Use the labels in the right column to find what you want. Or you can go thru them one by one, there are only 33,056 posts. Searching is done in the search box in upper left corner. I blog on anything to do with stroke. DO NOT DO ANYTHING SUGGESTED HERE AS I AM NOT MEDICALLY TRAINED, YOUR DOCTOR IS, LISTEN TO THEM. BUT I BET THEY DON'T KNOW HOW TO GET YOU 100% RECOVERED. I DON'T EITHER BUT HAVE PLENTY OF QUESTIONS FOR YOUR DOCTOR TO ANSWER.
Changing stroke rehab and research worldwide now.Time is Brain!trillions and trillions of neuronsthatDIEeach day because there areNOeffective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.
What this blog is for:
My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.
The one takeaway from this is your doctor doing a skeletal muscle index study so you get an objective view of your muscle atrophy/sarcopenia. Then your competent? doctor will have THE EXACT REHAB PROTOCOLS TO FIX THAT! Oh NO, you instead have an incompetent? doctor who has nothing! Fire them!
Have your competent? doctor and hospital get research going on possible benefits to stroke recovery! Of course, they being up-to-date on all things stroke already have stuff in the works for over a decade, right?
Oh NO, NOTHING WAS DONE! WHY?
Laziness? Incompetence? Or just don't care? NO leadership? NO strategy? Not my job? Not my Problem!
Targeted cooling to the brain during endovascular thrombectomy significantly improved functional outcomes in patients with large-vessel occlusion ischemic stroke.
Results of the CHILL-ART trial showed that cooling the brain by infusion of saline chilled to 4 °C led to a substantial increase in the number of patients who achieved a favorable functional outcome at 90 days.(Favorable to survivors is 100% RECOVERY; not your tyranny of low expectations where failure is considered success!)
“Even when we successfully remove the clot, many patients do not regain independence because of ongoing brain injury after blood flow is restored,” said principal investigator Zhi-Xin Huang, MD, Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, China.(Yeah, that's called the neuronal cascade of death and will kill off hundreds of millions of neurons in the first week! I'd suggest billing your doctors and hospital $1000 a dead neuron, that would concentrate their minds!)
“Our findings show that targeted cooling delivered directly into the brain at the moment of reperfusion can meaningfully improve recovery without adding risk,” he noted.
A second trial of a similar technique, FOCUS, also conducted in China, did not show a significant benefit, but functional outcomes trended in a positive direction in the intervention group, and there was a safety benefit with a reduction of any intracerebral hemorrhage (ICH) incidence at 24 hours.
“These findings validate the feasibility of selective intra-arterial cooling as an adjunctive therapy during endovascular thrombectomy. The marked decrease in any intracerebral hemorrhage indicates a potential protective effect on the blood-brain barrier and microvasculature, which may translate into clinical benefits,” FOCUS investigator, Shen Li, MD, Beijing Shijitan Hospital, Beijing, China, said.
The CHILL-ART trial investigator, Raul Nogueira, MD, University of Pittsburgh School of Medicine, Pittsburgh, explained that hypothermia is known to be an effective neuroprotectant.
He noted that substantial data support the concept, but implementation has remained challenging. Systemic hypothermia has been associated with several drawbacks: It takes time to induce, can disrupt endovascular treatment workflows, and has been linked to significant adverse effects, including higher rates of pulmonary infection, potential coagulopathy and bleeding complications, and refractory shivering. As a result, this approach has not been widely pursued.
The CHILL-ART and FOCUS trials investigated a novel approach of inducing regional hypothermia by infusing chilled saline intra-arterially directly into the brain at the end of the thrombectomy procedure.
The intervention uses standard thrombectomy equipment and refrigerated saline, making it readily scalable in routine clinical practice without requiring specialized devices or additional training.
The CHILL-ART trial enrolled 262 patients across 26 comprehensive stroke centers. Participants within 24 hours of stroke onset were randomized to receive either thrombectomy plus intra-arterial infusion of 350 ml of cold saline (hypothermia group) or thrombectomy with room-temperature saline (control group). The saline was administered at 50ml pre-reperfusion and 300 ml directly after reperfusion.
The median patient age was 70 years, and the median National Institutes of Health Stroke Scale score was 14. The trial imposed no exclusion criteria based on baseline ASPECTS, and patients could be enrolled up to 24 hours after stroke onset. However, the median ASPECTS was high at 8, and treatment was initiated fairly early, at a median of between 5 and 6 hours after stroke onset, Nogueira reported.
15% Absolute Increase in Functional Independence
The study’s primary outcome, functional independence defined as a modified Rankin Scale (mRS) score of 0-2 at 90 days, was achieved in 54.7% of patients in the hypothermia group compared with 39.8% in the control group (adjusted risk ratio, 1.36; 95% CI, 1.05 1.76; P =.018). This gives a number need to treat for one additional favorable outcome of 7.
Safety outcomes were comparable between groups, with no significant increase in symptomatic ICH (7.0% vs 9.0%) or 90-day mortality (13.3% vs 18.0%).
By combining reperfusion with targeted neuroprotection, the study introduces a promising new approach into acute stroke treatment, and these findings support broader adoption of intra-arterial hypothermia as an accessible, cost-effective strategy to reduce disability after stroke, the CHILL-ART trial investigators concluded.
However, the FOCUS trial results were not as favorable. The trial, conducted at 12 hospitals, enrolled 258 patients with anterior circulation large-vessel occlusion stroke who presented within 24 hours of symptom onset. Participants were randomized to receive either selective intra-arterial cooling plus endovascular thrombectomy or standard thrombectomy alone.
Results showed no significant difference in functional outcomes at 90 days between the two groups, with an adjusted common odds ratio of 1.16 (95% CI, 0.75-1.79; P = .51).
However, the safety results were encouraging, with a reduction in ICH rates in the cooling group with an adjusted risk difference of -0.174 (95% CI, -0.288 to -0.059; P = .003). There was no difference in the occurrence of symptomatic ICH or mortality between groups.
Easy and Inexpensive
Noguera pointed out that this approach is easy and inexpensive.
“We can use the typical neurovascular thrombectomy equipment, and it’s very easy to implement. You just need cold saline at 4 degrees,” he said.
Nogueira added that the results of the two studies were not necessarily contradictory, noting that both were only moderately sized trials. He suggested that the benefit seen in the CHILL-ART trial — a 15% absolute improvement in functional independence — was larger than expected, whereas the FOCUS trial produced more modest results than investigators had hoped for.
However, he noted that the mRS shift analyses from the two studies were actually similar, suggesting the apparent discrepancy may reflect differences in statistical power and sample size rather than fundamentally different findings.
“We are going to need more trials, larger numbers, and potentially meta-analyses, to really answer this question,” he said.
Still, Nogueira argued that the studies together provide important validation of the concept. “While we are going to need more data before changing guidelines, I think we have validated this concept here, and it is definitely a big step in the right direction,” he commented.
He added that regional brain cooling should now become a major focus of thrombectomy research because of its simplicity and apparent promise.
“I would say this regional cooling approach should be the biggest priority in thrombectomy research now because it’s so easy to implement, and we have a very strong signal of effectiveness,” Nogueira said.
Large Therapeutic Effect
Commenting on the CHILL-ART trial, Marieta Peycheva, MD, Medical University of Plovdiv, Plovdiv, Bulgaria, characterized the findings as “really amazing.”
She asked about safety, noting that there appeared to be slight increase in pneumonia in the intervention group.
Nogueira replied that the safety appears very good. He pointed out that rates of symptomatic ICH and mortality were numerically lower in the hypothermia groups in both trials, which he said was encouraging from a neurologic safety perspective.
Although pneumonia occurred slightly more often among patients receiving hypothermia, he emphasized that the cooling strategy produced minimal systemic effects because it was delivered over only a brief period rather than inducing prolonged whole-body hypothermia.
“Of course we need to look at that carefully in the future, but I think overall, in both trials we saw the same direction towards a benefit and very good safety.”
Commenting on the CHILL-ART trial, Peter Kelly, MD, University College Dublin, Dublin, Ireland, said the study really stood out.
“It showed a big therapeutic effect — a 15% absolute benefit in terms of 90-day functional independence, it looked very safe, and it involved just cooling a bag of saline to 4 °C.”
“This should certainly kick off a whole collection of new trials to try to confirm those really interesting results,” he added.
Both trials were investigator initiated. The authors reported having no relevant disclosures.
Tokyo, May 14 (Jiji Press)--A team including Takashi Shichita, a professor at the Institute of Science Tokyo's Medical Research Laboratory, has developed a drug candidate to suppress a type of protein that causes the rehabilitation-induced partial recovery of motor functions lost from a stroke to end after only about two months.
People who lost the abilities to move their hands or feet, or to speak due to the deaths of some nerve cells in their brains from the cerebral infarction can regain the functions to a certain extent through rehabilitation. The recovery normally lasts for about two months.
The recovery is possible because surviving nerve cells repair the neuron networks, with microglia, or cells in charge of brain immunity, helping the restoration process by secreting a protein called insulin-like growth factor 1, or IGF1.
In a genetic manipulation experiment using mice, Shichita and other members of the team discovered that microglia stopped secreting IGF1 after a while following a stroke due to the function of another protein, ZFP384. The same mechanism was confirmed in the brains of dead stroke patients.
The team developed the drug candidate to block the production of ZFP384. After injecting the drug into mice, the team found that microglia continued to secrete IGF1 and helped maintain the recovery of brain functions.
This is different than all the other stem cell research I've seen where stem cells aren't even monitored after transplantation and exosomes are the reason for improvement! But why go thru all the trouble of stem
cells if exosomes are the reason for the benefits? Which must be why no
one seems to be monitoring stem cell survival. Ask your competent? doctor for clarification!
Scientists have discovered that transplanted stem cell-derived brain cells may do far more than simply survive after a stroke.
A stem cell treatment helped mice recover from strokes by rebuilding damaged brain connections, restoring blood vessels, and improving movement, according to new research from the University of Zurich and the University of Southern California. The findings raise hopes that future therapies could one day repair stroke damage that is currently considered permanent.
Stroke remains one of the world’s leading causes of long-term disability. When blood flow to part of the brain is cut off, oxygen-starved cells die within minutes. Unlike skin or bone, the brain has only a limited ability to replace lost tissue, leaving many survivors with lifelong paralysis, speech problems, or memory loss.
Scientists have spent years searching for ways to help the brain rebuild itself. In the new study, researchers used neural progenitor cells, early-stage cells capable of developing into different types of brain tissue. The cells were created from induced pluripotent stem cells, which are adult human cells reprogrammed into a stem cell-like state.
The team transplanted these cells into the brains of mice one week after a stroke. That timing turned out to be critical. Earlier transplants survived poorly because the injured brain was still overwhelmed by inflammation and toxic chemical signals. Waiting several days allowed conditions to stabilize enough for the transplanted cells to take hold.
What happened next surprised the researchers.
New Neurons and Rebuilt Connections
Over five weeks, the transplanted cells survived, spread through nearby brain tissue, and matured mostly into functioning neurons. Many became GABAergic neurons, specialized inhibitory brain cells that help regulate neural activity and are heavily depleted after stroke. These cells are essential for balancing brain signaling, preventing excessive excitation, and coordinating movement.
Where the fuck is the protocol you delivered to all stroke hospitals? Oh, you DID NOTHING OF THE SORT! You're fired for extreme incompetence! The goal is to get survivors 100% recovered; NOT TO GET YOU PUBLISHED YOU FUCKING BASTARDS!
Your compeuppance is going to be a real bitch when you realize you could have solved stroke when still working; I'll have zero sympathy for your predicanent!
We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply.
Abstract
Background
Millions of people around the world experience post-stroke hemiparesis, making it difficult to move one side of the body. Hemiparesis impairs an individual’s muscle strength and coordination which limits gait speed, efficiency, and endurance and contributes to reduced community participation. These limitations in strength and control also negatively impact balance, leading to a high prevalence of instability, falls, and fall-related injuries. Assistive technologies like powered exoskeletons that apply torques to the hips in the sagittal plane (hip flexion and extension) and frontal plane (hip abduction and adduction) may benefit both gait efficiency and stability in hemiparetic populations.
Methods
In this study, we investigate the impact of exoskeleton-delivered frontal and sagittal plane hip torque in eight individuals with hemiparesis. Participants completed two-minute walking bouts on an instrumented treadmill with no exoskeleton, and then with the exoskeleton applying phase-based flexion and extension assistance. They then completed a series of abduction torque trials, in which they walked with the exoskeleton-supplied sagittal-plane assistance for 10 strides, and then sagittal-plane assistance and constant abduction torque for 10 strides. The abduction torque series consisted of four levels of abduction torque, each repeated 5 times, in random order.
Results
Compared to steady-state walking without the exoskeleton, the application of sagittal plane torques significantly increased propulsive forces at push-off for the non-paretic limb by 0.83 ± 0.32% BW (p = 0.0373) and had little impact on step width or margin of stability. In the transient period following onset, hip abduction torques significantly increased step width by 0.053 ± 0.011 m (adjusted p < 0.025) and margin of stability for the paretic and non-paretic limb by 0.039 ± 0.006 m (adjusted p < 0.025) and 0.014 ± 0.004 m (adjusted p = 0.01), respectively. These outcomes are correlated with the level of abduction assistance.
Conclusion
These results provide initial evidence supporting the use of a hip exoskeleton to impact foot placement, margin of stability, and propulsion in individuals with hemiparesis, which may benefit both gait efficiency and stability.
A self-administered, in-home, finger-stick blood test detected Alzheimer's disease (AD) biomarkers that correlated with cognitive performance in older adults — a finding that could open the door to large-scale dementia risk screening outside of clinical settings.
The cross-sectional observational validation study of 174 participants (mean age, 66 years; 54% female) showed capillary blood levels of p-tau217 correlated with episodic memory, attention, and executive function, while glial fibrillary acidic protein (GFAP) correlated with working memory and executive function, as measured by computerized cognitive tests.
When researchers combined the p-tau217 results with composite memory scores, they identified a high-risk group — about 9% of participants — who performed significantly worse across cognitive and functional measures.
The approach is designed to move AD biomarker testing out of specialist clinics and into the community, where most people with early cognitive concerns are never evaluated.
"This is the whole reason for doing the capillary blood sampling — to allow it to be scalable, to allow it to be done at a community level, which is where it's likely to be most usefully employed," study investigator Anne Corbett, PhD, professor in dementia research at the University of Exeter Medical School, Exeter, England, told Medscape Medical News.
The study builds on the DROP-AD trial, which validated capillary blood sampling for AD biomarkers in 337 participants.
As reported previously by Medscape Medical News, that study demonstrated strong concordance between capillary and venous samples — but collection was still supervised in clinical settings. In the current study, participants collected samples entirely at home and returned them by mail.
In the UK, only 1 in 1000 people with early cognitive decline receive a specialist evaluation. Corbett said the study deliberately set its memory threshold at 1 SD below age-matched norms — milder than the 1.5 SD cutoff for mild cognitive impairment — to catch people earlier in the disease course.
"When you look at the new generation of disease-targeted treatments, they are looking for preclinical mild cognitive impairment with biomarkers," she said. "That's even more relevant in the US, where some of these drugs are already in use."
Participants were either cognitively normal (n = 146) or had mild to moderate dementia (n = 28). Each collected 70 μL of capillary blood using a Capitainer dried blood spot device. Cards were dried at room temperature and mailed without cooling.
Capillary p-tau217 correlated with episodic memory (r = 0.299; P < .001), attention (r = 0.197; P = .019), and executive function (r = 0.191; P = .021). GFAP correlated with working memory (r = 0.183; P = .034) and executive function (r = 0.182; P = .046).
Both biomarkers discriminated between participants with and without dementia, though with modest accuracy (p-tau217 AUC = 0.656, P = .012; GFAP AUC = 0.688, P < .001). The high-risk group identified through the dual-threshold approach showed large effect sizes across cognitive and functional domains (Cohen d > 1.0).
In a subgroup of 40 participants with paired venous samples, capillary-venous correlations were strong (p-tau217: r = 0.711-0.743; GFAP: r = 0.700-0.790).
An unexpected finding was that only 6% of participants were positive for both biomarkers. GFAP-positive participants were nearly five times more likely to report a history of heart disease (odds ratio, 4.14; P = .016), while p-tau217 positivity had no cardiovascular association, suggesting the two markers may identify distinct at-risk populations.
"We didn't expect quite such a separation," Corbett said. She described the finding as exploratory and said her group planned to examine whether the two groups showed different cognitive trajectories.
Corbett estimated a timeline of 4 to 5 years before the approach could enter clinical pathways and said her group was launching a study this summer to prototype the technology in a real-world NHS context.
Foundational Research
Commenting for Medscape Medical News, Suzanne Schindler, MD, PhD, associate professor of neurology at Washington University School of Medicine, St. Louis, Missouri, said the study addressed a real problem but that the data supported feasibility, not clinical readiness.
"This isn’t ready for clinical practice, but it's laying groundwork for future studies," Schindler said.
She noted the cohort lacked a dedicated mild cognitive impairment (MCI) group, making it difficult to assess the tool's effectiveness in a population it seemed designed to reach. "They likely will be able to identify some of the individuals at highest risk and lowest risk, but there's going to be a lot of people that aren't stratified," said Schindler, who was not involved in the study. "It has value for the extremes, but for those folks in the middle, it's not going to stratify them."
Schindler differentiated this approach from a previous direct-to-consumer blood biomarker test by Quest Diagnostics that drew criticism for high false-positive rates. That test used the amyloid-beta 42-to-40 ratio, which was less specific, and was framed as a clinical tool. The current study's higher-specificity cutoff and triaging framing made it less concerning, she said.
She noted that blood biomarker testing is recommended only for symptomatic individuals, in part because approved treatments target people who already have cognitive impairment. But trials are underway testing anti-amyloid therapies in people with no symptoms.
"If that happens, we will then have a need to screen people who are cognitively unimpaired," she said, a scenario that would make scalable, home-based testing far more urgent.
Marwan Sabbagh, MD, professor of neurology and Moreno Family Chair for Alzheimer's Research at the Barrow Neurological Institute, Phoenix, Arizona, who was also not involved in the research, said the sample needed to be much larger and more diverse. "You need a bigger spread. … You need more MCI," Sabbagh told Medscape Medical News.
But Sabbagh did see major potential in getting at-risk individuals into the clinical pathway more quickly than what’s traditionally done.
"A typical 70-year-old goes to primary care, and primary care may or may not screen them, may or may not evaluate them, and may or may not refer them," he said. Capillary testing could compress that timeline dramatically — flagging at-risk individuals through an online cognitive test, sending a kit in the mail, and returning a result in days rather than months.
He added that capillary testing could eventually replace venous plasma testing as a gating mechanism before PET scans, but he said the field was not ready for a direct-to-consumer model.
"This could become part of the annual Medicare wellness visit," Sabbagh said. "I'm not sure we're ready to jump to a direct-to-consumer model."
The study was funded by the National Institute for Health and Care Research Invention for Innovation program and the NIHR Exeter Biomedical Research Centre. Disclosure information for study authors is available in the original study publication. Schindler reported no relevant financial relationships.
Can you walk while successfully doing another activity at the same time?
Known as dual-task gait performance, a 2023 paper found struggling to do this has been linked to a risk of falls and cognitive decline in adults aged 65 and over.
The researchers found that most people begin to struggle with the test in their 60s, and that after that point, participants’ cognitive health seemed to influence their performance most.
Another paper suggested a dual-task gait test could help to predict cognitive impairment better than single-task gait speed measurement.
But what is a dual-task gait test, and why might it matter? Here’s what Dr Donald Grant, a GP and senior clinical advisor at The Independent Pharmacy, told us.
What are dual-task gait tests?
These involve walking while doing another activity at the same time (hence the “dual” task). Often, the second task is distracting, e.g. counting back from 1,000 in sevens.
What do dual-task gait speeds say about how a person is ageing?
We know that older adults’ gait, or walking style and speed, can say a lot about how they’re ageing.
But when you add a cognitive or physical distraction to that, Dr Grant said, dual task walking tests “can give us a useful insight into how an individual’s brain and body are working together”.
He added: “As we age, our cognitive abilities can be impacted, making these tasks less automatic, requiring more active thinking.
“When people start to struggle with dual-task examinations, it could indicate cognitive ageing, which is perfectly natural as people get older. This means it can become more challenging to divide attention between thinking and movement simultaneously, which may increase people’s risk of falls.”
The doctor said “walking is more than a physical movement” as it requires clear thinking, coordination and strong mobility, “so dual task tests can help identify any early signs of concern”.
Dual-task walking tests are only one way to gauge how an individual is ageing
Despite being a “great functional assessment tool, as they accurately measure how well a person can perform everyday tasks simultaneously,” Dr Grant said dual-task walking tests aren’t the be-all and end-all.
“These walking tests can provide a good snapshot of overall health, but they’re never used to actively diagnose potential health concerns. They can help form part of a larger assessment, allowing medical professionals to better understand an individual’s mobility and cognitive abilities,” he said.
But to measure ageing, GPs tend to look at a combination of factors, such as pre-existing health conditions, physical function and cognitive abilities, he added
The expert ended: “Simple observations, such as memory tests, plus speed, balance or mobility examinations, can all help build a picture of how someone is functioning day to day.”
