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

Saturday, April 25, 2015

NDT-Bobath method in post-stroke rehabilitation in adults aged 42–55 years – Preliminary findings

I can't see how they can refute these earlier findings unless this is just to confuse the issue.
Why the hell are we still writing about NDT/Bobath? It has been proven multiple times to not be effective.

Comparison Of Two Physiotherapy Approaches InAcute Stroke Rehabilitation: Motor RelearningProgram Versus Bobath Approach.

Motor Relearning Program vs. Bobath:
http://cre.sagepub.com/content/14/4/361.short

And here is Peter Levines take on NDT:
http://recoverfromstroke.blogspot.com/2013/01/neuro-developmental-treatment.html


NDT-Bobath method in post-stroke rehabilitation in adults aged 42–55 years – Preliminary findings
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Abstract

Introduction

Stroke is among the leading causes of death in both developed and developing countries. Although stroke is perceived predominantly as a disease of middle aged and older people, its occurrence in younger people is not rare, influencing all aspects of young people's lives, including the ability to work.

Aim

Pilot study – a single group before-and-after preliminary study to investigate the feasibility of conducting a larger randomized controlled trial investigation of the efficacy of the NDT-Bobath method with the younger adult stroke survivor population.

Material and methods

Patients were admitted to the neurological rehabilitation unit after ischemic stroke. Ten sessions of the NDT-Bobath therapy were provided within 2 weeks, constituting 10 days of the therapy. The therapy was performed every day for 5 days a week. Measurements of the Ashworth Scale, the Bobath Scale, the Barthel Index, gait velocity, cadence and stride length were conducted twice: on admission, and after the last session of the rehabilitation.

Results and discussion

Statistically significant and favorable changes in the muscle tone, hand functions, selected activities of daily living, gait velocity, cadence and stride length have been observed. (You have done nothing to rule out that all this recovery is due to spontaneous recovery, go back to school and learn how to do clinical research)

Conclusions

Findings confirm that the NDT-Bobath method for adults may be perceived as a promising form of post-stroke rehabilitation in young adults.

St. Mary Medical Center to Host Stroke Symposium during National Stroke Awareness Month - Hobart, Indiana

I could bet you $100,000 that these so-called experts will not tell you how f*cked up stroke rehab and recovery is. They will not mention all the problems in stroke, or how screwed current stroke survivors are. You will just get pablum. Nothing on the appalling 10% full recovery rate, nothing on the 12% full restoration of function from using tPA. In fact all I bet you get is happy talk. So ask them how confident they would be after having a stroke and fully recovering being treated at their hospital. If it is not 100% confident, ask why the hell you should be treated for stroke there.(Keep asking them this same question over and over again until they answer truthfully) This is going to be damned uncomfortable but if they aren't uncomfortable about how poorly they treat stroke patients they shouldn't be in the business. But I bet they lie by omission anyway.
And yes, I can be a complete f*cking bastard, brain cells are worth saving and these people are failing at their job. Don't coddle them, they need to be told they are failing.
http://www.laportecountylife.com/health/education/52829-st-mary-medical-center-to-host-stroke-symposium-during-national-stroke-awareness-month
Every 40 seconds, someone in the United States has a stroke, according to the American Stroke Association, and one out of six Americans will suffer a stroke at some point in their lifetime. To raise awareness and help the community evaluate their risk for stroke, St. Mary Medical Center will host its annual Stroke Symposium from 8:30 a.m. to 1 p.m., Thursday, May 7 at the hospital, 1500 S. Lake Park Ave. in Hobart.
Healthcare specialists and leaders in the areas of stroke prevention, detection and treatment will present on a variety of stroke-related topics:
9 a.m. – Stroke is an Emergency
Hansa Sawlani, M.D.
St. Mary Medical Center Emergency Department
9:30 a.m. – Cardiology Related to Stroke
Zlatan Stepanovic, M.D.
Medical Director ICU, Director Heart Failure Clinic
10:30 a.m. – Stroke 101
Mark Simaga, M.D.
Neurologist, Medical Director of the Stroke Center
11:30 a.m. – Hemorrhagic Stroke
Ankit Mehta, M.D.
Neurosurgery, St. Mary Medical Center
12:15 p.m. – Rehabilitation after Stroke
Acute Rehabilitation Team
St. Mary Medical Center
12:45 p.m. – Get Your Plate in Shape
Chef Ryan C. Smith
Production Supervisor/Chef
The event will also feature a vendor fair providing stroke education and resources, and free health screenings, including lipid profile screening, A1C glucose screening, body composition and blood pressure. 12 hour fasting is recommended for the lipid profile and glucose screening.
Advanced registration for this free event is necessary. To register, call 219-836-3477 or toll free at 1-866-836-3477. Attendees are encouraged use the free valet parking at the West Entrance of the hospital.

Friday, April 24, 2015

A Mirror Therapy–Based Action Observation Protocol to Improve Motor Learning After Stroke

It's got protocol in the title so send your doctor after those details. And it is for chronic.
http://nnr.sagepub.com/content/early/2014/11/14/1545968314558598.full
  1. Wouter J. Harmsen, MSc1,2
  2. Johannes B. J. Bussmann, PhD1
  3. Ruud W. Selles, PhD1,3
  4. Henri L. P. Hurkmans, PhD1
  5. Gerard M. Ribbers, MD, PhD1,2
  1. 1Erasmus MC, Department of Rehabilitation Medicine, Rotterdam, the Netherlands
  2. 2Rijndam Rehabilitation Centre, Rotterdam, the Netherlands
  3. 3Erasmus MC, Department of Plastic and Reconstructive Surgery, Rotterdam, the Netherlands
  1. Wouter J. Harmsen, MSc, Department of Rehabilitation Medicine, Erasmus MC–University Medical Center, Room: Ee 1622, Dr Molewaterplein 50, 3015 GE Rotterdam, Netherlands. Email: w.harmsen@erasmusmc.nl

Abstract

Background. Mirror therapy is a priming technique to improve motor function of the affected arm after stroke. Objective. To investigate whether a mirror therapy–based action observation (AO) protocol contributes to motor learning of the affected arm after stroke. Methods. A total of 37 participants in the chronic stage after stroke were randomly allocated to the AO or control observation (CO) group. Participants were instructed to perform an upper-arm reaching task as fast and as fluently as possible. All participants trained the upper-arm reaching task with their affected arm alternated with either AO or CO. Participants in the AO group observed mirrored video tapes of reaching movements performed by their unaffected arm, whereas participants in the CO group observed static photographs of landscapes. The experimental condition effect was investigated by evaluating the primary outcome measure: movement time (in seconds) of the reaching movement, measured by accelerometry. Results. Movement time decreased significantly in both groups: 18.3% in the AO and 9.1% in the CO group. Decrease in movement time was significantly more in the AO compared with the CO group (mean difference = 0.14 s; 95% confidence interval = 0.02, 0.26; P = .026). Conclusion. The present study showed that a mirror therapy–based AO protocol contributes to motor learning after stroke.

Once and done.

Once and done. From Think Like a Freak by Steven D. Levitt and Stephen J. Dubner.
This could easily be applied to stroke. Once we get your donation the only email/mail you will get from us will be updates on successes on the stroke strategy. But this won't occur with the current leadership, it is way too innovative.

How do you tie the incentives/solutions that survivors want to being able to get them from your doctor?

All of you doctors out there are welcome to chime in. This is a major problem. What is YOUR solution?

Conscience laundering - doing charity to make themselves feel better rather than figuring out the best way to alleviate suffering.

From Think Like a Freak by Steven D. Levitt and Stephen J. Dubner.
To me this is the main problem with our stroke associations. They have absolutely NO sense of urgency to solve all the f*cking problems in stroke. They actually are dragging their feet by just putting out press releases and never putting together any public strategy.  You employees of these stroke associations can respond by pointing directly to public strategies with whom contributed to those strategies..

Doctor incentives for stroke

What are the incentives for your doctor or stroke hospital to keep up with the latest research?
Cash?
Don't want to fall behind other doctors?  Herd mentality?
Don't want to be shown up by patients?

This is a major problem because I really doubt your doctor has changed any stroke rehabilitation stuff(not ER work) based on research in the last 30 years. Any doctor can prove me wrong and gloat about it. 
What would incentivize your doctor to keep up with the latest?

Can Drinking Milk Prevent Alzheimer's Disease?

This is testing for secondary markers not primary so this is way premature.
http://news.yahoo.com/drinking-milk-prevent-alzheimers-disease-154903102.html

Los Angeles researcher receives $154,000 for stroke research - drop of blood

So is this researcher following in these footsteps?

Supersmall lab-on-a-chip is superfast

And maybe use this also:

Blood Test Can Determine Stroke Type 

and has this been considered?

Blood Test for Brain Injury May Not Be Feasible

That is because proteins that are triggered by brain damage are prevented from reaching the blood system in levels necessary for a precise diagnosis.

 

 

http://www.eurekalert.org/pub_releases/2015-04/aaon-lar042315.php
A Los Angeles researcher is receiving $154,000 to continue his research aimed at developing a blood test for diagnosing stroke through the Lawrence M. Brass, MD, Stroke Research Award, cosponsored by the American Brain Foundation and the American Heart Association/American Stroke Association. The award was presented in Washington, DC, during the American Academy of Neurology's 67th Annual Meeting, the world's largest meeting of neurologists.
Sunil Sheth, MD, a clinical instructor and fellow in the division of interventional neuroradiology at the University of California, Los Angeles, received the award for developing a lab test that can diagnose stroke from a single drop of blood. "We have shown that our test works well in a laboratory, and we would now like to validate this test where it matters the most--in actual people suffering from stroke in an emergency room," said Sheth.
Sheth's experiments will explore a new approach by looking at a class of molecules that are the most abundant in the brain, but have never previously been studied in relation to stroke. "This test would revolutionize how we initially evaluate for stroke, and help more patients get treatment faster," said Sheth.
Clinical research is the fundamental transition stage between discovery and treatment and provides the scientific basis for all forms of care, addresses patient and caregiver needs and is the backbone for drug development and cost-effectiveness studies needed to improve lives.
Added Sheth, "Gaining this kind of support at this early point in my career is both humbling and tremendously encouraging. I hope to take advantage of this generous support to continue advancing our ability to improve the lives of patients suffering from stroke."
###
Learn more about stroke at http://patients.aan.com.
About the American Brain Foundation
The American Brain Foundation, founded by the American Academy of Neurology, supports crucial research and education to discover causes, improved treatments, and cures for brain and other nervous system diseases. Learn more at http://www.americanbrainfoundation.org/ or find the Foundation on Facebook, Twitter, Google+ and YouTube.
About the American Heart Association
The American Heart Association is the nation's oldest, largest voluntary organization devoted to fighting cardiovascular diseases and stroke. Our mission is to build healthier lives, free of cardiovascular diseases and stroke. Our mission drives everything we do. Learn more at http://www.heart.org/, and find them on Facebook, Twitter, Google+, Instagram, YouTube, LinkedIn, Pinterest, and Heart.org blog.
Media Contacts:
Rachel Seroka, rseroka@aan.com, (612) 928-6129
Michelle Uher, muher@aan.com, (612) 928-6120

Cause-specific mortality and years of life lost in patients with different manifestations of vascular disease.

I assume a stroke is a vascular disease. I however will not die 7.8 years  sooner than the general population. This stroke is not going to cut my life short unless I die from something stupid like a wingsuit or mountaineering accident. My stroke was at exactly 50 years 3 months 10 days.
http://www.ncbi.nlm.nih.gov/pubmed/25595551

Abstract

BACKGROUND:

Patients with cardiovascular disease might be at increased risk of non-vascular mortality due to shared risk factors. Our aim was to evaluate causes of death and years of life lost (YLL) in patients with different manifestations of vascular disease.

DESIGN:

The design was a prospective cohort study.

METHODS:

A total of 5911 patients with stable coronary artery disease, cerebrovascular disease, peripheral artery disease (PAD), abdominal aortic aneurysm or polyvascular disease were followed-up for mortality. Cause-specific standardised mortality ratios (SMRs) and YLL, compared to the Dutch population, were estimated. Determinants for cause-specific mortality were evaluated using competing risks models.

RESULTS:

During a median follow-up of 6.0 years (interquartile range (IQR): 3.1-9.2), 958 (16.2%) patients died. All-cause mortality was increased compared to the general population (SMR: 1.26, 95% confidence interval (CI): 1.18-1.34). Patients with PAD and polyvascular disease were at highest risk, especially for ischaemic heart disease (SMR: 2.52, 95% CI: 1.70-3.60 and SMR: 3.97, 95% CI: 3.18-4.90, respectively). Patients with PAD were at increased risk of dying from cancer (SMR: 1.67, 95% CI: 1.25-2.17). On average, patients with vascular disease of ≥50 years died 7.8 years younger than the general population, with 80% of the excess YLL attributable to cardiovascular disease. In middle-aged patients the excess YLL were about 10 years, of which 24% were lost due to cancer. Important determinants for mortality were male gender, smoking, physical inactivity, renal insufficiency and polyvascular disease.

CONCLUSIONS:

Patients with manifest vascular disease are at increased risk of both cardiovascular and cancer mortality, particularly patients with PAD or polyvascular disease. On average, patients with vascular disease of ≥50 years die 7.8 years younger than the general population.

Sleep needs post-stroke

It's Friday afternoon and I'm running on empty. On Wednesday night I got 8 hours of sleep. Thursday, due to plane flights I got back to East Lansing at 1am.  I had to meet friends at 5am  to go together to the Windsor airport. Since that meant an hour drive I totally skipped sleep on Thursday night. In order to get there by 5am and leaving late at 4:10 am I set the cruise at 88mph. No problems except my friends overslept their alarms and were taking showers when I showed up 5 minutes late. Had numerous cups of heavy duty coffee this morning to get me going for the morning. I'm trying to  stop the caffeine since my flight to Rome leaves at 10:40pm and I'm lucky and got a left window seat. Maybe I'll be able to sleep. Toronto airport has lousy signage and it's a good thing I'm quite mobile since I had to walk all over the airport to find the correct terminal and gate.

Airplane seating stroke rehab

Of the 8 legs of flights I had the past two weeks only two had decent seating for me. That is a window seat on the left side. Otherwise I have to spend the whole trip with my left arm pulled over my right leg and forcefully grabbing it with my right hand to stop it from wandering into my neighbors space. With all that concentration needed I am never able to fall asleep on the plane. Today I'm in the Toronto airport waiting for a flight to Rome, then Barcelona where a seven day Mediterranean cruise starts, Stops at Nice, Corsica, Rome, Sicily, Malta.

Rental cars stroke chalenges

Key fob to start with. I rolled it around in my hand trying to figure out how to release the switchblade key. To no avail, there seems to be no key whatsoever. Finally realized that you just step on the brake and push the button called start.
I spent two weeks in Tampa writing technical documentation for a computer operator that gave two weeks notice. 
The first week I got a Chrysler 300, ok.
The 2nd week I got upgraded, personally I think it was a massive downgrade to a Chevy Tahoe. With the rear tinted windows I felt I couldn't see anything and the beast was huge. Took me forever to figure out the side mirrors after folding them down multiple times. Since the beast was so wide I managed to drive over the raised reflector bumps quite a bit.  When that occurred you got corresponding gooses in your right or left butt cheek. 
Had to sit and read the manual to figure out the gas tank release. The worst was that there were conflicting signs about where the gas port was. On the dash was an icon of a gas pump on the right side of the gas gauge, next to the pump was a small arrow pointing left. I made the incorrect assumption that the gas pump signified the correct side for the gas port.
The flashing yellow light on the side mirrors that signified that a car was approaching that blind spot was absolutely necessary for the beast. I swore I would never drive a car with a backup camera, but with the beast it was completely necessary, and the curved lines showing where the car was headed were needed. Although by the end of the week I just made sure I didn't have to back up.
The Tahoe required a running board to be climbed up on to enter the vehicle. Getting back to my Toyota Matrix was a joy, something small and maneuverable.

Thursday, April 23, 2015

Three Keys to Blazing Fast Thrombectomy

And you ill-informed idiots could probably cut that time in half if you embrace faster diagnosis  by maybe these methods.
Maybe you want to look at these;
The Qualcomm Xprize for the tricorder has selected 10 finalists?
I've already pointed out  these 17 ways for objective diagnosis

But then I'm obviously not as smart as these doctors. 
Three Keys to Blazing Fast Thrombectomy

Scientific Evidence for New Technologies

Specific information on new technologies in neurorehabilitation. A great slide presentation, go down to Slidepool 4:
Your doctor is still going to have to translate this into stroke protocols but hell it is at least a starting point and probably better than anything your are getting today.
http://www.iisartonline.org/services/education-material/

Step It Up For Stroke Pledge - latest NSA email

What a waste. No mention of all these other stroke risk reduction ideas. But that's only because I've been studying this for the past 6 years and they've been around for only 30 years to become a useless source of information on stroke.  Your choice which one you think is more useful, but don't choose mine because I have NO medical background.
Here are my ideas on stroke prevention: Never, ever follow me. But I do point to the research that backs up my writings.
Like my 11 Stroke risk reduction ideas.


Step It Up For Stroke Pledge

Discovery paves way for treatments to prevent brain damage or death following head trauma

If we had any competency whatsoever in the stroke associations this would be put at the top of the strategy list to solve. But we have crap so don't expect this to become useful to survivors for 50 years. If you want it sooner YOU will need to start screaming at every stroke medical person you see.
Scientists pinpoint brain-swelling mechanism
team of UBC researchers has made a significant discovery uncovering the cause of brain swelling after trauma to the head. Their research, published today in Cell, paves the way for a preventative drug treatment for severe brain damage following stroke, infection, head injury or cardiac arrest.
By turning off a single gene, scientists from the Djavad Mowafaghian Centre for Brain Health (DMCBH), a partnership of UBC and Vancouver Coastal Health, were able to successfully stop swelling in rodent brains.
Brain swelling is a gradual process that becomes life-threatening within days of the injury, and is caused by sodium chloride drawing water into the nerve cells. This swelling—known as cytotoxic edema—eventually kills brain cells.
Brian MacVicar
Brian MacVicar
“We’ve known for years that sodium chloride accumulation in neurons is responsible for brain swelling, but now we know how it’s getting into cells, and we have a target to stop it,” explains brain researcher Brian MacVicar, co-director of DMCBH with the Vancouver Coastal Health Research Institute and the study’s principal investigator.
The team, including Terrance Snutch, director of translational neuroscience at the DMCBH, developed several novel technological approaches to identify the cascade of events that took place within individual brain cells as they swelled.
They then switched off the expression of different genes and were able to pinpoint a single protein—SLC26A11—that acts as a channel for chloride to enter nerve cells. By turning off the chloride channel, the accumulation of fluid into the cells was halted, and nerve cells no longer died.
“It was quite a surprising result, because we had few indications as to what this protein did in the brain,” says Ravi Rungta, then a graduate student in the MacVicar lab and the paper’s lead author.
Though the technique used by the researchers to block swelling and cell death is unlikely to work quickly enough to mitigate swelling in the case of real head trauma, the discovery has provided a target for drug development.
“This discovery is significant because it gives us a specific target – now that we know what we’re shooting at, we just need the ammunition,” says MacVicar. “That’s what we’re doing now: looking for drugs to inhibit the chloride channel.”
BACKGROUND
This research was co-sponsored by the Canadian Institutes of Health Research, Brain Canada, Genome British Columbia, the Michael Smith Foundation for Health Research, and the Koerner Foundation.
About brain swelling:
Severe brain swelling is life threatening because the skull, which normally protects the brain, also limits its ability to expand. With increasing pressure and nowhere to go, the brain centres that control breathing can be crushed.
At present, treatment options are limited. When all other treatment options fail, an operation called a decompressive craniectomy is sometimes performed, in which a portion of the skull is removed and the brain is allowed to swell out of the skull. Although extreme, it can save the patient’s life, but the procedure is not always effective nor without complications. There is an urgent need for new treatments.
Some well-known figures whose lives were claimed by brain injuries include actress Natasha Richardson (wife of actor Liam Neeson), who died in 2009 after a skiing accident and Dr. Richard Atkins, creator of the Atkins diet, who died in 2003 after slipping on ice.
Public Affairs
310 - 6251 Cecil Green Park Road
Vancouver, BC Canada V6T 1Z1
Tel 604 822 6397
Fax 604 822 2684
Email public.affairs@ubc.ca

Wednesday, April 22, 2015

25 Of the Most Inspiring Quotes Ever Spoken

In case you need some inspiration.
http://frame.bloglovin.com/?post=4299376801&group=0&frame_type=p&context=&context_ids=&blog=11078067&
My favorite is Hunter S. Thompson;

“Life should not be a journey to the grave with the intention of arriving safely in a pretty and well preserved body, but rather to skid in broadside in a cloud of smoke, thoroughly used up, totally worn out, and loudly proclaiming "Wow! What a Ride!”

American Stroke Association Needs Your Feedback

No they don't want it. Two questions in and when I answered I was over 5 years out they didn't want me anymore. If they really want feedback  it is damned easy to find survivors on the web. I really think they don't want to talk to us because they're afraid we'll tell them they are doing a shitty job and ream them out. I certainly would have a few choice words and phrases to say. And look what the point of this is: to help physicians NOT survivors. What a waste of a stroke association.

The American Stroke Association is surveying Stroke Connection Magazine subscribers to learn about experiences related to stroke diagnosis, treatment, and education.

Please help us help stroke families by participating in this research. Your answers and opinions will help the American Stroke Association create tools for physicians who care for stroke survivors.

The survey is being conducted online and will take about 20 minutes to complete.

To participate, please click on the following link, or copy it into your Web browser:

http://survey.euro.confirmit.com/wix/p1843136812.aspx?r=4337&s=RKUDRVIE

An independent research firm, Veris Consulting, Inc., is conducting the survey for us; this way you can be assured that your responses will remain confidential. All of the information we learn will be reported only in total. Individual survey takers will not be identified.

Thank you in advance for your participation!

Sincerely,

Meredith Nguyen
Director, ASA
American Heart Association/American Stroke Association
7272 Greenville Avenue I Dallas, Texas 75231
www.strokeassociation.org

If you have any questions regarding the purpose of this study or how the results will be used, please contact M. Austen, Survey Manager, at mausten@verisconsulting.com.

Artificial intelligence system created to provide therapy for people who have suffered a cerebral stroke

I bet this doesn't make it to the United States because it was not invented here(Mexico). But ask your doctor about it anyway.
http://www.alphagalileo.org/ViewItem.aspx?ItemId=151870&CultureCode=en
The product is patented and aims to be commercialized. It has been successfully tested at the National Institutes of Pediatrics, Neurology and Neurosurgery.
Artificial intelligence, virtual worlds and interaction with video games, are the elements of a new therapy designed by several Mexican institutions to help people who have had a stroke and children with cerebral palsy to recover mobility of their upper extremities quickly.
The purpose of developing the computational system called Gesture Therapy (Terapia de Gestos) is to offer a low cost and more effective alternative than traditional methods, said the research leader, Luis Enrique Sucar Succar, researcher at the National Institute of Astrophysics, Optics and Electronics (INAOE) in Mexico.
The technology has been proven clinically successful at the National Institute of Neurology and Neurosurgery (INNN) and Pediatrics (INP), it encompasses a computer with a webcam and a special handle with a color sphere and force sensors, which detects the exercises performed by the patient.
The idea is that a virtual agent instructs the patient to perform tasks through different games designed to exercise important parts of the arm for rehabilitation, such as the shoulder, elbow, wrist, fingers and using different types of movement as flexion, extension and pressing. This allows the patient to perform their rehabilitation at home, without the need for a therapist to be present at all time.
On the other hand, the virtual environments in which the person does the therapy simulate daily activities to give present a normal lifestyle . For example, some of these tasks are cleaning a window, painting a room, cooking an egg, grocery shopping, added Enrique Sucar, PhD in Computer Science from the Imperial College in Britain.
An important part of the system is based on artificial intelligence, since it is responsible for monitoring and evaluating user’s performance, while he or she exercises as indicated by the virtual agent. With these results the difficulty level of the game is set, based on the movements recorded by the camera and pressure sensors of the handle, it increases or decreases the level of hardness.
The INAOE researcher, who is also an active member of the Mexico Academy of Engineering, said another utility of artificial intelligence is detection of "compensation" for the patient, which happens when he or she moves the whole body instead of just the affected arm.
While the visual tracking software analyzes images obtained from the camera, tracking the position of the hand in three space dimensions is performed. For this, a color ball at the side of the handle is used, its position estimated using computer vision techniques that combine color and texture information of the object.
The system maps the coordinates of the patient's hand in "real" space, and transfers them to the virtual space, where it interacts with an imaginary world, which is observed through the computer screen, Sucar Succar added.
The researcher, who is currently on a sabbatical stay in Italy, said that to achieve the development of Therapy Gestures collaboration of researchers and physicians at the from several institutes and universities were required.
The evaluation was carried out at the Rehabilitation Unit of the INNN where the results showed an improvement in the movement of the affected limb, increasing motivation and adherence to treatment.
Now, the next step is to simultaneously begin a series of clinical trials with about a hundred patients from various hospitals like INNN, the National Institute of Rehabilitation, the University Hospital of Puebla and CRIT (Children Rehabilitation Center) of the same federal entity; to provide the Therapy of Gestures as a commercial product.
Finally, the teacher in electrical engineering by Stanford University, added that he already has a patent in Mexico for the concept called "3D therapy system with monocular visual tracking for the rehabilitation of the upper limb in humans". (Agencia ID)

Brain Scans Can Predict The Best Type of Depression Treatment For an Individual - Stroke depression also?

But why do we care about the best type of depression treatment? Do we not have consensus that all survivors should get anti-depression drugs because they lead to a better recovery? So don't listen to me, ask you doctor for the latest including exactly how to get you 100% recovered.
Antidepressants may help people recover from stroke even if they are not depressed

 Brain Scans Can Predict The Best Type of Depression Treatment For an Individual

Tuesday, April 21, 2015

Muscle synergies and spinal maps are sensitive to the asymmetry induced by a unilateral stroke

I'm sure your doctor can use this to update your stroke walking protocol.
http://www.jneuroengrehab.com/content/12/1/39/abstract
Martina Coscia12*, Vito Monaco2, Chiara Martelloni2, Bruno Rossi3, Carmelo Chisari3 and Silvestro Micera12
For all author emails, please log on.
Journal of NeuroEngineering and Rehabilitation 2015, 12:39  doi:10.1186/s12984-015-0031-7
Published: 18 April 2015

Abstract (provisional)

Background Previous studies have shown that a cerebrovascular accident disrupts the coordinated control of leg muscles during locomotion inducing asymmetric gait patterns. However, the ability of muscle synergies and spinal maps to reflect the redistribution of the workload between legs after the trauma has not been investigated so far. 
Methods To investigate this issue, twelve post-stroke and ten healthy participants were asked to walk on a treadmill at controlled speeds (0.5, 0.7, 0.9, 1.1 km/h), while the EMG activity of twelve leg muscles was recorded on both legs. The synergies underlying muscle activation and the estimated motoneuronal activity in the lumbosacral enlargement (L2-S2) were computed and compared between groups. 
Results Results showed that muscle synergies in the unaffected limb were significantly more comparable to those of the healthy control group than the ones in the affected side. Spinal maps were dissimilar between the affected and unaffected sides highlighting a significant shift of the foci of the activity toward the upper levels of the spinal cord in the unaffected leg. 
Conclusions Muscle synergies and spinal maps reflect the asymmetry as a motor deficit after stroke. However, further investigations are required to support or reject the hypothesis that the altered muscular organization highlighted by muscle synergies and spinal maps may be due to the concomitant contribution of the altered information coming from the upper part of the CNS, as resulting from the stroke, and to the abnormal sensory feedback due to the neuromuscular adaptation of the patients.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

You can save a life - National Stroke Association

Of course you can but with the current state of stroke reporting you have no idea if your hospital is any good at all. I have yet to see any hospital report on their 30 day deaths and how much better they are than their competitors, or any reporting on the 100% recovery statistic. So if the NSA wants to do something useful then at least I would know which hospitals to avoid for my next stroke. Yes, this will be extremely disruptive for the stroke hospitals but I don't f*cking care. My brain is worth more than their poor fee-fees. Mr. Lopez, I hope you finally turn the corner and make the NSA into a survivor focused organization.
http://support.stroke.org/site/MessageViewer?dlv_id=40441&em_id=28501.0

Dear Friend,
As someone who has been touched by stroke, you know the life-changing effect it has on individuals and their families and friends. You’ve shared your stories with us, and the need for action:(Solve all the f*cking problems in stroke, that would be a good action)
“I don't want anyone else to experience the trauma of stroke. It is a scary and debilitating situation to happen to anyone. Let's eradicate this frightening occurrence.” – Cheryl
We couldn’t agree more. That’s why we hope you’ll register today for the 2015 Act FAST for Stroke Challenge to help raise awareness(Big Whoopee) and critical funds to save more lives.
This year alone, more than 100,000 people are at high-risk of dying from stroke:
  • Stroke kills twice as many women as breast cancer every year.
  • African Americans and Hispanic Americans are at higher risk than many other groups within the American population.
And, this year, your support can go twice as far through our matching gift challenge. Thanks to our generous sponsor, Bioness, all gifts made will be doubled, up to $20,000.
It’s a powerful way to come together to honor special people during National Stroke Awareness Month and help save more lives. 
Thank you for all that you do.
Sincerely,
signed by Matt Lopez, CEO
Matt Lopez
Chief Executive Officer
National Stroke Association


Sign of Remyelination

Do we need something like this? Do our doctors even know if demyelination is occurring as part of our stroke damage?
http://www.forbes.com/sites/matthewherper/2015/04/14/biogen-ms-drug-results-are-mildly-encouraging-in-eye-disease-test/

Taking Too Many Dietary Supplements May Increase Risk Of Some Cancers

Discuss this with your doctor.  I would expect our great stroke association to tell us what supplements we should be taking for the best recovery and to prevent the next stroke. But we don't have that great stroke association. We have nothing which is why every survivor is looking on the internet for answers and finally figuring out that there are no answers. We are F*cking screwed.
http://www.medicaldaily.com/taking-too-many-dietary-supplements-may-increase-risk-some-cancers-330020

Study: Statins Cost-Effective for Older Patients

Just in case you want to have a knockdown discussion with your doctor.
http://www.medpagetoday.com/Cardiology/Atherosclerosis/51102?

Emerging Treatments for Motor Rehabilitation After Stroke

Look at that appalling word - emerging - which means our stroke teams still have no idea what to do to get you to 100% recovery or any stroke rehab protocols at all.  And yet you are still paying them  for failing to get you to recovery.
http://nho.sagepub.com/content/5/2/77?etoc
  1. Edward S. Claflin, MD1
  2. Chandramouli Krishnan, PhD, PT1
  3. Sandeep P. Khot, MD2
  1. 1Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
  2. 2Department of Neurology, University of Washington, Seattle, WA, USA
  1. Edward S. Claflin, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, 325 E Eisenhower Pkwy, Ann Arbor, MI 48108, USA. Email: clafline@med.umich.edu

Abstract

Although numerous treatments are available to improve cerebral perfusion after acute stroke and prevent recurrent stroke, few rehabilitation treatments have been conclusively shown to improve neurologic recovery. The majority of stroke survivors with motor impairment do not recover to their functional baseline, and there remains a need for novel neurorehabilitation treatments to minimize long-term disability, maximize quality of life, and optimize psychosocial outcomes. In recent years, several novel therapies have emerged to restore motor function after stroke, and additional investigational treatments have also shown promise. Here, we familiarize the neurohospitalist with emerging treatments for poststroke motor rehabilitation. The rehabilitation treatments covered in this review will include selective serotonin reuptake inhibitor medications, constraint-induced movement therapy, noninvasive brain stimulation, mirror therapy, and motor imagery or mental practice.

An Acute Stroke Evaluation App A Practice Improvement Project

Well shit, something minimally effective. Now if we could just get our stroke medical teams to solve all the f*cking problems in stroke and create stroke rehabilitation protocols then maybe they might be worth paying. This would means thousands of hospitals trying to come up with something effective and useful as compared to having a great stroke association solve this for everyone worldwide. But we don't have anything close to a great stroke association.  You'll have to deal with your post-stroke disabilities  for the next 50 years because nothing useful will come before that under the current leadership.
http://nho.sagepub.com/content/5/2/63?etoc
  1. Mark N. Rubin, MD1
  2. Jennifer E. Fugate, DO2
  3. Kevin M. Barrett, MD, MSc3
  4. Alejandro A. Rabinstein, MD2
  5. Kelly D. Flemming, MD2
  1. 1Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA
  2. 2Department of Neurology, Mayo Clinic, Rochester, MN, USA
  3. 3Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
  1. Kelly D. Flemming, Department of Neurology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA. Email: flemming.kelly@mayo.edu

Abstract

A point-of-care workflow checklist in the form of an iOS (iPhone Operating System) app for use by stroke providers was introduced with the objective of standardizing acute stroke evaluation and documentation at 2 affiliated academic medical centers. Providers used the app in unselected, consecutive patients undergoing acute stroke evaluation in an emergency department or hospital setting between August 2012 and January 2013 and August 2013 and February 2014. Satisfaction surveys were prospectively collected pre- and postintervention from residents, staff neurologists, and clinical data specialists. Residents (20 preintervention and 16 postintervention), staff neurologists (6 pre and 5 post), and clinical data specialists (4 pre and 4 post) participated in this study. All 16 (100%) residents had increased satisfaction with their ability to perform an acute stroke evaluation postintervention but only 9 (56%) of 16 felt the app was more help than hindrance. Historical controls aligned with preintervention results. Staff neurologists conveyed increased satisfaction with resident presentations and decision making when compared to preintervention surveys. Stroke clinical data specialists estimated a 50% decrease in data abstraction when the app data were used in the clinical note. Concomitant effect on door-to-needle (DTN) time at 1 site, although not a primary study measure, was also evaluated. At that 1 center, the mean DTN time decreased by 16 minutes when compared to the corresponding months from the year prior. The point-of-care acute stroke workflow checklist app may assist trainees in presenting findings in a standardized manner and reduce data abstraction time. The app may help reduce DTN time, but this requires further study.


Monday, April 20, 2015

Can Specialised Electronic Musical Instruments Aid Stroke Rehabilitation?

Nothing objective seemed to be measured in this research, what a waste.
http://dl.acm.org/citation.cfm?id=2726965
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Stroke patients often have limited access to rehabilitation after discharge from hospital leaving them
to self-regulate their recovery. Previous research has indicated that several musical approaches can be
used effectively in stroke rehabilitation. Stroke patients (n = 43), between 6 months and 19 years
post-stroke, took part in specially created workshops playing music, both in groups and individually,
using a number of digital musical interfaces. Feedback forms were completed by all participants,
which helped to develop the prototypes and gain insights into the potential benefits of music making
for rehabilitation. 93% of participants stated they thought that the music workshops were potentially 
beneficial for their rehabilitation. The research project contributes to the field of HCI by exploring
the role of computer based systems in stroke rehabilitation.

Motor imagery training improves precision of an upper limb movement in patients with hemiparesis

How many decades before your stroke department has thousands of hours of guided imagery for you to think about? I'll guess 50 years. Now if they would compare motor imagery to action observation we would have something useful for survivors. Don't do this on your own, think how dangerous it is to think about your movements.
http://iospress.metapress.com/content/t67557518727350w/
Luzia Grabherr1, 2, Corinne Jola3, Gilberto Berra4, Robert Theiler4, Fred W. Mast1
1Department of Psychology, University of Bern, Bern, Switzerland
2School of Health Sciences, University of South Australia, Adelaide, Australia
3Division of Social and Health Sciences - Psychology, Abertay University, Dundee, UK
4Department of Rheumatology, Physical Medicine and Rehabilitation, Triemli City Hospital, Zurich, Switzerland

Abstract

BACKGROUND: In healthy participants, beneficial effects of motor imagery training on movement execution have been shown for precision, strength, and speed. In the clinical context, it is still debated whether motor imagery provides an effective rehabilitation technique in patients with motor deficits. OBJECTIVE: To compare the effectiveness of two different types of movement training: motor imagery vs. motor execution. METHODS: Twenty-five patients with hemiparesis were assigned to one of two training groups: the imagery or the execution-training group. Both groups completed a baseline test before they received six training sessions, each of which was followed by a test session. Using a novel and precisely quantifiable test, we assessed how accurately patients performed an upper limb movement. RESULTS: Both training groups improved performance over the six test sessions but the improvement was significantly larger in the imagery group. That is, the imagery group was able to perform more precise movements than the execution group after the sixth training session while there was no difference at the beginning of the training. CONCLUSIONS: The results provide evidence for the benefit of motor imagery training in patients with hemiparesis and thus suggest the integration of cognitive training in conventional physiotherapy practice.

Human Antibodies and Specific Binding Sequences Thereof for use in Stroke and Ischemia or Ischemic Conditions

Well shit, a patent application for this. A great stroke association would make sure that all research sponsored would be freely available to all.  This isn't even research it's something slightly unethical trying to tie up ideas before they have even been proven.
http://www.freepatentsonline.com/y2015/0104460.html
Kind Code:
A1

Abstract:
Specific binding members, particularly human antibodies, particularly recombinant antibodies, and fragments thereof, which are capable of binding to and recognizing neurons in the CNS and eliciting responses in CNS neurons are provided. The antibodies are useful in the diagnosis and treatment of conditions associated with nerve damage, injury or degeneration and neurodegenerative disease, and in particular in the treatment or alleviation of stroke or cerebral ischemia. The antibodies, variable regions or CDR domain sequences thereof, and fragments thereof of the invention may also be used in therapy in combination with chemotherapeutics, immune modulators, or neuroactive agents and/or with other antibodies or fragments thereof. The antibodies or active fragments thereof may be used in therapy for stroke or cerebral ischemia alone or in combination with thrombolytics such as TPA. Antibodies are exemplified by the antibodies IgM12 and IgM42 whose sequences are provided herein.

The Secret To Learning is Reverse of Conventional Wisdom

I'm sure in 50 years this will be implemented as part of your stroke protocol. We really don't care that you will be dead by then. It takes a long time to move the grounded ship of medical knowledge. Especially since they have purposely thrown dozens of anchors overboard.
Good luck, you'll need it.
http://www.spring.org.uk/2015/04/the-secret-to-learning-is-reverse-of-conventional-wisdom.php

StrokeSmart newsletter

The latest one is just another of how nothing in there describes solutions to any of the major problems in stroke.All we ever get are pap articles. I would expect the latest on research and efficacy of various interventions with detailed descriptions of those interventions. But no, we get meaningless crap.


Women Caregivers Are More At Risk

Married, female caregivers have higher stress levels and are more at risk for serious health conditions. Here's what you can do to protect your health.

How to Buy a Handicap Van

If you are thinking about getting back on the road again and looking for a handicap van, consider your options before settling on a purchase.
 

How Too Much Sitting Affects Your Health

It's not easy to realize how many hours the average person sits per day. The time spent commuting to work and sitting at a desk can add up fast.
 

Overcoming Stroke: One Stride at a Time

Andy was on track to run his 12th marathon, until his stroke. Doctors told him he couldn't run another marathon again, but Andy didn't take no for an answer.
 

Taking Control of Central Pain Syndrome

Central Pain Syndrome (CPS) is a condition that is difficult to manage, especially because it is triggered by unexpected cold temperatures.

ROBEAR Lifts! and walks!

I'm not sure I could stand staring into that face. Japanese nursing robot helpers.
Video of lifting from a couch.
Video of helping someone walk. Although I don't think the bear hug is that helpful for walking.
Video of helping stand.
Complete article here:
http://txchnologist.com/post/116914146295/robear-lifts-its-no-secret-that-one-of-the?

Upper extremity proprioception in healthy aging and stroke populations, and the effects of therapist- and robot-based rehabilitation therapies on proprioceptive function

I've got 25 posts on proprioception but  none struck me as being useful for rehab. But then if we had a decent or even mediocre stroke association we could go to their website and see the protocols for each deficit and their efficacy. But we have jackshit, deal with it.
http://journal.frontiersin.org/article/10.3389/fnhum.2015.00120/full?
Charmayne Mary Lee Hughes1*, imagePaolo Tommasino1, imageAamani Budhota1,2 and imageDomenico Campolo1
  • 1Robotics Research Centre, School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore
  • 2Interdisciplinary Graduate School, Nanyang Technological University, Singapore
The world’s population is aging, with the number of people ages 65 or older expected to surpass 1.5 billion people, or 16% of the global total. As people age, there are notable declines in proprioception due to changes in the central and peripheral nervous systems. Moreover, the risk of stroke increases with age, with approximately two-thirds of stroke-related hospitalizations occurring in people over the age of 65. In this literature review, we first summarize behavioral studies investigating proprioceptive deficits in normally aging older adults and stroke patients, and discuss the differences in proprioceptive function between these populations. We then provide a state of the art review the literature regarding therapist- and robot-based rehabilitation of the upper extremity proprioceptive dysfunction in stroke populations and discuss avenues of future research.

Introduction

Proprioceptive information is important for balance and postural control, the control and regulation of coordinated movements, motor learning, and error correction during movements (Jeannerod, 1988; Schmidt and Lee, 1988) and is generally composed of the modalities joint position sense and the sensation of limb movement (Gandevia et al., 2002). Joint position sense is defined as the ability of an individual to identify the static location of a body part, and is served by muscle spindle afferents and cutaneous afferents (Proske, 2006; Proske and Gandevia, 2009). Kinesthesia, a term introduced by Bastian (1887), refers to the perception of active and passive motion. Passive motion sense is served by slowly adapting mechanoreceptors (mainly secondary spindle endings and tendon organs in muscle), and tendon organs and Ruffini spray endings in other deep tissues, whereas active motion sense stems from the more rapidly adapting proprioceptors; mainly the muscle spindle primary endings, and lamellated corpuscles in other deep tissues (Grigg, 1994; Hogervorst and Brand, 1998).
The importance of proprioception in performing coordinated movements has been demonstrated in studies investigating motor control in individuals with proprioceptive deficits resulting from sensory neuropathy conditions or surgery (Rothwell et al., 1982; Ghez et al., 1995; Gordon et al., 1995; Messier et al., 2003; Sarlegna et al., 2006) and by disrupting proprioception in physically and neurologically healthy participants using tendon vibration (Cody et al., 1990; Cordo et al., 1995). Deficits in upper extremity proprioceptive function have also been reported in normally aging older adults (Adamo et al., 2007; Riberio and Oliveria, 2007) and individuals with stroke (Twitchell, 1951; Carey et al., 1993; Yekutiel, 2000), and have been found to negatively impact the quality of daily life and independence of the affected individual (Carey et al., 1997).
In this review, we first provide an overview of the behavioral research on upper extremity proprioceptive deficits in normally aging older adults, and then present an up-to-date overview of the proprioceptive declines in stroke patients. We conclude this review by reporting the state of the art in conventional and robotic rehabilitation of upper extremity proprioceptive function, and discuss the existing problems in this field and what may be proposed to move this area of science forward.