Use the labels in the right column to find what you want. Or you can go thru them one by one, there are only 29,286 posts. Searching is done in the search box in upper left corner. I blog on anything to do with stroke. DO NOT DO ANYTHING SUGGESTED HERE AS I AM NOT MEDICALLY TRAINED, YOUR DOCTOR IS, LISTEN TO THEM. BUT I BET THEY DON'T KNOW HOW TO GET YOU 100% RECOVERED. I DON'T EITHER BUT HAVE PLENTY OF QUESTIONS FOR YOUR DOCTOR TO ANSWER.
Changing stroke rehab and research worldwide now.Time is Brain!trillions and trillions of neuronsthatDIEeach day because there areNOeffective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.
What this blog is for:
My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.
In recent years, our understanding of motor learning, neuroplasticity and functional recovery after the occurrence of brain lesion has grown significantly. New findings in basic neuroscience provided stimuli for research in motor rehabilitation. Repeated motor practice and motor activity in a real world environment have been identified in several prospective studies as favorable for motor recovery in stroke patients. EMG initiated electrical muscle stimulation – but not electrical muscle stimulation alone – improves motor function of the centrally paretic arm and hand. Although a considerable number of physiotherapeutic “schools” has been established, a conclusive proof of their benefit and a physiological model of their effect on neuronal structures and processes are still missing. Nevertheless, evidence-based strategies for motor rehabilitation are more and more available, particularly for patients suffering from central paresis.
If the AHA/ASA would do their only fucking job(SOLVING STROKE TO 100% RECOVERY!) then they wouldn't need to publicize heroes. Nancy Brown, care to reply to me? oc1dean@gmail.com
We can discuss with your board of directors the strategy to 100% recovery. You'll want 100% recovery when you are the 1 in 4 per WHO that has a stroke?
The American Stroke Association spotlights the resiliency of
local individuals and groups in the fight against stroke
HIAWATHA, Iowa, May 16, 2024 – Reegan Lueken, a 10th grader
from Ely who experienced a stroke at age 12, is 1 of 6 stroke heroes
from across the country recognized by the American Stroke Association, a
division of the American Heart Association, for their resiliency and
dedication in the fight against stroke.
Lueken earned the Pediatric Hero Award as part of the American Stroke Association’s annual Stroke Hero Awards honoring stroke survivors, health care professionals, advocates and caregivers. During May, American Stroke Month,
the Association, devoted to a world of healthier lives for all and
celebrating 100 years of lifesaving service, honors these Stroke Heroes
and proudly advocates for stroke survivors year-round.
Each year, approximately 800,000 people in the U.S. have a stroke.[1] Those who have had a stroke often work against physical, emotional and cognitive changes to move forward.
Lueken experienced a stroke on her first day of 7th grade track
practice. Since then, her perseverance has been an inspiration. But
returning home from the hospital was just the beginning of her journey.
She has participated in intensive therapies to help get her life back on
track.
Now a 10th grader, Lueken’s stroke has taught her that every day is a
gift. She has worked hard to be on the honor roll and complete her
first community college course. She uses the Association’s platform to
share her story so others can learn from her experience. Lueken and her
mom, Maria – a heart disease survivor – want others to know that a
stroke can happen to anyone at any age.
The pair shared their story at the Cedar Rapids Heart Ball on Feb. 3.
In addition to Lueken, the 2024 Stroke Hero winners include:
Caregiver Hero: Loretta Sharp Gray, Oakwood Village, Ohio
Loretta Sharp Gray went from teaching students with disabilities to
personal caregiver for her life partner, who survived a serious stroke
and wasn’t expected to live. Never complaining or seeking recognition,
she takes care of him at home with periodic home visits from his primary
care doctor and nurse practitioner. At the same time, this grandmother
is an advocate, volunteer and trusted messenger in the community. She
also volunteers with the Association’s STEM Goes Red program. Students
from local schools learn about heart health, stroke and CPR, as well as
careers in science, technology, engineering and math.
Equity Hero: Dr. Kimon Bekelis, Babylon, New York
Kimon Bekelis, MD has worked tirelessly to ensure equal access to
lifesaving stroke care on Long Island, N.Y. regardless of demographics
or ability to pay. He led the development of the Stroke and Brain
Aneurysm Center at Good Samaritan, the first Comprehensive Stroke Center
on the south shore of Long Island, expanding access to high-quality
stroke care for an underserved population. He believes everyone deserves
an equal chance at the best possible outcome. Throughout his career,
Dr. Bekelis has embodied this commitment to health equity and worked to
enact meaningful improvements in equitable access to lifesaving stroke
care.
Group Heroes: Centre for Neuro Skills, various locations in California and Texas
For more than 40 years, the Centre for Neuro Skills has provided
community-based treatment for people recovering from brain injuries. As a
recognized leader in the stroke and brain injury rehabilitation field,
the Centre’s specially trained staff offer outcome-driven medical
treatment, therapeutic rehabilitation and disease management services.
The Centre lends its clinical expertise for educational interviews and
shares inspiring stroke patient stories to local and national media for
national recognition days, such as World Stroke Day and American Stroke
Month, to educate the public about stroke prevention, causes and
rehabilitation.
Survivor Hero: Craig Northcutt, Durant, Oklahoma
Craig Northcutt nearly lost his life in an ATV accident, leaving him
with a brain bleed that caused a stroke. After months of intensive
neurorehabilitation, he relearned how to walk, talk and return to work.
Now he raises awareness about stroke through professional mentorship and
by sharing his story with high school students and stroke survivors.
Craig is celebrating his 12-year stroke anniversary and his 30-year work
anniversary with the Choctaw Nation. As part of the organization’s
Tribal Advocacy program, he helps tribal nation members develop their
professional skills and find jobs.
Voters’ Choice Hero: Rick Hoeg, Northville, Michigan
After having a hemorrhagic stroke on Dec. 30, 2022, Rick Hoeg tackled
the hardest challenge of his life: recovery. While still in aggressive
outpatient rehab, Rick created a nine-part YouTube series on stroke
education and prevention, often featuring his rehabilitation therapists.
In his series, he taught stroke warning signs and shared his recovery
journey, reaching over 100,000 viewers. Rick’s video series culminated
in a $30,000 fundraiser benefiting the hospitals that saved his life.
Today, he continues to educate about stroke and supports hospital staff
in their vital work.
Winners were selected by a nationwide panel of volunteer judges from
the American Stroke Association, with the exception of the Voters’
Choice Award, which was selected via online popular vote.
Even superstars like Julie Bernhardt don't create protocols from research to get stroke survivors recovered! Who then will actually create recovery protocols? SPECIFIC NAMES ONLY!
Leeanne M. Carey, PhD; David F. Abbott, PhD; Gary F. Egan, PhD; Julie Bernhardt, PhD; Geoffrey A. Donnan, MD
Background and Purpose
Motor recovery after stroke is associated with cerebral reorganization. However, few studies have investigated the relationship directly, and findings are equivocal. We therefore aimed to characterize the relationship between motor impairment, motor recovery, and task-related changes in regional cerebral blood flow (△rCBF) longitudinally.
Methods
We obtained a profile of motor impairment and recovery in the upper limb and conducted positron emission tomography motor activation studies using a simple finger-tapping task in 9 stroke patients 2 to 7 weeks after stroke and 6 months later. For correlation analysis, mean images of task-related ⊿rCBF for each individual were linearly regressed with motor impairment scores. Motor recovery was correlated with longitudinal ⊿rCBF images.
Results—Patients
(7 males; 72.0±9.8 years) demonstrated a wide range of impairment severity and variable recovery. Upper-limb motor function was linearly correlated with task-related △rCBF. Importantly, sites of correlated ⊿rCBF differed over time. Subacutely correlated △rCBF was observed in supplementary motor area (SMA), bilateral cingulate, and contralesional insula with a small area in ipsilesional primary sensorimotor cortex (SM1). Conversely, at the 6-month study, correlated △rCBF was primarily in ipsilesional SM1, extending to the cingulate gyrus. Better motor recovery was correlated with reduction in contralesional activity and increase in ipsilesional SM1.
Conclusions
Upper-limb motor function and recovery are correlated with △rCBF in SMA, cingulate, insula, and SM1, highlighting the role of these areas in the recovery process. The dynamic nature of the relationship suggests ongoing adaptation within motor networks. (Stroke. 2005;36:625-629.)
Low-level
light therapy appears to affect healing in the brains of individuals
who suffered from a moderate traumatic brain injury (TBI), according to a
study published in Radiology.
Previous studies have
shown that low-level light therapy can modulate recovery in patients
with TBI. However, the impact of this treatment on the functional
connectivity
click to scroll down to continue reading the article
article continues here
of the brain when at rest has not been well studied.
For
the current study, Suk-tak Chan, PhD, Massachusetts General Hospital,
Boston, Massachusetts, and colleagues used functional magnetic resonance
imaging to assess the effect of low-level light therapy on whole-brain
resting-state functional connectivity in patients with moderate TBI at
acute (within 1 week), subacute (2-3 weeks), and late-subacute (3
months) recovery phases.
The researchers evaluated 17 patients treated with low-level light therapy, 21 treated with sham, and 23 healthy controls.
Seven
brain region pairs exhibited a greater change in connectivity in
patients treated with low-level light therapy than in those treated with
sham between the acute and subacute phases (range of z differences,
0.37; 95% confidence interval [CI], 0.20-0.53 to 0.45; 95% CI,
0.24-0.67; false discovery rate (FDR)-adjusted P value range, .010-.047).
There
was an increase in connectivity in 13 different brain regions among
patients treated with sham between the subacute and late-subacute phases
(range of z differences, 0.17; 95% CI, 0.09- 0.25 to 0.26; 95% CI,
0.14-0.39; FDR-adjusted P value range, .020-.047).
When
measured according to Rivermead Postconcussion Symptoms Questionnaire
scores, there was no evidence of a difference in clinical outcomes
between patients treated with low-level light therapy and those treated
with sham (range of differences in medians, -3.54; 95% CI, -12.65 to
5.57 to -0.59; 95% CI, -7.31 to 8.49; P value range, .44-.99).
“There
was increased connectivity in those receiving light treatment,
primarily within the first 2 weeks,” said Nathaniel Mercaldo, PhD,
Massachusetts General Hospital. “We were unable to detect differences in
connectivity between the 2 treatment groups long term, so although the
treatment appears to increase the brain connectivity initially, its
long-term effects are still to be determined.”
“There is still a lot of work to be done to understand the exact physiological mechanism behind these effects,” added Dr. Chan.
Additional
studies with larger cohorts of patients and correlative imaging beyond 3
months may help determine the therapeutic role of light in TBI.
“There
are lots of disorders of connectivity, mostly in psychiatry, where this
intervention may have a role,” concluded Rajiv Gupta, MD, Massachusetts
General Hospital.
Totally the wrong question! Just by asking that you're going down the route of prevention topics. LEAVING MILLIONS EACH YEAR DISABLED!!! Do the hard work of stopping the 5 causes of the neuronal cascade of death in the first week thus saving millions to billions of neurons. LEADERS would solve the real problem, not just spout prevention crapola. We have NO LEADERS IN STROKE!!!
(In this article, Brent E.
Masel, M.D, Executive Vice-President for Medical Affairs for CNS and a
Clinical Professor of Neurology at the University of Texas Medical
Branch in Galveston, discusses how we might decrease the severity of
strokes or even mitigate them completely).
Stroke is the 4th leading cause of
death in the US, where there are approximately 800,000 strokes yearly. A
stroke occurs every 40 seconds, and one person dies every four minutes
from a stroke. Globally, one person in four people over age 25 will have
a stroke in their lifetime. Interestingly, 60% of individuals who have
a stroke are female. (There are lots of
theories about this, but no one knows for sure). An individual
surviving a stroke has a 5.5-year reduction in their life span.
Aside from prevention, what can
we, as healthcare providers, do to reduce these numbers? People will
still have strokes, but we can do something to decrease the severity of
the stroke or even mitigate it completely.
We need to recognize the symptoms
of a stroke so the individual may receive an intervention that may
change the course of the event. The key is the acronym FAST: Face,
Arms, Speech, Time.
Facial weakness: Can the person smile? Has their mouth or eye drooped?
Arm weakness: Can the person raise both arms?
Speech problems: Can the person speak clearly and understand what you say?
Time to call 911 if you see any of the signs.
There are indeed other signs that
should be considered and taken seriously, including sudden weakness or
numbness on one side of the body, difficulty finding words or speaking
in clear sentences, sudden blurred vision or loss of sight in one eye,
sudden memory loss or confusion as well as dizziness or sudden fall.
“Time is brain.” 1.9 million brain cells die for every minute the brain is deprived
of blood. If we see these signs, the individual must immediately go to a
hospital emergency room – by ambulance if possible. But what happens
next, and what can be done?
Upon arrival, a “stroke team” will be activated. This team consists of specially trained doctors, nurses, andtechnicians who have
a protocol to work as quickly as possible to find the best intervention
for that patient. The patient will be evaluated and stabilized. Blood studies and a CT scan of the head will be done.
If the patient can receive treatment approximately 4.5 hours after the
onset of symptoms, they may be appropriate for IV medication, TPA, that
can break up the clot. It is believed that after approximately 4.5 hours, the chances of reversing the stroke and not causing further damage with the clot busters are markedly reduced. Studies have shown that individuals receiving TPA at the appropriate time are 30% more likely to have little or no symptoms at 3 months than those who received a placebo.
Another treatment possibility is removing the clot mechanically. This isn’t easy and requires highly trained interventionalists. A wire must be threaded up the artery to the clot and then the clot is “grabbed” and removed.
Unfortunately, only 10% of stroke patients are eligible for this
procedure, as the clot must be in a large artery close to the neck. The
ideal timing is six hours after the event occurred, but the procedure can be done up to 24 hours later. Studies have shown recanalization, opening of the artery, in 60-75% of cases.
Interesting that these were all health professionals, I'm assuming they have intellectually challenging jobs, I wouldn't assume that their diet had much to do with the results of the research. I don't drink orange juice anymore, I don't want the extra calories.
Eating leafy greens, dark orange and
red vegetables and berry fruits, and drinking orange juice may be
associated with a lower risk of memory loss over time in men, according
to a study published in the November 21, 2018, online issue of Neurology®, the medical journal of the American Academy of Neurology.
"One of the most important factors in this study is that we were able
to research and track such a large group of men over a 20-year period
of time, allowing for very telling results," said study author
Changzheng Yuan, ScD, of Harvard T.H. Chan School of Public Health in
Boston. "Our studies provide further evidence dietary choices can be
important to maintain your brain health."
The study looked at 27,842 men with an average age of 51 who were all
health professionals. Participants filled out questionnaires about how
many servings of fruits, vegetables and other foods they had each day at
the beginning of the study and then every four years for 20 years. A
serving of fruit is considered one cup of fruit or ½ cup of fruit juice.
A serving of vegetables is considered one cup of raw vegetables or two
cups of leafy greens.
Participants also took subjective tests of their thinking and memory
skills at least four years before the end of the study, when they were
an average age of 73. The test is designed to detect changes that people
can notice in how well they are remembering things before those changes
would be detected by objective cognitive tests. Changes in memory
reported by the participants would be considered precursors to mild
cognitive impairment. The six questions include "Do you have more
trouble than usual remembering a short list of items, such as a shopping
list?" and "Do you have more trouble than usual following a group
conversation or a plot in a TV program due to your memory?"
A total of 55 percent of the participants had good thinking and
memory skills, 38 percent had moderate skills, and 7 percent had poor
thinking and memory skills.
The participants were divided into five groups based on their fruit
and vegetable consumption. For vegetables, the highest group ate about
six servings per day, compared to about two servings for the lowest
group. For fruits, the top group ate about three servings per day,
compared to half a serving for the bottom group.
The men who consumed the most vegetables were 34 percent less likely
to develop poor thinking skills than the men who consumed the least
amount of vegetables. A total of 6.6 percent of men in the top group
developed poor cognitive function, compared to 7.9 percent of men in the
bottom group.
The men who drank orange juice every day were 47 percent less likely
to develop poor thinking skills than the men who drank less than one
serving per month. This association was mainly observed for regular
consumption of orange juice among the oldest men. A total of 6.9 percent
of men who drank orange juice every day developed poor cognitive
function, compared to 8.4 percent of men who drank orange juice less
than once a month. This difference in risk was adjusted for age but not
adjusted for other factors related to reported changes in memory.
The men who ate the most fruit each day were less likely to develop
poor thinking skills, but that association was weakened after
researchers adjusted for other dietary factors that could affect the
results, such as consumption of vegetables, fruit juice, refined grains,
legumes and dairy products.
The researchers also found that people who ate larger amounts of
fruits and vegetables 20 years earlier were less likely to develop
thinking and memory problems, whether or not they kept eating larger
amounts of fruits and vegetables about six years before the memory test.
The study does not show that eating fruits and vegetables and
drinking orange juice reduces memory loss; it only shows a relationship
between them.
A limitation of the study was that participants' memory and thinking
skills were not tested at the beginning of the study to see how they
changed over the course of the study. However, because all participants
completed professional training, they can be assumed to have started
with relatively high cognitive function in early adult life. In
addition, the study participants were all male health professionals such
as dentists, optometrists, and veterinarians. Thus, the results may not
apply to women and other groups of men.
The study was supported by a grant from the National Institutes of
Health and an anonymous gift to the Harvard T.H. Chan School of Public
Health.
I'm absolutely positive your competent? doctor will see this and immediately implement protocols to use this for stroke rehab. I wish there was a sarcasm punctuation tag.
Summary: Researchers found that people easily
learned to use a controllable, prosthetic “Third Thumb” for manipulating
objects. The device, tested on a diverse group, enhances motor
capabilities and shows promise for both productivity and aiding those
with disabilities. The study highlights the importance of inclusive
design in developing new technologies.
Key Facts:
98% of participants successfully used the Third Thumb within a minute.
The device was tested on 596 participants aged 3 to 96.
Inclusive design is crucial for ensuring accessibility and functionality for all.
Source: University of Cambridge
Cambridge
researchers have shown that members of the public have little trouble
in learning very quickly how to use a third thumb – a controllable,
prosthetic extra thumb – to pick up and manipulate objects.
The
team tested the robotic device on a diverse range of participants,
which they say is essential for ensuring new technologies are inclusive
and can work for everyone.
An emerging area of future technology
is motor augmentation – using motorised wearable devices such as
exoskeletons or extra robotic body parts to advance our motor
capabilities beyond current biological limitations.
The Third Thumb worn by different users. Credit: Dani Clode Design / The Plasticity Lab
While
such devices could improve the quality of life for healthy individuals
who want to enhance their productivity, the same technologies can also
provide people with disabilities new ways to interact with their
environment.
Professor Tamar Makin from the Medical Research
Council (MRC) Cognition and Brain Sciences Unit at the University of
Cambridge said: “Technology is changing our very definition of what it
means to be human, with machines increasingly becoming a part of our
everyday lives, and even our minds and bodies.
“These technologies
open up exciting new opportunities that can benefit society, but it’s
vital that we consider how they can help all people equally, especially
marginalised communities who are often excluded from innovation research
and development.
“To ensure everyone will have the opportunity to
participate and benefit from these exciting advances, we need to
explicitly integrate and measure inclusivity during the earliest
possible stages of the research and development process.”
Dani
Clode, a collaborator within Professor Makin’s lab, has developed the
Third Thumb, an extra robotic thumb aimed at increasing the wearer’s
range of movement, enhancing their grasping capability and expanding the
carrying capacity of the hand.
This allows the user to perform
tasks that might be otherwise challenging or impossible to complete with
one hand or to perform complex multi-handed tasks without having to
coordinate with other people.
The Third Thumb is worn on the
opposite side of the palm to the biological thumb and controlled by a
pressure sensor placed under each big toe or foot. Pressure from the
right toe pulls the Thumb across the hand, while the pressure exerted
with the left toe pulls the Thumb up toward the fingers.
The
extent of the Thumb’s movement is proportional to the pressure applied,
and releasing pressure moves it back to its original position.
In
2022, the team had the opportunity to test the Third Thumb at the annual
Royal Society Summer Science Exhibition, where members of the public of
all ages were able to use the device during different tasks.
The results are published today in Science Robotics.
Over
the course of five days, the team tested 596 participants, ranging in
age from three to 96 years old and from a wide range of demographic
backgrounds. Of these, only four were unable to use the Third Thumb,
either because it did not fit their hand securely, or because they were
unable to control it with their feet (the pressure sensors developed
specifically for the exhibition were not suitable for very lightweight
children).
Participants were given up to a minute to familiarise
themselves with the device, during which time the team explained how to
perform one of two tasks.
The first task involved picking up pegs
from a pegboard one at a time with just the Third Thumb and placing them
in a basket. Participants were asked to move as many pegs as possible
in 60 seconds. 333 participants completed this task.
The second
task involved using the Third Thumb together with the wearer’s
biological hand to manipulate and move five or six different foam
objects. The objects were of various shapes that required different
manipulations to be used, increasing the dexterity of the task.
Again,
participants were asked to move as many objects as they could into the
basket within a maximum of 60 seconds. 246 participants completed this
task.
Almost everyone was able to use the device straightaway. 98%
of participants were able to successfully manipulate objects using the
Third Thumb during the first minute of use, with only 13 participants
unable to perform the task.
Ability levels between participants
were varied, but there were no differences in performance between
genders, nor did handedness change performance – despite the Thumb
always being worn on the right hand.
There was no definitive
evidence that people who might be considered ‘good with their hands’ –
for example, they were learning to play a musical instrument, or their
jobs involved manual dexterity – were any better at the tasks.
Older
and younger adults had a similar level of ability when using the new
technology, though further investigation just within the older adults
age bracket revealed a decline in performance with increasing age.
The
researchers say this effect could be due to the general degradation in
sensorimotor and cognitive abilities that are associated with ageing and
may also reflect a generational relationship to technology.
Performance
was generally poorer among younger children. Six out of the 13
participants that could not complete the task were below the age of 10
years old, and of those that did complete the task, the youngest
children tended to perform worse compared to older children. But even
older children (aged 12-16 years) struggled more than young adults.
Dani
said: “Augmentation is about designing a new relationship with
technology—creating something that extends beyond being merely a tool to
becoming an extension of the body itself.
“Given the diversity of
bodies, it’s crucial that the design stage of wearable technology is as
inclusive as possible. It’s equally important that these devices are
accessible and functional for a wide range of users. Additionally, they
should be easy for people to learn and use quickly.”
Co-author
Lucy Dowdall, also from the MRC Cognition and Brain Science Unit, added:
“If motor augmentation – and even broader human-machine interactions –
are to be successful, they’ll need to integrate seamlessly with the
user’s motor and cognitive abilities.
“We’ll need to factor in
different ages, genders, weight, lifestyles, disabilities – as well as
people’s cultural, financial backgrounds, and even likes or dislikes of
technology. Physical testing of large and diverse groups of individuals
is essential to achieve this goal.”
There are countless examples of where a lack of inclusive design considerations has led to technological failure:
Automated
speech recognition systems that convert spoken language to text have
been shown to perform better listening to white voices over Black
voices.
Some augmented reality technologies have been found to be less effective for users with darker skin tones.
Women
face a higher health risk from car accidents, due to car seats and
seatbelts being primarily designed to accommodate ‘average’ male-sized
dummies during crash testing.
Hazardous power and industrial
tools designed for a right-hand dominant use or grip have resulted in
more accidents when operated by left-handers forced to use their
non-dominant hand.
Funding: This research
was funded by the European Research Council, Wellcome, the Medical
Research Council and Engineering and Physical Sciences Research Council.
About this neurotech and neuroplasticity research news
Author:Craig Brierley Source: University of Cambridge Contact: Craig Brierley – University of Cambridge Image: The image is credited to Dani Clode Design / The Plasticity Lab
See these doctors are so smart, they know
exactly when to use the nocebo effect. Telling you you won't recover.
That elicits the response of; 'I'll prove you blithering idiots wrong.'
After
having a stroke in 2016, doctors told Dan Leffert he would never be
able to walk again. Eight years later and with the help of Bioness L300
Go, Leffert is walking once again, with a goal to walk 200 miles by the
end of the year. Credit: Haley Lena
Dan Leffert dedicated most of his life to traveling across the globe
to places like Switzerland and Germany. He spent most of the time
outside, riding his motorcycle for thousands of miles. So hearing the
words “You’ll never walk again” felt like the end of the world.
He lost his mobility after having a stroke in 2016 and now 70, he has
undergone countless hours of physical and occupational therapy.
With the inspiration from his grandkids and the help of a medical
device, Dan is walking once again. And, like his motorcycle riding, he’s
measuring his miles. Dan has a goal of walking 200 miles by the end of
the year and even more the next year. He says it’s not about trying to
get back to where he used to, but more about seeing where he can go from
here.
“I’ve got to do 300 next year,” Dan said. “It’s not more what I had, it’s what I’m going to do.”
Everything changed on an ordinary February day in 2016. Dan was
sitting next to his wife, Vicky, taking part in a homeowners association
meeting in Castle Rock, speaking, when his words began to slur. Their
property manager asked if he was alright and when Dan responded “No,”
911 was called.
“I was coherent, but not speaking well,” said Dan.
The initial CT scan verified Dan had suffered a hemorrhagic stroke,
causing bleeding in the brain. Multiple times throughout the night, he
was taken in for more scans to monitor the bleeding, which eventually
stopped.
Stroke is not only a leading cause of death for Americans, the federal Centers for Disease Control and Prevention also states that it’s the leading cause of serious long-term disability in the U.S.
There are two main categories of strokes according to the American Stroke Association,
ischemic and hemorrhagic. An ischemic stroke, which accounts for 87% of
strokes, occurs when a blood vessel or artery going into the brain is
obstructed.
A hemorrhagic stroke is when a blood vessel leaks or ruptures and
bleeds into the brain, putting pressure on the brain, in turn, causing
damage.
Dan was in the intensive care unit for six days before spending the
next five weeks at Spalding Rehabilitation Center in Aurora.
He didn’t know how he could keep it up, but little did he know that
one of his inspirations had been born just months earlier: Hailey, his
granddaughter, who he calls his angel.
“We brought Hailey into the ICU, into rehab every single day and laid
her on his belly and said, ‘This is why you have to get better,’” Vicky
said.
The stroke left Dan in a wheelchair for a year and a half. He was
paralyzed on the right side of the body, his dominant side. He continues
to learn how to adapt everyday, oftentimes with unique products his
kids find.
For some time, he struggled with insurance for his occupational and
physical therapy, but his speech therapy was located at Sky Ridge
Medical Center. While at speech therapy one day, the couple noticed
occupational and physical therapists. They realized they wanted to be
with those therapists. Vicky walked up to the receptionist and asked how
she could get her husband in.
Dan soon began therapy to relearn movement and coordination skills
for over two years at Sky Ridge. Typically with insurance, Dan said
there were only 20 visits per year for occupational therapy and 20
visits for physical therapy, but he went 100 days a year, paying out of
pocket.
Dan
Leffert uses three Bioness devices, one on his thigh, knee and hand to
help stimulate the nerves in his arm and leg and help him with his
mobility. Credit: Vicky Leffert
He did multiple forms of therapy, including constraint therapy, aqua
therapy, acupuncture, deep needle therapy and massage therapy.
“I was looking for anything,” said Dan . “Everything I did contributed to getting better.”
Then, a friend from one of his motorcycle groups came to visit one day. He told Dan about a medical device called Bioness L300 Go,
which the friend’s father had used after having a stroke. After some
research and learning their insurance wouldn’t cover the device, the
couple met with a Bioness representative.
“It came down to, we don’t care what it costs,” Vicky said.
With one device on his thigh and two others on a knee and a hand, the
devices promote recovery by activating neuromuscular pathways required
for walking and movement. It’s a functional electrical stimulation
system that produces mobility improvements for patients who have
instability or mobility issues.
The device also has an app on the phone in which the patient can
alter the intensity and an adaptive algorithm that can predict walking
patterns and provide stimulation when needed to make it easier to move,
according to Bioness.
Needing more intense therapy, Dan began seeing a neuromuscular massage therapist in addition to using the devices.
It was during his first year with this therapist, Dan was back on his
feet. He walked a mile-long track. That distance has gradually gone up
each year, reaching 120 miles in 2023.
Although the recovery has been long and frustrating at times, said
Vicky, it’s also been rewarding. Their two youngest grandsons have
learned how to walk alongside Dan and the walking has become easier with
the help of his new puppy, Grizzly Bear.
Both Dan and Vicky want to encourage those who have had a stroke to not give up.
“You can do it,” said Vicky. “Try any and everything that’s out there because it all brings something to the table.”
If the ASA(American Stroke association) would do their FUCKING JOB OF GETTING PROTOCOLS FOR 100% RECOVERY! You wouldn't have to praise survivors for resilience.
Nancy Brown is Chief Executive Officer of the American Heart Association. Nancy, I await your reply.
Send me hate mail on this:
oc1dean@gmail.com. I'll print your complete statement with your name and my
response in my blog. Or are you afraid to engage with my stroke-addled
mind? You'll want 100% recovery when you are the 1 in 4 per WHO that has a stroke! Explain how you're going to get to 100% recovery if you don't start that research RIGHT NOW!
You do realize how fucking useless 'measurements' are to getting survivors recovered? Or do you not understand what survivors want? They want recovery; not some useless measurement you therapists have to do to get paid.
Movement
smoothness is a potential kinematic biomarker of upper extremity (UE)
movement quality and recovery after stroke; however, the measurement
properties of available smoothness metrics have been poorly assessed in
this group. We aimed to measure the reliability, responsiveness and
construct validity of several smoothness metrics.
Methods
This
ancillary study of the REM-AVC trial included 31 participants with
hemiparesis in the subacute phase of stroke (median time since stroke:
38 days). Assessments performed at inclusion (Day 0, D0) and at the end
of a rehabilitation program (Day 30, D30) included the UE Fugl Meyer
Assessment (UE-FMA), the Action Research Arm Test (ARAT), and 3D motion
analysis of the UE during three reach-to-point movements at a
self-selected speed to a target located in front at shoulder height and
at 90% of arm length. Four smoothness metrics were computed: a frequency
domain smoothness metric, spectral arc length metric (SPARC); and three
temporal domain smoothness metrics (TDSM): log dimensionless jerk
(LDLJ); number of submovements (nSUB); and normalized average rectified
jerk (NARJ).
Results
At
D30, large clinical and kinematic improvements were observed. Only
SPARC and LDLJ had an excellent reliability (intra-class
correlation > 0.9) and a low measurement error (coefficient of
variation < 10%). SPARC was responsive to changes in movement
straightness (rSpearman=0.64) and to a lesser extent to changes in movement duration (rSpearman=0.51) while TDSM were very responsive to changes in movement duration (rSpearman>0.8)
and not to changes in movement straightness (non-significant
correlations). Most construct validity hypotheses tested were verified
except for TDSM with low correlations with clinical metrics at D0 (rSpearman<0.5), ensuing low predictive validity with clinical metrics at D30 (non-significant correlations).
Conclusions
Responsiveness
and construct validity of TDSM were hindered by movement duration
and/or noise-sensitivity. Based on the present results and concordant
literature, we recommend using SPARC rather than TDSM in reaching
movements of uncontrolled duration in individuals with spastic paresis
after stroke.
Reliability, responsiveness and construct validity of SPARC were satisfactory.
Responsiveness and construct validity of LDLJ, NARJ and nSUB were highly related to movement duration.
LDLJ had an excellent reliability and a low measurement error, but not NARJ and nSUB.
Introduction
Spastic
paresis of the upper extremity (UE) was reported in 48% of survivors at
1 week after stroke in a community-based population (n = 421),
with full UE function achieved at discharge by 79% of those with mild
paresis but only 18% of those with severe paresis [1]. Three main symptoms are well described in spastic paresis syndrome [2]: structural alterations relating to immobility (spastic myopathy, leading to muscle contractures) [3, 4], impaired motor control (stretch-sensitive paresis) of the agonist muscles [5, 6], and overactivity of antagonist muscles [7, 8], (including spasticity [8,9,10], spastic dystonia [11] and spastic cocontractions [12,13,14,15]).
Spastic
paresis directly alters the movement trajectories and velocity with
spatial (poor movement control, less efficient trajectories) and
temporal (longer movement duration) discontinuities, resulting in a lack
of smoothness [16,17,18].
Changes in the smoothness of the hand trajectory after stroke have been
studied during reaching, grasping, and pointing movements [19], and the evaluation of smoothness has been suggested as a valid indicator of the quality of spontaneous motor recovery [20,21,22,23] and rehabilitation-induced recovery [18, 24,25,26].
The
assessment of measurement properties of smoothness metrics is needed
for the evaluation of changes in the poststroke spastic paretic UE. To
date, many metrics have been used to explore movement recovery after
stroke [27].
Research involving robotic rehabilitation systems in the last fifteen
years has particularly contributed to the development of kinematic
metrics, including smoothness, as potential biomarkers for movement
recovery [24, 25, 27,28,29].
However, the use of smoothness metrics in clinical research remains
limited, as those metrics require particular instrumentation and
expertise that might be an obstacle for multicentric studies, are often
insufficiently defined mathematically (some are even robot-specific
metrics) and validated, and are often non-reproducible,
non-dimensionless (i.e. highly relying on movement time), poorly robust
against measurement noise, or are not related to the intermittency of
movement [19, 27, 30].
New
smoothness metrics that attempt to avoid those limitations have been
developed and used to assess point-to-reach and point-to-grasp movement
in healthy subjects and individuals after stroke [23, 31,32,33],
namely the log dimensionless jerk (LDLJ), a smoothness metric conceived
in the temporal domain and the spectral arc length metric (SPARC). The
SPARC was conceived in the frequency domain by Balasubramanian and
colleagues, notably to overcome the bias of movement duration and
noise-sensitivity in previously developed smoothness metrics, who tested
its content validity and described it as a robust to noise, sensitive,
reliable, and practical metric after tests on mathematical models [30, 34].
In
an earlier study, we compared the properties of four smoothness metrics
currently used in the literature (SPARC, and three temporal domain
smoothness metrics (TDSM): LDLJ, number of zero-crossings in the
acceleration profile also called number of submovements (nSUB) and
normalized average rectified jerk (NARJ)) during UE reaching movements
in 32 middle-aged healthy participants [33].
In this setting, the SPARC had the lowest measurement error, and seemed
independent of movement duration whereas the TDSM were highly
time-dependent. A better understanding of the measurement properties of
these metrics is still needed for patients with poststroke UE
impairment. An international consensus was reached on the taxonomy,
terminology and definitions of measurement properties within the COSMIN
initiative (COnsensus-based Standards for the selection of health
Measurement INstruments) setting a framework for the present study [35].
This
study aimed to assess the measurement properties (reliability,
responsiveness and construct validity) of the SPARC and three TDSM
(NARJ, LDLJ and nSUB) for point-to-reach movements in people with
moderate to severe impairment in the subacute phase of stroke, before
and after a rehabilitation program.
Based on our previous work in healthy subjects [33]
and literature, we hypothesized that the three TDSM would be more
associated with movement duration while the SPARC would be more
associated with movement straightness in the present context.
Restoring
hand functionality is critical for fostering independence in
individuals with neurological disorders. Various therapeutic approaches
have emerged to address motor function restoration, with music-based
therapies demonstrating notable advantages in enhancing neuroplasticity,
an integral component of neurorehabilitation. Despite the positive
effects observed, there remains a gap in the literature regarding
implementing music treatments in neurorehabilitation, such as Neurologic
Music Therapy (NMT), especially in conjunction with emerging fields
like wearable devices and game-based therapies.
Methods
A
literature search was conducted in various databases, including PubMed,
Scopus, IEEE Xplore, and ACM Digital Library. The search was performed
using a literature search methodology based on keywords. Information
collected from the studies pertained to the approach used in music
therapy, the design of the video games, and the types of wearable
devices utilized.
Results
A
total of 158 articles were found, including 39 from PubMed, 34 from
IEEE Xplore, 48 from Scopus, 37 from ACM Digital Library, and 35 from
other sources. Duplicate entries, of which there were 41, were
eliminated. In the first screening phase, 152 papers were screened for
title and abstract. Subsequently, 89 articles were removed if they
contained at least one exclusion criterion. Sixteen studies were
considered after 63 papers had their full texts verified.
Conclusions
The
convergence of NMT with emerging fields, such as gamification and
wearable devices designed for hand functionality, not only expands
therapeutic horizons but also lays the groundwork for innovative,
personalized approaches to neurorehabilitation. However, challenges
persist in effectively incorporating NMT into rehabilitation programs,
potentially hindering its effectiveness.
Introduction
Neurological
disorders are a group of heterogeneous diseases, some of which
contribute to gait, balance, and strength problems that result in a
lower quality of life. They affect nearly one billion people globally
and comprise 6.3% of the worldwide disease burden [1].
Representative cases in this group are stroke, multiple sclerosis,
cerebral palsy, spinal cord injury (SCI), and Parkinson’s disease (PD) [2].
These disorders can lead to significant deterioration in hand function,
one of the most complex anatomical structures, and crucial in the human
capacity for executing activities of daily living [3].
Particularly in individuals with these conditions, due to the
significant deterioration in hand function, the ability to reach, grasp,
release, and move objects effectively is frequently affected as a
result of impairments of upper extremity function: reduced muscle
strength, sensory loss, increased muscle stiffness, and a lack of motor
control [4].
One of the primary methods of recovery after a neurological injury is neuroplasticity [5].
This phenomenon is defined as the capacity of the human brain to adapt
and reconfigure its neuronal connections in response to diverse
experiences [6].
When changes in the brain are connected to dysfunctional outcomes for
the individual, it is termed maladaptive neural plasticity [7],
such as neurological disorders. Conversely, when alterations in the
brain are correlated with enhancements in an individual’s behavioral
capabilities, this phenomenon is termed adaptive neural plasticity [7]. Some examples of the appearance of adaptive neural plasticity are during brain development [8] and motor skills learning [9].
As a result, ongoing research is dedicated to devising innovative
treatments that can enhance neuroplasticity to rehabilitate patients
with neurological disorders.
Evidence supports the effectiveness
of including intensive, repetitive, challenging, and task-specific
practices in interventions aimed at fostering neuroplasticity(But you have NO CLUE on how to make neuroplasticity repeatable on demsnd!) and
augmenting sensorimotor recovery [10,11,12,13]. Furthermore, Petzinger et al. [12]
underscore the significance of cognitive engagement as another critical
component for enhancing plasticity. These authors suggest that
cognitive engagement might be improved by feedback, attentional demand
through cueing, and motivation. Cueing is described as utilizing
external temporal or spatial stimuli to aid in initiating and sustaining
movement [14].
Standard neurorehabilitation techniques for upper limb movement primarily depend on physical therapy [15]. This therapy involves targeted exercises designed to restore the functioning of the affected portion of the motor system [16]. Unfortunately, traditional occupational therapy in its current form is a process that patients dislike going through [17],
as it proves difficult for them to sustain interest in repetitive
exercise routines while simultaneously focusing on the precision of
their movements (e.g., speed, precision, fluidity, and posture) [18, 19]
and assumes greater significance considering that a patient’s attitude
during physical therapy sessions is closely related to their compliance
and success [20].
Children are significantly more problematic in this area since it is
challenging to maintain their motivation throughout protracted therapy
sessions [21]. Moreover, heightened patient motivation in their ultimate objective is a crucial facet of neuroplasticity [22].
Therefore, based on the reviewed literature, it can be inferred that
effective strategies for improving neuroplasticity in
neurorehabilitation should involve elements such as intensity,
repetition, challenges, task-specificity, and cognitive engagement,
among others.
Consequently, in upper limb neurorehabilitation, many therapy options have emerged. Lin et al. [23]
realized a review of experimented training programs designed to enhance
motor recovery following a stroke; these include Constraint-Induced
Movement Therapy, Electromyography biofeedback, Motor imagery therapy,
Robot-assisted training, Virtual reality or gaming, etc. These treatment
options must incorporate the abovementioned components to promote
neuroplasticity in patients.
In the quest to provide hand
neurorehabilitation with intensive, repetitive, and task-specificity
practices for the patient, taking into account their limitations and
strengths, it is of paramount importance to assess hand functionality
during therapies, as it enables the identification of changes indicating
neurological decline or the tracking of responses to treatments [24].
In this regard, motion capture devices gain greater significance.
Camera-based systems and keyboard-based methods, such as the Musical
Instrument Digital Interface (MIDI), are widely used for movement
assessment in rehabilitation. Notable studies include those employing
the leap motion controller, such as a 2019 study on PD by
Fernández-González et al. [25] and a study on stroke by Shah et al. [26]. Additionally, studies have used keyboards by Altenmüller in 2009 [27] and Villeneuve in 2013 [28].
However, wearable devices distinguish themselves by assessing user
movement and providing assistance during rehabilitation. For instance,
wearable robotic devices outperform traditional therapy due to their
ability to provide a higher number of repetitions in each session,
objectively assess the patient’s performance, reduce the physical strain
on therapists, and enable the monitoring of the patient’s active
participation in the training regimen [29].
In the same way, non-robotic wearable devices, such as data gloves, are
effective instruments for tracking hand movements and evaluating hand
functionality within hand rehabilitation systems [30].
One
practical approach to enhancing cognitive engagement involves the use
of auditory cueing. One emerging rehabilitation process that uses
auditory cues is music therapy, specifically neurological music therapy
(NMT) [31].
NMT is one of the few clinical interventions utilizing music as a
primary rehabilitative stimulus to evoke diverse brain and motor
responses [32].
Additionally, evidence suggests that musical treatments provide a
therapeutic strategy for recovering functional capacities in the upper
extremities of individuals with neurological disorders [33].
This is accentuated by its reliance on a research-based system of
standardized clinical techniques for sensorimotor, speech/language, and
cognitive training [34].
Thaut and Hoemberg [35]
have classified NMT into twenty techniques, from which three address
motor rehabilitation: Rhythmic Auditory Stimulation (RAS), Patterned
Sensory Enhancement (PSE), and Therapeutic Instrumental Music
Performance (TIMP). RAS enhances motor control by applying rhythmic
sensory stimulation in rehabilitating movements with inherent biological
rhythmicity, such as gait [35]. Although RAS has been extensively studied for gait neurorehabilitation, especially on PD [36], it is also applied to upper limb rehabilitation. Ghai et al. [37]
realized a systematic review and meta-analysis to analyze the effects
of rhythmic auditory cueing on arm function recovery post-stroke, in
which beneficial effects on the Fugl Meyer test, Action reach arm test
and Wolf motor time test were reported. PSE is utilized for movements
that do not inherently follow a rhythm, such as typical arm and hand
motions. Besides employing rhythm and timing as cues for movement, like
RAS, PSE utilizes intricate patterned structures in music to organize
multiple smaller motions to accomplish a more extensive sequence of
movements [35]. An investigation led by Wang et al. [38]
within a home-based program employing PSE reveals significant
enhancements in the gross motor capacity of children with cerebral
palsy. Likewise, in a recent study by Fan et al. [39],
individuals with PD demonstrated enhanced speed and functionality in
upper-limb movements by integrating PSE. Finally, TIMP uses musical
instruments to assist patients in regaining effective movement patterns
and exercising compromised motor function [35].
According to Pascual-Leone, playing a musical instrument demands
extensive procedural and motor learning that results in the plastic
reorganization of the human brain, which further supports the potential
of music therapy in rehabilitation [40].
A systematic review performed by Yang et al. in 2022 summarizes the
effect of NMT in patients with cerebral palsy. It suggests the effect of
TIMP in enhancing both gross and fine motor skills, with a particular
focus on improving hand function and the power associated with piano key
pressing [41].
A growing aspect highlighted in Lin et al.’s [23]
review of neurological rehabilitation is the incorporation of gaming,
specifically the integration of gamification. Gamification is
characterized as implementing game-related components in settings that
extend beyond traditional gaming contexts [42].
It is suggested that incorporating gamification into
neurorehabilitation has the potential to tackle various challenges
related to the implementation of intensive, engaging, and cost-effective
therapeutic exercises [43], even promoting motivation [44]. Games introduce challenges to patients, transforming rehabilitation into a dynamic and appealing journey [45].
Numerous research groups have advocated integrating video games as a
supplementary tool alongside traditional neurorehabilitation therapy [46].
In
summary, there is a need to develop innovative approaches for
delivering therapeutic exercises, especially for hand
neurorehabilitation. Gathering evidence in rehabilitating neurological
disorders and enhancing neuroplasticity and patient adherence
underscores that interventions integrating repetitive, intensive,
challenging, and motivational tasks are highly likely to improve
functional recovery. For this reason, this narrative review aims to
investigate the effectiveness of music and game-based approaches, hand
functionality assessment, and assistance by wearable devices in
achieving neuroplasticity for successful hand neurorehabilitation.
