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:

Tuesday, July 26, 2016

Cannabinoids Hold Promise for Alzheimer’s Disease Treatment

Read it and weep because we will never get this into any protocol because of our stupid fucking federal legislators. This will never legally occur with our federal legislators in charge. Unless YOU get your Mom and grandma to ream them out for not allowing full legalization of marijuana.
You probably have to travel to Colorado or Oregon or list here or list here etc. and guess what form to take and the amount.
You could start using marijuana for your stroke rehab and then continue using it to prevent your likely chance of getting dementia.
My 13 reasons for marijuana use post-stroke.  

1. A documented 33% dementia chance post-stroke from an Australian study?   May 2012.
2. Then this study came out and seems to have a range from 17-66%. December 2013.
3. A 20% chance in this research.   July 2013.

Cannabinoids Hold Promise for Alzheimer’s Disease Treatment

The Interleaving Effect: Mixing It Up Boosts Learning

What does this say about our stroke rehab protocols? How does your doctor incorporate this into helping you recover? Interleaving has only been known since 1986. Has your doctor learned anything since 1986?
We’ve all heard the adage: practice makes perfect! In other words, acquiring skills takes time and effort. But how exactly does one go about learning a complex subject such as tennis, calculus, or even how to play the violin? An age-old answer is: practice one skill at a time. A beginning pianist might rehearse scales before chords. A young tennis player practices the forehand before the backhand. Learning researchers call this “blocking,” and because it is commonsensical and easy to schedule, blocking is dominant in schools, training programs, and other settings.
However another strategy promises improved results. Enter “interleaving,” a largely unheard-of technique that is capturing the attention of cognitive psychologists and neuroscientists. Whereas blocking involves practicing one skill at a time before the next (for example, “skill A” before “skill B” and so on, forming the pattern “AAABBBCCC”), in interleaving one mixes, or interleaves, practice on several related skills together (forming for example the pattern “ABCABCABC”). For instance, a pianist alternates practice between scales, chords, and arpeggios, while a tennis player alternates practice between forehands, backhands, and volleys.
Over the past four decades, a small but growing body of research has found that interleaving often outperforms blocking for a variety of subjects, including sports and category learning. Yet there have been almost no studies of the technique in uncontrived, real world settings—until recently. New research in schools finds that interleaving produces dramatic and long-lasting benefits for an essential skill: math. Not only does this finding have the potential to transform how math is taught, it may also change how people learn more generally.
The first signs of interleaving’s promise appeared in the domain of motor skills. One early study, published in 1986, involved training students to learn three types of badminton serves. Compared with blocking, interleaving produced better recall of each serve type and better ability to handle new situations, such as serving from the opposite side of the court. Similar results were later reported for baseball, basketball, and other sports. In 2003, one of the first studies to examine interleaving outside of sports found that using it to train medical students produced more accurate electrocardiogram diagnoses than blocking. In 2008, another widely-cited study found a similar benefit for teaching college students to recognize the painting styles of landscape artists. Even critical thinking skills benefit: in a 2011 study, students trained with the technique made more accurate assessments of complex legal scenarios.
Foreign language studies however suggest that the effectiveness of interleaving comes with an important caveat. When native English speakers used the technique to learn an entirely unfamiliar language, such as to generate English-to-Swahili translations, the results were better, the same, or worse than after blocking. These mixed results imply that learners should have some familiarity with subject materials before interleaving begins (or, the materials should be quickly or easily understood). Otherwise, as appears to be the case for foreign languages, interleaving can sometimes be more confusing than helpful.
Given interleaving’s promise, it is surprising then that few studies have investigated its utility in everyday applications. However, a new study by cognitive psychologist Doug Rohrer and colleagues at the University of South Florida, recently published in the Journal of Educational Psychology, takes a step towards addressing that gap. Rohrer and his team are the first to implement interleaving in actual classrooms. The location: middle schools in Tampa, Florida. The target skills: algebra and geometry.
The three-month study involved teaching 7th graders slope and graph problems. Weekly lessons, given by teachers, were largely unchanged from standard practice. Weekly homework worksheets, however, featured an interleaved or blocked design. When interleaved, both old and new problems of different types were mixed together. Of the nine participating classes, five used interleaving for slope problems and blocking for graph problems; the reverse occurred in the remaining four. Five days after the last lesson, each class held a review session for all students. A surprise final test occurred one day or one month later. The result? When the test was one day later, scores were 25 percent better for problems trained with interleaving; at one month later, the interleaving advantage grew to 76 percent.
These results are important for a host of reasons. First, they show that interleaving works in real-world, extended use. It is highly effective with an almost ubiquitous subject, math. The interleaving effect is long-term—lasting on the order of months—and the advantage over blocking actually increases with the passage of time (in other words, there’s less forgetting). The benefit even persists when blocked materials receive additional review. Overall, the interleaving effect can be strong, stable, and long-lasting.
Clearly interleaving does wonders for 7th grade math. Moreover, when combined with prior work showing similar benefits of the technique across a spectrum of topics (algebra, exponents, proportions, prisms, and volumes) and with students at different grade levels (elementary through college), interleaving may turn out to be among the most effective math learning techniques.
Researchers are now working to understand why interleaving yields such impressive results. One prominent explanation is that it improves the brain’s ability to tell apart, or discriminate, between concepts. With blocking, once you know what solution to use, or movement to execute, the hard part is over. With interleaving, each practice attempt is different from the last, so rote responses don’t work. Instead, your brain must continuously focus on searching for different solutions. That process can improve your ability to learn critical features of skills and concepts, which then better enables you to select and execute the correct response.
A second explanation is that interleaving strengthens memory associations. With blocking, a single strategy, temporarily held in short-term memory, is sufficient. That’s not the case with interleaving—the correct solution changes from one practice attempt to the next. As a result, your brain is continually engaged at retrieving different responses and bringing them into short-term memory. Repeating that process can reinforce neural connections between different tasks and correct responses, which enhances learning.
Both of these accounts imply that increased effort during training, either to discriminate correct responses or to strengthen them, is needed when interleaving is used. This corresponds to a potential drawback of the technique, namely that the learning process often feels more gradual and difficult at the outset. However, that added effort can generate better, longer-lasting results.
In modern society there is tremendous interest in ways to enhance learning and memory: brain training, learning apps, and so on. Interleaving has the benefit of scientific evidence in favor of its use across a range of circumstances. It also has the practical advantage of requiring no extra training, extra time, or special equipment to work. Only more careful planning is required, and possibly some extra effort at the outset.
Despite these relative advantages, interleaving remains mostly unknown and unused. Consider the example of grade school math. Out of all the math textbooks used in the U.S. today, all but one type—the Saxon series—uses blocked practice. One can only speculate on what would happen if interleaving were widely used in classrooms and in textbooks. The differences in academic achievement could be substantial.
As interleaving research progresses, we stand to learn much more about the technique: other areas where it works, or doesn’t, and what other limitations it might have. Yet that doesn’t preclude us from putting it to the test right now. For instance, are you studying statistics? Learning to play an instrument? Taking up a new sport? In all of these areas, you are faced with a series of skills or concepts to learn. The typical response would be to practice each of these, one at a time, over and over. Another option would be to mix it up. As it turns out, your brain may prefer doing exactly that.

Rights & Permissions

Are you a scientist who specializes in neuroscience, cognitive science, or psychology? And have you read a recent peer-reviewed paper that you would like to write about? Please send suggestions to Mind Matters editor Gareth Cook. Gareth, a Pulitzer prize-winning journalist, is the series editor of Best American Infographics and can be reached at garethideas AT or Twitter @garethideas.


Steven C. Pan is a National Science Foundation Graduate Research Fellow and doctoral candidate at the University of California, San Diego. His research involves using the tools of cognitive psychology and neuroscience to enhance human learning, memory, and performance. This article was drafted at the 2015 ComSciCon workshop, held at the Microsoft NERD Center and sponsored by Harvard University and MIT.

Monday, July 25, 2016

Electrosex - Maybe for stroke rehab?

I'm sure your doctor didn't prescribe sex for your stroke recovery. You do expect your doctor to know all about this and prescribe appropriate measures right after your stroke?

Sexual Frequency Predicts Greater Well-Being, But More is Not Always Better

Sex after stroke

Sex linked to better brain power in older age

Good News About Sex- It Doesn't Cause a Stroke

Sex Does Not Increase Heart Attack Risk - What about stroke?

Frequent orgasms may protect against heart attacks

An orgasm a day keeps the doctor away!


Sexuality Within Stroke Rehabilitation

Good News About Sex- It Doesn't Cause a Stroke

Let's talk about sex: A pilot randomised controlled trial of a structured sexual rehabilitation programme in an Australian stroke cohort

Sexual Function in Post-Stroke Patients: Considerations for Rehabilitation


 In case you don't have a partner she could prescribe this.


In a Hospital, Health Care Until the Clock Runs Out

Notice the word 'care', not results. Damn we have a lot of work to change the medical world to throw away the useless word 'care'.
This one paragraph is instructive;
These days, it may be easier to define hospitals by what they are not. They are not places for the sick to get well, not unless healing takes place in the brief interval of time that makes the stay a compensated expense.  
'Your time in a stroke hospital is not enough to get recovered from any of the effects, maybe if you are lucky you will learn enough to compensate for all your deficits.' By Dean.

Field Assessment Stroke Triage for Emergency Destination

I can't find the  FAST-ED tool so you will just have to take their word for it that it is good. It is your brain that is dying. Wouldn't the same have to be done for large hemorrhagic strokes also?

A Simple and Accurate Prehospital Scale to Detect Large Vessel Occlusion Strokes

  1. Raul G. Nogueira, MD
+ Author Affiliations
  1. From the Centro de Ciências da Saúde, Curso de Medicina, Universidade de Fortaleza, Fortaleza-CE, Brazil (F.O.L.); Neurovascular Service, Department of Neurology, Federal University of São Paulo, São Paulo-SP, Brazil (G.S.S.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Neuroendovascular and Neurocritical Care Services, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (M.R.F., D.C.H., R.G.N.); Department of Radiology (M.H.L.) and Stroke Service, Department of Neurology (É.C.S.C., A.B.S.), Massachusetts General Hospital, Boston; National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD (W.J.K.); and UCSF Neurovascular Service, Department of Neurology, University of California San Francisco (W.S.S.).
  1. Correspondence to Raul G. Nogueira, MD, 49 Jesse Hill Dr, SE Room No. 333, Atlanta, GA 30303. E-mail


Background and Purpose—Patients with large vessel occlusion strokes (LVOS) may be better served by direct transfer to endovascular capable centers avoiding hazardous delays between primary and comprehensive stroke centers. However, accurate stroke field triage remains challenging. We aimed to develop a simple field scale to identify LVOS.
Methods—The Field Assessment Stroke Triage for Emergency Destination (FAST-ED) scale was based on items of the National Institutes of Health Stroke Scale (NIHSS) with higher predictive value for LVOS and tested in the Screening Technology and Outcomes Project in Stroke (STOPStroke) cohort, in which patients underwent computed tomographic angiography within the first 24 hours of stroke onset. LVOS were defined by total occlusions involving the intracranial internal carotid artery, middle cerebral artery-M1, middle cerebral artery-2, or basilar arteries. Patients with partial, bihemispheric, and anterior+posterior circulation occlusions were excluded. Receiver operating characteristic curve, sensitivity, specificity, positive predictive value, and negative predictive value of FAST-ED were compared with the NIHSS, Rapid Arterial Occlusion Evaluation (RACE) scale, and Cincinnati Prehospital Stroke Severity (CPSS) scale.
Results—LVO was detected in 240 of the 727 qualifying patients (33%). FAST-ED had comparable accuracy to predict LVO to the NIHSS and higher accuracy than RACE and CPSS (area under the receiver operating characteristic curve: FAST-ED=0.81 as reference; NIHSS=0.80, P=0.28; RACE=0.77, P=0.02; and CPSS=0.75, P=0.002). A FAST-ED ≥4 had sensitivity of 0.60, specificity of 0.89, positive predictive value of 0.72, and negative predictive value of 0.82 versus RACE ≥5 of 0.55, 0.87, 0.68, and 0.79, and CPSS ≥2 of 0.56, 0.85, 0.65, and 0.78, respectively.
Conclusions—FAST-ED is a simple scale that if successfully validated in the field, it may be used by medical emergency professionals to identify LVOS in the prehospital setting enabling rapid triage of patients.

Clots, Collaterals, and the Intracranial Arterial Tree

But you are not even discussing the neuronal cascade of death by these 5 causes in the first week.
  1. Mayank Goyal, MD
+ Author Affiliations
  1. From the Departments of Clinical Neurosciences (B.K.M., M.G.), Radiology (B.K.M., M.G.), Community Health Sciences (B.K.M., M.G.), and Medicine (B.K.M., M.G.), Cumming School of Medicine, University of Calgary, Calgary, Canada; and The Hotchkiss Brain Institute, Calgary, Canada (B.K.M.).
  1. Correspondence to Mayank Goyal, MD, Department of Radiology, Seaman Family MR Research Centre, Foothills Medical Centre, 1403 – 29th St NW, Calgary AB T2N 2T9, Canada. E-mail
Key Words:
See related article, p 2061.
Acute ischemic stroke is a story of two parts; a thrombus blocks anterograde blood flow within the intracranial arterial tree while tiny vessels called collaterals sustain the brain until the thrombus is cleared. The location, size, and type of thrombus along with the degree and extent of collaterals likely determine the patient’s clinical symptoms, the likelihood of treatment success and the patient’s prognosis. A major focus of acute stroke research has been to image and measure various thrombus and collateral characteristics that help predict patient outcomes.(Shit, stop predicting and start solving.)
In vitro studies show that larger clots are less likely to lyse with thrombolytic agents, whereas clots with more surface area exposed to flowing blood are more likely to lyse early.1 This information can be used to create a theoretical framework for thrombus lysis within the intracranial arterial tree.2 Thrombi in proximal arteries such as the internal carotid or the M1 segment of the middle cerebral artery are likely to have greater volume than thrombi in smaller more distal arteries. Independent of thrombus volume, longer thrombi within the cylindrical framework of the intracranial arterial tree are likely to have less relative surface area (at the proximal and distal ends) exposed to blood flow. Poor collateral status is likely to result in less blood flow at the distal end of any thrombi within the arterial tree.2 Less number of arterial branches at the proximal and distal ends of thrombi are more likely to result in stasis …

Rehab Hospitals May Harm A Third Of Patients, Report Finds

This just documents sins of commission, not of omission where all the problems in stroke are never addressed. And since only 10% of stroke patients almost fully recover we are at 90% harm to stroke patients. And NO ONE is discussing those fucking failures.
Rehab Hospitals May Harm A Third Of Patients, Report Finds

Adverse events in rehabilitation hospitals: National Incidence Among Medicare Beneficiaries

Cabin flooding

On July 4th we drove to Pleasant Point Lodge on Willard Lake close to Kenora, Ont. Pattis' Mom stayed at a cabin there that her Dad built in the 20s. We actually found the cabin. The Lodge still had outhouses and a shower building for $70 Cn a night. The first night it poured rain and we were smugly commenting that we weren't tent camping. While working on salmon on the stove next to the front door, both Patti and Eva loudly exclaimed 'Water is coming thru the door!'.  Greg grabbed a broom opened the doors and started sweeping the water away. Bret noticing that water was still pouring into the cabin, grabbed a dustpan and threw the water thru Gregs' legs. I realized lots more was needed outside so grabbed another plastic dustpan and headed outside to try to scoop the water from pooling right in front of the door. That was futile so I moved closer to the corner of the cabin and tried trenching a ditch thru the gravel, somewhat useful. The downpour lasted one hour and flooded half the kitchen/bedroom front room. Obviously had occurred before since the furniture and bed were on blocks of wood. The main problem was the water coursing down the right side of the gravel driveway cut thru the roadbed. Two more days of great fishing there.
Then on Thursday it was off to the Winnipeg Folk Festival thru Sunday.
Barefoot in wet carpet in cabin

#2 Barefoot in wet carpet in cabin

Wetvac sucked up two gallons of water
Greg sweeping water until broom broke Bret throwing water thru Gregs' legs  

Berm and trench added by owner after rain stopped The timbers corraled the water
 laving no place to go but in the door.

Lost keys from Winnipeg

Woke up at 3:40 am Monday morning to search my carryon for my passport, found it and went back to sleep for the 5:15 alarm
On Monday I flew out of Winnipeg at 7:40 am, to Mpls, to Lansing arriving 1pm, I had packed away my keys while at Gregs and didn't find then in my carryon or my luggage. So I rented a car, got spare keys from the apt complex and completely searched my luggage, finally finding my keys in my security neck pouch, where I had removed my passport from earlier,  zipped in. Took a shower and booked the one hour drive over to Grand Rapids, MI for a 5:35 pm set of flights to Harrisburg, arriving at the hotel at 12:30 am. I flew out of GR because on the way back on Friday night it is only a 40 minute drive to Saugatuck and the crew that went to France is meeting there on Saturday.

Rain and an argument at Winnipeg Folk Festival

The 1.5 hours between the small stage shows and the main stage starting up usually has my four friends biking back to the campsite for snacks and libations. I stay at the site, getting dinner and waiting on the tarp for the shows to start. This day it started raining and I only had my jacket along, not my rain pants, so I pulled out a smaller tarp tucked under the main tarp just for that purpose just to cover my legs. It rained pretty steadily but warm and the tarp leaked a fair amount. Maybe 1.5 hours later my guy friends finally came to the tarp, never telling me where the two women friends were. They showed up a half hour later wondering why we all were sitting in the rain while they had been waiting for all of us under the beer tent with beer tickets. That then devolved into arguing which pair had done the most to save Dean. The women who were prepared to save us all like the St. Bernard Rescue Dog carrying a whiskey barrel? They had done the planning ahead of time. Or the guys who actually found me? Of course there were two in each group so they could have split up to find everyone.  Overall there was a lack of planning. If he is at the tarp bring him to safety in the beer tent. If he is in the beer tent fetch the guys back to the tent to celebrate Deans' survival. This argument went on for what seemed like hours, and I was supposed to choose which pair amongst the four best friends was actually the bestest. I refused to do so. We relitigated the argument at the beer tent later and managed to cadge a joint by our marijuana whisperer.
Sorry this is 3 weeks late from when it occurred but when you travel for work every week and social connections fill the weekends it is hard to keep up my prodigious blog output up to date.

Scientists look for the source of rigid thinking

You may have to analyze your doctors and therapists for signs of rigid thinking, with no looking at anything new from research since their medical training. Have fun with that.

Yale School of Medicine News
Rigid thinking — or an inability to adapt to new information in the environment — is a hallmark of schizophrenia and depression. Now a Yale team headed by Alex Kwan from the Department of Psychiatry provides some insights into what happens in the brain when flexible thinking is required. Using fluorescent sensors to monitor brain activity in living mice, the team noted distinct patterns of activity in the premotor cortex when mice were confronted with different situations. If confronted with familiar situations that favor internally guided action — the human equivalent of looking left automatically when crossing the street in the United States — activity change was gradual and late. However in demanding situations that call for heeding sensory cues — watching and listening for cars in unfamiliar country — neural activity pattern shifts abruptly and early, even before a behavior change. The changes were observable at the level of ensembles of individual brain cells, as seen in neurons firing in the accompanying movie. “Plausibly, the cognitive rigidity characteristic of disorders such as schizophrenia could result from an inability of frontal cortical networks to shift or maintain stable ensemble states,” the authors note. The findings were published July 11 in the journal Nature Neuroscience.

Scientists pinpoint a neural center of resilience

You need vast amounts of resilience to recover from your stroke. Was this area damaged and what stroke protocol is your doctor using to recover it?

Yale School of Medicine News
Why some people handle stress better than others is a question that has fascinated scientists for decades. Now a Yale–led team reports that flexible brain activity in a particular area of the brain may predict resilience. Conversely, its absence can help pinpoint those most at risk for binge drinking, emotional eating, and angry outbursts, according to a study published the week of July 18 in the journal Proceedings of the National Academy of Sciences. Thirty research participants were given fMRI scans while exposed to either highly threatening, violent, and stressful images and to neutral, non–stressful images for six minutes each. The scientists found three distinct patterns of response to stress. The first pattern was characterized by sustained neural activation of brain regions that signal, monitor, and process potential threats. The second response pattern involved a dynamic pattern with increased and then decreased activation, perhaps as the brain’s way of reducing initial distress to a perceived threat. Finally, subjects showed flexible neural responses in an area of the brain called the ventral medial prefrontal cortex (VmPFC) during sustained stress exposure. “Higher levels of neuroflexibility in this area of the brain helped predict those who would regain emotional and behavioral control during stress,” said Rajita Sinha, the Foundations Fund Professor of Psychiatry, director of the Yale Stress Center and lead author of the study. “The VmPFC seems to be the area of the brain which mobilizes to regain control over our response to stress.” Prior studies have shown consistently that repeated and chronic stress causes great damage to neural structures, connections, and functions of the prefrontal cortex, the seat of higher order cognition that helps regulate emotions, and more primitive areas of the brain. In subsequent interviews with the participants, the researchers found that those who did not show neural flexibility in the VmPFC during stress were more prone to binge drinking, episodes of emotional eating, and anger outbursts. Those subjects might be at higher risk of alcohol abuse and addiction or emotional dysfunction problems, which are hallmarks of exposure to repeated and high levels of chronic stress, Sinha hypothesized.

Penn Study Shows Elevated Brain Blood Flow Linked to Anxiety and Mood Symptoms in Females

Don't we want an elevated blood flow post-stroke? Ask your doctor? Do you need to be anxious and what protocol is your doctor using to get you anxious and moody?

Penn Medicine
Discoveries may lead to useful biomarker for treatment of anxiety and mood disorders.
Adolescence is a critical period for emotional maturation and is a time when significant symptoms of anxiety and depression can increase, particularly in females. Prior work by a team of Penn Medicine researchers found that sex–specific changes in cerebral blood flow (CBF) begin at puberty. The team’s newest research shows that higher blood flow in emotional brain regions such as the amygdala is associated with higher levels of anxiety and mood symptoms in females. These findings, which are published online in the journal Biological Psychiatry, provide further insight into the developmental biology of sex differences in mood and anxiety disorders. The study evaluated the hypothesis that sex differences in blood flow to brain regions involved in emotion processing during adolescence could be linked to sex differences in anxiety and mood symptoms. “We predicted that greater levels of anxiety would be associated with greater blood flow in emotional brain regions such as the amygdala. Following our prior work, we also predicted that females would have higher perfusion (blood flow) as adolescence progresses. And, finally we examined whether higher blood flow in emotional brain regions explained higher levels of anxiety and mood symptoms in females,” said the lead author, Antonia Kaczkurkin, PhD, a postdoctoral fellow at Penn’s Center for the Treatment and Study of Anxiety (CTSA). Results showed how the development of brain perfusion may relate to sex differences in anxiety during adolescence. Data revealed that anxiety and mood symptoms were associated with greater blood flow in a network of brain regions including the amygdala, anterior insula and fusiform cortex in both males and females. These regions also showed substantial developmental sex differences, with females demonstrating higher blood flow than males in post–pubertal period. It was also noted that the relationship between anxiety symptoms and blood flow in these regions increased in strength with age and puberty, and higher levels of symptoms present in post–pubertal females was in part explained by elevated blood flow to the left amygdala – a region known to be important for emotional processing. Taken together, these results suggest a new mechanism for understanding sex differences in anxiety and mood symptoms, which the authors say may be used to direct future research regarding targeted treatments.

Complex jobs, social ties appear to help ward off Alzheimer's: studies

Well my job is complex enough. Create business rules/requirements from 40+ years of undocumented code and and system information. If I wasn't traveling for work every week I could easily have social contacts every night of the week. I have to work at this since my grandma had some form of dementia and my dad has MCI and memory issues right now. But what I really want to know is how long I have to keep working at that challenging job.
The Washington Post
Work that involves complex thinking and interaction with other people seems to help protect against the onset of Alzheimer's Disease, according to research presented Sunday at the Alzheimer's Association's International Conference in Toronto.
Two studies looked at how complex work and social engagement counteract the effects of unhealthy diet and cerebrovascular disease on cognition. One found that while a "Western" diet (characterized by red and processed meats, white bread, potatoes, pre-packaged foods, and sweets) is associated with cognitive decline, people who ate such food could offset the negative effects and experienced less cognitive decline if they also had a mentally stimulating lifestyle.
Occupations that afforded the highest levels of protections included lawyer, teacher, social worker, engineer and doctor; the fewest protections were seen among people who held jobs such as laborer, cashier, grocery shelf stocker, and machine operator.
"You can never totally forget about the importance of a good diet, but in terms of your risk of dementia, you are better able to accommodate some of the brain damage that is associated with consuming this kind of (unhealthy) diet," said Matthew Parrott, a post-doctoral fellow at the Rotman Research Institute in Toronto, who presented the study.
In another study, researchers found that people with increased white matter hyperintensities (WMHs) - white spots that appear on brain scans and are commonly associated with Alzheimer's and cognitive decline - were able to better tolerate WMH-related damage if they worked primarily with other people rather than with things or data.
Occupations involving "mentoring" - such as social worker, physician, school counselor, psychologist, and pastor - were considered most complex, said Elizabeth Boots, a research specialist at the University of Wisconsin and the study's presenting author. Work involving taking instructions or helping was considered least complex. The study, conducted by the Wisconsin Alzheimer's Disease Research Center and Wisconsin Alzheimer's Institute, focused on people who were cognitively healthy but at risk for Alzheimer's.
"By showing that cognitive reserve is already at work early in the disease process, we believe this could have potential implications for early intervention, such as identifying those with potentially lower reserve and suggesting ways to boost that reserve in some way," Boots said, adding that it could be possible for those with lower reserve to implement more complex skills into their daily lives."
The studies support previous findings that more stimulating lifestyles are associated with better cognitive outcomes later in life, and bolster the importance of intellectual engagement, said Ronald Petersen, director of the Mayo Clinic Study of Aging and the Mayo Alzheimer's Research Center.
"Physical activity has been reasonably well-documented, but with intellectual activity the data get pretty soft. . .these two studies speak to that," he said. "What it may mean is the development of Alzheimer's Disease or cognitive change with aging need not be a passive process; you can do something about it. . .staying intellectually active whether it be your job or other kinds of activities may actually be beneficial."
When it comes to training your brain, speed may be more important than content. Researchers at AAIC presented 10-year results from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study, which looked at the impact of different kinds of brain training on 2,785 older adults across the U.S.
They were divided into three groups who received classroom-based memory strategies, classroom-based reasoning strategies, and computerized speed-of-processing training, along with a control group. The groups had 10 60-minute training sessions over five weeks, and some received booster sessions a year and three years after the training.
After 10 years, only the speed-of-processing group showed an effect: a 33 percent reduction in new cases of cognitive impairment or dementia, which rose to 48 percent among those who had participated in the booster session. The other two training groups did not show a significant difference from the control group.
The Washington Post

On the pointlessness of acupuncture in the emergency room…or anywhere else

For those apologists that believe in anything acupuncture. Have at it.

Incompetencies in stroke

Let me list the ways:
No protocols being followed or written up. It all seems to be 'winging it'. They really don't seem to have any idea what the hell is needed for stroke recovery. Proven by just writing three prescriptions to OT, PT and ST all saying the same thing; ET(Evaluate and Treat), dumping all the responsibility on the therapists. They have plausible deniability for why survivors don't recover by doing it this way.  Blame the therapists for survivors not recovering.
No protocols being followed or written up. It all seems to be 'winging it'.
They never list any statistics and results of their stroke care, they only list processes and guidelines. Those are fucking worthless to survivors.  
Lots of them don't seem to understand previous research that has gone on before and don't write up what the current complete understanding is in the area they are researching. 
Stroke associations:
These should be renamed Stroke doctor associations since I can see nothing for survivors there except for stroke groups and as pity parties to draw in donations.
Presidents of stroke associations:
They are doing the least possible; mainly just prevention press releases, nothing that might be difficult at all.

Boards of directors of stroke  associations:
They do not seem to be specifying that the president and staff should be tackling all the difficult problems in stroke. 
Or ANY BHAGs(Big Hairy Audacious Goals)
For decades survivors have not questioned their doctors why the hell they knew nothing about recovery and why the hospital has such poor recovery results. 

Scientists have a fascinating theory to explain why smart people should spend less time with friends

You'll have to see what happiness protocol your doctor has for you. Or are you too smart for that?

The "savanna theory of happiness" posits that the smarter you are, the less you need these guys. Flickr/Charleston Hospitality Group
If you're looking for an excuse to back out of a social engagement tonight — preferably one that's not, "I'd rather play Pokémon Go" — have we got the perfect line for you.
"I'm just too intelligent."
Be sure to come with plenty of supporting evidence, namely an IQ score and the results of a recent study on the "savanna theory of happiness." Your pals will be sure to understand.
The study, led by psychologists at Singapore Management University and the London School of Economics, found that people are generally happier the more time they spend with friends. That is, except really smart people.
The researchers arrived at these conclusions after conducting two studies. Both relied on data from the National Longitudinal Study of Adolescent Health, which involved interviews with more than 15,000 people between ages 18 and 28 in the years 2001 and 2002.
For the first study, the researchers looked at the link between three factors: participants' scores on an intelligence test, the population density in the area where participants lived, and how satisfied participants were with their lives.
Results showed that people were generally happier in less populated areas — except for highly intelligent people.
For the second study, the researchers looked at the link between participants' IQ scores, their life satisfaction, and how often they socialized (meaning hung out or talked on the phone with) friends.
Sure enough, the more time people spent with friends, the happier they were — except for the really smart people. In fact, results showed that the more intelligent people socialized with friends, the less satisfied they were with life.
Most of us haven't progressed too far from our caveman preferences. YouTube/GEICO Insurance
The researchers can't say for sure why they got these results. One possibility they propose is the savanna theory of happiness, an evolutionary theory that suggests the human brain responds to the "ancestral consequences" of its environment and well-being varies as a result.
In other words, humans used to live in communities of about 150 people, so when we're in environments where the population exceeds that number, we're not as comfortable or happy.
Likewise, in those groups of 150 hunters and gatherers, frequent contact with friends was crucial to our survival. So today, when we feel too isolated, we feel less happy.
Here's where intelligence comes in. One of the study authors previously proposed that intelligence is the ability to adapt to novel environments — i.e. environments that would have freaked out our ancestors. So highly intelligent people aren't as bothered by living in uber-crowded communities or by spending time alone.
Perhaps the most intriguing finding from this study is that highly intelligent participants actually spent more time socializing with friends. That suggests people either don't know what makes them happy, or don't have much control over how they spend their time.
So, regardless of what your IQ is or what you believe it to be, it's worth paying attention to what makes you happy — and not what you think should make you happy. If that means taking a "me" day or hopping off a subway car where passengers are packed like sardines, go for it. Your ever-evolving brain will thank you.

Sunday, July 24, 2016

Brain Tissue Oxygen Monitoring and the Intersection of Brain and Lung: A Comprehensive Review

No clue how feasible this would be at regular hospitals and what the hell good such monitoring does. What interventions could occur based on this knowledge? We'll never know since there is NO one in the whole world we can ask such fuckingly simple questions of.
  1. Geoffrey T Manley, MD PhD
+ Author Affiliations
  1. Department of Neurological Surgery, University of California San Francisco, San Francisco General Hospital, and the Brain and Spinal Injury Center, University of California San Francisco, San Francisco, California 94110.


Traumatic brain injury is a problem that affects millions of Americans yearly and for which there is no definitive treatment that improves outcome. Continuous brain tissue oxygen (PbtO2) monitoring is a complement to traditional brain monitoring techniques, such as intracranial pressure and cerebral perfusion pressure. PbtO2 monitoring has not yet become a clinical standard of care, due to several unresolved questions. In this review, we discuss the rationale and technology of PbtO2 monitoring. We review the literature, both historic and current, and show that continuous PbtO2 monitoring is feasible and useful in patient management. PbtO2 numbers reflect cerebral blood flow and oxygen diffusion. Thus, continuous monitoring of PbtO2 yields important information about both the brain and the lung. The preclinical and clinical studies demonstrating these findings are discussed. In this review, we demonstrate that patient management in a PbtO2-directed fashion is not the sole answer to the problem of treating traumatic brain injury but is an important adjunct to the armamentarium of multimodal neuromonitoring.

Nazareth company gets funds for stroke-busting drug - hemorrhagic


What do you get when two Israeli Muslims, an Israeli Jew and an Israeli Christian put their heads together? Well, since this isn’t a riddle, the answer is a stroke-defeating drug.

Founded by the husband and wife team of Prof. Abed Higazi and Dr. Noha Higazi, PamBio, a biotech company, claims to have found a way to halt acute bleeding and prevent brain damage after a hemorrhagic stroke — a condition that has no drug treatment today.
Hemorrhagic stroke usually occurs when a small blood vessel ruptures and bleeds into the brain tissue. The only way to treat this kind of stroke, which accounts for 10 to 15 percent of all strokes, is to drill a hole in the skull and relieve the pressure on the brain. And then wait, and pray, for the bleeding to stop.
Each year, 1.5 million-2 million people suffer from hemorrhagic stroke worldwide, of whom 31 percent die within a week, and 59% within a year. Those who survive the stroke suffer from severe disabilities. The financial toll attributed to stroke in the US and Europe is estimated at $43.6 billion annually, data provided by PamBio shows.
Abed Higazi, a clinical biochemist who heads the Division of Laboratories and the Department of Clinical Biochemistry at Hadassah Hospital in Jerusalem and his wife, Dr. Noha Higazi, discovered that after a hemorrhagic stroke, the body reacts in a counterintuitive way: instead of increasing clotting, it increases anti-coagulant activity. This causes the bleeding to continue, leading to more damage.
So they set out to find a solution to counter this increased activity, and came up with a drug that seems to do just that.
“We found a solution that inhibits this activity and stabilizes the number of blood clots, preventing further bleeding,” Abed Higazi said by phone. “We have a proof of concept after trying out our medication in pigs and mice, and now we need to take this to human trials.”
The benefits of the drug — a solution containing a protein molecule that prevents bleeding that is injected into the patient intravenously — include minimizing the blood toxicity in the brain, reduced side effects and strong binding to the target to minimize the required dose required. The drug also minimizes potential immunogenicity and organ tissue toxicity, the company said.
Proof of concept studies have shown that PamBio’s biomolecule reduces bleeding in the brains of mice with good neurological outcome; that piglets treated with the drug suffered less neurodegeneration; and that the drug is effective in preventing general and systemic bleeding, reducing by half both bleeding time in mice and bleeding volume in rats.
In the future, this drug product will also be used to treat other bleeding disorders, such as traumatic brain injury, general injuries, bleeding due to surgery, and post-birth hemorrhage, Higazi said.
“The next challenge will be to transfer this drug from the research labs into a product that is stable and can be manufactured in commercial amounts in an efficient way,” Dr. Amos Ofer, the CEO of the company said. “We also need to set out a timeframe and plans for the clinical trials which we hope to start in 2019.”

Furoshiki shoes

Wrap shoes, no lacing, maybe a solution for one-handed survivors. Assuming you don't need ankle support, but this might strengthen your ankles even faster.
Video here:

Saturday, July 23, 2016

“Alterations in aerobic exercise performance and gait economy following high intensity dynamic stepping training in subacute stroke”

Damn I wish SOMEONE(Like maybe our fucking failures of stroke associations) would write up these reports into stroke protocols so they can be critiqued and made better. Or is that too fucking difficult? Boo Hoo!
The following article has just been accepted for publication in Journal of Neurologic Physical Therapy:
“Alterations in aerobic exercise performance and gait economy following high intensity dynamic stepping training in subacute stroke”
Abigail Leddy; Mark Connolly; Carey Holleran; Patrick Hennessy; Jane Woodward; Kristan Leech; Gordhan Mahtani; Ross Arena; Elliot Roth; T. George Hornby, PT, PhD
Provisional Abstract:
Bhallmark characteristics of locomotor dysfunction in patients post-stroke. High-intensity (aerobic) training has been shown to improve peak oxygen consumption in this population, with fewer reports of changes in O2cost. However, inconsistent gains in walking function are observed, particularly in patents early post-stroke, with minimal associations with gains in metabolic parameters. The purpose of this study was to evaluate changes in aerobic exercise performance in patients with subacute stroke following high-intensity, variable stepping training as compared to conventional therapy. Methods: A secondary analysis was performed from a randomized controlled trial (RCT) comparing high-intensity training to conventional interventions, and a preliminary study that formed the basis for the RCT. Patients 1-6 months post-stroke received ≤40 sessions of high intensity variable stepping training (n=21) or conventional interventions (n=12). Assessments were performed at baseline (BSL), post-training and 2-3 month follow-up, and included changes in submaximal VO2 (VO2submax) and O2cost at fastest possible treadmill speeds and peak speeds at BSL testing. Results: Significant improvements were observed in VO2submax with less consistent decreases in O2cost, although individual responses varied substantially. Combined changes in both VO2submax and VO2 at matched peak BSL speeds revealed stronger correlations to improvements in walking function as compared to either measure alone. Conclusions: High-intensity stepping training may elicit significant improvements in VO2 submax, while changes in both peak capacity and economy better reflect gains in walking function. Providing such training to improve locomotor and aerobic exercise performance may increase the efficiency of rehabilitation sessions.
Want to read the published article?
To be alerted when this article is published, please sign up for the Journal of Neurologic Physical Therapy eTOC.

Pre-stroke CV risk factors may indicate higher stroke, dementia risk

It would be so simple for optimizing primary prevention if our doctors would just put together a diet stroke protocol that reduces blood pressure using commonly available foods and supplements. But that won't occur because we have no one in the stroke medical world that has two functioning neurons they can rub together. You, your children and grandchildren are screwed.
Portegies MLP, et al. Stroke. 2016;doi:10.1161/STROKEAHA.116.014094.

According to new research, CVD risk factors such as high BP before a first stroke confer higher risk for subsequent stroke and dementia up to 5 years later.
 “We already know that stroke patients have an increased risk of recurrent stroke and dementia. What we didn’t know was whether this increased risk persists for a long time after stroke and whether heart disease risk factors present before the first stroke influenced the risk of recurrent strokes or dementia,” M. Arfan Ikram, MD, PhD, from Erasmus University Medical Center in Rotterdam, Netherlands, said in a press release. “Our study found these risk factors influence future stroke and dementia and the risks persist for an extended period in some patients.”

The researchers analyzed based on propensity matching 1,237 patients with first-ever stroke and 4,928 participants without stroke from the population-based Rotterdam Study. Participants were matched based on sex, age, examination round, and date of selection. The outcomes of interest were stroke and dementia.
Ikram and colleagues calculated incidence rates of stroke and dementia for both groups and determined the population-attributable risk of prestroke CV risk factors for stroke and dementia.
Up to 1 year after first stroke, those with stroke had a threefold increased risk for stroke and a twofold increased risk for dementia compared with those without stroke, Ikram and colleagues wrote.
The researchers calculated that in the group with stroke, 39% (95% CI, 18-66) of recurrent strokes and 10% (95% CI, 0-91) of cases of dementia after stroke could be attributed to CV risk factors before stroke. The rates were similar in the group without stroke.
“Long-term risks of recurrent stroke and poststroke dementia remain high and are substantially influenced by prestroke risk factors, emphasizing the need for optimizing primary prevention,” the researchers wrote. – by Dave Quaile

Geometrical Axon Guidance

Send your doctor after this since we need axon guidance to reconnect up various areas of our brains.  What is your doctors current understanding of axon pathfinding and neurite outgrowth to help your brain reconnect? No knowledge, you need to fire that doctor.

Geometrical Axon Guidance

Efficacy and Safety of virtual reality in Stroke Rehabilitation: a multicenter randomized trial (EVREST Multicenter)

Now if we could get a written stroke protocol out of this. That is what a great stroke association president would be doing. But fuck we have none, you will be forever screwed until we destroy the complete stroke medical establishment.


Efficacy and Safety of virtual reality in Stroke Rehabilitation: a multicenter randomized trial (EVREST Multicenter)

Gustavo Saposnik, Leonardo G Cohen, Muhammad Mamdani, Sepideth Pooyania, Michelle Ploughman, Donna Cheung, Jennifer Shaw,
Judith Hall, Peter Nord, Sean Dukelow, Yongchai Nilanont, Felipe De los Rios, Lisandro Olmos, Mindy Levin, Robert Teasell, Ashley Cohen,
Kevin Thorpe, Andreas Laupacis, Mark Bayley, for Stroke Outcomes Research Canada
Background Non-immersive virtual reality is an emerging strategy to enhance motor performance for stroke rehabilitation. There has been rapid adoption of non-immersive virtual reality as a rehabilitation strategy despite the limited evidence about its safety and effectiveness. Our aim was to compare the safety and efficacy of virtual reality with recreational therapy on motor recovery in patients after an acute ischaemic stroke.
Methods In this randomized, controlled, single-blind, parallel-group trial we enrolled adults (aged 18–85 years) who had a first-ever ischaemic stroke and a motor deficit of the upper extremity score of 3 or more (measured with the Chedoke-McMaster scale) within 3 months of randomization from 14 in-patient stroke rehabilitation units from four countries
(Canada [11], Argentina [1], Peru [1], and Thailand [1]). Participants were randomly allocated (1:1) by a computer-generated assignment at enrollment to receive a programme of structured, task-oriented, upper extremity sessions (ten sessions, 60 min each) of either non-immersive virtual reality using the Nintendo Wii gaming system (VRWii) or simple recreational activities (playing cards, bingo, Jenga, or ball game) as add-on therapies to conventional rehabilitation over a 2 week
period. All investigators assessing outcomes were masked to treatment assignment. The primary outcome was upper extremity motor performance measured by total time to complete the Wolf Motor Function Test (WMFT) at the end of the 2 week intervention period, analysed in the intention-to-treat population. This trial is registered with,
number NTC01406912.
Findings The study was done between May 12, 2012, and Oct 1, 2015. We randomly assigned 141 patients: 71 received VRWii therapy and 70 received recreational activity. 121 (86%) patients (59 in the VRWii group and 62 in the recreational activity group) completed the fi nal assessment and were included in the primary analysis. Each group improved WMFT performance time relative to baseline (decrease in median time from 43·7 s [IQR 26·1–68·0] to 29·7 s [21·4–45·2], 32·0% reduction for VRWii vs 38·0 s [IQR 28·0–64·1] to 27·1 s [21·2–45·5], 28·7% reduction for recreational activity).
Mean time of conventional rehabilitation during the trial was similar between groups (VRWii, 373 min [SD 322] vs recreational activity, 397 min [345] ; p=0·70) as was the total duration of study intervention (VRWii, 528 min [SD 155] vs recreational activity, 541 min [142]; p=0·60). Multivariable analysis adjusted for baseline WMFT score, age, sex, baselineChedoke-McMaster, and stroke severity revealed no signifi cant diff erence between groups in the primary outcome
(adjusted mean estimate of diff erence in WMFT: 4·1 s, 95% CI –14·4 to 22·6). There were three serious adverse events
during the trial, all deemed to be unrelated to the interventions (seizure after discharge and intracerebral haemorrhage
in the recreational activity group and heart attack in the VRWii group). Overall incidences of adverse events and serious
adverse events were similar between treatment groups.

Additional effects of acupuncture on early comprehensive rehabilitation in patients with mild to moderate acute ischemic stroke: a multicenter randomized controlled trial

Impossible to have a direct effect. Energy meridians have never been proven to exist. It is all just theatrical placebo. Testing in the first three weeks would conflate with spontaneous recovery
  • Lifang Chen,
  • Jianqiao FangEmail author,
  • Ruijie Ma,
  • Xudong Gu,
  • Lina Chen,
  • Jianhua Li and
  • Shouyu Xu
BMC Complementary and Alternative MedicineBMC series – open, inclusive and trusted201616:226
DOI: 10.1186/s12906-016-1193-y
Received: 29 August 2015
Accepted: 7 July 2016
Published: 18 July 2016



Acupuncture is not considered a conventional therapy for post-stroke sequelae but it might have some additional positive effects on early rehabilitation. We conducted this trial to determine whether acupuncture has additional effects in early comprehensive rehabilitation for acute ischemic stroke and dysfunctions secondary to stroke.


Two hundred fifty patients were randomized into two groups: acupuncture (AG) or no acupuncture (NAG). Eighteen acupuncture treatment sessions were performed over a 3-week period. The primary outcome was blindly measured with National Institutes of Health Stroke Scale (NIHSS) at week 1, week 3, and week 7. Secondary outcomes included: Fugl-Meyer Assessment (FMA) for motor function, bedside swallowing assessment (BSA) and videofluoroscopic swallowing study (VFSS) for swallowing function, the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) for cognitive function, and the adverse reaction of acupuncture for safety assessment.


Significant improvements from acupuncture treatment were observed in NIHSS (p < 0.001), VFSS (p < 0.001), MMSE (p < 0.001), MoCA (p = 0.001), but not obtained from FMA (p  = 0.228). Changes from baseline of all above variables (except FMA) also had the same favorable results. A significant improvement in FMA lower extremity subscale appeared in AG (p = 0.020), but no significant difference was found for the upper extremity subscale (p = 0.707). More patients with swallowing disorder recovered in AG (p = 0.037). Low incidence of mild reaction of acupuncture indicated its safety.


This trial showed acupuncture is safe and has additional multi-effect in improving neurologic deficits, swallowing disorder, cognitive impairment, and lower extremity function, but has no significant improvement for upper extremity function during this short-term study period.

Trial registration ChiCTR-TRC −12001971 (March 2012).

Cannabis use and blood pressure levels: United States National Health and Nutrition Examination Survey, 2005–2012

You won't have to worry about this since your doctor will never prescribe marijuana for your stroke rehab. I however will get some.

My 13 reasons for marijuana use post-stroke. 

And if you do just ask your doctor what simple foods you need to eat to counteract this increase in blood pressure.

The intersection of these three sets will give lots of posts on foods that lower blood pressure.
119 posts on blood pressure.  26 posts on high blood pressure.   186 posts on diet.
I refuse to do the work your doctor should be doing and correlate all these posts. 
Your doctor had better know about all of them. Your doctor not knowing anything about blood pressure lowering foods is cause for calling the president of the hospital and asking why they are allowing such incompetence in their hospital. We have to start somewhere and get rid of all the dead wood in stroke.

Oops. Once again not following Dale Carnegie; 'How to Win Friends and Influence People'.
But I'm more concerned about getting stroke survivors recovered than worrying about the fee fees of the stroke medical establishment.
Journal of Hypertension, 07/15/2016
Alshaarawy O, et al. – The authors conduct this study investigating on cannabis use and BP levels utilizing the US National Health and Nutrition Examination Surveys 2005–2012 (n=12426). They exhibit the association between SBP and cannabis use among US adults.


  • Cannabis use was evaluated by computer-assisted self-interviews.
  • They investigated blood pressure by an average of up to four measurements taken during a single examination.
  • They used regression modeling to evaluate cannabis use and BP association.


  • Currently active cannabis use was associated with increase in SBP (β=1.6; 95% confidence interval: 0.6, 2.7) in the age–sex-adjusted model.
  • Additional covariate adjustment did not affect the positive association. No association between cannabis use and DBP was detected.
Go to PubMed Go to Abstract Print Article Summary Cat 2 CME Report

Friday, July 22, 2016

Mobile Stroke Unit Mixed Results

This is so goddamned easy to explain. Just because you are delivering tPA marginally faster doesn't mean it works better. You have done nothing to understand the 12% of tPA patients that fully recover and duplicate that. And nothing has been done on stopping the neuronal cascade of death by these 5 causes in the first week.
Ischemic stroke patients who received IV thrombolysis on the way to the hospital in a specialized ambulance kitted out with a CT scanner did not have a better chance of returning home without functional disability at 3 months than did those who got the same treatment at the hospital after usual transport.
So found a study from Berlin, where the system has been rolled out. But the researchers noted secondary findings suggestive "that pre-hospital start of intravenous thrombolysis might lead to improved functional outcome in patients."
"This evidence requires substantiation in future large-scale trials," they wrote in Lancet Neurology.