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 392 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

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

Saturday, April 19, 2014

New stroke diagnostic equipment at hospital - Wayne HealthCare, GREENVILLE, Ohio

This sounds wonderful. But why the hell are they rejoicing about putting in procedures that have only a 12% chance of success? You should be screaming at the absurdity of this. It may be the best they can do, but that best is f*cking appalling.
http://dailyadvocate.com/news/home_top-news/4509195/New-stroke-diagnostic-equipment-at-hospital
In cooperation with Wayne HealthCare, Premier Health is expanding its Telestroke Network into Greenville to quickly diagnose patients who are exhibiting signs of a stroke.
With the implementation of the Telestroke Network, a stroke patient arriving at the Wayne HealthCare emergency center can be examined via a computer linked to one of six on-call stroke specialists practicing at Premier Health any time of the day or night.

The telemedicine system is already in place at all Premier Health emergency departments. The Premier Health hospitals were the first in the Dayton area to introduce telemedicine to treat stroke patients.

“As a rural healthcare facility, it is imperative that we provide immediate treatment after a stroke occurs to maximize rehabilitation and recovery for patients,” said Kim Freeman, vice president of patient services at Wayne HealthCare.

The staff at WayneHealtchare brought the equipment online Thursday at 8 a.m., and have been running drills using the equipmnt for the past month.

Dawn Sweet, director of critical care services at Wayne HealthCare has been influential with leading this process at Wayne HealthCare.

In addition, Sweet said, “The virtual exam through the Telestroke Network will help expedite the process of being assessed by an expert neurologist who can order appropriate treatment from their location within a Premier Health facility. Our nurses and clinical staff have completed in-depth training and skills assessment for stroke certification programs, based on the National Institutes of Health Stroke Scale standards and are excited about the opportunity to add this service for our patients and community.”

The Premier Health Telestroke Network uses a rolling cart outfitted with a computer, video monitor, camera and audio system to connect the on-call stroke specialist with the patient. When a stroke patient arrives at the emergency department, the system is wheeled to the patient’s bedside. A staff member from the emergency center contacts the remote on-call stroke specialist from one of the Premier hospitals.

The specialist logs onto a computer and then can have two-way audio and video communication with, the emergency physician, the nurse, patient and family members. The specialist can “see” the patient, ask questions and view CT scans - all in real-time - to help assess the patient’s condition and help the emergency physician determine if the patient is a candidate for acute stroke therapy.

This technology dramatically increases the number of patients who can receive clot dissolving medication. This medicine is only effective within the first few hours after the stroke onset. Rapid administration can minimize the damage to the brain.

Dr. Jacob Kitchener, a Premier Health neurointerventional specialist who will be one of the physicians on-call for the telemedicine program, says the benefit this technology brings to patients is tremendous.

“Telemedicine enables physicians specifically trained in acute stroke care to be electronically transported to the patient’s bedside instantly, he says. He adds, “Such timely interactions with the family, emergency physician and most importantly, the patient, allow for a thorough and rapid patient evaluation. We are thrilled to bring this technology to the patients of Wayne HealthCare.”

In addition to Dr. Kitchener, the on-call team includes Ahmed Fathy, MD, Bradley Jacobs, MD, Bryan Ludwig, MD, Kiran Poudel, MD, and Robb Snider, MD.

Physicians believe that telemedicine will result in faster delivery of care which can improve patient outcomes. The possibilities for telemedicine are endless and Premier Hospitals could use the program in other areas such as cardiology in the future.
Big Whoopee. 

St. Cloud MN stroke center receives national honors

This would be more believable if they actually listed statistics on 30-day deaths and  100% recovery.
You could meet all these processes and still have a 100% death rate and be praised for that. Totally wrong thing to measure.
Ask the hospital administrator  for those statistics, this puffery is worthless.
Big Whoopee.
http://www.sctimes.com/story/money/business-quarry/2014/04/18/st-cloud-stroke-center-receives-national-honors/7896359/
St. Cloud Hospital Stroke Center has received the Get With The Guidelines-Stroke Silver Quality Achievement Award for implementing quality improvement measures outlined by the American Heart Association/American Stroke Association for the treatment of stroke patients.
St. Cloud Hospital also received the association’s Target: Stroke Honor Roll for meeting stroke quality measures that reduce the time between hospital arrival and treatment with the clot-buster tPA, the only drug approved by the U.S. Food and Drug Administration to treat ischemic stroke.


Heart failure and potassium

From an email from Harvard Medical School. What has your doctor told you about the usefulness of potassium for preventing strokes?  
Anything at all?

Slash Risk of Stroke with More Potassium and Less Salt

 

Woman Drinks Only Soda for 16 Years, Suffers Heart Problems

 

Why eat three bananas a day?

 --------------------------------------------------------------------------------------------------

Your body depends on the mineral potassium to help control the electrical balance of your heart as well as metabolize carbohydrates and build muscle.
Low potassium levels can cause muscle weakness and heart rhythm disturbances. On the other hand, too much potassium can cause dangerous heartbeat irregularities and even sudden death. If you have heart failure, you need to pay close attention to how much potassium you get each day. What’s more, some heart failure drugs can cause your body to excrete too much potassium, while others can cause your body to retain too much potassium.
Your doctor can tell you how the medications you need will affect your potassium levels. You’ll likely need to have your potassium level checked regularly to be sure it is within a good range for you.
Get your copy of Diagnosis: Heart Failure

Diagnosis: Heart Failure
In Diagnosis: Heart Failure, you’ll learn the mechanics of the heart, the symptoms and warning signs of heart failure, and the keys to an effective treatment plan. This report will help you understand and invest in the steps you need to take to keep heart failure in check. You’ll get guidance for monitoring symptoms, for sticking to your doctor's strategy, and for making heart-smart lifestyle changes.

Read More
If you need to raise your potassium level
If your potassium level is too low, the solution may be as simple as taking potassium supplements.
If you need to get your potassium level down
If your potassium level is too high, you may need to cut back on certain foods (see the table). These tips can also help:
  • Soak or boil vegetables and fruits to leach out some of the potassium.
  • Avoid foods that list potassium or K, KCl, or K+ — chemical symbols for potassium or related compounds — as ingredients on the label.
  • Stay away from salt substitutes. Many are high in potassium. Read the ingredient lists carefully and check with your doctor before using one of these preparations.
  • Avoid canned, salted, pickled, corned, spiced, or smoked meat and fish.
  • Avoid imitation meat products containing soy or vegetable protein.
  • Limit high-potassium fruits such as bananas, citrus fruits, and avocados.
  • Avoid baked potatoes and baked acorn and butternut squash.
  • Don’t use vegetables or meats prepared with sweet or salted sauces.
  • Avoid all types of peas and beans, which are naturally high in potassium.
Potassium levels in common foods
  High potassium Medium potassium Low potassium No potassium
Fruits and vegetables Artichokes, avocados, bananas, broccoli, coconut, dried fruits, leafy greens, kiwis, nectarines, oranges, papayas, potatoes, prunes, spinach, tomatoes, winter squash, yams Apples, apricots, asparagus, carrots, cherries, corn, eggplant, peaches, pears, peppers, pineapple juice, radishes Blueberries, cauliflower, cucumbers, grapefruit, grapes, green beans, lettuce, strawberries  
Meat and protein Dried beans and peas, imitation bacon bits, nuts, soy products Beef, eggs, fish, peanut butter, poultry, pork, veal    
Dairy Milk, yogurt   Sour cream  
Grains and processed foods Plain bagel, plain pasta, oatmeal, white bread, white rice Bran muffins and cereals, corn tortillas, whole-wheat bread   Fruit punches, jelly beans, nondairy topping, nondairy creamers
To learn more about the diagnosis and treatment of heart failure, buy Diagnosis: Heart Failure, a Special Health Report from Harvard Medical School.

Baseball gives California man new purpose after stroke

This sounds familiar to me, more at link
http://www.cbsnews.com/news/baseball-gives-california-man-new-purpose-after-stroke/
Prior to the stroke, Donnie worked as a bartender. He had no real direction. Coaching changed that. He learned to walk again. He enrolled in college, and is now studying to be a special-ed teacher. He volunteers at Arlington -- working with special-ed kids both in the classroom and on the baseball field where he has introduced them to the joys of whiffle ball.
"There's nothing like seeing these kids just run and smile and having fun," Donnie said. In fact, his life has changed so much; Donnie now says he's actually thankful he had that stroke.

He said, "(I'm) thankful that this happened, because if this didn't happen, then I would just be doing the same daily grind that I was, you know, just going to work every day to pay my mortgage, you know." There's no sweeter sound than a found purpose -- or at least, not many.
To contact On the Road, or to send us a story idea, email us.

Optimal Strategies of Upper Limb Motor Rehabilitation after Stroke

Well I the guess the strategies to recover upper limb function are out there.  Everyone else in the world is too dumb to find them. I think whatever is in the paper really doesn't work because there is no defined way to recover functionality that was in a dead brain area. But have your doctor get the paper because your doctor never knows what useful tidbits are found there.
http://synapse.koreamed.org/DOIx.php?id=10.12786/bn.2014.7.1.21
Myung Jun Shin, M.D., Sang Hun Kim, M.D., Chang-Hyung Lee, M.D., Ph.D.,1 and Yong-Il Shin, M.D., Ph.D.1
Department of Rehabilitation Medicine, Pusan National University Hospital, Korea.
1Department of Rehabilitation Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Korea.

Correspondence to: Yong-Il Shin, Department of Rehabilitation Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, 20, Geumo-ro, Mulgeum-eup, Yangsan 626-770, Korea. Tel: 055-360-2872, Fax: 055-360-4251, Email: rmshin@pusan.ac.kr



Abstract

The purpose of this review is to provide a comprehensive approach for optimal strategies of upper limb motor rehabilitation after stroke. Stroke is a common, serious, and disabling global health-care problem. Optimal organization of rehabilitation for stroke patients has been extensively documented.  (Bullshit) However, between 30% and 66% of individuals with stroke do not obtain satisfactory motor recovery of the affected upper limb with rehabilitative interventions. The recovery of the affected upper extremity depends on intensity, task progression, and repetition to neural plasticity, namely, the ability of central nervous system cells to modify their structure and function in response to external stimuli. Recently, constraint-induced movement therapy, motor imagery, action observation, or mirror therapy has emerged as interesting options as add-on interventions to standard physical therapies. In this review, we will discuss to establish a framework by which several promising interventions for neural plasticity.

Friday, April 18, 2014

Yield to temptation. It may not pass your way again. Robert A. Heinlein

I will follow almost any temptation. Tonight is a Japanese dinner in honor of the samurai movie and art museum we saw last weekend. Sake will be consumed, if that's not enough I'm sure we will break out regular wine. All in making my balance harder to maintain, thus speeding up my recovery.

Physiological responses and energy cost of walking on the Gait Trainer with and without body weight support in subacute stroke patients

No clue but I'm sure your therapist is all over this.
http://www.jneuroengrehab.com/content/11/1/54/abstract
Anna Sofia Delussu*, Giovanni Morone, Marco Iosa, Maura Bragoni, Marco Traballesi and Stefano Paolucci
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Journal of NeuroEngineering and Rehabilitation 2014, 11:54  doi:10.1186/1743-0003-11-54
Published: 10 April 2014

Abstract

Background

Robotic-assisted walking after stroke provides intensive task-oriented training. But, despite the growing diffusion of robotic devices little information is available about cardiorespiratory and metabolic responses during electromechanically-assisted repetitive walking exercise. Aim of the study was to determine whether use of an end-effector gait training (GT) machine with body weight support (BWS) would affect physiological responses and energy cost of walking (ECW) in subacute post-stroke hemiplegic patients.

Methods

Participants: six patients (patient group: PG) with hemiplegia due to stroke (age: 66 ± 15y; time since stroke: 8 ± 3 weeks; four men) and 6 healthy subjects as control group (CG: age, 76 ± 7y; six men).
Interventions: overground walking test (OWT) and GT-assisted walking with 0%, 30% and 50% BWS (GT-BWS0%, 30% and 50%). Main Outcome Measures: heart rate (HR), pulmonary ventilation, oxygen consumption, respiratory exchange ratio (RER) and ECW.

Results

Intervention conditions significantly affected parameter values in steady state (HR: p = 0.005, V’E: p = 0.001, V'O2: p < 0.001) and the interaction condition per group affected ECW (p = 0.002). For PG, the most energy (V’O2 and ECW) demanding conditions were OWT and GT-BWS0%. On the contrary, for CG the least demanding condition was OWT. On the GT, increasing BWS produced a decrease in energy and cardiac demand in both groups.

Conclusions

In PG, GT-BWS walking resulted in less cardiometabolic demand than overground walking. This suggests that GT-BWS walking training might be safer than overground walking training in subacute stroke patients.

New generation of wearable goniometers for motion capture systems

With this your therapist could objectively document your problems and present exact stroke protocols to recover functionality. That is what you expect your therapist to do? Isn't it?
http://www.jneuroengrehab.com/content/11/1/56/abstract
Alessandro Tognetti, Federico Lorussi, Gabriele Dalle Mura, Nicola Carbonaro, Maria Pacelli, Rita Paradiso and Danilo De Rossi

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Journal of NeuroEngineering and Rehabilitation 2014, 11:56  doi:10.1186/1743-0003-11-56
Published: 11 April 2014

Abstract (provisional)

Background

Monitoring joint angles through wearable systems enables human posture and gesture to be reconstructed as a support for physical rehabilitation both in clinics and at the patient's home. A new generation of wearable goniometers based on knitted piezoresistive fabric (KPF) technology is presented.

Methods

KPF single-and double-layer devices were designed and characterized under stretching and bending to work as strain sensors and goniometers. The theoretical working principle and the derived electromechanical model, previously proved for carbon elastomer sensors, were generalized to KPF. The devices were used to correlate angles and piezoresistive fabric behaviour, to highlight the differences in terms of performance between the single layer and the double layer sensors. A fast calibration procedure is also proposed.

Results

The proposed device was tested both in static and dynamic conditions in comparison with standard electrogoniometers and inertial measurement units respectively. KPF goniometer capabilities in angle detection were experimentally proved and a discussion of the device measurement errors of is provided. The paper concludes with an analysis of sensor accuracy and hysteresis reduction in particular configurations.

Conclusions

Double layer KPF goniometers showed a promising performance in terms of angle measurements both in quasi-static and dynamic working mode for velocities typical of human movement. A further approach consisting of a combination of multiple sensors to increase accuracy via sensor fusion technique has been presented.

Motor recovery patterns in arm muscles: coupled bilateral training and neuromuscular stimulation

I have no idea how this could be applied but I'm sure in the  next week your therapist will have incorporated it into your stroke protocol.
http://www.jneuroengrehab.com/content/11/1/57

Nyeonju Kang1, Jerelyne Idica1, Bhullar Amitoj1 and James H Cauraugh2*
1 Motor Behavior Laboratory, University of Florida, Gainesville, FL, USA
2 Motor Behavior Laboratory, Applied Physiology and Kinesiology Department, University of Florida, Gainesville, FL 32611-8206, USA
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Journal of NeuroEngineering and Rehabilitation 2014, 11:57  doi:10.1186/1743-0003-11-57

The electronic version of this article is the complete one and can be found online at: http://www.jneuroengrehab.com/content/11/1/57

Received:26 April 2013
Accepted:1 April 2014
Published:11 April 2014
© 2014 Kang et al.; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.

Abstract

Background

Neuromuscular stimulation coupled with bilateral movements facilitates functional motor recovery of the upper extremities post stroke. This study investigated electromyography activation patterns during training. The leading question asked: Do EMG activation patterns show rehabilitative effects of coupled bilateral movement training on wrist and fingers extension, elbow extension, and shoulder abduction?

Methods

Twelve stroke volunteers completed nine hours of coupled bilateral movement training on three sets of joints in their arms. Neuromuscular stimulation on the impaired limb assisted wrist and fingers extension, elbow extension, and shoulder abduction. Mean activation level data were analyzed in a three-way completely within-subjects ANOVA (Training Day × Movement Type × Trial Block: 3 × 3 × 3).

Results

The analysis revealed three important findings: (a) activation levels in Days 5 and 6 were significantly higher than Days 1 and 2, (b) muscle activation patterns increased across trial blocks, and (c) movements for the shoulder joint/girdle as well as wrist and fingers demonstrated higher activation than the elbow joint. Further analysis indicated that the muscle activation patterns for shoulder abduction were positively associated with force stabilization (ratio of good variability relative to bad variability) during bilateral force production.

Conclusions

The findings indicate that capability to increase muscle activity during the three joint movements was improved after training. There appears to be higher muscle activation in the primary proximal and distal muscles necessary for motor control improvement.

Thursday, April 17, 2014

Eat Your Broccoli—Choline in the Brain

I wrote about this in Oct. 2011 and I bet not one doctor in the world has taken the research to heart and created a stroke protocol for it. YOU are going to have to demand protocols that work because your doctor won't do it without pressure.

A chronic treatment with CDP-choline improves functional recovery and increases neuronal plasticity after experimental stroke

A blogger writing about it here:
http://psychneuro.wordpress.com/2014/04/17/eat-your-broccoli-choline-in-the-brain/

How much broccoli should you be eating on a daily basis? How long before your hospital has broccoli smoothies for you whenever you want them?

Illinois Sen. Kirk calls for more stroke research funding at meeting with Chicago-area doctors

Someone has to contact him so he can talk with specifics about what needs research. These 177 hyperacute possibilities needing research? Because if we don't the researchers won't  be following any sort of strategic plan. It would help if we had a strategic plan but I'm sure no one has rubbed their 2 neurons together to come up with one. And strokies will be screwed for another 50 years.
http://www.therepublic.com/view/story/2d3ba0c024ae465aaa06d924e3cdcbc9/IL--Kirk-Stroke-Agenda
Illinois Sen. Mark Kirk on Wednesday called for more funding for research to decrease the risk of strokes and to treat those who have them.

More funding will not do a bit of f*cking good unless there is a plan being followed.

Stroke Rounds: Depression Tied to Worse Stroke Outcomes

I think they have it totally backwards. Maybe if they actually use some of the neurons in their f*cking brains. They're depressed because they didn't get anything to stop the neuronal cascade of death so the damage continued for a whole week after the original event. Or maybe because they found out that they have at most a 10% chance of full recovery. Solve the real problem you lazy bastards. 
Stop the neuronal cascade of death.
http://www.medpagetoday.com/Neurology/Strokes/45302?

Digital mirror reveals what lies under your skin

Don't you want to see your muscles in all their glory not working so your therapists can give you specific exercises and protocols to recover all your muscular deficits?
http://www.newscientist.com/article/mg22229653.800#.U1Aw8RA1YZl
Cool 1.19 minute video at link.

Helping stroke patients regain control of constricted muscles

Research in Australia, participate if you can.
https://www.neura.edu.au/sites/neura.edu.au/files/neura-magazine/08/index.html#2-3/z
Prof Rob Herbert and his team are investigating why muscles in limbs affected by stroke sometimes become stiff, a condition known as contracture. Around half of stroke patients develop at least one contracture, which can affect many parts of the body. The team is currently seeking participants who have had a stroke. If you would like to participate, please contact Dr. Peter Stubbs at 02 9399 1830 or email p.stubbs@neura.edu.au

Measuring Health-Related Quality Of Life (HRQOL) During Inpatient Stroke Rehabilitation

The solution to low scores would be to have much less dead and damaged neurons because your doctor has stopped the neuronal cascade of death.
http://www.neurology.org/content/82/10_Supplement/S21.002.short
  1. A. Barrett1
  1. Neurology vol. 82 no. 10 Supplement S21.002

Abstract

OBJECTIVE: We examine whether it is feasible to ask stroke survivors to estimate their own health-related quality of life (HRQOL), and change in HRQOL during acute inpatient rehabilitation. We compared self-assessment with clinician, third-party assessment. We also examined whether HRQOL changes were associated with changes in functional status.BACKGROUND: Functional status may not represent the impact ofstroke on a patient’s life. Studies have shown that stroke patients canappear functionally independent while still reporting major problems with return to work, engaging in leisure activities or with emotional adjustment. Determinants of HRQOL have been studied on stroke patients across the health-care continuum.DESIGN/METHODS:Independent HRQOL assessments with the Euro-Quol (EQ-5) were made by moderate stroke survivors and clinicians, and functional status scores were assigned by clinicians with the functional independence measure (FIM), at admission and discharge.RESULTS: 175 moderate stroke survivors were tested, with only 10.2% unable to complete the EQ-5 due to cognitive/ language impairments (e.g., delirium, aphasia). Patients and clinicians reported significant improvements on each EQ-5 domain during inpatient rehabilitation (p < .05). Moreover, patient and clinician ratings positively and significantly correlated in all EQ-5 domains: mobility (r = .31, p <.001), self-care (r = .21, p < .01), activities (r = .31, p <.001), pain/discomfort (r =.52, p < .001), and anxiety/depression (r = .57, p <.001). Significant cognitive and motor FIM improvements during rehabilitation did not correlate with any improvements on EQ-5 therapist ratings of patients' HRQOL.CONCLUSIONS: EQ-5 ratings converged between stroke survivors and clinicians, suggesting it is valid and reliable to measure moderate stroke survivor HRQOL in inpatient rehabilitation. EQ-5 and FIM improvement were poorly associated; HRQOL may independently complement functional outcome assessment in inpatient rehabilitation. Future studies could explore different areas of function to clarify the factor structure of improvement on these measures relative to HRQL.Study Supported by: NIH, Kessler Foundation

May is National Stroke Awareness Month. For 25 years, the National Stroke Association (NSA) has been raising awareness about the causes and results of stroke through this annual campaign.

You notice that there are no action verbs there.
Solving the 10% full recovery failure.
Solving spasticity.
Solving fatigue.
Stopping the neuronal cascade of death. 
Creating an objective, fast, easy diagnosis for stroke.
Preventing stroke with specific actionable activities.
Renaming stroke to 'brain attack'.
Researching anything about stroke.
Creating and updating textbooks on stroke for stroke-related medical students.
GAH!!!!! 25 years of failure in my opinion. Nothing being done here will solve the upcoming tsunami of stroke.
And is the board of directors ok with that?

Casual Pot Use Impacts Brains of Young Adults, Researchers Find

Those who read me know that I think marijuana should be a part of the stroke protocols for various reasons. So does this change my mind? Not at all. If you disagree provide real research to back up your opinion.
Reefer Madness is not proof.

Casual Pot Use Impacts Brains of Young Adults, Researchers Find
  • Marijuana News: Casual Pot Use Impacts Brains of Young Adults, Researchers Find (The Oregonian)
  • Study Finds Brain Changes in Young Marijuana Users (Boston Globe)
  • Casual Marijuana Use Linked to Brain Changes (USA Today)
  • Even Casually Smoking Marijuana Can Change Your Brain, Study Says (Washington Post)
  • Study Finds Changes in Pot Smokers' Brains (Denver Post)
  • Recreational Pot Use Harmful to Young People's Brains (TIME)

Striking a Nerve: Bungling the Cannabis Story

These are all the reasons I think marijuana should be used. And unless you act now to tell your congressperson to get their heads out of the sand and remove Schedule I classification, when your parents or you have a stroke you will not be able to get the benefits.

1.  What will it take for marijuana/cannabis/weed/mj to be recognized and provided as a therapy for stroke?
  
2.  Study on marijuana for PTSD moves forward 
  
3. Cannabis may help stroke recovery 

 4.  Stroke survivors unaware of therapy options for spastic muscles, survey finds 

 5. Tapping Medical Marijuana’s Potential 

 6.  Small Quantities Of Marijuana Protect Against Brain Damage

 7.   A Marijuana Bud A Day Keeps The Stroke Away 

 8.   Cannabis chemical 'helps heart' The cannabis chemical helps ward off heart disease, scientists say 

 9.   Symptomatic therapy in multiple sclerosis: the role of cannabinoids in treating spasticity 

 10.  A cannabinoid type 2 receptor agonist attenuates blood–brain barrier damage and neurodegeneration in a murine model of traumatic brain injury

 11.  Marijuana might cause new cell growth in the brain

 12. Cannabidiol Reduces Aβ-Induced Neuroinflammation and Promotes Hippocampal Neurogenesis through PPARγ Involvement 

 13.  Medicinal Uses of Marijuana: Brain Trauma/Stroke 

Does your doctor know about ANY of these? What are they doing to help you recover  with these?





 







 

 

Heidi Moawad, MD Stroke- What you need to Know

I absolutely hate these statements from doctors putting all the responsibility on the layperson. Doctors should look at themselves once in a while and recognize that they are pretty much useless on getting survivors to 100% recovery. But they won't because they get paid regardless of how well you recover. What other service do you pay for even if you get nothing in return? Ok, homeopathy.
http://stroke.about.com/b/2014/03/17/stroke-what-you-need-to-know.htm?nl=1

Wednesday, April 16, 2014

Participate in the 2014 Brain Awareness Video Contest!

From the Society for Neuroscience.
http://echo4.bluehornet.com/hostedemail/email.htm?CID=26069024739&ch=1FD997FA52A340DEAD4F0FD5744FD133&h=08ed99038adc231e99321550d116e51f&ei=7tgn5p1jN



Participate in the 2014 Brain Awareness Video Contest!
Create a short, educational video about the brain for the 2014 Brain Awareness Video Contest. Demonstrate a neuroscience concept through animation, song, skit, or any other creative approach. Learn more about neuroscience and put your creative skills to work — you could win $1,000.
Anyone can enter. Videos must be submitted by an SfN member, so find a member near you with the Find a Neuroscientist program on BrainFacts.org
Top videos will be featured on SfN.org and BrainFacts.org and recognized at Neuroscience 2014. Submissions are due June 12.
Stumped on what kind of video to make? Visit BrainFacts.org/bavc to watch last year's winning videos, browse past submissions, and learn more about the contest.
Society for Neuroscience banner graphic

Are Blood Pressure Drugs Worth the Falls?

Something for you and your doctor to think about. Falls are extremely deadly especially to survivors. And why are physical therapists pushing such a deadly activity as walking immediately after a stroke?
http://newoldage.blogs.nytimes.com/2014/04/16/blood-pressure-drugs-may-raise-fall-risk/?_php=true&_type=blogs&_r=0

Flying Through Inner Space - your brain

With a decent stroke association we would be taking this idea and see exactly where the neuronal messages dead end. But nothing will occur until we get that great stroke association - One that is excited about figuring out how to solve the brains problems, not just content to put out press releases.
http://phenomena.nationalgeographic.com/2014/03/19/flying-through-inner-space/

Watch the 3rd one, it's good.

Factors Affecting the Ability of the Stroke Survivor to Drive Their Own Recovery outside of Therapy during Inpatient Stroke Rehabilitation

This solution is possibly the worst idea yet. It's very very simple, you stop the neuronal cascade of death resulting in much less disability.
Survivors don't know what to do to recover because doctors/therapists have no clue on how to get survivors to 100% recovery. Solve that problem first and then maybe you can dump the problem into the survivors lap.
Then you also don't have to worry about all the inactivity while in the hospital. Everyone here is solving the wrong problem. The medical stroke world has to attract the stupidest people in the world. Just so they can feel comfortable around all us stroke-addled persons.

Factors Affecting the Ability of the Stroke Survivor to Drive Their Own Recovery outside of Therapy during Inpatient Stroke Rehabilitation

New therapy helps to improve stereoscopic vision in stroke patients

You can see how long before your doctor recommends this for you. I'm betting never.
http://www.alphagalileo.org/ViewItem.aspx?ItemId=141013&CultureCode=en
Humans view the world through two eyes, but it is our brain that combines the images from each eye to form a single composite picture. If this function becomes damaged, impaired sight can be the result. Such loss of visual function can be observed in patients who have suffered a stroke or traumatic brain injury or when the oxygen supply to the brain has been reduced (cerebral hypoxia). Those affected by this condition experience blurred vision or can start to see double after only a short period of visual effort. Other symptoms can include increased fatigue or headaches. It is been suggested that these symptoms arise because the brain is unable to maintain its ability to fuse the separate images from each eye into a single composite image over a longer period. Experts refer to this phenomenon as binocular fusion dysfunction.
‘As a result, these patients have significantly reduced visual endurance,’ explains Katharina Schaadt, a graduate psychology student at Saarland University. ‘This often severely limits a patient’s ability to work or go about their daily life.’ Working at a computer screen or reading the newspaper can be very challenging. As binocular fusion is a fundamental requirement for achieving a three-dimensional impression of depth, those affected also frequently suffer from partial or complete stereo blindness. ‘Patients suffering from stereo blindness are no longer able to perceive spatial depth correctly,’ says Schaadt. ‘In extreme cases, the world appears as flat as a two-dimensional picture. Such patients may well have difficulties in reaching for an object, climbing stairs or walking on uneven ground.’
Although about 20% of stroke patients and up to 50% of patients with brain trauma injuries suffer from these types of functional impairments, there is still no effective therapy. Researchers at Saarland University working with Anna Katharina Schaadt and departmental head Professor Georg Kerkhoff have now developed a novel therapeutic approach and have examined its efficacy in two studies. ‘Test subjects underwent a six week training program in which both eyes were exercised equally,’ explains Schaadt. The aim was to train binocular fusion and thus improve three-dimensional vision. Participants in the study were presented with two images with a slight lateral offset between them. By using what are known as convergent eye movements, patients try to fuse the two images to a single image. This involves directing the eyes inward towards the nose while always keeping the images in the field of view. With time, the two images fuse to form a single image that exhibits stereoscopic depth, i.e. the patient has re-established binocular single vision.

More at link.

Outcome of stroke worse for people with infection

Wrong title, should be 'Outcome of stroke worse for rodents with pneumonia'. We know that rodent inflammation is not the same as human inflammation, so have your doctor make sure you don't get pneumonia just in case this turns out to be incorrect in this case.
The understandable writeup here;
http://www.alphagalileo.org/ViewItem.aspx?ItemId=140993&CultureCode=en

The abstract it is based upon here: 
Streptococcus pneumoniae worsens cerebral ischemia via interleukin 1 and platelet glycoprotein Ibα

Functional brain imaging reliably predicts which vegetative patients have potential to recover consciousness

This seems like something our doctors would need to do to prove that our locked-in patients are still all there. Before they start talking about harvesting organs when you die.
http://www.alphagalileo.org/ViewItem.aspx?ItemId=140968&CultureCode=en
A functional brain imaging technique known as positron emission tomography (PET) is a promising tool for determining which severely brain damaged individuals in vegetative states have the potential to recover consciousness, according to new research published in The Lancet.
It is the first time that researchers have tested the diagnostic accuracy of functional brain imaging techniques in clinical practice.
“Our findings suggest that PET imaging can reveal cognitive processes that aren't visible through traditional bedside tests, and could substantially complement standard behavioural assessments to identify unresponsive or “vegetative” patients who have the potential for long-term recovery", says study leader Professor Steven Laureys from the University of Liége in Belgium.*
In severely brain-damaged individuals, judging the level of consciousness has proved challenging. Traditionally, bedside clinical examinations have been used to decide whether patients are in a minimally conscious state (MCS), in which there is some evidence of awareness and response to stimuli, or are in a vegetative state (VS) also known as unresponsive wakefulness syndrome, where there is neither, and the chance of recovery is much lower. But up to 40% of patients are misdiagnosed using these examinations.

More at link.

Tuesday, April 15, 2014

A couple of falls

Fell on Sat. inside the apartment when my grippy tennis shoes grabbed the carpet and wouldn't let go in time. Fell directly on both knees, lucky it was on the carpet and far enough back from the bike so I didn't crash into it. Last night I fell going down some outside steps while leaving a 50th birthday party. There was snow and sleet on them, landed on my butt, but saved the painting I was carrying- the one from Rome. It was only 1:30am and I'd been consuming wine and snacks since 6:00pm. Embarassing but no injuries. I was testing out my theories on making balance more difficult so you recover faster by drinking lots of alcohol. Don't follow my example.

Effects of Quadriceps Muscle Fatigue on Stiff-Knee Gait in Patients with Hemiparesis

I know I never fatigued my quads when walking in therapy.
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0094138#pone-0094138-g002

  • Julien Boudarham mail,

  • Nicolas Roche,
  • Didier Pradon,
  • Eric Delouf,
  • Djamel Bensmail,
  • Raphael Zory
  • Published: April 09, 2014
  • DOI: 10.1371/journal.pone.0094138

Abstract

The relationship between neuromuscular fatigue and locomotion has never been investigated in hemiparetic patients despite the fact that, in the clinical context, patients report to be more spastic or stiffer after walking a long distance or after a rehabilitation session. The aim of this study was to evaluate the effects of quadriceps muscle fatigue on the biomechanical gait parameters of patients with a stiff-knee gait (SKG). Thirteen patients and eleven healthy controls performed one gait analysis before a protocol of isokinetic quadriceps fatigue and two after (immediately after and after 10 minutes of rest). Spatiotemporal parameters, sagittal knee and hip kinematics, rectus femoris (RF) and vastus lateralis (VL) kinematics and electromyographic (EMG) activity were analyzed. The results showed that quadriceps muscle weakness, produced by repetitive concentric contractions of the knee extensors, induced an improvement of spatiotemporal parameters for patients and healthy subjects. For the patient group, the increase in gait velocity and step length was associated with i) an increase of sagittal hip and knee flexion during the swing phase, ii) an increase of the maximal normalized length of the RF and VL and of the maximal VL lengthening velocity during the pre-swing and swing phases, and iii) a decrease in EMG activity of the RF muscle during the initial pre-swing phase and during the latter 2/3 of the initial swing phase. These results suggest that quadriceps fatigue did not alter the gait of patients with hemiparesis walking with a SKG and that neuromuscular fatigue may play the same functional role as an anti-spastic treatment such as botulinum toxin-A injection. Strength training of knee extensors, although commonly performed in rehabilitation, does not seem to be a priority to improve gait of these patients.

Delayed Ischemic Neurological Injury/Deficits

A boring non attention getting term - Use neuronal cascde of death instead, it implies immediate action needed.
But you can read up on the DINI/DIND research here;
http://www.google.com/url?url=http://scholar.google.com/scholar_url%3Fhl%3Den%26q%3Dhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC508786/pdf/1011992.pdf%26sa%3DX%26scisig%3DAAGBfm1GAcxAiUmZNTgyQbchX_aTQ9KoaQ%26oi%3Dscholarr&rct=j&q=&esrc=s&sa=X&ei=MExNU_eVLqbS2QWw8IHoAQ&ved=0CCkQgAMoATAA&usg=AFQjCNGP0bxIrYTq0tY-1SLAtpZdTzj4Gg&cad=rja

Products of hemolysis in the subarachnoid space inducing spreading ischemia in the cortex and focal necrosis in rats: a model for delayed ischemic neurological deficits after subarachnoid hemorrhage?

DNA methyltransferase contributes to delayed ischemic brain injury

Definition of Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage as an Outcome Event in Clinical Trials and Observational Studies 

 Delayed Post Traumatic Vasospasm Leading to Ischemia in a. Patient with Mild Traumatic Brain Injury

 

 

Antioxidants: The new frontier for translational research in cerebroprotection

This seems like important stuff for us to know but an intelligent medical person would need to translate what is being said here into some useful guidelines.
http://www.joacp.org/article.asp?issn=0970-9185;year=2014;volume=30;issue=2;spage=160;epage=171;aulast=Tewari
ASA - Dr. Mariell Jessup,  Whom are you going to assign to this task?

NSA - Mr. Baranski, Whom are you going to assign to this task?

WSO - Dr. Stephen Davis, Whom are you going to assign to this task?

Are you Connecting dots or collecting dots (and just spinning your wheels)?

A great insight from Seth Godin. Our stroke medical world seems to never want to actually connect research to solutions because that would require intellectual challenge.

Connecting dots (or collecting dots) 

Without a doubt, the ability to connect the dots is rare, prized and valuable. Connecting dots, solving the problem that hasn't been solved before, seeing the pattern before it is made obvious, is more essential than ever before.
Why then, do we spend so much time collecting dots instead? More facts, more tests, more need for data, even when we have no clue (and no practice) in doing anything with it.
Their big bag of dots isn't worth nearly as much as your handful of insight, is it?

 

Ask your doctor whether they are a connector or collector or just a useless bag of mostly water.

Cardiac Patients' Mental Distress Eased With Care Coordination

Should  the exact same thing be implemented for stroke patients?  Whom is going to roll this out worldwide?
The writeup on MedPage here;
http://www.medpagetoday.com/Cardiology/Prevention/45251?xid=nl_mpt_cardiodaily_2014-04-14&

The actual clinical trial here:
A Collaborative Care Program to Improve Treatment of Depression and Anxiety Disorders in Cardiac Patients (MOSAIC)
Purpose
For this trial, the investigators propose a prospective trial of a collaborative care program to identify and treat depression, generalized anxiety disorder (GAD), and panic disorder (PD) among patients admitted to the hospital for an acute cardiac illness (acute coronary syndrome [ACS], congestive heart failure [CHF], or arrhythmia). Such assessment and treatment for depression/GAD/PD will begin in the hospital, and ongoing management will continue for six months following discharge.
The investigators hypothesize that this model will lead to increased treatment rates, improved mood, reduced anxiety, and improved medical outcomes in this vulnerable population. If this model is effective, it could be implemented clinically to provide better and more complete care to patients hospitalized with acute cardiac illness, for whom depression and anxiety may be a risk factor for complications and death.
This will be a two-arm, single-blind randomized controlled trial, with one-half of patients randomized to collaborative care and one-half randomized to the control condition (usual care). Psychiatric treatment in the intervention arm will be provided in concert with patients' primary care physicians (PCPs)—with PCPs prescribing all medications—within a framework supervised by a psychiatrist.
The investigators will enroll patients who have any (or all) of the three included psychiatric diagnoses to improve the utility of the intervention. The investigators have chosen to enroll patients with several different cardiac diagnoses. This will allow the researchers to include patients with heterogeneous diagnoses and illness severity to determine if our intervention is effective in a broad population of patients with heart disease. The investigators will study an intervention targeting depression, GAD, and PD: all three disorders are disabling and associated with adverse cardiovascular outcomes, treatments for the conditions are highly similar, the investigators can treat patients who have more than one disorder, and a prior outpatient program successfully simultaneously addressed more than one mental health condition.
The project will involve: (1) screening patients for depression, GAD, and PD as part of usual clinical care, (2) evaluation of positive-screen patients by a study social work care manager, (3) a multicomponent in-hospital intervention (for collaborative care patients) that involves patient education, specialist-provided treatment recommendations, and a goal of in-hospital treatment initiation, and (4), after discharge, continued phone-based evaluation and care coordination with PCPs to provide stepwise treatment in the collaborative care arm. The intervention has been designed to be low-cost, low-burden, and easily generalizable to other settings.

Arm–Trunk Coordination for Beyond-the-Reach Movements in Adults With Stroke

More research done in pointing out a post-stroke problem but no solution even suggested to correct the problem. If I were running research grants there would always be some required discussion of a solution.
http://nnr.sagepub.com/content/28/4/355?etoc
  1. Tahir Shaikh, MD1
  2. Valerie Goussev, PhD2
  3. Anatol G. Feldman, PhD2,3
  4. Mindy F. Levin, PhD1,2
  1. 1McGill University, Montreal, Quebec, Canada
  2. 2Center for Interdisciplinary Research in Rehabilitation (CRIR)-Jewish Rehabilitation Hosptial, Laval, Quebec, Canada
  3. 3Université de Montréal, Montreal, Quebec, Canada
  1. Mindy F. Levin, School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir William Osler, Montreal, Quebec, Canada H3G 1Y5. Email: mindy.levin@mcgill.ca

Abstract

Background. By involving additional degrees of freedom, the nervous system may preserve hand trajectories when making pointing movements with or without trunk displacement. Previous studies indicate that the potential contribution of trunk movement to hand displacement for movements made within arm reach is neutralized by appropriate compensatory shoulder and elbow rotations. For beyond-the-reach movements, compensatory coordination is attenuated after the hand peak velocity, allowing trunk movement to contribute to hand displacement. Objective. To investigate if the timing and spatial coordination of arm and trunk movements during beyond-the-reach movements is preserved in stroke. Methods. Eleven healthy control subjects and 11 individuals with mild-to-moderate chronic unilateral hemiparesis participated. Arm and trunk kinematics during 60 target reaches to an ipsilaterally placed target were recorded. In 30% of randomly chosen trials, trunk movement was unexpectedly prevented (blocked-trunk trials) by an electromagnetic device, resulting in divergence of the hand trajectory from that in free-trunk trials. Hand trajectories and elbow–shoulder interjoint coordination were compared between trials. Results. In stroke participants, hand trajectory divergence occurred at a shorter movement extent and interjoint coordination patterns diverged at a relatively greater distance compared to controls. Thus, arm movements in stroke participants only partially compensated trunk displacement resulting in the trunk movement contributing to arm movement earlier and to a larger extent during reaching.  

Conclusion. Individuals with mild-to-moderate stroke have deficits in timing and spatial coordination of arm and trunk movements during different parts of a reaching movement. This deficit may be targeted in therapy to improve upper limb function.

Mirrored Feedback in Chronic Stroke Recruitment and Effective Connectivity of Ipsilesional Sensorimotor Networks

How many similar research studies need to be done before this is written up as a specific stroke protocol and distributed worldwide? Assuming there is any organization to take up this easy task.
ASA, NSA, WSO? None of these will do this work because it doesn't fall into their mission.

1. Mirror-box therapy: Rehabilitation of hemiparesis after stroke with a mirror
Altschuler EL, Wisdom SB, Stone L, Foster C, Galasko D, Llewellyn DME, Ramachandran V
The Lancet - Vol. 353, Issue 9169, 12 June 1999, Pages 2035-2036

2.  From March, 2012;
Mirror Therapy for Post-Stroke Rehabilitation
3. From may, 2012;
Mirror Training The Mirror as the Element Connecting Both Hands to One Hemisphere
4.  From Oct. 2012;

Upper extremity rehabilitation of stroke: Facilitation of corticospinal excitability using virtual mirror paradigm 
5.  From Nov. 2012;
Effects and Adherence of Mirror Therapy in People with Chronic Upper Limb Hemiparesis: A Preliminary Study
6.  From Dec. 2012;
Mirror Therapy for Improving Motor Function After Stroke
7.  From Feb. 2013;
Systematic Review on the Effectiveness of Mirror Therapy in Training Upper Limb Hemiparesis after Stroke
8.  From May, 2013 in New Zealand;
Fooling brain into restoring hand use
9.  From July, 2013 in Germany;
Mirror therapy for improving motor function after stroke
10.  From Dec. 2013
Mirrored Feedback in Chronic Stroke Recruitment and Effective Connectivity of Ipsilesional Sensorimotor Networks


11.And the latest here;
http://nnr.sagepub.com/content/28/4/344?etoc 
  1. Soha Saleh, PhD1,2
  2. Sergei V. Adamovich, PhD1,2,3
  3. Eugene Tunik, PhD, PT1
  1. 1Department of Rehabilitation and Movement Science, Rutgers University, Newark, NJ, USA
  2. 2Graduate School of Biomedical Sciences, Rutgers University, Newark, NJ, USA
  3. 3Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, USA
  1. Eugene Tunik, PhD, PT, Department of Rehabilitation and Movement Science, Rutgers University, 65 Bergen Street, 7th Floor, Newark, NJ 07101, USA. Email: eugene.tunik@rutgers.edu

Abstract

Background. Mirrored feedback has potential as a therapeutic intervention to restore hand function after stroke. However, the functional (effective) connectivity of neural networks involved in processing mirrored feedback after stroke is not known. Objective. To determine if regions recruited by mirrored feedback topographically overlap with those involved in control of the paretic hand and to identify the effective connectivity of activated nodes within the mirrored feedback network. Methods. Fifteen patients with chronic stroke performed a finger flexion task with their unaffected hand during event-related functional magnetic resonance imaging (fMRI). Real-time hand kinematics was recorded during fMRI and used to actuate hand models presented in virtual reality (VR). Visual feedback of the unaffected hand motion was manipulated pseudorandomly by either actuating the VR hand corresponding to the moving unaffected side (veridical feedback) or the affected side (mirrored feedback). In 2 control conditions, the VR hands were replaced with moving nonanthropomorphic shapes. Results. Mirrored feedback was associated with significant activation of regions within and outside the ipsilesional sensorimotor cortex, overlapping with areas engaged when patients performed the task with their affected hand. Effective connectivity analysis showed a significantly interconnected ipsilesional somatosensory and motor cortex in the mirrored feedback condition.  

Conclusions. Mirrored feedback recruits ipsilesional brain areas relevant for control of the affected hand. These data provide a neurophysiological basis by which mirrored feedback may be beneficial as a therapy for restoring function after stroke.