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:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal.

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 lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:http://oc1dean.blogspot.com/2010/11/my-background-story_8.html

Tuesday, February 19, 2019

Does Fractional Anisotropy Predict Motor Imagery Neurofeedback Performance in Healthy Older Adults? Stroke?

This goes with all these other research pieces in not knowing what exactly helps recovery using neurofeedback. It is a simple question. How should neurofeedback be used to help stroke recovery?  WHOM is going to answer that?  

Does Fractional Anisotropy Predict Motor Imagery Neurofeedback Performance in Healthy Older Adults?

  • 1Department of Psychology, University of Oldenburg, Germany
  • 2Cluster of Excellence Hearing4all, Germany
  • 3Research Center Neurosensory Science, University of Oldenburg, Germany
  • 4Oxford Centre for Human Brain Activity, Medical Sciences Division, University of Oxford, United Kingdom
  • 5Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neuroscience, University of Oxford, U.K.
Motor imagery neurofeedback (MI-NF) training has been proposed as a potential add-on therapy for motor impairment after stroke, but not everyone can successfully use an MI-NF system. Previous work has used fractional anisotropy (FA), a measure of white matter integrity, to predict MI-NF aptitude in healthy young adults. We set out to extend this finding by assessing its replicability in an MI-NF system that is closer to those used for stroke rehabilitation and in a sample whose age is closer to that of typical stroke patients. Using shrinkage linear discriminant analysis with FA values in 48 white matter regions as predictors, we predicted whether each participant in a sample of 21 healthy older adults (48 – 77 years old) was a good or a bad performer with 84.8% accuracy. The regions used for prediction in our sample differed from those identified previously, and previously suggested regions did not yield significant prediction in our sample. Furthermore, within our own sample the results for online MI-NF performance did not generalize to offline performance. Accounting for the effects of age on MI-NF performance and white matter structure by including age as a predictor led to loss of statistical significance and somewhat poorer prediction accuracy (71.3%). Our results suggest that if predictions are used to determine the potential benefit of MI-NF, those predictions should be based on data collected using the same paradigm and with subjects whose characteristics match those of the target case as close as possible.
Keywords: Motor Imagery (MI), Electroencephalography (EEG), neurofeedback (NF), White matter (WM), Fractional Anisotropy (FA), magnetic resonance imaging (MRI), Shrinkage linear discriminant analysis (SLDA)
Received: 18 Oct 2018; Accepted: 11 Feb 2019.
Edited by:
Juan H. Zhou, Duke-NUS Medical School, Singapore
Reviewed by:
Kang Sim, Institute of Mental Health, Singapore
Sebastian Walther, Universitätsklinik für Psychiatrie und Psychotherapie, Universität Bern, Switzerland  
Copyright: © 2019 Meekes, Debener, Zich, Bleichner and Kranczioch. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

Breakthrough toward developing blood test for pain

You'll have to have your doctors followup to see if any of this is usable in CPSP(Chronic Post Stroke Pain).

Breakthrough toward developing blood test for pain


ScienceDaily | February 18, 2019
A breakthrough test developed by Indiana University School of Medicine researchers to measure pain in patients could help stem the tide of the opioid crisis in Indiana and throughout the rest of the nation.
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A study led by psychiatry professor Alexander Niculescu, MD, PhD, and published this week in the Nature journal Molecular Psychiatry tracked hundreds of participants at the Richard L. Roudebush VA Medical Center in Indianapolis, IN, to identify biomarkers in the blood that can help objectively determine how severe a patient's pain is. The blood test, the first of its kind, would allow physicians far more accuracy in treating pain—as well as a better long-term look at the patient's medical future.
"We have developed a prototype for a blood test that can objectively tell doctors if the patient is in pain, and how severe that pain is. It's very important to have an objective measure of pain, as pain is a subjective sensation. Until now we have had to rely on patients self-reporting or the clinical impression the doctor has," said Niculescu, who worked with other Department of Psychiatry researchers on the study. "When we started this work it was a farfetched idea. But the idea was to find a way to treat and prescribe things more appropriately to people who are in pain."
During the study, researchers looked at biomarkers found in the blood—in this case, molecules that reflect disease severity. Much as glucose serves as a biomarker to diabetes, these biomarkers allow doctors to assess the severity of the pain the patient is experiencing and provide treatment in an objective, quantifiable manner. With an opioid epidemic raging throughout the state and beyond, Niculescu said never has there been a more important time to administer drugs to patients responsibly.
"The opioid epidemic occurred because addictive medications were overprescribed due to the fact that there was no objective measure whether someone was in pain or how severe their pain was," Niculescu said. "Before, doctors weren't being taught good alternatives. The thought was that this person says they are in pain, let's prescribe it. Now people are seeing that this created a huge problem. We need alternatives to opioids, and we need to treat people in a precise fashion. This test we've developed allows for that."
In addition to providing an objective measure of pain, Niculescu's blood test helps physicians match the biomarkers in the patient's blood with potential treatment options. Like a scene out of CSI, researchers utilize a prescription database—similar to fingerprint databases employed by the FBI—to match the pain biomarkers with profiles of drugs and natural compounds cataloged in the database.
"The biomarker is like a fingerprint, and we match it against this database and see which compound would normalize the signature," said Niculescu, adding that often the best treatment identified is a non-opioid drug or compound. "We found some compounds that have been used for decades to treat other things pair the best with the biomarkers. We have been able to match biomarkers with existing medications or natural compounds, which would reduce or eliminate the need to use the opioids."
In keeping with the Indiana University Grand Challenge Precision Health Initiative launched in June 2016, this study opens the door to precision medicine for pain. By treating and prescribing medicine more appropriately to the individual person, this prototype may help alleviate the dilemmas that have contributed to the current opioid epidemic.
"In any field, the goal is to match the patient to the right drug, which hopefully does a lot of good and very little harm," Niculescu said. "But through precision health, by having lots of options geared toward the needs of specific patients, you prevent larger problems, like the opioid epidemic, from occurring."
Additionally, study experts discovered biomarkers that not only match with non-addictive drugs that can treat pain, but can also help predict when someone might experience pain in the future—helping to determine if a patient is exhibiting chronic, long-term pain which might result in future emergency room visits.
"Through precision medicine you're giving the patient treatment that is tailored directly to them and their needs," Niculescu said. "We wanted first to find some markers for pain that are universal, and we were able to. We know, however, based on our data that there are some markers that work better for men, some that work better for women. It could be that there are some markers that work better for headaches, some markers that work better for fibromyalgia, and so on. That is where we hope to go with future larger studies."
The study was supported by a National Institutes of Health (NIH) Director's New Innovator Award and a VA Merit Award. Moving forward, Niculescu's group looks to secure more funding through grants or outside philanthropy to continue and accelerate these studies—with the hopes of personalizing the approach even more and moving toward a clinical application. A self-described longshot at the start, Niculescu said that the work his group has done could have a major impact on how doctors around the world treat pain in the future.
"It's been a goal of many researchers and a dream to find biomarkers for pain," Niculescu said. "We have come out of left field with an approach that had worked well in psychiatry for suicide and depression in previous studies. We applied it to pain, and we were successful. I give a lot of credit for that to my team at Indiana University School of Medicine and the Indianapolis Veterans Affairs (VA), as well as the excellent environment and support we have."
To read more, click here.

Machine Learning Algorithm Helps Search for New Drugs

WHOM in the stroke medical world will look at this and recognize the uses for stroke? Then bring that to the attention of stroke leadership and get the stroke strategy updated?  NOBODY BECAUSE SOMEONE ELSE WILL SOLVE THE PROBLEM?

This indifference and laziness is why survivors need to be in charge.

 

Machine Learning Algorithm Helps Search for New Drugs 


Wed, 02/13/2019 - 1:30pm
by University of Cambridge
Researchers have designed a machine learning algorithm for drug discovery has shown to be twice as efficient as the industry standard, which could accelerate the process of developing new treatments for disease.
The researchers, led by the University of Cambridge, used their algorithm to identify four new molecules that activate a protein, which is thought to be relevant for symptoms of Alzheimer's disease and schizophrenia.
The results are reported in the journal PNAS.
A key problem in drug discovery is predicting whether a molecule will activate a particular physiological process. It's possible to build a statistical model by searching for chemical patterns shared among molecules known to activate that process, but the data to build these models is limited because experiments are costly and it is unclear which chemical patterns are statistically significant.
"Machine learning has made significant progress in areas such as computer vision where data is abundant," said Alpha Lee from Cambridge's Cavendish Laboratory, and the study's lead author. "The next frontier is scientific applications such as drug discovery, where the amount of data is relatively limited but we do have physical insights about the problem, and the question becomes how to marry data with fundamental chemistry and physics."
The algorithm developed by Lee and his colleagues, in collaboration with biopharmaceutical company Pfizer, uses mathematics to separate pharmacologically relevant chemical patterns from irrelevant ones.
Importantly, the algorithm looks at both molecules known to be active and molecules known to be inactive, and learns to recognise what parts of the molecules are important for drug action and what parts are not.
A mathematical principle known as random matrix theory gives predictions about the statistical properties of a random and noisy dataset, which is then compared against the statistics of chemical features of active/inactive molecules to distil which chemical patterns are truly important for binding as opposed to arising simply by chance.
This methodology allows the researchers to fish out important chemical patterns not only from molecules that are active, but also from molecules that are inactive—in other words, failed experiments can now be exploited with this technique.
The researchers built a model starting with 222 active molecules, and were able to computationally screen an additional six million molecules. From this, the researchers purchased and screened the 100 most relevant molecules. From these, they identified four new molecules that activate the CHRM1 receptor, a protein that may be relevant for Alzheimer's disease and schizophrenia.
"The ability to fish out four active molecules from six million is like finding a needle in a haystack," said Lee. "A head-to-head comparison shows that our algorithm is twice as efficient as the industry standard."
Making complex organic molecules is a significant challenge in chemistry, and potential drugs abound in the space of yet-unmakeable molecules. The Cambridge researchers are currently developing algorithms that predict ways to synthesize complex organic molecules, as well as extending the machine learning methodology to materials discovery.

Five Things I Wish I’d Known Before My Chronic Illness

Effects of Perturbation-Based Balance Training in Subacute Persons With Stroke: A Randomized Controlled Trial

So I guess these 38 previous posts on perturbations were not enough to write up a stroke rehab protocol and you didn't bother to write one either. So your doctors and therapists have been incompetent since Jan. 2013

 

Effects of Perturbation-Based Balance Training in Subacute Persons With Stroke: A Randomized Controlled Trial

First Published February 15, 2019 Research Article
Background: Reactive balance responses are critical for fall prevention. Perturbation-based balance training (PBBT) has shown a positive effect in reducing the risk of falls among older adults and persons with Parkinson’s disease.  
Objective: To explore the effect of a short-term PBBT on reactive balance responses, performance-based measures of balance and gait and balance confidence.  
Methods: Thirty-four moderate-high functioning(cherry picking better candidates again), subacute persons with stroke (PwS) (lower extremity Fugl-Meyer score 29.2 ± 4.3; Berg Balance Scale [BBS] score 43.8 ± 9.5, 42.0 ± 18.7 days after stroke onset) hospitalized in a rehabilitation setting were randomly allocated to PBBT (n = 18) and weight shifting and gait training (WS&GT) (n = 16). Both groups received 12 training sessions, 30 minutes each, for a period of 2.5 weeks. PBBT included unexpected balance perturbations during standing and treadmill walking, WS&GT included weight shifting in standing and treadmill walking without perturbations. The main outcome measures, that is, multiple step-threshold and fall-threshold were examined at baseline, immediately postintervention, and about 5 weeks postintervention. The secondary outcome measures, that is, BBS, 6-minute walk test (6MWT), 10-meter walk test (10MWT), and Activity-specific Balance Confidence (ABC) scale were examined at baseline and immediately postintervention.
Results: Compared with the WS&GT group, immediately postintervention participants in the PBBT group showed higher multiple-step thresholds in response to forward and backward surface translations (effect size [ES] = 1.07 and ES = 1.10, respectively) and moderate ES in the ABC scale (ES = 0.74). No significant differences were found in fall-threshold, BBS, 6MWT, and 10MWT between the groups.  
Conclusions: Inclusion of perturbation training during rehabilitation of PwS improved reactive balance and balance confidence.

Language as a Predictor of Motor Recovery: The Case for a More Global Approach to Stroke Rehabilitation

No stroke survivor cares about predictions, they want recovery solutions. When the hell are you going to provide protocols for that? Lazy research.

Language as a Predictor of Motor Recovery: The Case for a More Global Approach to Stroke Rehabilitation 

First Published February 13, 2019 Research Article
Stroke is the third leading cause of death in the developed world and the primary cause of adult disability. The most common site of stroke is the middle cerebral artery (MCA), an artery that supplies a range of areas involved in both language and motor function. As a consequence, many stroke patients experience a combination of language and motor deficits. Indeed, those suffering from Broca’s aphasia have an 80% chance of also suffering hemiplegia. Despite the prevalence of multifaceted disability in patients, the current trend in both clinical trials and clinical practice is toward compartmentalization of dysfunction. In this article, we review evidence that aphasia and hemiplegia do not just coexist, but that they interact. We review a number of clinical reports describing how therapies for one type of deficit can improve recovery in the other and vice versa. We go on to describe how language deficits should be seen as a warning to clinicians that the patient is likely to experience motor impairment and slower motor recovery, aiding clinicians to optimize their choice of therapy. We explore these findings and offer a tentative link between language and arm function through their shared need for sequential action, which we term fluency. We propose that area BA44 (part of Broca’s area) acts as a hub for fluency in both movement and language, both in terms of production and comprehension.

Stroke survivor felt ‘lost’ when sent home from hospital

This is a direct result of your doctor and therapists having no clue or protocols to get you 100% recovered. Your doctor needs to come up with solutions and not just tell you to fuck off.  Your doctor will never use those exact words but the result is the same when they have nothing to help you get better.

Stroke survivor felt ‘lost’ when sent home from hospital


article_update_120be9b8-0de1-4c6a-9bb1-14c6d2deca65.jpg
Stroke survivor Rosemary Brown described the experience as her brain having the biggest shock of its life Photo: Stroke Association/PA
A stroke survivor has described how she felt lost when she was discharged from hospital.
Rosemary Brown suffered a stroke in 2017 and said while she was grateful for the great care she received in hospital, she felt lost when she was sent home.
She was speaking as the Stroke Association launched a new report at Stormont on Monday which finds stroke survivors in Northern Ireland are struggling to recover.
“My brain had just had the biggest shock of its life and I was feeling shell shocked,” she said.
Stroke survivor Rosemary Brown with her partner Martin
Stroke survivor Rosemary Brown with her partner Martin Credit: Stroke Association/PA
“I didn’t know where to turn and felt a bit abandoned for a few weeks.
“When I was sent home from hospital I was given a few leaflets but I don’t think my brain could really process that information at the time. It was just all too much.”
The Stroke Association’s Struggling to Recover report finds that around half of all stroke survivors in Northern Ireland feel abandoned when they leave hospital.
It also found they are unable to make a full recovery due to a lack of rehabilitation and on-going support.
Sorry, this content isn't available on your device.
No stroke survivor should be abandoned
Ursula Ferguson, Stroke Association
The report finds that stroke survivors in Northern Ireland receive approximately one third of the recommended 45 minutes of physiotherapy, occupational therapy and speech therapy per day.
Other findings include that 45% of stroke survivors feel abandoned when they leave hospital, 90% feel their emotional needs are not met, 78% feel the care and support they receive at home is poor or very poor and 98% of family carers say they sometimes find it difficult to cope.
Ms Brown added: “Stroke survivors need quick access to physiotherapy and speech therapy which can help them make the best recovery possible.
“Referring people from the health service to services that can help should be as seamless as possible. It should happen automatically so people can get the support they need, instead of waiting too long for help.”
Ahead of the upcoming public consultation on reforming hospital stroke services, the Stroke Association is calling for the creation of an appropriately funded regional stroke pathway to reduce the postcode lottery of stroke care and help all stroke survivors to make the best recovery they can.
Ursula Ferguson, head of stroke support at the Stroke Association, said rehabilitation and long term support for stroke survivors has “long been identified as the Cinderella of stroke services”.
“We cannot enter another decade of unmet need and chronic underfunding of community based stroke care. Everyone affected by stroke in Northern Ireland has the right to make the best possible recovery,” she said.
“No stroke survivor should be abandoned.”
Every year around 4,000 people in Northern Ireland have a stroke or TIA (mini-stroke) and there are around 1,000 stroke related deaths.
There are more than 37,000 stroke survivors in Northern Ireland.

Need a reason to celebrate National Wine Day? Here are 5

Don't do this, your doctor will never recommend wine regardless of what research says.   Your doctor will instead maybe point to this:

Ask Well: Health Benefits of Red Wine vs. Grape Juice

Which doesn't address the social connections at all.  And just to me the social connections are everything that makes life better and lack of recovery bearable.   Only split 3 bottles of red wine with a friend tonight. In preparation for the upcoming Italian trip. Practice is needed.

 

Need a reason to celebrate National Wine Day? Here are 5


Liz Meszaros, MDLinx | February 18, 2019
For thousands of years, wine has been a part of the human experience. The earliest evidence of wine production dates back to 4,100 BC in Armenia. Since then, this beverage, made from fermented grapes, has held a place in social, religious, and medicinal practices throughout the world.    
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The Greeks worshipped Dionysus (Bacchus), the god of the grape harvest, winemaking, and wine. Maybe they already knew what we are just beginning to prove: wine may be good for the body.
Only recently have researchers begun to find evidence of the possible therapeutic benefits wine may have. Although wine’s benefits for the cardiovascular system are well known, it’s not the only body system that may benefit.
To celebrate National Drink Wine Day 2019, here’s a list of some of the positive health effects wine may have.
Heart health. Although researchers have not directly assessed the specific effects of wine on the risk of developing heart disease or stroke, there is evidence that the incidence of heart disease in people who drink moderate amounts of alcohol is lower than in those who do not drink.
In some observational studies, drinking red wine—and other alcoholic beverages—was associated with an increase in high-density lipoproteins, decreased blood clot formation, and decreased vascular damage caused by low-density lipoproteins. This may be due, in part, to resveratrol, which is a polyphenol found in red wine.

“Drinking a glass of wine is good for the heart in the sense that the main mechanism by which alcohol protects the heart is increasing good cholesterol. The grape skin provides flavonoids and other antioxidant substances that protect the heart and vessels from the damaging effects of free oxygen radicals produced by our body,” Prakash Deedwania, MD, chief, Cardiology Division, and professor of medicine, University of California, San Francisco School of Medicine, San Francisco, CA, told the American Heart Association (AHA).
Although the AHA does not currently recommend drinking wine or any other alcoholic beverage to lower cardiovascular risk, it does strongly advise moderation should you choose to do so. This translates to an average of one to two drinks per day for men, and one drink per day for women.
Glycemic health. The cardiovascular protections red wine may afford could be especially valuable in patients with diabetes.
Alcoholic beverages, including wine, can lower blood sugar levels. Further, both the American Diabetes Association and the AHA recommend the Mediterranean diet—which includes moderate wine consumption—for those with type 2 diabetes who wish to improve their glycemic control and lower cardiovascular risk factors. A higher adherence to this diet is associated with a 20%-23% reduction in the risk of developing type 2 diabetes, with a 28% to 30% reduced risk of cardiovascular events.
“This is particularly true for diabetics because they have been shown to have a high production of free oxygen radicals.  But we don’t have any evidence specifically related to diabetes patients,” said Dr.  Deedwania.
Gastrointestinal health. Researchers recently reported on the health benefits of fermented foods, which included wine. The fermentation process may actually enhance the nutritive and health-regulating properties of foods, they noted. Fermented foods can also be an important source of live microorganisms, and many of the species found in these foods are phylogenetically related to probiotics.
“Fermented foods and beverages were among the first processed food products consumed by humans…Although only a limited number of clinical studies on fermented foods have been performed, there is evidence that these foods provide health benefits well-beyond the starting food materials,” researchers concluded.
Respiratory health. Another polyphenol found in red wine, ellagic acid, may inhibit the proliferation of lung cancer cells via induction of autophagy. Ellagic acid also demonstrates anti-lung cancer effects in vitro and in vivo, according to a recent study in the Journal of Cellular and Molecular Medicine. In previous studies, researchers have shown that ellagic acid is a potent antioxidant and may have preventive effects in several types of cancer.

Brain health. Low levels of alcohol consumption may reduce inflammation and help the brain clear toxins, including ones associated with Alzheimer’s disease, according to a recent study published in Scientific Reports.
“Prolonged intake of excessive amounts of ethanol is known to have adverse effects on the central nervous system,” said lead author Maiken Nedergaard, MD, DMSc, co-director, Center for Translational Neuromedicine, Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY.  “However, in this study we have shown for the first time that low doses of alcohol are potentially beneficial to brain health, namely it improves the brain’s ability to remove waste.”
Dr. Nedergaard and colleagues found that mice exposed to low levels of alcohol consumption (about 2.5 drinks/day) had less inflammation in the brain and were more efficient at removing waste from their brains compared with controls.
“Studies have shown that low-to-moderate alcohol intake is associated with a lesser risk of dementia, while heavy drinking for many years confers an increased risk of cognitive decline. This study may help explain why this occurs. Specifically, low doses of alcohol appear to benefit overall brain health,” noted Dr. Nedergaard.
Perhaps it was no accident that Louis Pasteur, considered by some to be the father of immunology, held wine in the highest esteem, and went as far as to say: “Wine is the most healthful and most hygienic of beverages.”
Or perhaps Ernest Hemingway said it best: “Wine is one of the most civilized things in the world and one of the most natural things of the world that has been brought to the greatest perfection, and it offers a greater range for enjoyment and appreciation than, possibly, any other purely sensory thing.”
The Greeks worshipped Dionysus (Bacchus), the god of wine. Maybe they already knew what we are just beginning to prove: wine may be good for the body and mind.
If you plan on celebrating National Drink Wine Day today, remember to always drink in moderation.

Monday, February 18, 2019

Who’s in the room when stroke is talked about?

If stroke survivors are not in your stroke conferences and guideline creations then you are missing the most important people in stroke. When your hospital has post mortem interviews on stroke rehab failures are there survivors in the room? Unless the survivor gets 100% recovered there should be a post mortem in every case to determine exactly why they didn't recover, in order to change the failure points. If your stroke hospital is not doing that you need to fire the president and the board of directors.   

Another great Seth Godin post.

Who’s in the room when stroke is talked about? 

We accidentally curate who comes to the meeting, who has a seat at the table where decisions are made. We almost randomly decide who is interviewing and being interviewed, who is brainstorming, who is reviewing the work…
What if we did it with intention? What if we thought deeply about who sits across from us during the key conversations?
Convenient should not be the dominant driver of this choice. Nor should existing protocol.
“Who’s not here?” might be the most important unasked question.

Half of Northern Ireland stroke survivors feel abandoned afterwards

Then they are measuring it wrong or asking the wrong question.'How close are you to 100% recovery? And has your doctor laid out a pathway to get there?' It should be 90% since only 10% will get to full recovery.

 

Half of Northern Ireland stroke survivors feel abandoned afterwards


Almost half of stroke survivors in Northern Ireland feel abandoned when they leave hospital and are unable to make a full recovery due to a lack of rehabilitation, a new report says. A stroke or ‘brain attack’ is the third biggest killer in Northern Ireland and the leading cause of adult disability. The report, ‘Struggling to recover, life after stroke in NI’, was developed in partnership with the Stroke Association and Dr Niamh Kennedy a neuroscientist at Ulster University with a specific interest in stroke recovery. The research found that stroke survivors in Northern Ireland receive approximately one-third of the recommended 45 minutes of physiotherapy, occupational therapy and speech therapy per day. A key finding was that 45% of stroke survivors feel abandoned when they leave hospital. One survivor, Rosemary Brown, suffered a stroke in 2017. While she was grateful for the great care she received in hospital, she said he felt lost when she was sent home. “I didn’t know where to turn and felt a bit abandoned for a few weeks.” She added: “My brain had just had the biggest shock of its life and I was feeling shell shocked. “When I was sent home from hospital I was given a few leaflets but I don’t think my brain could really process that information at the time. It was just all too much.” Continued from page one Ms Brown added: “Stroke survivors need quick access to physiotherapy and speech therapy which can help them make the best recovery possible. “Referring people from the health service to services that can help should be as seamless as possible. It should happen automatically so people can get the support they need, instead of waiting too long for help.” Ahead of the upcoming public consultation on reforming hospital stroke services, the Stroke Association is calling for the creation of an appropriately funded regional stroke pathway to reduce the postcode lottery of stroke care and help all stroke survivors to make the best recovery they can. Justgiving campaign for Connor Murphy - now closed Family of tragic chef reveal their heartbreak - after month-long search Ursula Ferguson, head of stroke support at the Stroke Association, said rehabilitation and long-term support for stroke survivors has “long been identified as the Cinderella of stroke services”. “We cannot enter another decade of unmet need and chronic underfunding of community-based stroke care. Everyone affected by stroke in Northern Ireland has the right to make the best possible recovery,” she said. “No stroke survivor should be abandoned.” The conclusions of the new report were based on research drawn from 305 stroke survivors, 75 of their carers, and 101 professionals who work in stroke services. The report was also based on findings from 142 individuals from the charity’s voluntary stroke support groups. The figure relates to separate unpublished research which was carried out by Trevor Gill Associates on behalf of the Stroke Association in April 2018. The unpublished survey, ‘Self expressed needs of NI stroke survivors and carers’, revealed many of the same findings as the latest report, particularly regarding gaps in emotional support, help to get back to work and support for carers. The findings were used to apply for funding for more support. The proportion of first-time strokes suffered by 40 to 69-year-olds rose from 33% to 38% in England from 2007 to 2016. The Act FAST campaign calls on people to phone 999 if they spot signs of stroke in the face, arms or in speech. Every year around 4,000 people in NI have a stroke or mini-stroke, and there are around 1,000 stroke related deaths. There are more than 37,000 stroke survivors in NI.
• 33% of survivors have communication problems
 • 54% of survivors say they often or always feel anxious and worried
 • 50% often or always feel depressed or have a low mood
• 67% do not feel their physical needs are well met after hospital
 • 85% of carers do not feel prepared for their loved one coming home from hospital
• 98% of carers say they find it sometimes difficult to cope
• 28% of carers know who to contact if they need more help
 • 25% of strokes happen to people under 65 A stroke can affect memory and thinking, vision, speech, swallowing, arm and leg strength and balance, bowel and bladder control, pins and needles, muscle and joint pain, numb skin.

Making the right decisions when planning stroke rehab for yourself or a loved one starts with asking the right questions. Here’s a detailed list of the important things to ask:

The tyranny of low expectations is all over these questions. The most important question is not even in there. HOW DO I GET TO 100% RECOVERY?

Until stroke survivors start demanding an answer to that question your stroke team will stay with the failures of the status quo. Getting to 100% recovery is going to require massive amounts of brainpower and research that your doctors and stroke hospital have shown no interest in doing.  

Making the right decisions when planning stroke rehab for yourself or a loved one starts with asking the right questions. Here’s a detailed list of the important things to ask:

Comparing the responsiveness of the Functional Autonomy Measurement System (SMAF) with that of the Functional Independence Measure (FIM) in post-stroke rehabilitation

Since neither of these is objective they are pretty much useless in deciding what rehab protocol is needed for specific recoveries. 

Functional Autonomy Measurement System

FIM is pretty much useless since it is subjective.

 

Comparing the responsiveness of the Functional Autonomy Measurement System (SMAF) with that of the Functional Independence Measure (FIM) in post-stroke rehabilitation


Clinical Effects of Early Edaravone Use in Acute Ischemic Stroke Patients Treated by Endovascular Reperfusion Therapy

So instead of coming up with a definitive answer we again need followup research. WHOM is going to do that and when?  

You'll have to ask your doctor why the hell edaravone is approved in Japan since 2001 but not the US.

Clinical Effects of Early Edaravone Use in Acute Ischemic Stroke Patients Treated by Endovascular Reperfusion Therapy

Originally publishedhttps://doi.org/10.1161/STROKEAHA.118.023815Stroke. 2019;0

Background and Purpose—

Although several clinical studies suggested the beneficial effects of edaravone in acute ischemic stroke, most were performed under settings that differ from those in the current treatment strategy, which has dramatically changed with progress in reperfusion therapies. This study aimed to evaluate the efficacy of edaravone in patients with acute ischemic stroke treated by emergent endovascular reperfusion therapy.

Methods—

We conducted a retrospective observational study using a national administrative database. Patients with acute ischemic stroke treated by emergent endovascular reperfusion therapy were identified and dichotomized by whether edaravone was used within 2 days of admission. We compared the functional independence at hospital discharge, in-hospital mortality, and intracranial hemorrhage after admission between groups, adjusted by a well-validated case-mix adjustment model, in multivariate mixed-effect regression and propensity score matching analyses.

Results—

Of 11 508 patients eligible for analysis, 10 281 (89.3%) received edaravone therapy. The established risk adjustment model had good predictability for functional independence at hospital discharge, with an area under the receiver operating characteristic curve of 0.74. In the mixed-effect regression analysis, edaravone use was significantly associated with greater functional independence at hospital discharge (32.3% in the edaravone group versus 25.9% in the control group; adjusted odds ratio, 1.21; 95% confidence interval, 1.03–1.41), lower in-hospital mortality (9.9% in the edaravone group versus 17.4% in the control group; adjusted odds ratio, 0.52; 95% confidence interval, 0.43–0.62), and reduced intracranial hemorrhage after admission (1.4% in the edaravone group versus 2.7% in the control group; adjusted odds ratio, 0.55; 95% confidence interval, 0.37–0.82). Results of the propensity score matching analysis corroborated these results.

Conclusions—

This retrospective analysis of a Japanese nationwide administrative database suggested that combination therapy with edaravone and endovascular reperfusion therapy could be a promising therapeutic strategy in acute ischemic stroke. Further randomized control trials are warranted.

Footnotes

The online-only Data Supplement is available with this article at https://www.ahajournals.org/doi/suppl/10.1161/STROKEAHA.118.023815.
Correspondence to Akira Endo, MD, PhD, Trauma and Acute Critical Care Medical Center, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113–8510, Japan. Email

Are you experiencing debilitating fatigue after your stroke? Researchers are trialling a wakefulness drug that could help - Australia

Join if you can. I had massive fatigue even with having the cardiovascular fitness of an athlete.

Are you experiencing debilitating fatigue after your stroke? Researchers are trialing a wakefulness drug that could help - Australia

The MIDAS2 study (Modafinil in Debilitating Fatigue After Stroke 2) is looking for people who have severe persisting fatigue after stroke to test the wakefulness medication called modafinil.
A previous study tested modafinil in stroke survivors with debilitating fatigue. They found that 6 weeks of treatment reduced fatigue and improved the quality of life for many trial participants.
This MIDAS 2 study will test whether 200mg of modafinil taken for 56 days is safe and can alleviate stroke-related fatigue in a much larger group of stroke survivors. There are currently hospitals in Newcastle, Melbourne and Adelaide participating in the study. Participants can choose to continue in the study for up to 12 months to test the long-term effectiveness of the drug.
Watch: David, Mark & Tracey & Michelle on their experience with modafinil in the previous MIDAS study

Who can participate in the research?

  • People who have had a stroke at least 3 months ago, and
  • People who have severe, persistent and debilitating fatigue
Modafinil may not be suitable for people with high levels of anxiety. People with stroke who are pregnant, or planning to become pregnant are not able to participate in this trial. A neurologist will perform a detailed medical assessment to see if you are eligible and whether it is safe for you to participate in the trial.

Mark and Tracey Laverick - Mark needed to nap 2-4 hours every day. After the previous modafinil trial, he rarely needed to nap and was able to get back into activities with his family.

Why is the research being done?

Fatigue affects up to 70% of stroke survivors. Fatigue has been defined as ‘a feeling of early exhaustion with weariness, lack of energy and aversion to effort that develops during physical or mental activity and is usually not improved by rest'. There are currently no approved medical therapies available for stroke survivors to help manage their fatigue.
What would you be asked to do?
If you’re happy to participate and you meet all of the eligibility criteria , you will be asked to do the following
1) Come to HMRI for 3 visits over the initial 8-week period. You will be reimbursed for parking costs for these visits. During these appointments, you will be asked to complete surveys, have health assessments (approx. 1-3 hours).
You will be asked for information on your health and function, fatigue levels, quality of life. You will also undergo testing of your current thinking and cognitive skills, fatigue, depression and anxiety.
2) Take tablets every day containing either 200mg modafinil or a placebo (an identical tablet with no active ingredients). There is a ½ or 50% chance of being in the modafinil group and neither you nor the doctors and scientists seeing you as part of the trial will know whether you’re receiving modafinil or placebo. In emergency situations, your study doctor can find out if needed.
You can also choose to take part in any or all of 3 sub-studies:
1) Extra 10 month trial of modafinil
After the first 8 weeks, participants can choose if they want to enrol for a further 10 months. The long-term safety and reliability of modafinil will be studied. There is no placebo arm to this sub-study so all patients who take part will be supplied with modafinil for the 10-month duration.
2) Physical activity monitoring
This will involve wearing a FitBit activity monitor for a period of 1 week during the course of the study.
3) Extra cognitive testing
This involves a more thorough set of cognitive tests at each visit to HMRI and adds approximately 40-60 minutes to each visit.
Click here to download a detailed Participant Information Statement
Researchers: Dr Andrew Bivard, Prof Chris Levi, Prof Neil Spratt, Dr Carlos Garcia-Esperon, Dr Tom Wellings, Dr Shyam Gangadharan, Linda Belevski, Thomas Lillicrap, Prof Michael Nilsson
To find out more or to register your interest please contact Linda Belevski on (02) 4922 3187 or Linda.belevski@hnehealth.nsw.gov.au
The study is being supported by The Greater Charitable Foundation.
This study is also inviting people from the Hunter Stroke Research Volunteer Register to participate. To be invited to participate in other studies in stroke rehabilitation and recovery, register here: https://hmri.org.au/stroke-register

Stroke Association UK We collaborate to ensure research results are shared openly

Old news but likely to be unhelpful.  Research is not written in plain enough language that survivors can communicate the protocols needed to be created to their doctors.  That is really the job of the Stroke Association, to communicate the protocols from research to all stroke hospitals AND make sure they are implemented in those hospitals. But that won't occur, you survivors are on your own to figure out how research will get you recovered.

Stroke Association UK We collaborate to ensure research results are shared openly

Tuesday 1 May 2018
Announced today, AMRC Open Research is a new online platform for publishing medical research findings.
The Stroke Association is one of 23 members of the Association of Medical Research Charities (AMRC) that are collaborating on the development and launch of this important new initiative.
We hope it will help charities maximise the value of the donations we receive by making it possible for all the findings from the research we fund to be rapidly and openly shared with the scientific community and public.
By removing traditional barriers and delays to publication, and making articles available in a matter of days, rather than the typical months or years that traditional publishing can take, AMRC Open Research could help accelerate our understanding of conditions and diseases that affect so many lives, including stroke.
Dr Richard Francis, Head of Research Awards at the Stroke Association said:
“We want to ensure that all the findings from our funded research, no matter how big or small, are available for all to see. This new platform will enable researchers to disseminate their findings efficiently and transparently”.

To find out more about AMRC Open Research visit the AMRC website.

How many push-ups can you do? Study finds men who can do 40 have lower risk of heart disease

Well, right now not any. Same reason as not being able to do missionary style sex.  Even before my stroke even though I was extremely fit I would never have gotten to 40 pushups.  I don't see the direct correlation between upper body strength and heart disease.  Go back to the drawing board and find a direct correlation.

Problems:

  1.  Fingers and thumb will not stay flat.
  2. Wrist collapses.
  3. Elbow collapses.
  4. Bicep spasticity pulls everything out of line.
What is your doctors' protocol to get pushups done? 

 

How many push-ups can you do? Study finds men who can do 40 have lower risk of heart disease

N'dea Yancey-Bragg
The number of push-ups a man can do may be a good indicator of his risk for heart disease, a new study found.
The study, conducted by researchers at the Harvard T.H. Chan School of Public Health, compared the heart health of male firefighters over a 10-year period. Those who could do more than 40 push-ups during a timed test at a preliminary examination were 96 percent less likely to have developed a cardiovascular problem compared to those who could do no more than 10 push-ups, according to the report published Friday in the medical journal JAMA Network Open.
Nearly half of U.S. adults deal with some form of cardiovascular disease as of 2016, according to the American Heart Association.The study's authors believe push-ups may be an easy way to test men's risk for heart disease.
“Our findings provide evidence that push-up capacity could be an easy, no-cost method to help assess cardiovascular disease risk in almost any setting,” study author Justin Yang said in a statement. “Surprisingly, push-up capacity was more strongly associated with cardiovascular disease risk than the results of submaximal treadmill tests.”
The men, who had an average age of 40 and an average body mass index (BMI) of 28.7 at the start of the study, performed both the push-up test and an exercise tolerance test on the treadmill. The participants were instructed to do push-ups in time with a metronome set at 80 beats per minute until they “reached 80, missed 3 or more beats of the metronome, or stopped owing to exhaustion.”
Over the following decade, the men underwent physical examinations and filled out health surveys. Among the 1,104 participants, 37 heart health problems were reported, such as coronary artery disease, heart failure, or sudden cardiac death.
The study found significantly lower rates of cardiovascular problems among those with higher push-up capacity compared with the lowest baseline push-up capacity. 
Though men who could do 40 or more push-ups had the lowest risk, participants able to perform 11 or more push-ups also showed reduced risk of subsequent heart health problems.
The study authors note that more research needs to be done before the findings can be generalized to other groups, like women, older people and those who are less active.
Contributing: Brett Molina, USA TODAY
Follow N'dea Yancey-Bragg on Twitter: @NdeaYanceyBragg