Mobile robot companion for walking training of stroke patients in clinical post-stroke rehabilitation

You'll have to ask your doctor what this looks like and how to purchase one. 
http://ieeexplore.ieee.org/abstract/document/7989124/?reload=true

Horst-Michael Gross

Cognitive Robotics Lab, TU Ilmenau, 98684, Ilmenau (Germany)

Sibylle Meyer

SIBIS Institute for Social Research, 10585 Berlin (Germany)

Andrea Scheidig

Cognitive Robotics Lab, TU Ilmenau, 98684, Ilmenau (Germany)

Abstract:

This paper introduces a novel robot-based approach to the stroke rehabilitation scenario, in which a mobile robot companion accompanies stroke patients during their walking self-training. This assistance enables them to move freely in the clinic practicing both their mobility and spatial orientation skills. Based on a set of questions for systematic evaluating the autonomy and practicability of assistive robots and a three-stage approach in conducting function and user tests in the clinical setting, we present the results of user trials performed with N=30 stroke patients in a stroke rehabilitation center between 4/2015 and 3/2016. This allowed us to make an honest inventory of the strengths and weaknesses of the developed robot companion and its already achieved practicability for clinical use. The results of the user studies show that patients and fellow patients were very open-minded and accepted the robotic coach. The robot motivated them for independent training and leaving their room, despite severe consequences of stroke (lower limbs paralysis, speech/language problems, loss of orientation, depression), provided a very self-determined training regime, and encouraged them to expand the radius of their training in the clinic.

Published in: Robotics and Automation (ICRA), 2017 IEEE International Conference on

Date of Conference: 29 May-3 June 2017

Date Added to IEEE Xplore: 24 July 2017

ISBN Information:

DOI: 10.1109/ICRA.2017.7989124

 

“If you always do what you’ve always done, you always get what you’ve always gotten.” Jessie Potter, Woman to Woman conference, 1981

So true in the stroke world, NOTHING  is being accomplished bacause it seems the only things being pushed are; F.A.S.T., prevention and tPA. Every one I would consider a failure.

People born in states with high rates of stroke death had greater risk of dementia

I don't know what you do about this.
https://www.medpagetoday.com/Neurology/Strokes/66972?

• by Kristin Jenkins, Contributing Writer, MedPage Today July 31, 2017
• This article is a collaboration between MedPage Today® and:
  

Action Points

• Americans born in a state with high rates of stroke deaths have a significantly increased incidence of dementia compared with those born elsewhere in the U.S., even when they subsequently move to a low-risk locale with equal access to medical care.
• This observational cohort study from Kaiser Permanente Northern California indicates that place of birth has enduring consequences for dementia risk and may be a major contributor to racial disparities in dementia.

Americans born in a state with high rates of stroke deaths have a significantly increased incidence of dementia compared with those born elsewhere in the U.S., even when they subsequently move to a low-risk locale with equal access to medical care, researchers found.
An observational cohort study of 7,423 members of Kaiser Permanente Northern California (KPNC) showed that birth in a state with high stroke mortality was associated with a 28% higher risk of dementia after adjustment for age, sex, and race, according to Rachel Whitmer, PhD, of Kaiser Permanente, in Oakland, Calif, and colleagues.
Black individuals born in states with high stroke mortality had a 67% higher risk of dementia compared with non-blacks born outside of the so-called "stroke belt," the study authors reported online in JAMA Neurology. This was followed by black individuals not born in a high stroke mortality state, who had a 48% increased risk of dementia, and non-black persons born in a high stroke mortality state who had a 46% increased risk.
At age 65, the cumulative 20-year dementia risk for those born inside and outside a high stroke mortality state were 30.13% and 21.8%, respectively. The 9 states with high stroke mortality were Alabama, Alaska, Arkansas, Louisiana, Mississippi, Oklahoma, Tennessee, South Carolina, and West Virginia, many of which are part of the so-called "stroke belt."
"Place of birth has enduring consequences for dementia risk and may be a major contributor to racial disparities in dementia," the study authors said, noting that the latter "may partially reflect geographic patterning of early-life exposures."
"Our findings underscore the importance of examining early life factors when researching dementia risk as these may inform on the timing, populations, and mechanism of interventions," they added. "One's place of birth can have lasting effects by influencing individuals' lifestyle and health behavior throughout adult life, even when residence has changed and access to healthcare is uniform."
In post-hoc analysis controlling only for age, black race was associated with a 56% increased risk of dementia. After adjustment for being born in a high stroke death state, the risk associated with being black "was attenuated by more than a third," Whitmer and colleagues wrote. "This has great public health relevance since many current black elderly individuals were born in the South and moved away during the 'great migration.'"
In an accompanying editorial, Daniel Lackland, DrPH, of the Medical University of South Carolina in Charleston, noted that while the effect of elevated blood pressure on cerebrovascular disease risk -- and the benefit of blood pressure reduction -- is well documented, understanding the influence of geography "remains at or near the same levels as in previous decades."
"The current study contributes a better understanding of the factors associated with the geographic disparity in cerebrovascular disease," Lackland wrote, adding that this is "a critical area of need given the high burden." The study authors have "restated the need for continued assessment of the excess disease burden in risks associated with dementia," he added.
For the study, data on place of birth, race, educational level, and midlife vascular risk factors were collected between 1964 and 1973 when the individuals had a mean age of 43 years. Some 55% were female and 18% were black. Between 1996 and 2015, dementia diagnoses were obtained from electronic health records, when the mean age of participants at the beginning of the 19-year follow-up period was 71 years.
Dementia was diagnosed in 30.4% and was more common among those born in states with high stroke mortality than those born elsewhere (39% versus 28.8%). Birth in the "stroke belt" was 9.6 times more common for black than non-black participants (58.7% versus 6.1%).
These findings are consistent with a previous study showing an elevated risk of dementia-related mortality after examining death records of individuals born in the stroke belt, Whitmer and colleagues noted. The southern U.S. region where many of the high stroke death states are located has been associated with the greatest number of people living in poverty and the largest racial disparities in cognitive outcomes, the investigators pointed out.
"Poverty early in life can reflect a host of factors that could affect brain health and cognitive reserve, such as nutrition, lead exposure, chronic stress, and cognitive stimulation," they said. "Poverty is highly associated with low birthweight and it is very likely that low birthweight disproportionately affected southern black persons in the 1920s, placing them at greater risk for elevated blood pressure, stroke, and cardiovascular disease mortality."
More research is needed to address the geographic patterns of dementia in different cohorts of aging populations to better understand the impact on health of birth place and the social and physical conditions to which individuals are exposed in early life, Whitmer and colleagues said.
Limitations of the study include the fact that the results are susceptible to selection bias, since the entire cohort migrated to California and "may be healthier or more highly educated than those who remained in a high stroke mortality state," the researchers said.

This work was supported by the National Institute on Aging, National Institutes of Health, and the University of California at San Francisco Training for Research on Aging and Chronic Disease.

• Reviewed by Henry A. Solomon, MD, FACP, FACC Clinical Associate Professor, Weill Cornell Medical College and Dorothy Caputo, MA, BSN, RN, Nurse Planner

• Primary Source

  JAMA Neurology

  Source Reference: Whitmer RA, et al "Association between birth in a high stroke mortality state, race, and risk of dementia" JAMA Neurol 2017; DOI:10.1001/jamaneurol.2017.1553.

• Secondary Source

  JAMA Neurology

  Source Reference: Lackland DT "Impact of birth place and geographic location on risk disparities in cerebrovascular disease: Implications for future research" JAMA Neurol 2017; DOI: 10.1001/jamaneurol.2017.1560.

Comment

Speech language therapy delivered through the Internet leads to similar improvements as in-person treatment

Well, there goes your insurance paying for your speech therapist.
https://medicalxpress.com/news/2017-07-speech-language-therapy-internet-similar.html
Telerehabilitation helps healthcare professionals reach more patients in need, but some worry it doesn't offer the same quality of care as in-person treatment. This isn't the case, according to recent research by Baycrest.

The study, published in the journal Aphasiology, found that patients who accessed speech language therapy over the Internet saw large improvements to their communication abilities that were similar to those of patients doing in-person therapy.
This finding encourages greater adoption of telerehabilitation to treat patients living in remote communities who are recovering from post-stroke communication disorders as a way to improve the use of limited healthcare resources.
"People with communication disorders, such as aphasia, are often provided with therapy only for the first few months after they have been diagnosed, despite evidence that therapy can benefit them for years," says Dr. Jed Meltzer, lead author and neurorehabilitation scientist at Baycrest's Rotman Research Institute. "Location can limit a patient's access to a speech-language pathologist, especially for individuals living in rural areas. Our study shows that telerehabilitation can remove this geographic barrier since participants saw similar recovery results."
Despite these comparable improvements, an unexpected finding was that patients who did telerehabilitation therapy weren't as confident in their communication abilities compared to those who did in-person treatment.
"Low confidence can lead to continued isolation and it is important that patients be encouraged to find other ways to socially engage with others beyond their therapy," says Dr. Meltzer.
Based on the study's findings, Dr. Meltzer suggests that speech-language pathologists continue to play a critical role in the creation and supervision of treatment for patients and computer-based or tablet-based applications can help handle day-to-day treatment exercises.
The study analyzed the recovery of 44 patients who had a communication disorder caused by a stroke at least six months prior to recruitment. All patients received an in-person assessment and participated in a language skills test in the first week of therapy. They were then assigned either telerehabilitation or in-person treatment for 10 weeks. Once treatment was completed, each patient completed a language skills test and a questionnaire. Their partners also provided feedback about the patient's recovery.
As the only Ontario hospital offering one of the few clinically validated, gold standard telerehabilitation programs for Parkinson's patients, the Lee Silverman Voice Treatment (LSVT®) eLOUD Clinic, offering telerehabilitation services at Baycrest allows clinicians to help more patients. "Older adults may face mobility issues and have a difficult time travelling to a specific location for treatment," says Maria Piccini, a Baycrest speech-language pathologist who runs the LSVT® Clinic. "Telerehabilitation makes it easier for these individuals to access the therapy they need and improves their chances of completing the treatment."
These findings support Dr. Meltzer's next steps which involve combining telerehabilitation technology with other therapies, such as medication or brain stimulation, to explore ways to provide more efficient treatment to patients.

Explore further: New intervention brings hope to patients with primary progressive aphasia

More information: Jed A. Meltzer et al, Computer-based treatment of poststroke language disorders: a non-inferiority study of telerehabilitation compared to in-person service delivery, Aphasiology (2017). DOI: 10.1080/02687038.2017.1355440

Breakthrough software teaches computer characters to walk, run, even play soccer

With this we could start from the incorrect muscle movements you currently have and gradually show them being corrected. Action observation at its' finest. But this will never occur. Video at link.
https://news.ubc.ca/2017/07/31/breakthrough-software-teaches-computer-characters-to-walk-run-even-play-soccer/
Computer characters and eventually robots could learn complex motor skills like walking and running through trial and error, thanks to a milestone algorithm developed by a University of British Columbia researcher.
“We’re creating physically-simulated humans that learn to move with skill and agility through their surroundings,” said Michiel van de Panne, a UBC computer science professor who is presenting this research today at SIGGRAPH 2017, the world’s largest computer graphics and interactive techniques conference. “We’re teaching computer characters to learn to respond to their environment without having to hand-code the required strategies, such as how to maintain balance or plan a path through moving obstacles. Instead, these behaviors can be learned.”
The work, called DeepLoco, offers an alternative way to animate human movement in games and film instead of the current method which makes use of actors and motion capture cameras or animators. DeepLoco allows characters to automatically move in ways that are both realistic and attentive to their surroundings and goals. In the future, two or four-legged robots could learn to navigate through their environment without needing to hand-code the appropriate rules.
Using his algorithm, simulated characters have learned to walk along a narrow path without falling off, to avoid running into people or other moving obstacles, and even to dribble a soccer ball towards a goal.
The method makes advanced use of deep reinforcement learning, a type of machine learning algorithm in which experience is gained through trial and error and is informed by rewards. Over time, the system progressively identifies better actions to take in given situations.
“It’s like learning a new sport,” said van de Panne. “Until you try it, you don’t know what you need to pay attention to. If you’re learning to snowboard, you may not know that you need to distribute your weight in a particular way between your toes and heels. These are strategies that are best learned, as they are very difficult to code or design in any other way.”
The motion of humans and animals is governed not just by physics but also control. While humans learn motor control through trial and error, van de Panne says it’s hard to tell how much the algorithm mimics the human learning process. After all, the computer program still learns much more slowly than a human. He began working on this type of motor learning problem when he had children; they are now 17 and 20.
“I distinctly remember wondering who will learn agile walking and running skills first: my son, daughter or the algorithm?” he said. “My son and daughter beat me by a long shot.”
For more information on DeepLoco, click here.

Traverse City Film Festival this past weekend

Friends have been going to this for years, finally was able to attend. First problem was a fundraiser on Thursday night that I'm a board member of. Got home at 4am, got three hours of sleep. Left at 2pm for the 3 hour drive north. Good thing I broke my cruise control stalk earlier this summer, that forced me to pay complete attention to my driving. Barely made it even with all the soda caffeine I was consuming. Was a wonderful town to visit.
Saw these films:
At the End of the Tunnel Great movie with lots of twists and turns.
I Am Evidence Rape kit lack of testing, depressing
What Lies Upstream  The West Virginia MCHM chemical spill and the Flint, MI lead contamination. Both depressing indictments of government inadequacies
My Life as a Zucchini Interesting but depressing, kids in a group foster home.
The Young Karl Marx Hard to follow as Marx and Engels moved from country to country.

What the Beach Does to Your Brain Science says the surf and sand does the mind (and body) good. Here’s how to reap the benefits of all that 'vitamin sea.'

But is 'forest bathing' better? Will your stroke hospital at least put pictures of oceans on the walls of your room? Or maybe give you a video loop of the ocean projected on your walls?
https://www.nbcnews.com/better/health/what-beach-does-your-brain-ncna787231
There’s nothing quite as synonymous with summer as the beach — and we’ve got good news for those who flock to the surf and sand as soon as work lets out on Friday afternoon.

Research finds that spending time by the ocean is pretty good for your wellbeing. In fact, according to an analysis of English census data published in the journal Health Place, those who live by the coast report better physical and mental health than those who don’t.

And in a study published in the Journal of Coastal Zone Management, participants who live in homes with ocean views report feeling calmer than those without them.

So, it makes sense then that Hawaii has earned the ranking of happiest state in the U.S. by the annual Gallup poll six times since 2008, doesn’t it? – What the Beach Does to Your Brain – Jul.29.2017 https://www.nbcnews.com/better/health/what-beach-does-your-brain-ncna787231?cid=sm_npd_nn_fb_bt_170731 via NBC News

Does drinking diet soda raise the risk of a stroke?

Conundrum time, confuse your doctor with questions about this.

 

Does drinking diet soda raise the risk of a stroke?

Posted July 31, 2017, 10:30 am

Julie Corliss, Executive Editor, Harvard Heart Letter

For diet soda fans, recent news reports linking these popular drinks to higher risk of stroke may have been alarming. A closer look at the study behind the headlines suggests there’s no need to panic. But beverages naturally low in calories are probably a healthier option than artificially sweetened drinks.
The study included 2,888 people ages 45 and older from the long-running Framingham Heart Study, all of whom filled out diet questionnaires up to three times over a seven-year period. People who said they drank at least one artificially sweetened soda a day were about twice as likely to have a stroke over the following decade when compared to those who drank less than one a week. Drinking regular, sugar-sweetened sodas or beverages did not appear to raise stroke risk.
However, these types of studies can’t prove cause and effect, only an association. Also, only 97 people (3%) had strokes during the follow-up, which means only two or three of those strokes could possibly be attributed to drinking diet soda, says Dr. Kathryn Rexrode, an associate professor of medicine at Harvard-affiliated Brigham and Women’s Hospital who co-authored an earlier, larger study looking at soda consumption and stroke risk.

Stroke risk from all sodas?

That study detected a slightly higher risk of stroke in people who drank more than one soda per day, regardless of whether it contained sugar or an artificial sweetener. Although the latest study didn’t detect a higher stroke risk from sugary beverages, that certainly doesn’t suggest they are a better choice than diet sodas. Many studies have already shown that drinking sugary beverages on a regular basis can lead to weight gain, diabetes, high blood pressure, heart disease, and stroke, she notes.

Possible explanations

In fact, one possible explanation why sugary beverages weren’t linked to stroke in the recent study might be a phenomenon known as survival bias. In this case, that would mean that people who drank a lot of sugar-sweetened beverages may have died earlier from other illnesses such as heart disease.
Conversely, diet beverages may have shown a link to stroke because of a different issue, called reverse causation. In an attempt to be healthier, people who are overweight or have diabetes may be more likely to choose diet drinks over sugary ones. Their heightened stroke risk may result from their health problems rather than their beverage choice. “We might just be measuring the residual impact of obesity and diabetes,” says Dr. Rexrode.

Artificial sweeteners: Other shortcomings

Another conundrum: researchers don’t have any plausible explanation for why artificial sweeteners might increase stroke risk. Still, there may be other reasons to ditch them.
If you use artificial sweeteners to control your weight, you should know that the support for that strategy is pretty shaky. Some evidence suggests that artificial sweeteners make people crave sugary, high-calorie foods, thereby negating the sweetener’s potential to cut your overall calorie intake. And some experts believe that people who use these high-intensity sweeteners (which are hundreds of times sweeter than sugar) may come to find naturally sweet foods, such as fruit, less appealing and less-sweet foods, such as vegetables, downright unpalatable. If so, those people might be missing out on the many heart-protecting nutrients found in fresh, natural foods.
But Dr. Rexrode isn’t a stickler when it comes to diet soda. “I encourage my patients to eliminate regular soda and other sugar-sweetened drinks to avoid empty calories,” she says. “But if someone says they can’t do without a Coke in the morning to wake up, I’ll encourage them to switch to coffee or diet Coke.” Water is an even better choice, however. “There are a lot of ways to make it more appealing, both visually and taste-wise.” she adds. Try flavoring flat or sparkling water with a splash of fruit juice, or add frozen fruit, cucumber, or crushed mint.

GRIT Study Recruitment Notice - How much do survivors of Stroke and their caregivers have?

A friends spouse is running this. I scored at 3.417, so-so in the grit category. To me this is a combination of persistence, resilience, perseverance.

We are currently recruiting participants for a study entitled GRIT: How much do survivors of Stroke and their caregivers have? GRIT is defined as perseverance and passion for long-term goals. The goal of this study is to learn about the grit experiences of patients who have survived stroke and the grit experiences of their caregivers. The results of this study may help us better understand how GRIT contributes to the recovery and community reintegration process. We also wonder how GRIT among caregivers influences successful community reintegration.

The study consists of 2 phases – an online survey and an optional interview. In the first phase, participants will be asked to complete a single online survey. We anticipate that the total time commitment of this survey to be approximately 20 - 30 minutes. Phase 2 is optional. It consists of an interview about grit experiences with reaching goals after having a stroke. The interview is expected to last between 45-60 minutes.

Expedited status has been received for this study (#0012-2017) from the Briar Cliff University Institutional Review Board. Completion of the survey in all or in part will be interpreted as consent to participate in the study. Respondents will be anonymous to the researchers for phase one. Demographic data will be analyzed and disseminated in aggregate. For phase 2 interviews, participants may choose a pseudonym for a name.

If you are interested in participating in this study, please complete the survey at the following link:

https://newqtrial2015az1.az1.qualtrics.com/jfe/form/SV_3wJPj73Y68fnt5z

If you have any questions or concerns, please feel free to contact me. I can be reached at:

Sue Klappa PT, PhD

Professor

Briar Cliff University

4280 Sergeant Road, suite 100

Sioux City, IA 51106

Office: 712-279-5560

Email: Susan.klappa@briarcliff.edu

Why some students succeed and some fail - Grit

I bet the same is for stroke survivors.
https://www.facebook.com/Illumeably/videos/255895358148905/

Care path of person with stroke: from onset to rehabilitation

Hope your doctor knows Portugese.
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-71672017000300495&lng=en&tlng=en

Camino que recorre la persona con accidente vascular encefálico: desde el acontecimiento hasta la rehabilitación

Ana da Conceição Alves Faria^I 

Maria Manuela Ferreira Pereira da Silva Martins^II 

Soraia Dornelles Schoeller^III 

Leandro Oliveira de Matos^IV 

^ICentro Hospitalar do Médio Ave Vila Nova Famalicão. Braga, Portugal.

^IIPorto Nursing School. Porto, Portugal.

^IIIUniversidade Federal de Santa Catarina, Nursing Departament. Florianópolis, Santa Catarina, Brazil.

^IVSecretaria do Estado de Saúde de Santa Catarina. Florianópolis, Santa Catarina, Brazil.

ABSTRACT

Objective: to describe the care path of the person with stroke goes through and to identify the important events in this path.

Method: qualitative descriptive exploratory research, using the semi-structured interview technique based on Meleis's Middle-Range Theory. The sample was composed of 13 people who became dependent after a stroke and were admitted to two hospital units in the region of Vale do Ave, Portugal. Data were collected between January and October 2013. Content analysis was used to analyze the data.

Results: The data revealed that the person's care path goes from recognition of the symptoms to preparation for hospital discharge. Adapting to the new situation of dependence brings the need for new competencies.

Final considerations: The research aims to contribute to the improvement of nursing care regarding care for people with stroke including onset, recovery and rehabilitation, and home care.

How to practice effectively...for just about anything - Annie Bosler and Don Greene

Another great TED video. Except it doesn't talk about this:
But does incorrect practice make perfection faster? Don't researchers read research at all?

Practice makes perfect — or does it?

How to practice effectively...for just about anything - Annie Bosler and Don Greene

Alcohol's Role as a Stroke Risk Factor

This is the negative side of alcohol. What is the positive side? Have your doctor lists pros and cons instead of reflexively stating no alcohol post-stroke.
But I'm not medically trained so I shouldn't be listened to.

Alcohol for these 12 reasons.

 

A little daily alcohol may cut stroke risk

 

An occasional drink doesn't hurt coronary arteries

 

Six healthy reasons to drink more beer   Red wine benefits are in this one also.

 

10 Health Benefits of Whiskey

The negative side here:

 Alcohol's Role as a Stroke Risk Factor

Excessive alcohol consumption is widely known to adversely impact many aspects of your health. It has been linked to cancer, liver disease, and even dementia. But Tennova Healthcare wants you to know that consistently drinking too much alcohol, particularly if you are middle-aged, can also escalate your likelihood of a stroke.

“A recent study indicates that people who average more than two alcoholic drinks per day during their 50s and 60s have a one-third higher risk for stroke, compared to those who consume less alcohol,” said Glen A. Pollock, M.D., a neurological surgeon with Tennova Healthcare. “Up to age 75, the increased risk caused by heavier drinking rivals the stroke risks posed by high blood pressure and diabetes.”
The study also showed that those who drink alcohol in excess are more likely to experience a stroke as many as five years sooner than those who drink less. The study did not identify a difference in the type of alcohol consumed, but the data indicates that men should not exceed two drinks per day and women should not go beyond one daily drink.
A stroke is the sudden death of brain cells, due to a lack of oxygen caused by a rupture of an artery or a blockage of blood flow to the brain. It is unclear precisely how alcohol consumption affects stroke risk. Some experts theorize that alcohol’s propensity to thin the blood is what increases the likelihood. Others point to the influence alcohol has on blood pressure and atrial fibrillation (an irregular heartbeat), which are two other health-related stroke risk factors.
“Regardless of the linkage, people who regularly over-indulge in alcohol consumption should consider cutting back,” Dr. Pollock said. “They should also become familiar with their other risk factors.”
According to Dr. Pollock, there are two principle types of stroke risk factors: controllable and non-controllable. “Non-controllable risk factors include gender, race and family history,” he said. “These are aspects over which you have no influence. However, controllable factors you can affect. They include diet and nutrition, physical activity, tobacco use, and alcohol consumption. Modifying these lifestyle behaviors can have a direct benefit, in this case by reducing the likelihood of a stroke.”
To help determine your risk of suffering a stroke, Tennova Healthcare offers a free assessment tool at TennovaStrokeQuiz.com. In as few as five minutes, the online tool identifies personal risk factors for stroke, offers tips to take control of manageable risk factors, and provides an instant report to share with your physician. Visit TennovaStrokeQuiz.com to take the free stroke risk assessment.

The risk assessment is a piece of crap, nothing on use of alcohol. I'm at a high risk for another stroke in the next ten years because of my previous stroke. Shit, I'm already 11 years out from previous stroke so this missed the mark. 

Novel Device Shows Promise for Early Identification of Serious Strokes

I see nothing here that compared this to other fast diagnosis possibilities. So further research is once again required which will never occur, you will continue to be screwed until we get a great stroke association.  Notice time of seconds to diagnose and no neurologist needed.

Hats off to Helmet of Hope - stroke diagnosis in 30 seconds

 

Microwave Imaging for Brain Stroke Detection and Monitoring using High Performance Computing in 94 seconds

 

New Device Quickly Assesses Brain Bleeding in Head Injuries - 5-10 minutes

http://www.prnewswire.com/news-releases/novel-device-shows-promise-for-early-identification-of-serious-strokes-300494693.html
Results of the VITAL study presented as a Late Breaker at the 14th Annual Meeting of The Society of NeuroInterventional Surgery demonstrate how a new technology may change the paradigm of emergency stroke care.

News provided by

Cerebrotech Medical Systems

Jul 26, 2017, 14:21 ET

Share this article

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PLEASANTON, Calif., July 26, 2017 /PRNewswire/ -- Cerebrotech Medical Systems, an innovative medical device company focused on the development of portable neurotechnology solutions, today reported results from a new study evaluating its proprietary VIPS™ technology for emergency stroke patients. The results of the study, VITAL, which are being presented at the 14th Annual Meeting of The Society of NeuroInterventional Surgery in Colorado Springs, CO, demonstrate that Cerebrotech's non-invasive, visor-like neurological device can identify those patients with large vessel occlusion (LVO) strokes and large hemorrhagic strokes versus those with less urgent strokes, allowing for earlier intervention to prevent further brain damage. 

"This multi-center clinical trial shows the viability of a non-invasive technology that can quickly identify treatable devastating strokes in ambulances or emergency rooms to enable rapid triage those patients to specialized, capable treatment centers, thereby saving lives," said Christopher P. Kellner, M.D., Director of the Intracerebral Hemorrhage Program at Mount Sinai and Assistant Professor of Neurosurgery at the Icahn School of Medicine at Mount Sinai. "This trial demonstrates that Cerebrotech's device has the potential to do for stroke what EKG has done for heart attack."
Dr. Kellner presented data demonstrating that Cerebrotech's device is capable of differentiating large strokes from small strokes with sensitivity of 93% (95% CI 83-98) and specificity of 92% (95% CI 75-99). Comparison of large strokes to healthy adults yielded 100% specificity. Importantly, Kellner's presentation also demonstrated the underlying reasons why the device offers this level of accuracy.  The data show that subjects with large strokes (55 ischemic and 2 hemorrhagic) have significantly higher bioimpedance asymmetry, a measure of the electrical characteristics of the brain, compared to those with small strokes (16 ischemic and 10 hemorrhagic) that do not require emergent triage to special centers. Large stroke subjects had an average asymmetry score of 16.5% (95% CI 14.6-18.4), versus those with small strokes, which had an average asymmetry score of 8.0% (95% CI 6.9-9.0, p<0.0001). Average bioimpedance asymmetry in a cohort of 79 healthy adults was 5.0% (95% CI 4.5-5.5).  By measuring bioimpedance asymmetry, the device is able to identify stroke and differentiate large strokes from small strokes.
The presented data consisted of: the VITAL study (N=128), which evaluated patients presenting with a range of brain injuries including strokes and was conducted by a group that included distinguished researchers from Icahn School of Medicine at Mount Sinai (New York City), The Medical University of South Carolina, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, and Baptist Medical Center Jacksonville; an initial pilot study (N=41) conducted at The Medical University of South Carolina; and a study of healthy volunteers for baseline comparators. The data were managed by Vastrax, a first-of-its kind neurovascular clinical research and development partner.
"There is a critical, highly-visible unmet need for effective, early stroke assessment in ambulances and emergency rooms to identify which patients need triage directly to specialty stroke hospitals for immediate surgical intervention," said Mitch Levinson, President and CEO, Cerebrotech Medical Systems. "By helping to minimize treatment delays, this technology has the potential to substantially improve healthcare outcomes for hundreds of thousands of people each year across the globe."
Cerebrotech's technology, Volumetric Integral Phase-shift Spectroscopy (VIPS), passes low-energy electromagnetic waves through the brain, detecting small changes to the brain's electrical properties. These electrical characteristics, called bioimpedance, are related to brain tissue and fluid status, and asymmetries can be indicative of clinical problems. Quantitative results provided by the device can be obtained in seconds by medical professionals after minimal training, and the simple device design allows results to be obtained without interfering with any aspect of patient care. The device holds a CE mark, but is not yet cleared for sale in the U.S.
Early detection of brain injury means early intervention, which can greatly improve patient outcomes and transform the management paradigm of these life-threatening neurological events. Every 45-minute reduction in time to thrombectomy, the new standard of care for large vessel occlusion strokes, yields a 10% increase in the number of patients achieving functional independence at 3 months.¹ 
The Society of NeuroInterventional Surgery (SNIS), a worldwide scientific and educational association, is dedicated to excellence in comprehensive, minimally-invasive care of patients with stroke, brain aneurysms, and other diseases in the head, neck and spine. SNIS draws its membership from three areas - interventional neuroradiology, endovascular neurosurgery and interventional neurology. 
About Cerebrotech Medical SystemsCerebrotech Medical Systems, Inc., is a venture capital-backed company dedicated to designing neurotechnology solutions to improve the care of brain-injured patients worldwide. The company is developing a portable, noninvasive neuro-monitoring device that allows for earlier detection of potentially life-threatening conditions such as large vessel occlusion stroke, cerebral edema, traumatic brain injury, and others. Founded in 2010 and based in Pleasanton, CA, Cerebrotech's core intellectual property is licensed exclusively from the University of California at Berkeley. For more information, visit www.cerebrotechmedical.com.
¹ Time to Treatment With Endovascular Thrombectomy and Outcomes From Ischemic Stroke: A Meta-analysis. JAMA. 2016;316(12):1279-1288. doi:10.1001/jama.2016.13647

This Eye Colour Linked to Being More Competitive, Egocentric And Skeptical

I have light gray eyes, from German descent. I wonder if this also would correlate to stroke recovery?
http://www.spring.org.uk/2016/01/this-eye-colour-linked-to-being-more-competitive-egocentric-and-skeptical.php

Eye colour could reveal an aspect of your personality, study finds.

Lighter eyes have been linked to more egocentric, competitive, skeptical individuals, research finds.
Darker eyes, though, are linked to sympathy, altruism and a higher altruistic behaviour.
The study, which was conducted in Australia, only held for those with Northern European ancestry, though, the study’s authors explain:

“A competitive person is characterised by a tendency to be antagonistic, egocentric, and sceptical of others’ intentions rather than cooperative…
…light-eyed people, whatever their sex, would be more competitive psychologically than dark eyed people if they are of north European descent.”

The authors provide an evolutionary explanation for the difference:

“…the rare-color advantage of light eyed females, is likely to increase the chance of being noticed by a male.
Moreover, competitive personality traits (such as wanting to beat others and being sceptical of others’ intentions) secure the long-term commitment necessary for self and off-spring survival.
Whilst some may argue that it is unlikely that a male would choose a disagreeable female we argue that mating is not the sole choice of males and that the disagreeable traits of competitive women are directed primarily at other female competition rather than towards males.”

The study was published in the journal Current Biology (Gardiner & Jackson, 2010).

Stroke rates higher in asymptomatic vs. symptomatic AF

Pretty much useless since nothing is presented on how to find  asymptomatic AF. Don't just describe a problem. Suggest a solution, otherwise this research is almost completely useless.
https://www.healio.com/cardiology/arrhythmia-disorders/news/online/%7B4f08a315-afbe-4605-9b90-8fbef54d60f0%7D/stroke-rates-higher-in-asymptomatic-vs-symptomatic-af?utm_source=selligent&utm_medium=email&utm_campaign=cardiology%20news&m_bt=592835816269
Previous stroke rates were higher among patients with newly diagnosed atrial fibrillation compared with those who experienced prior symptoms, according to results from the GLORIA-AF registry, presented at EHRA Europace-Cardiostim 2017.
According to the presentation from Steffen P. Christow, MD, cardiologist at Hospital Ingolstadt GmbH in Germany, AF has a significant effect on morbidity and mortality in patients because of a fivefold risk for stroke.

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“Patients with nonvalvular [AF] have a fivefold increased risk of stroke compared to those without [AF]. Strokes in patients with nonvalvular [AF] tend to be particularly severe and disabling, with about half of patients dying within 1 year,” Christow said in a press release from the European Society of Cardiology. “When patients are unaware of their [AF], they remain untreated and unprotected from stroke.”
The multinational, prospective GLORIA-AF registry enrolled 6,011 patients aged 18 years or older who were newly diagnosed with nonvalvular AF and had a high risk for stroke.
According to Christow and colleagues, the aims of the study were to investigate patient characteristics that influenced choice of antithrombotic treatment of newly diagnosed patients with nonvalvular AF at risk for stroke, describe antithrombotic treatment patterns and collect safety and efficacy data on antithrombotic treatments.
At the time of diagnosis, approximately two-thirds of the patients included in the study were asymptomatic and one-third of patients were symptomatic.
The results of the study showed that asymptomatic patients were twice as likely to have permanent AF (OR = 0.49; 95% CI, 0.4-0.59), more than twice as likely to have had a previous stroke (OR = 0.37; 95% CI, 0.3-0.46) and twice as likely to have had a previous stroke or transient ischemic attack (OR = 0.47; 95% CI, 0.4-0.56) vs. patients who were symptomatic.
Symptomatic patients were more likely to have had CAD (OR = 1.28; 95% CI, 1.1-1.48) or congestive HF (OR = 2.79; 95% CI, 2.45-3.18) than asymptomatic patients, Christow and colleagues found.
“The finding of a higher rate of previous stroke in the asymptomatic patients despite no differences in the number of stroke risk factors may be explained by a longer but undiagnosed history of [AF],” Christow said in the release. “These results underline the urgent need for public programs to detect [AF] in the general population.” – by Dave Quaile
Reference:
Christow SP, et al. Abstract 1669. Presented at: EHRA Europace – Cardiostim 2017; June 18-21, 2017; Vienna.

Post-Acute SNF Care Often Not Cost-Effective

With anything even close to resembling a great stroke association, followup research would occur to create a stroke protocol about when to do hospital release and followup rehabilitation. But since we have fucking failures of stroke associations we will continue to know nothing about what to do. Our stroke medical professionals don't give a shit since the effects of this lack of policy/protocol only affects stroke survivors. There is no blowback to them, no financial penalty for not getting survivors 100% recovered.
 https://www.medpagetoday.com/nursing/Nursing/66956?

Hospitals did better by focusing care on getting patients well enough to go home

• by Christopher Cheney, HealthLeaders Media July 30, 2017

New research on the cost-effectiveness of inpatient care at hospitals compared to skilled nursing facility (SNF) found that hospitals spending intensively on inpatient care and sending patients home rather than to a SNF generated lower one-year mortality rates than hospitals that spend more intensively on post-acute-care at SNFs.
The study used a standard technique for assessing hospital performance, the study's lead author said.
"When you compare hospitals, the big concern is [that] they treat different patients, which makes it very difficult to compare outcomes or how hospitals treat people. But now, we have a new way of comparing very similar patients who go to different hospitals," said Joseph J. Doyle, Jr.
Doyle is a professor of applied economics at the Massachusetts Institute of Technology. He and colleagues at MIT and Vanderbilt University are using Medicare ambulance-service claims data to compare spending and other performance measures at hospitals.
The study Doyle published this month in the Journal of Health Economics, "Uncovering Waste in U.S. Healthcare: Evidence from Ambulance Referral Patterns," examined average 90-day spending on more than 1.5 million Medicare patients.
"We characterized the types of hospitals that get better outcomes. [They] tend to be more intense on the inpatient side. It doesn't necessarily have to be length of stay. Hospitals with better outcomes could be doing more inpatient procedures, for example," Doyle said.
"These hospitals treat patients more intensively during their inpatient stay, then they send people home instead of sending them to SNFs."
More Research Needed
While this finding is provocative, more research is required to draw conclusions on the relative cost-effectiveness of inpatient care versus SNF care, he said. "We are able to characterize the hospitals that get good outcomes, but it's a leap to say we should all mimic the type of care that is given in those hospitals."
"Maybe the hospitals that spend more intensively on inpatient care and send patients home have better doctors and better nurses; it's possible that there are many characteristics of hospitals that result in that type of treatment profile."
In addition to further research to determine whether other hospitals can replicate the mortality outcomes of hospitals with an inpatient-care-intense treatment profile, more research is necessary to examine the cost-effectiveness of SNF care, Doyle said. "This spotlight is suggesting that we should take a close look at post-acute-care."
Comparing the treatment outcomes of patients who are sent home rather than to a SNF after inpatient care is prime area for future research.
"For patients where it is not obvious whether they should go home or go to a SNF, we should have studies that either historically or, even better, prospectively, randomize those patients to either go with home-health care or go to a SNF ... If we send more people home, do we achieve better outcomes or not?"
In addition to the tantalizing findings about inpatient care and SNF care, Doyle's latest research casts doubt about earlier comparative research conducted on hospital performance.
"There is a large literature that suggests it really does not matter what hospital a patient goes to for care, in terms such as survival rates from a heart attack. We are concerned that earlier hospital comparisons did not take into account that the patients were different. We say it does matter where you go," Doyle said.
"If it doesn't matter where you go, then people could say high-intensity hospitals are wasteful."
This report is brought to you by HealthLeaders Media.

• Primary Source

  Journal of Health Economics

  Source Reference: Doyle JJ, et al " Uncovering waste in US healthcare: Evidence from ambulance referral patterns" J Health Econ 2017; DOI: 10.1016/j.jhealeco.2017.03.005.

Monocyte depletion early after stroke promotes neurogenesis from endogenous neural stem cells in adult brain

This would seem to be very important for our 100% recovery. You better save up your money to hire researchers to accomplish this as a stroke protocol.
http://www.sciencedirect.com/science/article/pii/S0014488617301863

• Cecilia Laterza^a,
• Somsak Wattananit^a,
• Naomi Uoshima^{a, b},
• Ruimin Ge^a,
• Daniel Tornero^a,
• Emanuela Monni^a,
• Olle Lindvall^a,
• Zaal Kokaia^{a, ,}

 Show more

https://doi.org/10.1016/j.expneurol.2017.07.012

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Highlights

•

Depletion of circulating monocytes after stroke enhances striatal neurogenesis

•

Infiltrating monocytes compromise survival of newly generated neuroblasts

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Depletion of circulating monocytes after stroke attenuates reactive gliosis

•

Infiltrating monocytes do not affect neurogenesis from grafted human NSPCs

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Abstract

Ischemic stroke, caused by middle cerebral artery occlusion, leads to long-lasting formation of new striatal neurons from neural stem/progenitor cells (NSPCs) in the subventricular zone (SVZ) of adult rodents. Concomitantly with this neurogenic response, SVZ exhibits activation of resident microglia and infiltrating monocytes. Here we show that depletion of circulating monocytes, using the anti-CCR2 antibody MC-21 during the first week after stroke, enhances striatal neurogenesis at one week post-insult, most likely by increasing short-term survival of the newly formed neuroblasts in the SVZ and adjacent striatum. Blocking monocyte recruitment did not alter the volume of the ischemic lesion but gave rise to reduced astrocyte activation in SVZ and adjacent striatum, which could contribute to the improved neuroblast survival. A similar decrease of astrocyte activation was found in and around human induced pluripotent stem cell (iPSC)-derived NSPCs transplanted into striatum at one week after stroke in monocyte-depleted mice. However, there was no effect on neurogenesis in the graft as determined 8 weeks after implantation. Our findings demonstrate, for the first time, that a specific cellular component of the early inflammatory reaction in SVZ and adjacent striatum following stroke, i.e., infiltrating monocytes, compromises the short-term neurogenic response neurogenesis from endogenous NSPCs.

Abbreviations

• GFAP, glial fibrillary acidic protein;
• iPSCs, induced pluripotent stem cells;
• MCAO, middle cerebral artery occlusion;
• MCP-1, monocyte chemoattractant protein-1;
• MDMs, monocyte-derived macrophages;
• NSPCs, neural stem/progenitor cells;
• OB, olfactory bulb;
• OPN, osteopontin;
• SVZ, subventricular zone

Keywords

• Neurogenesis;
• Monocyte depletion;
• Reactive gliosis

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© 2017 Elsevier Inc. All rights reserved.

Update on the State of the Evidence for Stroke Family Caregiver and Dyad Interventions

You'll have to hope you get proper interventions for you and your caregivers mental health. But very very unlikely.
http://stroke.ahajournals.org/content/48/5/e122

Tamilyn Bakas, Michael McCarthy, Elaine T. Miller

https://doi.org/10.1161/STROKEAHA.117.016052

Stroke. 2017;48:e122-e125

Originally published March 28, 2017

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• clinical trial
• depression
• family caregiving
• stress
• stroke care

Stroke remains a leading cause of serious long-term disability,¹ with most stroke survivors returning home under the care of family members who are often unprepared for the caregiving role and lack training from healthcare providers.^2,3 As a result, many stroke family caregivers experience burden, depressive symptoms, and reduced health-related quality of life.^2,3 Aside from these individual issues, caregivers commonly experience interpersonal and organizational issues.^2,3 Interpersonal issues reflect changes in relationships with the survivor and others, impacting roles and social activities.² Organizational issues involve difficulty in finding resources and services.²

The American Heart Association/American Stroke Association published a scientific statement with evidence-based recommendations for stroke family caregiver and dyad interventions that are summarized in 5 main areas (Table I in the online-only Data Supplement).⁴ Dyad interventions were defined as those that targeted both the stroke survivor and the family caregiver, with both being active participants in the intervention.⁴ Intervention studies that involved family caregivers in the intervention, but did not target the health or well-being of the caregiver, were not considered to be dyad interventions.⁴ The recommendations were based on a critical analysis of 17 caregiver and 15 dyad intervention studies found in the literature between January 1990 and October 2012.⁴ Because of the rapidly growing literature in this area, the purpose of this article is to provide an update on the state of the evidence for stroke family caregiver and dyad interventions published between November 2012 and December 2016.

Methods

A critical analysis of published stroke family caregiver and dyad intervention studies was conducted using the following inclusion criteria: (1) written in the English language; (2) published from November 2012 through December 2016; (3) used a quasi-experimental or experimental research design; (4) involved a …

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A molecule for proper neural wiring in the cerebellum

Proper neural wiring sounds incredibly important to stroke recovery. But only to survivors, I bet absolutely nothing will be done with this. Our fucking failures of stroke associations won't lift a finger, neither will your doctor or stroke hospital. 
http://www.alphagalileo.org/ViewItem.aspx?ItemId=177722&CultureCode=en
A molecule produced by insulating glial cells facilitates the functional wiring of brain cells involved in motor coordination.
Researchers at Hokkaido University have found that the molecule “L-gutamate/L-aspartate transporter” (GLAST) plays an essential role in establishing and maintaining proper neural wiring of Purkinje cells in the cerebellum.
Purkinje cells are among the largest nerve cells in the brain. They are present in the cerebellum, a small structure in the back of the brain influencing motor coordination. They are mainly hooked up to the nervous system by means of two distinct types of nerve fibers, “parallel fibers” and “climbing fibers.” Those fibers connect to different part of Purkinje cell dendrites, or the branches projecting from the cell body, segregating their territories.
GLAST is a molecule produced by specialized insulating cells, called Bergmann glia, that wrap around Purkinje cell synapses (a synapse is the structure connecting one nerve cell to another). GLAST’s role is to remove excess glutamate, a neurotransmitter used by parallel and climbing fibers to send signals to Purkinje cells. This facilitates a “high-fidelity” signal, by allowing the right amount of glutamate to reach the targeted nerve cell without spilling over onto its neighbors. However, little is known about GLAST’s role in the development of neural circuits.
Professor Masahiko Watanabe of Hokkaido University and his colleagues in Japan compared the wiring of Purkinje cells in normal mice and mutant mice lacking GLAST. The wiring of Purkinje cells in the mutant mice was laden with abnormalities.
Each Purkinje cell is normally innervated by a single climbing fiber as a result of competition between the fibers during development. However, in the mutant mice, Purkinje cells were innervated by multiple climbing fibers, which apparently caused the Purkinje cells to be atypically excited.
Parallel fibers were also affected. They robustly increased the number of connections with Purkinje cells, impairing the territorial segregation between climbing fibers and parallel fibers. Furthermore, in the knockout mice, Bergmann glial cells were improperly wrapped around the Purkinje cells, exposing them to the external environment.
In a different experiment, they also found that functional blockade of GLAST in normal adult mice results in similar abnormalities as seen in the knockout mice.
“We have shown that the glutamate transporter, GLAST, plays important roles in establishing and maintaining proper nerve wiring and insulation in the cerebellum. Further investigation should reveal how GLAST’s function is related to the plasticity of the neural network,” says Masahiko Watanabe.
https://www.global.hokudai.ac.jp/blog/a-molecule-for-proper-neural-wiring-in-the-cerebellum/

Attached files

• In the normal mice (left panel), connections between Purkinje cells (asterisks) and climbing fibers or parallel fibers are thoroughly wrapped by Bergmann glia (colored in red), whereas they are exposed to their neighbors in the knockout mice lacking GLAST (right panel, arrowheads).
  

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• Full bibliographic informationMiyazaki T. et al., Glutamate transporter GLAST controls synaptic wrapping by Bergmann glia and ensures proper wiring of Purkinje cells. Proceedings of the National Academy of Sciences of the United States of America, June 27, 2017.
  DOI: 10.1073/pnas.1617330114