Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 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, May 11, 2021

Remote Ischemic Conditioning and Stroke Recovery

The ANGIE project: a new research programme tasked with developing micro-robots for localised, targeted drug delivery to unblock blood vessels and fight stroke from within

 With NO LEADERSHIP IN STROKE, it takes almost 10 years to make research useable. That is a disgusting timeline. Every stroke 'leader' should be fired.

If we had any leadership at all in stroke, when these nanorobots were introduced we would have had drug delivery and roto-rooter abilities already accomplished.

Remote-Controlled Nanospears Will Attack Cancer Cells June 2018 

Or maybe this solution from March, 2015

Magnetic nanoparticles could stop blood clot-caused strokes

Or this from May, 2012

Future of med devices: Nanorobots in your blood stream

The latest here:

The ANGIE project: a new research programme tasked with developing micro-robots for localised, targeted drug delivery to unblock blood vessels and fight stroke from within

 his ground-breaking project, called ANGIE, is funded by the EU and aims to develop nano-surgeons that will enter the body to treat blood clots.

The ANGIE project will develop a radical, new technology for localised, targeted drug delivery based on steerable wireless nanodevices, capable of navigating the body vascular system to deliver drugs where no other instrument can go. ANGIE will offer health professionals vastly improved intervention capacity to tackle multiple chronic diseases and enable them to deliver drugs precisely where needed, with minimal side effects.

Navigating inside the body to treat injured tissues has fascinated scientists and the public for decades, but the required technologies have lagged far behind. Scientists in the ANGIE project believe that they are now in a position to make it happen.

The ANGIE project will be run by a leading group of scientists working in universities, research centres, and innovative companies across Belgium, Germany, Greece, Portugal, Spain, and Switzerland.

This is a much-needed development because stroke is the leading cause of adult physical disability in the world, affecting 17 million people worldwide each year.

Salvador Pane

Salvador Pane

“This could be averted if we had a way to wirelessly navigate nano-surgeons along the body’s vascular network to deliver drugs directly where needed – on command” said Dr. Salvador Pané, the coordinator of the project.

Achieving such a breakthrough will require advances in fields such as medical robotics, numerical simulation and biomaterials. Also, it needs technical capabilities and facilities that only few organisations have. But even those who do often lack the knowledge to transform scientific knowledge into medical instruments ready for clinical application.

The scientists at ANGIE are confident that their team includes all the required knowledge, experience, and infrastructure to make it happen. For many years they have been building the needed knowledge for the use and control of small-scale robotic systems for different health applications. They recently developed the first system to treat cardiac arrhythmias using electromagnetically steerable catheters and their group includes high-calibre scientists who are often sought for by the World Health Organization, the European Space Agency, and the World Economic Forum for advice. The project has already attracted attention from multinational corporations like Siemens and CLS Behring.

The ANGIE project started at the beginning of this year (2021) and its team will need four years to develop the basic foundations of the technology.

The Consortium consists of a group of four research institutions, three small-medium enterprises, and two non-profit organizations from across the EU.

SAFE is part of the consortium and is responsible for disseminating information about ANGIE to the stroke community.

The project is funded by the European Commission under the Grant Agreement number 952152.

www.h2020-angie.eu

EXPRESS: Treatment of post-stroke aphasia: A Narrative Review for Stroke Neurologists

 Notice that fucking lazy word 'management' again. DO YOU NOT UNDERSTAND? Survivors want results, are you that much of a blithering idiot?

EXPRESS: Treatment of post-stroke aphasia: A Narrative Review for Stroke Neurologists

First Published May 5, 2021 Research Article Find in PubMed 

This review is intended to help physicians guide patients to optimal management of post-stroke aphasia. We review literature on post-stroke aphasia treatment, focusing on: (1) when and for whom language therapy is most effective, (2) the variety of approaches that can be effective for different individuals, and (3) the extent to which behavioral therapy might be augmented by non-invasive brain stimulation and/or medications.

Access Options
 

Effects of a robot‐aided somatosensory training on proprioception and motor function in stroke survivors

Since this was done at 12 months post stroke no survivor will be able to get this from an insurance paid therapist. Your insurance will have stopped because you  plateaued out months prior. You're going to have to do this on your own. I'd suggest Margaret Yekutiel who wrote a whole book about this in 2001, 'Sensory Re-Education of the Hand After Stroke'? Not robotics, but doable.

Effects of a robot‐aided somatosensory training on proprioception and motor function in stroke survivors

 

Abstract

Background

Proprioceptive deficits after stroke are associated with poor upper limb function, slower motor recovery, and decreased self-care ability. Improving proprioception should enhance motor control in stroke survivors, but current evidence is inconclusive. Thus, this study examined whether a robot-aided somatosensory-based training requiring increasingly accurate active wrist movements improves proprioceptive acuity as well as motor performance in chronic stroke.

Methods

Twelve adults with chronic stroke completed a 2-day training (age range: 42–74 years; median time-after-stroke: 12 months; median Fugl–Meyer UE: 65). Retention was assessed at Day 5. Grasping the handle of a wrist-robotic exoskeleton, participants trained to roll a virtual ball to a target through continuous wrist adduction/abduction movements. During training vision was occluded, but participants received real-time, vibro-tactile feedback on their forearm about ball position and speed. Primary outcome was the just-noticeable-difference (JND) wrist position sense threshold as a measure of proprioceptive acuity. Secondary outcomes were spatial error in an untrained wrist tracing task and somatosensory-evoked potentials (SEP) as a neural correlate of proprioceptive function. Ten neurologically-intact adults were recruited to serve as non-stroke controls for matched age, gender and hand dominance (age range: 44 to 79 years; 6 women, 4 men).

Results

Participants significantly reduced JND thresholds at posttest and retention (Stroke group: pretest: mean: 1.77° [SD: 0.54°] to posttest mean: 1.38° [0.34°]; Control group: 1.50° [0.46°] to posttest mean: 1.45° [SD: 0.54°]; F[2,37] = 4.54, p = 0.017, ηp2 = 0.20) in both groups. A higher pretest JND threshold was associated with a higher threshold reduction at posttest and retention (r = − 0.86, − 0.90, p ≤ 0.001) among the stroke participants. Error in the untrained tracing task was reduced by 22 % at posttest, yielding an effect size of w = 0.13. Stroke participants exhibited significantly reduced P27-N30 peak-to-peak SEP amplitude at pretest (U = 11, p = 0.03) compared to the non-stroke group. SEP measures did not change systematically with training.

Conclusions

This study provides proof-of-concept that non-visual, proprioceptive training can induce fast, measurable improvements in proprioceptive function in chronic stroke survivors. There is encouraging but inconclusive evidence that such somatosensory learning transfers to untrained motor tasks.

Trial registration Clinicaltrials.gov; Registration ID: NCT02565407; Date of registration: 01/10/2015; URL: https://clinicaltrials.gov/ct2/show/NCT02565407.

Background

Nearly two-thirds of stroke survivors exhibit forms of somatosensory or proprioceptive dysfunction [1, 2]. Proprioceptive deficits are related to longer length-of-stay in hospitals [3], poor quality of movement, poorer activities of daily (ADL) function and reduced participation in physical activity [4,5,6]. Proprioceptive deficits predict treatment responses to robot-assisted motor retraining with augmented proprioceptive feedback [7] These may be explained by the crucial role of proprioception in motor control and learning [8, 9]. Proprioceptive training is a form of somatosensory intervention that aims to enhance proprioceptive function. Several forms of somatosensory intervention such as passive, repetitive cutaneous stimulation [1011], passive limb movement training [12], repeated somatosensory discrimination practice and active sensorimotor training with augmented somatosensory feedback [7131415] have been proposed to aid recovery of proprioceptive function and motor function after stroke. Proprioceptive improvements observed after proprioceptive training interventions correlated with improvement of untrained motor performance in healthy young adults [1617]. This further supports the rationale to implement proprioceptive-motor training for people with stroke. Among all types of proprioceptive intervention, active sensorimotor training with augmented somatosensory feedback [7, 13,14,15] seem to produce consistent results across studies [1, 18]. These interventions often employ somatosensory signals either to replace visual feedback on motor performance or to augment existing visual and somatosensory feedback for online motor control. One well studied mode of somatosensory feedback is vibro-tactile feedback (VTF) applied to the skin surface. Incorporating VTF with movement training has been shown to improve the learning of simple motor tasks in healthy adults and clinical populations [19,20,21]. There is evidence that it can effectively enhance proprioceptive function [22].

Somatosensory evoked potentials (SEPs) recorded via electroencephalography (EEG) are an objective neurophysiological marker of somatosensory processing with established procedures and normative values that has been used among clinical populations. Adults after stroke typically present with a lower peak amplitude or longer peak latency of SEPs (e.g. [23, 24]). Moreover, the restoration of typical SEPs has been reported following somatosensory interventions [25, 26]. Thus, we here recorded SEP to verify changes in the neural processing of somatosensory signals in sensorimotor cortex as a function of the somatosensory-motor intervention employed in this project

Fig. 1
figure1

Recruitment flowchart. UMN University of Minnesota, PM&R Physical medicine and rehabilitation

.

To address if a somatosensory-based training is a meaningful approach for the rehabilitation of proprioceptive and motor function after stroke, this proof-of-concept study aimed to determine whether wrist proprioception could be trained in stroke survivors and whether such sensory learning transfers to other functional tasks involving the same joint and limb motor system.

Thrombectomy Stroke Treatment Reversing Paralysis and Preventing Death Gets Its Global Day

 But you tell us nothing factual about the 100% recovery success rate of thrombectomy.

Thrombectomy Stroke Treatment Reversing Paralysis and Preventing Death Gets Its Global Day


The first annual "World Stroke Thrombectomy Day" is declared on May 15, 2021 by The Society of Vascular and Interventional Neurology Mission Thrombectomy 2020+ Initiative.

WTD Logo

The Society of Vascular and Interventional Neurology (SVIN) Mission Thrombectomy 2020+ Initiative (MT2020+) will announce the first annual World Stroke Thrombectomy Day at the Global MT Revolution Regional Conference on May 15, 2021. By designating this official day, MT2020+ plans to raise public awareness about thrombectomy surgery for treatment of severe stroke and instill new global calls to action. Thrombectomy surgery is a time sensitive emergency treatment that can be done up to 24 hours from onset of stroke symptoms. It can reverse(Really? Where are your statistics from?) long-term stroke paralysis in the majority of eligible large severe stroke patients and saves lives. Currently, the number of eligible stroke patients worldwide who do not receive thrombectomy care is in the millions.

Global statistics on stroke patient:

  • 1 in 4 people over the age of 25 will suffer a stroke in their lifetime
  • Strokes are the leading cause of long term disability
  • Second highest cause of death

The level of care received by stroke patients globally:

  • Approximately 13.6 million people worldwide suffer from strokes each year
  • An estimated 5 million of stroke victims become disabled long term
  • Of that number, 2-3 million are eligible for thrombectomy surgery
  • Yet only a mere 200,000 of these eligible patients receive this treatment
  • This leaves close to 2 million of those who would benefit from the treatment never receiving it

Stroke thrombectomy is a minimally invasive, emergency surgery that was established as first line treatment in 2015 as a highly effective(My definition of effective is 100% recovery. What the hell is yours?), and safe first line treatment for large severe strokes due to large artery blockage in the brain. When administered during the first 24 hours of the onset of stroke symptoms, the treatment can reverse long-term paralysis and prevent death. The treatment restores blood flow to the brain by opening blocked arteries with catheter-based devices introduced through groin or wrist arteries and saves brain tissue from permanent damage. 

The MT2020+ goal is to double the ratio of thrombectomies in each global region every 2 years. To achieve these goals, MT2020+ is issuing the following calls to action:

  • Governments and Health Policy makers to allocate resources to build regional thrombectomy systems and implement regional emergency transportation protocols to triage eligible patients to thrombectomy capable hospitals
  • The Public to raise awareness about thrombectomy for severe large strokes
  • Medical Educators and organized medicine to rapidly increase the number of trained physicians in mechanical thrombectomy procedures

"We are very pleased to announce this annual global day that allows us to call on various stakeholders around the world to rapidly, equitably and sustainably continue to improve access to Thrombectomy for stroke in their regions. The first World Stroke Thrombectomy Day will be announced on May 15th when 22 countries will begin to report on the tremendous progress in thrombectomy access that has been made in their regions," said Dileep Yavagal, MT2020 Global Chair and GEC Co-Chair and Past-President of SVIN.

MT2020+ members from across the world will attend the 2-day Global MT Revolution Regional Conference. Regional committee leaders will present the progress made on thrombectomy capacity and access.

About SVIN

The Society of Vascular and Interventional Neurology was created to achieve the highest level of care for patients through increased collaboration in scientific research and by educating young professionals and training young investigators. The Society aims to provide opportunities to connect leaders in the field and provide a common ground for dialogue and creation of practice and safety standards. Our mission is to represent the advancement of interventional neurology as a field with the ultimate goal of improving clinical care and outcomes of patients with stroke and cerebrovascular diseases. For further information about SVIN, please visit www.svin.org or follow us on Facebook, Twitter, or LinkedIn.

For more information about the SVIN, contact the Executive Office at info@svin.org.

Source: The Society of Vascular and Interventional Neurology

Share:


Categories: Healthcare

Tags: best practice, global, healthcare, mechanical thrombectomy, stroke


About The Society of Vascular and Interventional Neurology

View Website

SVIN achieves the highest level of care through increased collaboration in scientific research & education. The Society provides opportunities to connect leaders in the field & provides a platform for dialogue & creation of practice standards.

 

Assessment of Recurrent Stroke Risk in Patients With a Carotid Web

Useless. You assessed something but gave no solution to completely prevent that stroke risk. 

Assessment of Recurrent Stroke Risk in Patients With a Carotid Web

JAMA Neurol. Published online May 10, 2021. doi:10.1001/jamaneurol.2021.1101
Key Points

Question  What is the 2-year risk of recurrent stroke in patients with a symptomatic carotid web (CW)?

Findings  In this cohort study among 3439 patients with large vessel occlusion stroke, during 2 years’ follow-up, 17% of patients with an ipsilateral CW had a recurrent stroke compared with 3% of patients without CW. Ninety-three percent of patients with a CW received medical management after the index stroke.

Meaning  In this study, 1 of 6 patients with a symptomatic CW had a recurrent stroke within 2 years, suggesting that medical management alone may not provide sufficient protection for patients with CW.

Abstract

Importance  A carotid web (CW) is a shelf-like lesion along the posterior wall of the internal carotid artery bulb and an underrecognized cause of young stroke. Several studies suggest that patients with symptomatic CW have a high risk of recurrent stroke, but high-quality data are lacking.

Objective  To assess the 2-year risk of recurrent stroke in patients with a symptomatic CW.

Design, Setting, and Participants  A comparative cohort study used data from the MR CLEAN trial (from 2010-2014) and MR CLEAN Registry (from 2014-2017). Data were analyzed in September 2020. The MR CLEAN trial and MR CLEAN Registry were nationwide prospective multicenter studies on endovascular treatment (EVT) of large vessel occlusion (LVO) stroke in the Netherlands. Baseline data were from 3439 consecutive adult patients with anterior circulation LVO stroke and available computed tomography (CT)–angiography of the carotid bulb. Two neuroradiologists reevaluated CT-angiography images for presence or absence of CW and identified 30 patients with CW ipsilateral to the index stroke. For these 30 eligible CW participants, detailed follow-up data regarding stroke recurrence within 2 years were acquired. These 30 patients with CW ipsilateral to the index stroke were compared with 168 patients without CW who participated in the MR CLEAN extended follow-up trial and who were randomized to the EVT arm.

Main Outcomes and Measures  The primary outcome was recurrent stroke occurring within 2 years after the index stroke. Cox proportional hazards regression models were used to compare recurrent stroke rates within 2 years for patients with and without CW, adjusted for age and sex. The research question was formulated prior to data collection.

Results  Of 3439 patients with baseline CT-angiography assessed, the median age was 72 years (interquartile range, 61-80 years) and 1813 (53%) were men. Patients with CW were younger (median age, 57 [interquartile range, 46-66] years vs 66 [interquartile range, 56-77] years; P = .02 and more often women (22 of 30 [73%] vs 67 of 168 [40%]; P = .001) than patients without CW. Twenty-eight of 30 patients (93%) received medical management after the index stroke (23 with antiplatelet therapy and 5 with anticoagulant therapy). During 2 years of follow-up, 5 of 30 patients (17%) with CW had a recurrent stroke compared with 5 of 168 patients (3%) without CW (adjusted hazard ratio, 4.9; 95% CI, 1.4-18.1).

Conclusions and Relevance  In this study, 1 of 6 patients with a symptomatic CW had a recurrent stroke within 2 years, suggesting that medical management alone may not provide sufficient protection for patients with CW.

Introduction

A carotid web (CW) is a shelf-like lesion located along the posterior wall of the internal carotid artery bulb. Imaging and pathologic analyses suggest CW is an intimal variant of fibromuscular dysplasia (FMD).1 Computed tomography angiography (CTA) imaging is a common noninvasive method for identification of CW.1-5 Because CWs protrude into the lumen of the carotid artery, flow disruption and blood stasis can occur, resulting in thrombus formation and subsequent ischemic stroke.2,6 Case-control studies have found that CWs are present in 9% to 37% of patients younger than 60 years with cryptogenic stroke, and that a CW increases the risk of ischemic stroke approximately 10- to 20-fold.3,7,8 Although data are limited, patients with CW with ischemic stroke are more often than usual women and of Black racial identity.2,4,7,9,10

It is unclear how patients with a symptomatic CW (those who have had an ipsilateral ischemic stroke) are best treated to prevent recurrent stroke.1 Most patients are treated with antiplatelet therapy, but some physicians advocate using anticoagulation therapy as a better choice because of focal blood stasis in the carotid artery caused by CW.1 Carotid artery stenting and surgical removal of the CW have also been reported, especially in those with recurrent ischemic stroke.9,10

One of the major knowledge gaps in deciding the optimal treatment is the lack of studies on the risk of recurrent stroke in patients with a symptomatic CW.1,3 A 2018 systematic review reported an ischemic stroke recurrence rate of 56% (with a median of 12 months to the recurrent stroke, range, 0-97 months) in patients with CW receiving medical management, but these data come from case reports and uncontrolled, retrospective, single center studies.10 Owing to publication and selection bias, the true recurrent stroke risk in patients with a symptomatic CW remains unknown. The aim of the current study was to assess the recurrent stroke risk in a population of patients with a large vessel occlusion (LVO) stroke of the anterior circulation and ipsilateral CW.

 

Hospital staff, volunteers’ and patients’ perceptions of barriers and facilitators to communication following stroke in an acute and a rehabilitation private hospital ward: a qualitative description study

And the simple solution to these communication problems is an objective damage diagnosis, leading to EXACT STROKE RECOVERY PROTOCOLS. Everything would be clear about what the doctor and therapists should be doing and exactly what the patient needs to do to recover. Exact responsibilities would be delineated resulting in zero confusion about who does what.  If you don't understand this solution get the hell out of stroke.


Hospital staff, volunteers’ and patients’ perceptions of barriers and facilitators to communication following stroke in an acute and a rehabilitation private hospital ward: a qualitative description study

  1. Sarah D'Souza1,2,
  2. Erin Godecke1,2,
  3. Natalie Ciccone1,
  4. Deborah Hersh1,
  5. Heidi Janssen3,
  6. Elizabeth Armstrong1
  1. Correspondence to Sarah D'Souza; s.dsouza@ecu.edu.au

Abstract

Objectives To explore barriers and facilitators to patient communication in an acute and rehabilitation ward setting from the perspectives of hospital staff, volunteers and patients following stroke.

Design A qualitative descriptive study as part of a larger study which aimed to develop and test a Communication Enhanced Environment model in an acute and a rehabilitation ward.

Setting A metropolitan Australian private hospital.

Participants Focus groups with acute and rehabilitation doctors, nurses, allied health staff and volunteers (n=51), and interviews with patients following stroke (n=7), including three with aphasia, were conducted.

Results The key themes related to barriers and facilitators to communication, contained subcategories related to hospital, staff and patient factors. Hospital-related barriers to communication were private rooms, mixed wards, the physical hospital environment, hospital policies, the power imbalance between staff and patients, and task-specific communication. Staff-related barriers to communication were staff perception of time pressures, underutilisation of available resources, staff individual factors such as personality, role perception and lack of knowledge and skills regarding communication strategies. The patient-related barrier to communication involved patients’ functional and medical status. Hospital-related facilitators to communication were shared rooms/co-location of patients, visitors and volunteers. Staff-related facilitators to communication were utilisation of resources, speech pathology support, staff knowledge and utilisation of communication strategies, and individual staff factors such as personality. No patient-related facilitators to communication were reported by staff, volunteers or patients.

Conclusions Barriers and facilitators to communication appeared to interconnect with potential to influence one another. This suggests communication access may vary between patients within the same setting. Practical changes may promote communication opportunities for patients in hospital early after stroke such as access to areas for patient co-location as well as areas for privacy, encouraging visitors, enhancing patient autonomy, and providing communication-trained health staff and volunteers.

Data availability statement

Data are available upon reasonable request. Patient interview and staff focus group data are stored in the Edith Cowan University data storage repository. These data will be available in a de-identified format by request through the first author ORCiD https://orcid.org/0000-0001-6221-3229. The availability and use of the data are governed by Edith Cowan University Research Ethics.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.