Alcohol Consumption and Risk of Ischemic Stroke

Well, I'm in the protective age range. If you don't like my cherry picking of positive research on alcohol you can quote this one, your doctor will:

Safest level of alcohol consumption is none, worldwide study shows

The latest here:

Alcohol Consumption and Risk of Ischemic Stroke

The Framingham Study

Luc Djoussé

,

R. Curtis Ellison

,

Alexa Beiser

,

Amy Scaramucci

,

Ralph B. D’Agostino

, and

Philip A. Wolf

Originally published1 Apr 2002https://doi.org/10.1161/hs0402.105245Stroke. 2002;33:907–912

• is corrected by

Abstract

Background and Purpose— Stroke is a major cause of death in the United States. The association between alcohol consumption and ischemic stroke (IS) remains controversial.
Methods— We used data collected on participants in the Framingham Study to assess the association between total alcohol intake and type of alcoholic beverage and development of IS, overall and according to age.
Results— A total of 196 men and 245 women developed IS during three 10-year follow-up periods. In the categories of never drinkers, drinkers of 0.1 to 11, 12 to 23, and ≥24 g/d of ethanol (a “typical drink” is ≈12 g of ethanol), and former drinkers of 0.1 to 11 and ≥12 g/d, crude incidence rates of IS were 6.5, 5.9, 4.9, 5.0, 6.7, and 17.8 cases per 1000 person-years, respectively, for men and 5.9, 4.1, 4.1, 4.3, 8.3, and 7.1, respectively, for women. Overall, compared with never drinkers in a multivariate Cox regression, current alcohol consumption was not related significantly to IS in either sex. Former drinking of ≥12 g/d of alcohol was associated with a 2.4 times higher risk of IS among men but not among women. When stratified by age, alcohol intake was associated with lower risk of IS among subjects aged 60 to 69 years. In beverage-specific analysis, only wine consumption was related to a decreased risk of IS.
Conclusions— Our data showed no significant association between total alcohol and IS overall but showed a protective effect of alcohol among subjects aged 60 to 69 years.

Potential benefits of music playing in stroke upper limb motor rehabilitation

And just why the fuck was this research done? You missed all this earlier research? And then you have the gall to suggest further research. 

• music (80 posts back to March 2011)

• music therapy (49 posts back to October 2014)

• musical training (13 posts back to June 2014)

 

Potential benefits of music playing in stroke upper limb motor rehabilitation

Author links open overlay panelJenniferGrau-Sánchez^ab

Thomas F.Münte^cEckartAltenmüller^dEstherDuarte^eAntoniRodríguez-Fornells^afg

https://doi.org/10.1016/j.neubiorev.2020.02.027Get rights and content

Highlights

•

Music-based interventions in stroke upper limb motor rehabilitation integrate most of the principles of motor training and multimodal stimulation.

•

The use of music in rehabilitation can improve motor and cognitive functions of subacute and chronic stroke patients.

•

Stroke patients treated with music-based interventions have better mood and quality of life than patients treated with conventional approaches.

•

Future studies should better address methodological aspects of therapy protocols, the evaluation of patients and study designs to improve the level of evidence of these interventions.

Abstract

Music-based interventions have emerged as a promising tool in stroke motor rehabilitation as they integrate most of the principles of motor training and multimodal stimulation. This paper aims to review the use of music in the rehabilitation of upper extremity motor function after stroke. First, we review the evidence supporting current music-based interventions including Music-supported Therapy, Music glove, group music therapy, Rhythm- and music-based intervention, and Musical sonification. Next, we describe the mechanisms that may be responsible for the effectiveness of these interventions, focusing on motor learning aspects, how multimodal stimulation may boost motor performance, and emotional and motivational aspects related to music. Then, we discuss methodological concerns in music therapy research related to modifications of therapy protocols, evaluation of patients and study designs. Finally, we highlight clinical considerations for the implementation of music-based interventions in clinical settings.

Mirror Therapy in Stroke Rehabilitation: Current Perspectives

We wouldn't need this repeated research if we had a complete database of stroke protocols and stroke research updated every time something new came in. But NO, our fucking failures of stroke associations can't even manage that simple task. 

Mirror Therapy in Stroke Rehabilitation: Current Perspectives

Dorcas BC Gandhi 1,2 Albert Sterba3 Himani Khatter2 Jeyaraj D Pandian2 1College of Physiotherapy, Christian Medical College & Hospital Ludhiana, Ludhiana, Punjab, India; 2Faculty of Medicine, Masaryk University, Stroke Brno, International Clinical Research Center, St. Anne´s University Hospital, Brno, Czech Republic; 3Department of Neurology, Christian Medical College & Hospital Ludhiana, Ludhiana, Punjab, India

Abstract: 

In contrast to varied therapy approaches, mirror therapy (MT) can be used even in completely plegic stroke survivors, as it uses visual stimuli for producing a desired response in the affected limb. MT has been studied to have effects not just on motor impairments but also on sensations, visuospatial neglect, and pain after stroke. This paper attempts to systematically review and present the current perspectives on mirror therapy and its application in stroke rehabilitation, and dosage, feasibility and acceptability in stroke rehabilitation. An electronic database search across Google, PubMed, Web of Science, etc., generated 3871 results. After screening them based on the inclusion and exclusion criteria, we included 28 studies in this review. The data collected were divided on the basis of application in stroke rehabilitation, modes of intervention delivery, and types of control and outcome assessment. We found that most studies intervened for upper limb motor impairments post stroke. Studies were equally distributed between intervention in chronic and acute phases post stroke with therapy durations lasting between 1 and 8 weeks. MT showed definitive motor and sensory improvements although the extent of improvements in sensory impairments and hemineglect is limited. MT proves to be an effective and feasible approach to rehabilitate post-stroke survivors in the acute, sub-acute, and chronic phases of stroke, although its long-term effects and impact on activities of daily living need to be analysed extensively.

From Their Perspective: A Qualitative Analysis of Stroke Survivor’s Motivation to Participate in Rehabilitation

You wouldn't need motivational strategies if you had EXACT STROKE PROTOCOLS LEADING TO 100% RECOVERY. That would be enough to motivate all stroke survivors even if you asked them to do 1 million reps.  You are solving a secondary problem. Damn it all, work on the primary problem, 100% recovery.

From Their Perspective: A Qualitative Analysis of Stroke Survivor’s Motivation to Participate in Rehabilitation

From Their Perspective: A Qualitative Analysis of Stroke Survivor’s Motivation to Participate in Rehabilitation

Katie Tinsley, Old Dominion UniversityFollow
Rachel Johnson, Old Dominion UniversityFollow

Description/Abstract

Introduction: It is common practice for healthcare professionals to make judgments about a patient's motivation based on their demeanor and compliance with therapy. Motivation is one of the predictors used to determine a stroke survivor's rehabilitation potential. There are several theories and constructs for motivation; however, there is limited research applying these concepts in stroke rehabilitation. Rehabilitation clinicians primarily rely on their clinical judgment and consult the evidence from related fields to identify the motivational needs of a stroke survivor. The objective of this study was to understand specific barriers to participation and identify motivational needs to sustain engagement in rehabilitation from the stroke survivor's rehabilitation experiences.
Method: This is a qualitative study involving six stroke survivors interviewed in two separate focus groups. The interview questions obtained information across seven themes: autonomy, competence, self-determination, self-efficacy, confidence, the external focus of attention, and relatedness. The interviews were videotaped, transcribed verbatim, then analyzed using a thematic approach.
Results: Preliminary analysis identified similar experiences for themes of relatedness, autonomy, confidence, self-determination, and competence. The analysis of the positive and negative experiences aligns to identify specific barriers and motivators for participation.
Discussion: The outcomes of this study identify barriers to participation and confirms the constructs of motivation important for participation in rehabilitation from a stroke survivor's perspective.

Presenting Author Name/s

Katie Tinsley

Faculty Advisor

Rachel Johnson

Presentation Type

Poster

Disciplines

Other Analytical, Diagnostic and Therapeutic Techniques and Equipment | Other Rehabilitation and Therapy | Speech Pathology and Audiology

Session Title

Poster Session

Location

Learning Commons, Atrium

Start Date

2-8-2020 8:00 AM

End Date

2-8-2020 12:30 PM

Brain injury-induced dysfunction of the blood brain barrier as a risk for dementia

 So you described a problem but offered NO SOLUTION, what the fuck good does that do?

Brain injury-induced dysfunction of the blood brain barrier as a risk for dementia

Author links open overlay panelEric E.Abrahamson^abMilos D.Ikonomovic^abc

Abstract

The blood-brain barrier (BBB) is a complex and dynamic physiological interface between brain parenchyma and cerebral vasculature. It is composed of closely interacting cells and signaling molecules that regulate movement of solutes, ions, nutrients, macromolecules, and immune cells into the brain and removal of products of normal and abnormal brain cell metabolism. Dysfunction of multiple components of the BBB occurs in aging, inflammatory diseases, traumatic brain injury (TBI, severe or mild repetitive), and in chronic degenerative dementing disorders for which aging, inflammation, and TBI are considered risk factors. BBB permeability changes after TBI result in leakage of serum proteins, influx of immune cells, perivascular inflammation, as well as impairment of efflux transporter systems and accumulation of aggregation-prone molecules involved in hallmark pathologies of neurodegenerative diseases with dementia. In addition, cerebral vascular dysfunction with persistent alterations in cerebral blood flow and neurovascular coupling contribute to brain ischemia, neuronal degeneration, and synaptic dysfunction. While the idea of TBI as a risk factor for dementia is supported by many shared pathological features, it remains a hypothesis that needs further testing in experimental models and in human studies. The current review focusses on pathological mechanisms shared between TBI and neurodegenerative disorders characterized by accumulation of pathological protein aggregates, such as Alzheimer's disease and chronic traumatic encephalopathy. We discuss critical knowledge gaps in the field that need to be explored to clarify the relationship between TBI and risk for dementia and emphasize the need for longitudinal in vivo studies using imaging and biomarkers of BBB dysfunction in people with single or multiple TBI.

10 Things Stroke Survivors Want You to Know

My number one thing is that doctors and therapists have NO CLUE on how to get you 100% recovered. So tell your family and friends that.  It is not for lack of effort. 

10 Things Stroke Survivors Want You to Know

Nurses, doctors, and therapists were really good at treating me physically after I had a stroke. However, once rehabilitation was over, it was up to me, the stroke survivor, my friends and family to come up with a new day-to-day dynamic. No one had this new script readily available — it was something we had to figure out as we went. I quickly learned open communication between the survivor and caregiver was key, and the more open the better. I have several stroke survivor friends and I asked them: if you were given the chance, what would you tell people about life after stroke? So here it is, the top 10 things survivors want you to know.

1. My brain is not the same as it was before the stroke.

Stroke affects people physically and mentally. Many stroke survivors look “normal” but are dealing with several inward struggles, such as aphasia, pseudobulbar affect and depression). Both the survivor and the caregiver can feel a loss — personalities often change and it feels like the person who was there before the stroke is gone forever. My son often refers to me as the “Old Mommy” and “New Mommy.” He had a hard time understanding that the “Old Mommy” was gone and the “New Mommy” was here to stay. Acceptance of the new person who has risen from the ashes can be a long and winding road, but acceptance of the new life needs to be reached by the survivor and caregiver before full healing can begin. When it comes right down to it, I’m still me, just different.

Related:​ 5 Things No One Tells You About Recovering From a Stroke

2. The stroke doesn’t define me.

“That’s the sisters who had strokes” or “Those are the parents whose two daughters had a stroke.” These were two phrases I often heard after my sister and I had strokes in 2011 and 2012. People didn’t know our names, but associated us with the word stroke. My sister’s name is Karen, I am Delanie, and yes we both happened to have strokes. However, that is not our whole essence.

3. I‘m disabled, not “stupid.”

People with strokes are not slower by any means, and just because it takes someone a longer time to come up with words or explain themselves, that doesn’t mean there is a deficit. We just do things differently. Right after I had a stroke, I couldn’t talk. But I heard and understood everything. I may have looked like I wasn’t understanding, but I definitely was. Even now, I get easily frustrated or confused, but it just means I’m now someone who has to take my time.

Related:​ The Big Lie 'Big Little Lies' Told About Stroke Survivors

4. Please encourage me to move.

It is very easy to come home after rehab and just want to stop. There are no therapists telling you what to do and people making decisions for you, which is a relief at first. But it’s so easy to fall into a slump. For the first year, I sat on the couch and watched TV while 100 pounds quickly added up. I was definitely more sedentary than I used to be, but I was depressed and had no drive. My husband was the one to encourage me to get off my butt and get moving. It’s OK to have rest days or to stop when tired, but don’t ever give up on anyone. Keep prodding!

5. My fatigue is real.

Many stroke survivors sleep a lot. And I mean a lot. I’m eight years out and still need a nap most days. Sleep helps us function and without it, you’ll see us trip, slur our words and be in bad moods. If we’re physically or emotionally drained, let us rest. When we say we’ve had enough for the day, we’re done. We know our bodies and what we can handle.

Related:​ Why Laughter Was the Best Medicine After My Stroke

6. My emotions may be all over the place.

Depression, anxiety and pseudobulbar affect are just some of the emotional issues I faced. I would be happy one minute and literally crying the next. My family could never keep up with what mood I was in. Know that I don’t choose to be this way. This is an effect of the stroke and how my brain chooses to behave. I’m handling it the best I can and would change it if I could.

7. I may move slowly, but eventually, I’ll reach my destination.

I’ve often referred to stroke recovery as being reborn. I had to relearn to walk, talk, swallow — all things that were innate and luckily I learned again, but I stood shakily on my two legs, said Mama, and drooled in the beginning. Many of us survivors use wheelchairs, walkers and canes. I push the grocery cart slower than others and hear the lady huffing behind me because I don’t walk fast enough. Just as one would have to be patient with a child, be patient with me. I’m trying.

8. Not all strokes are the same.

Ischemic vs. hemorrhagic. Brain stem vs. cerebellum. Young adult vs. senior. Strokes, like people, are different. Where it took place in the brain, the age of the person, how fast they got to the hospital — these are all factors in how strokes can affect someone. My sister and I both had strokes. She lost the use of her left arm while I was left with mostly emotional issues. So please don’t assume all people who have strokes are the same.

9. Strokes affect survivors and the people we‘re close to.

Life after stroke is new for everyone involved. Stroke survivors and caregivers need to be patient with each other and themselves. There are books out there on this topic, but until you actually are in the situation, it is hard to understand. Both sides will have bad days. Just get up tomorrow and do it all over again.

10. We’ll probably be recovering for the rest of our lives.

Many stroke survivors make a full recovery and regain everything the stroke took from them. Some start to make small advances after years of recovery. There are those that are locked in for the rest of their lives. Stroke survivors are resilient and as long as there are advancements to be had, we will work hard to make them.

I’m sure there is more, but these were the ones most mentioned. Stroke survivors and caregivers need to try not to compare one person’s recovery to another’s. We’re all going to get where we need to be when we need to get there.

Increasing Tenecteplase Dose Does Not Improve Reperfusion in Ischaemic Stroke

But you had the wrong endpoint. Survivors care nothing about reperfusion, they want 100% recovery. WHEN THE HELL will you design research correctly to deliver that?  This is why we need survivors in charge, they will not take their eyes off the only goal in stroke, 100% recovery.

Increasing Tenecteplase Dose Does Not Improve Reperfusion in Ischaemic Stroke

By Alex Morrisson

LOS ANGELES -- February 24, 2020 -- Increasing the dose of tenecteplase prior to endovascular thrombectomy does not improve reperfusion or clinical outcomes in patients with stroke, according to a study presented here at the 2020 International Stroke Conference (ISC).

In the EXTEND 1A TNK Part 2 study, Bruce Campbell, PhD, Royal Melbourne Hospital, and the University of Melbourne, Melbourne, Australia, and colleagues enrolled 300 patients who were diagnosed with ischaemic large vessel strokes and randomised half to receive tenecteplase 0.25 mg/kg and the other half to tenecteplase 0.40 mg/kg.

Only 29 patients in each group achieved the primary endpoint, which of a >50% improvement in reperfusion of blocked brain blood vessels (P = .89).

“The findings suggest that the 0.40 mg/kg dose of tenecteplase does not confer an advantage over the 0.25 mg/kg dose in patients with large vessel occlusion ischaemic stroke in whom endovascular thrombectomy is planned,” said Dr. Campbell.

The EXTEND-IA TNK Part 2 trial was an investigator-initiated, multicentre, randomised, open-label blinded trial in patients with ischaemic stroke due to large vessel occlusion of the intracranial internal carotid, middle cerebral, or basilar artery who were eligible for intravenous thrombolysis and endovascular thrombectomy within 4.5 hours of stroke onset.

Secondary outcomes, including modified Rankin Scale score at 90 days and early neurological recovery, did not differ significantly between groups. The adjusted odds ratio in ordinal analysis of the modified Rankin Scale score at 90 days was 0.96. Symptomatic intracranial haemorrhage occurred in 7 patients (4.7%) in the 0.40 mg/kg group, 4 of which were associated with wire perforation during the endovascular procedure, and 2 patients (1.3%) in the 0.25 mg/kg group (P = .12). There were 26 deaths in the 0.40 mg/kg group and 22 in the 0.25 mg/kg group (P = .35).

“That the optimal tenecteplase dose for patients with ischaemic stroke appears to be 0.25 mg/kg,” said Dr. Campbell.

ISC is sponsored by the American Heart Association and the American Stroke Association.

[Presentation title: Abstract LB1: Determining the Optimal Dose of Tenecteplase Before Endovascular Thrombectomy (EXTEND-IA TNK Part 2): a Multicenter, Randomized, Controlled Trial. Abstract LB1]

Year-Long Study Shows Brain Stenting Has Long-Term Effectiveness

I don't think a 8.5% stroke and death rate is effective. What would you do if your doctor said you have an 8.5% chance of dying or having another stroke from the stent procedure and 2.6% in the first days? 

Don't listen to me, I'm not medically trained and I don't have a Dr. in front of my name.

But I'd rather my doctor told me how much watermelon juice to drink.

Watermelon juice reverses hardening of the arteries  Nov. 2011

 

 The latest here:

Year-Long Study Shows Brain Stenting Has Long-Term Effectiveness

By Alex Morrisson

LOS ANGELES -- February 24, 2020 -- A long-term follow-up study appears to indicate that the Wingspan brain stent -- aimed at preventing recurrent strokes -- is safe and effective when used on-label, according to a study presented here at the 2020 International Stroke Conference (ISC).

Patients who received the Wingspan stent for intracranial atherosclerotic disease experienced a 1-year stroke and death rate of 8.5%.
“This trial is unique because prior studies included off-label patients,” said Michael J. Alexander, MD, Cedars-Sinai Medical Center, Los Angeles, California. “This is the largest intracranial stent trial for atherosclerotic disease performed according to the FDA [US Food and Drug Administration] indication for the Wingspan stent. The stroke and death rates were substantially lower than the 1-year rate of 20% in the stenting arm of the SAMMPRIS trial and slightly better than the 12.2% stroke and death rate in the medical arm of SAMMPRIS.”

The Stenting and Aggressive Medical Management for the Prevention of Recurrent Ischemic Stroke (SAMMPRIS) was a large multicentre study comparing the 2 methods of stroke prevention. In the follow-up study, the Wingspan One-year Vascular Imaging, Events and Neurologic Outcomes (WOVEN) study showed a low 2.6% stroke and death rate within the first few days of the procedure in patients who received the Wingspan stent.(Not low enough.)

A third study -- WEAVE -- was mandated by the FDA to assess the periprocedural safety of the Wingspan Stent system in the treatment of symptomatic intracranial atherosclerotic disease. It was conducted at 16 US centres and followed 152 patients. Enrolling sites performed chart and image reviews of patients who were stented with Wingspan under its strict on-label usage. Data of subsequent strokes and deaths were collected with respect to time from stenting and medications at the time of the index event. Follow-up imaging was assessed for incidence and severity of in-stent stenosis and the follow-up management of these patients.

At 1-year, the stroke and death rate was 8.5% for patients who received the Wingspan stent.

“The long-term results are important to determine if safer stenting practices and lower complication rates from the treatment itself resulted in improved patient outcomes at 1 year,” said Dr. Alexander. “Intracranial stenting could provide an alternative when medical therapy and other treatments have been unsuccessful.”

The patients in the trials were treated with Wingspan if it was determined that their ischaemic stroke was caused by a blockage of 70% to 99% of an intracranial artery.

ISC is sponsored by the American Heart Association and the American Stroke Association.

[Presentation title: The Woven Study: Wingspan One-Year Vascular Imaging, Events, and Neurologic Outcomes. Abstract LB4]

Treatment With Tranexamic Acid Shows Limited Effectiveness in Stopping Brain Bleeds

Your doctors need to be following this closely to see what the requirements are for use in the properly selected patients. 

Treatment With Tranexamic Acid Shows Limited Effectiveness in Stopping Brain Bleeds

By Alex Morrisson

LOS ANGELES -- February 24, 2020 -- Patients with stroke who are identified as having intracerebral haemorrhage (ICH) may be helped by treatment with tranexamic acid, according to a study presented here at the 2020 International Stroke Conference (ISC).

While there were differences in outcomes that favoured treatment with tranexamic acid, the low number of patients in the study prevented the trial from having statistically significant results, said Nawaf Yassi, PhD, Royal Melbourne Hospital, Melbourne, Australia.

In the phase 2 Spot Sign and Tranexamic Acid on Preventing ICH Growth - Australasia Trial (STOP-AUST), Dr. Yassi and colleagues randomised 100 patients who demonstrated the CT angiography spot sign 1:1 to receive 2 g tranexamic acid (1 g over 10 minutes followed by 1 g over 8 hours) or matching placebo within 4.5 hours of stroke onset.

The researchers found that ICH growth >33% or >6 mL above baseline volume occurred in 44% of patients taking tranexamic acid versus 52% of those taking placebo (adjusted odds ratio [aOR] = 0.72; 95% confidence interval [CI], 0.32-1.59; P = .41).

Median absolute haematoma growth was 1.9 mL in patients who took tranexamic acid versus 3.4 mL those who took placebo (adjusted median difference = -1.8 mL; 95% CI, -5.2 to 1.5; P = .28).

The study showed a trend towards reduced presence of haematoma growth in the prespecified subgroup treated ≤3 hours from stroke onset (aOR = 0.41; 95% CI, 0.15-1.12; n = 66), but not in treated those 3 to 4.5 hours from stroke onset (aOR = 2.45; 95% CI, 0.52-11.57; P = .06.) This was supported by a post hoc analysis of those treated ≤2 hours from stroke onset (aOR = 0.19; 95% CI, 0.03-1.15; P = .07; n = 27).

After 90 days, about 56% of the patients who received tranexamic acid and about 46% of those who received placebo had either returned to their baseline modified Rankin Scale status or had a score between 0 and 2, indicating minimal deficits from their stroke.

Major adverse events such as thromboembolism or death were not statistically significantly different between the groups. There was 1 thromboembolic event in a patient who received tranexamic acid compared with 2 events in the placebo group. Among patients who took tranexamic acid, there were 13 deaths compared with 8 deaths among patients who took placebo.
“Further trials using tranexamic acid are ongoing and [are] focusing on ultra-early treatment -- within 2 hours,” said Dr. Yassi. “This is where the greatest opportunity for intervention appears to be.”

“Tranexamic acid is inexpensive, safe, and widely available,” he concluded. “Our results and others provide great impetus for further, focused research using this treatment.”

ISC is sponsored by the American Heart Association and the American Stroke Association.

[Presentation title: The Spot Sign and Tranexamic Acid on Preventing ICH Growth - Australasia Trial (STOP-AUST): A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial. Abstract LB20]

Cilostazol Helps Prevent Carotid In-Stent Restenosis

I would think this whole problem could be eliminated by:

1. Determining if the Circle of Willis is complete.

2. If yes, then close the artery off to prevent ANY POSSIBILITY of clots breaking off and traveling to the brain.

3. This prevents stent placement complications per European Society of Cardiology

A - Minor complications

• Carotid artery spasm
• Sustained hypotension / bradycardia
• Carotid artery dissection
• Contrast encephalopathy (very rare)
• Minor embolic neurological events (TIAs)

B - Major complications

• Major embolic stroke
• Intracranial hemorrhage
• Hyperperfusion syndrome
• Carotid perforation (very rare)
• Acute stent thrombosis (very rare)
• Complications at the site of the vascular access

Don't listen to me, I'm not medically trained and I don't have a Dr. in front of my name.  But pepper your doctor with lots of questions, including GUARANTEEING NO PROBLEMS. Why would you want to place an inflexible stent in a flexible artery? Hell, my right carotid artery was 80% blocked at time of stroke which my doctors never found so luckily they didn't try to stent me. It eventually completely closed on its own with absolutely no cognitive problems encountered.

 

Cilostazol Helps Prevent Carotid In-Stent Restenosis

By Alex Morrisson

LOS ANGELES -- February 25, 2020 -- Patients undergoing carotid artery stenting to prevent recurrence of stroke who receive cilostazol tend to have a lower incidence of in-stent restenosis after 2 years, according to a study presented here at the 2020 International Stroke Conference (ISC).

In the Carotid Artery Stenting with Cilostazol Addition for Restenosis (CAS-CARE) study, Hiroshi Yamagami, MD, Osaka National Hospital, Osaka, Japan, and colleagues analysed 631 patients aged 45 to 80 years with symptomatic (≥50%) or asymptomatic (≥80%) carotid artery stenosis who were scheduled for carotid artery stenting within 30 days of enrolment. The patients were randomised 1:1 to receive cilostazol (50 mg or 100 mg twice daily) or any antiplatelet agents other than cilostazol, from 3 days before carotid artery stenosis and continued for 2 years.

The study found that in-stent restenosis occurred in 10.8% of patients receiving cilostazol and in 19.6% of patients who did not receive cilostazol -- a 36% reduction in the risk of in-stent restenosis that approached statistical significance (P = .056).

In secondary endpoints, occurrences of cardiovascular events or death from any cause and bleeding events were similar between the groups (5.8% vs 6.2% and 1.1% vs 0.3%, respectively).

Dr. Yamagami suggested that the study may have failed to reach significance because the trial recruited just 79% of its planned enrolment.

“This is the first trial to show potential effectiveness of medical management for the prevention of in-stent restenosis after carotid artery stenting,” he concluded.

ISC is sponsored by the American Heart Association and the American Stroke Association.

[Presentation title: Cilostazol Versus Other Antiplatelet Drugs for the In-Stent Restenosis After Carotid Artery Stenting: The Carotid Artery Stenting With Cilostazol Addition for Restenosis (CAS-CARE) Trial. Abstract LB21]

Kessler researchers test trunk-strengthening program for hemiplegia post stroke

Do you really think your hospital is going to buy this expensive equipment? Your doctor needs to have stroke protocols that deliver trunk strengthening without this high tech piece of equipment. At least if your doctor is competent. 

Kessler researchers test trunk-strengthening program for hemiplegia post stroke 

Rakesh Pilkar, Ph.D., will conduct a pilot study of the AllCore360º device for improving core strength, posture and balance in individuals with hemiplegia following chronic stroke

Kessler Foundation

IMAGE: Dr. Pilkar monitors a demo of the ALLCore360, the electromechanical device being tested for stroke rehabilitation at Kessler Foundation. view more 

Credit: Kessler Foundation/Carolann Murphy

East Hanover, NJ. February 26, 2020. Researchers at Kessler Foundation are studying a potential application of a trunk-strengthening program to improve posture, balance, and mobility in individuals recovering from stroke. They will test the feasibility of using an electromechanical device called the AllCore360º Core Therapy and Training System in the rehabilitation of stroke survivors with hemiplegia. Rakesh Pilkar, PhD, research scientist in the Center for Mobility and Rehabilitation Engineering Research, is the principal investigator for the study, titled, "A novel trunk-strengthening program for improving posture and balance for individuals with hemiplegia post stroke," which is supported by AllCore360º (Alpharetta, GA) and Kessler Foundation.
The impact of weakness of trunk muscles after stroke is substantial. Adverse effects on posture and balance impair the performance of activities of daily living, impede recovery, and limit independence. Poor trunk control is associated with longer hospital stays, increased risk for falls, and poorer function at discharge. "Despite evidence for the importance of trunk control to functional outcomes in this population, there is a lack of a standardized approach to trunk strengthening in stroke rehabilitation," said Dr. Pilkar, "and little information on the application of electromechanical devices for this type of therapy.(Don't allow this lack be the excuse your doctor uses for doing nothing on protocols for this.) This pilot study enables us to test a trunk-strengthening protocol using the AllCore360º in individuals with hemiplegia, examine the underlying neuromuscular mechanisms, and measure the effects on posture, balance, and walking ability," he explained. "If preliminary findings are promising, further studies of this protocol may be warranted."
The AllCore360º is an adjustable system that leverages gravity to engage all trunk muscles in a 10-minute session. While seated in the AllCore360º, the person uses isometric contraction of their trunk muscles to hold their position while the device rotates clockwise, then counterclockwise, at different angles and positions.
Participants will be recruited from the stroke rehabilitation program at Kessler Institute for Rehabilitation. All participants (10 in stroke group and 10 controls) will undergo baseline and follow-up assessments of trunk function, balance, posture, and ambulation. The stroke group will undergo the 4-week trunk-strengthening program, including neuromuscular assessment using electromyography.
"We are pleased to partner with the Kessler Foundation on this pilot study aimed at expanding options for stroke rehabilitation," said Scott Bertrand, DC, founder and inventor of AllCore360º. "Having witnessed the benefits of core strengthening in people seeking to improve their health and fitness, we are optimistic that the Kessler team will see improved outcomes in individuals recovering from stroke."

###

About AllCore360º
The Patented AllCore360° Rehabilitation Core Training System allows patients, seniors, athletes and everyday people, to balance and strengthen the more than 50 muscles that comprise the core in an innovative efficient way. In multiple facilities throughout the United States, therapists and leading edge trainers utilize the System to promote faster recovery, improve fitness, and enhance physical performance. The AllCore360° harnesses the forces of gravity to challenge all of the body's core muscles in a no impact, coordinated, isometric fashion designed to improve athletic or daily performance regardless of ability. For more information, please visit http://www.AllCore360.com.

Hand Extension Robot Orthosis (HERO) Grip Glove: enabling independence amongst persons with severe hand impairments after stroke

I can't even find a picture of these to determine if spastic fingers would be able to get in them without three therapists manipulating the fingers.

Hand Extension Robot Orthosis (HERO) Grip Glove: enabling independence amongst persons with severe hand impairments after stroke

• Aaron Yurkewich,
• Illya J. Kozak,
• Debbie Hebert,
• Rosalie H. Wang &
• Alex Mihailidis 

Journal of NeuroEngineering and Rehabilitation volume 17, Article number: 33 (2020) Cite this article

Abstract

Background

The Hand Extension Robot Orthosis (HERO) Grip Glove was iteratively designed to meet requests from therapists and persons after a stroke who have severe hand impairment to create a device that extends all five fingers, enhances grip strength and is portable, lightweight, easy to put on, comfortable and affordable.

Methods

Eleven persons who have minimal or no active finger extension (Chedoke McMaster Stage of Hand 1–4) post-stroke were recruited to evaluate how well they could perform activities of daily living and finger function assessments with and without wearing the HERO Grip Glove.

Results

The 11 participants showed statistically significant improvements (p < 0.01), while wearing the HERO Grip Glove, in the water bottle grasp and manipulation task (increase of 2.3 points, SD 1.2, scored using the Chedoke Hand and Arm Inventory scale from 1 to 7) and in index finger extension (increase of 147^o, SD 44) and range of motion (increase of 145^o, SD 36). The HERO Grip Glove provided 12.7 N (SD 8.9 N) of grip force and 11.0 N (SD 4.8) of pinch force to their affected hands, which enabled those without grip strength to grasp and manipulate blocks, a fork and a water bottle, as well as write with a pen. The participants were ‘more or less satisfied’ with the HERO Grip Glove as an assistive device (average of 3.3 out of 5 on the Quebec User Evaluation of Satisfaction with Assistive Technology 2.0 Scale). The highest satisfaction scores were given for safety and security (4.6) and ease of use (3.8) and the lowest satisfaction scores were given for ease of donning (2.3), which required under 5 min with assistance(This is not good, you have to be able to put it on yourself. That is the reason I quit using the Saeboflex splint.). The most common requests were for greater grip strength and a smaller glove size for small hands.

Conclusions

The HERO Grip Glove is a safe and effective tool for enabling persons with a stroke that have severe hand impairment to incorporate their affected hand into activities of daily living, which may motivate greater use of the affected upper extremity in daily life to stimulate neuromuscular recovery.

 

Marijuana use spikes among women over 65, study says

It would probably be even higher if our doctors were to prescribe marijuana for stroke. 

My 13 reasons for marijuana use post-stroke.  

Don't follow me, I'm not medically trained. Is your doctor?

I don't have a Dr. in front of my name.

 

Marijuana use spikes among women over 65, study says

In the midst of a vaping crisis that has largely been traced to THC-containing products, much of the discussion around marijuana has centered on young adults. But a new study in the Journal of American Medicine this week suggests high usage among another demographic: seniors.

Conducted by researchers at New York University’s Grossman School of Medicine, the study found that the past-year use of cannabis among those 65 and older had increased from 2.4 percent to 4.2 percent from 2015 to 2018 — a 75 percent increase over the course of three years. The number follows a major spike in use among seniors in the last decade, up from just 0.7 percent reporting yearly use of marijuana in 2006.

A new study has shown a spike in marijuana use among seniors in the last decade — specifically elderly women and those who are married. (Photo: Getty Images)

Data for the study came from the National Survey on Drug Use and Health, a nationwide survey that’s conducted yearly by the National Institutes of Health in all 50 states. The survey allowed researchers to zero in on certain subgroups in the category of those who shared their recent marijuana use. Particular increases appeared among women, married individuals, the college-educated, and those who drink alcohol.

While the increase among women over 65 may seem surprising, senior author Joseph Palamar, PhD, an associate professor of population health and NYU Grossman School of Medicine, says it’s likely more about the increasing destigmatization of marijuana use that’s driving up use. “Women 'catching up' to men may further signify normalization of use,” Palamar tells Yahoo Lifestyle. “However, men are still almost twice as likely to use than women.”

On top of those subgroups, researchers also found use to have more than doubled among patients with diabetes, which over 100 million Americans live with today. Recent studies have shown that cannabis has therapeutic potential for the difficult-to-treat condition, specifically due to its anti-inflammatory properties. It’s just one of many potential medical benefits of the drug that has emerged. Other conditions for which marijuana has proved beneficial include chronic pain, multiple sclerosis, wasting syndrome and epilepsy.

Lead author Benjamin Han, MD, assistant professor of geriatric medicine and palliative care at NYU Grossman School of Medicine, has a theory for why the researchers saw a spike in marijuana use among those with diabetes. “I suspect [it] may be related to [nerve damage],” Han tells Yahoo Lifestyle. “There is some consistent evidence that cannabis is of benefit for patients with neuropathy, and therefore could explain the increase in its use by people with diabetes. However, we are unable to tell from our study if this is the case.”

Han is also quick to note that while the drug likely has benefits, it’s not necessarily harmless for this age group. Iowa University researchers are currently exploring the potential for marijuana to put seniors more at risk of falling, for example — but there may also be other things to consider. “Certainly, with any drug with psychoactive properties, I worry about dizziness and falls, as well as cognitive changes over time for older adults,” Han tells Yahoo Lifestyle. “In addition, more study is needed to better understand if there is an association of lung disease or heart disease with smoking cannabis. Finally, for people of all ages cannabis use can be habit-forming over time and lead to cannabis-use disorder.”

In an interview with MedicalResearch.com, Han said it’s important to take these risks into account, as seniors may be “more vulnerable” to the harms of cannabis. But it may be equally important to weigh the fact that seniors are likely to “benefit most from its use due to their higher burden of chronic medical disease.” Overall, he says much more research is needed to determine whether it’s a safe solution.

As experts continue to explore this, doctors who treat the elderly — like Caroline S. Blaum, MD, director of the division of geriatric medicine and palliative care at NYU — say that the revelation is crucial to offering the best care. “This study gives us important insights into cannabis use among key groups of older adults, particularly baby boomers,” Blaum said in a statement. “Understanding how our older patients use marijuana and evaluating the potential effects is one of the most important questions our field must answer.”

Effects of Dynamic Stepping Training on Nonlocomotor Tasks in Individuals Poststroke: A Clinical Trial

But with nothing written in protocol format this is useless. 

Effects of Dynamic Stepping Training on Nonlocomotor Tasks in Individuals Poststroke: A Clinical Trial

 Don D. Straube, Carey L. Holleran, Catherine R. Kinnaird, Abigail L. Leddy,Patrick W. Hennessy, T. George Hornby
Background.
 During the physical rehabilitation of individuals post stroke, therapists are challenged to provide sufficient amounts of task specific practice in order to maximize outcomes of multiple functional skills within limited visits. Basic and applied studies have suggested that training of one motor task may affect performance of biomechanically separate tasks that utilize overlapping neural circuits.However, few studies have explicitly investigated the impact of training one func-tional task on separate, nonpracticed tasks.
Objective.
 The purpose of this preliminary study was to investigate the potential gains in specific non locomotor assessments in individuals post stroke following only stepping training of variable, challenging tasks at high aerobic intensities.
Methods.
 Individuals with locomotor deficits following subacute and chronic stroke (n=22) completed a locomotor training paradigm using a repeated measures design. Practice of multiple stepping tasks was provided in variable environments or contexts at high aerobic intensities for >=40 sessions over 10 weeks. The primary outcome was timed Five-Times Sit-to-Stand Test (5XSTS) performance, with secondary measures of sit-to-stand kinematics and kinetics, clinical assessment of balance,and isometric lower limb strength.
Results.
 Participants improved their timed 5XSTS performance following stepping training, with changes in selected biomechanical measures. Statistical and clinically meaningful improvements in balance were observed, with more modest changes in paretic leg strength.
Conclusions.
 The present data suggest that significant gains in selected non locomotor tasks can be achieved with high-intensity, variable stepping training.Improvements in non practiced tasks may minimize the need to practice multiple tasks within and across treatment sessions.
 

Only 10% of stroke patients that survive fully recover; What the hell is your stroke hospital doing to change that for the better?

If nothing then I suggest firings start at the top with the board of directors. 

Oops, once again Dean you are suggesting you know more than the stroke world. It is only arrogance if you don't know what you are talking about, I know what I'm talking about, fully referenced. 

Flint Rehab while wonderful pooh poohs the 10% full recovery statistic.

This begs the question, exactly how close can you or your loved one get to a full recovery?
The American Stroke Association states that 10% of stroke survivors recover almost completely and 25% recover with minor impairments.
The stroke rehabilitation field is rapidly advancing, though. With better rehabilitation facilities and home therapy tools, patients can often recover more function than they could in previous decades.
Try not to feel discouraged by a 10% chance of a full recovery from stroke. While it’s the only widely accepted statistic, it was produced at an unknown date through unknown survey criteria.
Focusing on the statistics can deplete your hope, and hope is a valuable, essential resource during stroke recovery.
Instead, shift your focus on what you can control. There are many steps you can take to maximize your chances of a full recovery and get yourself into that supposed 10%.

IH treatment for strokes world class, board hears

How the hell can it be world class if you give us no data on your 100% recovery statistics? Comparing it to the failures of all other stroke hospitals is not valid. 

IH treatment for strokes world class, board hears

    Steve MacNaull Feb 25, 2020 Updated 13 hrs ago



Interior Health Stroke Network

Dr. Aleksander Tkach, left, a vascular neurologist and medical director of stroke services at Kelowna General Hospital, and stroke services director Cory Bendall gave an update on the Interior Health Stroke Network at the Interior Health board meeting Tuesday in Kelowna.
Steve MacNaull



Interior Health is becoming a world leader in stroke treatment.

“We’re more co-ordinated and efficient than hospitals in Vancouver,” said Dr. Aleksander Tkach, medical director of stroke services at Kelowna General Hospital.

“Better and faster is paramount in treatment of a stroke, and the Interior Health Stroke Network is better and faster.”

Tkach, a vascular neurologist, and stroke services director Cory Bendall gave an update on the stroke network at Tuesday’s Interior Health board of directors meeting in Kelowna.

While the network has been around since 2009, it was standardized in 2019 and has really come together this year as a specialized system of care.

About 2,000 people a year have a stroke in the Interior Health region, which spans the entire Southern Interior of the province and has a population of 750,000.

When a 911 call comes in to pick up a stroke victim, an entire chain of care is activated.

An ambulance arrives as quickly as possible and rushes the patient to the hospital, where he or she is met by a stroke team and a CT (computed tomography) scan of the brain is done.

A stroke is caused by a lack of blood flow to the brain.

Seventy per cent of strokes will be ischemic, which means there’s a blood clot in the brain, and 30% will be hemorrhagic, meaning there’s a bleed in the brain.

With ischemic strokes, about 20% can be treated immediately with a tissue plasminogen activator (TPA) clot-busting drug given intravenously.(But what are your 100% recovery results? Don't know? )

For the first time available now at Kelowna General Hospital, another 20% of ischemic stroke patients, the most severe cases, can be given an endovascular thrombectomy.

A thrombectomy sees blood vessels blocked with the most stubborn clots opened mechanically by an interventional radiologist inserting a three-millimetre plastic tube to either vacuum out the clot or break it up using saline jets or ultrasound waves.

Either of these treatments done within an hour of onset of the stroke means blood flow to the brain is restored and a patient can make a full recovery in three months.(How many make that full recovery?)

“That’s why we call it the golden hour,” said Tkach.

“Acting quickly in a co-ordinated manner is of the utmost importance for good outcomes.”

While treatment in the first hour is best, there can still be drug and thrombectomy treatment for up to 24 hours from stroke onset.

However, damage done and amount of recovery will vary.

“Most people don’t die of strokes, but they are a big deal,” said Tkach.

“Stroke is the No. 1 cause of disability.”

Because a stroke can obliterate up to 1.9 million brain cells a minute, if not treated immediately it can cause long-lasting and permanent disability such as paralysis, pain, problems with thinking and memory, emotional disturbances, and problems with speech and understanding speech.

There are nine so called stroke-enabled hospitals in the Interior Health region: Kelowna General, Royal Inland in Kamloops, Vernon Jubilee, Penticton Regional, Cariboo in Williams Lake, Shuswap Lake General in Salmon Arm, East Kootenay Regional in Cranbrook, Kootenay Lake in Nelson and Kootenay Boundary Regional in Trail.

Of course, the best way to not have to deal with the consequences of a stroke is to not have one in the first place.

That’s why the Interior Health Stroke Network also advocates prevention, because up to 80% of strokes can be avoided with a healthy lifestyle of eating right, exercising, maintaining an ideal weight, not smoking, keeping stress low and not abusing alcohol or drugs.

The network also includes provisions for rehabilitation after a stroke, research and telehealth, so patients in remote areas can be seen via teleconferencing.

Research is key to curbing stroke

But only if you have a strategy being followed. If researchers are allowed to willy-nilly choose research on stroke, NOTHING WILL BE ACCOMPLISHED.  So YOU need to educate Ms. McGowan on that.  I'd suggest solving the 5 causes of the neuronal cascade of death in the first week. Or figure out how to make neuroplasticity EXACTLY REPEATABLE.

 

Research is key to curbing stroke

Sharon McGowan, Chief Executive Officer of the Australian Stroke Foundation, argues that research is key to curbing stroke

Stroke is one of Australia’s biggest killers and a leading cause of disability. It is a devastating disease that strikes the brain, the most complex organ in our bodies, responsible for our movement, thoughts and feelings.
Too many Australian lives are impacted by stroke when we know it can be prevented, treated and beaten. This year there will be more than 56,000 strokes in Australia – that’s one every nine minutes. That number continues to increase as our population grows and ages and lifestyles become more sedentary. Globally, one in four people will have a stroke in their lifetime.

The role of research

Curbing the rate and devastation caused by stroke is an enormous challenge both in Australia and around the world. Medical research is a key component, along with educating the community about stroke prevention.
Recently, the Australian Government announced it is investing $437 million in health and medical research. This included $58 million for cardiovascular disease (stroke and heart disease) research. The funding package builds on a previously announced $220 million Mission for Cardiovascular Health.
It is encouraging to see support from the Australian Government for high-quality research. There is still so much we do not know about the brain and investment is crucial for future breakthroughs in diagnosis, treatment and care.
The true value of research is evident in the significant advances in time-critical acute stroke treatments in the past two decades. This has led to a reduction in the number of lives lost to stroke and a greater number of patients return to independent living.
But we must not stop now, more funding is needed to make further developments a reality. With more people surviving stroke than ever before, we must now find the keys to maximise their recovery, to provide them with the best chance to live long and productive lives.
We know the transition from hospital to home can be challenging. Research in rehabilitation and mental health are important to improve the quality of life in the long term. People with stroke deserve effective treatments underpinned by an evolving understanding of brain recovery and human behaviour.

Stroke Foundation Research and Innovation Program

Research is a core part of our organisation’s mission to prevent stroke, save lives and enhance recovery. Since 2008, almost $5 million in research grants has been awarded to more than 200 researchers.
Historically, our seed grants are awarded to early to mid-career researchers (www.strokefoundation.org.au) for pilot or feasibility studies. This enables researchers to take their first step towards an idea which could provide the next big discovery in stroke. Seed funding the research pipeline is an essential role of funders such as the Stroke Foundation. Our close connection with the stroke community enables us to focus on supporting the research that matters most to those impacted by stroke.
Building capability in the stroke research community is the first link in the chain of discovery and can pave the way for future change in policy, practice and knowledge. It also encourages individuals to enter and stay in the research field.
In awarding the grants, we identify current gaps in research, where it is most needed and where studies can potentially have the biggest impact. A priority in the 2020 grant round was innovation to support the diverse needs of carers, recognising that the impact of stroke is widespread and life-changing for loved ones too.

Stroke researchers look to the skies for the latest breakthrough

Australia has unique needs in stroke research due to its large land mass, dispersed community and indigenous population. In an exciting project currently underway, Australia could become home to the world’s first stroke air ambulance.
Stroke Foundation is part of the Australian Stroke Alliance (ASA), an alliance between 37 research, industry and government entities that wish to develop a suite of World First portable imaging technologies that will radically transform access to early prehospital treatments, and dramatically improve stroke outcomes across Australia.
The ASA was successful in being awarded $1 million in Stage 1 funding from the Commonwealth of Australia under the Medical Research Future Fund – Frontier Health and Medical Research Program (MRFF) to develop a Research Plan for the project, which will form the basis for a MRFF Stage 2 submission which aims to deliver modern prehospital stroke care to Indigenous, rural and metropolitan Australians, including the world’s first stroke capable air ambulance.
This has the potential to transform access to emergency stroke treatment for patients in rural and remote areas and give them the best chance of survival. Sadly, people outside of Australia’s cities are 19% more likely to have a stroke and are also more likely to have a poorer outcome due to their distance to lifesaving, time-critical medical treatments.

Conclusion

Research has the power to save lives, prevent disability and ultimately reduce the burden of stroke on our community. It is more important now than ever as the incidence of stroke grows. By 2050, it is estimated there will be one stroke every four minutes in Australia and one million stroke survivors will be living in our communities unless action is taken.
We know research takes time and perseverance and a great deal of funding, but the outcomes provide hope and can make a difference to the lives of stroke survivors and their loved ones for generations to come.