Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective 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.My back ground story is here:http://oc1dean.blogspot.com/2010/11/my-background-story_8.html

Friday, February 26, 2021

Quality of Life and Disability-free Survival in the Elderly: The Locomotive Syndrome and Health Outcome in Aizu Cohort Study

My quality of life is great even though I will be disabled for half my life; age 50-100. I blame the stroke medical world primarily for my lack of recovery and specifically my doctor for not doing a damn thing when all his previous patients did not recover. Acceptance of failure to recover is endemic in the stroke medical world. 

Quality of Life and Disability-free Survival in the Elderly: The Locomotive Syndrome and Health Outcome in Aizu Cohort Study

First Published October 30, 2020 Research Article Find in PubMed 

Objectives: 

The Short Form 12 Survey (SF-12) three-component model is used to compute health-related quality of life (QoL): it includes physical, mental, and role-social QoL. We asked whether the SF-12 three-component model is associated with disability-free survival. 

Methods: 

People ≥65 years old were included (n = 2634). SF-12 scores were assessed at baseline. The outcome was a composite of loss of independence (LoI) and death. LoI was defined using Japan’s long-term care insurance categories. Hazard ratios (HRs) for LoI or death were estimated using Cox proportional hazards models.  

Results: 

Better physical QoL was inversely associated with LoI or death (adjusted HR per 10-point increase: .88 [95% CI: .81–.96]), but mental QoL was not. Better role-social QoL was inversely associated with LoI or death only among participants with higher than average physical QoL (adjusted HR per 10-point increase: .79 [95% CI: .65–.96], p for interaction = .04).  

Discussion: 

Physical QoL was associated with disability-free survival, and role-social QoL was associated with disability-free survival among those with better physical QoL.

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Personality, Retirement, and Cognitive Impairment: Moderating and Mediating Associations

I think I'm good on conscientiousness and lower neuroticism and nothing here will change my stance on retirement.

 Personality, Retirement, and Cognitive Impairment: Moderating and Mediating Associations

First Published October 25, 2020 Research Article Find in PubMed 

Objectives: 

Five-factor model (FFM) personality traits, including higher conscientiousness and lower neuroticism, are associated with lower risk of dementia and cognitive impairment. In this research, we test whether retirement status moderates and/or mediates the relation between personality and cognitive impairment.  

Method: 

We used data from the Health and Retirement Study (N = 9899), a longitudinal study of Americans over the age of 50 years, to examine moderating and mediating associations between personality traits and retirement status on risk of dementia and cognitive impairment not dementia (CIND) over an 8–10 year follow-up.  

Results: 

Personality and retirement each had strong, independent associations with risk of dementia and CIND. There were not, however, strong or consistent, moderating or mediating associations between personality and retirement predicting impairment risk.  

Discussion: Overall, these results indicate that personality and retirement are independent risk factors for incident cognitive impairment. Mechanisms other than retirement are likely to explain this association.

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Antioxidants Go After Secondary Injury in Brain Bleeds

 Good enough for at least a preliminary protocol? Or do we have to wait at least 50 years or never for followup to occur? Since we have NO STROKE LEADERSHIP, there is no specific person we can contact to ensure followup is done and protocols created. Stroke survivors will continue to be screwed until we overthrow the existing leadership failures in stroke.

Antioxidants Go After Secondary Injury in Brain Bleeds

Preliminary data show promise where no drugs have succeeded before

A computer tomography (CT) scan of a patient with large intracranial hemorrhage in his left cerebral hemisphere

Reactive oxygen species (ROS) scavengers were modestly neuroprotective in the acute period of intracerebral hemorrhage (ICH), according to a small randomized trial.

Perihematomal edema (PHE) expanded less with a 14-day course of N-acetylcysteine and selenium in the neurological ICU compared with placebo, reported Seungjoo Lee, MD, PhD, of Asan Medical Center in Seoul, Korea, and colleagues. Their manuscript was published online in Stroke.

That was true for both the edema volume (mean 21.90 vs 30.66 mL, P<0.01) and the ratio of volume at 2 weeks to that at baseline (1.19 vs 2.05, P<0.01).

However, brain hemorrhage volumes came out similar at 2 weeks with the ROS scavenger and placebo (mean 20.90 vs 18.70, P=0.74).

ROS scavenger recipients did reach target sedation levels faster (mean 5.98 hours vs 8.42 hours, P<0.01) and have shorter ICU stays (6.46 days vs 12.66 days, P<0.01) compared with the placebo group.

Yet 30-day functional outcomes on the modified Ranking Scale (mRS) didn't improve more (scores 3.34 vs 3.53 with placebo), nor were total hospital stays shorter (20.28 vs 23.71 days).(so really no functional efficacy.)

"These results propose that our ROS scavengers are potent antioxidants with properties that mitigate PHE and functional outcomes (that's not what you said in the previous sentence.) in the acute period of patients with ICH," Lee's group maintained.

Like other critically-ill patients, people with ICH have oxidative stress that contributes to direct cellular injury. PHE is an imaging marker of secondary injury following ICH, and its clinical significance has been a subject of debate.

"Discovering treatments that mitigate secondary injury is a major unmet need in the uphill battle of reducing the global burden of death and disability from ICH," according to Ashkan Shoamanesh, MD, and Aristeidis Katsanos, MD, PhD, both of the Population Health Research Institute at McMaster University in Hamilton, Ontario.

Lee's trial joins a short list of ICH clinical randomized trials showing a reduction in PHE volume with intervention and thus "provides exciting novel results supporting the potential benefit and safety antioxidant therapy in this fight," the pair wrote in an accompanying editorial.

"Although [the investigators'] findings are too preliminary to be implemented in clinical practice at this time, they are promising, supported by sound biological rationale, and warrant further exploration in large-scale clinical trials," the editorialists concluded.

Lee's group noted that ICH accounts for 10% and 27% of strokes and is associated with very high mortality and morbidity rates that have not budged in 30 years. No proven acute ICH therapies exist to date, as trial after trial has failed to show benefits to proposed medical and surgical interventions.

Their single-blind, randomized trial was conducted at several Korean centers. Eligible patients had spontaneous ICH and secondary ICH due to vascular anomalies, venous thrombosis, neoplasms, or hemorrhagic infarction (i.e., cases where hematoma and PHE can be measured on CT).

Lee and colleagues randomized 123 people to ROS scavengers (N-acetylcysteine 2000 mg/d and selenium 1600 µg/d IV for 14 days) or placebo starting within 24 hours of admission.

ROS scavenger and placebo groups shared similar baseline characteristics, including age (mean 54.4 vs 56.1 years) and sex (men 64.9% vs 53%). Initial hemorrhage volumes (34.78 vs 36.71 mL) and PHE volumes (18.47 vs 19.09 mL) were also comparable.

Hypertensive ICH was the most common type of ICH, accounting for over 40% of cases. Cerebrovascular disease was the second most common cause and was observed in 30%.

Study investigators reported no serious adverse events attributed to the ROS scavengers.

Their reasons for choosing N-acetylcysteine and selenium for this study, they said, included the abundance of existing safety data, their widespread availability, and low cost when compared with other ROS scavengers like edaravone and glutathione.

On top of the small sample size and single-blind design, the study couldn't determine whether the observed effects of ROS scavengers were due to one alone or the combination of the two.

Another major limitation was the heterogeneous cohort of ICH subtypes studied, as Shoamanesh and Katsanos noted that "the pathophysiology of secondary ICH subtypes, such as hemorrhagic neoplasms and infarction, includes additional mechanisms of brain injury and edema that likely overshadow the relative contribution of the hemorrhage to neuroimaging and clinical outcomes."

Furthermore, the literature suggests that ICH patients will need to be followed for at least 6 months to detect meaningful differences in the mRS, the editorialists added.

Nonetheless, the preliminary data from Lee's group suggest that "PHE can be mitigated safely through supplemental antioxidant therapy with ROS scavengers," they said.

  • author['full_name']

    Nicole Lou is a reporter for MedPage Today, where she covers cardiology news and other developments in medicine. Follow

 

European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke

 This was approved without even knowing or specifying the efficacy. 'IMPROVE' is NOT GOOD ENOUGH. You and your fucking tyranny of low expectations need to get out of stroke.

This research from Jan. 30, 2021 has this line: Nevertheless, there remains much to be elucidated about the efficacy of this treatment for specific neurological conditions, and more robust clinical data is needed

Cerebrolysin for stroke, neurodegeneration, and traumatic brain injury: review of the literature and outcomes Jan. 30, 2021 

The latest here:

European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke

First Published February 19, 2021 Research Article 

Intravenous thrombolysis is the only approved systemic reperfusion treatment for patients with acute ischaemic stroke. These European Stroke Organisation (ESO) guidelines provide evidence-based recommendations to assist physicians in their clinical decisions with regard to intravenous thrombolysis for acute ischaemic stroke. These guidelines were developed based on the ESO standard operating procedure and followed the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. The working group identified relevant clinical questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence, and wrote recommendations. Expert consensus statements were provided if not enough evidence was available to provide recommendations based on the GRADE approach. We found high quality evidence to recommend intravenous thrombolysis with alteplase to improve functional outcome in patients with acute ischemic stroke within 4.5 h after symptom onset. We also found high quality evidence to recommend intravenous thrombolysis with alteplase in patients with acute ischaemic stroke on awakening from sleep, who were last seen well more than 4.5 h earlier, who have MRI DWI-FLAIR mismatch, and for whom mechanical thrombectomy is not planned. These guidelines provide further recommendations regarding patient subgroups, late time windows, imaging selection strategies, relative and absolute contraindications to alteplase, and tenecteplase. Intravenous thrombolysis remains a cornerstone of acute stroke management. Appropriate patient selection(so cherry picking rather than having the ability to treat everyone. Hope you know enough to have the correct stroke.) and timely treatment are crucial. Further randomized controlled clinical trials are needed to inform clinical decision-making with regard to tenecteplase and the use of intravenous thrombolysis before mechanical thrombectomy in patients with large vessel occlusion.

 

Thursday, February 25, 2021

TED talk, global idea search: 100% stroke recovery: I failed

 Mine was here: Only 8 views so it never got past the first round.

TED Global Idea Search


I should have just focused on the 1 in 4 per WHO because at least one of the persons judging these will have a stroke and will not recover properly.

The generic form lettter here: I may have to work on a TEDx presentation first.

-------------------------------------------------------------------------------------------------

Hello!


Thank you so much for applying to this round of the TED Global Idea Search. We have completed our full review of more than 1,200 applications, and after much thought and careful deliberation, we have decided not to move you into the finalist round.


We selected only 15 finalists (under 2%) from this pool of applicants, but we saw so many more compelling ideas than that. So that means that there are many of you whose ideas we are saving for future opportunities, even if we aren't moving you into the finalist round at this time based on our curation plans for 2021.


Please know that your name and application will remain in our searchable system of potential speakers. So if your idea seems like it could be a good fit for a future program, we plan to reach out to you directly.


Throughout the review process, it was clear to us that each pitch was so thoughtfully crafted! We really appreciate the time you put into developing a sharp, inspiring presentation. 


Thank you again for taking part in the TED Global Idea Search, and for putting ideas that matter out into the world.


Very best,

The TED Team



Onyx embolization for dural arteriovenous fistulas: a multi-institutional study

I thought gluing was not done for brain work. Ask your doctor for guarantees on its use.
FDA issues warning about Covidien brain device that has killed nine - Onyx glue

 

Onyx embolization for dural arteriovenous fistulas: a multi-institutional study

  1. Yangchun Li1,
  2. Stephanie H Chen2,
  3. Ridhima Guniganti3,
  4. Akash P Kansagra4,
  5. Jay F Piccirillo4,
  6. Ching-Jen Chen5,
  7. Thomas Buell6,
  8. Jason P Sheehan7,
  9. Dale Ding8,
  10. Giuseppe Lanzino9,
  11. Waleed Brinjikji10,
  12. Louis J Kim11,
  13. Michael R Levitt12,
  14. Isaac Josh Abecassis13,
  15. Diederik O Bulters14,
  16. Andrew Durnford15,
  17. W Christopher Fox16,
  18. Adam J Polifka17,
  19. Bradley A. Gross18,
  20. Samir Sur1,
  21. David J McCarthy18,
  22. Dileep R Yavagal19,
  23. Eric C Peterson20,
  24. Minako Hayakawa21,
  25. Colin Derdeyn22,
  26. Edgar A Samaniego23,
  27. Sepideh Amin-Hanjani24,
  28. Ali Alaraj25,
  29. Amanda Kwasnicki26,
  30. Fady T Charbel25,
  31. J Marc C van Dijk27,
  32. Adriaan RE Potgieser28,
  33. Junichiro Satomi29,
  34. Yoshiteru Tada30,
  35. Adib Abla31,
  36. Ryan Phelps32,
  37. Rose Du33,
  38. Pui Man Rosalind Lai33,
  39. Gregory J Zipfel34,34,
  40. Robert M Starke1,35
  41. On behalf of the Consortium for Dural Arteriovenous Fistula Outcomes Research

Author affiliations

Abstract

Background Although the liquid embolic agent, Onyx, is often the preferred embolic treatment for cerebral dural arteriovenous fistulas (DAVFs), there have only been a limited number of single-center studies to evaluate its performance.

Objective To carry out a multicenter study to determine the predictors of complications, obliteration, and functional outcomes associated with primary Onyx embolization of DAVFs.

Methods From the Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) database, we identified patients who were treated for DAVF with Onyx-only embolization as the primary treatment between 2000 and 2013. Obliteration rate after initial embolization was determined based on the final angiographic run. Factors predictive of complete obliteration, complications, and functional independence were evaluated with multivariate logistic regression models.

Results A total 146 patients with DAVFs were primarily embolized with Onyx. Mean follow-up was 29 months (range 0–129 months). Complete obliteration was achieved in 80 (55%) patients after initial embolization. Major cerebral complications occurred in six patients (4.1%). At last follow-up, 84% patients were functionally independent. Presence of flow symptoms, age over 65, presence of an occipital artery feeder, and preprocedural home anticoagulation use were predictive of non-obliteration. The transverse-sigmoid sinus junction location was associated with fewer complications, whereas the tentorial location was predictive of poor functional outcomes.

Conclusions In this multicenter study, we report satisfactory performance of Onyx as a primary DAVF embolic agent. The tentorium remains a more challenging location for DAVF embolization, whereas DAVFs located at the transverse-sigmoid sinus junction are associated with fewer complications.


 
 

Pre-stroke physical activity and admission stroke severity: A systematic review

Useless. Nothing here helps any stroke survivor recover better. The mentors and senior researchers need to be fired for allowing this crapola. 

Pre-stroke physical activity and admission stroke severity: A systematic review

First Published February 23, 2021 Review Article Find in PubMed 

Admission stroke severity is an important clinical predictor of stroke outcomes. Pre-stroke physical activity contributes to stroke prevention and may also be associated with reduced stroke severity. Summarizing the evidence to date will inform strategies to reduce burden after stroke.

To summarize the published evidence for the relationship between pre-stroke physical activity and admission stroke severity and to provide recommendations for future research.

MEDLINE, Embase, Emcare, CENTRAL, and gray literature databases were searched on 14 February 2020 using search terms related to stroke and pre-stroke physical activity in adult stroke survivors. We screened 8,152 references and assessed 172 full-text references for eligibility. We included seven studies (n = 41,800 stroke survivors). All studies were observational, assessed pre-stroke physical activity using self-reported questionnaires, and assessed admission stroke severity using the National Institute of Health Stroke Scale. Analyses were categorized as the presence of pre-stroke physical activity (four studies) or dose-response (five studies). In three studies, presence of pre-stroke physical activity was associated with milder stroke severity, and no association in one study. Greater pre-stroke physical activity duration and intensity (two studies) or amount (three studies) were associated with milder stroke severity. Studies ranged between moderate to critical risk of bias, primarily due to confounding factors. Pre-stroke physical activity may be associated with reduced risk factors for severe stroke, distal occlusion, smaller infarcts, and shorter time-to-treatment delivery.

Pre-stroke physical activity may be associated with reduced admission stroke severity. Lack of randomized controlled trials limited causality conclusions. Future research recommendations were provided.

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First-ever ischemic stroke and increased risk of incident heart disease in older adults

 You have described a problem, offered NO SOLUTION. Useless.

You'll have to ask your doctor EXACTLY WHAT IS BEING DONE TO PREVENT THESE CARDIAC PROBLEMS. If they aren't even contacting researchers to get this solved they need to be fired.

First-ever ischemic stroke and increased risk of incident heart disease in older adults

Luciano A. Sposato, Melody Lam, Britney Allen, Lucie Richard, Salimah Z. Shariff, Gustavo Saposnik

This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.

Abstract

Objective Post stroke cardiac complications are common. It is unknown whether the reason is shared risk factors and preexisting heart disease or stroke-associated myocardial and coronary injury. We tested the hypothesis that first-ever ischemic stroke is associated with increased risk of incident cardiovascular complications in patients without known preexisting cardiac comorbid conditions.

Methods This population-based cohort study included residents in Ontario between 2002 and 2012 who were ≥66 years of age without known cardiovascular disease. We compared the incident risk of major adverse cardiovascular events (MACE), defined as myocardial infarction, unstable angina, congestive heart failure, coronary artery disease, coronary artery revascularization, or cardiovascular death, at 1 year in patients with first-ever ischemic stroke vs propensity-matched individuals without stroke (4:1 matching using 31 variables). To estimate cause-specific hazard ratios (HRs), we used Cox regression models adjusted for variables with weighted standardized differences >0.10 or known to influence the risk of MACE.

Results We included 21,931 patients with first-ever ischemic stroke and 71,696 propensity-matched individuals, well balanced on all variables used for propensity matching. First-ever ischemic stroke was associated with increased unadjusted incident MACE risk (HR 4.5, 95% confidence interval [CI] 4.3–4.8). MACE adjusted risk was highest in the first 30 days (HR 25.0, 95% CI 20.5–30.5) and declined both at 31 to 90 days (HR 4.8, 95% CI 4.1–5.7) and at 91 to 365 days (HR 2.2, 95% CI 2.0–2.4).

Conclusions In this large population-based study, ischemic stroke was independently associated with increased risk of incident MACE. Whether this association is explained by stroke-associated cardiac injury, preexisting subclinical cardiovascular comorbid conditions, or both remains unknown.

Glossary

CI=
confidence interval;
HR=
hazard ratio;
MACE=
major adverse cardiovascular events

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Editorial, page 644

  • CME Course: NPub.org/cmelist

 

Factors Associated with Poor Outcomes in Patients Undergoing Endovascular Therapy for Acute Ischemic Stroke due to Large-Vessel Occlusion in Acute Anterior Circulation: A Retrospective Study

Leaders would solve this problem, not just ask the question. But we have NO LEADERSHIP IN STROKE, and never will until survivors are in charge.  You notice they are not even measuring the correct goal, 100% recovery, just the intermediate goal of reperfusion.

Factors Associated with Poor Outcomes in Patients Undergoing Endovascular Therapy for Acute Ischemic Stroke due to Large-Vessel Occlusion in Acute Anterior Circulation: A Retrospective Study

a
Department of Neurology, the First Hospital of Jilin University, Changchun, China;
b
Department of Ultrasound, the First Hospital of Jilin University, Changchun, China;

Received 2 January 2021, Revised 12 February 2021, Accepted 13 February 2021, Available online 20 February 2021.

Abstract

Objective

To investigate factors associated with poor clinical outcomes in patients with acute ischemic stroke (AIS) undergoing endovascular therapy.

Methods

A retrospective review of 265 patients with AIS treated in the First Hospital of Jilin University between January 1, 2016 and November 1, 2019 was performed. The primary outcome was the proportion of patients with a modified Rankin score of 0–2 at 90 days. Univariate and multivariate analyses were performed to assess potential clinical factors associated with a poor 90-day outcome.

Results

The rates of successful revascularization,(NOT GOOD ENOUGH!) good prognosis, symptomatic intracranial hemorrhage (sICH), and mortality were 84.5%, 46.0%, 9.8%, and 12.8%, respectively. As per univariate analysis, age, diagnosis of atrial fibrillation, diagnosis of diabetes, high baseline glucose level, tandem occlusion, high National Institutes of Health Stroke Scale (NIHSS) score at admission, general anesthesia, number of passes, high NIHSS score on discharge, unsuccessful recanalization (modified treatment in cerebral ischemia [mTICI] score <2b), and development of sICH, hemorrhagic infarction, parenchymal hematoma, and subarachnoid hemorrhage were associated with poor prognosis. Tobacco use was positive in correlation with good prognosis in univariate analysis. Diabetes, tandem occlusion, high NIHSS score at admission, and general anesthesia were independent factors associated with poor 90-day outcome in multivariate analysis.

Conclusions

Diabetes, tandem occlusion, high NIHSS score at admission, and general anesthesia were independent risk factors associated with a poor 90-day outcome and should be considered a reference by neurointerventionalists in guiding their clinical decision-making.

 

Icometrix announces ischaemic stroke solution

I wondered if it does white matter damage from the stroke. It does find white matter hyperintensities from this research.  

How does icobrain enhance your radiological reporting for MS?

 

Because if white matter damage is found then that requires different protocols to solve. And your doctor has none.  

The latest here:

Icometrix announces ischaemic stroke solution

In a press release, icometrix announced the addition of icobrain cva, a stroke solution, to the icobrain portfolio. According to the company, this announcement follows clearance from the US Food and Drug Administration (FDA) and CE-marking of its image processing software for the analysis and communication of the tissue perfusion state on computer tomography (CT) perfusion scans in patients with ischaemic stroke. 

According to icometrix, the icobrain cva is a fully-automated software solution for the quantitative assessment of tissue perfusion on CT. The company claims that icobrain cva reports the volume of the core and perfusion lesion by quantifying reduced cerebral blood flow, volume, and transit time. Additionally, icometrix states the report includes information on the correctness of the selected arterial input function and the quality of the output.  

The press release details that icobrain cva provides physicians with fast, fully automated, and state-of-the-art insights to support treatment decisions in acute ischaemic stroke. It is further stated that the automated assessment of tissue parameters in an acute clinical setting by icobrain cva will allow more patients to get the right treatment and can improve patient outcomes and care while increasing efficiency. 

“With the launch of icobrain cva we address a persisting need in the treatment of acute ischaemic stroke. By democratising advanced CT perfusion analysis for healthcare systems worldwide, we take the next step in our mission to become a holistic brain solution provider,” says Wim Van Hecke, CEO at icometrix, Antwerp, Belgium. 

“The main challenge of current stroke solutions is correctly identifying the entry point of the injected contrast in the brain. icobrain cva introduces new, patented, deep learning technology into this identification process to achieve a more robust assessment of the infarcted area,” states Dirk Smeets, CTO at icometrix, Leuven, Belgium.

 

The Kickstart Walk Assist System for improving balance and walking function in stroke survivors: a feasibility study

The pictures show a Balance Master for testing your balance.

I was tested in one of these 4 weeks post-stroke. The force plates I was standing on could move side to side, front to back and tilt in various directions, all the while the three sides; front of you and each side were moving around. You were strapped into a harness to catch you when you fall. After it was all done my PT ran my scores thru the universe of  results and at that time my age of 50 results were better than the average 50 year old male. I just told him I would really have enjoyed that testing  challenge when I was healthy. It's like kneeling on a yoga ball for balance practice. This was all absolutely necessary for keeping upright in a squirrely whitewater canoe. My favorite was a Mad River Outrage. Ok, feeling sorry for myself again.

But is it better than this other spring loaded one? Your doctor has some comparisons to do. 

This was known about 5 years ago,did your doctor bring one in to help stroke patients recover? OR IS THAT NOT HIS/HER JOB?

Spring-based wearable device could help those with certain neurological conditions walk again December 2015

 

Or maybe this Levitation brace from December 2015 also.

World’s first ‘bionic knee brace’ returns energy to your joints to boost leg strength

 

The latest here, why was this research done?

The Kickstart Walk Assist System for improving balance and walking function in stroke survivors: a feasibility study

Abstract

Background

Compared with traditional physical therapy for stroke patients, lower extremity exoskeletons can provide patients with greater endurance and more repeatable and controllable training, which can reduce the therapeutic burden of the therapist. However, most exoskeletons are expensive, heavy or require active power to be operated. Therefore, a lighter, easy to wear, easy to operate, low-cost technology for stroke rehabilitation would be a welcome opportunity for stroke survivors, caregivers and clinicians. One such device is the Kickstart Walk Assist system and the purpose of this study was to determine feasibility of using this unpowered exoskeleton device in a sample of stroke survivors.

Methods

Thirty stroke survivors were enrolled in the study and experienced walking with the Kickstart exoskeleton device that provided spring-loaded assistance during gait. After 5 days of wearing the exoskeleton, participants were evaluated in the two states of wearing and not wearing the exoskeleton. Outcome measures included: (a) spatio-temporal gait measures, (b) balance measures and (c) exoskeleton-use feedback questionnaire.

Results

In comparison to not wearing the device, when participants wore the Kickstart walking system, weight bearing asymmetry was reduced. The time spent on the 10-m walk test was also reduced, but there was no difference in the timed-up-and-go test (TUGT). Gait analysis data showed reduction in step time and double support time. Stroke survivors were positive about the Kickstart walking system’s ability to improve their balance, speed and gait. In addition, their confidence level and willingness to use the device was also positive.

Conclusions

These findings show the feasibility of using the Kickstart walking system for improving walking performance in stroke survivors. Our future goal is to perform a longer duration study with more comprehensive pre- and post-testing in a larger sample of stroke survivors.

Trial registration Chinese Clinical Trial Registry, ChiCTR2000032665. Registered 5 May 2020—Retrospectively registered, http://www.chictr.org.cn/showproj.aspx?proj=53288

Background

Nearly one-third of strokes occur in people over the age of 65, and most stroke survivors have associated ambulation problems [1, 2]. In this population, the reduction in muscle mass and muscle strength frequently reduces their daily activities, confines them to bed, and reduces the ability to move, thus accelerating the degradation of the neuromuscular system. Stroke can lead to major impairments related to functional mobility [3,4,5] that consequently impacts independence and reduces the quality of life. Conventional gait therapy for stroke survivors, that is provided by therapists, can improve gait speed and endurance [6], especially when performed in the sub-acute stage [7]. However, it is demanding and exhausting for therapists and outcomes depend on the skill of the therapist which may vary a lot depending on experience and expertise. Devices that reduce this burden like the body weight support system or robot-assisted gait training devices like the Lokomat have other issues such as being too expensive and bulky, and may require superior technical skills to operate and therefore may not suitable for wide usage [8]. Therefore, in recent years, light and easy-to-operate exoskeletons have become popular which can help stroke survivors who are unable to stand independently to regain their ability to stand and walk [9].

Exoskeletons have been in development since at least the 1890′s [10]. In the past several decades, many universities, research institutions and companies have made great progress in developing exoskeleton-assisted rehabilitation devices [11, 12]. Based on power source types, exoskeletons can be categorized as active (powered by the external sources) or passive (self-powered through elastic components) [13,14,15]. Currently, several lower extremity exoskeletons are in the market that can assist with gait training in stroke survivors, including treadmill-based Lokomat [16], LokoHelp [17] and ReoAmbulator [18], and wearable systems such as Ekso GT [19], HAL-5 [20] and ReWalk [21]. They are mainly used for elderly people or patients who have lost walking ability due to stroke or spinal cord injury, so that they can walk, sit up, and climb stairs, thus reducing the burden on the caregiver and improving the quality of life of the patients [22].

Exoskeletal devices target characteristic deficiencies observed after a stroke—insufficient forward propulsion, reduced range of motion, hyper-reflexia which lead to compensatory strategies such as hip hiking, circumductory gait and elevated metabolic cost [23,24,25,26,27]. Compared with traditional physical therapy, lower extremity exoskeletons can provide patients with more repeatable and controllable training, which can reduce the treatment burden of the therapist, so that the therapist can pay attention to other aspects of the patient’s treatment [28].

Based on a Cochrane review of electromechanical and robotic-assisted training for walking after stroke [29], an analysis of 36 different research studies that involved over 1400 participants, it was shown that the use of such devices in combination with physical therapy can improve walking after stroke. These devices were shown to be safe and acceptable to most participants. It was noted that the improvement was greatest for those who were not ambulatory. Additionally, best results were obtained for treatment in the acute/sub-acute phase within 3 months of the stroke episode. It is important to note that a reason for the Cochrane review of this field was to determine the justification for large equipment and human resource costs that are needed to implement electromechanical-assisted gait devices.

Although in the past 20 years, research and development of robotic exoskeletons has grown rapidly, and many robotic-assisted systems have been successfully used in scientific research and clinical applications, the adoption rate remains very low. According to a survey of 1326 rehabilitation therapists in the US, about 2% of them used some robot-assisted devices for upper and lower movement rehabilitation [30]. Primary barriers to adoption include the lack of scientific evidence of effectiveness, high economic costs and low user-friendliness, which greatly limit clinical usage of robotic exoskeletons [31, 32]. While active devices, like Lokomat, provide several functional benefits to a variety of patient populations, these are only available to well-funded clinical facilities and research settings. Moreover, it is unrealistic for patients to use an active device by themselves because of its size, weight, cost, and complexity of use. Therefore, there is a significant need for lighter-weight, easy to wear, user-friendly, and low-cost technologies for walking training in stroke survivors.

The Kickstart® Walk Assist system is such a rehabilitation device that consists of a belt, an external support structure and an Exotendon (Fig. 1). The effect of the Exotendon is similar to an artificial tendon, which stores energy during the stance phase and releases it during the swing phase of the gait cycle. The Exotendon mechanism is inspired by the anatomical features of the hind limbs of the horse: in the hind limbs of the horse, several long tendons span multiple joints, and during the stance phase, the tendons stretch and store energy, and this stored energy is then used to initiate gait swing and consequently, reduce muscle exertion [33, 34]. Compared to other robotic lower extremity exoskeleton systems, the Kickstart walking system is lighter in weight, easier to wear and take off, and is inexpensive. In a series of case studies (2 stroke survivors and one spinal cord injury patient), it was shown that the Kickstart walking system could increase wearers' walking speed and endurance [35]. Unlike more tightly controlled exoskeletal systems like the Lokomat, the lightweight, spring-loaded Kickstart walking system could allow easier interaction with the environment that would be more explorative.

Fig. 1
figure1

The figure shows the setup for the weight bearing squat test in the a upright position and b The squatting position with the exoskeleton device attached unilaterally. c Shows a non-study participant walking with exoskeletal assistance on a set of force platforms in the gait lab that has motion capture cameras on the walls. d Shows the dial sticker that was attached to the hip piece to note the movement of the ratchet for tightening the exotendon cable

The purpose of this study was to determine the feasibility of using the Kickstart walking system in a sample of stroke survivors who were in the subacute and chronic stages of the disease and attending an inpatient rehabilitation center. Study participants were tested for several measures with/without the device after experiencing walking with the exoskeleton over a period of 5 days. Outcome measures included: (a) gait measures, (b) balance measures and (c) exoskeleton-use feedback questionnaire. Results from this study will help us to explore if the technology can offer a new option for encouraging the recovery of walking ability of stroke patients, optimizing the rehabilitation treatment strategy, and providing some reference for subsequent related research.