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:http://oc1dean.blogspot.com/2010/11/my-background-story_8.html

Friday, August 18, 2017

New study examines potential Alzheimer's disease prevention strategies

What are your doctors dementia prevention strategies? You will need them. You need to demand specifics not this general crap you are going to get.

1. A documented 33% dementia chance post-stroke from an Australian study?   May 2012.
2. Then this study came out and seems to have a range from 17-66%. December 2013.
3. A 20% chance in this research.   July 2013.


New study examines potential Alzheimer's disease prevention strategies

Alzheimer's disease (AD) is a type of dementia that causes problems with memory, thinking, and behavior. It affects more than 5 million Americans. The Alzheimer's Association estimates that some 16 million people will develop the disease by the year 2050 if an effective treatment is not discovered. Symptoms of AD usually develop slowly and worsen over time. They often become severe enough to interfere with daily tasks, and can eventually cause death.
In a new study, published in the Journal of the American Geriatrics Society, James E. Galvin, MD, MPH, Professor of Integrated Medical Science and Associate Dean for Clinical Research, Charles E. Schmidt College of Medicine, Florida Atlantic University, examined potential AD prevention strategies.
Dr. Galvin notes that just four medications have been approved to treat AD symptoms. A major effort is underway to develop new treatments for the disease by the year 2025, and researchers have launched several new studies.
Another area of research interest focuses on AD prevention strategies. In studies of people with AD, researchers have discovered conditions that increase risk factors associated with the disease. When these conditions are combined, they account for more than 50 percent of the risk for AD. They include:
  • Diabetes
  • High blood pressure
  • Kidney problems
  • Alcohol and tobacco use
  • High cholesterol
  • Coronary heart disease
  • Depression
  • Low activity life style
  • Diet
Researchers looked at 19 studies about various brain-stimulating activities that may lower risks for AD, . They discovered that doing crossword puzzles, playing card games, using a computer, making arts or crafts, taking classes, having group discussions, and listening to music all had protective effects against AD.
Researchers have learned that physical activity helps reduce AD risk by up to 65 percent, depending on the type of exercise and its intensity. That's because exercise reduces blood vessel disease risk, improves your breathing function, supports the survival of the cells that make up your body, and lessens inflammation.
Age remains the greatest risk factor for AD: by 82, the risk for developing the disease is 42 percent. The good news: 58 percent of older adults do not develop AD.
Presently, we don't understand why some people develop the disease and others don't. But addressing the risk factors we do know about could make a difference. For example, up to 30 percent of AD cases may be preventable by living a well-balanced, healthy life. That would include eating a healthy diet with plenty of fresh fruits and vegetables, whole grain foods, lean proteins, and few to no "fast" or processed foods. A healthy lifestyle also includes physical activity and social engagement.
The future of researching ways to prevent AD should probably focus on people at risk for developing the disease, said researchers, and should highlight how to improve management of chronic health conditions and education about living healthier.

Umbrella challenges

Luckily my umbrella has a powered opening. To close it I do have to push it against the floor. The real problem comes in trying to wrap the umbrella tight with the velcro strip. That usually ends up not being successful which results in not being able to put the umbrella back into the protective sleeve. Ask your occupational therapist for the protocol to accomplish this ADL. At least I no longer need a cane which made using an umbrella and cane at the same time impossible.

2017 IEEE-RAS-EMBS International Conference on Rehabilitation Robotics July 17-20, 2017, QEII Centre, London, UK

Your doctor has a lot of followup to do to to incorporate this information into your stroke protocols.  You better hope your doctor is the one in a million that gets this all right. Or maybe your doctor will DO NOTHING  because s/he is waiting for SOMEONE ELSE TO SOLVE THE PROBLEM? The solution to this overload of research is simple, that great stroke association takes all these and updates the stroke protocols publicly available in a database. 
The following were presented at the conference;
A Pilot Study on the Optimal Speeds for Passive Wrist Movements by a Rehabilitation Robot of Stroke Patients: A Functional NIRS Study

Clarification of Muscle Synergy Structure During Standing-Up Motion of Healthy Young, Elderly and Post-Stroke Patients

A Novel Pneumatic Stimulator for the Investigation of Noise-Enhanced Proprioception

Simulating the Impact of Sensorimotor Deficits on Reaching Performance

Position and Torque Control Via Rehabilitation Robot and Functional Electrical Stimulation

Codification Mechanisms of Wrist Position Sense

There Is Plenty of Room for Motor Learning at the Bottom of the Fugl-Meyer: Acquisition of a Novel Bimanual Wheelchair Skill after Chronic Stroke Using an Unmasking Technology

The Combined Action of a Passive Exoskeleton and an EMG-Controlled Neuroprosthesis for Upper Limb Stroke Rehabilitation: First Results of the RETRAINER Project

Maintaining Subject Engagement During Robotic Rehabilitation with a Minimal Assist-As-Needed (mAAN) Controller

Feedforward Model Based Arm Weight Compensation with the Rehabilitation Robot ARMin

Movement Therapy without Moving – First Results on Isometric Movement Training for Post-Stroke Rehabilitation of Arm Function

Application of Support Vector Machines in Detecting Hand Grasp Gestures Using a Commercially Off the Shelf Wireless Myoelectric Armband

Leap Motion Evaluation for Assessment of Upper Limbs Motor Skills in Parkinson's Disease

Improving Robotic Stroke Rehabilitation by Incorporating Neural Intent Detection: Preliminary Results from a Clinical Trial

Design of Continuous EMG Classification Approaches towards the Control of a Robotic Exoskeleton for Reaching Movements

Development of Elbow Spasticity Model for Objective Training of Spasiticy Assessment of Patients Post Stroke

A Multichannel-Near-Infrared-Spectroscopy-Triggered Robotic Hand Rehabilitation System for Stroke Patients

How Do Strength and Coordination Recovery Interact after Stroke? a Computational Model for Informing Robotic Training

Computational Rehabilitation of Neglect: Using State-Space Models to Understand the Recovery Mechanisms

The Effects of Silent Visuomotor Cueing on Word Retrieval in Broca’s Aphasics: A Pilot Study

MIT-Skywalker: On the Use of a Markerless System

Design of an Exoskeleton Ankle Robot for Robot-Assisted Gait Training of Stroke Patients

A Novel Robot-Assisted Training Approach for Improving Gait Symmetry after Stroke

A Generalized Framework to Achieve Coordinated Admittance Control for Multi-Joint Lower Limb Robotic Exoskeleton

The Effect of Haptic Interaction between Balance Assessment Robot and Pelvis on Muscle Activation of Leg Muscles

Research of the BWS System for Lower Extremity Rehabilitation Robot

Autonomous Hip Exoskeleton Saves Metabolic Cost of Walking Uphill

Biomechanical Effects of Robot Assisted Walking on Lower Limb Joint Kinematics and Muscle Activation Pattern

Development of an Automatic Rotational Orthosis for Walking with Arm Swing

Toward Goal-Oriented Robotic Gait Training: The Effect of Gait Speed and Stride Length on Lower Extremity Joint Torques

The Influence of the Re-Link Trainer on Gait Symmetry in Healthy Adults

Design and Experimental Evaluation of a Lightweight, High-Torque and Compliant Actuator for an Active Ankle Foot Orthosis

Comparing Neural Control and Mechanically Intrinsic Control of Powered Ankle Exoskeletons

Motor Adaptation to Lateral Pelvis Assistance Force During Treadmill Walking in Individuals Post-Stroke

Development of New Rehabilitation Robot Device That Can Be Attached to the Conventional Knee-Ankle-Foot-Orthosis for Controlling the Knee in Individuals after Stroke

Walking Speed Intention Model Using Soleus Electromyogram Signal of Nondisabled and Post-Stroke Hemiparetic Patients

Developing Safe Fall Strategies for Lower Limb Exoskeletons

Timing of Intermittent Torque Control with Wire-Driven Gait  Training Robot Lifting Toe Trajectory for Trip Avoidance

Using Wearable Physiological Sensors to Predict Energy Expenditure

Preliminary Assessment of a Lower-Limb Exoskeleton Controller for Guiding Leg Movement in Overground Walking

Effects of Partial Body-Weight Support and Functional Electrical Stimulation on Gait Characteristics During Treadmill Locomotion: Pros and Cons of Saddle-Seat-Type Body-Weight Support

An Optimized Design of a Parallel Robot for Gait Training

Active Impedance Control of a Knee-Joint Orthosis During Swing Phase

An Assistive Lower Limb Exoskeleton for People with Neurological Gait Disorders

Design and Evaluation of a Modular Lower Limb Exoskeleton for Rehabilitation

Comparison of Kinematic and EMG Parameters between Unassisted, Fixed and Adaptive-Stiffness Robotic-Assisted Ankle Movements in Post-Stroke Subjects

Gait Assessment System Based on Novel Gait Variability Measures

    

                                           

Does Intracranial Pressure Monitoring Improve Outcomes in Severe Traumatic Brain Injury?

Followup needed for hemorrhage stroke patients. Better interventions are needed.
http://dgnews.docguide.com/does-intracranial-pressure-monitoring-improve-outcomes-severe-traumatic-brain-injury?overlay=2&
NEW ROCHELLE, NY -- August 15, 2017 -- Use of intracranial pressure (ICP) monitoring in patients with severe traumatic brain injury (TBI) was associated with a significant decrease in mortality, but it did not improve the rate of favourable outcomes, according to a study published in the Journal of Neurotrauma.
Although ICP monitoring was linked to more aggressive therapy, the researchers concluded that current therapies cannot adequately control increased ICP.
For the study, the researchers retrospectively investigated the effects of ICP monitoring in the treatment of severe TBI using data from the Japan Neurotrauma Data Bank (JNTDB). The study was conducted in 1,091 subjects enrolled in the JNTDB (Project 2009) from July 2009 to June 2011. The subjects were divided into those treated with and treated without ICP monitoring in intensive care for severe TBI.
The rate of ICP monitoring in the treatment of severe TBI was only 28%, suggesting that use of this method has declined compared with previous studies.
The patients who received ICP monitoring had significantly higher rates of therapy with hyperventilation, hyperosmolar diuretics, sedatives, anticonvulsants, and surgery, and more intensive body temperature management. Yet there was no significant difference in the favourable outcome rate between the ICP and non-ICP monitoring groups of patients.
“We conclude that ICP monitoring and management of ICP are both important for management and care of severe TBI,” the authors wrote. “However, current therapies do not control ICP sufficiently, and more effective therapies are needed.”
“This well-reasoned retrospective analysis focuses on an issue that continues to generate controversy in relation to the care and management of traumatically brain injured patients,” wrote John T. Povlishock, PhD, Medical College of Virginia Campus of Virginia Commonwealth University, Richmond, Virginia, in an accompanying editorial. “What is of note in this communication is the fact that although those patients were aggressively managed, with concomitant ICP monitoring revealing a significant reduction in mortality, this occurred without any improvement in outcome, a finding that further highlights the continued controversy surrounding routine ICP monitoring.”
Reference: DOI: 10.1089/neu.2016.4948
SOURCE: Mary Ann Liebert, Inc.

Congressional Heart and Stroke Caucus

You might want to ask them what leadership they are exhibiting to get all survivors 100% recovered. Not press release crapola.
Chair/Co
-
Chair(s):
Rep. Christopher H. Smith -(R) New Jersey's 4th District
Marisa Kovacs, Marisa.Kovacs@mail.house.gov, (202) 225
-
3765
Rep. Joyce Beatty -(D) 3rd District of Ohio
Kevin Carson, Kevin.Carson@mail.house.gov, (202) 225
-
4324

Thursday, August 17, 2017

More Bad News for Embolic Protection Devices Randomized trial shows little benefit for filtration or suction

If you need this, you will have lots of questions for your doctor to answer.
https://www.medpagetoday.com/Cardiology/Strokes/67168?
  • by Contributing Writer, MedPage Today
  • This article is a collaboration between MedPage Today® and:
    Medpage Today
Cerebral embolic protection devices do nothing to cut down on ischemic strokes after surgical aortic valve replacement (SAVR), a randomized trial suggested.
Freedom from clinical or radiographic central nervous system (CNS) infarction stood at 32.0% at the 7-day mark after surgery with suction-based extraction using CardioGard, versus 33.3% for protection-less control (P=0.84), reported Annetine C. Gelijns, PhD, of New York's Icahn School of Medicine at Mount Sinai, and collaborators of the Cardiothoracic Surgical Trials Network, online in the Journal of the American Medical Association.
The Embol-X system for intra-aortic filtration also failed to deliver significant protection, with infarct freedom rate of 25.6% versus 32.4% for control (P=0.22).
Patients also gained no clinical advantage with respect to combined mortality, clinical ischemic stroke, and acute kidney injury within 30 days of surgery, no matter if they got a suction device (21.4% versus 24.2% for control) or a filter protector (33.3% versus 23.7%),
Preliminary results from the study were previously reported at this year's American College of Cardiology meeting.
No differences in the individual endpoints of mortality or clinical stroke were observed between device groups and control. Nor was there a benefit relative to control for quality of life at 90 days.
"Despite the fact that debris was captured in most patients who received a cerebral embolic protection device, rates of clinical and radiographic infarction were not reduced," Gelijns' group concluded.
"However, the infarct volume pattern suggested a possible differential effect of devices compared with the control intervention, with larger volume infarcts more numerous in patients in the control group. This observation may be important because the risk of clinically evident stroke increases with infarct volume," they suggested, even as study groups shared similar numbers of MRI lesions and total lesion volume.
One benefit for embolic protection was identified, though: a reduction in delirium risk at day 7 when suction was employed during surgery (6.3% versus 15.3% for control, P=0.03).
"This difference may be related to the fact that, in addition to particulate matter, the suction-based device also extracts gaseous microemboli, which have been shown to affect neuropsychological functioning early during the postoperative phase among patients undergoing cardiac surgery," they suggested.
Embol-X, on the other hand, not only failed to reduce delirium but was also associated with more 90-day acute kidney injury (3.8% versus 1.1% for control, P=0.02) and cardiac arrhythmias (15.3% versus 8.1%, P=0.004).
For this study, patients were randomized to a suction-based extractor (n=118), an intra-aortic filtration device (n=133), or standard aortic cannula/control (n=132) at the time of surgery, which was more likely than not to be isolated SAVR (58%) or concomitant SAVR and coronary artery bypass grafting (41%). North American centers performed all surgeries from 2015 to 2016.
Radiographic lesions -- identified using diffusion-weighted 1.5- or 3.0-T MRI scanners -- made up the bulk of CNS infarcts found. "The significance of the many small and clinically silent lesions identified by diffusion-weighted MRI cannot be established," Gelijns and colleagues admitted.
Another caveat: performing scans at 7 days could overestimate infarct burden by capturing lesions unrelated to intraoperative factors -- but also could underestimate it, if smaller lesions disappeared by then. Furthermore, the authors said, they stopped randomization prematurely due to low conditional power for the primary endpoint.
Gelijns disclosed no conflicts of interest.
Co-authors reported relationships with Edwards LifeSciences, Abbott Vascular, Medtronic, and Claret Medical.

New Material to Help Repair Brain Tissue Damaged by Stroke

And with a great stroke association following up on promising research this would be looked at to create stroke protocols for stroke repair. We need to repair 12 km (7.5 miles) of connections for each minute of infarct. But fucking nothing will be done with this because we have NO stroke leadership and NO stroke strategy. You're screwed because all the stroke medical professionals in the world can't get their act together and solve all the problems in stroke
https://www.medgadget.com/2017/08/new-material-help-repair-brain-tissue-damaged-stroke.html
One of the reasons why strokes are so devastating is that brain tissue does not exhibit the same healing mechanisms as other tissues that repair themselves quickly. Integrin proteins are responsible for some of the healing processes, including getting new cells to move and having them adhere to the extracellular matrix, and these are not strongly present within damaged brain tissue. In order to get the brain to heal itself better than on its own, a team led by UCLA scientists has come up with a material that is similar to the extracellular matrix and that promotes the activity of integrin to heal nearby tissues.
The hydrogel-based material, which has already been successfully tried in post-stroke mice, features vascular endothelial growth factor and a molecule that promotes α3/α5β1 integrin binding, which the researchers have shown leads to much stronger and less leaky blood vessels than a molecule that promotes αvβ3 integrin binding.
The studied mice demonstrated considerable repair of their brain tissues following a stroke, which bodes well that humans will also react similarly to this new approach to stroke care. Hopefully clinical trials will soon be underway to validate the new technology.
Study in Nature Materials: Hydrogels with precisely controlled integrin activation dictate vascular patterning and permeability…
Via: UCLA…

Virtual Reality Therapy Designed to Help Stroke Patients Recover

But is action observation better? 
https://www.rdmag.com/article/2017/08/virtual-reality-therapy-designed-help-stroke-patients-recover?
Those recovering from a stroke often face an uphill battle. Rehabilitation typically requires executing continuous, repetitive movements, which can be extremely frustrating and monotonous for the patient.
One company is hoping to change that by incorporating virtual reality-based physical and cognitive exercise games into stroke rehabilitation programs.
The neurotechnology company MindMaze has introduced MindMotion PRO, a 3D virtual environment therapy for upper limb neurorehabilitation for victims of stroke.
As early as one to six weeks post stroke, patients can use this technology to complete customized interactive exercises in a virtual reality environment. The exercises are designed to stimulate the specific area of the brain damaged by the stroke. These training games engage 3D motion tracking cameras, which capture and map patient movements onto 3D avatars in different exercises of the patient’s shoulder, elbow, forearm, and wrist movements. MindMotion is designed for patients starting in the earliest stage of recovery and can be used from a hospital bed if needed.
The technology received FDA clearance in May and is in the process of launching its first U.S. study, which will be based at University of California, San Francisco. The study is expected to launch in fall 2017.
So far, patient responses have been extremely positive, said Andrea Serino, Ph.D., the head of neuroscience at MindMaze.
“Most of the patients are enthusiastic about virtual reality technologies,” said Serino, in an interview with R&D Magazine. “In most clinics, rehabilitation is really boring. But with MindMotion instead of doing one simple, boring repetitive movement over and over, you can have the same movement— because it’s very important that you have the repetition of the same movement—but in a context that is gamified and enjoyable for the patients.”
MindMotion Mask. Credit: MindMaze
Benefits of virtual reality
In addition to making rehabilitation more enjoyable for the patients, virtual reality also has the potential to improve rehabilitation outcomes compared to traditional exercise-based therapies. By using an avatar in a virtual reality environment, healthcare professionals can directly stimulate not only the body of the patient, but their brain.
“We know that if you see another person doing movement, you activate the brain regions that normally activate when you do the same movement,” explained Serino. “By having an avatar in our MindMotion Pro machine which represents the movement of the patients while the patient is moving, we are stimulating both the motor cortex to produce the movement, and an action observation loop to activate the brain regions that have been damaged by the stroke.”
Patients that have no mobility on one side of the body can enter a virtual reality environment and participate in games that require them to move only their working arm. At the same time, their avatar can move the opposite arm, activating the areas that correspond to the damaged part of their cortex.
There is also potential to pair this type of virtual reality technology with robotics technologies that could physically move a paralyzed limb during this exercise.
Utilizing virtual reality for stroke rehabilitation also has benefits for the clinicians that work with these patients. Intensive, repetitive movements continued over a long duration have proven to be the best way for a patient to recover from a stroke. However, this type of treatment requires significant supervision and effort from medical personal.
A virtual reality machine can guide the patient in these repetitive exercises, allowing them to train more often and with increased intensity, while requiring a lower level of supervision and assistance. In addition, the machine monitors each patient’s progress, allowing healthcare providers to track and update their treatment regimen more specifically.
What’s Next
MindMaze is working to expand their MindMotion offerings for stroke rehabilitation virtual reality technology.
“The idea of MindMotion is to take care of patients from the beginning of their disease to the end,” said Serino. “We want to help patients all along the journey of their rehabilitation—from the acute care units, to the rehabilitation units, to the outpatient screenings, and when they go home. This means that you cannot have a single device to do all of these things, because depending on the status of the patient, and the phase of the disease, you will need different approaches and different technologies with different ideas behind them.”
In addition to MindMotion Pro, MindMaze has already developed MindMotion Go, which was created for patients in the later phases of stroke recovery. This is meant to be used in clinics and incorporates more “gamified” types of exercise.
There is also potential to branch out into other neurological diseases, although Serino said MindMaze wants to focus their resources on providing care to stroke patients first. However, he sees future applications for this technology for patients with multiple sclerosis, Parkinson’s disease, or those with dementia and mild cognitive impairment. He also sees potential for these devices to be used in children suffering from attention challenges or other cognitive challenges.
As virtual reality continues to take off within healthcare, and specifically within the neurological space, it is important that new technologies are designed with thought and care to the specific disease they are treating, said Serino.
Virtual reality has such good potential for the rehabilitation field that for sure it will continue to develop, but I think the challenge is how we do that,” he said. “We are now in the moment where we have to define how we are going to use this technology in healthcare. We have to do it in a way that really incorporates the rehabilitation techniques that we already know. We have to use it with a sufficient level of complexity so that we can implement the knowledge we have from the field of neuroscience. That will be the way that we really benefit from this technology.”

NIH StrokeNet

I see absolutely nothing here that even suggests that a strategy is being followed to solve all the problems in stroke.

http://www.nihstrokenet.org/

Welcome

The NIH has created the NIH StrokeNet to conduct small and large clinical trials and research studies to advance acute stroke treatment, stroke prevention, and recovery and rehabilitation following a stroke. This network of 25 regional centers across the U.S., which involves more than 200 hospitals, is designed to serve as the infrastructure and pipeline for exciting new potential treatments for patients with stroke and those at risk for stroke. In addition, NIH StrokeNet will provide an educational platform for stroke physicians and clinical trial coordinators.

The Amazing Body Benefit of Just One Minute of Running

If we had ANYTHING AT ALL resembling decent stroke rehabilitation there would be a stroke protocol to get survivors back to running. It would include getting rid of spasticity, correcting foot drop and foot slap. But nothing like that exists, you'll have to figure it out on your own, just like Tommye-K. Mayer had to do and her writeup of it in her book. Teaching Me to Run.

And this one, better blood flow to the brain. Which means your doctor should have you being able to extensively walk in the first week. Throw that requirement at your doctors feet.

How walking benefits the brain: Impact of feet hitting the ground opens up arteries and increases blood flow


https://www.livestrong.com/article/13429563-the-amazing-body-benefit-of-just-one-minute-of-running/? 

by

If you’re having a hard time motivating yourself to get your sneakers on and hit the treadmill, here’s some awesome news. According to new research, running for just one minute a day is linked to improved bone health in women, reducing the risk of osteoporosis and fractures.
The study evaluated more than 2,500 women, and those who did brief bursts of high-intensity, weight-bearing activity (such as a medium-paced run for premenopausal women or a slow jog for postmenopausal women) for one to two minutes each day had 4 percent better bone health than those who did less than a minute. For those who could sustain running for more than two minutes a day, the results were even better: 6 percent better bone health as compared with that of the participants who didn’t exercise.
Even just a couple of minutes of running has benefits for your body. (Though the researchers say they can’t be sure whether the high-intensity physical activity led to better bone health or whether those with better bone health tend to do more high-intensity activity.) Whether physical activity must be done daily to reap the benefits or whether more minutes of exercise on one day — and allowing for rest days — is better for bone health warrants further research.
In the meantime, a simple way to incorporate a one-minute daily run is to vary the pace of your walking. “We would suggest adding a few running steps to the walk, a bit like you might if you were running to catch a bus,” said lead author Dr. Victoria Stiles of the University of Exeter.
And if better bone health wasn’t enough of a reason to quicken the pace, consider some other perks running can provide, such as lowered risk of memory loss, improved mood and even longer life.




Reported use of technology in stroke rehabilitation by physical and occupational therapists

Lack of objective feedback to patients is a huge concern. With nothing objective you can't correlate interventions to recovery. 
https://tandf.figshare.com/articles/Reported_use_of_technology_in_stroke_rehabilitation_by_physical_and_occupational_therapists/5314591
byJeanne LanganHeamchand SubryanIfeoma NwoguLora Cavuoto
Purpose: With the patient care experience being a healthcare priority, it is concerning that patients with stroke reported boredom and a desire for greater fostering of autonomy, when evaluating their rehabilitation experience. Technology has the potential to reduce these shortcomings by engaging patients through entertainment and objective feedback. Providing objective feedback has resulted in improved outcomes and may assist the patient in learning how to self-manage rehabilitation. Our goal was to examine the extent to which physical and occupational therapists use technology in clinical stroke rehabilitation home exercise programs.
Materials and methods: Surveys were sent via mail, email and online postings to over 500 therapists, 107 responded.
Results: Conventional equipment such as stopwatches are more frequently used compared to newer technology like Wii and Kinect games. Still, less than 25% of therapists’ report using a stopwatch five or more times per week. Notably, feedback to patients is based upon objective data less than 50% of the time by most therapists. At the end of clinical rehabilitation, patients typically receive a written home exercise program and non-technological equipment, like theraband and/or theraputty to continue rehabilitation efforts independently.
Conclusions: The use of technology is not pervasive in the continuum of stroke rehabilitation.Implications for Rehabilitation
The patient care experience is a priority in healthcare, so when patients report feeling bored and desiring greater fostering of autonomy in stroke rehabilitation, it is troubling.
Research examining the use of technology has shown positive results for improving motor performance and engaging patients through entertainment and use of objective feedback.
Physical and occupational therapists do not widely use technology in stroke rehabilitation.
Therapists should consider using technology in stroke rehabilitation to better meet the needs of the patient.
The patient care experience is a priority in healthcare, so when patients report feeling bored and desiring greater fostering of autonomy in stroke rehabilitation, it is troubling.
Research examining the use of technology has shown positive results for improving motor performance and engaging patients through entertainment and use of objective feedback.
Physical and occupational therapists do not widely use technology in stroke rehabilitation.
Therapists should consider using technology in stroke rehabilitation to better meet the needs of the patient.

What it takes to recover from a stroke

You can read this but it tells you nothing, doesn't bother to mention that only 10% fully recover
http://www.newvision.co.ug/new_vision/news/1459911/takes-recover-stroke

Speaking at the 3rd European Stroke Organisation Conference, Haukeland University Hospital’s Kristin Modalsli Sand discussed visual disturbances in ischaemic stroke patients

She discusses a problem but offers no solutions. That great stroke association president should be contacting all these researchers that never propose solutions to the problems they describe.
http://www.paneuropeannetworks.com/health/stroke-and-visual-disturbances/
Kristin Modalsli Sand is a member of the stroke research group at the Center for Neurovascular Disease at Haukeland University Hospital in Bergen, Norway, and project manager of the multicentre prospective study NOR-OCCIP (Norwegian Occipital Ischemic Stroke Study), which focuses on the management and outcome of visual field defects in occipital cerebral infarction.
Speaking at the 3rd European Stroke Organisation Conference (ESOC) 2017, which Pan European Networks attended in Prague, Czech Republic, in May, Sand took as her topic visual disturbances in ischaemic stroke patients. Her presentation centred on three questions, namely ‘why should we care about visual disturbances?’, ‘when should we suspect a visual disturbance is actually an ischaemic lesion?’, and ‘should we thrombolyse the patient?’
Why should we care about visual disturbances?
The first answer to this question, Sand explained, is simple: because they happen frequently. Given the way that the brain is organised – the eyes being at the very front, the occipital lobe being at the very back, and the two of them very intricately communicating – “it’s not difficult to understand that a lesion in … say, any part of the brain could give some sort of problem with vision”.
This is also reflected in the literature, she continued, noting that 61% of the 1,200 patients included in a large study on VISTA (Virtual International Stroke Trials Archive) had a vision problem and 50% a visual field defect. “This is something that affects a lot of patients, and we have to deal with it,” Sand said.
Poor functional patient outcomes are the second reason that we should care about visual disturbances, she added, explaining that patients who experience vision problems after a stroke have higher scores on the National Institutes of Health Stroke Scale (NIHSS), higher modified Rankin Scale scores, and lower Barthel Index scores compared to patients who experience other problems or deficits after a stroke (and no vision problems – something which has been confirmed by numerous studies).
Multiple pieces of evidence have also shown that patients who experience vision problems after a stroke have a poor quality of life, Sand added, pointing to one of her own studies as an example and highlighting the “dose-response relationship” between increasing vision problems and an increasingly poor quality of life.
“We were quite surprised when we did a study on mortality and visual field defects, and we saw at first, in the acute phase with the severe stroke patients, that there was a clear tendency for visual field defect with hemianopia to have a higher mortality rate,” she continued.
“We then wanted to look at the mild strokes, asking: what about those who have an NIHSS score of four or below and have a visual field defect? We looked at them and in the acute phase we found what we expected: there was not really any difference. Then we looked at the long-term outcomes for these patients. Something happens after about four years. Those who have a hemianopia after four years as their only deficit after a small ischaemic stroke have higher mortality rates, and this was also still significant after trending for confounding factors. When you think about it, having a hemianopia, you’re prone to accidents. When you cross the street, you might be hit by a car or you might fall, so it’s not so difficult to imagine that this could actually be the case.”
The third reason that we should care about visual disturbances is because we can “fix” them, Sand said. Highly significant results from VISTA show that patients who experience visual problems and are treated with thrombolytic agents improve compared to patients who don’t receive thrombolytic agents. This makes treatment “really important”.
Visual disturbances can also be fixed in the sense that patients can receive training and visual rehabilitation. Sand explained: “We know that when you have a motor problem in the tongue, or in the arm or the leg, this can be trained. But somehow there’s a conception that a motor problem in an eye muscle is not available for training, and this is a really grave misconception.
“We have a short period of a ten-day programme to try to work with [patients’] eye muscles and strengthen them, and they have a really miraculous recovery, and we know that compensation techniques improve reading speeds for patients, improve their search strategies, and improve their activities in daily lifestyle function.”
She added that vision restitution therapy (VRT) is more controversial, as some studies have demonstrated it has an effect (but not necessarily as positive an effect as some had hoped), while others have not. VRT is nonetheless important to consider, Sand said, because “we know that VRT also improves reading speeds and significantly improves the quality of life for the patient”.
When should we suspect that a visual disturbance is actually an ischaemic lesion?
Sand then turned her attention to how to tell whether a patient presenting with an isolated vision problem is actually presenting with a stroke.
“The hallmark of any acute stroke is the acute onset, but in vision problems we have to be very critical … because the patient might just present with nausea or a headache, and not really recognise at all that they have a vision problem. So, you have to remember, in the acute setting, to examine the visual field.”
Sand explained that most of the information designed to help people recognise a stroke – for example FAST (Facial drooping, Arm weakness, Speech difficulties and Time to call emergency services) – don’t say anything about vision, so most people “don’t realise that an acute onset of a vision problem is or could be a stroke”.
However, many of the symptoms which persist do provide an indication of whether a stroke is more likely – for instance “if you have a hemifield where [the patient] just can’t see as opposed to a hemifield with flickering lights, which could of course also be a stroke”. Other things to consider include whether the lesion is localisable and whether you can you pinpoint a lesion from the patient’s symptoms. “Many times – for example, with a migraine – the patient has more global symptoms, and it’s more difficult to pinpoint the precise lesion,” Sand explained, “so that’s important to consider.”
Of course, there are cases where you might not be able to tell if a stroke has occurred, in which case you have to consider the patient’s “comorbidity and risk factors for stroke” when deciding whether or not to thrombolyse, and any of the numerous “differential diagnoses” which might be more likely, among them migraine, epilepsy and other ocular conditions.
Should we thrombolyse the patient?
Sand then returned to her final question: should we thrombolyse patients with visual disturbances? Such patients often score zero or else very low on the NIHSS, which might result in thrombolytic treatment being withheld, but “of course we know better,” she said. “We know that there’s actually increased mortality, poor post-stroke outcome, and poor quality of life. So, no, it’s not too much to treat and we really should do a lot of work to do better by these patients, because they often don’t get the treatment that they deserve.”
Drawing her presentation to a close, Sand summed up her “take-home message” to the ESOC audience: “When you have a visual disturbance in the ER, you need to assess whether it’s an acute onset and be very critical. Don’t forget to examine the patient when [they] present with acute headache or acute vertigo or acute nausea … Where is the lesion? Try to be critical. Can I explain all the patient’s symptoms with one lesion?” she asked, urging her listeners to consider the whole picture – that is, other risk factors for ischaemic stroke and whether a differential diagnosis is more likely.
“Of course, my main message here today is that, no, visual disturbances are not too much to thrombolyse,” she concluded.

This article will appear in issue two of Pan European Networks: Health, which will be published at the end of August.

Hypothermia After Stroke Reduces Dynamin Levels and Neuronal Cell Death

I haven't been able to figure out if hypothermia is good for stroke survivors. Nothing is clear in the 37 posts I've written on hypothermia. If we had a great stroke association all stroke research would be publicly available and summarized as to applicability to stroke recovery. But instead we have fucking ABSOLUTELY NOTHING.
http://www.alphagalileo.org/ViewItem.aspx?ItemId=178178&CultureCode=en
A new study has shown that following brain ischemia caused by cerebral blockage in mice both immediate and delayed reduction in body temperature helped limit cell death and levels of a protein called dynamin. These results, which suggest that dynamin may have a role in-and be a potential drug target for-stroke-related neuronal cell death, are reported in Therapeutic Hypothermia and Temperature Management, a peer-reviewed journal from Mary Ann Liebert, Inc., publishers. The article is available free on the Journal website until September 16, 2017.

The article entitled "Hypothermia Identifies Dynamin as a Potential Therapeutic Target in Experimental Stroke" is coauthored by Jong Youl Kim, PhD, Nuri Kim, Jong Eun Lee, PhD, and Midori Yenari, MD, University of California, San Francisco and Yonsei University College of Medicine, Seoul, Republic of Korea.

The researchers demonstrated increased expression of dynamin and the cell surface receptor FAS in a mouse model of stroke. They assessed the effects of two cooling approaches on the survival of brain cells: cooling as soon as cerebral blockage occurs (early hypothermia) and cooling that began 1 hour later (delayed hypothermia). The results were compared to those in mice not subjected to hypothermia.

"These exciting results present new injury pathways to target for utilizing therapeutic hypothermia in acute as well as sub-acute time points after stroke," says W. Dalton Dietrich, III, PhD, Editor-in-Chief of Therapeutic Hypothermia and Temperature Management, Scientific Director of The Miami Project to Cure Paralysis, and Kinetic Concepts Distinguished Chair in Neurosurgery, University of Miami Leonard M. Miller School of Medicine.
http://online.liebertpub.com/doi/full/10.1089/ther.2017.0005

Attached files

  • Therapeutic Hypothermia and Temperature Management

Silicon Valley’s ambitious new bet: Brain ‘modems’ that restore sight, hearing, and speech

This may not be able to directly help us in those cases where the neurons controlling a movement/function are dead. But our researchers with a bit of innovation could come up with a solution to the dead brain problem.
https://www.statnews.com/2017/08/17/brain-machine-interface-paradromics/?utm_source=STAT+Newsletters&
SAN JOSE, Calif. — In a warehouse district here, a few young engineers fueled by ramen and energy bars are inventing the future of mind reading.
Paradromics has big ambitions: It wants to squeeze a device the size of a mobile phone into a chip small enough to insert into a human brain, where it would “read” nerve signals and replace senses and abilities lost due to injury or diseases.
For now, the startup’s recently minted Ph.D.s are working in a small warren of scruffy offices and labs to perfect a stuffed-mouse mockup. You’d never guess that it won an $18 million Pentagon contract last month, vaulting it into the top ranks of Silicon Valley companies surging into the field of brain-machine interfaces.