Deans' stroke musings

Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 493 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:http://oc1dean.blogspot.com/2010/11/my-background-story_8.html

Saturday, April 21, 2018

11 steps to achieve insane focus and live the life you really want

My focus is to have fun, any stroke therapy distracts from that so I do no specific therapy.
You can read this or just simply absorb what Bruce Lee has to say, 'I fear not the man who has practiced 10,000 kicks once, but I fear the man who has practiced one kick 10,000 times.'
http://ideapod.com/achieve-focus-life/?utm_source=ideapod&utm_medium=email&utm_campaign=broadcast
The famous motivational speaker, Tony Robbins, once said:
“One reason so few of us achieve what we truly want is that we never direct our focus; we never concentrate our power. Most people dabble their way through life, never deciding to master anything in particular.”
How much does this quote resonate with you?
Is there something in your life that you might have been an expert at by now, only if you had put in the time and effort to master it?
Are there passions that you failed to pursue, simply because you let other things like laziness or boredom get in your way?
Here’s the biggest thing that stops us from mastering what we love:
Distractions.
The modern world is filled with distractions—smartphones, laptops, mobile apps, TV shows, bright lights, loud music.
Everywhere you turn, you can get lost in a maze of distractions that can eat up another day you will never get back.
The solution then is to fight back against the distractions.
Here are 10 ways you can reclaim your inherent insane focus and turn away from the distractions of the world:

1) Overset Your Time Expectations


2) Don’t Check Email in the Morning


3) Stop Multitasking


4) Pursue Your Passion Before Anything Else


5) Choose 2-3 Tasks Everyday That Have To Be Done


6) Take Some Days Slowly


7) Email Just Twice A Day


8) Turn Off Notifications

9) Stay Offline Until Core Tasks Are Done

10) Know What Matters

n Hack Spirit’s new eBook, The Art of Resilience, they deliver a practical primer on how you can become more resilient in a world of instability and narrowing opportunity, whether you’re facing financial troubles, health setbacks, challenges in your relationships, or any other problem.
We can all have our own resilience breakthrough, and each can learn how to use adverse circumstances as potent fuel for overcoming life’s hardships.

Stroke victims can be diagnosed TEN TIMES more accurately thanks to incredible new technology developed in Scotland

So you are going down the complete nocebo route. You will only recover so far, that lets the doctor off the hook for getting you 100% recovered. No point in doing any further stroke rehab research then, the computer never lies. The status quo is just fine for those who have never had a stroke. FUCKING LAZY ASSHOLES!
https://www.thescottishsun.co.uk/news/2530014/stroke-technology-scotland/
A new computer programme can predict more accurately than ever before a patient’s cognitive function — including speech and memory skills — after suffering a blood clot on the brain
STROKE victims can now be diagnosed TEN TIMES more accurately than current methods after breakthrough research carried out in Scotland.
A new computer programme can predict more accurately than ever before a patient’s cognitive function — including speech and memory skills — after suffering a blood clot on the brain.
New method can predict how patients will be in future
The software measures visible injuries from cerebral small vessel disease — which can lead to dementia — and brain degeneration.
It does this by translating millions of pieces of information stored in scans into a “brain health index”.
And researchers believe this will lead to better outcomes for the 31,000 Scots stroke survivors each year.
Dr David Dickie, a research fellow at the University of Glasgow, explained: “Right now scans are reviewed from different bits and pieces of damage caused by strokes.
“A doctor will then use their experience to say what they think the effects of that damage will be.
“But that can vary as two different doctors could give two different results which can lead to a disagreement about how you would do in the future.
“What we are trying to do is use the scan to predict far more accurately the outcomes of speech and other functions.
“It will standardise the results.
“This is a more mathematical approach and is then better at predicting how good you are going to be cognitively in the future.”

Pomegranate Can Help Reduce Risk Of Heart Attacks, Strokes, Diabetes, Anemia

No research listed to back any of this up but I started listing pomegranate research back to April 2014. I bet your doctor and stroke hospital did nothing with any of it.  
https://www.timeslifestyle.net/20180418/pomegranate-can-help-reduce-risk-of-heart-attacks-strokes-diabetes-anemia/
Not only this is Pomegranate of the most delicious fruits out there, but the number of benefits it provides us are innumerable. They have amazing properties like anti-oxidants, anti-tumor, and anti-viral.
In addition to that, they are rich in vitamins like vitamin A, C, and E, and it is also a great source of folic acid. This is a truly wonderful fruit that happens to have three times more anti-oxidants than Green Tea does.
Pomegranates are very good to you, they help to maintain a proper blood circulation reason why doctors would recommend an increase in the intake of this fruit if you are having blood regulatory issues. You can also eat pomegranate to help you recover from a long illness.
They are also great to help you clear your skin and fight off any inflammations. Do you have a sore throat? Then, a nice glass of pomegranate juice is great for you. But that isn’t enough, they also happen to be a great cure for heart conditions, stomach issues, cancer, diabetes, anemia, arthritis, and even dental conditions.
There is truly a never-ending list of benefits we can get from eating pomegranates, as they are so rich in antioxidants, they help to oxidize all the LDL cholesterol in our bodies.
It doesn’t matter if you consume your pomegranate as a juice, seeds, syrup, nectar, concentrated formula or paste, you will enjoy all the benefits all the same.
Doctors also recommend pomegranate to help your body repair damaged cartilage, and for pregnant women, it is useful to consume it in order to protect their babies brain’s from any damage that may occur during labor.
You want more, huh? Well, see this way, the health benefits from pomegranates range between curing stomach issues to improving erectile dysfunction problems.
In order to treat stomach problems like diarrhea or other digestive issues, you could drink a tea made out of the leaves from the pomegranate tree. This tea is also great to deal with dysentery and cholera.
Drinking pomegranate juice on a regular basis, daily if you can, will help you to maintain a proper blood circulation through your body and it reduces the risks of suffering from heart attacks or strokes.
There is a large concentration of Flavonoids in pomegranates, which are a form of antioxidants, they have been proven to be very effective in eradicating those free radicals in our bodies.

Glucose, blood pressure and temperature are prognostic biomarkers in acute ischaemic stroke

Not even close to what would describe causes of 3 month mortality. They should be looking at the fact nothing is being done in the first week to stop  the 5 causes of the neuronal cascade of death
Does no one in stroke understand cause and effect of early stroke mortality? Decent stroke leadership would point researchers to follow a stroke strategy to 100% recovery for all. This was a waste of time. 
https://eso-stroke.org/strokeresearch/glucose-blood-pressure-and-temperature-are-prognostic-biomarkers-in-acute-ischaemic-stroke
by ESO | 21.3.2018 | Stroke Research | 0 comments


Comment Authors: Daniela Pimenta Silva, Diana Aguiar de Sousa, Department of Neurology, Hospital de Santa Maria, University of Lisbon, Portugal
Original Article: Skafida A., Mitrakou A., Georgiopoulos G., et al. In-hospital dynamics of glucose, blood pressure and temperature predict outcome in patients with acute ischaemic stroke. European Stroke Journal. doi: 10.1177/2396987318765824
Stroke unit treatment is an evidence-based proven effective treatment.(Bullshit, 12% tPA full recovery, 10% full recovery on rehab; Neither can be considered effective) Surprisingly, randomised controlled trials aimed at reducing or normalising parameters such as glucose, blood pressure (BP) and temperature failed to demonstrate benefit from these interventions. But why wouldn’t the normalisation of these parameters improve outcomes? (Becauase you are looking at the wrong goddamn thing!)
Skafida and colleagues hypothesized that the variability of these parameters during the acute and sub-acute phase are significant factors in outcome.
To prove this argument, the authors conducted a prospective observational study, which included 1271 patients with acute ischaemic stroke admitted within 24h after symptom onset to the acute stroke unit of Alexandra Hospital, between 2001 and 2010. Serum glucose, systolic and diastolic blood pressure (SBP, DBP) and temperature were systematically measured during the first 7 days of hospitalisation. Variability across the hospitalisation period was addressed.
The primary outcome was all-cause death up to three months after acute iscaemic stroke and the secondary outcome was poor functional outcome also at three months. Final multivariable models were adjusted for all available major confounders of biological plausibility, including traditional risk factors, stroke severity, renal function and in-hospital treatment.
The authors found that subject-specific baseline glucose (HR=1.005; p-value=0.017) and temperature (HR=2.758; p-value<0.001) levels, variability of SBP (HR=1.028; p-value=0.005) and the rate of temperature changes (HR=1.841; p-value<0.001) are independent predictors of three-month all-cause mortality (primary outcome).
Interestingly, baseline glucose levels and its changes across hospitalisation were not predictors of poor clinical outcome at 3 months follow-up. One mentioned explanation was hyperglycaemia as a surrogate marker of critical illness, thus contributing to a higher mortality with no association to the poor clinical outcome.
Although this was not emphasised by the authors, another notable finding was the absence of an association between rise in blood sugar level and three-month mortality or poor clinical outcome, contrary to what other studies have shown.
Consistent with the literature, variation in BP values during hospitalisation was a predictor of all-cause mortality and poor functional outcome at three months after ischaemic stroke. Since cerebral autoregulation typically is impaired in the acute and sub-acute phase of stroke, it is likely that fluctuations in blood pressure compromise cerebral perfusion thus contributing to poor outcome.
Baseline temperature and slope of temperature change were both predictors of three-month all-cause mortality and poor clinical outcome. In addition to fever being also a surrogate index for nosocomial infections, the survival penumbra in the acute and sub-acute phase of ischaemic stroke can be influenced by changes in temperature, thus producing a worse functional outcome.
The variability between studies concerning parameters definitions, cut-off thresholds and statistical methods are important obstacles to interpretation and comparison. The large sample size, the assessment of serial values of parameters beyond the hyperacute phase and the careful adjustment for confounders are the strengths of this study.
Being a single centre study, with a long period of inclusion, makes the results extrapolation to other populations hazardous. Moreover, it is important to note that the etiology of the changes in glucose, BP and temperature were not discussed, which can also affect the mortality rate.
In conclusion, the results contribute to the understanding of of the complex physiology in acute ischaemic stroke. How to optimize supportive treatment of physiological factors such as blood pressure, blood glucose and temperature is yet to be answered. Hopefully, trials such as PRECIOUS (ISRCTN82217627) will bring us closer to a conclusion.

Friday, April 20, 2018

Road trips

Post retirement there is much to do. Was on two back to back road trips.  First was to St. Paul, 10.5 hours, got my two sea kayaks, tandem and single out of a friends garage, we then cleaned out most of his garage so I could empty my storage locker and store that stuff in the garage. Handed off the sea kayaks to friends from Duluth since I can't really use them now.  Bought a folding recumbent tricycle, more on that later.  Drove back on a Tuesday, left for Pittsburgh the next day, saw the Andy Warhol museum. Drove to New York in the fog and rain, including driving across 42nd street at the bottom of Times Square at 8pm, luckily with a navigator. Ate at the Wild Ginger restaurant where we had a couple of bottles of cold sake.



Friday saw Grand Central Station, United Nations, then to the Frick museum on 71st, On to MOMA where the crowds were ferocious. Finally headed to the Whitney around 13th St. On the way stopped at the Gonzo bar for drinks and a couple of empanadas for sustenance Only 32,118 steps for the day, 16 miles.
Saturday was the Museum of Arts and Design, lunch at 

Ousia restaurant, Mediterranean wines

  

 

walked thru Central Park, then to the Jewish Museum, tried for the Guggenheim but the lines stretched around 3/4s of the block. We decided that was it for the day since we needed to get up to Hyde Park  yet that night. Only 19,950 steps.
Sunday, the FDR museum and house. 11.5 hours of driving back to Michigan, had to hand off the last hour of driving to my friend.

After that was a flight to Albuquerque, drive to Santa Fe for a couple of days. Saw the Georgia O'Keefe museum, she was way ahead of her time. Had a wonderful dinner at Izanami  
where we learned that sake that is hot is served that way to disguise the flavor since it is really cheap sake. I'm really liking the cloudy unfiltered sake. Will have to look up the benefits of this type of alcohol. 


Thursday, April 19, 2018

Constraint-induced movement therapy in stroke patients. A systematic review

These are a total waste of time until we finally get stroke protocols written up.  
https://search.naric.com/research/rehab/redesign_record.cfm?search=2&type=all&criteria=I243968&phrase=no&rec=243968&article_source=CIRRIE&international=1&international_language=&international_location=
Terapia por restricción del lado sano en pacientes con ictus. Revisión sistemática.  Rehabilitación , Volume 51(4) , Pgs. 234-246.

NARIC Accession Number: I243968.  What's this?
Author(s): M.J. Mateos-Serrano; I. Calvo-Mu˜noz.
Publication Year: 2017.
Abstract: The aim of this study was to determine the effectiveness of constraint-induced movement therapy (CIMT) in patients with hemiparesis/hemiplegia following stroke and to analyze the main characteristics of CIMT in patients with stroke. A literature review was performed of experimental studies published up to February 2016. Among other search procedures, a search was carried out in different electronic databases. Selection criteria were as follows: the included studies had to be randomized clinical trials, and individuals had to be older than 18 years and to have been treated with CIMT after being diagnosed with subacute or chronic stroke. Twelve articles were included, thus providing 12 treatment groups and 12 control groups. The total sample consisted of 435 individuals divided into 2 groups: 219 persons in treatment groups and 216 individuals in control groups. The oldest study was conducted in 2010 and the most recent in 2015. Results indicate that CIMT is an effective alternative treatment for the rehabilitation of stroke patients, and the benefits can be observed at both the physical and functional levels.
Descriptor Terms: Adults, Hemiplegia, Movement therapy, Stroke, Treatment.
Language: Spanish
Geographic Location(s): Europe, Spain.

Can this document be ordered through NARIC's document delivery service*?: Request Information.
Get this Document: http://dx.doi.org/10.1016/j.rh.2017.01.001.

Citation: M.J. Mateos-Serrano, I. Calvo-Mu˜noz. (2017). Constraint-induced movement therapy in stroke patients. A systematic review.  Terapia por restricción del lado sano en pacientes con ictus. Revisión sistemática.  Rehabilitación , 51(4), Pgs. 234-246. Retrieved 4/19/2018, from REHABDATA database.


* The majority of journal articles, books, and reports in our collection are only available by regular mail, rather than downloadable electronic format. Learn more about our digital collection and our document delivery service.

More information about this publication: There are no references related to this document.

A systematic review of mechanisms of gait speed change post-stroke. Part 2: Exercise capacity, muscle activation, kinetics, and kinematics

So still no clue as to what rehab creates functional gains. Once again everything in your recovery is up to you. You find the appropriate research and deduce what the protocol is. What the fuck is your doctor for?
https://search.naric.com/research/rehab/redesign_record.cfm?search=2&type=all&criteria=J78167&phrase=no&rec=136199&article_source=Rehab&international=0&international_language=&international_location=
Topics in Stroke Rehabilitation , Volume 24(5) , Pgs. 394-403.

NARIC Accession Number: J78167.  What's this?
ISSN: 1074-9357.
Author(s): Wonsetler, Elizabeth C.; Bowden, Mark G..
Publication Year: 2017.
Number of Pages: 10.
Abstract: This systematic review explored potential mechanisms of change that may explain improvements in gait speed and quantify motor recovery following physical therapy interventions in the stroke population. PubMed, Ovid, and CINAHL databases were searched relevant rehabilitation trials with a statistically significant change in self-selected walking speed post-intervention that concurrently collected mechanistic variables. Twenty-five studies met the inclusion criteria and examined. Methodological quality was assessed using Cochrane Collaboration’s tool. Walking speed changes, mechanistic variables, and intervention data were extracted. The physical therapy interventions used within the included studies that were found to produce improvements in gait speed were: cardiorespiratory function, muscle activation, force production, and movement analysis. Interventions included: aerobic training, functional electrical stimulation, multidimensional rehabilitation, robotics, sensory stimulation training, strength/resistance training, task-specific locomotor rehabilitation, and visually-guided training. No systematic approach or set of outcome measures to mechanistically explain changes observed in walking speed were identified. Nor is there a theoretical basis to drive the complicated selection of outcome measures, as many of these outcomes are not independent of walking speed. Since rehabilitation literature has not yet identified a causal, mechanistic link for post-stroke functional gains, a systematic, multimodal approach to stroke rehabilitation will be necessary in doing so.
Descriptor Terms: AMBULATION, BIOENGINEERING, ELECTROPHYSIOLOGY, EXERCISE, LITERATURE REVIEWS, OUTCOMES, PHYSICAL THERAPY, REHABILITATION SERVICES, STROKE, THERAPEUTIC TRAINING.


Can this document be ordered through NARIC's document delivery service*?: Y.

Citation: Wonsetler, Elizabeth C., Bowden, Mark G.. (2017). A systematic review of mechanisms of gait speed change post-stroke. Part 2: Exercise capacity, muscle activation, kinetics, and kinematics.  Topics in Stroke Rehabilitation , 24(5), Pgs. 394-403. Retrieved 4/19/2018, from REHABDATA database.


* The majority of journal articles, books, and reports in our collection are only available by regular mail, rather than downloadable electronic format. Learn more about our digital collection and our document delivery service.

More information about this publication:
Topics in Stroke Rehabilitation.

The effect of water-based exercises on balance in persons post-stroke: A randomized controlled trial

I loved my water based therapy that I did on my own at the 'Y'. The hospital pool was closed years prior to my stroke.  When I was in Ecuador I did several sessions of therapy just standing in knee deep water and adjusting to the waves pounding my legs. By putting my impaired leg in front and standing sideways I could get to mid-thigh water and still stay upright.
https://search.naric.com/research/rehab/redesign_record.cfm?search=2&type=all&criteria=J78153&phrase=no&rec=136185&article_source=Rehab&international=0&international_language=&international_location=
Topics in Stroke Rehabilitation , Volume 24(4) , Pgs. 228-235.

NARIC Accession Number: J78153.  What's this?
ISSN: 1074-9357.
Author(s): Chan, Kelvin; Phadke, Chetan P.; Stremler, Denise; Suter, Lynn; Pauley, Tim; Ismail, Farooq; Boulias, Chris.
Publication Year: 2017.
Number of Pages: 8.
Abstract: Study examined the effect of water-based exercises compared to land-based exercises on the balance of stroke patients discharged inpatient neurological rehabilitation and referred to outpatient physical therapy. Thirty-two patients with first-time stroke were randomized into water-based plus land (WL) or land only (L) exercise groups. Both groups attended therapy two times per week for six weeks. Initial and progression protocols for the water-based exercises (a combination of balance, stretching, and strengthening, and endurance training) and land therapy (balance, strength, transfer, gait, and stair training) were devised. Outcome measures included the Berg Balance Score, Community Balance and Mobility Score, Timed Up and Go Test, and 2-Minute Walk Test. Baseline characteristics of the WL and L groups were similar in age, side of stroke, time since stroke, and wait time between inpatient discharge and outpatient therapy on all four outcome measures. Pooled change scores from all outcomes showed that significantly greater number of patients in the WL group showed improvement post-training compared to the L group. More patients in the WL group showed change scores exceeding the published minimal detectable change scores. The results indicate that a combination of water- and land-based exercises has potential for improving balance. The findings of this study extend the research showing benefit of water-based exercise in chronic and less-impaired stroke groups to patients with sub-acute stroke.
Descriptor Terms: AMBULATION, EQUILIBRIUM, EXERCISE, MOBILITY IMPAIRMENTS, PHYSICAL THERAPY, POSTURE, STROKE.


Can this document be ordered through NARIC's document delivery service*?: Y.

Citation: Chan, Kelvin, Phadke, Chetan P., Stremler, Denise, Suter, Lynn, Pauley, Tim, Ismail, Farooq, Boulias, Chris. (2017). The effect of water-based exercises on balance in persons post-stroke: A randomized controlled trial.  Topics in Stroke Rehabilitation , 24(4), Pgs. 228-235. Retrieved 4/19/2018, from REHABDATA database.


* The majority of journal articles, books, and reports in our collection are only available by regular mail, rather than downloadable electronic format. Learn more about our digital collection and our document delivery service.

More information about this publication:
Topics in Stroke Rehabilitation.

The use of virtual reality for balance among individuals with chronic stroke: A systematic review and meta-analysis

Once again this should have been totally unnecessary since that public database of all continually updated stroke research would have this. But since we have NO stroke leadership and NO stroke strategy we get wastes of time like this all the time.
https://search.naric.com/research/rehab/redesign_record.cfm?search=2&type=all&criteria=J78141&phrase=no&rec=136173&article_source=Rehab&international=0&international_language=&international_location=
Topics in Stroke Rehabilitation , Volume 24(1) , Pgs. 68-79.

NARIC Accession Number: J78141.  What's this?
ISSN: 1074-9357.
Author(s): Iruthayarajah, Jerome; McIntyre, Amanda; Cotoi, Andreea; Macaluso, Steven; Teasell, Robert.
Publication Year: 2017.
Number of Pages: 12.
Abstract: Study evaluated the evidence on the effectiveness of virtual reality interventions for improving balance among individuals with chronic stroke (≥6 months). Pubmed, Scopus, CINAHL, Embase, Psycinfo, and Web of Science databases were searched for randomized controlled trials published in English up to September 2015 assessing balance with virtual reality in chronic stroke participants. Mean and standard deviations from outcome measures were extracted. Pooled standard mean differences were calculated for the Berg Balance Scale (BBS) and the Timed Up and Go test (TUG). In total, 20 of the 984 articles identified met inclusion criteria: 7 examine the Nintendo® Wii Fit balance board, 7 examined treadmill training and virtual reality, and 6 examined postural training using virtual reality. The results from the meta-analyses demonstrate that patients receiving virtual reality treatment improved significantly on the BBS and the TUG compared to those receiving conventional rehabilitation. Furthermore, static balance outcomes significantly improved following virtual reality rehabilitation. Altogether, these results suggest that virtual reality interventions promote the recovery of impaired balance in chronic stroke patients more effectively than conventional rehabilitation.
Descriptor Terms: AMBULATION, COMPUTER APPLICATIONS, EQUILIBRIUM, LITERATURE REVIEWS, MOBILITY TRAINING, OUTCOMES, POSTURE, REHABILITATION TECHNOLOGY, STROKE.


Can this document be ordered through NARIC's document delivery service*?: Y.

Citation: Iruthayarajah, Jerome, McIntyre, Amanda, Cotoi, Andreea, Macaluso, Steven, Teasell, Robert. (2017). The use of virtual reality for balance among individuals with chronic stroke: A systematic review and meta-analysis.  Topics in Stroke Rehabilitation , 24(1), Pgs. 68-79. Retrieved 4/19/2018, from REHABDATA database.


* The majority of journal articles, books, and reports in our collection are only available by regular mail, rather than downloadable electronic format. Learn more about our digital collection and our document delivery service.

More information about this publication:
Topics in Stroke Rehabilitation.

The effect of self-management education following mild stroke: An exploratory randomized controlled trial.

Every stroke survivor has to do self management of their recovery. Your doctor and therapists have no clue how to get you 100% recovered. You are completely on your own, but your doctor won't tell you that. 
https://search.naric.com/research/rehab/redesign_record.cfm?search=2&type=all&criteria=J78164&phrase=no&rec=136196&article_source=Rehab&international=0&international_language=&international_location=
Topics in Stroke Rehabilitation , Volume 24(5) , Pgs. 345-352.

NARIC Accession Number: J78164.  What's this?
ISSN: 1074-9357.
Author(s): Wolf, Timothy J.; Spiers, Meredith J.; Doherty, Meghan; Leary, Emily V..
Publication Year: 2017.
Number of Pages: 8.
Abstract: Study evaluated the feasibility and preliminary effects of the Chronic Disease Self-Management Program (CDSMP) for use with individuals immediately post mild-stroke. The CDSMP is an education program based on the concept of self-management and is focused on three primary goals: medical management; (2) role management; and (3) emotional management. Participants were randomized to either receive the CDSMP intervention or to an inactive control group. The CDSMP was delivered by two licensed occupational therapists who were certified facilitators. Primary outcomes were self-reported health and self-efficacy and were obtained at baseline, post-intervention (treatment group only), and at six months post-baseline. Wilcoxon signed rank tests were used to compare change score differences for all participants and effect size was computed using effect size for non-parametric data. There were no differences between groups in demographics or baseline data with the exception of how participants felt they are able to manage their health in general. At follow-up, effect sizes ranged from 0 to 0.35 (no effect to medium effect); however, while the treatment group reported improvements in several areas of health at follow-up, the results are not compelling when compared to the control group over the same time period. This study did not identify a positive effect that would support the use of the CDSMP with individual’s post-mild stroke; however, the generalizability of these results is limited secondary to several limitations in this exploratory study.
Descriptor Terms: DISABILITY MANAGEMENT, FEASIBILITY STUDIES, OCCUPATIONAL THERAPY, PATIENT EDUCATION, PROGRAM EVALUATION, REHABILITATION SERVICES, SELF CARE, STROKE.


Can this document be ordered through NARIC's document delivery service*?: Y.

Citation: Wolf, Timothy J., Spiers, Meredith J., Doherty, Meghan, Leary, Emily V.. (2017). The effect of self-management education following mild stroke: An exploratory randomized controlled trial.  Topics in Stroke Rehabilitation , 24(5), Pgs. 345-352. Retrieved 4/19/2018, from REHABDATA database.


* The majority of journal articles, books, and reports in our collection are only available by regular mail, rather than downloadable electronic format. Learn more about our digital collection and our document delivery service.

More information about this publication:
Topics in Stroke Rehabilitation.

Validating accelerometry as a measure of physical activity and energy expenditure in chronic stroke.

If your doctor and therapists aren't doing this they have no objective idea of the movements you are doing. With NO objective diagnosis of your disability they will never be able to map protocols to recovery. 
https://search.naric.com/research/rehab/redesign_record.cfm?search=2&type=all&criteria=J78135&phrase=no&rec=136167&article_source=Rehab&international=0&international_language=&international_location=
Topics in Stroke Rehabilitation , Volume 24(1) , Pgs. 18-23.

NARIC Accession Number: J78135.  What's this?
ISSN: 1074-9357.
Author(s): Serra, ; Balraj, Elizabeth; DiSanzo, Beth L.; Ivey, Frederick M.; Hafer-Macko, Charlene E.; Treuth, Margarita S.; Ryan, Alice S..
Publication Year: 2017.
Number of Pages: 6.
Abstract: Study determined count thresholds for the Actical brand accelerometer specific to stroke disability in order to more accurately estimate time spent at differing activity levels. Eighteen men and 10 women with chronic hemiparetic gait participated in the study. Actical accelerometers were placed on the participants’ non-paretic hip to obtain accelerometry counts during eight activities of varying intensity: (1) watching TV; (2) seated stretching; (3) standing stretching; (4) floor sweeping; (5) stepping in place; (6) over-ground walking; (7) lower-intensity treadmill walking (1.0 mph at 4-percent incline); and (8) higher-intensity treadmill walking (2.0 mph at 4-percent incline). Simultaneous portable monitoring enabled quantification of energy cost for each activity in metabolic equivalents (oxygen consumption in multiples of resting level). Measurements were obtained for 10 minutes of standard rest and 5 minutes during each of the eight activities. Regression analysis yielded the following new stroke-specific Actical minimum thresholds: 125 counts per minute (cpm) for sedentary/light activity, 667 cpm for light/moderate activity, and 1,546 cpm for moderate/vigorous activity. The authors conclude that the standard, commonly applied Actical thresholds are inappropriate for this unique population. The revised cut points better reflect activity levels after stroke and suggest significantly lower thresholds relative to those observed for the general population of healthy individuals.
Descriptor Terms: AMBULATION, BODY MOVEMENT, CARDIOPULMONARY FUNCTION, EVALUATION TECHNIQUES, EXERCISE, MEASUREMENTS, MEDICAL TECHNOLOGY, PERFORMANCE STANDARDS, STROKE.


Can this document be ordered through NARIC's document delivery service*?: Y.

Citation: Serra, Validating accelerometry as a measure of physical activity and energy expenditure in chronic stroke.  Topics in Stroke Rehabilitation , 24(1), Pgs. 18-23. Retrieved 4/19/2018, from REHABDATA database.


* The majority of journal articles, books, and reports in our collection are only available by regular mail, rather than downloadable electronic format. Learn more about our digital collection and our document delivery service.

More information about this publication:
Topics in Stroke Rehabilitation.

Research indicates there is not enough patient centricity and patient engagement in research protocols for kidney disease.

I haven't seen any calls for stroke survivor involvement in any stroke research. Until that occurs most stroke research is totally fucking useless. All primary measures should be set by survivors.
https://patientengagementhit.com/news/patient-engagement-low-in-patient-centered-research-protocol

Haemostatic therapies for acute spontaneous intracerebral haemorrhage

No clue what this means. 
http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD005951.pub4/full?platform=hootsuite



Authors

Abstract



Background

Outcome after spontaneous (non-traumatic) intracerebral haemorrhage (ICH) is influenced by haematoma volume; up to one-third of ICHs enlarge within 24 hours of onset. Early haemostatic therapy might improve outcome by limiting haematoma growth. This is an update of a Cochrane Review first published in 2006, and last updated in 2009.

Objectives

To examine 1) the effectiveness and safety of individual classes of haemostatic therapies, compared against placebo or open control, in adults with acute spontaneous intracerebral haemorrhage, and 2) the effects of each class of haemostatic therapy according to the type of antithrombotic drug taken immediately before ICH onset (i.e. anticoagulant, antiplatelet, or none).

Search methods

We searched the Cochrane Stroke Trials Register, CENTRAL; 2017, Issue 11, MEDLINE Ovid, and Embase Ovid on 27 November 2017. In an effort to identify further published, ongoing, and unpublished randomised controlled trials (RCT), we scanned bibliographies of relevant articles and searched international registers of RCTs in November 2017.

Selection criteria

We sought randomised controlled trials (RCTs) of any haemostatic intervention (i.e. pro-coagulant treatments such as coagulation factors, antifibrinolytic drugs, or platelet transfusion) for acute spontaneous ICH, compared with placebo, open control, or an active comparator, reporting relevant clinical outcome measures.

Data collection and analysis

Two authors independently extracted data, assessed risk of bias, and contacted corresponding authors of eligible RCTs for specific data if they were not provided in the published report of an RCT.

Main results

We included 12 RCTs involving 1732 participants. There were seven RCTs of blood clotting factors versus placebo or open control involving 1480 participants, three RCTs of antifibrinolytic drugs versus placebo or open control involving 57 participants, one RCT of platelet transfusion versus open control involving 190 participants, and one RCT of blood clotting factors versus fresh frozen plasma involving five participants. We were unable to include two eligible RCTs because they presented aggregate data for adults with ICH and other types of intracranial haemorrhage. We identified 10 ongoing RCTs. Across all seven criteria in the 12 included RCTs, the risk of bias was unclear in 37 (44%), high in 16 (19%), and low in 31 (37%). Only one RCT was at low risk of bias in all criteria.
In one RCT of platelet transfusion versus open control for acute spontaneous ICH associated with antiplatelet drug use, there was a significant increase in death or dependence (modified Rankin Scale score 4 to 6) at day 90 (70/97 versus 52/93; risk ratio (RR) 1.29, 95% confidence interval (CI) 1.04 to 1.61, one trial, 190 participants, moderate-quality evidence). All findings were non-significant for blood clotting factors versus placebo or open control for acute spontaneous ICH with or without surgery (moderate-quality evidence), for antifibrinolytic drugs versus placebo (moderate-quality evidence) or open control for acute spontaneous ICH (moderate-quality evidence), and for clotting factors versus fresh frozen plasma for acute spontaneous ICH associated with anticoagulant drug use (no evidence).

Authors' conclusions

Based on moderate-quality evidence from one trial, platelet transfusion seems hazardous in comparison to standard care for adults with antiplatelet-associated ICH.
We were unable to draw firm conclusions about the efficacy and safety of blood clotting factors for acute spontaneous ICH with or without surgery, antifibrinolytic drugs for acute spontaneous ICH, and clotting factors versus fresh frozen plasma for acute spontaneous ICH associated with anticoagulant drug use.
Further RCTs are warranted, and we await the results of the 10 ongoing RCTs with interest.

Plain language summary

Treatments to help blood clotting to improve the recovery of adults with stroke due to bleeding in the brain
Review question
Do treatments to help blood clot reduce the risk of death and disability for adults with stroke due to bleeding in the brain?
Background
More than one-tenth of all strokes are caused by bleeding in the brain (known as brain haemorrhage). The bigger the haemorrhage, the more likely it is to be fatal. Roughly one-third of brain haemorrhages enlarge significantly within the first 24 hours. Therefore, treatments that promote blood clotting might reduce the risk of death or being disabled after brain haemorrhage by limiting its growth, if given soon after the bleeding starts. However, haemostatic drugs might cause unwanted clotting, leading to unwanted side effects, such as heart attacks and clots in leg veins.
Study characteristics
We found 12 randomised controlled trials, including 1732 participants, up to November 2017.
Key results
We found moderate-quality evidence of harm from platelet transfusion for people who had used antiplatelet drugs until they had a brain haemorrhage. We found no evidence of either benefit or harm from other haemostatic therapies for people with brain haemorrhage.
Quality of the evidence
Overall, the quality of the evidence was moderate to low.
More information will become available from the 10 trials that are ongoing.