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:

Friday, November 17, 2017

Balloon Buddies video game to aid rehabilitation

You can ask your doctor which of these other video games has been tested in their rehab program to determine which is best. 62 posts on video games.

Balloon Buddies video game to aid rehabilitation

A video game that enables healthy volunteers to play with patients who have physical impairments may improve their rehabilitation, suggests a new study.
The researchers from Imperial College have designed a video game called Balloon Buddies, which is a tool that enables those recovering from conditions such as a stroke to engage and play together with healthy volunteers such as therapists and family members as a form of rehabilitation.
The researchers from Imperial College have designed a video game called Balloon Buddies, which is a tool that enables those recovering from conditions such as a stroke to engage and play together with healthy volunteers such as therapists and family members as a form of rehabilitation.

Their findings were published in the latest issue of the Journal of NeuroEngineering and Rehabilitation (JNER)
Balloon Buddies is designed to level the playing field by allowing healthy participants to support the less abled player. The researchers have shown that this type of collaboration makes it more rewarding for the less-abled partner, more challenging for the better partner, and overall more fun for both, as they have to continuously work together to score points.
The team have trialled Balloon Buddies by getting patients to play it on their own in single player mode and then partnered with healthy volunteers during dual player gameplay. They found that the performance of the patient was boosted when they played with a healthy volunteer, compared to if they were playing the game on their own. In addition, they found that the poorer a patient’s single player performance was, the greater the improvement seen when they played with another during dual-player mode.
While the pilot study was limited to 16 patients and 32 healthy participants playing in 16 pairs, the researchers believe this form of rehabilitation through gaming may be beneficial to patients recovering from other illnesses such as musculoskeletal injuries, arthritis, and cerebral palsy. The researchers are aiming to further develop the game alongside new multiplayer concepts and show that it can be used in different settings including patients training with their therapist or with other patients, in community centres or even remotely at home.
Dr Michael Mace, lead author from the Department of Bioengineering at Imperial College London, said: “Video games are a great way of providing repetitive exercise to help patients recover from debilitating illnesses. However, most games are designed for users to play on their own, which can actually discourage and isolate many patients. We developed the Balloon Buddy game to enable patients to train with their friends, family or caregivers in a collaborative and playful manner. The technology is still being developed, but we have shown that playing jointly with another individual may lead to increased engagement and better outcomes for patients.”
Balloon Buddies uses animation, sounds, and vibration-feedback, similar to conventional video games. It requires users to balance a ball on a beam, which is lifted at each of its ends by balloons controlled by the players.
Balloon Buddies uses animation, sounds, and vibration-feedback, similar to conventional video games. It requires users to balance a ball on a beam, which is lifted at each of its ends by balloons controlled by the players.

The main aim of the game is for the players to vary the height of the beam so that the ball collides with moving targets in order to collect points.
Players are also required to work together to keep the beam horizontal so that the ball doesn’t roll off the platform. It is played with a wireless handgrip called GripAble, enabling people with arm weakness to control video
games on any standard tablet device.
In the study, the researchers tested the game on 16 patients who had arm weakness following a stroke with a healthy volunteer over three months at Charing Cross Hospital, which is part of Imperial College Healthcare NHS Trust, in 2016. Previously, the game was also tested on 16 healthy pairs with different baseline abilities.
The team will now carry out a larger study to examine whether the game leads to more efficient learning and to examine if patients are more motivated to train for longer periods. They will also explore social implications of interaction such as the effect of patients playing with a relative versus a stranger.
The Balloon Buddies game is an example of the work of the Imperial Academic Health Science Centre (AHSC). This is a partnership between Imperial College London and three NHS Trusts, which aims to improve patient outcomes by
harnessing scientific discoveries and translating them as quickly as possible into new diagnostics, devices and therapies, in the NHS and beyond.

New dye gives scientists a clearer insight into the brain

We should be able to use this to listen in on the signals being passed as neuroplasticity occurs. Then we might be able to make neuroplasticity repeatable.
And matching it with this could make understanding neuronal signals easy. Now we just need our stroke medical 'professionals' to put two and two together and we might make progress in 50 years. Long after I'm dead.

Hi-Res Probes Will Change Our Understanding of the Brain

New dye gives scientists a clearer insight into the brain

14 November 2017 Keele University
Keele University researchers have designed a new dye that can be used to observe the electrical activity of neurons in the brain and could lead to finding a new and more efficient way of treating neurological diseases, as presented at the prestigious Society for Neuroscience annual conference in Washington, D.C. this week.
As part of a two-year collaborative study between neuroscientists at Keele University and chemists at Newcastle University, funded by the Leverhulme Trust, a new near-infrared voltage-sensitive dye has been designed - JULBD6 - which offers comparable signal quality and toxicity when compared to the commonly used voltage-sensitive dye di-4-ANEPPS. These findings were recently published in Chemistry: A European Journal.
To observe networks of neurons and their interactions, neuroscientists most commonly use calcium imaging or voltage-sensitive dyes. Voltage-sensitive dyes respond to neuronal events faster than calcium dyes, allowing single neuron spikes to be observed as a change in fluorescence, but a major limitation of voltage-sensitive dyes is that the observed fluorescent changes are weaker than calcium dyes, which this research project aimed to improve.
A clearer insight into neuronal networks could improve treatment for neurological diseases, for example it may help further uncover how neuromodulators, such as dopamine, impact the functionality of neural circuits, which could lead to finding a new and more efficient way of treating people with Parkinson’s disease.
Keele University Research Associate Dr John Butcher commented: “This could have a large impact on neuroscience as a field. The structure of the new dye, JULBD6, is completely different from other dyes such as the widely used di-4-ANEPPS, but offers the same signal quality in terms of the change in fluorescence during neuronal spiking and does not affect the health of the neurons.”
Professor Peter Andras, the Keele lead on the project, said: “These results are very promising as we have shown a completely new voltage-sensitive dye that allows rational design of key molecular features and offers similar performance to other dyes which are widely used in neuroscience. This dye is also in the near-infrared range, rather than some green dyes which have higher toxicity, making it more suited to longitudinal studies. Based on these findings we now aim to design dyes based on the structure of JULBD6 in order to improve the fluorescence signal quality whilst making them as less toxic as possible. This new technology could really benefit neuron imaging studies.”

Attached files

  • fluorescent brain scan

The Simpler Talk Therapy That Treats Depression Effectively

What is your doctor doing about treating your depression after you realize s/he doesn't have a clue to get you 100% recovered? But maybe you would rather actually be treated with SSRIs since they provide better recoveries? But your doctor can decide which is best for you after you ask about pros and cons to each approach.

Antidepressants may help people recover from stroke even if they are not depressed

The Simpler Talk Therapy That Treats Depression Effectively

The talk therapy that is quicker (and cheaper) than cognitive-behavioural therapy.
Depression can be more simply treated by behavioural activation therapy, a new study concludes.
Behavioural activation therapy is a more straightforward alternative to cognitive-behavioural therapy — the gold standard of depression treatment.
Clinical depression affects around 350 million people around the world, but only a fraction receive the best care.
Behavioural activation therapy could be a good alternative that provides access to therapy for more people.
The therapy itself focuses on encouraging people to take part in meaningful activities that are linked to their core values.
It helps people find out which activities make them feel better.
Unfortunately, many people with depression engage in activities that ultimately make them feel worse.
Chief among these is rumination: letting depressing thoughts roll around in the mind.
The therapy helps people to make the connection between what they do and their mood.
It is also aimed at fighting avoidance and moving towards personally rewarding experiences.
The focus for policy-makers, though, is on cost and the potential to reduce it.
Professor David Richards, the study’s first author, said:
“Effectively treating depression at low cost is a global priority.
Our finding is the most robust evidence yet that Behavioural Activation is just as effective as CBT, meaning an effective workforce could be trained much more easily and cheaply without any compromise on the high level of quality.
This is an exciting prospect for reducing waiting times and improving access to high-quality depression therapy worldwide, and offers hope for countries who are currently struggling with the impact of depression on the health of their peoples and economies.”
The study itself recruited 440 people who were split into two groups, one of which received behavioural activation therapy, the other getting cognitive-behavioural therapy.
The results showed that behavioural activation therapy provided similar outcomes to CBT.
Around two-thirds of people in both groups felt better one year later.
The study was published in the journal The Lancet (Richards et al., 2016).

Restoring Motor Functions After Stroke: Multiple Approaches and Opportunities

What a complete waste of time. This type of review should not be necessary since they are continuously updated in that stroke protocol database so these reviews never need to be done. And proposing biomarkers to predict recovery is the height of fucking laziness. They should be solving all these problems in stroke rather than looking at what is currently possible(Only 10% full recovery).

More than 1.5 million people suffer a stroke in Europe per year and more than 70% of stroke survivors experience limited functional recovery of their upper limb, resulting in diminished quality of life. Therefore, interventions to address upper-limb impairment are a priority for stroke survivors and clinicians. While a significant body of evidence supports the use of conventional treatments, such as intensive motor training or constraint-induced movement therapy, the limited and heterogeneous improvements they allow are, for most patients, usually not sufficient to return to full autonomy. Various innovative neurorehabilitation strategies are emerging in order to enhance beneficial plasticity and improve motor recovery. Among them, robotic technologies, brain-computer interfaces, or noninvasive brain stimulation (NIBS) are showing encouraging results. These innovative interventions, such as NIBS, will only provide maximized effects, if the field moves away from the “one-fits all” approach toward a “patient-tailored” approach. After summarizing the most commonly used rehabilitation approaches, we will focus on NIBS and highlight the factors that limit its widespread use in clinical settings. Subsequently, we will propose potential biomarkers that might help to stratify stroke patients in order to identify the individualized optimal therapy. We will discuss future methodological developments, which could open new avenues for poststroke rehabilitation, toward more patient-tailored precision medicine approaches and pathophysiologically motivated strategies.

Nanoparticles help track human heart muscle cells in mice in Stanford study

And if our stem cell researchers don't do the same thing to track where they go in the brain, their research is totally useless.
This beautiful image shows human heart muscle cells called cardiomyocytes that have been derived from embryonic stem cells and then reintroduced into the beating heart of a living mouse. Understanding where these reintroduced cells go in the heart, and what they do when they get there, is a critically important step toward using the cells to repair heart disease.
Here Stanford Cardiovascular Institute instructor Xulei Qin, PhD, and cardiologist Joseph C. Wu, MD, PhD, along with radiologist Heike Daldrup-Link used a new technique called photoacoustic imaging to visualize semiconducting polymer nanoparticles they’ve latched onto the cardiomyocytes (whose nuclei are shown in blue) like microscopic ankle bracelets. The nanoparticles, indicated in the photo in red, absorb laser light and emit acoustic signals that be used to quickly and accurately track the cells’ location with unprecedented sensitivity and resolution — even when they are buried by several millimeters of tissue. They published their results earlier this month in Advanced Functional Materials.
As Wu explained to me in an email:
This technique provides a much better way to follow how the cells integrate in small animal models because these nanoparticles have strong photoacoustic signals and specific spectral features to sensitively detect and distinguish a small number of labeled cardiomyocytes from native heart tissues.
Previously: A new label will allow physicians to pinpoint locations of bacterial infections,  Nano-hitchhikers ride stem cells into heart, let researchers watch in real time and weeks later and Stem cells create faithful replicas of native tissue, according to Stanford study 
Photo by Xulei Qin

At the Bench-Stroke Recovery: Inducing Spinal Plasticity Amplifies Benefits of Rehabilitative Training and Improves Stroke Recovery

Now we just need human followup. Is your stroke hospital so fucking incompetent that they will do nothing to advance this research to humans?
Kreimer, Susan
doi: 10.1097/01.NT.0000527322.43736.10
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In an animal model of stroke, researchers removed plasticity-inhibiting signals in the spinal cord (via intraspinal injections of the enzyme chondroitinase ABC), which augmented rewiring of circuits connecting the brain to the spinal cord, even weeks after stroke. The researchers proposed that this plasticity can be harnessed by rehabilitative training to significantly promote sensorimotor recovery.
A combination of spinal therapy and rehabilitative training resulted in improved recovery in rats, even 28 days after experimental stroke conditions were induced, according to a study published October 12 in The Journal of Neuroscience.
The investigators amplified spinal plasticity during chronic stroke in male rats via intraspinal injections of chondroitinase ABC (ChABC), an enzyme that has been found to remove plasticity-inhibiting signals in the brain. Injections into the contralesional grey matter of the cervical spinal cord administered 28 days after stroke resulted in significant sprouting of corticospinal axons originating in the peri-infarct cortex.
Without rehabilitative training, ChABC injection during chronic stroke led to moderate improvements of sensorimotor deficits, said Ian R. Winship, PhD, a study author and associate professor and director of the neurochemical research unit at the University of Alberta's department of psychiatry in Edmonton, Alberta in Canada. But combined with the spinal therapy, rehabilitative training during chronic stroke was much more effective.
“These data suggest that the permanent disability affecting millions of individuals living with the chronic effects of stroke may be treatable with spinal therapy and rehabilitation initiated even months or years after the stroke,” the study authors wrote. “Our data also emphasize that inducing a state of plasticity is not sufficient to induce recovery, and that combining such therapies with rehabilitative therapy is required for optimal recovery.”
After inducing initial ischemic injury in the rats via photothrombosis, investigators tested their hypothesis that promoting plasticity in the spinal cord during chronic stroke could spur advances in recovery from persistent sensorimotor impairment. Sprouting of spared corticospinal tract axons in the contralesional spinal cord has a major impact on sensorimotor recovery, they noted, but this structural plasticity is limited to the first few weeks after stroke.
“The major drawback of the current approach is that injection of the enzyme only extends a certain distance and acts for a finite period of time,” Dr. Winship said. “In a human, we need the enzyme to be active over a much larger region,” he said, because “the spinal cord is so much bigger in human than in a rat.”
“Our findings strongly suggest that such a treatment could reduce disability due to stroke. The next question is, what would actually be required to undertake this approach in humans?” Dr. Winship told Neurology Today.
He acknowledged that “probably a different delivery system would be required for humans. One solution may be to employ viral vectors, which present a way to genetically express the same enzyme in tissue rather than injecting it directly,” Dr. Winship said. “A viral delivery system would allow for longer expression and greater spread within the spinal cord, and therefore, could be safer and possibly effective in larger animals such as dogs as well as humans.”
“We can do very similar injection procedures without damaging the spinal cord, without inducing any kind of injury, but we would need a system like one of these vectors, if the drug is going to trying to strengthen the wiring between the brain and the spinal cord,” he said.

A composite robotic-based measure of upper limb proprioception

If we can measure proprioception we can figure out a way to bring it back. I'm sure if I had a better sense of where my left foot was pointing or my arm was I could try to make corrections against its' spasticity.
  • Jeffrey M. KenzieEmail author,
  • Jennifer A. Semrau,
  • Michael D. Hill,
  • Stephen H. Scott and
  • Sean P. Dukelow
Journal of NeuroEngineering and Rehabilitation201714:114
Received: 16 May 2017
Accepted: 31 October 2017
Published: 13 November 2017



Proprioception is the sense of the position and movement of our limbs, and is vital for executing coordinated movements. Proprioceptive disorders are common following stroke, but clinical tests for measuring impairments in proprioception are simple ordinal scales that are unreliable and relatively crude. We developed and validated specific kinematic parameters to quantify proprioception and compared two common metrics, Euclidean and Mahalanobis distances, to combine these parameters into an overall summary score of proprioception.


We used the KINARM robotic exoskeleton to assess proprioception of the upper limb in subjects with stroke (N = 285. Mean days post-stroke = 12 ± 15). Two aspects of proprioception (position sense and kinesthetic sense) were tested using two mirror-matching tasks without vision. The tasks produced 12 parameters to quantify position sense and eight to quantify kinesthesia. The Euclidean and Mahalanobis distances of the z-scores for these parameters were computed each for position sense, kinesthetic sense, and overall proprioceptive function (average score of position and kinesthetic sense).


A high proportion of stroke subjects were impaired on position matching (57%), kinesthetic matching (65%), and overall proprioception (62%). Robotic tasks were significantly correlated with clinical measures of upper extremity proprioception, motor impairment, and overall functional independence. Composite scores derived from the Euclidean distance and Mahalanobis distance showed strong content validity as they were highly correlated (r = 0.97–0.99).


We have outlined a composite measure of upper extremity proprioception to provide a single continuous outcome measure of proprioceptive function for use in clinical trials of rehabilitation. Multiple aspects of proprioception including sense of position, direction, speed, and amplitude of movement were incorporated into this measure. Despite similarities in the scores obtained with these two distance metrics, the Mahalanobis distance was preferred.

This $100-million Startup Plans to Put Chips Into Human Brains to Enhance Intelligence

I could use this. What is your doctor doing to follow this up with interventions that might help fix your cognitive decline?

If you could, would you delete some memories you don't like and replace them with much better ones? How far are you willing to go to tweak your brain if doing so could give you super abilities? 
These are not just hypothetical questions to Bryan Johnson, the founder of the brain-hacking startup Kernel. He believes that in the next 15 years humans will be able to greatly expand their brain's natural abilities, and he put $100 million of his own money to make that happen.
Speaking recently at the Web Summit in Lisbon, Johnson said that in the next two decades, researchers should develop tools for the brain that will allow us to "pose any question we wanted" -
“For example, could I have a perfect memory?" asked Johnson. "Could I delete my memories? Could I increase my rate of learning, could I have brain to brain communication? Imagine a scenario where I say ‘I want to know what it’s like to be a cowboy in the American west in the 1800s?’ and someone creates that experience mentally. I’m able to take that and purchase that from that person and experience that.”

The current focus for Kernel, called by Johnson a "human intelligence (HI) company," will be on developing new tech to treat neurological diseases. 
They want to build a tiny implantable chip, called a "neuroprosthetic" that will help people suffering from damage caused by strokes, concussions or Alzheimer's disease. But Kernel's ultimate objective looks towards the future, to continue developing the chip for the purpose of the brain's "cognitive enhancement." 
The company's mission statement describes their goals this way:
"To further explore our own human boundaries, a wave of new technologies needs to emerge that can access, read, and write from the most powerful tool we have — the human brain."
Could Johnson pull this off? The entrepreneur has been successful in his ventures so far, making money by founding and selling the payments company Braintree to Paypal for $800 million in 2013.
Johnson is also not the only one betting on a future where our brains have enhancements. Elon Musk is also developing a brain-computer interface and has founded a company to make what he calls "neural mesh" a reality.
You can hear Johnson's speech at the Web Summit here:

Neurologic Diseases Found to Be the Largest Cause of Disability Worldwide

Even with all this factual documentation on stroke, NOTHING will be done by our fucking failures of stroke associations to solve and prevent the disabilities from stroke. You're screwed, your children will be screwed, your grandchildren will be screwed.

Collins, Thomas R.
doi: 10.1097/01.NT.0000527316.80068.88
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Figure. C

Figure. C

In an analysis of data for 195 countries, the Global Burden of Disorders Study Group found that neurological disorders caused 250.7 million disability-adjusted life years (DALYs) in 2015, an increase of 7.4 percent from 1990. Stroke was reported to be one of the leading causes of DALYs worldwide.
Neurological diseases are the world's largest cause of disability-adjusted life years (DALYs), or years of healthy life lost to due to death or disability, according to a systematic analysis performed for the Global Burden of Disease Study 2015, the most current overview of the way neurological diseases are affecting people around the world.
Neurologists specializing in global health told Neurology Today the analysis brings into sharp focus the immense burden of neurological disorders around the globe. Importantly, they said, its bold statement should help free up resources for neurological care, while the country-by-country breakdown — data for 195 nations are included — will help guide the way forward in addressing the problems faced around the world.
Published in the September 17 online edition of Lancet Neurology, the analysis includes data for disease groupings broken down from a myriad of perspectives: nation, socio-demographics, age, gender, and in proportion to one another.
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The analysis is largely a story about the devastating impact of stroke — no longer categorized as a cardiovascular disorder but as neurological by the World Health Organization (WHO) and the Global Burden of Disease study group.
With stroke included for the first time in such a broad and detailed analysis, neurological disorders caused 250.7 million DALYs in 2015, an increase of 7.4 percent from 1990.
“The most surprising findings were the amount of increase in the burden from 1990 to 2015 in virtually all countries of the world and that neurological disorders are now the leading causes of disability among all groups of diseases,” said Valery Feigin, MD, PhD, a lead author of the analysis and director of the National Institute for Stroke and Applied Neurosciences at Auckland University of Technology in New Zealand.
Neurological disorders caused 9.4 million deaths in 2015, up 36.7 percent from 1990, making them the second-leading cause of mortality around the world. Cardiovascular disorders, even without stroke, continue to be the leading mortality cause.
The increase in years of healthy life that have been lost among the world's population due to neurological disorders comes despite decreases in rates of DALYs per 100,000 when they are adjusted for age. This age-adjusted rate fell by 29.7 percent from 1990 to 2015.
“In terms of absolute number of people affected by neurological disorders, most of the increase in the burden was associated with aging of the population and population growth,” the study authors wrote.
Figure. D

Figure. D

The researchers found that stroke accounted for 118.6 million DALYs in 2015, an increase of 21.7 percent from 1990, and 6.3 million deaths, an increase of 36.4 percent.
Globally, stroke accounted for the largest proportion of DALYs, at 47.3 percent of the total, and deaths, at 67.3 percent.
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Migraine, meningitis, and Alzheimer's disease and other forms of dementia accounted for the next highest proportion of DALYs. The second largest contributor to deaths from neurological disorders was Alzheimer's disease and other dementia causes, with the other causes accounting for a much smaller proportion.
Stroke was also found to be the leading cause of age-adjusted DALY rates in 18 of 21 Global Burden of Disease regions.
The lowest age-adjusted DALY rates were seen in high-income countries, while the highest rates were seen in Afghanistan, Central African Republic, Guinea-Bissau, Kiribati, and Somalia. Communicable neurological diseases, such as meningitis, were a big contributor to the disease burden in low-income regions, while they ranked very low in high-income regions.
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Jerome H. Chin, MD, PhD, MPH, FAAN, chair of the International Subcommittee of the AAN and adjunct professor of neurology at New York University, said the report illustrates how the burden of neurological disorders is “substantial, varied, and growing.”
“Despite improvements in the prevention and treatment of some neurological disorders, for example, stroke, meningitis, and epilepsy, the absolute global burden has increased as a result of population expansion and increasing life expectancies,” he said. “Currently, 84 percent of the world's population resides in low- and middle-income countries where most of the population growth is occurring. The fastest growing region is sub-Saharan Africa whose population will double in the next few decades. Stroke is clearly the biggest threat to neurological health globally, responsible for 47 percent of the global burden of neurological disorders.”
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Wolfgang Grisold, MD, Secretary General of the World Federation of Neurology (WFN), said that with this study, the authors were “courageous enough to reach over the prevalent corset of classification,” thereby “allowing a more expanded and timely view on the prevalence of neurological diseases.”
“The new study provides important evidence that brain diseases have moved on from an under-estimated, under-recognized, and under-resourced group of conditions to a major challenge for health policy worldwide and that sufficient resources have to be provided for disease prevention and management,” he said.
Figure. D
The WFN cooperates with a wide range of organizations at the global and regional level to address this challenge, he said.
“The important impact of neurological diseases on global health is increasingly being discussed in the framework of international organizations,” he said. The WHO Global NCD (non-communicable diseases) Action Plan 2013-2020 and the Sustainable Development Goals of the United Nations are two projects aimed at the prevention of neurological conditions.
But he added that the recent WHO-WFN Neurology Atlas publication “shows that the resources available for neurological diagnosis, therapy, and access to neurological care are still very unevenly distributed globally. These new data will give us additional arguments to make the point that sufficient resources for brain health have to be provided at all levels.”
WFN is also devoted to improving neurological care worldwide, he said, with a program to “ensure knowledge transfer across national borders,” with low-income countries as the main target.
“The disparity and inequalities of health systems, the lack of financial resources in many countries, cultural and religious hurdles, as well as political aspects are among the major obstacles to making more progress in the field of neurological care on the global scale.”
The World Stroke Organization (WSO) is leading awareness campaigns among the general population and among health professionals, said Bo Noorving, MD, PhD, past president of the WSO.
“We advise decision-makers and governmental bodies on best scientifically-based policies,” he said. “We arrange stroke congresses, and we have many education activities ongoing. The greatest barriers relate to shortage of resources in the health system, the underfunding of stroke services, and the difficulties to change established habits.”
He said that the organization will continue its strong advocacy for stroke resources and that stroke “is no longer invisible under the umbrella of ‘cardiovascular diseases,’ but identified on its own as one of the core NCDs, possible to prevent and treat.”
Dr. Chin, who is now teaching and providing pro bono neurological care in Uganda, where he spends two months a year, said the barriers to basic neurological care in sub-Saharan Africa and South Asia, where he has also worked, are “numerous and complex.”


“The neurological workforce gap is a key element, in addition to a lack of universal health care coverage, limited health-sector budgets, and inadequate preventive care and health education,” he said.
For its part, the AAN, the membership of which 20 percent is international, offers reduced membership rates for members in low- and middle-income countries; offers an international scholarship award to attend the annual AAN meeting; provides education programs at its Annual Meeting; supports the annual European Academy of Neurology regional teaching course in Africa; and offers free copies of Continuum, a publication for lifelong learning, to eligible institutions through the WFN.
Dr. Chin said that the AAN Global Health Section, launched by him and four colleagues in 2011, has grown from 50 signatories to 400 members.
“As a result of the formation of the section, there are science and education topic categories in global health at the AAN Annual Meeting, which has stimulated increasing interest in global neurology.”
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•. GBD 2015 Neurological Disorders Collaborator Group. Global, regional, and national burden of neurological disorders during 1990-2015: A systematic analysis for the Global Burden of Disease Study 2015 http:// Lancet Neurol 2017; Epub 2017 Sep 17.

Ketogenic Diets Have "Profound Effect on Brain Function," Studies Find

You know the rules, nothing to be done with this until your doctor prescribes it in 50 years.
Ketogenic diets are this year’s weight-loss silver bullet. While we should approach every diet with a healthy dose of skepticism, the more studies being conducted on ketosis—the state your body enters when producing elevated amounts of ketone bodies, which are constructed via fatty acid metabolism in your liver—the more the benefits are accruing. 
Weight loss is a continually trending topic, though such popular pastimes sometimes lead to deeper inquiry. In the case of ketogenic diets, two new studies published in Cell Metabolism show how cutting back carbohydrates and intermittent fasting not only helps with weight, but may stretch out your life while improving your memory along the way—in mice, at least. 
A quick primer: your body burns fat as well as carbs for energy. Since our culture lives on carbs, with pretty much every processed food from a box or wrapped in plastic being carb- or sugar-dominated (which equates to the same thing once the saliva begins breaking down the nutrients in your mouth), we use the carbs and store the rest as fat. Hello obesity levels. Remove the carbs and your body turns to fat for energy. Burn the fat, weight loss follows. 
Unfortunately your brain can’t burn fat for its outsized energy needs. It requires sugar. Or ketone bodies if you decide to starve your body of glucose. Eat lots of fat, consume fewer carbs, and voila. While I’m not overweight I dropped ten pounds in weeks when experimenting with ketosis. Ever since I’ve maintained this weight, not by fasting—a popular ketogenic method is to fast for between 12 and 18 hours every day—but by keeping carb consumption down and fat intake high, also supported by recent research on 135,000 adults. 
Anecdotes are just that, personal stories, so let’s turn to the research. In the first study, mice were fed three diets: zero carbohydrates, a nutrient-balanced diet (the control group), and a high fat diet with just 15 percent carbohydrate intake, a percentage arrived at when researchers slowly added carbs to a carb-restricted diet to find the baseline in which mice remain in ketosis. After 15 percent their bodies suppressed ketosis, and would be little different than the control group. 
The mice were put on a cyclic ketogenic, high-fat, or control diet in mid-life. The cycle was one week, so they would eat this way for a week, then every mouse would spend a week on their respective diets. (Ketogenic- and high-fat only mice did not fare as well.) Interestingly, the high-fat group ended up heaviest, though the ketogenic and high-fat groups both had a higher caloric intake than the control group. In terms of longevity, the ketonic group proved most successful, at least through midlife. After thirty months of age, their mortality rate was the same as the control and high-fat groups. 
As for memory, the researchers write: 
In healthspan testing, we found a striking effect of Cyclic KD [ketogenic diet] on memory as well as more modest effects on a broader range of measures. We saw consistent memory improvement in two distinct tasks over 6 months.
The ketogenic group showed normal cognition wear with aging, but performed better in a visuospatial learning and memory test than the other groups, in which the mice learned to avoid (or not) an electric shock. The KD mice also showed improvement in late middle age (28-30 months) in novel object recognition.
Game-changer? Not quite. But anything that helps memory in aging bodies is a boost, especially given the crippling rates of dementia affecting millions of humans each year. An increase in midlife mortality rates means we’d be healthier during our prime. 
The second study also began at 12 months of age. It focused on calorie restriction, which, coupled with carbohydrate restriction, promotes production of ketone bodies. This study also featured the same three dietary guidelines: no carbs, low carbs, and a control group. While the first study showed better rates of midlife mortality, this one offered an optimistic view of longevity: 
The results clearly demonstrate that lifespan is increased in mice consuming a KD compared to a standard control diet. 
More tellingly, perhaps, is how the ketogenic group showed even better results in memory: 
Our results show that a KD slows cognitive decline and preserves motor function in aging mice. It should be noted that although the LCD [low carbohydrate diet] did not significantly differ from the ketogenic group in longevity, the two diets differed in their ability to preserve physiological function with age. This suggests that ketones may be necessary to elicit an extension of healthspan.
The role of ketones is playing a bigger role not only in general research but at pharmaceuticals companies as well. Researchers from these studies are interested in the physiological mechanisms behind ketones in hopes of isolating them for usage in pill form. If their protective effects can be better understood, perhaps humans won’t have to fast or restrict carbs to reap the cognitive and longevity benefits. 
As one researcher, molecular biologist Eric Verdin puts it, these results are hopeful, but a long road lies ahead—mice aren’t humans. Our diet and relationship to our environment has changed greatly over the last few hundred thousand years, while mice have been mice for a long time. As he states:
We’re very excited to see such a profound effect on brain function. Our results don’t imply this is going to work in humans. For that, we’ll need extensive clinical trials.
Until then read this extensive article on ketosis and fasting. We might not have conclusive results, but the data trickling in from varied confirmed sources is pointing in one direction: cut down on carbs.
Derek is the author of Whole Motion: Training Your Brain and Body For Optimal Health. Based in Los Angeles he is working on a new book about spiritual consumerism. Stay in touch on Facebook and Twitter.

Video and pictures at link.

One particular type of brain training exercise cut the long-term risk of dementia by 29%

I bet you will never get this as a protocol from your doctor. And you can't do this on your own without a prescription.
I will be following my ideas also.
Dementia prevention 19 ways
Don't follow me, I'm not medically trained.   

One particular type of brain training exercise cut the long-term risk of dementia by 29%

A newly published paper shows that one particular type of brain training exercise—called “speed of processing training” in the study—cut the long-term risk of dementia by 29%. This is a big deal: it’s the first study to show any activity or drug to do that. While other studies have shown that people who exercise, eat well, and have cognitively stimulating lives have a lower risk of dementia, scientists have never been sure if healthy living reduces dementia risk, or if it's just that people who aren't on the way to dementia are the ones who can still engage in healthy activities. These new results are from a gold-standard randomized controlled clinical trial—and allow scientists for the first time to say that doing the brain training directly reduces the risk of dementia.
The new paper is based on data from a large 10-year study called the ACTIVE trial. (ACTIVE stands for “Advanced Cognitive Training for Independent and Vital Elderly.”) In the ACTIVE study, scientists split the research participants into three groups: some people did the speed of processing training, while others did memory or reasoning training. Only the speed training had this effect on dementia risk, meaning that the specific type of brain training truly matters.
So does how much training people do. In the ACTIVE study, some participants completed 10 hours of the training, while others completed up to 18 hours (the original 10, plus two 4-hour “boosters”at later times). The researchers found that overall, people who trained with the speed of processing training cut their long-term risk of dementia by 29%. But those who trained the most cut their risk even more: the highest dose showed a 48% reduction.
For detailed information about the new paper and the ACTIVE study, see the FAQ. You can also read the paper online.
See Double Decision in action
Try Double Decision to check your brain speed
What Is Speed of Processing Training?
Speed of processing training is an online cognitive training exercise that increases visual processing speed. It was originally developed by Dr. Karlene Ball and Dr. Daniel Roenker. Now, it is exclusively available as the exercise “Double Decision” in BrainHQ.
Double Decision is designed to improve the speed and accuracy with which the brain can process visual information, both at the center of gaze and on the periphery. You can watch a short video showing Double Decision or try it yourself.
What Is BrainHQ?
BrainHQ is an online brain-training system built by Posit Science.  It features 29 exercises that work out attention, memory, brain speed, intelligence, navigation, and people skills. Double Decision—the updated version of the speed training used in ACTIVE—is one of them.  Various exercises in BrainHQ are proven in labs and in lives to bring real benefits to brain health and fitness. More than 100 papers have been published in scientific journals, such as the Journal of the American Medical Association, on the BrainHQ exercises and assessments.

Thursday, November 16, 2017

New Tool Identifies Patients With Headache Who Are at Risk of Aneurysms

Do you really think your stroke hospital is up-to-date enough to have this protocol in place? A great stroke association would make sure this is implemented in all stroke hospitals.
OTTAWA, Ontario -- November 13, 2017 -- A new tool to identify potentially fatal aneurysms in patients with headaches who seem otherwise well will help emergency departments to identify high-risk patients, improve survival rates, and reduce unnecessary imaging, according to a study published in the Canadian Medical Association Journal (CMAJ).
“Although rare, accounting for only 1% to 3% of headaches, these brain aneurysms are deadly,” said Jeffrey Perry, MD, Ottawa Hospital, and the University of Ottawa, Ottawa, Ontario. “Almost half of all patients with this condition die and about 2/5 of survivors have permanent neurological deficits. Patients diagnosed when they are alert and with only a headache have much better outcomes, but can be challenging to diagnose as they often look relatively well.”
The Ottawa Subarachnoid Hemorrhage Rule was developed by researchers at the Ottawa Hospital, which also created The Ottawa Rules, decision tools used in emergency departments around the world to identify ankle, knee, and spine fractures.
The current study, involving 1,153 alert adult patients with acute sudden onset headache admitted to 6 university-affiliated hospitals in Canada over 4 years from January 2010 to 2014, validates earlier published research that initially proposed the Ottawa Subarachnoid Hemorrhage Rule.
“Before any clinical decision rule can be used safely, it must be validated in new patients to ensure that the derived ‘rule’ did not come to be by chance, and that it is truly safe,” said Dr. Perry. “This is especially true with a potentially life-threatening condition such as subarachnoid haemorrhage.”
The newly validated rule gives emergency physicians a reliable tool to identify high-risk patients and rule out the condition in low-risk patients without having to order time-consuming imaging.
“We hope this tool will be widely adopted in emergency departments to identify patients at high risk of aneurysm while cutting wait times and avoiding unnecessary testing for low-risk patients,” said Dr. Perry. “We estimate that this rule could save 25 lives in Ontario each year.”
SOURCE: Canadian Medical Association Journal

Virtual Reality Training May Be as Effective as Regular Therapy After Stroke

Well then you lazy fuckers write up a stroke protocol on this so survivors can find it and make sure their therapists use it.
MINNEAPOLIS, Minn -- November 15, 2017 -- Using virtual reality therapy to improve arm and hand movement after a stroke is equally as effective as regular therapy, according to a study published in the November 15, 2017, online issue of Neurology.
“Virtual reality training may be a motivating alternative for people to use as a supplement to their standard therapy after a stroke,” said Iris Brunner, PhD, Aarhus University, Hammel Neurocenter, Aarhus, Denmark. “Future studies could also look at whether people could use virtual reality therapy remotely from their homes, which could lessen the burden and cost of traveling to a medical centre for standard therapy.”
The study involved 120 people with a mean age of 62 years who had suffered a stroke on average about 1 month before the study started. All of the participants had mild to severe muscle weakness or impairment in their wrists, hands or upper arms.
The participants had 4 to 5 hour-long training sessions per week for 4 weeks. The participants’ arm and hand functioning was tested at the beginning of the study, after the training ended, and again 3 months after the start of the study.
Half of the participants had standard physical and occupational therapy. The other half had virtual reality training that was designed for rehabilitation and could be adapted to the person’s abilities. The participants used a screen and gloves with sensors to play several games that incorporated arm, hand, and finger movements.
“Both groups had substantial improvement in their functioning, but there was no difference between the two groups in the results,” said Dr. Brunner. “These results suggest that either type of training could be used, depending on what the patient prefers.”
She noted that the virtual reality system was not an immersive experience.
“We can only speculate whether using virtual reality goggles or other techniques to create a more immersive experience would increase the effect of the training,” said Dr. Brunner.
SOURCE: American Academy of Neurology

Scientists have created brain implants that could boost our memory by up to 30%

Has your doctor measured your memory loss due to stroke and suggested a protocol to bring it back to normal?
  • Our memories could one day get a boost from a new brain implant device, according to a new study.
  • Researchers looked at how our brains naturally process memories in order to mimic what they do with micro-electric shocks.
  • The device can boost performance on memory tests by up to 30%, according to the study.

We'd all love to have a better memory. If there was a tool that could make us better at retaining information for exams, or at remembering important facts for a presentation or interview, we would probably pay good money for it.
This is what researchers have been working on at the University of Southern California. According to New Scientist, the team have developed a "memory prosthesis" brain implant, which could enhance human memory. Their findings were presented at the Society for Neuroscience meeting in Washington DC.
The device is made up of electrodes which are implanted in the brain. It's supposed to mimic the way we naturally process memories by giving small electric shocks to the hippocampus — the region of the brain involved in learning and memory. These electric burts imitate normal brain activity patterns, so the researchers hope it could help people with memory disorders such as dementia.
A group of 20 volunteers were fitted with the electrodes, and asked to participate in a training session where they were given a simple memory game. Each participant was shown images in a short presentation, then had to recall what they had seen up to 75 seconds later.
The researchers then looked at the responses of neurons in the subjects' brains to see which regions were activated while they were using their memory.
In a second session, the implants were used to stimulate these specific brain areas with micro-electric shocks.
According to the study, the device can boost performance on memory tests by up to 30%. The researchers hope in the future it could be adapted to be used as a tool to improve memory, vision, or movement.
"We are writing the neural code to enhance memory function," Dong Song, associate professor of biomedical engineering at the University of Southern California, and one of the authors of the study told New Scientist. "This has never been done before."

Wednesday, November 15, 2017

Milestone study could impact standard guidelines for stroke treatment

The key takeaway from this is that you have to have the correct type of stroke and be delivered to the right stroke hospital. The goal seems not to be leave no stroke survivor behind.
Standard guidelines for stroke treatment currently recommend clot removal only within six hours of stroke onset. But a milestone study with results published today in the New England Journal of Medicine shows that clot removal up to 24 hours after stroke led to significantly reduced disability for properly selected patients.
The international multi-center clinical study, known as the DAWN trial, randomly assigned 206 stroke victims who arrived at the hospital within six to 24 hours to either endovascular clot removal therapy, known as thrombectomy, or to standard medical therapy.
Thrombectomy involves a catheter placed in the femoral artery and snaked up the aorta and into the cerebral arteries where the clot that is blocking the artery, and causing the neurological symptoms, is retrieved.
Almost half of the patients (48.6 percent) who had clot removal showed a considerable decrease in disability, meaning they were independent in activities of daily living 90 days after treatment. Only 13.1 percent of the medication group had a similar decrease. There was no difference in mortality or other safety end-points between the two groups.
"These findings could impact countless stroke patients all over the world who often arrive at the hospital after the current six-hour treatment window has closed," says co-principal investigator Raul Nogueira, MD, professor of neurology, neurosurgery and radiology at Emory University School of Medicine and director of neuroendovascular service at the Marcus Stroke & Neuroscience Center at Grady Memorial Hospital.
"When the irreversibly damaged brain area affected by the stroke is small, we see that clot removal can make a significant positive difference, even if performed outside the six-hour window," says co-principal investigator Tudor Jovin, MD, director of the University of Pittsburgh Medical Center Stroke Institute. "However, this does not diminish urgency with which patients must be rushed to the ER in the event of a stroke. The mantra 'time is brain' still holds true."
To select patients for the trial, the researchers used a new approach which used brain imaging and clinical criteria as opposed to just time alone.
"Looking at the physiological state of the brain and evaluating the extent of tissue damage and other clinical factors seems to be a better way to decide if thrombectomy will benefit patients as opposed to adhering to a rigid time window," says Nogueira.
The researchers planned to enroll a maximum of 500 patients over the course of the study period. However, a pre-planned interim review of the treatment effectiveness after 200 patients were enrolled in the trial led the independent Data Safety Monitoring Board overseeing the study to recommend early termination of the trial, based on pre-defined criteria demonstrating that clot removal provided significant clinical benefit in the studied patients.
"Our research and clinical teams are immensely proud of these breakthrough findings, which are so profound they will likely result in a paradigm shift that will not be seen again for many years in the field of stroke therapeutics," says Michael Frankel, MD, professor of neurology, Emory University School of Medicine, chief of neurology and director of the Marcus Stroke and Neuroscience Center for the Grady Health System.
According to Frankel, the Emory neuroscience team was a major contributor to the DAWN trial, working at Grady Memorial Hospital, the second leading site of the trial's enrollment.
The DAWN trial included trial locations in the United States, Spain, France, Australia and Canada. The trial was sponsored by Stryker Corporation, a medical technology company that manufactures the clot removal devices used in the study.
The DAWN trial results were presented at the European Stroke Organization Conference in May.

Delayed ischemic stroke due to stent marker band occlusion after stent-assisted coiling

Be careful out there. I'm not planning on putting inflexible metal stents into my flexible arteries. But I'm not medically trained and should never be listened to.

Kawabata S, Imamura H, Suzuki K, Tani S, Adachi H, Sakai N; BMJ Case Reports 2017 (Nov 2017)

A middle-aged patient with an internal carotid-posterior communicating artery aneurysm and basilar artery tip aneurysm was treated by stent-assisted coiling. One ischemic infarction and two transient ischemic attacks occurred with the same symptoms (inability to walk unassisted and tendency to fall to the left) during the first 2 years post-treatment. The ischemic infarction was found in the right side of the pons, consistent with the vascular territory of the stent-containing vessel. The cause of the delayed ischemic stroke was investigated on DSA and cone beam CT, which revealed that the proximal end of the stent, one marker band, was just covering a small perforating artery of the basilar artery trunk. The present case suggests that marker band occlusion can induce delayed ischemic stroke. To prevent this complication, it is important to evaluate the perforating vessels preoperatively and carefully deploy a stent for the marker band to avoid occlusion of large perforating vessels. Post-treatment evaluation is also important because dual antiplatelet therapy will be required for a longer period if an artery is occluded by a marker band.

Drinking coffee may be associated with reduced risk of heart failure and stroke

You mean to tell me that you read nothing of ANY earlier research on the benefits of coffee? Wasting money and time on this?  I have 156 posts on coffee back to Feb. 2012
04 November 2017 American Heart Association
Drinking coffee may be associated with a decreased risk of developing heart failure or having stroke, according to preliminary research presented at the American Heart Association’s Scientific Sessions 2017, a premier global exchange of the latest advances in cardiovascular science for researchers and clinicians.
Researchers used machine learning to analyze data from the long-running Framingham Heart Study, which includes information about what people eat and their cardiovascular health. They found that drinking coffee was associated with decreased risk of developing heart failure by 7 percent and stroke by 8 percent with every additional cup of coffee consumed per week compared with non-coffee drinkers. It is important to note that this type of study design demonstrates an observed association, but does not prove cause and effect.
Machine learning, works by finding associations within data, much in the same way that online shopping sites predict products you may like based on your shopping history, and is one type of big data analysis. To ensure the validity of their results and determine direction of risk, the researchers further investigated the machine learning results using traditional analysis in two studies with similar sets of data - the Cardiovascular Heart Study and the Atherosclerosis Risk In Communities Study. The association between drinking coffee and a decreased risk of heart failure and stroke was consistently noted in all three studies.
While many risk factors for heart failure and stroke are well known, the researchers believe it is likely that there are as-yet unidentified risk factors. “Our findings suggest that machine learning could help us identify additional factors to improve existing risk assessment models. The risk assessment tools we currently use for predicting whether someone might develop heart disease, particularly heart failure or stroke, are very good but they are not 100 percent accurate,” said Laura M. Stevens, B.S., first author of the study and a doctoral student at the University of Colorado School of Medicine in Aurora, Colorado and Data Scientist for the Precision Medicine Institute at the American Heart Association in Dallas, Texas..
Another potential risk factor identified by machine-learning analysis was red-meat consumption, although the association between red meat consumption and heart failure or stroke was less clear. Eating red meat was associated with decreased risk of heart failure and stroke in the Framingham Heart Study but validating the finding in comparable studies is more challenging due to differences in the definitions of red meat between studies. Further investigation to better determine how red meat consumption affects risk for heart failure and stroke is ongoing.
The researchers also built a predictive model using known risk factors from the Framingham Risk Score such as blood pressure, age and other patient characteristics associated with cardiovascular disease. “By including coffee in the model, the prediction accuracy increased by 4 percent. Machine learning may a useful addition to the way we look at data and help us find new ways to lower the risk of heart failure and strokes,” said David Kao, M.D., senior author of the study and an assistant professor at the University of Colorado School of Medicine in Aurora, Colorado.
The American Heart Association suggest limiting red meat, which is high in saturated fat, as part of a healthy dietary pattern that should emphasize, fruit, vegetables, whole grains, low-fat dairy products, poultry and fish.
Co-author is Carsten Görg, Ph.D. Author disclosures are on the abstract.
The American Heart Association and the University of Colorado School of Medicine funded the study.