Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 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:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. 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 lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Wednesday, January 27, 2016

Epidural Electrical Stimulation for Stroke Rehabilitation

Whatever the hell this means. If they are trying to stimulate the damaged side motor cortex this would completely not work for me, most of it is dead. Using Fugl-Meyer as an endpoint seems useless since it is totally subjective and has limited discrimination.
http://nnr.sagepub.com/content/30/2/107?etoc

Results of the Prospective, Multicenter, Randomized, Single-Blinded Everest Trial

  1. Robert M. Levy, MD, PhD1
  2. Richard L. Harvey, MD2,3⇑
  3. Brett M. Kissela, MD4
  4. Carolee J. Winstein, PhD5
  5. Helmi L. Lutsep, MD6
  6. Todd B. Parrish, PhD2
  7. Steven C. Cramer, MD7
  8. Lalit Venkatesan, PhD8
  1. 1Marcus Neuroscience Institute, Boca Raton, FL, USA
  2. 2Northwestern University Feinberg School of Medicine, Chicago, IL, USA
  3. 3The Rehabilitation Institute of Chicago, Chicago, IL, USA
  4. 4University of Cincinnati, Cincinnati, OH, USA
  5. 5University of Southern California, Los Angeles, CA, USA
  6. 6Oregon Health & Science University, Portland, OR, USA
  7. 7University of California, Irvine, CA, USA
  8. 8St. Jude Medical, Plano, TX, USA
  1. Richard L. Harvey, The Rehabilitation Institute of Chicago, 345 East Superior Street, Chicago, IL 60611, USA. Email: rharvey@ric.org

Abstract

Background. This prospective, single-blinded, multicenter study assessed the safety and efficacy of electrical epidural motor cortex stimulation (EECS) in improving upper limb motor function of ischemic stroke patients with moderate to moderately severe hemiparesis. Methods. Patients ≥4 months poststroke were randomized 2:1 to an investigational (n = 104) or control (n = 60) group, respectively. Investigational patients were implanted (n = 94) with an epidural 6-contact lead perpendicular to the primary motor cortex and a pulse generator. Both groups underwent 6 weeks of rehabilitation, but EECS was delivered to investigational patients during rehabilitation. The primary efficacy endpoint (PE) was defined as attaining a minimum improvement of 4.5 points in the upper extremity Fugl-Meyer (UEFM) scale as well as 0.21 points in the Arm Motor Ability Test (AMAT) 4 weeks postrehabilitation. Follow-up assessments were performed 1, 4, 12, and 24 weeks postrehabilitation. Safety was evaluated by monitoring adverse events (AEs) that occurred between enrollment and the end of rehabilitation. Results. Primary intent-to-treat analysis showed no group differences at 4 weeks, with PE being met by 32% and 29% of investigational and control patients, respectively (P = .36). Repeated-measures secondary analyses revealed no significant treatment group differences in mean UEFM or AMAT scores. However, post hoc comparisons showed that a greater proportion of investigational (39%) than control (15%) patients maintained or achieved PE (P = .003) at 24 weeks postrehabilitation. Investigational group mean AMAT scores also improved significantly (P < .05) when compared to the control group at 24 weeks postrehabilitation. Post hoc analyses also showed that 69% (n = 9/13) of the investigational patients who elicited movement thresholds during stimulation testing met PE at 4 weeks, and mean UEFM and AMAT scores was also significantly higher (P < .05) in this subgroup at the 4-, 12-, and 24-week assessments when compared to the control group. Headache (19%), pain (13%), swelling (7%), and infection (7%) were the most commonly observed implant procedure-related AEs. Overall, there were 11 serious AEs in 9 investigational group patients (7 procedure related, 4 anesthesia related). Conclusions. The primary analysis pertaining to efficacy of EECS during upper limb motor rehabilitation in chronic stroke patients was negative at 4 weeks postrehabilitation. A better treatment response was observed in a subset of patients eliciting stimulation induced upper limb movements during motor threshold assessments performed prior to each rehabilitation session. Post hoc comparisons indicated treatment effect differences at 24 weeks, with the control group showing significant decline in the combined primary outcome measure relative to the investigational group. These results have the potential to inform future chronic stroke rehabilitation trial design.
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