Time to exercise!: an aide-memoire stroke app for post-stroke arm rehabilitation

Rehabbing from stroke wouldn't be so damned difficult if you would solve the neuronal cascade of death by these 5 causes in the first week such that preventing that damage there would be much less dead and damaged neurons. But no, you research something to make the survivors work harder rather than have the doctors actually do something. And you don't know exactly what makes neuroplastiity repeatable so your instructions to exercise more often have no basis in concrete research. In other words, you have no fucking clue what you are doing.
http://dl.acm.org/citation.cfm?id=2935338

Authors: Nicholas Micallef Heriot-Watt University, Edinburgh, UK Lynne Baillie Heriot-Watt University, Edinburgh, UK Stephen Uzor Heriot-Watt University, Edinburgh, UK Published in: · Proceeding MobileHCI '16 Proceedings of the 18th International Conference on Human-Computer Interaction with Mobile Devices and Services Pages 112-123 ACM New York, NY, USA ©2016 table of contents ISBN: 978-1-4503-4408-1 doi>10.1145/2935334.2935338 2016 Article   Bibliometrics

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A majority of Stroke survivors have an arm impairment (up to 80%), which persists over the long term (>12 months). Physiotherapy experts believe that a rehabilitation Aide-Memoire could help these patients [25]. Hence, we designed, with the input of physiotherapists, Stroke experts and former Stroke patients, the Aide-Memoire Stroke (AIMS) App to help them remember to exercise more frequently. We evaluated its use in a controlled field evaluation on a smartphone, tablet and smartwatch. Since one of the main features of the app is to remind Stroke survivors to exercise we also investigated reminder modalities (i.e., visual, vibrate, audio, speech). One key finding is that Stroke survivors opted for a combination of modalities to remind them to conduct their exercises. Also, Stroke survivors seem to prefer smartphones compared to other mobile devices due to their ease of use, usability, familiarity and being easier to handle with one arm.

5 States Voting on Recreational Marijuana This November

All these states are so damn far away from Michigan. You will need to convince your parents and grandparents that it could be useful in stroke rehab. They have a 1 in 6 chance per WHO of having a stroke.
My 13 reasons for marijuana use post-stroke. I would have to self treat my stroke rehab needs because we have NO stroke leadership or strategy to figure out how to create THC or marijuana protocols. I can't self treat using any form of medical marijuana including legal THC because it would require getting a prescription and with no protocol doctors are not going to write prescriptions. 
http://www.fool.com/investing/2016/08/14/5-states-voting-on-recreational-marijuana-this-nov.aspx

5 States Voting on Recreational Marijuana This November

The cannabis industry landscape is about to shift before our eyes.

Sean Williams

(TMFUltraLong)

Aug 14, 2016 at 9:12AM

Image source: Getty Images.

Ready or not, the marijuana industry could be reshaping right in front of our eyes.
Over the past 20 years we've seen incredible growth in the legal marijuana business. Starting with the passage of a compassionate use law in California in 1996 for medical patients, medical marijuana has become available in half of all U.S. states. Since 2012, four states -- Washington, Colorado, Oregon, and Alaska -- along with Washington, D.C., have passed laws allowing for the legal sale of recreational marijuana to adults aged 21 and up. Based on data from cannabis research firm ArcView, legal marijuana sales hit an estimated $5.4 billion in 2015, and legal sales could grow at an average of 30% per year through 2020.
Yet all of this could be just the tip of the iceberg.

These states are vying to legalize recreational marijuana

The November elections could wind up having a dramatic influence on the marijuana industry. Though there were plenty of state movements that fell short of the required votes or grassroots support to get a marijuana initiative on the ballot, residents in nine states will be voting on whether to give marijuana the thumbs up or thumbs down this fall.
Specifically, five states are vying to legalize recreational marijuana, which would more than double the current legal-state total in one year. Here are the votes that will matter most come November.

I

1. California

Without question, the crown jewel of the marijuana movement would be a victory in California. California has the largest economy among U.S. states by a mile, and if it were a stand-alone country it would represent the eighth-largest annual GDP in the world. Gaining recreational marijuana approval in California would give the industry access to a huge population of potential users, as well as give Congress the ultimate in marijuana guinea pigs to monitor.

2. Nevada

Among the nine states set to vote on marijuana this fall, residents of Nevada were the first to know they had an initiative on the 2016 ballot. Nevada is already home to "Sin City" and a vast network of medical marijuana dispensaries, making a move to legalize recreational marijuana only natural. If Question 2, as the ballot measure is know, is approved, recreational cannabis in Nevada would be subject to a 15% wholesale tax. The revenue generated from this tax would predominantly be shuffled into the K-12 education budget.

3. Maine

Maine was among the earliest states to note that residents would have the opportunity to vote on a marijuana initiative this November. The move isn't surprising given that Maine legalized medical cannabis in 1999, becoming the sixth state in the U.S. to legalize the substance for certain medical ailments.
But will recreational marijuana pass in Maine? Signs are cautiously pointing toward "yes" thus far, but as always anything could happen. A May poll from the Marijuana Policy Project (MPP) showed that 55% of respondents were in favor of seeing recreational marijuana legalized, as opposed to 41% who were against the idea. However, when MPP asked respondents how they felt about taxing and regulating marijuana, regardless of how they felt about it, 59% favored the idea of taxing and regulating the substance.

4. Massachusetts

Massachusetts is where we really see the possibility for an initiative to fail.
Although Massachusetts gathered more than enough signatures to get a recreational cannabis question on the ballot, mixed polling has shown that approval could be an uphill battle. In May, a Suffolk University/Boston Globe poll found that 43% of respondents favored legalizing recreational marijuana, while 46% opposed it. A July 2014 poll from the Boston Globe found a similar mixed bag, with 48% of respondents favoring legalization and 47% opposing it. While well within the margin for error, these figures aren't comforting for industry supporters.

5. Arizona

Perhaps the biggest longshot of all is Arizona, which also collected enough signatures to get a recreational cannabis ballot initiative in front of voters this fall.
A recently released poll from O.H. Predictive Insights showed that a mere 39% of Arizonans support the idea of recreational cannabis compared to 52.5% who oppose it. Another 8.5% of polled people remained undecided. According to Mike Noble, the managing partner of O.H. Predictive Insights, older Americans tend to be more conservative in their views of marijuana, and in Arizona older Americans appear more likely to vote, thus dooming the initiative to failure.

More at link.

Is cocoa good for you? New study may settle it

Was this earlier research not good enough to write up protocols? Do they even know about this earlier research?

Flavanol-rich chocolate acutely improves arterial function and working memory performance counteracting the effects of sleep deprivation in healthy individuals June 2016

Cocoa Flavanols: Scientifically proven health benefits  Feb. 2016

 

Boosting Cocoa's Dementia-Fighting Benefits  Oct. 2015 

 

2 Cups of Hot Cocoa-a-Day Keeps the Neurologist Away  June 2015

 

 

Sweet dreams: eating chocolate prevents heart disease  June 2015

 

 Cocoa flavanol consumption improves cognitive function, blood pressure control, and metabolic profile in elderly subjects: the Cocoa, Cognition, and Aging (CoCoA) Study—a randomized controlled trial  Jan. 2015 

 

Blueberries, Avocados and Cocoa Beans May Keep Cardiologists at Bay  Jan. 2015

 

This Common Beverage Reversed Normal Age-Related Memory Loss in Three Months - Cocoa  Oct. 2014 

 

Cocoa Extract May Counter Specific Mechanisms of Alzheimer’s Disease  June 2014 

 

Could Hot Cocoa Improve Brainpower in Seniors?  Aug. 2013

 

Chocolate-loving countries produce more Nobel laureates  Oct. 2012

 

Eating small bar of chocolate cuts risks of stroke in men  Sept. 2012

 

Hot Cocoa May Boost Seniors' Brain Power  Aug. 2012

 

Dark Chocolate: Sweet Prevention for CV Events  June 2012

 

 

 

The latest here:

Is cocoa good for you? New study may settle it

Even scientific research can be full of chocolatey goodness. Scientists are recruiting older men and women to take part in a large, nationwide cocoa study looking at its effects on the heart and brain.
Spoiler alert: Participants won’t get to gorge on chocolate bars, but will instead test supplements containing a cocoa extract. The researchers from Boston’s Brigham and Women’s Hospital, Harvard, and the Fred Hutchinson Cancer Research Center in Seattle, say the results could shed more light on what we already know about chocolate (other than the fact that it’s delectable) and its impact on health.
“We first announced the study in 2014, but we now have funding for a new cognitive component – to look at slowing of age-related memory loss​ – in addition to looking at prevention of heart attacks and strokes,” Dr. JoAnn Manson, chief of the Division of Preventive Medicine at Brigham and Women’s Hospital, told CBS News.
“There’s new research​ in the last two years suggesting benefits of the cocoa flavanols for cognition​,” explained Manson, who is also a professor of medicine at Harvard Medical School.

Play Video

All about the chocolate diet hoax

Cocoa flavanols are natural “bioactive compounds” in cocoa beans that past studies suggest may have a positive impact on blood pressure, cholesterol, insulin and inflammation, which are cardiovascular disease risk factors, according to the researchers.
These compounds may help create nitric oxide in the body, which could help blood vessels dilate and in doing so, may make for a healthier cardiovascular system.
However, the researchers said in an online description of their study, “It’s not clear whether or not these effects will translate into real reductions in CVD [cardiovascular disease] rates.”
This is the first study large enough to assess the effects of cocoa extracts and multivitamins on certain health conditions that are important at later ages, say the researchers, who will explore whether concentrated cocoa extract helps reduce heart disease and stroke. Another portion of the study will look at whether or not commonly used multivitamin supplements can help reduce the risk of cancer.

Play Video

Are we eating ourselves out of the world's chocolate supply?

The amount of cocoa the researchers want to give participants might lead to sick bellies and weight gain if it was eaten in chocolate candy form, so they’re providing it in supplement form. (“Pills with cocoa extract will not taste like chocolate,” they note on the study’s website.)
The study, sponsored by chocolate maker Mars and pharmaceutical company Pfizer, is set up as a randomized controlled trial, which means the participants will not know if they are taking cocoa supplements, multivitamins​, or placebo pills (the placebo pills have no active ingredients).
“We’re recruiting 18,000 men and women around the country – no need to live in Boston,” Manson said. To participate in the study, men must be older than 60 and women need to be over 65, with no prior history of heart attack and no cancer within the past two years.
“We’d like to get the word out that recruitment is going on right now,” Manson added.
It might help if participants got to go home with a goody bag of real chocolate when the study ends, but instead they’ll have to be satisfied with simply contributing to sweet scientific knowledge.
More information about the study is available on its website cosmostrial.org, or by phone at 1-800-633-6913.

Xbox can help patients with MS improve their ability to walk

This would make so much sense for our PTs to objectively analyze our walking. But I bet this won't get rolled out to stroke departments for decades because we have NO leadership to push this out to all stroke hospitals. You are screwed once again.
http://montreal.ctvnews.ca/video?clipId=940412

Towards an integration of deep learning and neuroscience

What is your doctor going to do with this to help your recovery? ANYTHING AT ALL?
http://journal.frontiersin.org/article/10.3389/fncom.2016.00094/abstract? 

Adam H. Marblestone^1*, Greg Wayne² and Konrad Kording³

• ¹Media Lab, Massachusetts Institute of Technology, USA
• ²Google Deepmind, United Kingdom
• ³Northwestern University, USA

Neuroscience has focused on the detailed implementation of computation, studying neural codes, dynamics and circuits. In machine learning, however, artificial neural networks tend to eschew precisely designed codes, dynamics or circuits in favor of brute force optimization of a cost function, often using simple and relatively uniform initial architectures. Two recent developments have emerged within machine learning that create an opportunity to connect these seemingly divergent perspectives. First, structured architectures are used, including dedicated systems for attention, recursion and various forms of short- and long-term memory storage. Second, cost functions and training procedures have become more complex and are varied across layers and over time. Here we think about the brain in terms of these ideas. We hypothesize that (1) the brain optimizes cost functions, (2) the cost functions are diverse and differ across brain locations and over development, and (3) optimization operates within a pre-structured architecture matched to the computational problems posed by behavior. In support of these hypotheses, we argue that a range of implementations of credit assignment through multiple layers of neurons are compatible with our current knowledge of neural circuitry, and that the brain's specialized systems can be interpreted as enabling efficient optimization for specific problem classes. Such a heterogeneously optimized system, enabled by a series of interacting cost functions, serves to make learning data-efficient and precisely targeted to the needs of the organism. We suggest directions by which neuroscience could seek to refine and test these hypotheses.

Neuron See, Neuron Do: The Mirror Neuron System and Clinical Implications

Sure sounds like action observation. What videos and gifs has your doctor setup as a stroke protocol for you? You should have hundreds of hours available to watch for every movement you need to work on.  But I bet your incompetent doctor has none.  For all those hours spent doing no therapy in the hospital should be filled with action observation videos.  And I bet a verbal description of what is happening would be even better.
http://knowingneurons.com/2016/08/31/mirror-neuron/

31 August 2016Jenn TribbleLeave a comment

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If you grew up with siblings, it is likely that you have heard the phrase, ”Imitation is the sincerest form of flattery.”  However, it wasn’t until a groundbreaking finding in the 1990s that the neural correlate to imitation was discovered in a class of neurons called mirror neurons.  These neurons were discovered in the macaque monkey but have since been identified and visualized through neuroimaging techniques in humans.  Mirror neurons are responsive both when performing a goal-directed action and when seeing another perform the same action.  In other words, the same neurons that fire when you throw a baseball also fire when you watch someone throw a baseball!

We know that brain activity generates rhythms, which can be measured through techniques such as EEG (electroencephalography).  One of these rhythms, mu rhythm, is a 10 Hz oscillatory pattern generated across activity of the motor cortex.  Mu rhythm is generated when a person is at rest, aka not performing a physical activity.  However, when an individual performs an action, mu rhythm is suppressed or desynchronized.  Sometimes, mu rhythm is even suppressed when a person simply imagines performing an action!  This close connection to the activity of mirror neurons has led some to believe that the mirror neuron system could influence the synchronization of mu rhythm.

Hickey Kills Teenage Boy: Blood Clot, Stroke Caused By 'Love Bite' From Girlfriend

Be careful out there.
http://www.medicaldaily.com/hickey-kills-teenage-boy-blood-clot-stroke-caused-love-bite-girlfriend-396464

Many of us who end up with a hickey have one big concern — how do we cover it up? A teenage boy in Mexico City, MX experienced a significantly more serious after-effect, a fatal stroke. Julio Macias Gonzalez, 17, suffered a stroke while eating dinner with family, shortly after hanging out with his 24-year-old girlfriend, before he died.
Doctors believe the stroke may have been triggered by the hickey Gonzalez received from his girlfriend earlier that day, according to Hoy Estado de Mexico, a local newspaper in Mexico. The suction of the hickey caused a blood clot, which then traveled to Gonzalez's brain and led to the stroke.

A teenage boy suffers a fatal stroke after receiving a hickey from his girlfriend. Photo courtesy of 
Thrombotic strokes occur when a blood clot forms in one of the arteries that supply blood to the brain.  A clot may be caused by fatty deposits (plaque) that build up in arteries, and cause reduced blood flow (atherosclerosis) or other artery conditions, according to the Mayo Clinic. When the clot blocks the blood flow to the heart or the brain, a heart attack or stroke can follow.
Gonzalez's case is one of two hickey-induced stroke cases reported. In a 2010 report published in the New Zealand Medical Journal, a 44-year-old woman in New Zealand went to the ER because she couldn't move her left arm. Doctors were puzzled by her symptoms until they spotted a clot in an artery on the right side of her neck beneath where she showed the bruising of a hickey. Luckily, she recovered after being treated with a blood thinner.
It seems like love does bite.

The 2nd annual Comeback Trail – Your Trail, Your way - NSA Stroke awareness and celebrate survivorship

This just completely proves that the NSA has no fucking business having stroke in their name. Just making people maybe feel better about themselves rather than providing solutions that get them back to 100% recovery. Another fucking awareness campaign, but not the awareness that should be promoted. Awareness that everything in stroke is a complete failure.

Dear dean, The 2nd annual Comeback Trail – Your Trail, Your Way is just around the corner.  Wherever you may be, we hope you join us on Sept. 10 to help raise stroke awareness and celebrate survivorship. Participation is as simple as walking along your favorite trail or around your neighborhood. You can hit the trail solo or invite family and friends to join you. Anything goes when it comes to Comeback Trail – Your Trail, Your Way. Get started Connect with other Comeback Trail – Your Trail, Your Way participants by sharing your Comeback Trail and Come Back Strong photos on social media using #comebackstrong or emailing images to events@stroke.org There is still time to earn our exclusive Comeback Trail t-shirt. When you register for Comeback Trail – Your Trail, Your Way, your personal fundraising page is automatically created. When you raise $250 on your personal website by Sept. 15, we’ll send you a free Comeback Trail t-shirt! Get started today! Betsy Hailstone Manager, Special Events

Beware of wake-up stroke

I personally think the solution to this problem is magnetic delivery of microbeads of tPA directly to the location of the clot. A much smaller bolus would be needed reducing the side effects of bleeding elsewhere. But since we have NO stroke leadership or strategy this will take decades to come about.
Will no one think of the stroke survivors and actually do something to help them?
This solution maybe from May, 2016.

Stroke victims' new saviour...magnetic blood: Pioneering research could transform treatment of killer condition 

Or maybe this solution from March, 2015

Magnetic nanoparticles could stop blood clot-caused strokes

 

Beware of wake-up stroke 

Thomas (50) (name changed) remembers the panic he felt that morning when he woke up and discovered that something was seriously wrong.

He could not move from the bed because the entire right side of his body was weak. He tried to wake up his wife by calling her but all he could manage was some garbled words.

It was after 8 a.m., when he was rushed to the emergency wing of Sree Chitra Tirunal Institute for Medical Sciences and Technology, where he was immediately rushed in for MRI imaging studies.

“He had presented with what is known as the “wake-up stroke,” wherein a patient awakens with symptoms of a stroke which were not there when he fell asleep.

Imaging studies showed that the brain had suffered only minimal damage and that there was a huge salvageable brain area.

There was a major clot in the main cerebral artery, which we removed using mechanical thrombectomy (removing clot using a device called Solitaire).

He made good recovery and walked out of the hospital,” says P.N. Sylaja, Professor of Neurology, SCTIMST. Approximately 25 per cent of ischemic strokes (strokes which are caused by a blood clot in the brain arteries) are wake-up strokes, wherein patients who go to sleep normally, wake up with stroke symptoms

Intravenous thrombolysis using a recombinant tissue plasminogen activator (rtPA) or clot-busting drug can improve the clinical outcomes of patients with acute ischemic stroke if it is administered within the first 4.5 hours of the stroke onset

The time of the onset of stroke is the key factor on which safe therapeutic decisions are based. Wake-up strokes present a therapeutic dilemma for neurologists because the time of the onset of stroke is unknown. Many patients with wake-up strokes thus suffer from poor outcomes because they are not taken to be candidates for tPA as it can only be delivered within the specified time window.

Delay in treatment has always been a problem in wake-up strokes because often the family might be late in discovering that the person has suffered a stroke and there might be multiple reasons for delays in reaching the hospital too.

“Many recent studies on wake-up strokes however show that most of these strokes actually happen in the morning hours and that the stroke itself may be what woke them up.

So these days, such patients are subjected to advanced CT/MRI Perfusion studies, which can tell us how much of the brain has suffered irreversible damage and how much can be salvaged and if thrombolysis can help him,” Dr. Sylaja says.

Perfusion studies can clearly indicate if significant time delay has occurred after the onset of stroke nad if the patient will benefit from thrombolysis

Wake-up strokes are currently an important area of discussion with large randomised controlled clinical trials happening world over on how best to treat wake-up strokes and the efficacy of IV thrombolysis and endovascular mechanical thrombectomy options.

The patho physiology of wake-up strokes phenomenon is not fully understood and is linked to a combination of bodily changes in the circadian cycle, such as adrenalin secretion, platelet aggregation (leading to clots) or the normal surge in one’s blood pressure, all seen in the early morning hours.

Reporting by

C. Maya

Time of the onset of stroke is the key factor on which safe therapeutic decisions are based

Caffeine and its analogues revert memory deficits by normalizing stress responses in the brain

This study suggests that the other compounds in coffee also provide a benefit.

Moderate coffee drinking may be linked to reduced risk of death

In a study reported in the American Heart Association journal Circulation, people who regularly drank moderate amounts of coffee daily —less than 5 cups per day — experienced a lower risk of deaths from cardiovascular disease, neurological diseases, Type 2 diabetes and suicide.

The benefit held true for drinking caffeinated and decaffeinated coffee, suggesting it’s not just the caffeine providing health perks but possibly the naturally occurring chemical compounds in the coffee beans.

The latest here:

Caffeine and its analogues revert memory deficits by normalizing stress responses in the brain

A study published in the journal Scientific Reports from Nature publishing group, describes the mechanism by which caffeine counteracts age-related cognitive deficits in animals.

The study coordinated by Portuguese researchers from Instituto de Medicina Molecular (iMM Lisboa) and collaborators from Inserm in Lille, France, along with teams from Germany and United States, showed that the abnormal expression of a particular receptor - the adenosine A2A, target for caffeine - in the brain of rats induces an aging-like profile namely memory impairments linked to the loss of stress controlling mechanisms.
"This is part of a larger study initiated 4 years ago in which we identified the role of this receptor in stress, but we did not know whether its activation would be sufficient to trigger all the changes. We now found that by altering the amount of this receptor alone in neurons from hippocampus and cortex - memory related areas - is sufficient to induce a profile that we designate as 'early-aging' combining the memory loss and an increase in stress hormones in plasma (cortisol)" - explains Luisa Lopes, Group Leader at iMM Lisboa and the coordinator of the study.
When the same animals were treated with a caffeine analogue, which blocks the action of adenosine A2A receptors, both memory and stress related deficits were normalized.
David Blum, from Inserm research director, adds: "In elderly people, we know there is an increase of stress hormones that have an impact on memory. Our work supports the view that the procognitive effects of A2AR antagonists, namely caffeine, observed in Alzheimer's and age-related cognitive impairments may rely on this ability to counteract the loss of stress controlling mechanisms that occurs upon aging"
This is important not only to understand the fundamental changes that occur upon aging, but it also identifies the dysfunctions of the adenosine A2A receptor as a key player in triggering these changes. And a very appealing therapeutic target" - concludes Luisa Lopes.

Explore further: Caffeine may block inflammation linked to mild cognitive impairment

More information: Vânia L. Batalha et al, The caffeine-binding adenosine A2A receptor induces age-like HPA-axis dysfunction by targeting glucocorticoid receptor function, Scientific Reports (2016). DOI: 10.1038/srep31493

Journal reference: Scientific Reports

Non-Invasive Brain Stimulation to Enhance Post-Stroke Recovery

My God., the big words used here are incomprehensible. Was that the point?


http://journal.frontiersin.org/article/10.3389/fncir.2016.00056/full?
Nathalie Kubis^1,2*

• ¹Service de Physiologie Clinique, AP-HP, Hôpital Lariboisière, Paris, France
• ²Université Paris Diderot, Sorbonne Paris Cité, CART, INSERM U965, Paris, France

Brain plasticity after stroke remains poorly understood. Patients may improve spontaneously within the first 3 months and then more slowly in the coming year. The first day, decreased edema and reperfusion of the ischemic penumbra may possibly account for these phenomena, but the improvement during the next weeks suggests plasticity phenomena and cortical reorganization of the brain ischemic areas and of more remote areas. Indeed, the injured ischemic motor cortex has a reduced cortical excitability at the acute phase and a suspension of the topographic representation of affected muscles, whereas the contralateral motor cortex has an increased excitability and an enlarged somatomotor representation; furthermore, contralateral cortex exerts a transcallosal interhemispheric inhibition on the ischemic cortex. This results from the imbalance of the physiological reciprocal interhemispheric inhibition of each hemisphere on the other, contributing to worsening of neurological deficit. Cortical excitability is measurable through transcranial magnetic stimulation (TMS) and prognosis has been established according to the presence of motor evoked potentials (MEP) at the acute phase of stroke, which is predictive of better recovery. Conversely, the lack of response to early stimulation is associated with a poor functional outcome. Non-invasive stimulation techniques such as repetitive TMS (rTMS) or transcranial direct current stimulation (tDCS) have the potential to modulate brain cortical excitability with long lasting effects. In the setting of cerebrovascular disease, around 1000 stroke subjects have been included in placebo-controlled trials so far, most often with an objective of promoting motor recovery of the upper limb. High frequency repetitive stimulation (>3 Hz) rTMS, aiming to increase excitability of the ischemic cortex, or low frequency repetitive stimulation (≤1 Hz), aiming to reduce excitability of the contralateral homonymous cortex, or combined therapies, have shown various effects on the functional disability score and neurological scales of treated patients and on the duration of the treatment. We review here the patients’ characteristics and parameters of stimulation that could predict a good response, as well as safety issues. At last, we review what we have learnt from experimental studies and discuss potential directions to conduct future studies.

Introduction

Stroke is the second leading cause of death, the second leading cause of dementia (Joray et al., 2009; Ovbiagele and Nguyen-Huynh, 2011; Roger et al., 2011) and the first cause of morbidity in industrialized countries. Reperfusion therapies such as thrombolysis using recombinant tissue plasminogen activator (Hacke et al., 2008), and more recently thrombectomy with a stent retriever, can rescue brain tissue of the penumbra (a rim of mild to moderate ischemic tissue around the core of the infarct), and improves the final neurological outcome (Fransen et al., 2014). Yet, it remains accessible to less than 5–10% of the population since the therapeutic window is restricted to 6 h (Wahlgren et al., 2016). In addition, the development of neuroprotective pharmacological treatments to limit the neuronal loss induced by ischemia proved disappointing when translating from experimental studies to clinical studies (Klein et al., 1999). The dogma, according to which, any brain injury is irreversible in adults and cannot be repaired has long prevailed both in medical schools and at the bedside. Yet, after a stroke, patients can improve spontaneously within the first 3 months (Maulden et al., 2005) and then more slowly in the following year. The first day, decreased oedema and partial reperfusion of the ischemic penumbra may possibly explain these phenomena, but the improvement of neurological deficit in the following weeks suggests plasticity phenomena and brain cortical reorganization (Chen et al., 2002). Restoring arm and hand skill after a stroke remains challenging, even though stroke rehabilitation programs have proven partial efficacy. Due to the worldwide increasing number of strokes predicted for 2030 (Béjot et al., 2016), and to the restricted number of centers able to provide reperfusion therapies in a limited therapeutic window, there is a need to develop new strategies that aim to enhance spontaneous cerebral plasticity. The complication comes from that, in stroke, post-lesional brain plasticity may be beneficial or “adaptive” or, detrimental or “maladaptive” and thus hamper neurological recovery.

The aim of this study is not to extensively review all the clinical studies published so far in the literature (for very complete reviews refer to Simonetta-Moreau (2014), dedicated to stroke, or Lefaucheur et al. (2014), about Non-Invasive Brain Stimulation [NIBS] in general neurology). The purpose of this review is rather to propose mechanisms from clinical and experimental data, and how up-coming clinical trials could be designed to better address these issues.

More at link