Deans' stroke musings: Priming the motor system enhances the effects of upper limb therapy in chronic stroke

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.

Tuesday, September 10, 2019

Priming the motor system enhances the effects of upper limb therapy in chronic stroke

'Speculation' is useless for stroke survivors

Priming the motor system enhances the effects of upper limb therapy in chronic stroke

Priming the motor system enhances the effectsof upper limb therapy in chronic stroke Cathy M. Stinear, 1 P. Alan Barber,2James P Coon,Melanie K.Fleming1 and Winston D. Byblow11 Movement Neuroscience Laboratory, Department of Sport & Exercise Science,University of Auckland and 2 Department of Medicine,University of Auckland, Auckland, New ZealandCorrespondence to: Winston D. Byblow, Movement Neuroscience Laboratory, Department of Sport & Exercise Science,University of Auckland, Private Bag 92019, Auckland, New ZealandE-mail: w.byblow@auckland.ac.nz After stroke, the function of primary motor cortex (M1) between the hemispheres may become unbalanced.T-balancing of M excitability may prime the brain to be more responsive to reha-bilitation therapies and lead to improved functional outcomes. The present y examined the effects of Active^Passive Bilateral Therapy (APBT), a putative movement-based priming strategy designed to reduce intracortical inhibition and increase excitability within the ipsilesional M1.Thirty-two patients with upper limbweakness at least 6 months after stroke were randomized to a 1-month intervention of self-directed motor practice with their affected upper limb (control group) or to APBT for10^15min prior to the same motor practice APBT group). A blinded clinical rater assessed upper limb function at baseline, and immediately and 1 month after the intervention. Transcranial magnetic stimulation was used to assess M1 excitability. Immediately after the intervention, motor function of the affected upper limb improved in both groups( P 5 0.005). One month after the intervention, the APBT group had better upper limb motor function than control patients ( P 5 0.05).The APBT group had increasedipsilesional M1excitability ( P 5 0.025), increased transcal-losal inhibition from ipsilesional to contralesional M1 ( >P 5 within contralesional M1 (P5 0.005).None of these changes were found in the control group. APBT produced sustained improvements in upper limb motor function in chronic stroke patients and induced specific and sustainedchangesin motor cortex inhibitory function.We speculate that APBT may have facilitated plastic reorganizationin the brain in response to motor therapy. The utility of APBTas an adjuvant to physical therapy warrants further consideration.