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

Monday, September 12, 2016

Effects of Unilateral Upper Limb Training in Two Distinct Prognostic Groups Early After Stroke

Well shit, treating only the good candidates. What the fuck are those survivors supposed to do that don't have voluntary finger extension? Like me. They didn't even try mCIMT on unfavorable finger extension candidates. They are not even trying to solve the hard survivor cases. You better fucking hope you have a small stroke because researchers obviously do not even try to solve the hard cases.
http://nnr.sagepub.com/content/30/9/804?etoc

The EXPLICIT-Stroke Randomized Clinical Trial

  1. Gert Kwakkel, PhD1,2
  2. Caroline Winters, MSc1
  3. Erwin E. H. van Wegen, PhD1
  4. Rinske H. M. Nijland, PhD2
  5. Annette A. A. van Kuijk, MD, PhD3
  6. Anne Visser-Meily, MD, PhD4
  7. Jurriaan de Groot, PhD5
  8. Erwin de Vlugt, PhD6
  9. J. Hans Arendzen, MD, PhD5
  10. Alexander C. H. Geurts, MD, PhD3
  11. Carel G. M. Meskers, MD, PhD1
  12. on behalf of the EXPLICIT-Stroke Consortium
  1. 1Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
  2. 2Amsterdam Rehabilitation Research Center, Reade, Amsterdam, The Netherlands
  3. 3Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
  4. 4Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
  5. 5Department of Rehabilitation Medicine, Leiden University Medical Center, Leiden, The Netherlands
  6. 6Department of Biomechanical Engineering, Faculty of Mechanical Engineering, Delft University of Technology, Delft, The Netherlands
  1. Erwin E. H. van Wegen, PhD, Department of Rehabilitation Medicine, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands. Email: e.vanwegen@vumc.nl

Abstract

Background and Objective. Favorable prognosis of the upper limb depends on preservation or return of voluntary finger extension (FE) early after stroke. The present study aimed to determine the effects of modified constraint-induced movement therapy (mCIMT) and electromyography-triggered neuromuscular stimulation (EMG-NMS) on upper limb capacity early poststroke.  
Methods. A total of 159 ischemic stroke patients were included: 58 patients with a favorable prognosis (>10° of FE) were randomly allocated to 3 weeks of mCIMT or usual care only; 101 patients with an unfavorable prognosis were allocated to 3-week EMG-NMS or usual care only. Both interventions started within 14 days poststroke, lasted up until 5 weeks, focused at preservation or return of FE.  
Results. Upper limb capacity was measured with the Action Research Arm Test (ARAT), assessed weekly within the first 5 weeks poststroke and at postassessments at 8, 12, and 26 weeks. Clinically relevant differences in ARAT in favor of mCIMT were found after 5, 8, and 12 weeks poststroke (respectively, 6, 7, and 7 points; P < .05), but not after 26 weeks. We did not find statistically significant differences between mCIMT and usual care on impairment measures, such as the Fugl-Meyer assessment of the arm (FMA-UE). EMG-NMS did not result in significant differences. Conclusions. Three weeks of early mCIMT is superior to usual care in terms of regaining upper limb capacity in patients with a favorable prognosis; 3 weeks of EMG-NMS in patients with an unfavorable prognosis is not beneficial. Despite meaningful improvements in upper limb capacity, no evidence was found that the time-dependent neurological improvements early poststroke are significantly influenced by either mCIMT or EMG-NMS.

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