Cardinal DiNardo discharged from hospital, expected to make full recovery

Under what objective criteria can anyone say that Cardinal DiNardo

will be one of the 10% who fully recover? 

Or is this the likely outcome?

Mercury astronaut Scott Carpenter suffers stroke; full recovery expected

Oops! 

 Scott Carpenter - Obituary

 

 

Cardinal DiNardo discharged from hospital, expected to make full recovery

Catholic News Agency / March 22, 2019 / 30

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Houston, Texas, Mar 21, 2019 / 08:59 am (CNA).- Cardinal Daniel DiNardo of Galveston-Houston has been released from the hospital, following a mild stroke last week, his archdiocese announced March 20.
The cardinal, who serves as president of the U.S. bishops’ conference, is expected to make a full recovery.
DiNardo had suffered a stroke on the evening of March 15, while leading Stations of the Cross. He was admitted to St. Joseph’s Hospital.
According to the archdiocese, he has now “entered a standard rehabilitation program which usually lasts in the neighborhood of two weeks.”
“I could not be more grateful to the truly wonderful doctors and nurses at St. Joseph’s for their expert care and compassion, which has helped hasten my way down the road to a full recovery,” DiNardo said in a statement released by the Archdiocese of Galveston-Houston.
“I am also doubly thankful for the many kind wishes and especially the prayers that have been directed towards my healing, which I can assure you are making a true difference. I look forward to getting back to work soon and continuing the important work we have before us.”
DiNardo, 69, was ordained a priest of the Diocese of Pittsburgh in 1977. As a priest, he spent six years working in the Vatican’s Congregation for Bishops, and became Bishop of Sioux City, Iowa, in 1998. He became coadjutor bishop of Galveston-Houston in 2004, and was installed as archbishop of that archdiocese two years later.
DiNardo became a member of the College of Cardinals in 2007. He was the first Archbishop of Galveston-Houston to be appointed a cardinal.
The cardinal served as vice president of the United States Conference of Catholic Bishops from 2013 to 2016. He began his three-year term as president of the conference in 2016.

Stroke treatment training program improves outcomes

Good, then write up a protocol and distribute this to every stroke hospital in the world. OR, figure out a way to get this to everyone of the stroke doctors in the world each year. Your choice, DOING NOTHING IS NOT AN OPTION.

Do nothing, get fired. 

Because there is no standard database of stroke protocols yet due to the fucking failures of our stroke associations, every single piece of stroke research needs to do this distribution with no standard to follow.

Stroke treatment training program improves outcomes

By Wayne Forrest, AuntMinnie.com staff writer

March 25, 2019 -- Interventional radiologists at Johns Hopkins University (JHU) have developed an innovative program to train their colleagues to perform endovascular thrombectomies and achieve better outcomes for stroke patients. So far, the results are impressive, according to a presentation on Monday at the Society of Interventional Radiology (SIR) 2019 meeting in Austin, TX.

Over the course of six months, JHU researchers brought in a neurointerventional radiologist to teach four interventional radiologists how to unblock clogged arteries in the brain quickly and effectively using thrombectomy, the gold standard. When the newly trained interventional radiologists proceeded on their own, their patient outcomes as measured by 90-day mortality were better than the current benchmark.
"More importantly, having this team of trained interventional radiologists allows us to avoid transporting medically fragile patients to other hospitals and allows us to provide critical and timely stroke care as soon as possible," said Dr. Kelvin Hong, division chief of interventional radiology at Johns Hopkins.
The cost of strokes
Stroke is the fifth-leading cause of death and the leading cause of disability in the U.S. Unfortunately, few people have access to endovascular thrombectomy. With this treatment, physicians can clear clogged arteries in the brain, increase the survival rate for patients with an acute ischemic stroke, reduce the likelihood of long-term disabilities, and hasten functional recovery.

Dr. Kelvin Hong from JHU.

"In order to gain these benefits, thrombectomies must be initiated and performed quickly," Hong said. "Favorable outcomes from endovascular thrombectomy are very time-dependent. In essence, time is brain. Yet there are many eligible stroke patients who could be treated and are not."
One reason why many stroke patients do not receive optimal care is the limited number of qualified clinicians. Thrombectomy is only available to 2% to 3% of eligible patients in the U.S., in part because many hospitals do not have physicians onsite to perform the treatment. Patients must be sent to another facility, which also adds to the time to treatment.
To find an efficient and sustainable way to expand access to thrombectomy, Hong and colleagues developed an interventional radiology stroke practice team at Suburban Hospital in Bethesda, MD. The initiative consisted of four interventional radiologists who made themselves available 24/7 for special training by a neurointerventional radiologist for six months. The neurointerventional radiologist was transported to the hospital by helicopter for every stroke case during the training period.
"Instead of bringing the trainee to the trainer, we brought the trainer to the trainee," Hong said. "In this way, we allow for the process to get the patient scanned and on the table and a preliminary preparation of the patient for the procedure, all while the trainer was being transported. We saved a significant amount of time."
Critical time to treatment
After the interventional radiologists began performing the thrombectomies on their own, the researchers set out to measure their technical prowess and the success of the program.
Hong and colleagues reviewed 35 stroke cases and compared the outcomes with results from the Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials (HERMES) meta-analysis published in 2016 in the Journal of the American Medical Association. The findings in that report have become the benchmark for the standard of care for stroke.
When they compared the performance of the Suburban Hospital stroke team against the findings in the HERMES analysis, the Johns Hopkins researchers found no statistically significant difference in patient outcomes at 90 days after stroke.

JHU program vs. HERMES for stroke thrombectomy
	JHU stroke team	HERMES
Mortality in first 90 days after stroke	14.0%	15.3%*
Median time from symptom onset to restoration of blood flow	325 minutes	285 minutes

*Difference was not statistically significant.

In the comparison, there was a median 40-minute difference in the time between onset of stroke symptoms and restoration of blood flow in the brain. To address this disparity, the researchers plan to improve patient transfer time and workflow prior to the procedures, along with other time metrics, Hong said.

The Important Reason Emilia Clarke Decided To Go Public About Her Brain Haemorrhages

While this is great, the takeaway from this is she is a complete outlier. Only 10% of stroke survivors fully recover. It is that bad and horrifying that nobody in the world is willing to discuss all the problems in stroke. 

The Important Reason Emilia Clarke Decided To Go Public About Her Brain Haemorrhages

Emilia Clarke is a national treasure. Over the course of nearly a decade on Game of Thrones, she has slain countless enemies, mothered three dragons, and generally bucked the patriarchy as Daenerys Targaryen - not to mention become an advocate for gender equality and body positivity in real life. Yet, in a moving essay published by The New Yorker, the 32-year-old revealed yesterday that her personal journey has actually been just as tumultuous as Khaleesi’s, a fact she somehow managed to keep a secret through all her years filming the blockbuster fantasy epic. Naturally, the reveal was met with a frenzy in the press and on social media, with an outpouring of dramatic headlines and messages of support from her legions of fans.

In brief, just after wrapping the first season, Clarke suffered a life-threatening aneurysm at just 24 years old, with another one following a few years later. Her description of her surgeries is a painful (if necessary) reminder of the horror of brain injury. Of the second, more invasive procedure, she writes: “I looked as though I had been through a war more gruesome than any that Daenerys experienced. I emerged from the operation with a drain coming out of my head. Bits of my skull had been replaced by titanium. These days, you can’t see the scar that curves from my scalp to my ear, but I didn’t know at first that it wouldn’t be visible.”

Sky Atlantic

Perhaps more important than her acute treatment, however, is what happened after she left the operating room. Following her first surgery in London in 2011, Clarke experienced aphasia - a condition that left her incapable of remembering her own full name. The experience nearly broke her: “I could see my life ahead, and it wasn’t worth living. I am an actor; I need to remember my lines.” Naturally, her second procedure in New York in 2013 triggered yet more frantic worry about cognitive loss. “Would it be concentration? Memory? Peripheral vision? Now I tell people that what it robbed me of is good taste in men. But, of course, none of this seemed remotely funny at the time,” she writes.

Sky Atlantic

What enabled her to recover fully (and conquer the world as Daenerys) was the quality of aftercare she received - a service available to a limited number of patients around the world. “The degree to which people can adapt and face the future after neurological trauma is dependent on the quality and provision of rehabilitation care,” Clarke shares on the website for her newly-launched charity, SameYou. “As more people recover from brain injury and stroke because of improvements in acute care, we urgently need a major initiative to propel neurorehabilitation support services to the forefront.” Despite its relatively low profile in public health discussions, traumatic brain injury is in fact the leading cause of mortality in young adults. SameYou will work in partnership with the Royal College of Nursing, Stroke Association, Spaulding Rehabilitation Network, and Nursing Now to increase both funding and research.

In typically self-deprecating fashion, Clarke took to Instagram Stories to speak directly to her 19.1 million followers about the news, saying: “So, today is a doubly important day. Number one, I launched a charity, which is… sizeable. Number two, I learned how to use Instagram stories, possibly the more important one… There’s this thing where you swipe up - ahhh! - and that takes you straight to the charity webpage.” She continued on her main feed: “I kept quiet about something that’s happened to me for quite a few years…And I really sincerely would love to hear what you think. I’d love to hear your stories. Because that’s why I started this.” SameYou is now taking donations through its JustGiving page - and has racked up 37,000 followers on Instagram in less than 24 hours. Khaleesi would be proud.

Does fluoxetine improve recovery after stroke?

I don't know, does it? I'm not paying for it, that is your stroke hospital responsibility. 

Does fluoxetine improve recovery after stroke?

BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l1029 (Published 25 March 2019) Cite this as: BMJ 2019;364:l1029

Editorial

NIHR’s research signals in The BMJ

• Article
• Related content
• Metrics
• Responses

1. Rob Cook, clinical director1,  
2. Vaughan Thomas, clinical adviser2,  
3. Rosie Martin, clinical specialist1
4. on behalf of NIHR Dissemination Centre

Author affiliations

1. Correspondence to R Cook rob.cook@bazian.com

The study

FOCUS Trial Collaboration. Effects of fluoxetine on functional outcomes after acute stroke (FOCUS): a pragmatic, double-blind, randomised, controlled trial. Lancet 2019;393:256-74.

The study was funded by the UK Stroke Association and the NIHR Health Technology Assessment Programme project number 13/04/30.

To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000729/a-commonly-used-antidepressant-doesnt-improve-recovery-after-stroke

Footnotes

• Competing interestsThe BMJ has judged that there are no disqualifying financial ties to commercial companies. The authors declare the following other interests: none.
• Further details of the BMJ policy on financial interests is here: https://www.bmj.com/about-bmj/resources-authors/forms-policies-and-checklists/declaration-competing-interests
• Contributors Anna Sayburn.
• All authors contributed to the development and review of this summary, as part of the wider NIHR Signals editorial team (https://www.bmj.com/NIHR-signals). RC is guarantor.
• Disclaimer NIHR Signals are owned by the Department of Health and Social Care and are made available to the BMJ under licence. NIHR Signals report and comment on health and social care research but do not offer any endorsement of the research. The NIHR assumes no responsibility or liability arising from any error or omission or from the use of any information contained in NIHR Signals.
• Permission to reuse these articles should be directed to disseminationcentre@nihr.ac.uk.

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Stroke Rehabilitation: What to Expect as You Recover (Fact Sheet)

Well this is complete whitewashing.

You can expect nothing.

1. Your doctor knows nothing about stroke rehab as evidenced by the prescriptions written to OT, PT, ST of E.T.(Evaluate and Treat.)

2. Only 10% of patients get to full recovery.

3. No protocols to prevent your 33% dementia chance post-stroke from an Australian study.
4. Nothing to alleviate your fatigue.
5. Nothing that will cure your spasticity.
6. Nothing on cognitive training unless you find this yourself.
7. No published stroke protocols.
8. No way to compare your stroke hospital results vs. other stroke hospitals.

 

Stroke Rehabilitation: What to Expect as You Recover (Fact Sheet) 

Haymarket Media

Rehabilitation is one of the most important phases of recovery for many stroke survivors, as they need to relearn the skills that were lost.

Stroke is one of the leading causes of long-term adult disability, affecting approximately 795,000 people each year in the United States. With an effective stroke rehabilitation process, survivors can improve function and make remarkable recoveries.

What’s involved in stroke rehabilitation?

Physical Activities	Cognitive/Emotional Activities
Motor-skill exercises	Occupational therapy
Mobility training	Speech therapy
Constraint-induced therapy	Psychological evaluation and treatment
Range-of-motion therapy	Medication

When should stroke rehabilitation begin?

Rehabilitation should start as soon as possible. In stable patients, rehabilitation can begin 2 days after the stroke occurred.

How long does stroke rehabilitation last?

The duration of rehabilitation depends on the severity of the stroke. Since each part of the brain controls a different function, each type of stroke can cause a different set of problems. Some survivors recover quickly, but most need months or years of rehabilitation.

Where does stroke rehabilitation take place?

Rehabilitation will begin in the hospital as you start to recover. Afterward, you, your family, and your care team will work together to determine the best rehabilitation setting for your needs.

Options include:

• Inpatient rehabilitation units – Intensive program lasting approximately 2 to 3 weeks
• Outpatient units – Less-intensive program that can last a couple of hours a few days each week
• Skilled nursing facilities – Type of care varies depending on the facility
• Home-based programs – Offer greater flexibility but lack specialized equipment

Who is part of your stroke rehabilitation team?

Physical Needs	Cognitive/Emotional Needs
Physicians	Speech and language pathologists
Rehabilitation nurses	Social workers
Physical therapists	Psychologists
Occupational therapists	Therapeutic recreation specialists

References
1. Stroke. Centers for Disease Control and Prevention. Updated May 3, 2018. Accessed August 8, 2018.
2. Stroke rehabilitation: what to expect as you recover. Mayo Clinic. May 24, 2017. Accessed August 8, 2018.

Muscle synergies demonstrate only minimal changes after treatment in cerebral palsy

There are massive amounts of synergies after stroke. Do we have ANY OBJECTIVE clue of which interventions stop synergies?  Or are we

waiting for SOMEONE ELSE TO SOLVE THE PROBLEM? 

Like that will ever occur with the current stroke leadership. 

Muscle synergies demonstrate only minimal changes after treatment in cerebral palsy

• Benjamin R. ShumanView ORCID ID profile,
• Marije Goudriaan,
• Kaat Desloovere,
• Michael H. Schwartz and
• Katherine M. SteeleEmail author

Journal of NeuroEngineering and Rehabilitation201916:46

https://doi.org/10.1186/s12984-019-0502-3

©  The Author(s). 2019

• Received: 30 November 2018
• Accepted: 22 February 2019
• Published: 29 March 2019

Abstract

Background

Children with cerebral palsy (CP) have altered synergies compared to typically-developing peers, reflecting different neuromuscular control strategies used to move. While these children receive a variety of treatments to improve gait, whether synergies change after treatment, or are associated with treatment outcomes, remains unknown.

Methods

We evaluated synergies for 147 children with CP before and after three common treatments: botulinum toxin type-A injection (n = 52), selective dorsal rhizotomy (n = 38), and multi-level orthopaedic surgery (n = 57). Changes in synergy complexity were measured by the number of synergies required to explain > 90% of the total variance in electromyography data and total variance accounted for by one synergy. Synergy weights and activations before and after treatment were compared using the cosine similarity relative to average synergies of 31 typically-developing (TD) peers.

Results

There were minimal changes in synergies after treatment despite changes in walking patterns. Number of synergies did not change significantly for any treatment group. Total variance accounted for by one synergy increased (i.e., moved further from TD peers) after botulinum toxin type-A injection (1.3%) and selective dorsal rhizotomy (1.9%), but the change was small. Synergy weights did not change for any treatment group (average 0.001 ± 0.10), but synergy activations after selective dorsal rhizotomy did change and were less similar to TD peers (− 0.03 ± 0.07). Only changes in synergy activations were associated with changes in gait kinematics or walking speed after treatment. Children with synergy activations more similar to TD peers after treatment had greater improvements in gait.

Conclusions

While many of these children received significant surgical procedures and prolonged rehabilitation, the minimal changes in synergies after treatment highlight the challenges in altering neuromuscular control in CP. Development of treatment strategies that directly target impaired control or are optimized to an individual’s unique control may be required to improve walking function.

Put a Cork in It: Drinking a Bottle of Wine Per Week Is as Bad as Smoking 10 Cigarettes, Researchers Say

Ask your doctor if all these benefits put more pros than cons on alcohol. Unless you doctor is reflexively biased against alcohol.

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 August 2018 

Alcohol for these 12 reasons.

Red wine

All the great things studies claim drinking red wine can do:

Ask your doctor if one glass of red wine a day can provide all these benefits

1. Lower the risk of breast cancer.

2. Raise levels of good HDL cholesterol.

3. Be equivalent to an hour of exercise.

3. Give you better sleep quality.

4. Prevent tooth decay.

5. Reduce plaque in your arteries.

6. Make you have fewer colds.

7. Help you lose weight.

8. Give you "gorgeous skin."

10. Aid digestion.

11. Enhance exercise performance.

12. Control Type 2 Diabetes.

13. Help you "chill out."

14. Reduce risk of depression.

15. Give you a longer life.

16. Increase diversity of bacteria in your gut.

17. Fight off cavities.

18. Stop bug bites.

19. Prevent memory loss.

 

 

 

Put a Cork in It: Drinking a Bottle of Wine Per Week Is as Bad as Smoking 10 Cigarettes, Researchers Say

Brittany Shoot 8 hours ago

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If you think a glass of wine a few nights a week can’t be that bad for your health, consider that it could be the healthy equivalent of smoking five to 10 cigarettes. That’s according to a new study published in the journal BMC Public Health, in which researchers looked at how one type of vice that causes cancer—smoking—compared with another.
The research focused on the absolute lifetime risk of drinking one bottle of wine a week. Absolute risk, as defined by the Mayo Clinic, is how likely a person is to develop a condition over their entire life. So for example, on average, American men have a 12% absolute risk of developing prostate cancer, meaning 12 out of 100 will develop the cancer, and 88 out of 100 men will not.

In the case of drinking a bottle of wine every week, non-smoking men’s absolute risk increased 1%, or roughly the equivalent of smoking five cigarettes. In non-smoking women, the absolute risk rose 1.4%, the equivalent of smoking 10 cigarettes, with a 0.8% absolute risk of breast cancer. In other words, depending on an individual’s other risk factors and lifestyle choices related to their likelihood of developing cancer, drinking that much wine could further elevate their risk rate.

The link between cancer and using tobacco products and smoking is relatively well understood, but when it comes to drinking, the study authors noted that the risks of even somewhat moderate alcohol consumption are often a little less obvious to the public.
But that doesn’t mean that drinking alcohol doesn’t have its drawbacks. The National Cancer Institute notes that the U.S. Department of Health and Human Services lists the consumption of alcohol as a known human carcinogen and accordingly, it is linked to various cancers including those of the breast, colon, esophagus, and liver.

Comparison of statins for secondary prevention in patients with ischemic stroke or transient ischemic attack: a systematic review and network meta-analysis

Yet you seem to recommend high dose statins even though the FDA suggests they not be prescribed anymore from 8 years ago.  How out of date are you? And you still have a job?

FDA announces new safety recommendations for high-dose simvastatin June 2011

Comparison of statins for secondary prevention in patients with ischemic stroke or transient ischemic attack: a systematic review and network meta-analysis

• Irene TramacereEmail author,
• Giorgio B. Boncoraglio,
• Rita Banzi,
• Cinzia Del Giovane,
• Koren H. Kwag,
• Alessandro Squizzato and
• Lorenzo Moja

BMC Medicine201917:67

https://doi.org/10.1186/s12916-019-1298-5

©  The Author(s). 2019

• Received: 18 October 2018
• Accepted: 5 March 2019
• Published: 26 March 2019

Open Peer Review reports

Abstract

Background

Statins may prevent recurrent ischemic events after ischemic stroke. Determining which statin to use remains controversial. We aimed to summarize the evidence for the use of statins in secondary prevention for patients with ischemic stroke by comparing benefits and harms of various statins.

Methods

We searched for randomized controlled trials (RCTs) assessing statins in patients with ischemic stroke or transient ischemic attack (TIA) in MEDLINE, EMBASE, and CENTRAL up to July 2017. Two authors extracted data and appraised risks of bias. We performed pairwise meta-analyses and trial sequential analyses (TSA) to compare statins versus placebo/no statin, and network meta-analyses using frequentist random-effects models to compare statins through indirect evidence. We used GRADE to rate the overall certainty of evidence. Primary outcomes were all-cause mortality and all strokes. Secondary outcomes were different types of strokes, cardiovascular events, and adverse events.

Results

We identified nine trials (10,741 patients). No head-to-head RCTs were found. The median follow-up period was 2.5 years. Statins did not seem to modify all stroke and all-cause mortality outcomes; they were associated with a decreased risk of ischemic stroke (odds ratio, OR, 0.81 [95% CI, 0.70 to 0.93]; absolute risk difference, ARD, − 1.6% [95% CI, − 2.6 to − 0.6%]), ischemic stroke or TIA (OR, 0.75 [95% CI, 0.64 to 0.87]; ARD, − 4.2% [95% CI, − 6.2 to − 2.1%]), and cardiovascular event (OR, 0.75 [95% CI, 0.69 to 0.83]; ARD, − 5.4% [95% CI, − 6.8 to − 3.6%]), and did not seem to modify rhabdomyolysis, myalgia, or rise in creatine kinase. In the comparison of different statins, moderate- to high-quality evidence indicated that differences between pharmaceutical products seemed modest, with high doses (e.g., atorvastatin 80 mg/day and simvastatin 40 mg/day) associated with the greatest benefits. TSA excluded random error as a cause of the findings for ischemic stroke and cardiovascular event outcomes. Evidence for increased risk of hemorrhagic stroke was sensitive to the exclusion of the SPARCL trial.

Conclusions

Evidence strongly suggests that statins are associated with a reduction in the absolute risk of ischemic strokes and cardiovascular events. Differences in effects among statins were modest, signaling potential therapeutic equivalence.

Trial registration

PROSPERO CRD42018079112

Unique Video Game May Improve Function in Stroke Survivors

Good, then write up a protocol and distribute this to every stroke hospital in the world. OR, figure out a way to get this to everyone of the 10 million yearly stroke survivors. Your choice, DOING NOTHING IS NOT AN OPTION.

Do nothing, get fired.

 

Unique Video Game May Improve Function in Stroke Survivors

Damian McNamara

March 27, 2019

Severely impaired stroke survivors may be able to regain function, sometimes after years of immobility, with a novel video game–led training device, preliminary research suggests.
Results from a small randomized control trial showed that the device, known as the myoelectric computer interface (MyoCI), reduced impairment and spasticity and improved stroke survivors' arm function.
"This myoelectric computer interface training enables chronic stroke patients to reduce abnormal coactivation in their arms, leading to some improvement in their ability to reach," study coauthor Marc Slutzky, MD, PhD, associate professor of neurology at Northwestern University Feinberg School of Medicine in Chicago, Illinois, told Medscape Medical News.
The study was published online March 19 in Neurorehabilitation and Neural Repair.

Unique Approach

The investigators developed the MyoCI training method to reduce abnormal muscle pair coactivation. This coactivation, in which two muscles around a joint contract at the same time, contributes to poststroke disability.
In contrast to traditional occupational therapy, which aims to improve specific functional tasks, MyoCI training focuses on reducing the underlying cause of impairment, Slutzky said. The approach "is unique in that it could potentially help patients benefit more from other therapies as well."
The current research builds on a pilot study that demonstrated that MyoCI training of bicep and anterior deltoid muscle pairs cut abnormal coactivation by 99%. The earlier research, however, did not feature a blinded occupational therapist to assess functional outcomes.

For the study, the investigators screened 42 adult chronic stroke survivors who had moderate to severe arm impairment after a period of at least 6 months from stroke onset. Of the participants, 15 were women; the mean period since stroke was 6.5 years.
The candidates each scored from 8 to 40 on the Fugel Meyer Upper Extremity (FMA-UE) assessment.
After exclusions and discontinuations, 32 patients were included in the analysis. Twelve patients were randomly assigned to undergo 60 minutes of isometric therapy; 11 patients were assigned to undergo 90 minutes of isometric therapy; and nine patients completed 90 minutes of unrestrained movements during the training.
The researchers placed wireless electromyography electrodes along the affected arms to measure muscle activity. They selected the muscle pairs with the largest abnormal coactivation disparities, compared to the contralateral healthy arm, for MyoCI training.

Improved Function

The approach significantly reduced impairment in all participants, as reflected by FMA-UE scores, which increased a mean of 3.3 points at 6 weeks and 3.1 points at 10 weeks. These outcomes were statistically significant (P < .0001 at both assessment points) compared to baseline.

Statins linked to higher diabetes risk

Well shit, this was known back in May 2015. Why the fuck repeat research? Because you didn't know of this earlier research? Are you agreeing you are incompetent?

Strong statin-diabetes link seen in large study of Tricare patients May 2015

 

Taking statins raises the risk of Type 2 diabetes by nearly a third: Findings reopens debate about the pills benefits and side effects

Be careful out there, don't stop taking statins without your doctors approval. 30% or 87%?  But is it statins or the underlying disease that causes your doctor to prescribe statins? Your doctor should have warned you about this and be monitoring your condition since May 2015;

In a database study of nearly 26,000 beneficiaries of Tricare, the military health system, those taking statin drugs to control their cholesterol were 87 percent more likely to develop diabetes.

Or is your doctor using coffee to try to prevent diabetes? Making the assumption that it will translate from mice to humans.

Substance in coffee delays onset of diabetes in laboratory mice

Your doctor can also consider this:

High-intensity statin therapy alters the progressive nature of diabetic coronary atherosclerosis, yielding regression of disease in diabetic and nondiabetic patients.

 The latest here:

Statins linked to higher diabetes risk

Wiley | March 06, 2019

Individuals who take cholesterol-lowering statins may be at higher risk for developing high blood sugar levels, insulin resistance, and eventually type 2 diabetes, according to an analysis published in the British Journal of Clinical Pharmacology.

Advertisement

The analysis examined information from 9,535 individuals older than 45 years of age who were free from diabetes at the start of the population-based Rotterdam study and were followed for up to 15 years.
Compared with participants who never used statins, those who used statins tended to have higher concentrations of serum fasting insulin and insulin resistance. Participants who had ever used statins had a 38% higher risk of developing type 2 diabetes during the study. This risk was more prominent in individuals with impaired glucose balance and in overweight/obese individuals.
“The findings suggest that in patients who initiate statin therapy, preventive strategies such as blood sugar control and weight loss may be warranted for minimizing the risk of diabetes,” said senior author professor Bruno Stricker, of the Erasmus Medical Centre, in the Netherlands.

• See Also: The percentage of adults taking cholesterol-lowering medication regularly remains low

To read more, click here.

Achievement of Guideline-Recommended Weight Loss Among Patients With Ischemic Stroke and Obesity

Your doctor has the responsibility to get you 100% recovered, then you can work on weight loss. 

Achievement of Guideline-Recommended Weight Loss Among Patients With Ischemic Stroke and Obesity

Jennifer L. Dearborn

,

Catherine M. Viscoli

,

Lawrence H. Young

,

Mark J. Gorman

,

Karen L. Furie

,

Walter N. Kernan

Originally published21 Feb 2019https://doi.org/10.1161/STROKEAHA.118.024008Stroke. 2019;50:713–717

Abstract

Background and Purpose—

The proportion of patients with acute ischemic stroke or transient ischemic attack (TIA) and obesity who successfully achieve goals for weight reduction recommended by major professional organizations is unknown.

Methods—

We examined the experience of participants in the placebo group of the IRIS trial (Insulin Resistance Intervention after Stroke) with a body mass index ≥30 kg/m² at entry. Patients were of age ≥40 years, with a qualifying stroke or TIA within 180 days of randomization and documented insulin resistance without diabetes mellitus. Weights at baseline and at years 1 and 2 after entry were analyzed to determine the proportion of patients achieving a 5% weight loss and achievement of body mass index <27 kg/m².

Results—

Of 1937 subjects assigned to placebo, 855 (44%) had obesity at entry. Median age of these 855 subjects was 60 years (interquartile range, 53–68), 41% were women, and median time from stroke/TIA to trial entry was 79 days. Among 788 subjects in the trial at 1 year, 166 (21%) had lost at least 5% of their starting weight and 12 (2%) had achieved a body mass index <27 kg/m². One hundred nine (14%) participants gained at least 5% of their baseline weight at 1 year. Among 744 subjects in the trial at 2 years, 185 (25%) had lost at least 5% of their baseline weight and 23 (3%) had achieved a body mass index <27 kg/m². One hundred forty (19%) participants gained at least 5% of their starting weight at 2 years.

Conclusions—

Only one quarter of obese patients with a recent ischemic stroke or TIA lost a clinically significant amount of weight after their vascular event. Many patients gained weight. Enhancing weight loss after ischemic stroke or TIA may help improve functional outcome and reduce risk for future vascular events, but clinical trials are needed to test and confirm these potential benefits.

Sociodemographic disparities in long-term mortality among stroke survivors in the United States: The REGARDS Study

WHOM is going to be assigned and come up with solutions to these disparities?  I bet incompetence will reign and nothing will be done.

Sociodemographic disparities in long-term mortality among stroke survivors in the United States: The REGARDS Study

Stroke — Elfassy T, et al. | March 14, 2019

In this REGARDS study, which included 1,329 black and white participants, researchers described long-term (> 30 days) mortality rates among stroke survivors, and determined whether there exist socioeconomic disparities. They found that long-term mortality was high in older individuals as well as among men vs women. The age-adjusted mortality rate among adults who survived ≥ 30 days poststroke was 82.3 per 1,000 person-years. Investigators found that long-term mortality rates among stroke survivors were higher among people with lower socioeconomic status (SES) and those living in lower SES neighborhood. No differences, however, were found in age-adjusted rates of long-term post-stroke mortality by race, rurality, or US region. These results highlighted the need for improvements in post-stroke long-term care(It shows a need for better results, NOT CARE), particularly among lower SES individuals.

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Does severity of motor impairment affect reactive adaptation and fall-risk in chronic stroke survivors?

Wrong question. What are the protocols that will prevent falls in chronic stroke survivors?

Does severity of motor impairment affect reactive adaptation and fall-risk in chronic stroke survivors?

• Tanvi BhattEmail author,
• Shamali Dusane and
• Prakruti Patel

Journal of NeuroEngineering and Rehabilitation201916:43

https://doi.org/10.1186/s12984-019-0510-3

©  The Author(s). 2019

• Received: 27 August 2018
• Accepted: 4 March 2019
• Published: 22 March 2019

Abstract

Background

A single-session of slip-perturbation training has shown to induce long-term fall risk reduction in older adults. Considering the spectrum of motor impairments and deficits in reactive balance after a cortical stroke, we aimed to determine if chronic stroke survivors could acquire and retain reactive adaptations to large slip-like perturbations and if these adaptations were dependent on severity of motor impairment.

Methods

Twenty-six chronic stroke participants were categorized into high and low-functioning groups based on their Chedoke-McMaster-Assessment scores. All participants received a pre-training, slip-like stance perturbation at level-III (highest intensity/acceleration) followed by 11 perturbations at a lower intensity (level-II). If in early phase, participants experienced > 3/5 falls, they were trained at a still lower intensity (level-I). Post-training, immediate scaling and short-term retention at 3 weeks post-training was examined. Perturbation outcome and post-slip center-of-mass (COM) stability was analyzed.

Results

On the pre-training trial, 60% of high and 100% of low-functioning participants fell. High-functioning group tolerated and adapted at training-intensity level-II but low-functioning group were trained at level-I (all had > 3 falls on level-II). At respective training intensities, both groups significantly lowered fall incidence from 1st through 11th trials, with improved post-slip stability and anterior shift in COM position, resulting from increased compensatory step length. Both groups demonstrated immediate scaling and short-term retention of the acquired stability control.

Conclusion

Chronic stroke survivors are able to acquire and retain adaptive reactive balance skills to reduce fall risk. Although similar adaptation was demonstrated by both groups, the low-functioning group might require greater dosage with gradual increment in training intensity.

Keywords

• Perturbation training
• Adaptation
• Motor impairment
• Stroke

Introduction

Approximately more than 800,000 individuals annually suffer from stroke and its associated detrimental long term disability in the USA [1]. The primary deficits associated with stroke, such as sensorimotor impairment, postural dysfunction, and cognitive impairment, result in secondary complications such as falls [2, 3, 4]. The high risk of falls during the acute phase persists even into the chronic phase when people with chronic stroke (PwCS) regain their ambulatory ability; especially predisposing them to falls from unexpected environmental perturbations such as slips or trips [5].

Reactive balance control plays a crucial role in recovering from large unexpected perturbations, thereby lowering fall-risk [6, 7, 8, 9, 10]. A rapid and sufficiently large stepping response helps to regain postural stability by restoring the displaced base of support (BOS) and providing the necessary lever arm to generate adequate rotational counter-torque at step touchdown to decelerate the body’s forward or backward moving center of mass (COM) [11]. Studies examining reactive responses to stance perturbations in PwCS have reported delayed onset latencies of lower extremity muscles, with smaller amplitude and altered sequence of activation [12, 13]. Moreover, PwCS often show delayed compensatory step initiation with a short compensatory step, or they exhibit an aborted step or multiple stepping responses; all of which compromise postural stability and increase fall-risk [14, 15, 16, 17, 18, 19, 20].

Considering the above-mentioned evidence, training reactive responses in PwCS could be critical for fall-risk reduction in this population. Leveraging the principle of task specificity, perturbation training elicits reactive motor adaptations and induces learning of effective recovery strategies by improving COM state stability control and compensatory stepping responses throughout trials [21, 22]. Even a single session of perturbation training has shown to induce longer-term reduction in laboratory-induced and real-life falls in healthy older adults [23]. However, limited evidence exists on the effect of perturbation training on acquiring adaptations for fall-risk reduction in PwCS.

The role of neuroplasticity, specifically reorganization of the sensorimotor cortex, in optimizing motor recovery and function for both skilled volitional and locomotor tasks in PwCS is well known [24, 25, 26]. It is also established that the cerebellum and cerebral cortex play a crucial role in acquiring locomotor-balance adaptations [27, 28]. While cerebellar stroke can impair acquisition of motor adaptation, this ability has been shown to be intact in cortical stroke [27, 29, 30]. Nonetheless, little is known whether adaptations within the reactive balance control system are possible post-stroke. A preliminary training study employing therapist-induced, small magnitude external pull-push perturbations showed reduction in daily falls for sub-acute stroke patients [31]. Such low intensity perturbations, while appropriate for individuals in the early phases of recovery, might not be challenging enough to mimic real-life perturbations faced by community-dwelling PwCS.

Previously, it has been established that there is a need for different dosage considerations when training patients with varying degrees of impairment in order to improve locomotor balance control [32]. However, there is lack of evidence on recommendations for an optimal perturbation training intensity for PwCS with different severity of motor impairment to suitably match their motor capabilities and ultimately induce reactive adaptation. It is also unknown if PwCS with varying levels of motor impairments could safely tolerate the perturbation intensity dosages provided to healthy young and older adults for training.

This study aimed to examine if PwCS could acquire reactive adaptation to large slip-like stance perturbations, and if adaptive gains differed based on the perturbation intensity and severity of motor impairment. We also examined if the adaptive gains could be scaled when exposed to a higher perturbation intensity and then retained over several weeks.

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