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

Saturday, March 31, 2012

Drug made from cobra venom among pharma startup’s targeted therapeutics

Three possibilities for use in strokes;
1. humanized cobra venom factor (CVF), a key protein in snake toxin. In studies, CVF has been found to subdue the body’s complement system, which is part of the immune system that activates cell killing.(If we can stop apoptosis we can save neurons)
2. a new class of proteasome inhibitors, which stop the degradation of proteins in cancer cell nuclei and initiate programmed cell death. Called syrbactins
(I do wonder if this is to initiate cell death or stop it)
3. a hybrid nanocarrier drug-delivery system that could target drugs directly to infected cancer cells. (nanocarriers can be very useful to get across the blood brain barrier)
http://www.medcitynews.com/2012/03/drug-made-from-cobra-venom-among-pharma-startups-targeted-therapeutics/?utm_source=rss&utm_medium=rss&utm_campaign=drug-made-from-cobra-venom-among-pharma-startups-targeted-therapeutics
An early stage pharmaceutical company with newly licensed anticancer, anti-inflammatory and nanoparticle drug-delivery technologies is looking for its first round of funding.

Pono Pharma, which was founded earlier this year with three technologies licensed from the University of Hawai’i, has already raised $1.5 million of a planned $4 million.


The rest at the link.

public atlas of the brain

I couldn't figure out how to work this site, bad design if stroke-addled patients can't navigate it.
http://thebrainobservatory.ucsd.edu/content/public-brain-atlas

Israeli Drug Could Save Stroke Victims

At least they acknowledge how poorly tPA works.
http://www.thecuttingedgenews.com/index.php?article=72680&pageid=28&pagename=Sci-Tech
Could a new Israeli treatment help save millions of people from death and severe disability after a stroke?
The six-person team of the recently funded company Thrombotech believes they have a fighting chance. Their new drug amplifies the effects of one of the only existing stroke medications on the market, while preventing dangerous side effects.
There is a critical window of time needed to get to the hospital if you are having a stroke. If it is an ischemic stroke, meaning an artery to the brain is blocked, doctors must get the blood flowing to the brain quickly.
The only approved treatment for this today is an enzyme called tPA. If given within three hours, tPA dissolves the blood clots blocking the flow of blood to the brain. However, it can be used in just 10 percent of cases and can cause life-threatening side effects such as hemorrhaging.
Yet except for tPA, there isn't much in a doctor's arsenal for fighting the serious effects of strokes, which are the leading cause of disability in the world and the third leading cause of death in the United States after cancer and heart disease.
This is precisely the unmet market need, worth about $3 billion per year, that Ness Ziona-based Thrombotech is targeting.
Dramatically better results
Rather than venture into the complicated and historically unsuccessful realm of trying to develop new neuro-protectant drugs, Thrombotech devised a technology to make the existing stroke treatment, tPA, more potent and effective.
The synthetic peptide, dubbed THR-18, came out of research at the Hadassah-Ein Karem Medical Center carried out by Arab-Israeli Prof. Abdel-Raouf Hijazi. THR-18 binds with tPA, giving the clot-buster more firepower and increasing the time window during which tPA can be effective, from three hours to nine hours. Pre-clinical studies suggest that THR-18 significantly reduces the dangerous potential side effects of tPA, too.
Thrombotech CEO Ruth Ben-Yakar, an Israeli biotech industry veteran, tells ISRAEL21c that the experimental drug may allow tPA to be used in up to 85% of ischemic stroke victims, including those whose symptoms and severity of attack would otherwise have excluded them.
"It's important to understand that neuro-protective drugs, which protect the brain from damage due to lack of oxygen, all have failed. This is very unfortunate, yet this is part of the reason I believe in this drug," she says of THR-18.
After successful phase I toxicity tests, Thrombotech is embarking on the next stage of clinical trials to meet US Food and Drug Administration guidelines. Participants for phase IIa clinical trials are now being recruited in Israel, Europe and the United States.
If all goes according to company expectations, a new treatment to make tPA work better could be on the market as early as 2017.
Thrombotech's major shareholders include Clal Biotechnology Industries, Ofer Hi-Tech and Hadasit Bio-Holdings. The company is also seeking other indications for its therapy, which may include treating blot clots caused by cardiovascular events and high blood pressure.

The ReWiiRe Project - Research for Wii Rehabilitation

Sounds cool but why can't the US have some innovative people working in stroke research? Do we need the UK to prove how its done?
http://www.rewiire.org.uk/

Motivation & Project Overview

Wii technology is recreational software and readily available on the market. The Wii technology has proved to be a great motivation tool for doing exercises at home. Currently there is some adoption of the Wii into physical rehabilitation practice with anecdotal evidence but little systematic evaluation. Therefore it is important to carry out this work to provide a solid evidence base for practice and commissioning.
In this project we would be also employing the Nintendo Wii remote technology that users are familiar with as a motivation tool and adapt it so that it can be used within healthcare for physiotherapy based rehabilitation.

ReWiiRe stand for Research for Wii technology in Rehabilitation. The project aim is twofold. Firstly to investigate therapist use and the patient experience of using the Nintendo Wii console technology in physical rehabilitation programmes in four NHS Trusts across hospital and community settings. We will be seeking to work with people with stroke, musculoskeletal conditions and amputation. Secondly to develop a customised rehabilitation platform that employs the Nintendo Wii remote technology and open source 3D software for the delivery of motivating rehabilitation sessions.

Furthermore we wish to investigate how this can be taken forward with a view to using it as part of physical rehabilitation and examining how game console technology may be adopted for personalised home rehabilitation that can be remotely monitored and adapted by the therapist.
This research is carried out by a multi-disciplinary team that includes Central London Community Healthcare NHS and Brunel University's School of Health Sciences and Social Care and School of Engineering and Design.

Local invention helps with brain trauma

From Hawaii for bleeds.
http://www.kitv.com/news/hawaii/Local-invention-helps-with-brain-trauma/-/8905354/9939930/-/s3kj16z/-/
LinkThe statistics are disturbing: Up to half the people who have bleeding in the brain due to head trauma will die within a month.

Sometimes it's a stroke or a concussion and it can happen to the elderly, soldiers, abuse victims or athletes.

That's why new technology being developed right here in the islands could one day save countless lives.

"Effectively we still have the same treatment we've had for a 1000 years. We do a burr hole to release the pressure in the skull," said Dr. Tom Hasling of Oceanit in Honolulu, who talked to KITV reporter Lara Yamada about treating bleeding in the brain.

Take what happened to Damien High School Quarterback Alan Mohika: after a concussion he was badly traumatized.

He quit football and will never be the same.

Or take the death of Actress Natasha Richardson: she got a concussion from skiing.

Friends said she seemed fine, but a short time later she died from what doctors couldn't catch soon enough.

"It remains undiagnosed until they get to the hospital so the paramedic doesn't even have any tools to deal with this," said Hasling.

But he came up with a revolutionary way to treat the injury.

"We're able to target the artery without damaging the brain underlying it," he said.

It's called LATCH technology. A laser that can pass through skin, skull and tissue, and pick out the damaged and bleeding arteries.

Then, it can cauterize or clamp those arteries, effectively stopping the damage. And they can do it without a single incision.

"We successfully stopped the blood flow and we did it successfully 100 percent of the time," said Hasling.

This is called an impact sensing helmet and if you take a look inside it has these sensors that detect the direction and strength of an impact so medics can tell almost immediately how bad a head injury might be.

This technology could easily be ported into sports equipment, bicycle helmets or football helmets.

Right now, it's being tested for the military. Head trauma is huge problem for soldiers on the battlefield.

But, one day, Hasling said, it will help those off the battlefield, of all ages.

"The potential for this is I could see it in every ambulance and in every emergency room," said Hasling.

Oceanit's having great success with treating those arteries feeding the lining of the brain.

They're also testing arteries deep in the brain.

And that, has the potential to one day significantly reduce the damage done by strokes.

Friday, March 30, 2012

Grid structure of the brain from NPR

Wonderful picture at the link from the Human Connectome Project.
http://www.npr.org/blogs/health/2012/03/29/149629657/how-your-brain-is-like-manhattan
24 second revolving video here:
http://www.youtube.com/watch?v=CySDbTH46P4&feature=youtube_gdata_player

This image shows the grid structure of the major pathways of the brain. It was created using a scanner that's part of the Human Connectome Project, a five-year effort which is studying and mapping the human brain.

It turns out your brain is organized even if you're not.

At least that's the conclusion of a study in Science that looked at the network of fibers that carry signals from one part of the brain to another.

Researchers used cutting-edge imaging technology to look at places where these fibers intersect. And they found a remarkably organized three-dimensional grid, says Van Wedeen of Harvard Medical School, the study's lead author.

The grid is a bit like Manhattan, Wedeen says, "with streets running in two dimensions and then the elevators in the buildings in the third dimension."

Thursday, March 29, 2012

Boosting good cholesterol could reduce cancer risk

I bolded the interesting part about bad cholesterol. Talk to your doctor about what statins really do for you. Wonder why this is from 2009 and just shows up now.
http://www.tuftsmedicalcenter.org/AboutUs/NewsReleases/2009NewsReleases/AHA_Scientific_Sessions_HDL_C

Data released today at the American Heart Association (AHA) Scientific Sessions 2009 demonstrate reduced cancer risk with increased levels of HDL-C (high density lipoprotein cholesterol, which is known as “good cholesterol” because of its ability to reduce heart disease risk). The data show a 21% (95% CI: 8%-33%) relative reduction in the rate of cancer incidence with every 10 point increase (10 mg/dl) in HDL-C (p = 0.05). The decrease in cancer risk with increasing HDL-C levels was even stronger when adjusted for baseline LDL-C (low density lipoprotein cholesterol), age, BMI and smoking status (p = 0.004).

“It may be that the anti-inflammatory and anti-oxidant properties of HDL-C help to counteract the inflammatory processes that cause cancer cells to multiply, and I believe future studies on this mechanism are necessary” said Richard Karas, MD, PhD, Professor of Medicine, Tufts University School of Medicine and Associate Director, Molecular Cardiology Research Institute, Tufts Medical Center, who led this research. “These data further support how important it is for researchers and clinicians to move away from looking only at the total cholesterol and instead to focus more on the various components of total cholesterol.”

Results demonstrate cancer risk is reduced with increased levels of HDL-C, independent of LDL-C, age, BMI and smoking status, based on a meta-analysis of 21 related randomized-controlled trials involving 586,528 person-years of follow-up, and 7,928 incident cancers, over a median follow-up of five years (interquartile range 2.9 - 5.1).

Findings also confirm previous data by the same research group at Tufts Medical Center demonstrating that increasing LDL-C (“bad cholesterol”) levels are associated with a decreased risk of cancer incidence, and reaffirmed a well-known association between increased age and increased cancer risk. Interestingly, the study found a connection between BMI (Body Mass Index, a statistical measurement of body fat and, therefore, obesity) and cancer risk, which was no longer significant when researchers adjusted for HDL-C.

About Tufts Medical Center and Floating Hospital for Children

Tufts Medical Center is an exceptional, not-for-profit, 451-bed academic medical center that is home to both a full-service hospital for adults and Floating Hospital for Children. Conveniently located in downtown Boston, the Medical Center is the principal teaching hospital for Tufts University School of Medicine. Founded in 1796 as the Boston Dispensary, Tufts Medical Center is the oldest permanent medical facility in New England and one of the first hospitals in the nation. For more than 200 years, Tufts Medical Center has pioneered innovative programs in clinical care and research and is a recognized leader in cancer care, cardiology, neurosciences, organ transplantation and pediatrics. More information is available at www.tuftsmedicalcenter.org.

How Old Are You?

This comes from caring.com I scored 14 so I'm not ancient yet.
http://www.caring.com/blogs/smile-of-the-week/test-yourself-how-old-Linkare-you?utm_medium=email&utm_source=suggests&utm_content=20120329

Count how many of the following you remember:

  1. Blackjack chewing gum
  2. Wax Coke-shaped bottles with colored sugar water
  3. Blue flashbulbs
  4. Soda pop machines that dispensed bottles
  5. Coffee shops with tableside jukeboxes
  6. Home milk delivery in glass bottles
  7. Party lines
  8. Newsreels before the movies
  9. P.F. Flyers
  10. Butch wax
  11. Telephone numbers with a word prefix (Amherst - 0155)
  12. Peashooters
  13. Howdy Doody
  14. 45 RPM records
  15. S&H Green Stamps
  16. Hi-fi's
  17. Metal ice trays with lever
  18. Mimeograph paper
  19. Candy cigarettes
  20. Beanie and Cecil
  21. Roller skate keys
  22. Cork popguns
  23. Drive-ins
  24. Studebakers
  25. Wash tub wringers

If you remembered 0-5 = You're still young

If you remembered 6-10 = You're getting older

If you remembered 11-15 = Don't tell your age

If you remembered 16-20 = You're older than dirt!

-- Anonymous

Cognitive impairment in Khat users

Our brains are impaired enough already so make sure you lay off the khat.
http://tlneuro.wordpress.com/2012/03/27/cognitive-impairment-in-khat-users/
A recently published study examines the cognitive effects of khat (Catha edulis) chewing. Colzato and colleagues (2011) recruited 20 khat users with 10.5 (6.5 SD) years of use, averaging 3.1 (1.8 SD) times per week. The average time spent chewing khat in each session was 5.8 hrs (1.7 SD) and all khat users met at least four criteria which define addiction under DSM-IV or ICD-10 criteria. Marijuana consumption in these individuals and the khat-free controls was about 2 joints per week, they consumed 6-8 drinks per week and had zero lifetime exposure to cocaine, amphetamines or ketamine. Subjects were also matched on IQ (using the Ravens Standard Matrices), age (~31 years), ethnicity/origin (all African) and sex (2 female in each group), although two male subjects from the khat-user group had to be excluded for excessive error rates in the switching task

Two Drinks a Day Reduce Mortality in Male Heart Attack Victims

Women, I guess you are on your own, Weird since this is from the Brigham and Women’s Hospital. They also mix heart attacks and stroke in the article so I really don't know what they are talking about.
http://www.united-academics.org/magazine/15313/two-drinks-a-day-reduce-mortality-in-male-heart-attack-victims/

The benefits of moderate alcohol consumption have been discussed thoroughly, but it remained unclear how it would affect people who had already suffered a heart attack. Now US researchers have found that a daily consumption of between 10 and 29.9 grams of alcohol may lower the risk of suffering another stroke by 42%.
The scientists, led by Jennifer K Pai, from Brigham and Women’s Hospital and Harvard Medical School in Boston, followed up 1.818 men between 1986 and 2006 who had been heart attack victims before starting the study. Every four years they were asked questions regarding their dietary and alcohol habits. The results showed that people who drank moderately every day also reduced their death risk from any cause by 14%.
10 to 29.9 grams of alcohol is the equivalent of two glasses of wine, two bottles or cans of beer or one shot of spirits.
‘If the men were already consuming moderate amounts, then it may be beneficial to continue consuming moderate amounts of alcohol after a myocardial infarction,’ said Jennifer K Pai. ‘However, because excessive alcohol intake is harmful, we recommend that patients discuss drinking alcohol in moderation with their physicians to individually assess their risks and potential benefits.’
In the case of women, however, the amounts may be lower.

A human brain dissection – in pictures

I really want to find a 3d representation of the arteries and veins in the brain.
http://www.guardian.co.uk/science/gallery/2012/mar/28/human-brain-dissection-in-pictures?CMP=twt_gu#/?picture=387992576&index=6

Wednesday, March 28, 2012

Stopping statin therapy increases risk of death for rheumatoid arthritis patients

Talk to your doctor.
http://www.eurekalert.org/pub_releases/2012-03/w-sst032Link612.php
Patients with rheumatoid arthritis (RA) who discontinue use of statin therapy are at increased risk of death from cardiovascular disease and other causes. According to the findings of a population-based study now available in Arthritis Care & Research, a journal published by Wiley-Blackwell on behalf of the American College of Rheumatology (ACR), RA patients should be advised of the importance of compliance to their statin therapy to reduce cardiovascular disease (CVD) mortality risk.
A report from the World Health Organization (WHO) estimates that RA affects up to one percent of the population in developed countries. Studies have shown that death rates among those with RA are 1.5-fold higher than in the general population, with CVD cited at the leading cause of mortality in this patient group. Statins—drugs such as atorvastatin (Lipitor) and rosuvastatin (Crestor) that are used to lower cholesterol and manage heart disease—are a common therapy for RA patients who are at greater risk of heart disease. Previous research reported 38% of RA patients permanently discontinue statin therapy, consequently increasing their heart attack risk by 67%.
"Our study provides evidence of the harmful effects of ceasing statin therapy," said lead author Mary De Vera, Ph.D., with the University of British Columbia School of Population & Public Health and Arthritis Research Centre of Canada. Using data from the British Columbia Ministry of Health records, researchers indentified 37,151 RA patients who received health services between January 1996 and March 2006. Of those with RA there were 4,102 patients who used statins. The team defined statin discontinuation as non-use of the prescribed medication for three months or more, anytime during the course of therapy.
The mean age of the RA group was 67 years, with 60% of the group being women. More than 16,144 person-years of follow-up were recorded for patients using statins, with roughly 45% of statin users discontinuing therapy at least once during the 4-year follow-up period. The authors reported 198 deaths from CVD and 467 deaths overall. Of the CVD deaths, 31% were from heart attacks and 15% from strokes.
Further analysis revealed that statin discontinuation was associated with a 60% increased risk of CVD deaths and 79% for deaths from all causes, which was not moderated by timing of the first statin prescription, age, or gender. "RA patients who discontinue statin therapy are at increased risk of death from cardiovascular disease," concludes Dr. De Vera. "Our study findings emphasize the importance of medication compliance in RA patients who are prescribed statins."

Tuesday, March 27, 2012

A Patient-Centered Approach to Exploring the Gastrointestinal Issues of Antiplatelet Therapy

This is Continuing Medical Education so you know at least as much as your doctor. Clopidogrel and aspirin are some of the anti-platelet therapies out there. You can sign up without being a doctor for free.

http://www.medscape.org/viewarticle/760409
Introduction
People with coronary stents are among the many cardiovascular patients prescribed long-term antiplatelet therapy. Dual antiplatelet therapy, comprising a P2Y12 inhibitor (usually clopidogrel) and aspirin, is recommended for a minimum of 12 months after drug-eluting stent placement.[1] Premature cessation of dual antiplatelet therapy in patients after acute coronary syndrome (ACS) and/or those treated with drug-eluting stents is associated with an increased risk for cardiovascular events, including stent thrombosis which can be fatal.[2]
Although this antiplatelet combination reduces the risk for ischemic events compared with aspirin alone, it is also associated with significantly more major bleeding.[3] In the VALsartan In Acute myocardial iNfarcTion trial (VALIANT) study of almost 15,000 survivors of myocardial infarction, serious gastrointestinal bleeding occurred in 0.7% over a median 2 years. Use of dual antiplatelet therapy was the most powerful predictor of this adverse event and serious gastrointestinal (GI) bleeding was associated with an increased risk of death [adjusted hazard ratio 2.54 (95% CI; 1.66-3.89)].[4] Smaller bleeds occur more frequently and long-term antiplatelet therapy is also associated with dyspepsia and other forms of GI distress.[5] Thus, proton pump inhibitors (PPIs) are often used in patients on long-term antiplatelet therapy.
Pharmacodynamic and Pharmacokinetic Interactions
Clopidogrel is a prodrug that is metabolized to its active form in a 2-step process through the cytochrome P450 (CYP) pathway with the majority of it being hydrolyzed to an inactive derivative. The CYP2C19 isoenzyme is involved in both steps (Figure 1). Most PPIs available in the United States are also metabolized via the CYP system.

View abbreviations used in this activity.
Please read the introduction, then watch Dr Cryer's video commentary that includes a patient case simulation.
Introduction
People with coronary stents are among the many cardiovascular patients prescribed long-term antiplatelet therapy. Dual antiplatelet therapy, comprising a P2Y12 inhibitor (usually clopidogrel) and aspirin, is recommended for a minimum of 12 months after drug-eluting stent placement.[1] Premature cessation of dual antiplatelet therapy in patients after acute coronary syndrome (ACS) and/or those treated with drug-eluting stents is associated with an increased risk for cardiovascular events, including stent thrombosis which can be fatal.[2]
Although this antiplatelet combination reduces the risk for ischemic events compared with aspirin alone, it is also associated with significantly more major bleeding.[3] In the VALsartan In Acute myocardial iNfarcTion trial (VALIANT) study of almost 15,000 survivors of myocardial infarction, serious gastrointestinal bleeding occurred in 0.7% over a median 2 years. Use of dual antiplatelet therapy was the most powerful predictor of this adverse event and serious gastrointestinal (GI) bleeding was associated with an increased risk of death [adjusted hazard ratio 2.54 (95% CI; 1.66-3.89)].[4] Smaller bleeds occur more frequently and long-term antiplatelet therapy is also associated with dyspepsia and other forms of GI distress.[5] Thus, proton pump inhibitors (PPIs) are often used in patients on long-term antiplatelet therapy.
Pharmacodynamic and Pharmacokinetic Interactions
Clopidogrel is a prodrug that is metabolized to its active form in a 2-step process through the cytochrome P450 (CYP) pathway with the majority of it being hydrolyzed to an inactive derivative. The CYP2C19 isoenzyme is involved in both steps (Figure 1). Most PPIs available in the United States are also metabolized via the CYP system.
In vitro studies using assays to measure metabolite levels or platelet reactivity show that co-administration of PPIs and clopidogrel results in reduced active metabolite generation and weak inhibition of platelet reactivity.[6-7]
This interaction persists with spaced administration of delayed-release omeprazole and clopidogrel.[8] However, spaced administration (10 hours) of an investigational drug combining enteric-coated delayed-release aspirin (325 mg) with immediate release omeprazole (40 mg) mitigated any pharmacodynamic interaction with clopidogrel.[9] It is not clear whether these pharmacodynamic and pharmacokinetic interactions hamper the clinical efficacy of clopidogrel.
Clinical Events
Observational studies show a higher risk for cardiovascular events in clopidogrel-treated patients co-administered PPIs, notably omeprazole.[10] Large randomized studies comparing clopidogrel with newer P2Y12 inhibitors, prasugrel in the TRITON-TIMI 38 (Trials to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition with Prasugrel -- Thrombolysis in Myocardial Infarction) trial or ticagrelor in the PLATO (PLATelet inhibition and patient Outcomes) trial have yielded conflicting findings. The TRITON-TIMI 38 study did not show higher event rates in patients assigned clopidogrel who were taking PPIs compared with those on clopidogrel and not taking PPIs, nor did it show any effect in a similar analysis of patients assigned prasugrel.[11] However, in the PLATO trial, patients on PPIs in both the clopidogrel and ticagrelor groups had worse outcomes compared with their counterparts who were not taking PPIs.[12] That any interaction was seen in the ticagrelor-treated group was surprising since ticagrelor is a direct acting P2Y12 inhibitor that does not require biotransformation. PPI use was not randomized in these trials and patients on these gastroprotective drugs tended to be higher risk at baseline, confounding the data.
To date, the Clopidogrel and Optimization of Gastrointestinal Events (COGENT) study is the only antiplatelet trial to randomize PPI use. Almost 3800 patients with an indication for dual antiplatelet therapy were randomized to a novel clopidogrel/omeprazole combination pill or clopidogrel alone; all patients were taking aspirin. The COGENT trial planned to enroll 5,000 patients but it was stopped early because the supporter and manufacturer of the clopidogrel/omeprazole pill filed for liquidation. The trial showed no difference in ischemic events between the 2 groups; indeed, those taking PPIs experienced significantly fewer upper GI bleeding events.[13]

Engaging with FDA: A Guide for Foundation Funders of Research

I bet the Alzheimers association and Michael J. Fox for Parkinsons are following these guidelines. Innovative stroke associations would be well served to attend.
https://fastercures.webex.com/mw0306ld/mywebex/default.do?nomenu=true&siteurl=fastercures&service=6&rnd=0.278627373281103&main_url=https%3A%2F%2Ffastercures.webex.com%2Fec0605ld%2Feventcenter%2Fevent%2FeventAction.do%3FtheAction%3Ddetail%26confViewID%3D1002464601%26siteurl%3Dfastercures%26%26%26
Date and time: Wednesday, April 18, 2012 1:00 pm
Eastern Daylight Time (New York, GMT-04:00)
Change time zone
Duration: 1 hour
Description:
Patient-driven foundations that fund medical research are increasingly seeking to productively engage with the Food & Drug Administration (FDA), to ensure that regulators understand the needs of patients and have the knowledge they need to review and approve treatments that are important to patients. What can be achieved by building relationships with and working more closely with the FDA? What unique assets can patient groups bring to the table? How should you prepare, and what challenges can you expect?

Learn from the experiences of senior leaders of two foundations that are pioneers in engaging in product development and in working with the FDA:
• Mary B. Dwight, Vice President of Government Affairs, Cystic Fibrosis Foundation
• Cynthia Rice, Vice President of Government Relations, Juvenile Diabetes Research Foundation

This free Webinar is part of FasterCures’ Webinar series designed to spotlight innovative approaches to disease research.

Monday, March 26, 2012

A Hand-Arm Rehabilitation Interface (HARI): Preliminary trial with stroke subjects

I wish we had someone who was interested and invested in consolidating all the various hand therapies and putting together a protocol with efficacy ratings.
http://scholar.google.com/scholar_url?hl=en&q=http://share.rurehablab.org/HARI/HARI_JRRD.doc&sa=X&scisig=AAGBfm0iTAPA_PsSXapQgvgklqf6EYCLHA&oi=scholaralrt

Many veterans are approaching the age when stroke and other risk factors for stroke, such as high blood pressure and carotid artery disease, are major health concerns. Surgical treatment of one ailment can accidentally initiate a stroke by cerebral thrombosis, such as by cardiac catheterization. In addition to those veterans who have survived a stroke or who have significant risk factors, there are particular groups of active military personnel who are at potential risk of stroke by virtue of their occupation. Divers and aviators are subjected to extreme changes in pressure, which places them at risk for arterial gas embolism, type II decompression sickness, and internal carotid artery dissection, which can lead to stroke. Traumatic brain injury also strikes many veterans and military personnel, which can exhibit stroke-like symptoms and disabilities.

Many stroke survivors recover ambulation through intensive rehabilitation, but arm function is often neglected, precluding a complete return of functionality. Since neither stroke nor TBI are inherently progressive diseases, the continued disability and often-inexorable decline in health and mental function are strictly due to secondary processes related to disuse. Thus the enormous health care expense borne by the military and loss in productivity could be cost-effectively ameliorated with improved rehabilitation strategies. The devices and protocols to be developed during this research are simple, and may be sufficiently inexpensive as a home use rehabilitation aid. Possible spin-offs include assistive devices, such as a controller for a computer mouse and a keyboard interface. With simple modifications, HARI technology could also be applied to the lower limbs.


1. Abstract

Recovery of upper-limb function after central paralysis is an uphill battle that can sometimes be won through intensive repetitions of task-oriented exercises. To help clients with these exercises, we developed the Hand Arm Rehabilitation Interface (HARI), a tool that guides the arm passively through task-specific reaching motions while providing biofeedback of muscular effort. Preliminary results with stroke subjects demonstrate its acceptability and utility for guiding motor rehabilitation of the paretic arm.

Keywords: hand, arm, upper-limb, paralysis, stroke, rehabilitation, biofeedback.

2. Introduction

2.1. Rationale

Paralysis of upper limb (PUL) affects many people each year through ischemic brain injury (stroke), traumatic brain injury and neurological conditions. Stroke in particular attacks over 700,000 Americans each year and there are over 4.8 million stroke survivors in the U.S.[1]. Typically, the stroke affects one arm significantly hindering fundamental activities of daily living (ADL) such as eating, self-care, writing, etc. Beyond functional loss, persons can experience chronic pain and distortion in the affected limb, as well as inexorable musculoskeletal deterioration through learned disuse[2].

Recovery outlook for PUL is relatively poor; for example, a study of stroke patients entering rehabilitation with non-functional arms revealed that 61% showed no improvement after 2 years[3], in contrast to steady improvement in walking. This dichotomy may be partly due to the fact that a lower limb devoid of sensorimotor control can ambulate, but a similarly affected arm cannot manipulate, and hence tends to stagnate. To give the arm an equal chance to function and exercise, rehabilitation strategies must encourage manipulation. When done repetitively over months, such exercises can maintain and possibly improve the integrity of the musculoskeletal system as well as the brain sensorimotor regions[3-23].

Beer bottle opening stroke rehab

We also bottle apple cider in beer bottles so I get lots of practice forcing my hand down the bottle enough to hold it still while I pry the cap off. The spasticity in my wrist prevents me from holding the bottle upright while opening it. It may take a few thousand repititions to get that neuroplasticity to take hold. I don't mind.