How to do a systematic review - International Journal of Stroke

Well fuck, systematic reviews should never be necessary. All research should update the last research on the subject. And protocols should be updated at the end of every piece of research.  You blithering idiots are missing the whole point of stroke research. Getting stroke survivors 100% recovered. Not wasting time doing systematic reviews.

How to do a systematic review - International Journal of Stroke

Alex Pollock, Eivind Berge,

First Published November 17, 2017 Review Article

https://doi.org/10.1177/1747493017743796

Article information

Abstract

High quality up-to-date systematic reviews are essential in order to help healthcare practitioners and researchers keep up-to-date with a large and rapidly growing body of evidence. Systematic reviews answer pre-defined research questions using explicit, reproducible methods to identify, critically appraise and combine results of primary research studies. Key stages in the production of systematic reviews include clarification of aims and methods in a protocol, finding relevant research, collecting data, assessing study quality, synthesizing evidence, and interpreting findings. Systematic reviews may address different types of questions, such as questions about effectiveness of interventions, diagnostic test accuracy, prognosis, prevalence or incidence of disease, accuracy of measurement instruments, or qualitative data. For all reviews, it is important to define criteria such as the population, intervention, comparison and outcomes, and to identify potential risks of bias. Reviews of the effect of rehabilitation interventions or reviews of data from observational studies, diagnostic test accuracy, or qualitative data may be more methodologically challenging than reviews of effectiveness of drugs for the prevention or treatment of stroke. Challenges in reviews of stroke rehabilitation can include poor definition of complex interventions, use of outcome measures that have not been validated, and poor generalizability of results. There may also be challenges with bias because the effects are dependent on the persons delivering the intervention, and because masking of participants and investigators may not be possible. There are a wide range of resources which can support the planning and completion of systematic reviews, and these should be considered when planning a systematic review relating to stroke.

New rehab method could double recovery in stroke patients

Well then, write this up as a protocol and get it distributed to all stroke hospitals. Not doing so is gross incompetence. 

New rehab method could double recovery in stroke patients

Targeted plasticity therapy doubles rate of movement recovery in stroke patients

A new rehabilitation technique called targeted plasticity therapy (TPT) could double movement recovery in stroke patients.
The novel technique invented by researchers at The University of Texas at Dallas has been shown, in a pilot study, to double the rate of upper limb recovery.
The results of the study were published in the journal Stroke.

The findings indicate that targeted plasticity therapy, which involves stimulation of the vagus nerve is safe and twice as effective as rehab alone. It has to be administered along with Physiotherapy.

A stroke occurs when blood flow to the brain is interrupted because of a blockage or a ruptured blood vessel. Limb mobility can be affected

“Stroke is too common and too debilitating for us to tolerate the status quo,” said Jane Wigginton, the lead author and chief medical officer at UT Dallas’ Texas Biomedical Device Center (TxBDC). “Patients need a real solution so they can get back to fully living their lives.”
The therapy technique pairs physical movements with precisely timed vagus nerve stimulation (VNS) which involves electrical stimulus of the nerve via a device implanted on the nerve in the neck.
Stimulating the vagus nerve initiates neural plasticity – reorganization of the brain’s circuitry. Synchronizing VNS with movement accelerates plasticity in a damaged brain, thereby facilitating recovery.
A stroke occurs when blood flow to the brain is interrupted because of a blockage or a ruptured blood vessel. Limb mobility can be affected when nerve cells are damaged. Such forms of brain trauma are often treated with traditional rehabilitation that includes repeated movement of the affected limb in an effort to regain strength and activity.
In this study neither the researchers nor the study subjects knew who was getting VNS stimulation and who was not.
In addition to showing that the technique is safe, the researchers found that subjects receiving active VNS scored more than twice as high as control subjects at the 30 and 90 day intervals.
“These results show our method has immense potential. We’re excited about what this could mean for millions of stroke patients worldwide,” said Kilgard, associate director and chief science officer of the TxBDC, who invented targeted plasticity therapy (TPT).

Brain Activity on Observation of Another Person’s Action: A Magnetoencephalographic Study

So we still don't know if action observation works in stroke rehab and the protocols for it. You'll just have to completely guess on your own.

Brain Activity on Observation of Another Person’s Action: A Magnetoencephalographic Study 

.

Jumpei Mizuno ,^*1 Masashi Kawamura ,^*1 and Minoru Hoshiyama ^*1Affiliations¹Nagoya University

*Mizuno, Kawamura, and Hoshiyama are with the Dept. of Occupational Therapy, Graduate School of Medicine, School of Health Sciences, Nagoya University, Nagoya, Japan. Hoshiyama is also with the Brain & Mind Research Center, Nagoya University, Nagoya, Japan.

Address author correspondence to Minoru Hoshiyama at hosiyama@met.nagoya-u.ac.jp.

Volume: 22 Issue: 4 Pages: 377-390

https://doi.org/10.1123/mc.2017-0053

• ABSTRACT
• FULL TEXT
• REFERENCES
• PDF

Brain activity was recorded using a whole-head magnetoencephalography system followed by coherence analysis to assess neural connectivity in 10 healthy right-handed adults to clarify differences in neural connectivity in brain regions during action observation from several perspectives. The subjects were instructed to observe and memorize or imitate the hand action from a first-person or second-person visual perspective. The brain activity in coherence was modified among frontal and central, sensorimotor, and mirror neuron system-related regions based on the visual perspectives of finger movements. The regional activity in coherence changed similarly under the imitation and observation tasks compared with the condition of observing static hand figures. The information from different visual perspectives of body movements was processed in the frontal–central regions related to sensorimotor processes and partially in mirror neuron system.

Pharmacological treatment of post-stroke epilepsy: still more questions than answers

You may have to worry about this. Still no protocol for treatment or prevention, so you may still be screwed.
Seizures occur in about 10% of stroke patients.  

The latest here:

Pharmacological treatment of post-stroke epilepsy: still more questions than answers

by ESO | 28.9.2018 | Stroke Research | 0 comments

Francesco Brigo, MD
– Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
– Division of Neurology, “Franz Tappeiner” Hospital, Merano, Italy
Johan Zelano, MD PhD
– Sahlgrenska academy and Sahlgrenska university hospital, Gothenburg, Sweden
Both organizers of the Seizures & stroke congress February 20-22 2019, Gothenburg
Cerebrovascular disease is the most commonly identified cause of acquired epilepsy,¹  and stroke represents the underlying cause in 11% of all epilepsies in adults.² Early post-stroke seizures occurring within one week from the stroke are not suggestive of an enduring predisposition of the brain to generate epileptic seizures;³ they do not entail a diagnosis of epilepsy, and considering the low risk of recurrence⁴ do not necessarily require a long-term treatment with antiepileptic drugs.⁵ Conversely, late post-stroke seizures are associated with a risk of recurrence over the following 10 year as high as 71.5% (95% CI: 59.7–81.9%).⁴ Hence, the occurrence of even a single late post-stroke seizure implies a diagnosis of epilepsy.⁶
 We have recently performed a systematic review of the literature to assess the available evidence on the efficacy and tolerability of antiepileptic drugs for the treatment of post-stroke epilepsy.⁷ Only two randomized controlled trials were identified through a comprehensive and systematic search of the literature. One trial compared levetiracetam (LEV) with controlled-release carbamazepine (CR-CBZ)⁸ and the other compared lamotrigine (LTG) with CR-CBZ.⁹ No significant difference in terms of seizure freedom was found between either LEV or LTG and CR-CBZ, whereas LEV and LTG had lower occurrence of adverse events. The lack of statistical difference in efficacy between LEV or LTG and CR-CBZ was likely the consequence of the small number of patients included in each trial, with a high risk of false negative results due to inadequate statistical power. Furthermore, both studies were affected by unclear or high risk of bias and differed for stroke etiology and inclusion of early post-stroke seizures.
In a network meta-analysis we also indirectly compared the efficacy and tolerability of LEV and LTG using CR-CBZ as common comparator. Not surprisingly, we found no difference between LEV and LTG for seizure freedom, whereas adverse events occurred more frequently with LEV than with LTG (odds ratio 6.87; 95%CI: 1.15-41.1), with a trend towards higher withdrawal rates due to poor tolerability in patients receiving LEV.
Overall, the evidence supporting the use of specific antiepileptic drugs for the treatment of post-stroke epilepsy is scarce and based on low-quality studies. Hence, it is insufficient to provide strong recommendations to inform clinical practice. However, LEV and LTG appear interesting options, particularly for their better tolerability compared to CR-CBZ. However, data on CR-CBZ are also insufficient to discourage its use, although the risk of pharmacological interactions and negative effects on lipid levels¹⁰ should be carefully considered before choosing this drug for treating post-stroke epilepsy.
Based on the available evidence, the choice of the antiepileptic drug for post-stroke seizures should take into consideration not only the efficacy and tolerability profile, but also the pharmacokinetic properties, ease of use, patient´s preferences, and the effects on cognition, behavior and motor functions.^7,11 It is astonishing that, despite the high prevalence of cerebrovascular disease among the underlying causes of epilepsy in adults and elderly, only two trials have been conducted so far to assess the role of antiepileptic drugs in post-stroke epilepsy. There is an urgent need for further studies to provide robust data on antiepileptic treatment of this common condition.
This and other unresolved issues will be extensively discussed in Seizures & Stroke, the first International Congress on Epilepsy in Cerebrovascular Disease, which will be held in Gothenburg, Sweden, from 20th to 22^nd February 2019 (https://seizuresandstroke.com/). The congress will gather experts in the field for scientific discussions and state-of-the art updates on management of seizures in the context of cerebrovascular disease. Strategies and opportunities for cooperative studies on pharmacological treatment of post-stroke seizures will be one of the main object of discussion among participants.
Undoubtedly, in this field there is a lot of work to be done. Let´s start doing it. Together.

Astrocyte-Derived Exosomes Treated With a Semaphorin 3A Inhibitor Enhance Stroke Recovery via Prostaglandin D2 Synthase

Have your doctor and stroke hospital follow this up with the researchers they work with for human testing. Or are they going to be incompetent like usual and DO NOTHING?

Astrocyte-Derived Exosomes Treated With a Semaphorin 3A Inhibitor Enhance Stroke Recovery via Prostaglandin D₂ Synthase

Kenichiro Hira

,

Yuji Ueno

,

Ryota Tanaka

,

Nobukazu Miyamoto

,

Kazuo Yamashiro

,

Toshiki Inaba

,

Takao Urabe

,

Hideyuki Okano

, and

Nobutaka Hattori

Originally published11 Sep 2018Stroke. 2018;49:2483–2494

Abstract

• Download figure
• Download PowerPoint

Background and Purpose—

Exosomes play a pivotal role in neurogenesis. In the peri-infarct area after stroke, axons begin to regenerate but are inhibited by astrocyte scar formation. The direct effect and underlying molecular mechanisms of astrocyte-derived exosomes on axonal outgrowth after ischemia are not known.

Methods—

Using a semaphorin 3A (Sema3A) inhibitor, we explored neuronal signaling during axonal outgrowth after ischemia in rats subjected to middle cerebral artery occlusion and in cultured cortical neurons challenged with oxygen-glucose deprivation. Furthermore, we assessed whether this inhibitor suppressed astrocyte activation and regulated astrocyte-derived exosomes to enhance axonal outgrowth after ischemia.

Results—

In rats subjected to middle cerebral artery occlusion, we administered a Sema3A inhibitor into the peri-infarct area from 7 to 21 days after occlusion. We found that phosphorylated high-molecular weight neurofilament-immunoreactive axons were increased, glial fibrillary acidic protein–immunoreactive astrocytes were decreased, and functional recovery was promoted at 28 days after middle cerebral artery occlusion. In cultured neurons, the Sema3A inhibitor decreased Rho family GTPase 1, increased R-Ras, which phosphorylates Akt and glycogen synthase kinase 3β (GSK-3β), selectively increased phosphorylated GSK-3β in axons, and thereby enhanced phosphorylated high-molecular weight neurofilament-immunoreactive axons after oxygen-glucose deprivation. In cultured astrocytes, the Sema3A inhibitor suppressed activation of astrocytes induced by oxygen-glucose deprivation. Exosomes secreted from ischemic astrocytes treated with the Sema3A inhibitor further promoted axonal elongation and increased prostaglandin D₂ synthase expression on microarray analysis. GSK-3β⁺ and prostaglandin D₂ synthase⁺ neurons were robustly increased after treatment with the Sema3A inhibitor in the peri-infarct area.

Conclusions—

Neuronal Rho family GTPase 1/R-Ras/Akt/GSK-3β signaling, axonal GSK-3β expression, and astrocyte-derived exosomes with prostaglandin D₂ synthase expression contribute to axonal outgrowth and functional recovery after stroke.

Status and Perspectives of Acute Stroke Care in Europe

I call complete bullshit on this reporting. Stroke is not treatable and you lazy fuckers have done nothing to get closer to 100% recovery.  I hope schadenfreude hits all of you really hard.
Bo Norrving shouldn't be commenting at all, I saw nothing he accomplished when he was president of the WSO.
YOU need to get involved, you can't leave this up to stroke medical professionals, they came up with the inadequate Helsingborg declarations.

Helsingborg 1996

Helsingborg 2006

 

Status and Perspectives of Acute Stroke Care in Europe

Urs Fischer

,

Diana Aguiar de Sousa

,

Bo Norrving

, and

Valeria Caso

Originally published30 Aug 2018Stroke. 2018;49:2281–2282

Stroke is the second most common single cause of death in Europe and the leading cause of long-term disability.^1,2 Every year, up to 1.3 million persons in Europe suffer a first-ever stroke.³ Consequently, the socioeconomic impact of stroke is considerable with an annual cost in Europe of up to €45 billion.¹ Projections show that the overall stroke burden in Europe will further increase by 35% in 2050, mostly because of the aging population.⁴ However, there is overwhelming evidence that an acute ischemic stroke is no longer an unavoidable fate because strokes can be prevented and treated(10% full recovery is not being treated successfully), dramatically reducing the burden of stroke and its long-term consequences.
Endovascular treatment (EVT) has recently become the standard of care in stroke patients with large vessel occlusions, and it is now, together with stroke unit (SU) treatment and intravenous thrombolysis (IVT), a main pillar of acute stroke management.(But you never tell us its full success rate , so I call that a failure.) However, and despite much discussion on the necessary overhaul of stroke systems of care, information on access and delivery of these acute stroke treatment strategies in Europe was lacking. In a recent publication in the European Stroke Journal, Aguiar de Sousa et al⁵ surveyed the status of acute stroke treatment in Europe.

Current Status of Acute Stroke Care in Europe

A survey drafted by stroke professionals from the European Stroke Organisation, the European Society of Minimally Invasive Neurological Therapy, the European Academy of Neurology, and the patient organisation Stroke Alliance for Europe was sent to national stroke societies and experts requesting best available national data on the number of SUs, as well as IVT and EVT rates, per year. Experts from 44 of 51 European countries provided data. Out of the 7 nonparticipating countries, 5 were from Eastern Europe. The authors compared both pooled and individual national data per 1 million inhabitants (United Nations data) and per 1000 annual incident ischemic strokes (Global Burden of Disease Report) with the best-performing countries.(Well fuck, you didn't request surveys from survivors asking how well they recovered because you didn't want to publicize your complete failure in getting them 100% recovered.)
The estimated mean number of SUs was 2.9 per 1 million inhabitants and 1.5 per 1000 annual incident strokes; highest country rates were 9.2 and 5.8, respectively. Forty-two countries provided the annual number of IVTs. The estimated mean annual number was 142 IVT per 1 million inhabitants, whereas 4 countries had rates per million above 350. Overall, 7.3% of all patients with an ischemic stroke in Europe received IVT. However, 15 countries had IVT rates <5%, whereas 6 countries reported that at least 15% of their patients received this treatment. The annual number of EVT was provided in 39 countries and was mostly for 2016. The estimated mean annual number of EVTs was 37.1 per 1 million inhabitants. Importantly, the annual number of treatments was estimated to be <10 per 1 million inhabitants in 13 countries, whereas rates for the 3 best-performing countries were 3× higher than the overall mean (up to 111.5). Overall, only 1.9% of incident ischemic stroke patients received EVT, whereas the top 3 countries reported rates above 5%.
These data showed that for most countries access to and delivery of SU care along with both IVT and EVT rates varied significantly, and in most countries, rates were far below best performers. The discrepancy means that 226 662 more patients could have been treated with IVT (339 929 instead of 113 267) and 67 347 with EVT (94 852 instead of 27 505), if best practice would have been followed in all countries. Although these are still rather conservative estimates, this means that two-thirds of patients that would potentially be eligible for IVT and three-quarters of candidates for EVT did not receive these treatments in Europe.
This survey provides a comprehensive snapshot of acute stroke care standards in European countries. These results are valuable for all stakeholders responsible for drawing up and implementing long-term strategies. The major limitation of this investigation was that it relied on surveyed data. Although it was requested that only best available information has to be utilized to compile the survey, in countries lacking organized nationwide registries, data came from variable sources, namely recent health ministerial statistics, service reports, national stroke registries, and estimates made by a consensus of coordinators and experts. In addition, no audit could be performed to assess the quality of the data. A larger prospective survey is planned for 2019.

Perspective of Acute Stroke Care in Europe

The findings of this survey have implications for the future organization of acute stroke care standards throughout Europe. In 2006, the second Helsingborg Declaration, cosponsored by the World Health Organization Regional Office for Europe, set new targets for stroke management and care.⁶ One specific goal for 2015 was that all patients with acute stroke who were potentially eligible for acute specific treatment should be transferred to hospitals with adequate capacity and expertise to administer treatments—defined as an SU or stroke dedicated area. The current survey suggests that this goal still is far from being reached.
The European Stroke Organisation has therefore prepared a European Stroke Action Plan (ESAP) for the years 2018 to 2030, in cooperation with the European patient organisation Stroke Alliance for Europe.⁷ The ESAP adheres to the format of the Helsingborg Declarations, presenting a review of the state of the art, the state of current services, research and development priorities, and targets for a series of domains in stroke care (organization of stroke services, management of acute stroke, prevention, rehabilitation, evaluation of stroke outcome, and quality assessment). The ESAP includes 2 additional domains, on primary prevention and life after stroke, along with research and development priorities for translational stroke research. The ESAP was prepared in an open, transparent process that involved >100 scientists and patient organization representatives from almost all of the European countries. A live-streamed consensus workshop was held in Munich, March 22 to 23, 2018. The ESAP was launched at the European Stroke Organisation Congress in Gothenburg in May 2018, and the publication of the document is currently being finalized.
ESAP provides 32 specific targets for 7 domains. Four overarching targets were identified:

1. To reduce the absolute number of strokes in Europe by 10%.
2. To treat 90% or more of all patients with stroke in Europe in a dedicated SU as the first level of care.
3. To have national plans for stroke encompassing the entire chain of care from primary prevention to life after stroke.
4. To fully implement national strategies for multisector public health interventions to promote and facilitate a healthy lifestyle, and reduce environmental (including air pollution), socioeconomic, and educational factors that increase the risk of stroke.
   Where the fuck is the goal for 100% recovery for all survivors? Leaders would tackle such a goal. 

An ESAP implementation plan will be prepared by European Stroke Organisation after having assessed an updated epidemiological report on stroke incidence, prevalence, and mortality and receiving detailed and reliable data from quality registries from national stroke and patient societies. Progress toward the targets and research and development priorities laid out in the ESAP will be reviewed in 2021 and 2024, with a midterm review scheduled for 2024. The extent to which the targets have been achieved will be reviewed in 2030.
Clearly, the implementation of the ESAP is a big challenge, which involves financial factors, as well as policy issues. Preventing and treating stroke should be seen as an investment for the society that has a favorable return, both social and economical, rather than just a cost to the healthcare sector. Governmental bodies need to substantially upscale efforts for stroke, along with other noncommunicable diseases, requiring a change of strategy in many of the European countries. National stroke and neurological societies will have a key role in the implementation of the targets. Role models of stroke management have been identified (ie, Austrian Stroke Network, Code Stroke System of Catalonia), as well as national quality registers currently set up in several European countries.
The ESAP is likely the most comprehensive and detailed plan for improvement of prevention and care of stroke in any large geographical region of the world, emphasizing the need to invest in stroke proportionally to the public health impact of the disease. Hopefully, this plan could also become an inspiration for other areas in the world. As Larry Elder said, “A goal without a plan is just a wish”.⁸

Disclosures

Dr Fischer is a Consultant for Medtronic, Stryker, and Commonwealth Serum Laboratories Behring. He is a principal investigator of the SWITCH (Swiss Trial of Decompressive Craniectomy Versus Best Medical Treatment of Spontaneous Supratentorial Intracerebral Hemorrhage (SWITCH): A Randomized Controlled Trial), ELAN (Early Versus Late Initiation of Direct Oral Anticoagulants in Post-Ischaemic Stroke Patients With Atrial Fibrillation: An International Multicenter, Randomized-Controlled, Two-Arm, Assessor-Blinded Trial), and SWIFT DIRECT trial (Solitaire With the Intention for Thrombectomy Plus Intravenous t-PA Versus DIRECT Solitaire Stent-Retriever Thrombectomy in Acute Anterior Circulation Stroke). Dr Norrving receives Honoraria for Data and Safety Monitoring Board work for Astra Zeneca and Bayer. Dr Caso receives Advisory boards and speaker fees for Bayer, Boehringer Ingelheim, BMS-Pfizer, Ever-Neuropharma. She also participated in a trial for Brainsgate and in the NAVIGATE-ESUS (New Approach Rivaroxaban Inhibition of Factor Xa in a Global Trial Versus ASA to Prevent Embolism in Embolic Stroke of Undetermined Source), RESPECT-ESUS (Dabigatran Etexilate for Secondary Stroke Prevention in Patients With Embolic Stroke of Undetermined Source), and SOCRATES trial (Acute Stroke or Transient Ischemic Attack Treated With Aspirin or Ticagrelor and Patient Outcomes). The other author reports no conflicts.

Footnotes

The opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.

Correspondence to Urs Fischer, MD, MSc, Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland. Email urs.fischer@insel.ch

Participation after stroke: the influence of depression in outpatient neurological rehabilitation

You goddamn fuckers; The main goal is 100% recovery NOT the lazy crapola you are pushing on survivors. Get the hell out of stroke if you are being worthless like this.  I would fire you all.
https://europepmc.org/abstract/med/30238233
Marheineke J ¹ , 

Deck R ² , 

Reuther P ³ , 

Pöppl D ⁴ , 

Theves F ⁵ , 

Kohlmann T ⁶  

Affiliations

Der Nervenarzt [20 Sep 2018]

Type: Journal Article, English Abstract (lang: ger)
DOI: 10.1007/s00115-018-0622-1

Abstract

Depressiveness is a known and common problem after stroke, which puts a great burden on those affected. The main goal for stroke rehabilitation is to achieve the maximum possible self-determination and participation in the community. This research study examined how depressive symptoms influence the course of participation in outpatient neurological rehabilitation.Stroke rehabilitants from 17 German outpatient neurological rehabilitation centers were interviewed in a multicentric observational study. Within the current work, data on participation and depressive symptoms recorded at the beginning and at the end of rehabilitation by self-assessment questionnaires, were evaluated.Data of 342 rehabilitants were considered. Results of a multinomial logistic regression analysis indicated that the depression value at the end of rehabilitation, in particular, proved to be a good predictor for the improvement in participation. The lower the depressiveness, the more likely an improvement in participation. At the beginning of the rehabilitation program there were no significant differences between mean depression scores of patients who improved and patients who deteriorated.A relationship between depressiveness and participation was shown. The treatment of depressive symptoms through timely administered psychotherapeutic and medicinal care and general activity promotion could influence the participation in a beneficial way.

Read Article at publisher's site

Guidelines for Stroke Rehabilitation and Recovery: Tailoring Care to Patients’ Needs and Improving..

What a useless piece of shit. Guidelines and care, NOT PROTOCOLS OR RESULTS. Do they think we are stupid and don't realize that our stroke professionals know ABSOLUTELY NOTHING about getting 100% recovered?

Guidelines for Stroke Rehabilitation and Recovery: Tailoring Care to Patients’ Needs and Improving.. 

Stroke AHA/ASA

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Exercise and new nerve cell growth in Alzheimer’s disease

You are likely going to need this. So what the fuck followup is being done by your doctor and stroke hospital? Or are they twiddling their thumbs again waiting for SOMEONE ELSE TO SOLVE THE PROBLEM? ?

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.

Exercise and new nerve cell growth in Alzheimer’s disease

At a Glance

• In a mouse model of Alzheimer’s disease, exercise stimulated the growth of new nerve cells in the brain and reduced memory problems.
• The researchers were able to design treatments to mimic some of the beneficial effects of exercise.
• The findings pave the way for studies in people with Alzheimer’s disease.

Researchers have been working to understand how Alzheimer’s disease disrupts the growth of new neurons in the brain.maksime/iStock/Getty Images Plus

Experts estimate that more than 5 million Americans may have Alzheimer’s disease, the most common form of dementia. This irreversible brain disorder gradually worsens and destroys memory and thinking skills. Current treatments may slow memory loss, but there’s no cure. There is some evidence that exercise can reduce the risk of cognitive decline during aging and decrease the risk of dementia, but studies with people have had mixed results.
Many changes take place during the course of Alzheimer’s disease, even before symptoms develop. Starting in the hippocampus region of the brain, abnormal deposits of proteins form amyloid plaques and tau tangles. Neurons (nerve cells) there stop functioning, lose their connections with other neurons, and die. Previous research with mice has suggested that there’s also a disruption in neurogenesis, the process of new neurons arising from progenitor cells, in the hippocampus.
A research team led by Dr. Rudolph Tanzi of Massachusetts General Hospital and Harvard Medical School set out to investigate whether spurring growth of new hippocampus neurons could lessen memory problems in a mouse model of Alzheimer’s disease. The work was funded in part by NIH’s National Institute on Aging (NIA) and National Institute of Mental Health (NIMH). Results were published in Science on September 7, 2018.
The researchers used mice engineered to develop an early, aggressive form of Alzheimer’s disease. The mice were injected with a compound known to boost survival of progenitor cells as well as a gene therapy that enhances proliferation of progenitor cells. The two treatments promoted the growth of nerve cells in the mice. However, the mice weren’t any better at a maze that tests memory.
The team also tested the effects of exercise. Untreated mice given access to an exercise wheel had new growth of nerve cells and performed better on memory tests. In addition, plaques and several proteins linked to Alzheimer’s disease, such as brain-derived neurotrophic factor (BDNF), improved in these mice.
Next, the research team tested the effects of combining the progenitor cell treatments with BDNF promotion. This combination, like exercise, promoted nerve cell growth and improved memory. It had these effects, however, without affecting plaques and other disease markers.
Blocking new growth of nerve cells in the hippocampus by various methods, in contrast, worsened memory and reduced BDNF. This finding suggests that the absence of new hippocampal neurons may play a role in Alzheimer’s disease.
“The lesson learned was that it is not enough just to turn on the birth of new nerve cells, you must simultaneously ‘clean up’ the neighborhood in which they are being born to make sure the new cells survive and thrive,” Tanzi says. “Exercise can achieve that, but we found ways of mimicking those beneficial cognitive effects by the application of drugs and gene therapy that simultaneously turn on neurogenesis and BDNF production.”
More research is needed to determine whether these findings extend beyond this mouse model of Alzheimer’s disease. If they prove relevant to human disease, they may lead to new ways to prevent or treat dementia.
—by Geri Piazza

 

South Texas Health System Edinburg Awarded Stroke Rehabilitation Certification from The Joint Commission

So fucking what? It tells you NOTHING about;

1. tPA full recovery? Better than 12%?
2. 30 day deaths? Better than competitors?
3. rehab full recovery? Better than 10%?

http://www.edinburgreview.com/news/20180925/south-texas-health-system-edinburg-awarded-stroke-rehabilitation-certification-from-joint-commission

South Texas Health System announces it has earned The Joint Commission’s Gold Seal of Approval for Stroke Rehabilitation Certification at South Texas Health System Edinburg. The Gold Seal of Approval® is a symbol of quality that reflects an organization’s commitment to providing safe and effective patient care. (NOT RESULTS!)

South Texas Health System Edinburg underwent a rigorous on-site review in July 2018. Joint Commission experts evaluated compliance with national disease-specific care standards(NOT RESULTS!) as well as with stroke rehab-specific requirements. Clinical practice guidelines and performance measures also were assessed.

Established in 2002 and awarded for a two-year period, The Joint Commission’s Disease-Specific Care Certification evaluates clinical programs across the continuum of care and addresses three core areas:(NOT RESULTS!)
Compliance with consensus-based national standards;

Effective use of evidence-based clinical practice guidelines to manage and optimize care; and An organized approach to performance measurement and improvement activities.(NOT RESULTS!)
“South Texas Health System Edinburg has thoroughly demonstrated a high level of care for patients who have suffered a stroke,” said Patrick Phelan, executive director, Hospital Business Development, The Joint Commission. “We commend the rehab team at South Texas Health System Edinburg for becoming a leader in stroke rehabilitation care, potentially providing a higher standard of service for stroke patients in its community.”

“South Texas Health System Edinburg is pleased to receive Disease-Specific Care Certification from The Joint Commission, the premier health care quality improvement and accrediting body in the nation,” added Lance Ames, CEO for South Texas Health System Edinburg. “The certification provides us with the framework to create a culture of excellence for those in our community.”
(NOT RESULTS!)

Enriched environments in stroke rehabilitation

Well fuck, you mean you didn't read, comprehend and implement this enriched environment talked about by Dr. Dale Corbett in 2011?  Wasn't good enough for clinical application? So you have wasted 7 years that could have helped survivors? The incompetence displayed in all of stroke is world class.

https://www.eventbrite.co.uk/e/enriched-environments-in-stroke-rehabilitation

by London ACPIN

£30 – £50

Actions and Detail Panel

Enriched environments in stroke rehabilitation

Sat 1 December 2018, 09:30 – 15:30 GMT

£30 – £50

Event Information

Description

London ACPIN are delighted to present a fantastic study day with Heidi Janssen, exploring environmental enrichment (EE) in acquired brain injury.

Heidi Janssen is a Physiotherapist and Researcher at the Hunter Medical Research Institute, Newcastle, NSW, Australia.

Heidi will be speaking about about the theory of enriched environments, animal models, evidence base, in community and inpatient environments. Click HERE for link to article

This study day aims to;

Provide evidence in animal models of acquired brain injury regarding the anatomical, molecular and behavioural effects of exposure to enriched environments.

Outline the main hypotheses concerning the underlying mechanisms of effect

Discuss barriers and enablers to activity and implementing enriched environments from both perspective of patient with ABI and staff, based on delegates’ experiences and research findings.

Present published evidence for the use of enriched environments with people recovering from or living with an ABI: in the Acute, Sub-acute and Chronic stages

09:00 registration for 9:30 start

Location

Basement Lecture Theatre
The Clinical Neuroscience Centre
33 Queen Square
London
WC1N 3BG
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Evaluation of a ketogenic diet for improvement of neurological recovery in individuals with acute spinal cord injury: a pilot, randomized safety and feasibility trial

Ask you doctor and hospital when they will do followup research on this for stroke survivors. Never is not an acceptable answer. Neither is; 'What the hell are you talking about?' This would seem to suggest that a ketogenic diet should be started immediately in the hospital to provide neuroprotection. But I'm not medically trained so therefore I know nothing.
https://www.nature.com/articles/s41394-018-0121-4

• Ceren Yarar-Fisher,
• Adarsh Kulkarni,
• Jia Li,
• Paige Farley,
• Cassandra Renfro,
• Hammad Aslam,
• Patrick Bosarge,
• Landon Wilson &
• Stephen Barnes 

Spinal Cord Series and Casesvolume 4, Article number: 88 (2018) | Download Citation

Abstract

Study design

Longitudinal, randomized study.

Objectives

(1) Test the safety and feasibility of a ketogenic diet (KD) intervention in the acute stages of spinal cord injury (SCI), (2) assess the effects of a KD on neurological recovery, and (3) identify potential serum biomarkers associated with KD-induced changes in neurological recovery.

Setting

Acute care and rehabilitation facility.

Methods

The KD is a high-fat, low-carbohydrate diet that includes ≈70–80% total energy as fat. Seven participants with acute complete and incomplete SCI (AIS A–D) were randomly assigned to KD (n = 4) or standard diet (SD, n = 3). Neurological examinations, resting energy expenditure analysis, and collection of blood for evaluation of circulating ketone levels were performed within 72 h of injury and before discharge. Untargeted metabolomics analysis was performed on serum samples to identify potential serum biomarkers that may explain differential responses between groups.

Results

Our pilot findings primarily demonstrated that KD is safe and feasible to be administered in acute SCI. Furthermore, upper extremity motor scores were higher (p < 0.05) in the KD vs. SD group and an anti-inflammatory lysophospholipid, lysoPC 16:0, was present at higher levels, and an inflammatory blood protein, fibrinogen, was present at lower levels in the KD serum samples vs. SD serum samples.

Conclusion

Taken together, these preliminary results suggest that a KD may have anti-inflammatory effects that may promote neuroprotection, resulting in improved neurological recovery in SCI. Future studies with larger sample size are warranted for demonstrating efficacy of KD for improving neurological recovery.

Effectiveness of neuromuscular electrical stimulation for wrist rehabilitation after acute ischemic stroke

Useless because it doesn't point to the protocol used or its efficacy and the starting point needed to use the protocol. 

Effectiveness of neuromuscular electrical stimulation for wrist rehabilitation after acute ischemic stroke

Guo, Xiao-xian, MB^a,*; Fan, Bai-ya, MB^a,*; Mao, Yan-yang, MD^b

Section Editor(s): Zhang., Qinhong

Medicine: September 2018 - Volume 97 - Issue 38 - p e12299

doi: 10.1097/MD.0000000000012299

Research Article: Observational Study

• Abstract
• Author Information
• Article Outline

This study investigated the effectiveness of neuromuscular electrical stimulation (NMES) for patients with wrist dysfunction after acute ischemic stroke (AIS).
A total of 82 patient cases with wrist dysfunction after AIS were selected in this study. Of these, 41 cases in the intervention group received physical training and NMES treatment. The other 41 cases in the control group received physical training only. The primary outcome was measured by Action Research Arm Test (ARAT) score. The secondary outcomes were measured by the Barthel Index (BI), and numerical rating scale (NRS).
After 4-week treatment, patients in the intervention group neither improved arm function recovery, measured by ARAT score (P = .79), and activities of daily living, measured by BI scale (P = .62), nor reduced pain, measured by the NRS scale (P = .11), compared with patients in the control group.
The results of this study demonstrated that NMES might not benefit for patients with wrist dysfunction after AIS after 4-week treatment.

Back to Top | Article Outline

1 Introduction

Stroke is one of the most server conditions, which often results in high disability, mortality, and morbidity.^[1–3] It is reported that it has affected 7 million adults in America with 3.0% of the population from 2007 to 2010, according to the American Stroke Association statistics.^[4,5] Of those populations, many stroke survivors often suffer from limb paralysis, abnormal gait, aphasia, and other complications.^[6–8]On the other hand, the large amount of burden brings for both those survivors and the society.^[9]

Patients after stroke often require long-term rehabilitation therapy, especially for the hemiplegia in order to the restore and improve motor functions for the paralyzed limbs.^[10,11] It has been reported that more than 50% patients can not recover arm function, although most stroke survivors can regain ability to walk independently after rehabilitation.^[12] If arm function can not be recovered timely, this condition can also lead to secondary complications such as spasticity, contractures, and pain.^[12,13]

To improve the upper extremity motor function after stroke, interventions should focus on not only enhancing the arm dysfunction, but also addressing the conditions of spasticity, contractures, and pain. It has been reported that alternative therapies, including neuromuscular electrical stimulation (NMES), acupuncture, and mirror therapy intervention have the potential to facilitate recovery of arm function and also help to prevent the development to the secondary complications.^[14–18] Among these interventions, NMES is one of the most widely used therapies.^[19–22] In spite of the promising results were reported from the previous studies, insufficient evidence is still available to support that NMES is an efficacious adjunctive therapy for patients with wrist rehabilitation after chronic stroke.^[19–22]

In the present study, we investigated the effectiveness of NMES in patients with wrist rehabilitation after acute ischemic stroke (AIS) among Chinese population.

 

The effect of rehabilitation measures on the quality of life of patients with cerebral stroke

Quality of life increased significantly is NOT good enough. Increased completely to normal is the ONLY goal. GET THERE!

The effect of rehabilitation measures on the quality of life of patients with cerebral stroke

 Nazi Hayat1, Misha Balooch1, Ali Khan2, Emran Aziz2*

1 Parwen University, Peshawar, Pakistan. 2 Indla Medical University, Lahoor, Pakistan.   Article Code: IJMPH-140

ABSTRACT Background and Objectives: Stroke is the third leading cause of death in advanced countries, which leads to various neurological defects. Considering the importance of rehabilitation measures to reduce the complications of this disease, this study aimed to determine the effect of rehabilitation measures on quality of life in patients. Materials and Methods: This quasi-experimental study was carried out on 30 patients with cerebral stroke admitted to the hospital. They were selected using easy sampling method and had inclusion criteria. Data were collected using a questionnaire on quality of life in the four areas (physical, mental, general health, social function) before and after the intervention. Descriptive statistics (mean, standard deviation and inferential statistics) were used for analyzing the data (paired t-test, Wilcoxon and independent t-test). Results: The results showed that the mean scores of quality of life in the areas of physical, psychological, social performance and general health after rehabilitation measures increased significantly (P = 0.05). Also, the overall score of quality of life after rehabilitation measures was significantly higher than before (P = 0.05). Conclusion: Rehabilitation measures have a positive effect on different aspects of quality of life. Establishing and strengthening rehabilitation, educational and support centers will enable these patients to benefit from these measures and is an important step in their independence.

Key words: Rehabilitation measures, quality of life, stroke. HOW TO CITE THIS ARTICLE: Hayat N, Balooch M, Khan A, Aziz E. The effect of rehabilitation measures on the quality of life of patients with cerebral stroke International Journal of Medicine and Public Health. 2018;2(1):17-21. *Corresponding author: Emran Aziz e-mail: Emranazizi@gmail.com Received: 22/04/2018 Accepted: 13/06/2018
 

Creative Arts-Based Therapies for Stroke Survivors: A Qualitative Systematic Review

Oh god, trying to make survivors feel better about their disabilities rather than solving those disabilities.
Creative Arts-Based Therapies for Stroke Survivors: A Qualitative Systematic Review 

Temmy Lee Ting Lo¹, Janet Lok Chun Lee¹ and Rainbow Tin Hung Ho^1,2,3*

• ¹Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, Hong Kong
• ²Centre on Behavioral Health, The University of Hong Kong, Hong Kong, Hong Kong
• ³Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong, Hong Kong

Background: Stroke is a life-threating cerebrovascular disease. Without proper and immediate treatment, it can cause long-term disabilities and even death. While current rehabilitation focuses on functional needs, it does not fully address the psychosocial issues. Creative arts-based therapies, however, may have the potential to be of assistance.

Methods: A systematic review was conducted to synthesize the qualitative findings of the stroke survivors' positive and negative experiences in participating in creative arts-based therapies. A systematic literature search was conducted across diverse databases. A thematic synthesis was adopted to analyze the results from different qualitative studies and mix-method studies.

Results: Among the 367 studies extracted from various databases, 11 studies met the inclusion criteria and were of acceptable quality. The following five analytical themes were identified: functional restoration, psychological support, social engagement, spiritual experience, and short-comings and barriers.

Conclusion: Creative arts-based therapies have demonstrated their strengths in addressing psychosocial needs for stroke survivors. Different art modalities are perceived to be useful in achieving different therapeutic goals. Therapies based on a single art modality or combined modalities have different specialties and characteristics. Further research is needed to demonstrate the differential benefits or special advantages of using single or multiple art modalities as well as having qualified therapists in creative arts-based therapies.

Introduction

Stroke is a severe cerebrovascular disease. The World Health Organization (WHO) defined stroke as a disease that has “rapidly developing clinical signs of focal (or global) disturbance of cerebral function, with symptoms lasting 24 hours or longer or leading to death, with no apparent cause other than of vascular origin” (WHO MONICA Project Investigators, 1988). Without immediate and proper treatment, it can cause permanent physical disabilities such as paralyzed limbs, or even death. There are three main types of stroke, namely, ischemic stroke, hemorrhagic stroke, and transient ischemic attack (TIA). According to the American Heart Association (2018), ischemic stroke occurs when there is a blockage in the blood vessel which supplies blood to the brain. Hemorrhagic stroke refers to the fracture in a weakened blood vessel in the brain. Transient ischemic attack (TIA), also named “mini-stroke,” occurs when there is a temporary obstruction in the blood vessel(s) of the brain.

Current Situation of Stroke

According to the latest global statistics, the prevalence rate of stroke was approximately 25.7 million and was the second leading cause of death in 2013 (Benjamin et al., 2017). Although older people have a higher risk of stroke, the onset of stroke among people aged 20–64 years has increased by 25% from 1990 to 2010 worldwide (Feigin et al., 2014). In the United States, around 795,000 people experience a new or recurrent stroke every year. Stroke is also the fifth leading cause of death and the leading cause of severe long-term disabilities in the United States (Benjamin et al., 2017). In Hong Kong, there are ~2 million patients with chronic illnesses and 2.2% of them are stroke patients (Census Statistics Department, 2015). Every year, ~3000 people die of stroke (Hospital Authority, 2018). Cerebrovascular diseases, including stroke, are the fourth leading causes of death in Hong Kong (Centre for Health Protection, 2018). These statistics indicate that the world is now facing a grave challenge with an increasing number of stroke survivors, thus more resources are needed for rehabilitation and post-stroke support.

Current Rehabilitation for Stroke Survivors

Current rehabilitation for stroke survivors depends heavily on physiotherapies, occupational therapies, and speech therapies. These rehabilitation programs are essential for stroke survivors as they aid in functional recovery. Physiotherapy, also recognized as physical therapy, focuses on the movement and physical function of patients and aims at the maintenance, development, and restoration of mobility (World Confederation for Physical Therapy, 2017). The main goal of occupational therapy is to facilitate patients to participate in their daily life activities and enhance their self-autonomy (World Federation of Occupational Therapy, 2012). Speech therapy aims at treating the patients' speech, language, and swallowing problems and at enhancing the patients' verbal communication and swallowing abilities (American Speech-Language-Hearing Association, 2018). Functional recovery is of utmost importance in stroke rehabilitation, especially during the first 6 months after the onset of stroke. The sudden loss of physical ability as well as the changes in various aspects of life caused by stroke also trigger psychological distress, social withdrawal and confusion in the meaning in life (Knapp et al., 2000; Yeung et al., 2011), which together need to be further addressed. These psychosocial and spiritual needs are also suggested to be crucial for the quality of life for stroke survivors (Katona et al., 2015). Enhancing the post-stroke quality of life has therefore been increasingly emphasized in recent years, in particular, in the United States (American Heart Association, 2013) and Australia (Australian Stroke Foundation, 2008). Due to their non-intrusive processes, therefore, non-pharmacological approaches, in particular, have been drawing considerable attention. Among them, creative arts-based therapies, which are mostly playful and without side-effects, have been recommended for stroke survivors. Different art modalities are also being suggested to be useful in stimulating different parts of the brain, and the stimulations from diverse art forms may further enhance the neuroplasticity in the brain and this may be helpful for facilitating the recovery process after stroke (Demarin, 2017). In addition, neurological evidence has shown that regularly listening to music after stroke may lead to structural changes in the brain among stroke survivors, and these structural changes may, in turn, relate to improvements in cognition (Särkämö et al., 2014). Moreover, engaging in a regular visual arts intervention has also been proven to facilitate the spatial improvement in functional connectivity in certain parts of the brain which may be associated with the psychological resilience in adults (Bolwerk et al., 2014). Apart from the above evidence, dance movement has also been suggested as an innovative approach for the rehabilitation for stroke survivors, due to its nature of engaging both physical and cognitive functions, dance may thus have the potential to tackle both the physical and cognitive impairments simultaneously (Dhami et al., 2015).