Walking and balance outcomes for stroke survivors: a randomized clinical trial comparing body-weight-supported treadmill training with versus without challenging mobility skills

But what about all these other treadmills? Don't you believe in testing the complete universe of treadmills? Or too lazy to do them all?  So once again we will need followup research to identify the best intervention via treadmill. What a fucking waste just because we have NO stroke leadership and NO stroke strategy.

Stroke Rehabilitation and the AlterG - Anti-gravity treadmill

 

The treadmill bike!?

 

air pressure treadmill 

 

Turning-Based Treadmill 

 

Air pressure treadmill instantly sheds 80% of your weight

 

underwater treadmill

 

Split Belt Treadmill 

 

rotating treadmill

 

Walking and balance outcomes for stroke survivors: a randomized clinical trial comparing body-weight-supported treadmill training with versus without challenging mobility skills 

 

• Sarah A. GrahamEmail authorView ORCID ID profile,
• Elliot J. Roth and
• David A. Brown

Journal of NeuroEngineering and Rehabilitation201815:92

https://doi.org/10.1186/s12984-018-0442-3

©  The Author(s). 2018

• Received: 16 January 2018
• Accepted: 18 October 2018
• Published: 1 November 2018

Abstract

Background

Treadmill training, with or without body-weight support (BWSTT), typically involves high step count, faster walking speed, and higher heart-rate intensity than overground walking training. The addition of challenging mobility skill practice may offer increased opportunities to improve walking and balance skills. Here we compare walking and balance outcomes of chronic stroke survivors performing BWSTT with BWSTT including challenging mobility skills.

Methods

Single-blind randomized clinical trial comparing two BWSTT interventions performed in a rehabilitation research laboratory facility over 6 weeks. Participants were 18+ years of age with chronic (≥5 months) poststroke hemiparesis due to a cortical or subcortical ischemic or hemorrhagic stroke and walking speeds < 1.1 m/s at baseline. A hands-free group (HF; n = 15) performed BWSTT without assistance from handrails or assistive devices, and a hands-free plus challenge group (HF + C; n = 14) performed the same protocol while additionally practicing challenging mobility skills. The primary outcome was change in comfortable walking speed (CWS), with secondary outcomes of fast walk speed (FWS), six-minute walk distance, Berg Balance Scale (BBS) scores, and Activities Specific Balance Confidence (ABC) scores.

Results

Significant pre-post improvement of CWS (Z = − 4.2, p ≤ 0.0001) from a median of 0.35 m/s (range 0.10 to 1.09) to a median of 0.54 m/s (range 0.1 to 1.17), but no difference observed between groups (U = 96.0, p = 0.69). Pre-post improvements across all participants resulted in reclassified baseline ambulation status from sixteen to ten household ambulators, three to seven limited community ambulators, and ten to twelve community ambulators. Secondary outcomes showed similar pre-post improvements with no between-group differences.

Conclusions

The addition of challenging mobility skills to a hands-free BWSTT protocol did not lead to greater improvements in CWS following 6 weeks of training. One reason for lack of group differences may be that both groups were adequately challenged by walking in an active, self-driven treadmill environment without use of handrails or assistive devices.

Trial registration

NCT02787759 Falls-based Training for Walking Post-Stroke (FBT); retrospectively registered June 1st, 2016.

Absence of a Transcranial Magnetic Stimulation–Induced Lower Limb Corticomotor Response Does Not Affect Walking Speed in Chronic Stroke Survivors

Absolutely no clue what this means or any use to your recovery.

A great stroke association president would ensure that all stroke research is understandable and usable by survivors in order to bring such research to the attention of their doctors and therapists. Anything less is pure incompetency. 

These prediction research efforts would also be deep-sixed as total wastes of effort.

We need to know exactly what is going on so we can train our doctors in how we can recover using the latest research. We have to do it this way since our doctors and stroke hospitals don't read or implement new or even ancient research.  You can easily prove that incompetence by asking 2 questions.

1. What was the last stroke research you read? Explain in detail.
2. What was the last stroke research implemented in your hospital? Explain the efficacy and patient disabilities that it will cover.

http://stroke.ahajournals.org/content/early/2018/07/06/STROKEAHA.118.021718?platform=hootsuite

Anjali Sivaramakrishnan, Sangeetha Madhavan

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https://doi.org/10.1161/STROKEAHA.118.021718

Stroke. 2018;STROKEAHA.118.021718

Originally published July 9, 2018

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Abstract

Background and Purpose—Transcranial magnetic stimulation is used to measure the functional integrity of the corticomotor system via motor evoked potentials (MEPs) in stroke. The association between corticomotor mechanisms and walking recovery is still not completely understood. This study determined the association between transcranial magnetic stimulation–induced MEPs and walking outcomes and examined the contribution of the contralesional hemisphere to walking recovery.

Methods—Contralateral and ipsilateral transcranial magnetic stimulation responses from the contralesional and ipsilesional hemispheres were collected from 61 chronic stroke survivors. Clinical assessments included gait speeds, 6-minute walk distance, Timed Up and Go test, Fugl Meyer lower extremity scale, and strength measurements.

Results—Stroke participants were classified based on the presence (MEP+ [n=28]) or absence (MEP− [n=33]) of MEPs in the paretic tibialis anterior and rectus femoris muscles. A between-group analyses showed no significant differences for any gait variable. MEP+ group showed significantly higher Fugl Meyer lower extremity and ankle dorsiflexor strength. Ipsilateral conductivity was not significantly different between groups. Finally, in the MEP+ group, MEP parameters did not predict gait recovery.

Conclusions—Our study investigated the association between walking outcomes and neurophysiological parameters of lower limb function in a large cohort of stroke survivors. We did not find an associations between transcranial magnetic stimulation–induced tibialis anterior and rectus femoris MEPs and walking speeds. Further work is required to develop more comprehensive models in stroke for predicting walking recovery.(Who the fuck cares about prediction you lazy bastards, 100% RECOVERY! GET THERE!)

• cerebrovascular disorders
• evoked potentials, motor
• stroke
• transcranial magnetic stimulation
• walking speed

• Received January 23, 2018.
• Revision received May 15, 2018.
• Accepted June 8, 2018.

• © 2018 American Heart Association, Inc.

Exercise physiology after stroke - Liam Johnson

What a fucking waste. GUIDELINES, NOT PROTOCOLS! Still not understanding why they are seeing early exercise from the AVERT trial not being useful. Do you not understand anything about the 5 causes of the neuronal cascade of death? This is why we need a stroke strategy because we have researchers going off half cocked. I suppose this crapola is what we should expect from the International Journal of Stroke, the journal of the WSO - World Stroke Organization.

Exercise physiology after stroke - Liam Johnson  

My, my; One of these days this will be enough to cause me to have a stroke. 

The Use of Repetitive Transcranial Magnetic Stimulation for Stroke Rehabilitation: A Systematic Review

A total fucking waste because a protocol on use of rTMS for stroke rehab should have been written years ago. Such fucking incompetence out there in the stroke world and NO ONE is fixing such failures.  I've written 32 posts on this since January 2013 and obviously still NO protocol has been written up. Incompetence in full force once again, not a problem for these researchers, only stroke survivors feel the results of this fucking incompetence. 

 Rant started

Yes I'm being a very bad cop but for years there has been research on rehab that looked promising but never seems to be translated into usable interventions for survivors.  Either we replace all the existing stroke medical doctors with newer ones that still have a sense of desire to help or we force our doctors to actually do their job.

Rant completed, I feel better now.

Of course I did this same rant 2 years ago and nothing has changed.

The Use of Repetitive Transcranial Magnetic Stimulation for Stroke Rehabilitation: A Systematic Review

Author links open overlay panelAnaDionísioMSc*†‡Isabel CatarinaDuarteMSc*‡MiguelPatrícioPhD‡§MiguelCastelo-BrancoMD, PhD*‡§‖

https://doi.org/10.1016/j.jstrokecerebrovasdis.2017.09.008Get rights and content

Objectives

Stroke is a leading cause of disability. Alternative and more effective techniques for stroke rehabilitation have been sought to overcome limitations of conventional therapies. Repetitive transcranial magnetic stimulation (rTMS) arises as a promising tool in this context. This systematic review aims to provide a state of the art on the application of rTMS in stroke patients and to assess its effectiveness in clinical rehabilitation of motor function.

Methods

Studies included in this review were identified by searching PubMed and ISI Web of Science. The search terms were (rTMS OR “repetitive transcranial magnetic stimulation”) AND (stroke OR “cerebrovascular accident” OR CVA) AND (rehab OR rehabilitation OR recover*). The retrieved records were assessed for eligibility and the most relevant features extracted to a summary table.

Results

Seventy out of 691 records were deemed eligible, according to the selection criteria. The majority of the articles report rTMS showing potential in improving motor function, although some negative reports, all from randomized controlled trials, contradict this claim. Future studies are needed because there is a possibility that a bias for non-publication of negative results may be present.

Conclusions

rTMS has been shown to be a promising tool for stroke rehabilitation, in spite of the lack of standard operational procedures and harmonization. Efforts should be devoted to provide a greater understanding of the underlying mechanisms and protocol standardization.

Social Participation as a goal of the post-stroke rehabilitation program: a literature review

What a fucking waste. A literature review that should already be in that complete database of stroke protocols and research. 
http://www.mtprehabjournal.com/files/v15nx/mtprehabAR1517503.pdf

REVIEW Manual Therapy, Posturology & Rehabilitation Journal. ISSN 2236-5435. Copyright © 2017. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License which permits unrestricted non- commercial use, distribution, and reproduction in any medium provided article is properly cited. Social Participation as a goal of the post-stroke rehabilitation program: a literature review Felipe Heylan Nogueira de Souza 1 , Edson Meneses da Silva Filho 1 , Leandro Gonçalves Cezarino 1 , Egmar Longo Araújo de Melo1 , Ênio Walker Azevedo Cacho 1
ABSTRACT
Introduction: Stroke is considered one of the leading causes of long-term disability worldwide. Physical, cognitive and psychological disabilities resulting from stroke can lead to a wide variety of activity limitations and participations restrictions.
Objective: To verify the incidence of articles in the literature that used physiotherapy programs aimed at social participation and to analyze if these programs are based on domains of the International Classification of Functioning Disability and Health (ICF) in post-stroke people. Method: It was selected any type of study that presented post-stroke human sample over 18 years of age with no gender restriction, to be written in any language and year of publication, to have used physical rehabilitation as a form of treatment and social participation assessed by ICF as outcome. The descriptors and Boolean operators: stroke, rehabilitation, International Classification of Functioning Disability and Health, social participation, were used in the sample search strategy in database PEDro, PubMed, Web of Science and Scielo.
Results: After applying the inclusion/exclusion criteria, five articles remaining. Assessment tools for participation in daily and social activities were not consensual in the range of areas that needed to be addressed in stroke rehabilitation. A single study used the ICF-based design model in its program. Conclusion: There are few studies that have measured the various characteristics of social participation using the ICF as a tool. More studies are needed to create an ideal standardization and strategy that direct interventions to improve specific aspects of social participation, including the involvement in activities that provide post-stroke individuals interaction with society. Keywords: Stroke; International Classification of Functioning, Disability and Health; Social Participation. Corresponding author: Edson Meneses da Silva Filho Rua Vila Trairi, S/N; Centro; Santa Cruz (RN), Brazil. CEP: 59200-000. Phone:+55 (81) 9 9470 6661; +55 (81) 3631 1304 Email: meneses.edson@yahoo.com.br 1

Universidade Federal do Rio Grande do Norte (UFRN), Santa Cruz (RN), Brazil. Financial support: None. Submission date 24 July 2017; Acceptance date 15 September 2017; Publication date 11 October 2017 http://dx.doi.org/10.17784/mtprehabjournal.2017.15.503 INTRODUCTION Described as a multidimensional concept, the social participation is defined by the International Classification of Functioning, Disability and Health (ICF) as involvement of a person in a real-life situation, representing a social perspective of functionality(1, 2) . Social participation is considered as one of the most relevant fundamental results to a successful recovery, however, individuals after cerebrovascular accident (CVA) have shown dissatisfaction with their own ability to develop some of its aspects such as socializing, tours and travelling (3) , so the ICF considers that the functionality is the result of complex interactions, among the health and environmental measures as well as personal factors conditions (1) . Corroborating the ICF, some authors state that several factors may affect the social participation, such as, the restrictions due to changes in functionality, limitations in activities and the interference of environmental and personal factors (2, 4) . Among the physical and social consequences, those which are generated by the stroke are one of the important health problems in industrialized countries (5) . Those impacts on functionality may result in neurological and functional changes, in which generate limitations in daily live activities of these subjects (4, 6) . The consequences of stroke and the complex recovery process often require the necessity for various therapeutic interventions (7, 8) . The knowledge regarding the treatments which promote the best results may help optimize its effects and provide a better functionality for these patients (2) . The successful recovery of a stroke should result in a quality of life and degree of participation in the community similar to the previous injury, however, not all patients have access to care and rehabilitation that they need (9, 10) . The provision of rehabilitation services after discharge is essential to promote independence and reintegration of patients in the community (10) . Although many interventions and measurements are not aimed at social participation, even though it is considered one of the most important and fundamental factors for a successful recovery, there is the necessity to measure what the studies have been using to 2 Social Participation as a goal of the post-stroke rehabilitation MTP&RehabJournal 2017, 15: 503 assess the social participation of people who had stroke, in order to suggest a standardization of the use of more sensitive tools to classify the social participation in this population. Therefore, and present study aimed to determine the incidence of articles which used physical therapy programs for the social participation and analyze if these programs are based on the ICF domains in people who had stroke.

Performance analysis of risk-aware control in upper limb of patients with post-stroke hemiparesis

What a fucking waste, demonstrates a problem but gives or points to NO protocol.

Performance analysis of risk-aware control in upper limb of patients with post-stroke hemiparesis

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Huaqing Hao ; Lin Gu ; Yong Bao ; Qing Xie ; Ning Lan ; Chuanxin M. Niu

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Abstract:

Evidence suggests that humans tune their motor behavior in response to environmental uncertainty. Such risk-aware sensorimotor performance is hypothetically affected in stroke due to impaired sensorimotor control, but its existence and the detailed pattern of impairment remain unclear - particularly due to lack of approaches for measurement of dynamic performance in stroke. Here we present the design and implementation of a platform for testing the upper-limb control in presence of motor uncertainty. The platform monitors how a patient with stroke, exclusively with the affected arm, navigates a virtual car by adjusting the hand position. We focus on how the control behavior changes when the car is perturbed with progressively larger Gaussian noise. Using this platform, we successfully collected data from 4 healthy subjects and 4 patients with post-stroke hemiparesis. Initial evidence suggests that patients with stroke failed to tune their performance with increasing level of Gaussian perturbation. The results imply that the risk-aware behavior potentially provides a new modality of biofeedback useful in therapeutic interventions.

Published in: Engineering in Medicine and Biology Society (EMBC), 2017 39th Annual International Conference of the IEEE

Date of Conference: 11-15 July 2017

Date Added to IEEE Xplore: 14 September 2017

ISBN Information:

Electronic ISSN: 1558-4615

DOI: 10.1109/EMBC.2017.8037007

Publisher: IEEE

Conference Location: Jeju Island, South Korea, South Korea

Join stroke rehab experts as they discuss highlights from the 2016 Stroke Rehab Guidelines 9/25/17 12pm CDT

I bet this will be a total waste, they won't talk about results, protocols or efficacy. Just fucking lazy guidelines. But great conscience laundering.
https://engage.vevent.com/index.jsp?eid=5564&seid=138

Analysis of Physical Therapy Interventions on Quality of Life of Patients after Stroke

What a fucking waste. No objective measurements of recovery. 
http://search.naric.com/research/rehab/redesign_record.cfm?search=2&type=all&criteria=I243538&phrase=no&rec=243538&article_source=CIRRIE&international=1&international_language=&international_location=
Análise de Intervenções Fisioterapêuticas na Qualidade de Vida de Pacientes Pós-AVC.  Revista Neurociências , Volume 22(2) , Pgs. 308-314.

NARIC Accession Number: I243538.  What's this?
Author(s): Arthur Flávio de Siqueira Barros; Sergimário Guilherme dos Santos; Gleidson Franciel Ribeiro de Medeiros; Luciana Protásio de Melo.
Publication Year: 2014.
Abstract: The aim of this study was to determine the influence of physical therapy interventions on the quality of life of patients post-stroke. For the study, a systematic review was conducted from September to November 2012 in the Scielo, PubMed, Science Direct and PeDro databases, published in Portuguese, English, and Spanish. The following descriptors were used: stroke, quality of life, rehabilitation, and physical therapy. A total of 161 studies were found, of which 153 were excluded. The remaining eight were analyzed regarding physical therapy that contributes to improved quality of life from interventions ranging from classical kinesiotherapy to new therapeutic possibilities, such as induction therapy and restriction of movement, mirror therapy, and body weight-supported treadmill. Results indicate that the various therapeutic approaches applied in clinical practice resonate with significant improvements in quality of life of patients post stroke, from the most traditional to the most contemporary.
Descriptor Terms: Literature reviews, Physical therapy, Quality of life, Rehabilitation, Stroke.
Language: Portuguese
Geographic Location(s): Brazil, South America.

Can this document be ordered through NARIC's document delivery service*?: Request Information.
Get this Document: http://dx.doi.org/RNC.2014.22.02.905.7p.

Citation: Arthur Flávio de Siqueira Barros, Sergimário Guilherme dos Santos, Gleidson Franciel Ribeiro de Medeiros, Luciana Protásio de Melo. (2014). Analysis of Physical Therapy Interventions on Quality of Life of Patients after Stroke.  Análise de Intervenções Fisioterapêuticas na Qualidade de Vida de Pacientes Pós-AVC.  Revista Neurociências , 22(2), Pgs. 308-314. Retrieved 9/10/2017, from REHABDATA database.

Treadmill training to improve mobility for people with sub-acute stroke: a phase II feasibility randomized controlled trial

But no mention of what kind of treadmill training. So once again we will need followup research to identify the best intervention via treadmill. What a fucking waste just because we have NO stroke leadership and NO stroke strategy. No clue what the protocol was.

Stroke Rehabilitation and the AlterG - Anti-gravity treadmill

The treadmill bike!?

air pressure treadmill 

Turning-Based Treadmill 

Air pressure treadmill instantly sheds 80% of your weight

underwater treadmill

Split Belt Treadmill 

rotating treadmill

 

 

 

 

 

 

http://journals.sagepub.com/doi/abs/10.1177/0269215517720486?

Show all authors

Gillian D Baer, Lisa G Salisbury, Mark T Smith, ...

First Published July 21, 2017 Research Article

Download PDF	Article information

Abstract

Objective:

This phase II study investigated the feasibility and potential effectiveness of treadmill training versus normal gait re-education for ambulant and non-ambulant people with sub-acute stroke delivered as part of normal clinical practice.

Design:

A single-blind, feasibility randomized controlled trial.

Setting:

Four hospital-based stroke units.

Subjects:

Participants within three months of stroke onset.

Interventions:

Participants were randomized to treadmill training (minimum twice weekly) plus normal gait re-education or normal gait re-education only (control) for up to eight weeks. (Speed?, inclined?, mileage?, length of time?)

Main Measures:

Measures were taken at baseline, after eight weeks of intervention and at six-month follow-up. The primary outcome was the Rivermead Mobility Index. Other measures included the Functional Ambulation Category, 10-metre walk, 6-minute walk, Barthel Index, Motor Assessment Scale, Stroke Impact Scale and a measure of confidence in walking.

Results:

In all, 77 patients were randomized, 39 to treadmill and 38 to control. It was feasible to deliver treadmill training to people with sub-acute stroke. Only two adverse events occurred. No statistically significant differences were found between groups. For example, Rivermead Mobility Index, median (interquartile range (IQR)): after eight weeks treadmill 5 (4–9), control 6 (4–11) p = 0.33; or six-month follow-up treadmill 8.5 (3–12), control 8 (6–12.5) p = 0.42. The frequency and intensity of intervention was low.

Conclusion:

Treadmill training in sub-acute stroke patients was feasible but showed no significant difference in outcomes when compared to normal gait re-education. A large definitive randomized trial is now required to explore treadmill training in normal clinical practice.

Abnormal EEG Responses to TMS During the Cortical Silent Period Are Associated With Hand Function in Chronic Stroke

Measurement but no solutions to this problem. What a waste when we have NO strategy being followed.
http://journals.sagepub.com/doi/abs/10.1177/1545968317712470

Show all authors

Whitney A. Gray, Jacqueline A. Palmer, PhD, Steven L. Wolf, PhD, ...

First Published June 12, 2017 Research Article

Abstract

Background. Abnormal brain excitability influences recovery after stroke at which time a prolonged transcranial magnetic stimulation (TMS)–induced electromyographic silent period is thought to reflect abnormal inhibitory interneuron excitability. Cortical excitability can be probed directly during the silent period using concurrent electroencephalography (EEG) of TMS-evoked responses. Objective. The primary study objectives were to characterize TMS-evoked cortical potentials (TEPs) using EEG and to investigate associations with persistent hand and arm motor dysfunction in individuals with chronic stroke.  
Methods. Thirteen participants with chronic stroke-related mild-moderate arm motor impairment and 12 matched controls completed a single TMS-EEG cortical excitability assessment. TEPs recorded from the vertex during cortical silent period (CSP) assessment and while at rest were used to evaluate differences in cortical excitability between stroke and control participants. Associations between TEPs and CSP duration with measures of upper extremity motor behavior were investigated. Results. Significantly increased TEP component peak amplitudes and delayed latencies were observed for stroke participants compared with controls during CSP assessment and while at rest. Delayed early TEP component (P30) peak latencies during CSP assessment were associated with less manual dexterity. CSP duration was prolonged in stroke participants, and correlated with P30 peak latency and paretic arm dysfunction.
Conclusions. Abnormal cortical excitability directly measured by early TMS-evoked EEG responses during CSP assessment suggests abnormal cortical inhibition is associated with hand dysfunction in chronic stroke. Further investigation of abnormal cortical inhibition in specific brain networks is necessary to characterize the salient neurophysiologic mechanisms contributing to persistent motor dysfunction after stroke.

Is Mirror Therapy an Effective Adjunct to Traditional Inpatient Care for Treating Upper Limb Hemiparesis and Spasticity In Individuals Post Stroke? A Meta-Analysis

Why the fuck is a meta-analysis needed? No one keeps up with research in your field? No publicly available database of research and protocols? Laziness? Stupidity? Waiting for SOMEONE ELSE TO SOLVE THE PROBLEM? I have 37 posts on mirror therapy going back to 2012. Proof we have NO strategy and NO leadership. Wasting money and time again.

http://search.proquest.com/openview/c5c6550129d2b174ca7751ef690fe7f5/1?pq-origsite=gscholar&cbl=18750&diss=y

Objective:

The purpose of this meta-analysis is to examine the effectiveness of mirror therapy as an adjunct to a traditional inpatient care for treating upper limb hemiparesis and spasticity in individuals post stroke.

Methods:

Studies examined the application of mirror therapy as an adjunct to traditional inpatient care provided for individuals post-stroke. These studies were performed in similar treatment settings and reported on Fugl-Meyer Upper

Extremity Assessment (FMA-UE) and/or the Modified Ashworth Scale (MAS).

Results:

In the analyses of the FMA-UE and the MAS, a moderate effect was observed, in favor of mirror therapy. No statistical significance was found with either outcome measure.

Conclusion:

Mirror therapy may be beneficial as an adjunct to traditional inpatient care for improving motor recovery of the upper limb post-stroke.

Effective management of spasticity after stroke requires a targeted, multimodal

approach.(But you don't tell us what that protocol is to do that)

Study Design:

A meta-analysis of randomized control trials (RCTs),

including pilot RCTs, examining the effects of mirror therapy applied as an

adjunct to traditional inpatient care for upper limb recovery post-stroke.

Marissa Nicole Carranza

May 2017

Modifying upper-limb inter-joint coordination in healthy subjects by training with a robotic exoskeleton

What a fucking waste, they talk about problems of stroke survivors with upper arm rehabilitation but do research on healthy volunteers. So more followup needed which will never occur.
https://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-017-0254-x

• Tommaso ProiettiEmail authorView ORCID ID profile,
• Emmanuel Guigon,
• Agnès Roby-Brami and
• Nathanaël Jarrassé

Journal of NeuroEngineering and Rehabilitation201714:55

DOI: 10.1186/s12984-017-0254-x

©  The Author(s) 2017

Received: 9 September 2016

Accepted: 15 May 2017

Published: 12 June 2017

Abstract

Background

The possibility to modify the usually pathological patterns of coordination of the upper-limb in stroke survivors remains a central issue and an open question for neurorehabilitation. Despite robot-led physical training could potentially improve the motor recovery of hemiparetic patients, most of the state-of-the-art studies addressing motor control learning, with artificial virtual force fields, only focused on the end-effector kinematic adaptation, by using planar devices. Clearly, an interesting aspect of studying 3D movements with a robotic exoskeleton, is the possibility to investigate the way the human central nervous system deals with the natural upper-limb redundancy for common activities like pointing or tracking tasks.

Methods

We asked twenty healthy participants to perform 3D pointing or tracking tasks under the effect of inter-joint velocity dependant perturbing force fields, applied directly at the joint level by a 4-DOF robotic arm exoskeleton. These fields perturbed the human natural inter-joint coordination but did not constrain directly the end-effector movements and thus subjects capability to perform the tasks. As a consequence, while the participants focused on the achievement of the task, we unexplicitly modified their natural upper-limb coordination strategy. We studied the force fields direct effect on pointing movements towards 8 targets placed in the 3D peripersonal space, and we also considered potential generalizations on 4 distinct other targets. Post-effects were studied after the removal of the force fields (wash-out and follow up). These effects were quantified by a kinematic analysis of the pointing movements at both end-point and joint levels, and by a measure of the final postures. At the same time, we analysed the natural inter-joint coordination through PCA.

Results

During the exposition to the perturbative fields, we observed modifications of the subjects movement kinematics at every level (joints, end-effector, and inter-joint coordination). Adaptation was evidenced by a partial decrease of the movement deviations due to the fields, during the repetitions, but it occurred only on 21% of the motions. Nonetheless post-effects were observed in 86% of cases during the wash-out and follow up periods (right after the removal of the perturbation by the fields and after 30 minutes of being detached from the exoskeleton). Important inter-individual differences were observed but with small variability within subjects. In particular, a group of subjects showed an over-shoot with respect to the original unexposed trajectories (in 30% of cases), but the most frequent consequence (in 55% of cases) was the partial persistence of the modified upper-limb coordination, adopted at the time of the perturbation. Temporal and spatial generalizations were also evidenced by the deviation of the movement trajectories, both at the end-effector and at the intermediate joints and the modification of the final pointing postures towards targets which were never exposed to any field.

Conclusions

Such results are the first quantified characterization of the effects of modification of the upper-limb coordination in healthy subjects, by imposing modification through viscous force fields distributed at the joint level, and could pave the way towards opportunities to rehabilitate pathological arm synergies with robots.

Stroke Rehabilitation: Exercise Improves Cognitive Function

DUH! But the researchers and doctors involved in this don't have enough brains to write this up in a stroke protocol so we don't waste further research dollars and time on this.

Defining Optimal Aerobic Exercise Parameters to Affect Complex Motor and Cognitive Outcomes after Stroke: A Systematic Review and Synthesis Feb. 2016

The latest here:

Stroke Rehabilitation: Exercise Improves Cognitive Function

Just when you’re at your lowest after suffering a stroke, you’ll be asked to do some of the hardest things you’ve ever done in your life. The road to recovery includes a significant amount of rehabilitation. You’ll undergo physical therapy to regain gross motor skills such as walking and maintaining your balance. Occupational therapy will help you relearn how to perform everyday tasks like eating and bathing yourself. Speech therapy supports your ability to communicate, and psychological counseling will help you deal with the emotional stress.
At the top of the list of tough challenges will be incorporating exercise into your recovery. New research shows that exercise may be one of the most important parts of your recovery – not just for your body, but for your mind as well.

What the Research Shows About Exercise After Stroke

Doctors and therapists have long known that exercise is helpful after a stroke, but an analysis of several research studies provides more insight into what exercise actually works best – specifically the type of exercise and the duration.
The biggest takeaway from the analysis is that exercise after a stroke is good not only for the body but for the brain as well. In the simplest terms, a stroke cuts off blood supply to the brain. It can impair cognition, which includes vital mental processes such as thinking, memory, understanding, and learning.
This new research shows that people who exercise after a stroke show greater improvements in cognition than people who do not exercise. And the good news is, that exercise does not need to be intense: Walking on a treadmill at a slow pace was enough to provide a benefit.
The people who have the most significant improvements in cognition after stroke combine this type of moderate aerobic exercise with strength and balance exercises. They see benefits in their working memory, mental processing speed, and attention.
While most people who suffer a stroke will be encouraged to start an exercise program early in the recovery process, the research showed the benefits were seen even if exercise started much later. Stroke patients who began exercising 2.5 years after their stroke still saw benefits in cognition. Additionally, the exercise program did not have to last long; programs that lasted four to 12 weeks were just as effective as longer-term regimens.

Exercise Is Only Part of the Equation

The holistic approach that brings together exercise with other forms of therapy are all important parts of the stroke recovery process. Equally important is making lifestyle changes that may help to ward off another stroke in the future.
These changes should include controlling medical conditions such as atrial fibrillation, high blood pressure, high cholesterol, diabetes, and obesity. You should also make sure that you get the recommended amount of exercise (when and if you’re physically able), and make changes to your diet – including cutting back on the amount of alcohol you drink – to reduce your risks.
Keep in mind that if you or someone you love has suffered a stroke, it’s critical to maintain hope and a positive outlook. Your rehabilitation team will be working hard (Bullshit, they really do nothing at all)to help you live a happy, independent, and healthy life.

Non-O blood groups at increased risk for CV events

Rather useless to know since we can't change our blood type, pretty much a fucking waste of research dollars. I'm O-negative so that didn't save me from having a CV event.
http://www.healio.com/cardiology/vascular-medicine/news/online/%7Bb27e3ce3-1a44-49d8-93b7-9195bd08b8be%7D/non-o-blood-groups-at-increased-risk-for-cv-events?
Individuals with non-O blood groups were at an increased risk for coronary events and combined CV events, according to findings presented at Heart Failure 2017 in Paris.

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American College of Cardiology Annual Scientific Session

“It has been suggested that people with non-O blood groups (A, B, AB) are at higher risk for [MI] and overall [CV] mortality, but this suggestion comes from case-control studies, which have a low level of evidence,” Tessa Kole, a master’s degree student at the University Medical Centre Groningen in the Netherlands, said in a press release. “If this was confirmed, it could have important implications for personalized medicine.”
Kole and colleagues conducted a meta-analysis of prospective studies with more than 1.3 million participants combined. The researchers looked at associations between blood type and all coronary events, combined CV events and fatal coronary events.
There were 23,154 CV events in total. In the analysis of coronary events, 1.5% (n = 11,437) of people with non-O blood had a coronary event vs. 1.4% (n = 7,220) of participants with O blood (OR = 1.09; 95% CI, 1.06-1.13).
For combined CV events, 2.5% (n = 17,449) of participants with non-O blood had an event vs. 2.3% (n = 10,916) of those with O blood (OR = 1.09; 95% CI, 1.06-1.11).
There was no significant association between risk for fatal coronary event and blood type (OR = 1; 95% CI, 0.85-1.18).
“More research is needed to identify the cause of the apparent increased [CV] risk in people with a non-O blood group,” Kole said in the release. “Obtaining more information about risk in each non-O blood group (A, B and AB) might provide further explanations of the causes.”
Possible mechanisms include higher concentration of von Willebrand factor and increased rates of dyslipidemia in individuals with non-O blood, Kole and colleagues wrote in an abstract. – by Cassie Homer
Reference:
Kole T, et al. Abstract 697. Presented at: Heart Failure 2017 and the 4th World Congress on Acute Heart Failure; April 29-May 2, 2017; Paris.

Poststroke Depression: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

What a fucking waste of words. Nothing on protocols to treat depression or that anti-depressants provide better functional recovery. Words, words, words, but 12,272 useless words.

Common antidepressant can help stroke patients improve movement and coordination Sept. 2015 

 

Antidepressants may help people recover from stroke even if they are not depressed Jan. 2013

  But you can read this on your own and figure out how to self treat yourself.

Poststroke Depression: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

Amytis Towfighi, Bruce Ovbiagele, Nada El Husseini, Maree L. Hackett, Ricardo E. Jorge, Brett M. Kissela, Pamela H. Mitchell, Lesli E. Skolarus, Mary A. Whooley, Linda S. Williams

and on behalf of the American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; and Council on Quality of Care and Outcomes Research

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https://doi.org/10.1161/STR.0000000000000113

Stroke. 2017;48:e30-e43

Originally published December 8, 2016

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Abstract

Poststroke depression (PSD) is common, affecting approximately one third of stroke survivors at any one time after stroke. Individuals with PSD are at a higher risk for suboptimal recovery, recurrent vascular events, poor quality of life, and mortality. Although PSD is prevalent, uncertainty remains regarding predisposing risk factors and optimal strategies for prevention and treatment. This is the first scientific statement from the American Heart Association on the topic of PSD. Members of the writing group were appointed by the American Heart Association Stroke Council’s Scientific Statements Oversight Committee and the American Heart Association’s Manuscript Oversight Committee. Members were assigned topics relevant to their areas of expertise and reviewed appropriate literature, references to published clinical and epidemiology studies, clinical and public health guidelines, authoritative statements, and expert opinion. This multispecialty statement provides a comprehensive review of the current evidence and gaps in current knowledge of the epidemiology, pathophysiology, outcomes, management, and prevention of PSD, and provides implications for clinical practice.

• AHA Scientific Statements
• depression
• management
• prevention & control
• screening
• stroke
• treatment

Introduction

Depression occurs in approximately one third of stroke survivors at any one time¹ and is associated with poor functional outcomes² and higher mortality.³ Although poststroke depression (PSD) is one of the most common complications after stroke, few guidelines exist regarding assessment, treatment, and prevention of PSD. This scientific statement summarizes published evidence on the causes, predisposing factors, epidemiology, screening, treatment, and prevention of PSD; illuminates gaps in the literature; and provides management implications for clinical practice.

Much more at link.

Coffee intake, cardiovascular disease, and all-cause mortality: Observational and Mendelian randomization analyses in 95000-223000 individuals

Was this research from Nov. 2015 not enough to answer the question? That it had to be repeated? This is why we need some leadership and a strategy so we don't waste time and money on stuff we already know.

Moderate coffee drinking may be linked to reduced risk of death Nov. 2015

 The latest here:

Coffee intake, cardiovascular disease, and all-cause mortality: Observational and Mendelian randomization analyses in 95000-223000 individuals

International Journal of Epidemiology, 01/05/2017 Nordestgaard AT, et al.

The goal of this study were: first whether coffee consumption is connected with cardiovascular disease and all–cause mortality observationally; second, whether genetic variations previously connected with caffeine consumption are connected with coffee consumption; and third, whether the genetic variations are connected with cardiovascular disease and all–cause mortality. Observationally, coffee consumption was connected with the U–shaped lower risk of cardiovascular disease and all–cause mortality; however, genetically caffeine consumption was not connected with the risk of cardiovascular disease or all–cause mortality.

Methods

• First, they utilized multivariable adjusted Cox proportional hazard regression models assessed with limited cubic splines to analyze the observational relationship in 95366 White Danes.
• Second, they evaluated mean coffee consumption as per 5 genetic variations near the AHR (rs4410790; rs6968865) and CYP1A1/2 genes (rs2470893; rs2472297; rs2472299).
• Third, they utilized sex– and age adjusted Cox proportional hazard regression models to inspect genetic relationship with cardiovascular disease and all–cause mortality in 112509 Danes.
• At last, they utilized sex and age–adjusted logistic regression models to analyze genetic associations with ischaemic heart disease including the Cardiogram and C4D consortia in a total of up to 223414 individuals.
• They applied comparable examinations to ApoE genotypes connected with plasma cholesterol levels, as a positive control.

Results

• In observational investigations, they found U–shaped relationship between coffee consumption and cardiovascular disease and all–cause mortality; lowest risks were found in individuals with medium coffee consumption.
• Caffeine consumption allele score (rs4410790 + rs2470893) was connected with a 42% higher coffee consumption.
• Hazard ratios per caffeine consumption allele were 1.02 (95% confidence interval: 1.00–1.03) for ischaemic heart disease, 1.02 (0.99–1.02) for ischaemic stroke, 1.02 (1.00–1.03) for ischaemic vascular disease, 1.02 (0.99–1.06) for cardiovascular mortality and 1.01 (0.99–1.03) for all–cause mortality.
• Including international consortia, odds ratios per caffeine consumption allele for ischaemic heart disease were 1.00 (0.98–1.02) for rs4410790, 1.01 (0.99–1.03) for rs6968865, 1.02 (1.00–1.04) for rs2470893, 1.02 (1.00–1.04) for rs2472297 and 1.03 (0.99–1.06) for rs2472299.
• Conversely, 5% lower cholesterol level caused by ApoE genotype had a corresponding odds ratio for ischaemic heart disease of 0.93 (0.89–0.97).

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Systematic review of mirror therapy compared with conventional rehabilitation in upper extremity function in stroke survivors

Why the fuck is a review needed? You don't keep up with research in your field? No publicly available database of research and protocols? Laziness? Stupidity? Waiting for SOMEONE ELSE TO SOLVE THE PROBLEM? I have 37 posts on mirror therapy going back to 2012. Proof we have NO strategy and NO leadership. Wasting money and time again.

Systematic review of mirror therapy compared with conventional rehabilitation in upper extremity function in stroke survivors

• First published: 29 December 2016Full publication history
• DOI: 10.1111/1440-1630.12342View/save citation
• Cited by: 0 articles

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• Declaration of conflicting interest
  The authors declare that there is no conflict of interest.
  

Abstract

Background/aim

Stroke is a leading cause of disability in developed countries. One of the most widespread techniques in clinical practice is mirror therapy (MT). To determine the effectiveness of MT over other methods of intervention in the recovery of upper limb function in people who have had a stroke.

Methods

A systematic review was conducted. The search string was established based on the last systematic review about MT that dated from 2009: “upper extremity” OR “upper limb “AND “mirror therapy” AND stroke. For this search Pubmed, Scopus and SciELO databases were used.

Results

Fifteen studies were included in the systematic review. Recovery of the upper limb, upper limb function and gross manual dexterity were frequently measured in these studies.

Conclusions

In the primary variables in promoting recovery, MT alone showed better results in acute and chronic stroke patients in upper limb functioning than either conventional rehabilitation (CR) or CR plus MT.
PROSPERO registration number: CRD42015026869

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