Deans' stroke musings

Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 493 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

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

Friday, February 25, 2011

3d anatomy and stroke rehab

I've always thought that survivors need to understand anatomy.
Anatomy of Pilates $199
demo and free trial here
My OT had a copy of this and it looked fascinating. You could move various limbs and agonist and antagonist muscles would be color coded so you could tell what was working vs. relaxing. At the time it only cost $80 but since my computer didn't have a DVD drive I didn't get it. It was great to see muscles in 3d rather than just flat depictions in an anatomy book.
This site also has demos and a free trial
I haven't gotten google body maps to work yet so that might be another possibility.

And you could stump your therapists.

hundredth monkey

Well since I mentioned it I thought I would present it.

 There are two parts to this post, first the story itself and then an analysis. I personally still subscribe to the story. So if we get enough survivors thiking about the same thing we can transfer that to our medical staff. This is similar to what  The Secret proposes.
Here is the link to this whole idea.
The Hundredth Monkey
by Ken Keyes
The Japanese monkey, Macaca fuscata, has been observed in the wild for a period of over 30 years.
In 1952, on the island of Koshima, scientists were providing monkeys with sweet potatoes dropped in the sand. The monkeys liked the taste of the raw sweet potatoes, but they found the dirt unpleasant.
An 18-month-old female named Imo found she could solve the problem by washing the potatoes in a nearby stream. She taught this trick to her mother. Her playmates also learned this new way and they taught their mothers, too.
This cultural innovation was gradually picked up by various monkeys before the eyes of the scientists.
Between 1953 and 1958 all of the young monkeys learned to wash the sandy sweet potatoes to make them more palatable.
Only the adults who imitated their children learned this social improvement. Other adults kept eating the dirty sweet potatoes.
Then something startling took place. In the autumn of 1958, a certain number of Koshima monkeys were washing sweet potatoes - the exact number is not known.
Let us suppose that when the sun rose one morning there were 99 monkeys on Koshima Island who had learned to wash their sweet potatoes.
Let us further suppose that later that morning the hundred monkey learned to wash potatoes.
By that evening almost everyone in the tribe was washing sweet potatoes before eating them.
The added energy of this hundredth monkey somehow created an ideological breakthrough!
But notice.
A most surprising thing observed by these scientists was that the habit of washing sweet potatoes then jumped over the sea -
Colonies of monkeys on other islands and the mainland troop of monkeys at Takasakiyama began washing their sweet potatoes!

The analysis;

Is there some magic key that provides a short cut to cultural transformation?
Elaine Myers has had articles in issues #2, #5, and #7. She lives in rural southwest Washington state.

THE STORY OF "The Hundredth Monkey" has recently become popular in our culture as a strategy for social change. Lyall Watson first told it in Lifetide (pp147- 148), but its most widely known version is the opening to the book The Hundredth Monkey, by Ken Keyes. (See below.) The story is based on research with monkeys on a northern Japanese Island, and its central idea is that when enough individuals in a population adopt a new idea or behavior, there occurs an ideological breakthrough that allows this new awareness to be communicated directly from mind to mind without the connection of external experience and then all individuals in the population spontaneously adopt it. "It may be that when enough of us hold something to be true, it becomes true for everyone." (Watson, p148)
I found this to be a very appealing and believable idea. The concept of Jung's collective unconscious, and the biologists' morphogenetic fields (IN CONTEXT #6} offer parallel stories that help strengthen this strand of our imaginations. Archetypes, patterns, or fields that are themselves without mass or energy, could shape the individual manifestations of mass and energy. The more widespread these fields are, the greater their influence on the physical level of reality. We sometimes mention the Hundredth Monkey Phenomenon when we need supporting evidence of the possibility of an optimistic scenario for the future, especially a future based on peace instead of war. If enough of us will just think the right thoughts, then suddenly, almost magically, such ideas will become reality.
However, when I went back to the original research reports cited by Watson, I did not find the same story that he tells. Where he claims to have had to improvise details, the research reports are quite precise, and they do not support the "ideological breakthrough" phenomenon. At first I was disappointed; but as I delved deeper into the research I found a growing appreciation for the lessons the real story of these monkeys has for us. Based on what I have learned from the Japan Monkey Center reports in Primates, vol. 2, vol. 5 and vol. 6, here is how the real story seems to have gone.
Up until 1958, Keyes' description follows the research quite closely, although not all the young monkeys in the troop learned to wash the potatoes. By March, 1958, 15 of the 19 young monkeys (aged two to seven years} and 2 of the 11 adults were washing sweet potatoes. Up to this time, the propagation of the innovative behavior was on an individual basis, along family lines and playmate relationships. Most of the young monkeys began to wash the potatoes when they were one to two and a half years old. Males older than 4 years, who had little contact with the young monkeys, did not acquire the behavior.
By 1959, the sweet potato washing was no longer a new behavior to the group. Monkeys that had acquired the behavior as juveniles were growing up and having their own babies. This new generation of babies learned sweet potato washing behavior through the normal cultural pattern of the young imitating their mothers. By January, 1962, almost all the monkeys in the Koshima troop, excepting those adults born before 1950, were observed to be washing their sweet potatoes. If an individual monkey had not started to wash sweet potatoes by the time he was an adult, he was unlikely to learn it later, regardless of how widespread it became among the younger members of the troop.
In the original reports, there was no mention of the group passing a critical threshold that would impart the idea to the entire troop. The older monkeys remained steadfastly ignorant of the new behavior. Likewise, there was no mention of widespread sweet potato washing in other monkey troops. There was mention of occasional sweet potato washing by individual monkeys in other troops, but I think there are other simpler explanations for such occurrences. If there was an Imo in one troop, there could be other Imo-like monkeys in other troops.
Instead of an example of the spontaneous transmission of ideas, I think the story of the Japanese monkeys is a good example of the propagation of a paradigm shift, as in Thomas Kuhn's The Structure of Scientific Revolutions. The truly innovative points of view tend to come from those on the edge between youth and adulthood. The older generation continues to cling to the world view they grew up with. The new idea does not become universal until the older generation withdraws from power, and a younger generation matures within the new point of view.
It is also an example of the way that simple innovations can lead to extensive cultural change. By using the water in connection with their food, the Koshima monkeys began to exploit the sea as a resource in their environment. Sweet potato washing led to wheat washing, and then to bathing behavior and swimming, and the utilization of sea plants and animals for food. "Therefore, provisioned monkeys suffered changes in their attitude and value system and were given foundations on which pre-cultural phenomena developed." (M Kawai, Primates, Vol 6, #1, 1965).
What does this say about morphogenetic fields, and the collective unconscious? Not very much, but the "ideological breakthrough" idea is not what Sheldrake's theory of morphogenetic fields would predict anyway. That theory would recognize that the behavior of the older monkeys (not washing) also is a well-established pattern. There may well be a "critical mass" required to shift a new behavior from being a fragile personal idiosyncrasy to being a well-established alternative, but creating a new alternative does not automatically displace older alternatives. It just provides more choices. It is possible that the washing alternative established by the monkeys on Koshima Island did create a morphogenetic field that made it easier for monkeys on other islands to "discover" the same technique, but the actual research neither supports nor denies that idea. It remains for other cultural experiments and experiences to illuminate this question.
What the research does suggest, however, is that holding positive ideas (as important a step as this is) is not sufficient by itself to change the world. We still need direct communication between individuals, we need to translate our ideas into action, and we need to recognize the freedom of choice of those who choose alternatives different from our own.

ten steps forward in stroke research
Herewith, ten relatively bright spots:
1. Overview: Treatment of stroke has advanced — though not as dramatically as hoped — and lab research has come a long way in recent years.
Experimenting in animal models and test tubes, scientists have come to understand far more about the biological cascade of events that kill or cripple people who have strokes. Dr. Michael A. Moskowitz of Massachusetts General Hospital, a leading stroke researcher, recently published an overarching look at the state of the science in the journal Neuron. Titled “The Science of Stroke: Mechanisms in Search of Treatments,” it covers an impressive array of recent research on how and why brain cells die in stroke, from inflammation to oxidative stress. I cover this here;
“Tremendous progress has been made in the understanding of fundamental mechanisms of neuronal cell death,” he writes.
“However,” he had to add, “the translation of these powerful molecular and cellular principles into clinically effective neuroprotective therapies in stroke has been challenging.”
Not that there have been no treatment advances. Dr. Black-Schaffer says: “We now have drugs that can be targeted, via sophisticated delivery devices and using our extraordinary imaging capability with MRI and CT scans, to dissolve, ensnare and retrieve blood clots in small cerebral arteries, enabling many patients to recover far more completely from a clot in the brain than was possible even 15 years ago.”
2. Prevent, prevent, prevent
The best stroke is still the one that never happens, and the research on preventing stroke is no less important than research on possible treatments.
Among the findings: About two-thirds of our risk for stroke can be affected by our own behavior. The American Stroke Association lists all the stroke risk factors here. They include: uncontrolled blood pressure, high cholesterol, (this was disputed for a while but is now backed by clear evidence) and smoking.
“You can’t emphasize enough the importance of that ounce of prevention,” Dr. Moskowitz said.
Dr. Lee Schwamm, director of telestroke and acute stroke services at Mass. General, says that systematic efforts to improve stroke care in hospitalized patients have been boosting the rates of stroke-prevention treatments, recent studies show. Many more patients are getting started early on prevention.

3. That first brief window — ‘clot-busters’ for the lucky few
It was an exciting advance when “clot-busters” such as Tissue Plasminogen Activator entered medical use over a decade ago. They can lessen or reverse the damage from a stroke, but must be given within about four-and-a-half hours of onset.
The nation has been developing a network of hospitals best equipped to treat stroke, in part so that specialists can administer clot-busters quickly enough. Mass. General, for example, reports that last year, 80% of its stroke patients received clot-busters within an hour of arrival at the emergency department.
The trouble is, the drugs cannot be used for all strokes; and researchers report that nationwide, only about 5 percent of stroke patients get treatment in time for clot-busting to be safely given by vein, though specialized centers can reach 20%.
Dr. Schwamm: “Many patients who aren’t eligible for intravenous clot-busting can be treated with special catheters that are advanced directly into brain arteries to remove blood clots and restore blood flow.” Also, newer clot-busting drugs are being tested to see whether they might do a better job or allow a longer window for treatment.
Bottom line: Time is of the essence, which mean we all need to know how to recognize a stroke and when to call for help. The American Stroke Association lists the warning signs here.

4. The longer, bigger window
Dr. Moskowitz says that the single greatest advance in the scientific understanding of stroke in recent years is the recognition that beyond that brief clot-busting window of several hours, “there are some very important events that shape the evolution of the stroke injury, and at the same time prepare the brain to repair itself.”
In the course of a stroke, he said, cells become “committed to die” — whether because of chemical signals they’ve received or their own injuries. “It’s very difficult to rescue cells in the process of cell death,” he said, “but we know more and more about what the mechanisms are that bring us to that point.” Now, that knowledge must be translated into treatment, he said.
(“Committed to die.” I can’t help thinking of my young stepmother. It remains a deep family mystery why she couldn’t just walk away. Guilt? Depression-induced psychosis? It was my father’s cells that were committed to die by the stroke. But it was as if, in her, an “I must die” switch were triggered, and that impulse, once unleashed, could not be turned off.)
“We used to think the stroke story was over in minutes or hours,” Dr. Moskowitz said, “so we would give some kind of clot-busting drug and that was it. But now we know that we can introduce certain types of drugs that target signaling mechanisms that work 24 hours later than that, even 48 hours, because there’s an evolution of tissue injury that gives us a handle for future therapy.”
Such treatments could target inflammation, for example, or “excitotoxicity,” in which an overabundance of the brain messenger glutamate kills cells.

5. Brain freeze
Studies clearly show that when a patient has a cardiac arrest and the brain is deprived of oxygen, cooling the brain to about 35 degrees somehow saves a lot of brain tissue, Dr. Moskowitz said.
Can this be used for the most common type of stroke, the ischemic form in which a clot cuts off blood from a part of the brain?
That’s tricky, because the rest of the brain is functioning and thus hard to cool. But techniques are developing. What’s clear is that lowering the brain’s temperature hinders all the signaling mechanisms that have been linked to cell damage, Dr. Moskowitz said. Hypothermia is not “ready for prime time” with ischemic strokes, but “it’s a potentially exciting therapeutic advance,” and clinical trials over the next several years should tell whether it will work out.
6. Not just neurons
Sometimes, it’s an important advance just to start thinking in a new way.
Stroke researchers used to think about blood vessels and brain cells rather separately.
“Now we’ve realized that there’s a tremendous amount of interdependence and integration, that the blood vessel is part and parcel of the brain, that there is a ‘neurovascular unit,’” Dr. Moskowitz said.
That new thinking may translate into a better understanding of how the brain fixes itself, how stem cells migrate from the blood into the stroke area to do repair work, Dr. Moskowitz said. “We don’t quite know how they’re doing that job, but the experimental data suggest they’re capable,” he said.
The new neurovascular thinking is also important for the growing understanding that stroke is powerfully connected to neurodegenerative diseases like Alzheimer’s and Parkinson’s. It has become ever clearer that stroke damage accelerates their deterioration.
7. Brain self-defense
The opposite of that deterioration is brain resilience. In “ischemic tolerance,” the brain “marshalls a whole series of defensive strategies to protect itself under conditions of lack of blood supply,” Dr. Moskowitz said.
Here’s an odd discovery: In some cases, after the brain is subjected to a stressful event — trauma, lack of oxygen — it becomes super-resilient over the next day or two or three. Hit it again with the same sort of stress, and the injury will be much less. Researchers are trying to understand how to reproduce that natural response.
“It would be nice to have that on all the time,” Dr. Moskowitz said, “and to identify a population who’s at very high risk and initiate these mechanisms. That’s very exciting.”
8. The Promise Of Prozac
Last month, researchers published some dramatic findings about the effects of the antidepressant Prozac on stroke patients. The study, funded by the French government and published by the journal Lancet Neurology, found that in a group of 118 patients, those given Prozac for three months improved 34 points on a 100-point scale, while those given a placebo improved only 24 points. That ten-point gap could make the difference between a patient being able to live independently or not.

Courtesy of Spaulding
Dr. Randie Black-Schaffer
Dr. Black-Schaffer:
“Fluoxetine (Prozac) has several effects that may benefit stroke patients. It improves mood, and therefore motivation and energy level, which is very helpful in the recovery and rehabilitation phase after a stroke. Approximately half of stroke patients become depressed at some point after their stroke, so this is an important effect for this population. Second, there is some data in animals and anecdotal data in humans that it can enhance muscle activation, which may improve the speed and extent of active movements. Third, there is animal data that if given at the time of the stroke it has neuroprotective effects and can limit the size of the stroke though this has not been tested in humans yet.
The current study is the largest to date to look at fluoxetine’s effects on stroke recovery, and their results are very positive.
My conclusion at present is that there is limited but promising evidence that it may be a useful drug for stroke patients fall of the reasons above. I’m not ready to prescribe it for all of my patients, but am inclined to start it early in those who are becoming depressed.”
9. Better clinical trials
This one depresses me, so I’m going to make it short. Dr. Moskowitz says that one of the advances in stroke research of the last ten years is to learn how not to do clinical trials. The experiments to assess drugs have often been less than optimal, he said. When you target one aspect of the stroke cascade, other pathways may compensate, muddying the waters. Some drugs may thus have been wrongly judged ineffective.
But methods of assessing drugs are getting more sophisticated, including brain imaging techniques.

Courtesy of Spaulding
10. The biggest window of all — rewiring in the years after
Of course, the most burning question of all is whether anything more, anything at all, can be done to help the millions of people who have been living with the effects of stroke for years.
Dr. Moskowitz says that there is growing understanding that stroke involves not just cell death but the brain rewiring that comes later.
Researchers “realized that we knew an enormous amount of what was going on at the early stages, but we knew almost nothing about the later stages, and we’re recognizing that there may well be a therapeutic opportunity here,“ she said.
As the head of Spaulding’s stroke rehab program, Dr. Black-Schaffer faces the question of rewiring every day. She sums up: “Where we are now is that we have a number of interventions” — including various forms of physical therapy and some medications — “that seem to have modest effect sizes in improving people’s outcomes after a stroke, but we haven’t really figured out how best to combine them.”
The take-home message of the last 15 years, she said, is just that intensive physical activity, intensive practice at meaningful tasks by a motivated patient, “will result in significant improvement for years after a stroke.” It’s “the piano lessons model of stroke recovery: practice and practice and practice.”
So no magic bullet?
“I don’t see one,” she said. “I wish I could. The various lines of research that have been pursued in the last 20 years have not revealed the possibility of one to me. Once you have brain damage, reestablishing connections is a very daunting task. Preventing it might be a lot easier.”
A happier ending
I didn’t want to end on such a down-note, so I asked Drs. Schwamm and Black-Schaffer for a more upbeat finish.
Dr. Black-Schaffer: “Twenty years ago, our only goal was to help people adapt to the disability caused by the stroke. Now we know enough about the cellular and molecular mechanisms that we aim higher — to improve the neurological recovery after stroke, not just ease adaptation to permanent deficits. Our growing impatience as a clinical and research community derives from this higher goal that we have now set for ourselves and our patients. I am hopeful that the creative tension thus generated among “neuro-recovery” investigators will lead to significant advances in stroke recovery research in the next decade.”
Dr. Schwamm: “Exciting new research suggests that major advances may be on the way. Animal studies conclusively show that a stimulus-rich environment promotes the growth of new brain connections critical to repair. The use of telemedicine or novel computer interfaces to engage stroke patients in rehabilitation activities promises to provide this stimulus-rich environment. Preliminary data shows that something as simple as playing computer video games like the Nintendo Wii can improve cardiovascular fitness and stroke recovery.”
“While the future often looks bleak when viewed from the bedside of a newly diagnosed stroke patient, the natural history for many is one of recovery and return to independent living. For those who don’t recover spontaneously, some day — hopefully soon — a wider array of restorative treatments will be readily available.”
Maybe the hundreth monkey theory is finally working for stroke rehab.

Sigma-1 receptor and stroke rehab

Therapy May Be Possible Up To 2 Days After A Stroke
The only acute treatment for a stroke currently available is thrombolysis. This uses drugs that dissolve the blood clot responsible for the stroke, but it only reaches around 10 per cent of stroke patients in time to prevent lasting damage. For other patients, there are no other effective drugs that reduce the loss of brain function following a stroke.
Researchers at the Laboratory for Experimental Brain Research in Lund, together with American researchers, have discovered a substance that reinforces the brain’s self-healing functions after a stroke. It has long been known that people affected by a stroke can regain some lost function during the first six months. Professor Tadeusz Wieloch and his colleagues have found a way to activate a protein in the brain, the sigma-1 receptor, which plays an important role in the brain’s recovery during the critical period after the injury.
The study, which is published in the scientific journal Brain, began with experiments on rats. The animals were subjected to a stroke and then placed in different environments — an enriched cage with extra stimulation in the form of several levels of tubes, beams and ladders, and a normal cage.
“After performing a genetic analysis of the rats that stayed in the normal cage and those that were in an enriched cage, we found that many genes were activated by the enriched environment. One of these genes coded for the protein sigma-1 receptor. We then injected the rats with a specific substance that activated the sigma-1 receptor and found that the rats regained their function more quickly than the untreated animals”, explains Professor Wieloch.

More acute options, I wonder which one is the best. This correlates with one of my posts on enriched stimulation so I wonder what specific substance was injected and if it is necessary.

Thursday, February 24, 2011

Simple Tests Can Tell Who Can Drive After Stroke Study
MONDAY, Feb. 21 -- A new review of existing research contends that three brief tests could help doctors figure out whether recovering stroke patients are well enough to drive.
"A quick and objective screening in the doctor's office can help them to make more accurate decisions," said review author Hannes Devos, a research assistant at Katholieke Universiteit Leuven in Belgium.
However, several U.S. stroke experts said they weren't ready to accept the new study's findings.

The American Heart Association estimates that 6.4 million stroke survivors are alive in the United States today. While some patients are able to recover with few permanent disabilities, strokes can cause some people to permanently lose memory and the ability to properly move their bodies.
In some cases, patients with serious motor-skill problems can still drive a car as long as they're able to get proper equipment, such as an automatic transmission, a left-sided accelerator pedal for patients who have trouble moving their right side, and steering knobs that allow one-handed driving, Devos said.
Stroke patients may need to get approval from a physician before they can legally begin driving again, but evaluation processes in the office can sometimes be a challenge. "Some physicians do not feel confident to screen for fitness to drive because they lack standardized tools that can be administered in the doctor's office," Devos said.
With that in mind, Devos and colleagues reviewed 30 surveys and included 27 in an overall statistical analysis. In total, the studies evaluated various screening tests before patients took on-road driving tests; 54 percent of 1,728 patients (average age 61) passed the driving tests.
The researchers found that three screening tests had accuracy levels of 80 percent to 85 percent for determining how patients would fare on an on-road driving test. One of the tests asks patients to match road signs to driving situations. Another requires patients to match cue cards in a mockup of a driving roundabout or rotary. The third test asks patients to connect 25 circles while alternating between numbers and letters in consecutive order, Devos said.
The tests only take about 15 minutes and doctors can easily administer them during a routine visit, Devos said.
So should the tests be administered?
Dr. Larry B. Goldstein, professor of medicine and director of the Duke Stroke Center at Duke University Medical Center, is skeptical, pointing out that the tests didn't correctly identify 15 percent to 20 percent of unsafe drivers, and they may also fail to identify safe drivers.
"I am not sure whether it is practical to include a formal driving assessment as part of the routine post-stroke follow-up visit or whether the cost would be reimbursed," he said, adding that patients can choose to be tested in a driving simulator before hitting the road as part of a test.
Dr. Jeffrey L. Saver, a professor of neurology and director of the University of California, Los Angeles Stroke Center, said the office tests might be helpful if patients and families aren't sure whether to spend money on on-road driving tests.
"However, on-road assessment will remain the gold standard and likely will continue as the approach generally pursued by physicians for patients with deficits that could potentially impair driving," he said.

I really doubt that any written or oral test could tell if you are prepared. There are so many distractions while driving that you have to be able to distinguish what to focus on and what to ignore.

acupuncture and stroke rehab

An old study - suggests it might
Does Acupuncture Improve Motor Recovery After Stroke?
Newer studies suggest it doesn't
Acupuncture May Not Aid Stroke Patients
Part of the problem here is that in China acupuncture is a common treatment for stroke. So much so that it is almost impossible to separate the spontaneous recovery from the use of acupuncture. This is a major problem with most treatments during the spontaneous recovery phase.
If you google acupuncture for stroke rehabilitation you will find 73,000 results so you can choose your belief system.

Opinion on Stroke Protocol part 1

I have been trying to come up with a comprehensive therapy protocol even though I am not medically trained because no one else seems to have done it or seems to care.
I leave the initial clot-busting or bleed stopage to the medical staff where it belongs. I was getting close to acute rehabilitation ideas for hospital stay use. This is absolutely necessary since I would compare the current acute stroke rehab to the civil war when the process was if you were injured in an extremity it was amputated and you were left to fend for yourself. Similar to today where if you are lucky you get tPA to remove the blockage or surgery to stop the bleeding and then are pretty much left to your own devices. But I did just find one doctor who has done a lot of thinking on acute stroke rehab and would like to publicize it more to see if it can be vetted. None of this would be helpful to me since I am now in the chronic phase and I'll talk about that rehab in another post.
Read up on Dr. Lewis Clarke
especially his Clarkes' Stroke Protocol and WHAT_IS_NEUROGENESIS
selected sections are below, but read them all on the link provided.
It's time to adopt a new emergent treatment plan for strokes that includes:
a. intervening in the chemical cascades that result in neuronal destruction occurring during the evolving ischemia; and
b. maximize local vasodilation to reperfuse this brain tissue; and
c. to bind receptors such as the NMDA receptors which will continue to propagate neuron death even after blood supply is restored; and
d. to reduce the free radicals released in enormous amounts during the stroke which continue to destroy more neurons and glia; and
e. to utilize biochemical mechanisms which minimize the damage resulting from the Ischemia-Reperfusion sequence.
These ongoing processes are the reason that the patient comes in initially with a weak arm and within 24 hours, the entire hemibody is paralysed.
The emergent treatment plan should focus on the following:

Stop the Cascade

v Increase Beneficial Tissue Perfusion

v Reduce Membrane Oxidative Potential

v Decrease Inflammation and Cytokine Production (IL-6, TNF-alpha)

v Block NMDA Receptors

v Block Platelet Activation Caused by Inflammation

I didn't see fish oil but you can read about that possibility in one of my posts. All you medical personnel start critiqueing and lets bring something like this to the attention of NINDS. There has to be a way to identify and create a standard stroke protocol. The comment usually used to debunk the standard part is 'all strokes are different, all stroke recoveries are different'. This is an incredibly convienent way to wash your hands of the survivor and leave them on their own.

Wednesday, February 23, 2011

Top 19 stroke rehab centers

their title is off by one.,--20-Top-Stroke-Rehab-Centers
1. Rehabilitation Institute of Chicago, Chicago, IL 

2.  TIRR – The Institute for Rehabilitation and Research, Houston, TX 

3.  University of Washington Medical Center, Seattle, WA 

4.  Mayo clinic, Rochester, MN 

5.  Craig Hospital, Englewood, CO 

6.  Kessler Institute for Rehabilitation, West Orange, NJ

7.  Rusk Institute, NYU Medical Center, NY 

8.  Thomas Jefferson University Hospital, Philadelphia, PA

9. Spaulding Rehabilitation Hospital, Boston, MA 

10.  Ohio State University Medical Center, Columbus, OH

11. Rancho Los Amigos National rehabilitation Center, Downey, CA

12. Johns Hopkins Hospital, Baltimore, MD

13. National Rehabilitation Hospital, Washington DC

14. University of Michigan Medical Center, Ann Arbor, MI 

15. Moss Rehabilitation Hospital, Albert Einstein Medical Center, Philadelphia, PA

16. Shepherd Center, Atlanta, GA

17. Stanford Hospital and Clinics, Stanford, CA

18.  Temple University Hospital, Philadelphia, PA 
19.  UCLA Medical Center, Los Angeles, CA 

I have no idea if this is anything more than  name recognition. Especially since there is no standard definition of stroke damage to be able to compare recoveries. I would ask them my questions for your stroke rehab doctor/therapist if you do decide to go to one of these.

Monday, February 21, 2011

Fish Oil Component and stroke rehab

Research Shows Fish Oil Component Given Up To 5 Hours After Stroke Limits Brain Damage
Research led by Dr. Nicolas Bazan, Boyd Professor, Villere Chair, and Director of the Neuroscience Center of Excellence at LSU Health Sciences Center, has shown that Docosahexaenoic acid (DHA), a component of fish oil, is a powerful therapeutic agent that can protect brain tissue and promote recovery in an experimental model of acute ischemic stroke, even when treatment is delayed by up to five hours. These findings not only target a new stroke treatment approach, but also provide vital information about the length of the therapeutic window. The NIH-funded research is published in the journal, Translational Stroke Research, now available online here.
Ischemic strokes result from loss of blood flow to an area of the brain due to a blockage such as a clot or atherosclerosis. The damage includes an irreversibly injured core of tissue at the site of the blockage. The area of tissue surrounding the core, called the penumbra, is also damaged but potentially salvageable. The penumbra has a limited life span and appears to undergo irreversible damage within a few hours unless blood flow is reestablished and neuroprotective therapy is administered. A cascade of chemicals floods the tissue along with restored blood flow, including damaging free radicals and pro-inflammatory enzymes which can cause further damage and cell death.
DHA is an essential omega-3-fatty acid and is vital for proper brain function. It is also necessary for the development of the nervous system, including vision. Moreover, omega-3 fatty acids, found in cold water fatty fish, including salmon, tuna, mackerel, sardines, shellfish, and herring, are part of a healthy diet that helps lower the risk of heart disease. DHA has potent anti-inflammatory effects. Since inflammation is at the root of many chronic diseases, DHA treatment has been widely demonstrated to have beneficial effects in patients with coronary heart disease, asthma, rheumatoid arthritis, osteoporosis, sepsis, cancer, dry eye disease, and age-related macular degeneration, but its potential benefit in stroke was not known.
"We are just now beginning to understand the significant impact of omega-3 essential fatty acids on stroke," notes Dr. Bazan. "There is no simple solution just yet, but each new discovery brings us closer to defeating stroke and other debilitating neurodegenerative diseases."
To determine how DHA might be effective in stroke treatment and recovery, the LSUHSC research team administered either DHA or saline intravenously at 3, 4, 5, and 6 hours after the onset of stroke. MRIs showed that neurological deficits were reduced by the administration of DHA. DHA treatment reduced swelling and facilitated neurobehavioral recovery. The volume of the area of destroyed tissue was reduced by an average of 40% when DHA was administered at 3 hours, 66% at 4 hours, and 59% at 5 hours. Further analysis showed it triggered production of Neuroprotectin D1 (NPD1),

And I wonder who is following up this idea in the acute stage rehab? Why not for bleeders too? For the probable size of my penumbra this could have helped tremendously.

cross-country skiing and stroke rehab again

During the presidents day weekend we went to the Maplelag ski resort near Detroit Lakes,Mn. Skied a total of 5.5km which was disappointing because I wanted to stay there and do lots more. They had had a major meltdown the previous week but the owners are great at grooming and still had good tracks set. The snow was quite crystalline and icy and in normal conditions I would love the speed you could get with it. But under my current condition I have to use waxless skis because they are slower and grip better in most uphill conditions. Except for this weekend when I couldn't ski up even the slightest incline. This year for the first time since my event I managed to half-herringbone up a number of the smaller hills. On the longer/larger hills I was able to fully herringbone except that it required perfect placement, which I only succeeeded at maybe 50% of the time. When I would miss I ground to a halt and with only one pole to get myself started again I think I fell on my knees at least a dozen times. At least this year I didn't fall when actively skiing. I used an old AFO without a toe crest so my toes curled under, a painful condition when trying to push off on my left leg. Its progressively getting better, I think I'll become fairly good at this before my left arm becomes useful again.

Saturday, February 19, 2011

reading and stroke rehab

When I first started trying to read I would have a difficult
time going from the end of one line to the start of the
next. My speech therapist wold hold the tip of a pencil at
the start of the next line while I read aloud. Her next
trick was to use a ruler under the line I was reading. This
worked as long as the reading material would lay flat. This
problem finally resolved itself in a couple of weeks. In
order for me to read in bed I bought a lap book holder that
had a bar that would hold the book open. Paperbacks are
especially problematic keeping open with one useable hand.
I'm not ever planning on getting a Kindle because I love the
feel of books. I had some left neglect but that resolved fairly soon.

Friday, February 18, 2011

Marijuana and stroke rehab

Medicinal Uses of Marijuana: Brain Trauma/Stroke
Medicinal Uses of Marijuana: Brain Trauma/Stroke
2-Arachidonoyl glycerol (2-AG) is an endogenous cannabinoid, identified both in the periphery and in the brain,
We administered synthetic 2-AG to mice after CHI and found significant reduction of brain oedema, better clinical recovery, reduced infarct volume and reduced hippocampal cell death compared with controls.
Patients in Cannabis-Based Drug Trial Reported Some Benefit for Relieving Spasticity in MS
Or maybe you want to try marijuana
Cannabis counters brain cell damage after a stroke
NEGATIVE EFFECTS: Short-term effects include memory and learning problems, distorted perception, and difficulty thinking and solving problems.
A lot of this looks like during acute phase although if it would do something for spasticity I would definitely try it.
And then there is the fact that marijuana also increases the risk of a stroke/heart attack.
Marijuana may up heart attack, stroke risk: study

Thursday, February 17, 2011

lifetime risk of stroke is 1 in 5 for women, 1 in 6 for men

First heard about this from the Australian Stroke Foundation with confirmation from the World Stroke Organization. This is appalling that with this high incidence that there is no general outcry about helping those who survive. We truly do need a high profile person like Michael J Fox.
If anyone wants to volunteer, step right up.

Seshadri S., Wolf P.A. (2007). Lifetime risk of stroke and dementia: current concepts, and estimates from the Framingham Study. The Lancet Neurology 6(12), 1106-14.
Seshadri S. et al. (2006). The lifetime risk of stroke: estimates from the Framingham Study. Stroke 37, 45-350.
Participants (n=4897) who were stroke- and dementia-free at 55 years of age were followed biennially for up to 51 years. ... A total of 875 participants (522 women) developed a first-ever stroke; 749 (448 women) had an ischemic stroke. LTR of stroke was high and remained similar at ages 55, 65, and 75 years, approximating 1 in 5 for women and 1 in 6 for men. Participants with a normal BP (<120/80 mm Hg) had approximately half the LTR of stroke compared with those with high BP (=140/90 mm Hg)
We observed that the LTR of stroke for middle-aged and "young-old" adults (55 to 75 years of age) was substantial at 1 in 6 or higher. This risk was higher in women (1 in 5) compared with men, largely because of the greater life expectancy in women, which increased their period at risk.
Bushnell, C.D. (2008). Stroke and the female brain. Nature Clinical Practice Neurology 4(1), 22-33.
Stroke is the third leading cause of death in most countries, and is one of the leading causes of long-term disability. Women have a higher lifetime risk of stroke than men (1 in 5 vs 1 in 6), a statistic that is influenced in part by the longer life expectancy in women. The female population not only carries a higher burden of stroke during their lifespan - women also account for the majority of stroke deaths.

Every two seconds, someone in the world suffers a stroke
Every six seconds, someone dies of a stroke
Every six seconds, someone’s quality of life will forever be changed – they will permanently be physically disabled

Wednesday, February 16, 2011

White Matter of the brain

It took me four years to figure this out. The gray matter(cerebrum) is only a couple of millimeters thick. 6 cell-layers thick. This could have been solved years ago by my doctors giving me a 3d map of the brain All the stuff under it is just neurons connecting to each other. So I have to assume that my MCA infarct killed off a lot of those neurons too. And since no one has any clue what the connections went to, it finally starts to make sense that doctors don't give you a damage diagnosis, they let the therapists figure out the deficits by trial and error.
Pictures here:

This does now start to explain why my sensation is not that good, the sensory cortex probably routed thru what is now dead white matter and is having a hard time getting the neurons to reconnect.
Knowing this doesn't really help me plan out my recovery but it will make more sense of some of the targeted neural growth factors.

Magic mirror to Monitor Muscle Movement During Exercise

This along with 3d movements and stroke rehab
would finally allow therapists to break down individual muscle movement problems.
System to Monitor Muscle Movement During Exercise
A short excerpt;
The magic mirror, developed under the leadership of professor Yoshihiko Nakamura of the Information and Robot Technology Research Initiative (IRT), was unveiled at the University of Tokyo last Friday. In a demonstration for the media, the system’s display monitor showed a real-time computer-generated image of a male model’s musculo-skeletal system while he performed a series of physical exercises.

The system, which is currently capable of monitoring the activity of 30% of the body’s roughly 300 skeletal muscles, consists of 16 electromyographs (instruments that record the electrical waves associated with muscle activity) attached to the user’s body, 10 motion-capture cameras, and a pair of floor sensors to measure the force exerted on the legs.
On the monitor, each muscle is shown in a different color depending on how much it is being used at a particular moment. Active muscles are shown in red, while inactive muscles are shown in yellow.
The magic mirror system uses newly developed software that is reportedly 10 times faster than previous technology, allowing the system to operate in real-time, even when the user is moving rapidly
The video doesn't really show off the muscle mapping.

quantitative measure of muscle spasticity

I'm glad there at least some researchers out there who think spasticity is worth looking into. At least if this can be quantitatively measured then interventions could be measured as to how much improvement there is.
Developing a quantitative measure of muscle spasticity
Quantitative measurement of spasticity is necessary and can contribute to clinical rehabilitation management, which aims to restore and/or improve function in the affected part of the body. The proposed study shows that by using computerized motional analysis systems, a more quantitative measurement of muscle spasticity can be obtained. High speed, high resolution, infrared, stroboscopic cameras are used to capture kinematic data of the hip, knee, and ankle during pendulum knee drop test. Electromagnetic sensors are used to gather angular motion data of the knee and ankle joint during performance of this test. Implementation of these methods provides accurate, consistent, and reproducible quantification of muscle spasticity, which can be used to assess the effectiveness of clinical treatments.
Another quantitative way to measure it is with inertial sensors



Spasticity is often clinically assessed with the Tardieu Scale, using goniometry to measure the range of motion and angle of catch. However, the test–retest and inter-rater reliability of these measurements have been questioned. Inertial sensors (IS) have been developed to measure orientation in space and are suggested to be a more appropriate tool than goniometry to measure angles in Tardieu Scale measurements.


To compare the test–retest and inter-rater reliability of Tardieu Scale scores measured with IS and goniometry.


Two physiotherapists performed Tardieu Scale measurements in two sessions, using both goniometry and IS, to quantify spasticity in elbow flexors of 13 stroke patients.


For goniometry, test–retest and inter-rater reliability proved to be excellent (ICC 0.86) and fair to good (ICC 0.66), respectively. For IS, both test–retest (ICC 0.76) and inter-rater reliability (ICC 0.84) were excellent.

Inertial sensors are reliable and accurate to use in Tardieu Scale measurements to quantify spasticity in the elbow flexors of hemiplegic stroke patients.

I do know that both my biceps and triceps have some spasticity which would be useful to measure to see if it has lessened in 4 years.

You'll have to buy the articles if you want more info.
Once again trying to suggest something for the medical staff to use.

Stimulate senses and stroke rehab

I liked this line in the article; researchers discovered that tickling rats’ whiskers helps them recover from ischemic stroke.
Senses Stoke Stroke Recovery
I can just see nurses going around with feathers.

In this presentation by Dale Corbett he talks about enriched environment similar to baby stimulation. I started visualizing mobiles hanging above each patients bed.
This is 45 minutes long but worth listening to.
■Neuroplasticity and Stroke Recovery: Past, Present and Future

I know if you read Jill Bolte-Taylors' book or saw her on video, she highly recommended not having much sensory stimulation at all because it caused her to shut down. To each his or her own, I could have used the extra stimulation to keep me awake.

Tuesday, February 15, 2011

ischemic stroke risk predictor

I know this is morbid but fascinating for me. No idea on why bleeders are not covered.
Ischemic Stroke Predictive Risk Score
I did have to look up a couple of words on the internet; lacunar, not sure what this meant -
Manual CNS/NHISS entry
I went thru mine based on when my stroke occurred, I ended up with a 3.6% chance in 30 days, 6.5% in 1 year, of course I was lucky to survive the first night.
Researchers at St. Michael's Hospital and the Institute for Clinical and Evaluative Sciences (ICES) in Toronto have developed a new tool that will help doctors predict the probability of death in patients after an ischemic stroke.
The study, published in the journal Circulation, found that the tool determined the likelihood of death in stroke patients 30 days and one year after an ischemic stroke. An ischemic stroke, the most common type of stroke, occurs when an artery to the brain is blocked.
The tool, available online for doctors at , is the first to use risk factors such as heart disease, diabetes, cancer and kidney disease to estimate the probability of death. The findings are being presented at the International Stroke Conference in Los Angeles.
"Doctors today have to rely on anecdotal experience to assess a patient's prognosis," says Dr. Gustavo Saposnik, a neurologist at St. Michael's Hospital and ICES scientist. "However, as doctors we tend to overestimate the likelihood of a good outcome in stroke patients. Now, with our new tool, we can accurately determine what type of outcome our patients may have, which will help guide clinical decisions."
The study examined 12,262 patients who visited an Ontario hospital from 2003 to 2008 and suffered an ischemic stroke. Using the new tool, researchers determined the death rate 30 days and one year after an ischemic stroke and compared the findings with data from the Ontario Stroke Audit to validate the results. Researchers found the tool was accurate and that risk factors including heart disease, heart failure, cancer, dementia and a history of atrial fibrillation ? an irregular heartbeat ? were associated with a higher probability of death.
"Our tool was developed and validated in the real world," Dr. Saposnik explains. "This is a tool that helps doctors estimate the risk of a poor outcome in stroke patients, helps families make more informed decisions and can be used by policymakers to accurately compare hospital performance in stroke care."

Migraines don't damage brain: study

I'm glad about this, although by now I know how to stop them before they get full-blown.
Migraines don't damage brain: study
"It is almost always the first question that migraine patients ask," said Christophe Tzourio, a doctor and researcher at the Universite Pierre et Marie Curie in Paris, and the main architect of a study published online this week in the British Medical Journal.
"Today we can provide an answer: there's nothing to worry about," he told AFP.
Migraines are acutely debilitating headaches -- sometimes with an "aura", in which patients have the impression of seeing through frosted glass -- that strike around one out of nine adults.
The causes remain uncertain, but are known to involve a link with blood vessels in the brain.
Earlier research using magnetic resonance imaging technology showed that people with a history of full-on migraines are more likely to incur tiny lesions to microvessels inside the brain.
Such ruptures result from a deterioration of the small cerebral arteries that supply blood to so-called white matter, which facilitates the flow on information across different parts of the brain.
The same type of lesions are more common in elderly people, diabetics and hypertension sufferers.
In large quantities, they have been linked to depression, an increased risk of stroke, neurodegenerative diseases such as Alzheimer's, and impaired memory and reasoning.
Tzourio and colleagues wondered if migraine patients are more likely to show some of these symptoms, so they tested the cognitive abilities of more than 800 over-65 seniors living in Nantes, western France.
Nearly 15 percent of the volunteers had suffered from migraines over the course of their lives.
On average their scores were indistinguishable from the others. Even seniors who had endured the most debilitating type of migraine, with aura, showed no cognitive damage.
"This is a very reassuring result for the many people who suffer from migraine," said co-author Tobias Kurth, also a researcher as Universite Pierre et Marie Curie.
"In spite of the increased presence of lesions of the brain microvessels, this disorder does not increase the risk of cognitive decline," he said in a press release.
Update on Feb. 18.
Can Migraines Damage the Brain?
However, there is abundant evidence now that migraine sufferers with a history of aura are at a twofold increased risk of stroke. These strokes are of the ischemic type, which are caused when a blockage in a brain blood vessel results in a lack of blood supply to a region of the brain (in contrast to hemorrhagic strokes, which are due to a ruptured blood vessel).

Update on April 21, 2011
All of society, ranging from youngsters, tykes, women, and elder folks usually feel migraine headache caused by varied causes. Frequent migraine may in reality be a risk issue which will cause stroke.

So I'm not sure which one I believe.

As reported by the medicalnewstoday, migraine typically usually caused by allergies, over bright lights, noise, smell, stress, irregular sleep patterns, active or passive smoking, late meals, alcohol, fluctuations within the menstrual cycle, contraception, hormone fluctuations throughout menopause , foods containing tyramine (red wine, cheese, smoked fish, chicken liver, and a few beans), monosodium glutamate (MSG), or nitrates (such as meat and hot dogs). And conjointly different foods like chocolate, nuts, peanut butter, avocados, bananas, oranges, onions, dairy merchandise, and fermented foods or pickles.

“Migraine may be a risk issue for stroke,” said Dr. Ashwin M. Rumawas, a nerve specialist. in line with Dr. Ashwin, migraines are in the middle of complaints of photophobia (fear of light), sonophobia (fear of loud noises), vertigo (sick head spinning), shaking, shivering, flushed face, cold sweat, vomiting, decreased ability to talk and in the middle of a weakening of the body, it will increase one’s risk of stroke.

“Better take care once you are usually attacked by migraine, as a result of it may well be an element which will increase your risk of stroke,” said the neurologist.

Dr. Ashwin absolutely make a case for the danger factors which will cause stroke, namely:

Which can’t be changed or can not be avoided,
1. Age
2. Gender
3. Hereditary
4. Racial or ethnic

Which can be changed and might be avoided,
1. Hypertension
2. Diabetes mellitus
3. Smoking
4. History of previous stroke. somebody who had suffered a stroke and later recovered, having a high risk for a stroke back.
5. Heart abnormalities
6. Anatomical abnormalities of blood vessels
7. Cholesterol disorders
8. Obesity or overweight
9. Endocarditis (heart infection)
10. Meningitis (infection of the brain)
11. Migraine
12. Blood disorders (Trombositas, leukemia, and others)

To prevent stroke, what ought to be done immediately as a precaution are:

A. Organize a healthy eating patern
1. Eat foods low in saturated fat (cholesterol). it’s advisable to consume whole grains like brown rice, corn, oats (whole wheat), kedelei, walnuts and cashews.
2. Consume low-fat milk and made in protein, zinc, and B12. Tuna, salmon, fish-rich ocean EPA and DHA.
3. Consumption of foods that are made in vitamins and antioxidants, like vegetables, fruits and seeds.
4. scale back intake of sodium (monosodium glutamate, sodium nitrate, NaCl)
5. Minimize foods high in saturated fats, scale back intake of trans fatty acids like cookies, fried foods and butter.
6. Prioritizing the fiber-rich foods, protein, vegetable
7. Avoid low-calorie foods (empty calories) and low nutritional quality, like candy, krupuk and snacks.

B. Exercising frequently, doing physical activity with aerobic values like walking, cycling, swimming, and others.
C. Stop smoking, avoid the active and passive smokers
D. Avoid alcohol and drug abuse
E. Maintaining correct weight, to avoid an unhealthy eating patern with regular exercise.
F. Avoid the employment of oral contraceptives for ladies smokers or that has different risk factors.
G. scale back stress, have regular rest, and sleep half dozen to eight hours/ day.
H. Regular health checks, managing diet and regular medication.

Protecting the Brain from a Glutamate Storm

I know this is from 2007, so I wonder if further research has been done.
Protecting the Brain from a Glutamate Storm
By Vivian Teichberg and Luba Vikhanski
May 10, 2007
When a stroke or head injury releases a flood of the chemical messenger glutamate, the excess glutamate leaves damaged neurons in its wake. Israeli scientist Vivian Teichberg, Ph.D., has developed a new method that may protect the brain from this destruction by harnessing the brain’s natural ability to keep glutamate levels in check.

The human brain is packed with a substance that needs to be treated like a handle-with-care explosive. Glutamate, one of the most abundant chemical messengers in the brain, plays a role in many vital brain functions, such as learning and memory, but it can inflict massive damage if it is accidentally spilled into brain tissue in large amounts.
Glutamate flow in the brain is normally kept in check by a system of dam-like structures, which release a trickle of the substance only when and where it is needed. But burst a dam—as happens in stroke, head trauma, and some other neurological disorders—and the treacherous messenger floods the brain. The surge of glutamate radiates out from the area of original damage, and kills neurons in nearby areas.  The expanded damage can leave in its wake signs of impaired brain function, such as slurred speech and shaky movement.
Depending on the severity and location of the stroke or head trauma, recovery can be slow and incomplete. Now new hope is coming from a completely new approach to protecting the brain against the ravages of injury and disease. It consists of “mopping up” excess glutamate by boosting a natural process that the healthy brain already uses to safeguard itself from a glutamate overdose. If this concept is borne out in clinical trials, it might be helpful in treating a variety of acute and chronic brain insults and diseases.

Inside the Glutamate Storm

The amino acid glutamate is the major signaling chemical in nature. All invertebrates (worms, insects, and the like) use glutamate for conveying messages from nerve to muscle. In mammals, glutamate is mainly present in the central nervous system, brain, and spinal cord, where it plays the role of a neuronal messenger, or neurotransmitter. In fact, almost all brain cells use glutamate to exchange messages. Moreover, glutamate can serve as a source of energy for the brain cells when their regular energy supplier, glucose, is lacking. However, when its levels rise too high in the spaces between cells—known as extracellular spaces—glutamate turns its coat to become a toxin that kills neurons.*

5 more pages to go. Go to the link to read the rest. This really won't help the current batch of survivors, but hey someone will eventually put all these possibilities together and do the research to prove the best one.

molecular cascade that drives sprouting in brain after stroke

I haven't quite absorbed this whole article yet but I will eventually connect it to my other posts.
Researchers identify molecular cascade that drives sprouting in brain after stroke
Most of the first page;
A stroke wreaks havoc in the brain, destroying its cells and the connections between them. Depending on its severity and location, a stroke can impact someone's life forever, affecting motor activity, speech, memories, and more.
The brain makes an attempt to rally by itself, sprouting a few new connections, called axons, that reconnect some areas of the brain. But the process is weak, and the older the brain, the poorer the repair. Still, understanding the cascade of molecular events that drive even this weak attempt could lead to developing drugs to boost and accelerate this healing process.
Now researchers at UCLA have achieved a promising first step. Reporting in the current online edition of the journal Nature Neuroscience, senior author Dr. S. Thomas Carmichael, a UCLA associate professor of neurology, and colleagues have, for the first time, identified in the mouse the molecular cascade that drives the process of reconnection or sprouting in the adult brain after stroke.
"We set out to learn three things," said Carmichael, a member of the UCLA Stroke Center and the Brain Research Institute. "We hoped to identify the molecular program that activates brain cells - neurons - to form new connections after stroke; to understand how this molecular program changes in the aged versus the young adult brain, and the role each specific molecule plays in this program to control the sprouting of new connections after stroke."

Can you move your arm?

A week or so after my event a friend from work came to visit me and asked if I could move my affected arm. I said sure and picked up my left arm with my right arm and moved it to the left. He and I both laughed. I still can't do this the correct way.

Thursday, February 10, 2011

breakthrough in chronic stroke research

This was one of the more fascinating articles I've read mainly because it is for chronic rather than acute survivors. And it it would be one of those magical fixes. Like Peter Levines' stroke eliminator.
Inflammation Identified as New Therapeutic Target Years After Stroke
To view the multimedia assets associated with this release, please click
The study utilized a new method of delivery of etanercept, a potent biotechnology anti-inflammatory therapeutic. Etanercept has been a breakthrough for rheumatoid arthritis and other inflammatory disorders. It works by neutralizing tumor necrosis factor (TNF), a cytokine that initiates and amplifies inflammation. The therapeutic potential of etanercept in Alzheimer&apos;s disease, traumatic brain injury, spinal cord injury, sciatica, and other neuroinflammatory disorders has attracted increasing attention(1).

Ask your doctor if you might be an off-label use for this. If s/he knows about this, you have a good up-to-date doctor. Looking at the paper for this I really doubt the ability of this. No proof that TNF was measured either before or afterward, and no rigorous therapist documentation, just mainly spousal comments.
I do wonder how many years after a stroke the tumor necrosis factor (TNF) is still around in the brain.
I'll add that to my question for stroke researchers

Wednesday, February 9, 2011

Vibration and stroke rehab

Two different whole body vibration tests came to different conclusions
Long-Term Effects of 6-Week Whole-Body Vibration on Balance Recovery and Activities of Daily Living in the Postacute Phase of Stroke
Conclusions— Daily sessions of whole-body vibration during 6 weeks are not more effective in terms of recovery of balance and activities of daily living than the same amount of exercise therapy on music in the postacute phase of stroke.
These results suggest that one session of whole body vibration can quickly increase voluntary force and muscle activation of the quadriceps muscle affected by a stroke. One session of whole body vibration (20 Hz frequency, 5mm amplitude) was shown to quickly increase isometric and eccentric strength of knee extensors at the affected side. Whole body vibration may help to increase the effectiveness of an additional functional rehabilitation program.

And this article on the use of it in the gym wonders about its effectiveness.Gimmick or Not, Vibrating Platforms Have Joined the Gym
But maybe it’s not so silly, exercise physiologists say. Although they don’t really know why vibrations should work, researchers report that they actually seem to slightly improve performance in the few minutes after a person gets off the machine.
The problem, though, is that there is little consensus on how fast the vibrations should be or in what direction platforms are supposed to vibrate. Some studies have failed to show any effects from vibrations. And then there is the question of what exactly vibrations are doing to muscles and nerves.
“It certainly is intriguing, and a large portion of the evidence would support that something is happening,” said Lee E. Brown, director of the Center for Sports Performance at California State University, Fullerton. But he added, “We are still trying to figure out exactly what the mechanism is.”

I know the first one failed but I think that if you are trying to get back proprioception this might be useful. I looked for gyms around here having this but no luck.
Four other possibilities:
1. Body Blades - I bought these but in order to get the vibration you need to be able to rapidly move your arm back and forth in a small arc. I currently only have gross movement so this didn't work.
2. Shake Weights - I tried this at a retailer and it has the same problems as the body blade.
3. Dynaflex Sports Pro Plus Gyro Wrist Exerciser - I bought this but it really does require two good hands to get the internal gyroscope spinning. For me I was looking for it to get proprioception going and the intrinsics of the hand.
4. Palm hand sanders. The random orbital kind. Mine is currently broken but I'll try it as soon as I get it fixed.

Remember, this is not something you should try without talking to your doctors.

Hand recovery and stroke rehab

My left hand is still pretty worthless I have looked all over for what to do about it and only came up with a few items.
What are the various options for rehabilitation of the hand? Neither my therapists or my doctors seem to have a good understanding of what the research points to as being the best way to accomplish this.
1.Saeboflex this looks like an outrigger on your hand with the springs pulling your fingers into extension.
Because the Saebo takes me 20 minutes to get on I don't use it very much. In the original Yahoo Saebo forum I complained about the bead chains being very hard to adjust one-handed and the Saebo representative said that they were not meant to be adjusted by patients, only trained therapists. This is poor planning on their part. They could easily change from bead chains to open chains with a hook to attach. The original research on this was for FTM(functional tone management)
I actually changed the velcro straps from the side they were on to the opposite side because tightening them was much easier for myself, it seems they were positioned that way for the therapist/caegiver to use rather than a one-handed patient. I also had to get a new outrigger for my thumb, still not quite positioned right.
2. Theraband makes progressive hand trainer sheets with prepunched holes for your fingers. You put the sheet into an embroidery hoop, the one that comes with the kit doesn't work, so buy a 7 or 9 inch embroidery hoop. none of the individual sheets were strong enough to keep my fingers open, so I used all six that came in the red refill pack and put them into one hoop. Once I get the flexors tired out I work on various finger movements. A lot cheaper than the SaeboFlex and probably just as good, except for maybe needing to anchor your thumb on the ring. This probably has no clinical support or research, just something I came up with myself. But I can get it on in less than a minute.
I personally think the Theraband hand-trainer sheets put into a crochet ring are at least as good and they also allow intrinsic muscle workouts. Actually tone is not triggered by exercising spastic muscles, therapists who say this have not been following the latest research. You should actually exercise those muscles to tell your brain that they are being controlled.
3.I got my own eStim machine, works great when I get around to using it. My hand will eventually come around but I'm focusing on arm and walking first. Allegro Medical #77715
4.Passive flexing and unflexing the fingers with my right hand. Right now I use the passive movement theory of flexing/unflexing my fingers hundreds of times each day. This is because I am into the hard neuroplasticity part, moving functions around rather than the easy neuroplasticity of just getting the penumbra to work better.
5. Hand Mentor for Stroke Patients
I have no idea if this is any good, I have never heard of any survivor talking about it.
6. Hand Helper I received one of these from my OT and would spend minutes willing my hand to relax. Getting the rubber bands on requires a two-handed person. At one time I saw on the internet a version of this that had it spaced out for individual fingers, but I didn't bookmark it. If someone sees this send me a link
7. Gripmaster I bought a couple of light resistance ones but they don't work for me because I can't separate my fingers enough to use them.
8. the ADL way, which is since you can do everything you need singlehandedly you do not need therapy for your hand.
And thats all folks.

My OT mentioned one of her patients that got his hand back after 5 years. No explanation of what he did.
Most patients that have motor deficits in the hand do not seem to have any guidance about the way to recover. I can go to all the stroke forums and see that lots of persons are complaining about not being able to get hand function back
I have heard about SaeboFlex, Mental imagery, Mirror box therapy, Bioness, Biomove and just waiting, hoping it will improve which seems to be the preferred method for the insurance companies and HMOs.

But then this is all just an uninformed opinion of mine. You need to go back to your doctors and therapists and say you are going to ask how to recover the hand every day you see them. Start putting the pressure on, they are supposed to be working for you.

Tuesday, February 8, 2011

multitasking and stroke rehab

 This was from petitep from DailyStrength.
It was so good it needed  to be passed on.
I started typing this as a reply to someone in another topic area and later thought it would be good to have it's own topic...
It was in reference to someone having short-term memory issues and being denied speech therapy..
Here are a few things I learned in speech therapy and now I'm good to go unless it's in a conference or (too much information too fast - needing more time to process) situation where I don't have one on one interaction with someone.
The reason he forgets quickly is because he's trying to multi-task. Us frontal lobe stroke people have short term memory issues and we cannot multi-task in it's simpliest forms...
Speech will teach him NOT to multi-task in it's simpliest forms. Such as "thinking of other things while hearing something else. Prior to my speech therapy, I couldn't hear and watch the therapist type at the same time she wanted me talk, ( I couldn't complete a sentence thought process or could retain the information she was asking long enough for a complete sentence to be said) because in it's simplist form it's multi-tasking. The distractions of doing more than one thing at once is too hard. (seeing thinking, hearing background sound or whatever it may be is all one more task at hand and short term memory people can't multi-task) Bring it down to the simplist forms..
When there is background sound or other things happening we go into "overload status" really fast, or multi-tasking when getting ready to walk out the door for instance, or coming in with groceries etc...)
When ALL is quiet, no surrounding sounds in the house or distractions. Have him stare you in the face when you are giving him instructions an instructions as long as it's not a long sentence (start with repeating simple words... and say three words, (apple, juice, flower) then four and five words- find out where his ceiling is = at the moment) or something you want him to remember in 1 minute. But get his UNDIVIDED attention, you cannot do this otherwise, we stroke people are like ADD people, we will forget if you don't have our undivided attention)
Then start saying... (I put the keys in the dish = let him put the keys there = he will remember it better then, always putting it in one spot) Start off with having him remember something in 15 second increments, 20 second, 1 minute, and so on... If he can retain it keep increasing the time, and going back to the same group of words until he's mastered it... then introduce one more thing (see below) or do something else and keep going back to the same words... (apple juice and flower work up to as far as he can get... 30 minutes or an hour is ideal. THEN he has learned to put it into his LONG TERM memory, by repeating it or knowing he has to remember it that far down the road... 30 minutes is a long time.
IF he does NOT retain it, the first time you ask him, at the 15 second mark, ask him "what other thoughts were in his mind when you said... a,b,c He will probably not even know because he's not aware, but you have to be aware of it... EVEN if it's a simple glance away (and not looking at you in the eyes) and he glanced past your shoulder to see something on the wall... He will NOT retain the information you are asking him at that exact moment. That little "glance was considered MULTI-TASKING when he was suppose to be paying attention to you.
For that half second (during this time he will not retain anything - then with the last half of a sentence if you're talking to him he is trying to figure out what he lost and he'll just go into "overload status" and will get lost and not have a clue of whats said.. trying to play "catch up"
You have to clue and zone in on him... even if his eyes move the slightest and not starting to pay attention... even if he's internally thinking of something else that was happening prior to you asking him and he thought of that while you're talking. (Such as if the baby needed something or if he came in from kitchen and he tried to hear if the faucet is running... Again, all of this is considered multi-tasking".
You're trying to increase his attention span and reteach him how to listen. He needs to learn to "clear his head" completely of ALL thoughts, stare at you and concentrate at what you are saying, no glancing away or looking out a window. My speech therapist pounded on me everytime I did something without me even realizing I was doing it. You have to make him aware that he's even doing it, once he has that, he'll start doing it on his own.
It may take many many times of practicing this... IF he can accomplish that, and remember.... He is then on his way of getting a better short term memory.
You have to "re-train his brain" how to receive incoming information. If someone is talking, he has to learn how to STOP everything and listen iwth NO outside influnces. Same goes for putting his keys down. nothing else counts, when he places his keys he has to clear his head.
After the 3 words or three numbers, you can progress into sentences or "where did you just put the keys? after he just placed them there.
He has to LOOK, STARE and CONCENTRATE and REPEAT in his mind "I'm PLACING THESE KEYS HERE" or I'm keeping them in my hand until I place them here" Putting his keys in the SAME PLACE each time. It is only then he will start remembering. Do this exercise with him in 1, 5, 10 and 30 minute increments... He probably has the memory to do it in 30 second increments, (if he doesn't do the same as above, what were you thinking, because he wasn't concentrating on this solely if he doesn't remember 15 seconds after he placed them) you will need to practice this consistently and see if they work. Do it for him, remind him he's doing it then reinforce it by you asking him, then he has to reinforce it by him telling you.
I was also having issues when it went past 2 minutes, when she asked, "tell me what time it is in 1 minute, we stroke (right side) don't have a perception of time and distance... we don't know if 2 minutes or 10 minutes has passed or 30 and 45 minutes... or... (miss by a half or quarter inch when pushing a shopping car and we'll push it right into the door jam)
If he can progress and tell you when 30 seonds has passed, that means he has remembered in 1 or 3 or 5 minute increments or... IF he does not remember you need to bring that to his attention so he can start remembering on his own...
I hope this has helped... Let me know how it works out or if anybody has anything to add or to make additional comments.

Annual Senior Citizen test

With thanks to Gulchman Notes for sending this around again.
“It’s that time of year to take your “Annual Senior Citizen test.” Probably a good one for us stroke-addled persons also, I flunked at the cow.
Exercise of the brain is as important as exercise of the muscles. As we grow older, it’s important to keep mentally alert. If you don’t use it, you lose it! Below is a very private way to test your loss or non-loss of intelligence. Take the test presented here to determine if you’re losing it or not. The large spaces below are so you don’t see the answers until you’ve made your answer.

OK, relax, clear your mind and begin.

1. What do you put in a toaster?

Answer: “bread,bagel or biscuits ” If you said “toast,” give up now and go do something else. Try not to hurt yourself. If you said, bread, go to Question 2.

2. Say “silk” five times. Now spell “silk.” What do cows drink?

Answer: Cows drink water. If you said “milk,” don’t attempt the next question. Your brain is over-stressed and may even overheat. Content yourself with reading a more appropriate literature such as Auto World or Family Circle or Redbook. Mad magazine is way out of your league. However, if you said “water”, proceed to question 3.

3. If a red house is made from red bricks and a blue house is made from blue bricks and a pink house is made from pink bricks and a black house is made from black bricks, what is a green house made from?

Answer: Greenhouses are made from glass. If you said “green bricks,” why are you still reading these???

If you said “glass,” go on to Question 4.

4. It’s twenty years ago, and a plane is flying at 20,000 feet over Germany (If you will recall, Germany at the time was politically divided into West Germany and East Germany.) Anyway, during the flight, TWO engines fail. The pilot, realizing that the last remaining engine is also failing, decides on a crash landing procedure. Unfortunately the engine fails before he can do so and the plane fatally crashes smack-dab in the middle of “no man’s land” between East Germany and West Germany. “Where would you bury the survivors? East Germany, West Germany, or no man’s land”?

Answer: You don’t bury survivors.

If you said ANYTHING else, you’re a dunce and you must stop NOW! If you said, “You don’t bury survivors”, proceed to the next question.

5. Without using a calculator – You are driving a bus from London to Milford Haven in Wales… In London, 17 people get on the bus; In Reading, six people get off the bus and nine people get on… In Sweden, two people get off and four get on… InCardiff , 11 people get off and 16 people get on… In Swansea, three people get off and five people get on… In Carmarthen, six people get off and three get on… You then arrive at Milford Haven. What was the name of the bus driver?

Answer: “Oh, for crying out loud!”

Don’t you remember your own name? It was YOU!!

Now pass this along to all your friends and pray they do better than you.
One person I was corresponding with said ' You don't have dementia if you forget why you came to the refrigerator, you may have it if you forget what the refrigerator is for.'

Remember even something like this is dangerous so make sure you ask your doctor for permission first. Don't even think about self-diagnosing. I heard a statistic that 40% of doctor diagnosed Alzheimer cases were wrong.

spasticity exercise

My therapists also did not recommend exercising spastic muscles but that is an incorrect assumption now. here is an article on it about CP which i think also applies to stroke spasticity.
This book also reports on the controversy.
Motor control: translating research into clinical practice
Anyway, now I try to exercise every muscle on my affected side even if the form doesn't look good.

Brunnstroms stages of recovery - spasticity
Brunnstrom (1966, 1970) and Sawner (1992) also described the process of recovery following stroke-induced hemiplegia. The process was divided into a number of stages:

Brunnstrom (1966, 1970) described the process of recovery following stroke-induced hemiplegia. The process was divided into a number of stages:
Synergy. A whole series of muscles are recruited when just a few are needed. Trying to reach forward, The arm wings outward, the shoulder lifts, the wrist curls down. Lots of this is from spasticity

1. Flaccidity (immediately after the onset)
No "voluntary" movements on the affected side can be initiated
2. Spasticity appears
Basic synergy patterns appear
Minimal voluntary movements may be present
3. Patient gains voluntary control over synergies
Increase in spasticity
4. Some movement patterns out of synergy are mastered (synergy patterns still predominate)
Decrease in spasticity
5. If progress continues, more complex movement combinations are learned as the basic synergies lose their dominance over motor acts
Further decrease in spasticity
6. Disappearance of spasticity
Individual joint movements become possible and coordination approaches normal
7. Normal function is restored

Where are the answers to this?
A lot of problems here are because spasticity is subjectively measured, if you can't properly measure something you can't figure out how to fix it.

spasticity rant and stroke rehab

This was when I first started researching on it in 2006, still no answers.

Sorry about ranting on spasticity. I guess if I look at it objectively I have a mild form, it is just that if I was truly paralyzed and only had to recover function instead of suppressing spasticity/tone first and then work on the paralyzed muscle it would be much easier. I have done both baclofen and zanaflex which didn't help the spasticity at all, just made me tired so I quit them. I have had several rounds of botox which helped with knocking out my bicep so my tricep could start working. Finger flexors were also knocked out but since my finger extensors need to move control to a different spot in my brain that didn't result in any improvement.
This was one of my early posts on lots of stroke forums. No one responded with any decent information

Found an interesting site Movement Disorder Virtual University that has lots of detail on spasticity. Here is the link
If you follow it down quite a few levels you can find this
Subject: Incidence and Consequences of Spasticity After Stroke

Date: 2/20/2004

Spasticity affects less than one quarter of stroke victims, according to this study.
Muscle overactivity and its consequences were assessed in 95 patients both immediately after and three months a first-time stroke. Seventy-seven (81%) were initially hemiparetic, of whom 20 had spasticity. Among these 20 patients, 14 had hyperreflexia. Within these patients, 3 had clonus, and 3 had muscle stiffness. Modified Ashworth score was grade 1 in 10 patients, grade 1+ in 7, and grade 2 in 3. None had grades of 3 or 4. At three months, 64 patients (67%) were hemiparetic, and 18 spastic, reflecting 5 whose tone normalized and 3 who became spastic in the interim. The correlation between muscle tone and a range of motor and activity scores was low for most measures at both time points, except for active movements initially, and rapid movement scores and 9-Hole Peg Test scores at three months.
The authors conclude, “spasticity seems to contribute to motor impairments and activity limitations and may be a severe problem for some patients after stroke,” but, given the relatively low numbers of patients with spasticity, they note, “Our findings support the opinion…that the focus on spasticity in stroke rehabilitation is out of step with its clinical importance.

Basically since only 25% of stroke survivors have it and most seem to be able to do ADL's, clinical research seems unlikely. So we are on our own unless we can somehow change that mindset.

As a final comment, my ADL's are just fine. If I can get past the spasticity I can start doing all the normal stuff I did pre-stroke which is why I am extremely interested in this.

Thursday, February 3, 2011

Acceptance of stroke deficits

Never,never, never.
I haven't gotten to the acceptance part yet, where I am comfortable in where I'm at. I have gotten to the acceptance of the fact that for the rest of my life I will probably always be tired and needing to use 100% of my brain all day/every day. There are still advances but they are almost impossible to measure. If I notice  something not working right I'll  try something to mimic  the movement and then add that to the mile-high list of exercises I should be doing every hour of the day.
Of course according to therapists this would mean I am in denial.

Tuesday, February 1, 2011

Finalist for Medgadget 2010 blog awards - polls are open

I found out today that Dean's Stroke Musings has been chosen as one of five finalists for Best Medical Weblog in the patient category in the 2010 Medical Weblog Awards, hosted by Medgadget.
I am thankful to be in such company. Check out all the finalists here.
Voting is from Thursday, Feb 3 to Sunday, Feb 13.

Polls Are Open in The 2010 Medical Weblog Awards Sponsored by Epocrates and Lenovo

You can vote here: scroll down a bit

Thanks to the 34 people who voted for me. I did come in 4th out of 5 by 1 vote. Wheelchair Kamikazee won with 864 votes