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, February 29, 2016

Pretty Women And Handsome Men Can Trigger Memory Improvement, Motivate Others To Work Harder

What is your doctor doing about this to help your recovery? ANYTHING AT ALL?
http://www.medicaldaily.com/pretty-women-handsome-men-mental-improvement-375557
Are pretty faces a distraction or motivation to improve your memory? According to a new study published in the journal Evolutionary Psychology, it's the latter — attractive people ignite a motivational impulse that makes others work harder to impress them.
"Although intuition might suggest that exposure to highly attractive people would be distracting and would impair cognitive performance," said the study’s lead researcher Michael Baker, a psychologist at East Carolina University, in a press release, "mating goals might lead people to display desirable mental traits." To test the theory, Baker and a team of researchers from East Carolina University conducted two experiments: First, they recruited 58 heterosexual college students and assigned half of them to view the opposite sex's face for seven seconds straight. Half of the participants were randomly designated to look at highly-attractive faces, while the others had to stare at average-looking faces.

More at link, men seem to do better.

This Approach To Stress May Protect Your Heart From Its Damaging Effects

How is your doctor handling the stress you have from not knowing how to completely recover since your doctor is causing that stress with NO protocols to get to 100% recovery? Or is your doctor relying on your resilience rather than anything the doctor is doing?
http://www.spring.org.uk/2016/02/the-psychological-approach-to-stress-that-protects-your-body-from-its-damaging-effects.php?
The results showed that it was the perception of the stressful events that predicted an unhealthier heart.
Some people in the study experienced many more stressful events, but had healthier hearts at least partly because their attitude was better, the study suggests.

More at link. Actual research is paywalled.

Dorsal Raphe Dopamine Neurons Represent the Experience of Social Isolation

Ask your doctor if damage to this area is causing your social isolation. S/he should know at least that much. What is their stroke protocol to fix that problem?
http://www.cell.com/cell/abstract/S0092-8674%2815%2901704-3
Open Access
Open access funded by Medical Research Council

Highlights

  • Dorsal raphe nucleus (DRN) dopamine neurons are sensitive to acute social isolation
  • DRN dopamine neurons release dopamine and glutamate in downstream structures
  • Optical activation induces, whereas inhibition suppresses, a “loneliness-like” state
  • Social rank predicts the behavioral effect induced by optical manipulations

Summary

The motivation to seek social contact may arise from either positive or negative emotional states, as social interaction can be rewarding and social isolation can be aversive. While ventral tegmental area (VTA) dopamine (DA) neurons may mediate social reward, a cellular substrate for the negative affective state of loneliness has remained elusive. Here, we identify a functional role for DA neurons in the dorsal raphe nucleus (DRN), in which we observe synaptic changes following acute social isolation. DRN DA neurons show increased activity upon social contact following isolation, revealed by in vivo calcium imaging. Optogenetic activation of DRN DA neurons increases social preference but causes place avoidance. Furthermore, these neurons are necessary for promoting rebound sociability following an acute period of isolation. Finally, the degree to which these neurons modulate behavior is predicted by social rank, together supporting a role for DRN dopamine neurons in mediating a loneliness-like state.
This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Shear-Activated Nanoparticle Aggregates Combined With Temporary Endovascular Bypass to Treat Large Vessel Occlusion

The video associated with this looks great. When do we get this in real life?  What is your doctor and hospital doing to get this validated? What about your stroke association doing ANYTHING AT ALL?
Video here:
https://www.facebook.com/ScienceNaturePage/videos/778434595622134/

Press release here:
http://wyss.harvard.edu/viewpressrelease/224/drugdevice-combination-opens-potential-new-path-to-treat-stroke

 Research article here:
Shear-Activated Nanoparticle Aggregates Combined With Temporary Endovascular Bypass to Treat Large Vessel Occlusion
  1. Ajay K. Wakhloo, MD, PhD
+ Author Affiliations
  1. From the New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester (M.G.M., M.J.G., S.V., E.T.L., O.W.B., A.S.P., J.-Y.C., A.K.W.); Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA (N.K., O.U., A.-L.P., C.J., D.B., M.K., B.R.B., D.E.I.); Department of Biomedical Engineering, Technion, Israel (N.K.); Vascular Biology Program, Boston Children’s Hospital and Harvard University, Boston, MA (D.E.I.); and Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, MA (D.E.I.).
  1. Correspondence to Donald E. Ingber, MD, PhD, Wyss Institute at Harvard, CLSB5, 3 Blackfan Circle, Boston, MA 02115. E-mail don.ingber@wyss.harvard.edu
  1. * Drs Marosfoi, Korin, and Gounis contributed equally.
  2. Drs Ingber and Wakhloo are joint senior authors.

Abstract

Background and Purpose—The goal of this study is to combine temporary endovascular bypass (TEB) with a novel shear-activated nanotherapeutic (SA-NT) that releases recombinant tissue-type plasminogen activator (r-tPA) when exposed to high levels of hemodynamic stress and to determine if this approach can be used to concentrate r-tPA at occlusion sites based on high shear stresses created by stent placement.
Methods—A rabbit model of carotid vessel occlusion was used to test the hypothesis that SA-NT treatment coupled with TEB provides high recanalization rates while reducing vascular injury. We evaluated angiographic recanalization with TEB alone, intra-arterial delivery of soluble r-tPA alone, or TEB combined with 2 doses of intra-arterial infusion of either the SA-NT or soluble r-tPA. Vascular injury was compared against stent-retriever thrombectomy.
Results—Shear-targeted delivery of r-tPA using the SA-NT resulted in the highest rate of complete recanalization when compared with controls (P=0.0011). SA-NT (20 mg) had a higher likelihood of obtaining complete recanalization as compared with TEB alone (odds ratio 65.019, 95% confidence interval 1.77, >1000; P=0.0231), intra-arterial r-tPA alone (odds ratio 65.019, 95% confidence interval 1.77, >1000; P=0.0231), or TEB with soluble r-tPA (2 mg; odds ratio 18.78, 95% confidence interval 1.28, 275.05; P=0.0322). Histological analysis showed circumferential loss of endothelium restricted to the area where the TEB was deployed; however, there was significantly less vascular injury using a TEB as compared with stent-retriever procedure (odds ratio 12.97, 95% confidence interval 8.01, 21.02; P<0.0001).
Conclusions—A novel intra-arterial, nanoparticle-based thrombolytic therapy combined with TEB achieves high rates of complete recanalization. Moreover, this approach reduces vascular trauma as compared with stent-retriever thrombectomy.

Sunday, February 28, 2016

The Bobath Concept/NDT: Clarifications and Context

Wow, The Bobath concept  is an individualised response-based treatment approach. Because of that it results in difficulty in investigating the Bobath concept using traditional experimental designs such as the Randomised Controlled Trial. What a crock, if you can't create a RCT then you have no basis in even using it for therapy. Apologists in force in this posting. I guess it is unprofessional to criticize Bobath, well shit, I'm not a medical professional so if you can't prove your stuff works then you can shove it.
http://www.bbta.org.uk/news/bobath-concept-clarifications-and-context

Point by point refutation here:
Thoughts on the BBTA’s thoughts

Effects of circuit training as alternative to usual physiotherapy after stroke: randomised controlled trial

No idea what the hell this is. This is totally useless unless your doctor contacts the researchers for the stroke protocol.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3349299/
Ingrid G L van de Port, assistant professor,1 Lotte E G Wevers, PhD student,1 Eline Lindeman, professor,1 and Gert Kwakkel, professorcorresponding author1,2

Abstract

Objective To analyse the effect of task oriented circuit training compared with usual physiotherapy in terms of self reported walking competency for patients with stroke discharged from a rehabilitation centre to their own home.
Design Randomised controlled trial with follow-up to 24 weeks.
Setting Multicentre trial in nine outpatient rehabilitation centres in the Netherlands
Participants Patients with stroke who were able to walk a minimum of 10 m without physical assistance and were discharged from inpatient rehabilitation to an outpatient rehabilitation clinic. Patients were randomly allocated to circuit training or usual physiotherapy, after stratification by rehabilitation centre, with an online randomisation procedure.
Intervention Patients in the intervention group received circuit training in 90 minute sessions twice a week for 12 weeks. The training included eight different workstations in a gym and was intended to improve performance in tasks relating to walking competency. The control group received usual outpatient physiotherapy.
Main outcome measures The primary outcome was the mobility domain of the stroke impact scale (SIS, version 3.0). Secondary outcomes were standing balance, self reported abilities, gait speed, walking distance, stair climbing, instrumental activities of daily living, fatigue, anxiety, and depression. Differences between groups were analysed according to the intention to treat principle. All outcomes were assessed by blinded observers in a repeated measurement design lasting 24 weeks.
Results 126 patients were included in the circuit training group and 124 in the usual care group (control), with data from 125 and 117, respectively, available for analysis. One patient from the circuit training group and seven from the control group dropped out. Circuit training was a safe intervention, and no serious adverse events were reported. There were no significant differences between groups for the stroke impact scale mobility domain (β=0.05 (SE 0.68), P=0.943) at 12 weeks. Circuit training was associated with significantly higher scores in terms of gait speed (0.09 m/s (SE 0.02), P<0.001), walking distance (20.0 m (SE 7.4), P=0.007), and modified stairs test (−1.6 s (SE 0.7), P=0.015). There were no significant differences between groups for the other secondary outcomes, except for the leisure domain of the Nottingham extended activities of daily living and the memory and thinking domain of the stroke impact scale. With the exception of gait speed (−0.04 m/s (SE 0.02), P=0.040), there were no significant differences between groups at follow-up.
Conclusion Task oriented circuit training can safely replace usual physiotherapy for patients with stroke who are discharged from inpatient rehabilitation to the community and need further training in gait and gait related activities as an outpatient.
Trial registration Dutch Trial Register (NTR1534).


Two of the doctors being interviewed here, still no help in understanding this at all.
Anne Moseley talked to Dr Jannette Blennerhassett and Dr Wayne Dite (Austin Health Royal Talbot Rehabilitation Centre, Australia) whose trial evaluating circuit class training in stroke rehabilitation is one of the most significant trials in physiotherapy.

Neuroscience reveals 4 rituals that will make you happy

Precisely what is the stroke protocol your doctor is using to make you happy? DO NOT follow these dangerous ideas without your doctors ok.
http://theweek.com/articles/601157/neuroscience-reveals-4-rituals-that-make-happy


The Saddest Thing About How Men View Their Own Depression

Is your doctor and family aware of this? I never had any discussions about the lost abilities from the stroke. Not that I ever considered myself depressed.
Readable article here:
http://www.spring.org.uk/2016/02/the-saddest-thing-about-how-men-view-their-own-depression.php?omhide=true&utm_source=PsyBlog&utm_campaign=79597397f5-RSS_EMAIL_CAMPAIGN_MAILCHIMP&utm_medium=email&utm_term=0_10ef814328-79597397f5-213838825
Research it is based upon here:
Stigma in Male Depression and Suicide: A Canadian Sex Comparison Study

What does a scientist think of "right brain/left brain" tests?

Hopefully your doctor doesn't fall into this left brain/right brain crap. Even if Dr. Jill Bolte-Taylor believes in it wholeheartedly.
http://www.bbc.com/news/blogs-trending-35640368
Millions of Facebook users have done the online tests.
Maybe you've noticed the recent spate of "brain tests" making the rounds online.
There are different versions - several have been shared hundreds of thousands of times on Facebook - but most of them take the form of a quiz which purports to show how "left-brained" or "right-brained" you are. The idea is that the left side of the brain is associated more with logic and rationality and the right side controls creativity and emotion.
So is there any evidence that the two sides of the brain correspond to those particular characteristics?

"It is certainly the case that some people have more methodical, logical cognitive styles, and others more uninhibited, spontaneous styles," says Jeffrey Anderson, a brain researcher at the University of Utah. "This has nothing to do on any level with the different functions of the [brain's] left and right hemisphere."
Anderson led a team that looked at the brains of more than a thousand people and measured strong connections on both sides of the brain. They found that these connections were distributed fairly evenly - in other words, it wasn't the case that some people had stronger connections on one side of the brain or the other.
So what explains the origins of the right/left myth? It stems from Nobel Prize-winning research which showed that different sections of the brain have different functions. But separating the brain's two halves into "logical" and "emotional" hemispheres appears to be a function of pop psychology, not science.
"The pop culture idea (creative vs. logical traits) has no support in the neuroscience community and flies in the face of decades of research about brain organization, the functional roles of the two brain hemispheres and evidence from patients with lesions in one or the other hemisphere in the brain," Anderson told BBC Trending via email.

Follow BBC Trending on Facebook

Join the conversation on this and other stories here.

A 2011 BBC Radio 4 programme debunked the right brain/left brain theory along with other popular brain myths, such as the idea that we only use 10% of our grey matter, or that listening to Mozart makes us smarter.
Now here at BBC Trending we hate to ruin the party, so by all means continue to take those Facebook brain quizzes if you like, but remember it's a just bit of fun - not a bit of science.


Coaching or gaming? Implications of strategy choice for home based stroke rehabilitation

We wouldn't need very much of this research if our stroke professionals would do their job and solve the neuronal cascade of death.  Or create repeatable neuroplasticity and neurogenesis protocols. But since stroke has absolutely NO strategy we are going to be flailing in the dark for decades. Your children and grandchildren will still be screwed if they have a stroke.
http://www.jneuroengrehab.com/content/13/1/18
Mónica S. Cameirão12*, Asim Smailagic3, Guangyao Miao3 and Dan P. Siewiorek3
1 Faculdade das Ciências Exatas e da Engenharia, Universidade da Madeira, Campus Universitário da Penteada, Funchal, 9020-105, Portugal
2 Madeira Interactive Technologies Institute, Polo Científico e Tecnológico da Madeira, Caminho da Penteada, Funchal, 9020-105, Portugal
3 Department of Electrical and Computer Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
For all author emails, please log on.
Journal of NeuroEngineering and Rehabilitation 2016, 13:18  doi:10.1186/s12984-016-0127-8
The electronic version of this article is the complete one and can be found online at: http://www.jneuroengrehab.com/content/13/1/18

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), 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 (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Abstract

Background

The enduring aging of the world population and prospective increase of age-related chronic diseases urge the implementation of new models for healthcare delivery. One strategy relies on ICT (Information and Communications Technology) home-based solutions allowing clients to pursue their treatments without institutionalization. Stroke survivors are a particular population that could strongly benefit from such solutions, but is not yet clear what the best approach is for bringing forth an adequate and sustainable usage of home-based rehabilitation systems. Here we explore two possible approaches: coaching and gaming.

Methods

We performed trials with 20 healthy participants and 5 chronic stroke survivors to study and compare execution of an elbow flexion and extension task when performed within a coaching mode that provides encouragement or within a gaming mode. For each mode we analyzed compliance, arm movement kinematics and task scores. In addition, we assessed the usability and acceptance of the proposed modes through a customized self-report questionnaire.

Results

In the healthy participants sample, 13/20 preferred the gaming mode and rated it as being significantly more fun (p < .05), but the feedback delivered by the coaching mode was subjectively perceived as being more useful (p < .01). In addition, the activity level (number of repetitions and total movement of the end effector) was significantly higher (p < .001) during coaching. However, the quality of movements was superior in gaming with a trend towards shorter movement duration (p = .074), significantly shorter travel distance (p < .001), higher movement efficiency (p < .001) and higher performance scores (p < .001). Stroke survivors also showed a trend towards higher activity levels in coaching, but with more movement quality during gaming. Finally, both training modes showed overall high acceptance.

Conclusions

Gaming led to higher enjoyment and increased quality in movement execution in healthy participants. However, we observed that game mechanics strongly determined user behavior and limited activity levels. In contrast, coaching generated higher activity levels. Hence, the purpose of treatment and profile of end-users has to be considered when deciding on the most adequate approach for home based stroke rehabilitation.

Saturday, February 27, 2016

Cross-education of strength has a positive impact on post-stroke rehabilitation: a systematic literature review

I have  no fucking clue what this means or how to accomplish this. If we had publicly available stroke protocols this would be easy to figure out. So call up the presidents of our fucking failures of stroke associations and ask why they won't even do this minute task to help stroke survivors.
http://www.maneyonline.com/doi/abs/10.1080/10749357.2015.1112062

Background: Since its discovery in 1894 cross-education of strength — a bilateral adaptation after unilateral training – has been shown to be effective in the rehabilitation after one-sided orthopedic injuries. Limited knowledge exists on its application within the rehabilitation after stroke. This review examined the evidence regarding the implication of cross-education in the rehabilitation of the post-stroke hemiplegic patient and its role in motor function recovery.
Methods: Electronic databases were searched by two independent assessors. Studies were included if they described interventions which examined the phenomenon of cross-education of strength from the less-affected to the more-affected side in stroke survivors. Study quality was assessed using the PEDro scale and the Cochrane risk of bias assessment tool.
Results: Only two controlled trials met the eligibility criteria. The results of both studies show a clear trend towards cross-educational strength transfer in post-stroke hemiplegic patinets with 31.4% and 45.5% strength increase in the untrained, more-affected dorsiflexor muscle. Results also suggest a possible translation of strength gains towards functional task improvements and motor recovery.
Conclusion: Based on best evidence synthesis guidelines the combination of the results included in this review suggest at least a moderate level of evidence for the application of cross-education of strength in stroke rehabilitation. Following this review it is recommended that additional high quality randomized controlled trials are conducted to further support the findings.

Relationship between the threshold of sole cutaneous sense and functional balance and mobility tests in patients with chronic hemiparesis

So they found a correlation, So what? What is your proposed solution to this problem? Don't just tell me what the problem is, tell me how you are going to solve it. If we had a strategy we wouldn't have wasted money and time on research like this.
http://mrj.tums.ac.ir/browse.php?a_id=5408&sid=1&slc_lang=en
Author(s): Soheila Fallah , Ghorban Taghizade , Laleh Lajavardi , Mohammad Ali Sanjari , Ali Ashraf Jamshidi , Mehdi Ebrahimpoor
MSc, Department of Occupational Therapy, School of Rehabilitation, Iran University of Medical Sciences.
Lecturer, Department of Occupational Therapy, School of Rehabilitation, Iran University of Medical Sciences , gh-taghizade@yahoo.com
Assistant Professor, Department of Occupational Therapy, School of Rehabilitation, Iran University of Medical Sciences
Assistant Professor, Department of Basic Rehabilitation Sciences and Rehabilitation Research Center, School of Rehabilitation, Iran University of Medical Sciences
Associate Professor, Department of Physiotherapy and Rehabilitation Research Center, School of Rehabilitation, Iran University of Medical Sciences
MSc, Department of Occupational Therapy, School of Rehabilitation, Iran University of Medical Sciences
Study Type: Research | Subject: Special | Received: 2016/02/16 - Accepted: 2016/02/16 - Published: 2016/02/16
Abstract:   (26 View)

Background and Aim: One of the impaired senses in patients with chronic hemiparesis is the sole cutaneous sense. The role of this sense in maintaining the functional balance and mobility is still controversial in these patients. The aim of this study was to investigate the relationship between the threshold of sole cutaneous sense and functional balance and mobility tests in patient with chronic hemiparesis.



Material and Methods: In this correlational study, seventeen chronic stroke patients by mean age of 59.10 (13.31) years and mean time after injury of 31.70 (23.61) months were selected by simple non– probability method. Functional Reach with ankle and hip strategy (FR), Step Test (ST) in affected and non- affected foot, Bend– Reach test (BR), Timed Up and Go test (TUG) and Berg Balance Scale (BBS) were used for assessment of functional balance and mobility and Semmes- Weinstein monofilaments test was used to measure the cutaneous sense of seven different points of sole in affected and non– affected foot.



Results: The main effect of foot (affected and non– affected foot) and points (seven different points of sole) of cutaneous sense threshold was significant (P<0.0001) and interaction effect of foot ˣ points not significant (P=0.2).

The cutaneous sense threshold in all seven points of affected sole showed significant (p<0.05) low to high correlation (r= 0.24-0.81) with all of functional balance and mobility tests. There was not significant correlation between cutaneous sense threshold in seven points of non- affected foot and any of functional balance and mobility tests, with the exception of cutaneous sense threshold of the little toe floor with total, dynamic and static score of BBS, FR with ankle and hip strategy and TUG; cutaneous sense threshold of big toe with static score of BBS and FR with hip strategy; and medial border of sole with static score of BBS and FR with ankle strategy.



Conclusion: The cutaneous sense threshold of affected sole has a more correlation with functional balance and mobility tests. The cutaneous sense threshold of sole in big toe and medial border points has a significant role in functional balance and mobility tests in patients with hemiparesis.



Keywords: Functional balance and mobility, Cutaneous sense threshold, Hemiparesis
Keywords: Functional balance and mobility, Cutaneous sense threshold, Hemiparesis,
Full text [PDF 416 kb]   (20 Download)
   (20 Download)












Neurogenesis in the Pediatric Brain Following Ischemic Stroke: a Potential Target for Endogenous Regeneration and Repair

The extremely obvious question is: Should stroke survivors be treated with young blood and young gut bacteria to maybe mimic the youthfulness of the brain and thus get better neurogenesis? We'll never know because NO one in stroke is leading or has any type of strategy being followed. Your children and grandchildren are screwed if they have a stroke.
http://stroke.ahajournals.org/content/47/Suppl_1/A70.short

  1. Paco S Herson4
+ Author Affiliations
  1. 1Dept of Pharmacology, Dept of Pharmacology, Univ of Colorado Denver, Anschutz Med Campus, Aurora, CO
  2. 2Dept of Cell and Developmental Biology, Dept of Cell and Developmental Biology, Univ of Colorado Sch of Medicine, Aurora, CO
  3. 3Dept of Anesthesiology, Dept of Anesthesiology, Univ of Colorado Denver, Anschutz Med Campus, Aurora, CO
  4. 4Depts of Pharmacology & Anesthesiology, Depts of Pharmacology & Anesthesiology, Univ of Colorado Denver, Anschutz Med Campus, Aurora, CO

Abstract

Introduction: Following stroke, neurons are seriously damaged or die, impairing local brain function and contributing to long-term disability. Mounting evidence suggests that stroke recovery in children is enhanced compared to adults. Neurogenesis, a process involving the generation of functionally integrated neurons from progenitor cells, may play a role in enhanced plasticity and neuronal repair. Stroke-induced neurogenesis in adults involves massive proliferation and migration of newborn neurons, however these newborn neurons go on to die, never repopulating areas of damage. We tested the hypothesis that neurogenesis in the young brain effectively repopulates injured regions following ischemia.
Methods: Stroke was induced in adult (2-3 mo, n=21) and pediatric (P20-25, n=21) mice by 45-min right middle cerebral artery occlusion (MCAo). Bromodeoxyuridine (BrdU) was injected on days 3 and 4, and mice sacrificed at 24 hr, 7 d or 30 d after recovery from MCAo. Immunohistochemistry was performed to assess cellular proliferation and neurogenesis.
Results: The results revealed extensive neuronal cell death in the striatum of both pediatric and adult mice at 24 hr and 7 d after stroke. Remarkably, significant numbers of healthy, mature neurons (NeuN+) were observed in the striatum of pediatric mice at 30 d post-injury. Birth-dating with BrdU demonstrated robust, ischemia-induced proliferation of neural progenitor cells in both adult and pediatric brain. Consistent with previous reports, we observed very few mature NeuN+ neurons double labeled with BrdU in the injured adult brain. In contrast, significant numbers of BrdU+NeuN cells were observed in the pediatric brain 30 d after MCAo, indicative of mature neurons and most importantly, with COUP-TF1-interacting protein 2 (Ctip2) expression, a marker of medium spiny striatal neurons.
Conclusion: Our results indicate that cerebral ischemia in pediatric mice increases neurogenesis and migration to sites of damage, and supports the possibility of true neuronal replacement in the pediatric brain. These findings have exciting implications for heightened restorative processes in the pediatric brain microenvironment.

Stroke Rounds: Statin Users Have Better Outcomes

But they didn't compare it to these other pretreatment options. So as far as research is concerned this is pretty worthless. Damn it all,  does no one in stroke ever think at all? Do they not know about this other research?

 

High altitudes for Training the Brain to Survive Stroke.

 

Neurovascular Mechanisms of Ischemia Tolerance Against Brain Injury

 

Prior Cannabis Use Is Associated with better Outcome after Intracerebral Hemorrhage

 

Vaccine shows potential to protect the brain before a stroke

 

Mice were pretreated with genistein (2.5, 5, and 10mg/kg) or vehicle orally once daily for 14 consecutive days before MCA.

  

Numerous reports of lower in-hospital mortality among smokers versus nonsmokers 

 

Clinically established low doses of memantine should be considered for patients 'at risk' of stroke 

 

Pretreatment of fish oil supplementation in a rat model of multiple mild traumatic brain injuries.

 

 

 

 

 And the fairly worthless one-off here:

 

Stroke Rounds: Statin Users Have Better Outcomes

Preexisting statin use was associated with better outcomes in patients with acute ischemic stroke (AIS) from large artery atherosclerosis (LAA), an international, multicenter study showed.
Neurologic improvement during hospitalization was greater in patients on a statin and taking it in the days prior to stroke than in those not taking a statin (66.7% versus 38.9%; P=0.004), Georgios Tsivgoulis, MD, PhD, of the University of Tennessee Health Science Center in Memphis, and colleagues found.
Statin use before stroke was independently associated with favorable functional outcome using a modified Rankin Scale (mRS) score of 0-1 (odds ratio 2.44%; 95% confidence interval 1.07-5.53), the investigators reported online in Neurology.
Patients with LAA who received statins prior to the onset of AIS also had a lower risk of stroke recurrence (hazard ratio 0.11; 95% CI 0.02-0.46) at 30 days and a lower risk of 1-month mortality (HR 0.24; 95% CI: 0.08-0.75), the study showed.
"Our findings provide preliminary observational evidence underscoring a potentially beneficial effect of statins in improving early stroke outcomes in AIS patients with an underlying atherothrombotic mechanism," the researchers wrote. "This hypothesis deserves to be further tested in the setting of a randomized controlled trial."
Results from this study lend support to current American Heart Association/American Stroke Association recommendations for continuation of statin treatment during the acute period in pretreated AIS patients, pointed out the investigators. However, they emphasized, in the absence of phase III, randomized controlled trial data on the safety and efficacy of statins during the first 30 days following stroke, the observational study design and the short follow-up "does not allow us to infer any causal associations between statin pretreatment and improved outcomes in patients with acute LAA."
While this study provides "key data" and adds to the growing evidence about the benefits of statin use in AIA, "the results should be interpreted with caution because of potential residual confounding," Andreas Charidimou, MD, PhD, of the Massachusetts General Hospital Stroke Research Center in Boston, and Áine Merwick, MB, PhD, of the Westminster NHS Foundation Trust in London, cautioned in an accompanying editorial.
"Unlike strong evidence supporting statin use in cardiovascular risk reduction and acute myocardial ischemia, their effects on cerebral tissue and potential benefits on stroke outcomes remain poorly understood and under-studied," said the editorialists. "The only current stroke-specific indication for statin use is atorvastatin (Lipitor) for secondary stroke prevention," they noted.
Charidimou and Merwick agreed on "the urgent need for a large randomized clinical trial of high-dose statin treatment in the acute stroke setting."
Statin pretreatment may play a role in symptomatic and asymptomatic patients undergoing carotid endarterectomy as well as in the periprocedural and postprocedural outcomes of patients undergoing carotid artery stenting procedures, they pointed out. In addition, data from this study may have implications for the management of asymptomatic carotid disease as well as interpretive value for ongoing studies such as the European Carotid Surgery Trial 2, said Charidimou and Merwick.
Tsivgoulis' study prospectively evaluated 516 consecutive first-ever AIS patients with LAA from seven tertiary stroke care centers from June 2011 to June 2014. The mean age was 65 years and 60.8% were male. The median NIHSS score was 9 points. LAA was diagnosed by TOAST criteria.
Statin pretreatment was documented in 192 (37.2%) patients. Information on the duration, dosage, and type of prestroke statin therapy was not collected, the authors noted.

Stroke care in London

This is a self serving pat yourself on the back video. They never talk RESULTS, just access, care and services. If you want results you are going to have to scream bloody murder at these people yourself.
https://vimeo.com/70425773?from=outro-local


Friday, February 26, 2016

Exercise for stroke patients

You will notice that there is nothing in this list for your doctor to do to help your recovery. Why the hell are you paying them anyway?
http://www.heartandstroke.com/site/c.ikIQLcMWJtE/b.9308599/k.D2B2/Exercise_for_stroke_patients.htm

"Take up one idea. Make that one idea your life - think of it, dream of it, live on that idea. Let the brain, muscles, nerves, every part of your body, be full of that idea, and just leave every other idea alone. This is the way to success." - Swami Vivekananda

Originally I thought my one idea was going to be full recovery and I'd do everything I could to get there. That passed when I became fairly mobile and realized no one had any clue on how to recover. Life took over and the goal was to become happy, I succeeded at that. Life is great.  My one idea is now to change the world of stroke research rehab and support.  I will succeed. Or as a friend once said, ' You need minions'. Yes I do, there are thousands upon thousands more articles to understand that might help stroke recovery and I don't have enough smarts or brainpower to do this alone. And the hundreds of employees of our stroke associations are not doing their part.

Six Healthcare IT Influencers in 2016

You will notice that not a single one has anything to do with stroke. It would be laughable how poorly stroke is run except for all the disability and death that comes from total lack of progress in stroke. We'll just have to deal with it until we can replace all the stroke boards of directors with actual stroke advocates not just zombies.
http://liveclinic.com/blog/2016/02/24/healthcareit-influencers-2016/
Eric Topol

Brian Aher

Kevin Pho

Robert Wachter

Berci Mesko

Matthew Herper

Fennel Seeds to Improve Athletic Performance - source of nitrates

This is interesting, but I hate these types of videos since I can't easily look up the research presented. No amount is given in here anywhere so once again we are left with nothing useful.
http://nutritionfacts.org/video/fennel-seeds-to-improve-athletic-performance/?
The pros and cons of fennel fruits as a cheap, easy-to-find, light-weight, nonperishable source of nitrates.

Restoring gut bacteria to youthful age linked to improved stroke recovery in mice

So young gut bacteria and young blood might help stroke survivors. How young in human terms are we talking about? When will your doctor complete research proving if this works or not in humans. If your doctor is not going to do such research s/he needs to be fired.
http://www.mdlinx.com/internal-medicine/top-medical-news/article/2016/02/26/3
American Heart Association News
Restoring microorganisms in the gut to a youthful age was linked to improved stroke recovery in old mice, according to a new study presented at the American Stroke Association’s International Stroke Conference 2016. Noting that different bacteria present in the gut change with age, researchers from the University of Connecticut in Mansfield, Connecticut, used fecal transplants to deliver a “young” set of bacteria to mice that were 18 to 20 months old as well as to mice just 3 or 4 months old, while another group of mice received an “aged” set of bacteria in each of those two age groups. The mice were first given an antibiotic to suppress their own microbial makeups and allow the new sets of gut bacteria to flourish. Follow–up behavioral and neurological tests showed that older mice with “young” sets of bacteria recovered from the induced stroke better than their peers with “aged” bacteria. Meanwhile, death rates after the stroke were particularly high — exceeding 50 percent — in young mice with “aged” bacterial makeups, researchers said.

HIMSS exec: CIOs most concerned about new payment models - Value-based payments

Your doctor and stroke hospital should be scared shitless if this gets applied for stroke. Since tPA only works fully 12% of the time and full recovery from stroke is only 10% the payment stream from stroke is going to be non-existent. This is actually a good thing. Fear of non-payment could finally drive innovation in stroke, maybe solve the neuronal cascade of death, create a new drug to replace tPA. There are thousands of research possibilities that just need further research and translation to stroke protocols. This is all easily solvable if we have anyone with leadership skills and a focus on stroke strategy.
http://medcitynews.com/2016/02/himss-exec-new-payment-models/?
By Neil Versel
While it may seem like healthcare CIOs are thinking about cybersecurity and about the future of Meaningful Use, those issues are less important to many health IT professionals than the transition to value-based payments.
That’s according to Carla Smith, executive vice president of the Healthcare Information and Management Systems Society, which holds its annual conference next week in Las Vegas. HIMSS will share more details of its yearly CIO survey Tuesday morning, but Smith gave MedCity News a small preview in a podcast interview this week.
Other findings she hinted at are that IT has become a “strategically critical tool” for successful healthcare providers nationwide and that there is a correlation between the strategic value placed on IT and organizations who have clinical IT executives. More organizations are including clinical IT executives like chief medical information officers and chief nursing information officers in strategic decisions — typically reporting directly to the CFO or CEO — though it’s still not a majority, Smith said.
As usual, the endurance event known as the HIMSS conference keep growing. Attendance could approach 50,000, far above the record of 45,000 that came to HIMSS15 in Chicago, and the exhibit hall will include more than 1,300 vendors.
Smith called attention to a session with Centers for Medicare and Medicaid Services Administrator Andy Slavitt and national health IT coordinator Dr. Karen DeSalvo at 5:30 Pacific time Tuesday. They plan on keeping their prepared remarks brief and will take a lot of questions, Smith said, and she encouraged the health IT community to tweet their  questions with the hashtag #HIMSS16.
Listen to the podcast below.

Thursday, February 25, 2016

Columbia professors develop robotic glove to help stroke survivors recover


I really do have to wonder if this was tested on any stroke survivors at all. That glove would be almost impossible for any survivor with finger spasticity to get on without at least 3 therapists and popsicle sticks. No help for the thumb.

http://columbiaspectator.com/news/2016/02/25/columbia-professors-develop-robotic-glove-help-stroke-victims-recover
Article Image
Nearly 800,000 people suffer from strokes every year, making it the leading cause of long-term disability in the United States.
Strokes can often lead to impaired hand function due to loss of blood flow to areas of the brain.
ADVERTISEMENT
To help address this, rehabilitation and regenerative medicine professor Joel Stein and mechanical engineering professor Matei Ciocarlie are combining their respective expertise in medicine and robotics to create MyHand, a glovelike device that aims to rehabilitate stroke survivors who have lost function in their hands.
The glove, currently in its prototype stage, is being funded by a Columbia-Coulter research partnership and a National Science Foundation award. Ciocarlie was also recently a recipient of the Sloan Research Fellowship, an award that commends early-career scientists and provides grant money to further their research.
Traditionally, stroke survivors with impaired hand function have turned to physical therapists to help them regain hand function. However, limited therapy resources and failure to exercise enough often pose major challenges to full recovery.
MyHand seeks to overcome those challenges by assisting stroke survivors with their rehabilitation exercises and overall hand motion. Stein and Ciocarlie's device is a portable, lightweight glove that uses artificial tendons to assist the user’s hand movement by helping them make grasping motions and other hand movements that would otherwise be difficult or impossible(Sorry, this looks like it might help grasp in the lower picture but the upper picture doesn't look like it helps grasping at all).
The hope is that MyHand would speed up recovery time by allowing people to do more exercises on their own, in their own time.
“If the task is to pick up objects … and you can’t actually pick them up quickly, you’ll get frustrated and call it a day,” Stein said. “But a device that can help you complete the task then gives you reason to keep at it and keep practicing—and hopefully, ultimately, not need the device.”
To successfully aid stroke survivors in these everyday tasks, MyHand must be both versatile and wearable. From an engineering perspective, the device has to be able to assist the many joints and digits of the hand while using very few motors to reduce weight and clunkiness.
“You don’t want a big, massive device that, you know, somebody sits down next to and then gets hooked up to,” Ciocarlie said. “You want something that the person can use in their kitchen, or in their living room.”
Currently, Stein and Ciocarlie are testing their prototypes on patients at the Columbia University Medical Center. There, the researchers are troubleshooting potential issues, such as correctly positioning the glove on the wrist and making sure the patient can take the glove on and off.
Stein and Ciocarlie are also working on finding the target population that would best benefit from the device. Those with hand impairment often exhibit different levels of impediment brought upon by their stroke, ranging from slightly slowed movements to complete immobility.
“There’s a sweet spot in terms of this type of technology. Some people don’t need it, some people can’t benefit from it, and some people can’t really tolerate it, or it’s too difficult for them to use,” Stein said. “To try to find the best population, the most targeted, the most likely to benefit population, is part of what we’ve been working on.” 
Though MyHand is still in its prototype stage, both Stein and Ciocarlie discussed the untapped potential that such collaborations between engineering and medicine stand to offer.
“It’s interesting—it’s a good, deep problem to work on,” Ciocarlie said. “We won’t run out of scientific challenges anytime soon.”