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.

Wednesday, November 30, 2022

'Do you fall?' Asked my doctor.

 Yep, when I'm out walking in the woods next to me.  Why the woods and not something safer like a mall? Well, the woods gives you forest bathing. Then she proceeded to tell me I should be walking with a partner. That will likely never occur, too regimented.

I should have told her that falling is probably the best way to prevent falls since you know what should be done to prevent them. Walking in the woods gives me tons of perturbations, which means my balance vastly improves on each perturbation.


Stroke Rehabilitation Guidelines for Exercise and Training to Optimize Motor Skill: Janet H Carr, Roberta B Shepherd

 I know Carr and Shepherd are famous in the stroke world but lets unpack what they aren't doing.

1. Guidelines; NOT PROTOCOLS

2. Optimize; NOT RECOVER

3. They also have bought into the tyranny of low expectations. Survivors deserve better than half assed work.  

Survivors want to know exactly how to recover, not just some possible exercises that might get you better. Better is NOT GOOD ENOUGH, survivors want 100% recovery.  GET THERE!

 

Oops, I'm not playing by the polite rules of Dale Carnegie,  'How to Win Friends and Influence People'. 

Politeness will never solve anything in stroke. Yes, I'm a bomb thrower and proud of it. Someday a stroke 'leader' will ream me out for making them look bad by being truthful , I look forward to that day.

 

  Stroke Rehabilitation Guidelines for Exercise and Training to Optimize Motor Skill: Janet H Carr, Roberta B Shepherd

Spasticity 101 - A debilitating yet treatable common condition after a stroke

Well, there are no effective treatments that cure spasticity, so lying once again about stroke.  I've had botox and muscle relaxants, neither of which did one damn bit of good for my spasticity.

Spasticity 101 - A debilitating yet treatable common condition after a stroke


MISSION, KS / ACCESSWIRE / November 28, 2022 / (Family Features) In the year following a stroke, about 1 in 3 stroke survivors will experience spasticity, a common post-stroke condition which causes muscle stiffness due to involuntary muscle contractions. Most commonly affecting the elbow, wrist and ankle, the condition may make it difficult to do activities people were able to do before their stroke like dressing, brushing their teeth or walking.

Family Features, Monday, November 28, 2022, Press release picture
Family Features, Monday, November 28, 2022, Press release picture

More than 3 million stroke survivors may wrestle with reduced independence and increased reliance on caregivers due to spasticity. The condition is particularly common in younger stroke survivors.


After a stroke, the way your brain communicates with your muscles may change. Muscles may be stiff or resistant to stretching. They may involuntarily contract or have a smaller range of motion.

"While there's no cure for spasticity,(Well, who the fuck is working on a cure? Solve the problem, don't just tell us it exists.) working with your care team to find the best treatment options for you can help provide comfort, relief and independence," said Richard D. Zorowitz, MD, volunteer past chair of the American Heart Association's Stroke Council Rehabilitation and Recovery Committee and chief medical informatics officer and outpatient attending physician at MedStar National Rehabilitation Network.

Some common symptoms include painful muscle spasms; difficulty stretching muscles; stiffness in the arm, hand, leg and ankle; an arm folded and pressed against the chest with a curled wrist and fingers; an involuntary tight fist; pointed foot; curled toes; and overactive reflexes.

If left untreated, spasticity can cause painful and debilitating bone and joint deformities. Experts stress seeing a doctor as soon as symptoms develop. Assessment of the condition is critical in developing a treatment plan based on individual needs and goals, the severity of the condition and overall health.

Management plans may include targeted injections of botulinum toxin, oral medications, intrathecal baclofen pump therapy, physical therapy or other methods to improve the muscles' ability to stretch and regain range of motion. Home modifications such as assistive devices and other adaptations to increase independence and safety may also help.

If you or a loved one is dealing with spasticity after a stroke, talk to your doctor or health care team about options to treat and manage it. Find resources and tools to help at Stroke.org/Spasticity. Spasticity education made possible through funding by Ipsen.

Family Features, Monday, November 28, 2022, Press release picture
Family Features, Monday, November 28, 2022, Press release picture

Knowing the Signs of Stroke Saved One Man's Life

When Herbert "Hub" Miller worked as a global leader for an international agriculture science company, his boss ended every meeting with a reminder of the "FAST" acronym to recognize the signs of stroke: Face drooping, Arm weakness, Speech difficulties and Time to call 911.

"I'd sit back and think, ‘Here comes the whole FAST speech again; let's move on,'" Miller said. "I didn't know I'd ever use it on myself."

In April 2021, Miller was working from home when he experienced throbbing head pain. As other symptoms began appearing, the 42-year-old remembered those meetings and checked off the symptoms: His face was numb, his left arm drooped and he struggled to form words.

It turned out to be a hemorrhagic stroke, a ruptured blood vessel bleeding into the brain. Miller's odds of surviving weren't good, but it wasn't until he was recovering in intensive care that he understood the full impact of the stroke. It caused abnormal increases in muscle tone causing stiffness, pain and spasms known as spasticity, leaving him with mobility and cognitive challenges.

After the stroke, Miller struggled with once-simple tasks like drawing a clock, completing a word puzzle and playing memory games.

"Spasticity changed my life and added an additional hurdle to my stroke recovery," Miller said. "Without being able to open and close my left hand, I can't write, type or drive like I used to. Those are things most of us take for granted until we can't do them."

Miller worked on his penmanship at the same time his youngest son learned to write in the first grade. Miller asked the teacher to send home extra worksheets, and father and son did homework together.

"I don't measure my success day by day, but when I look back to a year ago and where I am today, I am grateful every day how far I have come," he said.

Photo courtesy of Getty Images (patient undergoing physical therapy)

Michael French
mfrench@familyfeatures.com

The Effect of Neuromuscular Electrical Nerve Stimulation in the Management of Post-stroke Spasticity: A Scoping Review

Stroke survivors don't want spasticity 'managed'. They want it cured. GET THERE!

But there is no need to treat spaticity, Dr. William M. Landau says so in his uninformed expert opinion.  Survivors would immediately disabuse him of that notion. When schadenfreude hits him with his stroke he'll regret his ideas on the matter.

His statement from here:

Spasticity After Stroke: Why Bother? Aug. 2004 

The latest here:

The Effect of Neuromuscular Electrical Nerve Stimulation in the Management of Post-stroke Spasticity: A Scoping Review



Abstract

Stroke is a cerebrovascular disorder characterized by the sudden onset of symptoms and clinical signs caused by either vascular infraction or hemorrhage. One of the main symptoms in the majority of post-stroke patients is spasticity. The main therapeutic options of spasticity in post-stroke patients include pharmacological interventions, rehabilitation techniques, and surgery. This review aims to explore the effectiveness of Neuromuscular Electrical Stimulation (NMES) for post-stroke spastic hemiparetic limb (upper and lower). Thorough research of the PubMed Medline database was performed. Records were limited to clinical studies published between 01/01/2010 and 01/01/2022. The results were screened by the authors in pairs. The search identified 26 records. After screening, nine records met the inclusion-exclusion criteria and were assessed. There were seven studies for spastic upper limbs and two for spastic lower limbs. The approaches investigated the effectiveness of electrical stimulation on post-stroke spastic upper or lower limb. Spasticity was measured through the modified Ashworth scale (MAS) and electromyographic recordings (EMG). In most cases, spasticity was decreased for at least two weeks post-intervention. In conclusion, NMES can be used either solo or in combination with different physical therapy modalities in order to produce optimal results, taking into consideration the specific needs and limitations of each individual patient. Based on the existing literature, as well as the limitations of the included studies, the authors believe that future studies on the subject of NMES in the management of post-stroke spasticity should focus on carefully examining each electrical parameter.

Introduction & Background

Stroke is a cerebrovascular disorder characterized by the sudden onset of symptoms and clinical signs caused by either vascular infarction or hemorrhage [1]. It is considered one of the leading causes of death due to cardiovascular disease (CVD) worldwide, reaching a mortality rate of 33% of CVD patients in 2020 [1]. Simultaneously, the majority of strokes (ischemics and hemorrhagics) lead to long-term disability affecting the patient’s motor and sensory function, cognitive status, bladder, bowel, and sexual function [2].

One of the main symptoms in the majority of post-stroke patients (pSps) is spastisticity, a motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes with exaggerated tendon jerks, which is a typical sign of upper motor-neuron syndrome (UMNS). Spasticity is considered a “positive” feature of UMNS due to the loss of inhibition of the lower motor neuron pathways resulting from a sensory-motion control disorder in the muscle regulation system. PSps usually present with an eclectic, lateralized sensory and motor disorder, with their affected upper limb exhibiting a hypertonic flexion pattern while the equilateral lower limb exhibits a hypertonic extension pattern [2].

With one out of five first-ever stroke patients developing spasticity, many studies have examined and demonstrated its negative impact on the quality of life (QoL) of pSps due to the reduction of the mobility and functional use of the affected limbs, which restricts the person from working, performing daily life activities (ADL) and socializing. In addition, a significant percent of pSps exhibits a high degree of disability, thus needing around-the-clock assistance from a caregiver (usually a family member) [2].

The main therapeutic options of spasticity in post-stroke patients include botulinum toxin intramuscular injections, baclofen (per os or via intrathecal pump), intraneural phenol injections, surgical procedures aiming at altering the muscular, neural, or tendon structures, and physical therapy, which consists of stretching and strengthening exercises, hydrotherapy, and electrical stimulation (ES) [3].

Electrical stimulation is a supplementary modality with a variety of types that is utilized to increase muscle strength, reduce pain, and reduce hypertonia in the affected limbs [3,4]. Neuromuscular nerve stimulation (NMES) is a specific type of electrical stimulation that is used to produce muscle contractions through the application of an electrical stimulus in the distal part of a specific nerve [3,5]. Since the electrical excitability of lower motor units (and their respective innervated muscles) is usually intact, NMES can be used to stimulate the neuromuscular activity of the affected limbs with either direct stimulation of the affected muscles or the stimulation of their antagonists solo or in parallel with robotic assistive devices [6,7].

The purpose of this scoping review is to investigate the effectiveness of NMES in increasing the mobility and/or functionality of the affected upper and lower limb in pSps.

More at link.

Adiposity in the older population and the risk of dementia: The Rotterdam Study

I'm not sure women want to keep this fat as a preventative to dementia.

Gynoid fat is the body fat that forms around the hips, breasts and thighs.[1] Gynoid fat in females is used to provide nourishment for offspring, and is often referred to as 'reproductive fat'. 

Adiposity in the older population and the risk of dementia: The Rotterdam Study

First published: 29 November 2022

Sanne S. Mooldijk and Tosca O. E. de Crom contributed equally to this study.

Abstract

Introduction

We determined associations of total and regional adiposity with incident dementia among older adults.

Methods

Within the population-based Rotterdam Study, adiposity was measured as total, android, and gynoid fat mass using dual-energy X-ray absorptiometry in 3408 men and 4563 women, every 3 to 6 years between 2002 and 2016. Incident dementia was recorded until 2020.

Results

Higher adiposity measures were associated with a decreased risk of dementia in both sexes. After excluding the first 5 years of follow-up, only the association of gynoid fat among women remained significant (hazard ratio 0.85 [95% confidence interval 0.75–0.97] per standard deviation increase). No major differences in trajectories of adiposity measures were observed between dementia cases and dementia-free controls.

Discussion

Higher total and regional fat mass related to a decreased risk of dementia. These results may be explained by reverse causality, although a protective effect of adiposity cannot be excluded.

Highlights

  • Total and regional adiposity were assessed using dual-energy X-ray absorptiometry scans in 7971 older adults.
  • All adiposity measures were associated with a decreased risk of dementia.
  • The results suggest a beneficial effect of gynoid fat on the risk of dementia in women.
  • Reverse causation and competing risk may explain these inverse associations.

1 INTRODUCTION

Obesity and dementia are both substantial public health problems worldwide.1, 2 Obesity during mid-life is a well-established risk factor for dementia later in life,3-5 which may be explained by excessive adipose tissue.6 Especially visceral fat, located around the abdominal organs, is thought to underlie this via metabolic dysfunction, for example, hypertension, insulin resistance, and dyslipidemia.7, 8

Although visceral fat at older age likely affects the brain through similar metabolic dysfunctions, obesity at older age has consistently been linked to a decreased risk of dementia.4, 9-12 This may be explained by reverse causality, that is, weight loss caused by preclinical dementia symptoms,13-15 but biological mechanisms for a protective effect of subcutaneous adipose tissue in the gynoid (i.e., hips) region have also been suggested.16, 17 These different health effects of adipose tissue deposits highlight the need to differentiate between total and regional adipose tissue, particularly in older adults, as adipose tissue increases and the distribution changes during the aging process.18

Yet, existing literature on the link between obesity and the risk of dementia mostly used body mass index (BMI) or waist circumference as marker of obesity, which do not necessarily reflect the amount and location of adipose tissue.19-22 Alternatively, total and regional fat mass can be obtained using dual-energy X-ray absorptiometry (DXA), which allows the quantification of fat in the android (i.e., abdominal) and gynoid region.21 Android fat accumulation is typically seen in men and includes visceral fat, while gynoid fat is typically seen in women and comprises of subcutaneous fat.

To improve the understanding of the effects of adiposity on the risk of dementia among older adults, we examined associations of measures of adiposity derived from DXA scans, namely total body mass, total fat mass, android fat mass, and gynoid fat mass, with the risk of dementia in men and women separately. In addition, to understand the potential role of reverse causality in this association, we determined trajectories of adiposity measures before dementia diagnosis and compared those to trajectories of dementia-free controls.

 
More at link.

Ultra-Long Transfers for Endovascular Thrombectomy—Mission Impossible?: The Australia-New Zealand Experience

It makes zero difference in the requirements of the patient, it is still 100% RECOVERY. Don't you dare use distance or time as an excuse not to get there. 

Ultra-Long Transfers for Endovascular Thrombectomy—Mission Impossible?: The Australia-New Zealand Experience

and on behalf of the ANZ Ultra-Long EVT Transfer Group
Originally publishedhttps://doi.org/10.1161/STROKEAHA.122.040480Stroke. 2022;0

BACKGROUND:

Endovascular thrombectomy (EVT) access in remote areas is limited. Preliminary data suggest that long distance transfers for EVT may be beneficial; however, the magnitude and best imaging strategy at the referring center remains uncertain. We hypothesized that patients transferred >300 miles would benefit from EVT, achieving rates of functional independence (modified Rankin Scale [mRS] score of 0–2) at 3 months similar to those patients treated at the comprehensive stroke center in the randomized EVT extended window trials and that the selection of patients with computed tomography perfusion (CTP) at the referring site would be associated with ordinal shift toward better outcomes on the mRS.

METHODS:

This is a retrospective analysis of patients transferred from 31 referring hospitals >300 miles (measured by the most direct road distance) to 9 comprehensive stroke centers in Australia and New Zealand for EVT consideration (April 2016 through May 2021).

RESULTS:

There were 131 patients; the median age was 64 [53–74] years and the median baseline National Institutes of Health Stroke Scale score was 16 [12–22]. At baseline, 79 patients (60.3%) had noncontrast CT+CT angiography, 52 (39.7%) also had CTP. At the comprehensive stroke center, 114 (87%) patients underwent cerebral angiography, and 96 (73.3%) proceeded to EVT. At 3 months, 62 patients (48.4%) had an mRS score of 0 to 2 and 81 (63.3%) mRS score of 0 to 3. CTP selection at the referring site was not associated with better ordinal scores on the mRS at 3 months (mRS median of 2 [1–3] versus 3 [1–6] in the patients selected with noncontrast CT+CT angiography, P=0.1). Nevertheless, patients selected with CTP were less likely to have an mRS score of 5 to 6 (odds ratio 0.03 [0.01–0.19]; P<0.01).

CONCLUSIONS:

In selected patients transferred >300 miles, there was a benefit for EVT, with outcomes similar to those treated in the comprehensive stroke center in the EVT extended window trials. Remote hospital CTP selection was not associated with ordinal mRS improvement, but was associated with fewer very poor 3-month outcomes.

Tuesday, November 29, 2022

‘Historic’ breakthrough Alzheimer’s drug may be available from next year, says expert

FYI. Do you really think your hospital is following this because you'll likely need it? 

Your risk of dementia, has your doctor told you of this?

1. A documented 33% dementia chance post-stroke from an Australian study?   May 2012.

2. Then this study came out and seems to have a range from 17-66%. December 2013.`    

3. A 20% chance in this research.   July 2013.

4. Dementia Risk Doubled in Patients Following Stroke September 2018

‘Historic’ breakthrough Alzheimer’s drug may be available from next year, says expert

The breakthrough drug has been hailed as the "beginning of the end" of the war on Alzheimer's disease.

Patients could receive the game-changing Alzheimer’s treatment as early as next year, a top expert has predicted. But scientists have warned dementia services have much to do to deliver the drug if it gets regulatory approval. Drastic changes will be needed in UK clinics to accommodate the five percent of patients eligible for the drug, they cautioned.

The drug, Lecanemab, has been shown to clear the brain of toxic amyloid protein and delay the onset of symptoms during trials, making it the world-first treatment to slow brain decline.

Top geneticist Professor Sir John Hardy said he was confident a new era of treatments targeting amyloid was on the horizon.

He joined others in warning that the UK had too few clinics to diagnose the disease early.

NHS waiting times would need to be significantly reduced or patients will miss out, he added.


Continuity of Care Advocate Model (CCAM): Healthcare Workers’ Perspectives on Quality Stroke Care at an Acute Unit, Rehabilitation Center and Community Rehabilitation Program in Singapore

You don't ask staff what constitutes quality stroke 'care'. You ask patients what constitutes QUALITY STROKE RECOVERY. And that is only one question. Are you fully recovered? Y/N?

Continuity of Care Advocate Model (CCAM): Healthcare Workers’ Perspectives on Quality Stroke Care at an Acute Unit, Rehabilitation Center and Community Rehabilitation Program in Singapore

Abstract

Physicians, nurses, social workers, and allied health professionals including physiotherapists and occupational therapists play important roles as they work closely with stroke survivors to improve functional independence in daily activities and quality of life. Yet, in Singapore little is known about their perspectives on what constitute quality stroke care based on their clinical experiences. In this project, our qualitative interviews with 15 healthcare workers at a major stroke center in the country yielded a Continuity of Care Advocate Model (CCAM) to help us better understand our participants’ experience-based perspectives on quality stroke care(NOT RESULTS!). We found that CCAM, constructed based on the perspectives of HCWs across a stroke care continuum, is a holistic model of quality stroke care(NOT RESULTS!) which prioritizes support for patients and their families throughout the patient’s health trajectory. We conclude by discussing how this model is aligned with and differs from current research on definitions of care continuity.

Get full access to this article

Stroke Rehabilitation: AB No: 124: Do Kinematic variables have an added advantage over clinical variables in Predicting Upper Extremity Motor Recovery Post-Stroke?

What good does doing research that only predicts failure to recover? SOLVE THE FUCKING PROBLEM OF 100% STROKE RECOVERY!

 Stroke Rehabilitation: AB No: 124: Do Kinematic variables have an added advantage over clinical variables in Predicting Upper Extremity Motor Recovery Post-Stroke?

Purpose: Measurement of movement quality is essential to distinguish motor recovery patterns and optimize rehabilitation strategies post-stroke. The purpose of this study was to assess the added advantage of kinematic over clinical measures for predicting post-stroke upper extremity (UE) recovery by developing a regression model comprising of both.
Relevance: 
Meticulously formulated prognostic models could be used by rehabilitation specialists for improving prediction accuracy in stroke survivors.
Participants: 
This study comprises of 89 acute to early sub-acute stroke survivors (58.8 ± 11.8 years, 61 males)
Methods: 
Baseline characteristics, demographics, grip and pinch strength were measured within 7 days and 3D kinematic analysis of a simulated drinking task was performed within 1-month post-stroke. The sensorimotor impairment through Fugl Meyer Assessment of Upper Extremity (FM-UE) was assessed at 3-months. Kinematic metrics of time, displacement, velocity, shoulder and elbow angles and reaction time were determined.  
Results: 
Clinical variables were available for 89 participants by 7 days and kinematic for 50 individuals at 1 month. A strong correlation was found between FM-UE at three months with Shoulder Abduction Finger Extension (r=0.84), Nottingham Sensory Assessment (r=0.84), Motricity index (r=0.82), National Institutes of Health Stroke Scale (r=0.75), and moderate with pinch (r=0.69) and grip strength (r=0.62) measured within 7 days post-stroke. We found a weak correlation between FM-UE at 3 months with velocity (r=0.53), time (r= -0.43) and displacement (r=0.38). However, on combining clinical and kinematic variables the linear regression model was found to have an R2 value of 0.85. Conclusion: This model would help us predict impairment at 3 months for 85% stroke survivors with similar characteristics. However, kinematic variables should be used as an adjunct to clinical variables in order to comprehensively predict UE recovery in stroke survivors.  
Implications: 
 Predicting the amount of post-stroke recovery would enable us in realistic goal formation (So you're trying to justify your use of the tyranny of low expectations as to why you can't get your patients recovered. I'd fire anyone using that excuse.)
 
 
 
 
 
 
) and for planning rehabilitation to improve recovery potential.




 Manipal College of Health Professions, Manipal Academy of Higher Education

Correspondence Address:
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2456-7787.361075

A deuterohemin peptide protects cerebral ischemia-reperfusion injury by preventing oxidative stress in vitro and in vivo

 Sounds like this needs immediate human testing. But will never occur with NO stroke leadership or strategy.

A deuterohemin peptide protects cerebral ischemia-reperfusion injury by preventing oxidative stress in vitro and in vivo



https://doi.org/10.1016/j.yexcr.2022.113432Get rights and content

Abstract

Cerebral ischemia-reperfusion injury (CIRI) is a brain injury that usually occurs during thrombolytic therapy for acute ischemic stroke and impacts human health. Oxidative stress is one of the major causative factors of CIRI. DhHP-3 is a novel peroxidase-mimicking enzyme that exhibits robust reactive oxygen species (ROS) scavenging ability in vitro. Here, we established in vitro and in vivo models of cerebral ischemia-reperfusion to mechanistically investigate whether DhHP-3 can alleviate CIRI. DhHP-3 could reduce ROS, down-regulate apoptotic proteins, suppress p53 phosphorylation, attenuate the DNA damage response (DDR), and inhibit apoptosis in SH-SY5Y cells subjected to oxygen-glucose deprivation/re-oxygenation (OGD/R) and in the brain of Sprague Dawley rats subjected to transient middle cerebral artery occlusion. In conclusion, DhHP-3 has bioactivity of CIRI inhibition through suppression of the ROS-induced apoptosis.


Comparison of Bilateral and Unilateral Training for Upper Extremity Hemiparesis in Stroke

 Further research required since this only is for moderately impaired chronic stroke survivors. Did your stroke hospital implement this from 13 years ago or was their rehab already so successful they didn't need anything newer?

Comparison of Bilateral and Unilateral Training for Upper Extremity Hemiparesis in Stroke

2009, Neurorehabilitation and Neural Repair

Abstract

Background. 
Upper extremity hemiparesis is the most common poststroke disability. Longitudinal studies have indicated that 30% to 66% of stroke survivors do not have full arm function 6 months poststroke. One promising treatment approach is bilateral training. To date, no randomized, blinded study of efficacy comparing 2 groups (bilateral training vs unilateral training) using analogous tasks has been performed in chronic stroke survivors with moderate upper extremity impairment. 
Objective
To compare the effectiveness of bilateral training with unilateral training for individuals with moderate upper limb hemiparesis. The authors hypothesized that bilateral training would be superior to unilateral training in the proximal extremity but not the distal one.  
Methods
Twenty-four subjects participated in a randomized, single-blind training study. Subjects in the bilateral group (n = 12) practiced bilateral symmetrical activities, whereas the unilateral group (n = 12) performed the same activity with the affected arm only. The activities consisted of reaching-based tasks that were both rhythmic and discrete. The Motor Assessment Scale (MAS), Motor Status Scale (MSS), and muscle strength were used as outcome measures. Assessments were administered at baseline and posttraining by a rater blinded to group assignment.  
Results
Both groups had significant improvements on the MSS and measures of strength. The bilateral group had significantly greater improvement on the Upper Arm Function scale (a subscale of the MAS-Upper Limb Items).  
Conclusion
Both bilateral and unilateral training are efficacious for moderately impaired chronic stroke survivors. Bilateral training may be more advantageous for proximal arm function.
 
 

Bandaid removal failure

 Got the Flu and Pneumonia shots. One in each upper arm with a Bandaid put on the sites. Left arm one was easy to remove, good right arm/hand can easily do the job. The right arm took me rubbing it against the sharp edge of my bathroom mirror to get it halfway off. Then had to continually rub it against a sharp edge of a door frame to get it further. Finally was able to use a long scissors in my right hand to get it removed. I blame my doctor for HAVING NOTHING TO RECOVER MY LEFT HAND.  My therapist justified the hand recovery failure by quoting research that said that if you don't have movement at six weeks you're not likely to get it back. I didn't have the presence of mind back then to ask her what she was doing to change that failure to a success. 

Every single failure in your stroke recovery should initiate a plan from your doctor, therapists and hospital to change that failure to recovery.  If they are not doing that, they are sitting on the failures of the status quo and calling it good. Which means you don't have a functioning stroke doctor or hospital.

Monday, November 28, 2022

Does Diet Matter? Study Questions Links Between Diet and Dementia

Interesting, ask your doctor to clarify.

Does Diet Matter? Study Questions Links Between Diet and Dementia

Diet combined with other risk-reduction strategies may show different results

A photo of a mature couple chopping vegetables in the kitchen.

Midlife dietary habits were not tied to dementia incidence over a 20-year period, a prospective study in Sweden showed.

Adhering to conventional dietary recommendations or to a modified Mediterranean diet was not linked with lower incidence of all-cause dementia, Alzheimer's disease dementia, vascular dementia, or amyloid pathology, reported Isabelle Glans, MD, of Lund University in Sweden, and colleagues.

"The study does not exclude a possible association between diet quality and subsequent development of dementia," they wrote in Neurology.

"However, the present Swedish dietary recommendations, which are in line with those in the U.K. and U.S., or according to the Mediterranean dietary pattern, could not be confirmed to be associated with prevention of dementia," the researchers added.

It's "critically important to better understand the links between diet and nutrition and dementia risk," observed Heather Snyder, PhD, vice president of medical and scientific relations at the Alzheimer's Association in Chicago, who wasn't involved with the study.

"To get there, the connections between diet and dementia risk must be examined in multiple studies across multiple populations and even multiple countries," Snyder told MedPage Today.

"These new results represent one study and should be considered in the bigger landscape of the ongoing work," she emphasized. "This is an observational study that can find an association between factors, but does not prove causation. For that, we need an intervention study. Fortunately, there are studies today that are testing dietary and nutrition-related interventions."

"Beyond that, existing data suggest that there is synergy between different risk-reduction strategies and these strategies should be considered in combination, not one at a time," Snyder pointed out. For example, the 2-year U.S. POINTER trial is evaluating whether lifestyle interventions that target multiple risk factors can benefit people with a higher risk of cognitive decline.

The Swedish study isn't the first to suggest diet and dementia are not related. "The findings are overall in line with previous long-term studies addressing this topic," noted Nils Peters, MD, of the University of Basel in Switzerland, and Benedetta Nacmias, PhD, of the University of Florence in Italy, in an accompanying editorial.

"Diet as a singular factor may not have a strong enough effect on cognition, but is more likely to be considered as one factor embedded with various others, the sum of which may influence the course of cognitive function (diet, regular exercise, vascular risk factor control, avoiding cigarette smoking, drinking alcohol in moderation, etc.)," they wrote. "Thus, diet should rather be regarded as one part of a multidomain intervention with respect to cognitive performance."

Glans and colleagues followed 28,025 people in the Swedish population-based Malmö Diet and Cancer Study who were dementia-free at baseline and who had baseline exams from 1991-1996. Mean baseline age was 58 and 61% were women.

The researchers used a 7-day food diary, a detailed food frequency questionnaire, and a 45-60 minute interview to evaluate dietary habits at baseline.

Swedish dietary guidelines scores, designed to reflect a healthy diet based on Swedish nutritional guidelines, were calculated based on average daily food intake. Eating patterns also were assessed by adherence to a modified Mediterranean diet that focused on a high intake of vegetables, legumes, fruits, fish, and healthy fats and a low intake of dairy products, meat, and saturated fatty acids.

Dementia diagnoses were determined by memory clinic physicians. A subpopulation of 738 participants had analyses of cerebrospinal fluid (CSF) levels of amyloid-beta 42 when they were referred to the Skåne University Hospital in Malmö memory clinic after developing clinical signs of cognitive impairment.

The primary outcome was progression to all-cause dementia. Secondary outcomes were progression to Alzheimer's dementia and vascular dementia. Over a median follow-up of 19.8 years, 1,943 people (6.9%) were diagnosed with all-cause dementia.

A comparison of worst-versus-best adherence to conventional dietary recommendations showed no difference in risk of all-cause dementia (HR 0.93, 95% CI 0.81-1.08), Alzheimer's dementia (HR 1.03, 0.85-1.23) or vascular dementia (HR 0.93, 95% 0.69-1.26).

Likewise, worst-versus-best adherence to a modified Mediterranean diet did not lower the risk of developing all-cause dementia (HR 0.93, 95% 0.75-1.15), Alzheimer's dementia (HR 0.90, 95% 0.68-1.19) or vascular dementia (HR 1.00, 95% 0.65-1.55).

In sensitivity analyses, results were similar when excluding people who developed dementia within 5 years or people with diabetes. Neither conventional diet recommendations nor a modified Mediterranean diet had a significant association with abnormal CSF amyloid-beta markers.

The results come with several caveats, Glans and colleagues noted. Dietary data were collected only at baseline and dietary habits may have changed during the follow-up period. In addition, participants with CSF samples were not randomized, but were recruited based on clinical indications.

"Randomized controlled trials are needed to provide additional evidence regarding the potential role of diet in relation to Alzheimer's disease pathology," they wrote.

  • Judy George covers neurology and neuroscience news for MedPage Today, writing about brain aging, Alzheimer’s, dementia, MS, rare diseases, epilepsy, autism, headache, stroke, Parkinson’s, ALS, concussion, CTE, sleep, pain, and more. Follow

Disclosures

The study was funded by the Swedish Research Council, the Knut and Alice Wallenberg Foundation, the Marianne and Marcus Wallenberg Foundation, the Strategic Research Area MultiPark at Lund University, the Swedish Alzheimer Foundation, the Swedish Brain Foundation, the Parkinson Foundation of Sweden, the Konung Gustaf V:s och Drottning Victorias Frimurarestiftelse, the Skåne University Hospital Foundation, Regionalt Forskningsstöd, and the Swedish federal government.

Glans dislcosed no relationships with industry. Co-authors disclosed relationships with F. Hoffmann-La Roche, Biogen, Geras Solutions, AVID Radiopharmaceuticals, Eli Lilly, Eisai, GE Healthcare, Pfizer, Genentech, Siemens, Alzpath, and Cerveau.

Peters and Nacmias disclosed no relationships with industry.

Putting together a queen bed frame

 Finally got a queen bed again so I can do some rehab without having to get down on the floor. It's a mortise and tenon bed from Thuma so  just push together assembly. Have to get a queen mattress delivered yet.

The bed post with the multiple mortises for the rails.














It was quite the challenge to hold the first rail level with the floor so the second rail could be pushed into the joint.

The bed post after both rails are installed















The full frame put together















With slats added, just had to roll them out.


Trunk Restraint to Promote Upper Extremity Recovery in Stroke Patients: A Systematic Review and Meta-Analysis

 This would have done nothing for me, my whole reaching problem is spasticity, both arm and hand. Without the ability to open the hand reaching is useless. So solve spasticty first.

Trunk Restraint to Promote Upper Extremity Recovery in Stroke Patients: A Systematic Review and Meta-Analysis

2014, Neurorehabilitation and Neural Repair
 Seng Kwee Wee, PT
1,2
, Ann-Marie Hughes, PhD
1
, Martin Warner, PhD
1
, and Jane H. Burridge, PhD
1

Abstract

Background.
 Many stroke patients exhibit excessive compensatory trunk movements during reaching. Compensatory movement behaviors may improve upper extremity function in the short-term but be detrimental to long-term recovery.
Objective.  
To evaluate the evidence that trunk restraint limits compensatory trunk movement and/or promotes better upper extremity recovery in stroke patients.
 Methods.  
A search was conducted through electronic databases from January 1980 to June 2013. Only randomized controlled trials (RCTs) comparing upper extremity training with and without trunk restraint were selected for review. Three review authors independently assessed the methodological quality and extracted data from the studies. Meta-analysis was conducted when there was sufficient homogenous data.
Results. Six RCTs involving 187 chronic stroke patients were identified. Meta-analysis of key outcome measures showed that trunk restraint has a moderate statistically significant effect on improving Fugl-Meyer Upper Extremity (FMA-UE) score, active shoulder flexion, and reduction in trunk displacement during reaching. There was a small, nonsignificant effect of trunk restraint on upper extremity function.
Conclusion. 
Trunk restraint has a moderate effect on reduction of upper extremity impairment in chronic stroke patients, in terms of FMA-UE score, increased shoulder flexion, and reduction in excessive trunk movement during reaching. There is insufficient evidence to demonstrate that trunk restraint improves upper extremity function and reaching trajectory smoothness and straightness in chronic stroke patients. Future research on stroke patients at different phases of recovery and with different levels of upper extremity impairment is recommended.

Sunday, November 27, 2022

As Gen X and Boomers Age, They Confront Living Alone

I've been living alone now for 10 years. I can't see getting married, it would severely limit my traveling and social connections. But there are quite a few old college roommates which could work.

Martha Gellhorn on her relationship with Ernest Hemingway

I do very well without marriage
I'd rather sin respectably any day of the week
Ernest thinks, of course, that marriage saves you a lot of trouble and he is all for it,
I think sin is very clean, there are no strings attached to it

As Gen X and Boomers Age, They Confront Living Alone

Jay Miles has lived his 52 years without marriage or children, which has suited his creative ambitions as a videographer in Connecticut and, he said, his mix of “independence and stubbornness.” But he worries about who will take care of him as he gets older.

Donna Selman, a 55-year-old college professor in Illinois, is mostly grateful to be single, she said, because her mother and aunts never had the financial and emotional autonomy that she enjoys.

Mary Felder, 65, raised her children, now grown, in her row house in Philadelphia. Her home has plenty of space for one person, but upkeep is expensive on the century-old house.

Sign up for The Morning newsletter from the New York Times

Felder, Miles and Selman are members of one of the country’s fastest-growing demographic groups: people 50 and older who live alone.

In 1960, just 13% of American households had a single occupant. But that figure has risen steadily, and today it is approaching 30%. For households headed by someone 50 or older, that figure is 36%.

Nearly 26 million Americans 50 or older now live alone, up from 15 million in 2000. Older people have always been more likely than others to live by themselves, and now that age group — baby boomers and Gen Xers — makes up a bigger share of the population than at any time in the nation’s history.

The trend has also been driven by deep changes in attitudes surrounding gender and marriage. People 50-plus today are more likely than earlier generations to be divorced, separated or never married.

Women in this category have had opportunities for professional advancement, homeownership and financial independence that were all but out of reach for previous generations of older women. More than 60% of older adults living by themselves are female.

“There is this huge, kind of explosive social and demographic change happening,” said Markus Schafer, a sociologist at Baylor University who studies older populations.

In interviews, many older adults said they feel positively about their lives.

But while many people in their 50s and 60s thrive living solo, research is unequivocal that people aging alone experience worse physical and mental health outcomes and shorter life spans.

And even with an active social and family life, people in this group are generally more lonely than those who live with others, according to Schafer’s research.

In many ways, the nation’s housing stock has grown out of sync with these shifting demographics. Many solo adults live in homes with at least three bedrooms, census data shows, but find that downsizing is not easy because of a shortage of smaller homes in their towns and neighborhoods.

Compounding the challenge of living solo, a growing share of older adults — about 1 in 6 Americans 55 and older — do not have children, raising questions about how elder care will be managed in the coming decades.

“What will happen to this cohort?” Schafer asked. “Can they continue to find other supports that compensate for living alone?”

Planning for the Future

For many solo adults, the pandemic highlighted the challenges of aging.

Selman, the 55-year-old professor, lived in Terre Haute, Indiana, when COVID-19 hit. Divorced for 17 years, she said she used the enforced isolation to establish new routines to stave off loneliness and depression. She quit drinking and began regularly calling a group of female friends.

This year, she got a new job and moved to Normal, Illinois, in part because she wanted to live in a state that better reflected her progressive politics. She has met new friends at a farmers’ market, she said, and is happier than she was before the pandemic, even though she occasionally wishes she had a romantic partner to take motorcycle rides with her or just to help carry laundry up and down the stairs of her three-bedroom home.

She regularly drives 12 hours round trip to care for her parents near Detroit, an obligation that has persuaded her to put away her retirement fantasy of living near the beach, and move someday closer to her daughter and grandson, who live in Louisville, Kentucky.

“I don’t want my daughter to stress out about me,” she said.

Watching their own parents age seems to have had a profound effect on many members of Gen X, born between 1965 and 1980, who say they doubt that they can lean on the same supports that their parents did: long marriages, pensions, homes that sometimes skyrocketed in value.

When his mother died two years ago, Miles, the videographer, took comfort in moving some of her furniture into his house in New Haven, Connecticut.

“It was a coming home psychologically,” he said, allowing him to feel rooted after decades of cross-country moves and peripatetic career explorations, shifting from the music business to high school teaching to producing films for nonprofits and companies.

“I still feel pretty indestructible, foolishly or not,” he said.

Still, caring for his divorced mother made him think about his own future. She had a government pension, security he lacks. Nor does he have children.

“I can’t call my kid,” he added, “the way I used to go to my mom’s house to change light bulbs.”

His options for maintaining independence are “all terrible,” he said. “I’m totally freaked out by it.”

Several Gen X solo dwellers said they had begun exploring options to live communally as they age, inspired, in part, by living arrangements they had enjoyed in college years and young adulthood.

“I’ve been talking to friends about end-of-life issues and how we might want to get together,” said Patrick McComb, 56, of Riverview, Michigan, a graphic artist. “Being alone till the end would not be the worst thing in the world. But I would prefer to be with people.”

With Space to Spare

Katy Mattingly, 52, an executive secretary, bought a house in Ypsilanti, Michigan, three years ago. It is small but offers plenty of space, with three bedrooms.

The question for her, and many other single homeowners, is whether they can cash in when they get older.

Mattingly said she did not think she would ever be able to pay down the mortgage and build wealth.

“It’s implausible that I’ll ever be able to retire,” she said.

Living solo in homes with three or more bedrooms sounds like a luxury but, experts said, it is a trend driven less by personal choice than by the nation’s limited housing supply. Because of zoning and construction limitations in many cities and towns, there is a nationwide shortage of homes below 1,400 square feet, which has driven up the cost of the smaller units, according to research from Freddie Mac.

Forty years ago, units of less than 1,400 square feet made up about 40% of all new home construction; today, just 7% of new builds are smaller homes, despite the fact that the number of single-person households has surged.

This has made it more difficult for older Americans to downsize, as a large, aging house can often command less than what a single adult needs to establish a new, smaller home and pay for their living and health care expenses in retirement.

People in this group often face the reality that “it’s more expensive to get a smaller condo than the single family you’re selling — and that presumes the condo exists, which may not be the case,” said Jennifer Molinsky, director of the Housing an Aging Society Program at Harvard University.

And when they hold onto family-size houses well into retirement, there are fewer spacious homes placed on the market for young families, who in turn squeeze into smaller units or withstand long commutes in a search for affordable housing.

“Both ends of the age distribution are getting squeezed,” said Jenny Schuetz, an expert on housing and urban economics at the Brookings Institution.

The constraints are especially severe for many older Black Americans, for whom the legacy of redlining and segregation has meant that homeownership has not generated as much wealth. The percentage of people living alone in large houses is highest in many low-income, historically Black neighborhoods. In those areas, many homes are owned by single, older women.

One of them is Felder of Strawberry Mansion, a neighborhood in Philadelphia. She and her ex-husband bought their two-story brick row house in the mid-1990s for a song after it was damaged in a fire.

While raising three children, Felder worked a series of jobs, including retail, hotel housekeeping and airport security. She retired in 2008 and has lived by herself for more than a decade, although her sisters, children and grandchildren live nearby.

Maintaining her home is a challenge. In rainstorms, she sometimes had to use every piece of fabric in the house to sop up water pouring down a kitchen wall. And she worries about her safety.

At times, she dreams about relocating to small-town South Carolina, where she was born and raised.

She imagines a small home there, perhaps even a trailer.

But the median value of a home in her neighborhood was $59,000, according to recent census data. Felder thinks she could sell her house and net about $40,000.

“That’s not enough” to retire down south, she said, sighing, sitting in her living room filled with plants.

Felder is a fixture in her neighborhood, keeping watch over it, and has received help from Habitat for Humanity to repair her roof.

But in September, living alone became harder.

While she was cleaning the trash out of a nearby alley with neighbors, a masked gunman looked her in the eyes and shot her twice in the legs.

Felder had no clue who shot her, and there has been no arrest. She recovered at her daughter’s home across town, where the ground floor has a bedroom and bathroom, unlike in her own house.

By late November, she was feeling much better — physically, if not mentally, she said. But she had not stayed overnight in her own home. She is still a little afraid.

“But I’m working on it,” she said. “I really love my house.”

© 2022 The New York Times Company