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 438 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, October 24, 2014

Flint Rehabilitation Devices Introduces MusicGlove, World’s First FDA Approved, Clinically Validated Music-Based Hand Rehabilitation Device

It only took two years from concept to real life use.  This probably wouln't work for me, I don't have enough finger movement and there is no way I could get the glove on my spastic fingers. One drawback is that the game works best for patients who already have moderately high hand dexterity, so folks with more severe impairments will have a harder time playing the game and benefitting from it.
Flint Rehabilitation Devices today introduced MusicGlove™ (#musicglove), the world’s first FDA approved, clinically validated hand rehabilitation (#rehabilitation) device that uses music and gaming to make therapy (#therapy) fun and effective for the over six million people with stroke or other neurological or muscular injuries. The device, which helps increase users’ attention span, neuropsychological scores, cognitive functioning, well-being and recovery, empowers them to regain their independence by delivering a motivating therapy regimen that significantly restores hand function in just two weeks (Friedman et al., 2014). MusicGlove is now available for purchase at in both a Home Version from $1,149.00USD (or $99.00USD/month for twelve months) and a Clinic Version from $4,199.00USD.
“Engaging with music offers a form of therapy that will keep users motivated to continue their rehabilitation regimen, and facilitates a user’s hand’s ability to recover after a stroke”
The device features a sensorized glove that tracks a user’s hand movements. This allows them to play the included therapy-based game by completing specific movements along with scrolling notes displayed on a touch screen console that are timed to the rhythm of upbeat songs (similar to Guitar Hero). These movements, such as ‘pincer grasp’ and ‘key pinch grip,’ are vital to regaining the ability to use the hand after neural damage. MusicGlove motivates a high number of intensive and functional movements that have been proven1 to lead to clinically significant improvements in hand function.
MusicGlove is portable, easy-to-setup and easy-to-use so users can practice effective rehabilitation from the comfort of their home or on the go. Initial setup takes less than two minutes and requires no prior knowledge of how to use a computer. MusicGlove comes with everything needed to get started, right out of the box, including a dedicated 10-inch tablet (Home Version) or a 21-inch monitor (Clinic Version), the Glove, custom headphones, all connection cables and a user manual. MusicGlove is FDA approved for purchase without a prescription so users do not have to wait to start playing their way to a better life!
“Engaging with music offers a form of therapy that will keep users motivated to continue their rehabilitation regimen, and facilitates a user’s hand’s ability to recover after a stroke,” said Nizan Friedman, Ph.D., president and co-founder of Flint Rehabilitation Devices, LLC. “As music is naturally highly repetitive, people using MusicGlove typically make over 2,000 movements in a 45 minute session. In rehab, the number of repetitions is one of the most important factors for regaining hand function. Users involved in clinical studies with the device love MusicGlove and are laughing, singing along, and enjoying the experience while seeing measurable results in a short period of time.”
In addition to being fun and effective, MusicGlove changes the way clinics provide hand therapy. The device requires minimum intervention from a therapist while users play the game, so clinics can provide more intensive group therapy without increasing staff. MusicGlove also records accurate quantitative data that allows therapists to set goals for their patients and track functional improvements over time. The low price and ease of use of MusicGlove is a breath of fresh air for clinics that typically do not have access to other smart rehabilitation technology and equipment that can cost over $50,000USD and require advanced training to use.
Results of a randomized controlled trial of MusicGlove with individuals with stroke published in the Journal of Neuroengineering and Rehabilitation showed that people using MusicGlove had significantly greater improvements in hand function than people doing conventional hand exercises after only two weeks. Users reported regaining the ability to open doorknobs, type on a keyboard, wash dishes, use silverware, bathe and wash themselves, and use the restroom independently after exercising with the device.
“Options for hand therapy are typically limited to using things like play-dough, rubber bands or simply following a handout of exercises,” said Dr. David Reinkensmeyer, professor of Biomedical Engineering at the University of California in Irvine. “People lose motivation to do these exercises and do not recover to their full potential. With MusicGlove, they can have fun with their therapy while receiving quantitative feedback on their performance. This makes it easy for them to stick to their regimen, and when users get better in the game, they are actually improving their hand function.”
Another key unique benefit of MusicGlove is the continuity it provides between users’ home and clinic regimens. People with hand impairment typically only have access to therapy in outpatient clinics for one to two days per week. The rest of the time, they are left without any motivating tools to help them recover. With MusicGlove, users can continue their therapy on their own with ease. When users return to the clinic, therapists can see exactly how much exercise they did at home and how much they improved over the course of the week.
A video showing how MusicGlove works can be viewed at:

Speech and language therapist to trial innovative new technology for stroke rehabilitation based on patient needs

Something to ask your speech therapist about.
Of the 152, 000 individuals in the UK to survive a stroke each year, approximately 20-30% of them will experience slurred speech (dysarthria). Dysarthria is caused by muscle weakness and is known to impact significantly on psychological well-being and recovery after stroke.

The study, led by speech and language therapist Claire Mitchell at Manchester Royal Infirmary (MRI), will pilot an app called ReaDySpeech that Claire developed with funding from Central Manchester University Hospitals NHS Foundation Trust. The app is designed to provide with a more personalised speech and language , as it creates a tailored programme for each individual. The individual programme will then be adapted based on patient feedback, as they work through the programme, depending on how easy or hard they find tasks.
The app is a step away from the traditional therapy where paper worksheets are used, and can be accessed on any device with an internet or Wi-Fi connection, including tablets, PCs and mobile phones. This allows the patient to have more independence around following their rehabilitation programme.
Claire Mitchell, who is also Clinical Education Lead for Speech and Language Therapy at The University of Manchester, explains the reasons behind the ReaDySpeech app: "This study has only come about because of patient feedback to me as a clinician. After patients and families asked for alternatives to paper copies of exercises, I decided to look at other solutions. After consultation we decided we could use technology more broadly to support rehabilitation and this is when I first started to develop the app ReaDySpeech.
"Rehabilitation after a can often be a stressful and frustrating time for patients. I hope that by trialling this app, we have the potential to provide a more personalised therapy plan that will improve their journey to recovery."
By trialling the new technology with a small number of clinicians and patients, Claire aims to collate enough evidence to demonstrate whether the app is acceptable for patients as a form of therapy, and the feasibility of conducting a larger trial of the app therapy. Future research has the potential to reshape how speech therapy services are delivered to provide a better quality of provision with increased levels of support without increasing service costs.
63 year old Alan Moore suffered a serious stroke in 2005 and has since been an active member of the NIHR Clinical Research Network: Stroke speciality. Alan was one of a number of patients to input into the development of the app. Alan explains: "I wish this study and the new system had been available when I was recovering from my stroke.
"As part of my rehabilitation I used paper based resources, which worked well, but I was keen to recover my IT skills which I previously used in my day-to-day life. If this app had been around then, it would have been a perfect opportunity to combine both.
"As part of Claire's research I used the app and found it very user friendly. I was able to follow a course through the exercises at my own speed and progress through them as and when I was ready. I also found it very motivational because as I went through one stage, I really wanted to get on to the next.
Many people live a long way from a rehabilitation centre and this gives them the flexibility to progress in exercises between visits with their therapists, meaning patients have more control over their rehabilitation."

TSRI Scientists Create Mimic of ‘Good’ Cholesterol to Fight Heart Disease and Stroke

These people still don't know about cause and effect. If they would stop the inflammation in the first place you wouldn't have to worry about circulating cholesterol.
Scientists at The Scripps Research Institute (TSRI) have created a synthetic molecule that mimics “good” cholesterol and have shown it can reduce plaque buildup in the arteries of animal models. The molecule, taken orally, improved cholesterol in just two weeks.
This research, published in the October issue of Journal of Lipid Research, points scientists toward a new method for treating atherosclerosis, a condition where plaque buildup in the arteries can cause heart attacks and strokes.
“Atherosclerosis is the number one killer in the developed world,” said TSRI Professor M. Reza Ghadiri, senior author of the new study with TSRI Assistant Professor of Chemistry Luke Leman. “This research clears a big step toward clinical implementation of new therapies.”
Good vs. Bad Cholesterol
To combat atherosclerosis, researchers are looking for new ways to target and remove low-density lipoprotein (LDL) cholesterol (commonly known as “bad” cholesterol) from the body. Though the body needs some LDL to stay healthy, high levels lead to dangerous plaque buildups. In contrast, high-density lipoprotein (HDL) cholesterol (“good” cholesterol) is known for its protective effects.
“HDL is like a taxi in the bloodstream; it takes the LDL cholesterol out of the blood and delivers it to the liver,” said Yannan Zhao, a postdoctoral researcher in Ghadiri’s lab and first author of the new study. From the liver, the LDL is packaged for elimination from the body.
Using a method reported by the researchers last year in the Journal of the American Chemical Society, the team created a “nanopeptide” to have three arm-like structures that can wrap around cholesterol and fats in the blood.
Once the synthetic peptide wraps around LDL cholesterol, it removes it by mimicking the behavior of apoA-1, a protein of HDL, and carrying it to the liver for elimination.
A Surprising Finding
In collaboration with Linda Curtiss, formerly a faculty member at TSRI, and Bruce Maryanoff, formerly at Johnson & Johnson and currently a visiting scholar at TSRI, the researchers tested this synthetic peptide in a mouse model prone to atherosclerosis.
The team originally used the synthetic peptide in an experiment the researchers thought was a gamble. They gave it to mice in their drinking water, but assumed their digestive acids might break down the peptide before it got a chance to interact with its target and modify LDL cholesterol. To their surprise, it worked.
After 10 weeks of treatment, the mice had a 40 percent reduction in potentially harmful cholesterol in their blood and a 50 percent reduction in the size of plaque lesions in their hearts.
“We were definitely surprised at the results in the oral feeding studies,” said Leman. “We’ve repeated it many times.”
Many cholesterol treatments currently in development rely on an injection, not a pill. With the option of an orally effective peptide, Ghadiri believes researchers are closer to developing an accessible new therapy for atherosclerosis.
The researchers also reported no signs of increased inflammation in the blood or toxicity after 10 weeks of the peptide treatment.
Future Studies Point to Gut
Ghadiri and his team are now investigating exactly how the synthetic peptide works in the intestines and the possibility that it interacts with beneficial microbes. The researchers believe that finding new targets in the gastrointestinal tract could lead to new therapies for many more diseases.
“That’s one of the fun things in science—now we get to follow up on these different avenues,” said Leman.
In addition to Ghadiri, Leman, Zhao, Curtiss and Maryanoff, other contributors to the study, “In vivo efficacy of HDL-like nanolipid particles containing multivalent peptide mimetics of apolipoprotein A-1,” are Audrey S. Black and David J. Bonnet of TSRI.
Support for this study came from the National Institutes of Health (HL104462 and HL118114) and the American Heart Association Western States Affiliate. For access to this study, see; the Journal of Lipid Research also published a commentary on the work, available at

GERIATRIC APPLICATIONS OF CRANIOSACRAL THERAPY: Established allied health professionals’ use of a complementary modality

A couple of lines in here on stroke.
Post-stroke and transient ischemic attacks (TIAs)
Therapists spoke about treating clients who have completed their standard rehabilitation post-stroke,
and others who have experienced TIAs. The outcomes they reported included improved
communication, including articulation, as well as improvements in movement, balance and stability
standing, expression, sleep patterns, and elimination. Sometimes the results were striking; one
therapist described a client who took 15 minutes to walk 20 feet to the treatment room making the
return trip after treatment quickly.

Stroke patient with long-standing bursitis in the unaffected shoulder — the
combination resulted in functional limitations. Ultrasound treatments gave
temporary pain relief for the bursitis. CST achieved similar levels of pain
relief, but also improved shoulder mobility leading to increased function.
80-year-old WWII vet with severe bilateral foot pain secondary to multiple

Or another view of CST;

Craniosacral therapy may be helpful, but not curative


I personally can't see any possible way that cerebro spinal fluid could be moved by pressing on the skull without damaging the skull.

Health benefits of dance

Is this one of your doctors stroke protocols? Along with the music needed this could cover a lot of your deficits.

Warning over electrical brain stimulation

TDCS kits available to the public. I've written 20 posts on this so have your doctor tell you whether this is an appropriate intervention/stroke protocol for stroke rehab.
Given the option, would you want to think faster and have sharper attention? Research suggests that electrical brain stimulation kits could have just those effects. But now some companies are selling such devices online, leading to calls to regulate the technology.
It may sound too good to be true but scientists say the technology is promising.
Transcranial direct current stimulation (TDCS), which passes small electrical currents directly on to the scalp, stimulates the nerve cells in the brain (neurons).
It's non-invasive, extremely mild and the US military even uses TDCS in an attempt to improve the performance of its drone pilots.

Start Quote

You need to know how long to stimulate, at what time to stimulate and what intensity to use”
Dr Roy Cohen Kadosh University of Oxford
The idea is that it makes the neurons more likely to fire and preliminary research suggests electrical simulation can improve attention as well as have a positive impact on people with cognitive impairments and depression.
It has also been shown to increase performance in a maths task, an improvement which was still in place six months later.
The scientist behind this work is Dr Roy Cohen Kadosh from the University of Oxford. He uses TDCS to look at how cognitive functions improve.

More at link.

Relationship between zolpidem use and stroke risk and Parkinsons risk.

Check with your doctor on this. An insomnia drug.

Relationship between zolpidem use and stroke risk: a Taiwanese population-based case-control study.

OBJECTIVE: To evaluate the relationship between the use of zolpidem and risk of subsequent stroke in Taiwanese patients.

METHOD: This case-control study used data obtained from the National Health Insurance Research Database to determine whether the use of zolpidem is associated with an increased risk of stroke. The case group comprised 12,747 patients who were newly diagnosed with stroke between January 1, 2005, and December 31, 2009. We also randomly selected a 4-fold greater number of patients without stroke as a control group. Patients with ischemic and hemorrhagic stroke were frequency-matched with controls on sex, age, and year of index date. We measured the effect of zolpidem and determined the adjusted odds ratios (ORs) with 95% confidence intervals (CIs).

RESULTS: We found that exposure to zolpidem was associated with increased risk of ischemic stroke (OR = 1.37; 95% CI, 1.30-1.44). The risk of ischemic stroke increased significantly with increasing exposure to zolpidem; for average exposures of ≤ 70, 71-470, and > 470 mg per year, the ORs were 1.20, 1.41, and 1.50, respectively; the P value for the trend was <.0001. Regardless of whether people presented with a sleep disorder, the risk of stroke was still greatly increased with zolpidem exposure; the adjusted OR was 1.37 without sleep disorder and 1.41 with sleep disorder.

CONCLUSIONS: This population-based study positively associated the use of zolpidem with increased risk of ischemic stroke. Our findings warrant further large-scale and in-depth investigations in this area. 


Zolpidem and the risk of Parkinson's disease: A nationwide population-based study

Apathy and health-related quality of life in stroke

I lay this problem directly at the feet of your doctors. With no path and encouragement to 100% recovery who wouldn't be apathetic?
NARIC Accession Number: J68903.  What's this?
ISSN: 0003-9993.
Author(s): Taylor-Piliae, Ruth E.; Hoke, Tiffany M.; Hepworth, Joseph T.; Latt, L. Daniel; Najaafi, Bijan; Coull, Bruce M..
Publication Year: 2014.
Number of Pages: 9.
Abstract: Study examined the effect of a 12-week Tai Chi (TC) intervention on physical function and quality of life. A total of 145 community-dwelling survivors of stroke, aged 50 years or older, were randomly assigned to: (1) Yang style 24-posture short-form TC; (2) Silver Sneakers (SS), a program of strength and range of movement exercises for older adults; or (3) usual care (UC) for 12 weeks. The TC and SS groups attended a 1-hour class 3 times per week, whereas the UC group had weekly phone calls. Physical function was evaluated using the Short Physical Performance Battery, fall rates, and the 2-minute step test. Quality of life was assessed using the Medical Outcomes Study 36-Item Short-Form Health Survey, Center for Epidemiologic Studies Depression Scale, and Pittsburgh Sleep Quality Index. During the intervention, TC participants had two-thirds fewer falls (5 falls) than the SS (14 falls) and UC (15 falls) groups. There was a significant group-by-time interaction for the 2-minute step test. Post hoc tests indicated that the TC and SS groups had significantly better aerobic endurance over time, though not in the UC group. Intervention adherence rates were 85 percent. TC and SS led to improved aerobic endurance, and both are suitable community-based programs that may aid in stroke recovery and community reintegration. Results suggest that a 12-week TC intervention was more effective in reducing fall rates than SS or UC interventions. Future studies examining the effectiveness of TC as a fall prevention strategy for community-dwelling survivors of stroke are recommended.

In Stroke Rehab, Skip the ABC's - Bilingual Aphasia

People with damaged speech recover faster by focusing on harder words
When we learn, we usually begin with the basics and work our way up, mastering our do-re-mi’s before launching into an aria. But when people have difficulty speaking and understanding language after a stroke—a condition called aphasia—they seem to improve faster when they start at a harder level.
Speech researcher Swathi Kiran of Boston University works with bilingual aphasia patients to help them relearn words. She has found that when pa­tients practice the language they speak less fluently, their vocabulary grows in both languages. But when the patients study words in the language they are more comfortable in, only that language improves.
Although Kiran has not yet pub­lished a study on her bilingual patients, her observation is in line with her ear­lier, published papers and those of other researchers. These studies show that aphasics who speak only one language also benefit from more diffi­cult practice. When aphasics study unusual words in a category—such as “parsnip” and “rutabaga” when relearning vegetable names—they also improve their fluency with common words in that category (“pea” and “carrot”). Likewise, practicing complex sentences helps aphasics handle simple ones.

More behind the paywall.

A more detailed paper here;
Aphasia Therapy in the Age of Globalization: Cross-Linguistic Therapy Effects in Bilingual Aphasia

Cognitive control in the self-regulation of physical activity and sedentary behavior

Your doctor should be an expert at motivating you to get off your butt and exercise. Because unless YOU do the work you won't recover very well.
This might help your doctor create a stroke protocol on motivation. You can always hope your doctor is trainable.
Jude Buckley1, Jason D. Cohen2, Arthur F. Kramer2,3, Edward McAuley2,3 and Sean P. Mullen2,3*
  • 1School of Psychology, University of Auckland, Auckland, New Zealand
  • 2Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
  • 3Beckman Institute for Advanced Science and Technology, Urbana, IL, USA
Cognitive control of physical activity and sedentary behavior is receiving increased attention in the neuroscientific and behavioral medicine literature as a means of better understanding and improving the self-regulation of physical activity. Enhancing individuals’ cognitive control capacities may provide a means to increase physical activity and reduce sedentary behavior. First, this paper reviews emerging evidence of the antecedence of cognitive control abilities in successful self-regulation of physical activity, and in precipitating self-regulation failure that predisposes to sedentary behavior. We then highlight the brain networks that may underpin the cognitive control and self-regulation of physical activity, including the default mode network, prefrontal cortical networks and brain regions and pathways associated with reward. We then discuss research on cognitive training interventions that document improved cognitive control and that suggest promise of influencing physical activity regulation. Key cognitive training components likely to be the most effective at improving self-regulation are also highlighted. The review concludes with suggestions for future research.
For nearly half of a century, researchers have been trying to uncover how to motivate people to become more physically active (Trost et al., 2002; Schutzer and Graves, 2004; Buckworth et al., 2013) and, recently, more effort has been made to understand how to motivate people to be less sedentary (Hamilton et al., 2008). Despite resources devoted to these efforts, more than 30% of the world’s population remains physically inactive (Hallal et al., 2012) and, on average, people are sitting for more than 300 min/day (Bauman et al., 2011). Our understanding of the regulation of these behaviors has advanced, but these prevalence rates suggest that our knowledge of physical activity and sedentary behavior remains incomplete. Research supports theoretical proposals that health behavior is dependent, in part, on self-regulation capacities (Bandura, 1986; De Ridder and de Wit, 2006), but only recently has research attention been directed toward the preceding factors of self-regulation that influence physical activity and sedentary behavior.
Recent theory (e.g., Temporal Self-Regulation Theory; Hall and Fong, 2007, 2010, 2013) and evidence suggest that the relation between physical activity and cognitive control is reciprocal (Daly et al., 2013). Most research has focused on the beneficial effects of regular physical activity on executive functions-the set of neural processes that define cognitive control. Considerable evidence shows that regular physical activity is associated with enhanced cognitive functions, including attention, processing speed, task switching, inhibition of prepotent responses and declarative memory (for reviews see Colcombe and Kramer, 2003; Smith et al., 2010; Guiney and Machado, 2013; McAuley et al., 2013). Recent research demonstrates a dose-response relationship between fitness and spatial memory (Erickson et al., 2011), however the long-term effects of physical activity on working memory have been less consistent (Smith et al., 2010).
Positive physical activity effects on executive function have been found in children for both acute and regular activity (Chang et al., 2012; Hillman et al., in press). For example, findings from a 9-month randomized controlled trial in 221 prepubertal children attending an afterschool physical activity program (vs. a wait-list control group), showed improvements in fitness (VO2peak), cognitive control, and neuroelectrical activity (P3-ERP) during tasks that required significantly more cognitive control (Hillman et al., in press). In addition, a modest dose-response effect of program attendance on cognitive control measures was also found. Improvements in cognitive function are not always observed in older adults (Angevaren et al., 2008) or in children (Janssen et al., 2014) involved in physical activity programs. These findings suggest that the effects of physical activity on cognitive function may depend on the particular cognitive function being assessed. Taken together, this research suggests that physical activity training can enhance cognitive control abilities. The effects of physical activity on cognitive control appear to be underpinned by a variety of brain processes including: increased hippocampal volume, increased gray matter density in the prefrontal cortex (PFC), upregulation of neurotrophins and greater microvascular density (for a review see Voss et al., 2013). Much less is understood about the influence of cognitive control on physical activity but emerging evidence suggests that executive functions play an antecedent role in effective self-regulation of physical activity (Hall et al., 2008; Riggs et al., 2010; McAuley et al., 2011; Daly et al., 2013; Pentz and Riggs, 2013; Best et al., 2014).
The goals of this paper are (1) to review emerging evidence of the antecedence of cognitive control abilities in enabling successful self-regulation for physical activity, and in precipitating self-regulation failures that predispose individuals to remain sedentary; (2) to highlight neural networks that may underlie the cognitive control of physical activity and sedentary behavior; and (3) to review emerging research on training effects on cognitive and physical functioning and summarize components of training that may produce positive cognitive outcomes associated with increased physical activity engagement.

More at link.

Farm to patient food

Will your hospital actually supply healthy food to you while in the hospital?
My diet here: I'll have to add walnuts.

What would a post-stroke diet look like?

2014 Raising Awareness in Stroke Excellence (RAISE) Awards - NSA

More do nothing crap from the NSA. It's about raising awareness, not solving all the problems in stroke. More press release mentality crap.
Mr. Lopez, you have one hell of a lot of work to do to get your stroke organization on track.
Basic Stationery Top - Redesign 2010
Dear dean,
2014 RAISE Award medallionI am thrilled to share with you the 2014 Raising Awareness in Stroke Excellence (RAISE) Awards winners. This national program recognizes individuals and groups for taking stroke awareness activities to new heights.
This year we received 462 nominations, a 40 percent increase from last year! All the candidates represented wonderful happenings occurring across the country to increase stroke awareness.
And without further delay, here are this year’s winners:
  • Most Creative – Mount Carmel Stroke Outreach  
  • Most Impactful – Nancy Hermann
  • Most Impactful Fundraising Community Fundraising Event – Suridis Family
  • Outstanding Group – Bergan Stroke Team
  • Outstanding Individual – Susan Wilson
  • Outstanding Stroke Support Group – Marywood University Aphasia Group
  • Voter’s Choice – Winter Haven Hospital Stroke Support Group
I encourage you to read more about each winner.
We continue to be amazed at the passion and work put forth by everyone with regards to raising stroke awareness. We thank all the winners and nominees for their efforts and inspiration.
signed by Matt Lopez, CEO
Matt Lopez
Chief Executive Officer

New report on cardiovascular deaths reaffirms need for prevention - Australia

And by doing this they actually don't have to do any of the hard work of solving all of the problems in stroke. It's good to be able to 'blame the patient'. You don't have to actually do your job of figuring out how to solve the difficult problems in stroke. Damn you all to hell for sitting on the sidelines tut-tutting about the stroke you caused yourself.

Inspire Others with Your Story

More feel good crap email from the ASA. My inspiration for others is this blog post.
If you just had a stroke, You are F*cking screwed

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SC e-Extra / A Digital Monthly Newsletter from Strokeconnection Inspire Others with Your Story

October 24, 2014
Stroke connects many of us - perhaps it touched your life directly, or that of a family member or friend. Despite the challenging times, you can use your story and make a meaningful difference in the lives of others.
One in three Americans still cannot recall any of the stroke warning signs. We have made a lot of progress, but still have a ways to go to end stroke.
We need your help! This October 29th, in honor of World Stroke Day, we encourage you to inspire others with your story. Ask your family and friends to learn what a stroke looks like. Ask them to download our F.A.S.T. mobile app. It reminds them of the warning signs with an easy acronym-F.A.S.T. (Face drooping, Arm weakness, Speech difficulty, Time to call 9-1-1)-and shows them the nearest award-winning hospitals.

Scientists convert human skin cells directly into brain cells

So whom is going to take on the challenge of testing this in humans? ASA? NSA? WSO? None of these will because all they are is press release organizations. So if you have a spare 10 million or so you can hire your own researchers to do this. That is the only way this will get done in the next 30 years.
Or maybe you'd rather support these other neuron creation ideas;
So many places to get stem cells from;

1.  brain biopsies 
2.  Blood
3.  Bone marrow stem cells
4.  Skin cells 
5.  Re-programme other cells to become nerve cells, directly in the brain. 
6.  UK scientists use 3D printer to print human stem cells
7.  Reprogramming Adult Schwann Cells to Stem Cell-like Cells by Leprosy Bacilli Promotes Dissemination of Infection
8.  Fat cells 
9.  Urine 
10.  Bone marrow
11.  Placenta
12.  Umbilical cord blood
13.  hair follicles
14.  menstrual blood
15.   liver cells
16.  Dental pulp
17.  Stem Cell Scaffolding
18.  Converting fibroblasts into functional neurons 
19.  Cells grown from the lining of their nose.


Scientists convert human skin cells directly into brain cells
The study is unusual because, unlike many cell conversion techniques, the cells did not return to a stem cell stage first - they converted directly into brain cells - thus avoiding the risk of producing many other types of cells.
And the study is unique, because the team managed to reprogram the skin cells to become a particular type of brain cell instead of a range of brain cells.
Writing in the journal Neuron, researchers from Washington University School of Medicine in St. Louis (WUSTL), MO, report how they used a particular combination of microRNAs and transcription factors to reprogram the skin cells into a particular type of brain cell known as medium spiny neurons.

More at link.

Exercise Reduces the Risk of Alzheimer’s Disease

A compilation of the good things exercise does for you. What exactly is your doctor doing about this?
S/he does know about your 33% dementia chance post-stroke from an Australian study?
But which one is most effective? Your doctor better know the answer.
My bet is on these; but then I'm medically untrained and should never be listened to.
My 3 legged milking stool ones are here:
Fish Oil Supplements Reduce Incidence of Cognitive Decline, Brain Atrophy
Leg two:
Coffee May Lower Your Risk of Dementia
Leg three:
Evidence-Based Medicinal Properties of Coconut Oil - brain boosting 

To Stave off Alzheimer’s, Stay Hungry?
My complete list here:
Dementia prevention 19 ways

Thursday, October 23, 2014

Cholesterol medications: When diet and exercise aren't enough

Even the Mayo Clinic doesn't know what cause and effect is. Cholesterol doesn't cause atherscelerosis. Inflammation grabs the cholesterol floating by in the bloodstream and pulls it into the plaque. Solve the correct problem.
You can see a video of how plaque forms here:
Inflammation In Atherosclerotic Plaque Formation
It's the inflammation Stupid!!!

93% of U.S., 92% of New Yorkers Unaware that Stroke is Second Leading Cause of Death Globally

I lay this problem directly on the laps on the stroke associations. They've had years to get stroke to the Tipping Point where everyone is worried about it like Alzheimers has done.  But the only way you are going to do that is to acknowledge that If you just had a stroke, You are F*cking screwed

Global Stroke Bill of Rights launched - failure in action

This is completely worthless, first you have to have working stroke protocols that will 100% bring back functionality. This is just press release grandstanding to appear like you are doing something. Do you people at the WSO ever rub two neurons together and create a coherent thought about stroke?
These people should all be fired.

The WSO is calling on governments, ministries of health and healthcare systems, with the support of key opinion leaders and stroke advocates, to rise to this challenge and ensure that the Bill of Rights is fully supported and implemented. Global Bill of Rights (English version)

The best stroke care does not exist!!!
Only 10% get to full recovery.
tPA has a 88% failure rate of reversing the stroke

No protocols to prevent your 33% chance of getting dementia post-stroke

 No one knows how to cure spasticity.
No one knows how to cure fatigue 


BOR Infographics

A Consensus on the Brain Training Industry from the Scientific Community

So if brain training games do not work, what exactly is your doctor prescribing to prevent your cognitive decline post-stroke?
One line from there:
However at this point it is not appropriate to conclude that training-induced changes go significantly beyond the learned skills, that they affect broad abilities with real-world relevance, or that they generally promote “brain health”.

Changing lifestyle may improve cognitive function in the elderly

Is your doctor going to implement this in the hospital setting to prevent your cognitive decline post-stroke? Or will your doctor DO NOTHING?
A randomized controlled trial published in the current issue of Psychotherapy and Psychosomatics indicates that modifications in lifestyle may improve cognitive function in the elderly. Since a healthy lifestyle may protect against cognitive decline, the authors examined outcomes in elderly individuals after 18 months of a five-group intervention program consisting of various modalities: physical activity, antismoking, social activity, cognitive activity, alcohol drinking in moderation, and leaning about body mass and a healthy diet.
Between 2008 and 2010, a cluster randomized controlled trial assessing 460 community-dwelling individuals aged 60 years and older, was conducted in a geriatric community mental health center in Suwon, Republic of Korea. The intervention program based on the principles of contingency management was developed in a way that could be delivered by ordinary primary health workers. According to the research design, group A (n = 81) received standard care services, group B (n = 80) received bimonthly (once every 2 months) telephonic care management, group C (n = 111) received monthly telephonic care management and educational materials similar to those in group B, group D (n = 93) received bimonthly health worker-initiated visits and counseling and group E (n = 94) received bimonthly health worker-initiated visits, counseling, and rewards for adherence to the program.
The primary outcome was the change in Mini-Mental State Examination (MMSE) scores from baseline to the final follow-up visit at 18 months. Group E showed superior cognitive function to group A (adjusted coefficient β = 0.99, p = 0.044), with participation in cognitive activities being the most important determining factor among several health behaviors (adjusted coefficient β = 1.04, p < 0.01). The study showed that engaging in cognitive activities, in combination with positive health behaviors, may be most beneficial in preserving cognitive abilities in community-dwelling older adults.

A controlled pilot trial of two commercial video games for rehabilitation of arm function after stroke

Ask your doctor about all the other arm function rehabilitation games to see which one is the best. Which one brings back 100% arm function?

Portable virtual reality rehab for stroke victims

Usability Evaluation of Digital Games for Stroke Rehabilitation in Taiwan 

Scientists develop at-home 3D video game for stroke patients 

This Kinect Game Is Designed To Rehabilitate Stroke Patients – And It Works

 Study examines video games for stroke patient recovery 

 Clinical Feasibility of Interactive Commercial Nintendo Gaming for Chronic Stroke Rehabilitation

 Sony PlayStation EyeToy elicits higher levels of movement than the Nintendo Wii: implications for stroke rehabilitation

 Rejoyce - Stroke Rehab at Home

And the latest here;
A controlled pilot trial of two commercial video games for rehabilitation of arm function after stroke

Wednesday, October 22, 2014

Managing Acute Ischemic Stroke in the Emergency Department: Two Decades of Progress

A CME class. I'm not willing to take the time to listen since I'm sure that they will not be discussing how poorly tPA works. My ER doctor in 2006, 10 years after tPA was approved, told me that the fast recovery from tPA did not work, I would have to settle for the slow rehabilitation recovery. This had obviously occurred to him numerous times.

Looks Like The Medical Establishment Was Wrong About Fat

How many years before your stroke hospital revamps its food selections.? 50? 100? Probably as long as it will take to get a specific post-stroke diet.  To speed this up you are going to have to directly call the hospital president.

If you're over 60, drink up: Alcohol associated with better memory

I bet there is no way in hell that your doctor will ever recommend alcohol consumption post-stroke.  I may not be 60 yet but I'm sure drinking up.

Unbroken: A chronic fatigue patient’s long road to recovery

Whom is going to take on this challenge and see if the fatigue experienced by stroke patients might have the same basis? crickets?

Scientists say National Alzheimer’s Plan research milestones must be strengthened

We don't even have a National Stroke Plan because our stroke associations are falling down on the job.

Alzheimer's disease will strike 1 out of 6 older women, study says

Compare that to;

The WHO says women have a 1 in 5 chance of getting a stroke 

Everything in stroke is totally f*cked up, we don't have any strategy or plan on how to tackle all the problems. If we did we could at least comment on it and point out deficiencies.

With no plan no one has to take responsibility, damnable chickenshits.

The Alzheimers stuff here:

2014 Report on the Milestones for the US National Plan to Address Alzheimer's Disease

Concentrate! How to tame a wandering mind

If we are going to recover under the current lack of stroke rehab protocols we are going to have to be completely focused on all the work it is going to take to recover. This should be a mandatory prescription from your doctor until they actually come up with useful rehab protocols. Test yourself at bottom.
Procrastinate often? Caroline Williams does, so decided to find out if brain training could tackle her wandering mind. What she discovered could help everyone.

I am about to be zapped in the head with an electromagnet, once a second, for eight minutes. I fidget, trying to get comfortable in a huge black chair with jointed metal arms that stand between me and the door. I feel faintly ridiculous wearing a tight headband with what looks like a coat hook on the top. “All you need to do is relax,” says Mike Esterman, the researcher about to zap me. That’s easy for him to say – he’s holding the magnet.
"Willpower is like a muscle. I'm a big believer in that." — Tim Pychyl, psychologist
I’ve come to the Boston Attention and Learning Lab in the US to try and train my brain to focus better. Esterman and fellow cognitive neuroscientist Joe DeGutis have spent nearly seven years working on a training programme to help wandering minds stay “in the zone”.

Find out your ‘continuous concentration’ score at I got 53, which is below average. How well do you focus?
Your score was 94. The average score is 75.
more at link.

Vessel occlusion, penumbra, and reperfusion – translating theory to practice

Read it and weep, for our doctors still have no idea what is going on with stroke or how to treat it.
Bruce C. V. Campbell1,2*, imageGeoffrey A. Donnan2 and imageStephen M. Davis1
  • 1Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
  • 2Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
The management of ischemic stroke is at a critical juncture. Administration of intravenous tPA is currently restricted to within 4.5 h from stroke onset with several trials in longer time windows proving neutral (1, 2). Revascularization success with tPA in major vessel occlusion is widely recognized as suboptimal (3). Alternative thrombolytic agents with theoretical efficacy advantages such as tenecteplase and desmoteplase are yet to show benefit in phase 3 trials. The promise of endovascular therapy has also yet to translate into positive randomized trials (46), although a new generation of devices is currently being studied. While it is possible that these therapeutic approaches are simply ineffective, the heterogeneity of stroke pathophysiology is likely to be contributing to the neutral results we often observe.
Imaging selection has been proposed as a means of reducing heterogeneity by identifying patients with the potential to benefit from revascularization and therefore enhancing the probability of success in trials of new therapies. However, whether it is sufficient to demonstrate an occluded artery as the target or to also require evidence of salvageable downstream tissue has been debated. The recent announcement of neutral results in DIAS 3 (7), a trial that compared desmoteplase versus placebo 3–9 h after stroke onset in patients with vessel occlusion, without reference to downstream tissue status other than what was visible on non-contrast CT, will no doubt further stimulate this discussion. It is, therefore, salient to consider the current methods to identify salvageable ischemic penumbra and the potential value of commonly used surrogates for clinical outcome, chiefly reperfusion, recanalization, and infarct growth.

Management of fatigue in persons with multiple sclerosis

At least they have something. For stroke we have absolutely nothing. ASA, NSA, WSO are you going to step up to the plate and do the required research to solve the fatigue issue after stroke?

Regional white matter damage predicts speech fluency in chronic post-stroke aphasia

I really don't give a shit about predictions, I want to know what the solution is to fix the aphasia problem. It's really quite simple, solve the damned stroke problems, don't just describe them.
Alexandra Basilakos1*, imagePaul T. Fillmore1, imageChris Rorden2, imageDazhou Guo1, imageLeonardo Bonilha3 and imageJulius Fridriksson1
  • 1The Aphasia Lab, Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
  • 2Department of Psychology, University of South Carolina, Columbia, SC, USA
  • 3Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA
Recently, two different white matter regions that support speech fluency have been identified: the aslant tract and the anterior segment of the arcuate fasciculus (ASAF). The role of the ASAF was demonstrated in patients with post-stroke aphasia, while the role of the aslant tract shown in primary progressive aphasia. Regional white matter integrity appears to be crucial for speech production; however, the degree that each region exerts an independent influence on speech fluency is unclear. Furthermore, it is not yet defined if damage to both white matter regions influences speech in the context of the same neural mechanism (stroke-induced aphasia). This study assessed the relationship between speech fluency and quantitative integrity of the aslant region and the ASAF. It also explored the relationship between speech fluency and other white matter regions underlying classic cortical language areas such as the uncinate fasciculus and the inferior longitudinal fasciculus (ILF). Damage to these regions, except the ILF, was associated with speech fluency, suggesting synergistic association of these regions with speech fluency in post-stroke aphasia. These observations support the theory that speech fluency requires the complex, orchestrated activity between a network of pre-motor, secondary, and tertiary associative cortices, supported in turn by regional white matter integrity.

More at link.

New Research on Walnuts and the Fight Against Alzheimer’s Disease

How long before walnuts are added to your hospital diet? 100 years? What is the downside of doing this right now?
My diet here: I'll have to add walnuts.

What would a post-stroke diet look like? 

Animal study reveals potential brain-health benefits of a walnut-enriched diet
A new animal study published in the Journal of Alzheimer’s Disease indicates that a diet including walnuts may have a beneficial effect in reducing the risk, delaying the onset, slowing the progression of, or preventing Alzheimer’s disease.
Research led by Abha Chauhan, PhD, head of the Developmental Neuroscience Laboratory at the New York State Institute for Basic Research in Developmental Disabilities (IBR), found significant improvement in learning skills, memory, reducing anxiety, and motor development in mice fed a walnut-enriched diet.
The researchers suggest that the high antioxidant content of walnuts (3.7 mmol/ounce)1 may have been a contributing factor in protecting the mouse brain from the degeneration typically seen in Alzheimer’s disease. Oxidative stress and inflammation are prominent features in this disease, which affects more than five million Americans2.
“These findings are very promising and help lay the groundwork for future human studies on walnuts and Alzheimer’s disease – a disease for which there is no known cure,” said lead researcher Dr. Abha Chauhan, PhD. “Our study adds to the growing body of research that demonstrates the protective effects of walnuts on cognitive functioning.”
The research group examined the effects of dietary supplementation on mice with 6 percent or 9 percent walnuts, which are equivalent to 1 ounce and 1.5 ounces per day, respectively, of walnuts in humans. This research stemmed from a previous cell culture study3 led by Dr. Chauhan that highlighted the protective effects of walnut extract against the oxidative damage caused by amyloid beta protein. This protein is the major component of amyloid plaques that form in the brains of those with Alzheimer’s disease.
Someone in the United States develops Alzheimer’s disease every 67 seconds, and the number of Americans with Alzheimer's disease and other dementias are expected to rapidly escalate in coming years as the baby boom generation ages. By 2050, the number of people age 65 and older with Alzheimer's disease may nearly triple, from five million to as many as 16 million, emphasizing the importance of determining ways to prevent, slow or stop the disease. Estimated total payments in 2014 for all individuals with Alzheimer’s disease and other dementias are $214 billion2.
Walnuts have other nutritional benefits as they contain numerous vitamins and minerals and are the only nut that contains a significant source of alpha-linolenic acid (ALA) (2.5 grams per ounce), an omega-3 fatty acid with heart and brain-health benefits4,5. The researchers also suggest that ALA may have played a role in improving the behavioral symptoms seen in the study.

A rich vocabulary can protect against cognitive impairment

So is your doctor prescribing vocabulary work?

Some people suffer incipient dementia as they get older. To make up for this loss, the brain's cognitive reserve is put to the test. Researchers from the University of Santiago de Compostela have studied what factors can help to improve this ability and they conclude that having a higher level of vocabulary is one such factor.

'Cognitive reserve' is the name given to the brain's capacity to compensate for the loss of its functions. This reserve cannot be measured directly; rather, it is calculated through indicators believed to increase this capacity.

A research project at the University of Santiago de Compostela (USC) has studied how having a wide vocabulary influences cognitive reserve in the elderly.

As Cristina Lojo Seoane, from the USC, co-author of the study published in the journal 'Anales de Psicología' (Annals of Psychology), explains to SINC: "We focused on level of vocabulary as it is considered an indicator of crystallised intelligence (the use of previously acquired intellectual skills). We aimed to deepen our understanding of its relation to cognitive reserve."

The research team chose a sample of 326 subjects over the age of 50 - 222 healthy individuals and 104 with mild cognitive impairment. They then measured their levels of vocabulary, along with other measures such as their years of schooling, the complexity of their jobs and their reading habits.

They also analysed the scores they obtained in various tests, such as the vocabulary subtest of the 'Wechsler Adult Intelligence Scale' (WAIS) and the Peabody Picture Vocabulary Test.

"With a regression analysis we calculated the probability of impairment to the vocabulary levels of the participants," Lojo Seoane continues.
The results revealed a greater prevalence of mild cognitive impairment in participants who achieved a lower vocabulary level score.
"This led us to the conclusion that a higher level of vocabulary, as a measure of cognitive reserve, can protect against cognitive impairment," the researcher concludes.

Flu Vaccine May Hold Key to Preventing Heart Disease

And may be helpful for stroke also.

Seasonal flu vaccine may cut stroke risk

 Flu Vaccine May Hold Key to Preventing Heart Disease

 A new study in Vaccine explains how flu vaccines prevent heart attacks

Flu vaccines are known to have a protective effect against heart disease, reducing the risk of a heart attack. For the first time, this research, published in Vaccine, reveals the molecular mechanism that underpins this phenomenon. The scientists behind the study say it could be harnessed to prevent heart disease directly.

Heart disease is the leading cause of death worldwide. People can reduce their risk of heart disease by eating healthily, exercising and stopping smoking. However, to date there is no vaccine against heart disease.

Previous clinical findings show that people that receive the seasonal flu vaccine also benefit from its protective effect against heart disease; the risk of having a heart attack in the year following vaccination is 50% lower than people who did not receive the vaccination. The exact mechanism underlying this protective effect remained unknown.

This new study for the first time reveals this mechanism, showing that the flu vaccine stimulates the immune system to produce antibodies that switch on certain processes in cells. These processes lead to the production of molecules that protect the heart. The researchers say that based on the results it may be possible to develop a new vaccine against heart disease.

"Even though the protective effect of the flu vaccine against heart disease has been known for some time, there is very little research out there looking at what causes it. Our proposed mechanism could potentially be harnessed in a vaccine against heart disease, and we plan to investigate this further," said Dr. Veljkovic, Institute Vinca, Belgrade, the lead author of the new study.

The researchers identified a protein called the bradykinin 2 receptor (BKB2R), which is involved in cellular processes that protect the heart. Some of the antibodies the body produces after flu vaccination switch this protein on, therefore protecting against heart disease. The researchers analysed 14 flu viruses used in vaccines, and identified four that could be investigated for use in potential heart disease vaccines.

"The rate of administering flu vaccinations is disappointingly low, even in developed countries," added Dr. Veljkovic "We hope that our results will encourage more people to get vaccinated before the flu season starts."