Use the labels in the right column to find what you want. Or you can go thru them one by one, there are only 33,363 posts. Searching is done in the search box in upper left corner. I blog on anything to do with stroke. DO NOT DO ANYTHING SUGGESTED HERE AS I AM NOT MEDICALLY TRAINED, YOUR DOCTOR IS, LISTEN TO THEM. BUT I BET THEY DON'T KNOW HOW TO GET YOU 100% RECOVERED. I DON'T EITHER BUT HAVE PLENTY OF QUESTIONS FOR YOUR DOCTOR TO ANSWER.
Changing stroke rehab and research worldwide now.Time is Brain!trillions and trillions of neuronsthatDIEeach day because there areNOeffective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.
What this blog is for:
My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.
Nothing here will help persons like me recover hand function! There is zero opening of the hand or split fingers because NOBODY HAS CURED SPASTICITY YET!
A new guidance from the American Academy of Neurology (AAN) advised clinicians on how to approach the growing use of consumer wearable devices in neurologic care, with respect to their potential application in epilepsy, headache, sleep disorders, and stroke risk detection.
The document focuses on devices such as smartwatches, fitness trackers, and digital health apps that have not received FDA clearance. While these tools may provide additional patient-generated data, questions remain about their accuracy, reliability, and role in clinical care.
Wearable devices are best viewed as an adjunct to traditional care rather than a replacement for clinical evaluation, guideline author Sarah M. Benish, MD, associate professor and General Neurology Division Director at the University of Minnesota, Minneapolis, explained to Medscape Medical News.
“The clinical situations where wearable data will be helpful are expected to be highly variable both with clinical diagnosis but also due to each individual patient. I don’t see wearables replacing clinical visits. I see them as an add-on to bring more data for even better decision-making,” Benish said.
Defined by the authors as “electronics worn to monitor activities and vital signs,” wearables have become increasingly common. Individuals use them to track health data such as heart rate, sleep, and daily activity, and many are now sharing these data with their clinicians.
Sarah M. Benish, MD
This new guidance is part of the Emerging Issues in Neurology series which offers timely expert commentary on evolving technologies rather than formal clinical recommendations.
The document highlights examples of how wearable devices are being used or evaluated in areas such as cardiac monitoring, epilepsy management, headache disorders, and sleep assessment.
To develop the report, the authors drew on published research and illustrative case examples describing the use of consumer wearable devices in neurologic care. Part of the AAN’s Emerging Issues in Neurology series, the document, reflects expert consensus rather than a systematic review.
It also highlights common limitations of consumer wearables, including inconsistent patient adherence, incomplete data capture, and concerns about the accuracy and interpretation of device-generated data.
For cardiac monitoring, the guidance notes that consumer wearables may help flag possible arrhythmias such as atrial fibrillation (AFib), a major risk factor for stroke, but the authors note that abnormal readings should be confirmed with medical-grade testing.
Results of the 2019 Apple Heart Study, which was published in TheNew England Journal of Medicine, showed 0.52% of the study’s 419,297 participants received irregular pulse notifications from a smartwatch algorithm.
Among those who underwent follow-up ECG patch testing, AFib was detected in 153 participants, and 44% of those who received alerts later reported a new AFib diagnosis, compared with 1.0% of participants who received no alerts.
Tracking Seizures, Identifying Triggers
Beyond cardiac monitoring, wearable technologies are also being explored in other areas of neurologic care, including epilepsy management. However, the authors caution that many consumer devices and algorithms remain insufficiently validated and should not replace clinical evaluation.
Consumer wearable devices and associated digital applications may assist with epilepsy management in several ways, including seizure detection, trigger identification, seizure-risk forecasting, symptom logging, and management of comorbidities.
Seizure detection is the most widely studied application. Wrist- or arm-worn devices use sensors such as accelerometry, photoplethysmography, and electrodermal activity to detect physiologic changes associated with convulsive seizures. Some of these systems have been validated against video-electroencephalography monitoring, the clinical reference standard, although most consumer devices have not undergone extensive validation.
“The most studied application is detecting convulsive seizures to alert caregivers, reducing morbidity and mortality,” the guidance notes.
Wearable devices may also help identify seizure triggers. In a 2022 study published in Epilepsy & Behavior, 234 patients with epilepsy who used a smartwatch diary to self-report seizures identified stress and poor sleep as common triggers. Preliminary studies integrating electronic seizure diaries with fitness trackers have also shown potential to improve the accuracy of seizure forecasting.
Headache Management, Biofeedback
Wearable technologies are also being explored in the management of headache disorders.
The report highlights emerging uses of wearable technologies in the management of headache disorders, particularly for delivering biofeedback therapy and monitoring activity patterns.
Biofeedback is an evidence-based treatment for migraine and can be delivered through wearable sensors that measure heart rate variability, skin temperature, and muscle activity to help patients regulate stress responses.
Actigraphy data from wearable devices have also been used to assess patterns associated with headache episodes. In a 2022 study published in Pain and Therapy, 509 participants who used Fitbit devices along with daily headache diaries tended to sleep more, engage in less physical activity, and have lower maximum heart rates during headache episodes.
However, the study also highlighted challenges with data completion and sustained device use.
Sleep Monitoring
Wearable technologies are also increasingly being used to monitor sleep.
The AAN guidance notes that consumer wearable devices may help monitor sleep patterns but should be interpreted cautiously in clinical practice.
Devices such as wristbands, rings, and headbands estimate sleep duration and sleep stages using accelerometry and pulse rate variability.
“Most consumer sleep detection devices have been reasonably well-validated against the gold standard of laboratory polysomnography,” the authors noted.
However, many devices underestimate wake time after sleep onset and have not been fully validated in patients with neurologic disease or sleep disorders. Moreover, proprietary algorithms often prevent clinicians from gaining access to raw data for independent analysis, which can limit its clinical utility.
These proprietary algorithms may give “sleep clinicians and researchers pause toward adopting consumer technologies without ability to scrutinize validity of accurate sleep-wake state detection,” the authors noted.
Despite these limitations, the AAN guidance suggests wearable sleep monitors may become more useful because they allow extended home-monitoring over longer periods of time.
Real-World Uses, Practical Challenges
Wearable devices and smartphones are reshaping neurologic research and care by enabling real-time monitoring, event detection, and outcome tracking.
Guidance author Mia T. Minen, MD, MPH, director of Headache Services and associate professor in the Department of Neurology at NYU Langone Medical Center in New York City, said integrating wearable data into routine neurologic care will require changes to current reimbursement and workflow models.
“As a headache specialist, despite so many patients preferring or needing nonpharmacologic treatment options, it’s nearly impossible to get commercial insurances to pay for these safe management options,” she told Medscape Medical News.
“We also need to figure out effective reimbursable workflow solutions for reviewing and then acting upon the digital data,” she added.
The guidance also cautions clinicians to consider the psychological effects wearable devices may have on some patients. Benish said clinicians should discuss both the potential benefits and drawbacks of device use.
“As a neurologist works with a patient, it is their role to outline the risks and benefits of using such devices,” she said. “Important steps during a patient visit include discussing how the person feels when they get alerts, asking how often they check the device or app for information, and inquiring about the psychological impact.”
A ‘Transformative Effect’
Outside expert Richard Lipton, MD, professor of neurology at Albert Einstein College of Medicine in New York City, who was not involved in developing the AAN guidance, said he uses wearable devices and smartphones in research on cognitive aging, dementia, and migraine.
Lipton said these tools may be particularly valuable for neurologic conditions characterized by episodic or fluctuating events, including seizures, migraine attacks, and cardiac arrhythmias.
“Devices can provide an objective record of events otherwise identified by self-report, and frequently under-ascertained,” he told Medscape Medical News.
He noted that almost 1 in 3 Americans use a wearable device such as a smartwatch or band to track health and fitness.
Wearables may also help capture real-world consequences of neurologic conditions. For example, step counts often drop during migraine attacks, providing an objective measure of activity impairment, Lipton said.
Environmental data collected by wearable devices, such as air pollution exposure, may also offer insights into potential triggers affecting cognitive status, seizure risk, or headaches.
Lipton said he remains optimistic about the broader potential of wearable technologies in clinical care.
“I believe wearables will have a transformative effect on neurologic practice, promoting healthy behaviors, detecting events and diseases, characterizing risk factors, and supporting education and intervention,” he said.
The guidance was supported by the AAN. Benish and Lipton reported no relevant financial disclosures. Minen reported receiving research support from National Institutes of Health and personal compensation for serving on the American Headache Society first contact-primary care advisory board and as a consultant for a PCORI grant on migraine evidence-based map for stakeholders with ECRI.
A new wearable device named could help stroke survivors communicate, offering speech support without implants.
The device, called Revoice, uses ultra-sensitive sensors and artificial intelligence to decode speech signals and emotional cues so people with post-stroke speech impairment can communicate.
Worn as a soft, flexible choker, it captures heart rate and tiny vibrations from throat muscles, using those signals to reconstruct intended words and sentences in real time.
The development was led by researchers at the University of Cambridge.
Luigi Occhipinti is professor in Cambridge’s Department of Engineering and led the research.
He said: “When people have dysarthria following a stroke, it can be extremely frustrating for them, because they know exactly what they want to say, but physically struggle to say it, because the signals between their brain and their throat have been scrambled by the stroke.
“That frustration can be profound, not just for the patients, but for their caregivers and families as well.”
The signals from the device are processed by two AI agents: one reconstructs words from fragments of silently mouthed speech, while the other interprets emotional state and context, such as time of day or weather, to expand short phrases into full sentences.
In a small trial with five patients with dysarthria, a common post-stroke speech impairment affecting the muscles used for speaking, the device achieved a word error rate of 4.2 per cent and a sentence error rate of 2.9 per cent.
Unlike existing assistive speech technologies, which often require slow letter-by-letter input, eye tracking or brain implants, the Revoice device is claimed to provide seamless real time communication, turning a few mouthed words into full sentences.
The researchers say the technology could aid stroke rehabilitation and could also support people with conditions such as Parkinson’s and motor neurone disease.
They are planning a clinical study in Cambridge for native English-speaking dysarthria patients to assess viability, which they hope to launch this year.
About half of people develop dysarthria, or dysarthria in combination with aphasia, following a stroke.
Dysarthria is a physical condition that weakens the muscles of the face, mouth and vocal cords. Aphasia affects the ability to understand or produce language.
Dysarthria affects people in different ways and can cause unclear, slurred or slow speech, or short, disjointed bursts rather than full sentences.
Most stroke patients with dysarthria work with a speech therapist to regain their ability to communicate, primarily through repetitive word drills, where patients repeat words or phrases back to the speech therapist.
Typical recovery time varies from a few months to a year or more.
Occhipinti said: “Patients can generally perform the repetitive drills after some practice, but they often struggle with open-ended questions and everyday conversation.
“And as many patients do recover most or all of their speech eventually, there is not a need for invasive brain implants, but there is a strong need for speech solutions that are more intuitive and portable.”
The sensors in the Revoice device capture subtle vibrations from the throat to detect speech signals and decode emotional states from pulse signals.
The device also uses an embedded lightweight large language model, a type of AI system, to predict full sentences, so it uses minimal power.
Working with colleagues in China, the researchers carried out a small trial with five stroke patients with dysarthria, as well as 10 healthy controls.
In the study, participants wore the device and mouthed short phrases.
By nodding twice, they could choose to expand those phrases into sentences using the embedded large language model.
Participants reported a 55 per cent increase in satisfaction, suggesting the device could help stroke patients regain their ability to communicate.
Although extensive clinical trials will be required before the device can be made widely available, the researchers hope future versions will include multilingual capabilities, a broader range of emotional states and fully self-contained operation for everyday use.
Occhipinti said: “This is about giving people their independence back. Communication is fundamental to dignity and recovery.”
But this isn't addressing the wrong signals causing spasticity which I consider the major failure of all eStim techniques.
The proper research on this would be a way
to stop the signals causing spasticity instead of this stupid; 'Hey,
let's try to overcome the spasticity, which doesn't get you recovered at
all!' Does anyone in stroke have any brains at all?
Regardless
of severity, recovery from stroke or spinal cord injury (SCI) is always
a challenging process. This is especially true when the patient’s hands
are affected.
Because
standard physical rehabilitation tends to prioritize therapies focused
on walking and the lower extremities, there’s an unmet need among those
trying to recover the use of their hands, said Chad Bouton, founder and
CEO of Neuvotion, an early-stage medical device company that develops
neuromodulation technologies and products for neurorehabilitation,
brain-computer interfaces, and physical therapy.
“The
hand is very complicated – there are many joints, over 30 muscles
involved, and the hand has a large number of degrees of freedom,” Bouton
told MD+DI.
“With the complexity of the hand, that part of the brain is a bit
larger – so there is more susceptibility for a stroke to compromise a
patient’s hands. And with spinal cord injuries, we also often see a lot
at the neck level that unfortunately affects the hands. Recovery can be
challenging, but that’s what we’ve been focused on.”
Founded
in 2019, Neuvotion’s first product, NeuStim, a non-invasive,
surgery-free, high-precision wearable that electrically stimulates
muscles, has received 510(k) clearance.
The
device supports hand movement recovery after stroke or SCI through the
use of a touchscreen interface that enables clinicians to scan and
pinpoint muscle targets electronically to steer stimulation with
precision.
The
wearable is expected to launch within the next year and help produce
improved outcomes in stroke and SCI rehabilitation with the potential
for earlier intervention depending on how quickly patients are
stabilized.
Intended
to treat adult patients who have experienced a hemiplegic stroke
(paralysis or paresis on one side of the body) or those who have had a
SCI at the fifth cervical vertebra (C-5 level), the NeuStim device can
be initiated as early in the rehab process as the clinical care team
deems appropriate if the necessary clinical requirements for receiving
electrical stimulation are achieved. Evidence suggests that the timing
of intervention can play a role in outcomes, according to Bouton.
“Our
research has shown that when you can start patients on the therapy
earlier if they’re ready, that can help to reverse atrophy and
maladaptation of the neural circuits – these motor circuits that over
time can start to develop ‘bad habits’ because of impaired function,” he
said.
A
wireless, standalone, battery-operated device, NeuStim allows the
clinician to communicate instructions for stimulation from a tablet
interface to the patient once the wearable has been placed on the
affected arm. By sliding a finger over the touchscreen, the clinician
can move the point of stimulation via more than 150 small electrodes
that deliver electrical impulses to the muscles noninvasively through
the skin. Patches that are placed on the skin light up to indicate where
the stimulation point is moving electronically.
“The
electrodes do not need to be moved manually in the conventional way,”
Bouton said. “That method can take hours away from the rehab sessions to
map everything. It can also be much more difficult to find motor
points. But with our approach, we have demonstrated that you can touch a
screen to accomplish this task – and within minutes you can find the
motor points, stimulate the right muscles, and literally get patients
moving again. Insurance covers only a certain amount of time for
rehabilitation. You don’t want to be spending more time on setup.
NeuStim can be placed quickly, in under 90 seconds.”
Developmentally
focused on efficacy and safety, NeuStim’s design and functionality are
the result of a collaborative partnership between Neuvotion and
Intelligent Product Solutions (IPS), an end-to-end company that
specializes in medical device design and development.
While
there are a few contraindications and warnings related to receiving
electrical stimulation that must be considered before beginning the
therapy, including the use of synchronous (or demand) pacemakers and
implantable cardiac defibrillators, the device has been designed for a
variety of patient anatomies, according to Brad Carlson, vice president
of technology and business development at IPS.
“There’s
a human element here and we wanted ease of use to lead to adoption,”
Carlson said. “To ensure safety, we have used biocompatible materials
throughout the design. The device maintains safe stimulation levels on
its own with built-in safety mechanisms to maintain proper operation.”
Stimulation should not be applied over the carotid sinus nerves, particularly in patients with
a known sensitivity to the carotid sinus reflex.
Another innovative design aspect of the device is the thin, flexible patches that hold the electrodes in place.
“This
promotes contractions of the muscles after stroke or spinal cord injury
to reverse that atrophy and to promote rehabilitation or recovery over
time,” said Bouton.
The
specificity at which stimulation can be delivered has been especially
important in stroke recovery. “When you’re talking about the hand and
finger movements, these are very small muscles and muscle targets,” said
Bouton. “With stroke, hypertonicity will commonly occur, and patients
will have excessive flexion. And it’s difficult to counteract that with
conventional therapy when you’re only trying to mechanically move
something. But if you electrically stimulate the opposite side and you
can pinpoint those targets, those muscles can be activated and you can
get movement. Sometimes there’s a response within seconds.” To
promote continuity, stimulation profiles can be established and saved
for each user through the graphical interface. Patients are engaged by
watching the impulses that are sent by the clinician and providing
instant feedback about anything that they’re able to sense or feel
during the therapy, although sensation could be impaired, especially in
SCI cases. “Once
the clinician is set up and they have found those stimulation points,
and we’re seeing muscle activation and movements, they can then save
those patterns into the device for that patient,” Bouton said. “This is a
great feature because when they come in for future sessions their
settings can be loaded and repeated. We can then store those sequences
that the clinical team wants to work on – say, the opening of the hand
and the closing of the hand, or transfer tasks such as picking up
objects and putting them down, or compound movements. This device has
the advanced feature of having these sequences so that patients can be
helped with doing functional movements. And research has shown that if
the patient is actively involved in their therapy, the outcomes are
better.”
With
stimulation information stored, the clinician utilizes a slider on the
touchscreen that resembles a volume control to adjust the intensity or
level of stimulation. There’s also an option to modulate the stimulation
setting, allowing for the intensity to be adjusted up and down, which
contracts the muscle at different levels – something that’s effective
for trying to slow down or reverse any atrophy. This is also beneficial
for activating the muscles in the neural circuits to help promote
recovery, according to Bouton. “The patients can also be actively
involved in attempting these movements, which is common in a rehab
setting. But the difference here is the stimulation can be steered
electronically, and the levels can be adjusted in real-time,” he said.
Bouton
credits the collaboration with IPS with helping to design the device to
offer this level of sophistication. “IPS has been an extension of our
engineering team, and they have been fantastic to work with,” he said.
“Patients have different forearm shapes and sizes. IPS was instrumental
in looking at different sizes and shapes of arms with their human
factors team, which was a big challenge that helped us to shape and size
the design to fit unique anatomies. To be able to keep the device thin,
flexible, and fitting has been a fantastic design element that IPS led.
Future features already being researched
Bouton said Neuvotion has been focused on the next innovations for NeuStim prior to the device appearing on the market.
“Something
that is currently under development in our system as a future feature
is adding artificial intelligence that will allow patients to start a
gross motion that the AI will recognize and infer that they’re trying to
open their hand — and to automatically stimulate the hand to pick up an
object,” Bouton said. “We’ve completed early research studies and we anticipate adding this technology in the coming versions.”
Harvard University's Move Lab has
developed a wearable robotic device aimed at helping stroke survivors
and people with movement impairments regain mobility.
Harvard Move Lab makes wearable robotic devices for stroke victims
Dubbed Reachable, this device can
provide at-home therapy and enable independence in everyday tasks such
as cleaning, while delivering therapeutic benefits.
Design and Functionality
The product is lightweight and can be worn like a harness. It
contains a soft under-arm balloon that inflates and deflates, fitted
with sensors that track the user's movement.
These sensors understand the user's progress and adapt the level of support accordingly.
Therapeutic Effects
The technology is designed to immediately start exercising muscles to help the brain relearn.
Funding and Development
The Reachable team recently received a three-year, $5 million grant
from the U.S. National Science Foundation to expedite the transition of
practical research into the marketplace.
The team received Phase 2 funding in 2023, with the Move Lab as a
core partner, to continue testing and refining the device, aiming for
eventual licensing to a company.
Collaborations and Research
The Move Lab is also funded by the National Institutes of Health to
develop a neuroprosthesis for improving mobility for stroke survivors.
In a past project, Move Lab researchers developed new technology for
measuring sensation and muscle activity.
Reachable's partners include Massachusetts General Hospital, Cecropia
Strong, Imago Rehab, Simbex Product Development, and others.
Expert Insights
“After a stroke, the wearable robotic device’s control system that
synchronises and initiates all the movements that’s broken – not the
muscles,” said Executive Director Paul Sabin in the Harvard John A.
Paulson School of Engineering and Applied Sciences (SEAS).“If we can get
this to people before their muscles atrophy or before the disease
progresses, then they can focus on trying to recover their control
system.”
In simple words; the complete stroke medical world is totally fucking incompetent for not already having protocols on wearables!
With all this information out there who thinks this shows any sign of competence in your stroke medical 'professionals'? No one from the stroke medical world has ever contacted me to tell me I'm full of shit. I'm happily waiting for that day, it will be fun.
Advancements
in wearable technology have created new opportunities to monitor stroke
survivors’ behaviors in daily activities. Research insights are needed
to guide its adoption in clinical practice, address current gaps, and
shape the future of stroke rehabilitation. This project aims to: (1)
Understand stroke rehabilitation researchers’ perspectives on the
opportunities, challenges, and clinical relevance of wearable technology
for stroke rehabilitation, and (2) Identify necessary next steps to
integrate wearable technology in research and clinical practice.
Methods
Using
a phenomenological qualitative design, two 90-minute focus groups were
conducted with 12 rehabilitation researchers. The focus groups consisted
of semi-structured, open-ended questions on functional movement
behavior, motor performance and benefits and pitfalls of wearable
technology. The transcribed focus groups were analyzed using inductive
thematic analysis.
Results
Three
main themes were derived from the analysis: (1) Assessing activity
performance is critical to inform interventions, (2) The demonstrated
benefit is not commensurate with the added hassle, (3) Collaboration is
needed between the industry, academia and end-users. Necessary future
steps were recognized including the identification of intuitive and
actionable metrics, and the integration of sensor-derived data with
electronic health records and into clinical workflow to support
self-management strategies.
Conclusion
Wearable
technology shows great potential to complement and support stroke
rehabilitation. Many key barriers to clinical adoption remain(Well solve them! LEADERS WOULD SOLVE THEM! You're not leaders, are you?)which
underscore the necessity to foster collaborations between industry,
academia, and the participants we serve.
IMPLICATIONS FOR REHABILITATION
Wearable
technology provides critical information about activity performance to
understand stroke survivors’ behavior and inform interventions.
Concerted
efforts of interdisciplinary research teams in partnerships with users
and the industry are essential to accelerate clinical and research
adoption.
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