Moderate alcohol intake increases BP, stroke risk in men

I'm doing it for all the social connections I'm going to need to prevent my coming risk of dementia. 

See my quotes from Anthony Bourdain and Hunter S. Thompson for how I'm living my life to the fullest, this possible risk increase is worth all the fun I'm having.

But I'm not medically trained so I read research and should not be followed,

Alcohol, coffee could be key to living longer, study finds

Move over resveratrol: Ellagic acid in red wine exhibits potent effects against lung cancer cells 

Regular daily alcohol intake is best for heart health, study finds

Don't listen to the above research, it is obviously out-of-date.

The latest below: 

Moderate alcohol intake increases BP, stroke risk in men

Millwood IY, et al. Lancet. 2019;doi:S0140-6736(18)31772-0.
Yeung SLA, et al. Lancet. 2019;doi:S0140-6736(18)32214-1.

April 5, 2019

In a genetic epidemiological study, the assumed protective effect of moderate alcohol consumption on CV events was noncausal, and any level of alcohol consumption was associated with increased BP and stroke risk in men.
“Using genetics is a novel way to assess the health effects of alcohol, and to sort out whether moderate drinking really is protective, or whether it’s slightly harmful,” Iona Y. Millwood, DPhil, from the Medical Research Council Population Health Research Unit at the University of Oxford, U.K., said in a press release. “Our genetic analyses have helped us understand the cause-and-effect relationships.”

The researchers analyzed 512,715 Chinese adults with documented levels of alcohol consumption from the China Kadoorie Biobank and followed them for approximately 10 years. Outcomes of interest included ischemic stroke, intracerebral hemorrhage and MI.
In addition, the researchers genotyped 161,498 participants for two variants that alter alcohol metabolism, ALDH2-rs671 and ADH1B-rs1229984.
Among the cohort, 33% of men and 2% of women reported drinking alcohol most weeks.
Drinking not protective
In men, according to self-reported alcohol intake, those who had one or two drinks per day (approximately 100 g per week) had lower risk for ischemic stroke, intracerebral hemorrhage and MI than those who drank more or those who drank not at all. However, genotype-predicted alcohol intake in men was not associated with a similar pattern, Millwood and colleagues wrote.

In a genetic epidemiological study, the assumed protective effect of moderate alcohol consumption on CV events was noncausal, and any level of alcohol consumption was associated with increased BP and stroke risk in men.

Source: Adobe Stock

Rather, as genotype-predicted alcohol intake in men rose, so did risk for ischemic stroke (RR per 280 g per week = 1.27; 95% CI, 1.13-1.43) and especially for intracerebral hemorrhage (RR per 280 g per week = 1.58; 95% CI, 1.36-1.84), according to the researchers.
There was no relationship between genotype-predicted alcohol intake in men and MI risk (RR per 280 g per week = 0.96; 95% CI, 0.78-1.18).
Also in men, increases in usual alcohol intake and genotype-predicted alcohol intake corresponded with increases in BP (P < .0001 for all), according to the researchers.
In women, the genotypes did not predict elevated alcohol intake and were not associated with BP, stroke or MI, Millwood and colleagues wrote.
“There are no protective effects of moderate alcohol intake against stroke. Even moderate alcohol consumption increases the chances of having a stroke,” Zhengming Chen, DPhil, from the Clinical Trial Studies Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, said in the release. “The findings for heart attack were less clear-cut, so we plan to collect more evidence.”

Perspective

Matthew F. Muldoon

This study adds information about whether alcohol might be protective in smaller amounts. The study found that it was not.
The researchers did the study in China for a reason. There is a particular research strategy that they had using certain genetic polymorphisms that predict alcohol intake that are more robust in Chinese people. It nonetheless speaks generally to the effect of alcohol and CVD.
This study is not without significant limitations. At the end of the day, it is an observational study. It is not a clinical trial and it is only through experimental studies such as a clinical trial that we can really show cause and effect. This study employs a newer technique, Mendelian randomization, to improve upon our ability in observational studies to demonstrate cause and effect. It is a step forward in terms of methodologies for observational studies.
Nonetheless, this study was rigorously done and the findings are important. They are probably as important in China as they are around the world.
We have long thought that alcohol is protective at low levels, but we have always known that it is detrimental at high levels for CVD. Whether this protective effect in low amounts has not been proven. The suspicion has been based upon observational studies. It is not as if we have trials that show that low amounts of alcohol are protective. This “new and improved” observational study does not find a protective effect in low amounts. That is important.
Clinicians, by and large, do not encourage alcohol intake. What we often do is when we encounter someone with moderate intake, we say, "That is fine." We sometimes go so far as to say that what the patient is doing might be good. This study casts some doubt upon us continuing that last statement. The new study did not find that low amounts are bad (one drink per day for women and two drinks per day for men). Certainly, once you get beyond that, it is clearly bad no matter how you look at the data.
We may need to back away from saying or implying that mild consumption is a good idea and simply say that alcohol in excess is bad, rather than sometimes give some implicit encouragement to continue two drinks per day. The public has heard that message, but we have never known it to be a valid recommendation.
There is another subtlety in this study related to the fact that it was done in China. Asians have a lot more stroke than heart disease, and they have a lot more hemorrhagic stroke than ischemic stroke. These data show that high amounts of alcohol are particularly bad for stroke, yet not related much at all to heart disease. In the United States, we are burdened more so by ischemic heart disease. So that does affect the applicability of this study to Americans. The researchers found that alcohol was most strongly associated with hemorrhagic stroke, which is not as prominent of an issue here as it is in China.

• Matthew F. Muldoon, MD, MPH
• Professor of Medicine
  University of Pittsburgh

Neuroplastic changes in resting-state functional connectivity after stroke rehabilitation

You'll have to read this yourself.  I am most interested in this statement;

All participants received 5 min of tone(spasticity) normalization for the arm at the beginning of therapy. (Your doctor will need to get that protocol.)

Neuroplastic changes in resting-state functional connectivity after stroke rehabilitation

ORIGINAL RESEARCH
published: 06 October 2015doi: 10.3389/fnhum.2015.00546
Neuroplastic changes in resting-state functional connectivity after stroke rehabilitation
Yang-teng Fan
1†
 , Ching-yi Wu
 2,3†
 , Ho-ling Liu
4,5
 , Keh-chung Lin
1,6
*, Yau-yau Wai
7,8
 and Yao-liang Chen
8
1
School of Occupational Therapy, College of Medicine, National Taiwan University and Division of Occupational Therapy,Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan,
 2
Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan,
 3
Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan,
 4
Department of Imaging Physics, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA,
5
Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan,
 6
Department of Physical Medicine and Rehabilitation, Division of Occupational Therapy, National Taiwan University Hospital, Taipei, Taiwan,
7
Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Keelung, Taiwan,
 8
MRI Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
 Most neuroimaging research in stroke rehabilitation mainly focuses on the neural mechanisms underlying the natural history of post-stroke recovery.However,connectivity mapping from resting-state fMRI is well suited for different neurological conditions and provides a promising method to explore plastic changes for treatment-induced recovery from stroke. We examined the changes in resting-state functional connectivity (RS-FC) of the ipsilesional primary motor cortex (M1) in 10 post-acute stroke patients before and immediately after 4 weeks of robot-assisted bilateral arm therapy (RBAT). Motor performance, functional use of the affected arm, and daily function improvedin all participants. Reduced interhemispheric RS-FC between the ipsilesional andcontralesional M1 (M1-M1) and the contralesional lateralized connections were noted before treatment. In contrast, greater M1-M1 functional connectivity and disturbed resting-state networks were observed after RBAT relative to pretreatment. Increased changes in M1-M1 RS-FC after RBAT were coupled with better motor and functional improvements. Mediation analysis showed the pre-to-post difference in M1-M1 RS-FC was a significant mediator for the relationship between motor and functional recovery. These results show neuroplastic changes and functional recoveries induced by RBAT in post-acute stroke survivors and suggest that interhemispheric functional connectivity in the motor cortex may be a neurobiological marker for recovery after stroke rehabilitation.
Much more at link until you get to these results.
 

 Results
Clinical Measures
The results of the FMA-UL, WMFT-FAS, and FIM are presented in
 Table 1
. All participants had substantial deficits in motor performance, functional use of the ULs, and daily function before treatment.The results showed that there were significant differences between pretreatment and post-treatment at the corrected level of significance ( p < 0.017) on all clinical measures. The paired Wilcoxon test on the FMA-UL total scores revealed that participants showed significant improvements in levels of motor impairment from pre-treatment to the end of RBAT (Z = 2.82, p = 0.005). Moreover, the WMFT-FAS and FIM data indicatedthat eligible participants had better motor function (Z  = 2.81, p=0.005)andrunctional independence(Z =2.80, p=0.005) after RBAT relative to pre-treatment.
Functional Connectivity Results
The paired Wilcoxon test on the value of the M1-M1 RS-FCshowed that participants had significantly increased M1-M1functional connectivity from pre-treatment to the end of RBAT(Z  = 2.80, p = 0.005). A one sample t-test showed that for the ipsilesional M1pre-treatment, participants had positive RS-FC with the bilateral middle frontal gyrus, bilateral cerebellum, bilateral inferior frontal gyrus, bilateral thalamus, ipsilesional angular gyrus,ipsilesional posterior cingulate cortex, ipsilesional superiorfrontal gyrus, contralesional M1, contralesional caudatenucleus, and contralesional precuneus. Moreover, negativeRS-FC was observed before treatment between the ipsilesionalM1 and the bilateral middle temporal gyrus, ipsilesionalsomatosensory cortex ipsilesional SMA, ipsilesional insula,ipsilesional superior parietal lobule, and contralesional M1(Figure 1A and Table 2). Upon completion of RBAT, positiveRS-FC with the ipsilesional M1 was seen in the bilateralsomatosensory cortex (SI/SII), bilateral posterior cingulatecortex, bilateral cerebellum, bilateral thalamus, ipsilesionalSMA, ipsilesional middle temporal gyrus, contralesional M1,contralesional inferior frontal gyrus, contralesional caudatenucleus, contralesional medial prefrontal cortex, contralesionalanterior cingulate cortex (ACC), and contralesional middlefrontal gyrus. However, participants had negative RS-FCbetween the ipsilesional M1 and the ipsilesional inferior frontalgyrus, ipsilesional middle frontal gyrus, ipsilesional superiorfrontal gyrus, contralesional temporal pole, contralesionalinferior temporal gyrus, and contralesional insula after RBAT(Figure 1B and Table 2).
Figure 2
 shows the maps exhibiting significant differences in RS-FC between pre-treatment and post-treatment. Thesebrain regions are summarized in
 Table 3
. When compared with post-treatment, greater RS-FC of the ipsilesional M1 withcontralesional-lateralized brain regions was observed before treatment (Figure 2A). In contrast, increases in RS-FC were observed between the ipsilesional M1 seed and bilateral medial prefrontal cortex, bilateral M1, bilateral cerebellum,bilateral superior temporal gyrus, ipsilesional middle temporal gyrus, ipsilesional inferior parietal lobule (IPL), ipsilesional SMA, ipsilesional posterior cingulate cortex, ipsilesional SI/SII, ipsilesional caudate nucleus, contralesional ACC, contralesional insula, and contralesional middle occipital gyrus after RBAT relative to pre-treatment (Figure 2B).
Correlation of the RS-FC with Motor and Functional Recovery
Spearman correlation analysis showed that the pre-to-post difference in M1-M1 RS-FC was significantly positively correlated with changes in the WMFT-FAS score (R = 0.79, p = 0.006) and FIM total score (R = 0.92, p < 0.001). Theseindicated that participants with increased M1-M1 RS-FC afterthe intervention had greater gains in functional use of theaffected arm and daily function. However, the relations betweenthe pre-to-post difference M1-M1 connectivity and the changes of FMA-UL score were not significant (R = 0.55, p = 0.09). Mediation Analysis Results
On the basis of a standard three-variable path model with a bootstrap test for the statistical significance of the product a × b, a single-level version of the mediation path model was usedtogetfurther insight of linkage between the clinical measures and RS-FC. Matlab coding implementing mediation analyses, developed by  Wager et al. (2009) is freely available at
2
. In all participants,the change of interhemispheric M1-M1 functional connectivity from pre-treatment to post-treatment was a significant mediatorin predicting the WMFT-FIM relation. The increased change inM1-M1 connectivity was associated with greater improvementsin functional use of the affected arm and daily function after the intervention (a = 1.27, standard error = 0.61, p = 0.044; b = 0.17, standard error=0.057, p=0.021;a×b=0.21,Z =2.03, p=0.042;Figure 3).

Possibilities for Correcting Emotional and Behavioral Impairments in Stroke Patients during Rehabilitation Therapy

Possibility is not good enough. We need a protocol, NOT A GUESS OR GUIDELINE. 

Possibilities for Correcting Emotional and Behavioral Impairments in Stroke Patients during Rehabilitation Therapy

• Authors
• Authors and affiliations

• S. V. Kotov
• E. V. Isakova
• V. I. Sheregeshev

• S. V. Kotov
  • 1
  Email author
• E. V. Isakova
  • 1
• V. I. Sheregeshev
  • 1

1. 1.Vladimirskii Moscow Regional Research Clinical InstituteMoscowRussia

Article

First Online: 28 December 2019

Objectives. To assess the efficacy of a set of rehabilitation measures including use of mechanotherapy and cognitive stimulation using tablet PC technology in relation to emotional and behavioral impairments in patients during the acute phase of ischemic stroke.  

Materials and methods. The study included 100 patients with ischemic stroke admitted to hospital in the acute period. All patients were randomized to two groups: a study group and a control group. The study group (50 patients) received daily robot mechanotherapy using a MOTOmed bedside trainer and tablet PC technology for independent exercises for patients to develop memory, perception, reactions, and counting. Patients of the control group (50 patients) received standard therapy. Functional status was assessed using the modified Rankin scale. Objective evaluation of emotional and behavioral impairments was obtained using psychometric scales (Beck Depression and Anxiety Scales).  

Results. Use of complex rehabilitation programs in the acute period of ischemic stroke promoted regression of emotional and behavioral impairments (p = 0.0001). The severity of depressive disorders was decreased in patients of the study group by the end of the in-patient period, and further regression in these patients continued throughout the observation period, to the six-month point (p = 0.001). Measures of anxiety showed statistically significant decreases during the whole of the observation period in patients of the study group (p = 0.0001), in contrast to those of the control group, where no changes were seen. Functional recovery was better in patients of the study group, as evidenced by statistically significant changes in mean measures of changes on the Rankin scale. Conclusions. The rehabilitation program presented here, including mechanotherapy and cognitive stimulation using tablet PC technology, is a simple and accessible method for correcting emotional and behavioral impairments in patients in the acute period of ischemic stroke. The results achieved not only persisted over time, but were followed by further improvements in measures at three and six months.

Caffeine may be ally in preventing or retarding cataract

One more reason for my coffee habit, 12 cups a day.  Don't follow me, I'm not medically trained.

Caffeine may be ally in preventing or retarding cataract

ATHENS, Greece — Caffeine accumulates in the lens capsule and epithelial cells after oral intake and may be a potential ally in the prevention of cataract, according to a study presented at the European Society of Cataract and Refractive Surgeons Winter Meeting.
The lens is constantly subject to oxidative stress, mainly from UV radiation, and experimental and observational data suggest that antioxidants might play a role in retarding opacification.

See Also

• Caffeine may be ally in preventing or retarding cataract
• BLOG: Learn the risks of capsular breaks
• Surgeons hold strong opinions for and against FLACS vs. manual cataract surgery

“During the 1990s, the antioxidant properties of caffeine were proven in studies. Caffeine was shown to have a protective effect against UV radiation comparable to sun blockers and higher than vitamins E and C,” Manuel Ruiss, MD, said.
Despite the evidence of the anti-cataractogenic effect of caffeine, little is known about the pharmacokinetics of caffeine in the human lens.
A study carried out at the Vienna Institute for Research in Ocular Surgery investigated if peroral caffeine intake leads to caffeine accumulation in the human lens capsule and lens epithelial cells. Forty patients scheduled for bilateral cataract surgery abstained from caffeine from 1 week before surgery. On the day of the second eye surgery, they were randomly assigned to receive no caffeine or 60 mg, 120 mg or 180 mg of caffeine, which corresponded to one, two or three espressos. After capsulorrhexis, lens capsule tissue of each eye was sent to the lab for analysis of caffeine concentration.
“Seven patients had to be excluded because they did not resist a good cup of coffee,” Ruiss said.
Tissue analysis showed that coffee intake before cataract surgery increases caffeine levels in the lens capsule in a dose-dependent manner.
“Why is this important? Because there are epidemiological finding saying that caffeine has a positive effect on the prevention of cataract,” Ruiss said.
In a study published in Clinical Ophthalmology in 2016, it was shown that the incidence of cataract blindness was significantly lower in groups consuming higher amounts of coffee. In another study published in JAMA Ophthalmology, a diet rich in antioxidants, including coffee, was inversely associated with the risk for cataract in middle-aged and elderly women. – by Michela Cimberle

References:
Rautiainen S, et al. JAMA Ophthalmol. 2014;doi:10.1001/jamaophthalmol.2013.6241.
Ruiss M, et al. Assessing the pharmacokinetics of caffeine in the lens epithelium after peroral intake. Presented at: ESCRS Winter Meeting; Feb. 15-17, 2019; Athens, Greece.
Varma SD. Clin Ophthalmol. 2016;doi:10.2147/OPTH.S96394.

Researchers develop non-invasive deep brain stimulation method

What will it take to start using this for stroke rehab rather than TMS or tDCS? Whom will your doctor and stroke hospital contact to get this tested in stroke survivors?  I expect the board of directors to commence firings if this doesn't occur. You can't let incompetent people continue working at a stroke hospital if all they do is continue the failed status quo.

The worst failures at your stroke hospital: 

88% failure rate of tPA to get to full recovery

Current rehab only gets you 100% recovered 10% of the time. 

These two and the fact your stroke hospital is DOING NOTHING to improve either of those two.  They have fully bought into the tyranny of low expectations. Stroke rehab is hard and your medical providers are doing nothing to change that.

 

 

Their reasons for doing nothing?

Laziness? Incompetence? Or just don't care? No leadership? No strategy? Not my job?

I take no prisoners in my focus on survivors, shouldn't your hospital do the same?

Researchers develop non-invasive deep brain stimulation method

Researchers at MIT have developed a new method of electrically stimulating deep brain tissues without opening the skull

Mo Costandi

@mocost

Thu 1 Jun 2017 12.00 EDT Last modified on Fri 2 Jun 2017 08.38 EDT

Comments

3

Since 1997, more than 100,000 Parkinson’s Disease patients have been treated with deep brain stimulation (DBS), a surgical technique that involves the implantation of ultra-thin wire electrodes. The implanted device, sometimes referred to as a ‘brain pacemaker’, delivers electrical pulses to a structure called the subthalamic nucleus, located near the centre of the brain, and effectively alleviates many of the physical symptoms of the disease, such as tremor, muscle rigidity, and slowed movements.
DBS is generally safe but, like any surgical procedure, comes with some risks. First and foremost, it is highly invasive, requiring small holes to be drilled in the patient’s skull, through which the electrodes are inserted. Potential complications of this include infection, stroke, and bleeding on the brain. The electrodes, which are implanted for long periods of time, sometimes move out of place; they can also cause swelling at the implantation site; and the wire connecting them to the battery, typically placed under the skin of the chest, can erode, all of which require additional surgical procedures.

Blowing up the brain to reveal its finer details

Read more

Now, researchers at the Massachusetts Institute of Technology have a developed a new method that can stimulate cells deep inside the brain non-invasively, using multiple electric fields applied from outside the organ. In a study published today in the journal Cell, they show that the method can selectively stimulate deep brain structures in live mice, without affecting the activity of cells in the overlying regions, and also that it can be easily adjusted to evoke movements by stimulation of the motor cortex.
The new method, called temporal interference, exploits the fact that neurons do not respond to electric fields with frequencies of around 1,000 Hertz (Hz, or cycles per second) or more. Thus, high frequency electric fields applied to the brain pass through it without affecting neuronal activity. If, however, two fields are applied to the brain, at high frequencies that differ by small amounts corresponding to the frequencies to which neurons can respond, they interfere with each other to produce an ‘envelope’ electric field that excites the cells within it.

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For example, applying two opposing fields, with frequencies of 2000 and 2010Hz, produces an envelope field with a frequency of 10Hz wherever the two high frequency fields cross paths. This lies within the frequency range to which neurons respond, and so stimulates neurons lying beneath the envelope to fire. Nir Grossman and his colleagues at MIT’s Synthetic Neurobiology Group therefore reasoned that it might be possible to generate such low frequency electric field envelopes deep inside the brain, which would stimulate nerve cells in the envelopes without stimulating those on top, which are exposed to either one of the high frequency fields used to generate the envelope, but not both.
The researchers used computer models to simulate the effects of their technique, and then tested it in anaesthetised mice, aiming their electrodes at the hippocampus, a region lying deep within the temporal lobes, which is critical for learning and memory. They used automated patch clamping to show that stimulation activates cells in the envelope, then dissected the animals’ brains and used fluorescently-labelled antibodies to visualise the activity of c-Fos, a so-called ‘immediate-early’ gene that is switched on rapidly when neurons fire. This revealed c-Fos expression in the region of the hippocampus targeted by the electrodes, but not in other hippocampal regions, or in overlying regions of the cerebral cortex, confirming that the method specifically activates neurons in the low frequency electric field envelope generated at the intersection of the two high frequency fields (see image above).
To assess the safety of the technique, Grossman and his colleagues stimulated the hippocampus in awake mice and then stained the animals’ brains with antibodies that bind to proteins that are synthesized by dying cells. They also used thermometer probes placed immediately underneath the electrodes to measure brain temperature during the procedure. This revealed that the method did not alter the density of neurons, or the numbers of dying cells, and that the high frequency electrical fields did not increase brain tissue temperature beyond the normal range. Nor did any of the mice experience siezures – another complication of invasive DBS – during or after application of the electric fields to their brains.
Finally, the researchers made small adjustments to their stimulating electrodes, and steered them towards the primary cortex, which controls voluntary movement. Stimulation of the left motor cortex region associated with forepaw movements produced movements of the animals’ right paws, while stimulation of other regions of the motor cortex caused the ears and specific whiskers on the opposite side of the animals’ bodies to twitch.
The new technique has obvious advantages over deep brain stimulation. It also has advantages over existing non-invasive brain stimulation methods, such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). “With TMS and tDCS you can activate deep regions, but you also can activate overlying ones, and that could cause unwanted side effects,” says senior author Ed Boyden. “Targets for disorders such as depression, Alzheimer’s, PTSD, and so forth, are deep in the brain, and they might be more selectively stimulatable with our method.”
Boyden adds that the method is already being tested in humans. “We’ve already begun some human stimulation trials with normal healthy volunteers, although it’s very early days and very exploratory,” he says, “and we are now reaching out to experts on epilepsy, tinnitus, depression, and other disorders to see if we can help.”

Reference

Grossman, N., et al. (2017). Noninvasive Deep Brain Stimulation via Temporally Interfering Electric Fields. Cell, 169: 1029-41. [Full text]

'Life is short; Live it well'; from closing credits of A Bug's Life

That is going to be me. Instead of going to Mexico in March we are possibly going to Madagascar depending if all our passports go longer than 6 months past this.  Doesn't look like there is a ferry to get to Mozambique on the same trip. 

I won't want to have a stroke while there;

Stroke in a resource-constrained hospital in Madagascar

A review of the progression and future implications of brain-computer interface therapies for restoration of distal upper extremity motor function after stroke

If you were to properly think about this, all rehab therapies would work much better with vastly fewer dead neurons. And you do that by stopping the 5 causes of the neuronal cascade of death in the first week.

If my doctors had done that they would have saved me  5.4 billion neurons. Recovery would have been easy with only 171 million dead neurons.  And sending a bill to my doctor and stroke hospital at $1000 a dead neuron would only cost them 5.4 trillion dollars. That might concentrate their minds.  I don't expect neuroplasticity or neurogenesis to be precisely repeatable for at least 50 years. No one is looking at the signals that occur between neurons such that one neuron drops its current function and takes on a neighbor's function. Knowing that process is the only way to make neuroplasticity EXACTLY REPEATABLE.

A review of the progression and future implications of brain-computer interface therapies for restoration of distal upper extremity motor function after stroke

 Alexander Remsik, Brittany Young, Rebecca Vermilyea, Laura Kiekhoefer, Jessica Abrams, Samantha Evander Elmore,Paige Schultz, Veena Nair, Dorothy Edwards, Justin Williams and Vivek Prabhakaran
Department of Radiology Clinical Science Center, University of Wisconsin Madison School of Medicine and Public Health Ringgold StandardInstitution, Madison, WI, USA

 ABSTRACT

Stroke is a leading cause of acquired disability resulting in distal upper extremity functional motor impairment. Stroke mortality rates continue to decline with advances in healthcare and medical technology. This has led to an increased demand for advanced, personalized rehabilitation. Survivors often experience some level of spontaneous recovery shortly after their stroke event, yet reach a functional plateau after which there is exiguous motor recovery. Nevertheless, studies have demonstrated the potential for recovery beyond this plateau. Non-traditional neurorehabilitation techniques,such as those incorporating the brain-computer interface (BCI), are being investigated for rehabilitation. BCIs may offer a gateway to the brain’s plasticity and revolutionize how humans interact with the world.Non-invasive BCIs work by closing the proprioceptive feedback loop with real-time, multi-sensory feedback allowing for volitional modulation of brain signals to assist hand function. BCI technology potentially promotes neuroplasticity and Hebbian-based motor recovery by rewarding cortical activity associated with sensory-motor rhythms through use with a variety of self-guided and assistive modalities. (So you really know nothing useful?)
 

Task-oriented training in rehabilitation after stroke: systematic review

  So all this earlier research wasn't enough?  You had to do your own review,  proving once again that our fucking failures of stroke associations can't even do the simple task of creating a database of all stroke research and protocols. All this waste of time would be completely unnecessary if we had a great stroke association run by stroke survivors. At least they acknowledge Bobath doesn't work.

• task-orientated training (9 posts to October 2012)

 Task-oriented training in rehabilitation after stroke: systematic review 

  RENSINK M., SCHUURMANS M., LINDEMAN E. & HAFSTEINSDO ´TTIR T.(2009)(2009)
 Task-oriented training in rehabilitation after stroke: systematic review.
 Journal of Advanced Nursing
 65
(4), 737–754
doi: 10.1111/j.1365-2648.2008.04925.x

Abstract

Title. Task-oriented training in rehabilitation after stroke: systematic review.
Aim.
 This paper is a report of a review conducted to provide an overview of theevidence in the literature on task-oriented training of stroke survivors and its relevance in daily nursing practice.
Background.
 Stroke is the second leading cause of death and one of the leading causes of adult disability in the Western world. The use of neurodevelopmental treatment(Bobath) in the daily nursing care of stroke survivors does not improve clinical outcomes. Nurses are therefore exploring other forms of rehabilitation intervention,including task-oriented rehabilitation. Despite the growing number of studies showing evidence on task-oriented interventions, recommendations for daily nursing practice are lacking.
Data Sources.
 A range of databases was searched to identify papers addressing task-oriented training in stroke rehabilitation, including Medline, CINAHL, Embase andthe Cochrane Library of systematic reviews. Papers published in English between January 1996 and September 2007 were included. There were 42 papers in the finaldataset, including nine systematic reviews.
Review methods.
 The selected randomized controlled trials and systematic reviewswere assessed for quality. Important characteristics and outcomes were extractedand summarized.
Results.
 Studies of task-related training showed benefits for functional outcome compared with traditional therapies. Active use of task-oriented training with stroke survivors will lead to improvements in functional outcomes and overall health-related quality of life.
Conclusion.
 Generally, task-oriented rehabilitation proved to be more effective.Many interventions are feasible for nurses and can be performed in a ward or at home. Nurses can and should play an important role in creating opportunities to practise meaningful functional tasks outside of regular therapy sessions.

Standing and sitting next to a table filled with wine glasses

Last night was a wine tasting, southern hemisphere wines, led by a sommelier, 9 bottles for 13 people. The table was covered with champagne flutes, regular wine glasses and water glasses.  I needed to move seats which considering that I usually still need to use my right arm to push off the chair, that would leave my dangerous left arm free to swing wildly and knock over loads of glasses. So in order not to crash glasses I have to pivot my chair parallel to the table so I can grab my left hand with my right hand and use the swing your upper body over your legs method to stand up.  I've gotten so good at this I can do it even after more than a couple of glasses of wine. Luckily my friends keep me supplied with water so I don't have to leave the table for that. My bladder control is much much better than the first year.   See my quotes from Anthony Bourdain and Hunter S. Thompson for how I'm living my life to the fullest.

Prospective, Blinded, Randomized Crossover Study of Gait Rehabilitation in Stroke Patients Using the Lokomat Gait Orthosis

Pretty much useless; no written protocol, no objective diagnosis of disability prior to start, done in the spontaneous recovery timeframe - 3 months. 

Prospective, Blinded, Randomized Crossover Study of Gait Rehabilitation in Stroke Patients Using the Lokomat Gait Orthosis

 Andreas Mayr,MS,Markus Kofler,MD,Ellen Quirbach,PT,Heinz Matzak,MD,Katrin Fröhlich,MD,and Leopold Saltuari,MD
 Objective
Treadmill training with partial body weight support has been suggested as a useful strategy for gait rehabilitation after stroke.This prospective,blinded,randomized controlled study of gait retraining tested the feasibility and potential efficacy of using an electromechanical driven gait orthosis(Lokomat) for treadmill training.
Methods
Sixteen stroke patients,mostly within 3 months after onset,were randomized into 2 treatment groups,ABA or BAB (A=3 weeks of Lokomat training,B=3 weeks of conventional physical therapy) for 9 weeks of treatment.The outcome measures were the EU-Walking Scale, Rivermead Motor Assessment Scale,10-mtimed walking speed,6-minute timed walking distance,Motricity Index,Medical Research Council Scale of strength,and Ashworth Scale of tone.
Results
The EU-Walking Scale,Rivermead Motor Assessment Scale,6-minute timed walking distance,Medical Research Council Scale,and Ashworth Scale demonstrated significantly more improvement during the Lokomat training phase than during the conventional physical therapy phase within each 3-week interval.
Conclusions
.Despite the small number of patients,the present data suggest that the Lokomat robotic assistive device provides innovative possibilities (We don't need possibilities, we need EXACT PROTOCOLS. DO YOU NOT UNDERSTAND?)for gait training in stroke rehabilitation while eliminating prolonged repetitive movements in a nonergonomic position on the part of the physical therapist.

The nature and extent of upper limb associated reactions during walking in people with acquired brain injury

 I got nothing out of this, hopefully your doctor can explain how this is going to get you 100% recovered.  If you get my upper arm and hand spasticity cured this problem would cease to exist. Solve the correct problem, spasticity, not this secondary effect of spasticity. THIS is why we need a stroke strategy, we wouldn't be wasting time on secondary issues, we would solve the primary problem.

The nature and extent of upper limb associated reactions during walking in people with acquired brain injury

• Michelle B. Kahn,
• Ross A. Clark,
• Gavin Williams,
• Kelly J. Bower,
• Megan Banky,
• John Olver &
• Benjamin F. Mentiplay 

Journal of NeuroEngineering and Rehabilitation volume 16, Article number: 160 (2019) Cite this article

Abstract

Background

Upper limb associated reactions (ARs) are common in people with acquired brain injury (ABI). Despite this, there is no gold-standard outcome measure and no kinematic description of this movement disorder. The aim of this study was to determine the upper limb kinematic variables most frequently affected by ARs in people with ABI compared with a healthy cohort at matched walking speed intention.

Methods

A convenience sample of 36 healthy control adults (HCs) and 42 people with ABI who had upper limb ARs during walking were recruited and underwent assessment of their self-selected walking speed using the criterion-reference three dimensional motion analysis (3DMA) at Epworth Hospital, Melbourne. Shoulder flexion, abduction and rotation, elbow flexion, forearm rotation and wrist flexion were assessed. The mean angle, standard deviation (SD), peak joint angles and total joint angle range of motion (ROM) were calculated for each axis across the gait cycle. On a group level, ANCOVA was used to assess the between-group differences for each upper limb kinematic outcome variable. To quantify abnormality prevalence on an individual participant level, the percentage of ABI participants that were outside of the 95% confidence interval of the HC sample for each variable were calculated.

Results

There were significant between-group differences for all elbow and shoulder abduction outcome variables (p < 0.01), most shoulder flexion variables (except for shoulder extension peak), forearm rotation SD and ROM and for wrist flexion ROM. Elbow flexion and shoulder abduction were the axes most frequently affected by ARs. Despite the elbow being the most prevalently affected (38/42, 90%), a large proportion of participants had abnormality, defined as ±1.96 SD of the HC mean, present at the shoulder (32/42, 76%), forearm (20/42, 48%) and wrist joints (10/42, 24%).

Conclusion

This study provides valuable information on ARs, and highlights the need for clinical assessment of ARs to include all of the major joints of the upper limb. This may inform the development of a criterion-reference outcome measure or classification system specific to ARs.

Background

People with acquired brain injury (ABI) often present with movement abnormalities including upper limb associated reactions (ARs) during walking [1, 2]. Associated reactions are prevalent, recently being reported as a key goal area in 43% of people in a large stroke cohort (n = 964) [3]. Associated reactions are an effort-dependent phenomenon causing an involuntary increase in upper limb muscle tone, with awkward and uncomfortable postures [4]. Normal arm swing in walking is important to reduce energy expenditure [5], enhance gait stability and balance [6] and facilitate leg swing for faster walking speeds [7,8,9]. Abnormal upper limb kinematics resulting from ARs may negatively impact gait [10], balance [11], dynamic upper limb function [12, 13] and activities of daily living [10] for people with ABI. The treatment of ARs is therefore commonly a focus for physical and pharmacological management [3, 14].
Despite the prevalence and significance of ARs, there are many issues that exist in this field, such as, inconsistent terminology, no gold-standard assessment, unconfirmed contributing factors and varied treatment without supporting evidence [15]. In regards to assessment, there is currently no gold-standard outcome measure, with most having poor ecological validity for walking, involving stationary tests performed in a seated position [4]. The elbow joint is frequently the focus of assessment [4], despite literature suggesting that ARs affect all joints of the upper limb [16, 17]. Therefore, investigation into the upper limb movement abnormalities caused by ARs during walking is required.
Instrumented three-dimensional motion analysis (3DMA) is the criterion-reference for objective evaluation of joint kinematics during walking [18]. Despite the potential for 3DMA to fulfil the requirements of detailed dynamic upper limb assessment, it is not yet widely integrated into research or clinical practice. To date there have only been a few studies that have developed upper limb marker sets. These have been used for evaluation of arm posture during walking in healthy controls (HCs) [19, 20], paediatric cerebral palsy [21,22,23] and adults with stroke [2, 24]. While these studies have refined the use of upper body marker sets in gait analysis there has been no research to date in applying 3DMA specifically for the evaluation of ARs. Given that clinically, people with ARs and their therapists often describe ARs in terms of the visual impact, 3DMA is an appropriate methodology to quantify ARs.
A comprehensive assessment of the kinematics of upper limb ARs during walking in ABI may provide insight into the key abnormalities, facilitate the development of a criterion-reference outcome measure, help guide assessment, and clinical decision-making regarding therapeutic interventions. The aim of this study was therefore to determine the upper limb kinematic variables most frequently affected by ARs in people with ABI compared with a healthy cohort.

End-of-Treatment Intracerebral and Ventricular Hemorrhage Volume Predicts Outcome

What the hell are YOU doing to change the status quo of poor outcomes?  I hate these lazy people that inform us of not getting to 100% recovery by basically throwing up their hands in defeat and saying; 'We have nothing for that problem.'  Hope you are OK with such a fuckingly stupid answer when you are

the 1 in 4 per WHO that has a stroke and your doctor uses that line on you.

End-of-Treatment Intracerebral and Ventricular Hemorrhage Volume Predicts Outcome

A Secondary Analysis of MISTIE III

Adam de Havenon

,

Evan Joyce

,

Shadi Yaghi

,

Safdar Ansari

,

Alen Delic

,

Philipp Taussky

,

Matthew Alexander

,

David Tirschwell

,

Ramesh Grandhi

Originally published17 Dec 2019https://doi.org/10.1161/STROKEAHA.119.028199Stroke. ;0:STROKEAHA.119.028199

Abstract

Background and Purpose—

Trials have shown potential clinical benefit for minimally invasive clot evacuation of intracerebral hemorrhage (ICH). Prior research showing an association between ICH size and functional outcome did not fully address the spectrum of hematoma volumes seen after clot evacuation.

Methods—

In this secondary analysis of the MISTIE III trial (Minimally Invasive Surgery Plus Alteplase for Intracerebral Hemorrhage Evacuation III), we included patients randomized to the surgical arm. The primary outcome was good outcome (modified Rankin Scale score 0–3 at 1 year from study enrollment). The primary predictors were the end-of-treatment (EoT) ICH and intraventricular hemorrhage volumes and an end-of-treatment ICH stratification scale called the EoT ICH volume score.

Results—

In 246 patients, the end-of-treatment computed tomography was performed an average of 5 days from onset. For patients with good versus poor outcomes, the mean end-of-treatment ICH and intraventricular hemorrhage volumes were 12.9 versus 18.0 mL (P=0.002) and 0.5 versus 2.3 mL (P<0.001), respectively. The probability of a good outcome decreased from 73% for EoT ICH volume 3 (<5 mL) to 28% for EoT ICH volume 0 (>20 mL; P=0.001).

Conclusion

s—After surgical clot evacuation, both ICH and intraventricular hemorrhage volumes have a strong association with good neurological outcome. The EoT ICH volume score needs independent verification, but such an approach could be used for prognostication and therapeutic planning.

Hydrogen Sulfide as a Factor of Neuroprotection during the Constitutive and Reparative Neurogenesis in Fish Brain

I'm sure your incompetent doctor and stroke hospital did absolutely nothing with this earlier research on hydrogen sulfide, commonly found in rotten eggs and human flatulence,

 8 posts on hydrogen sulfide back to Sept. 2012 helping with stroke prevention, reduction in stroke damage, protects stem cells and helps neurogenesis.

One line from these 8 posts which just proves how fucking incompetent your doctor is;

When the new compound was injected an hour after the simulation of a stroke, the authors observed about a 70 percent reduction in the severity of the observed stroke damage. March 2016. 

 The latest here and yes this is in fish, but can your doctor read and put two and two together?

Hydrogen Sulfide as a Factor of Neuroprotection during the Constitutive and Reparative Neurogenesis in Fish Brain

By Evgeniya V. Pushchina, Anatoly A. Varaksin and Dmitry K. Obukhov

Submitted: June 13th 2019Reviewed: November 19th 2019Published: December 24th 2019

DOI: 10.5772/intechopen.90547

Downloaded: 6

Abstract

The H2S-producing systems were studied in trout telencephalon, tectum, and cerebellum at 1 week after eye injury. The results of ELISA analysis have shown a 1.7-fold increase in the CBS expression at 1 week post-injury, as compared to the intact trout. In the ventricular and subventricular regions of trout telencephalon, CBS+ cells, as well as neuroepithelial and glial types, were detected. As a result of injury, the number of CBS+ neuroepithelial cells in the pallial and subpallial periventricular regions of the telencephalon increases. In the tectum, a traumatic damage leads to an increase in the CBS expression in radial glia with a simultaneous decrease in the number of CBS immunopositive neuroepithelial cells detected in intact animals. In the cerebellum, we revealed neuroglial interrelations, in which H2S is probably released from the astrocyte-like cells with subsequent activation of the neuronal NMDA receptors. The organization of the H2S-producing cell complexes suggests that the amount of glutamate produced in the trout cerebellum and its reuptake is controlled with the involvement of astrocyte-like cells, reducing its excitotoxicity. We believe that the increase in the number of H2S-producing cells constitutes a response to oxidative stress, and the overproduction of H2S neutralizes the reactive oxygen species.

Targeting Muscles in the Brain to Enhance Cerebral Perfusion

  You can ask your doctor how she is ensuring you have proper reperfusion post stroke. She should know the exact answer, hemming and hawing are bad signs  and your response should be; ' So you know fucking nothing about getting me 100% recovered?'

Oops, I'm not playing by the polite rules of Dale Carnegie,  'How to Win Friends and Influence People'. 

Politeness will never solve anything in stroke. I expect all doctors should know more about stroke than you or me.

 

Targeting Muscles in the Brain to Enhance Cerebral Perfusion

Treadmill walking with partial body weight support versus floor walking in hemiparetic subjects

 So you described something, but with no protocol written this is totally useless.

And your mentors and senior researchers are OK with this crapola?

Treadmill walking with partial body weight support versus floor walking in hemiparetic subjects

 Stefan Hesse, MD, Matthias Konrad, MD, Dietmar Uhlenbrock, MPhil ABSTRACT. Hesse S, Konrad M, Uhlenbrock D. Treadmill walking with partial body weight support versus floor walking in hemiparetic subjects. Arch Phys Med Rehabil 1999;80:
421-7.
Objective: 
To compare the gait of hemiparetic subjects walking on a treadmill with various body weight supports and walking on the floor. Design: Hemiparetic subjects walked on a treadmill, secured in a harness, with no body weight support and with 15 and 30 body weight relief, and walked on a floor. Setting: Kinematic laboratory of a department of rehabilitation. Subjects: Eighteen hemiparetic stroke patients. 
Main Outcome Measures: 
Gait cycle parameters and kinesiologic electromyogram of six muscles of the affected side and of two muscles of the nonaffected side. Results: On the treadmill, patients walked more slowly because of a reduced cadence, with a longer single stance period of the paretic limb, more symmetrically, and with a larger hip extension (multivariate profile analysis, p < .05). The mean functional activities of the gastrocnemius muscle and of the first crest of the erector spinae of the paretic side were smaller on the treadmill (univariate test, p < .05). Further, the premature activity of the gastrocnemius muscle, indicating spasticity, was less on the treadmill (univariate test, p < .05); correspondingly the qualitative muscle pattern analysis revealed less co-contraction between the gastrocnemius and tibialis anterior muscles in 11 of the 18 subjects. 
Conclusions: 
Treadmill training with partial body weight support in hemiparetic subjects allows them to practice a favorable gait characterized by a greater stimulus for balance training because of the prolonged single stance period of the affected limb, a higher symmetry, less plantar flexor spasticity, and a more regular activation pattern of the shank muscles as compared with floor walking. 0 1999 by the American Congress of Rehabilitation Medi- cine and the American Academy of Physical Medicine and Rehabilitation