World Stroke Day - Oct. 29

The focus of this day should be how incredibly F*CKED UP everything in stroke is.
The whole focus on F.A.S.T. is complete false advertising. tPA is given to maybe 5-10% of those eligible and of those that get it it works to completely reverse the stroke around 12% of the time. It probably will save your life like it did mine but truthfulness about this wouldn't make people feel good about the stroke associations. I consider the stroke associations a major part of the problem. No acknowledgement of the problems and deflection to news of reduced deaths by stroke which has almost nothing to do with them.


0. There is no fast, easy and objective way to diagnose a stroke.
Thornhill woman’s “stroke selfie” goes viral It was the second attack in two days — the first time she was sent home after being treated for stress.
Ohio hospital settles stroke misdiagnosis lawsuit
Pediatric Stroke Often Misdiagnosed, Treatment Delayed
Doctors tell boy, 15, he had a migraine after rugby tackle - but he was actually suffering a paralyzing stroke which nearly killed him
Factors Associated With Misdiagnosis of Acute Stroke in Young Adults
Investigation as Stafford Hospital - England - fails to spot stroke 
"Weekend effect" seen in large stroke study  
Amy on her 36 hour wait for a diagnosis.
1. tPA may save your life but only has a 12% efficacy for full recovery.
2. Your neurologist doesn't have any concrete stroke protocols to save all the neurons that are dying in the first week. The neuronal cascade of death is occurring in full force and I bet your doctor doesn't know about it and is doing nothing to stop it.
Like these 31 hyperacute possibilities
3. Your neurologist or physiatrist doesn't have any clue about how to get you to full recovery. (Ask them exactly how to do it), you'll get excuses.
4. Only 10% get to full recovery.
5. No protocols to prevent your 33% chance of getting dementia post-stroke.
6. Nothing to alleviate your fatigue. In one study, two years after their stroke 10 per cent of stroke survivors said they were always tired and 30 per cent said they were sometimes tired. In another study, at least 12 months after their stroke, 50 per cent of stroke survivors said tiredness was their main problem.

7. Nothing that will cure your spasticity.
Spasticity following a stroke occurs in about 30% of patients


8. Nothing on cognitive training unless you find this yourself.
9. No published stroke protocols.
If there are any out there I haven't found them.
10. No way to compare your stroke hospital results vs. other stroke hospitals.
Everything in stroke is a complete failure. And that should be the focus of the World Stroke Day, not  the feel good crap you are going to hear. 

Myelin Vital for Learning New Practical Skills

If this is truly the case, what is your doctor doing to make sure you have enough myelin to recover your skills? ANYTHING AT ALL?
http://www.biosciencetechnology.com/news/2014/10/myelin-vital-learning-new-practical-skills?
New evidence of myelin’s essential role in learning and retaining new practical skills, such as playing a musical instrument, has been uncovered by UCL research. Myelin is a fatty substance that insulates the brain's wiring and is a major constituent of "white matter." It is produced by the brain and spinal cord into early adulthood as it is needed for many developmental processes, and although earlier studies of human white matter hinted at its involvement in skill learning, this is the first time it has been confirmed experimentally.

The study in mice, published in Science, shows that new myelin must be made each time a skill is learned later in life and the structure of the brain’s white matter changes during new practical activities by increasing the number of myelin-producing cells. Furthermore, the team say once a new skill has been learnt, it is retained even after myelin production stops. These discoveries could prove important in finding ways to stimulate and improve learning, and in understanding myelin’s involvement in other brain processes, such as in cognition.

For a child to learn to walk or an adult to master a new skill such as juggling, new brain circuit activity is needed and new connections are made across large distances and at high speeds between different parts of the brain and spinal cord. For this, electrical signals fire between neurons connected by “axons”– thread-like extensions of their outer surfaces which can be viewed as the "wire" in the electric circuit. When new signals fire repeatedly along axons, the connections between the neurons strengthen, making them easier to fire in the same pattern in future. Neighboring myelin-producing cells called oligodendrocytes (OLs) recognize the repeating signal and wrap myelin around the active circuit wiring. It is this activity-driven insulation that the team identified as essential for learning.

The team demonstrated that young adult mice need to make myelin to learn new motor skills but that new myelin does not need to be produced to recall and perform a pre-learned skill. They tested the ability of mice to learn to run on a complex wheel with irregularly spaced rungs. The study looked at thirty-six normal mice and thirty-two mice with a drug-controlled genetic switch to prevent new OLs and myelin from being made. They found the mice that were prevented from producing new myelin could not master the complex wheel, whereas those that could produce myelin did learn, with differences between the two groups’ abilities seen after only two hours of practice.

A second experiment looked at mice that were first allowed to learn to run on the complex wheel before being treated with the drug to prevent further myelin production. When the mice were later re-introduced to the complex wheel, they were immediately able to run at top speed without having to spend time re-learning. This shows that the inability to make new myelin did not affect the mouse’s running ability and that new myelin is not required to remember and perform a skill once learned; it is required only during the initial learning phase.

"From earlier studies of human white matter using advanced MRI technology, we thought OLs and myelin might be involved in some way in skill learning, so we decided to attack this idea experimentally. We were surprised how quickly we saw differences in the ability of mice from each group to learn how to run on complex wheel, which shows just how fast the brain can respond to wrap newly-activated circuits in myelin and how this improves learning. This rapid response suggests that a number of alternative axon pathways might already exist in the brain that could be used to drive a particular sequence of movements, but it quickly works out which of those circuits is most efficient and both selects and protects its chosen route with myelin," said Lead Researcher and Professor Bill Richardson, director of the UCL Wolfson Institute for Biomedical Research.

Richardson added: “We think these findings are really exciting as they open up opportunities to investigate the role of OLs and myelin in other brain processes, such as cognitive activities (like navigating through a maze), to see if the requirement for new myelin is general or specific to motor activity. I’m keen to find out the precise sequence of changes to OLs and myelin during learning and whether these changes are needed more in some parts of the brain than others, which might shed light on some of the mysteries still surrounding how the brain adapts and learns throughout life.”

Source: University College London

High-Tech Way to Diagnose Stroke

This is just a job saving initiative for neurologists. Fairly soon the  Qualcomm Tricorder X Prize will make this totally obsolete. Don't expect your neurologist to embrace this change, I bet you will need to call the hospital president directly to accomplish this change since I'm sure the stroke department head will not want to embrace technology that will lead to less doctors needed in the department.
http://www.wcvb.com/Sponsors/bethisrael/hightech-way-to-diagnose-stroke/28320644
What is TeleNet:Stroke Service:
TeleNet: Stroke service is a program that allows community hospitals to get an immediate diagnosis and treatment to a patient suspected of stroke. By collaborating with neurologic specialists, hospitals in the network can improve care while keeping a patient close to home, using this high-tech system.
Dr. Cole points out most community hospitals do not have a neurologist on-site 24 hours a day, 7 days a week.  But with TeleNet:Stroke, Dr. Cole says now a specialist can actually see, examine and interact with the patient in real time, enabling the team to make an accurate decision to administer medication and develop a treatment plan.
“We can quickly, accurately, and efficiently evaluate stroke patients to determine if they are candidates for thrombolytic therapy,” says Dr. Cole.

Read more: http://www.wcvb.com/Sponsors/bethisrael/hightech-way-to-diagnose-stroke/28320644#ixzz3GPwb9Vrl

What Do Mirror Neurons Really Do? (BSP 112)

From Dr. Ginger Campbell interviewing Dr. Gregory Hickok
What is your doctor doing with this to help your recovery? 
What Do Mirror Neurons Really Do? (BSP 112)

Ever since their chance discovery back in 1992 mirror neurons have captured the imagination of both scientists and nonscientists, but their actual role remains mostly speculative. In The Myth of Mirror Neurons: The Real Neuroscience of Communication and Cognition Dr. Gregory Hickok (UC-Irvine) explains why the most popular theory is probably wrong. He also provides a fascinating account of how science is really done and the sobering lesson that scientists can fall prey to the same cognitive biases (and tendencies toward laziness) that plague all humans.

I first discussed the discovery of mirror neurons back in BSP 35 when I featured  Mirrors in the brain: How our minds share actions, emotions, and experience (2008) by Giacomo Rizzolatti and Corrado Sinigaglia. At that time what I found most fascinating was that since mirror neurons fire both when a subject (usually a monkey) performs an action and when a similar action is observed, this proves that single neurons are not necessarily purely motor or purely sensory. This surprising discovery seems to have been overshadowed in the rush to use mirror neurons to explain everything from autism to language evolution.

The latest Brain Science Podcast  (BSP 112) features an interview with Dr. Gregory Hickok. BSP 35 is also available for FREE via the Brain Science Podcast Mobile APP.

This is probably only available free for the next couple of months.

Ohio hospital settles stroke misdiagnosis lawsuit

One would think that this would initiate objective diagnosis research. Like these sixteen.
Although the assumption that earlier diagnosis would have prevented damage is not based on any medical action that I can think of.
http://www.toledoblade.com/Courts/2013/03/02/UTMC-agrees-to-pay-499-900-to-settle-lawsuit.html
The University of Toledo Medical Center has agreed to pay $499,900 to a patient for failing to diagnose and treat his bleeding on the brain that led to a stroke.
The Court of Claims of Ohio approved the settlement agreement Wednesday.
Adrian Fitzgerald of Toledo, who was a patient at the former Medical College of Ohio Hospital on Aug. 4, 2011, cited several incidences of negligence and medical malpractice during his hospital stay, including negligent administration of heparin; negligent failure to appropriately monitor him; negligent failure to timely and appropriately follow up on the results of a CT scan, and negligent failure to timely and appropriately report the results of a CT scan to the ordering physician and/or the physician in charge of the patient’s care.
In his complaint filed Jan. 7, Mr. Fitzgerald said he is “permanent and partially” disabled and had serious injuries including “traumatic brain injury, damage to the left visual field of both eyes, and loss of motor function.”
The complaint also cites the “loss of services and consortium” for his wife and two sons.
UTMC released a written statement about the settlement.
“At UTMC, patients’ and their families’ privacy is our priority. It is our internal policy not to discuss the details or facts surrounding their personal health care, even though some of the information is available due to the public nature of our institution,” the statement said “UTMC, in settling a matter of this nature, is making no admission of liability.”

Read more at http://www.toledoblade.com/Courts/2013/03/02/UTMC-agrees-to-pay-499-900-to-settle-lawsuit.html#fRxxyTYdRe5SDQ6q.99

Cost of informal caregiving associated with stroke among the elderly in the United States

And if we had a great stroke association we could reduce the caregiving needs substantially by having stopped the neuronal cascade of death.  Cause and effect is so important that I wish our stroke medical staff understood the concept and used it.
http://www.neurology.org/content/early/2014/10/10/WNL.0000000000000986.short?rss=1

1. Heesoo Joo, PhD,
2. Diane O. Dunet, PhD,
3. Jing Fang, MD and
4. Guijing Wang, PhD

+Show Affiliations

| + Show Full Disclosures

1. Correspondence to Dr. Joo: hj528176@gmail.com

1. Published online before print October 10, 2014, doi: 10.1212/WNL.0000000000000986 Neurology 10.1212/WNL.0000000000000986

• Abstract
• Full Text (PDF)

1. Also available:
2. Data Supplement

Abstract

Objectives: We estimated the informal caregiving hours and costs associated with stroke.

Methods: We selected persons aged 65 years and older in 2006 and who were also included in the 2008 follow-up survey from the Health and Retirement Study. We adapted the case-control study design by using self-reported occurrence of an initial stroke event during 2006 and 2008 to classify persons into the stroke (case) and the nonstroke (control) groups. We compared informal caregiving hours between case and control groups in 2006 (prestroke period for case group) and in 2008 (poststroke period for case group) and estimated incremental informal caregiving hours attributable to stroke by applying a difference-in-differences technique to propensity score–matched populations. We used a replacement approach to estimate the economic value of informal caregiving.

Results: The weekly incremental informal caregiving hours attributable to stroke were 8.5 hours per patient. The economic value of informal caregiving per stroke survivor was $8,211 per year, of which $4,356 (53%) was attributable to stroke. At the national level, the annual economic burden of informal caregiving associated with stroke among elderly was estimated at $14.2 billion in 2008.

Conclusions: Recent changes in public health and social support policies recognize the economic burden of informal caregiving. Our estimates reinforce the high economic burden of stroke in the United States and provide up-to-date information for policy development and decision-making.

Seven Surprising Facts About Stroke

This is appalling that it doesn't discuss what should be the focus, that everything in stroke is a complete f*cking failure. See the bottom for my list of problems in stroke
http://www.newswise.com/articles/seven-surprising-facts-about-stroke
In recognition of World Stroke Day Oct. 29, Loyola University Medical Center neurologist Jose Biller, MD, lists seven surprising things you may not know about strokes.
Time is brain. During a stroke, 32,000 brain cells per second (1.9 million per minute) die. But if a patient receives timely treatment, the damage can be minimized. So it’s critically important to know the warning signs and symptoms of a stroke. However . . .
One in three Americans can’t name even a single stroke warning sign. These warning signs include sudden: numbness or weakness of the leg, arm or face; confusion or trouble understanding; trouble seeing in one or both eyes; trouble walking, dizziness, loss of balance or coordination; or severe headache with no known cause. An easy way to remember signs and symptoms is FAST. F: Face drooping. A: Arm weakness. S: Speech difficulty. T: Time to call 9-1-1 if any of these symptoms are present.
Strokes are surprisingly common in young people. And more young people are showing risk factors for such strokes. Between 532,000 and 852,000 people ages 18 to 44 in the United States have had a stroke. And between 1995-96 and 2007-08, U.S. hospital discharges for stroke among patients ages 15 to 44 increased by amounts ranging from 23 percent to 53 percent, depending on age and gender, according to a report, co-authored by Biller, in the journal Neurology.
Strokes are also common in presidents. Ten U.S. presidents likely suffered strokes, according to a study Biller and colleagues published in the Journal of Stroke and Cerebrovascular Diseases. Woodrow Wilson, Franklin Roosevelt and Dwight Eisenhower suffered strokes while in office, and Roosevelt’s stroke was fatal. Seven other presidents suffered apparent strokes after leaving office: John Tyler, Millard Fillmore, John Quincy Adams, Andrew Johnson, Chester Arthur, Richard Nixon and Gerald Ford.
How sex triggered a stroke. In the Journal of Stroke and Cerebrovascular Diseases, Biller and colleagues described an unusual case of a woman who suffered a stroke during sexual intercourse. Doctors believe a small clot formed in one of the veins in her thigh, broke loose and traveled to the right atrium (upper right pumping chamber). Pressure changes in the heart, triggered by sexual intercourse, enabled the clot to travel, through a hole in her heart, from the right atrium to the left atrium. From there, the clot traveled up to the brain and triggered a stroke.
The worst possible stroke. Among the most feared and devastating strokes are ones caused by blockages in the brain's critical basilar artery system. When not fatal, basilar artery strokes can cause devastating deficits, including head-to-toe paralysis called “locked-in syndrome,” according to a review article in MedLink Neurology by Biller and colleagues.
A character in "The Count of Monte Cristo," described as a "corpse with living eyes," had what appears to be locked-in syndrome. More recently, the book and movie "The Diving Bell and the Butterfly" describe a journalist with locked-in syndrome. He was mentally intact, but able to move only his left eyelid. He composed a moving memoir by picking out one letter at a time as the alphabet was slowly recited.
Neck manipulation may be associated with stroke. Treatments that involve neck manipulation may be associated with strokes, according to an American Heart Association Scientific Statement written by Biller and other leading stroke experts.
A small tear in a neck artery, called a cervical dissection, is among the most common causes of strokes in young and middle-aged adults. A dissection can lead to a blood clot that travels to the brain and triggers a stroke. Sudden movements that hyperextend or rotate the neck can cause a cervical dissection. Some maneuvers used by health practitioners also extend and rotate the neck. (Like chiropractic neck adjustments)
“Although a cause-and-effect relationship between these therapies and cervical dissection has not been established and the risk is probably low, a dissection can result in serious neurological injury,” Dr. Biller said. “Patients should be informed of this association before undergoing neck manipulation.”
World Stroke Day was established by the World Stroke Organization in 2006 to help spread public awareness of the world's high stroke risk and stroke prevalence. The theme of the 2014 World Stroke Day is women and stroke. Women have a higher stroke mortality rate than men. Six in ten stroke deaths occur in women, largely due to strokes occurring later in life in women, when strokes are more dangerous.
Biller is an internationally known expert on strokes(supposedly). He is professor and chair of the Department of Neurology of Loyola University Chicago Stritch School of Medicine.


0. There is no fast, easy and objective way to diagnose a stroke.
1. tPA may save your life but only has a 12% efficacy for full recovery.
2. Your neurologist doesn't have any concrete stroke protocols to save all the neurons that are dying in the first week.
3. Your neurologist or physiatrist doesn't have any clue about how to get you to full recovery. (Ask them exactly how to do it), you'll get excuses.
4. Only 10% get to full recovery.
5. No protocols to prevent your 33% chance of getting dementia post-stroke.
6. Nothing to alleviate your fatigue.
7. Nothing that will cure your spasticity.
8. Nothing on cognitive training unless you find this yourself.
9. No published stroke protocols.
10. No way to compare your stroke hospital results vs. other stroke hospitals.
Everything in stroke is a complete failure. 

Scorpion Venom Heat-Resistant Peptide (SVHRP) Enhances Neurogenesis and Neurite Outgrowth of Immature Neurons in Adult Mice by Up-Regulating Brain-Derived Neurotrophic Factor (BDNF)

This can join snake venom.

Intravenous Ancrod for Treatment of Acute Ischemic Stroke

Biting back - snake venom contains toxic clotting factors

 

Or tick spit

A tick’s spit leads to an entire lesson in blood clotting

Or bat saliva

vampire bat saliva

 

http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0109977#pone-0109977-g007

Tao Wang equal contributor,

    Shi-Wei Wang equal contributor,

    Yue Zhang,

    Xue-Fei Wu,

    Yan Peng,

    Zhen Cao,

    Bi-Ying Ge,

    Xi Wang,

    Qiong Wu,

    Jin-Tao Lin,

    Wan-Qin Zhang,

    Shao Li mail,

    Jie Zhao mail

    Published: October 09, 2014

    DOI: 10.1371/journal.pone.0109977

    Article

    About the Authors

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    Comments

    Related Content

    Abstract

    Introduction

    Materials and Methods

    Results

    Discussion

    Author Contributions

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Abstract

Scorpion venom heat-resistant peptide (SVHRP) is a component purified from Buthus martensii Karsch scorpion venom. Although scorpions and their venom have been used in Traditional Chinese Medicine (TCM) to treat chronic neurological disorders, the underlying mechanisms of these treatments remain unknown. We applied SVHRP in vitro and in vivo to understand its effects on the neurogenesis and maturation of adult immature neurons and explore associated molecular mechanisms. SVHRP administration increased the number of 5-bromo-2’-dexoxyuridine (BrdU)-positive cells, BrdU- positive/neuron-specific nuclear protein (NeuN)-positive neurons, and polysialylated-neural cell adhesion molecule (PSA-NCAM)-positive immature neurons in the subventricular zone (SVZ) and subgranular zone (SGZ) of hippocampus. Furthermore immature neurons incubated with SVHRP-pretreated astrocyte-conditioned medium exhibited significantly increased neurite length compared with those incubated with normal astrocyte-conditioned medium. This neurotrophic effect was further confirmed in vivo by detecting an increased average single area and whole area of immature neurons in the SGZ, SVZ and olfactory bulb (OB) in the adult mouse brain. In contrast to normal astrocyte-conditioned medium, higher concentrations of brain-derived neurotrophic factor (BDNF) but not nerve growth factor (NGF) or glial cell line-derived neurotrophic factor (GDNF) was detected in the conditioned medium of SVHRP-pretreated astrocytes, and blocking BDNF using anti-BDNF antibodies eliminated these SVHRP-dependent neurotrophic effects. In SVHRP treated mouse brain, more glial fibrillary acidic protein (GFAP)-positive cells were detected. Furthermore, immunohistochemistry revealed increased numbers of GFAP/BDNF double-positive cells, which agrees with the observed changes in the culture system. This paper describes novel effects of scorpion venom-originated peptide on the stem cells and suggests the potential therapeutic values of SVHRP.

New Algorithms Search for Signs of Consciousness in Brain Injury Patients

Sounds like something useful to test possible locked-in-syndrome patients.
http://www.wired.com/2014/10/neural-signature-consciousness/

Plasticity and Response to Action Observation

I wish they would just take all these damned studies on action observation and just make a stroke protocol out of it. Stop studying it and deliver some results! That is what a great stroke association would do instead of just putting out press releases.
http://nnr.sagepub.com/content/28/9/874?etoc

1. Iris C. Brunner, PhD1
2. Jan Sture Skouen, MD, PhD1
3. Lars Ersland, PhD2
4. Renate Grüner, PhD1,2

1. ¹University of Bergen, Bergen, Norway
2. ²Haukeland University Hospital, Bergen, Norway

1. Iris C. Brunner, Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, Post Box 7804, 5020 Bergen, Norway. Email: iris.brunner@igs.uib.no

Abstract

Background. Action observation has been suggested as a possible gateway to retraining arm motor function post stroke. However, it is unclear if the neuronal response to action observation is affected by stroke and if it changes during the course of recovery. 

 Objective. To examine longitudinal changes in neuronal activity in a group of patients with subacute stroke when observing and executing a bimanual movement task.  

Methods. Eighteen patients were examined twice using 3-T functional magnetic resonance imaging; 1 to 2 weeks and 3 months post stroke symptom onset. Eighteen control participants were examined once. Image time series were analyzed (SPM8) and correlated with clinical motor function scores.  

Results. During action observation and execution, an overlap of neuronal activation was observed in the superior and inferior parietal lobe, precentral gyrus, insula, and inferior temporal gyrus in both control participants and patients (P < .05; false discovery rate corrected). The neuronal response in the observation task increased from 1 to 2 weeks to 3 months after stroke. Most activated clusters were observed in the inferior temporal gyrus, the thalamus and movement-related areas, such as the premotor, supplementary and motor cortex (BA4, BA6). Increased activation of cerebellum and premotor area correlated with improved arm motor function. Most patients had regained full movement ability.  

Conclusions. Plastic changes in neurons responding to action observation and action execution occurred in accordance with clinical recovery. The involvement of motor areas when observing actions early and later after stroke may constitute a possible access to the motor system.

Corticospinal Excitability as a Predictor of Functional Gains at the Affected Upper Limb Following Robotic Training in Chronic Stroke Survivors

I wish they would just take all these damned studies on robotic training and just make a stroke protocol out of it. Stop studying it and deliver some results! That is what a great stroke association would do instead of just putting out press releases.
http://nnr.sagepub.com/content/28/9/819?etoc

1. Marie-Hélène Milot, PhD1,2
2. Steven J. Spencer, PhD2
3. Vicky Chan2
4. James P. Allington, PhD2
5. Julius Klein, PhD2
6. Cathy Chou2
7. Kristin Pearson-Fuhrhop, PhD2
8. James E. Bobrow, PhD2
9. David J. Reinkensmeyer, PhD2
10. Steven C. Cramer, MD2

1. ¹Université de Sherbrooke, Sherbrooke, Quebec, Canada
2. ²University of California; Irvine, CA, USA

1. Marie-Hélène Milot, Université de Sherbrooke, Faculté de médecine et des sciences de la santé, École de réadaptation, Centre de recherche sur le vieillissement, 1036 Belvédère sud, Sherbrooke, Québec, J1H 4C4, Canada. Email: marie-helene.milot@usherbrooke.ca

Abstract

Background. Robotic training can help improve function of a paretic limb following a stroke, but individuals respond differently to the training. A predictor of functional gains might improve the ability to select those individuals more likely to benefit from robot-based therapy. Studies evaluating predictors of functional improvement after a robotic training are scarce. One study has found that white matter tract integrity predicts functional gains following a robotic training of the hand and wrist.  

Objective. To determine the predictive ability of behavioral and brain measures in order to improve selection of individuals for robotic training.  

Methods: Twenty subjects with chronic stroke participated in an 8-week course of robotic exoskeletal training for the arm. Before training, a clinical evaluation, functional magnetic resonance imaging (fMRI), diffusion tensor imaging, and transcranial magnetic stimulation (TMS) were each measured as predictors. Final functional gain was defined as change in the Box and Block Test (BBT). Measures significant in bivariate analysis were fed into a multivariate linear regression model.  

Results. Training was associated with an average gain of 6 ± 5 blocks on the BBT (P < .0001). Bivariate analysis revealed that lower baseline motor-evoked potential (MEP) amplitude on TMS, and lower laterality M1 index on fMRI each significantly correlated with greater BBT change. In the multivariate linear regression analysis, baseline MEP magnitude was the only measure that remained significant.  

Conclusion. Subjects with lower baseline MEP magnitude benefited the most from robotic training of the affected arm. These subjects might have reserve remaining for the training to boost corticospinal excitability, translating into functional gains.

Virtual reality for upper extremity rehabilitation in early stroke: a pilot randomized controlled trial

I wish they would just take all these damned studies on virtual reality and just make a stroke protocol out of it. Stop studying it and deliver some results! That is what a great stroke association would do instead of just putting out press releases.
http://cre.sagepub.com/content/28/11/1107.abstract?

1. Chan Wai Yin1
2. Ng Yee Sien2
3. Low Ai Ying3
4. Stephanie Fook-Chong Man Chung4
5. Dawn Tan May Leng3

1. ¹Allied Health Division, Department of Occupational Therapy, Singapore General Hospital, Singapore
2. ²Division of Medicine, Department of Rehabilitation Medicine, Singapore General Hospital, Singapore
3. ³Allied Health Division, Department of Physiotherapy, Singapore General Hospital, Singapore
4. ⁴Division of Research, Health Services Research and Biostatistics, Centre for Quantitative Medicine, Duke-NUS, Singapore General Hospital, Singapore

1. Chan Wai Yin, Department of Occupational Therapy, Singapore General Hospital, Rehabilitation Center, Block 1 Level 1, Outram Road, 169608, Singapore. Email: yetta.chan.w.y@sgh.com.sg

Abstract

Objectives: To investigate the effect of virtual reality (VR) rehabilitation on upper extremity motor performance of patients with early stroke.

Design: Pilot randomized controlled trial.

Setting: Rehabilitation wards.

Participants: Twenty three adults with stroke (mean age (SD) = 58.35 (13.45) years and mean time since stroke (SD) = 16.30 (7.44) days).

Interventions: Participants were randomly assigned to VR group (n=11) or control group (n=12). VR group received nine 30 minutes upper extremity VR therapy in standing (five weekdays in two weeks) plus conventional therapy, which included physical and occupational therapy. Control group received only conventional therapy, which was comparable to total training time received by VR group (mean training hours (SD):VR = 17.07 (2.86); control = 15.50 (2.79)).

Main outcome measures: The main outcome measure was the Fugl-Meyer Assessment (FMA). Secondary outcomes included Action Research Arm Test, Motor Activity Log and Functional Independence Measure. Results were taken at baseline, post intervention and 1-month post intervention. Participants’ feedback and adverse effects were recorded.

Results: All participants improved in FMA scores (mean change (SD) = 11.65 (8.56), P<.001). These effects were sustained at one month after intervention (mean (SD) change from baseline = 18.67 (13.26), P<.001). All other outcome measures showed similar patterns. There were no significant differences in improvement between both groups. Majority of the participants found VR training useful and enjoyable, with no serious adverse effects reported.

Conclusion: Although additional VR training was not superior to conventional therapy alone, this study demonstrates the feasibility of VR training in early stroke.

Connectomics at the cutting edge: Challenges and opportunities in high-resolution brain mapping

Your doctors should be gong to this webinar because they need to know exactly how to connect up your brain regions again after your stroke. You do expect at least a minimum of knowledge from your doctor? Don't you? Or will you need to train yourself in this also?

New complimentary webinar from Science:

Connectomics at the cutting edge: Challenges and opportunities in high-resolution brain mapping

You are invited to hear our panel of experts on November 3, 2014, in this live, online educational seminar. For more information and complimentary registration visit: webinar.sciencemag.org

Date: Monday, November 3, 2014
Time: 12 Noon Eastern, 9 a.m. Pacific, 5 p.m. UK, 6 p.m. Central Europe
Duration: 1 hour

About This Webinar

Researchers in the field of connectomics endeavor to analyze the complex synaptic network formed by the billions of interconnected neurons. By thinly slicing neural tissue and imaging each section with a scanning electron microscope at high resolution, fine structural details can be visualized. Careful delineation of each neuron in the 3-D volume allows for the high-resolution mapping of all connections made by each cell, providing a detailed wiring diagram of the brain: the connectome. The sheer size and complexity of this scientific challenge is daunting. Tens of thousands of sections or more need to collected and hundreds of thousands of images recorded, resulting in many terabytes of data that require rapid processing, making connectomics a real “speed game.” Automated sample preparation robots and high throughput electron microscopes have now become available, bringing the promise of a larger (1 mm³), high-resolution connectome within reach. However, extracting neuronal circuit information from such large datasets is still a daunting task. This webinar will outline the challenges of connectomics, explain the latest methodological developments that are bringing imaging and data analysis closer to the desired throughput, and provide insights into how this research can provide a deeper understanding of brain function and dysfunction.

During the webinar, the speakers will:
• Provide an overview of high-resolution connectomics and the methods currently used to create dense reconstructions of the brain
• Discuss new advances in the field that are enabling researchers to take the next quantum leap
• Present their own research and provide some thoughts on how connectomics might evolve in the future
• Discuss the limitations of what can be learned with these new approaches
• Answer your questions live during the webinar!

Participants:

Jeffrey Lichtman, M.D., Ph.D.
Harvard University
Cambridge, MA

Moritz Helmstaedter, M.D.
Max Planck Institute for Brain Research
Frankfurt, Germany

Register at:
webinar.sciencemag.org

Questions? E-mail: webinar@aaas.org.

Produced by the Science/AAAS Custom Publishing Office and sponsored by ZEISS.