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

Saturday, April 30, 2016

Bilateral robots for upper-limb stroke rehabilitation: State of the art and future prospects

This is a review article so your doctor should already have read and updated your stroke protocols based on those earlier research trials. And pigs fly. You're screwed.
http://www.sciencedirect.com/science/article/pii/S1350453316300480
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Highlights

A comprehensive overview of robot mechanism for bilateral upper-limb rehabilitation robots since 1993.
A systematic overview of clinical trials (total 34 randomized controlled trials and 877 participants) and effectiveness for robots described above.
Several suggestions of robot mechanisms, clinical trials and directions for further researches.

Abstract

Robot-assisted bilateral upper-limb training grows abundantly for stroke rehabilitation in recent years and an increasing number of devices and robots have been developed. This paper aims to provide a systematic overview and evaluation of existing bilateral upper-limb rehabilitation devices and robots based on their mechanisms and clinical-outcomes. Most of the articles studied here were searched from nine online databases and the China National Knowledge Infrastructure (CNKI) from year 1993 to 2015. Devices and robots were categorized as end-effectors, exoskeletons and industrial robots. Totally ten end-effectors, one exoskeleton and one industrial robot were evaluated in terms of their mechanical characteristics, degrees of freedom (DOF), supported control modes, clinical applicability and outcomes. Preliminary clinical results of these studies showed that all participants could gain certain improvements in terms of range of motion, strength or physical function after training. Only four studies supported that bilateral training was better than unilateral training. However, most of clinical results cannot definitely verify the effectiveness of mechanisms and clinical protocols used in robotic therapies. To explore the actual value of these robots and devices, further research on ingenious mechanisms, dose-matched clinical protocols and universal evaluation criteria should be conducted in the future.

Keywords

  • Rehabilitation robot;
  • Upper-limb;
  • Bilateral training;
  • Clinical protocols

Corresponding author at: Department of Mechanical Engineering, the University of Auckland, 20 Symonds Street, Auckland city, New Zealand. Tel.: +64 9 9238143.

Early feeds not force feeds: enteral nutrition in traumatic brain injury

Exact same question for stroke. We'll never know because we have NO stroke leadership or strategy to answer such fuckingly simple questions.
http://journals.lww.com/jtrauma/Abstract/publishahead/Early_feeds_not_force_feeds___enteral_nutrition_in.99541.aspx
Azim, Asad MD; Haider, Ansab A. MD; Rhee, Peter MD, MPH; Verma, Ket MD; Windell, Elizabeth MD; Orouji Jokar, Tahereh MD; Kulvatunyou, Narong MD; Meer, Mary RD, CNSC; Latifi, Rifat MD; Joseph, Bellal MD
Published Ahead-of-Print
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Abstract

BACKGROUND: Brain Trauma Foundation guidelines recommend the early use of enteral nutrition to optimize recovery following traumatic brain injury (TBI). Our aim was to examine the effect of early feeds (<=24 hours) on clinical outcomes after TBI.
MATERIALS: We performed a 3-year retrospective study of patients with severe TBI (GCS<8) who were intubated, admitted to the ICU, and received tube feeds. Early tube feeds (Early-TF) was defined as initiation of tube feeds within 24 hours, while Late tube feeds (Late-TF) was defined as initiation of tube feeds after 24 hours. Outcome measures included pneumonia rates, days on ventilator, hospital and ICU stay, and mortality rates.
RESULTS: A total of 90 patients (Early-TF: 58, Late-TF: 32) were included of which 73.3% were male, mean age was 42+/-20 years, and median h-AIS was 4 [3-5]. There was no difference in age (p=0.1), h-AIS (p=0.5), or admission GCS (p=0.9) between the 2 groups. Patients with Early-TF were associated with higher no of ICU days (p=0.03) and higher pneumonia rates (p=0.04) but there was no significant difference in mortality (p=0.44) as compared to those who underwent Late-TF.
CONCLUSION: Although early tube feeds are known to improve outcomes in TBI patients, our data suggests that early feeds in TBI patients are associated with higher rates of pneumonia and greater hospital resource utilization.

The molecular neurobiology of the sleep-deprived, fuzzy brain

What is your doctors sleep protocol? I got nightly Ambien, still wonder if sleeping pill induced sleep is equivalent to regular sleep.
http://stke.sciencemag.org/content/9/425/fs7.abstract
Sci. Signal.  26 Apr 2016:
Vol. 9, Issue 425, pp. fs7
DOI: 10.1126/scisignal.aaf6196
You are currently viewing the abstract.
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Abstract

Sleep deprivation is well established to cause diminution of cognitive function, including disruption of both minute-to-minute working memory and decrements in the stabilization of long-term memories. Moreover, “replay” during sleep of episodes and sequences of events that were experienced during wakefulness has been implicated in consolidation of long-term memories. However, the molecular mechanisms underlying the role of sleep in memory function are just starting to be defined. In this issue of Science Signaling, Tudor et al. identify one molecular component underlying the effects of sleep on memory function: dynamic experience-dependent regulation of protein synthesis in the hippocampus.

The impact of mastication on cognition: evidence for intervention and the role of adult hippocampal neurogenesis

Send your doctor after the question. How much chewing do I need to do to improve neurogenesis?  Any laughter is grounds for firing that doctor.
http://www.fasebj.org/content/30/1_Supplement/679.11.short
  1. Sophie Miquel-Kergoat
+ Author Affiliations
  1. Science & Technology, Wrigley (Mars Inc.), Chicago, IL

Abstract

Adult hippocampal neurogenesis (AHN) in the dentate gyrus of the hippocampus has been shown to affect mood, cognition, learning ability and memory. A growing area of interest is whether mastication or chewing also affects AHN. This article aims to collect the evidence from animal and human studies to ascertain whether mastication is an oral environment enrichment capable of having a modulatory effect on AHN and associated behaviors.
Current data point toward a causal relationship between masticatory ability and cognitive function. Experimental studies on mice and rats have consistently shown that impairing masticatory function results in physical and behavioral changes. A recurring theme of decreased neural stem cells proliferation in the hippocampus was seen in most of the studies found. Human population study has shown that tooth loss and masticatory difficulty are positively correlated with having greater odds of cognitive impairment. However, no causal mechanism has yet been found to explain the effects of mastication on AHN.
Further clinical studies, in humans, are currently conducted to ascertain whether mastication could be used as a potential health intervention to slowdown cognitive decline in the aging population or delay the onset of diseases such as dementia.

Herbs that can boost your mood and memory

I bet nothing here will change your non-existent stroke diet protocol.
http://www.alphagalileo.org/ViewItem.aspx?ItemId=163655&CultureCode=en
The herbs peppermint, chamomile, rosemary and lavender have been proven to have an impact on mood and memory, with significant benefits displayed for older people, according to new research from Northumbria University.
Researchers from the University’s Department of Psychology have found that drinking peppermint tea improves alertness, while chamomile tea has a calming effect. They also found that smelling the aromas of rosemary and lavender impacted on memory in people over 65, with the scent of rosemary enhancing their memory, while lavender impaired it.
The findings have been presented at the annual British Psychological Society Conference in Nottingham this week (26-28 April 2016).
In one study, the researchers asked 180 volunteers to consume either a chamomile or peppermint tea drink and tested their cognition and mood before and after drinking. A control group drank hot water for comparison.
They found that peppermint enhanced and aroused both mood and cognition, helping to improve long term memory, working memory and alertness, while chamomile had a calming and sedative effect which significantly slowed memory and attention speed.
In a separate study, 150 healthy people aged 65 and over were placed in rooms which had been scented with rosemary and lavender essential oils, or a control room which had no scent. They were asked to undertake tests that assessed their prospective memory – the ability to remember to do something at a given time, such as taking medication, or after receiving a prompt, such as posting a letter after seeing a post box. They also completed a mood assessment test.
Those who had been in the rosemary scented room displayed significantly enhanced prospective memory, with test scores 15% higher than those who had been in the room with no aroma. They were also more alert.
In contrast, those who had spent time in the lavender scented room displayed significantly increased calmness and contentedness, with a decrease in their ability to remember to do something at a given time.
Dr Mark Moss, Head of the Department of Psychology, said: “Peppermint has a reputation for being psychologically or mentally alerting. It picks you up and makes you feel a little bit brighter, so we endeavoured to test this out by giving people peppermint tea, or chamomile tea, which is a more calming drink and then put them through some computerised tests. We found that those people who had drunk the peppermint tea had better long-term memory. They were able to remember more words and pictures that they had seen. In contrast, the people who had the chamomile were slower in responding to tasks.
“Rosemary meanwhile has a reputation about being associated with memory – even Shakespeare said ‘rosemary is for remembrance’ – and it’s also associated with being invigorating. We have found that people are more alert after being in a room that has rosemary aroma in it. We tested prospective memory – our ability to remember to remember to do something – on people over 65 years of age, to see if we could improve their ability and we found that rosemary could do that. This is potentially very important because prospective memory, for example, enables you to remember to take your medication at certain times of the day.
“It is interesting to see the contrasting effects that different herbs can have on both mood and memory, and our research suggests that that they could have beneficial effects, particularly in older age groups. If you were otherwise healthy then this research suggests that there is an opportunity to have an improved memory.”
Northumbria University’s Department of Psychology has undertaken a number of studies into the effects of herbs and substances on mood and memory. They have also found that sage, ginseng, lemon balm and gingko biloba can all have positive effects on improving mental performance.
Northumbria is ranked in the top 20 in the UK for its research in psychology, which was judged to have outstanding reach and significance for its impact, according to the 2014 Research Excellence Framework, which measures the quality of research undertaken at UK universities.

Massive failure to publish trial results exposes patients to risks without providing benefits for others

This following all research on stroke should be the minimum that our fucking failures of stroke associations should do for us.  I don't have enough brainpower or minions to know about research that is registered but not published.  As an example, what are the 1000+ failed neuroprotective research trials that Dr. Michael Tymianski, of the Toronto Western Hospital Research Institute in Canada  talks about?  I'm sure that with a minute amount of brainpower someone could figure out where to go from those failures. But we have to publicly know about them.
http://www.alphagalileo.org/ViewItem.aspx?ItemId=163549&CultureCode=en
Although the publication of results of clinical trials carried out in the US within 12 months of their completion has been mandatory since 2007, an astoundingly high number of Phase III radiotherapy trials did not do so, according to new research to be presented at the ESTRO 35 conference today (Saturday). An analysis of 802 trials with a primary completion date of before 1 January 2013 showed that 655, or 81.7%, did not publish even a summary result.
Jaime Pérez-Alija and his colleague Pedro Gallego, medical physicists from the radiotherapy and oncology department, Hospital Plató, Barcelona, Spain, also looked at radiotherapy trials that began before the 2007 Act was passed, and found little difference; 422 out of 552, or 76.4%, did not deposit their results with the ClinicalTrials.gov database.
“These findings came as a surprise for many reasons, not least of which was that many of the trials had been funded by the US National Institutes of Health. Since we know that clinical trials produce the best data for decision-making in modern evidenced-based medicine, it is particularly worrying that the law is being ignored on such a wide scale,” Mr Pérez-Alija will tell the conference.
One possible reason for non-publication, say the researchers, is that some of the trials may have been granted a deadline extension. But, if this is the case, it is not publicly known. “Therefore, our first problem is that we do not know with any certainty whether a trial is truly overdue. The registry says clearly that all dates must be updated if an extension has been allowed, but it seems likely that this is not happening in many cases,” says Mr Pérez-Alija.
The researchers are investigating the issue further to see, for example, how many of the trials registered in ClinicalTrials.gov or in other databases are being published in medical journals. They will also analyse bias, in the knowledge that it is easier and more usual to publish positive rather than negative findings. They intend to email principal investigators to ask why the mandatory deposition of results did not take place, and to enquire about the reasons for non-publication in medical journals of those trials where there is a published deposition.
“Interestingly, we found that company-funded trials are far better at complying with the rules than academic trials – 55% and 30% respectively. However, only one-third of all the trials we studied were company trials,” Mr Pérez-Alija will say.
The researchers broke down their results further by cancer sub-type. The only sub-type where more than half the trial results were published was eye cancer, with 47% unpublished, whereas in testicular and anal cancer the percentage of unpublished trial results was 100% for both categories. Even common cancers such as breast and lung fared badly, with 78% and 73.7% of results unpublished respectively.
“We have shown that a large number of study participants are routinely exposed to the risks of trial participation without the benefits that sharing and publishing results would have for patients in the future. This ethical issue should be at the heart of our current medical practice, and our leaders should be made aware that withholding these data poses a significant threat to public health. Both the US and, more recently, EU laws have made important steps to correct this situation. But if most trials – even those funded by public institutions – do not comply with these requirements, further measures need to be taken,” says Mr Pérez-Alija.
The US Act allows for economic sanctions to be taken against trial sponsors who do not comply with regulations. But the danger here, the researchers say, is that some investigators might decide not to begin a new trial if sanctions are a possibility. Having fewer trials could be damaging to the health system as a whole as well as to future patients.
A potential solution would be to institute a system whereby if clinical investigators apply for public funding, they would have to disclose results of all previously-conducted trials. And for privately-funded trials, results from all previous studies would have to be made available before the new trial could be registered.
“Millions of volunteers have participated in clinical trials to help find out more about the effects of treatments on disease, yet the important ethical issue of reporting results has been ignored widely. Information about what was done, and what was found in these trials could be lost forever, leading to bad treatment decisions, missed opportunities for good medicine, and trials being repeated unnecessarily. This situation should not be allowed to continue,” Mr Pérez-Alija will conclude.
ESTRO President Professor Philip Poortmans commented: “Patients who agree to participate in trials do so for the unselfish reason that they want to help others to have the best possible treatment in the future. Not to publish results is unfair to them, to future patients, and to medicine as a whole.”

Effect of Statin Treatment on Modifying Plaque Composition: A Double-Blind, Randomized Study

So it seems statins are a primary preventative after all, not just going after cholesterol which seems like going after an incidental factor in atheroscelerosis. But your doctor should know about all this, so ask for this in layperson terms.
http://www.ncbi.nlm.nih.gov/pubmed/27081016

Abstract

BACKGROUND:

How statins alter the natural course of coronary atherosclerosis with compositional changes remains unclear.

OBJECTIVES:

This study aimed to determine the effect of statin therapy on modifying plaque composition.

METHODS:

The STABLE (Statin and Atheroma Vulnerability Evaluation) prospective, single-center, double-blind, randomized study evaluated the effect of statins on functionally insignificant coronary stenoses. We randomly assigned 312 patients with a virtual histology (VH) intravascular ultrasound-defined fibroatheroma-containing index lesion to rosuvastatin 40 mg versus 10 mg (2:1 ratio). In 225 (72%) patients, grayscale- and VH-intravascular ultrasound were completed at baseline and 12 months. The primary endpoint was the change in VH-defined percent compositional volume within the target segment from baseline to follow-up in the per-protocol analysis set.

RESULTS:

Percent necrotic core (NC) volume within the target segment significantly decreased from 21.3 ± 6.8% to 18.0 ± 7.5% during 1-year follow-up, whereas the percent fibrofatty volume increased (11.7 ± 5.8% vs. 14.8 ± 9.3%; all p < 0.001). Percent fibrous (59.4 ± 7.8% vs. 59.2 ± 8.6%) and dense calcium (7.6 ± 5.1% vs. 7.8 ± 5.6%) volumes were unchanged. Frequencies of VH (55% vs. 29%) decreased significantly. Normalized total (202.9 ± 72.3 mm(3) vs. 188.5 ± 67.8 mm(3); p = 0.001) and percent (51.4 ± 8.3% vs. 50.4 ± 8.8%; p = 0.018) atheroma volumes decreased. Independent predictors of percent NC volume change were body mass index (β = 0.37; 95% confidence interval [CI]: 0.05 to 0.70), high sensitivity C-reactive protein (β = -3.16; 95% CI: -5.64 to -0.69), and baseline percent NC volume (β = -0.44; 95% CI: -0.68 to -0.19; all p < 0.05). VH-defined percent compositional volume changes in the rosuvastatin 40- and 10-mg groups were similar.

CONCLUSIONS:

Rosuvastatin reduced NC and plaque volume and decreased thin-cap fibroatheroma rate. There were no significant differences between high- versus moderate-intensity rosuvastatin. (Statin and Atheroma Vulnerability Evaluation [STABLE]; NCT00997880).

Effect of stem cell-based therapy for ischemic stroke treatment: A meta-analysis

So nothing useful yet, it is all just hype and scams. Even though the Gordie Howe family claims success.
http://www.clineu-journal.com/article/S0303-8467%2816%2930144-5/abstract?rss=yes
, , , , ,
1These authors contributed equally to this work.
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Highlights

  • We reviewed the effects of stem cell-based therapies on ischemic stroke.
  • We assessed all the trials using the error matrix approach.
  • A dose-response meta-analysis was performed in our research.

Abstract

Stroke is a major cause of death and long-term disability worldwide. Cell-based therapies improve neural functional recovery in pre-clinical studies, but clinical results require evaluation. We aimed to assess the effects of mesenchymal stem cells on ischemic stroke treatment.
We searched the PubMed, Embase and Cochrane databases until July 2015 and selected the controlled trials using mesenchymal stem cells for ischemic stroke treatment compared with cell-free treatment. We assessed the results by meta-analysis using the error matrix approach, and we assessed the association of mesenchymal stem cell counts with treatment effect by dose-response meta-analysis.
Seven trials were included. Manhattan plots revealed no obvious advantage of the application of stem cells to treat ischemic stroke. For the comprehensive evaluation index, stem cell treatment did not significantly reduce the mortality of ischemic stroke patients (relative risk (RR) 0.59, 95% confidence interval (CI) 0.29–1.19; ln(RR) 0.54, 95% CI −0.18 to 1.25, p = 0.141). The National Institutes of Health Stroke Scale was also not significantly improved by stem cell treatment (standardized mean difference (SMD) 0.94, 95% CI −0.13 to 2.01, p = 0.072). The European Stroke Scale was significantly improved using the stem cell treatment (SMD 1.15, 95% CI 0.37–1.92). The dose-response meta-analysis did not reveal a significant linear regression relationship between the number of stem cells and therapeutic effect, except regarding the National Institutes of Health Stroke Scale index.
In conclusion, our assessments indicated no significant difference between stem cell and cell-free treatments. Further research is needed to discover more effective stem cell-based therapies for ischemic stroke treatment.

Neuroprotective effects of the catalytic subunit of telomerase: A potential therapeutic target in the central nervous system

No clue. You could ask our fucking failures of stroke associations but they won't even know about it much less do any followup research. In case you haven't figured it out yet, you're screwed, your children and grandchildren are screwed unless we destroy the existing stroke organizations and replace them with survivor focused ones.
http://www.ncbi.nlm.nih.gov/pubmed/27095058

Abstract

Senescence plays an important role in neurodegenerative diseases and involves key molecular changes induced by several mechanisms such as oxidative stress, telomere shortening and DNA damage. Potential therapeutic strategies directed to counteract these molecular changes are of great interest for the prevention of the neurodegenerative process. Telomerase is a ribonucleoprotein composed of a catalytic subunit (TERT) and a RNA subunit (TERC). It is known that the telomerase is involved in the maintenance of telomere length and is a highly expressed protein in embryonic stages and decreases in adult cells. In the last decade, a growing number of studies have shown that TERT has neuroprotective effects in cellular and animal models after a brain injury. Significantly, differences in TERT expression between controls and patients with major depressive disorder have been observed. More recently, TERT has been associated with the decrease in reactive oxygen species and DNA protection in mitochondria of neurons. In this review, we highlight the role of TERT in some neurodegenerative disorders and discuss some studies focusing on this protein as a potential target for neuroprotective therapies. (We don't need discussion, we need followup research and if we had a strategy we could get somewhere by following a strategy.)

Friday, April 29, 2016

Gloves That Speak When You Sign

This would be great for forcing use of your affected hand with lots of repetitions. The biofeedback would be great, the word would not be enunciated properly if you don't get the signage correct. But I bet there will not be a single occupational therapist in the world suggesting this to bring back finger function.
http://www.rdmag.com/articles/2016/04/gloves-speak-when-you-sign?et_cid=5259871&
In the United States, one in eight people over the age of 12 has hearing loss in both ears, according to the National Institute on Deafness and Other Communication Disorders. For some, American Sign Language is the only means of communication. However, it’s hardly ubiquitous when it comes to the entire U.S. population.
Two University of Washington undergraduate students are looking to bridge that gap. Navid Azodi and Thomas Pryor, earlier this month, won a $10,000 Lemelson-MIT Student Prize for their gloves that can translate sign language into text and speech.
“Our gloves are lightweight, compact and worn on the hands, but ergonomic enough to use as an everyday accessory, similar to hearing aids or contact lenses,” Pryor said in a statement.
Called “SignAloud,” the gloves contain sensors that record hand movements and shoot the data wirelessly to a central computer, which matches the movement with a known gesture. The corresponding word or phrase is spoken through a speaker.
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Azodi and Pryor won the competition’s “Use It” category, which recognizes technology-based inventions capable of improving consumer devices.
“Our purpose for developing these gloves was to provide an easy-to-use bridge between native speakers of American Sign Language and the rest of the world,” Azodi said in a statement. “The idea initially came out of our shared interest in invention and problem solving. But coupling it with our belief that communication is a fundamental human right, we set out to make it more accessible to a larger audience.”
“SignAloud” is less bulky than some of its predecessors, one of which covers the entire forearm.
“The gloves can also be commercialized for use in many fields, including medical technology to monitor stroke patients during rehabilitation, gesture control of remote devices, and enhanced dexterity in virtual reality,” according to Lemelson-MIT. “The gloves offer superior resolution and accuracy to other hand-gesture recognition devices currently available including the Myo Armband and the Leap Motion.”
Azodi and Pryor, and the other winners of the various Lemelson-MIT Student Prizes, won from an applicant pool that included 77 other colleges and universities. 

Patients as Partners: A Qualitative Study of Patients’ Engagement in Their Health Care

Our stroke doctors need to follow this, they should meet an intelligent survivor sometime who tells them everything they are doing is wrong.
http://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0122499
  • Marie-Pascale Pomey ,
  • Djahanchah P. Ghadiri ,
  • Philippe Karazivan ,
  • Nicolas Fernandez ,
  • Nathalie Clavel
  • Marie-Pascale Pomey, 
  • Djahanchah P. Ghadiri, 
  • Philippe Karazivan, 
  • Nicolas Fernandez, 
  • Nathalie Clavel


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  • Abstract
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Abstract
To advocate for patients to be more actively involved with the healthcare services they receive, particularly patients living with chronic illness, the Faculty of Medicine of the University of Montreal and its affiliated hospitals developed the Patients as Partners concept where the patient is considered a full-fledged partner of the health care delivery team and the patient’s experiential knowledge is recognized. This study aims to show how patients view their engagement with healthcare professionals regarding their direct care. Using theoretical sampling, 16 semi-structured interviews were conducted with patients with chronic illness who were familiar with the concept of Patients as Partners. Data analysis followed a constructivist grounded theory approach. Patients describe themselves as proactively engaging in three types of practice, regardless of health professionals’ openness to their role as partners. The first is a process of continuous learning that allows them to acquire experiential knowledge about their health, as well as scientific information and technical know-how. The second involves their assessment of the healthcare they receive, in terms of its quality and how it aligns with their personal preferences. It includes their assessment of the quality of their relationship with the health professional and of the latter’s scientific knowledge and technical know-how. The third type, adaptation practices, builds on patients’ learning and assessments to compensate for and adapt to what has been perceived as optimal or non-optimal health or healthcare circumstances. Patients appear to play a more active and less docile role in their own direct care than suggested so far in the literature, regardless of the degree of reciprocity of the partnership or the degree to which the health professional seeks to encourage patient engagement.