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:

Wednesday, September 30, 2015

The next revolution in stroke care

I most assuredly am not going to buy this because it probably contains less than I already know about.


Stroke is the second leading cause of death and disability worldwide. Initiatives to decrease the burden of stroke have largely focused on prevention and acute care strategies. Despite considerable resources and attention, the focus on prevention and acute care has not been successful in changing the clinical trajectory for the majority of stroke patients. While efforts to prevent strokes will continue to have an impact, the total burden of stroke will increase due to the aging population and decreased mortality rates. There is strong evidence for the effectiveness of rehabilitation in better managing stroke and its related disabilities. The time has come to shift the attention in stroke care and research from prevention and cure to a greater focus and investment in the rehabilitation and quality of life of stroke survivors. The rebalancing of stroke care and research initiatives requires a reinvestment in rehabilitation and community reintegration of stroke survivors.


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Oxygenating Blood With Nitrate-Rich Vegetables

Is this something your doctor should have as an immediate stroke protocol? What is the downside?
Probably much better and easier than HBOT.

Doctor's Note

Nitrates are one of the reasons I recommend eating dark green leafy vegetables every day. Beets are another good option (not just drinking the juice—see my last video Whole Beets vs. Juice for Improving Athletic Performance).

Stroke Challenge, Your Way

Another total waste of resources on the part of the National Stroke Association. Solve some fucking stroke problems instead of this meaningless fundraising crap. Betsy, you can do much better.
Stroke Challenge, Your Way
Dear dean,
3 people in Stoke Challenge T-shirts
Join this Stroke Challenge team
Did you know you can participate on a Stroke Challenge team without running a marathon, without traveling many miles to an event, and without a fundraising minimum?
Stroke Challenge, Your Way allows you to do just that—participate in YOUR WAY! And, there’s still time to get involved this year. Many communities have popular M onster Races, Turkey Trots or Jingle Bell Jogs that are a great opportunity for walkers and runners of all abilities to get out and celebrate their favorite holiday while sharing the stroke message. Don’t forget to invite your friends and family to join you!
It’s easy to get started today—visit our Stroke Challenge, Your Way page for details on getting started.
Join a community of teammates and volunteers and you’ll receive:
  • Access to National Stroke Association’s personal fundraising website to set up your online fundraising page
  • Dri-fit Stroke Challenge team t-shirt (when you raise $500 or more)
  • One-on-one fundraising support from National Stroke Association staff
  • Online social media group to connect with other Stroke Challenge team athletes
Questions? Contact Betsy at 303-754-0931 or
signature of Betsy Vanderpoel
Betsy Vanderpoel
Sr. Coordinator, Development

Two Human Brains Directly Connected To Play Parlour Game Over The Internet

With any innovative thinking at all, research into connecting a stroke brain with a normal brain would commence to see if this would jumpstart recovery. But since we have nothing for stroke associations or any strategy at all, this will never be looked into. You as a stroke survivor are fucking screwed.
Two human brains have been directly linked to play a game over the internet for the first time.
The experiment, carried out at the University of Washington, allowed people to send signals directly from one brain to the other over the internet.
Dr Andrea Stocco, the study’s first author, said:
“This is the most complex brain-to-brain experiment, I think, that’s been done to date in humans.
It uses conscious experiences through signals that are experienced visually, and it requires two people to collaborate.”
For the research, two people played a game similar to ’20 questions’ — a parlour game where you have to guess what object the other person is thinking of.
One person wore a cap measuring their brainwaves (EEG) and looked at a screen, on which was displayed an object, such as a dog.
They then responded to questions by focussing on one of two flashing LEDs.
Each were flashing at a different frequency and produced different types of brain waves.

When the sender looked at the ‘yes’ LED it activated (via the internet) a magnetic coil behind the receiver’s head.
This induced a phosphene — a line, wave or blob in the receiver’s visual field.
The results showed that in control experiments receivers guessed the correct object only 18% of the time.
But, when their brains were connected via the internet, the rate jumped to 72%.
The team are now working on the idea of sending whole brain states from one person to another.
For example, it may be possible to send signals from a healthy brain to someone who has suffered brain damage or has a developmental problem.
Dr Stocco said:
“Evolution has spent a colossal amount of time to find ways for us and other animals to take information out of our brains and communicate it to other animals in the forms of behavior, speech and so on.
But it requires a translation.
We can only communicate part of whatever our brain processes.
What we are doing is kind of reversing the process a step at a time by opening up this box and taking signals from the brain and with minimal translation, putting them back in another person’s brain.”
The study was published in the journal PLOS ONE (Stocco et al., 2015)

Survivors’ physical limitations rapidly increase over decade following heart attack and stroke; many face disability, depression and caregiver reliance

The solution to this is to stop the neuronal cascade of death resulting in much less dead and damaged neurons. But that will not occur under the current stroke leadership because it is more work than creating a new press release.
A record number of people are surviving heart attacks and stroke but those who do may experience a sharp decline in physical abilities that steadily accelerates over time, according to a new nationally-representative study led by the University of Michigan.
Heart attack and stroke were associated with a rapid decline in survivors’ ability to take care of themselves over the next 10 years, many requiring long-term assistance for daily activities like dressing, bathing, grocery shopping and managing finances. Stroke survivors also appeared to be at a higher risk of depression and mental declines, including memory loss.
The findings appear in Circulation: Cardiovascular Quality and Outcomes.
“More people are surviving heart attack and stroke than ever before but the long-term consequences for survivors may be much greater than we thought,” says lead author Deborah Levine, M.D., M.P.H. assistant professor of internal medicine in the division of general medicine and the Stroke Program in the U-M Medical School and researcher in the VA Center for Clinical Management Research.
Dr. Deborah Levine
Dr. Deborah Levine
“We found that over time, survivors had increasing difficulty performing everyday tasks like walking, bathing, shopping and managing money and that these struggles got progressively worse every year following a heart attack or stroke.”
Over 10 years, survivors of heart attack gained approximately 1.5 to 3.5 new functional limitations (problems with performing daily tasks) and survivors of stroke gained approximately 3.5 to 4.5 limitations.
In 2010, the U.S. saw 7.6 million heart attack survivors and 6.8 million stroke survivors, with rates expected to increase by 25 percent over the next two decades due to treatment advances and an aging population. Meanwhile, the supply of caregivers for older adults is expected to decline dramatically over the same time period.
“Our findings suggest that heart attack and stroke survivors should be screened and monitored for functional disability long after discharge from the hospital because patients may need additional help with activities of daily living over the years after heart attack and stroke,” says senior author Theodore Iwashyna, M.D., Ph.D. associate professor of internal medicine at the U-M Medical School and researcher in the Institute of Social Research and the VA Center for Clinical Management Research.

“Our research suggests an urgent need to understand whether the acute and accelerated functional disability after heart attack and stroke are the result of incomplete rehabilitation from the initial hospitalization, additional vascular events, behavioral changes, or other mechanisms.”
The researchers also found that the new functional limitations contributed to significant increases in depressive symptoms among survivors of heart attack and stroke.  The risk of developing severe depressive symptoms were 20% greater for every new functional limitation gained after heart attack and 34% greater for every new functional limitation gained after stroke.
“As we continue to see more survivors of heart attack and stroke, we expect a dramatic increase in demand for chronic care, which not only takes a tremendous toll on patients and their families but will also mean significant demands and expenses for our healthcare system, caregivers and other resources, says Levine. “Further research is needed to develop cost-effective methods of care to best manage the needs of this growing and vulnerable population.”

Researchers analyzed Medicare records from 1998-2010 and from the Health and Retirement study, a national survey of older Americans funded by the National Institute on Aging and based at the U-M Institute for Social Research (ISR).
The study included 391 heart attack survivors and 370 stroke survivors.
Other authors: Dimitry Davydow, M.D., M.P.H. and Catherine Hough, M.D., M.Sc, of the University of Washington. Kenneth Langa, M.D., Ph.D. and Mary A.M. Rogers, Ph.D., of the Department of Internal Medicine at U-M. All U-M authors from this study are members of the U-M Institute for Healthcare Policy and Innovation. Langa is also with the U-M School of Public Health.
Disclosures: None
Funding: The Health and Retirement Study is sponsored by the National Institute
on Aging (U01 AG09740) and the Social Security Administration.
Levine received research support from the National Institutes of
Health (NIH; P30DK092926 and K23AG040278). Davydow received
research support from the NIH (KL2 TR000421). Iwashyna
received research support from the NIH (K08, HL091249) and VA
HSR&D (IIR 11–109).
Reference: “Functional Disability and Cognitive Impairment After
Hospitalization for Myocardial Infarction and Stroke,” Circ Cardiovasc Qual Outcomes, Nov.11, 2014.

Dog gets massages as Fremont man regains hand coordination - stroke rehabilitation

Thanks to Mindpop for pointing this out. Has your hospital implemented any of the following? I would have tried something like this on my ex but finger spasticity prevented any possibility of getting the hand flat.

The Healing Power of Dogs

The Healing Power of Cat Purrs

Dog gets massages as Fremont man regains hand coordination 

It's 2 in the afternoon and Bella is waiting.

At the same time each weekday afternoon — when she hears the click of a cane — Bella heads to the edge of the carpet, the dividing line that separates Dunklau Gardens from Fremont Health Medical Center.
That's where Bella waits for Roger Randall and a massage, the Fremont Tribune ( ) reported.
Sitting in a cushiony chair, Randall massages the Labrador retriever's neck and back. And before long, the yellow dog has melted into a furry heap on the tile floor.
It's a unique partnership, but one that's mutually beneficial.



Tuesday, September 29, 2015

Best of Stroke Forum - Determining Candidacy: Applying Inclusion and Exclusion Criteria for IV Thrombolysis

This is certainly not a very good CME. Not one word on the appalling full tPA efficacy rate of 12% or the fact that this doesn't address the neuronal cascade of death at all. No wonder stroke survivors are screwed. Even supposedly the best doctors don't even talk about any of the problems in stroke. Naked emperor and all.
When you see the exclusion criteria on slide 6 you realize you practically have to be the perfect candidate to get tPA. Survivors are almost never perfect candidates, if they were they likely wouldn't be having a stroke in the first place. With that mindset it is obvious why we haven't found a better replacement for tPA.  This just continues to prove that the current stroke medical leadership should have no say in how a stroke strategy is created and followed.
Slide 21 discusses door-to-needle time and never mentions delivering it prior to the door or any way to achieve that. No focus on a BHAG (Big Hairy Audacious Goal).

How Coffee Loves Us Back

I don't remember coffee even being an option while in the hospital. I'm sure your doctor will fail once again in not talking to the hospital nutritionist about creating a stroke diet protocol.
But what else is new? Failure in stroke anything is to be expected, it has been failing for the past 50 years and will continue to fail until the stroke leadership is replaced..
Coffee, said the Napoleon-era French diplomat Talleyrand, should be hot as hell, black as the devil, pure as an angel, sweet as love.
Bach wrote a cantata in its honor, writers rely on it, and, according to legend, a pope blessed it. Lady Astor once reportedly remarked that if she were Winston Churchill’s wife, she’d poison his coffee, to which Churchill acerbically replied: “If I were married to you, I’d drink it.”
Coffee is everywhere, through history and across the world. And increasingly, science is demonstrating that its popularity is a good thing.
Harvard scientists have for years put coffee under the microscope. Last year, researchers announced they had discovered six new human genes related to coffee and reconfirmed the existence of two others. The long-running Nurses’ Health Study has found that coffee protects against type 2 diabetes and cardiovascular disease. Researchers are continuing to follow up on 2001 findings that it protects against Parkinson’s disease.
The work at Harvard is just part of an emerging picture of coffee as a potentially powerful elixir against a range of ailments, from cancer to cavities.
Sanjiv Chopra, a professor of medicine at Harvard Medical School and Harvard-affiliated Beth Israel Deaconess Medical Center, has been so impressed he’s become something of a coffee evangelist. The author of several books, Chopra included a chapter on coffee in his 2010 book, “Live Better, Live Longer.”
Chopra first became aware of the potentially powerful protective effects of coffee when a study revealed that consumption lowers levels of liver enzymes and protects the liver against cancer and cirrhosis. He began asking students, residents, and fellows on the liver unit to quiz patients about their coffee habits, finding repeatedly that none of the patients with liver ailments drank coffee.
Chopra himself makes sure to have several cups a day, and encourages others to do the same. Though other researchers are less bold in their dietary recommendations, they’re convinced enough to continue investigations into the benefits.
Alberto Ascherio, a professor of epidemiology and nutrition at the Harvard T.H. Chan School of Public Health and a professor of medicine at HMS, has been studying the potential anti-Parkinson’s effects first suggested in the 2001 findings. That study showed that four or five cups of coffee daily cut disease risk nearly in half compared with little or no caffeine.
Professor of Nutrition and Epidemiology and Professor of Medicine Frank Hu, who leads the diabetes section of the long-running Nurses’ Health Study, has become interested in whether coffee drinking affects total mortality.
“I’m not a huge coffee drinker, two to three cups a day,” Hu said. “[But] I like it and, thinking about the extra benefits, that’s comforting.”
Last year, a Harvard team led by then-research associate Marilyn Cornelis — today an assistant professor at Northwestern University — traced coffee’s fingerprints to the human genome, discovering six new genes related to coffee consumption and reconfirming two others found earlier. The six genes included two related to metabolism, two related to coffee’s psychoactive effects, and two whose exact purpose in coffee consumption is unclear, but which are related to lipid and glucose metabolism.
Daniel Chasman, an associate professor of medicine at HMS and associate geneticist at Harvard-affiliated Brigham and Women’s Hospital, who worked with Cornelis on the study, said caffeine consumption habits are highly heritable and that the genes they found appear to explain about 7 percent of the heritability. That’s a significant amount, he said, considering how strong an influence culture also plays on coffee consumption.
Though the links between coffee and better health have become considerably clearer, what exactly confers the benefit remains murky. Caffeine alone does not explain the effects. For starters, some of the benefits are seen even with decaf, which has prompted researchers to turn their attention to the many other active compounds — including antioxidants such as chlorogenic acid — in your morning cup.
“Coffee is a complex beverage. It’s very difficult to pinpoint which component of coffee is responsible for the benefit,” Hu said. “There are numerous bioactive compounds.”
Other highlights from Harvard research include:
  •     A 2005 study exploring concerns that too much coffee was bad for blood pressure found no link between higher blood pressure and coffee and found some suggestion that it improved blood pressure.
  •     Regular coffee drinking was linked in a 2011 Harvard study to lower risk of a deadly form of prostate cancer.
  •     Also in 2011, a study showed that drinking four or more cups a day lowered the rate of depression among women.
  •     A 2012 study tied three cups a day to a 20 percent lower risk of basal cell carcinoma.
  •     A 2013 Harvard study linked coffee consumption to a reduced risk of suicide.
  •     Also in 2013, a Harvard analysis of 36 studies covering more than a million people found that even heavy coffee consumption did not increase the risk of cardiovascular disease and that three to five cups of coffee daily provided the most protection against cardiovascular disease.
  •     Also in 2014, Harvard Chan School researchers found that increasing coffee consumption by more than a cup a day over a four-year period reduced type 2 diabetes risk by 11 percent.
  •     The same study showed that those who decreased their coffee consumption by more than a cup a day increased their type 2 diabetes risk by 17 percent.
“That first cup of coffee in the morning is happiness.” Chopra said. “It’s a real joy.”
Source: Harvard Gazette

Kinematic measures of Arm-trunk movements during unilateral and bilateral reaching predict clinically important change in perceived arm use in daily activities after intensive stroke rehabilitation

No idea what good this will do for your stroke rehabilitation. Ask your doctor. I hate research that doesn't provide any translational ideas on how this could be used to help stroke survivors recover.
Hao-ling Chen12, Keh-chung Lin12, Rong-jiuan Liing3, Ching-yi Wu34* and Chia-ling Chen5
1 School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
2 Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
3 Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
4 Healthy Ageing Research Center, Chang Gung University, Taoyuan, Taiwan
5 Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan, Taiwan
For all author emails, please log on.
Journal of NeuroEngineering and Rehabilitation 2015, 12:84  doi:10.1186/s12984-015-0075-8
The electronic version of this article is the complete one and can be found online at:

Received:19 January 2015
Accepted:11 September 2015
Published:21 September 2015
© 2015 Chen et al.

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.



Kinematic analysis has been used to objectively evaluate movement patterns, quality, and strategies during reaching tasks. However, no study has investigated whether kinematic variables during unilateral and bilateral reaching tasks predict a patient’s perceived arm use during activities of daily living (ADL) after an intensive intervention. Therefore, this study investigated whether kinematic measures during unilateral and bilateral reaching tasks before an intervention can predict clinically meaningful improvement in perceived arm use during ADL after intensive poststroke rehabilitation.


The study was a secondary analysis of 120 subjects with chronic stroke who received 90–120 min of intensive intervention every weekday for 3–4 weeks. Reaching kinematics during unilateral and bilateral tasks and the Motor Activity Log (MAL) were evaluated before and after the intervention.


Kinematic variables explained 22 and 11 % of the variance in actual amount of use (AOU) and quality of movement (QOM), respectively, of MAL improvement during unilateral reaching tasks. Kinematic variables also explained 21 and 31 % of the variance in MAL-AOU and MAL-QOM, respectively, during bilateral reaching tasks. Selected kinematic variables, including endpoint variables, trunk involvement, and joint recruitment and interjoint coordination, were significant predictors for improvement in perceived arm use during ADL (P < 0.05).


Arm–trunk kinematics may be used to predict clinically meaningful improvement in perceived arm use during ADL after intensive rehabilitation. Involvement of interjoint coordination and trunk control variables as predictors in bilateral reaching models indicates that a high level of motor control (i.e., multijoint coordination) and trunk stability may be important in obtaining treatment gains in arm use, especially for bilateral daily activities, in intensive rehabilitation after stroke.

Polymorphism of brain derived neurotrophic factor and recovery of functions after ischemic stroke

No clue what this means so ask your doctor that doesn't follow any research at all for answers.

Abteilung für Neurorehabilitation, Kliniken Schmieder, Zum Tafelholz 8, 78476, Allensbach, Deutschland.
Highlight Terms
BACKGROUND: After ischemic stroke, many factors influence the restitution of functions. In particular they include the patient age, the initial stroke severity and the presence of cognitive and neuropsychological deficits. In this study we investigated whether a polymorphism in the gene encoding for brain derived neurotrophic factor (BDNF) influences improvements of motor functions and everyday activities.

METHODS: Patients with subacute ischemic stroke (n = 67) were examined at the beginning of an inpatient neurological rehabilitation, after 4 weeks of treatment and after 6 months. The Barthel index (BI) and the Rivermead motor assessment (RMA) were used to measure motor functions and everyday activities. Patients were allocated to three groups (valine [Val]/valine, val/methionine [Met] and Met/Met) depending on the BDNF polymorphism at codon 66.

RESULTS: The 3 groups (Val/Val, n = 34 patients, Val/Met, n = 26 and Met/Met, n = 7) showed significant improvements in BI and RMA after 4 weeks and after 6 months as compared to the preceding measurements. The BI and RMA were positively correlated. The three groups did not differ with respect to the extent of improvement.

CONCLUSION: After ischemic stroke, motor functions and everyday activities improved continuously over a period of at least 6 months. The BDNF polymorphism did not influence this development.

Factors associated with posttraumatic stress disorder following moderate to severe traumatic brain injury: a prospective study.

If we had anything approaching even a minimally decent stroke association this research would already be accomplished for survivors. But we don't, you'll just have to live with their fucking failures. Does your doctor even know that 23% of survivors get PTSD?
Epworth Authors: Ponsford, Jennie
Johnston, Lisa
Other Authors: Alway, Yvette
McKay, Adam
Gould, Kate
Keywords: Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Victoria, Australia
Anxiety Disorders
Neuroses, Anxiety
Stress Disorders, Post-Traumatic
Posttraumatic Stress Disorders
Neuroses, Posttraumatic
Quality of Life
Recovery of Function
Disability Evaluation
Brain Injuries
Injuries, Brain
Trauma, Brain
Traumatic Brain Injury
Patient Outcome Assessment
Assessment, Patient Outcomes
Outcomes Assessments, Patient
Patient Admission
Issue Date: 2015
Publisher: Wiley Online Library
Citation: Depression and Anxiety 2015 Jul 28
Abstract: BACKGROUND: This study prospectively examined the relationship between preinjury, injury-related, and postinjury factors and posttraumatic stress disorder (PTSD) following moderate to severe traumatic brain injury (TBI). METHOD: Two hundred and three participants were recruited during inpatient admission following moderate to severe TBI. Participants completed an initial assessment soon after injury and were reassessed at 3, 6, and 12 months, 2, 3, 4, and 5 years postinjury. The Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders-fourth edition was used to diagnose pre- and postinjury PTSD and other psychiatric disorders. The Glasgow Outcome Scale-Extended (GOSE) and the Quality of Life Inventory (QOLI) were used to evaluate functional and psychosocial outcome from 6 months postinjury. RESULTS: The frequency of PTSD ranged between 0.5 and 9.4% during the 5-year period, increasing throughout the first 12 months and declining thereafter. After controlling for other predictors, shorter posttraumatic amnesia duration (odds ratio = 0.96, 95% CI = 0.92-1.00), other concurrent psychiatric disorder (odds ratio = 14.22, 95% CI = 2.68-75.38), and lower GOSE (odds ratio = 0.38, 95% CI = 0.20-0.72) and QOLI scores (odds ratio = 0.97, 95% CI = 0.95-0.97) were associated with greater odds of having injury-related PTSD. DISCUSSION: The results of this study indicate that while shorter posttraumatic amnesia duration is associated with PTSD, greater TBI severity does not prevent PTSD from evolving. Patients with PTSD experienced high rates of psychiatric comorbidity and poorer functional and quality of life outcomes after TBI. CONCLUSION: There is a need to direct clinical attention to early identification and treatment of PTSD following TBI to improve outcomes.
DOI: 10.1022/da.22396
PubMed URL:

The H2 robotic exoskeleton for gait rehabilitation after stroke: early findings from a clinical study

Does your hospital have any walking exoskeleton at all? If not, why are they so fucking incompetent?
I have 55 posts on exoskeletons so your doctor doesn't have to do any research at all, just read about them. If they can't even keep up with current rehabilitation research, why are you paying them at all? Sounds like a call to the president is needed to find out why the stroke department head is not doing their job.
Picture here:

Study here:
The H2 robotic exoskeleton for gait rehabilitation after stroke: early findings from a clinical study
Magdo Bortole12*, Anusha Venkatakrishnan24, Fangshi Zhu2, Juan C Moreno1, Gerard E Francisco3, Jose L Pons1 and Jose L Contreras-Vidal2
1 Neural Rehabilitation Group, Cajal Institute, Spanish Research Council, Av. Doctor Arce 37, Madrid 28002, Spain
2 Noninvasive Brain-Machine Interface Systems Laboratory, Department of Electrical and Computer Engineering, University of Houston, Houston 77204-4005, USA
3 TIRR Memorial Hermann and Department of PM&R, University of Texas Health Sciences Center, 1333 Moursund Street, Houston 77030, USA
4 Currently at Palo Alto Research Center, a Xerox company, Palo Alto CA 94304, USA
For all author emails, please log on.
Journal of NeuroEngineering and Rehabilitation 2015, 12:54  doi:10.1186/s12984-015-0048-y
The electronic version of this article is the complete one and can be found online at:

Received:30 August 2014
Accepted:4 June 2015
Published:17 June 2015
© 2015 Bortole et al.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.



Stroke significantly affects thousands of individuals annually, leading to considerable physical impairment and functional disability. Gait is one of the most important activities of daily living affected in stroke survivors. Recent technological developments in powered robotics exoskeletons can create powerful adjunctive tools for rehabilitation and potentially accelerate functional recovery. Here, we present the development and evaluation of a novel lower limb robotic exoskeleton, namely H2 (Technaid S.L., Spain), for gait rehabilitation in stroke survivors.


H2 has six actuated joints and is designed to allow intensive overground gait training. An assistive gait control algorithm was developed to create a force field along a desired trajectory, only applying torque when patients deviate from the prescribed movement pattern. The device was evaluated in 3 hemiparetic stroke patients across 4 weeks of training per individual (approximately 12 sessions). The study was approved by the Institutional Review Board at the University of Houston. The main objective of this initial pre-clinical study was to evaluate the safety and usability of the exoskeleton. A Likert scale was used to measure patient’s perception about the easy of use of the device.


Three stroke patients completed the study. The training was well tolerated and no adverse events occurred. Early findings demonstrate that H2 appears to be safe and easy to use in the participants of this study. The overground training environment employed as a means to enhance active patient engagement proved to be challenging and exciting for patients. These results are promising and encourage future rehabilitation training with a larger cohort of patients.


The developed exoskeleton enables longitudinal overground training of walking in hemiparetic patients after stroke. The system is robust and safe when applied to assist a stroke patient performing an overground walking task. Such device opens the opportunity to study means to optimize a rehabilitation treatment that can be customized for individuals.
Trial registration: This study was registered at ( webcite).

85 with Dementia? Good Chance It's HS-AGING and Not Alzheimer's

Your doctor has more dementia stuff to create prevention protocols for. What is your doctor doing to prevent your 33% dementia chance post-stroke from an Australian study? ANYTHING AT ALL? Or is your doctor expecting you to figure this out on your own?
3 important dementia studies focus on HS-AGING. It's a type of dementia almost as common as Alzheimer's in the 85+ group. Yet few people have heard of it. Why? What makes it different?

In those who live to a very advanced age (beyond the age of 85) HS-AGING (hippocampal sclerosis in the elderly) is almost as prevalent as Alzheimer's. Remarkably, HS-Aging appears to be a completely separate disease from Alzheimer's, although it is almost always diagnosed as Alzheimer's disease while people are alive.

Three important papers authored by Dr. Peter Nelson and others at the University of Kentucky Sanders-Brown Center on Aging, explore the neuropathology behind this little-understood brain disease.

HS-AGING, much like Alzheimer's disease, causes symptoms of dementia, such as cognitive decline and impaired memory. Although Alzheimer's disease is probably the most recognized cause of dementia, HS-AGING also causes serious cognitive impairment in many older adults.

Overview of 3 New Studies on HS-AGING:

  1. The first paper, published in the Journal of Alzheimer's Disease, draws from a very large sample population and shows that presently, around 20% of all dementia cases are diagnosed as HS-AGING at autopsy, although almost none are given that diagnosis during life. That means that the presence of this disease is currently almost unknown by the health care providers who are seeing patients.
  2. A second study, "Arteriolosclerosis that affects multiple brain regions," appears in a recent issue of the journal Brain, and looks at small blood vessels in patients with HS-Aging and describes a specific change, called "arteriolosclerosis," which is present in patients with HS-Aging. This small blood vessel change may provide a new therapeutic target to alter the progression of the disease.
  3. Finally, the third paper, "Hippocampal sclerosis of aging, a prevalent and high morbidity brain disease," appears in Acta Neuropathologica and offers an overview of HS-AGING for patients and researchers. This paper reviews the relevant scientific literature and also presses home the point that HS-AGING is a very common disease that exerts a strongly adverse impact on public health.
It is important for physicians and scientists to understand the unique pathology of HS-AGING, and to be able to differentiate it from other diseases, as it is only by making an accurate diagnosis that clinicians can hope to treat people who present with signs of cognitive decline. These current studies represent a leap forward in the knowledge base about HS-AGING, and represent potential new paths to explore for diagnosis and treatment of this serious, but under-appreciated brain disease.

In people over 95, a type of dementia called HS-Aging is about as common as Alzheimer's. Yet few people have heard of it. Why? What makes it different?

What is HS-Aging?

HS-Aging stands for "Hippocampal Sclerosis in Aging People".

Alzheimer's and HS-Aging are types of dementia. In people over 95, their prevalence is about equal.

HS-Aging is Not Well Known. Everyone Has Heard of Alzheimer's. Why?

There are hundreds of types of dementia. In people aged 65 to 95, 60% of dementia cases are Alzheimer's. That is why Alzheimer's is so well-known.

At age 95, the balance shifts and HS-Aging becomes about as common as Alzheimer's.

Few people have heard of HS-Aging. The main reason is because it is often mis-diagnosed as Alzheimer's. Why?

When dementia is seen in the elderly, the default diagnosis is Alzheimer's. This is caused by many factors, among them:
  • Patients often do not want to go through extensive testing for a variety of reasons.
  • There is no simple test. The differences between dementias can be subtle. Therefore, distinguishing between dementias is often technically challenging.
  • Cost comes into play. For example, F18 dementia scans can run thousands of dollars. Therefore, many a diagnosis is made based on incomplete information.

With these realities, it is common for a diagnosis to default to the most common dementia, which is Alzheimer's.

As a result, people with dementias such as HS-Aging often live out their lives thinking they have Alzheimer's.

How does HS-Aging differ from Alzheimer's?

Alzheimer's and HS-Aging both damage the hippocampus. It seems that HS-Aging hits harder than Alzheimer's, causing greater disturbances to memory.

HS-Aging describes a brain under attack from a protein called TDP-43. It causes sclerosis, or the hardening of tissues. In the case of HS-Aging, TDP-43 proteins harden brain tissue in the hippocampus (sometimes called the memory-processing center), causing the loss of a large number of crucial brain cells. It is called Hippocampal Sclerosis because the brain's hippocampus is the focus of the attack.

Alzheimer's, on the other hand, is an attack on the brain by plaques (made from beta-amyloid) and tangles (made of tau proteins). Researchers speculate that the plaques clump together and "choke" brain cells, while the tangles strangle them from within.

How does HS-Aging differ from regular HS?

Regular Hippocampal Sclerosis (HS) occurs in younger people where brain tissue hardening is associated with epilepsy. HS-Aging is a similar hardening, but it occurs in the elderly with different consequences. It is caused by a long life of physical wear-and-tear on the brain, similar to vascular dementia. As a matter of fact, once people hit 95, the combined occurrences of HS-Aging PLUS vascular dementia actually outstrip Alzheimer's.

Why does the type of dementia matter?

As explained above, the biochemistry of each dementia differs significantly. This implies different medications are required to fight the chemicals causing the dementia. A person's response to medicines and supplements will be entirely different, depending on the disease.

Importantly, new F18 imaging techniques have recently been introduced that let doctors see if a person with dementia has the plaques associated with Alzheimer's. Using this technique helps doctors tell the difference between Alzheimer's and HS-Aging. This is particularly crucial in the world of clinical trials, where participants must closely match the experimental drugs they are testing.

CTE Research Leading to Rapid Improvements in HS-Aging Treatments

When we talk about dementia in aging athletes, it is usually the type of dementia called CTE (Chronic Traumatic Encephalopathy). Recent studies showed athletes in contact sports like football are 19 times more likely than average to develop dementia. As a result, there has been a huge burst of research on CTE treatment.

CTE treatment has a lot in common with HS-Aging treatment. With the new attention both of these dementias are now receiving, there is good reason to hope for effective new treatments in the immediate future.
Study #1 above was done with the collaboration of the National Alzheimer's Coordinating Center (or "NACC"; the first author of this study, Willa Brenowitz, is based in Washington state and works with NACC), enabling Nelson and colleagues to incorporate data from dozens of federally funded Alzheimer's Disease Centers around the country. These centers are funded by the National Institute on Aging, part of the National Institutes of Health. The research was supported by NIA grant numbers U01 AG016976 and P30 AG028383.

Study #2 above was based on analyses that were boosted through collaboration with the larger NACC-based dataset. Further, the first author, Dr. Janna Neltner, provided critical expertise in digital pathologic measurement of the brain.

University of Kentucky Sanders-Brown Center on Aging

Table tennis is a helpful activity for people with Alzheimer's - Maybe stroke?

Would this be helpful for stroke survivors? A very simple question that our stroke associations should easily be able to answer. It would seem to be an excellent physical therapy intervention for balance and proprioception.

Table tennis is a helpful activity for people with Alzheimer's. See how it combines physical activity with brain exercise, spatial skills and staying social.

Will Sugar Bankrupt Healthcare?

Your doctor should be contacting the hospital nutritionist to update the diet stroke protocol. But that won't occur unless YOU contact the hospital to get it done. Please pay it forward.
With apologies to Pogo, we have met the enemy and it is sugar.
That message may now be playing in a theater near you, so consider skipping the super size drink at the concession stand.

Here's the trailer: Sugar -- not dietary fat, not cholesterol, not sodium, not red meat, not carbohydrates -- that is the fundamental threat to good health in this country. It drives obesity, which promotes type 2 diabetes, which leads to heart disease. Oh, and yes, there is always tooth decay.
Yet, for more than four decades now, almost the entire nutritional community has been focused on dietary fat. Nutrition fell prey to the vices of politics and popularity, and it is only now barely starting to recover.
This isn't just a minor problem requiring a small course correction. It is a scandal, and the whole field must be overturned.
That, at least, is how some people see nutritional science. It's a view that was recently propagated in two films: That Sugar Film, from Australia, and Sugar Coated, from Canada. In a third film -- sugar is clearly having its day in the spotlight as the culprit in a whole host of chronic diseases -- titled Sugar Rush, British celebrity chef Jamie Oliver shows the toll sugar is taking in Great Britain and urges the country to adopt a sugar tax and use the proceeds for health education.
That Sugar Film

Of the three movies, That Sugar Film is most entertaining. It is the lightest on the science, but it's also the funnest and most watchable. Its strength is visual: It is one thing to hear that the average child in the U.S. eats about 32 teaspoons of sugar per day, but it's stunning to see on the screen just how much sugar that actually is.
Like the influential 2004 documentary Super Size Me -- in which the filmmaker eats nothing but McDonald's for 30 days -- That Sugar Film consists of one man doing disgusting things for entertainment. Only this time, the culprit is sugar: 40 teaspoons of it per day for 60 days, to be precise. But the catch in the film is that filmmaker Damon Gameau isn't eating candy or ice cream, or even drinking soda. He's consuming only foods that are marketed as healthy, like juices, yogurts, and granola bars. In one sequence, he forgoes snacks and eats the corresponding amount of sugar instead.
And the results weren't pretty. By the end of the experiment, his skin is noticeably worse, he's gained weight, he has trouble finding the motivation to exercise, he has mood swings, and his doctors say he's well on the path to diabetes.
But the problem with a film like this, of course, is that it is essentially a study with an "n of one": the filmmaker himself. The film is, though, bolstered by interviews with experts -- playfully replayed on packages of sugar or juice cartons -- and actors explaining the history or the effects of sugar that are all woven together into a highly entertaining package.
And by that measure, it's a success.
Sugar Coated
If That Sugar Film is the most entertaining, Sugar Coated is its somber, determined, and moody avatar.
In the film, we learn -- through numerous interviews with experts, which constitute nearly the entire documentary -- that sugar is a threat to society. We learn that were it not for the fact that money talks, in this case in the form of dollars (and lots of them) from industry to politicians, sugar would have been declared a culprit long ago. And we learn that if we don't do something soon, sugar will break our healthcare system.
In both of these films, the narrative is the same: In the 1970s, the researchers and even policy-makers started to consider the possibility that excess sugar consumption was really unhealthy. But the sugar industry, having taken lessons from their cousins in tobacco, proved masterful with public relations and did everything in their power to obscure answers about the unhealthiness of sugar. And perhaps even more importantly, they gave considerable funds to scientists who found that sugar played no role in the emerging problem of obesity and other health problems; rather, people simply ate too many calories or too much fat.
"A calorie is a calorie," is something heard often, and implicitly criticized, in the films. There is some evidence that the blame was placed unfairly on dietary fat, leading to a "low-fat" craze that made up for worse taste by adding more sugar.
Also, the same in the films is the presence of Gary Taubes, a contrarian journalist who, even long ago, was warning of the dangers of sugar. In a controversial 2002 New York Times Magazine article criticizing low-fat diets, he began: "If the members of the American medical establishment were to have a collective find-yourself-standing-naked-in-Times-Square-type nightmare, this might be it."
In Sugar Coated, another contrarian makes an appearance: Robert Lustig, MD, of the University of California San Francisco. He's accused in an interview with a reporter of "taking everything we've learned about healthy eating over the last 30 years and turning it upside down." Lustig answered: "Well it deserves to be turned upside down because it didn't work, did it?"
Another heavy presence in the film is Yoni Freedhoff, MD, an obesity doctor in Ottawa, Canada, who has also been pointing out for years the high toll sugar has been taking on our bodies. Freedhoff openly criticizes the Canadian Obesity Network in the film for taking funding from fast food and soft drink companies, and he said that the Heart & Stroke Foundation -- the Canadian version of the American Heart Association -- committed an "abuse of public trust" when they put their health check endorsement on sugary products.
But there's good news at the end of Sugar Coated: the Heart & Stroke Foundation took note, apparently, as we learn that they did away with their endorsement program. This fits the narrative of the films perfectly: nutritionists were wrong, but thanks to people who were not afraid to push an unpopular idea, now we know the Truth, and it's only a matter of time before things change.
Contrarian Crusaders
One of the problems with that narrative as it's presented is that it doesn't feel like the people in these films are doing what we think good scientists should do -- forming cautious theories around the data they look at. Taubes, Lustig, and Freedhoff, rather, are crusaders.
They have evidence, to be sure. But they're also seeing that evidence from a rigid set of glasses: in a field that is so convoluted that nearly every food it studies has been found to be associated with cancer, it's relatively easy to pick a theory and to stick with it.
Sugar causes cancer? There's some evidence for that. Sugar causes obesity? Yup. Diabetes? Almost definitely.
But there are plenty of studies showing the opposite; that's the nature of nutritional research -- and of imperfect science. And so it is up to the person approaching the evidence to decide with whom they want to set up camp. Some researchers shop around before eventually deciding. But some make a name for themselves and become advocates, and they wield media and politics to get their message out.
They are not bought by drug companies, but they may be accused of a less-discussed bias: holding on to a theory so tightly that virtually no new evidence could make them change their mind.
Hell Hath No Fury Like Industry Scorned
Nonetheless, the data are piling up, and it increasingly looks like critics of sugar got it right.
There are signs that the critics of sugar may soon be moving from contrarian to mainline status: the upcoming U.S. Dietary Guidelines are expected to take a much harsher stand against added sugars. It appears that the medical establishment is no longer standing naked in Times Square.
From here, it looks as if the contrarian view made sense all along, and we should laud the writers and the researchers that warned us long ago. But to think that way is to forget what a difficult fight against sugar it has been, and in some ways still is. And it is also to forget that the early scientists that fought for their viewpoint were often viewed as crackpots, were personally smeared, and their research was discounted.
In this sense, the films are a good reminder that science is a thoroughly human endeavor.
To do science is to do politics. And politics, like nutrition, is messy.