Deans' stroke musings: Clinicians should pay attention to stroke patients who cannot walk at 3-6 mon after onset

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 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:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. 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 lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Wednesday, July 17, 2013

Clinicians should pay attention to stroke patients who cannot walk at 3-6 mon after onset

If we had objective analysis of gait problems we could solve each individual problem. I know that's wishing for the moon but unless we demand results we aren't getting anywhere. So be a pain in the ass to your clinicians, they should know how to get you recovered.
http://www.sciencecodex.com/clinicians_should_pay_attention_to_stroke_patients_who_cannot_walk_at_36_mon_after_onset-115583
Gait dysfunction is one of the most serious disabling sequelae of stroke. Regaining gait ability in stroke is a primary goal of neurorehabilitation. Furthermore, gait is a less demanding motor function than hand function. Stroke patients can walk when motor function is recovered in the proximal joint (hip and knee), at least to the degree of being able to oppose gravity. In general, most motor recovery after stroke occurs within 3-6 months after onset, and gait function usually recovers within 3 months of stroke onset. Therefore, clinicians need to look for the cause of gait inability and perform intensive rehabilitation for stroke patients who cannot walk after 3-6 months after insult. Sung Ho Jang and team from the College of Medicine, Yeungnam University (Daegu, Republic of Korea) reported on a stroke patient who showed delayed gait recovery between 8 and 11 months after the onset of intracerebral hemorrhage, which has been reported in the Neural Regeneration Research (Vol. 8, No. 16, 2013).

This 32-year-old female patient underwent craniotomy and drainage for right intracerebral hemorrhage due to rupture of an arteriovenous malformation. Brain MRI revealed a large leukomalactic lesion in the right fronto-parietal cortex. Diffusion tensor tractography at 8 months after onset revealed that the right corticospinal tract was severely injured. At this time, the patient could not stand or walk despite undergoing rehabilitation from 2 months after onset. It was believed that severe spasticity of the left leg and right ankle was largely responsible, and thus, antispastic drugs, antispastic procedures (alcohol neurolysis of the motor branch of the tibial nerve and an intramuscular alcohol wash of both tibialis posterior muscles) and physical therapy were tried to control the spasticity.

These measures relieved the severe spasticity, with the result that the patient was able to stand at 3 months. In addition, the improvements in sensorimotor function, visuospatial function, and cognition also seemed to contribute to gait recovery. As a result, she gained the ability to walk independently on even floor with a left ankle foot orthosis at 11 months after onset. This case illustrates that clinicians should attempt to find the cause of gait inability and to initiate intensive rehabilitation in stroke patients who cannot walk at 3-6 months after onset.