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:

Sunday, July 31, 2016

Differences in cognitive profiles between traumatic brain injury and stroke: a comparison of the Montreal Cognitive Assessment and Mini-Mental State Examination

What is your doctor going to do with this to get you cognitively back to normal?
Open Access funded by Daping Hospital and the Research Institute of Surgery of the Third Military Medical University
Under a Creative Commons license



To investigate the profiles of cognitive impairment through Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) in patients with chronic traumatic brain injury (TBI) or stroke and to evaluate the sensitivity of the two scales in patients with TBI.


In this cohort study, a total of 230 patients were evaluated, including TBI group (n=103) and stroke group (n=127). The cognitive functions of two groups were evaluated by designated specialists using Moca (Beijing version) and MMSE (Chinese version).


Compared with the patients with stroke, the patients with TBI received significantly lower score in orientation subtest and recall subtest in both tests. MoCA abnormal rates in the TBI group and stroke group were 94% and 87% respectively, while MMSE abnormal rates were 70% and 57%, respectively. In the TBI group, 87% patients with normal MMSE score had abnormal MoCA score and in the stroke group, about 70% patients with normal MMSE score had abnormal MoCA score. The diagnostic consistency of two scales in the TBI group and the stroke group were 72% and 69%, respectively.


In our rehabilitation center, patients with TBI may have more extensive and severe cognitive impairments than patients with stroke, prominently in orientation and recall domain. In screening post-TBI cognitive impairment, MoCA tends to be more sensitive than MMSE.

Avoid This Dietary Fat Because It Destroys Cognitive Function - saturated fat

Well, there seems to be other research out there that doesn't point directly to cognition but other health measures that saturated fat is not bad for you. If your doctors were any good at all they would have all the hospital nutritionists get together and create a stroke diet protocol.  There are two variables here; saturated fat and fish oil; bad research because you don't know which one caused the effect. Is it that fish oil is so good for you? Or that saturated fat is that bad? You can't tell from this research anything at all. You should never have more than one variable in research.

For decades, the government steered millions away from whole milk. Was that wrong?


Trans fats, not saturated fats, linked to increased mortality, CHD risks


FENS Satellite Symposium reveals beneficial health effects of regular fat dairy foods

No Evidence to Support Dietary Fat Recommendations, Meta-Analysis Finds

Dietary Saturated Fat Has Undeserved Bad Reputation, Says Review 


But the negative one here:

 Avoid This Dietary Fat Because It Destroys Cognitive Function

Some fats have an amazing negative effect on cognitive function and, potentially, eating habits.
Diets high in saturated fats can slow brain function, new research finds.
Saturated fats have a direct effect on the hypothalamus, an area of the brain which is critical for regulating hunger.
Eating saturated fats could, therefore, make it difficult to control your eating habits.
They can make it difficult to control how much you eat, the types of foods you choose to consume and when to stop eating.
Saturated fats are typically found in:
  • lard,
  • butter,
  • or fried food.
Unsaturated fats are typically found in:
  • fish,
  • avocado,
  • or olive oil.
Professors Marianna Crispino and Maria Pina Mollica, two of the study’s authors, said:
“These days, great attention is dedicated to the influence of the diet on people’s wellbeing. Although the effects of high fat diet on metabolism have been widely studied, little is known about the effects on the brain.”
The study on rats compared the effects of feeding them fish oils or a lardy diet over a period of six weeks.
Professors Crispino and Mollica said:
“The difference was very clear and we were amazed to establish the impact of a fatty diet onto the brain.
Our results suggest that being more aware about the type of fat consumed with the diet may reduce the risk of obesity and prevent several metabolic diseases.”
The study was published in the journal Frontiers in Cellular Neuroscience (Viggiano et al., 2016).


Resveratrol appears to restore blood-brain barrier integrity in Alzheimer's disease

So how much red wine should stroke patients be drinking to maybe solve this cause of the neuronal cascade of death?  Does this also restore blood brain barrier integrity in stroke? Inquiring minds want to know.

Georgetown University Medical Center News
Resveratrol, given to Alzheimer’s patients, appears to restore the integrity of the blood–brain barrier, reducing the ability of harmful immune molecules secreted by immune cells to infiltrate from the body into brain tissues, say researchers at Georgetown University Medical Center. The reduction in neuronal inflammation slowed the cognitive decline of patients, compared to a matching group of placebo–treated patients with the disorder. The laboratory data provide a more complete picture of results from a clinical trial studying resveratrol in Alzheimer’s disease that was first reported in 2015. The new findings will be presented at the Alzheimer’s Association International Conference 2016 in Toronto on July 27th. According to the researchers, this study suggests that some of the immune molecules that can cause inflammation in the blood can enter the brain through a leaky blood–brain barrier. “These findings suggest that resveratrol imposes a kind of crowd control at the border of the brain. The agent seems to shut out unwanted immune molecules that can exacerbate brain inflammation and kill neurons,” says neurologist Charbel Moussa, MD, PhD, scientific and clinical research director of the GUMC Translational Neurotherapeutics Program. “These are very exciting findings because it shows that resveratrol engages the brain in a measurable way, and that the immune response to Alzheimer’s disease comes, in part, from outside the brain.” In this new study, Moussa and Turner found that treated patients had a 50 percent reduction in matrix metalloproteinase–9 (MMP–9) levels in the cerebrospinal fluid. MMP–9 is decreased when sirtuin1 (SIRT1) is activated. High levels of MMP–9 cause a breakdown in the blood–brain barrier, allowing proteins and molecules from the body to enter the brain. Normally low MMP–9 levels maintain the barrier, say the researchers.

Spaulding Rehab Hospital Receives National Accreditation - CARF stroke speciality

I couldn't find any stroke standards at the CARF website -
so with nothing public, this is completely f*cking worthless.

Big f*cking whoopee. 
SANDWICH – Spaulding Rehabilitation Hospital Cape Cod has received a three-year accreditation from CARF International for its inpatient rehabilitation and stroke specialty programs.
The nonprofit organization promotes quality, value and optimal outcomes of services provided by rehabilitation facilities.
Surveyors evaluated the facility’s programs, focusing on what they called “promotion of a culture of ongoing performance improvement.”

CARF also cited the “chasing zero harms” program for “greatly improving patient safety.”
The hospital’s staffing ratios were also praised, as well as its model for inpatient physician care.

NOTHING on results, so this is useless for evaluating whether this hospital is any good for stroke patients.
No 30-day death statistics.
No 100% recovery statistics.
No tPA full recovery statistics.

Saturday, July 30, 2016

Face the Facts: Stroke is Treatable: World Stroke Day Oct. 29

What a fucking pile of shit. Yes, stroke can be treatable but you are doing NOTHING with the thousands of research articles that show a way forward. You guys are fucking hopeless. You are doing NOTHING to solve all these problems in stroke or stopping the neuronal cascade of death by these 5 causes in the first week. But you will pat yourself on the back with 'happy talk' and conscious laundering.

New Campaign Theme in 2016

New World Stroke Day campaign will highlight the treatable aspects of stroke.
The WSD Campaign Committee and Working Group have been busy working to develop the new campaign theme for the 2016 World Stroke Campaign and World Stroke Day.
The theme is Face the Facts: Stroke is Treatable with the tagline of: Lives can improve with better awareness, access, and action.
The key objectives are:
  • To raise awareness of the incidence of stroke world-wide and the fact that Stroke is Treatable. Who gives one fuck about awareness? Survivors want results.
  • To highlight the importance of improved outcomes from access to best-practice evidence-based treatments:
    • Knowing the FAST signs of stroke and getting treatment saves lives and improves recovery.
    • Promoting admission to Stroke Units.
    • Highlighting conditions for best-practice treatments such as clot-busting drugs, and mechanical clot retrieval.
    • Acknowledging that rehabilitation is a critical step in the treatment process.
    • Highlighting secondary prevention treatments and lifestyle changes.
  • To encourage everyone to take action to drive awareness and push for better access to stroke treatments.
    • Advocacy action can occur at all levels including individual, health care professional, governments and decision makes.
    • The new World Stroke Organization Global Stroke Services Guidelines will be promoted to health professionals as even with limited resources, they can do something to improve care.
    • The new World Stroke Organization Advocacy Toolkit will be promoted to increase the effectiveness of advocacy at a local level.
    • The most important thing to focus on World Stroke Day is all the failures in stroke that need fixing, not this stupid bullshit of 'happy talk.'
Launch of Campaign Content in May and Webinars
The new campaign content and collateral will be launched online in May via email and the WSC website.
In June/July we will be hosting a series of webinars to introduce the new theme and opportunities to promote advocacy in action to improve access to evidence-based treatments worldwide.
To register your interest in participating in a Webinar, please email: Victoria Gray at

I'm 50 and weed has been my medicine for 37 years

This will never legally occur with our fucking stupid federal legislators in control. I would be doing this regularly if I could access it easily. Don't do this, you know that the federal government is right in this prohibition.
My 13 reasons for marijuana use post-stroke. 

Advanced assistive communication technology from Control Bionics

This is great and not so great at the same time. For those needing this it opens up lots of possibilities. But the downside is that this compensation technology if relied on too much will stop your recovery. Recovery is damned hard and while this may look like recovery you have to understand you may have limited your real recovery by accepting the easy way out. Up to you to decide.
“There is no greater feeling in the world than watching a patient, connected to their NeuroSwitch for the first time, realize that the world has opened back up for them. It’s real communication, functional communication.Caitlin Smith, MA CCC-SLP
If you are paralyzed, suffer from loss of speech, and loss of motor control, the NeuroSwitch provides the easiest, most effective way to communicate and control your environment. The NeuroSwitch is made for people with conditions such as acute spinal cord injury (SCI), ALS (Lou Gehrig’s Disease), MND (motor neuron disease), or cerebral palsy.
The NeuroSwitch is the only assistive communication device that works from diagnosis to advanced stages of ALS/MND. 
The NeuroSwitch enables you to control a computer using your body’s EMG signals. EMG stands for “electromyography,” which is the measurement of electrical activity associated with the activation of a muscle group as detected by non-invasive electrodes on the surface of the skin. EMG signals have been used in clinical and research settings since the 1980s, for things like diagnosis of neuromuscular diseases, rehabilitation, and controlling prosthetic devices.
The EMG technology in the NeuroSwitch has been fine-tuned for over 7 years especially for people with severe paralysis. It can detect and amplify the faintest EMG signals. It also adapts to your body’s changes over time, requiring no manual recalibration.

Acupuncture for insomnia after stroke: a systematic review and meta-analysis.

What stupidity. Impossible to have a direct effect. Energy meridians have never been proven to exist. It is all just theatrical placebo. But if you believe, have at it, you are ignoring the possible side effects.

Thigh haematoma following acupuncture treatment in a patient on warfarin

Acupuncture Risks - Mayo Clinic

Acupuncture for insomnia after stroke: a systematic review and meta-analysis. 



Insomnia is the common complaint among patients with stroke. Acupuncture has increasingly been used for insomnia relief after stroke(Whoopee, appeal to antiquity, bloodletting was used for hundreds of years also ). The aim of the present study was to summarize and evaluate evidence on the effectiveness of acupuncture in relieving insomnia after stroke.


Seven databases were searched from inception through October 2014 without language restrictions. Randomized controlled trials (RCTs) were included if acupuncture was compared to placebo or other conventional therapy for treatment of insomnia after stroke. Assessments were performed using the Pittsburgh sleep quality index (PSQI), the insomnia severity index (ISI), the Athens insomnia scale (AIS), and the efficacy standards of Chinese medicine.


A total of 165 studies were identified; 13 RCTs met our inclusion criteria. Meta-analysis showed that acupuncture appeared to be more effective than drugs for treatment of insomnia after stroke, as assessed by the PSQI (weighted mean difference, 4.31; 95 % confidence interval [CI], 1.67-6.95; P = 0.001) and by the efficacy standards of Chinese medicine (risk ratio, 1.25; 95 % CI, 1.12-1.40; P < 0.001). Intradermal acupuncture had significant effects compared with sham acupuncture, as assessed by the ISI (weighted mean difference, 4.44; 95 % CI, 2.75-6.13; P < 0.001) and the AIS (weighted mean difference, 3.64; 95 % CI, 2.28-5.00; P < 0.001).


Our results suggest that acupuncture could be effective for treating insomnia after stroke. However, further studies are needed to confirm the role of acupuncture in the treatment of this disorder.


Acupuncture; Insomnia; Intradermal acupuncture; Review; Stroke
[PubMed - in process]
Free PMC Article

Green Tea Consumption and the Risk of Incident Dementia in Elderly Japanese: the Ohsaki Cohort 2006 Study

Don't go down the route of thinking you can shortcut this by taking green tea extract.

15 Supplement Ingredients to Always Avoid

Green Tea Extract Powder
Also called: Camellia sinensis
Dizziness, ringing in the ears, reduced absorption of iron; exacerbates anemia and glaucoma; elevates blood pressure and heart rate; liver damage; possibly death 
And this:
It comes after West Australian man Matthew Whitby spoke to the ABC after losing his liver — most likely as a result of taking a protein powder with green tea extract and a supplement containing garcinia cambogia

Green Tea Consumption and the Risk of Incident Dementia in Elderly Japanese: the Ohsaki Cohort 2006 Study

Division of Epidemiology, Department of Health Informatics and Public Health, Tohoku University School of Public Health, Graduate School of Medicine, Sendai, Japan
Open Access Article has an altmetric score of 3



Biological studies have shown that certain components of green tea may have protective effects on neurocognition. However, because of the lack of human epidemiological studies, the impact of green tea consumption on the incidence of dementia has never been confirmed. The objective of this cohort study was to clarify the association between green tea consumption and incident dementia.


A 5.7-year prospective cohort study


Using a questionnaire, information on daily green tea consumption and other lifestyle factors was collected from elderly Japanese individuals aged 65 years or more. Data on incident dementia were retrieved from the public Long-term Care Insurance Database.


Among 13,645 participants, the 5.7-year rate of incident dementia was 8.7%. More frequent green tea consumption was associated with a lower risk of incident dementia (HR for ≥5 cups/day vs. <1 cup/day, 0.76; 95% confidence interval: 0.64–0.91). The lower risk of incident dementia was consistent even after selecting participants who did not have subjective memory complaints at the baseline.


Green tea consumption is significantly associated with a lower risk of incident dementia.

Statin Use and Cognitive Impairment in Patients With Type 1 Diabetes: An Observational Study.

No clue what the last line means.



We aimed to assess a wide range of cognitive functions in patients with type 1 diabetes (DM1) compared with healthy control subjects and to evaluate the effects of statins on cognitive functions in DM1 patients.


The sample studied consisted of 55 DM1 patients (80.0% with hyperlipidemia, 20% with statin treatment) and 36 age-matched control subjects (77.8% with hyperlipidemia) without diabetes or statin use. Their cognitive functions (attention, memory, and executive functions) were evaluated with the trail making test, controlled oral word association test (COWAT), Rey-Osterrieth complex figure test, brain damage test (diagnosticum für cerebralschädigung, DCS), Wisconsin card sorting test (WCST), and digit span and block design tests from the revised Wechsler adult intelligence scale.


Cognitive performance was impaired in DM1 patients when compared with the control group with regard to semantic verbal fluency (COWAT_animals), visual learning (DCS), conceptual-level responses, executive functions (WCST random errors), and WCST trials to complete the first category. Subgroups of DM1 patients distinguished on the basis of statin therapy did not differ with regard to verbal fluency (COWAT_animals), visual learning (DCS), conceptual-level responses, executive functions (WCST random errors), and WCST trials to complete the first category. Multivariate analysis also does not show the impact of statin therapy on cognitive functioning regardless of the duration of education, microangiopathic evidence, the presence of hyperlipidemia, or antihypertensive therapy.


We find impairment of cognitive functions in DM1 patients when compared with control subjects without diabetes. However, we show neither the effect of statins nor the significant influence of metabolic control, microangiopathic complications, or the presence of hyperlipidemia on cognitive functions in DM1 patients. (What the hell is this?)
[PubMed - in process]

Evidence for the efficacy of melatonin in the treatment of primary adult sleep disorders

More research needed before this can replace the feeding of sleeping pills while in the hospital.


Melatonin is a physiological hormone involved in sleep timing and is currently used exogenously in the treatment of primary and secondary sleep disorders with empirical evidence of efficacy, but very little evidence from randomised, controlled studies. The aim of this meta-analysis was to assess the evidence base for the therapeutic effects of exogenous melatonin in treating primary sleep disorders.
An electronic literature review search of MEDLINE (1950-present) EMBASE (1980- present), PsycINFO (1987- present), and SCOPUS (1990- present), along with a hand-searching of key journals was performed in July 2013 and then again in May 2015. This identified all studies that compared the effect of exogenous melatonin and placebo in patients with primary insomnia, delayed sleep phase syndrome, Non 24-hour sleep wake syndrome in people who are blind, and REM-Behaviour Disorder. Meta-analyses were performed to determine the effect of magnitude in studies of melatonin in improving sleep.
A total of 5030 studies were identified; of these citations, 13 were included for review based on the inclusion criteria of being: double or single-blind, randomised and controlled. Results from the meta-analyses showed the most convincing evidence for exogenous melatonin use was in reducing sleep onset latency in primary insomnia (p=0.002), delayed sleep phase syndrome (p<0.0001), and regulating the sleep-wake patterns in blind patients compared with placebo.
These findings highlight the potential importance of melatonin in treating certain first degree sleep disorders. The development of large-scale, randomised, controlled trials is recommended to provide further evidence for therapeutic use of melatonin in a variety of sleep difficulties.

Physical Declines Begin Earlier Than Expected Among U.S. Adults

So when you are trying to get back to normal you are also going against the tide of aging. Your doctor needs to know this and counsel you appropriately.
Contact: Sarah Avery
Phone: 919-660-1306
FOR IMMEDIATE RELEASE on Thursday, July 21, 2016
DURHAM and KANNAPOLIS, N.C. – Physical declines begin sooner in life than typically detected, often when people are still in their 50s, according to a Duke Health study that focused on a large group of U.S. adults across a variety of age groups.
The finding suggests that efforts to maintain basic strength and endurance should begin before age 50, when it’s still possible to preserve the skills that keep people mobile and independent later in life.
“Typically, functional tests are conducted on people in their 70s and 80s, and by then you’ve missed 40 years of opportunities to remedy problems,” said Miriam C. Morey, Ph.D., senior fellow in the Center for the Study of Aging and Human Development at Duke University School of Medicine. Morey is senior author of research published in the Journals of Gerontology: Medical Sciences.
Morey and colleagues studied a group of 775 participants enrolled in the Measurement to Understand the Reclassification of Disease Of Cabarrus/Kannapolis (MURDOCK) Study. The MURDOCK Study is Duke Health’s longitudinal clinical research study based at the North Carolina Research Campus in Kannapolis, N.C. The MURDOCK community registry and bio-repository includes more than 12,000 participants and nearly 460,000 biological specimens.
For the MURDOCK Physical Performance Lifespan Study, the Duke-led team enrolled participants ranging in age from their 30s through their 100s, with broad representation across sexes and races.
All participants performed the same simple tasks to demonstrate strength, endurance or balance: rising from a chair repeatedly for 30 seconds; standing on one leg for a minute; and walking for six minutes. Additionally, their walking speed was measured over a distance of about 10 yards.
Men generally performed better than women on the tasks, and younger people outperformed older participants. But the age at which declines in physical ability began to appear – in the decade of the 50s – were consistent regardless of gender or other demographic features.
Specifically, both men and women in that mid-life decade began to slip in their ability to stand on one leg and rise from a chair. The decline continued through the next decades. Further differences in aerobic endurance and gait speed were observed beginning with participants in their 60s and 70s.
The study provides physical ability benchmarks that could be easily performed and measured in clinical exams, providing a way to detect problems earlier.
“Our research reinforces a life-span approach to maintaining physical ability – don’t wait until you are 80 years old and cannot get out of a chair,” said lead author Katherine S. Hall, Ph.D., assistant professor of medicine at Duke. “People often misinterpret ‘aging’ to mean ‘aged’, and that issues of functional independence aren’t important until later in life. This bias can exist among researchers and healthcare providers, too. The good news is, with proper attention and effort, the ability to function independently can often be preserved with regular exercise.”
Hall and Morey said the next phase of research will be to study blood samples of the participants to determine whether there are biological markers that correlate with declines in physical ability. They are also revisiting the study participants for two-year checkups.
In addition to Hall and Morey, study authors include Harvey J. Cohen, Carl F. Pieper, Gerda G. Fillenbaum, William E. Kraus, Kim M. Huffman, Melissa A. Cornish,Andrew Shiloh,Christy Flynn, Richard Sloane, and L. Kristin Newby.
The study received funding from a philanthropic gift to Duke University from the David H. Murdock Institute for Business and Culture. Additional funding was provided in part by the Claude D. Pepper Older Americans Independence Center program of the National Institute on Aging (P30AG028716) and the National Center for Research Resources, a component of the NIH (UL1TR001117).
The authors reported no conflicts of interest associated with this research.
Image: Norris Dearmon of Kannapolis, N.C., enrolls in the MURDOCK Physical Performance Study, with Duke Health employee Chris Lewis. Researchers using data from the study have found that physical declines begin sooner in life than typically detected. Credit: Duke Health
About the MURDOCK Study
The MURDOCK Study, or the Measurement to Understand the Reclassification of Disease of Cabarrus/Kannapolis, is Duke University’s longitudinal clinical research study and precision medicine initiative working to reclassify health and disease. The MURDOCK Study began in 2007 at the North Carolina Research Campus in Kannapolis, N.C., and is led by L. Kristin Newby, M.D., professor of medicine in the Division of Cardiology and co-director of the Cardiac Care Unit at Duke University Hospital.

Ultrasound Could Treat High Blood Pressure

No where could  I see how long this lasts so you will have to have your doctor get the research and protocols behind it.

(Copyright DPC)

Thursday, 28 Jul 2016 11:41 AM
Ultrasound could become a new way to treat high blood pressure, a new study shows.

About 70 million American adults (29 percent) have high blood pressure—that's 1 of every 3 adults. Only about half (52 percent) of people with high blood pressure have their condition under control.

In a new study, Japanese researchers found that applying 20 minutes of ultrasound to the forearm of patients resulted in a significant drop in blood pressure.

Japanese researchers at Tohoku University enrolled 212 patients with type 2 diabetes, the most common form of the disease, who also had treatment resistant high blood pressure. Treatment resistant high blood pressure means that people are unable to control their condition despite the use of multiple medications.

They were divided into four groups. One received 20 minutes of low frequency (800 kHz), low-intensity ultrasound radiation to the forearm. Another received 500 kHz of low-intensity radiation for 20 minutes. The other two groups were used as controls, receiving a placebo procedure.

They found that the patients' blood pressure and pulse rates were significantly reduced after both 800kHz and 500kHz irradiation sessions compared to pre-treatment levels.

Blood pressure levels were also lower than those of the placebo groups, but significantly so in the case of the 500kHz treatment. No adverse effects were found in either group as a result of the ultrasound treatment.

How ultrasound improves blood pressure in these patients is still unclear, but it might suppress sympathetic nerve activity, responsible for the “fight or flight response” by means of nerve pathways from the forearm to the cardiovascular system, the researchers say. 

The “flight or fight” response is a biological reaction in the body that releases hormones that quickens the heartbeat, constricts the blood vessels and increases blood pressure.

"We do not have specific treatments for resistant hypertension. The cost of anti-hypertensive agents for patients is high. Ultrasound has the advantage of being cheap and non-invasive,” says researcher Katsunori Nonogaki of the study, which appears in the International Journal of Cardiology.

Friday, July 29, 2016

Mirror Therapy for Hemiparesis Following Stroke: A Review

Once again this should never have been needed because publicly available stroke protocols are updated as new research comes in. But I'm not accounting for the complete stupidity of our non-existent stroke leaders.
Stroke Rehabilitation (G.E. Francisco, Section Editor)
DOI: 10.1007/s40141-016-0131-8
Cite this article as:
Hartman, K. & Altschuler, E.L. Curr Phys Med Rehabil Rep (2016). doi:10.1007/s40141-016-0131-8
Part of the following topical collections:
  1. Stroke Rehabilitation


Purpose of Review

Ramachandran (Nature 377:489–490, 1995) showed that in amputees, phantom limb pain described as a spasming or immobile phantom limb can be alleviated by watching their reflection of the intact limb in a parasagittally placed mirror while moving the intact limb and the phantom simultaneously. This suggested that therapy via mirror visual feedback—mirror therapy—might be considered for other diseases and conditions characterized by poor mobility. We were the first to show that mirror therapy might be beneficial for hemiparesis following stroke. There have now been numerous case reports and studies of mirror therapy for hemiparesis following stroke.

Recent Findings

Overall, the majority of studies done thus far on patients with hemiparesis in the subacute or chronic phase following stroke find mirror therapy to be more beneficial than control treatments. Even when mirror therapy is not superior to control therapy, the reason for this is there are similar improvements in both groups. There have not been adverse effects in patients that perform mirror therapy for hemiparesis following stroke.


There appears to be a benefit of mirror therapy for hemiparesis following stroke in the subacute and chronic phase. Trial of mirror therapy for hemiparesis may be warranted. Further study of mirror therapy for hemiparesis following stroke will be welcomed; in particular, it would be important to study different groups of patients given the heterogeneity of stroke.

Building a Knowledge to Action Program in Stroke Rehabilitation

Precisely what I've been railing about for years. We'll see if our fucking failures of stroke associations pick up on this and actually do something. My quibble with this is they talk about guidelines not protocols. Guidelines are suggestions, protocols are exact ways of doing things.

Review Article

Building a Knowledge to Action Program in Stroke Rehabilitation

Shannon Janzena1 c1, Amanda McIntyrea1a2, Marina Richardsona3, Eileen Britta4 and Robert Teasella1a4a5

a1 Lawson Health Research Institute, Parkwood Institute, London, Ontario, Canada
a2 University Hospital, London Health Sciences Centre, London, Ontario, Canada
a3 Canadian Agency for Drugs and Technologies in Health, Ottawa, Ontario, Canada
a4 Parkwood Institute, St. Josephs Health Care London, London, Ontario, Canada
a5 Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
The knowledge to action (KTA) process proposed by Graham et al (2006) is a framework to facilitate the development and application of research evidence into clinical practice.(otherwise known as translational science) The KTA process consists of the knowledge creation cycle and the action cycle. The Evidence Based Review of Stroke Rehabilitation is a foundational part of the knowledge creation cycle and has helped guide the development of best practice recommendations in stroke. The Rehabilitation Knowledge to Action Project is an audit-feedback process for the clinical implementation of best practice guidelines, which follows the action cycle. The objective of this review was to: (1) contextualize the Evidence Based Review of Stroke Rehabilitation and Rehabilitation Knowledge to Action Project within the KTA model and (2) show how this process led to improved evidence-based practice in stroke rehabilitation. Through this process, a single centre was able to change clinical practice and promote a culture that supports the use of evidence-based practices in stroke rehabilitation.

What is current practice for upper limb rehabilitation in the acute hospital setting following stroke? A systematic review

So no one in the world seems to know anything about arm stroke rehabilitation. At least not enough to put it out there publicly and freely. Have your therapists paid for these latest research articles? Just another failure point of our fucking failures of stroke associations. If they did know of this shortcoming and did nothing, that is fucking appalling. If they didn't even know of this shortcoming, that is even worse and deserves keel-hauling. On your own once again. This research should have never been required. A fully functioning stroke protocol database would have all the relevant research and would have updated the protocols as research came in. God, this is so simple to do and understand. Why the fuck can't our stroke teams get this done?
Price: EUR 27.50

The Question That Boosts Motivation And Performance

Proving once again that your complete stroke rehabilitation is up to you and your work.
Self-affirmations are not the best type of self-talk to help motivate you.
Asking yourself a question helps boost motivation more than a simple self-affirmation, research finds.
In other words: “Will I exercise?” works better than “I will exercise.”
In the study one group of people told themselves they would complete an anagram task.
The other group, though, asked themselves whether they would complete the task.
The results showed that those who asked themselves the question solved more anagrams than those who ordered themselves.
Further experiments showed that the questioning approach helped to boost internal or ‘intrinsic’ motivation.
Psychologist have found that internal motivation is the strongest type.
It is fascinating how a simple change to language like this can help boost motivation.
Professor Dolores Albarracin, one of the study’s authors, said:
“We are turning our attention to the scientific study of how language affects self-regulation.
Experimental methods are allowing us to investigate people’s inner speech, of both the explicit and implicit variety, and how what they say to themselves shapes the course of their behaviors.”
Professor Albarracin continued:
“The popular idea is that self-affirmations enhance people’s ability to meet their goals.
It seems, however, that when it comes to performing a specific behavior, asking questions is a more promising way of achieving your objectives.”
Professor James W. Pennebaker, an expert on the psychology of language, said:
“This work represents a basic cognitive approach to how language provides a window between thoughts and action.
The reason it is so interesting is that it shows that by using language analysis, we can see that social cognitive ideas are relevant to objective real world behaviors and that the ways people talk about their behavior can predict future action.”
The study was published in the journal Psychological Science (Senay et al., 2010).

Proof That Intense Cardio May Help You Live Longer

If you don't think you can do this try this. Why didn't your doctor tell you about this?

Want to Exercise Harder? Try Drinking Beet Juice

Proof That Intense Cardio May Help You Live Longer

If you knew that simply adding more cardio to your life would help you live longer, would you work out more?
A new study published in Science Advances shows that that exercise endurance (a sexy term for intense cardio that increases your breathing and heart rate) may help keep our telemores(sic) in tact. Telemores(sic) are the protective “caps” on the ends of our DNA chromosomes which keep us young.
And just to underscore this study’s significance, as we age — and with added effects of stress and disease — our telemores(sic) structures start to break down. So, finding ways to keep our telemores(sic)long and strong give us a better chance of living a longer life.
To prove that exercise could add on years to our life, a research team had ten healthy and young volunteers cycle for 45 minutes. They found that the amount of telomere transcripts (which control telemores)(sic) increased in volunteers post-workout.
The experiment results also support recent theories that exercise and diet (another potential influence on telemores)(sic) could delay or reduce the effects of aging. (Wrinkle prevention? Sign me up!)
If you're interested in increasing your lifeline, add more endurance to your workout routine. Endurance exercise includes everything cardio — from swimming to dancing — at an intense level for extended periods of time (hello romp session!).
In addition to longevity, exercise also keeps us sharp as a whip, influencing everything from our brain’s blood flow to cognitive functioning. In fact, research shows that specific cardio strengthens specific mental functions. For example, ballroom dancing helps with memory, or Tai Chi can help with problem solving.
If this new research won’t get you to get out there to break a sweat, we don’t know what will.


Which Patients with Acute Stroke Don't Need Thrombolysis?

Why would you not treat some patients?
Have you identified why some stroke patients are too good to treat? What are you doing to get rid of this asinine idea?

VIDEO: "Too good to treat" stroke patients may benefit from tPA  Feb. 2015

Outcomes mostly favorable for ‘too good to treat’ stroke patients  Dec, 2011


  Other news here:

Minor Stroke and Transient Ischemic Attack: Research and Practice

 The latest here:

Which Patients with Acute Stroke Don't Need Thrombolysis?

Characteristics of daily life gait in fall and non fall-prone stroke survivors and controls

So I guess we still have no clue about protocols to prevent falls and how to walk. Maybe in 50 years the stroke world will have standardized a few things, dragged into the current century kicking and screaming. And still they go down the prediction route rather than coming up with solutions that will prevent the falls in the first place.
  • Michiel PuntEmail author,
  • Sjoerd M. Bruijn,
  • Kimberley S. van Schooten,
  • Mirjam Pijnappels,
  • Ingrid G. van de Port,
  • Harriet Wittink and
  • Jaap H. van Dieën
Journal of NeuroEngineering and Rehabilitation201613:67
DOI: 10.1186/s12984-016-0176-z
Received: 9 December 2015
Accepted: 17 July 2016
Published: 27 July 2016



Falls in stroke survivors can lead to serious injuries and medical costs. Fall risk in older adults can be predicted based on gait characteristics measured in daily life. Given the different gait patterns that stroke survivors exhibit it is unclear whether a similar fall-prediction model could be used in this group. Therefore the main purpose of this study was to examine whether fall-prediction models that have been used in older adults can also be used in a population of stroke survivors, or if modifications are needed, either in the cut-off values of such models, or in the gait characteristics of interest.


This study investigated gait characteristics by assessing accelerations of the lower back measured during seven consecutive days in 31 non fall-prone stroke survivors, 25 fall-prone stroke survivors, 20 neurologically intact fall-prone older adults and 30 non fall-prone older adults. We created a binary logistic regression model to assess the ability of predicting falls for each gait characteristic. We included health status and the interaction between health status (stroke survivors versus older adults) and gait characteristic in the model.


We found four significant interactions between gait characteristics and health status. Furthermore we found another four gait characteristics that had similar predictive capacity in both stroke survivors and older adults.


The interactions between gait characteristics and health status indicate that gait characteristics are differently associated with fall history between stroke survivors and older adults. Thus specific models are needed to predict fall risk in stroke survivors.

Thursday, July 28, 2016

New technology allows researchers to temporarily shut down brain area to better understand function

This should make understanding our disabilities so much easier and make stroke research repeatable. Assuming of course that our stroke leaders understand this significance and use it to drive stroke recovery science.
Capitalizing on experimental genetic techniques, researchers at the California National Primate Research Center, or CNPRC, at the University of California, Davis, have demonstrated that temporarily turning off an area of the brain changes patterns of activity across much of the remaining brain.
The research suggests that alterations in the functional connectivity of the brain in humans may be used to determine the sites of pathology in complex disorders such as schizophrenia and autism.
The research is published online July 20 in the journal Neuron.
The research, led by David Amaral, distinguished professor in the Department of Psychiatry and Behavioral Sciences, and spearheaded by graduate student David Grayson, targeted the amygdala -- a small, almond-shaped region deep within brain. The amygdala is known to be important for emotions, especially fear.
Using a technology called "designer receptors exclusively activated by designer drugs," or DREADDs, the team genetically modified the neurons of the amygdala to produce molecular on-off switches, or receptors, that are triggered by a drug administered to the animal. When the drug is injected, the receptors shut down activity in the amygdala -- effectively turning off this brain region.
Amaral and his colleagues then evaluated the activity in the rest of the brain using functional magnetic resonance imaging, or fMRI, when the amygdala was either on or turned off. FMRI allows researchers to measure what is called functional connectivity -- the extent to which different brain regions coordinate their activity and form networks.
The team demonstrated that when the amygdala was turned off, patterns of brain activity in other brain regions either decreased or increased. Areas known to be well-connected to the amygdala were particularly affected, but so were brain regions that have no known connections to the amygdala.
"This type of study, where a brain region is turned on and off while carrying out functional imaging, has never been done previously in a monkey," said Amaral, who is also the director of research at the UC Davis MIND Institute. "This technology establishes a new era of behavioral neuroscience that reduces the number of animal subjects since each subject acts as its own control. We see very direct linkage between this research and our overarching interest in understanding the neural alterations associated with autism."
John Morrison, director of the CNPRC, said the findings represent "groundbreaking research that has enormous clinical potential. Similar techniques in the future may control abnormal activity in disorders such as epilepsy and Parkinson's disease. Understanding how brain areas form networks is critical for determining the origin of pathology and eventually developing effective interventions."
University of California - Davis