This self-assessment has 30 questions on the topic of stroke and requires a minimum passing score of 70% to claim CME. You will have unlimited attempts to achieve a passing score.

This learning activity meets the self-assessment criteria of the Part II: Life-long Learning and Self-Assessment component as part of the ABPM&R's Maintenance of Certification^©program.

Partial support of this activity has been provided through an educational grant from Allergan, Inc. in compliance with ACCME Guidelines.

Learning Objectives
After completing this enduring material, the participant should be able to:

• Recognize appropriate clinical management strategies and apply these techniques and knowledge into their practice.
• Assess the current state of their knowledge specific to the activity topic and identify knowledge gaps in which additional study is needed.
• Develop a strategy to closing the identified knowledge gaps using resources provided as references within the activity.

Associated Articles

• Boehme AK, Esenwa C, Elkind MSV. Stroke Risk Factors, Genetics, and Prevention. Circulation Research. 2017; 120(3): 462-495.
• McCaffrey P. The Neuroscience on the Web Series: SPPA 636 Neuropathologies of Language and Cognition. California State University. 2011
• Matos Casano HA, Tadi P, Ciofoaia GA. Anterior Cerebral Artery Stroke. [Updated 2019 Apr 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan
• Hatem SM, Saussez G, Della Faille M, et al. Rehabilitation of Motor Function after Stroke: A Multiple Systematic Review Focused on Techniques to Stimulate Upper Extremity Recovery. Front Hum Neurosci. 2016;10:442. Published 2016 Sep 13.
• Coupar R, Pollock A, Rowe P, Weir C, Langhorne P.  Predictors of upper limb recovery after stroke:  a systematic review and meta-analysis.  Clin Rehabilitation. 2012 Apr;26(4):291-313.  Epub 2011 Oct 24
• Sawner KA, LaVigne JM.  Brunnstrom’s Movement Therapy in Hemiplegia:  A Neurophysiological Approach, 2nd ed.  Philadelphia:  J.B. Lippincott, 1992.
• Grotta JC, Noser EA, Ro T, Boake C, Levin H, Aronowski J, Schallert T.  Constraint-Induced Movement Therapy Stroke. 2004;35:2699-2701. 
• Twitchell TE.  The restoration of motor function following hemiplegia in man.  Brain 1951;74:443-480.
• Ioannides K, Tadi P, Naqvi IA. Cerebellar Infarct. [Updated 2019 Mar 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan
• Mair G, Wardlaw JM. Imaging of acute stroke prior to treatment: current practice and evolving techniques. Br J Radiol. 2014;87(1040):20140216. doi:10.1259/bjr.20140216. 
• Jauch EC, Saver JL, et. al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline From the American Heart Association/ American Stroke Stroke. 2013; 44 (3).
• Campbell BCV, Christensen S, et. al. Comparison of Computed Tomography Perfusion and Magnetic Resonance Imaging Perfusion-Diffusion Mismatch in Ischemic Stroke. 2012; 43(10).
• Broderick J, et al.  Guidelines for the management of intracerebral hemorrhage in adults.  Stroke 2007; 38(6):2001-23.
• Demchuk AM, Burgin WS, Christou I, Felberg RA, Barber PA, Hill MD, Alexandrov AV. Thrombolysis in brain ischemia (TIBI) transcranial Doppler flow grades predict clinical severity, early recovery, and mortality in patients treated with intravenous tissue plasminogen activator. Stroke. 2001; 32: 89–93.
• Connolly, Jr. ES, Rabinstein AA, et. al. Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association, Stroke. 2012; 43: 1711-1737. 
• Brott TG, Halperin JL, Abbara S, et. al. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients with Extracranial Carotid and Vertebral Artery Disease.  Stroke.  42(8). 2011, p e464-e540. 
• Celeste F, Muratori M, Mapelli M, Pepi M. The Evolving Role and Use of Echocardiography in the Evaluation of Cardiac Source of Embolism. J Cardiovasc Echogr. 2017;27(2):33–44. doi:10.4103/jcecho.jcecho_1_17.
• Emos MC, Agarwal S. Neuroanatomy, Internal Capsule. [Updated 2019 Jun 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan
• Datta R, Agrawal J, Sharma A, Rathore VS, Datta S. A study of the efficacy of stellate ganglion blocks in complex regional pain syndromes of the upper body. J Anaesthesiol Clin Pharmacol. 2017;33(4):534–540. doi:10.4103/joacp.JOACP_326_16.
• Ifejlka-Jones NL, Francisco G, Jones W. Cerebrovascular Disorders Part 1.  Knowledge NOW. Originally published July 2012; updated April 2016.
• Itabashi R, Nishio Y, Kataoka Y, Yazawa Y, Furui E, Matsuda M, Mori E.Damage to the Left Precentral Gyrus Is Associated With Apraxia of Speech in Acute Stroke. Stroke. 2016 Jan;47(1):31-6. doi: 10.1161/STROKEAHA.115.010402. Epub 2015 Dec 8.
• Rupareliya C, Naqvi S, Hejazi S. Alexia Without Agraphia: A Rare Entity. Cureus. 2017;9(6):e1304. Published 2017 Jun 2. doi:10.7759/cureus.1304.
• Matos Casano HA, Tadi P, Ciofoaia GA. Anterior Cerebral Artery Stroke. [Updated 2019 Apr 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan 
• Lindberg RH, Khan M. Cerebrovascular Disorders, Part 2. Knowledge NOW. Originally published October 2, 2012; updated May 5, 2016.
• Baker E, Lui F. Neuroanatomy, Vagal Nerve Nuclei (Nucleus Vagus) [Updated 2019 Jul 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan
• Grigoriu AI, Dinomais M, Rémy-Néris O, Brochard S. Impact of Injection-Guiding Techniques on the Effectiveness of Botulinum Toxin for the Treatment of Focal Spasticity and Dystonia: A Systematic Review. Arch Phys Med Rehabil. 2015 Nov;96(11):2067-78
• Kedlaya D. Moberg-Wolff EA, editor. Botulinum Toxin. Medscape. Updated July 13, 2018.
• Walker HW, Lee MY, Bahroo LB, Hedera P, Charles D. Botulinum Toxin Injection Techniques for the Management of Adult Spasticity. PMR Journal (7) 2015;417-427
• Moon D. Intrathecal Agents. Knowledge NOW. Published April 11, 2016; updated May 5, 2016.

Accreditation Statement

AAPM&R is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

CME Credit Designation

AAPM&R designates this enduring material for a maximum of 8.00 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Faculty and their Disclosures
All faculty, planners and reviewers participating in continuing medical education programs must disclose to the learner any financial interests with any commercial supporter or other relationships with manufacturer(s) or providers of any product or service related to content of their presentation. For this activity, all self-assessment questions were developed and peer-reviewed to ensure quality and independence by the Self-Assessment Committee, under the oversight of the chair and the Medical Education Committee.  Their disclosures are provided below.  Disclosures from the article authors can be found in the article PDFs.

Self-Assessment Committee Members:
Atul T. Patel, MD, MHSA, Chair
Speaker's Bureau for Allergan, Ipsen, Merz; participates in clinical trials for Ipsen, Merz, and Revance; Guideline and AUC Committee for the AAOS, nonremunerative position of influence.

Hans L. Carlson
Consultant, Standard Insurance

Carol Y. Crooks, MD
Disclosed no relevant financial relationships.

Colby Hansen, MD
Consultant for CSRA International, Inc.

Prathap Jacob Joseph, MD
Disclosed no relevant financial relationships.

Robert A. Lavin, MD
Disclosed no relevant financial relationships.

Nathan P. Olafsen, MD
Disclosed no relevant financial relationships.

Marilyn S. Pacheco, MD
Disclosed no relevant financial relationships.

Virtaj Singh, MD
Disclosed no relevant financial relationships.

Mark E. Tornero, MD
Disclosed no relevant financial relationships.

AAPM&R Medical Education Committee:
Steve R. Flanagan, MD, Chair
Royalties from Springer Publishing; research grant from Brain Injury of America

John C. Cianca, MD, Vice Chair
Independent contractor, Houston Marathon Committee; owner, Musculoskeletal Ultrasound Consultants, LLC; consultant, 2nd MD; royalties from Demos Medical Publishing

Karen P. Barr, MD
Disclosed no relevant financial relationships.

Anna-Christina Bevelaqua, MD
Disclosed no relevant financial relationships.

Rachel A. Brakke Holman, MD
Disclosed no relevant financial relationships.

Joseph E. Burris, MD
Serves on the Speakers Bureau for, and received clinical research grants from Allergan.

Kevin N. Hakimi, MD
Disclosed no relevant financial relationships.

Rita G. Hamilton, DO
Disclosed no relevant financial relationships.

Charles D. Kenyon, DO (PHiT Liaison)
Disclosed no relevant financial relationships.

R. Sam Mayer, MD
Royalties from Demos Medical Publishing.

Atul T. Patel, MD, MHSA
Speakers Bureau for Allergan, Ipsen, Merz; participates in clinical trials for Ipsen, Merz, and Revance; Guideline and AUC Committee for the AAOS, nonremunerative position of influence.

Sunil Sabharwal, MD
Royalities from Demos Publishing; board member, American Board of Physical Medicine and Rehabilitation.

G. Sunny Sharma, MD (PHiT Liaison)
Disclosed no relevant financial relationships.

Rebecca DeVivo, MPH, MSW, CHCP
Staff Liaison
Disclosed no relevant financial relationships.

Brian S. Thompson, MBA, FACEHP
Staff Liaison
Disclosed no relevant financial relationships.

No other planners, faculty or other individuals in control of content disclosed any relevant financial relationships.