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

Thursday, January 31, 2013

The 113th Congress and Medical Research Funding: A Perfect Storm Approaching?


We probably won't be able to depend on the US government to fund medical research much longer.
This just makes the need to create a Great Stroke association that funds research  that much more important. An innovative stroke association would have prepared for this situation 5-10 years ago.
If you expect your children/grandchildren to have a better chance at recovery from stroke you will need to step up to the plate because the current players have failed and will continue to fail. Your ability to buy recovery does not exist so you may try to fund research now.

News from FasterCures 
The 113th Congress and Medical Research Funding: A Perfect Storm Approaching?
Wednesday, Feb. 20
1 p.m. to 2 p.m. Eastern
This is no garden-variety budget year in Washington: a tsunami of budget and fiscal issues threaten federal science programs, including the postponed "sequester," the drafting of the fiscal year 2014 budgets and likely fights over the debt ceiling. This FREE webinar will tell you what you need to know about what could happen on Capitol Hill, when, and who the important players are, including some new faces. Register today. Speakers include:

  • Ceci Connolly, managing director, Health Research Institute, PricewaterhouseCoopers.
  • Sudip S. Parikh, Ph.D., vice president and director, Center for Analytics & Public Health, Battelle.
  • Carrie D. Wolinetz, Ph.D., associate vice president for federal relations, Association of American Universities.
  • Moderator: Margaret Anderson, executive director, FasterCures.

Neuroprotection vs. Neuronal Cascade of Death


If you were an agency funding research and a stroke researcher came to you with a proposal, Which of those words in the title would be more likely to at least get reviewed?  Never ever refer to neuroprotection, thats boring. Words can cause action, use ones that denote urgency. Both refer to the death of neurons that has been set in place by the original stroke. This will occur over the next week or so(at least until someone researches the real timeframe)  Some of the causes of those neuron deaths;
1.  Excitotoxicity
2.  Glutamate poisoning
3.  Capillaries that don't open due to pericytes
4.  Inflammatory action leaking through the blood brain barrier

Your doctor should know about all of these and if we had a Great stroke association pushing this type of research we might get results in 20-30 years.
This is where all the focus of stroke research should be, not tPA. The irrational focus on tPA is preventing something better from being found.
You stop the neuronal cascade of death and I bet we could reduce the 30 day deaths from stroke substantially. Why hasn't someone from the stroke medical world been pushing this? Are they all brain-dead?
ASA - Dr. Sacco, 
NSA - Mr. Baranski, 
WSO - Dr. Stephen Davis


Time is Brain, you know. F.A.S.T.  How many neurons will they let die because of inaction?

An Experimental Brain Death Transplantation Model

This one is going to be hard because if you need a brain transplant you wouldn't be able to tell your doctor  about this paper.
No abstract so if you are interested you'll have to get your doctor to buy it. Good luck with that.
I'm sure your doctor subscribes to Transplantation: The Official Journal of the Transplantation Society.
Donor Management with N‐Octanoyl‐Dopamine Improves Renal Function and Reduces Inflammation in An Experimental Brain Death Transplantation Model

Traveling waves and trial averaging: the nature of single-trial and averaged brain responses in large-scale cortical signals

You researcher should be able to translate this for you into something useful or why are they doing it?
http://www.sciencedirect.com/science/article/pii/S1053811913000633

Abstract

Analyzing single trial brain activity remains a challenging problem in the neurosciences. We gain purchase on this problem by focusing on globally synchronous fields in within-trial evoked brain activity, rather than on localized peaks in the trial-averaged evoked response (ER). We analyzed data from three measurement modalities, each with different spatial resolution: magnetoencephalogram (MEG), electroencephalogram (EEG) and electrocorticogram (ECoG). We first characterized the ER in terms of summation of phase and amplitude components over trials. Both contributed to the ER, as expected, but the ER topography was dominated by the phase component. This means the ER topography is akin to an interference pattern in phase across trials. Hence the observed topography of cross-trial phase will not accurately reflect the phase topography within trials. To assess the organization of within-trial phase, traveling wave (TW) components were quantified by computing the phase gradient. TWs were intermittent but ubiquitous in the within-trial evoked brain activity. At most task-relevant times and frequencies, the within-trial phase topography was described better by a TW than by the trial-average of phase. The trial-average of the TW components also reproduced the topography of the ER; we suggest that the ER topography arises, in large part, as an average over TW behaviours. These findings were consistent across the three measurement modalities. We conclude that, while phase is critical to understanding the topography of event-related activity, the preliminary step of collating cortical signals across trials can obscure the TW components in brain activity and lead to an underestimation of the coherent motion of cortical fields.

The harmonic ratio of trunk acceleration predicts falling among older people: results of a 1-year prospective study

Prevent your falls, your therapist will be able to translate this into a stroke protocol.
http://www.jneuroengrehab.com/content/10/1/7/abstract

Abstract (provisional)

Background

Gait variables derived from trunk accelerometry may predict the risk of falls; however, their associations with falls are not fully understood. The purpose of the study was to determine which gait variables derived from upper and lower trunk accelerometry are associated with the incidence of falls, and to compare the discriminative ability of gait variables and physical performance.

Methods

This study was a 1-year prospective study. Older people (n = 73) walked normally while wearing accelerometers attached to the upper and lower trunk. Participants were classified as fallers (n = 16) or non-fallers (n = 57) based on the incidence of falls over 1 year. The harmonic ratio (HR) of the upper and lower trunk was measured. Physical performance was measured in five chair stands and in the timed up and go test.

Results

The HR of the upper and lower trunk were consistently lower in fallers than non-fallers (P < 0.05). Upper trunk HR, was independently associated with the incidence of falls (P < 0.05) after adjusting for confounding factors including physical performances. Consequently, upper trunk HR showed high discrimination for the risk of falls (AUC = 0.81).

Conclusions

HR derived from upper trunk accelerometry may predict the risk of falls, independently of physical performance. The discriminative ability of HR for the risk of falls may have some validity, and further studies are needed to confirm the clinical relevance of trunk HR.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

Neutrophil Extracellular Traps (Nets) Formation After Traumatic Brain Injury

Sounds like another hyperacute research possibility.
http://journals.lww.com/ccmjournal/Abstract/2012/12001/201___Neutrophil_Extracellular_Traps__Nets_.168.aspx

Abstract

Introduction: Brain inflammation significantly contributes to the progression of tissue damage after traumatic brain injury (TBI). Neutrophil recruitment has been shown to increase over the first 24 hours after experimental TBI. There is evidence that upon activation, neutrophils release DNA fibers decorated with antimicrobial proteins forming neutrophil extracellular traps (NETs). NET formation, when excessive, may also lead to tissue injury. The role of NETs in traumatic brain injury has not been investigated.
Hypothesis: NETs release by activated neutrophils may contribute to tissue damage and edema formation after TBI.
Methods: We used a controlled cortical impact (CCI) as a model for traumatic brain injury (TBI) in anesthetized adult Sprague-Dawley rats and divided in sham,12, 24, and 72 hours groups (n =5 each group) After TBI rats were euthanized at 12, 24 and 72 hours, brains were removed, examined by histology and assayed for histones, MPO and NE activity
Results: Significant increase in neutrophil accumulation, MPO and NE activity was demonstrated in the traumatized area at 12, 24 and even 72 hours after TBI when compared with non-traumatized area and sham animals.
Conclusions: We provide evidence for the formation of neutrophil extracellular traps (NETs), in areas of tissue injury, suggesting their potential link with brain tissue damage.

Human Gait Optimized for Efficiency

You therapist will be able to share this with you  and figure out your inefficient traits.
http://www.wired.com/wiredscience/2013/01/human-gait-optimization/

Activation of Brain Sensorimotor Network by Somatosensory Input in Patients with Hemiparetic Stroke: A Functional MRI Study

Tell your doctor to use this as a basis for your recovery protocols for sensation and motor areas.
http://cdn.intechopen.com/pdfs/41874/InTech-Activation_of_brain_sensorimotor_network_by_somatosensory_input_in_patients_with_hemiparetic_stroke_a_functional_mri_study.pdf
1. Introduction
Stroke is one of the leading causes of disability in the elderly in many countries. Residual motor impairment, especially hemiparesis, is one of the most common sequelae after stroke.  Motor recovery after stroke exhibits a wide range of difference among patients, and is dependent on the location and amount of brain damage, degree of impairment, and nature of deficit (Duncan et al., 1992). Full recovery of motor function is often observed when initial impairment is mild, but recovery is limited when there were severe deficits at stroke onset. The motor recovery after stroke may be caused by the effects of medical therapy against acute stroke, producing a resolution of brain edema and an increase in cerebral blood flow in the penumbra and remote areas displaying diaschisis. However, functional
improvements may be seen past the period of acute tissue response and its resolution. The role of rehabilitation in facilitating motor recovery is considered to be produced by promoting brain plasticity.
Non-invasive neuroimaging techniques, including functional magnetic resonance imaging (fMRI) and positron emission tomography (PET), enable us to measure task-related brain activity with excellent spatial resolution (Herholz & Heiss, 2000; Calautti & Baron, 2003;
Rossini et al., 2003). The functional neuroimaging studies usually employ active motor tasks, such as hand grip and finger tapping, and require that the patients are able to move their hand. Neuroimaging studies in stroke patients have reported considerable amounts of data that suggest the mechanisms of motor functional recovery after stroke. Initial cross-sectional studies at chronic stages of stroke have demonstrated that the pattern of brain activation is different between paretic and normal hand movements, and suggested that long-term recovery is facilitated by compensation, recruitment and reorganization of cortical motor
function in both damaged and non-damaged hemispheres (Chollet et al., 1991; Weiller et al., 1992; Cramer et al., 1997; Cao et al., 1998; Ward et al., 2003a). Subsequent longitudinal studies from subacute to chronic stages (before and after rehabilitation) have revealed a dynamic, bihemispheric reorganization of motor network, and emphasized the necessity of
successive studies (Marshall et al., 2000; Calautti et al., 2001; Feydy et al., 2002; Ward et al, 2003b).
When the stroke patients are unable to move their hand, alternative paradigms are necessary to study their brain function. Passive, instead of active, hand movement has been employed for this purpose, and increases in brain activities are found not only in sensory but also motor cortices (Nelles et al., 1999; Loubinoux et al., 2003; Tombari et al., 2004).
Functional neuroimaging studies suggest that a change in processing of somatosensory information in the sensorimotor cortex may play an important role in motor recovery after stroke (Schaechter et al., 2006).
Most significant recovery of motor function takes place within the first weeks after stroke and an early introduction of rehabilitation is crucial for a good outcome. Rehabilitation at the early stages of stroke uses physiotherapy, such as massage and passive movement of the
paretic hand, as an initial step of rehabilitation, especially in patients with severe motor impairment. However, it is difficult to assess the effects of physiotherapy in patients with severe impairment early after stroke. In this fMRI study, we investigated the effects of somatosensory input on the activity of brain sensorimotor network in stroke patients. Since
somatosensory feedback is essential for the exact execution of hand movement, the result can provide a scientific basis for the establishment of rehabilitation strategies

New stroke gene discovery could lead to tailored treatments

Well this is a question for your researcher, how this helps you.
http://www.sciencecodex.com/new_stroke_gene_discovery_could_lead_to_tailored_treatments-106099
An international study led by King's College London has identified a new genetic variant associated with stroke. By exploring the genetic variants linked with blood clotting – a process that can lead to a stroke – scientists have discovered a gene which is associated with large vessel and cardioembolic stroke but has no connection to small vessel stroke.
Published in the journal Annals of Neurology, the study provides a potential new target for treatment and highlights genetic differences between different types of stroke, demonstrating the need for tailored treatments.
About 15 million people worldwide suffer a stroke each year. Of these, five million die and another five million are left permanently disabled, according to numbers from the World Health Organization (WHO). Risk factors for a stroke are high blood pressure, a heart rhythm disorder, high blood cholesterol, tobacco use, unhealthy diet, physical inactivity, diabetes and advancing age.
A stroke occurs when the blood supply to the brain is cut off, often due to a blood clot blocking an artery that carries blood to the brain, which then leads to brain cell damage. Coagulation (blood clotting) abnormalities, particularly easy clotting of the blood, are therefore common contributing factors in the development of stroke.
Dr Frances Williams, Senior Lecturer from the Department of Twin Research and Genetic Epidemiology at King's and lead author of the paper, said: 'Previous studies have demonstrated the influence of genetic factors on the components of coagulation. The goal of this study was to extend these observations to determine if they were further associated with different types of stroke.'
The research was carried out in three stages. The first consisted of a genome-wide association study (GWAS) in 2100 healthy volunteers which identified 23 independent genetic variants that were involved in coagulation. The second stage examined the 23 variants in 4200 stroke and non-stroke cases from centres across Europe (Wellcome Trust Case Control Consortium 2 and MORGAM collections) and found that a particular mutation on the ABO gene was significantly associated with stroke.
Stage three of the study used the MetaStroke cohort, a project of the International Stroke Genetics Consortium which comprises 8900 stroke cases recruited from centres in the Europe, USA and Australia, whose DNA has been collected and undergone GWA scan. It was confirmed that a variant in the ABO blood type gene was associated with stroke, a finding specific to large vessel and cardioembolic stroke.
Dr Williams said: 'The discovery of the association between this genetic variant and stroke identifies a new target for potential treatments, which could help to reduce the risk of stroke in the future. It is also significant that no association was found with small vessel disease, as this suggests that stroke subtypes involve different genetic mechanisms which emphasises the need for individualised treatment.'

A step towards repairing the central nervous system

So ask your doctor how many steps are left until this is understood.
http://www.alphagalileo.org/ViewItem.aspx?ItemId=128006&CultureCode=en
Despite recent advances in understanding the mechanisms of nerve injury, tissue-engineering solutions for repairing damage in the central nervous system (CNS) remain elusive, owing to the crucial and complex role played by the neural stem cell (NSC) niche. This zone, in which stem cells are retained after embryonic development for the production of new cells, exerts a tight control over many crucial tasks such as growth promotion and the recreation of essential biochemical and physical cues for neural cell differentiation.
According to the first author of the paper, Zaida Álvarez, from the Group on Biomaterials for Regenerative Therapies of the Institute for Bioengineering of Catalonia (IBEC), “in order to develop tissue-engineering strategies to repair damage to the CNS, it is essential to design biomaterials that closely mimic the NSC niche and its physical and biochemical characteristics”.
In the study headed by Soledad Alcántara of the University of Barcelona, the team tested types of polylactic acid (PLA) with different proportions of isomers L and D/L, a biodegradable material allowing neural cell adhesion and growth, as materials for nerve regeneration. They found that one type, PLA with a proportion of isomers of 70/30, maintained the important pools of neuronal and glial progenitor cells in vitro. PLA 70/30 was more amorphous, degraded faster and, crucially, released significant amounts of L-lactate, which is essential for the maintenance and differentiation of neural progenitor cells. “The aim of the research was to find a biomaterial able to sustain the population of neural stem cells and to generate new differentiated cells in order to start the development of an implant that allows brain regeneration,” explains Dr Alcántara.
“The mechanical and surface properties of PLA70/30, which we used here in the form of microthin films, make it a good substrate for neural cell adhesion, proliferation and differentiation,” adds Álvarez. “The physical properties of this material and the release of L-lactate when it degrades, which provides an alternative oxidative substrate for neural cells, act synergistically to modulate progenitor phenotypes”, concludes the researcher.
The results suggest that the introduction of 3D patterns mimicking the architecture of the embryonic NSC niches on PLA70/30-based scaffolds may be a good starting point for the design of brain-implantable devices. “These will be able to induce or activate existing neural progenitor cells to self-renew and produce new neurons, boosting the CNS regenerative response in situ,” states Álvarez.
Enabling the CNS to regenerate could open doors to promising new strategies to tackle accidental damage as well as numerous diseases like stroke and degenerative disorders such as Parkinson's and Alzheimer's diseases.
http://www.ub.edu

Differential Activation of Brain Regions Involved with Error-Feedback and Imitation Based Motor Simulation when Observing Self and an Expert's Actions in Pilots and Non-Pilots on a Complex Glider Landing Task

Whenever your doctor finally gives you action observation as a therapy ask her/him about these findings.
http://www.sciencedirect.com/science/article/pii/S105381191300075X

Abstract

In this fMRI study we investigate neural processes related to the action observation network using a complex perceptual-motor task in pilots and non-pilots. The task involved landing a glider (using aileron, elevator, rudder, and dive brake) as close to a target as possible, passively observing a replay of ones own previous trial, passively observing a replay of an experts trial, and a baseline do nothing condition. The objective of this study is to investigate two types of motor simulation processes used during observation of action: imitation based motor simulation and error-feedback based motor simulation. It has been proposed that the computational neurocircuitry of the cortex is well suited for unsupervised imitation based learning, whereas, the cerebellum is well suited for error-feedback based learning. Consistent with predictions, pilots (to a greater extent than non-pilots) showed significant differential activity when observing an expert landing the glider in brain regions involved with imitation based motor simulation (including premotor cortex PMC, inferior frontal gyrus IFG, anterior insula, parietal cortex, superior temporal gyrus, and middle temporal MT area) than when observing ones own previous trial which showed significant differential activity in the cerebellum (only for pilots) thought to be concerned with error-feedback based motor simulation. While there was some differential brain activity for pilots in regions involved with both Execution and Observation of the flying task (potential Mirror System sites including IFG, PMC, superior parietal lobule) the majority was adjacent to these areas (Observation Only Sites) (predominantly in PMC, IFG, and inferior parietal loblule). These regions showing greater activity for observation than for action may be involved with processes related to motor-based representational transforms that are not necessary when actually carrying out the task.

Unstoppable menstruation induced by the concomitant use of tizanidine and warfarin

Women, be careful out there.
http://www.cadrj.com/qikan/epaper/zhaiyao.asp?bsid=17703
Abstract  A 51-year-old woman with rheumatic heart disease and cerebral embolism received warfarin for about one year and the dosage was reduced gradually from 2.25 mg/d to 1.5 mg/d. At the same time, she was given tizanidine 2 mg thrice daily (2 mg twice daily at the first week)because of her right upper limb spasticity. About 20 days later, her menstruation started and lasted more than 20 days. Tizanidine was withdrawn and, 5-6 days later, her menstruation stopped. Laboratory examination showed the following results: prothrombin time 19.5 s, prothrombin activity 64.9%, prothrombin time ratio 1.56, international normalized ratio 1.61, partial thromboplastin time 37.2 s, thromboplastin time 13.5 s, fibrinogen 3.8 g/L. Warfarin was continued at the same dose as before. The situation of prolonged menstrual period and increased menstrual flow did not reccur at a one-year follow-up.

Contamination and adulteration of herbal medicinal products (HMPs):

Be careful out there. I wouldn't call this stuff medicine.
http://www.ncbi.nlm.nih.gov/pubmed?term=22843016

Abstract

PURPOSE:

The aim of this overview of systematic reviews is to summarise and critically evaluate the evidence from systematic reviews of the adulteration and contamination of herbal medicinal products (HMPs).

METHODS:

Five electronic databases were searched to identify all relevant systematic reviews.

RESULTS:

Twenty-six systematic reviews met our inclusion criteria. The most commonly HMPs were adulterated or contaminated with dust, pollens, insects, rodents, parasites, microbes, fungi, mould, toxins, pesticides, toxic heavy metals and/or prescription drugs. The most severe adverse effects caused by these adulterations were agranulocytosis, meningitis, multi-organ failure, perinatal stroke, arsenic, lead or mercury poisoning, malignancies or carcinomas, hepatic encephalopathy, hepatorenal syndrome, nephrotoxicity, rhabdomyolysis, metabolic acidosis, renal or liver failure, cerebral edema, coma, intracerebral haemorrhage, and death. Adulteration and contamination of HMPs were most commonly noted for traditional Indian and Chinese remedies, respectively.

CONCLUSIONS:

Collectively these data suggest that there are reasons for concerns with regards to the quality of HMPs. Adulteration and contamination of HMPs can cause serious adverse effects. More stringent quality control and its enforcement seem to be necessary to avoid health risks.

Neural Integration of Risk and Effort Costs by the Frontal Pole: Only upon Request

A question for your doctor. Has your risk/reward center been damaged? What protocol will be used to fix it? These are extremely serious questions your doctor better know the answers to. If not then they should be setting up research to find out about it.
http://www.jneurosci.org/content/33/4/1706.abstract

Abstract

Rewards in real life are rarely received without incurring costs and successful reward harvesting often involves weighing and minimizing different types of costs. In the natural environment, such costs often include the physical effort required to obtain rewards and potential risks attached to them. Costs may also include potential risks. In this study, we applied fMRI to explore the neural coding of physical effort costs as opposed to costs associated with risky rewards. Using an incentive-compatible valuation mechanism, we separately measured the subjective costs associated with effortful and risky options. As expected, subjective costs of options increased with both increasing effort and increasing risk. Despite the similar nature of behavioral discounting of effort and risk, distinct regions of the brain coded these two cost types separately, with anterior insula primarily processing risk costs and midcingulate and supplementary motor area (SMA) processing effort costs. To investigate integration of the two cost types, we also presented participants with options that combined effortful and risky elements. We found that the frontal pole integrates effort and risk costs through functional coupling with the SMA and insula. The degree to which the latter two regions influenced frontal pole activity correlated with participant-specific behavioral sensitivity to effort and risk costs. These data support the notion that, although physical effort costs may appear to be behaviorally similar to other types of costs, such as risk, they are treated separately at the neural level and are integrated only if there is a need to do so.

Looking ahead to living

The following is taken from the Jan.-Feb. 2013 AARP Bulletin.  This pretty much matches my attitude. I have too many people to meet and discuss with to curl up and wait for death.

I'm still looking ahead. I don't want to die. There's too much fun in this world and a lot of good folks. A lot of them. And good books to read and fish to catch and pretty women to admire and good men to know. Why life is a joy.

Palliative care for stroke affected by age, gender, stroke type

And if we had decent hyperacute therapies stopping most of the neuronal cascade of death we wouldn't send so many to pallative care.
http://www.news-medical.net/news/20130131/Palliative-care-for-stroke-affected-by-age-gender-stroke-type.aspx

Sensors envisage stroke recovery

This makes so much sense that it won't get to the US for 5-10 years.
http://lifestyle.myjoyonline.com/pages/health/201301/100733.php
Academics and designers have come up with a device to help people recover from the physical effects of a stroke.

Envisage uses motion sensor technology to show patients whether or not they are doing their rehabilitation exercises correctly.

It was created by a team from the Glasgow School of Art and the University of Strathclyde.

Focus groups suggested stroke survivors needed a way to keep motivated during the long road to recovery.

Linda Gordon, who had a stroke last year, said: "I think it's been a great thing, it's been really good."

At the age of 54, Ms Gordon is only one year older than BBC presenter Andrew Marr, who suffered a stroke earlier this month.

She lost the use of her right arm and leg - and has had to learn to walk again.

Reflective balls

Ms Gordon describes the after-effects of the stroke as "devastating".

"My mother had strokes, but you don't think it'll happen to you," she said. "You just don't."

Ms Gordon was the first patient to be enrolled on the Envisage trial, taking place in Lanarkshire stroke clinics.

Small reflective balls are placed on her leg and thigh, allowing motion sensor cameras to capture her precise movements and show them on screen.

A "swingometer" at the side of the screen moves into red if her position is wrong and green if she is doing an exercise correctly.

Occupational therapist Gillian Sweeney explained: "Occupational therapists and physiotherapists have always used verbal feedback and mirrors in therapy sessions.

"This technology allows us to wind it back and play it to the patient.

"Patients like to be able to see where they're going wrong and to get advice on how to correct that."

About 30 patients have used the Envisage programme so far.

Patients' homes

It is hoped that larger-scale studies will follow and the technology will eventually be a standard part of stroke rehabilitation.

Research fellow Dr Anne Taylor, from the Glasgow School of Art, said: "What a lot of therapists said before is that therapy can be very prescriptive, very instructive.

"They're telling the patient what they have to do, whereas hopefully the use of the visuals will allow an interaction where the patient takes more ownership.

"The aim is to use it in patients' homes eventually."

Ms Gordon's long recovery continues and she is now concentrating on trying to get more movement in her arm.

"I just need to learn to be patient," she said. "I was so naive. I thought I'd be back at my work in a couple of months.

"Now I've spoken to people who say it takes two years to recover. It's just a slow process." 

Scientific communication crisis threatens progress

From a Faster Cures email. This is so obvious in stroke research. I have found numerous instances where the authors have missed previous research that contradicted their conclusions.
Society and Ethics  Scientific communication crisis threatens progress
The science community has long had a reputation for having poor public communication skills, but lately scientists have failed to communicate with one another, writes David Rubenson, Stanford Cancer Institute's associate director for administration and strategic planning. Presentations have become incomprehensible because researchers lack preparation time and large conferences make audience questions difficult to field; the number of scientific publications has exploded; research institutions have expanded; specialization has increased; and funds have declined. "It is up to our scientific leaders at the national institutes, foundations, and academic centers to recognize this problem and realign priorities and goals appropriately," Rubenson writes. Scientist, The (free registration) (1/2013)

Science Reveals How Owls Avoid Stroke While Rotating Heads

So until your chiropractor can explain  how your neck structure is similar to an owls don't get your neck adjusted. Or for a more graphic image,Regan MacNeil from the Exorcist. 
http://news.health.com/2013/01/31/science-reveals-how-owls-avoid-stroke-while-rotating-heads/
What a hoot: Scientists say they’ve discovered how owls can almost fully rotate their heads without damaging the blood vessels in their necks or cutting off the blood supply to their brains.
Owls have four major bone structure and blood vessel adaptations that prevent injury when they rotate their head. Humans lack these adaptations, which helps explain why people are more vulnerable to neck injuries, according to the Johns Hopkins researchers.
“Until now, brain imaging specialists like me who deal with human injuries caused by trauma to arteries in the head and neck have always been puzzled as to why rapid, twisting head movements did not leave thousands of owls lying dead on the forest floor from stroke,” study senior investigator and interventional neuroradiologist Dr. Philippe Gailloud said in a Hopkins news release.

More at link.

Jocks beat bookworms on brain test

This can probably be explained by the neurogenesis created by exercize.
Peter Levine also proposes that;  Jim Thorpe. The World's Smartest Man?
http://www.psypost.org/2013/01/jocks-beat-bookworms-on-brain-test-16276
The study demonstrates a possible outcome of the increased cortical thickness that has been found in areas of trained athletes’ brains. It also offers researchers new avenues for exploring the treatment of people who have issues with attention, such as the elderly.

Wednesday, January 30, 2013

Jan Medical’s Nautilus Neurowave Platform Could Be a Game-Changer for Quickly Identifying Stroke and Other Brain Abnormalities

This can join the fourteen other options for your clinics and ERs to diagnose a stroke properly. You'll have to let your medical team know about these options if you want them available in any reasonable timeframe.
http://www.onemedplace.com/blog/archives/12674
Dr. Lovoi has more than 30 years of experience managing and starting  innovative companies. Prior to founding Jan Medical, he was co-founder, prime inventor and CEO of Xoft Inc., a company focused on using tiny x-ray tubes to treat cancer. Xoft’s AXXENT® cancer treatment product is FDA-cleared for breast, endometrial, rectal and skin cancer treatment.  In addition to Jan Medical and Xoft, Dr. Lovoi founded Candescent Technologies, a flat panel display company; and INTA, a high temperature materials company. Dr. Lovoi has 50 patents issued and 20 pending applications. He has a Ph.D. in physics from the University of New Mexico (his research was conducted at Los Alamos National Laboratory) and has completed the Stanford Executive MBA program.
While Jan Medical’s Nautilus NeuroWave system is designed to address all areas of stroke, and ultimately traumatic brain injury, the company’s initial focus is detection and monitoring of vasospasm after subarachnoid hemorrhagic stroke and determination of ischemic stroke in the critical first few hours post-event.
Vasospasms are a serious complication for survivors of hemorrhagic stroke. Severe vasospasms can cause a second stroke when a brain vessel becomes constricted such that blood flow is severely restricted or even prevented from flowing beyond the constriction. Existing protocols for patients who survive an initial subarachnoid hemorrhagic stroke caused by bleeding into the space surrounding the brain call for monitoring for vasospasm for up to 21 days in a Neuro Critical Care Unit (NCCU).

More at the link

Tuesday, January 29, 2013

To repeat – Diagnosis is job #1

From

Medical societies unite on patient-centered measures for nonsurgical stroke interventions

And because I bet they didn't talk to any survivors this will just be more of the same status quo.
Note the word patient-centered Maybe I'm missing something but I don't see any objective diagnosis or even something as simple as hypothermia to reduce brain damage. Nothing on treating the neuronal cascade of death. I'll have to see if I can find the authors and ask why they missed everything good.
http://medicalxpress.com/news/2013-01-medical-societies-patient-centered-nonsurgical-interventions.html
In February, the guidelines will be published first in SIR's Journal of Vascular and Interventional Radiology and subsequently by each society either in its respective journal or on its website. "These groundbreaking guidelines are the product of two years of collaboration among multidisciplinary teams from eight societies," said Marshall E. Hicks, M.D., FSIR, president of the Society of Interventional Radiology, the national society of nearly 5,000 doctors, scientists and allied health professionals dedicated to improving health care through minimally invasive treatments. "With real progress being made in research and treatment of stroke over the last decade, this distinguished group of international authors—from societies whose members perform minimally invasive stroke treatments—felt that the time was right for a consensus on how to effectively treat and manage stroke patients," said Hicks, the head of the division of diagnostic imaging at the University of Texas MD Anderson Cancer Center in Houston. "The one constant in stroke treatment is time," noted David Sacks, M.D., FSIR, an interventional radiologist at Reading Hospital and Medical Center in West Reading, Pa., and the study's lead author. "Seconds count from time of admission to treatment. Meeting the outcomes described in these guidelines will ultimately benefit patients by requiring strict adherence to a rapid treatment schedule," he added. Stroke is the fourth leading cause of adult death and disability in the United States and the third leading cause of death in Canada, Europe and Japan. The guidelines recommend submission of outcomes to a national registry that will allow research and also comparisons between facilities. Sacks noted that the benchmarks in the paper are intended to be used in a quality assurance program to assess and improve processes and outcomes in acute stroke revascularization, which is the opening of a blocked artery to the brain. He said that the guidelines may also be helpful to facilities that are interested in applying for accreditation as a comprehensive stroke center. "As the field of stroke revascularization evolves, the guidelines will be revised as needed," he added. In 2003, the Journal of Vascular and Interventional Radiology published a joint society document to guide the design and reporting of stroke research; the new guidelines address clinical care. The co-authors completed a review of the relevant literature from 1986 through February 2012 as the basis for creating performance metrics and thresholds. "All society representatives vigorously discussed each issue based on the literature review and personal experience," said Sacks. More information: "Multisociety Consensus Quality Improvement Guidelines for Intra-arterial Catheter Directed Treatment of Acute Ischemic Stroke" Journal of Vascular and Interventional Radiology,

Read more at: http://medicalxpress.com/news/2013-01-medical-societies-patient-centered-nonsurgical-interventions.html#jCp
 In February, the guidelines will be published first in SIR's Journal of Vascular and Interventional Radiology and subsequently by each society either in its respective journal or on its website. "These groundbreaking guidelines (nothing groundbreaking here)are the product of two years of collaboration among multidisciplinary teams from eight societies," said Marshall E. Hicks, M.D., FSIR, president of the Society of Interventional Radiology, the national society of nearly 5,000 doctors, scientists and allied health professionals dedicated to improving health care through minimally invasive treatments. "With real progress being made in research and treatment of stroke over the last decade, this distinguished group of international authors—from societies whose members perform minimally invasive stroke treatments—felt that the time was right for a consensus on how to effectively treat and manage stroke patients," said Hicks, the head of the division of diagnostic imaging at the University of Texas MD Anderson Cancer Center in Houston. "The one constant in stroke treatment is time," noted David Sacks, M.D., FSIR, an interventional radiologist at Reading Hospital and Medical Center in West Reading, Pa., and the study's lead author. "Seconds count from time of admission to treatment. Meeting the outcomes described in these guidelines will ultimately benefit patients by requiring strict adherence to a rapid treatment schedule," he added. Stroke is the fourth leading cause of adult death and disability in the United States and the third leading cause of death in Canada, Europe and Japan. The guidelines recommend submission of outcomes to a national registry that will allow research and also comparisons between facilities. Sacks noted that the benchmarks in the paper are intended to be used in a quality assurance program to assess and improve processes and outcomes in acute stroke revascularization, which is the opening of a blocked artery to the brain. He said that the guidelines may also be helpful to facilities that are interested in applying for accreditation as a comprehensive stroke center. "As the field of stroke revascularization evolves, the guidelines will be revised as needed," he added. In 2003, the Journal of Vascular and Interventional Radiology published a joint society document to guide the design and reporting of stroke research; the new guidelines address clinical care. The co-authors completed a review of the relevant literature from 1986 through February 2012 as the basis for creating performance metrics and thresholds. "All society representatives vigorously discussed each issue based on the literature review and personal experience," said Sacks. More information: "Multisociety Consensus Quality Improvement Guidelines for Intra-arterial Catheter Directed Treatment of Acute Ischemic Stroke" Journal of Vascular and Interventional Radiology,

Read more at: http://medicalxpress.com/news/2013-01-medical-societies-patient-centered-nonsurgical-interventions.html#jCp
In February, the guidelines will be published first in SIR's Journal of Vascular and Interventional Radiology and subsequently by each society either in its respective journal or on its website. "These groundbreaking guidelines are the product of two years of collaboration among multidisciplinary teams from eight societies," said Marshall E. Hicks, M.D., FSIR, president of the Society of Interventional Radiology, the national society of nearly 5,000 doctors, scientists and allied health professionals dedicated to improving health care through minimally invasive treatments. "With real progress being made in research and treatment of stroke over the last decade, this distinguished group of international authors—from societies whose members perform minimally invasive stroke treatments—felt that the time was right for a consensus on how to effectively treat and manage stroke patients," said Hicks, the head of the division of diagnostic imaging at the University of Texas MD Anderson Cancer Center in Houston. "The one constant in stroke treatment is time," noted David Sacks, M.D., FSIR, an interventional radiologist at Reading Hospital and Medical Center in West Reading, Pa., and the study's lead author. "Seconds count from time of admission to treatment. Meeting the outcomes described in these guidelines will ultimately benefit patients by requiring strict adherence to a rapid treatment schedule," he added. Stroke is the fourth leading cause of adult death and disability in the United States and the third leading cause of death in Canada, Europe and Japan. The guidelines recommend submission of outcomes to a national registry that will allow research and also comparisons between facilities. Sacks noted that the benchmarks in the paper are intended to be used in a quality assurance program to assess and improve processes and outcomes in acute stroke revascularization, which is the opening of a blocked artery to the brain. He said that the guidelines may also be helpful to facilities that are interested in applying for accreditation as a comprehensive stroke center. "As the field of stroke revascularization evolves, the guidelines will be revised as needed," he added. In 2003, the Journal of Vascular and Interventional Radiology published a joint society document to guide the design and reporting of stroke research; the new guidelines address clinical care. The co-authors completed a review of the relevant literature from 1986 through February 2012 as the basis for creating performance metrics and thresholds. "All society representatives vigorously discussed each issue based on the literature review and personal experience," said Sacks. More information: "Multisociety Consensus Quality Improvement Guidelines for Intra-arterial Catheter Directed Treatment of Acute Ischemic Stroke" Journal of Vascular and Interventional Radiology,

Read more at: http://medicalxpress.com/news/2013-01-medical-societies-patient-centered-nonsurgical-interventions.html#jCp
In February, the guidelines will be published first in SIR's Journal of Vascular and Interventional Radiology and subsequently by each society either in its respective journal or on its website. "These groundbreaking guidelines are the product of two years of collaboration among multidisciplinary teams from eight societies," said Marshall E. Hicks, M.D., FSIR, president of the Society of Interventional Radiology, the national society of nearly 5,000 doctors, scientists and allied health professionals dedicated to improving health care through minimally invasive treatments. "With real progress being made in research and treatment of stroke over the last decade, this distinguished group of international authors—from societies whose members perform minimally invasive stroke treatments—felt that the time was right for a consensus on how to effectively treat and manage stroke patients," said Hicks, the head of the division of diagnostic imaging at the University of Texas MD Anderson Cancer Center in Houston. "The one constant in stroke treatment is time," noted David Sacks, M.D., FSIR, an interventional radiologist at Reading Hospital and Medical Center in West Reading, Pa., and the study's lead author. "Seconds count from time of admission to treatment. Meeting the outcomes described in these guidelines will ultimately benefit patients by requiring strict adherence to a rapid treatment schedule," he added. Stroke is the fourth leading cause of adult death and disability in the United States and the third leading cause of death in Canada, Europe and Japan. The guidelines recommend submission of outcomes to a national registry that will allow research and also comparisons between facilities. Sacks noted that the benchmarks in the paper are intended to be used in a quality assurance program to assess and improve processes and outcomes in acute stroke revascularization, which is the opening of a blocked artery to the brain. He said that the guidelines may also be helpful to facilities that are interested in applying for accreditation as a comprehensive stroke center. "As the field of stroke revascularization evolves, the guidelines will be revised as needed," he added. In 2003, the Journal of Vascular and Interventional Radiology published a joint society document to guide the design and reporting of stroke research; the new guidelines address clinical care. The co-authors completed a review of the relevant literature from 1986 through February 2012 as the basis for creating performance metrics and thresholds. "All society representatives vigorously discussed each issue based on the literature review and personal experience," said Sacks. More information: "Multisociety Consensus Quality Improvement Guidelines for Intra-arterial Catheter Directed Treatment of Acute Ischemic Stroke" Journal of Vascular and Interventional Radiology,

Read more at: http://medicalxpress.com/news/2013-01-medical-societies-patient-centered-nonsurgical-interventions.html#jCp
In February, the guidelines will be published first in SIR's Journal of Vascular and Interventional Radiology and subsequently by each society either in its respective journal or on its website. "These groundbreaking guidelines are the product of two years of collaboration among multidisciplinary teams from eight societies," said Marshall E. Hicks, M.D., FSIR, president of the Society of Interventional Radiology, the national society of nearly 5,000 doctors, scientists and allied health professionals dedicated to improving health care through minimally invasive treatments. "With real progress being made in research and treatment of stroke over the last decade, this distinguished group of international authors—from societies whose members perform minimally invasive stroke treatments—felt that the time was right for a consensus on how to effectively treat and manage stroke patients," said Hicks, the head of the division of diagnostic imaging at the University of Texas MD Anderson Cancer Center in Houston. "The one constant in stroke treatment is time," noted David Sacks, M.D., FSIR, an interventional radiologist at Reading Hospital and Medical Center in West Reading, Pa., and the study's lead author. "Seconds count from time of admission to treatment. Meeting the outcomes described in these guidelines will ultimately benefit patients by requiring strict adherence to a rapid treatment schedule," he added. Stroke is the fourth leading cause of adult death and disability in the United States and the third leading cause of death in Canada, Europe and Japan. The guidelines recommend submission of outcomes to a national registry that will allow research and also comparisons between facilities. Sacks noted that the benchmarks in the paper are intended to be used in a quality assurance program to assess and improve processes and outcomes in acute stroke revascularization, which is the opening of a blocked artery to the brain. He said that the guidelines may also be helpful to facilities that are interested in applying for accreditation as a comprehensive stroke center. "As the field of stroke revascularization evolves, the guidelines will be revised as needed," he added. In 2003, the Journal of Vascular and Interventional Radiology published a joint society document to guide the design and reporting of stroke research; the new guidelines address clinical care. The co-authors completed a review of the relevant literature from 1986 through February 2012 as the basis for creating performance metrics and thresholds. "All society representatives vigorously discussed each issue based on the literature review and personal experience," said Sacks. More information: "Multisociety Consensus Quality Improvement Guidelines for Intra-arterial Catheter Directed Treatment of Acute Ischemic Stroke" Journal of Vascular and Interventional Radiology,

Read more at: http://medicalxpress.com/news/2013-01-medical-societies-patient-centered-nonsurgical-interventions.html#jCp

Nootropics Reduce the Severity of Brain Trauma

Pre-condition the physiological system to withstand trauma. Fascinating idea but I can't quite see saying, 'I'm going to have a stroke in 3 months, run my brain thru this pre-conditioning'. But maybe we could repurpose some into neuroprotection strategies.
http://brainblogger.com/2013/01/29/nootropics-reduce-the-severity-of-brain-trauma/

Neuro-Protection after Traumatic Brain Injury: Novel Strategies.

Nothing really new here but it does put the problem into more scientific terms than I can regarding the neuronal cascade of death.
http://www.iosrjournals.org/iosr-jdms/papers/Vol3-issue6/Q0367585.pdf
I. Introduction
Traumatic brain injury (TBI), also known as acquired brain injury, head injury, or brain injury,
causes substantial disability and mortality. Traumatic Brain Injury is a significant public health
problem worldwide and is predicted to surpass many diseases as a major cause of death and disability
by the year 20201. The majority of TBI cases (60%) are a result of road traffic injuries (RTI),
followed by falls (20-30%), and violence (10%)2. In India it is estimated nearly 1.6 million individuals will sustain TBI and seek hospital care annually3.RTI are the leading cause of TBI in India accounting for 45-60% of TBI, and falls account for 20-30% of TBI, paralleling the findings from the Global Burden of Disease Study4. Traumatic brain injury causes mechanical tissue destruction which can be supposed to be the primary mechanism of brain injury that results in neuronal cell death causing cerebral edema and rise in intracranial tension contributing to impaired cerebral vasoregulation, cerebral ischemia/hypoxia and brain damage. Primary injury itself acts as trigger for secondary mechanism responsible for brain injury i.e. the neuronal cell death associated with cerebral ischemia is due to the lack of oxygen and glucose, and may involve the loss of ATP, excitotoxicity of glutamate, oxidative stress, reduced neurotrophic support, and multiple other metabolic stresses5. One major event taking place at the moment of TBI is the massive ionic in flux referred to as traumatic depolarization.
Excitatory amino acids may play a vital role in this depolarization. This represents one of the most
important mechanisms of diffuse neuronal cell dysfunction and damage associated with TBI. Cerebral edema and associated increased intracranial pressure are the major immediate consequences of TBI that contribute to most early deaths. There are at least two kinds of delayed and progressive pathobiological changes induced by TBI. One of these is axonal damage, which is not the direct
consequence of traumatic tissue tearing. Rather, results from complex axolemmal or cyto-skeletal
changes, or both, which lead to cyto-skeletal collapse and impairment of axoplasmic transport. The
other change in traumatized brains occurs concomitantly with compromised blood brain barrier (BBB) function. Secondary damage in TBI is influenced by changes in cerebral blood flow (CBF), cerebral metabolic dysfunction and inadequate cerebral oxygenation. Excitotoxic cell damage and inflammation may lead to apoptosis6. Furthermore, it is also becoming clear that these secondary insults are, to a significant degree, are preventable. Since multiple derangements starts simultaneously it is essential to have effective neuroprotective therapy to prevent early brain damage. Management of head injury focuses on preventing, detecting and correcting the secondary brain injury after trauma. Duration and severity of such secondary brain damage influences the possible outcome. Unfortunately, numerousneuroprotective drugs have failed to demonstrate beneficial effects in Phase II/III clinical trials, despite previous encouraging preclinical results7. However, some drugs that have been approved for use in the clinic have neuroprotective effects, and these could be used for the treatment and improvement in functional recovery in patients of traumatic brain injury.

Lots more at the link.

Voluntary resistance running induces increased hippocampal neurogenesis in rats comparable to load-free running

Ask your doctor if strapping on a 50 lb. backpack while walking or on a treadmill will increase your neurogenesis. You do expect them to know the answer, don't you?
http://www.sciencedirect.com/science/article/pii/S0304394013000220

Abstract

Recently, we reported that voluntary resistance wheel running with a resistance of 30% of body weight (RWR), which produces shorter distances but higher work levels, enhances spatial memory associated with hippocampal brain-derived neurotrophic factor (BDNF) signaling compared to wheel running without a load (WR) (Lee et al., 2012). We thus hypothesized that RWR promotes adult hippocampal neurogenesis (AHN) as a neuronal substrate underlying this memory improvement. Here we used 10-week-old male Wistar rats divided randomly into sedentary (Sed), WR, and RWR groups. All rats were injected intraperitoneally with the thymidine analogue 5-Bromo-2′-deoxuridine (BrdU) for 3 consecutive days before wheel running. We found that even when the average running distance decreased by about half, the average work levels significantly increased in the RWR group, which caused muscular adaptation (oxidative capacity) for fast-twitch plantaris muscle without causing any negative stress effects. Additionally, immunohistochemistry revealed that the total BrdU+ cells and newborn mature cells (BrdU+/NeuN+) in the dentate gyrus increased in both the WR and RWR groups. These results provide new evidence that RWR has beneficial effects on AHN comparable to WR, even with short running distances.

UVic study looks to help stroke recovery

Cross-training as a way to strengthen your weaker side. For your researcher to find out - Does this only work with the partially damaged neurons? Or can it be used for  the dead area also? Inquiring minds want to know. You know how dangerous this can be without your doctor or therapists approval.
http://cupwire.ca/articles/54228
Stroke patients affected by decreased strength on one side of their body can improve walking ability through high-intensity strength training on their unaffected side, according to new findings by University of Victoria (UVic) researchers.
More at the link.

Stroke robot arrives at EMCH

I know these save lives but every time one of these rolls out, it just pushes further into the future when we find hyperacute therapies that are not so dangerous and time sensitive. Inertia becomes cement shoes. And as Rebecca says, you could do all this with Skype. At least then you wouldn't have so much sunk cost into defending the status quo. The whole system is broken and this band aid will not fix it.
http://www.brushnewstribune.com/ci_22472665/stroke-robot-arrives-at-emch

First Stroke Patients In Florida Treated In UM Stem Cell Trial

Hopefully this works but it seems researchers are going after the glitzy stem cell research rather than spend the brainpower on stopping the neuronal cascade of death.
http://www.medicalnewstoday.com/releases/255500.php

The snow is going, going, gone

Damn these weather patterns. I'm finally in a place where I could walk out the door and go cross-country skiing. On Sunday we received 3 inches of new snow on top of the 2 inches that were there. This morning, Tuesday, after an all night rain the grass is once again showing, 51F at 11am and foggy out.

Monday, January 28, 2013

Large-vessel correlates of cerebral small-vessel disease

Definitely a question for your doctor. How does knowing this prevent your next stroke?
http://www.docguide.com/large-vessel-correlates-cerebral-small-vessel-disease
OBJECTIVE: Our aim was to investigate the relationship of carotid structure and function with MRI markers of cerebral ischemic small-vessel disease. METHODS: The study comprised 1,800 participants (aged 72.5 ± 4.1 years, 59.4% women) from the 3C-Dijon Study, a population-based, prospective cohort study, who had undergone quantitative brain MRI and carotid ultrasound. We used multivariable logistic and linear regression adjusted for age, sex, and vascular risk factors. RESULTS: Presence of carotid plaque and increasing carotid lumen diameter (but not common carotid artery intima-media thickness) were associated with higher prevalence of lacunar infarcts: odds ratio (OR) = 1.60 (95% confidence interval [CI]: 1.09-2.35), p = 0.02 and OR = 1.24 (95% CI: 1.02-1.50), p = 0.03 (by SD increase). Carotid plaque was also associated with large white matter hyperintensity volume (WMHV) (age-specific top quartile of WMHV distribution): OR = 1.32 (95% CI: 1.04-1.67), p = 0.02, independently of vascular risk factors. Increasing Young elastic modulus and higher circumferential wall stress, reflecting augmented carotid stiffness, were associated with increasing WMHV (effect estimate [β]± standard error: 0.0003 ± 0.0001, p = 0.024; β ± standard error: 0.005 ± 0.002, p = 0.008). Large WMHV was also associated with increasing Young elastic modulus (OR = 1.22 [95% CI: 1.04-1.42], p = 0.01) and with decreasing distensibility coefficient (OR = 0.83 [95% CI: 0.69-0.99], p = 0.04), independently of vascular risk factors. Associations of carotid lumen diameter with lacunar infarcts and of carotid stiffness markers with WMHV were independent of carotid plaque. CONCLUSIONS: In addition to and independently of carotid plaque, increasing carotid lumen diameter and markers of carotid stiffness were associated with increasing prevalence of lacunar infarcts and increasing WMHV, respectively.

Staten Island University Hospital receives 'Gold Plus' award for stroke care

Lets examine the claims here.
http://www.silive.com/healthfit/index.ssf/2013/01/siuh_receives_gold_plus_award_for_stroke_care.html
The American Heart and American Stroke associations have acknowledged the high quality of Staten Island University Hospital’s (SIUH) care of stroke patients.
SIUH, part of the North Shore-LIJ Health System, has received the two associations’ Get With The Guidelines–Stroke Gold Plus Quality Achievement Award. The award recognizes the hospital’s commitment and success in implementing a higher standard of care by ensuring that stroke patients receive treatment according to nationally accepted guidelines.
 -----------------------------------------------------------------------------------
What are those guidelines and why can't survivors see them? With no openness we can't tell if this is a statement of fact or puffery.
---------------------------------------------------------------------------------
“We are dedicated to making our care for stroke patients among the best in the country. The American Heart Association’s Get With The Guidelines–Stroke program helps us to accomplish this goal,” said Dr. Souhel Najjar, director of neurology.
---------------------------------------------------------------------
How do we know if the goal has been accomplished? Or even how hard the goal is?  If its not 100% recovery then you should be relieved of duty. Survival of the fittest and all.
---------------------------------------------------------------------
 “This recognition demonstrates that we are on the right track and we’re very proud of our team.”
Get With The Guidelines–Stroke helps the SIUH staff develop and implement acute and secondary prevention guideline processes to improve patient care and outcomes. The program provides hospitals with a web-based patient management tool, and best practice discharge protocols and standing orders. It also provides the tools to track performance.
----------------------------------------------------------------------------------
 What is your performance on recovery? Make it public.
----------------------------------------------------------------------------------
“Recent studies show that patients treated in hospitals participating in the American Heart Association’s Get With The Guidelines-Stroke program receive a higher quality of care and may experience better outcomes,” said Dr. Lee H. Schwamm, chair of the Get With The Guidelines national steering committee and director of the TeleStroke and Acute Stroke Services at Massachusetts General Hospital in Boston.
Following Get With The Guidelines-Stroke treatment guidelines, patients are started on aggressive risk-reduction therapies including the use of medications, antithrombotics and anticoagulation therapy, plus cholesterol reducing drugs and smoking cessation counseling.
Hospitals must adhere to these measures at a set level for a designated period of time to be eligible for the achievement awards.
For more information about the Stroke Center at SIUH, call 718-226-9000.

UK docs aim to `rewire` brains of stroke patients

You'll have to ask your doctor why vagus nerve stimulation might help recovery. I don't understand.
British news via India.
http://zeenews.india.com/news/health/diseases/uk-docs-aim-to-rewire-brains-of-stroke-patients_20469.html
Evidence from animal studies suggests that vagus nerve stimulation could cause the release of neurotransmitters which help facilitate neural plasticity and help people re-learn how to use their arms after a stroke; particularly if stimulation is paired with specific tasks. Dual therapy, so why should we believe the vagus stuff was the cause?



Stem cells aid recovery from stroke

Don't expect this to magically solve all your deficits any time soon. If you want to recover you'll have to use the tried and true, repetition, repetition, repetition. The timeframe is impossible if we can't get tPA within 3 hours. Curious as to how the stem cells traveled thru the blood brain barrier.
http://www.alphagalileo.org/ViewItem.aspx?ItemId=127915&CultureCode=en
Stem cells from bone marrow or fat improve recovery after stroke in rats, finds a study published in BioMed Central’s open access journal Stem Cell Research & Therapy. Treatment with stem cells improved the amount of brain and nerve repair and the ability of the animals to complete behavioural tasks.

Stem cell therapy holds promise for patients but there are many questions which need to be answered, regarding treatment protocols and which cell types to use. This research attempts to address some of these questions.

Rats were treated intravenously with stem cells or saline 30 minutes after a stroke. At 24 hours after stroke the stem cell treated rats showed a better functional recovery. By two weeks these animals had near normal scores in the tests. This improvement was seen even though the stem cells did not appear to migrate to the damaged area of brain. The treated rats also had higher levels of biomarkers implicated in brain repair including, the growth factor VEGF.

A positive result was seen for both fat (adipose) and bone-marrow derived stem cells. Dr Exuperio Díez-Tejedor from La Paz University Hospital, explained, “Improved recovery was seen regardless of origin of the stem cells, which may increase the usefulness of this treatment in human trials. Adipose-derived cells in particular are abundant and easy to collect without invasive surgery.”

Sunday, January 27, 2013

Pandora’s Boxes Inside nanotechnology’s little universe of big unknowns

From the Orion magazine. Something our researchers should be familiar with as they work on delivering tPA via nanoparticles or other hyperacute drugs.
http://livasperiklis.com/2013/01/27/pandoras-boxes/

Factors Associated With Misdiagnosis of Acute Stroke in Young Adults

My god, this is so blasted simple. You get an objective diagnosis. Maybe all these fourteen weren't available in 2009 but they don't even discuss getting to objective. Failure, Failure, Failure.
http://www.sciencedirect.com/science/article/pii/S1052305710000844
Misdiagnosis or delayed diagnosis of acute ischemic stroke can result in neurologic worsening or a missed opportunity for thrombolysis. Because stroke in young adults is less common than stroke in the elderly, we sought to determine clinical characteristics associated with misdiagnosis of stroke in young adults. Patients from the prospectively maintained Young Stroke Registry in our comprehensive stroke center were reviewed. Demographic information, past medical history, presentation within the 3-hour time window, and outcomes were assessed. We compared patients misdiagnosed and those correctly diagnosed to identify factors associated with misdiagnosis of acute stroke. A total of 57 patients aged 16-50 were enrolled in the registry during 2001-2006. Eight patients (14%; 4 men and 4 women; mean age, 38 years) were misdiagnosed. Seven of these 8 patients were discharged from the emergency department initially. Patients age &lt35 years (P = .05) and patients with posterior circulation stroke (P = .006) were more likely to be misdiagnosed. All 8 misdiagnosed patients were initially evaluated at hospitals that were not certified primary stroke centers. Patients presenting with vertebrobasilar territory ischemia have a greater rate of misdiagnosis. Our study demonstrates the increasing need for “young stroke awareness” among emergency department personnel. Initial misdiagnosis can potentially lead to a lost opportunity for thrombolysis in otherwise good candidates. 
 No, what you need is an objective method for diagnosis.

The Role of Pericytes in Blood-Brain Barrier Function and Stroke

And maybe pericytes will finally get enough research to figure out how they can be controlled in the hyperacute phase of stroke. Somehow I missed this last August. An unacceptable failure on my part.
http://www.ingentaconnect.com/content/ben/cpd/2012/00000018/00000025/art00006
Abstract:
Central nervous system pericytes have critical and complex inductive, structural, and regulatory roles interacting with other cell types of the neurovascular unit, especially endothelial cells and astrocytes. Pericyte-endothelial interactions are particularly prominent for blood-brain barrier (BBB) maintenance, with profound effects on basement membrane and endothelial tight junction structure and function. Under experimental conditions of hypoxia-ischemia mimicking stroke, pericytes migrate from their usual microvascular location and influence, directly or indirectly, BBB permeability. The contractile properties of pericytes provide the capacity to regulate capillary blood flow, but this may have detrimental effects on ischemic injury. Stem cell characteristics of pericytes imply an important regenerative role following stroke. Pericytes thus appear to orchestrate multiple critical functions in stroke, involving blood flow, permeability, and repair of the neurovascular unit.

Bluberries May Lessen Heart Attacks in Women and What Do Blueberries Have in Common with Viagra?

A little light-hearted humor to learn about your arteries. I'm sure your doctor explained nothing of this to you.
http://www.purplemedicalblog.com/2013/01/bluberries-may-lessen-heart-attacks-in.html

Is acupuncture as effective as antidepressants? Part 2. Blinding readers who try to get an answer

You need to read this if you are even considering using acupuncture instead of real anti-depressent medicine.
http://www.sciencebasedmedicine.org/index.php/is-acupuncture-as-effective-as-antidepressants-part-2-blinding-readers-who-try-to-get-an-answer/

But then here are the benefits of real antidepressent medicine.
http://oc1dean.blogspot.com/2012/05/poststroke-depression.html

Robust Short-Term Memory without Synaptic Learning

Ask your doctor to explain your short-term memory problems and how to correct them in light of this article.
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0050276

Or use this bloggers explanation to teach your doctor something.
Is This How Memory Works?

How Math Could Improve Life for Nearly 6 Million With Parkinson's

With 10 million stroke survivors a year we dwarf Parkinsons' 6 million total. Why don't we have numerous TED talks on stroke? A Great stroke association would have these available in every city.
http://www.huffingtonpost.com/max-little/parkinsons-diagnosis-test_b_2545128.html

Woman in Bionic Suit Runs Marathon

A real life use of ReWalk. So ask your doctor when their clinic will have this or these other possibilities.
http://abcnews.go.com/International/paralyzed-woman-finishes-london-marathon/story?id=16304503#.T6pbVJ9Yv40

Bradford project ensures stroke and heart attack patients get best care

Another failure, just push everything to do with stroke prevention onto the public. Thats the wrong focus, the focus should be preventing neuron death. By preventing the neuronal cascade of death a lot of those deaths in the first 30 days could probably be prevented. This will be difficult to achieve, First to convince the medical stroke world that they don't know what they are doing, then to find hyperacute therapies in the face of a thousand failures.

http://www.ilkleygazette.co.uk/news/news_local/10186082.Bradford_project_ensures_stroke_and_heart_attack_patients_get_best_care/
So get on that effectiveness team and 'Give them hell'
They are doing nothing more than the status quo. We need innovative people not plodders.

Ambulance stroke talk

If you are anywhere close to this in the UK, you need to go and ask what objective methods they will be using to determine stroke. Anything else is just incompetency, maybe one of these fourteen.
http://oc1dean.blogspot.com/2013/01/how-wave-of-wand-can-detect-bleeding-in.html
 You do want to get tPA if at all possible, don't you?
Well then, do something about it!
http://www.gainsboroughstandard.co.uk/news/local-news/ambulance-stroke-talk-1-5350478
People can find out about the ambulance service’s work to manage stroke patients in Rotherham on Tuesday.
During the talk at the Carlton Park Hotel, Jacqui Crossley, Yorkshire Ambulance Service’s assistant clinical director, will discuss the latest developments in pre-hospital stroke care.
They include how staff look after people, from the initial emergency call for help to being assessed, treated and transferred to a hospital with specialist stroke services.
People can also find out more about the ambulance service’s bid to become an NHS foundation trust, and apply to become a member.
To register your interest email corp-comms@yas.nhs.uk or call 01924 584 035.

Concert challenges

I went to a tribute band of Pink Floyd, a 50 minute drive away in a wonderful old theater in Jackson, MI  - Michigan theater. The restrooms were upstairs on the balcony level. So since the railing was on the left side I tottered up the steps using the right wall as a guide. Since it had a laser light show and strobes it was a good thing I didn't have visual deficits.
Echoes of Pink Floyd, the songs I recognized were:
Welcome to The machine
Time
Money
Wish you were here
Brick in the wall
Shine on you crazy diamond
Other Pink Floyd sounding songs were played but I think the audience wanted less echoes and more Pink Floyd.
At intermission I traveled to the restroom, lights not on in the house.  Coming back, there were two steps for each row of seats, hard to tell in the dim light.  I stumbled once but caught myself on the wall. I'm sure the people in the row behind me thought I'd had too much to drink.  None whatsoever.
I missed a wine and cheese party to go here instead. It was worth it, got home around 1am

Family Conferences in Stroke Rehabilitation: A Literature Review

I got absolutely nothing out of the family conferences I had, but maybe that was the fault of my doctor since there was no diagnosis, no stroke protocol, and nothing about what recovery would look like.
http://www.strokejournal.org/article/S1052-3057%2812%2900408-9/abstract

Background

Family conferences in hospital settings are acknowledged as being important and beneficial for enhancing communication between patients, family members, and the multidisciplinary team. They provide feedback on progress and therapeutic findings, and facilitate problem solving in cases of complex discharge planning.

Methods

A literature review was conducted, with 23 articles highlighting problem areas within current practice and discussing the merits of existing approaches.

Results

The articles suggest that stroke survivors and their families have additional education and support needs beyond what is already provided, and that intervention may be enhanced by being more proactive rather than reactive, preventing potentially avoidable crises or disputes. This review provides insight into the ideal methods for communicating and planning and identifies better uses of these opportunities.

Conclusions

Much more can be done within the multidisciplinary team to ensure that the information needs of patients and families are catered for during their inpatient admission and on their return to the community. Additional research and trials of interventions by established rehabilitation services will allow for improved and more informed clinical practice (including cost effectiveness), enhanced knowledge of caregiver needs, and essentially more positive outcomes for rehabilitation patients and their families. Research may be able to develop best practice guidelines to ensure reduced caregiver stress and anxiety during admission and discharge. We require additional investigation of the effects of educational and emotional support provided in the hospital setting and as an outpatient on quality of life for caregivers and prevention of readmission to hospital or entrance into residential care for patients.

My god, this is so easy to solve. You just ask experienced survivors what they should have been told. I wrote a complete blog post on that subject;
What my doctor should have told me.

The Use of Low level Laser Therapy and Injury Recall Technique in the Treatment of Closed head and Other Brain Injuries

I can't make head or tails of what the mechanism is supposed to do. Ask all the doctors you know before you attempt anything like this.
 Ok, probably quackery.
Injury recall technique is a technique to erase the neurological memory of the past. Video here: http://www.youtube.com/watch?v=fI3MaInxMlM&feature=share

http://scholar.google.com/scholar_url?hl=en&q=http://blog.drhogg.com/wp-content/uploads/LASER_IRT_BRAIN_INJURY_PAPER.doc&sa=X&scisig=AAGBfm1sG4tgbP4YlHLyeJCFIuakPbshoA&oi=scholaralrt


Introduction

Closed head injuries are a common occurrence in the United States with en estimated incidence of 200 per 100,000 people per year. (1,2) A “closed head” injury is one in which there is trauma to the brain which does not pierce the cranium. Common causes of closed head injuries include traffic accidents and falls in which the head is struck. Often the greatest injury is not from the original trauma but due to edema and intracranial bleeding putting pressure on vulnerable neural tissue in an enclosed space. Free radical damage and ischemia are likely contributor to this secondary type of brain injury. Approximately 100,000 people die as a result of closed head injuries in the United States each year(3,4). Of those who survive, another 90,000 each year suffer some level of long-standing or permanent disability (3,4). As our service men and women return, injured, from Iraq, Afganistan and elsewhere, persisting disability resulting from brain injury becomes an increasing concern.

Types of trauma in closed head injuries include “coup” injuries from direct transmission of trauma through the skull to the brain which causes injury directly beneath the point of impact. A second type of injury is the “contrecoup” in which indirect trauma to the brain occurs via rotational shear forces that cause the brain to bounce against or sweep across the interior of the cranium. In the contrecoup injury, multiple areas of brain trauma occur that are less obvious based on the point of impact. When all primary and secondary sources of brain injury in a closed head incident are considered, understanding the possible brain areas actually affected becomes complex.

Other types of brain injury considered in this paper will include additional sources of ischemic injury. Specifically I will be discussing my experience with stroke, open heart surgery and birth trauma.