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:http://oc1dean.blogspot.com/2010/11/my-background-story_8.html

Wednesday, August 3, 2016

Is Virtual-Reality Rehabilitation Beneficial After Stroke?

FUCK this has to be one of the stupidest questions that should never be asked. Our fucking failures of stroke associations don't have a database of stroke protocols with efficacy ratings that are updated each time new research comes out.  That is what a great stroke association would be doing.
ARGHHH!!! WHERE ARE THE TWO FUNCTIONING NEURONS AMONGST ALL THE STROKE MEDICAL PERSONS IN THE WORLD?  All stroke survivors are still guinea pigs in single case studies run by their doctor. Have you signed a consent agreement for that research?
http://www.jwatch.org/na41889/2016/08/03/virtual-reality-rehabilitation-beneficial-after-stroke 

Nonimmersive VR gaming enhances motor performance after stroke but is no better than simple recreational activities.

In small studies, nonimmersive virtual-reality (VR) video game systems improved poststroke motor performance when added to conventional rehabilitation. However, these studies lacked active control interventions and may have lacked matched amount of therapy time. To compare the effects of nonimmersive VR and recreational therapy (RT), researchers conducted a multicenter, single-blind, parallel-group study. They randomized 141 patients with mild-to-moderate motor disability within 3 months after a first-time ischemic stroke, to receive conventional rehabilitation plus either VR training with the Nintendo Wii gaming system (using commercially available software) or RT (playing cards, bingo, Jenga, or ball games). Each group completed ten 60-minute sessions over a 2-week period. Rehabilitation therapists administered the interventions and provided feedback to avoid inappropriate compensatory movements. The primary endpoint was improvement from baseline to end of the intervention in time on an abbreviated Wolf Motor Function Test (WMFT), with added grip strength and flip-a-card tasks. Secondary outcomes included activities of daily living, quality-of-life and global outcome measures, and grip strength. Outcome measures were also assessed at 4 weeks after baseline.
The median WMFT performance time improved in both groups, with no significant between-group differences at 2 or 4 weeks postbaseline. The only difference between groups was better 2-week performance in the RT group on the Box and Block test, a secondary outcome.

Comment

This well-executed study is one of several that have failed to demonstrate superior benefits of novel neurorehabilitation interventions, with or without technology. Several issues are worth noting. Supplemental therapy of some type improved short-term motor function. Whether gains for either group were sustained beyond 4 weeks was not addressed. The type of VR or the timing, intensity, and duration of training may not have been optimal, and issues such as patient preference were not addressed. Nevertheless, the cautionary conclusion about indiscriminate adaptation of innovative, but costly, rehabilitation interventions without adequate clinical trials is well taken.
Dr. Abrams is Director of the Neurorehabilitation Clinic, University of California, San Francisco, Medical Center.

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