Life after stroke: Tips for recovery and daily living

 What absolute crapola! 'TIPS'; NOT PROTOCOLS OR EXACT RECOVERY PATHS. This is the useless crapola you get from the American Stroke Association, which is why they need to be destroyed and run by stroke survivors!

Life after stroke: Tips for recovery and daily living

Published

2 days ago

on

12/28/2022

By

bowienews

(Family Features) In the weeks and months immediately following a stroke, an early rehabilitation program offers the best possible recovery outcomes. While each person’s stroke recovery journey is unique, starting the path toward rehabilitation as soon as it’s medically safe allows stroke survivors to mitigate(Survivors don't want mitigation, they want recovery. Have you never talked to survivors without suggesting the tyranny of low expectations?) the lasting effects.

According to the American Stroke Association, a division of the American Heart Association, each year, approximately 800,000 people in the United States have a stroke. Strokes can happen to anyone, at any age. In fact, globally about 1 in 4 adults over the age of 25 will have a stroke in their lifetime.

Early Intervention
The rehabilitation and support a survivor receives can greatly influence health outcomes and recovery. The first three months after a stroke are especially critical. Although recovery may continue for years after a stroke, this time in the immediate aftermath of a stroke is when the brain is most able to adjust to the damage done by the stroke so the survivor can learn new ways to do things.

Physical, Communication and Cognitive Changes
Following a stroke, a survivor may experience physical changes, such as fatigue, seizures, weakness or paralysis on one side of the body or spasticity, stiff or rigid muscles which may cause difficulty with completing daily activities and tasks. If experiencing fatigue, speak with your health care provider about ways to reduce it. Your care team may also be able to provide medications to help with seizures and spasticity. Physical therapy is also an option.

Challenges after a stroke depend on the severity and location of the stroke. In addition to various physical disabilities, stroke survivors may experience aphasia, communication and thought problems related to speaking, listening, understanding or memory. Planning, organizing ideas or making decisions can also be harder.

“Remember to be patient when communicating with a stroke survivor,” said Elissa Charbonneau, M.S., D.O., chief medical officer of Encompass Health and an American Stroke Association national volunteer. “The impact of a stroke on cognitive, speech and language can be significant and isolating. When connecting with a stroke survivor, some helpful practices include demonstrating tasks, breaking actions into smaller steps, enunciating, asking multiple choice questions and repetition.”

Customized Rehabilitation
Once a stroke survivor’s medical condition is stabilized and he or she is ready to leave the hospital, rehabilitation can help restore function and teach new ways to complete everyday tasks. Rehabilitation may take place in an inpatient facility, skilled nursing facility or long-term acute care facility. Outpatient clinics and home health agencies can also provide rehabilitative care in certain circumstances.

One patient’s rehab journey might include therapy to improve balance, strength or mobility while another might need speech or other therapies. A rehabilitation designed for the individual is critical.

Preventing a Recurrence
After a first stroke, nearly 1 in 4 survivors will have another. Stroke survivors can help reduce their risk of having another stroke by working with their health care team to identify what caused the stroke and uncover personal risk factors.

Taking steps such as healthy eating, reducing sedentary time and taking medications as prescribed can help your brain and reduce your risk of a repeat stroke. Controlling conditions such as high blood pressure, diabetes and sleep apnea also reduce your risk of having another stroke.

Support During Your Journey
Caregivers and other loved ones can provide important long-term support during your recovery and rehabilitation.

Find resources for stroke rehab and recovery including the “Life After Stroke” guide, “Simply Good” cookbook and a support network to connect with other survivors at Stroke.org/Recovery.

Photo courtesy of Getty Images

$6M Idaho rehab unit to be 1st of its kind in region

Unless YOU get involved NOW they won't set the correct goals for stroke patients. 100% RECOVERY FOR ALL!  They will fall back on the complete failures of only 12% full recovery for tPA delivery and 10% full recovery for normal rehab.

When you are the 1 in 4 per WHO that has a stroke, you'll want full recovery.  Make it personal to the staff there, ask how they are going to fully recover when their time comes to have a stroke.

$6M Idaho rehab unit to be 1st of its kind in region

Lewiston, Idaho-based St. Joseph Regional Medical Center is beginning construction of a new $6 million rehabilitation unit, which will be the only one of its type within a 100-mile radius. The unit should be complete by mid-June 2023, the hospital said Dec.29.

The 10-bed unit will also include a gym and state-of-the-art equipment used in rehab therapies for patients recovering from stroke, brain and spinal cord injuries, amputation, and trauma, among others.

"Adding a dedicated [acute rehabilitation unit] to our hospital will enable St. Joe's to provide acute-level, physician-led rehabilitation expertise while avoiding the disruption of transferring a patient to a separate, out-of-area facility," Taylor Rudd, chief operations officer, said in a statement.

The hospital, the largest full-service medical center between Boise, Idaho, and Spokane, Wash., is part of Louisville, Ky.-based ScionHealth, which operates 61 acute-care hospitals and 18 community hospitals across the U.S.

A crossover pilot study evaluating the functional outcomes of two different types of robotic movement training in chronic stroke survivors using the arm exoskeleton BONES

If the Box and Block test is used to evaluate results then chronic patients like me with hand and finger spasticity would never even get into the research. Thus, this is cherry picking of the highest degree, choosing minimally impaired patients.

A crossover pilot study evaluating the functional outcomes of two different types of robotic movement training in chronic stroke survivors using the arm exoskeleton BONES

 
RESEARCH Open Access
A crossover pilot study evaluating the functional outcomes of two different types of robotic movement training in chronic stroke survivors using the arm exoskeleton BONES
Marie-Hélène Milot 1,2,3*, 

Steven J Spencer 2, 

Vicky Chan 2, 

James P Allington 2, 

Julius Klein 2, 

Cathy Chou 2, 

James E Bobrow 2, 

Steven C Cramer 3

and David J Reinkensmeyer 2,3

* Correspondence: marie-helene.milot@usherbrooke.ca
1 Université de Sherbrooke, Faculté de médecine et des sciences de la santé,École de réadaptation, Centre de recherche sur le vieillissement, 1036Belvédère sud, Sherbrooke (Québec) J1H 4C4, Canada
2 Department of Mechanical and Aerospace Engineering, University of California; Irvine, 4200 Engineering Gateway, University of California, Irvine,Irvine, CA 92697, USAFull list of author information is available at the end of the article

3  Departments of Neurology and Anatomy & Neurobiology, University of California, Irvine, 843 Health Sciences Road, Hewitt Hall room 1331, Irvine, CA92697, USA.

Abstract

Background:
 To date, the limited degrees of freedom (DOF) of most robotic training devices hinders them from providing functional training following stroke. We developed a 6-DOF exoskeleton (“BONES”) that allows movement of the upper limb to assist in rehabilitation. The objectives of this pilot study were to evaluate the impact of training with BONES on function of the affected upper limb, and to assess whether multi-joint functional robotic training would translate into greater gains in arm function than single joint robotic training also conducted with BONES.
Methods:
 Twenty subjects with mild to moderate chronic stroke(In my opinion none of these were moderate) participated in this crossover study. Each subject experienced multi-joint functional training and single joint training three sessions per week, for four weeks, with the order of presentation randomized. The primary outcome measure was the change in Box and Block Test (BBT). The secondary outcome measures were the changes in Fugl-Meyer Arm Motor Scale (FMA), Wolf Motor Function Test(WMFT), Motor Activity Log (MAL), and quantitative measures of strength and speed of reaching. These measures were assessed at baseline, after each training period, and at a 3-month follow-up evaluation session.
Results:
 Training with the robotic exoskeleton resulted in significant improvements in the BBT, FMA, WMFT, MAL,shoulder and elbow strength, and reaching speed (p < 0.05); these improvements were sustained at the 3 month follow-up. When comparing the effect of type of training on the gains obtained, no significant difference was noted between multi-joint functional and single joint robotic training programs. However, for the BBT, WMFT and MAL,inequality of carryover effects were noted; subsequent analysis on the change in score between the baseline andfirst period of training again revealed no difference in the gains obtained between the types of training.
Conclusions:
 Training with the 6 DOF arm exoskeleton improved motor function after chronic stroke, challenging the idea that robotic therapy is only useful for impairment reduction. The pilot results presented here also suggest that multi-joint functional robotic training is not decisively superior to single joint robotic training. This challenges the idea that functionally-oriented games during training is a key element for improving behavioral outcomes.
Trial registration:
 NCT01050231.
Keywords:
 Robot, Training, Stroke, Function, Activity of daily living

 JOURNAL OF NEUROENGINEERINGAND REHABILITATION
© 2013 Milot et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the CreativeCommons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, andreproduction in any medium, provided the original work is properly cited.

Modular hip exoskeleton improves walking function and reduces sedentary time in community-dwelling older adults

 If your hospital did nothing with this research when it was done on stroke patients, YOU DON'T HAVE A FUNCTIONING STROKE HOSPITAL! So your hospital has been incompetent for at least 3 years. Why hasn't the board of directors replaced everyone? Even the board of directors is incompetent?

Training for walking efficiency with a wearable hip-assist robot in patients with stroke: a pilot randomized controlled trial December 2019 

The latest here:

Modular hip exoskeleton improves walking function and reduces sedentary time in community-dwelling older adults

• Chandrasekaran Jayaraman,
• Kyle R. Embry,
• Chaithanya K. Mummidisetty,
• Yaejin Moon,
• Matt Giffhorn,
• Sara Prokup,
• Bokman Lim,
• Jusuk Lee,
• Younbaek Lee,
• Minhyung Lee &
• Arun Jayaraman 

Journal of NeuroEngineering and Rehabilitation volume 19, Article number: 144 (2022) Cite this article

• 3 Altmetric

• Metrics details

Abstract

Background

Despite the benefits of physical activity for healthy physical and cognitive aging, 35% of adults over the age of 75 in the United States are inactive. Robotic exoskeleton-based exercise studies have shown benefits in improving walking function, but most are conducted in clinical settings with a neurologically impaired population. Emerging technology is starting to enable easy-to-use, lightweight, wearable robots, but their impact in the otherwise healthy older adult population remains mostly unknown. For the first time, this study investigates the feasibility and efficacy of using a lightweight, modular hip exoskeleton for in-community gait training in the older adult population to improve walking function.

Methods

Twelve adults over the age of 65 were enrolled in a gait training intervention involving twelve 30-min sessions using the Gait Enhancing and Motivating System for Hip in their own senior living community.

Results

Performance-based outcome measures suggest clinically significant improvements in balance, gait speed, and endurance following the exoskeleton training, and the device was safe and well tolerated. Gait speed below 1.0 m/s is an indicator of fall risk, and two out of the four participants below this threshold increased their self-selected gait speed over 1.0 m/s after intervention. Time spent in sedentary behavior also decreased significantly.

Conclusions

This intervention resulted in greater improvements in speed and endurance than traditional exercise programs, in significantly less time. Together, our results demonstrated that exoskeleton-based gait training is an effective intervention and novel approach to encouraging older adults to exercise and reduce sedentary time, while improving walking function. Future work will focus on whether the device can be used independently long-term by older adults as an everyday exercise and community-use personal mobility device.

Trial registration This study was retrospectively registered with ClinicalTrials.gov (ID: NCT05197127).

Food failure again

 At our late Christmas dinner there were bread pieces and olive oil and herbs for dipping. Normal people use their second hand to cup underneath the food as it goes to your mouth to catch any drips. NOPE!  My therapists and doctor COMPLETELY FUCKING FAILED TO GET ANY RECOVERY OF MY LEFT HAND AND ARM. So I ended up with drops of oil on my shirt.  Damn, this lack of recovery is a pisser, and my therapists and doctors did not have any repercussions from their failures.

Novel Blood Test Detects Alzheimer's Neurodegeneration

 With your elevated chances of getting dementia, your doctor should be running this test on you to establish a baseline.

Your risk of dementia, has your doctor told you of this?

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:

Novel Blood Test Detects Alzheimer's Neurodegeneration

Brain-derived tau distinguished Alzheimer's from other dementias

by Judy George, Deputy Managing Editor, MedPage Today December 30, 2022

A novel blood test to assess brain-derived tau detected Alzheimer's-related neurodegeneration and differentiated Alzheimer's from other neurodegenerative diseases.

The test outperformed total tau and, unlike neurofilament light, showed specificity to Alzheimer's disease-type neurodegeneration, reported Thomas Karikari, PhD, of the University of Gothenburg in Sweden and the University of Pittsburgh in Pennsylvania, and co-authors in Brainopens in a new tab or window.

"Thus, brain-derived tau demonstrates potential to complete the AT(N) scheme in blood, and will be useful to evaluate Alzheimer's disease-dependent neurodegenerative processes for clinical and research purposes," Karikari and colleagues wrote.

The AT(N) frameworkopens in a new tab or window requires three components of Alzheimer's pathology -- amyloid plaques, tau tangles, and neurodegeneration -- to be detected by imaging or in cerebrospinal fluid (CSF) samples for Alzheimer's disease to be diagnosed.

Blood-based biomarkers could make detecting Alzheimer's easier and more accessible. Blood tests have been developed to detect amyloid and tau, but a reliable blood test for neurodegeneration has remained elusive. For example, neurofilament light, a marker of axonal damage, is elevated in Alzheimer's disease but also is elevated in other forms of dementia and other neurodegenerative diseases.

As a marker of neurodegeneration, "current plasma total-tau (t-tau) assays do not show good diagnostic utility, contrary to CSF t-tau that reliably reflects neurodegeneration in Alzheimer's disease but not in other neurodegenerative diseases like Parkinson's disease, Lewy body dementia, and frontotemporal dementia," the researchers observed.

To selectively detect brain-derived tau, Karikari and colleagues developed an antibody that binds to an expressed glutathione S-transferase-linked protein construct for the MAPT gene exons 4–5 of tau and recombinant full-length tau-441 (rPeptide). The resulting TauJ.5H3 monoclonal antibody demonstrated specific reactivity to the junction between MAPT exons 4 and 5, excluding peripherally-originated tau species that have an exon 4a insert.

The researchers validated their assay in five cohorts that spanned 609 patient samples and found:

• Serum and CSF brain-derived tau identified with the antibody were significantly correlated (rho=0.85, P<0.0001), while CSF total-tau and blood-based tau measured with typical techniques were not (rho=0.23, P=0.3364).
• Blood-based brain-derived tau showed equivalent diagnostic performance to both CSF total-tau and CSF brain-derived tau in distinguishing biomarker-positive Alzheimer's disease participants from biomarker-negative controls.
• Blood-based brain-derived tau accurately distinguished autopsy-confirmed Alzheimer's disease from other neurodegenerative diseases with an area under the receiver operating curve (AUC) of 86.4%, while neurofilament light did not (AUC 54.3%).

Performances were independent of the presence of concomitant pathologies, the researchers noted. Results were verified in two memory clinic cohorts where serum brain-derived tau differentiated Alzheimer's from other neurodegenerative disorders -- including frontotemporal lobar degeneration and atypical parkinsonian disorders -- with AUCs up to 99.6%.

"Across cohorts, plasma/serum brain-derived tau was associated with CSF and plasma AT(N) biomarkers and cognitive function," Karikari and co-authors wrote. "Notably, plasma/serum brain-derived tau correlated with neurofilament light only in Alzheimer's disease, but not in the other neurodegenerative diseases."

The researchers plan to conduct large-scale clinical validation of blood brain-derived-tau in a wide range of cohorts including ones with diverse racial and ethnic backgrounds. Studies will include older adults with no biological evidence of Alzheimer's disease as well as those at different stages of the disease.

• Judy George covers neurology and neuroscience news for MedPage Today, writing about brain aging, Alzheimer’s, dementia, MS, rare diseases, epilepsy, autism, headache, stroke, Parkinson’s, ALS, concussion, CTE, sleep, pain, and more. Follow

Disclosures

This research was supported by the Swedish Research Council the Alzheimer's Association, the BrightFocus Foundation, the International Society for Neurochemistry's Career Development Grant, the Swedish Alzheimer Foundation, the Swedish Brain Foundation, the Swedish Dementia Foundation, the Swedish Parkinson Foundation, Gamla Tjänarinnor Foundation, the Aina Wallströms and Mary-Ann Sjöbloms Foundation, the Agneta Prytz-Folkes & Gösta Folkes Foundation, the Gun and Bertil Stohnes Foundation, the Anna Lisa and Brother Björnsson's Foundation, and others.

Karikari declared no competing interests. Co-authors reported several relationships with industry.

Primary Source

Brain

Source Reference: opens in a new tab or windowGonzalez-Ortiz F, at al "Brain-derived tau: a novel blood-based biomarker for Alzheimer's disease-type neurodegeneration" Brain 2022; DOI: 10.1093/brain/awac407.

Research progress on mechanical perturbation in stroke rehabilitation

 In my opinion if your therapists and doctors don't have a protocol to perturb your walking they aren't preparing you for real world walking. I continually practice perturbed walking at bars where I listen to music, walking thru crowds to get to the bathrooms does wonders for balance recovery especially after a couple of drinks. Don't follow me, I'm not medically trained and this does not mean you should try this.

Research progress on mechanical perturbation in stroke rehabilitation

[Article in Chinese]

Ying Liu  ¹ , Yanjian Liao  ¹

Affiliations

• PMID: 36575094
• DOI: 10.7507/1001-5515.202206059

Abstract

in English, Chinese

Sensorimotor disorder can be easily caused by stroke, and there are many targeted movement rehabilitation therapies. With the development of rehabilitation robot technology, robot-assisted therapy combined with mechanical perturbations has become a more effective motor rehabilitation therapy. In this paper, the definition of mechanical perturbation and its physiological mechanism in stroke rehabilitation are introduced, the research progress on mechanical perturbation in the field of stroke rehabilitation therapy is mainly discussed, the application of mechanical perturbation in motor control, postural response and sensory evaluation of stroke rehabilitation is summarized, and the future development direction of mechanical perturbation rehabilitation therapy is also prospected.

Keywords: Mechanical perturbation; Motor rehabilitation; Sensorimotor disorder; Stroke.

Publication types

The Role of Baseline Functional MRI as a Predictor of Post-Stroke Rehabilitation Efficacy in Patients with Moderate to Severe Upper Extremity Dysfunction

I can see no use in predicting failure to recover.

 The Role of Baseline Functional MRI as a Predictor of Post-Stroke Rehabilitation Efficacy in Patients with Moderate to Severe Upper Extremity Dysfunction 

Reza Almasi Ghaleh¹, Sarvenaz Rahimibarghani¹, Niloofar Shirzad¹, Ailar Ahangari¹, Mohammad-Reza Nazem-Zadeh², Abolfazl Mahmoudi Aqeel Abadi², Abbas Tafakhori³, Hamid R. Fateh^1,4*
1Physical Medicine and Rehabilitation Department, Shariati Hospital, Tehran University of Medical Science, Tehran, Iran.
²Medical Physics and Biomedical Engineering Department, Research Center for Molecular and Cellular Imaging, Advanced Medical Technologies and Equipment Institute, Tehran University of Medical Sciences, Tehran, Iran.
³Neurology Department, Iranian Center of Neurological Research, Neuroscience Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
⁴Neuromuscular Research Center, Tehran University of Medical Sciences, Tehran, Iran.
DOI: 10.4236/jbbs.2022.1212039   PDF   HTML   XML   18 Downloads   104 Views  

Abstract

Introduction: Upper extremity impairment is one of the common complications following a stroke. There are numerous rehabilitation strategies to address this problem. However, patients with moderate to severe upper limb disabilities respond differently to the same rehabilitation protocol. Apart from each patient’s unique characteristics, there are specific brain reorganizing patterns that affect the post-rehabilitation response rate. Functional magnetic resonance imaging (fMRI) determines brain activation area and connectivity patterns and has been utilized in the neurorehabilitation field.  

Material and Methods: Six stroke patients who suffered from moderate to severe upper extremity dysfunction were enrolled in this pilot study. Upper extremity function tests including the Fugl-Meyer assessment test for upper extremity (FMA-UE), and Wolf Motor Function Test (WMFT) were utilized before and after completing an intensive rehabilitation. The intensive rehabilitation program was conducted one hour a day for five days per week for four weeks. Moreover, fMRI was applied before initiating rehabilitation. The regions of interest were those associated with movement, including Brodmann areas (BA) BA1-BA6. 

Results: Six stroke patients in the sub-acute to chronic phase and ages ranging between 33 - 75 years were enrolled. All patients showed an improvement in upper limb function after four weeks of rehabilitation. Patient number one (Pt1) had the most improvement in FMA-UE, while patient number four (Pt4) recovered the most measured by WMFT. Pt1 demonstrated increased activity in all contralesional regions, whereas Pt4 had only increased activity in ipsilesional areas. Furthermore, patients with greater activation in the ipsilesional BA6 (Pt1, Pt4, Pt5, and Pt6) had better responses to the rehabilitation therapy.  

Conclusion: Patients with greater activation in the baseline fMRI, particularly ipsilesional BA6, had a better response to the intensive rehabilitation therapy. However, the patients with the most severe hand dysfunction showed lesser improvement despite the same brain activity as others in the initial fMRI.

Keywords

Stroke, Functional MRI, Rehabilitation, Upper Extremity

Share and Cite:

Ghaleh, R. , Rahimibarghani, S. , Shirzad, N. , Ahangari, A. , Nazem-Zadeh, M. , Aqeel Abadi, A. , Tafakhori, A. and Fateh, H. (2022) The Role of Baseline Functional MRI as a Predictor of Post-Stroke Rehabilitation Efficacy in Patients with Moderate to Severe Upper Extremity Dysfunction. Journal of Behavioral and Brain Science, 12, 658-669. doi: 10.4236/jbbs.2022.1212039.

1. Introduction

Stroke is one of the most important causes of disability worldwide. The incidence and mortality of stroke are increasing due to the growing elderly population [1] [2]. Contralateral upper limb hemiparesis is the most prevalent impairment following a stroke, affecting more than 80% of acute stroke patients and more than 40% of chronic ones. Upper-extremity motor paresis may be accompanied by additional neurological symptoms that impede motor function recovery, necessitating targeted rehabilitation therapy [3].

The primary goal of post-stroke management is to re-establish daily activities through different rehabilitation methods despite the residual impairments [4]. Neurological recovery follows a nonlinear, logarithmic pattern, meaning that most recovery is expected in the first three months after a stroke. Furthermore, recovery from a stroke can be characterized as an improvement in several outcomes, starting with biological and neurologic changes that appear to improve performance and activity-based behavioral measures. Adaptation, regeneration, and neuroplasticity are the three fundamental mechanisms in brain recovery following a stroke. Adaptation happens by using alternate physical movements or equipment to compensate for functional loss. Regeneration is known as the growth of damaged neural cells into new tissue to restore function. The main recovery mechanism is neuroplasticity, characterized by alterations or rewiring within the neural network [3] [4] [5].

Functional disabilities after a stroke affect the patient’s quality of life and leave a significant financial burden on society [6]. In addition, only a few patients with severe hand dysfunction will show promising results after the rehabilitation program [7]. However, it is relatively difficult to predict the recovery outcome and success rate only based on the clinical data in severely disabled patients. Thus, a prognostic tool to determine long-term motor recovery in terms of rehabilitation efficacy costs many expenses. Previous clinical studies have suggested the effectiveness of intensive motor training paired with repetitive transcranial magnetic stimulation (rTMS), muscular electrical stimulation, brain-computer interfaces, and robotic devices in upper limb rehabilitation in stroke patients [8] [9].

Notably, stroke patients are more likely to have permanent functional deficits because the non-activated brain has a limited neuroplasticity capacity. Neuroplasticity is also affected by the type of intervention, the patient’s age, the location of the lesion, and handedness. Therefore, tools like functional magnetic resonance imaging (fMRI) are utilized to investigate brain activity and the influence of neurorehabilitation methods on neuroplasticity in addition to clinical disability assessment tools. FMRI has an excellent spatial resolution, allowing researchers to gain insight into the brain reorganization process and its associated functional recovery after stroke neurorehabilitation [10]. In general, fMRI captures the blood oxygen level-dependent (BOLD) signal is captured using T2*-weighted imaging. Higher neuron activity is associated with higher blood flow in the related areas, increasing the oxyhemoglobin-to ratio and the signal [11]. Task performance during fMRI causes hemodynamic response function (HRF) in the motor cortex area, which changes the BOLD signal recorded by the MRI machine.

We conducted this study using the fMRI as a prognostic tool for upper limb functional recovery after intensive rehabilitation from a stroke. Although these findings should not exclude the most severe patients from rehabilitation therapy, but also help to define the realistic rehab consequences for both therapist and patients.(So you're pushing the tyranny of low expectations because you have completely failed at your job of getting survivors 100% recovered. I'd fire you all as failures.)

More at link.

Machine Learning Techniques for the Prediction of Functional Outcomes in the Rehabilitation of Post-Stroke Patients: A Scoping Review

In what multiverse do you live where predicting failure to recover is of any use at all to survivors? And your mentors and senior researchers approved this crapola?

Machine Learning Techniques for the Prediction of Functional Outcomes in the Rehabilitation of Post-Stroke Patients: A Scoping Review 

by

Christos Kokkotis

¹,

Serafeim Moustakidis

¹,

Georgios Giarmatzis

¹,

Erasmia Giannakou

¹,

Evangelia Makri

¹,

Paraskevi Sakellari

¹,

Dimitrios Tsiptsios

²,

Stella Karatzetzou

²,

Foteini Christidi

²,

Konstantinos Vadikolias

² and

Nikolaos Aggelousis

^1,*

¹

Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece

²

Department of Neurology, School of Medicine, University Hospital of Alexandroupolis, Democritus University of Thrace, 68100 Alexandroupolis, Greece

^*

Author to whom correspondence should be addressed.

BioMed 2023, 3(1), 1-20; https://doi.org/10.3390/biomed3010001

Received: 10 November 2022 / Revised: 18 December 2022 / Accepted: 21 December 2022 / Published: 27 December 2022

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Versions Notes

Abstract

Stroke is one of the main causes of long-term disabilities, increasing the cost of national healthcare systems due to the elevated costs of rigorous treatment that is required, as well as personal cost because of the decreased ability of the patient to work. Traditional rehabilitation strategies rely heavily on individual clinical data and the caregiver’s experience to evaluate the patient and not in data extracted from population data. The use of machine learning (ML) algorithms can offer evaluation tools that will lead to new personalized interventions. The aim of this scoping review is to introduce the reader to key directions of ML techniques for the prediction of functional outcomes in stroke rehabilitation and identify future scientific research directions. The search of the relevant literature was performed using PubMed and Semantic Scholar online databases. Full-text articles were included if they focused on ML in predicting the functional outcome of stroke rehabilitation. A total of 26 out of the 265 articles met our inclusion criteria. The selected studies included ML approaches and were directly related to the inclusion criteria. ML can play a key role in supporting decision making during pre- and post-treatment interventions for post-stroke survivors, by utilizing multidisciplinary data sources.

Keywords:

post-stroke; artificial intelligence; prognosis; outcome assessment; rehabilitation

1. Introduction

Stroke, as a result of either a sudden brain blood supply interruption or local brain blood vessel eruption [1], may cause paralysis (plegia) or weakness (paresis), with detrimental consequences on daily activities, such as dressing, eating, and walking, as well as problems with memory, cognition, speaking, emotion control, numbness, and pain [2,3,4]. An aging population and the interaction of risk factors enhance the risk of stroke, leading to an increased number of people with long-term disabilities [3,5]. Forms of stroke rehabilitation include a mixture of pharmacologic and nonpharmacologic interventions that target physiological and functional deficits; however, traditional one-size-fits-all approaches often leave a considerable portion of patients without effective treatment. The design of effective interventions has proven a challenging task due to the high variability of patients’ level of impairment and symptoms [6,7,8]. Hence, the development of personalized assessment/prognostic tools that could lead to better risk stratification and prediction of functional outcomes, based on past and current data, is necessary. Innovative, evidence-based strategies that can utilize longitudinal, multisource population data could aid individual rehabilitation by shaping personalized interventions, both at admission and throughout the patient’s path of care.

To this end, classical statistical approaches such as linear regression have been employed to model post-stroke rehabilitation and predict functional outcomes, using a binary (good or poor) classification or specific score outcomes. These models, which are typically based on standard scales and relevant clinical data, fail to incorporate meaningful factors that are detrimental to patient-specific recovery pathways, such as the level of family or community support and the cultural level. On the contrary, advanced artificial intelligence (AI)-based correlation models, such as machine learning algorithms, can analyze large, inhomogeneous datasets, map nonlinearities between multiple input and output variables, and extract patterns among various clinical outcomes.

ML is the study of how machines (i.e., learning algorithms) can learn patterns or complex relationships from daily data and produce trained mathematical models linking target variables of interest with a huge number of covariates. Furthermore, deep learning (DL) is defined as a subfield of ML concerned with learning algorithms inspired by the function and structure of the brain [7]. DL provides an alternative architecture system by overcoming the burden of feature engineering. Hence, ML has the ability to cope with high-dimensionality data and complex cases [9,10], going beyond the traditional statistical approaches and overcoming significant limitations in the prediction of the functional outcome in the rehabilitation of post-stroke survivors, offering valuable tools in the field of stroke rehabilitation [3].

Currently, various ML techniques have been employed to model individual disease pathways, and their contribution plays a key role in the scientific community. For example, in the case of knee osteoarthritis, several ML-based patient-specific prediction models have been developed (e.g., ML models for diagnosis, post-treatment assessment, and segmentation in knee osteoarthritis) [11]. Moreover, ML demonstrated excellent performances in predicting the outcome for several neurosurgical conditions [12,13]. In addition, Bivard et al. demonstrated the importance of AI and imaging in stroke management [14]. Furthermore, they presented the need for AI tools for the quick assessment of meaningful imaging data and to support clinical decisions.

In this context, the current scoping review was carried out to (i) investigate ML methods employed to predict functional outcome in stroke rehabilitation, (ii) identify current trends in this field, and (iii) identify the existing literature gap for future scientific approaches. Compared to the already available literature on the field of post-stroke rehabilitation [15], this paper focuses specifically on the various ML models being used to predict functional outcomes in stroke rehabilitation, as well as their specific characteristics and underlying principles. By providing an in-depth examination of these models, the paper aims to shed light on the current state of the field and identify trends and areas for future research. Overall, the primary aim of the paper is to provide a comprehensive overview of the ML approaches being used in this area of study.

 

More at link.

Inhibition of Notch 1 signaling in the subacute stage after stroke promotes striatal astrocyte-derived neurogenesis

Well shit this was already confirmed in August 2018. Why didn't you do the followup research that would deliver these results in human testing? Your mentors and senior researchers incompetently didn't know about this earlier research and thus didn't instruct you to actually solve the problem for survivors? How many times do I have to point out stroke incompetence before the offending parties are removed?

Inhibition of Notch1 Signaling at the Subacute Stage of Stroke Promotes Endogenous Neurogenesis and Motor Recovery After Stroke August 2018

The latest here:

Inhibition of Notch 1 signaling in the subacute stage after stroke promotes striatal astrocyte-derived neurogenesis

Xiao-Zhu Hao1, Cheng-Feng Sun1, Lu-Yi Lin1, Chan-Chan Li1, Xian-Jing Zhao1, Min Jiang2, Yan-Mei Yang1, *, Zhen-Wei Yao1, *

AbstractInhibition of Notch1 signaling has been shown to promote astrocyte-derived neurogenesis after stroke. To investigate the regulatory role of Notch1 signaling in this process, in this study, we used a rat model of stroke based on middle cerebral artery occlusion and assessed the behavior of reactive astrocytes post-stroke.We used the γ-secretase inhibitor N-[N-(3,5-diuorophenacetyl)-1-alanyl]-S-phenylglycine t-butylester (DAPT) to block Notch1 signaling at 1, 4, and 7 days after injury. Our results showed that only administration of DAPT at 4 days after stroke promoted astrocyte-derived neurogenesis, as manifested by recovery of white matter fiber bundle integrity on magnetic resonance imaging, which is consistent with recovery of neurologic function. These findings suggest that inhibition ofNotch1 signaling at the subacute stage post-stroke mediates neural repair by promoting astrocyte-derived neurogenesis.Key Words: astrocyte; diffusion kurtosis imaging; magnetic resonance imaging; middle cerebral artery occlusion; N-[N-(3,5-diuorophenacetyl)-1-alanyl]-S-phenylglycine t-butylester; neural repair; neurogenesis; neuron; Notch1 signaling; subacute stagehttps://doi.org/10.4103/1673-5374.363179Date of submission: October 18, 2021Date of decision: February 16, 2022Date of acceptance: October 11, 2022Date of web publication: December 21, 2022IntroductionImpaired neural tissue can be supplemented by endogenous neurogenesisafter stroke. One third of endogenous neurogenesis derives from proliferatedsubventricular neural stem cells, and two thirds from striatal reactiveastrocytes, both of which are negatively regulated by Notch1 signaling(Arvidsson et al., 2002; Li et al., 2010). Notch1 signaling exerts various effectsat different times and locations during neurogenesis, which explains theconflicting results from studies involving interventions at different time points;therefore, timely control of Notch1 signaling is important for promoting theproduction of new neurons (Oya et al., 2009; Wang et al., 2009b; Li et al.,2012; Zhao et al., 2012). In our previous study, we found that the number ofneuroblasts increased in the subacute stage after stroke, and that inhibition ofNotch1 signaling during this period with the γ-secretase inhibitor N-[N-(3,5-diuorophenacetyl)-1-alanyl]-S-phenylglycine t-butylester (DAPT) promotedneuroblast and neuron generation (Hao et al., 2018). However, the temporalprofile of Notch1 signaling activity in astrocytes and whether DAPT treatmentin the subacute stage after stroke can promote transdifferentiation ofastrocytes into the neural linage remained unclear.The Notch1 signaling system comprises the Notch1 receptor and the Notch1ligand (Oya et al., 2009; Wang et al., 2009a, b), which receive and send theNotch1 signal, respectively. Astrocytes can concurrently express both theNotch1 receptor and the Notch1 ligand (Lebkuechner et al., 2015). Notch1signaling has been reported to stimulate proliferation and migration ofresident astrocytes in the subventricular zone (SVZ) and striatum into theperi-infarct area after stroke (Shimada et al., 2011). A recent study indicatedthat striatal astrocytes enter the neurogenic program 3 days after stroke, asNotch1 signaling decreases, and that inhibition of Notch1 signaling at thistime point promotes this process (Magnusson et al., 2014). Two other studiesindicated that striatal astrocytes become neuroblasts 1 week after strokeand transdifferentiate into neurons, and that synapses form 2 weeks later(Arvidsson et al., 2002; Duan et al., 2015). Thus, promoting striatal astrocyte-derived neurogenesis through inhibition of Notch1 signaling in the subacutestage after cerebral ischemia is a promising area for investigation.The central nervous system is a complex neural network. Only newbornneurons have been reported to establish new connections and undergomyelination, which would be beneficial effects for the recovery of damagedbrain tissue (Tanaka et al., 2003; Jiang et al., 2006). In vivo imaging toolsneed to be developed to monitor the functional effects of newborn neuronswithin the existing or newly built neural circuitry and their contribution tobrain function after stroke (Deng et al., 2010). Diffusion kurtosis imaging (DKI)parameters, such as mean kurtosis (MK), axial kurtosis (Ka) and radial kurtosis(Kr), provide detailed information about microstructural deformation andreorganization that indirectly illustrates functional recovery (Hao et al., 2018;Shen et al., 2019; Wei et al., 2019).In this study, we first elucidated the temporal profile of both astrocytictransdifferentiation into neurons and Notch1 activation in astrocytes andthen attempted to analyze the effects of DAPT administered at different timepoints on astrocyte-derived neurons. More importantly, we used magneticresonance imaging (MRI) to evaluate neurogenesis-related microstructuralchanges in the damaged brain in vivo.