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:

Friday, August 18, 2017

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.
Rep. Christopher H. Smith -(R) New Jersey's 4th District
Marisa Kovacs,, (202) 225
Rep. Joyce Beatty -(D) 3rd District of Ohio
Kevin Carson,, (202) 225

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.
  • 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
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?
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.


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 


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.
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

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.
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.
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.

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.
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.

Stroke Survivors' Experiences of Physical Rehabilitation: A Systematic Review of Qualitative Studies

3 years old and I bet your stroke hospital has not done one goddamn thing with this. This is all the result of NO stroke protocols and NO way forward to 100% recovery
Presented in part to SMART STROKES, August 28, 2014, Sydney, Australia.



To report and synthesize the perspectives, experiences, and preferences of stroke survivors undertaking inpatient physical rehabilitation through a systematic review of qualitative studies.

Data Sources

MEDLINE, CINAHL, Embase, and PsycINFO were searched from database inception to February 2014. Reference lists of relevant publications were searched. All languages were included.

Study Selection

Qualitative studies reporting stroke survivors' experiences of inpatient stroke rehabilitation were selected independently by 2 reviewers. The search yielded 3039 records; 95 full-text publications were assessed for eligibility, and 32 documents (31 studies) were finally included. Comprehensiveness and explicit reporting were assessed independently by 2 reviewers using the consolidated criteria for reporting qualitative research framework. Discrepancies were resolved by consensus.

Data Extraction

Data regarding characteristics of the included studies were extracted by 1 reviewer, tabled, and checked for accuracy by another reviewer. All text reported in studies' results sections were entered into qualitative data management software for analysis.

Data Synthesis

Extracted texts were inductively coded and analyzed in 3 phases using thematic synthesis. Nine interrelated analytical themes, with descriptive subthemes, were identified that related to issues of importance to stroke survivors: (1) physical activity is valued; (2) bored and alone; (3) patient-centered therapy; (4) recreation is also rehabilitation; (5) dependency and lack of control; (6) fostering autonomy; (7) power of communication and information; (8) motivation needs nurturing; and (9) fatigue can overwhelm.


The thematic synthesis provides new insights into stroke survivors' experiences of inpatient rehabilitation. Negative experiences were reported in all studies and include disempowerment, boredom, and frustration. Rehabilitation could be improved by increasing activity within formal therapy and in free time, fostering patients' autonomy through genuinely patient-centered care, and more effective communication and information. Future stroke rehabilitation research should take into account the experiences and preferences of stroke survivors.

2017 Canadian Stroke Congress - Join us in Calgary from September 9 to 11!

I'm deadly serious here; your doctor should be asking exactly how ALL stroke survivors can get to 100% recovery. If your doctor doesn't ask that question at the conference they are complete chickenshits.

2017 Canadian Stroke Congress

Wednesday, August 16, 2017

Study examines timing of mechanical thrombectomy, call burden on physicians at stroke centers

Oh, oh look over here a squirrel. News that only shows positive outcomes in stroke. Nothing about all the fucking failures in stroke. You are screwed forever.
1. Only 10% of patients get to full recovery.
2. tPA only fully works to reverse the stroke 12% of the time. Known since 1996.
3. No protocols to prevent your 33% dementia chance post-stroke from an Australian study.
4. Nothing to alleviate your fatigue.
5. Nothing that will cure your spasticity.
6. Nothing on cognitive training unless you find this yourself.
7. No published stroke protocols.
8. No way to compare your stroke hospital results vs. other stroke hospitals.
Stroke centers average mechanical thrombectomies once every five days with nearly 60 percent of the procedures occurring during non-work hours, according to a new study presented today at the Society of NeuroInterventional Surgery's (SNIS) 14th Annual Meeting. This finding could have implications for physician staffing at stroke centers and the patients receiving treatment.
A Multicenter Study Evaluating the Frequency and Burden of Mechanical Thrombectomy on Stroke Centers is the first study to examine the times at which mechanical thrombectomies occur and the call burden on neurointerventional staff.
"As awareness increases of the benefits of mechanical thrombectomy for emergent large vessel occlusion (ELVO), it's vital that we understand the frequency and the times at which these procedures occur so that we can optimize outcomes for our patients," said Dr. Kyle Fargen, lead author of the study and Assistant Professor of Neurological Surgery at Wake Forest University.
The study collected data from 10 stroke centers over a three-month period in 2016. During the study period, 189 patients with ELVO underwent emergent angiography with the intent to have a mechanical thrombectomy at participating centers. During that time, the peak period when most procedures were started was between 8 - 11 p.m. The average number of procedures per hospital was 18.9. The median procedural time was 57 minutes and the overall physician time for each patient was approximately 2.5 hours, although this metric did not include post-procedure responsibilities.
The study did not find any differences in the frequency of the procedure based on the day of the week, or of the procedure's length based on time of day.​​

Little evidence shows cannabis helps chronic pain or PTSD

You can't expect positive evidence on this because of the extreme difficulty of doing research with marijuana.

Does your doctor even know about the 23% chance of stroke survivors getting PTSD? And what is s/he doing about it?

 I will use marijuana post-stroke for these reasons;

My 13 reasons for marijuana use post-stroke.  

But don't listen to me, I have absolutely no medical training,

Little evidence shows cannabis helps chronic pain or PTSD

Alzheimer's Disease: Prevent or Treat? Alzheimer's field is shifting its focus

What about for stroke? Obviously our fucking failures of stroke associations have gone down the easy press release prevention route. Leaving stroke survivors high and dry. There are thousands of pieces of research just needing some followup and recovery from stroke could be made vastly better,even 100% recovery.  The answers are out there, you just have to have some stroke leadership willing to tackle the BHAGs(Big Hairy Audacious Goals) in stroke.
Alzheimer's Disease: Prevent or Treat? Alzheimer's field is shifting its focus  

Six months after stroke, 44% to 74% of patients present some degree of cognitive disturbance

And just what the hell is your doctor doing to prevent that? ANYTHING AT ALL? Or is s/he just sitting on their ass waiting for SOMEONE ELSE TO SOLVE THE PROBLEM?  I'm pretty sure I have no cognitive disturbance, friends may disagree and say arrogance is a disturbance.
From this article:

Citicoline in Vascular Cognitive Impairment and Vascular Dementia After Stroke


Overviews should be completely unnecessary. You just look up the stroke protocol in the public database, and use that to treat your patients. If done right these wastes of time would no longer occur.


Stefano Mazzoleni, PhD1,2*, Christophe Duret, MD3,4, Anne Gaëlle Grosmaire3, Elena Battini1,2

1 :The BioRobotics Institute, Scuola Superiore Sant’Anna, Pisa, Italy  2 : Rehabilitation Bioengineering Laboratory, Volterra, Italy 3 : Centre de Rééducation Fonctionnelle Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Neurorééducation, Boissise-Le-Roi (77), France 4 : Centre Hospitalier Sud Francilien, Neurologie, Corbeil-Essonnes (91), France 
Abstract:  A better understanding of the neural substrates that underlie motor recovery after
stroke has led to the development of innovative rehabilitation strategies and tools that
incorporate key elements of motor skill re-learning, i.e. intensive motor training involving
goal-oriented repeated movements. Robotic devices for the upper limb are increasingly used
in rehabilitation. Studies have demonstrated the effectiveness of these devices in reducing
motor impairments, but less so for the improvement of upper limb function. Other studies
have begun to investigate the benefits of combined approaches that target muscle function
(functional electrical stimulation and Botulinum Toxin injections), modulate neural activity
(Noninvasive Brain stimulation) and enhance motivation (Virtual Reality) in an attempt to
potentialize the benefits of robot-mediated training. The aim of this paper is to overview the
current status of such combined-treatments and to analyze the rationale behind them. 

Hand Rehabilitation Robotics on Post-Stroke Motor Recovery

And yet with the total lack of  hand recovery stroke protocols, this helps not one bit.
Hand Rehabilitation Robotics on Post-Stroke Motor Recovery
Zan Yuea, 1   Xue Zhanga,1   Jing Wanga, *
a School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, 710049, China

Abstract: The recovery of hand function is one of the most challenging topics in stroke rehabilitation. Although the robot-assisted therapy has got some good results in latest decades, the development of hand rehabilitation robotics is left behind. Existing reviews of hand rehabilitation robotics focus either on the mechanical design on designers’ view or on the training paradigms on the clinicians’ view, while these two parts are interconnected and both important for designers and clinicians. In this review, we explore the current literature surrounding hand rehabilitation robots, to help designers make better choices among varied components and thus promoting the application of hand rehabilitation robots. An overview of hand rehabilitation robotics is provided in this paper firstly, to give a general view of the relationship between subjects, rehabilitation theories, hand rehabilitation robots and its evaluation. Secondly, the state of art of hand rehabilitation robotics is introduced in details according to the classification of the hardware system and the training paradigm. As a result, the discussion gives available arguments behind the classification and comprehensive overview of hand rehabilitation robotics.

Tuesday, August 15, 2017

‘I can walk for 50m without stopping. I feel on top of the world now’ How mirror stroke therapy is changing people's lives

That is pathetic as a goal. It should be running. Ask your doctors how to get running.
PJ Wymbs was getting out of bed on the morning of April 1st, 2016, when he fell.
He knew as his legs gave way that it was a stroke. The 66 year old from Kinlough, Co Leitrim, had been diagnosed with cancer five years earlier and “was just getting back to myself” when his health suffered this latest blow.
A carpenter who had discovered a gift for basket weaving and wood turning during his recovery from cancer, Wymbs is left-handed. “I lost the power on my left side,” he explained. Overnight, he went from someone who was making intricate working spinning wheels which were getting attention at craft fairs around the country, to someone who was unable to lift an empty cup or use cutlery.
The six months following the stroke was “a bad time in my life”, he says, but physiotherapists at Sligo University Hospital told him about the clinical trials being done by researchers at IT Sligo and he grabbed the opportunity.

Sensation in my fingers

PhD students Daniel Simpson and Monika Ehrensberger started calling to his home three times a week to do the mirror therapy and strengthening techniques which they believe have helped up to 40 per cent of patients tested.
“I loved to see them coming,” said PJ. “I felt an improvement after the third session. I think they did not believe me but I could feel a sensation in my fingers and I could move my arm.”
He had been trying to do without a walking stick, but was “walking around walls”. While he had been back driving six weeks after the stroke, he had to reach over with his hand to pull the handbrake.
All that has changed. After four weeks of therapy he says the progress made changed his life. “I can do most things now. I could do nothing with the hand, I could not even raise it but I’m back at the wood turning. It is weaker than it was but it is a massive improvement.
“I still have a little bit of a limp and I get tired but I can walk for 50m without stopping and I can walk faster. I feel on top of the world now.”



Helen Cassells laughs when she recalls her introduction to the treadmill and mirror, which researchers at IT Sligo are using to enhance rehabilitation for stroke patients. “The first day was hilarious. As far as I was concerned I had three legs, ” she said.
Before she suffered a stroke in 2011, Cassells from Glencar, Co Sligo, played golf “morning, noon and night”.
She remembers the first day for another reason because she maintains that almost immediately she felt a sensation in her “bad leg”.
“I think the nerves were beginning to wake up,” she said.
She was 57 when she had a stroke . “I woke up at about 7am and I could not turn over on my right side. I thought at first that I was dreaming.” While she was able to get up, she discovered at breakfast that she could not lift the spoon to eat her cereal. She started to tell her husband Laurence what was happening. “As far as I was concerned I was speaking normally but he couldn’t make out a word.”

Pronounced limp

As a result of the stroke she was paralysed on the right side. After rehabilitation in St John’s Hospital, Sligo, and the National Rehabilitation Hospital in Dún Laoghaire, her mobility had improved dramatically but she still needed a walking stick sometimes and had a “very pronounced limp”. She might have settled for this life-changing limited mobility but she heard about the clinical trials at IT Sligo and decided to volunteer.
The changes have been so dramatic that “sometimes I have to remind myself that I had a stroke”. The little things delight her almost as much as the fact that she can actually run now and can go hill walking.
“Filling the kettle is one thing. I used to have to hold the kettle in my left hand but suddenly I realised I could use my right hand. I can iron now with my right hand.”
And while she hasn’t climbed Knocknarea yet, “I can walk up a hill and down again”. She is back working as a water diviner, a job she says which clearly requires the ability to hold a stick and to detect any movements in it.
“I may not be 100 per cent better but I’m back 95 per cent.”

West Jefferson Medical Center recognized for 'gold quality' stroke care

Having to present 'Stroke Warrior' awards means this hospital is a complete fucking failure to stroke patients.  No way to sugarcoat that and the Get With the Guidelines award is worthless. Ask for RESULTS, and then call for the resignation of the president and the board of directors. They are all completely incompetent. Care mentioned 6 times but never results.

The staff at West Jefferson Medical Center's Stroke Center recently received the American Heart Association/American Stroke Association's "Get With the Guidelines Gold Plus Quality Achievement Award- Target: Stroke Honor Roll Elite Plus.
Misty Rains, of American Heart Association presented the award to the staff that has consistently met the guidelines and received this award for a number of year. Patients have come to rely upon their dedicated care.
WJMC spokeswoman Taslin Alfonzo announced this year's achievement/award to the public in July. Posters of recognition are displayed in prominent locations of the medical center to assure the public of the continued quality care that is available at their community hospital. This provision of quality care begins immediately upon arrival of the West Jefferson Medical Emergency transport team or the patient's arrival at West Jefferson Medical Center.
Alyana A. Samai, WJMC Stroke Program Coordinator, and staff facilitated the ceremony honoring the stroke team for their work in meeting national stroke guidelines.
The WJMC staff includes Monica Balogna, chief nursing officer; Dr. Michael Puente, neurologist and stroke medical director; Nancy Cassagne, chief executive officer; Dr. Robert Chugden, chief medical officer; Dr. Michael D'Antonio, chief radiologist; and Dr. Andrew Mayer, emergency department director.
The WJMC stroke team honorees included: Registered Nurses Terri Heirsch, Ina Dragicevic, stroke program navigator, Marie Slowey, Tyler Koelling, and Kim Scott. Each team member received "Stroke Warrior" plaques for their commitment to providing "Excellent Stroke Care" to the people served.
Heirsch, the stroke unit charge nurse, was awarded the Stroke Warrior Award for handling the highest volumne of stroke activations in a single weekend for quarters 1 and 2 of 2017.
Kip Schellhaas, received a Stroke Warrior Award as a surviving stroke patient who quickly won his battle against stroke.
"He is the first recipient of the award due to his courage and strength in his amazing recovery from stroke that left him unable to speak and paralyzed on the right side of his body. After only five months he is back at work and functioning well," Alonzo said.
Knowing the signs of the onset of a stroke could mean life or death to the patient.

Dementia and low brain serotonin may be linked: Study finds

You need to know about this with your likely descent into dementia. Now we'll need to find which is the cause and which is the effect. Don't do anything with this on your own.

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.
Johns Hopkins researchers looked into the brain scans of persons with mild loss of thought and memory and have found that they have significantly low levels of serotonin in their brains. Serotonin is a natural brain chemical that is responsible for several functions including mood, sleep and appetite and also is important for several mental health conditions.
Image Credit: Shidlovski / Shutterstock
Image Credit: Shidlovski / Shutterstock
There have been studies previously that have shown that persons with Alzheimer's disease and those with severe cognitive decline tend to have lower levels of serotonin. However no studies could quantify or explain the phenomenon and it was unclear if low serotonin caused the disease or the disease caused serotonin levels to drop. This new study on persons with early stages of memory decline showed conclusively that serotonin loss was causing the memory loss rather than the other way round. The study is published in the September issue of the journal Neurobiology of Disease.
The study was published alongside a report that states that if ways could be determined to stop or slow down the loss of serotonin or introducing a substitute chemical into the brain, the progression of Alzheimer’s and other dementias could be stopped.
Gwenn Smith, professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine and director of geriatric psychiatry and neuropsychiatry at Johns Hopkins University School of Medicine, said that this study gives us the evidence we needed that low serotonin levels are the reason for cognitive decline of the brain. So understandably increasing serotonin function in the brain could be the key to prevent memory loss and also slow the progression of these diseases she explained.
In a normal brain when a message comes via a neuron, the neuron releases serotonin at its end. This is detected by the next neuron receiving the message. Once the message is propagated, there is a serotonin transporter SERT that picks up the serotonin and takes it back to the message-sending neuron. This shows up as the flow of the chemical serotonin. The serotonin neurons and transporters reduce with age in normal persons. As the neurons die with age, the SERTs also reduce in number.
One group of drugs that improve brain serotonin levels are the drugs that block the brain's reuptake of serotonin (known as SSRIs or Selective Serotonin reuptake inhibitors). These drugs are helpful in patients with depression and some forms of anxiety. They can significantly affect mood. According to Smith, with this idea in mind, researchers have already tried to treat Alzheimer’s disease and other diseases of cognitive decline with SSRIs but have met with limited success. But these drugs need adequate number of serotonin transporters or SERTs in the brain to work, she noted, and that was missing among those with cognitive decline. That is probably why SSRIs do not show as much success as expected.
For this study the researchers looked at the brain positron emission tomography (PET) scans of the participants who suffered from mild cognitive problems. These mild cognitive problems usually lead to severe dementias and Alzheimer’s. The participants were recruited using advertisements and flyers and also from the Johns Hopkins Memory and Alzheimer's Treatment Center. There were 28 participants with mild cognitive impairment who were matched to 28 healthy participants for comparison. The participants were all aged around 66 years and 45% of the participating population was female.
Mild cognitive impairment was defined for the study as slight decline in cognition including loss of memory, remembering sequences or organization and those who scored low on California Verbal Learning Test that asked participants to remember related words for example from a shopping list. Average scores of learning and memory tests especially California Verbal Learning Test, on a scale of 0 to 80 showed, average score of 55.8 among healthy participants and average of 40.5 among those with mild cognitive impairment. Another memory test was the Brief Visuospatial Memory Test where the participants were shown a series of shapes and they had to redraw them later from memory. On a scale of 0 to 36, healthy participants scored an average of 20.0 whereas those with mild cognitive problems scored an average of 12.6.
Once diagnosed and grouped, these participants underwent an MRI and PET scan to measure brain structures and levels of the serotonin transporters. To detect the serotonin transporters the patients took a drug that had a radioactive carbon label at a dose low enough to not cause any effect. The chemical went and bound to the serotonin transporter and the PET scanner picked up the radio labels.
Researchers in this study found that people with mild cognitive impairment had up to 38 percent less SERT in their brains compared to their matched healthy controls who were of same age. This means that this loss of the SERTs is more to do with the pathology than with age alone explain the researchers. None of the persons with mild cognitive impairment had higher levels of SERT compared to their healthy control.
The scores of the two memory tests and the PET scan results were compared next. They noted that lower serotonin transporters were associated with lower test scores. According to Smith, there are 14 types of serotonin receptors that could become the potential new targets for drug development in dementia.

Regional Variation in 30-Day Ischemic Stroke Outcomes for Medicare Beneficiaries Treated in Get With The Guidelines–Stroke Hospitals

There should be zero variation in the regions. This is because you are using fucking guidelines rather than protocols. Do you not know the difference?
Michael P. Thompson, Xin Zhao, Kimon Bekelis, Daniel J. Gottlieb, Gregg C. Fonarow, Phillip J. Schulte, Ying Xian, Barbara L. Lytle, Lee H. Schwamm, Eric E. Smith, Mathew J. Reeves
This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.


Background—We explored regional variation in 30-day ischemic stroke mortality and readmission rates and the extent to which regional differences in patients, hospitals, healthcare resources, and a quality of care composite care measure explain the observed variation.
Methods and Results—This ecological analysis aggregated patient and hospital characteristics from the Get With The Guidelines–Stroke registry (2007–2011), healthcare resource data from the Dartmouth Atlas of Health Care (2006), and Medicare fee-for-service data on 30-day mortality and readmissions (2007–2011) to the hospital referral region (HRR) level. We used linear regression to estimate adjusted HRR-level 30-day outcomes, to identify HRR-level characteristics associated with 30-day outcomes, and to describe which characteristics explained variation in 30-day outcomes. The mean adjusted HRR-level 30-day mortality and readmission rates were 10.3% (SD=1.1%) and 13.1% (SD=1.1%), respectively; a modest, negative correlation (r=−0.17; P=0.003) was found between one another. Demographics explained more variation in readmissions than mortality (25% versus 6%), but after accounting for demographics, comorbidities accounted for more variation in mortality compared with readmission rates (17% versus 7%). The combination of hospital characteristics and healthcare resources explained 11% and 16% of the variance in mortality and readmission rates, beyond patient characteristics. Most of the regional variation in mortality (65%) and readmission (50%) rates remained unexplained.
Conclusions—Thirty-day mortality and readmission rates vary substantially across HRRs and exhibit an inverse relationship. While regional variation in 30-day outcomes were explained by patient and hospital factors differently, much of the regional variation in both outcomes remains unexplained.
  • Received January 26, 2017.
  • Accepted July 6, 2017.
View Full Text

MSU’s Tyson Smith works to put stroke behind him

Lucky to be one of the 10% that fully recover.

Older Age, Low Socioeconomic Status, and Multiple Comorbidities Lower the Probability of Receiving Inpatient Rehabilitation Half a Year After Stroke

All stroke survivors should be able to receive and use stroke protocols that get them to 100% recovery. No stroke survivor left behind. If you can't get behind that goal then get the fuck out of the stroke profession.



To determine the predictors of receiving inpatient rehabilitation during 7 to 12 months after stroke.


Retrospective cohort study.


A nationally representative sample of 1 million National Health Insurance enrollees.


Patients with new-onset stroke (N=13,828) were included. Studied participants were patients who received inpatient rehabilitation during 4 to 6 months after stroke. Patients who died within 1 year of the stroke event were excluded (n=488).


Not applicable.

Main Outcome Measures

The outcome variable of interest was the probability of receiving inpatient rehabilitation during 7 to 12 months after stroke. The characteristics of both patients and medical care providers were investigated to determine their effect on patients receiving inpatient rehabilitation.


Older patients, patients of low socioeconomic status, patients with Charlson Comorbidity Index ≥5, and patients who received outpatient rehabilitation during 4 to 6 months after stroke have a lower rate of receiving inpatient rehabilitation than do their counterparts. In addition, receiving inpatient rehabilitation during 7 to 9 months after stroke is a strong positive predictor of receiving inpatient rehabilitation during 10 to 12 months after stroke (odds ratio, 38.556; P<.0001).


This study revealed that older age, lower socioeconomic status, and multiple comorbidities are negative predictive factors with a cumulative predictive power for the probability of receiving inpatient rehabilitation during 7 to 12 months after stroke.