Visceral Fat May Indicate Alzheimer’s Risk Decades Before Symptoms

 Your competent? doctor needs to first prevent this visceral fat and then if it occurs, remove it! You need excellent brain blood flow for recovery, so don't let your doctor weasel out of this requirement!

In case your doctor is incompetent in this matter, use this to train them:

Visceral Fat: What It is & How to Get Rid of It

With your chances of getting dementia post stroke, you need prevention solutions. YOUR DOCTOR IS RESPONSIBLE FOR PREVENTING 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:

Visceral Fat May Indicate Alzheimer’s Risk Decades Before Symptoms

Summary: A new study links visceral fat, a deep layer of abdominal fat, to increased brain amyloid and tau proteins—key markers of Alzheimer’s disease—decades before dementia symptoms arise. Researchers found that visceral fat accounted for 77% of the relationship between high BMI and amyloid accumulation, while other fat types showed no similar impact.

The study highlights how managing visceral fat through lifestyle changes or medication could reduce Alzheimer’s risk. Midlife interventions are especially critical, as participants in their 40s and 50s exhibited these pathologies early on. The findings further reveal that metabolic factors like insulin resistance and cholesterol levels amplify obesity-related brain damage. This research emphasizes the urgent need for targeted prevention strategies against obesity-related Alzheimer’s risk.

Key Facts:

• Visceral fat is strongly associated with amyloid and tau protein buildup in the brain.
• Insulin resistance and low HDL cholesterol worsen obesity-related Alzheimer’s pathology.
• Managing visceral fat through weight loss or metabolic treatments may reduce dementia risk.

Source: RSNA

Researchers have linked a specific type of body fat to the abnormal proteins in the brain that are hallmarks of Alzheimer’s disease up to 20 years before the earliest symptoms of dementia  appear, according to a study being presented today at the annual meeting of the Radiological Society of North America (RSNA).

The researchers emphasized that lifestyle modifications targeted at reducing this fat could influence the development of Alzheimer’s disease.

The effects of visceral fat on amyloid pathology were partially reduced in people with higher HDL. Credit: Neuroscience News

“This crucial result was discovered because we investigated Alzheimer’s disease pathology as early as midlife—in the 40s and 50s—when the disease pathology is at its earliest stages, and potential modifications like weight loss and reducing visceral fat are more effective as a means of preventing or delaying the onset of the disease,” said lead study author Mahsa Dolatshahi, M.D., M.P.H., post-doctoral research associate at Mallinckrodt Institute of Radiology (MIR) at Washington University School of Medicine in St. Louis, Missouri.

An estimated 6.9 million Americans, aged 65 and older, are living with Alzheimer’s disease, according to the Alzheimer’s Association. The association estimates this number could grow to 13 million by 2050, barring the development of medical breakthroughs to prevent or cure the disease.

For the study, the researchers focused on the link between modifiable lifestyle-related factors, such as obesity, body fat distribution and metabolic aspects, and Alzheimer’s disease pathology.

A total of 80 cognitively normal midlife individuals (average age: 49.4 years, female: 62.5%,) were included in the study. Approximately 57.5% of participants were obese, and the average body mass index (BMI) of the participants was 32.31.

The participants underwent brain positron emission tomography (PET), body MRI and metabolic assessment (glucose and insulin measurements), as well as a lipid (cholesterol) panel.

MRI scans of the abdomen were performed to measure the volume of the subcutaneous fat (the fat under skin) and visceral fat (deep hidden fat surrounding the organs).

“We investigated the association of BMI, visceral fat, subcutaneous fat, liver fat fraction, thigh fat and muscle, as well as insulin resistance and HDL (good cholesterol), with amyloid and tau deposition in Alzheimer’s disease,” said Dr. Dolatshahi, a member of the Raji Lab at MIR’s Neuroimaging Labs Research Center.

Thigh muscle scans were used to measure volume of muscle and fat. Alzheimer’s disease pathology was measured using PET scans with tracers that bind to amyloid plaques and tau tangles that accumulate in the brains of people with Alzheimer’s disease.

The findings revealed that higher levels of visceral fat were related to increased amyloid, accounting for 77% of the effect of high BMI on amyloid accumulation. Other types of fat did not explain obesity-related increased Alzheimer’s pathology.

“Our study showed that higher visceral fat was associated with higher PET levels of the two hallmark pathologic proteins of Alzheimer’s disease—amyloid and tau,” Dr. Dolatshahi said.

“To our knowledge, our study is the only one to demonstrate these findings at midlife where our participants are decades out from developing the earliest symptoms of the dementia that results from Alzheimer’s disease.”

The study also showed that higher insulin resistance and lower HDL were associated with high amyloid in the brain. The effects of visceral fat on amyloid pathology were partially reduced in people with higher HDL.

“A key implication of our work is that managing Alzheimer’s risk in obesity will need to involve targeting the related metabolic and lipid issues that often arise with higher body fat,” said senior study author Cyrus A. Raji, M.D., Ph.D., associate professor of radiology at MIR.

Although previous studies have shown the role of high BMI in damaging the cells of the brain, no similar study has investigated the differential role of visceral and subcutaneous fat or metabolic profile, especially in terms of Alzheimer’s amyloid pathology as early as midlife, Dr. Dolatshahi pointed out.

“This study goes beyond using BMI to characterize body fat more accurately with MRI and, in so doing, reveals key insights about why obesity can increase risk for Alzheimer’s disease,” Dr. Dolatshahi said.

Drs. Raji, Dolatshahi and colleagues are also presenting a study at RSNA 2024 that shows how obesity and visceral fat reduce blood flow in the brain.

In that study, the researchers performed brain and abdominal MRI on cognitively normal midlife individuals with a wide range of BMI and compared whole-brain and regional cerebral blood flow on brain MRI in individuals with high vs. low visceral and subcutaneous fat. 

The high visceral fat group showed lower whole-brain blood flow. No significant difference was observed in cerebral blood flow in the groups with high vs. low subcutaneous fat.

“This work will have a considerable impact on public health because nearly three out of four Americans are overweight or obese,” Dr. Raji said.

“Knowing that visceral obesity negatively affects the brain opens up the possibility that treatment with lifestyle modifications or appropriate weight-loss drugs could improve cerebral blood flow and potentially lower the burden of and reduce the risk for Alzheimer’s disease.”

Other co-authors are Paul K. Commean, B.E.E., Mahshid Naghashzadeh, M.S., Sara Hosseinzadeh Kassani, Ph.D., Jake Weeks, B.S., Caitlyn Nguyen, B.S., Abby McBee-Kemper, B.S., Nancy Hantler, B.S., LaKisha Lloyd, M.Sc., Shaney Flores, M.S., Yifei Xu, M.S., Jingxia Liu, Ph.D., Claude B. Sirlin, M.D., Bettina Mittendorfer, Ph.D., Joseph E. Ippolito, M.D., Ph.D., John C. Morris, M.D., and Tammie L.S. Benzinger, M.D., Ph.D.

This study was awarded the RSNA Trainee Research Prize.

About this Alzheimer’s disease research news

Author: Linda Brooks
Source: RSNA
Contact: Linda Brooks – RSNA
Image: The image is credited to Neuroscience News

Original Research: The findings will be presented at the 110th Scientific Assembly and Annual Meeting of the Radiological Society of North America

A Review of Rehabilitation Devices to Promote Upper Limb Function Following Stroke

 Absolutely useless research since NO protocols were created and distributed. If you can't do even minimally useful research to get survivors recovered, then get the hell out of stroke.

A Review of Rehabilitation Devices to Promote Upper Limb Function Following Stroke

Jacob Brackenridge 1 , Lynley V. Bradnam 2,3 , Sheila Lennon 2 , John J. Costi 1 and David A. Hobbs 1, * 1 Medical Device Research Institute, School of Computer Science, Engineer- ing and Mathematics, Flinders University, Adelaide, South Australia, Australia; 2 Discipline of Physiotherapy, School of Health Sciences, Flinders Uni- versity, Adelaide, South Australia, Australia; 3 Discipline of Physiotherapy, Graduate School of Health, University of Technology, Sydney, NSW, Australia 

Abstract: 

Background: 

Stroke is a major contributor to the reduced ability to carry out activities of daily living (ADL) post cerebral infarct. There has been a major focus on understanding and improving rehabilitation interventions in order to target cortical neural plasticity to support recovery of upper limb function. Conventional therapies delivered by therapists have been combined with the application of mechanical and robotic devices to provide controlled and assisted movement of the paretic upper limb. The ability to provide greater levels of intensity and reproducible repetitive task practice through the application of intervention devices are key mechanisms to support rehabilitation efficacy. 

Results: 

This review of literature published in the last decade identified 141 robotic or mechanical devices. These devices have been characterised and assessed by their individual characteristics to provide a review of current trends in rehabilitation device interventions. Correlation of factors identified to promote positive targeted neural plasticity has raised questions over the benefits of expensive robotic devices over simple mechanical ones. 

Conclusion: 

A mechanical device with appropriate functionality to support the promotion of neural plasticity after stroke may provide an effective solution for both patient recovery and to stimulate further research into the use of medical de- vices in stroke rehabilitation. These findings indicate that a focus on simple, cost effective and efficacious intervention solutions may improve rehabilitation outcomes. 

Keywords: 

Activities of daily living, exercise therapy, paresis, recovery of function, robotics, stroke, upper extremity, mechanical devices, neural plasticity.

Effectiveness of early vocational rehabilitation versus usual care to support RETurn to work After stroKE: a pragmatic, parallel arm multi-centre, randomised-controlled trial

 The simplest way to get survivors back to work is EXACT 100% RECOVERY PROTOCOLS! And you blithering idiots don't know that! Doesn't anyone in stroke know how to think?

Effectiveness of early vocational rehabilitation versus usual care to support RETurn to work After stroKE: a pragmatic, parallel arm multi-centre, randomised-controlled trial

Kathryn Alice Radford, Alexandra Wright-Hughes https://orcid.org/0000-0001-8839-6756 a.wright-hughes@leeds.ac.uk, […], and Amanda Farrin+18View all authors and affiliations

Accepted Manuscripts

https://doi.org/10.1177/17474930241306693

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Abstract

Background

Return-to-work is a major goal achieved by fewer than 50% stroke survivors. Evidence on how to support return-to-work is lacking.

Aims

To evaluate the clinical effectiveness of Early Stroke Specialist Vocational Rehabilitation (ESSVR) plus usual care (UC) (i.e. usual NHS rehabilitation) versus UC alone for helping people return-to-work after stroke.

Methods

This pragmatic, multicentre, individually randomised controlled trial with embedded economic and process evaluations, compared ESSVR with UC in 21 NHS stroke services across England and Wales. Eligible participants were aged ≥18 years, in work at stroke onset, hospitalised with new stroke and within 12-weeks of stroke. People not intending to return-to-work were excluded. Participants were randomised (5:4) to individually-tailored ESSVR delivered by stroke-specialist occupational-therapists for up to 12-months or usual National Health Service rehabilitation. Primary outcome was self-reported return-to-work for ≥2 hours per week at 12-months. Primary and safety analyses were done in the intention-to-treat population.

Results

Between 1st June-2018, and 7th March-2022, 583 participants (mean age 54.1 years [SD 11.0], 69% male) were randomised to ESSVR (n=324) or UC (n=259). Primary outcome data were available for 454(77.9%) participants. Intention-to-treat analysis showed no evidence of a difference in the proportion of participants returned-to-work at 12-months (165/257[64.2%] ESSVR vs 117/197[59.4%] UC; adjusted odds ratio 1.12 [95%CI 0.8 to 1.87],p=0.3582). There was some indication that older participants and those with more post-stroke impairment were more likely to benefit from ESSVR (interaction p=0.0239 and p=0.0959 respectively).

Conclusions

To our knowledge, this is the largest trial of a stroke VR intervention ever conducted. We found no evidence that ESSVR conferred any benefits over UC in improving return-to-work rates 12-months post-stroke. Return-to-work (for at least 2 hours per week) rates were higher than in previous studies (64.2% ESSVR versus 59.4% UC) at 12-months and more than double that observed in our feasibility trial (26%). Interpretation of findings was limited by a predominantly mild-moderate sample of participants and the Covid-19 pandemic. The pandemic impacted the trial, ESSVR and UC delivery, altering the work environment and employer behaviour. These changes influenced our primary outcome and the meaning of work in people’s lives; all pivotal to the context of ESSVR delivery and its mechanisms of action.

Data access:

Data available on reasonable request.

Registration:

ISRCTN12464275.

Get full access to this article

A century of bold hearts: The American Heart Association celebrates 100 years of lifesaving impact

 The founding of the American Stroke Association in 1998 has to be considered a complete failure! They don't even have 100% recovery as their goal!  I don't know why stroke is in their name because it certainly is NOT to help stroke survivors!

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? I'm curious why you aren't working on what survivors want:100% RECOVERY!

A century of bold hearts: The American Heart Association celebrates 100 years of lifesaving impact

For 100 years, the American Heart Association has been at the forefront of scientific innovation and community impact, saving and improving lives across the globe. Founded on June 10, 1924, by six visionary cardiologists in Chicago, the American Heart Association has grown into the nation’s largest voluntary organization dedicated to fighting heart disease and stroke(You're doing nothing for stroke survivors!). In 2024, the American Heart Association proudly celebrates its centennial milestone — Bold Hearts™ — while continuing its relentless mission to advance health and hope for everyone, everywhere.

100 years of progress and innovation

From its humble beginnings, the American Heart Association has driven groundbreaking advancements in cardiovascular care. Over the past century, the organization has been instrumental in the development of the artificial heart valve, implantable pacemakers, and lifesaving CPR techniques. It has invested more than $5.7 billion in cardiovascular research, making it the leading nonprofit funder of heart and stroke research worldwide.

“Our mission has always been clear: to ensure equitable health for all,” said Laura Lopez, executive director of the American Heart Association. “We’ve achieved so much in 100 years, but there is still so much to do as we look ahead to our second century.”

The American Heart Association’s centennial celebration, Bold Hearts™, honors this legacy while reinforcing a vision for the future. By addressing health inequities, removing barriers to care, and championing innovative research, the organization is paving the way for a healthier world.

Collaborating for a healthier tomorrow

The American Heart Association’s success would not be possible without the support of its volunteers, researchers, individuals and corporate sponsors. Among these valued partners is JE Dunn Construction, which is also celebrating its centennial in 2024.

JE Dunn has been a steadfast supporter of the American Heart Association’s mission, demonstrating the power of partnership in creating healthier communities. The Kansas City-based construction firm has not only transformed skylines but also prioritized philanthropic efforts that align with the American Heart Association’s goals of advancing health equity and extending lives.

“For 100 years, the American Heart Association has saved, improved, and extended lives across the country and here in Kansas City,” said Gordon Lansford, president and CEO of JE Dunn Construction. “Having the opportunity for JE Dunn to support this organization over the years, and for me personally to serve our community as honorary chair of the 2025 Kansas City Heart Ball, is an honor and privilege.”

The Kansas City Heart Ball, one of the American Heart Association’s premier fundraising events, serves as a vital platform to raise awareness and funds in the fight against heart disease and stroke. Lansford’s leadership as the 2025 Honorary Chair highlights a shared commitment to advancing health and hope for all. The event, chaired by Nate Orr of Spencer Fane and his wife Stephanie Orr, will take place on Feb. 22, 2025, at the Loews Kansas City Hotel. Guests will come together to celebrate the American Heart Association’s legacy and help drive its lifesaving mission forward into the next century.

A vision for the future

Heart disease remains the leading cause of death worldwide, with stroke ranking second globally. Despite these challenges, the American Heart Association continues to fuel scientific discovery, advocate for patients and caregivers, and work alongside communities to create meaningful change.

Key initiatives, such as the organization’s “10 Commitments” to advance health equity, underscore its dedication to removing systemic barriers to care. The American Heart Association also leads the creation of evidence-based guidelines for cardiovascular care and CPR, ensuring that everyone has access to the best possible treatment.

The American Heart Association remains steadfast in its mission to prevent heart disease and stroke(Well, your mission is wrong in case of stroke! Solve stroke to 100% recovery!). Its efforts are powered by more than 35 million volunteers and supporters, as well as partnerships with organizations like JE Dunn Construction that share a passion for improving lives.

Join the celebration

For 100 years, the American Heart Association has been a beacon of hope, innovation and progress. As the American Heart Association celebrates this historic milestone, everyone is invited to join the mission of the American Heart Association. Because our future is about improving yours.

Contact Jackie McMahon at Jackie.McMahon@heart.org to learn more about how you can support the American Heart Association’s lifesaving mission and improve health outcomes in Kansas City.

The Surprising Sign of Dementia You Might Miss, According to Neurologists

 Your competent? doctor already knows about this and has protocols on this prevent your chance of dementia post-stroke.

Eye Movements Interfere With Limb Motor Control in Stroke Survivors  August 2018

With your chances of getting dementia post stroke, you need prevention solutions. YOUR DOCTOR IS RESPONSIBLE FOR PREVENTING 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:

The Surprising Sign of Dementia You Might Miss, According to Neurologists

• Involuntary eye movements, known as saccades, can be an early sign of dementia according to neurologists.
• Dementia can impact eye motor control functions, leading to challenges with visual searching and reading.
• Involuntary eye movements can also be caused by other conditions such as strokes, tumors, and medications, not just dementia.

See a mistake?

When picturing signs of dementia to look for, the first ones that come to mind may be memory loss, struggling to think of the right word and having difficulty problem-solving. You may have also heard about how dementia can cause a loss of smell and even falling.

Unfortunately, those aren’t the only signs of dementia, and there's at least one that you literally may not even be able to see yourself.

Related: The Unexpected Early Dementia Sign You Might Miss, According to Neurologists

The Surprising Sign of Dementia You Might Miss, According to Neurologists

According to research and a neurologist, there’s another sign that’s more surprising, and hard to notice: involuntary eye movements.

Dementia affects the brain, which can affect bodily functions and lead to a loss of motor control. One of the earliest signs is involuntary eye movements, known as saccades, according to researchers working to detect the disease with a special earpiece.“Eye movements are an important window into how the brain is functioning,” says Dr. Meredith Bock, MD, a board-certified neurologist and chief medical officer at Remo Health. “For people with Alzheimer’s, their eye motor control functions may be impacted due to a decline in the brain areas that govern eye movements.”She also notes that saccades are one of the earliest signs of neurodegenerative diseases. “Neurodegenerative illness can cause increased delays and imprecision in saccades,” she says. “They can also cause ‘saccadic intrusions’ into the smooth pursuit, where the normally smooth movements of the eyes following an object in motion become more ratchet-y.”

These patients may also have challenges with visual searching and reading, she adds, or move their whole head instead of just their eyes to look at something.

Related: This Seemingly Harmless Condition May Be Linked With Dementia, According to Study

What Those Involuntary Eye Movements Entail

Given these movements are small and rapid—and given eye movement happens frequently on purpose—this sign isn't super easy to spot.

“In most cases, only a trained professional, like a neurologist, would notice,” Dr. Bock says.

That’s not always the case, however. The severity can vary greatly, she continues, and other factors are at play. “Some people may have noticeable signs because they are slow to look at something or lose track of a moving object," she adds.

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Other Conditions That Can Cause Involuntary Eye Movements

Involuntary eye movements aren’t a clear sign someone has dementia, and many conditions can cause this symptom.

According to Dr. Bock, involuntary eye movements can indicate problems in the central nervous system (such as the brain and spinal cord) or the peripheral nervous system (such as nerves, muscles, and the junction between the nerve and muscles).

More specific causes she mentions include progressive supranuclear palsy, nystagmus, strokes, tumors, antiepileptic medications, myasthenia gravis and more.

Related: Eating This Daily May Reduce Your Dementia Risk, According to Doctors

What to Do If You Notice Involuntary Eye Movements

If you suspect something is wrong with your eyes or a loved one's, Dr. Bock encourages consulting with a physician.

“If this happens suddenly, it could be an emergency, like a stroke,” she adds. “While it might be a symptom related to dementia, there are other underlying causes that require medical attention, so it’s best to rule out other potential causes for this condition.”

Sources

• Dr. Meredith Bock, MD, a board-certified neurologist

• Listening for early signs of Alzheimer’s disease, Acoustical Society of America

Human Digital Twins in Rehabilitation: A Case Study on Exoskeleton and Serious-Game-Based Stroke Rehabilitation Using the ETHICA Methodology

I'm thinking this is action observation of yourself. But ask your competent? doctor to explain how this will get you recovered.

 Human Digital Twins in Rehabilitation: A Case Study on Exoskeleton and Serious-Game-Based Stroke Rehabilitation Using the ETHICA Methodology

MARTIN W. LAUER-SCHMALTZ1, PHILIP CASH2, JOHN P. HANSEN1, and NEHA DAS3 1 Department of Technology, Management and Economics, Technical University of Denmark, 2800 Kgs. Lyngby, Denmark (e-mail: mwola@dtu.dk, jpha@dtu.dk) 2 School of Design, Northumbria University, Newcastle upon Tyne NE1 8ST, United Kingdom (philip.cash@northumbria.ac.uk) 3 Chair of Information-Oriented Control, TUM School of Computation, Information and Technology, Technical University of Munich, 80333 Munich, Germany (neha.das@tum.de) Corresponding author: Martin W. Lauer-Schmaltz (e-mail: mwola@dtu.dk). This project has received funding from the European Union’s Horizon 2020 research and innovation program under grant agreement No 871767.

ABSTRACT 

Human Digital Twins (HDTs) hold significant potential to transform physical rehabilitation by monitoring patient conditions and personalizing therapeutic interventions. However, practical applications of HDTs in stroke rehabilitation remain limited. This paper presents the design and implementation of an HDT system for upper-limb stroke rehabilitation using exoskeletons and serious games, following the ETHICA methodology. Our system demonstrates how HDTs can enable real-time adjustments to therapy difficulty and exoskeleton assistance based on patient conditions, enhance collaboration between medical and non-medical stakeholders through data visualizations and decision-support mechanisms, and boost patient engagement through personalized feedback. Further, we developed a motion-based muscle fatigue estimation algorithm, predicting muscle fatigue on a continuous scale from 0 to 100% based on movement speed variations, and a compensatory movement detection model, trained with 1590 data samples, which detects unnatural supportive movements with 96% accuracy. Finally, we highlight key implications for the field, including i) the need for interdisciplinary collaboration to address human factors and sensor technology limitations; ii) the importance of aligning HDT components to avoid incompatibilities; iii) the value of user-centered design for increasing HDT usability and acceptance, and iv) the potential of HDT embodiments for enhancing user engagement and rehabilitation outcomes. Together, these insights provide a roadmap for advancing HDT research and its application in physical rehabilitation.

Myelinated Glial Cells: Their Proposed Role in Waste Clearance and Neurodegeneration in Arachnid and Human Brain

 Is your competent? doctor and hospital ensuring this research gets completed and a protocol created? NO? So, you don't have a functioning stroke doctor or hospital? Why are you staying at an incompetent place?

Myelinated Glial Cells: Their Proposed Role in Waste Clearance and Neurodegeneration in Arachnid and Human Brain

Ruth Fabian-Fine  ¹ , Adam L Weaver  ¹ , Abigail G Roman  ¹ , Melanie J Winters  ¹ , John C DeWitt  ²

Affiliations

• PMID: 39610046
• PMCID: PMC11605019
• DOI: 10.1002/cne.70000

Abstract

One of the most important goals in biomedical sciences is understanding the causal mechanisms of neurodegeneration. A prevalent hypothesis relates to impaired waste clearance mechanisms from the brain due to reported waste aggregation in the brains of Alzheimer patients, including amyloid-β plaques and neurofibrillary tau tangles. Currently, our understanding of the mechanisms by which waste is removed from the brain is only fragmentary. Here we provide compelling evidence that waste clearance from brain tissue is highly conserved in arachnids and humans. Utilizing RNAscope in situ hybridization, immunohistochemical, ultrastructural, and histological approaches, we demonstrate that cellular debris in spider neurons is engulfed by myelin-forming ependymal glial cells that transect into neuronal somata and form myelin-derived waste-internalizing receptacles. These canal systems channel this debris into the lymphatic system likely in an aquaporin-4 (AQP4) water channel-dependent manner. We provide robust evidence that a similar process may be true in human hippocampus where vast numbers of myelinated AQP4-immunoreactive ependymal glial cells send cellular projections into the somata of neurons and glial cells where they differentiate into waste internalizing receptacles. In the brains of Alzheimer decedents, hypertrophic impairment of these myelinated glial cells leads to the catastrophic obstruction and depletion of neuronal cytoplasm into the ependymal glial cells. At the cellular level, the structural impairment of macroglia leads to swelling myelin protrusions that appear as electron-lucent circular profiles, explaining spongiform abnormalities associated with the neurodegenerative diseases described here. We propose to term this novel type of macroglia-mediated cell death "gliaptosis."

Keywords: Alzheimer disease; Cupiennius salei; glymphatic system; tanycyte; waste clearance.

© 2024 The Author(s). The Journal of Comparative Neurology published by Wiley Periodicals LLC.   

Healing the gut can reduce long-term impact of stroke

 Is your competent? doctor and hospital ensuring this research gets completed and a protocol created? NO? So, you don't have a functioning stroke doctor or hospital? Why are you staying at an incompetent place?

Healing the gut can reduce long-term impact of stroke

A paper published this fall by researchers in the Department of Neuroscience and Experimental Therapeutics at the Texas A&M College of Medicine is the latest of multiple studies highlighting the potential of this novel avenue of treatment, which takes advantage of the link between the brain and digestive system to curb cognitive impairment and other lingering impacts of a stroke or brain trauma.

The team demonstrated how a drug that was effective at protecting the brain in the immediate aftermath of a stroke failed to prevent long-term cognitive impairment when applied only to the brain. The same drug, when applied to the gut, reduced impairment significantly.

"Just fixing the brain directly won't do it. As a neuroscientist, that was kind of shocking to me," said Regents Professor and Department Head Dr. Farida Sohrabji. "But this tells us that if you don't repair the gut, you won't see (improvement in long-term function)."

The study, which appears in the November edition of Brain, Behavior, and Immunity, builds on previous research led by Sohrabji, spearheaded by graduate student Yumna El-Hakim and associate research scientist Dr. Kathiresh Kumar Mani, exploring how the brain and gut influence each other during and after a stroke. By understanding and leveraging the relationship between these systems, the team hopes to develop therapeutic techniques to prevent cognitive impairment in stroke patients and reduce their risk of developing dementia or Alzheimer's disease (AD). Their work is supported by a grant awarded to Sohrabji by the National Institutes of Health, as well as additional funding from the WoodNext Foundation.

"Stroke is one of the leading causes of dementia and AD," Sohrabji said. "While there are acute, immediate consequences of stroke, there are also these long-term consequences that affect quality of life for the patient as well as the caregivers, so there's a lot of interest in understanding how to improve long-term outcomes."

What Happens In The Gut After A Stroke?

Within mere moments of a stroke, patients experience a cascade of symptoms, many of which are immediately apparent, Sohrabji said.

"You have individuals who can't lift their arms, whose faces droop on one side, their speech is slurred," she said. "That's classic and occurs very, very quickly."

Less apparent, she said, is the damage being done to key structures in the intestine, as the brain communicates to the gut that something is wrong. "What we've found is that minutes after a stroke occurs, normal gut anatomy is completely disrupted," Sohrabji explained.

Most notably, cells responsible for keeping the contents of the gut sealed off from the rest of the body begin to erode, allowing digestive bacteria to leak out and cause harm to other bodily systems. Under certain conditions, Sohrabji said, these bacteria can end up in the brain itself and disrupt its functioning. Even if bacteria don't make it all the way to the brain, brain function can still be impaired as the body's immune system recognizes the threat and mounts an inflammatory response to fight it. Increased inflammation exacerbates the impact of a stroke, further injuring the brain and increasing long-term cognitive impairment.

"If you just repair the brain, you will see short-term effects but not long-term improvement because the gut is still leaky," Sohrabji said. "It's (causing inflammation) and constantly impacting brain function in the long term."

Heal The Gut, Save The Brain

In the 2024 study, a treatment applied directly to the gut -- a dose of Insulin-like Growth Factor or IGF-1 -- was shown to significantly reduce post-stroke inflammation and cognitive impairment. Sohrabji and her team's investigation showed that the structures in the gut that become damaged after a stroke appeared to be repaired by the IGF-1 treatment, reinforcing the idea that healing the gut is crucial in facilitating stroke recovery.

In addition to its recent work with IGF-1, the team is exploring the use of stem cell transplants to rapidly repair the gut after a stroke -- a treatment proposed by Mani that has proven effective in previous studies.

Under normal conditions, the gut produces a steady supply of stem cells to repair itself, Sohrabji said. Existing research shows that these cells can be transplanted from a healthy donor to a host with a damaged gut to speed up their recovery.

"We were fairly sure that (the stem cells) would repair the gut. What was not known, and what was a very pleasant surprise to us, was that in that process, it also improved stroke outcomes," Sohrabji said. "As a result of (the treatment), the amount of dead tissue in the brain as a result of stroke was reduced and cognitive function was preserved."

Sohrabji and her team plan to continue their work in this area, in hopes of developing a stem cell-derived treatment that could be administered to patients in the aftermath of a stroke to reduce the long-term risk for dementia and other adverse effects.

Story Source:

Materials provided by Texas A&M University. Original written by Luke Henkhaus. Note: Content may be edited for style and length.

---

Journal Reference:

1. Yumna El-Hakim, Kathiresh Kumar Mani, Kaylin A. Pickle, Zara Akbari, Nadia Samiya, Chloe Pham, Gianna Salas, Rachel Pilla, Farida Sohrabji. Peripheral, but not central, IGF-1 treatment attenuates stroke-induced cognitive impairment in middle-aged female Sprague Dawley rats: The gut as a therapeutic target. Brain, Behavior, and Immunity, 2024; 122: 150 DOI: 10.1016/j.bbi.2024.08.008

Telerehabilitation using a 2-D planar arm rehabilitation robot for hemiparetic stroke: a feasibility study of clinic-to-home exergaming therapy

 You could get the same effects by just grasping your cane in front of you and pushing it forward, backward and side to side. No robotics though, so not cool enough for your therapists to suggest. 

Telerehabilitation using a 2-D planar arm rehabilitation robot for hemiparetic stroke: a feasibility study of clinic-to-home exergaming therapy

• Gabriel Aguirre-Ollinger,
• Karen Sui Geok Chua,
• Poo Lee Ong,
• Christopher Wee Keong Kuah,
• Tegan Kate Plunkett,
• Chwee Yin Ng,
• Lay Wai Khin,
• Kim Huat Goh,
• Wei Binh Chong,
• Jaclyn Ai Mei Low,
• Malaika Mushtaq,
• Tengiz Samkharadze,
• Simone Kager,
• Hsiao-Ju Cheng &
• Asif Hussain 

Journal of NeuroEngineering and Rehabilitation volume 21, Article number: 207 (2024) Cite this article

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Abstract

Background

We evaluated the feasibility, safety, and efficacy of a 2D-planar robot for minimally supervised home-based upper-limb therapy for post-stroke hemiparesis.

Methods

The H-Man, end effector robot, combined with web-based software application for remote tele-monitoring were evaluated at homes of participants. Inclusion criteria were: strokes > 28 days, Fugl-Meyer Motor Assessment (FMA) > 10-60/66, presence of a carer and absence of medical contraindications. Participants performed self-directed, minimally supervised robotics-assisted therapy (RAT) at home for 30 consecutive days, after 2 therapist-supervised clinic on-boarding sessions. Web-based compliance measures were: accessed sessions of > 20 min/day, training minutes/day and active training hours/30 days. Clinical outcomes at weeks 0, 5 (post-training), 12 and 24 (follow-up) consisted of FMA, Action Research Arm Test (ARAT) and WHO-Stroke Specific Quality of Life (SSQOL). To estimate immediate economic benefits of the home-based robotic therapy, we performed cost-effectiveness analysis (CEA), followed by budget impact analysis (BIA).

Results

Altogether, all 12 participants completed Home-RAT without adverse events; 9 (75.0%) were males, mean (SD) age, 59.4 years (9.5), median (IQR) stroke duration 38.6 weeks (25.4, 79.6) baseline FMA (0–66) 42.1 ± 13.2, ARAT (0–57) 25.4 ± 19.5, SSQOL (0–245) 185.3 ± 32.8. At week 5 follow-up, mean (SD) accessed days were 26.3 days ± 6.4, active training hours of 35.3 h ± 14.7/30 days, or ~ 6 days/week and 77 training minutes ± 20.9/day were observed. Significant gains were observed from baseline across time; ΔFMA 2.4 at week 5 (FMA 44.5, CI 95% 39.7–49.3, p < 0.05) and ΔFMA 3.7 at week 24 (FMA 45.8, CI 95% 40.5–51, p < 0.05); ΔARAT 2.6 at week 5 (ARAT 28.0, CI 95% 19.3–36.7, p < 0.05), and ΔARAT 4.8 at week 24 (ARAT 30.2, CI 95% 21.2–39.1, p < 0.05). At week 5 follow-up, 91% of participants rated their overall experience as satisfied or very satisfied. Incremental CEA observed savings of -S$144/per cure over 24 weeks, BIA—potentially 12% impact reduction over five years.

Conclusions

This study demonstrates the feasibility, acceptability, safety, clinical efficacy, and cost-effectiveness of a home-based, web-enabled telemonitored carer-supervised robotics-aided therapy.

Trial registration: NCT05212181  (https://clinicaltrials.gov).

Introduction

Stroke is a disorder characterized by significant impairment of sensorimotor and cognitive functions. Globally, stroke is the second-leading cause of death, accounting for 11.6% of total deaths and the third-leading cause of death and disability combined, accounting for 5.7% of total disability-adjusted life years (DALYs) [1].

In particular, hemiparetic weakness is common after stroke [2, 3], affecting 70–80% of stroke survivors. In terms of upper extremity (UE) motor function, only 10–20% of stroke survivors achieve complete or useful upper limb recovery [4, 5]. Thus, stroke should be regarded as a long-term condition requiring continuing support [6].

Stroke rehabilitation aims to maximise functional independence and improve the patient’s quality of life through a combination of reduction of impairment and learning of compensatory motor strategies [7]. Greater functional independence in the patient leads to reduced caregiver burden, better quality of life and potentially lower costs of care [8]. Current evidence in stroke rehabilitation emphasises the need for repetitive, intensive and adaptive task-specific UE training to facilitate motor relearning and neuroplasticity [9, 10].

Upper-limb Robotics-Assisted Therapy (RAT) can deliver task-specific, repetitive, intensive UE exercises safely with comparable clinical outcomes and improved neuroplasticity [11,12,13]. Current studies on RAT and dose-matched conventional therapy show comparable effects on improving motor outcome with high levels of safety and acceptability, with reduced supervision of therapist. [14,15,16,17]. Thus, RAT provides a potential solution to provide quality-ensured upper limb intensive therapy and decrease therapists’ workload [12, 18].

The development of table-top, portable, simple to use, upper limb end effectors has afforded innovative, effective, low-cost solutions comparable to more complex exoskeletal robots. A typical model is the current device tested, a 2-dimensional planar end effector robot which is a portable, low-cost commercial model with haptic handle. (www.articares.com) (Fig. 1a) This was combined with a web-based telerehabilitation platform and clinically applied as a potential innovation to extend clinic RAT and circumvent barriers such as scheduling, limited access from pandemic-related lockdowns, through decentralized and minimally supervised home-based therapy [14, 19,20,21,22].

Fig. 1

H-Man upper-limb rehabilitation robot. a Robot and graphic interface for exergames. b Study participant training at home with the H-Man

Full size image

It had also long been assumed that stroke patients reach a plateau in their recovery within 6 months of their stroke, however, several studies challenge this assumption. A proportion of interventions delivered > 6 months post-stroke demonstrated a positive benefit for individuals in the chronic stage of stroke [23]. Ward et al. reported results of a clinic-based UE rehabilitation programme consisting of 90 h over 3 weeks, for chronic stroke survivors (median time 18 months post-stroke) with severe UE disability (mean Fugl-Meyer-Motor Assessment (FMA) score 26/66), who achieved clinically significant gains of 42% in motricity and 50% gains in motor function, which persisted for 6 months [24, 25].

These findings suggest that given the length of time needed for post-stroke UE recovery in relation to motor and functional benefits, substantial provisions should be made for post-hospitalisation rehabilitation to be continued for months to years after the initial stroke. However, challenges remain in matching therapy provision to optimise recovery or neuroplasticity in the poststroke subacute to chronic phase, in large part related to healthcare resource limitations and various barriers. For example, a 2014 Singaporean study found that, in general, post-hospital rehabilitation attendance was low [26]. While 87.1% of the patients viewed rehabilitation as beneficial, overall longitudinal attendance rate fell from 100% as inpatient to 20.3% at 3 months, 9.8% at 6 months, 6.3% at 9 months and 4.3% at 12 months. Reasons for this included physical and social barriers, which were high initially, but decreased with time, while the prevalence of financial and perceptual barriers increased with time [26].

Home-based training and telerehabilitation combined with technology deployment at home or nursing facilities are various methods which can increase therapy delivery without over-burdening healthcare manpower. [19, 22, 27]. Also, home-based therapy combined with telerehabilitation and technology are potential methods to optimise therapy intensity and circumvent traditional barriers to access, such as transportation, scheduling and staff availability [19].

Telerehabilitation (TR) for stroke rehabilitation has emerged as a feasible way to deliver various services asynchronously or simultaneously, thus prolonging, or intensifying hospital or clinic-based treatments without concomitant strain on healthcare resources and circumventing physical barriers or clinic scheduling. Stroke patients who completed home-based telerehabilitation achieved outcomes equal to or better than those from conventional care during the first 3 months of stroke. Home-based self-managed UE therapy can also be regarded as another method for extending UE rehabilitation beyond the clinic. A systematic review by Westlake et al., showed largely equivalent efficacy between clinic and purposely designed, self-managed UE home programmes [27,28,29,30].

A large randomised controlled trial (RCT) of 124 subacute and chronic strokes with moderate to severe UE impairment established that 36 h of 70 min each of telerehabilitation, combining computer games with and without supervision, was non-inferior to dose-matched clinic-based rehabilitation, with both groups achieving 7.86–8.36 FMA gains after 6 weeks of training [31]. Reports involving minimally- or un-supervised home-based actuated robot aided training with asynchronous therapist monitoring are sparse, hence this novel therapeutic approach requires further study to determine its feasibility, safety and efficacy and role in stroke rehabilitation.

However, development of medical robotic devices suitable for home-based use still lags with respect to other technologies involved in telerehabilitation such as digital telecommunications and virtual reality. There is a need for less complex and user-friendly robotic systems designed specifically for non-clinical environments [32]. However, most commercially available robots for rehabilitation usually have large dimensions and are complex and costly to operate, which makes them suitable only for clinical settings. Consequently, to-date, there are few publications pertaining to minimally supervised or unsupervised telerehabilitation at home involving RAT.

Hence, this pilot study aimed to evaluate the feasibility, safety, and efficacy of carer-minimally supervised RAT using a portable arm robot, H-Man (Articares Pte Ltd, Singapore) within homes of patients, supervised by carers (i.e., family members or untrained paid helpers,) supported by a web-based platform and remote telemonitoring. For this study, we termed H-Man and web-based platform as “Home-RAT”. Analysis of the experimental data involved both longitudinal assessment of standardised outcome measures and patient-reported outcomes. Secondary outcomes evaluated included the cost-effectiveness and budget impact of Home-RAT.

The innovations of this study fall into four main categories: user acceptance, initial training effectiveness, asynchronous interaction with the clinician and clinical efficacy.

The study’s hypothesis was that telerehabilitation using a carer-minimally supervised portable robot at home for 30 days and clinic remote telemonitoring by occupational therapists (OT) would be feasible to achieve the following outcomes:

1. i.

   75% of sample achieving an active day defined as any log-in of > 20 min/day continuously.

2. ii.

    < 10% drop out rate of enrolled participants during the 30-day robot-assisted home training period.

3. iii.

    < 10% of participants’ adverse events related to robotics-assisted therapy such as arm pain, shoulder pain, increased spasticity on clinically measured scales by independent assessors.

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