, or suicidality.
• Unstable medical conditions (e.g., uncontrolled diabetes, uncompensated cardiac issues, heart failure, pulmonary issues, or chronic obstructive pulmonary disease);
• Amputated limbs.
• Absence of weakness as per the NIHSS (0 points = no drift for motor arm and leg items) or severe motor impairment NIHSS 4 points for motor arm).
• Stroke mimics (e.g., infections, medication effects from sedatives, electrolyte imbalances, etc.).
• Stroke worsening between assessments.