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:http://oc1dean.blogspot.com/2010/11/my-background-story_8.html

Tuesday, December 28, 2010

nanoparticles and stroke rehab

Since I think too much about all things stroke related I came across nanoparticles and tried to envision what use they could be for stroke rehab.
They have several interesting abilities;
1. They can cross the blood-brain barrier
http://www.ncbi.nlm.nih.gov/pubmed/16154222
2. They are already used to treat thrombi in parts of the body.
http://www.springerlink.com/content/vj1528n166147410/
3. They can be magnetically directed.
http://www.redorbit.com/news/video/health/4/magnetic_nanoparticles_remotely_control_neurons_and_animal_behavior/32320/
For our purposes they could be used to deliver a clot-busting drug directly to the clot using the magnetic properties to guide it. And since the amount could be sized to the clot size the risk of bleeding could be lowered significantly and the 3-4.5 hour window for tPA ignored.
The more interesting delivery mechanism would be to deliver neuronal growth factors, c3a peptides and NOGO receptors to the penumbra and dead brain areas. Or deliver stem cells to the most likely place for them to survive and start working.
And after we deliver these growth factors or stem cells we can use connectomics to find out if they are working as we expected.

This could be incredibly useful for those who need some magical properties in order to recover, not all of us are willing to spend the rest of our lives working on recovery or have the mental cognition to understand the work needed to recover.

Monday, December 20, 2010

stroke guidelines around the world

best practices in stroke rehab
Canada has several
Strokengine
http://www.strokengine.ca/index.php
http://www.strokebestpractices.ca/
Canadian Stroke strategy for 2010
http://canadianstrokestrategy.com/
Australian stroke strategy
http://www.strokefoundation.com.au/images/stories/stroke%20support%20strategy%20low%20res.pdf
Britain stroke strategy
http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Healthcare/Longtermconditions/Vascular/Stroke/DH_099065
Stroke guidelines of the Royal College of Physicians
http://www.nice.org.uk/nicemedia/live/12018/41363/41363.pdf
Scottish Intercollegiate Guidelines Network
http://www.sign.ac.uk/pdf/sign118.pdf
And what the World Stroke Organization lists as international stroke guidelines for countries.
http://www.world-stroke.org/guidelines_hb02.asp
You will notice that the United states doesn't even have an entry
One would think that the WSO would put together a single guideline but that obviously will not occur until a survivor gets in power in the WSO.
Most of these have probably been put together with limited survivor input so take them with a grain of salt.
If your country has some please post them in the comment section.

Saturday, December 18, 2010

late start to stroke therapy ok

http://www.medgadget.com/archives/2010/04/robotassisted_post_stroke_therapy_beneficial_even_for_late_starters_1.html
A late start to stroke therapy has been thought to be detrimental to getting much benefit out of it, so exercises must begin as soon as possible. A new study, published in the New England Journal of Medicine, has now shown that even late starters can see substantial improvement when using robotically assisted therapy.
This belief is represented in most stroke associations and doctor/therapist statements. I don't believe this is limited to only robotically assisted. I bet it takes 10-15 years before this statement shows up in these places and 30 years before it is taught in schools. So now when you see articles extolling starting therapy immediately reply to them and quote this article back to them

Tuesday, December 14, 2010

Stroke blogging - do it now!

Start your own stroke blog. Stroke survivors as a whole are invisible, we need to change that.
http://www.baltimoresun.com/news/opinion/oped/bs-ed-stroke-20101028,0,4151798.story I don't want to find out 20 years from now that survivors still do not have a voice in their stroke associations and a way to direct where the future of stroke rehab leads.
Even if all we do is document our own case study that can immeasureably help another survivor.
You can create one here on Google, just click on the CreateBlog link at the top of this blog. Its free and I am sure there are other sites that allow free blogging.
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When you have created one and posted a few entries please send me a link. I want to see thousands/millions out there. If it is not in English please tell me what language it is in. I will add yours to my blog list for others to find. If you want to be found by google read my posting on how to stay informed of stroke rehab


Do it now!!!!!!!

Monday, December 13, 2010

caffeine and stroke/alzheimers risk

I was having an Q&A at a stroke forum on Alzheimers and the worry was getting it and what possibly could prevent that from happenning. I responded with this research.

Caffeine Treats Alzheimer's?
http://www.everydayhealth.com/alzheimers/specialists/coffee-for-alzheimers-prevention.aspx

This just came in.
Upping your coffee intake 'doubles the risk of a stroke'
http://www.dailymail.co.uk/health/article-1337684/Upping-coffee-intake-doubles-risk-stroke.html?ito=feeds-newsxml
or if you're a woman can coffee cut a womans stroke risk?
So do you want to prevent Alzheimers but have the greater possibility of a stroke? In my opinion/case my stroke was not a bleed so I will take the extra risk, anyway I need the caffeine in order to function during the day. This is the perfect question to ask your doctor and see if they are following the latest news. Depends on which research you believe in.

Sunday, December 12, 2010

REM sleep and stroke fatigue

A theory of mine, I don't think I have dreamed since my event and was wondering if that was causing some of my fatigue. As the episode Night Terrors in Star Trek Next Generation shows what happens when you don't dream. Please respond if you have or have not dreamed and list the fatigue you have. I can easily fall asleep anytime during the day even with 12 hours of sleep.
SYMPTOMS: A person lacking REM sleep will show all the general symptoms of sleep deprivation, such as reduced productivity in the workplace, daytime sleepiness, and not handling stress well. Losing REM sleep makes people more sensitive to pain, too. In addition, REM sleep seems to be necessary for verbal skills. A lack of it will cause a person to not be as creative in using language, and they will not do too well on language tests.
As both these articles state; The success of a stroke patients rehabilitation plan is heavily dependent on sleep.
http://strokerehabonline.com/2010/06/sleeping-and-sleep-for-stroke-recovery-speed-up/comment-page-1/#comment-503
http://ezinearticles.com/comment.php?Sleep-is-an-Important-Aid-to-Stroke-Recovery&id=3866857
What are your dreams like and do you have them? Do you dream pre-stroke or after stroke abilities?
I have now changed both my zocor and zoloft from evening meds to morning meds and I now dream. Don't do that without your doctors ok.

Thursday, December 9, 2010

bowling and stroke rehab

Today our unit at work had a bowling outing. I had not done this since my
event and my main worry was needing to ask a co-worker to tie the bowling
shoes. Luckily that wasn't a problem because they had velcro straps.
Bowling went fairly well. I would limp/shuffle to the line and just use
arm motion to throw the ball. By the time I planted my left foot there
was no momentum to my swing. I started out with a 15lb. ball but that was
too heavy, so I managed to get a 13 lb. ball instead, lighter ones are
obviously meant for smaller fingers. Scores were 124, 119, 113 about 10
points less than pre-stroke. All-in-all a successful outing, I'll have to
do it again.

Saturday, December 4, 2010

split-belt treadmill and stroke rehab

Physical Therapists Use A Split-belt Treadmill To Help Stroke Patients Walk More Easily
The other problem is that it looks like it will be very expensive so that few clinics will be able to afford them, similar to Lokomat training. Luckily I moved to a clinic with the Lokomat and thought that using it was probably the most helpful in getting somewhat of a normal gait.
When the legs move at speeds different from one another, the brain receives an error signal and the brain and nervous system use the feedback to adjust. The cerebellum recalls this message even after the treadmill stops and for a few minutes, stroke patients can walk easier.
Split-belt treadmill training poststroke: a case study.
BACKGROUND AND PURPOSE: Even after rehabilitation, many individuals with strokes have residual gait deviations and limitations in functional walking. Applying the principles of motor adaptation through a split-belt treadmill walking paradigm can lead to short-term improvements in step length asymmetry after stroke. The focus of this case study was to determine whether it is possible to capitalize on these improvements for long-term gain.
CASE DESCRIPTION: The participant was a 36-year-old woman who was 1.6 years poststroke. She had a slow walking speed and multiple specific gait deviations, including step length asymmetry.
INTERVENTION: The participant walked on a split-belt treadmill 3 d/wk for 4 weeks, with the paretic leg on the slower of the two treadmill belts. The goal was 30 minutes of split-belt treadmill walking each day, followed by overground walking practice to reinforce improvements in step length symmetry.
OUTCOMES: With training, step length asymmetry decreased from 21% to 9% and decreased further to 7% asymmetry 1 month after training. Self-selected walking speed increased from 0.71 m/s to 0.81 m/s after training and 0.86 m/s 1 month later. Percent recovery, measured by the Stroke Impact Scale (SIS), increased from 40% to 50% posttraining and to 60% 1 month later.
DISCUSSION: Improvements in step length symmetry were observed following training and these improvements were maintained 1 month later. Concomitant changes in clinical measures were also observed, although these improvements were modest. The outcomes for this participant are encouraging given the relatively small dose of training. They suggest that after stroke, short-term adaptation can be capitalized on through repetitive practice and can lead to longer-term improvements stroke.

There should be a way to duplicate this without having the split-belt treadmill but no one will research this since nothing could be sold as part of it.