Association Between Onset-to-Door Time and Clinical Outcomes After Ischemic Stroke

All these words and nothing useful was said. Exactly how fast should arrival at hospital occur? Then how fast should DTN occur? Without that specific knowledge you have no clue what actions need to be taken to meet those timelines. Damn it all learn about cause and effect.  
http://stroke.ahajournals.org/content/48/11/3049?etoc=

Ryu Matsuo, Yuko Yamaguchi, Tomonaga Matsushita, Jun Hata, Fumi Kiyuna, Kenji Fukuda, Yoshinobu Wakisaka, Junya Kuroda, Tetsuro Ago, Takanari Kitazono, Masahiro Kamouchi, on behalf of the Fukuoka Stroke Registry Investigators†

https://doi.org/10.1161/STROKEAHA.117.018132 Originally published October 3, 2017

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Abstract

Background and Purpose—The role of early hospital arrival in improving poststroke clinical outcomes in patients without reperfusion treatment remains unclear. This study aimed to determine whether early hospital arrival was associated with favorable outcomes in patients without reperfusion treatment or with minor stroke.

Methods—This multicenter, hospital-based study included 6780 consecutive patients (aged, 69.9±12.2 years; 63.9% men) with ischemic stroke who were prospectively registered in Fukuoka, Japan, between July 2007 and December 2014. Onset-to-door time was categorized as T_0-1, ≤1 hour; T_1-2, >1 and ≤2 hours; T_2-3, >2 and ≤3 hours; T_3-6, >3 and ≤6 hours; T_6-12, >6 and ≤12 hours; T_12-24, >12 and ≤24 hours; and T_24-, >>24 hours. The main outcomes were neurological improvement (decrease in National Institutes of Health Stroke Scale score of ≥4 during hospitalization or 0 at discharge) and good functional outcome (3-month modified Rankin Scale score of 0–1). Associations between onset-to-door time and main outcomes were evaluated after adjusting for potential confounders using logistic regression analysis.

Results—Odds ratios (95% confidence intervals) increased significantly with shorter onset-to-door times within 6 hours, for both neurological improvement (T_0-1, 2.79 [2.28–3.42]; T_1-2, 2.49 [2.02–3.07]; T_2-3, 1.52 [1.21–1.92]; T_3-6, 1.72 [1.44–2.05], with reference to T_24-) and good functional outcome (T_0-1, 2.68 [2.05–3.49], T_1-2 2.10 [1.60–2.77], T_2-3 1.53 [1.15–2.03], T_3-6 1.31 [1.05–1.64], with reference to T_24-), even after adjusting for potential confounding factors including reperfusion treatment and basal National Institutes of Health Stroke Scale. These associations were maintained in 6216 patients without reperfusion treatment and in 4793 patients with minor stroke (National Institutes of Health Stroke Scale ≤4 on hospital arrival).

Conclusions—Early hospital arrival within 6 hours after stroke onset is associated with favorable outcomes after ischemic stroke, regardless of reperfusion treatment or stroke severity.

National action urged to tackle rising cost of strokes as annual costs hit £26 billion - UK

And I bet the solution will not contain stopping the neuronal cascade of death by these 5 causes in the first week resulting in fewer dead and damaged neurons.

National action urged to tackle rising cost of strokes as annual costs hit £26 billion - UK

Written by Jemma Crew

Strokes are costing the UK £26 billion annually and this could triple within 20 years if action is not taken, charity figures suggest.
A new report by the Stroke Association found that strokes are taking a financial toll three times higher than the previous estimate in 2009.
Researchers believe the current cost could triple to £75 billion by 2035, due to a growing ageing population, increasing numbers of survivors and rising care costs.
Currently informal care and private treatment accounts for most of the cost (£15.8 billion), while £5.2 billion is spent on formal social care, and £3.4 billion on care by the NHS.
Lost productivity in the workplace costs employers an additional £1.6 billion annually.
Juliet Bouverie, chief executive of the Stroke Association, said "radical changes" needed to be made in how the condition was managed.
She said: "The majority of the vast financial burden caused by stroke is shouldered by thousands of families and carers, who give up everything, including their jobs, to look after loved ones whose lives are turned upside down in an instant by stroke.
"Stroke survivors without close family are left isolated, without the long-term support they desperately need.
The report, Current, future and avoidable costs of stroke, Part 2, was based on research at Queen Mary University of London and London School of Economics.
The latest figures mean the costs associated with strokes are roughly the same as the financial burden of dementia.
However, for every stroke sufferer £48 is spent a year on medical research, compared to £118 for each dementia patient, the charity said.
The charity is calling for a Government commitment to replace the current stroke strategy with a new national plan.
They hope this will pave the way for more stroke survivors to return to employment and live independently, while helping ease some of the emotional and financial pressures on family members.
It is also calling for further funding for stroke research, estimating that a £60 million investment now into stroke research could save £10 billion overall by 2035.

Spicy foods may reduce salt intake, BP

And your doctor can get a two-for-one by adding this sensation creating spice to your diet protocol.

The Szechuan pepper that sends the equivalent of 50 light taps to the brain per second. 

  Of course nothing like that will occur, it is not in the medical training for stroke rehab. I don't think doctors know one damn thing about stroke rehab. They just have to be able to spell E. T.(Evaluate and Treat) three times on prescription pads for PT, OT, and ST. I once asked a stroke doctor if Bobath or  Brunnstrom ideas were being followed for therapy.  The deer in the headlights look told me everything, he knew absolutely nothing.

Spicy foods may reduce salt intake, BP

Li Q, et al. Hypertension. 2017;doi:10.1161/HYPERTENSIONAHA.117.09950.
Wainford RD. Hypertension. 2017;doi:10.1161/HYPERTENSIONAHA.117.10025.

October 31, 2017

Adults who enjoyed spicy foods ate less salt and had lower BP, potentially reducing risk for MI and stroke, according to a study published in Hypertension.
“Current measures for reducing salt intake include education on healthy lifestyles, a campaign for the use of salt spoons, and the promotion of low-sodium salt with the addition of magnesium and potassium. However, traditional cooking habits and changes in the taste of food have dampened the effectiveness of salt reduction at the population level.” Qiang Li, MD, from the Center for Hypertension and Metabolic Diseases at the Daping Hospital in China and the Chongqing Institute of Hypertension, and colleagues wrote. “Thus, an alternative strategy for reducing salt intake may be to modify the perception of saltiness.”

See Also

• Salt-reduction program benefited rural villagers in China
• Food intake self-regulation, parental rules during toddler years...
• FGF21 hormone associated with sugar intake in humans

Li and colleagues studied data from 606 Chinese adults to determine their spicy vs. salty preferences.
Salt preference was assessed by a salt perception test, and salt tolerance was assessed by a salt super-threshold test.
Salt preference, intake
Salt preference was associated with daily salt intake (P < .01). Older age, physical labor, hypertension and lower levels of education were all associated with a higher salt preference.
Compared with those who had a low salt preference, participants with a high salt preference had about a 1.8 g per day (95% CI, 0.7-2.9) increase in salt intake, a 5 mm Hg (95% CI, 1.7-8.4) increase in systolic BP and a 4.4 mm Hg (95% CI, 2-6.7) increase in diastolic BP (P < .01 for all).
A higher salt preference was associated with a lower spice preference (P < .01), a more sensitive perception of saltiness (P = .001) and a lower threshold for declaring a solution to be intolerably salty (P = .001).
Participants with a higher spice preference had a lower salt intake and lower systolic BP (118 mm Hg vs. 126 mm Hg) and diastolic BP (73 mm Hg vs. 78 mm Hg) compared with those who had a low spice preference.

In a study of activity in the insula and orbitofrontal cortex, the researchers found evidence of increased brain metabolic activity in those with high salt intake and preference.
When a 0.5 mol/L of capsaicin, the chemical that gives chili peppers their spiciness, was administered, there was a reported increase in perception of saltiness without burning on the tongue. In addition, the capsaicin showed increased activity in the brain that was previously stimulated by high salt intake.

See Also

• Salt-reduction program benefited rural villagers in China
• Food intake self-regulation, parental rules during toddler years...
• FGF21 hormone associated with sugar intake in humans

“The major findings in this study demonstrate that the enjoyment of spicy taste enhanced the sensitivity to salty taste and lowered the daily salt intake and blood pressure in participants,” the researchers wrote. “Furthermore, high salt intake and salt preference were closely correlated with increased brain activity in the insula and [orbitofrontal cortex] of the participants.”
Intervention may succeed
In an accompanying editorial, Richard David Wainford, PhD, of the department of pharmacology and experimental therapeutics and the Whitaker Cardiovascular Institute at Boston University School of Medicine, wrote: “Despite many ongoing global public health campaigns designed to reduce dietary salt intake, including those promoted by the American Heart Association and WHO, global and Chinese daily consumption of salt continues to exceed recommended limits. ... A lifestyle intervention that adds taste to the diet, in the form of extra spice and flavor, versus reduction of the pleasure given by the salt we add to our food may have more success as a public health strategy to promote population-level dietary salt reduction.” – by Cassie Homer

Fatigue a major barrier to physical, cognitive recovery after stroke, new study finds

 Well shit, survivors could have told you that decades ago. And once again a description of a problem but no solutions. Damn it all, do something for survivors, solve their problems.This can be solved, call the presidents of the ASA, NSA and WSO and ask them how and when they are going to solve this. I would suggest not being polite about this, they have incompetently ignored this issue for decades. And why should they care?  They need to keep the charity going, solving stroke problems means they would be out of a job. I bet those presidents don't even have a stroke survivor council to actually talk to real survivors on a daily basis. Why should they? Stroke survivors know nothing about stroke and can't raise the funds to pay for their salaries. 

Fatigue a major barrier to physical, cognitive recovery after stroke, new study finds

For immediate release: Tuesday, October 31, 2017. 12:00 p.m. EDT

Better diagnosis, more research needed to counteract debilitating condition
TORONTO _ Fatigue is closely related to poorer physical recovery after stroke, according to a study of 335 stroke patients at four rehabilitation centres in Ontario published today in Frontiers in Aging Neuroscience.
A third of the people who have a stroke(wrong it is 50%) – there are 62,000 strokes in Canada every year – experience debilitating fatigue, which may be caused by depression, sleep disturbances, lesions in the brain, or other unidentified factors. 
“Post-stroke fatigue is paralyzing,” says Dr. Bradley MacIntosh, neuroimaging scientist at Sunnybrook Research Institute, who is the lead author. “It is characterized by extreme tiredness, weakness, and exhaustion. It is the feeling that even if I could move, it would take too much effort.” Sunnybrook’s Dr. Walter Swardfager, scientist in the Brain Sciences Program and senior author of the study adds: “It is easy to imagine how these symptoms might impact recovery, given the many benefits of being physically active after a stroke.”
To complicate things, some symptoms of fatigue overlap with post-stroke depression, making it difficult to disentangle their impacts on different aspects of stroke recovery.
If fatigue is misidentified as depression, some anti-depressants may, in fact, make fatigue worse. “There is no proven treatment for fatigue after a stroke,” says Dr. Swardfager, who is also an Assistant Professor of Pharmacology & Toxicology at the University of Toronto. “We need to identify how fatigue poses a barrier to recovery, and understand the causes of fatigue so that we can treat it specifically.” 
Funded by the Heart and Stroke Foundation Canadian Partnership for Stroke Recovery (CPSR), the post-stroke fatigue study is one of the largest ever conducted. As part of the study, patients who had experienced stroke within the previous six months were recruited from four CPSR-affiliated rehabilitation centres. These patients were screened for fatigue (using a tool called the Fatigue Assessment Scale) and they were assessed on their mobility (walking and balance) and cognitive function (memory, thinking speed and reasoning).
“Fatigue and depressive symptoms have influences that we previously failed to appreciate,” Dr. MacIntosh says. The study found that fatigue was directly linked to poorer physical recovery. Fatigue was also related to poorer cognitive recovery, but only if patients also experienced depressive symptoms. 
The authors say that improved screening is required to identify and treat fatigue and depression in order to ensure the best possible physical and cognitive recovery from stroke. They want to see the establishment of a working group to dig deeper into the causes of post-stroke fatigue. “If we screen for and treat Obstructive Sleep Apnea, will that improve fatigue? Or Type 2 Diabetes, which affects about a third of stroke survivors?” Dr. Swardfager says that identifying and studying fatigue “opens the door to finding the intervention that will be most useful for each person.” 
Former intensive-care-unit nurse Marilyn Kenny, who has experienced fatigue since her stroke at age 52, says further research is critical because “as I tell my doctor, I can live without my right-hand working, but the fatigue is so annoying because it affects everything in your life.” She describes fatigue as feeling completely depleted of energy. “It’s the absolutely undeniable feeling that you have to put your head down and lose consciousness for a while.”
Sunnybrook stroke neurologist Dr. Rick Swartz agrees: “This is an important area of research because, for many patients, fatigue is a major limiting factor.  I hear this especially often from my younger patients after stroke. They frequently tell me that they may be doing very well when, all of a sudden, they “hit a wall” and just need to rest or sleep. This is often a source of frustration, especially as they are trying to recover or reintegrate back to work or life responsibilities.”  
There are more than 405,000 Canadians living with long-term stroke disability, a number that’s expected to rise by 80% in the next 20 years due to the aging population and a rise in stroke risk factors.
Study co-authors include Jodi Edwards, Mani Kang, Hugo Cogo-Moreira, Joyce L. Chen, George Mochizuki, and Nathan Herrmann.
-30-
Contact:

Cathy Campbell
HSF Canadian Partnership for Stroke Recovery
cathy@canadianstroke.ca
613-852-2303

Massage Helps Treat The Most Common Mental Health Problem - anxiety

With your doctor giving you nothing concrete about how you are going to 100% recover, s/he could at least address your anxiety by having Swedish massage done in the hospital. It would also help for that extra sensory stimulation needed to help your motor recovery. 
http://www.spring.org.uk/2016/08/massage-treat-common-mental-health-problem.php

The latest research could be a step up in the evidence for massage therapy.

Just five sessions of Swedish massage is enough to improve the symptoms of anxiety, new research finds.
Levels of cortisol — known as the stress hormone — were also reduced.
People who took part in the study also saw reduced depression symptoms.
Swedish massage is the type of deep-tissue massage that people are most familiar with.
Professor Mark Hyman Rapaport, the study’s first author, said:

“These finding are significant and if replicated in a larger study will have important ramifications for patients and providers.”

The study was carried out on 47 people with generalised anxiety disorder or GAD.
People experiencing GAD find they are in near-constant anxiety.

With negative thoughts clouding their mind all day, it can be very hard to function normally.
GAD is typically treated with therapy and/or medication.
For the study itself, a group given Swedish massage was compared with another group in which people received light touch.
Both groups had the massage or light touch twice a week for six weeks.
Each therapy session lasted 45 minutes.
The researchers found that massage reduced anxiety, along with depression symptoms, in comparison to the light touch condition.

Better than relaxing?

One previous study has found that massage is no better than simply being in a relaxing room with soft, soothing music (Sherman et al., 2010).
Dr Karen J. Sherman, that study’s first author, said:

“We were surprised to find that the benefits of massage were no greater than those of the same number of sessions of ‘thermotherapy’ or listening to relaxing music.
This suggests that the benefits of massage may be due to a generalized relaxation response.”

So the latest research could be a step up in the evidence for massage therapy.
Other studies have linked massage therapy to better sleep and improvements in the immune system.
The new study was published in The Journal of Clinical Psychiatry (Rapaport et al., 2016).

A randomized trial of beta carotene supplementation and cognitive function in men: the Physicians' Health Study II

Pretty useless unless your doctor can find the amounts needed for protection.  Don't do this on your own, problems with beta carotene overdose

A randomized trial of beta carotene supplementation and cognitive function in men: the Physicians' Health Study II

F Grodstein, JH Kang, RJ Glynn… - Archives of internal …, 2007 - jamanetwork.com

Background Oxidative stress contributes to brain aging. Antioxidant treatment, especially
over the long term, might confer cognitive benefits. Methods We added cognitive testing to
the Physicians' Health Study II (PHSII), a randomized trial of beta carotene and other vitamin
supplements for chronic disease prevention. The PHSII is a continuation of the Physicians'
Health Study (PHS), which had randomized male participants to low-dose aspirin and ...

Strategies for dementia prevention: latest evidence and implications

So no real clue on how to prevent dementia.

Maybe my ideas here?
Dementia prevention 19 ways
Don't follow me, I'm not medically trained. 

Strategies for dementia prevention: latest evidence and implications 

Show all authors

Gopalkumar Rakesh, Steven T. Szabo, George S. Alexopoulos, ...

First Published June 27, 2017 Review Article

Download PDF	Article information

Abstract

Dementia is a common and debilitating syndrome with enormous impact on individuals and societies. Preventing disease onset or progression would translate to public health and societal benefits. In this review, we discuss the latest evidence on interventions that may show promise for the prevention of cognitive decline. We appraise existing evidence primarily drawn from randomized controlled trials, systematic reviews, and meta-analyses, but also highlight observational studies in humans and relevant work in model organisms. Overall, there is currently limited evidence to support a cause–effect relationship between any preventive strategy and the development or progression of dementia. However, studies to date suggest that a multifactorial intervention comprising regular exercise and healthy diet, along with the amelioration of vascular risk factors, psychosocial stress, and major depressive episodes may be most promising for the prevention of cognitive decline. We discuss the challenges, future directions, and implications of this line of research.

More at link. 

Re-establishing an occupational identity after stroke – a theoretical model based on survivor experience

This is bad, the tyranny of low expectations by your doctor that they aren't even considering the possibility of getting you fully recovered. This defeatist attitude needs to be removed, maybe by firing them. Solve the primary problem - full recovery - and this secondary problem goes away.
http://journals.sagepub.com/doi/abs/10.1177/0308022617722711

Kim Walder, Matthew Molineux

First Published August 31, 2017 Research Article

Download PDF	Article information

Abstract

Introduction

Annually, approximately five million people worldwide(wrong,  10 million) are left with a permanent disability following a stroke, often with ongoing occupational issues. A deeper understanding of the emerging picture of occupational disruption and identity reconstruction after stroke is needed to inform client-centred practice.

Method

In-depth interviews using constructivist grounded theory methodology were conducted with six Queensland (Australia) adult stroke survivors. Data analysis identified themes which were woven into an overarching theory about the process of reintegration back into the community and living a meaningful life.

Findings

The central process of adjustment for all participants was reconstruction of an occupational identity, facilitated through connections within and across three domains – self, others and reality. Connecting with self involved emotional management; motivation; confidence; occupational engagement; and seizing control. Connecting with others included being understood; belonging; receiving help; and interactions. Connecting with reality meant confronting the impact on daily life and one's unfolding life story according to three realities: past reality, the reality of the stroke and future reality.

Conclusion

Exploring how stroke survivors form and maintain connections across the domains of self, reality and others provides a framework to ground occupational therapy services in the reality of individual needs from an occupational perspective.

Mayo Clinic Resilience Seminar - Nov. 17, 2017

You need this since your doctor has no fucking clue how to get 100% recovered. You hospital should be sending you there or have this seminar repeated in your hospital.
https://attendesource.com/profile/form/index.cfm?PKformID=0x1018792f2e

Thank you for your interest in the Mayo Clinic Resilience Seminar
Resilience is the core strength you rely on to help you bounce back from adversity, withstand hardships and grow despite life’s downturns. During this engaging seminar, Amit Sood, M.D., a Mayo Clinic resilience expert, will help you understand how your brain can produce unwanted stress and teach skills you can use for living a more resilient life. The Mayo Clinic Resilience program is an evidence-based program developed by Dr. Sood, and backed by more than 20 clinical trials proven to decrease stress and improve well-being in just minutes each day. Sign up today and take the first step to discover greater peace and happiness for you and your loved ones.
Mayo Clinic Resilience Seminar: $199
1 pm – 5 pm
Mayo Clinic Healthy Living Program
Dan Abraham Healthy Living Center
56 1st Street SW, Floor 6
Rochester, MN 55902

Keynote: Discover the Magic of Leadership from the Disney Institute

Maybe you can petition the boards of directors of the ASA, NSA, and WSO to send themselves and their president to this so they can learn what actual leadership is about. Right now I see NO leaders in stroke, everyone is hunkered down pushing the simplistic F.A.S.T., prevention and tPA. None of which helps ANY survivor get to 100% recovery.  This is so fucking simple to solve. You write up RFPs to researchers to solve a specific problem in stroke, get the money for it from foundations and soon results will start flowing in. The current scattershot approach to stroke research is a total disaster, from pie-in-the-sky stem cell research to repeating research that was done decades ago.

Keynote: Discover the Magic of Leadership from the Disney Institute

 Jeff James serves as vice president and general manager of Disney Institute, which is the professional development and business advisory arm of Walt Disney Parks and Resorts. A 20 plus year veteran of The Walt Disney Company, Jeff is an expert in the company’s successful core competencies and values.

The R&D 100 Conference is pleased to welcome Jeff to the stage as a Keynote for this year’s third annual conference, Nov. 16-17 in Orlando.

Learn about time-tested business insights on leadership, employee engagement and service that create a culture of excellence as Jeff presents Disney’s Approach to Customer Experience. For over 30 years, Disney Institute has helped organizations in a wide variety of industries apply the Disney approach to improve their own customer experiences. This is your special opportunity to learn from Jeff James, Vice President and General Manager, as he shares the business insights behind Disney’s success. Join us for this one-of-a-kind experience and learn how you can unlock the magic inside your organization. There’s still time left to register!

Register Now

Leapfrog gives nearly 1,000 hospitals a 'C' for patient safety, but a handful of states are making significant strides

Our great stroke association should be making the same determination for stroke hospitals. How safe is it for you to be treated there? 30-day deaths? 100% recovery? Right now we know zilch about our stroke hospitals, I have yet to see one that posts factual results. You get crapola like, We follow 'Get With the Guidelines' or Joint Commission standards. Neither of which tells you one damn thing about how good they are for survivors.
http://www.fiercehealthcare.com/population-health/leapfrog-group-hospital-rankings-a-third-u-s-hospitals-earn-a?mkt_tok=eyJpIjoiT1dSbVpXWm1aRE5tT1dZNSIsInQiOiJrMEhSQnlwbHpNdVBDVnV2cURseThaZGk2S2NoU3NZazdwbk1hVlg5eXZIUm5xMVpyK2FtZ1hZTU1sM01mb0tETFwvYzRcLzVXTW1BMzM3R1RXQU9Kdm1vU2Z0aHhaeGhiS0ZBbU1QYzN4dkcralg0VmRFYTFUSG51bjcrbTZDVW1UIn0%3D&mrkid=638281&utm_medium=nl&utm_source=internal
Follow this link to select the state you are interested in;

State Rankings

Nitric Oxide Signaling in Neurodegeneration and Cell Death

 This is fascinating because nitric oxide is so useful in blood pressure management. 85 posts on nitric oxide so your doctor can inform you when you should be getting it post stroke.
http://www.sciencedirect.com/science/article/pii/S1054358917300819

Author links open overlay panelTed M.Dawson^*Valina L.Dawson^*

https://doi.org/10.1016/bs.apha.2017.09.003Get rights and content

Abstract

In this tribute to Solomon H. Snyder (Sol) we discuss the mechanisms by which nitric oxide (NO) kills neurons. We provide a historical perspective regarding the discovery that glutamate excitotoxicity is mediated by NO. It also contains a discussion of the discovery that neuronal nitric oxide synthase (nNOS) catalytic activity accounts for NADPH diaphorase activity and its localization in the central nervous system. NADPH diaphorase/nNOS neurons are unique in that they are resistant to toxic effects of excess glutamate and that they are resistant to neurodegeneration in a variety of neurodegenerative diseases. NADPH diaphorase/nNOS neurons are resistant to neurotoxicity and neurodegeneration through the overexpression of manganese superoxide dismutase. The review also delves into the mechanisms by which NO kills neurons including NO's activation of the glyceraldehyde-3-phosphate dehydrogenase-dependent cell pathway. In addition, there is a review of parthanatos in which NO combines with the superoxide anion (

) to form peroxynitrite (ONOO⁻) that damages DNA and activates poly (ADP-ribose) (PAR) polymerase (PARP). This ultimately leads to activation of the PARP-dependent apoptosis-inducing factor-associated nuclease, the final executioner in NO-dependent cell death. Finally, there is a discussion of potential targets that are under development that target the mechanisms by which NO kills neurons.

Keywords

NADPH diaphorase

Nitric oxide

Neuronal nitric oxide synthase

Parthanatos

Poly (ADP-ribose) polymerase

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SPSC17: Physios should embrace technology in stroke rehab, says biomechanics lecturer

You wouldn't need to try to fix the appalling rate of 10% full recovery via physiotherapy if your doctors were stopping the neuronal cascade of death by these 5 causes in the first week resulting in fewer dead and damaged neurons.
http://www.csp.org.uk/news/2017/10/30/spsc17-physios-should-embrace-technology-stroke-rehab-says-biomechanics-lecturer

Many physiotherapy students are anxious about the use of biomechanics in rehab, according to a lecturer in biomedical engineering.

1 Comment 0

_{Biomechanical engineering lecturer Andy Kerr spoke about technology and stroke rehab}
Andy Kerr, who is also a researcher at the University of Strathclyde, spoke about the issue during a keynote speech at the Scottish Physiotherapy Student Conference 2017 (SPSC17) in Edinburgh on 28 October.
Dr Kerr has worked on several projects associated with stroke rehabilitation and the use of technology to support its delivery and evaluation.
And his primary research interest is the study of human movement, shaped from many years as both a clinical and teaching physiotherapist.
He asked the conference whether the solution to delivering rehabilitation is technology and provided details of a study that counted the number of sit to stand movements performed during the rehab of older people who have had a stroke.
Some participants were fitted with sensors, he explained, and an avatar on a screen moved in time and told them when to push up.
Dr Kerr said: ‘There are too many barriers to the use of technology: cost, dogma, complexity, access, NHS firewalls that stop apps and staff fear of being replaced by therapy robots.
‘There are not enough physios and the technology cannot replace your skills and knowledge. My aim is greater integration of technology and more use. Next year there will be a master’s level course in technology and health.’
Virtual reality treadmill training
Dr Kerr’s research into gait and recovery of walking function suggests that, although 80 per cent of stroke survivors do recover some walking ability, they are too slow and unskilled for the challenges of walking outdoors.
He has also been involved in a study that combined virtual reality with treadmill training for stroke survivors. People taking part followed virtual 'road and forest paths' and the treadmill slowed when users stepped over ‘objects’.
This feasibility study found treadmill walking (with and without virtual reality) to be similar enough to overground walking to justify it as a training modality for chronic stroke patients, who had already attained some independence in walking.
Installation of the equipment currently costs £600,000 to £1 million, but work is ongoing to use cheaper TV screens.

Transcutaneous Vagus Nerve Stimulation Combined With Robotic Rehabilitation Improves Upper Limb Function After Stroke

And just when will vagus nerve stimulation be written up into a stroke protocol? Then we don't need to repeat this research because we know it works. 25 posts on vagus nerve back to July 2012. Fucking lack of stroke leadership. That is you; ASA, NSA, WSO. My criteria to be considered a fucking failure of a stroke association here.
I'm sure your doctor can read 20 pages and produce a protocol from that.

Transcutaneous Vagus Nerve Stimulation Combined With Robotic Rehabilitation Improves Upper Limb Function After Stroke

Theoretical Basis Underlying Physiotherapy Practice in Stroke Rehabilitation - Portugal

You can see from this that total incompetence reigns in stroke rehab. NO protocols, NO standards, NO measurements, NO efficacy rating, and they refer to Bobath.  Only 1 page.

Theoretical Basis Underlying Physiotherapy Practice in Stroke Rehabilitation - Portugal

The Use of Repetitive Transcranial Magnetic Stimulation for Stroke Rehabilitation: A Systematic Review

A total fucking waste because a protocol on use of rTMS for stroke rehab should have been written years ago. Such fucking incompetence out there in the stroke world and NO ONE is fixing such failures.  I've written 32 posts on this since January 2013 and obviously still NO protocol has been written up. Incompetence in full force once again, not a problem for these researchers, only stroke survivors feel the results of this fucking incompetence. 

 Rant started

Yes I'm being a very bad cop but for years there has been research on rehab that looked promising but never seems to be translated into usable interventions for survivors.  Either we replace all the existing stroke medical doctors with newer ones that still have a sense of desire to help or we force our doctors to actually do their job.

Rant completed, I feel better now.

Of course I did this same rant 2 years ago and nothing has changed.

The Use of Repetitive Transcranial Magnetic Stimulation for Stroke Rehabilitation: A Systematic Review

Author links open overlay panelAnaDionísioMSc*†‡Isabel CatarinaDuarteMSc*‡MiguelPatrícioPhD‡§MiguelCastelo-BrancoMD, PhD*‡§‖

https://doi.org/10.1016/j.jstrokecerebrovasdis.2017.09.008Get rights and content

Objectives

Stroke is a leading cause of disability. Alternative and more effective techniques for stroke rehabilitation have been sought to overcome limitations of conventional therapies. Repetitive transcranial magnetic stimulation (rTMS) arises as a promising tool in this context. This systematic review aims to provide a state of the art on the application of rTMS in stroke patients and to assess its effectiveness in clinical rehabilitation of motor function.

Methods

Studies included in this review were identified by searching PubMed and ISI Web of Science. The search terms were (rTMS OR “repetitive transcranial magnetic stimulation”) AND (stroke OR “cerebrovascular accident” OR CVA) AND (rehab OR rehabilitation OR recover*). The retrieved records were assessed for eligibility and the most relevant features extracted to a summary table.

Results

Seventy out of 691 records were deemed eligible, according to the selection criteria. The majority of the articles report rTMS showing potential in improving motor function, although some negative reports, all from randomized controlled trials, contradict this claim. Future studies are needed because there is a possibility that a bias for non-publication of negative results may be present.

Conclusions

rTMS has been shown to be a promising tool for stroke rehabilitation, in spite of the lack of standard operational procedures and harmonization. Efforts should be devoted to provide a greater understanding of the underlying mechanisms and protocol standardization.

Brain Imaging Science Identifies Individuals With Suicidal Thoughts

Be careful out there.  Your doctor should be following up with this since there is a 33% chance of depression after stroke. 
https://www.biosciencetechnology.com/news/2017/10/brain-imaging-science-identifies-individuals-suicidal-thoughts?
Mon, 10/30/2017 - 12:44pm

by Carnegie Mellon University

On the left is the brain activation pattern for "death" in participants who had made a suicide attempt. The image in the right depicts the activation pattern for "death" in control participants. Credit: Carnegie Mellon University

Researchers led by Carnegie Mellon University's Marcel Just and the University of Pittsburgh's David Brent have developed an innovative and promising approach to identify suicidal individuals by analyzing the alterations in how their brains represent certain concepts, such as death, cruelty and trouble.
Suicidal risk is notoriously difficult to assess and predict, and suicide is the second-leading cause of death among young adults in the United States. Published in Nature Human Behaviour, the study offers a new approach to assessing psychiatric disorders.
"Our latest work is unique insofar as it identifies concept alterations that are associated with suicidal ideation and behavior, using machine-learning algorithms to assess the neural representation of specific concepts related to suicide. This gives us a window into the brain and mind, shedding light on how suicidal individuals think about suicide and emotion related concepts. What is central to this new study is that we can tell whether someone is considering suicide by the way that they are thinking about the death-related topics," said Just, the D.O. Hebb University Professor of Psychology in CMU's Dietrich College of Humanities and Social Sciences.
For the study, Just and Brent, who holds an endowed chair in suicide studies and is a professor of psychiatry, pediatrics, epidemiology and clinical and translational science at Pitt, presented a list of 10 death-related words, 10 words relating to positive concepts (e.g. carefree) and 10 words related to negative ideas (e.g. trouble) to two groups of 17 people with known suicidal tendencies and 17 neurotypical individuals.
They applied the machine-learning algorithm to six word-concepts that best discriminated between the two groups as the participants thought about each one while in the brain scanner. These were death, cruelty, trouble, carefree, good and praise. Based on the brain representations of these six concepts, their program was able to identify with 91 percent accuracy whether a participant was from the control or suicidal group.
Then, focusing on the suicidal ideators, they used a similar approach to see if the algorithm could identify participants who had made a previous suicide attempt from those who only thought about it. The program was able to accurately distinguish the nine who had attempted to take their lives with 94 percent accuracy.
"Further testing of this approach in a larger sample will determine its generality and its ability to predict future suicidal behavior, and could give clinicians in the future a way to identify, monitor and perhaps intervene with the altered and often distorted thinking that so often characterizes seriously suicidal individuals," said Brent.
To further understand what caused the suicidal and non-suicidal participants to have different brain activation patterns for specific thoughts, Just and Brent used an archive of neural signatures for emotions (particularly sadness, shame, anger and pride) to measure the amount of each emotion that was evoked in a participant's brain by each of the six discriminating concepts. The machine-learning program was able to accurately predict which group the participant belonged to with 85 percent accuracy based on the differences in the emotion signatures of the concepts.
"The benefit of this latter approach, sometimes called explainable artificial intelligence, is more revealing of what discriminates the two groups, namely the types of emotions that the discriminating words evoke," Just said. "People with suicidal thoughts experience different emotions when they think about some of the test concepts. For example, the concept of 'death' evoked more shame and more sadness in the group that thought about suicide. This extra bit of understanding may suggest an avenue to treatment that attempts to change the emotional response to certain concepts."
Just and Brent are hopeful that the findings from this basic cognitive neuroscience research can be used to save lives.
"The most immediate need is to apply these findings to a much larger sample and then use it to predict future suicide attempts," said Brent.
Just and his CMU colleague Tom Mitchell first pioneered this application of machine learning to brain imaging that identifies concepts from their brain activation signatures. Since then, the research has been extended to identify emotions and multi-concept thoughts from their neural signatures and also to uncover how complex scientific concepts are coded as they are being learned.

Low-Dose Rivaroxaban Green-Lighted by FDA

At first I wouldn't have gone on this because of a lack of a reversal agent but since Dec. 2015 Praxbind (idrucizumab) is approved.
https://www.medpagetoday.com/Cardiology/VenousThrombosis/68882?

For continued prevention of recurrent VT

• by Nicole Lou, Contributing Writer, MedPage Today October 30, 2017

The FDA approved the 10 mg once-daily dose of rivaroxaban (Xarelto) for patients who have taken at least 6 months of anticoagulation, manufacturer Janssen announced.
Approval was based on the EINSTEIN CHOICE study in which both 20-mg and 10-mg doses of rivaroxaban beat aspirin in reducing a patient's risk of recurrent venous thromboembolism (VTE) -- by 66% and 74%, respectively -- without an elevated bleeding risk.
The 3,396-patient trial was presented as a late-breaker at the American College of Cardiology meeting this year. "This is a useful and safe clinical pathway for managing these patients," the presenter said at the time. There is "really no role for aspirin in this setting ... I hope these findings will encourage more physicians to prescribe rivaroxaban for these patients."
Rivaroxaban is to be prescribed at 15 mg twice daily in the first 21 days after a VTE occurrence, followed by 20 mg once daily up to the 6-month mark. With this new approval, physicians can then start patients on a 10 mg once-daily regimen if they are at continued risk for deep vein thrombosis and pulmonary embolism.
Recurrent VTE is a quality marker used by Medicare.

How Green Tea Blocks Alzheimer's

You need this but go ask your doctor if green tea is better than coffee and the EXACT
 amounts to drink on a daily basis. You doctor better know the answers. I'm going to be doing coffee, it does Parkinsons also.

You need it for these reasons;

1. A documented 33% dementia chance post-stroke from an Australian study?   May 2012.
2. Then this study came out and seems to have a range from 17-66%. December 2013.
3. A 20% chance in this research.   July 2013.

 

How coffee protects against Parkinson’s Aug. 2014 

 

Drinking Coffee Can Lower Alzheimer's Risk By 20%, All It Takes Is 3 Cups A Day  Dec. 2014

 

How Green Tea Blocks Alzheimer's 

Green tea is widely considered to be beneficial for the brain. The antioxidant and detoxifying properties of green tea extracts help fight catastrophic diseases such as Alzheimer’s. However, scientists have never fully understood how they work at the molecular level and how they could be harnessed to find better treatments.

Research from McMaster University is shedding new light on those underlying mechanisms. Preclinical evidence suggests that the green tea compound known as EGCG interferes with the formation of toxic assemblies (oligomers), one of the prime suspects in the early steps of the molecular cascade that leads to cognitive decline in Alzheimer’s patients.

 “At the molecular level, we believe EGCG coats toxic oligomers and changes their ability to grow and interact with healthy cells,” explains Giuseppe Melacini, lead author and a professor in the Departments of Chemistry and Chemical Biology as well as of Biochemistry and Biomedical Sciences at McMaster, who has worked on Alzheimer’s-related research for 15 years.
The findings, which are the results of a decade of advancements in nuclear magnetic resonance (NMR) methodology and are featured in the cover page of the Journal of the American Chemical Society, could lead to new therapies and further drug discovery, say researchers.

Despite decades of research, the causes of Alzheimer’s remain not fully understood, and treatment options are limited. According to the latest census numbers, seniors living in Canada now outnumber children, dramatically increasing the need for effective drugs and prevention. By some estimates, the number of Canadians with dementia is expected to rise to 937,000 by the year 2031, an increase of 66 per cent compared to current numbers.

“We all know that currently there is no cure for Alzheimer’s once symptoms emerge, so our best hope is early intervention. That could mean using green tea extracts or their derivatives early on, say 15 to 25 years before any symptoms ever set in” says Melacini.

Next, researchers hope to tackle nagging problems such as how to modify EGCG and similar molecules so they can be used effectively as a food additive, for example. EGCG is unstable at room temperature and notoriously difficult to deliver into the human body, particularly the brain.

“Food additives could prove to be a crucial therapy or adjuvant” says Melacini. “It will be important to capitalize on them early in life to increase the odds of healthy aging, in addition to exercise and a healthy lifestyle.”

SOURCE:

• McMaster University

Why I think stroke rehab protocols should be publicly available

Rebecca Dutton does not think so.
I disagree, my reasoning follows:
1. Most survivors are kicked out of therapy by insurance at the six month mark, Doing therapy on your own is usually the only possibility.
2. Currently only 10% of stroke survivors fully recover, survivors on their own can't do much worse..
3. Doing exercises perfectly is not the fastest way to learn.

    a. Rebecca does have a point in that having someone else spot the problems you are doing is great especially since your doctor failed at getting your proprioception recovered. 
    b. Practicing to perfection is only possible when you have full control of your muscles, For the 30% of stroke survivors with spasticity that is impossible.
   c. Until we get objective measurements of our movements, therapists are a poor second for seeing exactly what is being done wrong and which specific muscles are incorrectly moving. I had a PT who demonstrated and said, 'Walk this way'. 'Fuck you, if I could walk that way I wouldn't need you'.
   d. This research suggests that; 'A study led by Maurice Smith and colleagues at the Harvard School of Engineering and Applied Sciences (SEAS) suggests that simple task repetition may not be the most efficient way for the brain to learn a new move'.  I took this to means that if errors are encountered as you practice you learn faster because you know what is wrong and what is needed to correct it.

How the body learns to make accurate movements: In motor learning, it's actions -- not intentions -- that count

4.  As Dr. Steven Wolf writes, a rehabilitation stroke expert and professor at Emory University School of Medicine in Atlanta.  "Stroke patients need to rely more on their own problem solving to regain mobility".
5. Peter Levine has two relevant posts on this;

DIY Stroke Recovery

Why a little means a lot

6.  By making them public, survivors can be involved in making them better.

 

 

Learning fast accurate movements requires intact frontostriatal circuits

Is this intact from your stroke? Or does your doctor first have to have a protocol to recover this before you try fast intricate movements? Don't accept the fuckingly lazy, 'I don't know' for an answer. Start screaming at him/her, they deserve such a response.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3826079/

Britne Shabbott,¹ Roshni Ravindran,¹ Joseph W. Schumacher,¹ Paula B. Wasserman,^2,3 Karen S. Marder,^2,3,4 and Pietro Mazzoni^1,2,*

Author information ► Article notes ► Copyright and License information ►

This article has been cited by other articles in PMC.

Go to:

Abstract

The basal ganglia are known to play a crucial role in movement execution, but their importance for motor skill learning remains unclear. Obstacles to our understanding include the lack of a universally accepted definition of motor skill learning (definition confound), and difficulties in distinguishing learning deficits from execution impairments (performance confound). We studied how healthy subjects and subjects with a basal ganglia disorder learn fast accurate reaching movements. We addressed the definition and performance confounds by: (1) focusing on an operationally defined core element of motor skill learning (speed-accuracy learning), and (2) using normal variation in initial performance to separate movement execution impairment from motor learning abnormalities. We measured motor skill learning as performance improvement in a reaching task with a speed-accuracy trade-off. We compared the performance of subjects with Huntington's disease (HD), a neurodegenerative basal ganglia disorder, to that of premanifest carriers of the HD mutation and of control subjects. The initial movements of HD subjects were less skilled (slower and/or less accurate) than those of control subjects. To factor out these differences in initial execution, we modeled the relationship between learning and baseline performance in control subjects. Subjects with HD exhibited a clear learning impairment that was not explained by differences in initial performance. These results support a role for the basal ganglia in both movement execution and motor skill learning.

More at link.