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 481 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

Wednesday, May 4, 2016

Structured transitional stroke care could decrease hospital readmission rates

And I bet that stopping the neuronal cascade of death in the first week would do more than any after the fact interventions to reduce readmission rates. But we seem to have no one in stroke that has a functioning brain.
http://www.news-medical.net/news/20160429/Structured-transitional-stroke-care-could-decrease-hospital-readmission-rates.aspx
A transitional stroke clinic developed by doctors and nurse practitioners at Wake Forest Baptist Medical Center reduced 30-day readmission rates by 48 percent, according to a study published in the April 28 online issue of the journal Stroke.
The study's goal was to determine if a structured transitional stroke clinic led by nurse practioners could reduce 30-day and 90-day hospital readmission rates.
"The needs of patients discharged directly home after suffering a stroke are often complex," said Cheryl Bushnell, M.D., director of the Stroke Center at Wake Forest Baptist and lead author of the study.
"Patients are faced with physical and cognitive limitations, complex medication regimens, new diagnoses of chronic conditions and lack of social support. These barriers challenge independence and stroke recovery and leave patients at high risk for readmissions."
The study evaluated 510 stroke or transient ischemic attack patients who had been discharged to their homes over a three-year period. The Wake Forest Baptist transitional care model included follow-up phone calls within a week of discharge and follow-up clinic visits within two to four weeks of discharge.
The researchers found that a visit to the stroke clinic was associated with a 48 percent lower risk of 30-day readmissions compared to patients who did not attend the follow-up clinic visit. A clinic visit did not affect 90-day readmission rates. A limitation of the study was that only readmissions at Wake Forest Baptist were included.
"A lot of stroke programs are doing follow-up phone calls to patients, but our data shows that phone calls alone are not good enough to reduce readmissions," Bushnell said. "It is really important for patients to be engaged in their own stroke recovery, and part of that involves coming to clinic and making sure they get all the services they need."
Bushnell also said that primary care doctors caring for stroke patients should be alert to changes that are hallmarks of stroke: patients not thinking as clearly as they used to, memory problems, limited ability to use their hands or overall mobility issues, as well as depression and social isolation.
"We are at the forefront of a trend that really emphasizes the initial transition phase in post-stroke care," Bushnell said. "The next steps include expanding our model to include community services and individualized electronic-care plans."
Source:
Wake Forest Baptist Medical Center

Clinical study to evaluate safety of investigational cell therapy to treat chronic motor deficits after stroke

Safety in this case could be proven by the fact that all the stem cells died. Are they even monitoring whether or not they survive?

Tracking of Administered Progenitor Cells in Brain Injury and Stroke by Magnetic Resonance Imaging



Clinical study to evaluate safety of investigational cell therapy to treat chronic motor deficits after stroke

University Hospitals Case Medical Center is the first surgical site for a Phase 2b clinical trial study to further evaluate the safety and efficacy of an investigational cell therapy for the treatment of chronic motor deficit following an ischemic stroke.
"With strokes, focus has been on prevention or treatment within the first few hours," said Jonathan Miller, MD, Director of the Center for Functional and Restorative Neurosurgery at UH Case Medical Center and Assistant Professor of Neurosurgery at Case Western Reserve University School of Medicine, who performs the stem cell surgery as part of the study. "Stroke is the leading cause of adult disability in the U.S., and there really hasn't been much for this patient population."
Ischemic strokes account for approximately 87 percent of all strokes in the US and occur when there is an obstruction in a blood vessel supplying oxygen to the brain. With approximately 800,000 strokes occurring in the United States every year, stroke is the leading cause of acquired disability in the United States. Traditional stroke treatments generally show little or no improvement in patients after the first six months following a stroke.
The ACTIsSIMA "Allogeneic Cell Therapy for Ischemic Stroke to Improve Motor Abilities" trial will examine the effects of genetically modified adult bone-marrow-derived stem cells in patients who have experienced an ischemic stroke in the previous six months to five years and still suffer from motor impairments.
Dr. Miller said, "For the hundreds of thousands of people living with the debilitating effects of ischemic stroke, the ACTIsSIMA trial will help determine whether this investigational cell therapy is a safe and effective treatment option."
The Phase 2b clinical trial follows a previous open label Phase 1/2a clinical trial in a similar patient population. The Phase 2b study will further evaluate the safety and efficacy of the treatment in a blinded and controlled setting.
The study will enroll 156 patients with chronic motor deficits after stroke. They are being recruited through 50 assessment sites throughout the United States. Patients will range in age from 18 to 75 years of age. Once enrolled through an assessment site, patients will come to one of 18 surgical sites such as UH Case Medical Center, for the injection of cells. The patient will then be monitored for the duration of the study at the assessment sites. The closest assessment sites to UH are in Toledo and Detroit.
The ACTIsSIMA trial will further evaluate the safety and efficacy of intracranial administration of modified adult bone-marrow-derived stem cells when administered to patients with chronic motor deficit secondary to ischemic stroke.
"UH Case Medical Center has been in the forefront of adult stem cell research," said Dr. Miller. "We are excited to be part of this study to evaluate the potential of this treatment for stroke. Although it will take time, this study and others involving stem cells, may lead to new methods of helping patients."
Source:
University Hospitals Case Medical Center

LBB Rehab Group Demonstrates Two New stroke Technologies

I'm sure your stroke department already is investigating all these other arm and hand rehab technologies and the walking assist technologies and comparing them to these new ones.
42 posts on arm.
131 posts on upper limb.
24 on FES.
Your doctor can put together the intersection of those three sets.
No, I'm not that stupid, your stroke department is doing nothing of the kind. And I'm 100% positive your stroke association is doing nothing at all. Ask them what the best arm rehab protocol is. You'll get crickets.
http://www.prnewswire.com/news-releases/lbb-rehab-group-demonstrates-two-new-technologies-300262007.html
Life Beyond Barriers Rehabilitation Group (LBBRG) displayed two life-impacting technologies at a recent demonstration at their Rockford, Michigan center.
The first was MyndMove, a non-invasive functional electrical stimulation (FES) therapy for individuals with arm and hand paralysis due to a stroke, spinal cord or other neurological injury.  In attendance was Dr. Milos Popovich, inventor of MyndMove, and Toronto Rehabilitation Institute's Associate Scientific Director and Chair in Spinal Cord Injury Research & University of Toronto Professor.
MyndMove is manufactured by MyndTec Inc., a privately held medical technology company located in Mississauga, Ontario.
"MyndMove improves the lives of individuals with paralysis such as stroke and spinal cord injury by stimulating the muscles in the upper extremities.  We have selected Life Beyond Barriers Rehabilitation Group to help us run our United States clinical trials," said Dr. Milos Popovich.  "LBBRG President Richard Widgren sits on the MyndMove board and is helping us here in the United States."


The second demonstrated technology was REX, the standing exercise tool with the ability to ambulate.
Developed in New Zealand, REX is a hands-free robotic mobility device for rehabilitation. Designed for people with limited mobility, REX is completely self-supporting and can adjust quickly to each user. REX lifts patients from a sitting position into a robot-supported standing position, allowing them to take part in a set of supported walking and stretching exercises designed by specialist physiotherapists.
Wheelchair users are at risk of developing numerous medical complications from extended periods of sitting. By enabling them to spend more time standing, walking and receiving therapy, REX may offer significant health benefits.
"The clients at LBBRG in both Rockford and Traverse City will get to test MyndMove for the next nine months and REX for the next 30 days," said Sandy Burns, PT, MSPT and director, LBBRG.  "Our goal is to create innovative options for our clients.  These technologies will provide hope that individuals with disabilities should have with all opportunities, therefore the highest quality of life."
About Life Beyond Barriers Rehabilitation Group 
With locations in Rockford and Traverse City, Michigan, Life Beyond Barriers Rehabilitation Group is an intensive, non-traditional therapy program that addresses the nervous system below the diagnosed level of injury.   The website is http://www.lbbrehab.com.  
MEDIA CONTACT:   Colleen Robar, Robar PR, 313-207-5960, crobar@robarpr.com

SOURCE Life Beyond Barriers Rehabilitation Group

Related Links

http://www.lbbrehab.com

Effects of Anxiety on Caloric Intake and Satiety-Related Brain Activation in Women and Men

I'm sure every survivor has anxiety about 100% recovery. So ask your doctor to address the root cause of that rather than prescribing lazy diet counseling. I don't give a shit that 100% recovery is not possible right now. What is your doctor doing to solve that problem?  ANYTHING AT ALL?
http://www.ncbi.nlm.nih.gov/pubmed/26867073

Abstract

OBJECTIVE:

To test the relationship of anxiety to caloric intake and food cue perception in women and men.

METHODS:

Fifty-five twins (26 complete, 3 incomplete pairs; 51% women) underwent 2 functional magnetic resonance imaging (fMRI) scans (before and after a standardized meal) and then ate at an ad libitum buffet to objectively assess food intake. State and trait anxiety were assessed using the State-Trait Anxiety Inventory. During the fMRI scans, participants viewed blocks of fattening and nonfattening food images, and nonfood objects.

RESULTS:

In women, higher trait anxiety was associated with a higher body mass index (BMI) (r = 0.40, p = .010). Trait anxiety was positively associated with kilocalories consumed at the buffet (r = 0.53, p = .005) and percent kilocalories consumed from fat (r = 0.30, p = .006), adjusted for BMI. In within-pair models, which control for shared familial and genetic factors, higher trait anxiety remained associated with kilocalories consumed at the buffet (p = .66, p = .014), but not with BMI. In men, higher state anxiety was related to macronutrient choices, but not to total caloric intake or BMI. FMRI results revealed that women with high trait anxiety did not suppress activation by fattening food cues across brain regions associated with satiety perception after eating a standardized meal (low anxiety, mean difference = -15.4, p < .001; high anxiety, mean difference = -1.53, p = .82, adjusted for BMI).

CONCLUSIONS:

In women, trait anxiety may promote excess caloric consumption through altered perception of high-calorie environmental food cues, placing women with genetic predispositions toward weight gain at risk of obesity.

TRIAL REGISTRATION:

Clinicaltrials.govidentifier:NCT02483663.

Sub-sensory vibratory noise augments the physiologic complexity of postural control in older adults

Would putting vibratory insoles in shoes of survivors help them have better balance? We'll never know because we have fucking failures of stroke associations that never followup promising research. You're screwed.
http://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-016-0152-7 
  • Junhong ZhouEmail author,
  • Lewis Lipsitz,
  • Daniel Habtemariam and
  • Brad Manor
Journal of NeuroEngineering and Rehabilitation201613:44
DOI: 10.1186/s12984-016-0152-7
Received: 23 December 2015
Accepted: 22 April 2016
Published: 3 May 2016

Abstract

Background

Postural control requires numerous inputs interacting across multiple temporospatial scales. This organization, evidenced by the “complexity” contained within standing postural sway fluctuations, enables diverse system functionality. Age-related reduction of foot-sole somatosensation reduces standing postural sway complexity and diminishes the functionality of the postural control system. Sub-sensory vibrations applied to the foot soles reduce the speed and magnitude of sway and improve mobility in older adults. We thus hypothesized that these vibration-induced improvements to the functionality of the postural control system are associated with an increase in the standing postural sway complexity.

Method

Twelve healthy older adults aged 74 ± 8 years completed three visits to test the effects of foot sole vibrations at 0 % (i.e., no vibration), 70 and 85 % of the sensory threshold. Postural sway was assessed during eyes-open and eyes-closed standing. The complexity of sway time-series was quantified using multiscale entropy. The timed up-and-go (TUG) was completed to assess mobility.

Results

When standing without vibration, participants with lower foot sole vibratory thresholds (better sensation) had greater mediolateral (ML) sway complexity (r 2 = 0.49, p < 0.001), and those with greater ML sway complexity had faster TUG times (better mobility) (r 2 = 0.38, p  < 0.001). Foot sole vibrations at 70 and 85 % of sensory threshold increased ML sway complexity during eyes-open and eyes-closed standing (p  < 0.0001). Importantly, these vibration-induced increases in complexity correlated with improvements in the TUG test of mobility (r 2 = 0.15 ~ 0.42, p < 0.001 ~ 0.03).

Conclusions

Sub-sensory foot sole vibrations augment the postural control system functionality and such beneficial effects are reflected in an increase in the physiologic complexity of standing postural sway dynamics.
https://static-content.springer.com/image/art%3A10.1186%2Fs12984-016-0152-7/MediaObjects/12984_2016_152_Fig1_HTML.gif
Fig. 1
Vibratory Shoe Insoles. Stochastic resonance was delivered to the soles of the feet via controlled vibratory stimuli. Vibrations were generated by piezo-electric actuators mounted within the insoles and driven by a control unit (black box) secured to the outside top of the shoe

Full article at link, you can quiz your doctor on it to explain 'stochastic resonance' and  the 'complexity theory of aging'.

Tuesday, May 3, 2016

Study: Earlier Is Better for Kids' Return to Activity After Concussion

Whom is going to reconcile these two conflicting studies?

First-of-Its-Kind Study Explains Why Rest is Critical After A Concussion  Feb. 2016

Study: Earlier Is Better for Kids' Return to Activity After Concussion

  • by Molly Walker
    Contributing Writer
  • This article is a collaboration between MedPage Today® and:
    Medpage Today

Action Points

  • Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
  • Children and teens who returned to physical activity within 1 week after a concussion had a reduced risk of persistent post-concussion symptoms (PPCS) compared with those who did not resume early physical activity, based on self-reporting in a small Canadian observational study.
  • Note that contrary to guideline recommendations, most symptomatic children resumed exercising at 1 week.
BALTIMORE -- Children and teens diagnosed with a concussion in the emergency department who returned to physical activity in 1 week had a reduced risk of persistent post-concussion syndrome compared with kids who did not resume early physical activity, according to a small observational study from Canada presented here.
In an unadjusted logistic regression analysis, kids who reported resumption of earlier physical activity were less likely to develop persistent post-concussion syndrome (defined as ≥3 concussion symptoms, as per the Post-Concussion Symptom Inventory) versus kids who did not (25% versus 43%, respectively, odds ratio 0.42, P<0.001), reported Roger Zemek, MD, of Children's Hospital of Eastern Ontario in Canada, and colleagues.
Overall, of the 2,413 participants ages 5-18 years, 70% reported resumption of physical activity 1 week following diagnosis of concussion, with one half reporting light activity and 25% returning to full competition. Of those engaging in physical activity, 31% reported being symptom-free. There were 30.4% who reporting meeting the criteria for persistent post-concussion syndrome.
These findings were presented at the Pediatric Academic Societies (PAS) annual meeting.
While these findings may appear controversial, given the media attention surrounding concussion, Zemek told MedPage Today that the amount of rest required following a concussion is unknown. He added that for other neurological conditions, early return to physical activity is part of the treatment protocol.
"In severe traumatic brain injury, such as a stroke, early rehabilitation is cornerstone of management. In stroke, we know that physiological, psychological and functional benefits are clear and have become the standard of care," said Zemek. "Too much rest may lead to deconditioning and an activity restriction cascade in which children become depressed and psychologically more likely to develop persistent symptoms."
Joseph Gigante, MD, of Vanderbilt University, said in an email interview with MedPage Today said that the fact that the study measured both symptoms and return to physical activity via self-report (Web or phone surveys) was a limitation of this research.
"Children want to return to activities as soon as possible so you wonder how truthful the participants in the study were with regard to reporting symptoms," said Gigante, who was not involved with the study. "It is also counterintuitive to think there is a potential benefit of earlier return to physical activity in children who have had a concussion."
Zemek noted these limitations (though he emphasized in the presentation that there is no "gold standard" for measuring physical activity) and said that the next step would be a randomized controlled trial. He said that was necessary, because as this study proved, kids do not adhere to current concussion treatment guidelines.
"We're going to be embarking ourselves on a randomized trial, where kids are randomly assigned to exercise," said Zemek. "We know that 'home jail' doesn't work, but since the mainstay of treatment right now is rest, it's so important to make sure we get that at least right."
In the current study, besides the unadjusted analyses, Zemek and colleagues also performed a propensity score analysis, where 645 kids who returned to physical activity within a week were matched with 645 controls. They also performed an inverse probability treatment weighting of the entire cohort.
Using these three analyses, Zemek and colleagues then performed two sensitivity analyses. The first replaced used symptoms at 1 week as a baseline (instead of their initial ED evaluation) compared to 4 weeks later. All three methodologies found statistically significant differences in persistent post-concussion syndrome among kids who resumed early physical activity vs those who did not:
  • Unadjusted OR 0.42 (95% CI 0.35-0.51, P<0.001)
  • Matched propensity OR 0.75 (95% CI 0.60-0.94, P=0.013)
  • Inverse probability treatment weighting OR 0.69 (95% CI 0.57-0.85, P<0.001)
The second sensitivity analysis was limited to the children who reported ≥3 symptoms at 1 week (n=1,387). The differences remained significant in the unadjusted model (OR 0.68, 95% CI 0.54-0.85, P<0.001), but did not reach significance in the other two models. Zemek said this may have been due to small sample size.

Northern Ireland Stroke Conference Tuesday 17 May 2016, La Mon Hotel & Country Club, Castlereagh, Belfast

Not one session on tackling the neuronal cascade of death or anything on fatigue, spasticity, neuroplasticity or neurogenesis. Or any discussion on the failures of tPA. Do they not even know what the major problems in stroke are? Obviously not concerned with any direct problems of stroke survivors.
https://www.stroke.org.uk/professionals/uk-stroke-forum/northern-ireland-stroke-conference? 
What a waste. 
Unless stroke survivors start screaming bloody murder about the appalling stroke services available, we have to live with our medical staff failures to advance solutions to stroke problems.

Medical marijuana board rips Rauner's rejections - Illinois

Stroke wasn't even on the recommendation list. That is a complete failure of our stroke associations not even working to lay the groundwork for use in stroke.  They are failing your parents, grandparents, children and grandchildren for not getting all possible help for stroke recovery.
My 13 reasons for marijuana use post-stroke. Don't follow me but I will figure out some way to get some after my next stroke.
In fact it is fucking stupid for legislators to be proposing medical rules. They should lay out what clinical research is needed to prove efficacy for any disease use for any prohibited drug. Then as clinical trials conclude new diseases are automatically included. 
http://www.chicagotribune.com/news/local/politics/ct-illinois-medical-marjiuana-20160502-story.html
The board rejected using medical marijuana for persistent depressive disorder, Lyme disease and MRSA, a drug-resistant staph infection.
Ten conditions Rauner's public health agency rejected again were autism, chronic pain syndrome, irritable bowel syndrome, neuropathy, post-traumatic stress disorder???, chronic pain due to trauma, chronic post-op pain, intractable pain, migraines and osteoarthritis.

Monday, May 2, 2016

Certified Stroke Rehabilitation Specialist - NSA

So these people are good at taking tests, not necessarily can produce any results for you. If all you get is that they went thru this program but can't point to any successful recoveries then run, run, run away.
If this comes out of their mouth, 'All strokes are different, all stroke recoveries are different'. Then scream and run away.  I bet I could pass these exams without studying, not that it does any good, my recovery still has a long way to go.
http://www.stroke.org/we-can-help/healthcare-professionals/improve-your-skills/tools-training-and-resources/csrs

Program Overview

The Certified Stroke Rehabilitation Specialist (CSRS) enables therapists to become preeminent stroke clinicians through a rigorous set of courses culminating in a written examination and nationally-recognized credential.
The program consists of a four-tiered, seminar-based, stroke educational program. Each, CSRS seminar is 8 hours (6.5 hours of continuing education units). Successive seminars build on knowledge gained in previous courses, with the series culminating in an online test. Successful test completion with a score of 80% or above grants the CSRS certification, which are placed behind your professional credentials.
View the CSRS Directory

Goals and Objectives

The CSRS credential indicates successful completion of 32 hours of current, evidence-based instruction with hands-on-training, and a commitment to maintaining up-to-date education. The program provides you with the knowledge and tools to excel in the rehabilitation setting.

Courses

The CSRS educational program consists of four 8 hour seminars, which usually take place on weekends over a few months.
Course locations will vary each year and the courses fill quickly.
Learn more

Testing process

The certification exam is available online. The cost of the certification exam is $150 for National Stroke Association members and $175 for non-members (this is in addition to the fees collected for the seminars).
A list of designated CSRS will be maintained for professional verification.

Target Audience

Physical Therapists, Physical Therapy Assistants, Occupational Therapists and Occupational Therapy Assistants looking for evidenced-based information on stroke rehabilitative care.

Maintaining Certification

To maintain current certification, 16 hours of continuing education specific to stroke and a re-certification fee of $75 for National Stroke Association members and $100 for non-members will be necessary every 2 years.
Get Recertified
Download this PDF for more information on examples of approved continuing education options. A random sampling of 10 percent of renewal applicants will be contacted to submit documentation of their continuing education activities.

Discounts for National Stroke Association Members

Employees of Stroke Center Network facilities and individuals with Professional Society memberships are eligible for a 10% discount on the CSRS seminars. Members also receive a discount on the CSRS certification exam and recertification fees.
Learn more

Legal Information
The Certified Stroke Rehabilitation Specialist (CSRS) designation indicates that a Physical Therapist, Physical Therapy Assistant, Occupational Therapist or Occupational Therapy Assistant has completed advanced training through a series of four seminars and successfully completed an examination on that material.
Certification indicates that a person has met the specific requirements of the certification process, but is not a guarantee of competency, accuracy, or any particular treatment result.
The CSRS does not inherently expand a professional’s scope of practice.  It does not certify expertise.  It does not qualify a Physical Therapist, Physical Therapy Assistant, Occupational Therapist or Occupational Therapy Assistant to offer professional services without the appropriate licensure or credentials.
National Stroke Association shall not be liable for any loss, damage, injury, claim, or otherwise, whether an action in contract or tort and shall further not be liable for an lost profits, or direct, indirect, special, punitive, or consequential damages of any kind (including, without limitation, attorneys’ fees and expenses).

Dramatic Results Seen in Pilot Stroke Recovery Navigator(SM) Program

So once again after the fact interventions are proposed and set up, rather than actually preventing lots of these problems in the first place by stopping the neuronal cascade of death. Are there any functioning neurons anywhere in the National Stroke Association?
http://www.reuters.com/article/idUSnMKWfJ9VHa+1d6+MKW20160218
(Marketwired - Feb 18, 2016) - National Stroke Association released today the promising results from the pilot of its Stroke Recovery Navigator(SM) program (SRN) at the International Stroke Conference in Los Angeles. The results underscore the value and impact of human connections, personal guidance and support in stroke recovery, to survivors and caregivers alike.
In 2014, National Stroke Association launched the pilot program to examine the use of community-based patient navigation with stroke survivors and their caregivers. The SRN program was designed as a telephone-based navigation program to engage survivors and/or their caregivers from two to six months post-discharge after a stroke. The results were dramatic:
  • Re-hospitalizations dropped to 13% from 49%, the national average for all-cause re-hospitalization.
  • 90% of participants (92% of survivors, 88% of caregivers) reported that the stroke survivor was taking medications exactly as directed.
  • 95% of participants found the SRN program to be a valuable service. 
  • 85% reported that the program made them feel better equipped to make decisions about their health.
"Stroke Recovery Navigator is the only patient navigator program of its kind in the United States," said Julia Richards, Survival Programs Manager at National Stroke Association. "We expected positive outcomes from this pilot, but we were really amazed at how dramatic the benefits were all around -- from the stroke survivors, to the caregivers, to even the hospitals. We're excited to share these promising findings with the larger stroke community."
A stroke leaves survivors and their caregivers without time to prepare for life after stroke. For the 795,000 people who will survive a stroke this year, the return home can mean long-term disability, isolation, confusion and for nearly half, re-hospitalization. For caregivers, the added responsibility can be overwhelming and often leads to dangerous increases in stress and anxiety.
Stroke Recovery Navigator Pilot Program: Subjects and Methods
National Stroke Association initiated a pilot of the Stroke Recovery Navigator program with the goal of reintegrating clients into their community and measuring the impact of patient navigation in the stroke community. A voice of hope for stroke survivors, SRN's telephone support engaged survivors and caregivers, providing help with medication management, overcoming barriers, confronting relationship problems, identifying community services for such needs as transportation, and general adaptations to daily living.
During the six-month pilot program, 89 participants were included in the SRN program. Referred survivors or caregivers were contacted within three to five days, and weekly thereafter.
The program addressed the following topics:
  • barriers to care
  • adjusting to deficits from stroke
  • connection with Stroke Support Groups
  • unexpected consequences of post-stroke recovery
  • prevention of secondary stroke
  • management of stroke risk factors
  • community resources to address challenges experienced by the survivor or caregiver
  • management of post-stroke conditions
  • return to work, and
  • emotional support for adjustment to community living.
  • (Nothing on rehabilitation protocols to get to 100% recovery)  
At enrollment, participants were provided with a recovery packet of information from National Stroke Association, including Hope: A Stroke Recovery Guide, as well as tools for managing stroke risk factors.
Participants reported that they valued the relationship with their Navigator and appreciated the information given to them. As stroke survivors moved through the navigation program, they reported a greater confidence in their ability to manage daily activities and assessed themselves as better able to engage with their community.
Additionally, Navigators noted that caregivers reported more satisfaction with their stroke survivors' adjustment, leading to a reduction in their perception of the burden of care. Participating hospitals also reported satisfaction with the program. They indicated a desire to have a closer relationship with the Navigators and to get specific feedback regarding patient participation and satisfaction with the program.
"These results clearly point to the benefit of navigation services in the stroke disease state," added Richards. "Post-discharge support is imperative to recovery. This pilot program provides important validation that more should be done in this arena to service to the stroke community."

Cardiovascular risk tool overestimates actual chance of cardiovascular events

A completely worthless article, no link to the problem calculator in question.
http://medicalxpress.com/news/2016-05-cardiovascular-tool-overestimates-actual-chance.html
A widely recommended risk calculator for predicting a person's chance of experiencing a cardiovascular disease event—such as heart attack, ischemic stroke or dying from coronary artery disease—has been found to substantially overestimate the actual five-year risk in adults overall and across all sociodemographic subgroups. The study by Kaiser Permanente was published today in the Journal of the American College of Cardiology.
Atherosclerotic , also known as atherosclerosis, is a silent disease that starts early in life and can have serious consequences, including heart attack, stroke or even death if untreated. It progresses through a build-up of cholesterol plaque and other substances in the walls of arteries, causing obstruction of blood flow. Evidence-based use of statins to reduce cholesterol has been a cornerstone for primary prevention of atherosclerotic cardiovascular disease events in those patients who are at high enough risk to benefit.
Publication of the American College of Cardiology and American Heart Association Pooled Cohort risk equation for estimating the likelihood of atherosclerotic cardiovascular disease events in 2013 was considered an important step forward. However, the equation was developed from several groups of enrolled volunteers primarily conducted in the 1990s with limited ethnic diversity and age range, so its accuracy may vary in current community-based populations.
"Our study provides critical evidence to support recalibration of the risk equation in 'real world' populations, especially given the individual and public health implications of the widespread application of this risk calculator," said senior author Alan S. Go, MD, chief of Cardiovascular and Metabolic Conditions Research at the Kaiser Permanente Northern California Division of Research.
The actual incidence of atherosclerotic cardiovascular disease events over five years was substantially lower than the predicted risk in each category of the ACC/AHA Pooled Cohort equation:
  • For predicted risk less than 2.5 percent, actual incidence was 0.2 percent
  • For predicted risk between 2.5 and 3.74 percent, actual incidence was 0.65 percent
  • For predicted risk between 3.75 and 4.99 percent, actual incidence was 0.9 percent
  • For predicted risk equal to or greater than 5 percent, actual incidence was 1.85 percent
"From a relative standpoint, the overestimation is approximately five- to six-fold," explained Dr. Go. "Translating this, it would mean that we would be over-treating a good many people based on the ."
The study followed a population of 307,591 men and women aged 40 to 75 years old, including non-Hispanic whites, non-Hispanic blacks, Asian, Pacific Islanders and Hispanics, from 2008 through 2013 and had complete five-year follow-up. The study population did not include patients with diabetes, prior atherosclerotic cardiovascular disease, or prior use of lipid-lowering therapy such as statins.
To determine whether the risk equation might be improved by being recalibrated in "real world" clinical care, Kaiser Permanente researchers examined a large, multi-ethnic, community-based population of the health plan's members in Northern California whose cholesterol levels and other clinical measures could theoretically trigger a discussion about whether to consider starting cholesterol-lowering therapy based on estimated risk using the ACC/AHA Pooled Cohort tool.
Among both men and women, there was consistent overestimation of observed five-year atherosclerotic cardiovascular disease incidence in each predicted risk category, with similarly poor calibration in both genders. Researchers also found consistent overestimation of actual atherosclerotic cardiovascular disease risk in each of the major ethnic subgroups. Results were also similar across measures of socioeconomic status.
On the other hand, researchers found that observed atherosclerotic was substantially closer to that predicted by the ACC/AHA tool among adults with diabetes who were not treated with statin therapy for primary prevention.
"Statin therapy is a mainstay treatment for millions of Americans," said lead author Jamal S. Rana, MD, PhD, cardiologist at Kaiser Permanente Oakland Medical Center and adjunct investigator with the Division of Research. "Our study highlights the importance of ongoing research and dialogue in this area to provide more rigorous evidence to guide treatment for the patients most likely to benefit from this approach."
Journal reference: Journal of the American College of Cardiology search and more info website

Mild CAD - Coronary artery disease

The results from my heart catheterization were that two small arteries were 30% blocked, one other scanned was clear. So no real worry there, my blood pressure pills and statins should keep it at bay. Was really disappointed that there was no mention of foods that can clear the plaque in arteries.
I'm doing all of these, will never know if they work at all.

Watermelon juice reverses hardening of the arteries  

Pomegranate juice consumption for 3 years by patients with carotid artery stenosis reduces common carotid intima-media thickness, blood pressure and LDL oxidation 

Cranberry juice consumption may protect against cardiovascular disease

 

Drinking low-calorie cranberry juice may help lower risk of heart disease, diabetes and stroke

Black Raspberry Extract Increased Circulating Endothelial Progenitor Cells and Improved Arterial Stiffness in Patients with Metabolic Syndrome: A Randomized Controlled Trial 

 

High blood pressure: Why me?

A great read from Harvard Health Publications.
http://www.health.harvard.edu/blog/high-blood-pressure-why-me-201605029288
No one explained any cause for my hypertension, I get enough exercise, doing 10,000 steps a day(5 miles), No extra salt, slightly overweight, alcohol = yes.
Now almost under control with Amlodipine, bloated ankle as a side effect.

National Stroke Awareness Month 2016

So rather than actually solve any of the problems in stroke, let's just be lazy and raise awareness. Damn small bore ideas, I want the BHAGs(Big Hairy Audacious Goals) worked on and solved.
Or you can enable such pathetic responses by donating. Up to you.
1. Make neuroplasticity repeatable on demand. 
2. Make neurogenesis repeatable on demand.
 3. Solve spasticity, Ignore Dr. William M. Landaus' pronouncements on this. 
4. Solve fatigue.
5. Solve aphasia. 
http://support.stroke.org/site/R?i=8shCjDaB7sDiRyidDOnnyQ



National Stroke Awareness Month 2016
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National Stroke Awareness Month is a great opportunity to ask questions and get answers.Our Idea Generator Tool is an interactive way to find out the best way you can raise awareness of stroke. This simple tool asks three questions to identify the most effective way you can help make a difference.