Deans' stroke musings: Enhancing the alignment of the preclinical and clinical stroke recovery research pipeline: Consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable translational working group

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.

Thursday, July 13, 2017

Enhancing the alignment of the preclinical and clinical stroke recovery research pipeline: Consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable translational working group

The expert panel included NO stroke survivors, so they are completely missing the boat.
http://journals.sagepub.com/doi/full/10.1177/1747493017711814

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Dale Corbett, S Thomas Carmichael, Timothy H Murphy, ...

First Published July 12, 2017 Research Article

Abstract

Stroke recovery research involves distinct biological and clinical targets compared to the study of acute stroke. Guidelines are proposed for the pre-clinical modeling of stroke recovery and for the alignment of pre-clinical studies to clinical trials in stroke recovery.

Keywords Rehabilitation, stroke recovery, translational medicine, stroke, consensus, neurorehabilitation, neurorecovery

Introduction

Moving treatments from the preclinical to the clinical realms is notoriously difficult. For all diseases, only 10% of agents that enter phase 1 trials result in a clinically used drug.^1,2 The success rate in stroke and traumatic brain injury is also low and well-documented.^3–5 The translational failure in stroke has been attributed to the narrow therapeutic window and to mistakes such as very broad inclusion criteria, and imprecise, global outcome measures.^3–5 On the preclinical side, depth and rigor of study design, analysis and interpretation have received special focus.
Stroke recovery involves distinct biological principles and a very different time window compared to stroke neuroprotection.^6–8 Unlike acute stroke, post-stroke behavioral activity shapes recovery and can be manipulated to promote recovery, or to negatively interact with recovery.^6,9 In addition, stroke recovery involves a unique biology of altered synaptic signaling, enhanced synaptic plasticity and changes in neuronal circuits that provide novel drug and cellular targets but also raise special considerations in clinical translation. The special considerations include: the animal stroke models, the tissue and behavioral outcome measures, imaging biomarkers and conceptual management of the full translational pipeline.
Recent conceptual and technological developments in neuroscience are bringing promising physical, pharmacological and cellular therapies to the field of neurorehabilitation and brain repair. This paper outlines a series of guidelines and recommendations specifically tailored to enhance the quality and rigor of preclinical stroke recovery research.
The task of the translational working group of the Stroke Recovery and Rehabilitation Roundtable (SRRR)¹⁰ was to develop a set of guidelines and recommendations appropriate for preclinical stroke recovery research. Existing preclinical stroke research recommendation papers (e.g. STAIR, STEPS) focus chiefly on acute stroke.^11,12 Although cognitive impairments and depression are common after stroke,¹³ the SRRR working groups concluded that these topics require a subsequent roundtable discussion so the emphasis here is on preclinical sensorimotor recovery. The ultimate goal of the translational group was to align preclinical to clinical stroke recovery studies so as to avoid past mistakes and maximize clinical translation.

Methodology

An expert panel of basic and clinical scientists was assembled. Care was taken to include individuals at early, mid and late career stages with broad geographical representation. To facilitate the process, a questionnaire was sent to each team member asking them to answer a series of questions including: 1. What are the top research priorities in the stroke recovery field; 2. What key animal models should be employed; 3. What core tissue and behavioral analyses and outcome measures should be used to assess post-stroke recovery and 4. What flaws or mistakes in this field have impeded progress towards clinical trials or development of new therapies? The responses showed a high level of consensus and were summarized, recirculated, and subsequently formed the basis for discussion at the two-day SRRR meeting held in Philadelphia in May 2016. The ensuing consensus guidelines and specific recommendations described herein were achieved after extensive discussion including input from the other three SRRR working groups (Biomarkers, Interventions, Measurements).