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

Wednesday, October 31, 2012

Control and Implementation of a Powered Lower Limb Orthosis to Aid Walking in Paraplegic Individuals

I'm sure with some modifications this could easily be adapted for a hemiplegic, So ask your doctor who is going to do that for you.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3402219/

Abstract

This paper describes a powered lower-limb orthosis that is intended to provide gait assistance to spinal cord injured (SCI) individuals by providing assistive torques at both hip and knee joints, along with a user interface and control structure that enables control of the powered orthosis via upper-body influence. The orthosis and control structure was experimentally implemented on a paraplegic subject (T10 complete) in order to provide a preliminary characterization of its capability to provide basic walking. Data and video is presented from these initial trials, which indicates that the orthosis and controller are able to effectively provide walking within parallel bars at an average speed of 0.8 km/hr.

Sugary drinks linked to higher stroke risk: study

Another one of these alarmist titles, putting all the prevention responsibility on you. Doctor question.
http://o.canada.com/2012/10/31/sugary-drinks-linked-to-higher-stroke-risk-study/

Cleveland Clinic will school IBM’s Watson on medicine in new partnership

This is so simple, Our stroke associations and the WSO should be jumping all over this, to have Dr. Watson go thru all the stroke research and come up with off-label uses of drugs for a stroke protocol and then point the good doctor to where research should go next. ASA, NSA and WSO are you going to fail here also? 
http://medcitynews.com/2012/10/cleveland-clinic-will-school-ibms-watson-on-medicine-in-new-partnership/

iPads help stroke patients

I found other possibilities:
1. anxiety coach,
2. iPad Apps for Toddlers,
3.Apps for Brain Injury Rehab
4.  Therapist iPad apps
5. Dementia? There's an app for that!
6. Circus Challenge video games
7. KineLabs, this has cockroach stomping
And do you really think these therapists  or even yours knows about all these possibilities?
http://www.northdevongazette.co.uk/news/ipads_help_stroke_patients_1_1672351

Why eating fish might be better supplements for stroke risk

I only copied a couple of paragraphs. This one is for your doctor to expend their considerable brainpower on, so ask them.
http://www.emaxhealth.com/1020/why-eating-fish-might-be-better-supplements-stroke-risk
The researchers think the reason eating fish is better than taking supplements might be because fish contains other nutrients like vitamins, minerals and amino acids that interact with each other to lead to better cardiovascular health.
Another possible explanation is that if you’re eating more fish you’re eating less red meat. Saturated fat which is found in red meat is known to contribute to poor blood vessel health that can lead to coronary heart disease, heart attack and stroke.

scalp acupuncture for stroke rehabilitation

I have no idea why anyone would think that putting needles in your scalp  would help your dead and dying neurons inside your brain. I don't know what language this is.
http://www.youtube.com/watch?v=3OZWvwkBG4U
And this one:
 Complete Recovery from Stroke Using Zhu's Scalp Acupuncture

Anecdotes don't prove anything

ReoGo by Motorika - Robotic Rehabilitation- Treatment for Stroke

I know this is a commercial site but this is so easy to duplicate at home except for the video part. Its simple because this unweights the arm. My way of doing this was suggested by my OT with my cane. My example here, the last large paragraph:
http://oc1dean.blogspot.com/2010/10/cane-exercise-for-stroke-rehab.html
Or another commercial product here:

Armeo(®)Spring

The new one here:
 http://www.youtube.com/user/MotorikaMedical

Tuesday, October 30, 2012

New Report Confirms Europe is on the Brink of a Stroke Crisis

This is no different that the call that  Asia-Pacific put out here;
http://oc1dean.blogspot.com/2012/10/asia-pacific-health-experts-call-for.html
This is so incredibly simple, the WSO should be in charge but only after survivors start running it.
Europe here:
http://www.stopafib.org/newsitem.cfm/NEWSID/436/Action-for-Stroke-Prevention/policy-makers-health-experts-patients-call-for-preventing-atrial-fibrillation-strokes

Nonprofits bring enthusiasm, innovation to drug R&D

The paragraph and title come from a Faster Cures email.
Disease-focused foundations have transitioned from groups that raise small amounts of money through local walkathons to sophisticated investors driving drug research, writes Luke Timmerman. Encouraged by the success of the Cystic Fibrosis Foundation's partnership with Vertex Pharmaceuticals on the new drug Kalydeco, nonprofits are combining their money, advocacy and patient networks to make a difference. "When you talk to Big Pharma, it's been a bit humbling for a lot of them to look at (CEO) Bob Beall and the CF Foundation, and say 'here's a nonprofit that raises money through walkathons, and look at what they did,'" says FasterCures executive director Margaret Anderson. "It's a profound example of how the system can work.
 http://www.xconomy.com/national/2012/10/29/the-new-power-players-in-drug-rd-are-wearing-fluorescent-t-shirts/
This is like what the Michael J. Fox foundation does for Parkinsons:
http://oc1dean.blogspot.com/2012/03/michael-j-fox-foundation-awards-468k-to.html

Our stroke associations are way behind  and unless we get involved as a board member will that change. If you know James Baranski or any of these  board members of the NSA, contact them and demand to know when they will start to follow this model.

Board of Directors

Michael D. Walker, MD, Chairman*
Sarasota, FL
Phillip Gorelick, MD, MPH
Chicago, IL
George Davis, Jr., Vice Chairman*
Boston, MA
Daniel F. Hanley, MD
Baltimore, MD
Sue Anschutz-Rodgers
Denver, CO
C. Martin Harris, MD
Cleveland, OH
Mollye Block, MS Ed
Boston, MA
James Peake
Austin, TX
Howard M. BrennerNew York, NY Robert Shapiro
New York, NY
Anastasia ColemanPalm Beach, FL Carla Smith
Ann Arbor, MI
Edward F. Cox, Esq.
New York, NY
David Sproat
Naperville, IL
Patricia Nixon Cox
New York, NY
Tim van Biesen
New York, NY
Michael Darling
New York, NY
* Indicates Executive Committee Member

Honorable Samuel K. Lessey, Jr.

Chairman Emeritus
Hancock, NH

Valerie Ireland

Chairman Emeritus
New York, NY
Director-At-Large
Jose Biller, MD, FACP, FAAN, FAHA
Editor, Journal of Stroke and Cerebrovascular Diseases (JSCVD)


For the American Stroke Association if you know Dr.
Ralph L. Sacco or any of his board members contact them and ask when they will follow this model.  Board members here are not easily found, Are they afraid?


















       

Resveratrol inhibits the proliferation of neural progenitor cells and hippocampal neurogenesis

This is for your doctor to decide between the protective benefits of resveratrol here:

Resveratrol protects against experimental stroke: Putative neuroprotective role of heme oxygenase 1 

and the negative  part here:


http://www.jbc.org/content/early/2012/10/26/jbc.M112.406413.short

Abstract

Resveratrol is a phytoalexin and natural phenol that is present at relatively high concentrations in peanuts and red grapes and wine. Based upon studies of yeast and invertebrate models, it has been proposed that ingestion of resveratrol may have anti-aging actions in mammals including humans. It has also been suggested that resveratrol exerts its beneficial effects on health by activating the same cellular signaling pathways that are activated by dietary energy restriction (DR). Some studies have reported therapeutic actions of resveratrol in animal models of metabolic neurodegenerative disorders. However, the effects of resveratrol on cell, tissue and organ function in healthy subjects are largely unknown. In the present study, we evaluated the potential effects of resveratrol on the proliferation and survival of neural progenitor cells (NPCs) in culture, and in the hippocampus of healthy young adult mice. Resveratrol reduced the proliferation of cultured mouse multi-potent NPCs, and activated AMP-activated protein kinase (AMPK), in a concentration-dependent manner. Administration of resveratrol to mice (1-10 mg/kg) resulted in activation of AMPK, and reduced the proliferation and survival of NPCs in the dentate gyrus of the hippocampus. Resveratrol down-regulated the levels of the phosphorylated form of cyclic AMP response element-binding protein (pCREB) and brain-derived neurotrophic factor (BDNF) in the hippocampus. Finally, resveratrol-treated mice exhibited deficits in hippocampus-dependent spatial learning and memory. Our findings suggest that resveratrol, unlike DR, adversely affects hippocampal neurogenesis and cognitive function by a mechanism involving activation of AMPK and suppression of CREB and BDNF signaling.

Monday, October 29, 2012

Retinoic acid induces neurogenesis by activating both retinoic acid receptors (RAR) and peroxisome proliferator-activated receptor β/δ (PPARβ/δ)

You have to ask your doctor how this can be translated into a therapy protocol.
http://www.jbc.org/content/early/2012/10/26/jbc.M112.410381.short

Abstract

Retinoic acid (RA) regulates gene transcription by activating the nuclear receptors RAR and PPARβ/δ and their respective cognate lipid binding proteins CRABP-II and FABP5. RA induces neuronal differentiation but the contributions of the two transcriptional pathways of the hormone to the process are unknown. Here we show that RA-induced commitment of P19 stem cells to neuronal progenitors is mediated by the CRABP-II/RAR path and that the FABP5/PPARβ/δ path can inhibit the process through induction of the RAR repressors SIRT1 and Ajuba. In contrast with its inhibitory activity in early steps of neurogenesis, the FABP5/PPARβ/δ path promotes differentiation of neuronal progenitors to mature neurons, an activity mediated in part by the PPARβ/δ target gene PDK1. Hence, RA-induced neuronal differentiation is mediated through RAR in early stages and through PPARβ/δ in late stages of the process. The switch in RA signaling is accomplished by a transient upregulation of RARβ concomitantly with a transient increase in the CRABP-II/FABP5 ratio at early stages of differentiation. In accordance with these conclusions, hippocampi of FABP5-null mice display excess accumulation of neuronal progenitor cells and a deficit in mature neurons vs. wild-type animals.

Neuroproteomics approach & neurosystems biology analysis: ROCK inhibitors as promising therapeutic targets in neurodegeneration & neurotrauma

You'll have to talk to your researcher and doctor about what this could mean.
http://onlinelibrary.wiley.com/doi/10.1002/elps.201200470/abstract
Several common degenerative mechanisms and mediators underlying the neuronal injury pathways characterize several neurodegenerative diseases including Alzheimer's Parkinson's, and Huntington's disease, as well as brain neurotrauma. Such common ground invites the emergence of new approaches and tools to study the altered pathways involved in neural injury alongside with neuritogenesis, an intricate process that commences with neuronal differentiation.
Achieving a greater understanding of the impaired pathways of neuritogenesis would significantly help in uncovering detailed mechanisms of axonal regeneration. Among the several agents involved in neuritogenesis are the Rho and Rho kinases (ROCKs) which constitute key integral points in the Rho/ROCK pathway that is known to be disrupted in multiple neuropathologies such as spinal cord injury, traumatic brain injury and Alzheimer's disease. This in turn renders ROCK inhibition as a promising candidate for therapeutic targets for treatment of neurodegenerative diseases.
Among the novel tools to investigate the mechanisms involved in a specific disorder is the use of neuroproteomics/systems biology approach, a growing subfield of bioinformatics aiming to study and establishing a global assessment of the entire neuronal proteome, addressing the dynamic protein changes and interactions. This review aims to examine recent updates regarding how neuroproteomics aids in the understanding of molecular mechanisms of activation and inhibition in the area of neurogenesis and how Rho/ROCK pathway/ROCK inhibitors, primarily Y-27632 and Fasudil compounds, are applied in biological settings, promoting neuronal survival and neuroprotection that has direct future implications in neurotrauma.

A Study of Fire Ant Venom Uncovers 46 Proteins with a Variety of Functions

We've got snake venom and vampire bats why not fire ants? Ask your researcher if any of these compounds would be useful in stroke rehab, neuron protection?
http://www.genomeweb.com//node/1133266?hq_e=el&hq_m=1389394&hq_l=1&hq_v=0298141c7f
Register for free access.
To get a full characterization of fire ant venom components, Palma and his colleagues combined both a two-dimensional gel electrophoresis approach and a high-performance liquid chromatography MS/MS approach. This allowed them to identify 46 proteins, some of which were not previously known to be in fire ant venom. The proteins also play a number of roles. "Some of these proteins are related to envenomating ... but half of the material, 50 percent of the proteins, present other functions," Palma says.
The 21 venom proteins identified include a number of allergens, neurotoxins, and metalloproteinases. Neurotoxins, Palma says, are primarily found in the venom of solitary hunters like scorpions or spiders, rather than social insects like fire ants — indeed, he adds that they had not been previously described in fire ant venom. Neurotoxins, he says, could lead to hallucinations or other neurological effects in affected people. And metalloproteinases break down the connective tissues between cells, possibly leading to edema.
In addition, Palma says that they uncovered proteins that gave researchers a better peek into the ants' biology. For example, the venom contains a number of proteins used for chemical communication, like pheromone transporters.
As some ants release venom, others pick it up as they walk. "That means that when the insect involved in the attack just touches the substrate where they are walking on, they can identify the presence of the pheromone already activated by the transporters," he says, adding that "this makes the stinger ants much more aggressive than they were before. … This is a kind of public relations of fire ants. The proteins make the fire ant colony much more aggressive, much more ready for a mass attack."

Flu Shot Linked To Heart Disease Protection

Preliminary but hell we should be getting a flu shot anyway. Yeah for Canadians again.
http://www.wibw.com/home/nationalnews/headlines/Flu-Shot-Linked-To-Heart-Disease-Protection-176333631.html
Getting a flu shot might protect against heart disease and deadly heart attacks.
That's what a new study presented over the weekend at the 2012 Canadian Cardiovascular Congress in Toronto found. It showed people who got an influenza vaccine were 50 percent less likely to experience a major cardiac event such as a heart attack, stroke or cardiac death, compared with those who had a placebo vaccine.
"The use of the vaccine is still much too low, less than 50 percent of the general population; it's even poorly used among health care workers," he says. "Imagine if this vaccine could also be a proven way to prevent heart disease," study author Dr. Jacob Udell, a cardiologist at Women's College Hospital and the University of Toronto, said in a press release.
The study involved 3,227 patients, half of which had established heart disease and were part of earlier studies dating back to the 1960s. Half of participants were randomly assigned to receive the flu shot.
Besides reducing cardiovascular risk, the study found those who had a flu shot also were 40 percent less likely to die from any cause compared with those who had a placebo.
Udell said the results support current recommendations for influenza vaccines for those with a prior history of heart attack or attacks, but now they could potentially be used for another reason besides reducing flu risk.
Cold or flu? Symptoms help distinguish illnesses Officials urge flu vaccine for unpredictable 2012-2013 season
"In addition to leading a heart healthy life, having an annual flu shot could be another easy way to help prevent cardiac events," Heart and Stroke Foundation spokesperson Dr. Beth Abramson said in a statement.
Udell told WebMD that the benefits may be explained because they provide protection for vulnerable patients who might have breathing difficulties while sick with the flu. These problems put them at higher risk for stroke or heart attack. The vaccine may also prevent inflammation that causes arteries to rupture.
The findings are considered preliminary because they were presented at a conference and not in a peer-reviewed journal.
Dr Harindra Wijeysundera, a cardiology researcher at Sunnybrook Health Sciences Centre in Toronto, Canada, who co-moderated the presentation, told Theheart.org that the treatment effect "is hard to believe," adding more research is needed.
"As the presenter stated, it lays the foundation as a hypothesis for more study," he said.

Centre for Stroke Recovery begins major national expansion

Yea for Canada. Much better than the isolated and uncoordinated efforts in the US. Failures once again for the US stroke associations in comparison.
http://www.newswire.ca/en/story/1060485/centre-for-stroke-recovery-begins-major-national-expansion
The Heart and Stroke Foundation Centre for Stroke Recovery and the Canadian Stroke Network (CSN) have partnered to promote a major national expansion of stroke recovery research, beginning with $1 million in seed funding from the CSN over two years to bolster scientific efforts and bring together researchers across the country.
"Canada has a strong track record in doing research in stroke rehabilitation and recovery," says CSN Executive Director Katie Lafferty. "We are excited there is a mechanism to forge new partnerships, speed research progress and further strengthen the scientific community."

Sunday, October 28, 2012

Walking in the woods - stroke rehab

Just across the parking lot is the Meridian Township Natural Area - Northwest Preserve. There are a few unimproved walking trails thru it - only 125 acres. This weekend it was finally cool enough and enough leaves had fallen for me to walk thru part of it. It reminded me of grouse hunting in northern Minnesota, looking ahead constantly trying to see a grouse before it exploded into flight right next to you. That will be my therapy goal, walking on these uneven trails without staring at the ground. I want to see black squirrels and deer which is only possible if I look up.
http://www.meridian.mi.us/vertical/Sites/%7B1800D46E-0900-43BD-B3FA-10A5660870B1%7D/uploads/%7B015BABDF-FB7A-4A11-9B18-975D62D8CBE9%7D.JPG

Baby steps in biking#4 - stroke rehab

Its getting close to the end of the biking season, about 45 degrees out today. Solved the loose seat by buying a vise-grip to clamp onto the nut side of the quick release. Feels much better not having the seat twist under me. Biked around the parking lot and one of the 2 foot wide unevenly paved walking paths. 15 minutes in total.  The left foot kept slipping forward on the pedal causing me to stop numerous times, eventually caused me to fall, again twisting to land on my left butt cheek, no harm done. It just means I will be getting a set of toe clips.  BS(before stroke) I would bike to work from March thru November, layering up the clothes and gloves, I bought a rain cap for my bike helmet just to prevent the cold air from rushing thru the helmet air slits and freezing my bald head, that worked to about 20 degrees, ear head bands would be needed below that.  I'll probably try a couple more weekends, I'll spend 30 minutes wrestling on a finger glove. Maybe get one of those bike trainers for the winter. Nothing here is to suggest this is a valid science-based therapy.

Asia-Pacific Health Experts Call for Urgent Action to Prevent a Stroke Crisis

And the first place to start would be in their back yard, contacting president of the WSO, Australian Professor Stephen Davis to see what specific
steps they are taking, not the pablum produced by the synergium.
http://www.pharmiweb.com/pressreleases/pressrel.asp?ROW_ID=66060#.UI2FjIZPGxM
Asia-Pacific remains at risk of a devastating stroke crisis, according to regional health experts launching two new Reports published today, on World Stroke Day, by Action for Stroke Prevention (ASP). Building on ASP’s 2011 Report, How Can We Avoid a Stroke Crisis in the Asia-Pacific Region?, the launch of today’s supplementary Reports focus on specific action steps that can be taken by healthcare decisions makers and professional and patient organisations, to reduce the catastrophic personal and economic impact of AF-related stroke.
Alarmingly, the Reports highlight the fact that the first time many people will find out they have AF is when they have a stroke. Furthermore, approximately 70% of patients with known AF who had a stroke caused by a blood clot were not receiving anticoagulant therapy to prevent AF-related stroke at the time it occurred.v,vi,vii With stroke placing a huge financial burden on countries in the Asia-Pacific region, more needs to be done to reduce the number of these serious, costly, and yet preventable strokes.
Reducing a Preventable Burden: Effecting Change
“We need to ensure that AF is recognised as a serious risk factor for stroke in national prevention plans and that concrete actions are defined in these plans that support earlier diagnosis and improved awareness, education and prevention,” said world-renowned Cardiology expert, John Camm, Professor of Clinical Cardiology at St George’s University, London, UK. “It is our hope that national governments will address this as they plan how to meet the United Nations’ commitment to reduce non-communicable diseases by 25% by the year 2025.”
Recommendations made by the Reports include:
  • improving public awareness and understanding of AF and the risk of AF-related stroke
  • implementing effective practice standards and targets for healthcare professionals; for example, targets for AF screening
  • creating national strategies for the early diagnosis of AF
  • developing strategies to support adherence to clinical guidelines and the provision of equal and adequate administration of therapy for people with AF 
  • Everyone of these sound wonderful but do nothing.

Now, a 'cooling' cap to treat stroke patients

This can join all the other cooling devices. Someone has to do the research for which is best. Other devices;
1. the cold cure for brain injury,
2. neck cooler,
3. Arctic Sun 5000,
4. Cool Aid Drug,
5. brain cooling helmet,
6. RhinoChill IntraNasal Cooling System,
http://www.hindustantimes.com/Entertainment/Wellness/Caps-to-save-lives-of-stroke-victims/Article1-951503.aspx
Call up your emergency ambulance service and make sure they are following these research results and point-blank ask them when they are going to supply all their vehicles with this stuff.  But you know me, I'm not medically trained and thus can't suggest anything useful. You do know that patients are only here to hand over money to the medical staff. There is nothing in your contract with your doctors that they provide guaranteed results.

Discovery: Resistin Protein Causes High Levels Of LDL Cholesterol

A serious question for your doctor, and don't allow them to throw up their hands and say 'I don't know'. Send them back to study the issue and report back to you.  You are paying them for their expertise, so have them display it.
http://www.science20.com/news_articles/discovery_resistin_protein_causes_high_levels_ldl_cholesterol-95725
Researchers have discovered that the protein resistin, which is secreted by fat tissue, causes high levels of "bad" cholesterol (low-density lipoprotein or LDL), increasing the risk of heart disease.

High blood cholesterol is a major risk factor for heart disease and stroke. It can lead to a buildup of plaque in the artery walls and narrowing of the arteries, causing atherosclerosis, which can make it more difficult for blood to flow through the heart and body.

Rest at the link.

Saturday, October 27, 2012

2012 statistics


Heart Disease and Stroke Statistics—2012 Update

 http://circ.ahajournals.org/content/125/1/e2

Magnetic targeting of nanoparticles across the intact blood–brain barrier

This is so simple, attach tPA to them and direct them to the site of the infarct, even stroke-addled me can figure this out.
http://www.sciencedirect.com/science/article/pii/S0168365912007092

Abstract

Delivery of therapeutic or diagnostic agents across an intact blood–brain barrier (BBB) remains a major challenge. Here we demonstrate in a mouse model that magnetic nanoparticles (MNPs) can cross the normal BBB when subjected to an external magnetic field. Following a systemic administration, an applied external magnetic field mediates the ability of MNPs to permeate the BBB and accumulate in a perivascular zone of the brain parenchyma. Direct tracking and localization inside endothelial cells and in the perivascular extracellular matrix in vivo was established using fluorescent MNPs. These MNPs were inert and associated with low toxicity, using a non-invasive reporter for astrogliosis, biochemical and histological studies. Atomic force microscopy demonstrated that MNPs were internalized by endothelial cells, suggesting that trans-cellular trafficking may be a mechanism for the MNP crossing of the BBB observed. The silica-coated magnetic nanocapsules (SiMNCs) allow on-demand drug release via remote radio frequency (RF) magnetic field. Together, these results establish an effective strategy for regulating the biodistribution of MNPs in the brain through the application of an external magnetic field.