Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 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.

Tuesday, May 5, 2020

Opposing Associations of Stress and Resilience With Functional Outcomes in Stroke Survivors in the Chronic Phase of Stroke: A Cross-Sectional Study

Of course stroke survivors are under massive amounts of stress. Your doctors have practically nothing to help you get fully recovered. S/he doesn't even have 100% recovery as a goal.

Here is an abbreviated list of stressors;

1. 30% get spasticity NOTHING THAT WILL CURE IT.

2. At least half of all stroke survivors experience fatigue Or is it 70%?

Or is it 40%?

NOTHING THAT WILL CURE IT.

3. Over half of stroke patients have attention problems.

NOTHING THAT WILL CURE IT.

4.  The incidence of constipation was 48%.

NO PROTOCOLS THAT WILL CURE IT.

5. No EXACT stroke protocols that address any of your muscle limitations.

6. Post stroke depression(33% chance)

NO PROTOCOLS THAT WILL ADDRESS IT. 

7.  Post stroke anxiety(20% chance) NO PROTOCOLS THAT WILL ADDRESS IT. 

8. Posttraumatic stress disorder(23% chance)  NO PROTOCOLS THAT WILL ADDRESS IT.

  9.  12% tPA efficacy for full recovery NO ONE IS WORKING ON SOMETHING BETTER.

10.  10% seizures post stroke NO PROTOCOLS THAT WILL ADDRESS IT. 

11. 21% of patients had developed cachexia NO PROTOCOLS THAT WILL ADDRESS IT. 

 

12. You lost 5 cognitive years from your stroke  NO PROTOCOLS THAT WILL ADDRESS IT.

13.  33% dementia chance post-stroke from an Australian study?

       Or is it 17-66%?

       Or is it 20% chance in this research?

NO PROTOCOLS THAT WILL ADDRESS THIS 

Look at this list and tell me who wouldn't be stressed out knowing that normal life will never come back?

 The latest here:

Opposing Associations of Stress and Resilience With Functional Outcomes in Stroke Survivors in the Chronic Phase of Stroke: A Cross-Sectional Study

Prajwal Gyawali1,2,3, Wei Zhen Chow1,2,3, Madeleine Hinwood2,4, Murielle Kluge1,2, Coralie English2,3,5,6, Lin Kooi Ong1,2,3,7, Michael Nilsson1,2,3,5† and Frederick Rohan Walker1,2,3,5*†
  • 1School of Biomedical Sciences and Pharmacy and Priority Research Centre for Stroke and Brain Injury, The University of Newcastle, Callaghan, NSW, Australia
  • 2Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
  • 3NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Heidelberg, VIC, Australia
  • 4School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
  • 5Centre for Rehab Innovations, The University of Newcastle, Callaghan, NSW, Australia
  • 6School of Health Sciences, University of Newcastle, Callaghan, NSW, Australia
  • 7School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
Stroke survivors report significant levels of psychological distress post stroke. To date, most studies conducted have focused on the relationship between psychological stress and functional outcomes in the acute phase of stroke. However, no studies had considered the role of stress over the chronic phase, where stress may continue to exert negative effects on cognitive and psychological processes. Further, the role of potentially modulatory variables, such as psychological resilience, on stroke outcomes has been understudied. The purpose of this study was to consider the relationships between stress and resilience with functional outcomes in long-term survivors of stroke. People (N = 70) who had experienced a stroke between 5 months and 28 years ago were included in the cross-sectional study, along with age-matched controls (N = 70). We measured stress using both the Perceived Stress Scale and biological markers, and resilience using both the Brief Resilience Scale and the Connor-Davidson Resilience Scale. Stroke outcomes were assessed using the Stroke Impact Scale. We found that, compared with age-matched controls, stroke survivors reported greater levels of perceived stress, and lower levels of resilience. In stroke survivors, both perceived stress and resilience were independently associated with stroke outcomes in linear regression models. In particular, these relationships were observed for cognitive outcomes including mood, memory, and communication. The association between stress and stroke outcome did not differ across time post stroke. Given that resilience is a modifiable psychological construct, future research may consider whether strategies directed at enhancing resilience may improve recovery from stroke.
Australia and New Zealand Clinical Trials Registry: ACTRN12617000736347.

Introduction

Psychological stress refers to the negative emotional states generated when an individual perceives that they do not have the resources to cope with or respond to a threat, whether that threat is real or imagined (1). When stress is experienced repeatedly, or is severe and persistent in nature, it is almost always associated with negative health outcomes. For instance, chronic stress has been found to precede the development of depression, anxiety, diabetes, and cardiovascular disease, as well as contribute other poor health outcomes such as immunosuppression, fatigue, apathy, and emotional lability (2–4). Psychological stress is therefore a likely modulator of long-term cognitive changes associated with stroke.
To date the investigation of stress in stroke survivors has been relatively limited, with a particular emphasis given over to considering stress levels within ~12 months of infarction. Several studies have identified that greater levels of perceived stress in the hyper-acute (+72 h post-stroke) and acute (14 days post-stroke) periods post-stroke were associated with worse outcomes (5, 6). Over a longer time frame, Ostwald et al. identified a relationship between self-reported stress, using the ten-item Perceived Stress Scale (PSS-10), and functional outcomes at 3, 6, 9, and 12 months post-stroke (7). Each item on the PSS-10 is rated on a 5-point scale (0 = never to 4 = very often), with an overall range of 0–40, with a higher score signifying a higher level of stress. The authors noted that mean PSS scores were ~12 (SD ~7) at discharge and declined slightly across the first 12 months, and that function was a significant predictor of stress levels for stroke survivors. Similarly, Dos Santos et al., followed 56 stroke survivors for 6 months following discharge, and observed a strong relationship between the levels of functional independence and perceived stress (8). A recent systematic review of 48 studies showed that elevated cortisol, a stress biomarker, is associated with increased dependency, morbidity, and mortality post-stroke (9). Although these studies have examined relationships between stress and broad functional stroke outcomes for up to 24 months post-stroke, increasing survival rates mean that stroke survivors may live for several decades following stroke onset. Knowledge around the impact of stress over these longer time frames remains limited.
The impact of stress post-stroke on cognitive and psychological outcomes in particular has been less well-characterized. Recently, however, the published results of the Tel Aviv Brain Acute Stroke Cohort (TABASCO) study examining a number of predictors for post-stroke outcomes are notable. In a prospective characterization of 182 stroke survivors, the study authors observed that levels of bedtime salivary cortisol levels immediately post-stroke (N = 182), and hair cortisol levels (used as an index of persistent stress) at 6, 12, and 24 months post-stroke (N = 65), were associated with significantly poorer cognitive function at these same time points (10, 11).
Collectively, those studies that have examined the impact of stress on outcomes post-stroke suggest that perceived stress and stress biomarkers predict worse cognitive, functional, and dependency status. There are, however, several components of the relationship between stress and cognition that have yet to be characterized, in particular the influence of resilience, a well-recognized modulator of stress. Apart from having purely theoretical interest, the relationship between stress, resilience, and stroke outcomes is a salient as there are several well characterized resilience building strategies available that could be deployed to modulate the negative effect of stress on outcomes (12).
Resilience is often defined as the ability to “bounce back” after experiencing a stressful or otherwise challenging event (13), or to adapt quickly and effectively to stress (14). There is a strong delineation between the common cognitive changes after stroke and the skills required for resilience. For example, increased rates of emotional lability, anxiety, depression, and poor communication skills are all common outcomes post-stroke (15–17). In contrast, traits such as emotional stability, optimism, self-regulation, problem solving skills, and effective communication are associated with resilience (12, 18). Resilience and changes in resilience post-stroke may explain variability in cognitive symptoms post-stroke.
The inverse relationship between stress and resilience has led to the hypothesis that the qualities that contribute to resilience may be capable of limiting the intensity of stress and in doing so mitigate many of the associated negative health outcomes (18). Resilience and vulnerability to stress is one of the most important topics in the field of stress research, and offers a potential point of intervention that will improve the rehabilitation of individuals after stroke (19).
The overall aim of this study was to examine stress levels in community-dwelling stroke survivors in the chronic phase of recovery from stroke, and consider the potential relationship between stress, resilience and a number of stroke outcomes during this period. Specifically, it was hypothesized that stroke survivors in the chronic phase of stroke will have higher levels of perceived stress and stress biomarkers than age matched controls; that higher stress levels will be associated with worse cognitive and emotional outcomes on the Stroke Impact Scale (SIS); and that greater levels of resilience will be associated with better cognitive and emotional outcomes on the SIS. We also explore whether the relationship between stress and cognitive or emotional outcomes is affected by time post stroke. This cross-sectional study was reported in accordance with the STROBE guidelines for reporting observational studies (20).

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