Deans' stroke musings

Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 493 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:http://oc1dean.blogspot.com/2010/11/my-background-story_8.html

Tuesday, July 25, 2017

Motor Recovery Prediction With Clinical Assessment and Local Diffusion Homogeneity After Acute Subcortical Infarction

Who the fuck cares about predicting recovery? The non-negotiable goal is 100% recovery for all stroke survivors. Research dollars could be much better spent getting patients recovered. 
http://stroke.ahajournals.org/content/48/8/2121?etoc=
Gang Liu, Shuangquan Tan, Chao Dang, Kangqiang Peng, Chuanmiao Xie, Shihui Xing, Jinsheng Zeng
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Abstract

Background and Purpose—Initial clinical assessment or conventional diffusion tensor imaging parameters alone do not reliably predict poststroke recovery of motor function. Recently, local diffusion homogeneity (LDH) has been proposed to represent the local coherence of water molecule diffusion and can serve as a complementary marker for investigating white matter alterations of the brain. We aimed to determine whether a combination of initial clinical assessment and LDH could predict motor recovery after acute subcortical infarction.
Methods—Standard upper extremity Fugl-Meyer assessment and diffusion tensor imaging were performed 1, 4, and 12 weeks after onset in 50 patients with subcortical infarction. Proportional recovery model residuals were used to assign patients to proportional recovery and poor recovery groups. Tract-based spatial statistics analysis was used to compare diffusion differences between proportional and poor recovery outcomes. Multivariate logistic regression model was used to identify the predictors of motor improvement within 12 weeks after stroke.
Results—The poor recovery group had lower LDH than the proportional recovery group, mainly in the ipsilesional corticospinal tract in the superior corona radiate and posterior limb of internal capsule 1 week after stroke (P<0.005; family-wise error corrected). Multivariate logistic regression analysis indicated that both initial Fugl-Meyer assessment and LDH in the ipsilesional corticospinal tract in the superior corona radiate and posterior limb of internal capsule were predictors of motor improvement within 12 weeks after stroke (G=47.22; P<0.001). Leave-one-out cross-validation confirmed a positive predictive value of 0.818, a negative predictive value of 0.833, and an accuracy of 0.824 (P<0.00 001; permutation test).
Conclusions—These results suggest that a combination of clinical assessment and LDH in the ipsilesional corticospinal tract in the acute phase can accurately predict resolution of upper limb impairment within 12 weeks after subcortical infarction.

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