Haptic Adaptive Feedback to Promote Motor Learning With a Robotic Ankle Exoskeleton Integrated With a Video Game

Background: Robotic devices have been used to rehabilitate walking function after stroke. Although results suggest that post-stroke patients benefit from this non-conventional therapy, there is no agreement on the optimal robot-assisted approaches to promote neurorecovery. Here we present a new robotic therapy protocol using a grounded exoskeleton perturbing the ankle joint based on tacit learning control. Method: Ten healthy individuals and a post-stroke patient participated in the study and were enrolled in a pilot intervention protocol that involved performance of ankle movements following different trajectories via video game visual feedback. The system autonomously modulated task difficulty according to the performance to increase the challenge. We hypothesized that motor learning throughout training sessions would lead to increased corticospinal excitability of dorsi-plantarflexor muscles. Transcranial Magnetic Stimulation was used to assess the effects on corticospinal excitability. Results: Improvements have been observed on task performance and motor outcomes in both healthy individuals and post-stroke patient case study. Tibialis Anterior corticospinal excitability increased significantly after the training; however no significant changes were observed on Soleus corticospinal excitability. Clinical scales showed functional improvements in the stroke patient. Discussion and Significance: Our findings both in neurophysiological and performance assessment suggest improved motor learning. Some limitations of the study include treatment duration and intensity, as well as the non-significant changes in corticospinal excitability obtained for Soleus. Nonetheless, results suggest that this robotic training framework is a potentially interesting approach that can be explored for gait rehabilitation in post-stroke patients.

section_content: It is our pleasure to share with you the advances we have made and the goals we have attained throughout this past year. Our 2018 annual report is presented with great gratitude to all those who support us and our cause, and all those who have taken part in the success of our organization. With fair representation in mind, we welcomed a new Executive Committee and Board of Directors, with eight additional seats destined for women and people under the age of 45. 

In October, we held our 2018 World Stroke Congress in Montreal, Canada with a program that covered epidemiology, prevention, acute care and stroke recovery. This year, we created an experience for stroke professionals, researchers and policy makers to meet, network and share experiences. A unique feature during this congress was our brief-presentation and e-poster model. The variety of short presentation formats made for easily communicable information and granted visibility to many more researchers and professionals, including early-career researchers hoping to gain visibility. With registrations hitting the 2700 delegate mark, we were able to connect many individuals and organizations and enable them to share experiences and strategize around prevention, awareness and recovery. 

We celebrated World Stroke day with our 2018 World Stroke Campaign. This year, our focus was the support for "life after stroke" to show people that a meaningful life after stroke is possible with the right care and support. The campaign of October 29, which included a record 194 events, was a phenomenal success and appearing on the social media feeds of 70 million people around the world. The campaign news release in which WSO President Michael Brainin reinforced the messages in our submissions to the UN regarding the need for urgent action to address the growing prevalence of stroke was widely picked up creating a 84 million opportunities to view. 

The World Stroke Academy continues to grow and become more modern and accessible than ever before. We have created a series of new learning modules, and now offer CME accredited content online for our members. New science is now presented fortnightly, including modules on TIA, rehabilitation, recovery, and so on. Our app that can be downloaded from the Apple and Google Play stores provides constant access to this high-quality educational material. 

Our 2018 annual report is presented with great gratitude to all those who support us and our cause, and all those who have taken part in the success of our organization. "

Offline opportunities to connect and learn were offered at major regional workshops and conferences held in China and Brazil spearheaded by our Education Committee. We also held sessions at the 29 th Summer Stroke School in Dubrovnik, the annual 4-day Regional Teaching Course on Stroke and Neurology in Africa, and the 7 th WSO International Meeting in Georgia on Stroke prevention, diagnosis, and treatment. Furthermore, the WSO worked with the World Heart Foundation on the 2018 Emerging Leaders Program as part of our effort to support and develop future generation of expert stroke leaders globally focused on reducing global premature mortality from circulatory disease. The WSO's Official Relations status with the World Health Organization (WHO) was renewed at the beginning of the year in order to continue our efforts to globalize stroke prevention, treatment and long-term care. Together, the WSO and the WHO have worked on developing a document on "Essential technology and interventions for stroke patients" in order to better communicate and describe integrated care for stroke patients. 

We participated in a joint event on Hypertension with the Global Coalition for Circulatory Health at the Seventy-First World Health Assembly in May 2018. We also participated in two UN High-Level Meetings on NCDs in New York where we, in collaboration with other organizations, discussed the importance of combating the NCD epidemic. In addition, we worked to launch a White paper on Circulatory Health at a side event to the UN High-Level Meeting in September. Likewise, the WHO/GCN/NCD meeting took place in Geneva in early November and gave the participants a platform through which to address the goal of reduction of NCD mortality. These connections and discussions (and others that followed) strengthened our commitment to active engagement with NCD and stroke efforts. 

We are very pleased to see our global membership grow and broaden to now represent well over 50,000 stroke experts and over 85 society members. Our biggest change from previous years is that fifty of our society members are now Stroke Support Organizations thanks to the outreach efforts of our SSO committee, which constantly works to strengthen and establish SSOs around the world. 

For the future, and particularly in 2019, we plan to review our progress in our key strategy areas by revisiting and updating our core strategy which has been in place for two years now, in order ensure we are on track to deliver on our priorities. We are very excited for our upcoming projects, in particular, our 2020 World Stroke Congress in Vienna. We expect that this congress, a joint effort between the WSO and the European Stroke Organization and co-chaired by President Michael Brainin, will be the largest international stroke conference yet. Preparations for our 2022 World Stroke Conference are also underway. We will continue towards engaging more with other communities involved with our cause and towards providing a more active and effective platform for reducing the global burden of stroke. 

We thank our colleagues, partners, members, and sponsors for their contributions to this work and for your continuous support to this cause. We are optimistic about the future of the WSO and proud of the changes we have already been able to make.
section_name: Dear colleagues, partners and friends,

section_content: For the future, and particularly in 2019, we plan to review our progress in our key strategy areas by revisiting and updating our core strategy which has been in place for two years now, in order ensure we are on track to deliver on our priorities. "

The World Stroke Organization (WSO) was established in October 2006 through the merger of the International Stroke Society and the World Stroke Federation with the purpose of coordinating efforts and constituting One World Voice for Stroke. The aims of the WSO are to

• foster the best standards of practice in stroke care, • increase public awareness, • influence polices for prevention of stroke and vascular dementia, improve health services, • provide education through collaboration with private and public organizations,

• facilitate stroke research and • advocate and foster systems for long-term support of stroke survivors and their families. 

WSO is working towards the goals set in the 2016-2020 strategic plan. The organization is on track with most priorities. A strategic review is planned for 2019 to define an action plan for the coming years.
section_name: Sincerely, Michael Brainin, President and Werner Hacke, Immediate Past-President

section_content: To reduce the global burden of stroke through prevention, treatment and long-term care

Strengthen global capacity to reduce the impact of stroke Through our advocacy and awareness activities, WSO aims to ensure that stroke gets both the public and policy attention and the resources that are required to tackle second leading cause of death and disability worldwide. 

As the only global organization focused solely on stroke WSO and with our diverse membership base, WSO is uniquely positioned to inform and advance the global stroke agenda. Our collaborative partnership status with the World Health Organization, and UN ECOSOC consultative status, enable us to speak up on stroke in global policy discussions and to ensure that the voices and experiences of people living with stroke are heard at regional and global level. Throughout 2018, we worked closely with global and regional policy makers to address key issues in health systems strengthening, prevention strategies and to improve access to stroke treatment.
section_name: A life free of stroke

section_name: DEVELOPING GLOBAL POLICy

section_content: Following many years of advocacy and contributions to the WHO technical advisory committee, WSO welcomed the 2018 publication of ICD 11 where stroke was reclassified along with all cerebrovascular diseases to form a single block under diseases of the nervous system. This addressed a long-standing error, in which stroke had been placed under diseases of the circulatory system. Furthermore, the new ICD 11 provides precise definitions of stroke and other cerebrovascular diseases for global use. 

The final decision was brought about by the Neurology Technical Advisory Group, chaired by Raad Shakir, and included a separate working group on cerebrovascular diseases chaired by Bo Norrving. The ICD 11 beta version was released by WHO in June 2018, for expected final approval at the World Health Assembly in May 2019. The ICD 11 is expected to be implemented by member states from 2022 and onwards. 

We firmly believe that correct classification will help to focus action on effective prevention and treatment, saving millions of lives and reducing the massive individual and global impact of stroke-related disabilities in years to come.
section_name: ICD 11

section_content: The WHA in May represented a critical opportunity to lay the foundations of a strong outcome from the UN HLM later in the year. The Assembly was attended by WSO leadership. WSO also contributed to the planning and delivery of a side event on 22nd May, Positioning Circulatory Health in Universal Health Coverage: The Case for Hypertension our contribution was critical to ensuring that the perspectives of healthcare providers from LMICs and the experiences of stroke survivor were included in presentations. In 2018 preparations and contributions to the UN High Level Meeting on NCDs were the focus of our advocacy programmes. The UN HLM was considered critical to ensuring international commitment to key policies and actions required to deliver government commitments in relation to UN Sustainable Development Goal 3 -the reduction of premature deaths by 30% NCDs by 2030. 

President Werner Hacke and Mia Grupper attended and gave input to the Civil Society Interactive and to the UN HLM in New York. WSO submissions to both events were captured in a written statement calling for three key actions to tackle stroke and NCDs. 

In September, a WSO delegation attended the UN High Level Meeting on NCDs along with many UN and civil society leaders from around the world. The goal of the meeting was to secure international commitment to a program of action to accelerate the progress on NCDs. 

The UN decided that the next General Assembly on NCDs will be held in 2025. A seven year gap on monitoring was seen by WSO, alongside many other civil society organizations as, an indication that governments around the world are failing to give the growing burden and development threat of NCDs the urgency that is required. For the stroke community which has seen increased lifetime risk of stroke over the past 10 years the proposed outcome for the meeting did not go far enough, but the voice of NGOs is growing, and we will continue to make our voice heard through our partnerships with organizations in the NCD Alliance.
section_name: The 71 sT WOrlD healTh assembly Geneva

section_content: In the wings of the September UN HLM in New York, WSO and our partners in the Global Coalition for Circulatory Health, launched a key White Paper -Delivering Sustainable Action for Circulatory Health. The document provides an overview of the global burden of CVD and Stroke and identifies key interventions and investments that governments can take to reduce the burgeoning system and individual costs of stroke and circulatory disease. The WSO will support all member states in their efforts to improve prevention, address dangerous lifestyle and provide access to medical services, health coverage and access to essential drugs. ‫״‬
section_name: GlObal COalITIOn FOr CIrCUlaTOry healTh WhITe PaPer laUnCh

section_content: In partnership with the NCD Alliance and the American Stroke Association, WSO launched a policy brief in October 2018 that aims to drive reduction in stroke mortality at national, regional and global level, by raising awareness on how best to address stroke prevention, treatment and longer-term support.
section_name: POlICy brIeF: aCTInG On sTrOke anD nCDs

section_content: Our efforts to influence regional policy were supported by input
section_name: WhO reGIOnal meeTInGs

section_content: Throughout 2018, WSO has been working to ensure that the WHO Essential Medicines list expands to improve access to key stroke treatments that have the potential to prevent strokes and significantly improve outcomes for patients around the world. The essential medicines list sets out core and complementary medicine requirements for priority conditions and informs service development at national and institutional levels. WSO has applied for Alteplase to be included in the 2019 WHO Model List of Essential Medicines EML as an individual medicine for intravenous thrombolysis in acute ischaemic stroke.
section_name: WhO lIsT OF essenTIal meDICInes

section_content: The WSO co-authored the WHO HEARTS Technical Package, which includes practical information and guidance protocols to prevent and treat heart diseases and stroke. WSO has supported the HEARTS initiative over the last 3 years, as part of our efforts to support health ministries worldwide implement more effective systems for circulatory disease prevention and management. HEARTS stands for:

• Healthy Lifestyle • Evidence based treatment protocols • Access to medicines and technologies • Risk based management • Team based care and task sharing • Systems for monitoring
section_name: WhO hearTs PaCkaGe

section_content: Michael Brainin and Mia Grupper participated in the 3 rd Global Summit on Circulatory Health that was held on December 4 th -5 th in Dubai. The Summit focused on the topic of access to essential medicines and technologies and was built around the need for achievable solutions and pragmatic approaches to the issue. A diverse group of speakers from governments, international and nongovernmental organizations, academia, and the private sector participated in the event, which concluded with a series of calls to action to accelerate progress.
section_name: rD GlObal sUmmIT On CIrCUlaTOry healTh

section_name: BUILDING PUBLIC AWARENESS OF STROkE

section_content: World Stroke Day on the 29 th of October is the annual focal point of the campaign year for WSO. 

In 2018 the focus of the day was on the support needs of the 116m people living in the world who have had a stroke. The key messages of the Up Again After Stroke campaign was that, with the right support, a meaningful life after stroke is possible. 

The campaign was supported by a toolkit that included a campaign guide, a video, patient information brochure and social media tools, translated to enable global engagement. 

On social media, in the press and at events around the world, stroke survivors, caregivers and professionals got together to raise visibility of stroke, share their experiences of getting #UpAgainAfterStroke and helped to develop on the ground political commitment to action on stroke prevention, treatment and support. Innovation was in evidence throughout the event from session format to digital technology. E-posters and ultra-short poster presentations not only ensured the maximum engagement in researchers' work, but also provided an important experience for early-career stroke researchers to gain exposure on a global platform. In total, there were 947 e-posters and 321 ultra-short abstract presentations.
section_name: WOrlD sTrOke Day 2018 #UPaGaInaFTersTrOke

section_content: The event offered a number of engaging session formats, which provided diverse engagement opportunities for delegates. Several late-breaking trials presented ground-breaking contributions to advancing stroke treatment, while a humorous Jeopardy-style panel quiz informed, entertained and could have secured the host with a new career pathway in stand-up. 

Even coffee breaks became opportunities to discuss stroke in the context of global healthcare policy, with a daily program of informal dialogues. Delivered in partnership with the NCD Alliance, with input from WHL the NCD Café drew good numbers and led to lively discussions while helping to disseminate the WSO-NCD Alliance joint policy brief 'Acting on Stroke and NCDs'. 

This partnership theme was continued through 11 joint sessions with affiliate societies including the World Hypertension League and World Heart Federation. An SSO tailored program offered opportunities for patients and carers organizations to connect, share experiences and strategize around shared advocacy and capacity building concerns. 

Looking over the past 11 th World Stroke Congress it is exciting to see how the events have helped support these partnerships to grow, as well as providing local impetus, networks and knowledge to contribute the development of national stroke prevention and treatment strategies to an increasingly international standard. 

delegates 2,670
section_name: WOrlD sTrOke CamPaIGn sTraTeGy DevelOPmenT

section_content: The International Journal of Stroke is going from strength to strength, our impact factor continues to grow steadily, and our downloads continue to have an influence. 

219,119 episodes 396,285 page views 159,215 unique users. 

China is currently our top submitting country, reflecting the trends in this region where research and publishing is growing at a pace. Trends continue with practice guidelines leading the way with downloads and citations. 

The USA currently downloads the most content from IJS, followed by the UK, Canada, Australia, China, India, Japan, Germany, Italy and Brazil. 

This year our esteemed Editor-in-Chief Professor Geoffrey Donnan, who has driven the journal from strength to strength since 2006, has advised WSO that he will be ending his editorial tender at the end of December 2019. It has been an incredible journey with many successes and innovations. We are currently seeking to find a new Editor in Chief to continue the great work.
section_name: InTernaTIOnal JOUrnal OF sTrOke

section_content: Over the 2018 period, the academy has extended its CME capacity and now offers CME credits for 10 modules, and this will increase into 2019. Access to this premium content is free for WSO members and CME certificates can be downloaded directly on the portal, or via the WSA app. 

The Academy has increased its user uptake over the past 24 months, and this trend looks to steadily increase. 

Marketing plan. The emphasis of the 2018-2019 marketing plan will be to:

• continue to increase visibility at global stroke conferences using flyers and asking speakers involved with WSA to place posters and video within slides for presentations, and target conference attendees through targeted development of content for specific events. 

• place targeted advertisements in high-impact journals, in agreement SAGE we have banners advertising WSA on the IJS website, which has approximately 219,000 downloads per year and

• continue to extend our presence on social media. We have a series of campaigns planned around content for International Women's Day, and other 'world health days' and around popular content and presenters. Our campaigns have an average of 23. 6k impressions on social media -our aim would be over 70K impressions by the end of 2019. 

A way that you can support us is to:

• Spread the word to your colleagues and students. 

• Ask attendees of talks to which you have been invited to use the tag @worldstrokeed or @worldstroke in tweets from your session. 

• Tweet and include us @worldstrokeed or @worldstroke • Offer to build case studies for the WSA 'Question of the week'

Over the 2018 period, the academy has extended its Cme capacity and now offers CME credits for 10 modules, and this will increase into 2019".
section_name: WOrlD sTrOke aCaDemy

section_content: Philippine In this Congress, experts on cerebrovascular diseases from the Ibero-American countries (Portugal, Spain and the Americas) and other areas of the world met in Gramado to present the greatest innovations in the field. A Ministerial Meeting gathered healthcare decision makers, administrators and practitioners from Latin America, in addition to experts from other continents. They discussed the impact of stroke on the region, the organization of services and healthcare networks, successful models, challenges and potential solutions. We expect that this meeting will have a great impact on public healthcare policies in the region, making Latin America a reference for the world.
section_name: WsO reGIOnal anD naTIOnal TeaChInG COUrses anD WOrkshOPs

section_content: In 2018, the WSO Research Committee welcomed several new members, and a Co-Chair, Roland Veltkamp. 

In line with WSO goals to develop the stroke research workforce and culture of our members, a highlight of 2018 was our partnership with the Global Alliance of Independent Networks focussed on Stroke trials (GAINS) to hold a highly successful all-day training workshop in Montreal, Canada for 100 early to mid-career researchers from across the globe. The enthusiastic response to this event has prompted planning for the next meeting in 2020. In 2018 we also finalised a policy that opens the door for us to review and potentially endorse research-related activity that supports the goals of the WSO. A number of other activities are in the pipeline and we continue to build strategic partnerships to advance the WSO research agenda. 

sUPPOrTInG early Career sTrOke PrOFessIOnals
section_name: esTablIshmenT OF researCh PrIOrITIes

section_content: The WSO Young Stroke Professionals Committee was established in 2014 to support and promote best practices among young stroke professionals. 

As part of this goal, the Committee established the WSO Brief Clinical Exchange Scholarship Program in January 2015. These scholarships, worth up to US$2,000, are designed to expose young stroke professionals from medical, nursing and allied health backgrounds to best practice clinical stroke care at international centers of excellence. At least two of the five annual scholarships are granted to applicants from developing countries. The primary purpose of the exchange should be clinical, but opportunities for collaborative research may arise and are strongly encouraged. The selection panel consider the potential benefit to the applicant and stroke patients at their institution. The host institution must have recognized status as a center of excellence in stroke care. 

In 2018, a total of five scholarships were awarded. Dr. Henry Zhao and Dr. Susanna Zuurbier have already completed their brief exchanges.
section_name: WSO Scholarships and Clinical Exchange Program

section_content: The WSO, along with the Educational Program of the European Stroke Organization, offers a postgraduate master's program in Stroke Medicine in Danube University in Krems, Austria. This program is aimed at neurologists and stroke physicians who want to gain more practical knowledge and scientific background by participating in clinical research and networking. 

In 2018, three delegates were awarded a WSO scholarship for this program:

Medhi Gorky, Sikkim Manipal Institute of medical sciences, India, an interventional neuroradiologist involved in endovascular management and CT /MR diagnosis of stroke. He was able to develop a more holistic approach to stroke patient care (particularly in epidemiology, detection, and management) and form networks to remain updated on stroke efforts around the world. He is further interested in implementing alumni organizations to conduct multicenter study and improve stroke care in parts of the world where it remains most underdeveloped. 

Mamushet Yifru Yared, Addis Ababa University College of Health Sciences, Ethiopia aims through participation in the Masters Program to bring comprehensive training and expertise to the field of stroke care in the region of East Africa. He is also further interested in engaging with others on the program through alumni organizations to conduct multicenter research and have exchange visits. 

Waweru Peter Kuria, MP Shah Hospital Nairobi, Kenya, joined the Program to help combat the lack of stroke physicians and uncommon use of interventional radiology in Kenya and other parts of Sub-Saharan Africa. 

He is specifically interested in exploring the feasibility of point of care transcranial Doppler ultrasonography in the region. He was able to engage in hands on experience with neurosonology and research on cerebral small vessel disease, which is largely disregarded in his home region. Through networking, he was able to get a stroke unit to observe in Sweden and widen his understanding of stroke neurosurgery.
section_name: Stroke Master's program

section_content: The WSO Roadmap to Delivering Quality Stroke Care presents a prioritized model for basic, essential, and advanced stroke care in different income level areas. It covers a wide range of topics and provides a step-by-step guide to reviewing current stroke care resources, as well as tools for the implementation, monitoring, and evaluation of stroke services globally. Despite differences in resource availability, the message the WSO wishes to convey is that stroke is treatable, and life can improve with better awareness, access and action. 

Two years after the launch of the Roadmap to Delivering Quality Stroke Care in 2016, the document has been translated into six languages: Chinese, Vietnamese, Russian, Persian, Portuguese, and Spanish. By the end of 2019, we will also finalize the translations in Arabic, French, Turkish, Korean and Japanese. 

We are excited about this opportunity to make the Roadmap accessible to more people and contribute to the enhancement of stroke care in various regions. 

All versions of the Roadmap can be downloaded from the WSO website. 

We are also happy to share that users of the Roadmap are now supported with three short videos, which provide an accessible and visual way introduction to the Roadmap and explain how it should be used. The first video demonstrates how the roadmap is organized across the stroke continuum of care. At each stage of the continuum, the roadmap provides a roadmap assessment framework to guide its users. The second video discusses the difference in models for stroke services delivery and helps roadmap users identify which resources and services are available in their region. The third video clarifies how the roadmap assists users in developing an implementation plan and provides them with the tools to measure its success. In 2018 we continued our work to establish, support and strengthen stroke support organizations (SSOs) globally, particularly in low and middle-income countries. 

Our SSO network grew to 52 members during the year; the highest number to date and a 44% increase from 2017. We had a 97% SSO member retention rate and a third of members were new to WSO. 35% of SSO members in 2018 were from lower-middle-income or low-income countries (World Bank 2018). 

We had significant SSO representation at the World Stroke Congress in Montreal, with a third of SSO members present. The Testimonial Exhibition included 145 stories of people affected by stroke from 28 countries and was an important reminder that they are a fundamental part of the World Stroke Congress and 'the reason we are here'. An e-book of these testimonials can be accessed on the WSO website.
section_name: WsO GlObal GUIDelInes anD TOOls

section_content: WsO FellOWshIP

In the beginning of October 2018, WSO announced the launching of the WSO Fellowship, which particularly recognizes excellence, innovation and sustained contributions in stroke and cerebrovascular disease. 

The Fellows are stroke experts with a stroke physician, scientist, nursing or allied health background. The advantage to the individual in becoming a Fellow is special recognition of their expertise in stroke and the right to use the FWSO designation. Advantages to the World Stroke Organization include an increased profile and evidence of leadership by appropriately trained stroke clinicians and scientists. 

The first cohort of fellows has already been selected and new Calls for Applications will be published regularly in 2019.
section_name: Uniting the Stroke Community

section_content: Each year, WSO endorses important national and regional stroke conferences and events worldwide. WSO endorsement signifies that the organization publicly and visibly supports joint activities, campaigns, statements, literature, conferences or other initiatives, consistent with the aims and mission of WSO. 

Since late 2018, organizers of events endorsed by WSO have been befitting from the use of a specially designed logo, which they are encouraged to use on their printed materials and websites.
section_name: WsO enDOrseD evenTs

section_content: Achieving our vision of a life free of stroke is a task that WSO cannot achieve alone. We are committed to building our partnerships at global, regional and national level to scale up and deliver improvements in prevention, treatment and support to reduce the burden of stroke. 

In 2018 we continued to work with WHO as a collaborating partner on the delivery of the HEARTS program and to ensure that opportunities to improve stroke prevention and treatment are reflected in the WHO Essential Medicines List. We also continued to work closely with our partners in the NCD Alliance, coordinating our policy advocacy efforts to ensure that the voices of stroke experts, survivors and caregivers were heard in global and regional fora. This year we were active participants in the NCD Alliance Advocacy group and collaborated with other Alliance members to increase understanding of the potential impact of stroke prevention and treatment could have on accelerating achievement of global health and development goals. 

We continued to contribute to the Leadership Group of the Global Coalition for Circulatory Health. This Coalition, hosted by the World Heart Federation is focused on advancing the principles and commitments outlined in the Mexico Declaration. Through this partnership we are building collaborative and innovative approaches to improve CVD and stroke prevention. As part of our work together this year, we contributed to the publication and launch of the White Paper -Delivering Sustainable Action for Circulatory Health. 

Of course, our engagement in these external organizations is informed and driven by our working partnerships with our Member Associations who contribute their expertise and work with us to raise awareness and advocate around key issues in stroke treatment, prevention and support. 

We welcome and actively seek new partners and in 2018 will continue to work to broaden our industry, NGO and philanthropic partners.
section_name: WOrkInG In ParTnershIP FOr lIves Free FrOm sTrOke

section_content: We are most grateful to our supporting partners who play critical role in supporting WSO's work towards a world free from stroke. 

PlaTInUm PlUs sPOnsOr ParTner sIlver sPOnsOr ParTner

We are committed to building our partnerships at global, regional and national level to scale up and deliver improvements in prevention, treatment and support to reduce the burden of stroke".
section_name: BRONZE SPONSOR PARTNER

section_content: WSO concluded the 2018 financial year with a positive result of USD 169'423. This result has been added to the general reserve which now stands at USD 1'540'063. 

In 2018, grants and donations from partners, membership dues, and income from the journal were the main income streams. The main income from the congress will be received in 2019. 

We managed and controlled our costs in line with budget throughout the year. The main operational expenses are related to projects, i. e. WS Campaign, WS Academy and IJS Journal as well as staff costs. Meetings, travels and representation costs increased in 2018 mainly due advocacy activities linked to the HLM on NCD's. 

The detailed financial report for all WSO activities is shown below, this includes the operations of both WSO Switzerland and WSO USA.
section_name: Financial Report

section_name: GlObal sTrOke FaCT sheeT

section_content: In 2018, a WSO expert team worked on the compilation of a Global Stroke Fact Sheet. 

The 10-page fact sheet overviews the best available scientific evidence to provide reliable and up to date data on stroke and its impact around the world. Using reliable and consistent stroke data to support stroke advocacy helps to build awareness of the scale of the disease and supports the call for urgent action at global, regional and national levels. 

The values in the document have all been extracted from the most current Global Burden of Disease Stroke Statistics Worldwide for the year 2016. They will be reviewed and updated by the WSO executive committee on an annual basis as appropriate. The present document and all its subsequent revisions are reviewed and approved by the WSO leadership. 

We hope that Global Stroke Fact Sheet will be a valuable resource and a useful point of reference in your work, practice, and research. The full document and a useful infographic can be downloaded from the WSO website. 

2016 GBD estimates for stroke burden (as measured by DALys) attributable to risk factors.
section_name: GlObal sTrOke FaCT sheeT