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, September 30, 2014

Open Office Hours: Stanford neurobiologist taking your questions on brain research

I put in a few of mine. If we had anything even approaching a crappy stroke association he could have gone directly there and gotten loads of questions. But that will only occur after I'm running one of them. Ask away and innundate him.
Ignore the Oct. 1 deadline, that's way too limiting.

Today, more than ever, patient organisations are playing an increasing role in influencing the drug development process

If we had a stroke patient organization I'm sure we could solve one hell of a lot of the problems in stroke. But we don't, they are press release organizations and really just for doctors regardless of what their mission statement says.

If you just had a stroke, You are F*cking screwed

0. There is no fast, easy and objective way to diagnose a stroke.
1. tPA may save your life but only has a 12% efficacy for full recovery.
2. Your neurologist doesn't have any concrete stroke protocols to save all the neurons that are dying in the first week.
3. Your neurologist or physiatrist doesn't have any clue about how to get you to full recovery. (Ask them exactly how to do it), you'll get excuses.
4. Only 10% get to full recovery.
5. No protocols to prevent your 33% chance of getting dementia post-stroke.
6. Nothing to alleviate your fatigue.
7. Nothing that will cure your spasticity.
8. Nothing on cognitive training unless you find this yourself.
9. No published stroke protocols.
10. No way to compare your stroke hospital results vs. other stroke hospitals.
11. No dietary plan to help you recover or even to prevent the next stroke.
Everything in stroke is a complete failure.

"If you have a stroke in the United States in 2014, you're better off if you're a rodent than if you're a human being."

A John Krakauer    quote. Quite true because you are screwed if you have a stroke right now.
His presentation "Motor Recovery After Stroke in Mice and Men" at a Johns Hopkins University seminar on brain science research got off to this start: "If you have a stroke in the United States in 2014, you're better off if you're a rodent than if you're a human being."
It was arresting, glib, and, based on what Krakauer has learned through experiments with rats and mice, true. When receiving intensive therapy in a stimulating environment—through interaction with toys, chutes, mirrors, rodent friends, interesting areas to explore—lab rats get better faster. Though humans unquestionably get excellent care at the time of a stroke with the delivery of clot-busting drugs and surveillance for complications, in Krakauer's opinion, standard post-stroke care for humans is intolerably backward.
Current rehabilitation therapies are medieval, Krakauer, a professor of neurology and neuroscience at Hopkins, told the audience of science writers. "It's time for a revolution."
A Rebel With a Cause
John Walter Krakauer is 47 years old and wears narrow rectangular blue eyeglasses that confer a kind of wry, postmodern look. The tone (British in accent) is by turns ironic, questioning (science, he says, is all about doubts and questions—not methodology), and supremely self-assured. To his patients he is compassionate, respectful, and accessible. He does not wear a white coat when making rounds and will unhesitatingly order a neurology resident who is more focused on email than on the patient to leave the room. (Related: "Virtual Dolphin on a Mission".)

More at link.

Mechanisms of Stroke Induced Neuronal Death: Multiple Therapeutic Opportunities

It is nice to see a pretty complete writeup of of the neuronal cascade of death. Now if we just had a great stroke association pushing a strategy to solve these problems we might get somewhere. But we don't, we have press release organizations that believe their highest calling is unknown to survivors.
But this was mostly written about by Dr. Michael A. Moskowitz in 2010;
The Science of Stroke: Mechanisms in Search of Treatments Dr. Michael A. Moskowitz 
We shouldn't have to write up the same crap every couple of years. Create a damn strategy and plan and follow it to a complete solution. Does no one have two neurons to rub together?

Learn signs, symptoms of a stroke seminar - Cincinnati OH

You will need to attend and ask very hard hitting questions.
1. How exactly are you objectively determining that a stroke is occurring?
2. What is your tPA full recovery percentage? Not just that they survived, that their brain returned to normal.
3. What are you doing in the first week to stop the neuronal cascade of death?
Not knowing these answers is a reason to call up the hospital president and ask when the incompetent stroke department head is going to be fired.
According to the National Stroke Association, nearly 800,000 people experience a stroke each year. Medical experts know that it is critical to recognize the symptoms and get treatment quickly when stroke occurs.
That’s why St. Elizabeth is hosting a free program at 9 a.m. Oct. 9 at Cincinnati Airport Marriott, 2395 Progress Drive in Hebron.
Dr. Daniel Kim, a vascular surgeon with the St. Elizabeth Heart & Vascular Institute, will explore the different types of strokes, the signs and symptoms of a stroke, and what to do if you think you or someone you love is having a stroke. The event is sponsored by the St. Elizabeth Cardiovascular Mobile Health Unit and includes a breakfast.
Information: There is no charge for the program, but reservations are required by Oct. 1. To register, call 859-301-9355.

Blood Pressure–Lowering Treatment With Candesartan in Patients With Acute Hemorrhagic Stroke

Someday our medical teams will figure out exactly what should be done for blood pressure lowering post-stroke. Maybe create a f*cking protocol and publish it for the world to see. Other research here:
1. Detrimental effect of blood pressure reduction in the first 24 hours of acute stroke onset
 2. Early Intensive Blood-Pressure Lowering Improves Recovery in Patients With Acute Intracerebral Haemorrhage
 3.  Systolic Blood Pressure During Acute Stroke Is Associated With Functional Status and Long-term Mortality in the Elderly
 4. External Counterpulsation Augments Blood Pressure and Cerebral Flow Velocities in Ischemic Stroke Patients With Cerebral Intracranial Large Artery Occlusive Disease
5.  The One Benefit Of High Blood Pressure? It May Prevent Dementia
6.  Stopping Pre-Stroke Antihypertensive Medication Advised During Acute Stroke 
7.  Mild induced hypertension improves blood flow and oxygen metabolism in transient focal cerebral ischemia
8.  Low Diastolic Pressure Linked to Brain Atrophy 
9.  New Treatment for Stroke Set to Increase Chances of Recovery - haemorrhage blood pressure lowering

Blood Pressure–Lowering Treatment With Candesartan in Patients With Acute Hemorrhagic Stroke
  1. Eivind Berge, MD, PhD;
  2. on behalf of the Scandinavian Candesartan Acute Stroke Trial Study Group
+ Author Affiliations
  1. From the Departments of Neurology (M.J., E.C.S.) and Internal Medicine (E.B.), Oslo University Hospital, Oslo, Norway; and Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom (P.M.W.B.).
  1. Correspondence to Eivind Berge, MD, PhD, Oslo University Hospital, Department of Internal Medicine, Kirkeveien 166, NO-0407 Oslo, Norway. E-mail


Background and Purpose—Early and intensive blood pressure–lowering treatment seems to be beneficial in patients with acute hemorrhagic stroke and high blood pressure. We wanted to see if similar benefits can be shown from a later and more gradual blood pressure lowering, using data from the Scandinavian Candesartan Acute Stroke Trial (SCAST).
Methods—SCAST was a randomized- and placebo-controlled, double-masked trial of candesartan given for 7 days, in 2029 patients with acute stroke and systolic blood pressure ≥140 mm Hg. We assessed the effects of candesartan in the 274 patients with hemorrhagic stroke, using the trial’s 2 coprimary effect variables: the composite vascular end point of vascular death, stroke or myocardial infarction, and functional outcome at 6 months, according to the modified Rankin Scale. We used Cox proportional hazards models and ordinal regression for analysis and adjusted for key, predefined prognostic variables.
Results—There was no association between treatment with candesartan and risk of vascular events (17 of 144 [11.8%] versus 13 of 130 [10.0%]; hazard ratio, 1.36; 95% confidence interval, 0.65–2.83; P=0.41). For functional outcome we found evidence of a negative effect of candesartan (common odds ratio, 1.61; 95% confidence interval, 1.03–2.50; P=0.036).
Conclusions—There was no evidence that blood pressure–lowering treatment with candesartan is beneficial during the first week of hemorrhagic stroke. Instead, there were signs that such treatment may be harmful, but this needs to be verified in larger studies.
Clinical Trial Registration—URL: Unique identifier: NCT00120003.

Monday, September 29, 2014

13 Scientific Reasons To Drink Coffee

Is your hospital plying you with lots of coffee? Why not? Are they totally incompetent?
details at link.

1. Coffee Can Improve Energy Levels and Make You Smarter

2. Coffee Can Help You Burn Fat

3. The Caffeine Can Drastically Improve Physical Performance

4. There Are Essential Nutrients in Coffee

5. Coffee May Lower Your Risk of Type II Diabetes

6. Coffee May Protect You From Alzheimer's Disease and Dementia

7. Caffeine May Lower The Risk of Parkinson's

8. Coffee Appears to Have Protective Effects on The Liver

9. Coffee Can Fight Depression and Make You Happier

10. Coffee Drinkers Have a Lower Risk of Some Types of Cancer

11. Coffee Does Not Cause Heart Disease and May Lower The Risk of Stroke

12. Coffee May Help You Live Longer

13. Coffee is The Biggest Source of Antioxidants in The Western Diet

Virtual reality training for upper extremity in subacute stroke (VIRTUES): study protocol for a randomized controlled multicenter trial

You will have to have your doctor get the complete study because there is not enough in the details here to tell how good it is or what the protocol looks like. If your stroke department head doesn't know about this study before you bring it up it is time to call your hospital president and demand some people get fired. Damn it all, these people are supposed to know more than their patients.
Novel virtual reality rehabilitation systems provide the potential to increase intensity and offer challenging and motivating tasks. The efficacy of virtual reality systems to improve arm motor function early after stroke has not been demonstrated yet in sufficiently powered studies.

The objective of the study is to investigate whether VR training as an adjunct to conventional therapy is more effective in improving arm motor function in the subacute phase after stroke than dose-matched conventional training, to assess patient and therapist satisfaction when working with novel virtual reality training and to calculate cost-effectiveness in terms of resources required to regain some degree of dexterity.Methods/DesignRandomized controlled observer-blind trial.One hundred and twenty patients up to 12?weeks after stroke will be randomized to either a group receiving VR training or dose-matched and therapist attention-matched conventional arm training in addition to standard rehabilitation. During a period of four weeks the patients will be offered additional 4?5 training sessions a week of 45?60 minutes duration by a physiotherapist or an occupational therapist.Study outcomes: Arm motor function, dexterity and independence in daily life activities will be evaluated at baseline, post treatment and three months follow-up assessments with the Action Research Arm Test, Box and Blocks Test and the Functional Independence Measure, respectively.

Patient and therapist satisfaction with the implementation of a VR rehabilitation system will also be assessed with questionnaires and interviews.DiscussionVirtual reality systems are promising tools for rehabilitation of arm motor function after stroke. Their introduction in combination with traditional physical and occupational therapy may enhance recovery after stroke, and at the same time demand little personnel resources to increase training intensity.

The VIRTUES trial will provide further evidence of VR-based treatment strategies to clinicians, patients and health economists.Trial NCT02079103

Sunday, September 28, 2014

Rehabilitation Institute of Chicago First to Develop Thought Controlled Robotic Leg

The main problem with this for stroke survivors is that we aren't sending decent signals down to the leg muscles. So I don't see any use for this until that is solved.
The science of bionics helped the more than 1 million Americans1 with leg amputations take a giant step forward, as the Rehabilitation Institute of Chicago (RIC) revealed clinical applications for the world’s first thought-controlled bionic leg in the September 26, 2013 issue of The New England Journal of Medicine. This innovative technology represents a significant milestone in the rapidly growing field of bionics. Until now, only thought-controlled bionic arms were available to amputees.
RIC's Levi Hargrove announces new bionic legLevi Hargrove, PhD, the lead scientist of this research at RIC’s Center for Bionic Medicine, developed a system to use neural signals to safely improve limb control of a bionic leg.
“This new bionic leg features incredibly intelligent engineering,” said Hargrove. “It learns and performs activities unprecedented for any leg amputee, including seamless transitions between sitting, walking, ascending and descending stairs and ramps and repositioning the leg while seated.”
This method improves upon prosthetic legs that only use robotic sensors and remote controls and do not allow for intuitive thought control of the prosthetic.
Zac Vawter with RIC's bionic legThe case study focuses on RIC research subject Zac Vawter, a lower-limb amputee who underwent targeted muscle reinnervation surgery – a procedure developed at RIC and Northwestern University – in 2009 to redirect nerves from damaged muscle in his amputated limb to healthy hamstring muscle above his knee. When the redirected nerves instruct the muscles to contract, sensors on the patient’s leg detect tiny electrical signals from the muscles. A specially-designed computer program analyzes these signals and data from sensors in the robotic leg. It instantaneously decodes the type of movement the patient is trying to perform and then sends those commands to the robotic leg. Using muscle signals, instead of robotic sensors, makes the system safer and more intuitive.
RIC's bionic leg with targeted muscle reinnervation“The bionic leg is a big improvement compared to my regular prosthetic leg,” stated Vawter. “The bionic leg responds quickly and more appropriately, allowing me to interact with my environment in a way that is similar to how I moved before my amputation. For the first time since my injury, the bionic leg allows me to seamlessly walk up and down stairs and even reposition the prosthetic by thinking about the movement I want to perform. This is a huge milestone for me and for all leg amputees.”

Saturday, September 27, 2014

Walking Really Is Just Falling and Catching Yourself

You should probably understand this as soon as you start walking post-stroke.

Cyberdyne exoskeleton

For those survivors with extreme walking problems, this might be a good solution. Ask your doctor for recommendations and see how little they actually know.

Multi-function robotic exoskeleton REX.

For those survivors with extreme walking problems, this might be a good solution. Ask your doctor for recommendations and see how little they actually know.

League of Denial: The NFL’s Concussion Crisis

I know I'm just a stroke-addled non-medical person but it seems incredibly stupid that no one in football is talking about possible interventions.
A repeat of the Frontline show on PBS, Tuesday, September 30.

UC to Study New Drug in Patients with Traumatic Brain Injury

Looking at pretreatment with fish oil or post-treatment with fish oil

After the fact here;
Aspirin plus fish oil for a hyperacute treatment 

What the hell is the downside? Fish breath?

London Calling Microwave Helmets Will help Save Stroke Victims

But can this not be fooled by old infarcts? Or would these 7 others be better?
Call up your hospital president and demand to know what they are doing to have a fast easy and objective stroke diagnosis. Doing nothing is a sign of extreme incompetence. That should be a fireable offense.
1. New EEG electrode set for fast and easy measurement of brai function abnormalities

2. Eye-Tracking Tool Might Quickly Spot Stroke

3.  How the wave of a wand can detect bleeding in the brain 

4. Neurokeeper EEG Headset Spots Signs of Stroke in Brainwave Signatures 

5.  Pupil response via infrared light 

6. Brain oximeter and frontal near-infrared spectroscopy
7. Ischiban headband 


The newest one here:
London Calling Microwave Helmets Will help Save Stroke Victims

An International Randomized Clinical Trial of Activity Feedback During Inpatient Stroke Rehabilitation Enabled by Wireless Sensing

What a novel idea. Objective measurements of muscle activity. What took so f*cking long to think of this?
Would this
3-D Body Suit Put to Use in Healthcare Research
have been even better?
Or this?
Rapid Rehab Smart Insole Will Train Athletes and Assist Rehab Patients

And Bruce Dobkin is known for this book:

The Clinical Science of Neurologic Rehabilitation.

 From this lack of using the most up-to-date technology for research our stroke researchers are failing us.
  1. Andrew K. Dorsch, MD1
  2. Seth Thomas1
  3. Xiaoyu Xu, PhD1
  4. William Kaiser, PhD1
  5. Bruce H. Dobkin, MD1
  6. on behalf of the SIRRACT investigators
  1. 1University of California, Los Angeles, CA, USA
  1. Bruce H. Dobkin, Department of Neurology, Geffen School of Medicine, University of California Los Angeles, RNRC, Room 1-129, 710 Westwood Plaza, Los Angeles, CA 90095, USA. Email:


Background. Walking-related disability is the most frequent reason for inpatient stroke rehabilitation. Task-related practice is a critical component for improving patient outcomes.  

Objective. To test the feasibility of providing quantitative feedback about daily walking performance and motivating greater skills practice via remote sensing. 

Methods. In this phase III randomized, single blind clinical trial, patients participated in conventional therapies while wearing wireless sensors (triaxial accelerometers) at both ankles. Activity-recognition algorithms calculated the speed, distance, and duration of walking bouts. Three times a week, therapists provided either feedback about performance on a 10-meter walk (speed only) or walking speed feedback plus a review of walking activity recorded by the sensors (augmented). Primary outcomes at discharge included total daily walking time, derived from the sensors, and a timed 15-meter walk.  

Results. Sixteen rehabilitation centers in 11 countries enrolled 135 participants over 15 months. Sensors recorded more than 1800 days of therapy, 37 000 individual walking bouts, and 2.5 million steps. No significant differences were found between the 2 feedback groups in daily walking time (15.1 ± 13.1 vs 16.6 ± 14.3 minutes, P = .54) or 15-meter walking speed (0.93 ± 0.47 vs 0.91 ± 0.53 m/s, P = .96). Remarkably, 30% of participants decreased their total daily walking time over their rehabilitation stay.  

Conclusions. In this first trial of remote monitoring of inpatient stroke rehabilitation, augmented feedback beyond speed alone did not increase the time spent practicing or improve walking outcomes. Remarkably modest time was spent walking. Wireless sensing, however, allowed clinicians to audit skills practice and provided ground truth regarding changes in clinically important, mobility-related activities.

Hospital Patients To Get Organic Fruit & Veggie Prescriptions As Part Of New Project

There are lots of diet possibilities post-stroke that could be helpful if our hospitals would do anything useful for stroke survivors. This won't occur at your hospital unless YOU contact the hospital president directly. Your stroke department head will not be doing anything innovative so don't even bother talking to her/him.

Mine here:

What would a post-stroke diet look like?

Friday, September 26, 2014

GOP Congressman Warns Of The Real Social Ill Destroying American Values: Marijuana

If you are a constituent of Rep. John Fleming (R-La.) call him up and ream him out about his stupidity on marijuana. Tell him you need it for stroke recovery and point directly to the research proving it works. WE have to take charge on this because doctors like him are what is so wrong with our marijuana policy.  We need complete legalization because medical marijuana rules never allow stroke survivors to use it.

My 13 reasons to use it post-stroke.

Barbara Arrowsmith Young (Arrowsmith Program): Every kid should practice stress reduction and targeted cognitive exercises at school

Look how simple this would be for our hospitals to set up. They could buy a cognitive exercise program from the Arrowsmith Program for all stroke survivors and have it running within weeks. But your stroke doctor head is going to do absolutely nothing unless YOU start screaming about this stuff to the president of the hospital. WE have to take charge because the stroke medical world has proven their incomptence for the last 50 years or so.

8 Foods That Could Help Unclog Your Arteries

You can read this but they missed a big one.

Watermelon juice reverses hardening of the arteries 

1. Garlic

2. Pomegranate

3. Turmeric

4. Chia Seeds

5. Cinnamon

6. Apples

7. Tomatoes

8. Greens



Singapore to set up rehabilitation research institute

This is only going to be helpful if YOU tell them to solve the problems in stroke. This will be a waste of money if you don't get involved and force a strategy to be followed.
Problems in stroke;

1. There is no fast, easy and objective way to diagnose a stroke. Maybe when the Qualcomm Tricorder X Prize is available. A number of friends have waited hours in ERs until stroke symptoms have visibly manifested themselves.
2. Only 10% get to almost full recovery.
3. 12% tPA efficacy
4. Nothing being done to stop the neuronal cascade of death during the first week.
5. No one knows how to cure spasticity.
6.  No one knows how to cure fatigue.
7. F.A.S.T is actually a failure because even at its best tPA is only delivered to 33% of those eligible and then of those that get it  it only works to completely reverse the stroke 12% of the time.
About S$100 million will be pumped into setting up a new rehabilitation research institute in Singapore to develop innovative solutions for better patient outcomes.
Announced by Health Minister Gan Kim Yong at the opening of the Singapore Health and Biomedical Congress 2014 on Friday (Sep 26), the Rehabilitation Research Institute of Singapore (RRIS)’s key areas of study will include stroke and neurological rehabilitation, clinical robotics and biomechanics as well as the development of computer games for rehabilitation.
The institute, a collaboration between the Agency for Science, Technology and Research (A*STAR), Nanyang Technological University (NTU) and the National Healthcare Group (NHG), will leverage the expertise of scientists, clinicians and engineers.
There are up to 9,000 new stroke cases in Singapore yearly, and about one in three stroke survivors requires various types of rehabilitation. Advanced technology that combines the use of innovative robots and simulation games with traditional rehabilitation therapy have helped stroke patients' with their mobility at Tan Tock Seng Hospital, and the aim is for similar projects to be developed at the new research institute.
A*STAR Executive Director Tan Geok Leng pinpointed nutrition as one of the areas the institute will focus on: "In an Asian society, we have an idea that if we take tonic you would speed up your healing. So in A*STAR, we have a site that's called nutrition research. We intend to bring that in so that we not just look at the mechanical part, but also at how nutrition helps rehab."
The centre will also leverage the expertise of scientists, clinicians and engineers to develop such innovative technology solutions for patients. Scientists at NTU will play a key role in translating basic science and clinical findings into real-life applications, through the use of cutting-edge technology.
Meanwhile A*STAR will provide a wide range of expertise in biomedical sciences and physical sciences while NHG, through Tan Tock Seng Hospital will lend clinical expertise from its team of rehabilitation physicians. A multi-disciplinary team of therapists will also provide expertise to bring research from bench to bedside and develop solutions for patients.
In order to tackle the complex challenges of a growing ageing population, partners of this collaboration said inter-disciplinary research combining biomedical engineering with medicine is the way forward. The research institute plans to come up with two new projects yearly.
Mr Gan stressed that research, constant innovation and manpower development are all crucial for transforming the care model  in Singapore. All stakeholders, such as acute and community hospitals, polyclinics, home care and day-rehab providers, also play an important role in redefining the care delivery. "By integrating care across settings within a regional health system, we want to gradually change the focal point for care, from acute hospitals, to the patients at the centre," he said.

Researchers Find Benefit for Foot Drop Stimulator in Rehabilitation After Stroke

Is there anything about stroke rehab that actually works?
Use of a foot drop stimulator during a task-specific movement for 4 weeks can retrain the neuromuscular system after a stroke, according to a study published in the journal NeuroRehabilitation.
This finding indicates that applying the foot drop stimulator as rehabilitation intervention may facilitate recovery from this common complication of stroke.
Foot drop, a common sequela of hemiplegia caused by stroke, decreases mobility and limits activities of daily living.
“Compensatory strategies have a negative effect on gait pattern,” said Karen J. Nolan, PhD, Kessler Foundation, West Orange, New Jersey. “While use of an ankle-foot orthosis can improve speed and function, it is not designed to restore muscle function.(Exactly what Peter Levine writes about).
“We looked at whether stimulation of the peroneal nerve during walking would retrain the temporal activation of the tibialis anterior muscle,” she said.
For the study, 4 patients more than 3 months post right-sided stroke completed 10 walking trials (5 with and 5 without stimulator) at baseline and after 4 weeks of using a commercial device (WalkAide).
“We found a potential training effect in all participants,” said Dr. Nolan. “These results indicate that use of the stimulator may facilitate recovery of muscle function.”
SOURCE: Kessler Foundation

The mirror illusion induces high gamma oscillations in the absence of movement

You are going to have to have your doctor explain how this helps your recovery using mirror therapy.
I can't figure it out.
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We examined movement-related high gamma oscillations (HGOs) in healthy humans with MEG.
Real hand movements produced sensorimotor HGO in the contralateral hemisphere.
Similar HGO response was triggered by mirror visual feedback from a moving hand.
HGO in sensorimotor cortex may reflect the neural mechanism of mirror-hand illusion.


We tested whether mirror visual feedback (MVF) from a moving hand induced high gamma oscillation (HGO) response in the hemisphere contralateral to the mirror and ipsilateral to the self-paced movement. MEG was recorded in 14 subjects under three conditions: bilateral synchronous movements of both index fingers (BILATERAL), movements of the right hand index finger while observing the immobile left index finger (NOMIRROR), and movements of the right hand index finger while observing its mirror reflection (MIRROR). The right hemispheric spatiospectral regions of interests (ROIs) in the sensor space, sensitive to bilateral movements, were found by statistical comparison of the BILATERAL spectral responses to baseline. For these ROIs, the post-movement HGO responses were compared between the MIRROR and NOMIRROR conditions. We found that MVF from the moving hand, similarly to the real movements of the opposite hand, induced HGO (55–85 Hz) in the sensorimotor cortex. This MVF effect was frequency-specific and did not spread to oscillations in other frequency bands. This is the first study demonstrating movement-related HGO induced by MVF from the moving hand in the absence of proprioceptive feedback signaling. Our findings support the hypothesis that MVF can trigger the feedback-based control processes specifically associated with perception of one's own movements.

Living scaffolds for neuroregeneration

This sounds extremely important for our exercise generated neurogenesis to find their way to the correct locations. So ask your doctor what they are doing about contacting these researchers to make sure they are doing this correctly and creating good translational research that will directly help survivors.
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Tissue engineered “living scaffolds” consist of cells in a defined 3D architecture.
Living scaffolds present cues to facilitate nervous system repair.
They mimic developmental mechanisms of axon growth and cell migration.
Living scaffolds modulate the regenerative environment based on local feedback.
They may elicit tissue reconstruction following neurodegenerative disease or trauma.


Neural tissue engineers are exploiting key mechanisms responsible for neural cell migration and axonal pathfinding during embryonic development to create living scaffolds for neuroregeneration following injury and disease. These mechanisms involve the combined use of haptotactic, chemotactic, and mechanical cues to direct cell movement and re-growth. Living scaffolds provide these cues through the use of cells engineered in a predefined architecture, generally in combination with biomaterial strategies. Although several hurdles exist in the implementation of living regenerative scaffolds, there are considerable therapeutic advantages to using living cells in conjunction with biomaterials. The leading contemporary living scaffolds for neurorepair are utilizing aligned glial cells and neuronal/axonal tracts to direct regenerating axons across damaged tissue to appropriate targets, and in some cases to directly replace the function of lost cells. Future advances in technology, including the use of exogenous stimulation and genetically engineered stem cells, will further the potential of living scaffolds and drive a new era of personalized medicine for neuroregeneration.


  • Tissue engineering;
  • Cell transplant;
  • Biomaterials;
  • Regeneration;
  • Neurotrauma;
  • Neurodegeneration;
  • Axon pathfinding;
  • Cell migration

Corresponding author at: 105E Hayden Hall/3320 Smith Walk, Philadelphia, PA 19104, United States. Tel.: +1 215 746 8176; fax: +1 215 573 3808.
The first two authors contributed equally to this manuscript.
Address: 373 Stemmler Hall/3450 Hamilton Walk, Philadelphia, PA 19104, United States. Tel.: +1 215 898 9218; fax: +1 215 573 3808.
Address: 502 Stemmler Hall/3450 Hamilton Walk, Philadelphia, PA 19104, United States. Tel.: +1 215 898 9218; fax: +1 215 573 3808.

Transformation of cortical and hippocampal neural circuit by environmental enrichment

How long before environment enrichment is standard practice at all stroke hospitals? Whats the downside? Dale Corbett wrote about this years ago.
Stimulate senses and stroke rehab


It has been half a century since brain volume enlargement was first reported in animals reared in an enriched environment (EE). As EE animals show improved memory task performance, exposure to EE has been a useful model system for studying the effects of experience on brain plasticity. We review EE-induced neural changes in the cerebral cortex and hippocampus focusing mainly on works published in the recent decade. The review is organized in three large domains of changes: anatomical, electrophysiological, and molecular changes. Finally, we discuss open issues and future outlook toward better understanding of EE-induced neural changes.

Goal setting practice in services delivering community-based stroke rehabilitation: a United Kingdom (UK) wide survey

Goal setting is great but what would be even more important would be goal results. If you don't even know how badly you are missing your stroke rehabilitation goals you can never get them corrected. YOU will have to demand this as the next step since otherwise this will not get done and you as a stroke survivor will be negatively affected.
Address for correspondence:
Lesley Scobbie, MSc
, Clinical Research Fellow, NMAHP Research Unit,
Unit 13, Scion House, Innovation Park, University of Stirling, Stirling FK9 4NF, Scotland
, UK. Tel: 01786 466115. E-mail:


Purpose: We investigated the nature of services providing community-based stroke rehabilitation across the UK, and goal setting practice used within them, to inform evaluation of a goal setting and action planning (G-AP) framework. 

Methods: We designed, piloted and electronically distributed a survey to health professionals working in community-based stroke rehabilitation settings across the UK. We optimised recruitment using a multi-faceted strategy. Results: Responses were analysed from 437 services. Services size, composition and input was highly variable; however, most were multi-disciplinary (82%; n = 335/407) and provided input to a mixed diagnostic group of patients (71%; n = 312/437). Ninety one percent of services (n = 358/395) reported setting goals with “all” or “most” stroke survivors. Seventeen percent (n = 65/380) reported that no methods were used to guide goal setting practice; 47% (n = 148/315) reported use of informal methods only. Goal setting practice varied, e.g. 98% of services (n = 362/369) reported routinely asking patients about goal priorities; 39% (n = 141/360) reported routinely providing patients with a copy of their goals. 
Conclusions: Goal setting is embedded within community-based stroke rehabilitation; however, practice varies and is potentially sub-optimal. Further evaluation of the G-AP framework is warranted to inform optimal practice. Evaluation design will take account of the diverse service models that exist.Implications for Rehabilitation
  • Community-based stroke rehabilitation services across the UK are diverse and tend to see a mixed diagnostic group of patients.
  • Goal setting is implemented routinely within community-based stroke rehabilitation services; however, practice is variable and potentially sub-optimal.
  • Further evaluation of the G-AP framework is warranted to assess its effectiveness in practice.

Read More:

"Stroke alert: Take action!" - Mineola, NY seminar

Go to it and see if they talk about anything other than the stupid generic prevention ideas.

According to the National Stroke Association(r), about 80% of strokes are preventable. To learn the latest information about stroke prevention guidelines, the public is invited to attend Winthrop-University Hospital's Health Update for Seniors free seminar, "Stroke Alert: Take Action!," on Wednesday, October 8, 2014, at 1:15 PM. It will be held at the Mineola Community Center, 155 Washington Avenue in Mineola (one block south of Jericho Turnpike and one block east of Mineola Boulevard), and will focus on how individuals can reduce their risk, as well as identify the warning signs of a stroke and understand the significance of taking immediate action if symptoms occur.
Kathleen Michel, CNRN, MSN, FNPBC, Administrative Director and Coordinator of the Cerebrovascular Program at Winthrop, will explain the mechanisms of a stroke, risk factors and the latest advances in treatment. A question and answer period will be included. Free parking is adjacent to the building. Metered parking is available across the street. Seating is limited and reservations are required. To reserve a space, please call (516) 663-3916.

Here are my ideas on stroke prevention: Never, ever follow me.
Like my 11 Stroke risk reduction ideas.

Ask what they are doing in the first week to prevent the neuronal cascade of death.
Like these 31 hyperacute possibilities

Wednesday, September 24, 2014

The importance of cognition to quality of life after stroke

Well shit, this is stupid. Pointing out the obvious with nothing about what should be done to correct any cognition problems post-stroke. Don't just explain what the problem is, expend some of your brainpower and propose a solution. Stupidity and laziness rule once again.



Suffering a stroke typically has a negative impact on a person's quality of life. There is some evidence that post-stroke cognitive impairment is associated with poor quality of life, but the relative importance of deficits in different cognitive domains has not been established.


Patients with confirmed stroke were recruited in the acute hospital. A subgroup of patients completed 2 computerized cognitive tasks (simple and choice reaction time) within 2weeks of stroke. The full cohort was followed up at 3months with a comprehensive neuropsychological battery and then at 12months with the Assessment of Quality of Life ('AQoL).


Sixty patients participated in the study (mean age 72.1years, SD 13.9), with a subgroup of 33 patients tested acutely (mean age 75.5years, SD 11.9). Presence of cognitive impairment at 3months was independently associated with lower quality of life at 12months (p=0.021). Attention and visuospatial ability were the cognitive domains most closely associated with quality of life. Faster choice reaction time in the acute stage (mean 5.4days post-stroke) was significantly associated with better quality of life at 12months (p=0.003).


Cognition, particularly attention and visuospatial ability, is strongly associated with quality of life after stroke. It is possible that straightforward reaction time tasks are sensitive to the extent of brain damage, and might therefore be surrogate markers for quality of life.

6 ways to reduce your risk of developing Alzheimer’s Disease - The neuroprotective lifestyle by Mo Constandi

Once again writing about the mostly unhelpful general prescriptions that Mayo Clinic, Cleveland Clinic and Harvard push.

1. Exercise your body: 
2. Exercise your brain:
3. Stay in school:
4. Maintain a balanced diet: 
5. Get motivated:
6. Sleep well

Mine are here and backed by research articles. But never listen to me I'm not medically trained.
Dementia prevention 19 ways

New EEG electrode set for fast and easy measurement of brain function abnormalities

Possible use in stroke diagnosis if only we had a stroke association that would follow up research to create useful stroke protocols to help stroke survivors.  They could compare this to One of these 17 ways to diagnose a stroke
Photo credit: Pasi Lepola.

A new, easy-to-use EEG electrode set for the measurement of the electrical activity of the brain was developed in a recent study completed at the University of Eastern Finland. The solutions developed in the PhD study of Pasi Lepola, MSc, make it possible to attach the electrode set on the patient quickly, resulting in reliable results without any special treatment of the skin. As EEG measurements in emergency care are often performed in challenging conditions, the design of the electrode set pays particular attention to the reduction of electromagnetic interference from external sources.

EEG measurements can be used to detect such abnormalities in the electrical activity of the brain that require immediate treatment. These abnormalities are often indications of severe brain damage, cerebral infarction, cerebral haemorrhage, poisoning, or unspecified disturbed levels of consciousness. One of the most serious brain function abnormalities is a prolonged epileptic seizure, status epilepticus, which is impossible to diagnose without an EEG measurement. In many cases, a rapidly performed EEG measurement and the start of a proper treatment significantly reduces the need for aftercare and rehabilitation. This, in turn, drastically improves the cost-effectiveness of the treatment chain.

Although the benefits of EEG measurements are indisputable, they remain underused in acute and emergency care. A significant reason for this is the fact that the electrode sets available on the markets are difficult to attach on the patient, and their use requires special skills and constant training. This new type of an electrode set is expected to provide solutions for making EEG measurements feasible at as an early stage as possible.

The EEG electrode set was produced using screen printing technology, in which silver ink was used to print the conductors and measurement electrodes on a flexible polyester film. The EEG electrode set consists of 16 hydrogel-coated electrodes which, unlike in the traditional method, are placed on the hair-free areas of the patient's head, making it easy to attach. The new EEG electrode set significantly speeds up the measurement process because there is no need to scrape the patient's skin or to use any separate gels. As the electrode set is flexible and solid, the electrodes get automatically placed in their correct places. Furthermore, there is no need to move the patient's head when putting on the EEG electrode set, which is especially important in patients possibly suffering from a neck or skull injury. Due to the fact that the disposable electrode set is easy and fast to use, it is particularly well-suited to be used in emergency care, in ambulances and even in field conditions. Thanks to the materials used, the electrode set does not interfere with any magnetic resonance or computed tomography imaging the patient may undergo.

The performance of the electrode set was tested by using various electrical tests, on several volunteers, and in real patient cases. The results were compared to those obtained by traditional EEG methods.

The PhD study also focused on the use of screen printing technology solutions to protect electrodes against electromagnetic interference. The silver or graphite shielding layer printed to the outer edge of the electrode set was discovered to significantly reduce external interference on the EEG signal. This shielding layer can be easily and cost-efficiently introduced to all measurement electrodes produced with similar methods. Protecting the electrode with a shielding layer is beneficial when measuring weak signals in conditions that contain external interference.

Protein Mfn2 may increase the currently short therapeutic window in stroke

What the f*cking hell will it take to complete the testing and creation of a translational stroke protocol based on this? Or will everybody assume this is somebody else's problem and nothing will get done for 50 years because our stroke associations will not take it upon themselves to solve this to improve stroke survivors lives?  I'm looking at the boards of directors to push this forward.
A new study published in the prestigious publication The EMBO Journal shows that the mitochondrial protein Mfn2 may be a future therapeutic target for neuronal death reduction in the late phases of an ischemic stroke. The study has been coordinated by Dr Francesc Soriano, Ramón y Cajal researcher at the Department of Cell Biology of the University of Barcelona (UB) and member of the Research Group Celltec UB.
The study, funded by the Fundació La Marató de TV3, is part of the PhD thesis developed by Àlex Martorell Riera (UB), first author of the article. Experts Antonio Zorzano and Manuel Palacín, from the Department of Biochemistry and Molecular Biology of UB and the Institute for Research in Biomedicine (IRB Barcelona), and Jesús Pérez Clausell and Manuel Reina, from the Department of Cell Biology of UB, also collaborated in the study.
When blood flow is blocked in the brain
According to the World Health Organization (WHO), strokes are the second leading cause of death in the world. A stroke occurs when a blood vessel is blocked interrupting blood flow in the brain. Ictus damage is progressive: it begins some minutes after the attack. Recommended treatment consists in restoring blood flow to the brain, but it must be done during the first four hours after the stroke.
According to researcher Francesc Soriano, “one of the main causes of brain death in ictus events is glutamate increase; glutamate is the main excitatory neurotransmitter in the central nervous system. Glutamate extracellular concentrations remain low due to the activity of membrane transporters, which require energy to work”.
When blood flow is blocked, energy levels are reduced in the affected area. This phenomenon leads glutamate transporters to work inversely, so glutamate is expelled to the extracellular space. Glutamate activates its receptors —particularly, the N-methyl-D-aspartate receptor (NMDA)— on neurons’ surface, a process that triggers an excessive flux of calcium, the activation of a series of reactions and neuronal death, in a process known as excitotoxicity. “Many of these excitotoxic cascades —points out Soriano— converge on the mitochondrion, an organelle which plays a major role not only in energy production, but also in apoptosis”.
New therapeutic strategies against ischemic ictus
Specifically, Mfn2 is a mitochondrial protein involved in the regulation of organelles’ morphology and function. The team led by Dr Francesc Soriano has just discovered that the reduction in Mfn2 protein levels occurs four hours after the initiation of the excitotoxic process in in vitro and in vivo animal models.
In vivo experiments proved that if Mfn2 reduction is stopped, delayed excitotoxic cell death is blocked. The research team from the Department of Cell Biology of UB found that the Mfn2 reduction is triggered by a genetic transcription mechanism (DNA is transcribed into RNA molecules). UB experts also discovered that MEF2 is the transcription factor involved in this process. Authors affirm that these findings are essential to find a strategy to reverse Mfn2 reduction.
Currently, the team led by Dr Francesc Soriano are researching on brain damage in excitotoxic conditions in animal models where the gene Mfn2 has been removed. The main objective is to design therapeutic strategic in order to reduce damage.

Short-term changes in ambient particulate matter and risk of stroke: a systematic review and meta-analysis

Ambient particulate matter = air pollution. You may need to be wearing dust masks like the Chinese do. Your doctor should know whether you are at risk for this and the protocols to prevent that stroke risk.



Stroke is a leading cause of death and long-term disability in the United States. There is a well-documented association between ambient particulate matter air pollution (PM) and cardiovascular disease morbidity and mortality. Given the pathophysiologic mechanisms of these effects, short-term elevations in PM may also increase the risk of ischemic and/or hemorrhagic stroke morbidity and mortality, but the evidence has not been systematically reviewed.


We provide a comprehensive review of all observational human studies (January 1966 to January 2014) on the association between short-term changes in ambient PM levels and cerebrovascular events. We also performed meta-analyses to evaluate the evidence for an association between each PM size fraction (PM2.5, PM10, PM2.5-10) and each outcome (total cerebrovascular disease, ischemic stroke/transient ischemic attack, hemorrhagic stroke) separately for mortality and hospital admission. We used a random-effects model to estimate the summary percent change in relative risk of the outcome per 10-μg/m(3) increase in PM.


We found that PM2.5 and PM10 are associated with a 1.4% (95% CI 0.9% to 1.9%) and 0.5% (95% CI 0.3% to 0.7%) higher total cerebrovascular disease mortality, respectively, with evidence of inconsistent, nonsignificant associations for hospital admission for total cerebrovascular disease or ischemic or hemorrhagic stroke. Current limited evidence does not suggest an association between PM2.5-10 and cerebrovascular mortality or morbidity. We discuss the potential sources of variability in results across studies, highlight some observations, and identify gaps in literature and make recommendations for future studies.

Reflections on Mirror Therapy: A Systematic Review of the Effect of Mirror Visual Feedback on the Brain

These researchers are lazy. They just look up existing articles and base their analysis on that. Rather than actually doing clinical research with actual subjects. Hell, they could have just pointed to this and not even bothered to write this up.


Background. Mirror visual feedback (MVF), a phenomenon where movement of one limb is perceived as movement of the other limb, has the capacity to alleviate phantom limb pain or promote motor recovery of the upper limbs after stroke. The tool has received great interest from health professionals; however, a clear understanding of the mechanisms underlying the neural recovery owing to MVF is lacking. Objective. We performed a systematic review to assess the effect of MVF on brain activation during a motor task. Methods. We searched PubMed, CINAHL, and EMBASE databases for neuroimaging studies investigating the effect of MVF on the brain. Key details for each study regarding participants, imaging methods, and results were extracted. Results. The database search yielded 347 article, of which we identified 33 suitable for inclusion. Compared with a control condition, MVF increases neural activity in areas involved with allocation of attention and cognitive control (dorsolateral prefrontal cortex, posterior cingulate cortex, S1 and S2, precuneus). Apart from activation in the superior temporal gyrus and premotor cortex, there is little evidence that MVF activates the mirror neuron system. MVF increases the excitability of the ipsilateral primary motor cortex (M1) that projects to the "untrained" hand/arm. There is also evidence for ipsilateral projections from the contralateral M1 to the untrained/affected hand as a consequence of training with MVF.
Conclusion. MVF can exert a strong influence on the motor network, mainly through increased cognitive penetration in action control, though the variance in methodology and the lack of studies that shed light on the functional connectivity between areas still limit insight into the actual underlying mechanisms.

Tuesday, September 23, 2014

Dean's coming

I heard this several times during the night. I was at a wedding on Sat. , One of my cousins twin daughters got married .  I think I'd met her precisely 3 times. The first time at her high school graduation party, two other times at other cousins kids graduation parties.  Upon opening her RSVPs to the wedding, when she got to mine she called up her mom and dad and exclaimed, 'Dean's coming'. I'm not sure how I got to this exalted status but I'm one of the few that will take on her dad, called T-bear by her college friends.  It was only a 11.5 hour drive each way and going thru Chicago.
My cousin walking the bride down the aisle

The end of the ceremony

Eugene Saint Julien Cox House in St. Peter, Mn

Eugene Saint Julien Cox House in St. Peter, Mn

100 Days, 100 Ways to Support Parkinson's Research

If we had anything approaching a great stroke association something like this would be well known in the stroke world. But alas, we have press releases, not research. Big f*cking whoopee.
Dear Friend,
Only 100 days remain in 2014. With fall in full swing and the holidays just around the corner, the countdown is on to make the most of this year.
Today, Team Fox announces the launch of 100 Days, 100 Ways to showcase the hundreds of ways our community is helping speed a cure for Parkinson’s disease. With 100% of Team Fox proceeds going directly to research programs through the end of 2014, this group is making a real impact on the countless lives touched by Parkinson’s. And we want you to roll up your sleeves and be part of it!
Are you ready to join us? Whether you GET MOVING by participating in a local Turkey Trot 5K, JOIN IN by organizing a dress-down-day at work, or INSPIRE OTHERS by asking friends and family for donations in a holiday card insert, there are countless ways — big and small — to sprint to the finish of 2014 and raise funds and awareness through these last 100 days. Share photos of your fundraising efforts online using #TF100DAYS and we’ll post our favorite pix on the 100 Days, 100 Ways homepage.
Need inspiration? Next Tuesday, September 30, we are hosting an informational webinar to suggest more ideas, provide support and help get you started. Register today, and then share our campaign with friends and family online to inspire others to make their contribution towards Parkinson’s research this year.
Let's finish the year strong!
Team Fox