FDA-Approved Device Will Help Stroke Victims Regain Use Of Hands

 A friend sent me this, but here is a transcript, much better to read it than listen to it. This could possibly help me.

FDA-Approved Device Will Help Stroke Victims Regain Use Of Hands

May 27, 20215:11 AM ET

Heard on Morning Edition

Jon Hamilton

Stroke patients who are struggling to regain the use of a hand will soon have access to a new FDA-cleared device that uses signals from the undamaged part of the brain to retrain the injured limb.

RACHEL MARTIN, HOST:

The Food and Drug Administration has authorized a device that can help stroke patients regain the use of a disabled hand. The device uses signals from the uninjured side of a patient's brain. NPR's Jon Hamilton has more.

JON HAMILTON, BYLINE: On a winter night in 2015, Mark Forrest started feeling bad. He thought it was his blood sugar. His wife, Patti, realized he was having a stroke.

MARK FORREST: So we called 911, and off to the hospital I went. And by the time I got there, most of my right side was paralyzed.

HAMILTON: Including his right hand. And more than six months after his stroke, Forrest was still struggling to pull on his socks and button his shirts. What he missed the most, though, was fishing for bass in the rivers and lakes near St. Louis.

M FORREST: I mean, I'm a die-hard fisherman, so that really hurt for me not to be able to do that.

HAMILTON: Forrest even tried cutting down a fishing pole so he could hold it with his left hand, but his right hand wouldn't reel in the line. So he kept working with a physical therapist, month after month, until he got really frustrated.

M FORREST: I said, how much more am I going to improve? She says, I don't think you're going to improve hardly at all.

PATTI FORREST: That was tough.

M FORREST: And that was hard for me to take.

HAMILTON: Around that time, Forrest started talking to Dr. Eric Leuthardt, a brain surgeon at Washington University in St. Louis. For many years, Leuthardt had been puzzled by something he often heard from patients.

ERIC LEUTHARDT: If you talk to a stroke patient, they can imagine moving their hand, they can try to move their hand, but they just can't actually move it.

HAMILTON: So Leuthardt had been looking for the source of those thoughts and he found them in a surprising place - the side of the brain that had not been injured by the stroke.

LEUTHARDT: So now we're starting to look at signals being generated on the opposite side of the brain, where there's still kind of the intent to move and it's present.

HAMILTON: Leuthardt and his team were able to build a device that used those signals to control a robotic exoskeleton. The device could open and close a patient's disabled hand for them. But a mechanical hand wasn't Leuthardt's ultimate goal. He wanted to help his patients regain the ability to move their own hand, and that meant answering a question.

LEUTHARDT: If somebody can generate a brain signal that's associated with their desire to move, and the exoskeleton moves it so they're getting feedback, can we use this device that controls their affected limb to essentially encourage the brain to rewire?

HAMILTON: Early experiments suggested the approach worked. Leuthardt says video of one man showed him initially trying and failing to grasp a marble and place it on a shelf.

LEUTHARDT: Then, after six weeks of training, you see his hand - it's not perfect, but he's more dexterous. He can pick up that marble and he can move it on top of the shelf.

HAMILTON: Leuthardt had founded a company called Neurolutions to develop the technology. Its CEO is Leo Petrossian, a brain scientist with a business degree.

LEO PETROSSIAN: I got involved specifically to help take something that was great in clinical studies and figure out how we can now bring this out to the million-plus people in the United States living with disability post-stroke.

HAMILTON: Petrossian says the conventional wisdom is that most recovery from a stroke takes place in the first 90 days or so.

PETROSSIAN: So if it's day 100 and a person can't move their arm very well, that's how their arm's going to be for the rest of their life.

HAMILTON: The company began developing a system to challenge that sort of thinking. It included a headset that analyzes brain signals, a tablet computer and a robotic exoskeleton worn over the patient's wrist and hand. Petrossian says they began trying prototypes on patients who got better.

PETROSSIAN: If you spend an hour a day doing this exercise of thinking and visualizing opening and closing a hand, five days a week for 12 weeks, you retrain a different part of the brain to drive that previously disabled appendage.

HAMILTON: Mark Forrest, the die-hard fisherman, tested several different versions of the device called IpsiHand. He often spent several hours a day working to open and close his hand with the exoskeleton's help. His wife, Patti Forrest, says by this time, more than a year had passed since the stroke and other therapies had stopped helping.

P FORREST: But with this, he was making great strides. Like, all of a sudden, he could touch his index finger with his thumb and he would be like, whoa. And so it was much bigger gains in a shorter period of time.

HAMILTON: Mark Forrest decided to test his new dexterity by building a fishing boat. Dealing with the tiny screws was still a challenge, and his friends kept joking that the homemade boat was going to sink.

M FORREST: It didn't. I built a really nice one; it's got wheels on the bottom of it, so it rolls in and out of the water.

HAMILTON: Forrest put the boat in the water for the first time in March, and he discovered that he had regained the ability to reel in a fishing line with his right hand.

M FORREST: We sat and fished for five hours on that boat and probably every cast, every other cast, we were catching fish.

HAMILTON: In April, the FDA OK'd the IpsiHand for people recovering from a stroke, even if it occurred years earlier. Neurolutions is gearing up to manufacture the device and expects it to be on the market in a matter of months.

Jon Hamilton, NPR News.

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Predicting functional motor potential in chronic stroke patients using diffusion tensor imaging

Providing no protocols that will recover this predicted motor potential, THIS IS ABSOLUTELY FUCKING USELESS. 

Predicting functional motor potential in chronic stroke patients using diffusion tensor imaging

 2012, Human Brain Mapping
 Robert Lindenberg,1*
 Lin L. Zhu,1
Theodor Ru¨ber,1,2
and Gottfried Schlaug 1*
1 Department of Neurology, Neuroimaging and Stroke Recovery Laboratories, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
2 Department of Epileptology, Bonn University Hospital, Bonn, Germany
r r

Abstract:

 Electrophysiological and neuroimaging studies suggest that the integrity of ipsilesional andinter-hemispheric motor circuits is important for motor recovery after stroke. However, the extent towhich each of these tracts contributes to the variance in outcome remains unclear. We examined whether diffusion tensor imaging (DTI)-derived measures of corticospinal and transcallosal tracts predict motor improvement in an experimental neurorehabilitation trial. 15 chronic stroke patients received bihemispheric transcranial direct current stimulation and simultaneous physical/occupational therapy for five consecutive days. Motor impairment was assessed prior to and after the intervention.At baseline, the patients underwent DTI; probabilistic fiber tracking was used to reconstruct the pyramidal tract (PT), alternate descending motor fibers (aMF), and transcallosal fibers connecting primary motor cortices (M1-M1). Ipsilesional corticospinal tracts (PT, aMF) and M1-M1 showed significantly decreased fractional anisotropy (FA) and increased directional diffusivities when compared to age-matched healthy controls. Partial correlations revealed that greater gains in motor function were related to higher FA values and lower directional diffusivities of transcallosal and ipsilesional corticospinal tracts. M1-M1 diffusivity had the greatest predictive value. An additional slice-by-slice analysis of FA values along the corticospinal tracts demonstrated that the more the ipsilesional FA profiles of patients resembled those of healthy controls, the greater their functional improvement. In conclusion,our study shows that DTI derived measures can be used to predict functional potential for subsequent motor recovery in chronic stroke patients. Diffusivity parameters of individual tracts and tract combinations may help in assessing a patient’s individual recovery potential and in determining optimal neurorehabilitative interventions.
 Hum Brain Mapp 00:000–000, 2011
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 2011 Wiley-Liss, Inc.

Benchmarking the Extent and Speed of Reperfusion: First Pass TICI 2c-3 Is a Preferred Endovascular Reperfusion Endpoint

THIS is the whole problem in stroke. An endpoint of reperfusion, NOT RECOVERY! Will you talk to survivors sometime? They don't give a shit about reperfusion, it's only an intermediate step to recovery. What are the rest of the protocols to get to 100% recovery?

Benchmarking the Extent and Speed of Reperfusion: First Pass TICI 2c-3 Is a Preferred Endovascular Reperfusion Endpoint

Albert J. Yoo^1*, Jazba Soomro¹, Tommy Andersson^2,3, Jeffrey L. Saver⁴, Marc Ribo⁵, Hormozd Bozorgchami⁶, Guilherme Dabus⁷, David S. Liebeskind⁸, Ashutosh Jadhav⁹, Heinrich Mattle¹⁰ and Osama O. Zaidat¹¹ on behalf of ARISE II Investigators

• ¹Department of Neurointervention, Texas Stroke Institute, Fort Worth, TX, United States
• ²Neuroradiology, Karolinska University Hospital, Clinical Neuroscience Karolinska Institutet, Stockholm, Sweden
• ³Medical Imaging, Allgemeine Ziekenhuis Groeninge, Kortrijk, Belgium
• ⁴Department of Neurology, University of California, Los Angeles, Los Angeles, CA, United States
• ⁵Stroke Unit, Department of Neurology, Vall D'Hebron University Hospital, Barcelona, Spain
• ⁶Department of Neurology, Oregon Health and Science University Hospital, Portland, OR, United States
• ⁷Department of Interventional Neuroradiology, Miami Cardiac and Vascular Institute at Baptist Hospital of Miami, Miami, FL, United States
• ⁸Department of Neurology, Neurovascular Imaging Research Core and Stroke Center, University of California, Los Angeles, Los Angeles, CA, United States
• ⁹Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
• ¹⁰Department of Neurology, Inselspital, University of Bern, Bern, Switzerland
• ¹¹Mercy St. Vincent Medical Center, Toledo, OH, United States

Background and Purpose: End-of-procedure substantial reperfusion [modified Treatment in Cerebral Ischemia (mTICI) 2b-3], the leading endpoint for thrombectomy studies, has several limitations including a ceiling effect, with recent achieved rates of ~90%. We aimed to identify a more optimal definition of angiographic success along two dimensions: (1) the extent of tissue reperfusion, and (2) the speed of revascularization.

Methods: Core-lab adjudicated TICI scores for the first three passes of EmboTrap and the final all-procedures result were analyzed in the ARISE II multicenter study. The clinical impact of extent of reperfusion and speed of reperfusion (first-pass vs. later-pass) were evaluated. Clinical outcomes included 90-day functional independence [modified Rankin Scale (mRS) 0–2], 90-day freedom-from-disability (mRS 0–1), and dramatic early improvement [24-h National Institutes of Health Stroke Scale (NIHSS) improvement ≥ 8 points].

Results: Among 161 ARISE II subjects with ICA or MCA M1 occlusions, reperfusion results at procedure end showed substantial reperfusion in 149 (92.5%), excellent reperfusion in 121 (75.2%), and complete reperfusion in 79 (49.1%). Reperfusion rates on first pass were substantial in 81 (50.3%), excellent reperfusion in 62 (38.5%), and complete reperfusion in 44 (27.3%). First-pass excellent reperfusion (first-pass TICI 2c-3) had the greatest nominal predictive value for 90-day mRS 0–2 (sensitivity 58.5%, specificity 68.6%). There was a progressive worsening of outcomes with each additional pass required to achieve TICI 2c-3.

Conclusions: First-pass excellent reperfusion (TICI 2c-3), reflecting rapid achievement of extensive reperfusion, is the technical revascularization endpoint that best predicted functional independence in this international multicenter trial and is an attractive candidate for a lead angiographic endpoint for future trials.

Clinical Trial Registration: http://www.clinicaltrials.gov, identifier NCT02488915.

Introduction

The current consensus statement-endorsed benchmark for procedural success after intra-arterial stroke therapy (IAT) is procedure end substantial reperfusion [modified Treatment in Cerebral Ischemia (mTICI) score of 2b or higher], defined as the restoration of anterograde tissue perfusion in more than 50% of the target downstream territory (1, 2). The impressive clinical benefits observed in recent thrombectomy trials reflected improved reperfusion with second generation devices, most notably stent retrievers (3, 4). Since these pivotal trials, there has been a further increase in reported rates of substantial reperfusion (5). In the recent ARISE (Analysis of Revascularization in Ischemic Stroke with EmboTrap) II study, the core lab-adjudicated TICI 2b-3 rate at procedure end was 92.5% (6).

However, there are considerable limitations to using the rate of TICI 2b-3 as a lead technical efficacy endpoint for IAT trials. First, this endpoint counts moderate reperfusion as a success, but when reperfusion is only 50–90% achieved, substantial tissue volumes remain in jeopardy. Second, the outcome of TICI 2b-3 is considered a success regardless of the number of passes required to achieve it, but maximal benefit is likely to be conferred by first-pass success, thus reducing ischemia duration (7). Third, the high rate of TICI 2b-3 seen with modern endovascular technology results in a ceiling effect, making the measure insensitive to further improvements in endovascular technique. Accordingly, a reevaluation of the optimal angiographic endpoint is necessary.

Using core-lab adjudicated data from ARISE II, we aimed to assess the clinical impact of the first-pass effect (FPE) and to identify the optimal definition of angiographic success along two dimensions: (1) the extent of tissue reperfusion, and (2) the speed of revascularization.

More at link.

 

Effect of RehaCom cognitive rehabilitation software on working memory and processing speed in chronic ischemic stroke patients

But you don't tell us how many years of cognitive ability are recovered, that is the goal, recover 5 years. So your research was useless.

You 5 lost years of brain cognition from your stroke!

 The latest here:

Effect of RehaCom cognitive rehabilitation software on working memory and processing speed in chronic ischemic stroke patients

Sanaz Amiri , MSc, Peyman Hassani-Abharian , Ph.D., Salar Vaseghi , Ph.D., Rouzbeh Kazemi , Ph.D. & Mohammad Nasehi , Ph.D.

Received 17 Feb 2020, Accepted 20 May 2021, Accepted author version posted online: 25 May 2021

• Download citation
• https://doi.org/10.1080/10400435.2021.1934608

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Accepted author version

Abstract

Stroke survivors need assistance to overcome cognitive impairments. Working memory (WM) and processing speed (PS) as two critical cognitive functions are disrupted by stroke. The goal of this study was to investigate the effect of RehaCom rehabilitation software on WM and PS in participants with chronic ischemic stroke with hemiplegia (right/left side). Participants were selected among stroke patients who were referred to our special rehabilitation clinic. Fifty participants were assigned to control (n = 25) and experimental (n = 25) groups. The results of the experimental group were compared with the control group before and after the treatment with RehaCom (ten 45-min sessions across five weeks, two sessions per week). The results showed a significant improvement in WM and PS in the experimental group in comparison with the control group after a 5-week training with RehaCom. In conclusion, our findings indicate that treatment with RehaCom software improves WM and PS in chronic ischemic stroke participants with hemiplegia. The exact mechanism of RehaCom is largely unknown and further studies are needed, but its effects on the function of brain regions involved in modulating cognitive functions such as the prefrontal cortex, cingulate cortex, and parietal cortex may be mechanisms of interest.

 

Effects of Motor Imagery as a Complementary Resource on the Rehabilitation of Stroke Patients: A Meta-Analysis of Randomized Trials

But is action observation better than motor imagery? You didn't even give us a preliminary protocol so this was useless research. But you punted and asked for further research.  

• action observation (110 posts to January 2013)

Effects of Motor Imagery as a Complementary Resource on the Rehabilitation of Stroke Patients: A Meta-Analysis of Randomized Trials

Author links open overlay panelKarullyny BarretoMonteiro^⁎Márcia dos SantosCardoso^⁎Vanessa Rodrigues da CostaCabral^⁎Andressa Oliveira Barros dosSantos^†‡Paula Soares daSilva^⁎Juliana Brandão Pinto deCastro^†‡

Rodrigo Gomes de SouzaVale^⁎†‡§

https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.105876Get rights and content

Abstract

Background

Stroke is the second leading cause of death and a leading cause of disability worldwide. Motor imagery is a technique that can be utilized in the rehabilitation process to improve the lives of patients with a functional disability acquired by this pathology.

Aim

To evaluate the effects of motor imagery as a complementary intervention for the rehabilitation of stroke patients.

Methods

We conducted a systematic review in MEDLINE/PubMed, Scopus, Web of Science, and PEDro databases. We included randomized controlled trials (RCTs) that used motor imagery as a complementary resource for the rehabilitation of patients affected by stroke, who had motor function and functional independence as outcomes.

Results

Of the 1,473 studies found, ten RCTs were included. Regarding the interventions, motor imagery was associated with traditional rehabilitation, virtual reality, physical practice, structured progressive circuit class therapy, and electromyography. The upper and lower extremity performance were accessed through the Fugl-Meyer Assessment (FMA) and gait speed, respectively. Although the practice of motor imagery at least twice a week during three weeks showed to be effective in improving the motor performance of post-stroke patients, the studies’ protocols present a high heterogeneity, with training session times lasting between 30 to 180 minutes and a post-stroke invention window of one to 12 months.

Conclusions

Motor imagery has been shown to be an efficacious technique in the treatment of post-stroke patients when used as a complement to traditional rehabilitation techniques. However, greater standardization of interventions and studies with higher methodological quality are required to determine further conclusions.

 

 

The Need for a Global Neurology Alliance

I guess stroke survivors are about as useless as a laboratory rat.  I see nothing here that is going to help stroke survivors. With no mention of creating a strategy to solve stroke or any neurological disease just putting together these impressive initials will do nothing, but I guess that is the point; 'All hat, no cattle'.

This just proves once again what Amy Farber has to say. For the past five years Farber has been battling not only her own disease but also the wall of resistance erected by those who believe that a patient can make about as much of a meaningful contribution to the process of scientific discovery as a laboratory rat.

The Need for a Global Neurology Alliance 

Original article by W. (Bill) M. Carroll, MB, BS, MD, FRACP, FRCP(E) published 7 June 2017 in World Neurology Vol 32 No. 3

---

William Carroll, MD

Recently, there has been an explosion of health awareness recognised by individuals, nations, and the global community. The decade of the brain was followed by the human genome project, accompanied by the near eradication of malaria and polio. Yet, we now stand at the threshold of even more rapid advances on many fronts.

3-D printing of the human heart is being used in planning cardiac surgery. Next-genome sequencing is revolutionising old concepts of disease. Gene therapy shows success in some inherited neuropathies (spinal muscular atrophy) and myopathies (Duchenne muscular dystrophy). Precision medicine is no longer an aspiration in some diseases and countries, and the ability to use publicly accessible data via expanding cloud technologies is yielding unexpected information and the repurposing of medications. Conversely, the cost of drug development, especially in bringing them to market, is becoming prohibitive, exacerbating the accessibility of therapies in many countries.

For the thoughtful and the less fortunate, it is obvious that the developing progress, while exciting and to be celebrated, is creating problems that need to be addressed. The increasing burden of non-communicable diseases (NCD) adds up to what can only be viewed as a potential tsunami for the economies of the world. These NCDs include mental (neurological) and substance-abuse disorders; musculoskeletal disorders; neurodegenerative conditions such as dementia, stroke and Parkinson's disease; poor lifestyle choices in diet and exercise; and the effects of unhealthy environments¹ together with the changing demographic of ageing populations in so-called developed countries.

Those people and countries least able to afford the advances and/or mobilize services to adjust to them will see a widening gap, not only in these areas of disease but also in their ability to respond to the periodic recrudescence of infectious disease. This was seen with the outbreaks of Ebola, MERS, SARS, and, most recently, the Zika emergency. It is not by chance that the recent waves of mass migration have occurred as much because people seek better lifestyles (and health services) as fleeing armed conflict.

It is in this environment that those in the neurological fraternity need to mobilize and prepare measures at a number of levels that will mitigate the consequences of these changes. To begin, we must look at the magnitude of the problems facing us. Then, we will evaluate the resources we have available. Finally, we will view three illustrations of how those resources can be optimised to provide the organizational readiness for rapid and effective action as well as long-term planning on a national, regional, and global scale.

The Problem

The global burden of neurological disease figures as a relatively small fraction of the global burden of all disease (GBD) for a range of reasons². Although not included in the WHO 2014 global status report on NCDs³, stroke and dementia are of major concern to clinicians and national health systems.

The annual stroke toll is approximately 15 million, with one-third being fatal and another third permanently disabling. Indeed, stroke mortality is double that of HIV/AIDS, malaria, and tuberculosis combined, emphasising the rising burden of brain NCDs. With rates of dementia estimated to triple from 47.5 million to 115 million worldwide by 2050^4, it is clear that the world faces a rising impost on resources.

Currently, the total burden of mental, neurological, and substance abuse (MNS) is now reckoned to be 258 million disability-adjusted life years — a measure of overall disease burden expressed as the number of years lost due to ill health, disability, or early death. That is up from 182 million in 1990, which has been equated to a $8.5 trillion (U.S.) loss of economic value now, and which will increase again by a factor of two by 2030⁵.

With the addition of other NCDs to stroke and dementia, it is clear that the world neurological fraternity must act in concert and alert governments. Those other NCDs include age-related Parkinson's disease and other chronic neurodegenerative disease, perinatal injury largely due to asphyxia, childhood developmental and degenerative disease, schizophrenia, high levels of traumatic brain disease, all causes of epilepsy, substance and alcohol abuse, and rising neuroinflammatory disease of the brain and spinal cord.

While world neurological expertise has been steadily advancing partly in parallel with the recognition of the increasing challenges on the horizon and partly with the advances in medical science, it is far from equitably distributed. When the widening gap between well-developed countries with comprehensive health care and those less developed populations and health care systems is appreciated, the likelihood for an emergency is evident⁶.

Resources

There are a number of valuable resources available. These include measures of the GBD and specific problem areas, such as the NCDs, BNCDs, and MNSs, as well as WHO monitoring for more acute challenges to health through national health departments and WHO's regional structural organization. (The WHO regional organization mirrors approximately that of the WFN). The periodic assessments of the GBD by the WHO and the Atlas of Neurology (a joint WHO-WFN project) provide the broad sweep, big picture view of resources and needs.

The WFN itself plays an important and growing role in the equalisation of access to neurological care both through regional organization support and neurological education. The establishment of the African Academy of Neurology (AFAN) and its first meeting in Tunis this year are illustrative. It joins the expanding roles of other WFN regional organizations, including the Pan American Federation of Neurological Societies (PAFNS), the Australasian and Oceanian Association of Neurology (AOAN), the Pan Arab Union of Neurological Societies (PAUNS), the American Academy of Neurology (AAN), and the European Academy of Neurology (EAN).

Neurological training, the improvement in access to neurological care, and an increasing awareness of the importance of brain health in the general population are furthered by World Brain Day (WBD)⁷ and the biennial World Congress of Neurology (WCN). The WFN, in partnership with AFAN, has followed the World Federation of Neurosurgical Societies (WFNS) program to train young African specialists. The WFN plans to have four regional training centers in Africa — two each for the Francophone and Anglophone regions. Additional emphasis of WFN involvement at a global level was given by WFN President Raad Shakir as chair of the Neurosciences Topic Advisory Group for the WHO-sponsored International Classification of Disease (ICD-11), due for release in 2018.

More generally, other areas are developing, which will enhance the ability to respond to challenges. Increasingly rapid communication through electronic media, including social media, draws attention to emerging problems. The maturation and expanding expertise of neurological subspecialties and their involvement in wider educational activities (e.g. the International League Against Epilepsy, the World Stroke Organization, and the Movement Disorders Society) as well as the added interest of the larger regional neurological organizations, such as the AAN and EAN, provide a rich resource of intellectual and monetary capital.

Over the last few years, the WFN has provided a focal point for those involved in the medical care of neurological disease through two similar, though importantly different, groups. The first is the World Brain Alliance (WBA). Originally chaired by Vladimir Hachinski, MD, when he was WFN president, it is now chaired by Dr. Shakir. The WBA members include, in addition to the WFN, global organizations that usually do not include neurologists, such as the WFNS, the International Brain Research Organization (IBRO), the World Psychiatric Association (WPA), the International Child Neurology Association (ICNA), and the World Federation of Neurorehabilitation (WFNR). The second group is the Global Neurology Network (GNN) for which the WFN is the current convener and whose members mainly include neurological disease-specific organizations from around the world. Many were originally part of the WFN but have grown to be independent organizations. They include the World Stroke Organization (WSO), the International League Against Epilepsy (ILAE), the Multiple Sclerosis International Federation (MSIF), the Treatment and Research in Multiple Sclerosis (TRIMS) Group, Alzheimer's Disease International, the Movement Disorder Society, the International Headache Society, the International Society for Clinical Neurophysiology, the Peripheral Nerve Society, and the Tropical Disease Group. Closely associated with this category of disease-specific organizations are both large regional organizations supporting all neurological subspecialties, such as the AAN and the EAN, and the smaller WFN-affiliated regional organizations, such as the AOAN, PAUNS, PAFNS, and AFAN.

Together, these two groups create an impressive global alliance of neurological expertise. It is an alliance appropriately suited to provide global disease-specific advice to international organizations, such as the WHO and the U.N., and to advocate with these organizations and national governments. It is an alliance worthy of the term Global Neurology Alliance.

 

Circadian rhythm of ischaemic core progression in human stroke

You will soon need to have the stroke at the correct time along with having the classic stroke symptoms so you get diagnosed correctly as having a stroke. Your responsibility, not your doctor's responsibility to have the protocols in place to treat any size stroke at any time. You don't want to burden your doctors with having to prepare for any stroke eventuality.

 Circadian rhythm of ischaemic core progression in human stroke

1. Paul Reidler1,
2. Alex Brehm2,
3. Peter B. Sporns2,3,
4. Vanessa Granja Burbano4,
5. Lena Stueckelschweiger1,
6. http://orcid.org/0000-0002-7575-9850Gabriel Broocks3,
7. Thomas Liebig5,
8. Marios-Nikos Psychogios2,
9. Jens Ricke1,
10. Konstantinos Dimitriadis4,6,
11. Martin Dichgans4,7,8,
12. Wolfgang G. Kunz1,
13. http://orcid.org/0000-0002-8817-8457Steffen Tiedt4,8

1. Correspondence to Dr Steffen Tiedt, Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany; steffen.tiedt@med.uni-muenchen.de

Abstract

Introduction Experimental stroke studies suggest an influence of the time of day of stroke onset on infarct progression. Whether this holds true after human stroke is unknown, but would have implications for the design of randomised controlled trials, especially those on neuroprotection.

Methods We pooled data from 583 patients with anterior large-vessel occlusion stroke from three prospectively recruited cohorts. Ischaemic core and penumbra volumes were determined with CT perfusion using automated thresholds. Core growth was calculated as the ratio of core volume and onset-to-imaging time. To determine circadian rhythmicity, we applied multivariable linear and sinusoidal regression analysis adjusting for potential baseline confounders.

Results Patients with symptom onset at night showed larger ischaemic core volumes on admission compared with patients with onset during the day (median, 40.2 mL vs 33.8 mL), also in adjusted analyses (p=0.008). Sinusoidal analysis indicated a peak of core volumes with onset at 11pm. Core growth was faster at night compared with day onset (adjusted p=0.01), especially for shorter onset-to-imaging times. In contrast, penumbra volumes did not change across the 24-hour cycle.

Discussion These results suggest that human infarct progression varies across the 24-hour cycle with potential implications for the design and interpretation of neuroprotection trials.

http://dx.doi.org/10.1136/jnnp-2021-326072

 

d-dimer Level as a Predictor of Recurrent Stroke in Patients With Embolic Stroke of Undetermined Source

Useless. This prediction does absolutely no good without a protocol implemented that will alleviate this risk.  The reason for stroke research is to help stroke survivors or actually prevent strokes. This does neither.  What were the mentors and senior researchers thinking? 

d-dimer Level as a Predictor of Recurrent Stroke in Patients With Embolic Stroke of Undetermined Source

Kang-Ho Choi

,

Ja-Hae Kim

,

Jae-Myung Kim

,

Kyung-Wook Kang

,

Changho Lee

,

Joon-Tae Kim

,

Seong-Min Choi

,

Man-Seok Park

,

Ki-Hyun Cho

Originally published11 May 2021https://doi.org/10.1161/STROKEAHA.120.033217Stroke. ;0:STROKEAHA.120.033217

Abstract

Background and Purpose:

This study aimed to investigate the value of d-dimer levels in predicting recurrent stroke in patients with embolic stroke of undetermined source. We also evaluated the underlying causes of recurrent stroke according to d-dimer levels.

Methods:

A total of 1431 patients with undetermined source were enrolled in this study and divided into quartiles according to their baseline plasma d-dimer levels. The primary outcome measure was the occurrence of recurrent stroke (ischemic or hemorrhagic) in the year following the stroke event.

Results:

The risk of recurrent stroke increased significantly with the increasing d-dimer quartile (log-rank P=0.001). Patients in the higher d-dimer quartiles had a higher probability of recurrent embolic stroke because of covert atrial fibrillation, hidden malignancy, or undetermined sources. Most recurrent strokes in Q3 and Q4 were embolic but not in Q1 or Q2. Multivariate analysis revealed that patients in Q3 and Q4 had a significantly increased risk of recurrent stroke compared with those in Q1 (hazard ratio, 3.12 [95% CI, 1.07−9.07], P=0.036; hazard ratio, 7.29 [95% CI, 2.59−20.52], P<0.001, respectively; P_trend<0.001). Binary analyses showed a significant association between a high d-dimer level above normal range and the risk of recurrent stroke (hazard ratio, 2.48 [95% CI, 1.31−4.70], P=0.005). In subgroup analyses, a high d-dimer level was associated with a significantly higher risk of recurrent stroke in men than in women (P=0.039).

Conclusions:

Our findings suggest that d-dimer levels can be a useful risk assessment biomarker for predicting recurrent stroke, especially embolic ischemic stroke, in patients with undetermined source.

• Download figure
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The Implications of Step Count, Intensity on Adult Mortality

 Well, my findings on step count are as follows:

  Other numbers for steps.

10,000 Steps A Day? How Many You Really Need To Boost Longevity - 4,400

This one suggests 8900 steps a day.

Can Exercise Protect Against Alzheimer's?

 

Exactly How Many Steps You Need to Take a Day to Not Gain Weight - 15,000

Start guessing since nothing is concrete and your doctor won't know a damn thing.

The Implications of Step Count, Intensity on Adult Mortality

The goal of completing 10,000 steps per day is widely promoted although, evidence to support its benefits is sparse and the evidence of implications on mortality rates is limited. To date, higher step counts have been linked to decreased mortality but most prior research has focused on older demographics, those with debilitating chronic conditions, or groups with relatively few deaths making the findings challenging to generalize. Higher gait speeds and self-reported walking paces may be associated with lower mortality risk although, conflicting evidence exists regarding accelerometer-measured step intensity and improved cardiometabolic health.

To clarify the relationship between step count, intensity, and adult mortality, a team of researchers set out to define the dose-response relationships between these factors in a representative sample of U.S. adults aged 40 or older. The recent study published in JAMA reported a decreased mortality rate associated with a greater daily step count but no significant correlation between step intensity.

Investigating Daily Step Patterns 

As part of their study, the research team examined data from the National Health and Nutrition Examination Survey of a representative sample of U.S. adults aged at least 40 years who wore an accelerometer for up to 7 days. A total of 4840 participants with a mean age of 56.8 years were included in the study, 54% were women and 36% participants had obesity. The accelerometers were worn for a mean of 5.7 days and a mean of 14.4 hours per day.

The examined exposures were the accelerometer-measured number of steps per day and 3 different step intensity measures, including extended bout cadence, peak 30-minute cadence, and peak 1-minute cadence. The primary outcome was all-cause mortality while secondary outcomes were cardiovascular disease (CVD) and cancer mortality. Hazard ratios, mortality rates, and confidence intervals were estimated and adjusted for relevant factors.

Effects of Step Count and Intensity 

Researchers observed a mean number of steps per day of 9,124 in the participant cohort. Overall, there were 1,165 deaths recorded over the mean follow-up period of 10.1 years, which included 406 cardiovascular disease and 283 cancer deaths.

The unadjusted incidence density for all-cause mortality was 76.7 per 1,000 person-years (or 419 deaths) for the 655 individuals who took less than 4,000 steps per day. For the 1,727 participants who took between 4,000 and 7,999 steps per day, the density was 21.4 per 1,000 person-years, or 488 deaths. For the 1,539 individuals who took between 8,000 and 11,999 steps per day, the unadjusted incidence density was 6.9 per 1,000 person-years, or 176 deaths. Finally, in the 919 individuals who took the most steps daily at a minimum of 12,000 steps per day, the density was 4.8 per 1,000 person-years (82 deaths).

When compared with participants who took 4,000 steps per day, those taking 8,000 steps per day had a significantly lower all-cause mortality, as did those taking 12,000 steps per day. The research team then defined the unadjusted incidence density for all-cause mortality by peak 30-minute cadence; the density was 32.9 per 1,000 person-years (406 deaths) for the 1,080 participants who took between 18.5 to 56.0 steps per minute. For the 1,153 individuals who took between 56.1 to 69.2 steps per minute, the density was 12.6 per 1,000 person-years, or 207 deaths. In the group of 1,074 participants who took between 69.3 and 82.8 steps per minute, the result was 6.8 per 1,000 person-years, or 124 deaths. Finally, for the 1,037 participants who took between 82.9 and 149.5 steps per minute, the rate was 5.3 per 1,000 person-years, resulting in 108 deaths.

After adjusting for total steps taken per day, the authors’ findings revealed that greater step intensity was not significantly associated with lower mortality, however, a greater number of steps per day was significantly associated with lower all-cause mortality.The latest findings provide tangible evidence in support of the well-established recommendation to take a greater number of steps per day for cardiometabolic health benefits. Based on these results, patients should be encouraged to take a minimum of 8,000 steps daily to meaningfully impact their all-cause mortality risk.

 

Blood-Based Cardiac Biomarkers and the Risk of Cognitive Decline, Cerebrovascular Disease, and Clinical Events

 Useless, you describe a biomarker prediction; THEN GIVE US NOTHING TO PREVENT THAT COGNITIVE DECLINE. What the hell do you think research is for?

Blood-Based Cardiac Biomarkers and the Risk of Cognitive Decline, Cerebrovascular Disease, and Clinical Events

Bibek Gyanwali

,

Mitchell K.P. Lai

,

Benedict Lui

,

Oi Wah Liew

,

Narayanaswamy Venketasubramanian

,

Arthur Mark Richards

,

Christopher Chen

,

Saima Hilal

Originally published11 May 2021https://doi.org/10.1161/STROKEAHA.120.032571Stroke. ;0:STROKEAHA.120.032571

Abstract

Background and Purpose:

Cardiac biomarkers, NT-proBNP (N-terminal probrain natriuretic peptide), hs-cTnT (high-sensitivity-cardiac troponin T), and GDF-15 (growth differentiation factor-15) have been proposed as important biomarkers of early vascular pathology. However, little is known of the longitudinal associations of these cardiac biomarkers with cerebrovascular disease and clinical events. We examine the association of blood-based cardiac biomarkers (NT-proBNP, hs-cTnT, and GDF-15) with cognitive decline, incident cerebrovascular disease, vascular events, and mortality.

Methods:

Four hundred thirty-four memory-clinic patients provided blood samples at baseline, underwent 3 annual neuropsychological assessments and brain magnetic resonance imaging scans at baseline and follow-up. NT-proBNP and hs-cTnT concentrations were measured by electrochemiluminescence immunoassay and GDF-15 by quantitative sandwich immunoassay. Baseline and follow-up magnetic resonance imagings were graded for white matter hyperintensities, lacunes, cerebral microbleeds, cortical infarcts, and intracranial stenosis. Data on incident vascular events and mortality were obtained.

Results:

Patients with higher levels of NT-proBNP, hs-cTnT, and GDF-15 showed greater decline in memory domain. Additionally, hs-cTnT was associated with decline in global cognition, executive function, and visuomotor speed. Higher levels of NT-proBNP were associated with incident cerebral microbleeds and hs-cTnT with incident cortical infarcts. During a mean follow-up of 3 years, 26 (5.9%) patients died and 35 (8.1%) developed vascular events. Patients with higher levels of NTpro-BNP and hs-cTnT were at increased risk of vascular events whereas those with higher levels of NT-proBNP and GDF-15 were at risk of mortality.

Conclusions:

Higher levels of blood-based cardiac biomarkers were associated with decline in memory and risk of vascular events and mortality. Moreover, NT-proBNP and hs-cTnT were associated with incident cerebral microbleeds and cortical infarcts. Thus, these biomarkers are potentially useful in identifying patients at risk of adverse vascular events and death.

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Science Says You Can Reverse the Aging Process by Three Years in Just Eight Weeks

 This gets you 3 out of the 5 years you lost, so 2 more years are needed from a protocol from your doctor. Pretty much useless though since there is no reference to where the protocol is located. 

Your 5 lost years of brain cognition from your stroke!

Science Says You Can Reverse the Aging Process by Three Years in Just Eight Weeks

Eating tasty, nutritious meals and staying physically fit are just a couple of wellness-related goals that studies have shown can support healthy aging. According to a new peer-reviewed study by Helfgott Research Institute scientists published in Impact Journals LLC, movement and a mindful diet don't just make you feel good—they can also reverse your biological age. The researchers explained that aging is what causes chronic disease, so making these subtle lifestyle changes can actually help you live "better, longer."

About 40 healthy adult males between the ages of 50 and 72 volunteered for the study's controlled clinical trial. Over the course of the eight-week treatment program, the research team tracked their diet, sleep, exercise and relaxation, and supplemental probiotics and phytonutrients intake. The result? Scientists found that participants' biological ages—measured by the Horvath 2013 DNAmAge clock—decreased by three years. "The combined intervention program was designed to target a specific biological mechanism called DNA methylation, and in particular the DNA methylation patterns that have been identified as highly predictive of biological age," Dr. Kara Fitzgerald, ND IFMCP, the study's lead author, said. "We suspect that this focus was the reason for its remarkable impact. These early results appear to be consistent with, and greatly extend, the very few existing studies that have so far examined the potential for biological age reversal. And it is unique in its use of a safe, non-pharmaceutical dietary and lifestyle program, control group, and the extent of the age reduction."

Related: How to Protect Your Memory as You Age

Dr. Moshe Szyf, PhD, a leading epigeneticist from McGill University and the study's co-author, explained that this research is also singular since the trial was both natural and theory-based, revealing more about our body's methylation system. "This study provides the first insight into the possibility of using natural alterations to target epigenetic processes and improve our well-being and perhaps even longevity and lifespan," the scientist added.

DNA methylation patterns, which track the accumulation of damage and loss of function to our cells, tissues, and organs, are one of the ways scientists understand aging. In turn, with even more research, the team believes they will be able to better decode aging-related diseases. "What is extremely exciting is that food and lifestyle practices, including specific nutrients and food compounds known to selectively alter DNA methylation, are able to have such an impact on those DNA methylation patterns we know predict aging and age-related disease," said Dr. Fitzgerald. "I believe that this, together with new possibilities for us all to measure and track our DNA methylation age, will provide significant new opportunities for both scientists and consumers."

 

 

EXPRESS: Protocol of a randomised controlled trial investigating the effectiveness of Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke (ReCAPS)

You really think this is going to work for elderly people? My mother at 92 could never figure out a cell phone, much less the apps on it.

EXPRESS: Protocol of a randomised controlled trial investigating the effectiveness of Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke (ReCAPS)

Show all authors

Dominique Cadilhac, Jan Cameron, Monique F Kilkenny, , , , , , , , , , , , , , , , , , , , , ,

First Published May 26, 2021 Research Article 

https://doi.org/10.1177/17474930211022678

Article information

Abstract

Rationale: To address unmet needs, electronic messages to support person-centred goal attainment and secondary prevention may avoid hospital presentations/readmissions after stroke, but evidence is limited.

Hypothesis: Compared to control participants, there will be a 10% lower proportion of intervention participants who represent to hospital (emergency/admission) within 90 days of randomisation.

Methods and design: Multicentre, double-blind, randomised controlled trial with intention-to-treat analysis. The intervention group receives 12 weeks of personalised, goal-centred and administrative electronic messages, while the control group only receives administrative messages. The trial includes a process evaluation, assessment of treatment fidelity and an economic evaluation.

Participants: Confirmed stroke (modified Rankin Score: 0-4), aged ≥18 years with internet/mobile phone access, discharged directly home from hospital.(Well, I guess you are cherry picking participants.)

Randomisation: 1:1 computer-generated, stratified by age and baseline disability.

Outcomes Assessments: Collected at 90 days and 12 months following randomisation.

Outcomes: Primary: Hospital emergency presentations/admissions within 90 days of randomisation. Secondary outcomes include goal attainment, self-efficacy, mood, unmet needs, disability, quality-of-life, recurrent stroke/cardiovascular events/deaths at 90 days and 12 months, and death and cost-effectiveness at 12 months.

Sample size: To test our primary hypothesis, we estimated a sample size of 890 participants (445 per group) with 80% power and two-tailed significance threshold of α=0.05. Given uncertainty for the effect size of this novel intervention, the sample size will be adaptively re-estimated when outcomes for n=668 are obtained, with maximum sample capped at 1100.

Discussion: We will provide new evidence on the potential effectiveness, implementation and cost-effectiveness of a tailored eHealth intervention for survivors of stroke.

Keywords Clinical trial, Protocols, Stroke, ehealth, healthcare technology, self-management

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The PrecivityAD™ test is an innovative new blood test(for amyloid plaques in Alzheimer's) intended for use in patients with cognitive impairment.

With your risk of dementia post stroke your doctor should have this test be a protocol to establish a baseline for you.

If found then your doctor needs to prescribe the dementia prevention protocols that they have already assembled. If s/he doesn't have any call the president and ask when competent people will be hired to create them.  Hopefully in time for your children and grandchildren to use.

1. A documented 33% dementia chance post-stroke from an Australian study?   May 2012.

2. Then this study came out and seems to have a range from 17-66%. December 2013.`    

3. A 20% chance in this research.   July 2013.

4. Dementia Risk Doubled in Patients Following Stroke September 2018 

The latest here:

The PrecivityAD™ test is an innovative new blood test(for amyloid plaques in Alzheimer's) intended for use in patients with cognitive impairment.

The PrecivityAD™ test is an innovative new blood test intended for use in patients with cognitive impairment. The test aims to help physicians better determine the presence or absence of amyloid plaques in the brain, a hallmark sign of Alzheimer’s disease.

The PrecivityAD™ test identifies whether a patient is likely to have amyloid plaques in the brain. The test relies on precise and robust quantitation of the Amyloid Beta 42/40 ratio (Aβ 42/40) and detection of the Apolipoprotein E proteotype (equivalent to ApoE genotype) in blood samples, using C₂N’s proprietary mass spectrometry platform.

The PrecivityAD™ test is intended for use in individuals experiencing memory and thinking issues. The test is only available through an order by a physician.

The test is available in 48 states, the District of Columbia, and Puerto Rico; the exceptions are Maryland and New York, which require individual state processes for CLIA labs. C₂N is working toward obtaining the requisite certifications that will permit the PrecivityAD™ test to be available in these states in the near future. Please periodically refer back to this website or contact C₂N at 1.877.226.3424 for status updates on test availability in these two states. 

Summary of Test and Benefits

Knowing that your symptoms are due to Alzheimer’s can help inform your physician to prescribe specific Alzheimer’s treatments in order to aid in the management of the disease.(This is a problem,you don't want it managed, you want it prevented. DEMAND THAT!) If your symptoms are unlikely due to Alzheimer’s (e.g. a normal test result), your physician can search for other causes, some of which can be treated with different interventions.

Earlier detection provides the opportunity for earlier care options, including clinical trials. Many clinical trials for Alzheimer’s disease are looking for participants who show initial signs of cognitive impairment. You also may be eligible to enroll in clinical trials as a result of the PrecivityAD™ test results.

Researchers at C₂N Diagnostics have found the PrecivityAD™ test results to be an accurate indicator of Alzheimer’s disease pathology among people with memory and thinking issues. The PrecivityAD™ test is easy to administer, does not involve any radiation, and is non-invasive. These features make it more accessible than other diagnostic methods doctors use to evaluate issues with memory and thinking.
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The Best Time of Day to Exercise for Metabolic Health

So they didn't want to do the hard analysis to include women:(not including women to avoid issues related to women’s menstrual cycles). All my exercise is during daylight hours so fall, winter and spring don't help me.

The Best Time of Day to Exercise for Metabolic Health

Evening exercise may be more potent than morning workouts for improving metabolic health, according to a helpful new study of exercise timing. The study, which looked at high-fat diets and overweight men, found that late-day workouts moderated the undesirable health effects of a greasy diet, while morning exercise did not.

The study involved only men who were eating a fatty diet, but adds to growing evidence that exercise timing matters and, for many of us, working out later might have particular advantages.

Although we may be only dimly aware of this, operations inside our bodies follow busy, intricate and mutable circadian schedules. All of our tissues contain molecular clocks that coordinate biological systems, prompting our blood sugar to rise and dip throughout the day, along with our hunger, heart rates, body temperature, sleepiness, gene expression, muscle strength, cell division, energy expenditure and other processes.

The full workings of these internal clocks remain mysterious. But scientists know they recalibrate themselves, based on complex cues from inside and outside of our bodies. Most obviously, they synchronize to light and sleep. But they also set themselves by meals, meaning that when we eat, as well as what we eat, may influence our health and metabolism.

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Most researchers believe exercise timing likewise tunes internal clocks. But the results of relevant past studies have been inconsistent. Some suggest morning workouts, before breakfast, incinerate more fat than evening exercise. Others find the opposite. And some recent experiments indicate that early exercise, if it is intense, actually impairs blood-sugar control, while the same workouts, performed later, smooth blood-sugar spikes and improve metabolic health, which may have particular benefits for heart health and controlling Type 2 diabetes.

Most of those studies, though, focused on one type of exercise and rarely controlled people’s meals during the experiments, making it difficult to tease apart the effects of exercise timing from those of what and when people eat.