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:

Tuesday, December 31, 2013

Study: Vitamin E May Help Slow Alzheimer’s Decline

Well I know coffee does. I'll see if I want to follow this.
Attenuation of oxidative neuronal cell death by coffee phenolic phytochemicals
Coffee may help perk up your blood vessels
Coffee Every Day Keeps the Dementia Away reblogged from BrainBlogger
The story at USA Today;

Anxiety Linked to Increased Stroke Risk

Don't you dare be anxious about your recovery you'll increase your risk of stroke. writeup here;
The abstract here:
  1. Rebecca C. Thurston, PhD
+ Author Affiliations
  1. From the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA (M.J.L., R.C.T.); and Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (L.D.K.).
  1. Correspondence to Maya J. Lambiase, PhD, Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara St, Pittsburgh, PA 15213. E-mail


Background and Purpose—Higher levels of anxiety are associated with increased risk for coronary heart disease. However, few studies have investigated whether anxiety is associated with stroke risk. The purpose of this study was to examine the association between anxiety symptoms and incident stroke in a nationally representative longitudinal study of the US population.
Methods—Participants (n=6019) in the First National Health and Nutrition Examination Survey were assessed at baseline and followed for 16.29±4.75 years. Multivariate Cox proportional hazards regression models were used to estimate hazard ratios and 95% confidence intervals of incident stroke associated with a 1 SD increase in anxiety symptoms. Models were adjusted for standard cardiovascular risk factors and additionally for depression.
Results—A total of 419 incident stroke cases were identified from hospital/nursing home discharge reports and death certificates. Reporting more anxiety symptoms at baseline was associated with increased risk of incident stroke after adjusting for standard biological and behavioral cardiovascular risk factors (hazard ratio, 1.14; 95% confidence interval, 1.03–1.25). Findings persisted when additionally controlling for depression. Exploratory analyses considering the role of potential confounding versus pathway variables suggested that behavioral factors may be a key pathway linking anxiety to stroke risk.
Conclusions—Higher anxiety symptom levels were associated prospectively with increased risk for incident stroke independent of other risk factors, including depression. Anxiety is a modifiable experience that is highly prevalent among the general population. Its assessment and treatment may contribute to developing more effective preventive and intervention strategies for improving overall cardiovascular health.

10 Surprising Clues You'll Live to 100

I  plan on getting there.
Clue #1: How many elderly relatives are on your family tree? Mostly 80s 1 90+
What it may mean: You may have longevity genes.

Clue #2: How fast and how far can you walk? I don't know
What it may mean: You're in good condition for the long haul.
Faster walkers live longer. University of Pittsburgh researchers crunched numbers from nine different studies including almost 35,000 subjects ages 65 or older. The result: For each gait speed increase of 0.1 meters per second came a corresponding 12 percent decrease in the risk of death.
The average speed was 3 feet per second (about two miles an hour). Those who walked slower than 2 feet per second (1.36 miles per hour) had an increased risk of dying. Those who walked faster than 3.3 feet per second (2.25 miles per hour) or faster survived longer than would be predicted simply by age or gender.
A 2006 report in the Journal of the American Medical Association found that among adults ages 70 to 79, those who couldn't walk a quarter mile were less likely to be alive six years later. They were also more likely to suffer illness and disability before death. An earlier study of men ages 71 to 93 found that those who could walk two miles a day had half the risk of heart attack of those who could walk only a quarter mile or less.

Clue #3: Do you have a lot of people in your life? Yes
What it may mean: Social engagement is a key lifespan-extender.

Clue #4: Are you a woman? No
What it may mean: Odds are more in your favor from the start.

Clue #5 (for women only): Did you have a child after age 35?
What it may mean: This is possible evidence that you're a slow ager.

Clue #6: When were you born?
What it may mean: Growing lifespans give younger people an edge.

And if you're 99 now? You have a whopping 67 percent chance of seeing another year.

Clue #7: Do you worry -- but not too much? NO
What it may mean: There's a "healthy" worry level.

Clue #8: Is your weight normal -- or are you only slightly overweight? Yes
What it may mean: You have better odds of reaching 100 than if you were obese.
A surprising 2011 Albert Einstein College of Medicine study of 477 adults ages 95 to 112 found that these solid-gold agers had no better health habits overall than a comparison group born at the same time that had been studied in the 1970s. One difference: Those in long-lived group were much less likely to be obese.
Both male and female centenarians in the study were overweight at about the same rates as those in the shorter-lived group. But only 4.5 percent of the long-lived men and 9.6 of the women were obese, compared to 12.1 percent and 16.2 percent, respectively, of the younger-lived controls. ("Normal weight" is a Body Mass Index -- or BMI, a measure of height in proportion to weight -- in the range of 18 to 24; "overweight" is 25 to 30; over 30 is "obese.")
This finding echoes other studies showing the greatest risks of death among those who are obese or underweight at age 65 (BMI under 18.5), compared to those of normal weight or slight overweight. A 2011 study at Loma Linda University in Southern California found that men over age 75 with a BMI over 27.4 lived nearly four years less than those with a lower BMI. For women over age 75, a BMI over 27.4 led to a two-year shorter lifespan. Studies of centenarians show that men who reach 100 are almost always lean (more so than women).
Luckily, this clue is one you can control. "Since you can't be sure if you'll live to 100, I wouldn't take the chance of ignoring the lifestyle interventions that we know will at least put you in the half the population who die after age 80 -- starting with watching weight and being sure to exercise," says the senior author of the Albert Einstein study, Nir Barzilai, director of the college's Institute for Aging Research.

Clue # 9: How long are your telomeres? Who knows?
There's this: 

Coffee Ages telomere length of Cells but beer extends length

What it may mean: Many people who live to 100 have a hyperactive version of an enzyme that rebuilds telomeres.

Clue #10: Are you a positive person? Yes
What it may mean: Emotion influences health, which influences aging.
But what about the research that says that pessimists live longer?

Stroke’s Global Burden of Death and Disability Highlights Need for Awareness, Prevention, and Rehabilitative Strategies

A great paper from the Dana Foundation. I'll comment on several sections. Full paper available at link.

Few medical conditions, neurological or otherwise, exact a greater public-health toll than stroke, a fact underscored by a new published report on the global burden of stroke. An acute brain injury that may begin insidiously years prior, stroke is now the second leading cause of death and the third most common cause of disability worldwide. Nearly 17 million people in the world will have a first stroke in the next year, and 33 million people are stroke survivors.
In the U.S., stroke is the No. 1 cause of serious long-term disability. Approximately 800,000 strokes occur annually in this country, and about 130,000 people die annually from stroke. The risk of stroke has decreased by roughly 70 percent in the U.S. since incidence was first tracked in the mid-1900’s, a downward trend that has not plateaued, suggesting there is still room for improvement. Stroke risk factors are well known, and experts estimate that 80 percent of strokes could be prevented with better management of hypertension, blood lipids, and glucose.
Getting Aggressive About Prevention
“Most people believe there could be substantial, dramatic stroke reduction if we just really aggressively managed the risk factors we currently know about,” says Walter Koroshetz, M.D., deputy director of the National Institute for Neurological Disorders and Stroke and a member of the Dana Alliance for Brain Initiatives. “In many diseases, you need a major scientific breakthrough to make a difference. That’s not true with stroke.”
Except you could reduce stroke risk by hundreds of percents following these;
Green tea and coffee 20%  - Green tea, coffee may reduce stroke risk by 20 percent

Potassium 21%   Why eat three bananas a day?
 Marijuana buds 50%  A Marijuana Bud A Day Keeps The Stroke Away

 Dietary magnesium 8% Higher magnesium intake associated with reduced ischemic stroke risk
Mediterranean diet 30% - Mediterranean Diet Proven Key In Avoiding Heart Disease And Stroke

lycopene - tomatoes 55%  -Tomatoes Linked to Lower Stroke Risk

Fish 6% - Does Eating Two Fish a Day REALLY Keep the Chance of Stroke Away?

 Chocolate eating 17%Eating small bar of chocolate cuts risks of stroke in men

Walking 43% - Walking wards off stroke for women
Speed walking 50% - Speed Walking Halves Stroke Risk
Dietary fiber 7% -    More Dietary Fiber Might Help Thwart Stroke
Total 307%

Opening the Window for Acute Treatment
Public-health advocates have tried for years to drive home the message that strokes require immediate medical attention, ever since a treatment became available that could help some people with ischemic stroke, which occurs when blood flow to part of the brain is restricted by a clot or narrowed blood vessel. Tissue plasminogen activator, or tPA, is still the only drug approved for treating acute stroke, but its use is severely limited, largely because published guidelines call for it to be administered within three hours of stroke onset for most patients. Some experts have criticized these guidelines and are calling for them to be revised.
With a pathetic 12% efficacy that means that they are lying about 88% of the results 

Public Awareness Still Lacking
The advent of tPA has triggered a system-wide reorganization of stroke urgent care that is still evolving nearly 17 years later. For example, specialized stroke centers have been established where expert care, along with the tools and technologies for swift, accurate diagnosis, is readily available. A tiered system based on minimum requirements, much like the system that designates hospitals as Level 1-4 trauma centers depending on their capabilities, is being put in place for stroke care as well, so that patients can be transported to the most advanced center in their area. While there have been vast improvements, a number of obstacles remain. Primary among them is public awareness, experts say.
“Public knowledge about stroke is still very low,” says Caplan. “This is the more difficult problem, because a lot of people don’t know they’ve had a stroke.”
The real problem here is that there is no easy objective way to diagnose a stroke. Friends have been in ERs for hours because the stroke hadn't established severe enough effects to be obvious. That should be accomplished with the tricorder possibly thru one of these 17 ways. 
Better Rehab Through Brain Science
The Global Burden of Disease report underscores the dichotomy between richer, developed countries like the U.S., where the majority of people who suffer a stroke survive, and poorer, developing countries where people are more likely to die from a stroke. While cutting stroke deaths is a major global-health goal, better recovery and rehabilitation strategies are desperately needed to address the ever-growing population of stroke survivors who struggle to function with varying degrees of disability.
“We have in the U.S. alone 800,000 people who have a stroke each year. So the question becomes, what can be done to return functional recovery to those patients?” says Koroshetz. “That’s where the really interesting science is, because it intersects with the area of neuroplasticity–how the brain learns to function for a particular purpose and how it rewires itself to get lost function back.”
You have this all wrong, you need to stop the neuronal cascade of death resulting in much less death and disability. The silo of rehabilitation is not where the breakthroughs are going to occur because no one knows exactly how to make neuroplasticity repeatable.
Brain Recovery Not Passive
Armed with such investigational tools, neuroscience has already revealed some fundamental principles of recovery in the brain. “The general rule, at least in the cortex, is that somehow the brain recovers function after an initial injury, whether it’s a stroke or some other lesion,” says Koroshetz. “Now people are studying how that happens, and the hope is that we can translate that to therapeutic strategies.”
One key finding already, Koroshetz says, is that recovery from injury is not “passive.” Rather, it requires enhancement by active exposure to sensory stimuli or motor practice. He points to the LEAPS study, which was the first large randomized, controlled clinical trial that investigated recovery of locomotor function in people who had had a stroke. The NIH-funded study compared two fairly intensive therapies: treadmill walking vs. strength and balance training performed at home with a physical therapist. A third group, serving as controls, received “standard of care”–whatever physical therapy or rehab they were getting as part of their regular medical care.
‘Standard of Care’ Substandard?
What the hell is the standard of care for stroke? Does anyone know?

“Better to do something imperfectly than to do nothing flawlessly.”

I got this from the latest Tiny Buddha post. Exactly what Peter Levine says about your movements in rehab
And more great quotes from there;
“What have you done to make your dream come true?”

I was scared that I wouldn’t be good enough, posh enough, young enough, confident enough, and Lord-knows-what-else enough to learn how to play a musical instrument. 

I hate the way my walking looks, my hip hikes, my foot swings out, my knee barely bends. The only thing that mostly recovered is I can dorsiflex the foot by thinking about it. But I'll walk every weekend in the trails in the woods, falling down doesn't occur too much anymore.  And my skiing is atrocious, it would be even worse if I had to step over all the fallen limbs and trees I cleared in the past 4 months. Right now I'd call it shuffling on skis, there is no glide yet.
Too many of my email correspondents want the instant rehab - if only I can find the right therapy/therapist.

I think the best advice our doctors and therapists could give us would be; There are NO shortcuts to stroke rehab, its going to look ugly for a long time. We have no idea how much you'll recover. Are YOU willing to put in the time and effort to recover?


How Ultrasound Became the Newest Weapon Against Stroke

The earlier  research  was problematic because they didn't distinguish between two therapies - ultrasound and xenon gas.
How many hospitals would have this machine and what training is needed?
This article does mention that tPA is 20% effective with no attribution, I've been using the 12% rate.

7 Signs Providers Are Opening Up About Bad Healthcare Outcomes

The continued death of your neurons in the first week is probably a bad healthcare outcome but its because of total inaction by your doctor.  Going down the anger route with your hospital may be the only thing that will change that inaction. That would be paying it forward for future stroke survivors. So start screaming at your doctors and hospitals.

Monday, December 30, 2013

What help desk do you call for your stroke rehabilitation needs?

A long time ago in my job in technology we had a technical help desk for when programmers were stumped. They were helped by the analyst answering the phone or directed to the expert in the area.  I once was perplexed by a difficult problem and called the help desk. The analyst didn't know the answer and after finding out I was supporting the life insurance area, directed me to Dean R. I was asked if I knew that person. Yeah, thats me.  Recovering from stroke feels exactly the same way, there is no more knowledgeable person I can go to for answers.  You could try the ASA- American Stroke Association helpline  1-888-4-STROKE      but I'm sure that won't do a damn bit of good.
Or the NSA - National Stroke Association 1-800-STROKES (787-6537)
The WSO - World Stroke Organization has no numbers for survivors to contact them because they are not for survivors.
Or maybe the uk Stroke Helpline: 0303 3033 100 
Or maybe The Stroke Organization at the End of the Universe -1-800-youarescrewed 

Simvastatin Promotes Adult Hippocampal Neurogenesis by Enhancing Wnt/β-Catenin Signaling

This was already researched and written about in March, 2011.
Acute statin therapy improves survival after ischemic stroke
How many times do researchers have to prove almost exactly the same thing before someone notices and decides to put it into a stroke protocol? What the hell is the downside from having every survivor get statins immediately? Its not a new drug, its even being used for the correct purpose. We have complete idiots not in charge of anything in the stroke world. Are they smarter than a fifth grader? No, but they are dumber than a box of rocks.
Stem Cell Reports, 26 December 2013
Copyright © 2014 The Authors
This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-No Derivative Works License, which permits non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited.


  • Highlights
  • Simvastatin enhances Wnt signaling in adult neural progenitor cells
  • Simvastatin promotes neuronal differentiation via enhanced Wnt signaling
  • Simvastatin concurrently enhances adult hippocampal neurogenesis
  • The effect of simvastatin on Wnt is through inhibited prenylation


Statins improve recovery from traumatic brain injury and show promise in preventing Alzheimer disease. However, the mechanisms by which statins may be therapeutic for neurological conditions are not fully understood. In this study, we present the initial evidence that oral administration of simvastatin in mice enhances Wnt signaling in vivo. Concomitantly, simvastatin enhances neurogenesis in cultured adult neural progenitor cells as well as in the dentate gyrus of adult mice. Finally, we find that statins enhance Wnt signaling through regulation of isoprenoid synthesis and not through cholesterol. These findings provide direct evidence that Wnt signaling is enhanced in vivo by simvastatin and that this elevation of Wnt signaling is required for the neurogenic effects of simvastatin. Collectively, these data add to the growing body of evidence that statins may have therapeutic value for treating certain neurological disorders.

Exploring staff experience of an “enriched environment” within stroke rehabilitation: a qualitative sub-study

This was written about by Dale Corbett back in Feb. 2011
What the hell is it going to take to get this into a stroke protocol rolled out to all hospitals? Are we going to need a scenario like had in the movie

John Q in  2002 before anything gets done?

1Hunter Stroke Service, John Hunter Campus,
New Lambton, New South Wales
, Australia,
2Department of Medical Sciences, The University of Newcastle,
Callaghan, New South Wales
, Australia, and
3Rankin Park Unit,
New Lambton, New South Wales
, Australia
Address for correspondence:
Jennifer H. White, MMSc (Occupational Therapy), Hunter Stroke Service, Level 2, The Lodge
, John Hunter Campus,
Lookout Rd, New Lambton, New South Wales 2301
, Australia. E-mail:


Background: Environmental Enrichment (EE) is shown to facilitate recovery of motor and cognitive function in animal models of stroke. The efficacy of EE in the clinical setting with stroke survivors remains unknown. Successful implementation of EE in a busy rehabilitation unit requires identification of barriers and enablers which are best informed by staff feedback. Aim: To qualitatively explore the experiences of nursing staff involved in a pilot study investigating the feasibility of EE in a rehabilitation ward. Methods: This was a qualitative study consisting of analysis of semi-structured interviews with nine nursing staff who were asked to reflect on “routine care” and their own “experience of the EE study”. An inductive thematic approach was used to collect and analyse data using a process of constant comparison. Results: Male and female staff with varying years of experience working in stroke rehabilitation participated in focus group and individual interviews. Three key themes were identified concerning the implementation of EE including: (i) “Nurses are so busy” – perceptions on routine work practice; (ii) “A better outlook” – perceptions of the benefit of EE; (iii) “They’re just not going to participate” – perceptions of barriers to EE. Indeed, the challenges identified in this study align with practice change literature, which indicates that staff workload, routine and attitudes can influence the implementation of a new practice. Discussion: Staff perceived the use of an EE in their rehabilitation unit promoted activity/participation and increased patient moral. The barriers and enablers experienced by staff in this study may be used to inform the design and conduct of future studies investigating the efficacy of EE during inpatient stroke rehabilitation after stroke.

Oxford Textbook of Stroke and Cerebrovascular Disease

I'm sure this is a useless book, edited by Bo Norrving formerly president of the WSO.  But someone will buy it.
The stroke rehabilitation process aims to support the person to obtain knowledge and
understanding of the stroke and its consequences, to mobilize their own coping strate- gies, to
take responsibility of the life situation, and to become aware of the possibilities considering the

More harm than good: Antiseizure prophylaxis after traumatic brain injury does not decrease seizure rates but may inhibit functional recovery

Ask your doctor if this would also apply to stroke survivors. And get in their face until they actually study up on this.



The purposes of this study were to examine the current Brain Trauma Foundation recommendation for antiseizure prophylaxis with phenytoin during the first 7 days after traumatic brain injury (TBI) in preventing seizures and to determine if this medication affects functional recovery at discharge.


The records of adult (age ≥ 18 years) patients with blunt severe TBI who remained in the hospital at least 7 days after injury were retrospectively reviewed from January 2008 to January 2010. Clinical seizure rates during the first 7 days after injury and functional outcome at discharge were compared for the two groups based on antiseizure prophylaxis, no prophylaxis (NP) versus phenytoin prophylaxis (PP). Statistical analysis was performed using χ.


A total of 93 adult patients who met the previously mentioned criteria were identified (43 [46%] NP group vs. 50 [54%] PP group). The two groups were well matched. Contrary to expectation, more seizures occurred in the PP group as compared with the NP group; however, this did not reach significance (PP vs. NP, 2 [4%] vs. 1 [2.3%], p = 1). There was no significant difference in the two groups (PP vs. NP) as far as disposition are concerned, mortality caused by head injury (4 [8%] vs. 3 [7%], p = 1), discharge home (16 [32%] vs. 17 [40%], p = 0.7), and discharge to rehabilitation (30 [60%] vs. 23 [53%], p = 0.9). However, with PP, there was a significantly longer hospital stay (PP vs. NP, 36 vs. 25 days, p = 0.04) and significantly worse functional outcome at discharge based on Glasgow Outcome Scale (GOS) score (PP vs. NP, 2.9 vs. 3.4, p < 0.01) and modified Rankin Scale score (2.3 ± 1.7 vs. 3.1 ± 1.5, p = 0.02).


PP may not decrease early posttraumatic seizure and may suppress functional outcome after blunt TBI. These results need to be verified with randomized studies before recommending changes in clinical practice and do not apply to penetrating trauma.

EQUAL: A Compact Electric Vehicle Specially Designed for People with Disabilities

Would you rather have this one in your hospital therapy dept. or  the cool off road one?

Extreme Offroad Tracked Wheelchair the Original Ripchair 2.0

Computer chips with cell membranes may change how artificial organs and drugs are tested before they can be used on patients

And since we already can grow brains on a chip this style of testing might solve rodent model in inflammation is not the same as humans. At least that could be the case if we had a great stroke association directing where research should be going.
Imagine if medical research and clinical drug tests could be done on artificially grown organs on microchips to save time, costs, and ease ethical concerns?
That’s the dream of James Feng, a professor in biological and chemical engineering at UBC.
“The potential is tremendous,” says Feng. “The main impact of organs grown this way will be on the design of drugs; the understanding of the pathological processes.”
Dr. Feng’s group carries out research in three broad areas: mechanics of biological cells and tissues, interfacial fluid dynamics, and mechanics and rheology of complex fluids.
The group has an inter-disciplinary flavour–crosscutting applied mathematics, cell biology, soft-matter physics and chemical and biomedical engineering—that is well-suited for exploring this burgeoning technology.
Implications for the pharmaceutical industry
Feng cites a Harvard study using a small silicon device that holds a thin layer of real cell membranes capable of producing motion similar to the heaving and breathing of a lung.
Organ models designed this way have the potential to be more accurate in drug and treatment trials, says Feng, as they can better mimic the functions of human organs, as opposed to animal models which are the current research standard.
“It’s more controlled and you can simplify the process much faster,” said Feng.
“Harvard researchers also injected drugs into their chip model to see how it changed its behaviour and to see the tissue’s reaction to mechanical or chemical disturbance,” he added.
“It’s very important for drug design and discovery and the pharmaceutical industry would be tremendously interested in that.”
In addition, organs on a chip present a less controversial option for organ model testing compared to stem cell research. According to Feng, this is because their ultimate goals are very different from each other.
“The research that tried to grow organs directly from stem cells is aiming for eventually implantable organs,” he said. “The idea of making the chip is to work toward replacing animal models, so as to be more accurate and realistic like human organs. While the ability to replicate a complex human organ function remains far off, the direction appeals to anyone who is hoping to reduce the use of animals in research.”
Simulating organ functions on a chip
Feng says this kind of organ testing offers the possibility of greatly reducing cost and time required for clinical trials.
“By using computer simulations we can generate results and insights, and run virtual tests much more easily and quickly,” he says.
“We can test maybe hundreds or thousands of designs of organ chips to be able to tell you whether you should try those ten designs instead of the hundreds one by one.”
Feng, who has a background in aerospace engineering, says this new bio-technology has the potential to transform the development of artificial organs and drugs the way computer simulations have replaced the use of wind tunnels for designing aircrafts.
“That used to be the dominant mode of designing crafts,” he said, “but that’s being replaced by online computer simulations because we understand the principles of aerodynamics so well.”
While UBC’s efforts in the field are in the early stages, Feng is reaching out to researchers from other backgrounds. He will be inviting leading scientists to UBC in July 2014 for a workshop that will centre on the growth of artificial organs and computer simulations. He is also exploring ideas of his own.
“I have a collaboration with an engineering colleague on how to use the microfluidic chip, the technology used to emulate the lung in the Harvard study, as a way of measuring malaria-infected red cells,” he said, suggesting that this is just one of the countless ways this new technology could be used to fuel future innovation.

The Quality of Life Scale (QOLS): Reliability, Validity, and Utilization

I'm sure your doctor is not using this to determine the effectiveness of stroke interventions. As of 2003 there seems to be no use of it for stroke survivors. Unless our worthless stroke associations have done something since I bet no one cares about our Quality of Life. In fact its probably better if you just die, my ex-wife would have preferred that.
Carol S Burckhardt1* and Kathryn L Anderson2
1 School of Nursing Oregon Health & Science University, Portland, Oregon, USA
2 School of Nursing, Seattle University, Seattle, Washington, USA
For all author emails, please log on.
Health and Quality of Life Outcomes 2003, 1:60  doi:10.1186/1477-7525-1-60

The electronic version of this article is the complete one and can be found online at:

Received:22 July 2003
Accepted:23 October 2003
Published:23 October 2003
© 2003 Burckhardt and Anderson; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.


The Quality of Life Scale (QOLS), created originally by American psychologist John Flanagan in the 1970's, has been adapted for use in chronic illness groups. This paper reviews the development and psychometric testing of the QOLS. A descriptive review of the published literature was undertaken and findings summarized in the frequently asked questions format. Reliability, content and construct validity testing has been performed on the QOLS and a number of translations have been made. The QOLS has low to moderate correlations with physical health status and disease measures. However, content validity analysis indicates that the instrument measures domains that diverse patient groups with chronic illness define as quality of life. The QOLS is a valid instrument for measuring quality of life across patient groups and cultures and is conceptually distinct from health status or other causal indicators of quality of life.
Quality of Life Scale; QOLS; chronic illness outcomes; quality of life evaluation

Why assess Quality of Life in chronic illness?

Quality of life (QOL) measures have become a vital and often required part of health outcomes appraisal. For populations with chronic disease, measurement of QOL provides a meaningful way to determine the impact of health care when cure is not possible. Over the past 20 years, hundreds of instruments have been developed that purport to measure QOL [1]. With few exceptions, these instruments measure what Fayers and colleagues [2,3] have called causal indicators of QOL rather than QOL itself. Health care professionals need to be clear about the conceptual definition of QOL and not to confound it with functional status, symptoms, disease processes, or treatment side-effects [4-7]. Although the definition of QOL is still evolving, Revicki and colleagues define QOL as "a broad range of human experiences related to one's overall well-being. It implies value based on subjective functioning in comparison with personal expectations and is defined by subjective experiences, states and perceptions. Quality of life, by its very natures, is idiosyncratic to the individual, but intuitively meaningful and understandable to most people [[8], p. 888]." This definition denotes a meaning for QOL that transcends health. The Quality of Life Scale (QOLS) first developed by American psychologist, John Flanagan, [9,10] befits this definition of QOL. 

Much more available at the link.

Why The Southern U.S. is Also Known as ‘The Stroke Belt’

And rather than looking for other preventive ideas, they go down the failed route of telling us generalities like control hypertension, eat better. Like this  worthless statement - The association encourages patients to change their lifestyle to decrease their risk of stroke and to treat their medical risks by working with their doctors.
Maybe you want to ask your doctor about these 10 prevention ideas. But they come from me, a non-medical person, so they are automatically worthless.

Sunday, December 29, 2013

Researchers Find Early Success in New Treatment for Stroke Recovery

Earlier research on this is here July, 2012;
Nerve stimulation plus standard therapy may accelerate stroke recovery
and here Jan. 2013;
UK docs aim to `rewire` brains of stroke patients
and here - Sept. 2013;
Researchers Find Early Success in New Treatment for Stroke Recovery 
And just when the hell will the research be enough to create a stroke protocol? And who will do that if our craptastic stroke associations will not?
The latest one here: 
Researchers at The University of Texas at Dallas have taken a step toward developing a new treatment to aid the recovery of limb function after strokes.
In a study published online in the journal Neurobiology of Disease, researchers report the full recovery of forelimb strength in animals receiving vagus nerve stimulation.
“Stroke is a leading cause of disability worldwide,” said Dr. Navid Khodaparast, a postdoctoral researcher in the School of Behavioral and Brain Sciences and lead author of the study. “Every 40 seconds, someone in the U.S. has a stroke. Our results mark a major step in the development of a possible treatment.”
Vagus nerve stimulation (VNS) is an FDA-approved method for treating various illnesses, such as depression and epilepsy. It involves sending a mild electric pulse through the vagus nerve, which relays information about the state of the body to the brain.
Khodaparast and his colleagues used vagus nerve stimulation precisely timed to coincide with rehabilitative movements in rats. Each of the animals had previously experienced a stroke that impaired their ability to pull a handle.
Stimulation of the vagus nerve causes the release of chemicals in the brain known to enhance learning and memory called neurotransmitters, specifically acetylcholine and norepinephrine. Pairing this stimulation with rehabilitative training allowed Khodaparast and colleagues to improve recovery.

More at link.

Homeopathy and stroke

A biased writeup in favor of homeopathy here;
It has the standard excuse that traditional scientific methods can't  be used because they don't honor the principles of homeopathy. What a load of crock. They have to disparage the scientific method because that method proves that homeopathy is nothing more than placebo. So if you are going down this route ask for scientific research, not this type of misleading puff piece.

Homeopathy research review

Some Homeopathy writeups for stroke here to balance this out; I will never do this.

 Alternative and Complementary Medicine for Stroke  This one is bad because it lists first aid for stroke. Yeah, lets put a bandaid on the owie in the brain.

Homeopathy and Stroke Talks about needing to correct the ' vital force'. Whoa what a load of xxx.

Cerebral Stoke and Homeopathy

Fascinating ideas from this one, a couple of lines for your amusement.
There are following remedies which are helpful in the treatment of cerebral stroke:
Aconite Nap.: good remedy for stroke, for a person who is panicky and fear of dying.
Aurum mur: when stroke is caused by depression or while person loses his face.
Opium: excellent remedy for apoplexy; comma and obstructed respiration; patient lies down; loss of consciousness with eyes half open after the brain hemorrhage. And where the hell is this person going to get opium? Never mind, after succussing numerous times there is no actual atoms of the original element in the result, so there is no need to even start out with the named element. Unless you happen to believe in magical water memory.



Stroke Network Leads to Better Outcomes

And absolutely no mention of doing anything to stop the neuronal cascade of death. Solve that and you can congratulate yourself, until then you have very little to be pleased about.
Stroke care networks save lives and reduce the need for long-term care, a study of one of the largest and longest operating networks confirmed.
In an integrated system of stroke care delivery in Ontario mortality rates 30 days after hemorrhagic stroke decreased from 38.3% to 34.4% after the networks were fully implemented (P<0.001) and discharge to a long-term care or chronic care facility dropped from 16.9% to 14.8% (P<0.001), reported Moira Kapral, MD, of the University of Toronto Institute for Clinical Evaluative Sciences, and colleagues in CMAJ.
The 10-year study included data on 243,287 patient visits to emergency departments (ED) and 163,198 hospital admissions for acute stroke or transient ischemic attack before and after 2005, when the stroke care network became fully operational in Ontario.
The networks are designed to integrate the delivery of stroke treatment across regions to optimize the chances that patients will receive timely, evidence-based therapies even if they don't live near a designated stroke center.
"After the stroke network was introduced there were clear improvements in the quality of stroke care," Kapral told MedPage Today. "More patients were treated with optimal stroke care interventions, such as thrombolysis, including clot-busting drugs, and stroke-unit care."
Kapral's group used population-based provincial administrative databases to identify all ED visits and hospital admissions for acute stroke and transient ischemic attack from 2001 to 2010.
They assessed the effect of the full implementation of the Ontario Stroke System in 2005 on the proportion of patients who received care at stroke centers, and on rates of discharge to long-term care facilities and 30-day mortality after stroke.
The proportion of patients who received care at either a regional or district stroke center increased from 40% before 2005 to 46.5% after full implementation of the system (P<0.001). The median time from stroke presentation to carotid revascularization decreased from 50 to 22 days (P<0 .001="" p="">Piecewise regression analysis showed a gradual increase in the rate of care at stroke centers before 2005, followed by a significant upward shift in rates in 2005.
And significant increases were seen between 2002 and 2009 in rates for the following (P<0.001 for all):
  • Thrombolytic therapy use: 10% to 27%
  • Neuroimaging: 77% to 93%
  • Carotid imaging: 44% to 68%
  • Care in a stroke unit: 3% to 24%
  • Dysphagia screening: 47% to 57%
  • Antithrombotic therapy: 80% to 94%
By far the biggest improvements were seen at regional and district stroke centers, with little or no change evident at nondesignated centers, the authors reported.
The authors cautioned that "although we observed an increase in the proportion of patients seen at designated stroke centers over the study period, the absolute magnitude of the increase was modest, with more than half of the population receiving care at nondesignated centers even 5 years following the full implementation of the stroke system."
They suggested that this was the result of the system being designed mostly to facilitate the transfer, or bypass, of those patients most likely to be good candidates for thrombolytic therapy or neurosurgical interventions.
Nonetheless, the decreases would be expected to result in about 200 fewer stroke-related deaths and 300 fewer patients requiring long-term care or chronic care annually, they pointed out.
The researchers conceded that significant regional variations in care persist, and they acknowledged that Ontario's large and geographically diverse territory has made the implementation of an integrated stroke care network a challenge.
Kapral said increased utilization of telemedicine and other efforts to provide evidence-based therapies to patients not treated at designated stroke centers should improve patient outcomes.
The Ontario Telestroke Program has provided neurologist consultations for stroke patients treated at regional hospitals without stroke centers over the last decade and 30% received thrombolytic treatments.
"Despite our best efforts, there will always be patients who just don't live close enough to a stroke center to be treated at one," she said. "That is why networks are especially important in rural and remote areas."
The study had some limitations. The authors focused on hospital-based processes of care and outcomes and did not have data on longer-term outcomes such as functional status, quality of life, or after-stroke care. Also, the piecewise regression analyses did not account for the potential effects of concurrent interventions.
Still, they concluded that the findings provide stroke support for the ongoing development and implementation of networks to coordinate the delivery of stroke care, and that "future research should focus on identifying the specific components of such systems that are most likely to account for improvements in outcomes."

Saturday, December 28, 2013

Vitamin K status and cognitive function in healthy older adults

I would think if we had any smart doctors or hospital administrators they would be using this to make sure the meals in the hospital post-stroke were cognitive friendly. Unless you are on Warfarin  and need to stay away from vitamin K.
But I can almost 100% guarantee that absolutely nothing will be done to help your stroke recovery in this regard. Because we have shit for stroke associations and lead-assed inertia for doctors and stroke centers.
But thats just my reasoned opinion, if you have some proof otherwise please respond.
Received 19 December 2012; received in revised form 22 April 2013; accepted 30 May 2013. published online 15 July 2013.


Evidence is accumulating that vitamin K could have a role in cognition, especially in aging. Using data from the Québec Longitudinal Study on Nutrition and Successful Aging (NuAge), a cross-sectional analysis was conducted to examine the associations between vitamin K status, measured as serum phylloquinone concentrations, and performance in verbal and non-verbal episodic memory, executive functions, and speed of processing. The sample included 320 men and women aged 70 to 85 years who were free of cognitive impairment. After adjustment for covariates, higher serum phylloquinone concentration (log-transformed) was associated with better verbal episodic memory performances (F = 2.43, p = 0.048); specifically with the scores (Z-transformed) on the second (β = 0.47; 95% confidence interval [CI] = 0.13–0.82), third (β = 0.41; 95% CI = 0.06–0.75), and 20-minute delayed (β = 0.47; 95% CI = 0.12–0.82) free recall trials of the RL/RI-16 Free and Cued Recall Task. No associations were found with non-verbal episodic memory, executive functions, and speed of processing. Our study adds evidence to the possible role of vitamin K in cognition during aging, specifically in the consolidation of the memory trace.

What We Know Currently about Mirror Neurons

Demand your doctor read up on this and see what needs to change in your stroke protocol. You do expect your doctor to want to keep up-to-date, don't you? Or is your doctor  still staying with the knowledge learned in medical school?
Current Biology, Volume 23, Issue 23, R1057-R1062, 2 December 2013
Copyright © 2013 Elsevier Ltd All rights reserved.



Mirror neurons were discovered over twenty years ago in the ventral premotor region F5 of the macaque monkey. Since their discovery much has been written about these neurons, both in the scientific literature and in the popular press. They have been proposed to be the neuronal substrate underlying a vast array of different functions. Indeed so much has been written about mirror neurons that last year they were referred to, rightly or wrongly, as “The most hyped concept in neuroscience”. Here we try to cut through some of this hyperbole and review what is currently known (and not known) about mirror neurons.

A blogger discussing it here;

Will you make a full recovery?

Don't listen to your doctors, they know absolutely nothing. They don't even know enough to get an objective damage diagnosis, dead neuron area vs. damaged neuron area.
Like Scott Carpenter;

Mercury astronaut Scott Carpenter suffers stroke; full recovery expected


 Scott Carpenter - Obituary


Monty Don: I'll make full recovery from stroke 

And this hallelujah case for tPA. Whats the difference between her getting it at 3 hours and it completely working and me getting it at 90 minutes and blowing out the clot but not restoring function?

Beau Biden in 'Good Spirits,' Expected to Make Full Recovery


This guy was very lucky, that tPA actually worked. 

Expert stroke treatment, full recovery

Former Wallabies coach Eddie Jones expects to make full recovery following stroke

Kirk faces a potentially long recovery from stroke

Chances for full mental recovery are good
chances for full physical recovery are 'not great,' his neurosurgeon says







Scott Carpenter


I Am Unstoppable

Just in case you need to see what other handicapped individuals have done.
I dream big;
Why I believe I'll recover - stroke rehab

Diana Nyad: Never, ever give up

What Is Positive Thinking?

Critics of the power of positive thinking often say it is a naive world view that refuses to look at the facts. "Life is hard and then you die" is their motto. Psychologists and others who have studied the subject in depth disagree. Truly positive thinkers, far from hiding their heads in the sand, face life's challenges head-on because they are able to learn and grow from negative experiences and take advantage of existing opportunities.
She obviously learned from her previous failures. Are you learning from all the hundreds of thousands of failures you will need to experience to recover?

Pinnacle Cookie Dough Vodka

Found this empty bottle in the parking lot after clearing the inner loop of the trail in two hours. It was wonderful, 50 degrees out and I'll be able to at least ski one loop this winter.  Only 2 falls into the wet snow and getting up is an exercise in getting every inch of your pants wet.
Imitation Chocolate Chip Cookie Dough  Flavored Vodka, the smell is not great.  As compared to the Johnnie Walker Blue Label I had last night.

New Jersey family moving to Colorado to get pot butter for epileptic child

Are your parents going to move to a legal marijuana state for their recovery from stroke? Having it as medical marijuana only is just way too limiting.
What is your doctor doing with your stroke protocols based on all this research? Nothing?
The reasons for marijuana stroke rehab here:
1. Small Quantities Of Marijuana Protect Against Brain Damage 
2. Cannabis chemical 'helps heart' The cannabis chemical helps ward off heart disease, scientists say
3. Neuroimmmune interactions of cannabinoids in neurogenesis: focus on interleukin-1β (IL-1β) signalling
4.  Symptomatic therapy in multiple sclerosis: the role of cannabinoids in treating spasticity
5.  A cannabinoid type 2 receptor agonist attenuates blood–brain barrier damage and neurodegeneration in a murine model of traumatic brain injury
6.  Marijuana might cause new cell growth in the brain
7.  A Marijuana Bud A Day Keeps The Stroke Away 
8.  Marijuana and stroke rehab