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:

Sunday, June 30, 2013

Slash Risk of Stroke with More Potassium and Less Salt

You can talk to your doctor on this. Make sure you scroll down to the comment.

Think You're Too Young for a Stroke ?

A set of 26-year-old twins suffered strokes only months apart. As is common among women, it was misdiagnosed.

You can read the details here:

I will direct you back to my screaming rant here; instead of repeating it. Otherwise every other post would be filled with font 36 red capital letters.

Center of the Brain Funding

I have biases here because I have had several discussions with Billy on this.
Its gotta be better than the existing stroke organizations out there that are just PR producing.
I will have to disagree that the NSA is an excellent organization, I look toward Michael J. Fox Foundation Myelin Repair and the Alzheimers Association as examples to emulate.
This has been tried before, Walter Steinhoff of formerly this forum tried and couldn't make a go of it.
Probably very similar to the 
What is Center of the Brain (COTB) seeking?

~ To create a 501(c)3 not-for-profit organization for the rehabilitation of severely injured people (including those with Strokes and Traumatic Brain Injuries)

~ To generate authentically "disruptive" research in order to expedite the diagnosis of severe brain injuries, and to develop & deploy that research.

~  With San Diego as the initial hub for treatment and research, we intend to build a facility which will serve as a worldwide destination for COTB. 

~ Why TCOB? Aren't many excellent organizations and networks available? Indeed they are, as these examples demonstrate.  For sheer neurological data, TBI, Stroke, Et al.  Each of these organizations is focused on a different aspect of brain injury (family participation, political change, medication, etc.): 

***We are developing a riveting focus on immediate help for the person having the severe brain injury including timely, evidence-based rehabilitation, ongoing healing, and access to the latest research. If and when the person's insurance has expired, our intent is to provide care at no-charge.***

We already have a superb group of  MDs, Rehabiltation Therapists, Economists & Financiers, Business Executives, Filmmakers, Musicians  and others who have said they will be on our Advisory Team. 
What we are now doing is simply asking those who want to be involved, however little or large, to donate whatever amount they choose. $10, $100, $250, or other. Your donation can be public or private. See: 

If you want to know more, you can email, skype or call me:
William "Billy" N. Ethridge 
Skype: billy.ethridge
San Diego, CA, USA

Phase II angiogenesis stimulators

Don't just complain about lack of efficacy, do something about.
Introduction: Therapeutic angiogenesis is a strategy of inducing new collateral vessels and stimulating new capillaries that enhance tissue oxygen exchange in ischemic cardiovascular disorders, including acute myocardial infarction, chronic cardiac ischemia, peripheral artery disease and stroke.
Areas covered: Over the last 10 years, promising results of early clinical trials have generated great expectation on the potential of therapeutic angiogenesis. However, even if large randomized placebo-controlled and double-blinded Phase II clinical trials have confirmed the feasibility, safety and potential effectiveness of therapeutic angiogenesis, they provided very limited evidence of its efficacy in terms of clinical benefit.
(Whine, whine, whine)
Expert opinion: Results of the latest trials on therapeutic angiogenesis have not provided satisfactory results. Much is still unknown about the optimal delivery of angiogenic factors. Trials using alternative growth factors, dose regimens and methods of delivery are needed to enhance the treatment benefit of therapeutic angiogenesis.

Read More:

Three upper limb robotic devices for stroke rehabilitation: A review and clinical perspective

You'll have to ask your therapist what they are and why their clinic doesn't have them.


BACKGROUND: Stroke is a leading cause of disability worldwide. Many survivors of stroke remain with residual disabilities, even years later. Advances in technology have led to the development of a variety of robotic devices for use in rehabilitation. The integration of robotics in the delivery of neurorehabilitation is promising, but still not widely used in clinical settings.

OBJECTIVES: The aim of this review is to discuss the general design of three typical upper limb robotic devices, and examine the practical considerations for their use in a clinical environment.

METHODS: Each device is described, the available clinical literature is reviewed and a clinical perspective is given on the usefulness of these robotic devices in rehabilitation of this population.

RESULTS: Current literature supports the use of robotics in the clinical environment. However, claims that robotic therapy is more effective than traditional treatment is not substantially supported. The majority of clinical trials reported are small, and lack the use of a control group for comparison treatment.

CONCLUSIONS: The use of robotics in stroke rehabilitation is still a relatively new treatment platform, and still evolving. As technological advances are made, there is much potential for growth in this field.

What aspects of rehabilitation provision contribute to self-reported met needs for rehabilitation one year after stroke – amount, place, operator or timing?

We wouldn't need this type of research if we had decent stroke rehab. Your medical staff has no clue about how to get you to complete recovery. If they did this problem would not exist. So stop trying to solve a secondary problem and focus on the real issue.
Get me to full recovery. 


Background and Objective

To a large extent, people who have suffered a stroke report unmet needs for rehabilitation. The purpose of this study was to explore aspects of rehabilitation provision that potentially contribute to self-reported met needs for rehabilitation 12 months after stroke with consideration also to severity of stroke.


The participants (n = 173) received care at the stroke units at the Karolinska University Hospital, Sweden. Using a questionnaire, the dependent variable, self-reported met needs for rehabilitation, was collected at 12 months after stroke. The independent variables were four aspects of rehabilitation provision based on data retrieved from registers and structured according to four aspects: amount of rehabilitation, service level (day care rehabilitation, primary care rehabilitation and home-based rehabilitation), operator level (physiotherapist, occupational therapist, speech therapist) and time after stroke onset. Multivariate logistic regression analyses regarding the aspects of rehabilitation were performed for the participants who were divided into three groups based on stroke severity at onset.


Participants with moderate/severe stroke who had seen a physiotherapist at least once during each of the 1st, 2nd and 3rd–4th quarters of the first year (OR 8.36, CI 1.40–49.88 P = 0.020) were more likely to report met rehabilitation needs.


For people with moderate/severe stroke, continuity in rehabilitation (preferably physiotherapy) during the first year after stroke seems to be associated with self-reported met needs for rehabilitation.

Neurogenesis A bombshell of a finding

So ask your doctor how to use those new 1400 brain cells every day. What protocol is being given to you? Demand an answer.
The question of whether adult neurogenesis occurs in the human hippocampus has been a hotly debated topic in neuroscience. In a study published in Cell, Frisén and colleagues now settle the debate by providing evidence that around 1,400 dentate gyrus cells are born in the human brain every day.

Water diffusion in brain cortex closely tracks underlying neuronal activity

Way the hell over my head so ask your researcher what it means. I think it may lead to much better damage analysis. Anything would be better than the useless crap we get now.


Neuronal activity results in a local increase in blood flow. This concept serves as the basis for functional MRI. Still, this approach remains indirect and may fail in situations interfering with the neurovascular coupling mechanisms (drugs, anesthesia). Here we establish that water molecular diffusion is directly modulated by underlying neuronal activity using a rat forepaw stimulation model under different conditions of neuronal stimulation and neurovascular coupling. Under nitroprusside infusion, a neurovascular-coupling inhibitor, the diffusion response and local field potentials were maintained, whereas the hemodynamic response was abolished. As diffusion MRI reflects interactions of water molecules with obstacles (e.g., cell membranes), the observed changes point to a dynamic modulation of the neural tissue structure upon activation, which remains to be investigated. These findings represent a significant shift in concept from the current electrochemical and neurovascular coupling principles used for brain imaging, and open unique avenues to investigate mechanisms underlying brain function.

A review of cardiorespiratory fitness-related neuroplasticity in the aging brain

Sounds like making sure you are cardiovascularily fit leads to healthy brain aging. Whatever that means.
The literature examining the relationship between cardiorespiratory fitness and the brain in older adults has increased rapidly, with 30 of 34 studies published since 2008. Here we review cross-sectional and exercise intervention studies in older adults examining the relationship between cardiorespiratory fitness and brain structure and function, typically assessed using Magnetic Resonance Imaging (MRI). Studies of patients with Alzheimer’s disease are discussed when available. The structural MRI studies revealed a consistent positive relationship between cardiorespiratory fitness and brain volume in cortical regions including anterior cingulate, lateral prefrontal, and lateral parietal cortex. Support for a positive relationship between cardiorespiratory fitness and medial temporal lobe volume was less consistent, although evident when a region-of-interest approach was implemented. In fMRI studies, cardiorespiratory fitness in older adults was associated with activation in similar regions as those identified in the structural studies, including anterior cingulate, lateral prefrontal, and lateral parietal cortex, despite heterogeneity among the functional tasks implemented. This comprehensive review highlights the overlap in brain regions showing a positive relationship with cardiorespiratory fitness in both structural and functional imaging modalities. The findings suggest that aerobic exercise and cardiorespiratory fitness contribute to healthy brain aging, although additional studies in Alzheimer’s disease are needed.

Neuroplasticity and cognitive aging: The scaffolding theory of aging and cognition

Sounds like a slightly different take on cognitive/brain reserve.  What protocol is your doctor prescribing to prevent   your 33% chance of getting dementia. There are quite a few pages here. Have your doctor explain them all including the references.  You do expect your doctor to more about this than you or I do, don't you?


A recent proposal called the Scaffolding Theory of Cognitive Aging (STAC) postulates that functional changes with aging are part of a lifespan process of compensatory cognitive scaffolding that is an attempt to alleviate the cognitive declines associated with aging. Indeed, behavioral studies have shown that aging is associated with both decline as well as preservation of selective cognitive abilities. Similarly, neuroimaging studies have revealed selective changes in the aging brain that reflect neural decline as well as compensatory neural recruitment. While aging is associated with reductions in cortical thickness, white-matter integrity, dopaminergic activity, and functional engagement in posterior brain regions such as the hippocampus and occipital areas, there are compensatory increases in frontal functional engagement that correlate with better behavioral performance in older adults. In this review, we discuss these age-related behavioral and brain findings that support the STAC model of cognitive scaffolding and additionally integrate the findings on neuroplasticity as a compensatory response in the aging brain. As such, we also examine the impact of external experiences in facilitating neuroplasticity in older adults. Finally, having laid the foundation for STAC, we briefly describe a proposed intervention trial (The Synapse Program) designed to evaluate the behavioral and neural impact of engagement in lifestyle activities that facilitates successful cognitive scaffolding using a controlled experiment where older adult participants are randomly assigned to different conditions of engagement.

Saturday, June 29, 2013

11 Intelligence Killing Foods You Need To Avoid

I guess I've already killed all my intelligence. You'll have to read their opinion at the link. Mine is right here with my reduced intelligence. So don't listen to me. Your doctor should know all this.
1. Sugary Products
From this link comes this paragraph:  
How Coffee and Donuts Enhance Memory
From your brain's perspective, sugar is indispensable. It will do whatever is necessary to convince you to eat sugar as often as possible. Why? Your brain needs sugar (usually in the form of glucose) to function normally. The billions and billions of neurons in your brain require a constant supply of sugar to maintain their ability to produce energy and communicate with other neurons. Your neurons can only tolerate a total deprivation of sugar for a few minutes before they begin to die.
2. Alcohol
I think I fall in this category.
Can alcohol make men smarter? Study suggests yes
Dark beer is good for you, in moderation 
Intelligence isn't everything, social companionship counts for a lot, its why I love wine tasting parties.

3. Junk Food
4. Fried Foods
5. Processed Or Pre-Cooked Foods
6. Very Salty Foods
But they haven't figured out salt yet.
World Health Day 2013: Cutting down on salt reduces stroke risk

7. Grains, Except 100% Whole Grain
8. Processed Proteins
9. Avoid Trans Fats At All Costs
10. Artificial Sweeteners
11. Nicotine  
But I think nicotine is going to help recovery.

nicotine and stroke rehab

Stubborn, persistent, perservering

Which one of these traits are you using for your recovery?
Or one from this list?


One of these better describe you if you expect to recover to the best of you ability
Are You Stubborn?

Are you a persistent person? can you hold on to something you decide to do ?


The Neuroscience of Perseverance

You've heard me mention the trait towards bloody-minded stubbornness in the face of adversity that's part of being 'British'?

Can Caresses Protect the Brain from Stroke? from Scientific American

Hell I wrote about this a year and a half ago. Why isn't this in every hospitals stroke protocol? What is the negative possibility that could occur with this? Or is your hospital just so out-of-date with research that they don't even know about this?
You are visiting your elderly aunt, and you notice her speech begin to slur. She seems to be having trouble staying upright in her seat, and she looks confused. You recognize the signs of a stroke. You shout for your uncle to call 911 as you help your aunt lie down in a comfortable position. You run your fingers gently over her lips, face and fingertips as you sing into her ear and continue talking to her. The EMTs rush in and outfit her in what looks like a bathing cap encrusted with electronic bling—a kind of defibrillator designed to deliver electrical stimulation to her brain. As they carry her out on a stretcher, your worry is slightly eased, knowing that the sensory stimulation you gave her in those first minutes may have saved her from serious disability.

My earlier take on this here:
Sensory Stimulation Protects from Stroke Damage in Awake Animals

NAACP Endorses Pennsylvania Marijuana Legalization Bill

Woo hoo, this would only be a 3 hour drive away. You have to support this bill. How will you answer to your parents when they are crippled by spasticity and you didn't support one of the only  drugs that can help the condition?
Various research support here;
MUltiple Sclerosis and Extract of Cannabis: results of the MUSEC trial
Marijuana might cause new cell growth in the brain
 Smoked marijuana reduced spasticity in a small trial of MS patients
Sativex, which is sprayed under the tongue as a cannabis mist, has been approved for use against multiple sclerosis, or MS, in Canada, the UK, and some European countries. (In the U.S., parent company GW Pharma is seeking FDA approval for the use of Sativex to treat cancer pain).

There is accumulating evidence that cannabinoid receptors may be involved in controlling spasticity, and that anandamide, the brain’s endogenous form of cannabis, is a specific antispasticity agent.
Medical Marijuana: Clearing Away the Smoke

And for prevention:
A Marijuana Bud A Day Keeps The Stroke Away

What the hell are you waiting for? Do you think the medical establishment is going to do anything about this on their own?

Smart Floor Hopes to Help Improve Walking Skills

We could get us dancing to the lights.
IEEE just wrapped up its Presidents’ Change the World Competition, designed to award engineering students for well developed ideas that may have real positive impact on the world. One of the winning entries, designed to help handicapped children practice walking skills, is from a team out of B.V.Bhoomaraddi College of Engineering & Technology in Hubli, India. The basic idea is an electronic tiled floor (think Michael Jackson’s Billie Jean music video) that can light up based on a predefined algorithm and the person’s movement, that motivates the user to step on the next tile. By turning simple walking into a game, the team hopes this will prove to be a viable option as a therapy for all kinds of motor defects.

More at link.

AlterG M300 Trainer Takes The Strain Off Fragile Joints

A different type of body weight assisted treadmill training.
Being able to drop half your body weight for a run can take quite a bit of strain off your joints. People recovering from surgery or injuries can use the AlterG (Fremont, California) treadmill to do just that and get a good workout for their lower extremities muscles. The device is able to continuously pump air into a cavity enclosing the legs and helps lift a person a bit, thereby reducing effective weight. AlterG just released a new model, the M300, which costs a third of their previous unit, features the same technology, and looks pretty damn slick.

Its a time saver for therapists, I bet you could save 10 minutes per patient trying to strap them into Lite-Gait or the Lokomat.

more at link.
alterg AlterG M300 Trainer Takes The Strain Off Fragile Joints

Honda To Exhibit Walking Legs at the Smithsonian in New York

They look weird.
Rather goofy-looking at first glance, Honda’s new legs (aka Bodyweight Support Assist Device) makes walking and stair-climbing easier for the elderly and folks on rehab. Leveraging walking technology from full-body ASIMO robot, the leggy device provides natural walking and crouching support with its combined saddle, motorized leg frame and force-sensing shoes. With a control computer and battery pack neatly tucked away under the femur of the frame, the legs sense and guide motion while walking, going up and down stairs and in a semi-crouching position. An assisting force is directed towards the user’s center of gravity and in sync with movement to support one’s bodyweight and reduce the load on the user’s leg muscles and joints.

More at link.
j234nnsfd Honda To Exhibit Walking Legs at the Smithsonian in New York

DizzyFIX Takes Care of Vertigo at Home

I never had the balance problems or spinning that some complain about.
Benign paroxysmal positional vertigo (BPPV) is an unpleasant condition that usually requires frequent visits with a therapist or a crazy ride on a specialty body spinning system. A cheaper at-home solution is the DizzyFIX device from Clearwater Clinical, which has been shown to achieve very positive results in a new University of Western Ontario study. The DizzyFIX is kind of a magnified simulator of what’s going on in the inner ear. You attach it to the tip of a baseball hat, load in a small marble, and guide the marble through the tubes by tilting your head.

More at link.
DizzyFIX Takes Care of Vertigo at Home

LOPES Robotic Exoskeleton Helps Stroke Victims Walk Again

Should be available now so your therapist should have it in stock.
LOPES (LOwer-extremity Powered ExoSkeleton) is a 10-year old project from the Netherlands’ University of Twente whose goal is to develop a robotic device to assess motor skills and assist in teaching stroke victims how to walk again. Unlike traditional rehabilitative devices such as leg braces, or even the upcoming ReWalk, the newest version of LOPES allows for eight degrees of freedoms, which provides the legs better movement and less confined therapy.
LOPES researchers hope to get the device into rehabilitation clinics by early 2012, with a mid-2012 target for introduction into the market.

More at link.
LOPES Robotic Exoskeleton Helps Stroke Victims Walk Again

Motorized Shoes Help Elderly Prepare for Walking Accidents

I can just see the therapists trying to get this thru the rehab approval committee. It does what? perturbs the walking?
Engineers at the University of Strathclyde have been working with Israeli firm Step of Mind Ltd. to develop shoes that teach elderly folks how to walk with confidence. The SMILING (Self Mobility Improvement in the Elderly by Counteracting Falls) system utilizes motors on the bottom of the shoes to randomly create obstacles for the wearer. The idea is to give people a controlled environment to practice situations that may otherwise lead to slips and falls. So far researchers have conduced trials in Italy, Switzerland, Israel and Slovakia, and are analyzing the results.
picture from link.
Motorized Shoes Help Elderly Prepare for Walking Accidents

SMARTPATCH May Soon Reduce Post Stroke Shoulder Pain

I had shoulder pain for a couple of weeks and the only direction I got was to rest it. Which led to the start of subluxation.
MedCity News is reporting that SPR Therapeutics of Cleveland, Ohio is close to receiving FDA regulatory approval for its SMARTPATCH Peripheral Nerve Stimulation System aimed at treating shoulder pain in patients post stroke. The device utilizes percutaneous leads to stimulate muscle activity and in turn reduce pain.

More at link.

Vibrating Glove May Enhance Sense of Touch

Every therapist working on your hands should get you this glove. It follows
what Margaret Yekutiel wrote in the book Sensory Re-Education of the Hand after Stroke in 2001. 
Surgeons, artists, and others who require above-average tactile skills and dexterity may soon have a tool that  enhances their sense of touch.  Researchers at the Georgia Institute of Technology have developed a glove which applies a small vibration via piezoelectric materials to the side of the fingertip. According to their research, this background vibration – known as “stochastic resonance” – can enhance tactile sensitivity and motor performance.

More at link.

Toyota Unveils Quartet of Healthcare Robots; Coming to a Hospital Near You Around 2013

I like the Walk Training Assist one.
First is the Walk Training Assist robot, which helps patients walk by using sensors to detect the intention to make a walking movement, and subsequently helping in swinging the knee forward.

Others at link with video.
Independent Walk Assist
Balance Training Assist
Patient Transfer Assist
8jaqenxu Toyota Unveils Quartet of Healthcare Robots; Coming to a Hospital Near You Around 2013

Robot Arms Dress the Elderly or Disabled

See if your discharge planner ever mentions this.
The system comes from the collaboration of Barrett Technology‘s patented robotic WAM arms and NAIST‘s advanced computer intelligence.  The robot will potentially help older people or those disabled with maintaining a level of personal independence.

More at link.
f4us5jqw Robot Arms Dress the Elderly or Disabled

3-D Body Suit Put to Use in Healthcare Research

And using this our therapists could objectively determine all the muscles and joints that need correcting.
The suit, called MVN BIOMECH from Xsens out of Enschede, The Netherlands, is a 3-D human kinematic, camera-less measurement system with integrated small tracking sensors placed on the joints. Each sensor on the suit consists of three components: an accelerometer, magnetometers and a gyroscope. All together it gives information on each of the joints, the body segments between the joints and the 3-D movements. The technology sends the information a computer using a wireless signal which is then reconstructed into movements on the screen.

More at link.
 3-D Body Suit Put to Use in Healthcare Research

Study Shows That Vibroacoustic Therapy is More Than Just Noise

Hey if it works for Parkinsons get that clinical trial going for stroke.
According to a study from the University of Toronto in Canada, research suggests that Vibroacoustic Therapy (VAT), which uses vibrations produced by low frequency sounds to “massage” deep parts of the body, could help patients with neurological diseases such as Parkinson’s. The study involved two groups of 20 Parkinson’s patients being treated with five minutes of 30 Hz vibrations. Results showed marked improvement of all symptoms in both groups, including less rigidity, better walking speed, and less tremor. Before you decide to crank up the volume on your speakers and park yourself on your subwoofer, however, keep in mind that the VAT was administered using special transducers that convert the sound to inner body massage. It’s thought that brain waves at a frequency of 40 Hz are the carriers of information that control movement; the transducers are fine tuned to produce vibrations between 20 and 100 Hz, which are almost too low to hear audibly, but whose vibrations can add stimulation to brainwaves.
In addition to affecting the brain, VAT also provides deep physical cellular stimulation to skin, muscles and joints, much like vibrating muscle massagers, but deeper acting. As such, researchers have observed decreased pain and increased mobility when VAT is applied to the rest of the body.

More at link.

FlexLeg Gives Users With Lower-Leg Injuries Increased Mobility (videos)

And maybe you could get by without the hated AFOs.
Ask anyone who’s ever had to spend part of their life hobbling around on crutches, and they’ll probably agree that it’s a chore. Running, let alone anything faster than a brisk walk, is out of the picture, and ascending or descending stairs becomes an adventure.
A new product, called FlexLeg, from a couple of mechanical engineers from Brigham Young University in Utah, seeks to make life with an injured lower leg a little less burdensome. Looking somewhat like the Cheetah Flex-Foot prostheses that Olympic sprinter Oscar Pistorius uses, FlexLeg is a hands-free alternative for people with temporary lower-leg injuries to help them walk with a more natural rhythm than using crutches, and for those always on the go, the ability to even run. Running, yeah your therapist is not going to ok that.

More at link.
FlexLeg Gives Users With Lower-Leg Injuries Increased Mobility (videos)

Creators of the Kinecthesia Haptic Belt for Blind People

If you have one-sided neglect this belt could inform you of what is on your neglected side. Much more easily than having to swivel your head all the time.
the Kinecthesia, a haptic belt which allows the wearer to virtually sense objects ahead, and to the left and right thanks to three motors which vibrate in response to objects in their immediate vicinity. As the name would imply, at the heart of the Kinecthesia is an XBox Kinect 3D camera which is connected to a Beagle Board computing platform that processes the depth data from the device and drives the motors.

More at link.

EnableTalk, a Synchronous Interpreter for Sign Language

I could easily see repurposing this for passively moving the stroke affected fingers hours each day. And by the end you would know sign language. Getting the glove on might take hours.
TechCrunch is reporting from Microsoft’s Imagine Cup where a team from Donetsk, Ukraine is showing off EnableTalk, an electronic glove that can read and sign language being spoken by the wearer.  The idea is for the technology to bridge the gap and act as an interpreter for deaf/mute folks to speak with the rest of us.
This is not the first example of this idea in action, as we reported earlier this year on the Mobile Lorm Glove from Design Research Lab in Germany, but we’re hopeful that EnableTalk, that features touch and flex sensors, a gyro, compass and accelerometer to monitor hand movement, will actually become a real product in the near future.

More at link.
EnableTalk, a Synchronous Interpreter for Sign Language

Wireless Electronic Glove Helps Improve Motor Skills of Spinal Cord Injury Victims

This should be able to be used for stroke survivors also. Get your therapist to run a clinical trial on it. Instructions for running a trial here.

A research team from Georgia Tech has been working on a rehab glove that is already showing effectiveness for people with limited hand motor skills and proprioception due to spinal injury. The electronic Mobile Music Touch (MMT) glove works with a piano and vibrates individual fingers to point to which keys should be pressed.
Using the MMT, people in the study practiced playing the piano for thirty minutes three times a week, and followed up with the glove but without the piano (air piano?), and saw considerable improvement at a time when traditional therapy is usually no longer effective.

More at link.
Wireless Electronic Glove Helps Improve Motor Skills of Spinal Cord Injury Victims

New Wireless Sensor Can “Predict the Future” for Fall-Risk Patients

Sounds like something every therapy department needs. Gotta prevent those killer falls.
A new device from Texas Tech University is being developed to predict when a person might fall – even days in advance. It may sound like magic, but the device works by analyzing posture and gait trends and patterns, and sends an alert if there is a break in routine.
The device, which is wireless and small enough to be clipped to a belt, works by employing a number of accelerometers and gyroscopes. These sensors measure and build a database of a person’s normal movements, including standing up and sitting down. The data is processed using sophisticated algorithms that identify patterns and will alert the patient to take caution if the pattern is broken.

More at link.

“Magic Carpet” Could Predict and Detect Falls

All this wonderful stuff that could objectively analyze walking.
The smart carpet has other applications beyond use for fall-prone patients. Physical therapists can use the carpet to map changes and improvements in a person’s gait. Moreover, the imaging technology can be easily modified to gather other information about a patient’s condition (weight changes, for instance, might indicate a pending CHF exacerbation). According to team lead Dr Patricia Scully, these sensors make the carpet a very versatile device for monitoring a patient.
more at link.
"Magic Carpet" Could Predict and Detect Falls

Ghost Smart Sensor Glove Coaches Blind Athletes (video)

Or maybe stroke patients as a form of neurofeedback.
PhysOrg is profiling the work of researchers at Imperial College London who developed a vibrational feedback device that teaches blind people to perform precise repetitive movements without an ever-present coach.  The Ghost system can memorize specific movements when demonstrated by a trainer.  The athlete can then repeatedly practice those movements while the Ghost monitors their accuracy and provides guidance using vibrations and audio cues.
Moreover, the system can import motion recordings taken from star athletes, helping the blind reproduce techniques that win medals in the Olympics.  Although the system was designed specifically for blind athletes, we expect the technology to find its way to people recovering from a stroke or other neurological conditions.
video and more at link.
Ghost arm trainer Ghost Smart Sensor Glove Coaches Blind Athletes (video)

Toyota’s Human Support Robot to Help Patients Stuck in Bed at Home

It seems like it might be useful for survivors trying to live on their own at home. But thats not medical advice.
An interesting part of the robot is the interface, which works either through voice commands or by the user controlling it through a tablet.  Toyota is still quiet on the full feature set of the new robot, which is probably an early development version of a future device. Nevertheless, though it might still look too big and clunky, it can perform the most important job for a patient stuck in bed at home, which of course is to bring over the TV remote.

image from link
Toyota Human Support Robot 2 Toyotas Human Support Robot to Help Patients Stuck in Bed at Home

Rapid Rehab Smart Insole Will Train Athletes and Assist Rehab Patients

This should become mandatory for all therapists working with patients walking. Accurately and objectively  detecting gait problems might be useful. That would then require a whole new way of training physical therapists  to focus on individual muscles to correct walking problems. Sorry Amy and Rebecca if I'm stepping on the PT world. But at least we would have objective data.
The device, called Rapid Rehab, consists of a custom gel insole embedded with force sensors, accelerometers, and gyroscopes to detect a person’s gait. Rapid Rehab also contains a wireless transmitter to send the data from the sensors to a custom smartphone app that tracks it and provides immediate visual, audio, or sensory feedback to the user. The current version specifically contains two force-sensitive resistors for tracking pressure when the foot is on the ground and an accelerometer and gyroscope for measuring foot movement and angle of position.
U of U smart insole Rapid Rehab Smart Insole Will Train Athletes and Assist Rehab Patients

More at link

Friday, June 28, 2013

Surrey GPs use iPad dementia detection system

Still subjective but better than nothing. Make sure before you leave the hospital you take this type of test to provide a baseline for your 33% chance of getting dementia.
Surrey GP practices are rolling out an iPad-based patient memory assessment system to quickly spot signs of dementia.
The Guildford and Waverley Clinical Commissioning Group (CCG) is promoting the use of the CANTABmobile system to help improve dementia diagnosis rates.
CANTABmobile enables GPs to test a patient’s episodic memory through an easy to use ten-minute cognitive assessment. Of the 21 GP practices in the Guildford and Waverley region, 19 have been provided with iPads and the software to assess patients who have concerns about their memory loss.
The app is based on tests that have previously only been available to pharmaceutical companies and academia for specialist trials and research. The CANTABmobile medical software has been developed by Cambridge Cognition, a British developer of neuropsychological tests born out of research at Cambridge University.

More at link.

Cute robotic animals help dementia patients

They could put this together with the stroke one.
picture from link.
Robotic seals are helping seniors cope with dementia

Study: Fruits and veggies may prevent dementia

Well, probably time to get that juicer.

James Paget University Hospital wins high praise for stroke rehabilitation work

But they don't give any details about recovery percentages. How many fully recovered?
The Early Supported Discharge (ESD) team - including stroke physician Dr Hilary Wyllie and stroke therapy team leader Evie Cooper, pictured - won the East of England Stroke Forum Conference award for their poster presentation explaining how the ESD had improved patient recovery times and benefited the Gorleston hospital over the past 18 months.
While not suitable for everyone, ESD helps patients receive rehabilitation at home as an alternative to staying in hospital.
Around 50 per cent of stroke JPH patients currently benefit from ESD which started at the hospital in May 2011. Patient feedback was impressive; JPH said 100pc of its ESD patients were ‘very satisfied’, 100pc would recommend it to other patients, and nine out of ten patients (89pc) were satisfied with the level of therapy they received.
Since ESD was introduced, recovery times has improved and the average length of stay has dropped from 17.3 days before May 2011 to the current time of 13.7 days.
Lead stroke physician Dr Hilary Wyllie said: “We are delighted to have won the regional award. It’s a credit to all the staff involved that Early Supported Discharge has worked even better than we thought it would for our stroke patients. A lower length of stay has benefits for the hospital but the most important thing is that patients get home more quickly, they get better rehabilitation and we can see from the patient feedback that their satisfaction is very high.”

David Butler-Jones, Canada’s top doctor, stepping down a year after suffering stroke

Too bad, he's probably the only one who could have  led a strategy for where stroke research/rehab should go next. But you in Canada can make sure his successor works on stroke stuff.

Jeri Rowe: Shot offers hope in stroke recovery

Well, the PR is working for etanercept. With no clinical trials this is masterful magical thinking.
This here seems to be the only study referenced in PubMed and its only observational;
If the idea is to get Enbrel into the brain why do it this way?
Why not have your doctor try the nasal to brain route. I have 13 posts on it with this one being the most interesting.
It bypasses the danger of the needle and the patent.

Schneck to Host Stroke Awareness Program -Seymour, IN

Go and be a pain in the ass. Ask what percentage of patients they see fully recover. Why is that percentage so bad?
Other questions;
11 risk reduction ideas,  Which ones are good? Did he tell you about marijuana buds?
these 17 objective diagnosis ideas, Do they objectively diagnose your stroke or do they guess?
 these 177 hyperacute therapies. What do they do in the first week? If nothing, why are you being delivered to their hospital?

The Schneck Foundation in Seymour will host "Recognizing the Signs and Symptoms of a Stroke" on Tuesday, July 23 at 6 p.m. It will be held in Suite 130 the Jackson Medical Building on South Pine Street.

The featured speaker will be Dr. Frank Pangallo, medical director at the Schneck Emergency Department. He will help you to learn to recognize the signs and symptoms of a stroke and what you can do to decrease your chances of having a stroke.
This is a free program. To make your reservation, call Betty Leslie, Schneck Foundation Development Coordinator, at 812-524-4247, or email Please call early as space is limited.

If you don't start  demanding answers as to why stroke recovery is so bad we will never get anywhere. Getting the medical establishment off their ass is not going to be easy or pleasant. But hey, if you want the same treatment you got after your last stroke just stay sitting on your ass. 

Erectile Dysfunction: Cialis, Levitra, Staxyn, and Viagra to Treat ED

OK, ok, this just completes some more information on using Viagra as a therapy for stroke.
Women , you need to ask about this from your doctor and have their jaws hit the floor
This made it sound helpful, even though it was just in rats and during the first week:
Viagra and stroke rehab

One paragraph from this link; 

Who Should Not Take Cialis, Levitra, Staxyn, Stendra, or Viagra?

If you have suffered from a heart attack, stroke or life threatening arrhythmia (irregular heart rate) within the last 6 months you should discuss other options with your doctor. It is also advised to avoid these drugs if you have uncontrolled high or low blood pressure or if you experience chest pain with sex.

Who is going to drive the human clinical testing?

No self-prescription.

Executive Functions: What They Are, How They Work, and Why They Evolved

A book for your doctor to explain to you if your stroke affected your executive functions. You do expect your doctor to know precisely which functions of your brain are dead and damaged, Don't you?.
Mine obviously didn't because there was no discussion on my damage at all, he must have figured since he couldn't do anything about it there was no reason to ever learn about stroke damage as compared to external manifestations of that damage. What laziness.

Thursday, June 27, 2013

Strategies to improve recovery in acute ischemic stroke patients: Iberoamerican Stroke Group Consensus

What a bunch of weasel words in that abstract. They should have just said, you're screwed if you get a stroke.;jsessionid=222DF01AC26B4649653F9CEDDE01E24C.d02t03
Stroke is not only a leading cause of death worldwide but also a main cause of disability. In developing countries, its burden is increasing as a consequence of a higher life expectancy. Whereas stroke mortality has decreased in developed countries, in Latin America, stroke mortality rates continue to rise as well as its socioeconomic dramatic consequences. Therefore, it is necessary to implement stroke care and surveillance programs to better describe the epidemiology of stroke in these countries in order to improve therapeutic strategies. Advances in the understanding of the pathogenic processes of brain ischemia have resulted in development of effective therapies during the acute phase. These include reperfusion therapies (both intravenous thrombolysis and interventional endovascular approaches) and treatment in stroke units that, through application of management protocols directed to maintain homeostasis and avoid complications, helps to exert effective brain protection that decreases further cerebral damage. Some drugs may enhance protection, and besides, there is increasing knowledge about brain plasticity and repair mechanisms that take place for longer periods beyond the acute phase. These mechanisms are responsible for recovery in certain patients and are the focus of basic and clinical research at present. This paper discusses recovery strategies that have demonstrated clinical effect, or that are promising and need further study. This rapidly evolving field needs to be carefully and critically evaluated so that investment in patient care is grounded on well-proven strategies.

Stroke patients able to regain language after external brain stimulation in experimental treatment

No homemade devices now.
Is this better than this? Or the same thing applied at different times.
Magnetic treatment improves stroke patients' ability to communicate

 Stroke patients able to regain language after external brain stimulation in experimental treatment
 An experimental procedure that stimulates the brain with electrical pulses through the skull may help people recover the ability to speak after suffering a stroke, researchers say.
Up to 30% of stroke survivors are left with a condition called aphasia, in which they have difficulty understanding language, speaking, reading or writing.

In a small study, Canadian and German researchers tested the effects of transcranial magnetic stimulation, or TMS, on patients recovering from a stroke but left with different degrees of aphasia caused by the damage to their brains.
Twenty-four stroke patients were enrolled in the trial, with 13 getting TMS and 11 treated with a sham procedure. Following the sessions, participants were immediately given speech language therapy.
Patients received 20 minutes of TMS or sham stimulation followed by 45 minutes of speech and language therapy for 10 days, the authors report in the American Heart Association journal Stroke.

More at link.

Consumption of Fermented Milk Product With Probiotic Modulates Brain Activity

Researchers at UCLA found that regularly eating yogurt with probiotics seems to affect brain functioning in women. But what about us men? Maybe we should be getting this immediately after the stroke? Smarter patients could be quite destabilizing to your medical establishment.
A Huffington Post article on it here;
The abstract of the research here:

Background & Aims

Changes in gut microbiota have been reported to alter signaling mechanisms, emotional behavior, and visceral nociceptive reflexes in rodents. However, alteration of the intestinal microbiota with antibiotics or probiotics has not been shown to produce these changes in humans. We investigated whether consumption of a fermented milk product with probiotic (FMPP) for 4 weeks by healthy women altered brain intrinsic connectivity or responses to emotional attention tasks.


Healthy women with no gastrointestinal or psychiatric symptoms were randomly assigned to groups given FMPP (n = 12), a nonfermented milk product (n = 11, controls), or no intervention (n = 13) twice daily for 4 weeks. The FMPP contained Bifidobacterium animalis subsp Lactis, Streptococcus thermophiles, Lactobacillus bulgaricus, and Lactococcus lactis subsp Lactis. Participants underwent functional magnetic resonance imaging before and after the intervention to measure brain response to an emotional faces attention task and resting brain activity. Multivariate and region of interest analyses were performed.


FMPP intake was associated with reduced task-related response of a distributed functional network (49% cross-block covariance; P = .004) containing affective, viscerosensory, and somatosensory cortices. Alterations in intrinsic activity of resting brain indicated that ingestion of FMPP was associated with changes in midbrain connectivity, which could explain the observed differences in activity during the task.


Four-week intake of an FMPP by healthy women affected activity of brain regions that control central processing of emotion and sensation.

Elderly people can benefit from surgery that lowers the risk of stroke

Once again these writers  either don't know what they are writing about or the source doesn't.
A new study from the John P Robarts Research Institute in Ontario, Canada, now reveals that older people actually do benefit from surgery aimed at preventing stroke. The operation cleans out blockages in the carotid artery serving the brain. Left untreated, the artery might become completely blocked by a blood clot, resulting in a stroke.  
Wrong, wrong, wrong. If the carotid artery becomes blocked the Circle of Willis allows enough blood to supply the brain. The problem is if the blockage tears, clots and then throws that clot into the brain arteries. 
The surgery is useful, just not for the explanation given. My dad had it.

From Stroke Survivor to President of the American Heart Association

I'll have to contact her to see if she is going to direct the ASA to actually do some strategic planning. You need to contact her also.
Dr. Donna Arnett was only 27 when she had a stroke that left her temporarily paralyzed and unable to speak. She was at home, and it was early in the morning.

How to Improve Stroke Care Conversations

You can read this all at the link but the paragraph I am highlighting is what is completely wrong with current rehab.
Dr. Mair and a team of scientists from the United Kingdom and the United States observed that post-stroke patients spend a substantial amount of time and effort seeking out, processing and reflecting on information about the management of their condition because the information provided by health services is inadequate.

I have seen dozens of stroke bloggers writing that they created their blog because their medical staff knew nothing and was unable to answer simple questions.
Its all quite simple.
Your medical staff has no clue about how to get you to complete recovery. If they did this problem would not exist. So stop trying to solve a secondary problem and focus on the real issue.
Get me to full recovery.

The effectiveness of problem solving therapy for stroke patients: study protocol for a pragmatic randomized controlled trial

If you were smart you would realize that the whole problem here is that survivors have a small chance of full recovery  using current methods. Making them feel better about the lack of recovery is not useful. Go back and start figuring out how to reduce disability in the first place by maybe using one of these 177 hyperacute therapies.

This is just another version of getting better at breaking bad news.
Coping style is one of the determinants of health-related quality of life after stroke. Stroke patients make less use of active problem-oriented coping styles than other brain damaged patients.

Coping styles can be influenced by means of intervention. The primary aim of this study is to investigate if Problem Solving Therapy is an effective group intervention for improving coping style and health-related quality of life in stroke patients.

The secondary aim is to determine the effect of Problem Solving Therapy on depression, social participation, health care consumption, and to determine the cost-effectiveness of the intervention.

Methods: We strive to include 200 stroke patients in the outpatient phase of rehabilitation treatment, using a multicenter pragmatic randomized controlled trial with one year follow-up. Patients in the intervention group will receive Problem Solving Therapy in addition to the standard rehabilitation program.

The intervention will be provided in an open group design, with a continuous flow of patients. Primary outcome measures are coping style and health-related quality of life.

Secondary outcome measures are depression, social participation, health care consumption, and the cost-effectiveness of the intervention.DiscussionWe designed our study as close to the implementation in practice as possible, using a pragmatic randomized trial and open group design, to represent a realistic estimate of the effectiveness of the intervention. If effective, Problem Solving Therapy is an inexpensive, deliverable and sustainable group intervention for stroke rehabilitation programs.Trial registration: Nederlands Trial Register, NTR2509

Stroke Prevention Tips for Women

More generalized blather. By keeping it this general your doctor never has to take any responsibility for preventing your stroke.
Did they consider these earlier research findings?
Aspirin ‘not worth the risk’ for healthy women
Aspirin in primary prevention: New meta-analysis finds bleeding outweighs benefits for most
Nearly half a million women in the United States will have a stroke this year, but there are many ways for them to reduce their risk.
“Knowledge is power,” said Dr. Natalia Rost, associate professor of neurology at Harvard Medical School. “If you know that a particular risk factor is sabotaging your health and predisposing you to a higher risk of stroke, you can take steps to alleviate the effects of that risk.”
Two leading contributors to stroke are age and family history, which can’t be controlled, but factors such as blood pressure and lifestyle behaviors are modifiable, Rost said in a Harvard news release.
Stroke — sometimes called a brain attack — occurs when blood flow to the brain is disrupted.
In the June issue of Harvard Women’s Health Watch, Rost suggested the following ways to reduce stroke risk:
  • Manage your blood pressure. Uncontrolled high blood pressure doubles or even quadruples stroke risk. Monitoring blood pressure and treating high blood pressure is an important way to prevent stroke.
  • Watch your weight. Obesity and the complications linked to it — such as high blood pressure and diabetes — boost the risk of having a stroke. For overweight people, losing as little as 10 pounds can reduce stroke risk.
  • Be active. Exercise helps control weight and blood pressure, and is also an
    independent reducer of stroke risk. One study found that women who walked three hours a week were less likely to have a stroke than women who didn’t walk.
  • Take baby aspirin. The Women’s Health Initiative study found that women over age 65 who took a daily baby aspirin lowered their stroke risk. Aspirin helps reduce stroke risk by preventing blood clots from forming. But if you’re considering daily aspirin use, talk to your doctor first.

Wednesday, June 26, 2013

Doctor Who Mistook Stroke for Carpal Tunnel Must Pay $1.2M

Once again proving that an objective test for stroke is needed.  Send this damn note to every doctor you know, tweet away with it. Your life may depend on it.
How many more will need to die or become disabled before the ASA, NSA, WSO and the Joint Commission will do something?
Like these 17 objective diagnosis ideas.

Is Sonothrombolysis an Effective Stroke Treatment?

Pose that exact question to your doctor and hospital. I wouldn't presume to say one way or another.


New therapeutic strategies under development aim to improve recanalization rates and clinical outcomes after ischemic stroke. One such approach is ultrasound (US)-enhanced thrombolysis, or sonothrombolysis, which can improve thrombolytic drug actions and even intrinsic fibrinolysis. Although the mechanisms are not fully understood, it is postulated that thrombolysis enhancement is related to nonthermal mechanical effects of US. Recent results indicate that US with or without microbubbles may be effective in clot lysis of ischemic stroke even without additional thrombolytic drugs. Sonothrombolysis is a promising tool for treating acute ischemic stroke, but its efficacy, safety, and technical details have not been elucidated and proved yet in stroke treatment.

Reducing fever after a stroke

Something this simple will still take 20 years to get to stroke hospitals. No hurry you know, if you were in such poor physical shape you had a stroke, you can get better the old-fashioned way.
Dutch researchers have tested the effect of acetoaminophen, a well-known fever-reducing drug, on 75 patients with ischaemic stroke – that is, one caused by a blood clot in the vessel serving the brain. The patients had a temperature ranging between 36 and 39 degrees Celsius, so not all of them had a fever. Half of them received acetoaminophen and half a placebo for five days. The first group had temperatures 0.4 degrees lower than the placebo group after 24 hours. But after five days, there was no difference in temperature between the two.
It may sound like only a small drop, but it’s reckoned that each one degree rise in temperature is linked to a two-fold increase in the death risk from stroke.
 I dislike this site because it never provides research links.
More at link.

McMaster University gets millions for heart and stroke research

You in Canada need to get involved in the Heart and Stroke Foundation so you can direct the research dollars to the correct needs. They should be specifying what research they want done and have research teams reverse auction off the proposed solution.
Start with these;
12 risk reduction ideas,
these 17 objective diagnosis ideas,
 these 177 hyperacute therapies.
Or you can just let it be and get the same results we have for the last 30 years - Nothing.
McMaster University researchers are getting a $31-million boost courtesy of the Heart and Stroke Foundation.
Officials announced Tuesday that Mac is one of 19 research institutions across the country that will be receiving $300 million from the charity over the next decade.
“Many of us rely on funding from the Heart and Stroke Foundation to do our work,” said Dr. Sonia Anand, a McMaster professor of medicine and director of the vascular medicine clinic at Hamilton Health Sciences. “This announcement is very positive, very encouraging.”

The foundation has provided more than $1.35 billion to heart and stroke research since 1952 — an amount only surpassed by the federal government. However, this is the first time it has made an upfront commitment that can support long-term research planning.
This year, Mac received $2.8 million in grants and awards from Heart and Stroke, as well as support for 23 faculty members at the university and its research partners.
Anand, who is also one of four endowed chairs at McMaster sponsored in part by the foundation, says its financial contributions support her salary — giving her protected time to work on research — as well as funding the studies themselves.
“I’ve been a great beneficiary of their funding over the years,” she said.
Anand is working on a study examining how our communities can affect our health and influence our behaviour. She is particularly focusing on factors such as walkability, affordability, access to healthy food and tobacco policies.
The study includes populations in Canada that have traditionally been skipped over, including people of South Asian and Chinese descent, and 2,000 aboriginal people across the country.
The Heart and Stroke Foundation’s goal is to reduce Canadians’ rate of death from those diseases by 25 per cent by 2020.

Migraine With Aura May Be Linked to All Stroke Types

Check it out, but again correlation vs.causation needs your doctors experience.

A 2007 study here;

Is It Just a Headache? Study Links Migraine to Brain Damage in Mice

And how do the mice answer when asked if they have a migraine? I'd love to hear them describe an aura.

Ischemic Stroke in Young Adults: Increasing Incidence and Long-term Risk

Be careful out there.
Examination of the excess risk of death stratified by age at initial stroke shows that the younger the patient, the higher the relative risk of death (7 observed deaths versus 1.1 expected deaths, or a 6.4-fold higher risk in the 18- to 29-year-old age group). The absolute excess of deaths, however, was greatest among the older patients (77 observed versus 22.8 expected, or a 3.4-fold higher risk in the 40- to 50-year-old age group).

PTSD May Raise Risk of Heart Disease

We're screwed, we have a 1 in 4 chance of getting PTSD, then we can get heart disease after that.

Tuesday, June 25, 2013

Uncovering Treatment Burden as a Key Concept for Stroke Care: A Systematic Review of Qualitative Research

This is actually fairly easy to explain;
1. There is no damage diagnosis given
2. With no diagnosis there can be no standard recovery protocol given.
3. The stupidity of 'All strokes are different, all stroke recoveries are different'  is still believed in.
4. This results in no stroke protocols being published.
5. This all leads to no assurances that you will get any recovery from the stroke.
Send them back to find out why stroke patients don't recover and then you can discuss communication issues. Still have their head in the sand.



Patients with chronic disease may experience complicated management plans requiring significant personal investment. This has been termed ‘treatment burden’ and has been associated with unfavourable outcomes. The aim of this systematic review is to examine the qualitative literature on treatment burden in stroke from the patient perspective.

Methods and Findings

The search strategy centred on: stroke, treatment burden, patient experience, and qualitative methods. We searched: Scopus, CINAHL, Embase, Medline, and PsycINFO. We tracked references, footnotes, and citations. Restrictions included: English language, date of publication January 2000 until February 2013. Two reviewers independently carried out the following: paper screening, data extraction, and data analysis. Data were analysed using framework synthesis, as informed by Normalization Process Theory. Sixty-nine papers were included. Treatment burden includes: (1) making sense of stroke management and planning care, (2) interacting with others, (3) enacting management strategies, and (4) reflecting on management. Health care is fragmented, with poor communication between patient and health care providers. Patients report inadequate information provision. Inpatient care is unsatisfactory, with a perceived lack of empathy from professionals and a shortage of stimulating activities on the ward. Discharge services are poorly coordinated, and accessing health and social care in the community is difficult. The study has potential limitations because it was restricted to studies published in English only and data from low-income countries were scarce.


Stroke management is extremely demanding for patients, and treatment burden is influenced by micro and macro organisation of health services. Knowledge deficits mean patients are ill equipped to organise their care and develop coping strategies, making adherence less likely. There is a need to transform the approach to care provision so that services are configured to prioritise patient needs rather than those of health care systems.

Meta-analysis shows mixed results for percutaneous PFO closure

If you have one of these your doctor will need to give you all the pros and cons.
A meta-analysis has found that percutaneous closure of patent foramen ovale in patients with cryptogenic stroke is not superior to medical therapy and is associated with an increased incidence of atrial fibrillation. However, there also were signals pointing toward a potential benefit with the therapy.
Researchers of the analysis looked at randomized controlled trials and nonrandomized observational studies through May 2013 that compared percutaneous PFO closure with best medical therapy.

Rest at link.

Testosterone Improves Woman’s Brain Functions

So its not from a clinical trial yet. Ask your doctor why you wouldn't want better brain function after a stroke.
One selected paragraph.
The authors noted that while these postmenopausal women were cognitively intact, those randomized to testosterone still scored statistically significantly better than those who received placebo.  The improvement was coincident to an increase in testosterone level from low normal to mid-normal range.  Luckily, there were no negative outcomes in this small short study.  If you can’t wait, ask your doc about this way off-label use of testosterone.  But just to be on the safe side, wait if you can afford to do so.

Woman Drinks Only Soda for 16 Years, Suffers Heart Problems

You can read it all at the link, I'll highlight concerns we should know about.
High amounts of caffeine can also increase urine production and decrease potassium reabsorption, the researchers said. Potassium plays a role in helping a person's heartbeat, and low levels of potassium may cause heart rhythm problems.
So the amount of coffee you are drinking may need to adjust your potassium intake. I eat 3 bananas a day, that may not be enough for the 4-5 cups of coffee I drink. Question for your doctor.

Boredom may lead to heart disease, stroke death

I hate these sensationalized headlines, they also do not link to the study itself so you can determine if the study says anything even remotely related to the headline. But I'm guilty of falling for the trap.
Only one paragraph here, rest at link.
Psychological factors can play a big part in heart disease. A study, from researchers the Department of Epidemiology and Public Health, University College, London, finds a link between being bored at work and death from heart disease and other causes. They surveyed over 7,500 civil servants, aged between 35 and 55, between 1985 and 1988 about their boredom levels. Now, they noted how many of their participants had died, including heart disease deaths.

Study: Meds containing caffeine tied to double or triple risk of stroke

For your doctor to decipher, I just finished giving a presentation where Coffee, coffee, coffee was highlighted for all its beneficial effects.
Taking medications containing caffeine was tied to a doubled or even tripled risk of having a stroke in a new Korean study that might seem to contradict recent evidence suggesting coffee and tea exert protective effects.
But the results may be in fact be in line with that research, according to the study authors, who point out that people who drank the least coffee were most at risk when taking caffeinated drugs.
The products included mostly over the counter pain relievers, cold medicines and alertness aids containing small amounts of caffeine.
"Caffeine is a vasoconstrictor, causing blood vessels to tighten and increasing the pressure of the blood flow," Nam-Kyong Choi of Seoul National University College of Medicine, who co-led the study, told Reuters Health in an email.
But what about this study?;
Tea and coffee lower blood pressure in large French registry

This shows correlation, not causation which is why your doctor needs to be involved. What does s/he think of the studies conclusion?