A Standardized Checklist Improves the Transfer of Stroke Patients from the Neurocritical Care Unit to Hospital Ward

What is really needed is a specific list of rehab protocols required to get those transferred 100% recovered. 

A Standardized Checklist Improves the Transfer of Stroke Patients from the Neurocritical Care Unit to Hospital Ward 

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Nick M. Murray, MD, Aditya N. Joshi, MD, Kassi Kronfeld, MD, ...

First Published September 10, 2019 Research Article

https://doi.org/10.1177/1941874419873810

Article information

Abstract

Background and Purpose:

The transfer of patients with ischemic stroke from the intensive care unit (ICU) to noncritical care inpatient wards involves detailed information sharing between care teams. Our local transfer process was not standardized, leading to potential patient risk. We developed and evaluated an “ICU Transfer Checklist” to standardize communication between the neurocritical care team and the stroke ward team.

Methods:

Retrospective review of consecutive patients with ischemic stroke admitted to the neurocritical care unit who were transferred to the stroke ward was used to characterize transfer documentation. A multidisciplinary team developed and implemented an ICU Transfer Checklist that contained a synthesis of the patient’s clinical course, immediate “to-do” action items, and a system-based review of active medical problems. Post intervention checklist utilization was recorded for 8 months, and quality metrics for the post intervention cohort were compared to the preintervention cohort. Providers were surveyed pre- and post intervention to characterize perceived workflow and quality of care.

Results:

Patients before (n = 52) and after (n = 81) ICU Transfer Checklist implementation had similar demographic and clinical characteristics. In the post checklist implementation period, the ICU Transfer Checklist was used in over 85% of patients and median hospital length of stay (LOS) decreased (8.6 days vs 5.4 days, P = .003), while ICU readmission rate remained low. The checklist was associated with improved perceptions of safety and decreased time needed to transfer patients.

Conclusions:

Use of the standardized ICU Transfer Checklist was associated with decreased hospital LOS and with improvements in providers’ perceptions of patient safety.

Long-Term Risk of Hip Fracture After Ischemic Stroke

My hip must be pretty strong because this incident did not result in a broken hip.  I've fallen on it many times since then and making it stronger each time it occurs.

Epic failure at bike stroke therapy

Similar to boxers microfracturing their hands so they grow back stronger. I should be able to ask my doctor specifically if the hip is now strong enough to survive a fall. Don't listen to me, I'm not medically trained.

 

Long-Term Risk of Hip Fracture After Ischemic Stroke 

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Setareh Salehi Omran, MD, Santosh B. Murthy, MD, MPH, Babak B. Navi, MD, MS, ...

First Published June 30, 2019 Research Article

https://doi.org/10.1177/1941874419859755

Article information

Abstract

Background and Purpose:

Data are lacking on the long-term risk of hip fracture among patients with ischemic stroke. A better understanding of the contemporary incidence of hip fracture after ischemic stroke could benefit patient care by promoting strategies to prevent this disabling complication in stroke survivors.

Methods:

We performed a retrospective cohort study using inpatient and outpatient claims between 2008 and 2015 from a nationally representative 5% sample of Medicare beneficiaries. We included patients ≥66 years of age who were hospitalized with acute ischemic stroke, defined through a validated diagnostic code algorithm. We excluded patients who had a prior or concurrent hip fracture diagnosis at the time of ischemic stroke. The primary outcome was hip fracture requiring hospitalization. Survival statistics were used to calculate crude incidence rates, and the Kaplan-Meier method was used to calculate cumulative rates.

Results:

Among the 1 772 550 beneficiaries in our sample, 60 099 were diagnosed with an acute ischemic stroke without prior or concomitant hip fracture. During 4.5 (±2.2) years of follow-up, the incidence of hip fracture was 1.6 (95% confidence interval [CI]: 1.5-1.6) per 100 person-years in patients with acute ischemic stroke versus 0.6 (95% CI: 0.6-0.6) per 100 person-years in patients without acute ischemic stroke. The cumulative 5-year rate of hip fracture was 7.6% (95% CI: 7.2%-8.0%) among patients with acute ischemic stroke versus 2.8% (95% CI: 2.8%-2.9%) among the remaining Medicare beneficiaries.

Conclusion:

We found that among elderly Medicare beneficiaries with acute ischemic stroke, nearly 1 in 12 developed a hip fracture over the next 5 years.

Body Weight–Supported Treadmill Training Is No Better Than Overground Training for Individuals with Chronic Stroke: A Randomized Controlled Trial

So in the past 6 years has your hospital discontinued BWSTT? Do you prefer your hospital incompetence to be: NOT KNOWING, or NOT DOING?

Body Weight–Supported Treadmill Training Is No Better Than Overground Training for Individuals with Chronic Stroke: A Randomized Controlled Trial

Topics in Stroke Rehabilitation, 2014

Addie Middleton, DPT,
1
 Angela Merlo-Rains, PhD, DPT,
 2
 Denise M. Peters, DPT,
1
 Jennifaye V. Greene, PhD, MS, PT, NCS,
1
 Erika L. Blanck, DPT, ATC,
 3
 Robert Moran, PhD,
4
 and Stacy L. Fritz, PhD, PT
1
1
Department of Exercise Science, Physical Therapy Program, University of South Carolina, Columbia, South Carolina;
 2
College of Health and Human Services, Physical Therapy Program, Northern Arizona University, Phoenix, Arizona;
3
Department of Cell Biology and  Anatomy, University of South Carolina, School of Medicine, Columbia, South Carolina;
4
Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina
Background:
Body weight–supported treadmill training (BWSTT) has produced mixed results compared with other therapeutic techniques.
Objective:
The purpose of this study was to determine whether an intensive intervention (intensive mobility training) including BWSTT provides superior gait, balance, and mobility outcomes compared with a similar intervention with overground gait training in place of BWSTT.
Methods:
 Forty-three individuals with chronic stroke (mean [SD] age, 61.5 [13.5] years; mean [SD] time since stroke, 3.3 [3.8] years), were randomized to a treatment (BWSTT,n= 23) or control (overground gait training,n= 20) group. Treatment consisted of 1 hour of gait training; 1 hour of balance activities; and 1 hour of strength, range of motion, and coordination for 10 consecutive weekdays (30 hours). Assessments (step length differential, self-selected and fast walking speed, 6-minute walk test, Berg Balance Scale [BBS], Dynamic Gait Index [DGI], Activities specific Balance Confidence [ABC] scale, single limb stance, Timed Up and Go [TUG], Fugl-Meyer [FM], and perceived recovery [PR]) were conducted before, immediately after, and 3 months after intervention.
Results:
 No significant differences (α= 0.05) were found between groups after training or at follow-up; therefore, groups were combined for remaining analyses. Significant differences (α= 0.05) were found pretest to post test for fast walking speed, BBS, DGI, ABC, TUG, FM, and PR. DGI, ABC, TUG, and PR results remained significant at follow-up. Effect sizes were small to moderate in the direction of improvement.
Conclusions:
 Future studies should investigate the effectiveness of intensive interventions of durations greater than 10 days for improving gait, balance, and mobility in individuals with chronic stroke.
Key words:
balance, gait, mobility, rehabilitation, stroke, treadmill training 

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

 Reviews are useless to survivors, they need EXACT STROKE PROTOCOLS. The title should be; ' The creation of stroke protocols for upper limb recovery from robotic and mechanical devices'. Leadership would assure that this would be the result of all stroke research. But we have NO LEADERSHIP. I don't know what we have but it sure is incompetent.

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

 Jacob Brackenridge
1
, Lynley V. Bradnam
2,3
, Sheila Lennon
2
, John J. Costi
1
 and David A. Hobbs
1,
*

1
Medical Device Research Institute, School of Computer Science, Engineering and Mathematics, Flinders University, Adelaide, South Australia, Austra-lia;
2
 Discipline of Physiotherapy, School of Health Sciences, Flinders University, Adelaide, South Australia, Australia;

3
 Discipline of Physiotherapy, Graduate School of Health, University of Technology, Sydney, NSW, Australia

Abstract:

 Background:

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

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

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

Conflicting results of robot-assisted versus usual gait training during postacute rehabilitation of stroke patients: a randomized clinical trial

Bad research since your mentors and senior researchers didn't inform you that Bobath doesn't work. So 17 years of incompetency.

Physiotherapy Based on the Bobath Concept for Adults with Post-Stroke Hemiplegia: A Review of Effectiveness Studies 2003

  The latest here:

Conflicting results of robot-assisted versus usual gait training during postacute rehabilitation of stroke patients: a randomized clinical trial

Giovanni Taveggia
a,b
, Alberto Borboni
c
, Chiara Mulé
a,b
, Jorge H. Villafañe
d
andStefano Negrini
d,e
Robot gait training has the potential to increase the effectiveness of walking therapy. Clinical outcomes after robotic training are often not superior to conventional therapy. We evaluated the effectiveness of a robot training compared with a usual gait training physiotherapy during a standardized rehabilitation protocol in inpatient participants with post stroke hemiparesis. This was a randomized double-blind clinical trial in a postacute physical and rehabilitation medicine hospital. Twenty-eight patients,39.3% women (72±6 years), with hemiparesis (<6 months after stroke) receiving a conventional treatment according to the Bobath approach were assigned randomly to an experimental or a control intervention of robot gait training to improve walking (five sessions a week for 5 weeks). Outcome measures included the 6-min walk test, the 10mwalk test, Functional Independence Measure, SF-36physical functioning and the Tinetti scale. Outcomes were collected at baseline, immediately following the intervention period and 3 months following the end of the intervention.The experimental group showed a significant increase in functional independence and gait speed (10m walk test) at the end of the treatment and follow-up, higher than the minimal detectable change. The control group showed a significant increase in the gait endurance (6-min walk test)at the follow-up, higher than the minimal detectable change. Both treatments were effective in the improvement of gait performances, although the statistical analysis of functional independence showed a significant improvement in the experimental group, indicating possible advantages during generic activities of daily living compared with overground treatment.
 International Journal of Rehabilitation Research
39:29
–
35 Copyright © 2016 Wolters Kluwer Health, Inc. Allrights reserved.

Adaptive conjunctive cognitive training (ACCT) in virtual reality for chronic stroke patients: a randomized controlled pilot trial

Hope you can figure out what adaptive conjunctive cognitive training is so you can ask your doctor for it. I have no clue.

Adaptive conjunctive cognitive training (ACCT) in virtual reality for chronic stroke patients: a randomized controlled pilot trial

• Martina Maier,
• Belén Rubio Ballester,
• Nuria Leiva Bañuelos,
• Esther Duarte Oller &
• Paul F. M. J. Verschure 

Journal of NeuroEngineering and Rehabilitation volume 17, Article number: 42 (2020) Cite this article

• 346 Accesses
• 10 Altmetric
• Metrics details

Abstract

Background

Current evidence for the effectiveness of post-stroke cognitive rehabilitation is weak, possibly due to two reasons. First, patients typically express cognitive deficits in several domains. Therapies focusing on specific cognitive deficits might not address their interrelated neurological nature. Second, co-occurring psychological problems are often neglected or not diagnosed, although post-stroke depression is common and related to cognitive deficits. This pilot trial aims to test a rehabilitation program in virtual reality that trains various cognitive domains in conjunction, by adapting to the patient’s disability and while investigating the influence of comorbidities.

Methods

Thirty community-dwelling stroke patients at the chronic stage and suffering from cognitive impairment performed 30 min of daily training for 6 weeks. The experimental group followed, so called, adaptive conjunctive cognitive training (ACCT) using RGS, whereas the control group solved standard cognitive tasks at home for an equivalent amount of time. A comprehensive test battery covering executive function, spatial awareness, attention, and memory as well as independence, depression, and motor impairment was applied at baseline, at 6 weeks and 18-weeks follow-up.

Results

At baseline, 75% of our sample had an impairment in more than one cognitive domain. The experimental group showed improvements in attention (χ2F

(2) = 9.57, p < .01), spatial awareness (χ2F (2) = 11.23, p < .01) and generalized cognitive functioning (χ2F (2) = 15.5, p < .001). No significant change was seen in the executive function and memory domain. For the control group, no significant change over time was found. Further, they worsened in their depression level after treatment (T = 45, r = .72, p < .01) but returned to baseline at follow-up. The experimental group displayed a lower level of depression than the control group after treatment (Ws = 81.5, z = − 2.76, r = − .60, p < .01) and (Ws = 92, z = − 2.03, r = − .44, p < .05).

Conclusions

ACCT positively influences attention and spatial awareness, as well as depressive mood in chronic stroke patients.

Trial registration

The trial was registered prospectively at ClinicalTrials.gov (NCT02816008) on June 21, 2016.

Maximum walking speeds obtained using treadmill and overground robot system in persons with post-stroke hemiplegia

Now you need to create a protocol out of this and deliver it to all 10 million yearly stroke survivors. Otherwise this will never get into common use. 

Maximum walking speeds obtained using treadmill and overground robot system in persons with post-stroke hemiplegia

 Abstract

Background:
 Previous studies demonstrated that stroke survivors have a limited capacity to increase their walking speeds beyond their self-selected maximum walking speed (SMWS). The purpose of this study was to determine the capacity of stroke survivors to reach faster speeds than their SMWS while walking on a treadmill belt or while being pushed by a robotic system (i.e. “push mode”).
Methods:
 Eighteen chronic stroke survivors with hemiplegia were involved in the study. We calculated their self-selected comfortable walking speed (SCWS) and SMWS overground using a 5-meter walk test (5-MWT). Then,they were exposed to walking at increased speeds, on a treadmill and while in
 “push mode”
 in an overground robotic device, the KineAssist, until they were tested at a speed that they could not sustain without losing balance.We recorded the time and number of steps during each trial and calculated gait speed, average cadence and average step length.
Results:
 Maximum walking speed in the “push mode” was 13% higher than the maximum walking speed on the treadmill and both were higher (“push mode”: 61%; treadmill: 40%) than the maximum walking speed overground.Subjects achieved these faster speeds by initially increasing both step length and cadence and, once individuals stopped increasing their step length, by only increasing cadence.
Conclusions:
 With post-stroke hemiplegia, individuals are able to walk at faster speeds than their SMWS overground, when provided with a safe environment that provides external forces that requires them to attempt dynamic stability maintenance at higher gait speeds. Therefore, this study suggests the possibility that, given the appropriate conditions, people post-stroke can be trained at higher speeds than previously attempted.

Hearing Aids May Delay Cognitive Decline

Is this one of the tests your doctor is performing to ensure you don't get cognitive decline after your stroke?

Hearing Aids May Delay Cognitive Decline

Researchers in Australia have found that nearly all participants in a study who used their hearing aids significantly improved their mental ability to plan, organize information and initiate tasks. Find out more.

---

Wearing hearing aids may delay cognitive decline in older adults and improve brain function, according to promising new research.

Hearing & Dementia

Cognitive decline is associated with hearing loss, which affects about 32 per cent of people aged 55 years, and more than 70 per cent of people aged over 70 years. Hearing loss has been identified as a modifiable risk factor for dementia.

University of Melbourne researchers have tested the use of hearing aids in almost 100 adults aged 62-82 years with hearing loss.

Participants were assessed before and 18 months after having hearing aids fitted on their hearing, cognitive function, speech perception, quality of life, physical activity, loneliness, mood and medical health.

After 18 months of hearing aid use, researchers found speech perception, self-reported listening disability and quality of life had significantly improved for participants.

Most notably, 97.3 per cent of participants in this study showed either clinically significant improvement or stability in executive function -- their mental ability to plan, organise information and initiate tasks.

Women, in particular, showed significant improvements in working memory -- used for reasoning and decision-making -- as well as most other cognitive functions assessed.

The study also found more frequent use of hearing aids was associated with greater improvements in cognitive function, and women were much more diligent at wearing the devices than men.

University of Melbourne Associate Professor and Chief Investigator of the study, Julia Sarant, said improvement in cognitive function is something that is not usually seen in older adults.

"Although there are successful treatments for hearing loss, there is currently no successful treatment for cognitive decline or dementia," Associate Professor Sarant said.

"This research is a positive step in investigating the treatment of hearing aids to delay cognitive decline.

"Further research is underway to compare cognitive outcomes from a larger sample size with those of a healthy aging comparison group of older Australians with typical hearing for their age."

More at link.

Arterial Stiffness and Cognition Among Adults: A Systematic Review and Meta‐Analysis of Observational and Longitudinal Studies

So if you have arterial stiffness what the fuck is your doctor's protocol to address the problem? Maybe something in one of these?

• Arterial stiffness (34 posts) 

Arterial Stiffness and Cognition Among Adults: A Systematic Review and Meta‐Analysis of Observational and Longitudinal Studies

Celia Alvarez‐Bueno

,

Pedro G. Cunha

,

Vicente Martinez‐Vizcaino

,

Diana P. Pozuelo‐Carrascosa

,

Maria Eugenia Visier‐Alfonso

,

Estela Jimenez‐Lopez

, and

Ivan Cavero‐Redondo

Originally published28 Feb 2020https://doi.org/10.1161/JAHA.119.014621Journal of the American Heart Association. 2020;9:e014621

Abstract

Background

To estimate the strength of the cross‐sectional and longitudinal association between arterial stiffness, measured by pulse‐wave velocity, and cognitive function, distinguishing between global cognition, executive functions, and memory and to examine the influence of demographic, clinical, and assessment characteristics on this relationship.

Methods and Results

Systematic review of MEDLINE (via PubMed), Scopus, and WOS databases from their inception to March 2019, to identify cross‐sectional and longitudinal studies on the association between pulse‐wave velocity and cognitive domains (ie, global cognition, executive functions, and memory) among adult population. A total of 29 cross‐sectional and 9 longitudinal studies support the negative relationship between arterial stiffness and cognitive function, including global cognition, executive function, and memory. Demographic, clinical, and assessment characteristics did not substantially modify the strength of this association.

Conclusions

Evidence reveals a negative association between arterial stiffness, measured using pulse‐wave velocity, and cognition, specifically executive function, memory, and global cognition. This association seems to be independent of demographic, clinical, and assessment characteristics. These results accumulate evidence supporting that pulse‐wave velocity assessment could be a useful tool to identify individuals at high risk of cognitive decline or early stages of cognitive decline, to implement interventions aimed at slowing the progression to dementia.

 

High olive oil consumption lowers risk for heart disease

The good thing is that they give you an amount but assume you have a scale that measures in grams. The bad news is that they don't know that stroke is not a heart disease.  

WHO reclassified stroke in 2006, now a neurological disease not cardiovascular disease?

High olive oil consumption lowers risk for heart disease 

March 5, 2020

Marta Guasch-Ferre

Patients who consumed at least 7 g per day of olive oil had lower risk for CHD and total CVD compared with those who did not consume it, according to data presented at the American Heart Association Epidemiology, Prevention, Lifestyle and Cardiometabolic Health Scientific Sessions.
This study was also published in the Journal of the American College of Cardiology.

“The main message is that our results further support to recommend replacing fats with oils such as olive oil to prevent heart disease,” Marta Guasch-Ferre, PhD, research scientist in the department of nutrition at Harvard T.H. Chan School of Public Health and instructor in medicine at the Channing Division of Network Medicine at Harvard Medical School, told Healio.
Researchers analyzed data from 63,867 women from the Nurses’ Health Study and 35,512 men from the Health Professionals Follow-Up Study who were free from heart disease, cancer and stroke at baseline. Patients completed food frequency questionnaires to collect information on diet at baseline and every 4 years.
“There was some evidence showing that olive oil was beneficial for heart disease, but most of the research until now was conducted in Mediterranean populations,” Guasch-Ferre said in an interview. “We wanted to see if these associations were also significant in the U.S. population, where usually intake of olive oil is lower.”

CV risk for adults in the U.S. who consume olive oil vs. those who do not.

There were 10,240 incident cases of CVD during 24 years of follow-up. This included 6,270 cases of CHD and 3,970 cases of stroke.
Compared with patients who did not consume olive oil, those with higher olive oil intake, defined as more than 7 g per day, had a 21% lower risk for CHD (pooled HR = 0.79; 95% CI, 0.7-0.89) and a 15% lower risk for total CVD (pooled HR = 0.85; 95% CI, 0.77-0.93) after adjusting for major lifestyle and diet factors. Total stroke or ischemic stroke did not exhibit a similar association.
Researchers estimated that replacing 5 g of butter, margarine, dairy fat or mayonnaise with olive oil was linked to a 5% to 7% lower risk for CHD and total CVD.
Other plant oils such as safflower and corn did not exhibit significant associations with CHD or total CVD.
“One of the things that we couldn’t analyze here was the different varieties of olive oil, if it was extra-virgin or common olive oil,” Guasch-Ferre told Healio. “That’s something we need a little bit more research on this area, and also the effects of vegetable oils on health outcomes. That’s also something that needs a little bit more research, and to try to understand better the underlying mechanisms of this association.” – by Darlene Dobkowski

Brain Aging Tied to Leisure Time Physical Activity

So your doctor needs to get you recovered enough to get 52 hours of exercise in 6 months. THIS IS YOUR DOCTOR'S RESPONSIBILITY. Don't let them use the fuckingly lazy excuse of: 'All strokes are different, all stroke recoveries are different.' If that comes from your doctor, then you need to call the hospital president and ask when incompetent doctors will be fired. 

Brain Aging Tied to Leisure Time Physical Activity

— Walking, gardening, swimming, dancing linked to larger brain volume in older adults

by Judy George, Senior Staff Writer, MedPage Today March 6, 2020

TORONTO -- More leisure-time physical activity -- walking, gardening, swimming, or dancing, for example -- was associated with larger brain volume in older adults, a cross-sectional study showed.
Adults with an average age of 75 who had the most physical activity had a total brain volume that was 1.4% larger than those with the least activity, reported Yian Gu, PhD, of Columbia University in New York City, and co-authors, in an early-release abstract from the American Academy of Neurology annual meeting, which will be held here in April.
The effect was equal to about 4 years of brain aging, Gu noted.
"These results are exciting, as they suggest that people may potentially prevent brain shrinking and the effects of aging on the brain simply by becoming more active," she said in a statement.
Previous research has linked physical activity with cognition in older adults. A systematic review in 2018 showed that exercising for 52 hours over 6 months was associated with improvements in processing speed and executive function. Last year, a longitudinal study showed that a higher level of daily physical activity was tied to slower amyloid-beta related cognitive decline in clinically normal older adults.
In their analysis, Gu and colleagues studied leisure-time physical activity and MRI measures of 1,557 older adults in the Washington/Hamilton Heights-Inwood Columbia Aging Project (WHICAP) study, a community-based, multi-ethnic cohort of older adults.
No participants had dementia, but 296 people had mild cognitive impairment and 28% carried the APOE E4 allele. Participants had a mean 11.4 years of education and body mass index of 28.4. In total, 64% were women; 26% were non-Hispanic white, 34% were African American, and 38% were Hispanic.
Participants reported their daily tasks and leisure time physical activity, and researchers grouped them into three categories:

• Inactive
• Somewhat active: either 2.5 hours of low-intensity physical activity, 1.5 hours of moderate physical activity, or 1 hour of high-intensity physical activity a week
• Most active: either 7 hours of low-intensity physical activity, 4 hours of moderate physical activity, or 2 hours of high-intensity physical activity a week

MRIs showed that average total brain volume was 883 mL for the most active people and 871 mL for inactive people, a 1.4% difference.
Compared with people in the lowest tertile of leisure activity, those with the highest tertile had larger total brain volume (β=12.17, P=0.001; P=0.001 for trend), total gray matter volume (β=7.18, P<0.0001; P=0.001 for trend), and total white matter volume (β=6.82, P=0.005; P=0.005 for trend) after adjusting for age, sex, race/ethnicity, education, APOE E4 status, intracranial volume, and recruitment waves. Leisure activity was not associated with white matter hyperintensity volume.
Associations were slightly attenuated after further adjusting for body mass index and vascular comorbidities. Results remained similar after excluding people with mild cognitive impairment.
The effect size comparing the highest to the lowest tertile of leisure activity was equivalent to about 3 to 4 years of aging (about 4 years for total brain and total gray matter volumes, and about 3 years for total white matter volume), Gu told MedPage Today.
The study had several limitations. It was observational and does not prove exercise prevents brain shrinkage, Gu noted. In addition, physical activity was based on self-report and may be subject to recall bias.

Last Updated March 06, 2020

Disclosures

The study was supported by the National Institute on Aging and the National Institutes of Health.

Primary Source

American Academy of Neurology

Source Reference: Gu Y, et al "Leisure Time Physical Activity and MRI-based Brain Measures in a Multi-ethnic Elderly Cohort" AAN 2020.

Does blood-flow restriction training work, and who can it help?

Would this help in stroke recovery? Who the fuck do we ask to get this researched?  NO LEADERSHIP AND NO STRATEGY means nothing will be done on this for stroke recovery. All because we don't have survivors in charge.  But we do have an excellent quota of incompetency.

Does blood-flow restriction training work, and who can it help?

Blood-flow restriction training has almost as many applications and names as it has uses. 
Some call it occlusion training; others, hypoxic training. Bands, cuffs, and even ACE bandages have been used in attempting to utilize the benefits of the training for a number of desired outcomes.
Yet just about everyone agrees on one point – the practice is gaining popularity due to its effectiveness.
First things first: no matter what name you choose to use, let’s clarify how it works. People, for any number of reasons, may be unable to lift heavier weights or do extensive strength training for a period of time. Whether it’s an injury or another condition, blood-flow restriction training allows the patient to lift lighter weights while receiving benefits similar to people lifting heavier. 
“They can gain strength and hypertrophy without having to work at a particularly high intensity,” explained Pieter de Smidt, PT, DPT, Cert. MDT, MTC, who is the president and owner of Reset-Wellness Physical Therapy in Houston, TX. “That makes it ideal for physical therapy patients.”
De Smidt’s explanation is as follows: the accepted standard is that in order to gain strength or hypertrophy, a person must be able to lift weights that are at least 65 percent of the person’s maximum capacity for that exercise. For example, if you can lift 100 pounds, you must lift at least 65 pounds in order to see tangible benefits in added strength. 
Of course, for people coming off of recent injury or surgery, this is an impossible task. It becomes challenging for the physical therapist to allow these patients to strengthen themselves because of the reduced capacity for exercise and lifting. “I can’t make you work hard enough for the body to adapt,” explained de Smidt.
With blood-flow restriction training (BFRT), however, that same patient who is unable to lift 65 pounds while recovering or while injured can suddenly see benefits while lifting only, say, 20-25 pounds. 
How? Say you want to work your upper body. You wrap a pressure cuff or similar restrictive instrument around the upper portion of that limb, reducing the ability of blood to flow out of the working muscle. When properly performing blood-flow restriction training, blood is able to enter the muscle via arterial flow, but the veins are restricted so that blood is partially prevented from leaving the working muscle. 
“That’s the ideal scenario for repairing the tissues,” de Smidt explained. “But by lifting lighter weights, you’re not providing any mechanical stress or doing mechanical damage to your muscles. Everything you do goes toward growth.
It’s a great way to gain that strength safely, while slowly progressing toward your ability to lift those weights normally. It’s a temporary solution – you don’t need to be doing it forever, just until you’ve safely regained strength and the patient is able to lift heavier items again.”
De Smidt was originally attracted to blood-flow restriction training not only by its ability to create hypertrophy, but by the potential for utilizing the training for prevention in a passive state. “If I restrict your blood flow without anything else,” he explained, “while you’re, say, in a cast, you will not lose your muscle mass or strength if you do this training during immobilization. Otherwise, strength loss and atrophy can occur very quickly.”
Post-injury, post-surgical, post-immobilization – they’re all strong indicators for the potential benefits of blood-flow restriction training. “It works for anyone who has a reason why they’re unable to perform typical, high-intensity exercises can benefit,” said de Smidt. “But it can also be used in your athletic population.”
De Smidt outlined a pair of uses for BFRT in athletes – in-season training, when coaches and trainers are leery of players hitting the weights too hard, or use it as the finishing touch at the end of the workout to maximize the benefit of strength training. “You can reduce the mechanical stress component,” de Smidth said of the first example.

Contraindications

De Smidt cautioned against using the method with post-surgical patients before consulting with the surgeon. It’s also important to account for any cardiovascular restrictions, such as hypertension, before proceeding with blood-flow restriction training. PTs should avoid utilizing BFRT in areas with open wounds or impacted by lymphedema. ANy area with clotting risks or limbs with a dialysis port should also be avoided.

Benefits

Years ago, patients would undergo surgery for vascular necrosis of the hip. These patients were too young for a total hip replacement, so the chosen procedure would require six months non-weight bearing, It’s easy to imagine the atrophy and loss of strength that would take place over that time.
“Initially, we started those patients on a passive protocol, followed by an aerobic protocol, and finally strength training,” de Smidt recalled. “Using BFRT, we saw significant differences in the strength loss as opposed to in the past.
“That’s how I got into this – they were immobilized, they weren’t allowed to do many exercises because of that initial fragility. This allowed us, for a few weeks, to get ahead of the atrophy. Slowly, we made the patients more and more active, and it was nice to see how BFRT helped in that process.”
PTs, OTs, certified athletic trainers, and personal trainers can all benefit by utilizing BFRT similarly with their patient populations. “As long as [the professionals] know how to use it, it can be very effective.”
De Smidt cautioned that each session shouldn’t exceed 10-20 minutes, and that this strategy should not be used as a primary strength-building approach. “If you’re healthy, and able, the research shows you should be lifting heavier weights to gain strength and hypertrophy,” he urged. “Once, twice a week in a healthy person, this can provide a different kind of stimulus because you fatigue much more quickly. You can use it as the finishing touch to a regular workout.”  
BFRT is great for strength training, hypertrophy, aerobic endurance – it can be used to increase a patient’s VO2 max in a short amount of time – and can be performed actively or passively. But by using it at the beginning of a session, de Smidt says you can reduce the patient’s pain, expanding their capacity for exercise throughout the session. After injury, the patient can start day one, while post-surgical patients tend to wait 1-2 weeks before starting through a slow progression. 
Lastly, a few safety precautions: de Smidt says the gold standard is usage of a Doppler to determine lymph occlusion pressure. “Say, at 200, we have no more pulse shown, we work at about 50 percent of that. We don’t want maximum occlusion –the key is doing this safely to maximize its potential.
With several decades of research behind the method, de Smidt says BFRT should likely be used more liberally within the clinical setting, but some practitioners have concerns about safety…
If you would like to learn more from de Smidt himself, sign up for one of his seminars by following this link.

Eating one egg per day does not increase CVD risk

Oh god, researchers that are 14 years out-of-date not knowing that

WHO reclassified stroke in 2006, now a neurological disease not cardiovascular disease?

Eating one egg per day does not increase CVD risk

Drouin-Chartier JP, et al. BMJ. 2020;doi:10.1136/bmj.m513.
Odegaard AO. BMJ. 2020;doi:10.1136/bmj.m744.

March 12, 2020

Jean-Philippe Drouin-Chartier

Moderate egg consumption, defined as up to one egg per day, was not linked to CVD risk, according to a study published in The BMJ.
The study also found that moderate egg consumption may be associated with lower CVD risk in Asian patients.

See Also

• Tooth loss related to hypertension risk in postmenopausal women
• Healthy lifestyle lowers CVD risk in type 2 diabetes
• Minimal cigarette consumption still increases risk for stroke, CHD

“Our main finding that no evidence supports a higher risk of CVD associated with moderate egg consumption (up to 1 egg per day) can be easily translated into practice,” Jean-Philippe Drouin-Chartier, RD, PhD, assistant professor in the faculty of pharmacy and researcher at NUTRISS Center of INAF at Université Laval in Quebec City and visiting scientist in the department of nutrition at Harvard T.H. Chan School of Public Health, told Healio. “Still, while moderate egg consumption can be part of a healthy eating pattern, they are not essential. There is a range of other foods that can be included in a healthy breakfast, such as whole grain toasts, plain yogurt and fruits.”

Prospective cohort study
Researchers analyzed data from 83,349 women from the Nurses’ Health Study, 90,214 women from the Nurses’ Health Study II and 42,055 men from the Health Professionals’ Follow-Up Study who were free from CVD, cancer and diabetes at baseline.
Patients from all three cohorts completed questionnaires to collect information on disease risk factors, disease diagnosis, lifestyle characteristics, drug use and food frequency, which asked patients how often they consumed whole eggs in the past year.
The primary endpoint was incident CVD, defined as fatal CHD, nonfatal MI, and fatal and nonfatal stroke.
During 5,540,314 person-years of follow-up, 14,806 patients developed incident CVD. Patients with a higher egg intake were less likely to be treated with statins, had a higher BMI and had higher intakes of unprocessed red meat, calories, bacon and other unprocessed meats, whole milk, potatoes, refined grains, coffee and sugar-sweetened beverages. In 1998-1999, 1.24% of patients ate at least one egg per day, and of these patients, 0.2% consumed at least two eggs per day.
After adjusting for lifestyle and dietary characteristics linked to egg intake, consuming at least one egg per day was not associated with incident CVD risk compared with consuming less than one egg per month in a pooled multivariable analysis (HR = 0.93; 95% CI, 0.82-1.05).
An increase in egg consumption of one per day was also not linked to CVD risk in an updated meta-analysis of prospective cohort studies (RR = 0.98; 95% CI, 0.93-1.03; I² = 62.3%). Results were similar for stroke (RR = 0.99; 95% CI, 0.91-1.07; I² = 71.5%) and CHD (RR = 0.96; 95% CI, 0.91-1.03; I² = 38.2%).
When stratified by geographical location, there was no association between egg consumption and CVD risk in European cohorts (RR = 1.05; 95% CI, 0.92-1.19; I² = 64.7%) and U.S. cohorts (RR = 1.01; 95% CI, 0.96-1.06; I² = 30.8%), although there was an inverse association for Asian cohorts (RR = 0.92; 95% CI, 0.85-0.99; I² = 44.8%).

Association of moderate alcohol intake with in vivo amyloid-beta deposition in human brain: A cross-sectional study

Your doctor will never tell you about this benefit, you'll get this instead. Of course you'll have to figure out the dose needed yourself. 

Safest level of alcohol consumption is none, worldwide study shows

The latest here:

Association of moderate alcohol intake with in vivo amyloid-beta deposition in human brain: A cross-sectional study

• Jee Wook Kim,
• Min Soo Byun,
• Dahyun Yi,
• Jun Ho Lee,
• Kang Ko,
• So Yeon Jeon,
• Bo Kyung Sohn,
• Jun-Young Lee,
• Yu Kyeong Kim,
• Seong A Shin,
• Chul-Ho Sohn,
• Dong Young Lee ,
• for the KBASE Research Group

• Jee Wook Kim, 
• Min Soo Byun, 
• Dahyun Yi, 
• Jun Ho Lee, 
• Kang Ko, 
• So Yeon Jeon, 
• Bo Kyung Sohn, 
• Jun-Young Lee, 
• Yu Kyeong Kim,  …
• 
  

x

• Published: February 25, 2020
• https://doi.org/10.1371/journal.pmed.1003022

• Article
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Abstract

Background

An emerging body of literature has indicated that moderate alcohol intake may be protective against Alzheimer disease (AD) dementia. However, little information is available regarding whether moderate alcohol intake is related to reductions in amyloid-beta (Aβ) deposition, or is protective via amyloid-independent mechanisms in the living human brain. Here we examined the associations of moderate alcohol intake with in vivo AD pathologies, including cerebral Aβ deposition, neurodegeneration of AD-signature regions, and cerebral white matter hyperintensities (WMHs) in the living human brain.

Methods and findings

The present study was part of the Korean Brain Aging Study for Early Diagnosis and Prediction of Alzheimer’s Disease (KBASE), an ongoing prospective cohort study that started in 2014. As of November 2016, 414 community-dwelling individuals with neither dementia nor alcohol-related disorders (280 cognitively normal [CN] individuals and 134 individuals with mild cognitive impairment [MCI]) between 56 and 90 years of age (mean age 70.9 years ± standard deviation 7.8; male, n [%] = 180 [43.5]) were recruited from 4 sites (i.e., 2 university hospitals and 2 public centers for dementia prevention and management) around Seoul, South Korea. All the participants underwent comprehensive clinical assessments comprising lifetime and current histories of alcohol intake and multimodal brain imaging, including [¹¹C] Pittsburgh compound B positron emission tomography (PET), [¹⁸F] fluorodeoxyglucose (FDG) PET, and magnetic resonance imaging (MRI) scans. Lifetime and current alcohol intake were categorized as follows: no drinking, <1 standard drink (SD)/week, 1–13 SDs/week, and 14+ SDs/week. A moderate lifetime alcohol intake (1–13 SDs/week) was significantly associated with a lower Aβ positivity rate compared to the no drinking group, even after controlling for potential confounders (odds ratio 0.341, 95% confidence interval 0.163–0.714, p = 0.004). In contrast, current alcohol intake was not associated with amyloid deposition. Additionally, alcohol intake was not related to neurodegeneration of AD-signature regions or cerebral WMH volume. The present study had some limitations in that it had a cross-sectional design and depended on retrospective recall for alcohol drinking history.

Conclusions

In this study, we observed in middle- and old-aged individuals with neither dementia nor alcohol-related disorders that moderate lifetime alcohol intake was associated with lower cerebral Aβ deposition compared to a lifetime history of not drinking. Moderate lifetime alcohol intake may have a beneficial influence on AD by reducing pathological amyloid deposition rather than amyloid-independent neurodegeneration or cerebrovascular injury.

Author summary

Why was this study done?

• An emerging body of literature has indicated that moderate alcohol intake may be protective against Alzheimer disease (AD) dementia.
• Preclinical studies from animal and cell culture models have demonstrated that moderate alcohol intake confers protection by attenuating molecular amyloid-beta (Aβ) pathology.
• Little information is available regarding whether moderate alcohol intake is related to decreased Aβ deposition, or is protective via amyloid-independent mechanisms in the living human brain.

What did the researchers do and find?

• We performed cross-sectional analyses of the baseline data from 414 middle- and old-aged individuals with neither dementia nor alcohol-related disorders who participated in the Korean Brain Aging Study for Early Diagnosis and Prediction of Alzheimer’s Disease (KBASE), an ongoing prospective cohort study.
• All participants were systematically interviewed on current and past alcohol intake and underwent brain imaging to examine the associations of alcohol intake with various in vivo AD pathologies.
• We observed that moderate lifetime alcohol intake (i.e., 1–13 standard drinks [SDs]/week) was significantly associated with lower amyloid deposition compared to no drinking, whereas current alcohol intake did not affect amyloid deposition.
• In contrast, neither lifetime nor current alcohol intake was associated with neurodegeneration of the AD–signature cortical regions or cerebral white matter injury.

What do these findings mean?

• The present findings from middle- and old-aged individuals with neither dementia nor alcohol-related disorders suggest that moderate lifetime alcohol intake may have a beneficial influence on AD by reducing pathological amyloid deposition.
• The findings should be cautiously interpreted because the present study had a cross-sectional design and depended on retrospective recall for alcohol drinking history.

Position-Cortical Coherence as a Marker of Afferent Pathway Integrity Early Poststroke: A Prospective Cohort Study

What the fuck good does this do in getting any stroke survivor 100% recovered? Your mentors and senior researchers don't know that the only goal in stroke is 100% recovery?  They are that fucking incompetent?

Position-Cortical Coherence as a Marker of Afferent Pathway Integrity Early Poststroke: A Prospective Cohort Study 

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Sarah B. Zandvliet, MSc, Erwin E. H. van Wegen, PhD, S. Floor Campfens, PhD, ...

First Published March 4, 2020 Research Article

https://doi.org/10.1177/1545968319893289

Article information

Abstract

Background.
Addressing the role of somatosensory impairment, that is, afferent pathway integrity, in poststroke motor recovery may require neurophysiological assessment.  
Objective.
We investigated the longitudinal construct validity of position-cortical coherence (PCC), that is, the agreement between mechanically evoked wrist perturbations and electroencephalography (EEG), as a measure of afferent pathway integrity.  
Methods. PCC was measured serially in 48 patients after a first-ever ischemic stroke in addition to Fugl-Meyer motor assessment of the upper extremity (FM-UE) and Nottingham Sensory Assessment hand-finger subscores (EmNSA-HF, within 3 and at 5, 12, and 26 weeks post stroke. Changes in PCC over time, represented by percentage presence of PCC (%PCC), mean amplitude of PCC over the affected (Amp-A) and nonaffected hemisphere (Amp-N) and a lateralization index (L-index), were analyzed, as well as their association with FM-UE and EmNSA-HF. Patients were retrospectively categorized based on FM-UE score at baseline and 26 weeks post stroke into high- and low-baseline recoverers and nonrecoverers.  
Results.
%PCC increased from baseline to 12 weeks post stroke (β = 1.6%, CI = 0.32% to 2.86%, P = .01), which was no longer significant after adjusting for EmNSA-HF and FM-UE. A significant positive association was found between %PCC, Amp-A, and EmNSA-HF. Low-baseline recoverers (n = 8) showed longitudinally significantly higher %PCC than high-baseline recoverers (n = 23). Conclusions.
We demonstrated the longitudinal construct validity of %PCC and Amp-A as a measure of afferent pathway integrity. A high %PCC in low-baseline recoverers suggests that this measure also contains information on cortical excitability. Use of PCC as an EEG-based measure to address the role of somatosensory integrity to motor recovery post stroke requires further attention.