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

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal.

Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:http://oc1dean.blogspot.com/2010/11/my-background-story_8.html

Tuesday, April 30, 2019

The sooner the better?!: Providing ankle-foot orthoses in the rehabilitation after stroke

The more important question to answer is; What is the protocol to wean yourself off the AFO? If your doctor and therapists don't know that answer you need to fire them. 

The sooner the better?!: Providing ankle-foot orthoses in the rehabilitation after stroke


Abstract 
 In stroke, the blood circulation in the brain is affected, being either ischemic or hemorrhagic. Depending on the location of the lesion, the effects can widely vary. Initial walking function is limited in approximately two-third of the patients. A “drop-foot”, the inability to dorsiflex the foot, is estimated to be present in 20-30% of the people after stroke and causes foot-clearance problems during swing phase and also affects initial contact at the start of the stance phase. Insufficient foot-clearance is associated with high risks for stumbling and falling. Ankle-foot orthoses (AFOs) are commonly used to correct drop-foot after stroke and are reported to improve mobility and balance, ankle kinematics, walking speed, self-confidence and fear of falling after stroke. However, most studies reporting on AFOs after stroke included chronic stroke patients who were already provided with AFOs in daily life and were able to walk independently. The general aim of this thesis was to increase the understanding of the effects of providing AFOs early after stroke. The EVOLUTIONS-project was conducted, including a randomized controlled trial in which the effects of AFO-provision on two different time points in the rehabilitation after stroke were studied. Subjects were included within six weeks after stroke and randomized for AFO-provision at inclusion of the study (in week 1) or eight weeks later (in week 9). The subjects were provided with one of three commonly used types of off-the-shelf, non-articulated AFOs with variability in stiffness. Subjects randomized for delayed provision did not use an AFO in the first eight weeks of the study. Subjects were studied up to 17 weeks with (bi)weekly intervals. Follow-up measurements up to 26 and 52 weeks were included. Measurements included functional outcomes related to balance, walking and activities of daily life. Furthermore, gait kinematics of the affected lower limb, muscle activation patterns of the tibialis anterior muscle, and falls and near falls were studied. Results showed positive effects on functional outcomes, both when AFOs were provided early or delayed. After 26 weeks no differences in functional outcomes were found between both groups. However, the results suggest that early provision results in better outcomes in the first 11-13 weeks of the study. Ankle dorsiflexion significantly improved directly after AFO-provision, changing the ankle from a plantarflexion into a dorsiflexion angle at initial contact, foot-off and during swing. These results were obtained regardless of AFO-provision early or delayed after stroke. In general, knee, hip and pelvis angles did not change directly after AFO-provision. After 26 weeks, no differences in kinematics in any of the joint angles were found between the two groups. These kinematic results indicate that AFOs improved drop-foot, but did not influence movement patterns around pelvis and hip. Previous literature suggested that AFO-use might increase muscle weakness, and thereby could impede recovery. Therefore, the effects of AFO-provision on muscle activity of the tibialis anterior were assessed. Results showed that AFO-use reduced muscle activity during swing within a measurement session, compared to walking without AFO. However, 26 weeks use of an AFO did not affect tibialis anterior muscle activity during walking without AFO. Again, early or delayed AFO-provision did not affect the results. These results indicate that there is no need to fear negative consequences on tibialis anterior activity because of long-term AFO-use (early) after stroke. In addition, the effects on the occurrence and circumstances of (near) falls were studied using diaries. In case of an incident, the location, performed activity, possible injuries and whether the AFO was used. We found that subjects in the early group, who had already been provided with AFOs, fell significantly more often in the first eight weeks of the study, compared to the delayed group who had not yet been provided with AFOs. The majority of the falls in the early group in week 1-8 occurred without wearing the AFO. Falls mainly occurred during transfers and standing, during activities related to getting in/out bed, toileting and showering. The majority of the subjects had not yet reached an independent ambulation level at the time of the fall (Functional Ambulation Categories ≤3) and had low balance levels (Berg Balance Scale <45). This highlights the need for careful instructions from clinicians and nursing staff to patients and their relatives, and to emphasize the potential risks of performing activities without the proper assistance, especially in situations without wearing the AFO and without independent walking ability. Summarizing, the results of the current thesis show that clinicians, together with the patient, can decide what they value most in when making the decision on when to commence with AFO-provision. AFOs were found to improve drop-foot regardless of the timing of AFO-provision after stroke. Early AFO-use is expected to result in higher functional levels earlier in the rehabilitation. Despite potential functional gains in the first period of rehabilitation, early AFO-provision does not lead to higher functional levels after 26 weeks, compared to delayed provision. In addition, early or delayed AFO-provision did not influence pelvis, hip and knee kinematics on the short- or long-term. Therefore, AFOs should be provided to correct the drop-foot, but there is no reason to assume that early AFO-provision will influence the development of compensatory movements around the pelvis and hip in the rehabilitation after stroke. AFO-use reduced muscle activity of the tibialis anterior in swing compared to walking without AFO, when effects were measured within one measurement session. However, no negative effects over 26-weeks were found. Therefore, based on the results of our study, fear of disuse concerning the tibialis anterior does not seem to be a justifiable reason to delay AFO-use in the rehabilitation after stroke. One should be aware that higher numbers of falls were found in case that subjects were provided with AFOs early after stroke. Special attention needs to be made to the specific instructions given regarding AFO-use, since the majority of the falls occurred without wearing the AFO and while subjects were not allowed to ambulate independently.
Title The sooner the better?! : Providing ankle-foot orthoses in the rehabilitation after stroke
Author Nikamp-Simons, C.D.M.
Thesis advisor Buurke, Jaap Hilbert, Rietman, Johan Swanik
Publisher Biomedical Signals and Systems
Date issued 2019
Access Embargoed Access
Reference(s) Stroke rehabilitation, Ankle-foot orthosis, functional outcomes, Gait kinematics, electromyography (EMG), falls
Language English
Type Doctoral thesis
Publisher University of Twente
Publication https://research.utwente.nl/en/publications/ec347c8e-bd20-4a...
OpenURL Search this publication in (your) library
Persistent Identifier urn:nbn:nl:ui:28-ec347c8e-bd20-4a1d-9e0e-3c03922a9501
ISBN 978-90-365-4747-5
DOI 10.3990/1.9789036547475
NBN urn:nbn:nl:ui:28-ec347c8e-bd20-4a1d-9e0e-3c03922a9501
Url https://research.utwente.nl/en/publications/ec347c8e-bd20-4a...
Metadata XML
Source University of Twente


Robotics for rehabilitation of hand movement in stroke survivors

You'll have to read this to see if there is anything effective for hand rehab. Unless you have the mistaken impression that your doctor is reading and applying research to their rehab practice.

Robotics for rehabilitation of hand movement in stroke survivors

Francesco Aggogeri1, Tadeusz Mikolajczyk2and James O’Kane3

Abstract

This article aims to give an overall review of research status in hand rehabilitation robotic technology, evaluating a number of devices. The main scope is to explore the current state of art to help and support designers and clinicians make better choices among varied devices and components. The review also focuses on both mechanical design, usability and training paradigms since these parts are interconnected for an effective hand recovery. In order to study the rehabilitation robotic technology status, the devices have been divided in two categories: end-effector robots and exoskeleton devices. The end-effector robots are more flexible than exoskeleton devices in fitting the different size of hands, reducing the setup time and increasing the usability for new patients. They suffer from the control of distal joints and haptic aspects of object manipulation. In this way, exoskeleton devices may represent a new opportunity. Nevertheless their design is complex and a deep investigation of hand biomechanics and physical human–robot interaction is required. The main hand exoskeletons have been developed in the last decade and the results are promising demonstrated by the growth of the commercialized devices. Finally, a discussion on the complexity to define which design is better and more effective than the other one is summarized for future investigations.

14 total pages at link.

Variation in Hospital-Based Rehabilitation Services Among Patients With Ischemic Stroke in the United States

There should be zero variation among services provided. You follow the protocols exactly that lead to 100% recovery. Until we get to this state survivors will be screwed.  If your doctors and hospitals can't see that then you have idiots in charge. And you are paying those idiots.

Variation in Hospital-Based Rehabilitation Services Among Patients With Ischemic Stroke in the United States

Physical Therapy, Volume 99, Issue 5, May 2019, Pages 494–506, https://doi.org/10.1093/ptj/pzz014
Published:
30 April 2019
Article history

Abstract

Background
Little is known about variation in use of rehabilitation services provided in acute care hospitals for people who have had a stroke.
Objective
The objective was to examine patient and hospital sources of variation in acute care rehabilitation services provided for stroke.
Design
This was a retrospective, cohort design.
Methods
The sample consisted of Medicare fee-for-service beneficiaries with ischemic stroke admitted to acute care hospitals in 2010. Medicare claims data were linked to the Provider of Services file to gather information on hospital characteristics and the American Community Survey for sociodemographic data. Chi-square tests compared patient and hospital characteristics stratified by any rehabilitation use. We used multilevel, multivariable random effect models to identify patient and hospital characteristics associated with the likelihood of receiving any rehabilitation and with the amount of therapy received in minutes.
Results
Among 104,295 patients, 85.2% received rehabilitation (61.5% both physical therapy and occupational therapy; 22.0% physical therapy only; and 1.7% occupational therapy only). Patients received 123 therapy minutes on average (median [SD] = 90.0 [99.2] minutes) during an average length of stay of 4.8 [3.5] days. In multivariable analyses, male sex, dual enrollment in Medicare and Medicaid, prior hospitalization, ICU stay, and feeding tube were associated with lower odds of receiving any rehabilitation services. These same variables were generally associated with fewer minutes of therapy. Patients treated by tissue plasminogen activator, in limited-teaching and nonteaching hospitals, and in hospitals with inpatient rehabilitation units, were more likely to receive more therapy minutes.
Limitation
The findings are limited to patients with ischemic stroke.
Conclusion
Only 61% of patients with ischemic stroke received both physical therapy and occupational therapy services in the acute setting. We identified considerable variation in the use of rehabilitation services in the acute care setting following a stroke.
This content is only available as a PDF.
This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

A web-based carepartner-integrated rehabilitation program for persons with stroke: study protocol for a pilot randomized controlled trial

So you acknowledge that stroke rehab at your hospitals are complete failures. What the fuck are you doing to fix that? Rather than just dumping recovery on the caregivers? Solve the correct problem, hospitals having no protocols to 100% recovery.

A web-based carepartner-integrated rehabilitation program for persons with stroke: study protocol for a pilot randomized controlled trial

  • Email authorView ORCID ID profile,
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  • ,
  • ,
  • ,
  • and
Pilot and Feasibility Studies20195:58
  • Received: 20 November 2018
  • Accepted: 4 April 2019
  • Published:
Open Peer Review reports

Abstract

Background

Family carepartner management and support can improve stroke survivor recovery, yet research has placed little emphasis on how to integrate families into the rehabilitation process without increasing negative carepartner outcomes. Our group has developed creative approaches for engaging family carepartners in rehabilitation activities to improve physical and psychosocial health for both the carepartner and stroke survivor. The purpose of this study is to explore a novel, web-based intervention (Carepartner and Constraint-Induced Therapy; CARE-CITE) designed to facilitate positive carepartner involvement during a home-based application of constraint-induced movement therapy (CIMT) for the upper extremity.

Methods

The primary aim of the study is to determine feasibility of CARE-CITE for both stroke survivors and their carepartners. Carepartner mental health, family conflict surrounding stroke recovery, and stroke survivor upper extremity function will be evaluated using an evaluator blinded, two-group experimental design (blocked randomization protocol according to a 2:1 randomization schema) with 32 intervention dyads and 16 control dyads (who will receive CIMT without structured carepartner involvement). CARE-CITE consists of online education modules for the carepartner to review in parallel to the 30-h CIMT that the stroke survivor receives. The intent of CARE-CITE is to enhance the home-based intervention of CIMT, by helping the carepartner support the therapy and create a therapeutic home environment encouraging practice of the weaker arm in functional tasks.

Discussion

The CARE-CITE study is testing the feasibility of a family-integrated rehabilitation approach applied in the home environment, and results will provide the foundation for larger clinical studies. The overall significance of this research plan is to increase the understanding and further development of interventions that may serve as models to promote family involvement in the rehabilitation process.

Trial registration

ClinicalTrials.gov, NCT02703532. Registered 9 March 2016

Does pre-existing cognitive impairment impact on amount of stroke rehabilitation received? An observational cohort study

My conclusion is you better not be cognitively impaired because YOU are going to need to research how to recover.

Does pre-existing cognitive impairment impact on amount of stroke rehabilitation received? An observational cohort study

 Verity Longley1,2, Sarah Peters3, Caroline Swarbrick4, Sarah Rhodes2,5 and Audrey Bowen1,2 

Abstract 

Objective: To examine whether stroke survivors in inpatient rehabilitation with pre-existing cognitive impairment receive less therapy than those without.
Design: Prospective observational cohort.Setting: Four UK inpatient stroke rehabilitation units.Participants: A total of 139 stroke patients receiving rehabilitation, able to give informed consent/had an individual available to act as personal consultee. In total, 33 participants were categorized with pre-existing cognitive impairment based on routine documentation by clinicians and 106 without.
Measures: Number of inpatient therapy sessions received during the first eight weeks post-stroke, referral to early supported discharge, and length of stay.Results: On average, participants with pre-existing cognitive impairment received 40 total physiotherapy and occupational therapy sessions compared to 56 for those without (mean difference = 16.0, 95% confidence interval (CI) = 2.9, 29.2), which was not fully explained by adjusting for potential confounders (age, sex, National Institutes of Health Stroke Scale (NIHSS), and pre-stroke modified Rankin Scale (mRS)). While those with pre-existing cognitive impairment received nine fewer single-discipline physiotherapy sessions (95% CI = 3.7, 14.8), they received similar amounts of single-discipline occupational therapy, psychology, and speech and language therapy; two more non-patient-facing occupational therapy sessions (95% CI = –4.3, –0.6); and nine fewer patient-facing occupational therapy sessions (95% CI = 3.5, 14.9). There was no evidence to suggest they were discharged earlier, but of the 85 participants discharged within eight weeks, 8 (42%) with pre-existing cognitive impairment were referred to early supported discharge compared to 47 (75%) without.
Conclusion: People in stroke rehabilitation with pre-existing cognitive impairments receive less therapy than those without, but it remains unknown whether this affects outcomes.1Division of Neuroscience and Experimental Psychology, MAHSC, The University of Manchester, Manchester, UK2CLAHRC Greater Manchester, Manchester, UK3Manchester Centre for Health Psychology, MAHSC, The University of Manchester, Manchester, UK4Division of Health Research, Lancaster University, Lancaster, UK843984CRE0010.1177/0269215519843984Clinical RehabilitationLongley et al.research-article2019Original Article5Centre for Biostatistics, MAHSC, The University of Manchester, Manchester, UKCorresponding author:Verity Longley, Division of Neuroscience and Experimental Psychology, MAHSC, The University of Manchester, Oxford Road, Manchester M13 9PL, UK. Email: verity.longley@manchester.ac.uk; twitter handle: @veritylongley

Task Specificity & Functional Outcome: What is best for Post-Stroke Rehabilitation?

No one has a fucking clue on how to get stroke survivors recovered. No protocols, no nothing.  Your doctors know nothing, your therapists are just using guidelines. You are on your own for your complete recovery. Start researching now.  I don't expect to ever get recovered in my lifetime of 30 more years. No one has a strategy to solve stroke.

Task Specificity & Functional Outcome: What is best for Post-Stroke Rehabilitation?


Faculty Advisor

Abigail Kerr

Graduation Year

2019

Location

Center for Natural Sciences, Illinois Wesleyan University

Event Website

https://digitalcommons.iwu.edu/jwprc/

Start Date

13-4-2019 9:00 AM

End Date

13-4-2019 10:00 AM

Description

Stroke is a debilitating insult to the brain occurring from a blockage in blood supply (ischemic), or a bleed (hemorrhagic) in one hemisphere of the brain. Worldwide, approximately 10 million people are left with moderate to severe disability due to stroke; the most common deficit is upper extremity impairment. Current stroke rehabilitation strategies utilize task specific training of a skill, meaning one practices the specific skill they want to regain. However, it is possible that there are more generalized types of therapy that can be as effective in rehabilitating debilitated skills. The current study utilizes several skilled reaching tasks in mice that have shown striking parallels to human dexterous movements to observe the effects of task-specific versus generalized upper extremity rehabilitation post-stroke. Our findings have meaningful implications for rehabilitative strategies post-stroke and test the validity of a skilled reaching task used in the rodent model.
This document is currently not available here.

The Effect of Noninvasive Brain Stimulation on Poststroke Cognitive Function: A Systematic Review

My conclusion from this is we learned absolutely nothing that will get us anywhere closer to 100% recovery. So useless.

The Effect of Noninvasive Brain Stimulation on Poststroke Cognitive Function: A Systematic Review

First Published April 25, 2019 Review Article
Introduction. Cognitive impairment after stroke has been associated with lower quality of life and independence in the long run, stressing the need for methods that target impairment for cognitive rehabilitation. The use of noninvasive brain stimulation (NIBS) on recovery of language functions is well documented, yet the effects of NIBS on other cognitive domains remain largely unknown. Therefore, we conducted a systematic review that evaluates the effects of different stimulation techniques on domain-specific (long-term) cognitive recovery after stroke.  
Methods. Three databases (PubMed, EMBASE, and PsycINFO) were searched for articles (in English) on the effects of NIBS on cognitive domains, published up to January 2018.  
Results. A total of 40 articles were included: randomized controlled trials (n = 21), studies with a crossover design (n = 9), case studies (n = 6), and studies with a mixed design (n = 4). Most studies tested effects on neglect (n = 25). The majority of the studies revealed treatment effects on at least 1 time point poststroke, in at least 1 cognitive domain. Studies varied highly on the factors time poststroke, number of treatment sessions, and stimulation protocols. Outcome measures were generally limited to a few cognitive tests.
Conclusion. Our review suggests that NIBS is able to alleviate neglect after stroke. However, the results are still inconclusive and preliminary for the effect of NIBS on other cognitive domains. A standardized core set of outcome measures of cognition, also at the level of daily life activities and participation, and international agreement on treatment protocols, could lead to better evaluation of the efficacy of NIBS and comparisons between studies.

Article available in:

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Coconut oil: what do we really know about it so far?

Obviously no one knows a damn thing about it yet, so you are on your own. Start reading. I'm doing some, but I'm not medically trained so don't listen to me.

 

Coconut oil: what do we really know about it so far?

Food Quality and Safety, fyz004, https://doi.org/10.1093/fqsafe/fyz004
Published:
22 April 2019
Article history



In recent years, coconut oil has emerged as a potential ‘miracle’ food. Some media vehicles and health specialists assure that this fat is capable of promoting health benefits, such as weight reduction, cholesterol lowering, prevention of cardiovascular diseases, and anti-inflammatory effect, among others. These claims are used to market the product and boost its sales by coconut oil companies. However, governmental regulatory agencies in many countries are still sceptical about the benefits obtained by the consumption of coconut oil due to its high-saturated fatty acid content. In light of such controversy, this review focused on analysing the published literature on the alleged health claims, in order to investigate if there is enough scientific evidence to support them. It was verified that the metabolism of lauric acid, the major fatty acid in coconut oil, remains unclear. Many studies reported that the product was not efficient in weight loss. Also, it has been reported that the consumption of coconut oil increased low-density lipoprotein cholesterol, consequently increasing the risk of cardiovascular diseases. In general, the studies present conflicting results and there is a lack of long-term human-based clinical trials. Therefore, as a saturated fat, coconut oil should be consumed with moderation and the health allegations should not be used to market the product, once they are not scientifically proven so far.

Introduction

Coconut is one of the most important foods in some tropical and subtropical countries, with the coconut tree being referred as the ‘tree of life’. In such places, coconut and its products (milk and oil, among others) are used in daily life by the general population for several purposes, such as cooking, hair and skin treatment, food ingredient, and folk medicine (DebMandal and Mandal, 2011). This plant is cultivated in more than 90 countries, yielding a total production of 59 million tons in the year of 2016. The production of coconut is heavily located in Asia, which was responsible for 83.8 per cent of the world’s coconut production in 2016. In this same year, Indonesia was the largest coconut producer with 16.6 million tons, followed by the Philippines (14.1 million tons), India (9.8 million tons), Brazil (2.5 million tons), and Sri Lanka (2.2 million tons) (Statista, 2018a).
In recent years, coconut oil (CO), the main coconut product, has attracted the attention of the media and the population worldwide, especially in Europe and North America. Celebrities, digital influencers, and even doctors have endorsed the use of this oil as a cooking media in substitution to other vegetable oils and as a supplementary ingredient to be consumed with coffee and vitamin shakes. Blogs, internet videos, and articles are promoting the consumption of CO based on allegations that this product is capable of bringing several health benefits. These benefits include cholesterol-lowering effect, reduction of the risk of cardiovascular diseases (CVDs), weight loss, improvement of cognitive functions, action as an antimicrobial agent, and others (BBC News, 2018; Medical News Today, 2018; New Straits Times, 2018; SBS, 2018; The Indian Weekender, 2018).
Following this modern trend, the sales of this product have grown. According to Statista (2018b), the consumption of CO in the USA increased by 34 per cent from 2004 to 2014. Many of the CO brands market their product based on the supposed health benefits promoted by its consumption. In their labels, we can find allegations such as ‘good for cooking’ (iHerb, 2018a, iHerb, 2018d, eVitamins, 2018; Piping Rock, 2018; Lucky Vitamin, 2018a), ‘one of nature’s healthiest cooking oils’ (iHerb, 2018b), and ‘easy digestion, generating quick energy, helping the protection and equilibrium of our organism’ (Americanas, 2018; Natumesa, 2018; Lucky Vitamin, 2018b; Lucky Vitamin, 2018c; iHerb, 2018c). Some labels may even suggest the consumption of one tablespoon once to three times a day with a meal (iHerb, 2018b; iHerb, 2018c); others affirm that the consumption of CO is capable of reducing cholesterol levels and the risk of a heart attack, besides of aiding in weight reduction (QualiCôco, 2018; iHerb, 2018c).
At the same time, CO has also been attracting attention from the scientific community with an exponential growth of scientific articles on CO through the years (Figure 1).
Figure 1.
Number of scientific papers about coconut oil through the years. (Scopus, 2018).
Number of scientific papers about coconut oil through the years. (Scopus, 2018).
However, the health-promoting effects of CO are far from reaching a consensus. This may be attributed to the product’s majorly saturated nature, with about 90 per cent of saturated fatty acids in its composition. The excessive ingestion of saturated fatty acids has been positively correlated with the increase of low-density lipoprotein (LDL) cholesterol, with consequent development of CVDs (Eyres et al., 2016). The US Department of Agriculture (USDA) recommends that the daily intake of saturated fat should not surpass 10 per cent of the total calories (USDA, 2015). Likewise, the World Health Organization (WHO) also recommends limiting the intake of saturated fat to a maximum of 10 per cent of the daily total calories (World Health Organization, 2018). On the other hand, the European Food Safety Authority (EFSA), which does not specify a limit for the ingestion of saturated fat, recommends that the intake of saturated fat should be as low as possible (EFSA, 2017).
The American Heart Association, specifically for coconut fat, does not recommend its consumption above the limit established by the USDA for saturated fat intake (Sacks et al., 2017; USDA, 2015). Considering that the fatty acid profile of CO is majorly composed of saturated fatty acids, the consumption of this fat at the established 10 per cent limit in a 2000 kcal diet means that the subject would ingest an amount of approximately 24 g of saturated fat on a daily basis.
As the USDA and the American Heart Association, the EFSA also have issued a scientific opinion on the specific claims about medium-chain fatty acids (MCFAs) as a weight reduction agent. MCFAs account for 62 per cent of CO’s fatty acid composition. The EFSA panel concluded that there is not enough evidence in human intervention studies to support that MCFAs show a positive effect in weight management. The statement concludes that this specific allegation is weak and not convincing (EFSA, 2011).
In Brazil, the fourth largest CO producer, the Brazilian Society of endocrinology and metabolism (SBEM) and the Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO) have also issued a position on the use of CO as a weight loss agent. Both health agencies support that there is not conclusive scientific evidence about this topic. Therefore, the use of CO should be restricted. SBEM and ABESO also do not recommend CO as a cooking media due to its high-saturated fatty acid composition. On the other hand, unsaturated vegetable oils such as soybean oil, olive oil, and canola oil are recommended to diminish the risk of CVDs (SBEM and ABESO, 2015).
The scientific evidence on the supposed benefits of CO should be examined and more information should reach the population. In this review, the chemistry and the processing, as well as the published data on the major and minor health claims attributed to CO by the media, the general public, and the manufacturing companies are presented and discussed.

 

Recognizing the Therapeutic Benefits of Dance

Dancing is great for you.  Where the fuck is your doctors protocol to get you dancing again? Or is your doctor incompetent in that also?

The use of dance in post-stroke rehabilitation Feb. 2018

 

Cognitive Benefits of Social Dancing and Walking in Old Age: The Dancing Mind Randomized Controlled Trial May, 2016

 

Therapeutic Argentine Tango Dancing for People with Mild Parkinson’s Disease: A Feasibility Study July, 2015

 

Feasibility of Delivering a Dance Intervention for SubAcute Stroke in a Rehabilitation Hospital Setting March, 2015

 

New framework for rehabilitation – fusion of cognitive and physical rehabilitation: the hope for dancing Feb. 2015

 

Dancing Makes You Smarter? How Dancing may Prevent Dementia April 2013


The latest here:

 

Recognizing the Therapeutic Benefits of Dance


Dance is a great form of exercise that can also be a great way to stay social–two important lifestyle factors we often cite in our Successful Aging & Your Brain program for maintaining better brain health. But it offers additional therapeutic opportunities for those with movement disorders such as Parkinson’s disease, which can affect functional mobility and mood.
Dance for PD, launched in Brooklyn in 2001, offers specialized dance classes for Parkinson’s patients to address some of the disease’s symptoms. Though small in scale, published peer-reviewed studies on the program have reported improvement in areas such as gait, mobility, and even mood. The popularity of the program has led to its expansion to 25 countries.
Medical treatments and therapies aren’t often something one enjoys, but the creative expression, music, and social connections can make dance therapy seem less like work and more like fun.
Two recent “On the Mind” events I attended, one focused on Parkinson’s disease and the other on Huntington’s disease (another progressive movement disorder), presented research on dance therapy, but also showcased the dance talents of people with those diseases, who went beyond dance classes to join performance groups. In the clip below, Manny Torrijos, who has Parkinson’s, dances with Erin Landers, his partner from the Dnaga dance company, based out of Oakland.
For those who don’t want to join a troupe or dance with a partner, preliminary studies have shown there may be even be benefits to playing Dance Dance Revlolution, an interactive video game that gained popularity in the early 2000s, which choreographs dances for the player to perform (“sight-dance”) on the spot. As I previously reported from the Huntington’s event, Greg Youdan, a PhD. candidate at Columbia University delivered some detail:
Youdan cited a small study with 18 participants with mid-stage HD who played the active video game Dance Dance Revolution as a potential exercise therapy. At the end of six weeks, the participants improved their game scores and also their ability to walk. To top it off, they enjoyed the experiment and wanted to continue playing the game even after the study ended.
So, as we celebrate #International Dance Day today, keep in mind the many benefits that dance can bring, as an art form, cultural expression, exercise, and therapy.
– Ann L. Whitman


Technology-aided assessments of sensorimotor function: current use, barriers and future directions in the view of different stakeholders

Assessments really do nothing for survivors because after you have been assessed as having this problem there is absolutely nothing your therapist can do that will guarantee your recovery. You'll get guidelines and suggestions but nothing concrete.  All in all this is totally useless for survivors.  The only goal for survivors is 100% recovery and this does nothing to get there.

Technology-aided assessments of sensorimotor function: current use, barriers and future directions in the view of different stakeholders

Contributed equally
Journal of NeuroEngineering and Rehabilitation201916:53
  • Received: 8 October 2018
  • Accepted: 27 March 2019
  • Published:

Abstract

Background

There is growing interest in the use of technology in neurorehabilitation, from robotic to sensor-based devices. These technologies are believed to be excellent tools for quantitative assessment of sensorimotor ability, addressing the shortcomings of traditional clinical assessments. However, clinical adoption of technology-based assessments is very limited. To understand this apparent contradiction, we sought to gather the points-of-view of different stakeholders in the development and use of technology-aided sensorimotor assessments.

Methods

A questionnaire regarding motivators, barriers, and the future of technology-aided assessments was prepared and disseminated online. To promote discussion, we present an initial analysis of the dataset; raw responses are provided to the community as Supplementary Material. Average responses within stakeholder groups were compared across groups. Additional questions about respondent’s demographics and professional practice were used to obtain a view of the current landscape of sensorimotor assessments and interactions between different stakeholders.

Results

One hundred forty respondents from 23 countries completed the survey. Respondents were a mix of Clinicians (27%), Research Engineers (34%), Basic Scientists (15%), Medical Industry professionals (16%), Patients (2%) and Others (6%). Most respondents were experienced in rehabilitation within their professions (67% with > 5 years of experience), and had exposure to technology-aided assessments (97% of respondents). In general, stakeholders agreed on reasons for performing assessments, level of details required, current bottlenecks, and future directions. However, there were disagreements between and within stakeholders in aspects such as frequency of assessments, and important factors hindering adoption of technology-aided assessments, e.g., Clinicians’ top factor was cost, while Research Engineers indicated device-dependent factors and lack of standardization. Overall, lack of time, cost, lack of standardization and poor understanding/lack of interpretability were the major factors hindering the adoption of technology-aided assessments in clinical practice. Reimbursement and standardization of technology-aided assessments were rated as the top two activities to pursue in the coming years to promote the field of technology-aided sensorimotor assessments.

Conclusions

There is an urgent need for standardization in technology-aided assessments. These efforts should be accompanied by quality cross-disciplinary activities, education and alignment of scientific language, to more effectively promote the clinical use of assessment technologies.

Trial registration

NA; see Declarations section.

Saturday, April 27, 2019

Cognitive dysfunction predicts worse health-related quality of life for older stroke survivors: A nationwide population-based survey in Taiwan

No solution described so totally worthless.

Cognitive dysfunction predicts worse health-related quality of life for older stroke survivors: A nationwide population-based survey in Taiwan

Aging and Mental HealthKuo LM, et al. | April 18, 2019
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Researchers analyzed a subsample of 592 older stroke survivors in a nationwide population-based survey of cognitive-dysfunction prevalence to examine how cognitive status is correlated with specific/overall health-related quality of life (HRQoL) in these patients in Taiwan. Findings suggest a strong predictive value of dementia and mild cognitive dysfunction for worse overall and specific HRQoL dimensions, especially self-care and usual activities for older stroke survivors. Compared to stroke survivors with normal cognitive function, those with dementia were 5.60 times more likely to have mobility problems, 12.20 times to have self-care problems, 16.61 times to have problems in usual activities, 4.31 times to have pain/discomfort, and 3.28 times to have anxiety/depression; those with mild cognitive dysfunction (MCD) were 2.57 times more likely to have mobility problems, 3.17 times to have self-care problems, 3.31 times to have problems in usual activities, 2.11 times to have pain/discomfort, and 2.35 times to have anxiety/depression.
Read the full article on Aging and Mental Health

ESJ Comment: Therapeutic hypothermia for acute ischaemic stroke. Results of a European multicenter, randomized, phase III clinical trial

All my previous research posts on this suggested no useful intervention. Obviously no protocols were ever written on hypothermia so everyone is still shooting in the dark. The result being that survivors are still screwed with no consequences to the doctors who haven't written up protocols on this. Don't you just love incompetence?

 

ESJ Comment: Therapeutic hypothermia for acute ischaemic stroke. Results of a European multicenter, randomized, phase III clinical trial

Comment by Nicolas Martinez-Majander, Department of Neurology, Helsinki University Hospital, Finland
Original Article: H Bart van der Worp, Malcolm R Macleod, Philip MW Bath et al, 2019. Therapeutic hypothermia for acute ischaemic stroke. Results of a European multicenter, randomized, phase III clinical trial https://journals.sagepub.com/doi/10.1177/2396987319844690
Previous systematic reviews and meta-analyses of animal studies have shown that therapeutic hypothermia is highly effective in reducing infarct size and improving neurological outcome. Hypothermia can affect several ongoing processes in the penumbra, such as counteracting edema, reducing lactacidosis, and inhibiting free radical formation and apoptosis. However, there is only little evidence of therapeutic hypothermia in human stroke.
In this paper of ESJ, van der Worp and colleagues reported results of EuroHYP-1, a European multicentre, randomized, phase III clinical trial which aimed to assess whether modest systemic cooling started within 6 hours of symptom onset could improve functional outcome at three months in awake patients with acute ischaemic stroke. These patients were allocated to hypothermia (target body temperature of 34-35°C either with intravenous infusion or a pre-specified surface cooling method) within 6 h after onset of stroke. Hypothermia was maintained for 12 to 24 hours. The primary outcome was mRS score at 91 days, assessed by independent blinded adjudicators. Although the target sample size was 1500 patients, the trial was stopped after inclusion of 98 patients, at 23 study sites, because of slow recruitment. Of these, 49 were randomized to hypothermia and 49 to control arm. The intention-to-treat analysis showed no difference between the groups (OR for good outcome, 1.01; 95% CI, 0.48-2.13; p=0.97). 38% in the hypothermia group and 29% controls had at least one serious adverse event, such as pneumonia and symptomatic intracranial haemorrhage. Unfortunately however, the final sample was underpowered to detect any benefit or harm of therapeutic hypothermia. Furthermore, in about two thirds of patients randomized to hypothermia, it was not possible to achieve cooling target of body temperature of 34-35 °C, mainly because of shivering and discomfort. As the authors conclude, despite of a well-balanced and robust study protocol, the feasibility of cooling needs to be improved before launching any new trials.
Reference
H Bart van der Worp, Malcolm R Macleod, Philip MW Bath et al, 2019. Therapeutic hypothermia for acute ischaemic stroke. Results of a European multicenter, randomized, phase III clinical trial. European Stroke Journal. DOI: 10.1177/2396987319844690 https://journals.sagepub.com/doi/10.1177/2396987319844690