Deans' stroke musings

Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 493 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:

Sunday, April 22, 2018

Extra glass of wine a day 'will shorten your life by 30 minutes'

But if it reduces my chances of Alzheimers I'll take that tradeoff.  Ask your doctor if coffee or wine is more likely to prevent dementia. I'm doing both, don't want to take any chances.

Wine Cleans Alzheimer's Plaque 

Wine experts less vulnerable to Alzheimer's, study says

Coffee May Lower Your Risk of Dementia Feb. 2013


Extra glass of wine a day 'will shorten your life by 30 minutes'  

Drinking will shorten your life, according to a study that suggests every glass of wine or pint of beer over the daily recommended limit will cut half an hour from the expected lifespan of a 40-year-old.
Those who think a glass of red wine every evening will help keep the heart healthy will be dismayed. The paper, published in the Lancet medical journal, says five standard 175ml glasses of wine or five pints a week is the upper safe limit – about 100g of alcohol, or 12.5 units in total. More than that raises the risk of stroke, fatal aneurysm (a ruptured artery in the chest), heart failure and death.
The risks for a 40-year-old of drinking over the recommended daily limit were comparable to smoking, said one leading scientist. “Above two units a day, the death rates steadily climb,” said David Spiegelhalter, Winton professor for the public understanding of risk at the University of Cambridge.
“The paper estimates a 40-year-old drinking four units a day above the guidelines [the equivalent of drinking three glasses of wine in a night] has roughly two years’ lower life expectancy, which is around a 20th of their remaining life. This works out at about an hour per day. So it’s as if each unit above guidelines is taking, on average, about 15 minutes of life, about the same as a cigarette.
“Of course, it’s up to individuals whether they think this is worthwhile.”
There is still a small benefit to drinking, which has been much flagged in the past. It does reduce the chance of a non-fatal heart attack. But, said Dr Angela Wood, from the University of Cambridge, lead author of the study, “this must be balanced against the higher risk associated with other serious – and potentially fatal – cardiovascular diseases.”
The big international study supports the new UK recommended limits of a maximum of 14 units a week for both men and women, which were fiercely contested when introduced by England’s chief medical officer, Dame Sally Davies, in 2016. Other countries with higher limits should reduce them, it suggests. They include Italy, Portugal and Spain as well as the US, where for men the recommended limit is almost double.
The study included data from nearly 600,000 current drinkers included in 83 studies carried out in 19 countries. About half the participants reported drinking more than 100g per week, and 8.4% drank more than 350g per week. Early deaths rose when more than 100g per week, which is five to six glasses of wine or pints of beer, was consumed.
A 40-year-old who drank up to twice that amount (100 to 200g) cut their life expectancy by six months. Between 200g and 350g a week, they lost one to two years of life, and those who drank more than 350g a week shortened their lives by four to five years.
Tim Chico, professor of cardiovascular medicine at the University of Sheffield, said smokers lost on average 10 years of life. “However, we think from previous evidence that it is likely that people drinking a lot more than 43 units are likely to lose even more life expectancy, and I would not be surprised if the heaviest drinkers lost as many years of life as a smoker.
“This study makes clear that on balance there are no health benefits from drinking alcohol, which is usually the case when things sound too good to be true.”
Spiegelhalter said it was “a massive and very impressive study. It estimates that, compared to those who only drink a little, people who drink at the current UK guidelines suffer no overall harm in terms of death rates, and have 20% fewer heart attacks.”
Prof Jeremy Pearson, associate medical director at the British Heart Foundation, which part-funded the study, called it “a serious wakeup call for many countries.”
Dr Tony Rao, visiting lecturer in old age psychiatry at King’s College London, said the study “highlights the need to reduce alcohol related harm in baby boomers, an age group currently at highest risk of rising alcohol misuse”. It did not take into account the possibility of mental disorders such as dementia, which could accompany the other health problems drinkers incur.
In a commentary in the Lancet, Profs Jason Connor and Wayne Hall from the University of Queensland Centre for Youth Substance Abuse Research in Australia, anticipated that the suggestion of lowering recommended drinking limits will come up against opposition.
“The drinking levels recommended in this study will no doubt be described as implausible and impracticable by the alcohol industry and other opponents of public health warnings on alcohol. Nonetheless, the findings ought to be widely disseminated and they should provoke informed public and professional debate.”
The headline on this article was amended on 13 April 2018 to clarify that the extra glass of wine applies on a daily basis.


Human-mouse HYBRID: Scientists grow human brain in tiny rodent

So Christine O’Donnell was right, just a few years late.  Famously insisting that scientists were putting human brains into mice.

SCIENTISTS have controversially yet successfully grown part of a human brain inside a mouse and the organ even managed to survive for months in a major scientific breakthrough.

mouse brainGETTY
Human-mouse HYBRID: Scientists grow human brain in tiny rodent
For the first ever time miniature human brains have grown in a new species and scientists have suggested the breakthrough could help with stem cell research.
Scientists created the pin-sized human brains from stem cells and then placed them inside the skulls of mice, where a piece of tissue had been removed to make room for the new organ.
Of the test mice, roughly 80 percent survived the operation, and within two weeks the rodents’ implants had been successfully received and were even spawning new neurons.
The brain implants survived for an average of 233 days, but began the process of dying much earlier.
Mice were fitted with 'organoid' brains
Lead researcher Fred Gage, a neuroscientist at the Salk Institute, said: "In our hands, the organoids stop growing around five weeks.
"It's a function of size rather than time. We see some cell death even in the edge of the organoids starting at 10 weeks, which becomes really dramatic over time.
“This is an obvious hurdle for longtime study."
Abed Al-Fattah Mansour, a research associate at the Salk Institute, said: "That was a big accomplishment.

Saturday, April 21, 2018

11 steps to achieve insane focus and live the life you really want

My focus is to have fun, any stroke therapy distracts from that so I do no specific therapy.
You can read this or just simply absorb what Bruce Lee has to say, 'I fear not the man who has practiced 10,000 kicks once, but I fear the man who has practiced one kick 10,000 times.'
The famous motivational speaker, Tony Robbins, once said:
“One reason so few of us achieve what we truly want is that we never direct our focus; we never concentrate our power. Most people dabble their way through life, never deciding to master anything in particular.”
How much does this quote resonate with you?
Is there something in your life that you might have been an expert at by now, only if you had put in the time and effort to master it?
Are there passions that you failed to pursue, simply because you let other things like laziness or boredom get in your way?
Here’s the biggest thing that stops us from mastering what we love:
The modern world is filled with distractions—smartphones, laptops, mobile apps, TV shows, bright lights, loud music.
Everywhere you turn, you can get lost in a maze of distractions that can eat up another day you will never get back.
The solution then is to fight back against the distractions.
Here are 10 ways you can reclaim your inherent insane focus and turn away from the distractions of the world:

1) Overset Your Time Expectations

2) Don’t Check Email in the Morning

3) Stop Multitasking

4) Pursue Your Passion Before Anything Else

5) Choose 2-3 Tasks Everyday That Have To Be Done

6) Take Some Days Slowly

7) Email Just Twice A Day

8) Turn Off Notifications

9) Stay Offline Until Core Tasks Are Done

10) Know What Matters

n Hack Spirit’s new eBook, The Art of Resilience, they deliver a practical primer on how you can become more resilient in a world of instability and narrowing opportunity, whether you’re facing financial troubles, health setbacks, challenges in your relationships, or any other problem.
We can all have our own resilience breakthrough, and each can learn how to use adverse circumstances as potent fuel for overcoming life’s hardships.

Stroke victims can be diagnosed TEN TIMES more accurately thanks to incredible new technology developed in Scotland

So you are going down the complete nocebo route. You will only recover so far, that lets the doctor off the hook for getting you 100% recovered. No point in doing any further stroke rehab research then, the computer never lies. The status quo is just fine for those who have never had a stroke. FUCKING LAZY ASSHOLES!
A new computer programme can predict more accurately than ever before a patient’s cognitive function — including speech and memory skills — after suffering a blood clot on the brain
STROKE victims can now be diagnosed TEN TIMES more accurately than current methods after breakthrough research carried out in Scotland.
A new computer programme can predict more accurately than ever before a patient’s cognitive function — including speech and memory skills — after suffering a blood clot on the brain.
New method can predict how patients will be in future
The software measures visible injuries from cerebral small vessel disease — which can lead to dementia — and brain degeneration.
It does this by translating millions of pieces of information stored in scans into a “brain health index”.
And researchers believe this will lead to better outcomes for the 31,000 Scots stroke survivors each year.
Dr David Dickie, a research fellow at the University of Glasgow, explained: “Right now scans are reviewed from different bits and pieces of damage caused by strokes.
“A doctor will then use their experience to say what they think the effects of that damage will be.
“But that can vary as two different doctors could give two different results which can lead to a disagreement about how you would do in the future.
“What we are trying to do is use the scan to predict far more accurately the outcomes of speech and other functions.
“It will standardise the results.
“This is a more mathematical approach and is then better at predicting how good you are going to be cognitively in the future.”

Pomegranate Can Help Reduce Risk Of Heart Attacks, Strokes, Diabetes, Anemia

No research listed to back any of this up but I started listing pomegranate research back to April 2014. I bet your doctor and stroke hospital did nothing with any of it.
Not only this is Pomegranate of the most delicious fruits out there, but the number of benefits it provides us are innumerable. They have amazing properties like anti-oxidants, anti-tumor, and anti-viral.
In addition to that, they are rich in vitamins like vitamin A, C, and E, and it is also a great source of folic acid. This is a truly wonderful fruit that happens to have three times more anti-oxidants than Green Tea does.
Pomegranates are very good to you, they help to maintain a proper blood circulation reason why doctors would recommend an increase in the intake of this fruit if you are having blood regulatory issues. You can also eat pomegranate to help you recover from a long illness.
They are also great to help you clear your skin and fight off any inflammations. Do you have a sore throat? Then, a nice glass of pomegranate juice is great for you. But that isn’t enough, they also happen to be a great cure for heart conditions, stomach issues, cancer, diabetes, anemia, arthritis, and even dental conditions.
There is truly a never-ending list of benefits we can get from eating pomegranates, as they are so rich in antioxidants, they help to oxidize all the LDL cholesterol in our bodies.
It doesn’t matter if you consume your pomegranate as a juice, seeds, syrup, nectar, concentrated formula or paste, you will enjoy all the benefits all the same.
Doctors also recommend pomegranate to help your body repair damaged cartilage, and for pregnant women, it is useful to consume it in order to protect their babies brain’s from any damage that may occur during labor.
You want more, huh? Well, see this way, the health benefits from pomegranates range between curing stomach issues to improving erectile dysfunction problems.
In order to treat stomach problems like diarrhea or other digestive issues, you could drink a tea made out of the leaves from the pomegranate tree. This tea is also great to deal with dysentery and cholera.
Drinking pomegranate juice on a regular basis, daily if you can, will help you to maintain a proper blood circulation through your body and it reduces the risks of suffering from heart attacks or strokes.
There is a large concentration of Flavonoids in pomegranates, which are a form of antioxidants, they have been proven to be very effective in eradicating those free radicals in our bodies.

Glucose, blood pressure and temperature are prognostic biomarkers in acute ischaemic stroke

Not even close to what would describe causes of 3 month mortality. They should be looking at the fact nothing is being done in the first week to stop  the 5 causes of the neuronal cascade of death
Does no one in stroke understand cause and effect of early stroke mortality? Decent stroke leadership would point researchers to follow a stroke strategy to 100% recovery for all. This was a waste of time.
by ESO | 21.3.2018 | Stroke Research | 0 comments

Comment Authors: Daniela Pimenta Silva, Diana Aguiar de Sousa, Department of Neurology, Hospital de Santa Maria, University of Lisbon, Portugal
Original Article: Skafida A., Mitrakou A., Georgiopoulos G., et al. In-hospital dynamics of glucose, blood pressure and temperature predict outcome in patients with acute ischaemic stroke. European Stroke Journal. doi: 10.1177/2396987318765824
Stroke unit treatment is an evidence-based proven effective treatment.(Bullshit, 12% tPA full recovery, 10% full recovery on rehab; Neither can be considered effective) Surprisingly, randomised controlled trials aimed at reducing or normalising parameters such as glucose, blood pressure (BP) and temperature failed to demonstrate benefit from these interventions. But why wouldn’t the normalisation of these parameters improve outcomes? (Becauase you are looking at the wrong goddamn thing!)
Skafida and colleagues hypothesized that the variability of these parameters during the acute and sub-acute phase are significant factors in outcome.
To prove this argument, the authors conducted a prospective observational study, which included 1271 patients with acute ischaemic stroke admitted within 24h after symptom onset to the acute stroke unit of Alexandra Hospital, between 2001 and 2010. Serum glucose, systolic and diastolic blood pressure (SBP, DBP) and temperature were systematically measured during the first 7 days of hospitalisation. Variability across the hospitalisation period was addressed.
The primary outcome was all-cause death up to three months after acute iscaemic stroke and the secondary outcome was poor functional outcome also at three months. Final multivariable models were adjusted for all available major confounders of biological plausibility, including traditional risk factors, stroke severity, renal function and in-hospital treatment.
The authors found that subject-specific baseline glucose (HR=1.005; p-value=0.017) and temperature (HR=2.758; p-value<0.001) levels, variability of SBP (HR=1.028; p-value=0.005) and the rate of temperature changes (HR=1.841; p-value<0.001) are independent predictors of three-month all-cause mortality (primary outcome).
Interestingly, baseline glucose levels and its changes across hospitalisation were not predictors of poor clinical outcome at 3 months follow-up. One mentioned explanation was hyperglycaemia as a surrogate marker of critical illness, thus contributing to a higher mortality with no association to the poor clinical outcome.
Although this was not emphasised by the authors, another notable finding was the absence of an association between rise in blood sugar level and three-month mortality or poor clinical outcome, contrary to what other studies have shown.
Consistent with the literature, variation in BP values during hospitalisation was a predictor of all-cause mortality and poor functional outcome at three months after ischaemic stroke. Since cerebral autoregulation typically is impaired in the acute and sub-acute phase of stroke, it is likely that fluctuations in blood pressure compromise cerebral perfusion thus contributing to poor outcome.
Baseline temperature and slope of temperature change were both predictors of three-month all-cause mortality and poor clinical outcome. In addition to fever being also a surrogate index for nosocomial infections, the survival penumbra in the acute and sub-acute phase of ischaemic stroke can be influenced by changes in temperature, thus producing a worse functional outcome.
The variability between studies concerning parameters definitions, cut-off thresholds and statistical methods are important obstacles to interpretation and comparison. The large sample size, the assessment of serial values of parameters beyond the hyperacute phase and the careful adjustment for confounders are the strengths of this study.
Being a single centre study, with a long period of inclusion, makes the results extrapolation to other populations hazardous. Moreover, it is important to note that the etiology of the changes in glucose, BP and temperature were not discussed, which can also affect the mortality rate.
In conclusion, the results contribute to the understanding of of the complex physiology in acute ischaemic stroke. How to optimize supportive treatment of physiological factors such as blood pressure, blood glucose and temperature is yet to be answered. Hopefully, trials such as PRECIOUS (ISRCTN82217627) will bring us closer to a conclusion.

Friday, April 20, 2018

Road trips

Post retirement there is much to do. Was on two back to back road trips.  First was to St. Paul, 10.5 hours, got my two sea kayaks, tandem and single out of a friends garage, we then cleaned out most of his garage so I could empty my storage locker and store that stuff in the garage. Handed off the sea kayaks to friends from Duluth since I can't really use them now.  Bought a folding recumbent tricycle, more on that later.  Drove back on a Tuesday, left for Pittsburgh the next day, saw the Andy Warhol museum. Drove to New York in the fog and rain, including driving across 42nd street at the bottom of Times Square at 8pm, luckily with a navigator. Ate at the Wild Ginger restaurant where we had a couple of bottles of cold sake.

Friday saw Grand Central Station, United Nations, then to the Frick museum on 71st, On to MOMA where the crowds were ferocious. Finally headed to the Whitney around 13th St. On the way stopped at the Gonzo bar for drinks and a couple of empanadas for sustenance Only 32,118 steps for the day, 16 miles.
Saturday was the Museum of Arts and Design, lunch at 

Ousia restaurant, Mediterranean wines



walked thru Central Park, then to the Jewish Museum, tried for the Guggenheim but the lines stretched around 3/4s of the block. We decided that was it for the day since we needed to get up to Hyde Park  yet that night. Only 19,950 steps.
Sunday, the FDR museum and house. 11.5 hours of driving back to Michigan, had to hand off the last hour of driving to my friend.

After that was a flight to Albuquerque, drive to Santa Fe for a couple of days. Saw the Georgia O'Keefe museum, she was way ahead of her time. Had a wonderful dinner at Izanami  
where we learned that sake that is hot is served that way to disguise the flavor since it is really cheap sake. I'm really liking the cloudy unfiltered sake. Will have to look up the benefits of this type of alcohol. 

Thursday, April 19, 2018

Constraint-induced movement therapy in stroke patients. A systematic review

These are a total waste of time until we finally get stroke protocols written up.
Terapia por restricción del lado sano en pacientes con ictus. Revisión sistemática.  Rehabilitación , Volume 51(4) , Pgs. 234-246.

NARIC Accession Number: I243968.  What's this?
Author(s): M.J. Mateos-Serrano; I. Calvo-Mu˜noz.
Publication Year: 2017.
Abstract: The aim of this study was to determine the effectiveness of constraint-induced movement therapy (CIMT) in patients with hemiparesis/hemiplegia following stroke and to analyze the main characteristics of CIMT in patients with stroke. A literature review was performed of experimental studies published up to February 2016. Among other search procedures, a search was carried out in different electronic databases. Selection criteria were as follows: the included studies had to be randomized clinical trials, and individuals had to be older than 18 years and to have been treated with CIMT after being diagnosed with subacute or chronic stroke. Twelve articles were included, thus providing 12 treatment groups and 12 control groups. The total sample consisted of 435 individuals divided into 2 groups: 219 persons in treatment groups and 216 individuals in control groups. The oldest study was conducted in 2010 and the most recent in 2015. Results indicate that CIMT is an effective alternative treatment for the rehabilitation of stroke patients, and the benefits can be observed at both the physical and functional levels.
Descriptor Terms: Adults, Hemiplegia, Movement therapy, Stroke, Treatment.
Language: Spanish
Geographic Location(s): Europe, Spain.

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Citation: M.J. Mateos-Serrano, I. Calvo-Mu˜noz. (2017). Constraint-induced movement therapy in stroke patients. A systematic review.  Terapia por restricción del lado sano en pacientes con ictus. Revisión sistemática.  Rehabilitación , 51(4), Pgs. 234-246. Retrieved 4/19/2018, from REHABDATA database.

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A systematic review of mechanisms of gait speed change post-stroke. Part 2: Exercise capacity, muscle activation, kinetics, and kinematics

So still no clue as to what rehab creates functional gains. Once again everything in your recovery is up to you. You find the appropriate research and deduce what the protocol is. What the fuck is your doctor for?
Topics in Stroke Rehabilitation , Volume 24(5) , Pgs. 394-403.

NARIC Accession Number: J78167.  What's this?
ISSN: 1074-9357.
Author(s): Wonsetler, Elizabeth C.; Bowden, Mark G..
Publication Year: 2017.
Number of Pages: 10.
Abstract: This systematic review explored potential mechanisms of change that may explain improvements in gait speed and quantify motor recovery following physical therapy interventions in the stroke population. PubMed, Ovid, and CINAHL databases were searched relevant rehabilitation trials with a statistically significant change in self-selected walking speed post-intervention that concurrently collected mechanistic variables. Twenty-five studies met the inclusion criteria and examined. Methodological quality was assessed using Cochrane Collaboration’s tool. Walking speed changes, mechanistic variables, and intervention data were extracted. The physical therapy interventions used within the included studies that were found to produce improvements in gait speed were: cardiorespiratory function, muscle activation, force production, and movement analysis. Interventions included: aerobic training, functional electrical stimulation, multidimensional rehabilitation, robotics, sensory stimulation training, strength/resistance training, task-specific locomotor rehabilitation, and visually-guided training. No systematic approach or set of outcome measures to mechanistically explain changes observed in walking speed were identified. Nor is there a theoretical basis to drive the complicated selection of outcome measures, as many of these outcomes are not independent of walking speed. Since rehabilitation literature has not yet identified a causal, mechanistic link for post-stroke functional gains, a systematic, multimodal approach to stroke rehabilitation will be necessary in doing so.

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Citation: Wonsetler, Elizabeth C., Bowden, Mark G.. (2017). A systematic review of mechanisms of gait speed change post-stroke. Part 2: Exercise capacity, muscle activation, kinetics, and kinematics.  Topics in Stroke Rehabilitation , 24(5), Pgs. 394-403. Retrieved 4/19/2018, from REHABDATA database.

* The majority of journal articles, books, and reports in our collection are only available by regular mail, rather than downloadable electronic format. Learn more about our digital collection and our document delivery service.

More information about this publication:
Topics in Stroke Rehabilitation.