Deans' stroke musings

Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 438 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

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

Wednesday, October 7, 2015

Stroke patients with spatial neglect more likely to fall and have longer stays in hospital

Well shit, and water is wet.  We'll see if they approve my comment. And I bet water is wet also. Were any solutions to this problem proposed?
Using the Kessler Foundation Neglect Assessment Process (KF-NAP), Kessler researchers found a high rate of spatial neglect among inpatients with stroke. Affected patients had a higher risk for falls, longer lengths of stay and lesser likelihood of returning home after discharge. "Impact of Spatial Neglect on Stroke Rehabilitation: Evidence from the Setting of an Inpatient Rehabilitation Facility" was published in the Archives of Physical Medicine & Rehabilitation (doi: 10.1016/j.apmr2015.03.019. The authors are Peii Chen, PhD, and A.M. Barrett, MD, of Kessler Foundation, and Kimberly Hreha, MS, and Yekyung Kong, MD, of Kessler Institute for Rehabilitation.
Of 108 stroke patients screened at admission with the KF-NAP, 68.4% had spatial neglect. This complication was more common and more severe after right brain stroke. "Higher KF-NAP scores were associated with lower FIM scores and prolonged recovery during rehabilitation," said Peii Chen, PhD, research scientist. "Falls were 6.5 times more likely in the group with spatial neglect and hospital stays were 10 days longer. Moreover, people with spatial neglect were 45% less likely to be discharged home. To lessen this negative impact on outcomes, screening for spatial neglect and specific early intervention are essential."
Kessler Foundation

Cancer Research UK invests £15 million to unite finest minds across UK to develop better treatments

The key point here is uniting the finest minds. In stroke nobody seems to want to attempt that. The WSO had their World Stroke Organization Synergium in 2010 and you can see why in my opinion it is totally worthless. You as a stroke survivor are totally screwed until the complete stroke leadership is deposed and removed from any part of this.
My list of finest minds:
Dr. Steven Wolf;
Peter Levine
Dr. S. Thomas Carmichael;
Dr. Bruce H. Dobkin;
Dr. Dale Corbett;
Dr. Michael Tymianski, of the Toronto Western Hospital Research Institute in Canada;
Dr. Michael A. Moskowitz ;
Dr. Watson, IBM computer;
Dr. Google;
Dr. Amy Shissler;
Barb Polan;
Jo Murphy;  
Rebecca Dutton
My list of those that should NOT be invited:
Dr. William M. Landau - his ideas on spasticity are appalling;
Matt Lopez, president of the NSA;
Dr. Mariel Jessup, president of the ASA;
WSO President - Steve Davis (Australia); 

Immediate Past-president WSO - Bo Norrving (Sweden)

Learning from "Super Agers": What Centenarians Can Teach Us About Aging Well

I'm going to be a super-ager. My Mom and Dad are already 85 and 88 and considering my health compared to theirs I will easily pass that even after having my stroke. I plan on having wine parties well into my nineties. Is your doctor doing anything to help you age well? Or is it , Die early, die young?
The number of centenarians is predicted to increase threefold over the next two decades. Examine what these "super agers" can tell us about aging, the health and well-being of older adults, and our understanding of dementia.
ELIZABETH KELSON is a postdoctoral fellow and sessional lecturer in the UBC School of Nursing.
This is a One Day @ UBC Centennial Lecture. As part of the UBC Centennial celebrations, UBC Continuing Studies is offering 20 free lectures on Saturdays at the UBC Point Grey campus from September 2015 through May 2016. Find out more.

Course Format

The format of this lecture is in-class.

Available Sessions

Open all | Close all
Oct 17-Oct 17, 2015 | Sat | 9:30am-12:00pm |UBC Point Grey | $0.00

For decades, the government steered millions away from whole milk. Was that wrong?

I have no idea. Your doctors and hospital nutritionists should be analyzing this and come up with a stroke diet protocol. No protocol, they should be fired. This pretty much proves the earlier post on research:

Editor In Chief Of World’s Best Known Medical Journal: Half Of All The Literature Is False

Tuesday, October 6, 2015

Soon we'll cure diseases with a cell, not a pill

This switch in thought processes can't come too soon for stroke. But I bet not a single stroke leader will think of putting this into practice for solving all the problems in stroke. Our current stroke leadership is non-existent. We should be growing all the different types of neurons along with a blood supply to nourish them. There is the request for proposal to researchers. Send it out to find out what the cost would be to find answers and then go grant writing to get foundations to pay for that research. It's so fucking simple to accomplish stroke solutions. You describe the problem in specific terms that researchers will be able to create clinical trials on. None of this pie-in-sky research.
Current medical treatment boils down to six words: Have disease, take pill, kill something. But physician Siddhartha Mukherjee points to a future of medicine that will transform the way we heal.

The Daily Chore That Can Increase Mental Stimulation and Decrease Anxiety - Mindful dishwashing

Sounds like something our doctors could initiate in the next couple of days. But I bet this will never occur.
When done properly, the chore decreased nervousness by 27% and increased mental inspiration by 25%.
Mindful dishwashing can decrease stress and calm the mind, a new study finds.
People in the study focused on the smell of the soap, the feel and shape of the dishes to help them enter a mindful state.
Doing the dishes in a mindful way also increased the pleasurable feeling of time slowing down, the researchers found.
Mr Adam Hanley, the study’s first author, said:
“I’ve had an interest in mindfulness for many years, both as a contemplative practitioner and a researcher.
I was particularly interested in how the mundane activities in life could be used to promote a mindful state and, thus, increase overall sense of well-being.”
In the study 51 people were split into two groups.
One group did the dishes in their normal way — most likely while letting their minds wander to the usual anxieties.
The other group were encouraged to focus on the sensory experience of washing the dishes.
The mindful group showed a 27% decrease in nervousness.
They also reported a 25% increase in mental inspiration.
This was an impressive result given that people were only washing dishes for six minutes.
The study’s authors write:
“It is interesting to note that a task potentially construed as unpleasant or a “chore” can be experienced as reducing nervousness and being inspirational by simply shifting one’s approach to the task and quality of attention.
That mindfulness practices elevate mindfulness, encourage positive affect, and decrease negative affect is well established; however, that these changes were associated with the coupling of a mindful practice with an everyday task is a novel finding.”


This first line is not occurring in stroke health care:
The crisis in stroke is simple; nothing is available or works. Our providers have been failing for so long they don't even know what the goal is. Only 19 pages that your hospital should be able to implement in the next 50 years. If you want it sooner you'll have to install your own stroke department head. 
What's the solution to the world's seemingly intractable health care crisis? It starts with a clear and achievable goal—better value—supported by an innovative strategy that's driven by the needs of patients, not providers. In this Harvard Business Review article, Harvard Business School Faculty Chair Michael Porter and his co-author outline such a strategy. They present a groundbreaking approach to high-value health care that focuses on six components: medical conditions, measurement of costs and outcomes, bundled pricing, integrated care delivery, geographically expanded service, and an enabling IT platform. 

Tired of Post-stroke Fatigue? - StrokeSmart magazine

Pretty much worthless. You doctors only effort in this seems to be testing for sleep apnea.
As a stroke survivor, you may be struggling with fatigue. That’s not surprising. Strokes are physically and emotionally exhausting. Most stroke survivors grapple with some sort of fatigue and many have trouble sleeping.
“Sleep has a great restorative function,” says Kyoung Bin Im, M.D., M.S, staff physician at University of Iowa Hospitals and Clinics’ Sleep Disorders Center and assistant professor of clinical neurology and psychiatry at Roy J. and Lucille A. Carver College of Medicine. “Stroke affects the brain itself—sleep may be even more important for stroke survivors.”
If you’re a stroke survivor and you never feel rested, consider these recommendations:
Wake up at the same time every morning.
Go to bed only when you are ready to fall asleep. “Bed time isn’t as important as the time you wake up. Don’t go to bed until you feel really ready,” Dr. Im says. “Lots of patients with insomnia go to bed too early in the evening.”
Don’t worry about the number of hours of sleep you’re getting. “There’s no right amount of sleep in terms of a number. In general, sleeping seven to nine hours is a really healthy duration,” Dr. Im says, adding some people need more and some need less. The key is whether you feel refreshed.
Talk to your doctor if you are tired and are having trouble sleeping, especially if you are snoring, gasping for breath, or waking up a lot. Obstructive sleep apnea is common in stroke survivors.
Avoid sleeping on your back. This can help with sleep apnea. “Sleeping on the side can make a huge difference,” Dr. Im says. Sleeping on the back may not be right for everyone. Ask your doctor if it’s OK for you.
Consider pillows. They are not just for your head. Using a body pillow can be helpful and keeping a pillow behind your back may help you stay on your side.
Get exposure to light in the morning. “It could be a natural source—sunlight—or a light box,” Dr. Im says. “That morning light will reset your time clock in the brain.”
If your primary care physician can’t solve your sleep challenges, Dr. Im suggests asking for a referral to a sleep specialist.
“Sleep is really important in restoring function back,” Dr. Im says.

8 Steps to Use Physical Therapy to Recover From a Stroke

Pretty damn worthless. Once again dumping all the recovery planning on the survivor.

Method 1 of 2: Using Physical Therapy While in the Hospital

1. Talk to your doctor.
2. Start moving as soon as you are directed to.

3. Discuss any disabilities with your doctors and medical staff.

4. Talk to your health insurance company about your benefits. 

Method 2 of 2: Using Physical Therapy After Discharge

1. Meet with your physical therapist to discuss goals and treatments. 

2. Follow the exercise program created by your physical therapist. 

3. Involve your family and close friends. 

4. Develop a regular schedule of physical therapy.
Details at link

Design of a biofeedback device for gait rehabilitation in post-stroke patients

I wonder if these earlier insole and sock versions are better? What does your doctor think? Do they really think negative reinforcement is a good idea?

  Sensoria™ Fitness Socks

Rapid Rehab Smart Insole Will Train Athletes and Assist Rehab Patients

 Design of a biofeedback device for gait rehabilitation in post-stroke patients

5 Author(s)
Khoo, I-Hung ; Electrical Engineering Department, California State University, Long Beach, 90840, United States ; Marayong, Panadda ; Krishnan, Vennila ; Balagtas, Michael Nico
more authors
A novel device, named ‘Walk-Even’, was developed to measure human gait and provide real-time feedback to correct gait asymmetry. Gait asymmetry is usually exhibited in patients with stroke or with certain neurological disorders. Our device can measure the weight pressure distribution that the patient exerts on each foot, in addition to the gait time, swing time, and stance time of each leg while walking. Based on the real time information, a biofeedback is given by means of auditory, and unpleasant electrotactile stimulation to actively correct gait asymmetry. The device consists of custom insoles with embedded force sensors adjustable to fit any shoe size, electrotactile and auditory feedback circuits, microcontroller, and wireless XBee transceivers. We compared the gait measurements from our device with that of a commercial device (MobilityLab) to verify its accuracy. Preliminary testing on post-stroke patients has shown that our device helps to improve their gait symmetry.

Published in:

Circuits and Systems (MWSCAS), 2015 IEEE 58th International Midwest Symposium on

Date of Conference:

2-5 Aug. 2015


Insole plantar pressure systems in the gait analysis of post-stroke rehabilitation

I wonder if these earlier insole and sock versions are better? What does your doctor think?

  Sensoria™ Fitness Socks

Rapid Rehab Smart Insole Will Train Athletes and Assist Rehab Patients


Insole plantar pressure systems in the gait analysis of post-stroke rehabilitation
3 Author(s)
Qin, Lai-yin ; Division of Biomedical Engineering, Faculty of Engineering, The Chinese University of Hong Kong, Hong Kong ; Ma, Hao ; Liao, Wei-Hsin
This article presents a review of the application of insole plantar pressure sensor system in recognition and analysis of the hemiplegic gait in stroke patients. Based on the review, tailor made 3D insoles for plantar pressure measurement were designed and fabricated. The function is to compare with that of conventional flat insoles. Tailor made 3D contour of the insole can improve the contact between insole and foot and enable sampling plantar pressure at a high reproducibility.

Published in:

Information and Automation, 2015 IEEE International Conference on

Date of Conference:

8-10 Aug. 2015

Towards a bio-inspired control strategy for bilateral stroke rehabilitation based on motor control principles

I'm sure someplace in there is some useful information for us. But your doctor should be reading all these research articles as part of their goals and objectives from their hospital. And then update the stroke protocols as needed.
3 Author(s)
Singh, Anushree ; Rehabilitation Robotics Lab, University of Pennsylvania, Philadelphia, USA. 19104 ; Rai, Roshan ; Johnson, Michelle J.
Conventional robotic devices used for robot aided neurorehabilitation focus on unilateral training of the upper extremity post neurologic injury such as stroke, cerebral palsy etc. In this paper, we seek to establish adherence of bimanual motions of healthy and stroke subjects to the higher laws governing principles of symmetric and asymmetric division of labor in bimanual activities. As a first pass, we propose three metrics to capture these principles. We identify that the Euclidean and velocity difference metrics were able to capture key aspects of key bilateral motion control principles for the bilateral tasks studied, but may fall short if the tasks were different and asymmetric. We propose a control strategy to use the metrics to support task-oriented, bilateral stroke rehabilitation. Future work requires the development of metrics that more fully capture the motor control principles irrespective of tasks and the implementation of a bilateral controller.

Published in:

Rehabilitation Robotics (ICORR), 2015 IEEE International Conference on

Date of Conference:

11-14 Aug. 2015

Stroke rehabilitation: long-term rehabilitation after stroke - UK

It would be nice to have publicly available the Health and Care Excellence Clinical Guideline 162 on stroke rehabilitation. Just to see if anything there is specific and useful at all. But I'm sure you're going to be left in the dark because you're just a patient, you don't need to know the efficacy of stroke protocols.
  1. E Diane Playford, reader in neurological rehabilitationC
+ Author Affiliations
  1. ARoyal College of Obstetricians and Gynaecologists, London, UK
  2. BNational Clinical Guideline Centre, Royal College of Physician, London, UK
  3. CUCL Institute of Neurology, London, UK
  1. Address for correspondence: Dr D Playford, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK.Email:


Many stroke survivors, despite improvements in mortality and morbidity, remain dependent on others for everyday activities. People with stroke need access to effective specialist multidisciplinary rehabilitation services that are organised and integrated within the whole system of health and social care. They also commonly come under the care of generalists in various clinical contexts, including intercurrent illness. This Clinical Medicine Concise Guideline abstracts key recommendations from the National Institute for Health and Care Excellence Clinical Guideline 162 on stroke rehabilitation of particular relevance to clinicians in general medicine, to inform their front-line practice and promote liaison and collaboration with the specialist service.

A feasibility study to assess intralimb coordination in stroke rehabilitation: two indices of mechanical impedance by coactivation of agonist muscles

I'm sure that someplace in here is some good information on how we can recover. But it is gobbledegook to me.

9 Author(s)
Oku, Takanori ; Department of Mechanical Science and Bioengineering, Graduate School of Engineering Science, Osaka University, Toyonaka, 560-8531, Japan ; Uno, Kanna ; Nishi, Tomoki ; Kageyama, Masayuki
more authors
Stroke rehabilitation requires intralimb coordination to achieve natural movement after recovery. Focusing on mechanical impedance by the coactivation of agonist muscles, we performed two experiments to assess the intralimb coordination of a post-stroke subject using two indices of the endpoint stiffness and muscle synergies. The results of the first experiment showed that the endpoint stiffness of a post-stroke subject during posture maintenance estimated from muscle synergy analysis resembled that estimated from the mechanical perturbation method. Based on the validity of proposed muscle synergy analysis shown in the first experiment, the results of the second experiment revealed that muscle activities of both the post-stroke and healthy subjects are composed of three muscle synergies in the circle-tracing task. These muscle synergies were invariant despite being determined from time-variant muscle activities; muscle synergies of the post-stroke subject before rehabilitation were different from those of the healthy subject. In addition, the muscle synergies of the post-stroke subject after rehabilitation resembled those of the healthy subject. It is assumed that the post-stroke subject regained appropriate muscle synergies (i.e., the balance of mechanical impedance) after rehabilitation. This study tested the feasibility for practical uses in the assessment, diagnosis, and interventions for stroke rehabilitation using two indices of muscle synergies and endpoint stiffness.

Published in:

Rehabilitation Robotics (ICORR), 2015 IEEE International Conference on

Date of Conference:

11-14 Aug. 2015

Ipsilateral Motor Pathways after Stroke: Implications for Non-Invasive Brain Stimulation

I'm sure your doctor can figure out how to use this in your stroke rehabilitation protocols. Way beyond my pay grade.


In humans the two cerebral hemispheres have essential roles in controlling the upper limb. The purpose of this article is to draw attention to the potential importance of ipsilateral descending pathways for functional recovery after stroke, and the use of non-invasive brain stimulation (NBS) protocols of the contralesional primary motor cortex (M1). Conventionally NBS is used to suppress contralesional M1, and to attenuate transcallosal inhibition onto the ipsilesional M1. There has been little consideration of the fact that contralesional M1 suppression may also reduce excitability of ipsilateral descending pathways that may be important for paretic upper limb control for some patients. One such ipsilateral pathway is the cortico-reticulo-propriospinal pathway (CRPP). In this review we outline a neurophysiological model to explain how contralesional M1 may gain control of the paretic arm via the CRPP. We conclude that the relative importance of the CRPP for motor control in individual patients must be considered before using NBS to suppress contralesional M1. Neurophysiological, neuroimaging, and clinical assessments can assist this decision making and facilitate the translation of NBS into the clinical setting.
Keywords: stroke, rehabilitation, upper limb, propriospinal, transcranial direct current stimulation


Reaching forward with the arm to manipulate objects with the hand is a quintessential function for higher order primates. Upper limb movements involve a fine balance between proximal stability and distal dexterity, presenting a unique motor control challenge to the central nervous system. There is a growing body of evidence that skilled upper limb function is under the control of both contralateral (cM1) and ipsilateral (iM1) motor cortices (Chen et al., 1997; Gerloff et al., 1998; Muellbacher et al., 2000; Hummel et al., 2003; Sohn et al., 2003; Verstynen et al., 2005; Davare et al., 2007; Duque et al., 2008; Perez and Cohen, 2008, 2009; Lee et al., 2010). Exactly how iM1 contributes to ipsilateral upper limb control is unclear, and is likely to involve both interhemispheric and descending projections. Neurophysiological studies have shown that iM1 assists cM1 to shape motor output by modulating the degree of transcallosal inhibition between homologous muscle representations in the two hemispheres (Sohn et al., 2003; Davare et al., 2007; Perez and Cohen, 2008). The potential importance of descending pathways from iM1 to spinal cord for upper limb control has largely been ignored. In this paper we present a novel hypothesis to account for how iM1 contributes to skilled upper limb motor control. We propose that the pathway involves a robust ipsilateral projection called the cortico-reticulo-propriospinal pathway (CRPP), based on findings in the cat and non-human primate (Illert et al., 1981; Alstermark et al., 1984; Isa et al., 2006). The CRPP descends from iM1 via the reticulospinal tract and terminates on propriospinal neurons (PNs) located at C3/4 in the spinal cord (Alstermark et al., 2007). PNs project to alpha motoneurons (αMNs) innervating muscles involved in specific tasks so movements can be rapidly generated and modified as necessary (Pierrot-Deseilligny and Burke, 2005). Our hypothesis is that neural inputs from the CRPP are integrated by PNs with those from the disynaptic (indirect) portion of the contralateral corticospinal tract. As a result, descending inputs from both hemispheres shape the final motor command reaching αMNs innervating upper limb musculature for optimal movement control.
Up-regulation of contralesional motor cortex excitability and the CRPP pathway may be important for paretic arm function after stroke (Turton et al., 1996; Netz et al., 1997; Alagona et al., 2001; Lewis et al., 2004; Misawa et al., 2008), particularly in poorly recovered patients (Turton et al., 1996; Netz et al., 1997; Gerloff et al., 1998; Caramia et al., 2000; Trompetto et al., 2000; Lewis and Perreault, 2007; Misawa et al., 2008). The degree of reorganization toward contralesional hemisphere control may depend on the residual integrity of white matter tracts from the ipsilesional hemisphere (Ward et al., 2006, 2007; Stinear et al., 2008; Grefkes and Fink, 2011). The neurophysiological model proposed here explains how increased excitability of the CRPP disrupts the normal cM1-iM1 balance of descending inputs reaching C3/4 PNs. In patients with a relatively intact ipsilesional corticospinal tract, up-regulation of the CRPP pathway would interfere with descending commands to PNs from the ipsilesional cortex. The model also accounts for why the CRPP is integral to residual function when the ipsilesional corticospinal tract is severely compromised. In these patients the CRPP may be the only intact descending pathway from cortex to spinal cord, and therefore of particular importance for their motor recovery.
Finally, a contribution by contralesional M1 to upper limb motor control via the CRPP has implications for NBS protocols aimed at improving rehabilitation of the paretic upper limb after stroke. The proposed model shows that contralesional M1 suppression after NBS may affect stroke patients differently depending on the severity of damage to the ipsilesional corticospinal tract and the degree of up-regulation of the contralesional CRPP. Studies that have included more severely impaired patients seem to indicate paretic upper limb motor performance is degraded by contralesional M1 NBS (Ackerley et al., 2010; Theilig et al., 2011; Bradnam et al., 2012). We propose that NBS protocols that aim to suppress contralesional M1 may be contraindicated for some patients. We argue that NBS is not a “one size fits all” solution for recovery after stroke, but that it can be tailored to individual patients based on neurophysiological and clinical biomarkers that are relative easy to obtain (Stinear et al., 2007, 2012; Jang et al., 2010; Kwon et al., 2011; Riley et al., 2011).

More at link.

Degree of muscle shortening in chronic hemiparesis in patients not treated with guided self-rehabilitation contracts (GSC)

More research that describes a problem but offers no solutions or suggests more research.
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Antagonist muscle resistance, including due to muscle contracture, is a fundamental factor of motor impairment in spastic paresis. We aimed to quantify the degree of shortening in the main muscles involved in chronic hemiparesis (>1 year post-lesion), in patients following a conventional system of rehabilitation.


From their first clinic visit in the neurorehabilitation unit of the PM&R department we retrospectively collected the assessments of passive range of motion (XV1) – based on the 5-step clinical assessment, including the Tardieu Scale – against 8 key antagonists in the lower limb (n = 19 patients with chronic hemiparesis, age: 48 ± 13, mean ± SD; time since lesion 3.7 ± 3.8 years) and 13 antagonists in the upper limb (n = 13 patients, age: 39 ± 13, mean ± SD; time since lesion 5.2 ± 3.9 years), then derived coefficients of shortening (CSH) by referring them to the normal expected amplitude (XN), CSH = (XN-XV1)/XN.


The higher coefficients of shortening were: vertical adductors (latissimus dorsi – pectoralis major – teres major), 36 ± 3%; shoulder extensors with flexed elbow (long head of triceps; latissimus dorsi) 33 ± 4%; horizontal adductors (pectoralis major), 23 ± 1%; gastrocnemius, 20 ± 1%; soleus, 15 ± 2%; gluteus maximus, 16 ± 3%; rectus femoris, 12 ± 1% and pronator teres, 12 ± 4%.


Shoulder extensors, plantar flexors and gluteus maximus in patients untreated with self-stretching postures have undergone major muscle shortening in chronic hemiparesis. A future study could assess the effectiveness of stretching postures taught and applied from the early phase of stroke on shortening of these muscles.

Monday, October 5, 2015

Guides to Recovering from a Stroke - Stroke Recovery Association of British Columbia

This is pretty good for what is says, but it is totally appalling for what it doesn't say. There is nothing in there that suggests your doctor can do anything for you. Because there are NO stroke rehab protocols.

Prescription for recovery? Researchers determine ideal DOSE of exercise to improve walking, thinking and quality of life after stroke

I think the ideal dose is 'A lot more than any therapist is willing to give you'. I'd suggest 8 hours a day, that way you could get in 10,000 hours of exercise in only 1250 days. And since you probably have lots of muscles to recover you have lots of batches of 1250 days to complete.

Determining Optimal post-Stroke Exercise (DOSE) trial is the first study to control for exercise intensity and dose early after stroke.  Preliminary data have found that individuals post-stroke in in-patient rehabilitation programs may be able to tolerate more exercise during their day. Funded by the HSF Canadian Partnership for Stroke Recovery and led by researchers in Vancouver, Calgary and Toronto, the goal of the DOSE trial is determine the appropriate exercise prescription to promote optimal recovery in the early phase after stroke. The first phase of the study assigned 20 stroke patients to one of three groups: usual care physical therapy, usual care physical therapy replaced by an hour of physical therapy emphasizing aerobic and walking exercise, or usual care physical therapy replaced by two hours of physical therapy emphasizing aerobic and walking exercise. Preliminary data have shown that patients can tolerate a daily, two-hour intensive physical therapy exercise program emphasizing walking and aerobic exercise during inpatient rehabilitation. The DOSE trial will recruit a total of 75 participants and investigate how exercise may improve walking, cognition, and quality of life in stroke patients at a critical stage of rehabilitation and recovery.
Principal investigators: Janice Eng at UBC, Sean Dukelow at U of Calgary and Mark Bayley at Toronto Rehab.

Editor In Chief Of World’s Best Known Medical Journal: Half Of All The Literature Is False

Well shit, now more than ever we need stroke survivors directing and running the strategy for solving all the problems in stroke.
In the past few years more professionals have come forward to share a truth that, for many people, proves difficult to swallow. One such authority is Dr. Richard Horton, the current editor-in-chief of the Lancet – considered to be one of the most well respected peer-reviewed medical journals in the world.
Dr. Horton recently published a statement declaring that a lot of published research is in fact unreliable at best, if not completely false.
“The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue. Afflicted by studies with small sample sizes, tiny effects, invalid exploratory analyses, and flagrant conflicts of interest, together with an obsession for pursuing fashionable trends of dubious importance, science has taken a turn towards darkness.” (source)This is quite distrubing, given the fact that all of these studies (which are industry sponsored) are used to develop drugs/vaccines to supposedly help people, train medical staff, educate medical students and more.
It’s common for many to dismiss a lot of great work by experts and researchers at various institutions around the globe which isn’t “peer-reviewed” and doesn’t appear in a “credible” medical journal, but as we can see, “peer-reviewed” doesn’t really mean much anymore. “Credible” medical journals continue to lose their tenability in the eyes of experts and employees of the journals themselves, like Dr. Horton.
He also went on to call himself out in a sense, stating that journal editors aid and abet the worst behaviours, that the amount of bad research is alarming, that data is sculpted to fit a preferred theory. He goes on to observe that important confirmations are often rejected and little is done to correct bad practices. What’s worse, much of what goes on could even be considered borderline misconduct.
Dr. Marcia Angell, a physician and longtime Editor in Chief of the New England Medical Journal (NEMJ), which is considered to another one of the most prestigious peer-reviewed medical journals in the world, makes her view of the subject quite plain:
“It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of the New England Journal of Medicine”  (source)
I apologize if you have seen it before in my articles, but it is quite the statement, and it comes from someone who also held a position similiar to Dr. Horton.
There is much more than anecdotal evidence to support these claims, however, including documents obtained by Lucija Tomljenovic, PhD, from the Neural Dynamics Research Group in the Department of Ophthalmology and Visual Sciences at the University of British Columbia, which reveal that vaccine manufacturers, pharmaceutical companies, and health authorities have known about multiple dangers associated with vaccines but chose to withhold them from the public. This is scientific fraud, and their complicity suggests that this practice continues to this day. (source)
This is just one of many examples, and alludes to one point Dr. Horton is referring to, the ommision of data. For the sake of time, I encourage you to do your own research on this subject. I just wanted to provide some food for thought about something that is not often considered when it comes to medical research, and the resulting products and theories which are then sold to us based on that research.
It’s truly a remarkable time to be alive. Over the course of human history, our planet has experienced multiple paradigm shifting realizations, all of which were met with harsh resistence at the time of their revelation. One great example is when we realized the Earth was not flat. Today, we are seeing these kinds of revelatory shifts in thinking happen in multiple spheres, all at one time. It can seem overwhelming for those who are paying attention, especially given the fact that a lot of these ideas go against current belief systems. There will always be resistance to new information which does not fit into the current framework, regardless of how reasonable (or factual) that information might be.

Management of Central Poststroke Pain

So no one knows a damn thing about CPSP. A great stroke association would be in the thick of this research figuring out how to use this knowledge to solve CPSP. But we have craptastic stroke associations whose highest calling is press releases. You are completely on your own. Start hiring researchers to solve your stroke problems. Good luck on your pain, you'll need it.
  1. Jason W. Busse, PhD
+ Author Affiliations
  1. From the Departments of Clinical Epidemiology and Biostatistics (S.M.M., R.K., Z.I., L.T., G.H.G., J.W.B.), Anesthesia (D.N.B., L.T., J.W.B.), Medicine (A.P., G.H.G.), and Pediatrics (L.T.) and Michael G. DeGroote Institute for Pain Research and Care (L.W., R.C., D.N.B., A.P., S.M.K., J.W.B.), McMaster University, Hamilton, Ontario, Canada; Outcomes Research Consortium, Cleveland, OH (S.M.M.); Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (A.A.); Departments of Clinical Neurological Sciences and Oncology, Western University, London, Ontario, Canada (D.E.M.); Department of Outcomes Research, Cleveland Clinic, OH (A.T., D.I.S.); and Knowledge and Evaluation Research Unit, Divisions of Endocrinology and Diabetes, and Health Care and Policy Research, Mayo Clinic, Rochester, MN (V.M.M.).
  1. Correspondence to Sohail M. Mulla, MSc, Department of Clinical Epidemiology and Biostatistics, HSC-2C7, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4K1, Canada. E-mail


Background and Purpose—Central poststroke pain is a chronic neuropathic disorder that follows a stroke. Current research on its management is limited, and no review has evaluated all therapies for central poststroke pain.
Methods—We conducted a systematic review of randomized controlled trials to evaluate therapies for central poststroke pain. We identified eligible trials, in any language, by systematic searches of AMED, CENTRAL, CINAHL, DARE, EMBASE, HealthSTAR, MEDLINE, and PsychINFO. Eligible trials (1) enrolled ≥10 patients with central poststroke pain; (2) randomly assigned them to an active therapy or a control arm; and (3) collected outcome data ≥14 days after treatment. Pairs of reviewers, independently and in duplicate, screened titles and abstracts of identified citations, reviewed full texts of potentially eligible trials, and extracted information from eligible studies. We used a modified Cochrane tool to evaluate risk of bias of eligible studies, and collected patient-important outcomes according to recommendations by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials. We conducted, when possible, random effects meta-analyses, and evaluated our certainty in treatment effects using the Grading of Recommendations Assessment, Development, and Evaluation System.
Results—Eight eligible English language randomized controlled trials (459 patients) tested anticonvulsants, an antidepressant, an opioid antagonist, repetitive transcranial magnetic stimulation, and acupuncture. Results suggested that all therapies had little to no effect on pain and other patient-important outcomes. Our certainty in the treatment estimates ranged from very low to low.
Conclusions—Our findings are inconsistent with major clinical practice guidelines; the available evidence suggests no beneficial effects of any therapies that researchers have evaluated in randomized controlled trials.