AHA issues framework to work toward better blood pressure control

 What is your competent? doctors' EXACT BLOOD PRESSURE MANAGEMENT  post stroke?

Doesn't have one I bet; so, COMPETELY FUCKING INCOMPETENT!

Not having one allows many more neurons to die! Charge your doctor $1000 for each dead neuron! That might get your doctor to solving stroke!

A framework is NOT A PROTOCOL So, the AHA  is pushing incompetence!

AHA issues framework to work toward better blood pressure control

Key takeaways:

• The American Heart Association issued a framework of necessary investments to improving BP control in the U.S.
• Investments included research, policy, education, clinical care and community.

The American Heart Association issued a science advisory statement outlining a framework for the investment of resources and funding to address the high prevalence of uncontrolled blood pressure in the U.S.

Investment in research and policy, education, clinical care and community and workplace were identified as the primary domains by which long-term change in the prevalence of uncontrolled BP can be affected, according to the scientific advisory published in Hypertension.

Approximately 122.4 million U.S. adults are estimated to have hypertension with only approximately 20.7% reaching BP control, according to the advisory.

“We have effective treatments and strong guidelines, so the gap is about delivering care consistently and reaching the people most affected. The American Heart Association already does a great deal of work in this space, through Target: BP — part of the National Hypertension Control Initiative — public awareness campaigns, policy advocacy and community partnerships. We wanted to show how these efforts fit together and how they are expected to lead to measurable improvements in BP control while giving other organizations a framework they can adapt,” Yvonne Commodore-Mensah, PhD, MHS, RN, FAHA, professor and associate dean for research at Johns Hopkins School of Nursing and Johns Hopkins Bloomberg School of Public Health, department of epidemiology (joint appointment), told Healio. “No single intervention will close the BP control gap. Clinical quality improvement is essential, but so are the conditions people live in, including access to care, medication costs, food insecurity and transportation. I hope health systems see that their work is strongest when connected to community partners, and that policymakers recognize how much policy matters. Medicaid coverage for home BP monitors and reimbursement for patient training, for example, still varies widely by state. Disparities in BP control are largely driven by modifiable factors, which means they can be addressed.”

AHA BP Control Logic Model

The logic model is designed to outline what investment must be done, what each input in to each component produces and how those activities support short-, medium- and long-term changes in population-level BP control.

For the first step of the model, the authors identified the current BP situation in the U.S. — nearly half of adults have high BP and less than one-quarter have controlled BP — and items to prioritize: equitable health, culturally and linguistically appropriate interventions, multisector collaboration and community.

Next, the authors identified resources and capabilities, including staff and volunteers, research networks, scientific evidence and more, as well as funding sources that included philanthropies and corporate sponsors.

“Starting points will vary by setting, but the closest thing to a universal first step is knowing your own data,” Commodore-Mensah told Healio. “Look at your current BP control rate and break it down by race, ethnicity, age, insurance and geography to see where the gaps are. That baseline tells you where to focus. Then map what you are already doing onto the model’s four strategy areas: research and policy, education, clinical care, and community and workplace. Most organizations will find they are strong in one or two areas and thin in others, which shows where new investments or partnerships would add the most value.”

Investment of resources for long-term successes

The authors identified four domains that may benefit from these inputs — research and policy, education, clinical care and community and workplace — and explained how their outputs could impact long-term outcomes in BP control.

“Organizations should define specific, measurable indicators for each outcome. ‘Improved BP control’ might mean the percentage of patients below 130/80 mm Hg, with a target such as 70% or higher and a timeline based on your starting point,” Commodore-Mensah told Healio. “The model also lets institutions track earlier progress, such as clinicians trained, adoption of treatment protocols, social needs screening, and use of home BP monitoring. This kind of measurement works: Health centers in the National Hypertension Control Initiative improved BP control by 9.8 percentage points from 2020 to 2023, compared with 6.9 points at other health centers. Institutions should also track results across population groups, since overall gains can mask persistent gaps.”

Investment of resources, capabilities and funding into BP research and policy could produce scientific publications, professional guidelines, policy recommendations and advocacy materials. In the long term, these outputs may institutionalize evidence-based policies, establish a supportive regulatory environment and create sustainable funding and change health system infrastructure, according to the advisory.

The authors added that investment in education could produce culturally and linguistically appropriate educational materials, public education campaigns and patient resources, which may lead to long-term changes such as sustained behavioral changes.

Investment in the domain of clinical care could lead to the creation of professional training programs, clinical toolkits, best-practice protocols, evidence-based guidelines, quality improvement initiatives and achievement awards. In the long term, these outcomes could result in increased hypertension control, reduced disparities and reduced CV events and CV mortality, according to the advisory.

The authors wrote that investment in community and workplace may produce community partnership programs and technical assistance resources that, together with investment in clinical care, may improve social needs screening and connect community with clinical care.

“BP control is a shared responsibility. Clinicians, including nurses, pharmacists and community health workers, can deliver team-based care. Public health professionals can lead population-level strategies, community organizations can build trust and connect people to care, employers can support wellness and funders can sustain what works,” Commodore-Mensah told Healio. “Prevention also needs to start early, beginning with maternal health and continuing through childhood. Finally, we still need to learn which strategies work best, for whom, and in what settings. I hope this model encourages organizations to measure, share what they learn, and build that evidence together.”

For more information:

Yvonne Commodore-Mensah, PhD, MHS, RN, FAHA, can be reached at ycommod1@jhu.edu and on X at @ycommodore.

Cardiometabolic risk factors in midlife impact risk for dementia in late life

 Between 40-50 my BMI was great. My midlife exercise capability(50-69) was almost reduced to nothing because my incompetent? doctor had nothing to get me 100% recovered.

3 years post stroke at a physical I had a resting heart rate of 54 at age 53, level of an athlete. My doctor asked what exercises I was doing, 'I've done no exercises for the past 3 years'. So now after 20 years of little exercise I'm no longer that athlete.

Cardiometabolic risk factors in midlife impact risk for dementia in late life

Key takeaways:

• Controlling cardiometabolic risk factors can help prevent dementia and Alzheimer’s disease.
• Implementing lifestyle modifications can delay the onset of cognitive decline.

BOSTON — Vascular pathology and changes in midlife play a major role in brain health later in life, suggesting that reducing cardiometabolic risk factors may lower risk for dementia and Alzheimer’s disease, according to a speaker.

“We now know with advances in neuroimaging that most people diagnosed with Alzheimer’s disease also have vascular injury and vice versa,” Rachel Whitmer, PhD, professor of public health sciences and neurology at the University of California, Davis, said during a presentation at the Cardiometabolic Health Congress. “So, this is a multifactorial process with multiple pathways leading to it, which can get complicated when you’re thinking about how to reduce risk and precision medicine, but it also opens up the idea that there are multiple ways to actually lower risk. So, we do a lot of work looking at risk factors over the life course.”

Data derived from Whitmer R. Keynote: 25 years of dementia prevention: From risk factor discovery to prevention trials. Presented at: Cardiometabolic Health Congress; Oct. 14-17, 2026; Boston.  

High BMI between age 40 and 50 years is associated with elevated risk for Alzheimer’s disease late in life, as is smoking in midlife, Whitmer said.

Cardiometabolic risk factors and dementia odds

“There is a midlife dementia risk score that was published in 2006 out of Finland, which shows a combination of mostly modifiable cardiovascular risk factors in middle age are strongly associated with future risk for dementia,” Whitmer said. “We replicated this in Kaiser Permanente in a diverse group of people, and it predicted quite well across different racial and ethnic groups. If you’re looking at midlife, increasing odds of dementia go up the more risk factors that you have, and both of these studies look at high cholesterol, hypertension, diabetes or prediabetes and obesity in midlife.”

The relationship extends throughout the life course, as one study showed that people with CV risk factors early in life had worse cognitive performance later in life, even if they did not have dementia, Whitmer said.

A Lancet commission on dementia prevention, intervention and care identified 14 modifiable risk factors that could greatly reduced risk for dementia and Alzheimer’s if controlled: diabetes, high BP in midlife, obesity in midlife, high LDL cholesterol, physical inactivity, depression, smoking, low education, hearing loss, vision loss, traumatic brain injury, high alcohol consumption, social isolation and air pollution, Whitmer said.

“We know that dementia is a multifactorial process,” Whitmer said. “The thinking was, what can we do when we target several things at once, which of course is challenging to do.”
the U.S. POINTER study of 2,111 older adults to determine whether lifestyle interventions could improve brain health and prevent dementia. Participants were aged 60 to 75 years, had suboptimal diet, did not exercise regularly and had risk for cognitive decline but did not have dementia at baseline.

Participants were assigned to a self-guided intervention in which they met with a study navigator three times per year to receive lifestyle education and support and tools to implement it or to a structured intervention in which they conducted physical activity at a community facility while wearing a Fitbit, received encouragement to follow the MIND diet, underwent home-based computer cognitive training and regular participation in engaging activities and met with a medical advisor once every 6 months.

Both groups improved in cognitive function at 2 years, but the structured intervention group improved to a greater degree, Whitmer said.

‘Wonderful to see’

“And this was the part that was so wonderful to see: It was the same effect whether you were male vs. female,” Whitmer said. “It was the same effect no matter what age group you were in. It was the same effect whether or not you had the APOE4 genotype. And it was the same effect given your heart health. The magnitude of the effect of the study was the same or larger than a lot of the drug trials that are looking at change in cognitive function with medications for Alzheimer’s disease. So in thinking about that change over 24 months, we think about what could that be in a longer lifetime if someone incorporates some of these lifestyle changes.

“I get asked the question, what can you do? You can’t change your family history. You can’t change your genetics,” Whitmer said. “But I want to remind people that you can do things to at least delay the onset. And that’s very powerful as a clinical tool, speaking from a personal level, a health level, and then also on a population level for our community and our world and our country. So if you can delay, it would give huge benefits just in terms of valuing the economics, but also in what you are specifically experiencing.”

Napping characteristics and incident dementia: results from the National Health and Aging Trends Study

 Correlation! Solve the causation problem; NAPS ARE NOT THE PROBLEM! What is causing the naps? If your incompetent? doctor can't figure out and prevent the cause; get them fired!

Napping characteristics and incident dementia: results from the National Health and Aging Trends Study

Kening Jiang, PhD ,

Alden L Gross, PhD ,

Catriona Tingsea Wu ,

Junxin Li, PhD ,

Halima Amjad, MD, PhD ,

Emerson M Wickwire, PhD ,

Jennifer S Albrecht, PhD ,

Atul Malhotra, MD ,

Chien-Yu (Irene) Tseng, PharmD ,

Marc Kaizi-Lutu, BA

... Show more

The Journals of Gerontology: Series A, Volume 81, Issue 10, October 2026, glag208, https://doi.org/10.1093/gerona/glag208

Published:

25 August 2026

Article history

Abstract

Background

Whether daytime napping may be a risk factor for dementia, in addition to nighttime sleep disturbances, remains unclear. This study investigated longitudinal associations of napping characteristics with incident dementia among U.S. older adults.

Methods

Data came from the National Health and Aging Trends Study (NHATS). Napping characteristics were self-reported in a sleep module at round 3 (2013), including (1) frequency (non-napper, infrequent, frequent); (2) intention (non-napper, intentional, unintentional); (3) duration (non-napper, ≤30 minutes, >30 minutes). Dementia classification was established at each round using a validated algorithm, and possible/probable dementia served as our outcome. We included 995 participants free of possible/probable dementia at round 3 who were followed up to round 13 (2023). Discrete-time complementary log-log models were used for hazard ratio (HR) of incident possible/probable dementia associated with napping characteristics, adjusting for demographic, health, and sleep variables (duration, daytime sleepiness, and obstructive sleep apnea risk).

Results

When compared to non-nappers, frequent nappers had 1.48 times the hazard of developing incident possible/probable dementia (95% confidence interval [CI]: 1.14, 1.94). Unintentional napping was associated with incident possible/probable dementia (HR = 1.39, 95% CI: 1.06, 1.81). No associations were found for infrequent or intentional napping. Napping ≤30 minutes was associated with possible/probable dementia (HR = 1.40, 95% CI: 1.06, 1.85), but the association of napping >30 minutes was attenuated with additional adjustment for sleep variables (HR = 1.28, 95% CI: 0.96, 1.69).

Conclusions

Daytime napping may be a modifiable risk factor for dementia if supported by further evidence. Future studies with detailed napping characteristics and longer follow-up are needed.

The Fruits and Veggies With the Most Heart-Protective Flavanols

 Did your competent? doctor completely miss this? So, your dietician HASNT CREATED DIET PROTOCOLS ON THIS,  right?

So, PURE INCOMPETENCE!

The Fruits and Veggies With the Most Heart-Protective Flavanols

Eating a flavanol-rich diet can support heart health. Here’s how to do it.

You’ve got your daily diet down to a science: a fruit smoothie in the morning, a banana as an afternoon snack, and yogurt and berries with dinner. While you’re getting in all the recommended servings of fruit a day, you may be missing out on heart-healthy compounds.  Certain foods are higher in antioxidants known as flavanols, and flavanol-rich produce is important for heart health.

Recent research points out not all produce is created equal, and getting “enough” fruits and veggies doesn’t actually mean you’re reaping all the heart-healthy benefits these antioxidants can offer. Here’s what to know about adding flavanol-rich produce to your diet to protect your ticker. 

What You Should Know About Flavanols

Flavanols are a type of flavonoids known for their antioxidant properties. These natural compounds create vibrant hues of many fruits, veggies, and flowers. Research published in Hypertension in 2021 found that a higher intake of flavonoid-rich foods, like apples, berries, and pears, was associated with lower blood pressure. And, previous research, a study on polyphenols called COSMOS, suggests that you need 500 mg of flavanols daily to effectively lower your risk of dying from cardiovascular disease, and can reduce this risk by up to 27 percent.

But turns out, even those who eat a healthy diet may not be hitting this target. A recent study published in Food and Function found most people fall short of that 500 mg target, even when they follow standard healthy-eating guidance like the recommended servings of fruit.

“Flavanols can significantly reduce the risk of dying from cardiovascular disease, but only if you consume enough of them,” Javier Ottaviani, Ph.D., the paper’s lead author said in a press statement. “Most people assume that eating plenty of fruit and vegetables covers this, but what this research shows is that the specific choices you make matter far more than the total amount.”

Going Deeper: The Highest-Flavanol Picks

Researchers used data from the COSMOS trial as well as an ongoing (EPIC)-Norfolk and tracked about 30,000 people in the UK and U.S. to see if people who adhered to the daily recommendations of fruits and veggies (two to three servings in the U.S. and five portions in the U.K.) were getting enough flavanols in their daily diet to protect their heart health. They found that even for those who reported intake of plenty of fruits and vegetables, a very low number of people were seeing benefits from flavanols that would protect their tickers. 

The research highlights a need to be a little picky when it comes to choosing what makes it into your daily diet, since not all foods are high in flavanols, and not all flavanols are created equal. For example, drinking about 2.5 cups of green tea per day would provide you with 500mg of flavanols, but instead it’s better to get them from a variety of foods.

“Including a handful of blackberries, a whole apple or having a cup of green tea alongside your meal could make a real difference to how much of these beneficial compounds you actually consume and absorb from the diet,” Ottaviani said.  

Flavanol content varies widely from food to food. Plums top the list at about 450 mg per 500 g, followed by 250 g of cranberries at about 300 mg and 200 g of blackberries (about 1.5 cups) at about 250 mg. A cup of green tea delivers around 200 mg, and 80 g of broad or fava beans about 140 mg. From there: 400 g of cherries (about two cups) provide roughly 130 mg, one medium apple with skin (200 g) about 110 mg, 200 g of strawberries about 90 mg, 150 g of blueberries about 80 mg, and 40 g of pinto beans about 70 mg.

All fruits can fit into a healthy diet, but regularly choosing flavanol-rich options like berries and apples may offer added cardiovascular benefits. This isn’t about chasing a few “superfoods.” Being a little more intentional within an overall balanced, plant-rich diet is what refines which foods add an extra layer of heart protection.

The Takeaway

Rather than being concerned about totally changing your diet to include flavanol-rich foods only, pick one or two favorites and make them a staple. Find enjoyable options like berries at breakfast, cherries as a snack, or a daily cup of green tea you can stick to. This will help you keep consistent, and up your fruit and veggie intake overall. Flavanol intake should also come from food, not supplements. 

Bottom Line

Dietary intake of flavanols is linked to many heart health benefits including lower blood pressure and reduced risk of death from cardiovascular events. While it’s important to keep in mind some produce delivers far more heart-protective flavanols per serving than others, your first focus should be eating enough produce to hit daily recommended guidelines. After that, you can focus on the types of produce you’re adding, and aim to eat more flavanol-rich options throughout the day.

A 30-day plank plan to build a stronger core

 What is your objective measurement of core strength? Oh, Your doctor doesn't have one, right?

PURE INCOMPETENCE! 
And surely without any measurement there is no exercise protocol to build one correctly either, right? 

Because my doctor was a complete failure at curing my hand spasticity; didn't even try, I can only do forearm ones and still not very good. Pictures and videos at link.

A 30-day plank plan to build a stronger core

Medically reviewed by Amy Kwan, PT

• Why this matters: The plank plan can improve core strength and posture, essential for overall fitness and health.
• What you can do: Start the 30-day plank plan to progressively strengthen your core.
• The payoff: Consistently practicing planks can increase your core stability, improve posture, and support long-term fitness.

Want to build your core endurance? This 30-day plan combines plank holds with moving variations, gradually increasing your time and rounds while including scheduled rest days.

What to Expect From This 30-Day Plank Plan

This 30-day plan gradually builds your core strength and endurance by increasing how long you hold a plank and introducing different plank variations. You’ll start with 30-second intervals and work your way up to one-minute holds, with some days combining multiple exercises into a single workout.

The plan includes scheduled rest days to give your muscles time to recover. You can also shorten intervals or modify exercises to match your fitness level. Focus on maintaining good form rather than holding a plank for longer than you comfortably can.

To track your progress, record how long you can hold a plank with good form on Day 1. After completing the plan, repeat the same plank variation to see whether your endurance has improved. Allow extra recovery time before retesting if needed.

30-Day Plank Plan Schedule

Days 1–6

• Day 1: Hold a plank for as long as you can maintain good form. Record your time.
• Day 2: Hold a plank for 30 seconds, then do rocking planks for 30 seconds.
• Day 3: Hold a plank for 30 seconds, then do plank hip dips for 30 seconds.
• Day 4: Hold a plank for 30 seconds, then do plank up-downs for 30 seconds.
• Day 5: Complete one circuit: plank, rocking planks, plank hip dips, and plank up-downs for 30 seconds each.
• Day 6: Rest.

Days 7–11

• Day 7: Hold a plank for 30 seconds, then do rocking planks for 30 seconds. Complete two rounds.
• Day 8: Hold a plank for 30 seconds, then do plank hip dips for 30 seconds. Complete two rounds.
• Day 9: Hold a plank for 30 seconds, then do plank up-downs for 30 seconds. Complete two rounds.
• Day 10: Complete two rounds of this circuit: plank, rocking planks, plank hip dips, and plank up-downs for 30 seconds each.
• Day 11: Rest.

Days 12–16

• Day 12: Hold a plank for 45 seconds, then do rocking planks for 45 seconds.
• Day 13: Hold a plank for 45 seconds, then do plank hip dips for 45 seconds.
• Day 14: Hold a plank for 45 seconds, then do plank up-downs for 45 seconds.
• Day 15: Complete one circuit: plank, rocking planks, plank hip dips, and plank up-downs for 45 seconds each.
• Day 16: Rest.

Days 17–21

• Day 17: Hold a plank for 45 seconds, then do rocking planks for 45 seconds. Complete two rounds.
• Day 18: Hold a plank for 45 seconds, then do plank hip dips for 45 seconds. Complete two rounds.
• Day 19: Hold a plank for 45 seconds, then do plank up-downs for 45 seconds. Complete two rounds.
• Day 20: Complete two rounds of this circuit: plank, rocking planks, plank hip dips, and plank up-downs for 45 seconds each.
• Day 21: Rest.

Days 22–26

• Day 22: Hold a plank for one minute, then do rocking planks for one minute.
• Day 23: Hold a plank for one minute, then do plank hip dips for one minute.
• Day 24: Hold a plank for one minute, then do plank up-downs for one minute.
• Day 25: Complete one circuit: plank, rocking planks, plank hip dips, and plank up-downs for one minute each.
• Day 26: Rest.

Days 27–30

• Day 27: Hold a plank for one minute, then do rocking planks for one minute. Complete two rounds.
• Day 28: Hold a plank for one minute, then do plank hip dips for one minute. Complete two rounds.
• Day 29: Hold a plank for one minute, then do plank up-downs for one minute. Complete two rounds.
• Day 30: Complete four one-minute plank holds, resting 60 seconds between holds. After your final hold, rest as needed, then do plank jacks for one minute.

Optional Day 31 progress check: Repeat your Day 1 plank using the same variation. Record how long you can hold it with good form and compare your times. If you still feel fatigued from Day 30, save this check for after you’ve recovered.

How to Use the Plank Schedule

• Plank choice: Choose a straight-arm or forearm plank and stick with it through the whole plan. For the moving exercises, repeat the movement for the listed time.
• Two-move workouts: Rest 10–30 seconds between exercises.
• Four-move circuits: Move from one exercise to the next without a planned break, but pause if you need to reset your form.
• Multiple rounds: Complete the full sequence once to finish one round. Rest 60 seconds before starting the next.
• Time targets: Shorten an interval or use an easier variation if you cannot maintain control. Keep breathing throughout each exercise.

How To Do the Plank Exercises

Straight-arm Plank

Credit: Rozalynn S. Frazier

The straight-arm plank gives you a foundation for this plan: supporting your body on your hands and toes while keeping your middle steady. You’ll also use this position to start plank up-downs.

How to do it:

1. Start on all fours with your wrists under your shoulders.
2. Step your feet back one at a time until your legs are extended.
3. Hold this position for the planned interval.
4. Lower your knees to the floor to finish.

Focus on: Keep your hips in line with your shoulders and heels.

Make it easier: Place your hands on a sturdy countertop instead of the floor.

Make it harder: Bring your feet closer together to narrow your base of support.

Forearm Plank

Credit: Rozalynn S. Frazier

The forearm plank is another option for the plan’s timed holds. It also sets you up for rocking planks, hip dips, and plank jacks.

1. Lie on your stomach with your forearms on the floor and elbows under your shoulders.
2. Tuck your toes under.
3. Lift your torso and hips off the floor.
4. Hold this position for the planned interval.
5. Lower your body to the floor with control.

Focus on: Keep your lower back from sagging as you hold.

Make it easier: Keep your knees on the floor, with your body aligned from your head to your knees.

Make it harder: Bring your feet closer together while keeping your hips steady.

Rocking Plank

Rocking planks add a small forward-and-back movement to your hold. The challenge is to keep your trunk steady as your weight shifts.

1. Start in a forearm plank with your elbows under your shoulders.
2. Shift your body forward a few inches over your toes.
3. Push back through your toes to move your body slightly behind the starting position.
4. Continue rocking forward and back for the planned interval.
5. Lower your knees to the floor to finish.

Focus on: Move your shoulders and hips together as one unit.

Make it easier: Use a smaller rocking motion.

Make it harder: Pause briefly at the forward position before rocking back.

Plank Hip Dips

Hip dips introduce controlled rotation to the plan. You’ll practice moving your pelvis from side to side while supporting your upper body on your forearms.

1. Start in a forearm plank.
2. Rotate your pelvis to lower your right hip toward the floor.
3. Return to the center plank position.
4. Rotate your pelvis to lower your left hip toward the floor.
5. Continue alternating sides, returning to center between dips.

Focus on: Control each dip instead of dropping your hip toward the floor.

Make it easier: Reduce how far you lower your hips.

Make it harder: Pause just above the floor on each side without resting your hip.

Plank Up-Downs

Plank up-downs challenge you to keep your trunk steady while changing your arm support. They add upper-body work as you move between forearm and straight-arm planks.

1. Start in a straight-arm plank with your feet slightly wider than hip-width apart.
2. Lower onto your right forearm, followed by your left.
3. Plant your right palm beneath your shoulder.
4. Press up onto your right hand, then your left, returning to a straight-arm plank.
5. Repeat the sequence, switching which arm leads each time.

Focus on: Keep your hips from swaying side to side.

Make it easier: Perform the movement with your knees on the floor.

Make it harder: Bring your feet closer together while keeping your pelvis steady.

Plank Jacks

Plank jacks add a jumping movement to the final workout. Your goal is to keep your trunk steady while your feet move apart and together.

1. Start in a forearm plank with your feet close together.
2. Hop both feet out wider than hip-width apart.
3. Hop your feet back to the starting position.
4. Continue hopping out and in for the planned interval.
5. Lower your knees to the floor to finish.

Focus on: Keep your hips at a steady height as your feet move.

Related video: Start mat Pilates at home! Simple beginner moves for core strength (Natasa Boucher)

Make it easier: Step one foot out at a time, then step each foot back in.

Make it harder: Gradually increase your pace while keeping your landings controlled.

After the Plan

Keep using your favorite plank variations as part of your regular strength workouts. Choose a hold and a moving variation, using a duration you can complete with control. Progress by extending your time or trying a harder variation—one change at a time.

Read the original article on Health

Microvascular Measure Gives Clues to Poor Response to Successful Thrombectomy

 You've known of 100% recovery failure after thrombectomy for a long long time! WHEN ARE YOU GOING TO DO SOMETHING ABOUT THAT?

Or just sit with your heads up your asses? That doesn't help.

Microvascular Measure Gives Clues to Poor Response to Successful Thrombectomy

Capillary bed perfusion could point to a treatment target, proof-of-concept study suggests

Microvascular hemodynamics might provide an early marker of poor recovery despite successful large-vessel thrombectomy in acute ischemic stroke, an imaging study suggested.

Poor capillary bed perfusion as indicated by relative transit time heterogeneity around the infarct on immediate post-thrombectomy perfusion MRI predicted substantial infarct progression (≥10 mL, OR 1.4 per 10% increase, 95% CI 1.0-2.0, P=0.04), with a stronger association than seen for baseline infarct volume (OR 1.1 per 1 mL, 95% CI 1.0-1.2).The microvascular measure also outperformed baseline stroke severity as an independent predictor of poor 90-day functional outcome, defined as a modified Rankin Scale score over 2 (OR 1.4 per 10% increase, 95% CI 1.0-1.9, P=0.03, vs OR 1.2 per 1-point increase on the NIH Stroke Scale, 95% CI 1.0-1.2).

In contrast, conventional post-thrombectomy perfusion parameters, such as cerebral blood flow and volume and time to maximum residue function, failed to predict outcomes, "demonstrating their insensitivity to microvascular dysfunction," reported Yannan Yu, MD, of the University of California San Francisco, at the American Society of Functional Neuroradiology meeting in Newport Beach, California.

Despite acute stroke treatment advances, "still a significant portion of the stroke patients have a bad outcome even though they have successful thrombectomy and have reperfusion of the tissue," Yu said.

While no reflow in these cases isn't well understood, animal models have shown that microvascular hemodynamic failure is one mechanism, she noted.

"In routine practice, what people get [for imaging] is maybe 24 to 48 hours after the stroke treatment, and when you evaluate no-reflow on that time point, a lot of things may have already happened," she said. "They may have late recanalization, they may have early reocclusion. ... But in this immediate post-thrombectomy MRI, we're hoping that this MRI will reflect the truth of what happened immediately after we recanalize the vessel."

The researchers aren't proposing that centers switch from their routinely done diffusion MRI to the perfusion MRI as done in this study. Rather, the findings serve as proof of concept that the microvasculature can be measured and matters in this setting.

It's one of the pieces of the puzzle to sort out what's happening to these no-reflow patients to move toward finding better treatment for them, Yu said.

"Currently our limitation is that this is a pretty small sample size. There's not a lot of analysis we can do with such a small sample size," she said. "A larger cohort will be important to validate the scientific factuality of the findings. And then after that, if we're able to validate that, I think then it could potentially become a treatment target."

The study included 47 acute ischemic stroke patients (mean 72 years, 62% women) treated for anterior circulation large vessel occlusion from 2015 through 2020 who had complete or near-complete brain tissue reperfusion (modified Thrombolysis in Cerebral Infarction score ≥2c) after thrombectomy. Participants needed to have had diffusion-weighted imaging (DWI) and dynamic susceptibility contrast perfusion MRI both pre-treatment and within 2 hours after thrombectomy as well as 24-48 hour follow-up DWI.

Among them, 43% (20 of 47) had substantial infarct progression, and the same proportion had poor functional outcomes.

Relative capillary transit time heterogeneity was calculated as the ratio of the standard deviation of mean transit time to the mean transit time of red blood cells across a capillary bed.

Allied’s Wilkes-Barre rehab hospital treats neuro patients with new 3-in-1 machine

 With no mention of 100% recovery this is still a failure! WHEN THE HELL do we get survivor needs worked on? Survivors in charge would only focus on 100% recovery protocols.  I'd fire anyone doing prediction, biomarkers, prognostication or 'assessments'. None of them do a damn thing getting survivors recovered! All they do is turn on anxiety and depression!

Allied’s Wilkes-Barre rehab hospital treats neuro patients with new 3-in-1 machine

Submitted by Allied Services

Pediatric therapist Sarah Prebich helps her patient Liam in the Rise&Walk.

Allied Services has been marking “Rehab Week” for a half century – longer, even, than the nation itself.

What started as a company-wide picnic for staff, patients, residents and families in 1976 became the inspiration for an annual September commemoration, now known as National Rehabilitation Awareness Week.

This year, Allied marked Rehab Week as it was approaching another milestone: More than 30,000 steps taken by patients on its new machine, the Rise&Walk rehabilitation station, at Allied Services Wilkes-Barre Rehab Hospital.

“Rehab week just allows us to highlight the dedicated people that we have here day in and day out, helping patients achieve their goals and their milestones," said Jennifer Lutkowski, the director of rehabilitation at the hospital.

"Whether it's just something small, like a basic activity of daily living, or climbing 24 steps, or getting back into a big rig, that is just an opportunity for all of us to just highlight each other and get recognition for something that we all do here 24/7,” Lutkowski said.

Lackawanna County-based Allied provides rehabilitation, skilled nursing, behavioral health, home care services and more.

Rise&Walk

The Rise&Walk, developed by Healing Innovations is a 3-in-1 neurorehabilitative piece of equipment that Allied started using towards the end of this summer. The machine features seated, supported standing and walking modes.

“When patients do suffer a neurological event, sometimes the connections between the brain and the body are affected, and your body has to find other ways to readjust and to get those pathways working again,” Lutkowski said. “If you think about it like a roadblock, you have to find different detours, different avenues, so your body is able to do that through a repetitive motion or repetitive movement.”

About 17 patients have used the machine so far, taking about 33,000 steps in total. The machine helps therapists to target parts of the body that need to build back strength.

“They actually have sensors in the footplates now, so people know how much they weigh. Especially if you have somebody with a stroke, oftentimes the weakness is all down one side of their body, so they might put all their weight onto their strong side, or all their weight might be falling onto the weak side,” said Ashlynn Fitzgerald, a physical therapist at Allied’s Wilkes-Barre Rehab Hospital.

The Rise&Walk provides 10 different levels of assistance based on a patient’s ability and can offer a challenge to patients that need less assistance. There’s also arm bars that allow patients to move as if on an elliptical workout machine. And, it can go in reverse. Allied purchased a pediatric component to the machine so it can adjust for younger patients.

“Pretty much every person that we have put on here, when they come off of the machine, if their gait speed or their walking speed isn't improving, the quality of their walking is at least improving in some aspect,” Fitzgerald said.

“We get some people who can't move a leg on their own or they can't stand up on their own, and then they're coming off this machine and they're standing more upright. They're moving their walkers themselves. They're moving their legs themselves again. We're seeing a lot of that kind of translation, they get off the machine and then things are rebooted and working a little better,” she continued.

Importance of tech in physical therapy 

The physical therapists notice hesitation in some of their neuro patients during rehab. The Rise&Walk provides a sense of security with the harness that alternate physical therapy methods might not.

Submitted by Allied

From left, Allied physical therapists Rosa Bartoletti, Sarah Prebich, Ashlynn Fitzgerald and Jennifer Lutkowski, director of rehabilitation use the Rise&Walk on some of their patients.

“We want to get them walking as early and as often as we can. Sometimes the extent of a neurological injury can prevent us from getting them walking over ground and really getting repetition. Having a safe environment to get a ton of repetitions that someone may not have the opportunity to get over ground really pushes people,” Fitzgerald said.

Allied therapists appreciate having the technology to supplement their work, adding that they don’t believe there are any other similar machines operating yet in the region.

“There's a lot of research out there now in the therapy world that high-intensity gait, which is that quick-moving continuously, has shown to have a lot of great results … That's a big component of this piece of equipment. I think it really has been kind of a driving force behind us getting it and the importance of having newer pieces of technology that focus on those types of things,” Lutkowski said.

Fitzgerald and her fellow physical therapists see patients get faster results, and a confidence boost, when they use the Rise&Walk.

“It's indescribable, honestly, how well it worked. We're always looking for new tools in the toolbox and as clinicians we even have our limits. When you're physically having to help somebody move, and you go maybe 30 feet, and then you watch them come out of this machine, and you don't have to move their legs anymore, and they're going 50 feet or more. Like the first time it happened, I had chills, honestly, because I did not believe it at first. It means a lot to be able to provide new opportunities for these patients,” she said.