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.

Sunday, December 31, 2023

What are the healthiest fruits? This one has cognitive and cardiovascular benefits.

You'll never find wild blueberries in a store, they are extremely small and must be handpicked. For all the outdoor camping I've done, only once did we find a patch of blueberries large enough to make a pie. Useless title.

This one just suggests blueberries, not focusing on wild ones.

This ‘Superfruit’ Improves Memory and Cognitive Function - Blueberries

The latest here:

What are the healthiest fruits? This one has cognitive and cardiovascular benefits.

While all fruits are healthy, registered dietitian nutritionist  Danielle Crumble Smithrecommends one nutrient-packed fruit in particular – wild blueberries.

An apple a day keeps the doctor away, right? We grew up hearing the cliched expression, but do you know how much fruit you should actually be eating per day? The recommended intake depends on several factors, but adults should generally consume1.5 to 2 cups of fruit daily, One cup of fruit could be an apple, a banana, a cup of blueberries, three medium-size plums or seven slices or chunks of mango, for example.Here’s your guide to the health benefits of fruit, plus tips for including more in your diet. What is the healthiest fruit?While all fruits are healthy, registered dietitian nutritionist Danielle Crumble Smith Blueberries contain lots of fiber, which keeps you fuller for longer. They also rank among the fruits and vegetables with the highest antioxidant content.prevent or delay cell damage.  "From a cognitive standpoint, there are a lot of benefits in terms of memory, and some studies show cardiovascular benefits or cancer-fighting compounds," Crumble Smith says. "Overall, [they] decrease inflammation." Still, Crumble Smith says eating wild blueberries is not essential to getting the healthy nutrients of fruits. Eating fruit of any kind will yield healthy results, though some fruits have nutrients that serve different purposes. Which fruit must you never eat outside in the sun? For example, apples contain pectin, a fiber that acts as a prebiotic that can aid colon function and digestionVitamin C-rich fruits should also be on your radar, including citrus (oranges, grapefruit and lemons, to name a few) and strawberries. "Vitamin C helps with collagen production, and in our generation, people are concerned about decreasing wrinkles and hair, skin and nail health," Crumble Smith says. "Vitamin C is actually really crucial for that."Is the sugar in fruit OK for you? Some fruit fears come from their sugar content. Does the high amount of sugar mean fruit is bad for you? Absolutely not, says Crumble Smith."Fruit has so many vitamins, minerals, fiber, water and other nutrients that our body needs," she says.In fact, fruit can combat the afternoon slump when most peoplereach for another cup of coffee. Because natural sugar is a healthy source of energy, pairing fruit with protein will give you a similar boost you’d get through caffeine. The Pioneer Woman Cooks: Food From My Frontier By Ree Drummond (Mar 13, 2012) Crumble Smith does recommend caution for people with diabetes, insulin resistance or blood sugar issues. In that case, be mindful of portion size or try to pair your afternoon raspberries with a protein, like yogurt or cheese.Fruit smoothies are an easy and accessible way to get your daily fruit content. Crumble Smith recommends making them at home rather than grabbing one from a smoothie bar or a pre-packaged drink from the store. If you’re going for make sure to read the nutritional label and ingredients thoroughly.  "Just because something says 100% fruit … oftentimes that’s not the best choice," Crumble Smith says. "Because in that case, all the concentrated fruit tends to be really high in sugar and don’t have any protein to help stabilize blood sugar levels." Is the fat in avocados good for you?  Contrary to popular belief, yes, avocados are fruits and yes, their fat content is an important part of a healthy, balanced diet. "People sometimes fear fat, but healthy fats coming from avocados, nuts, seeds, olives, olive oil, fatty fish, they have so many anti-inflammatory benefits," Crumble Smith says.Avocados are rich in potassium, which can help lower blood pressure and cholesterol. They also contain large amounts of fiber, which can keep you feeling satisfied for longer and help with blood sugar regulation, according to Crumble Smith. "Oftentimes fruits and veggies can be great sources of fat-soluble vitamins A, E and K," Crumble Smith says. “With fat-soluble vitamins, we need a fat source for our body to be able to actually absorb them. So having an avocado with a salad enhances your body’s absorption of those nutrients.”How to incorporate fruit into your diet Other than upping your smoothie and fruit salad intake, an easy way to get yourself to eat more fruit is to experiment at the grocery store. Crumble Smith says she tells her clients to put a fruit they’ve never tried in their basket every week when they go to the store. "It’s a great way to expose yourself to that which you’ve never tried and potentially find something you love," Crumble Smith says. "And it’s not overwhelming; you’re not coming home with all of these different things that you’re afraid are going to go bad."But if you’re hesitant to try something new, there’s no harm in eating the same ol' fruit every day. You’ll still get a host of benefits. And once you’re feeling more adventurous, you can try swapping – maybe blueberries in your oatmeal instead of a banana, or snack on an orange instead of an apple.

The association between inpatient rehabilitation intensity and outcomes after stroke in Ontario, Canada

 Why are you focusing on intensity rather than the EXACT PROTOCOLS NEEDED TO RECOVER? Your mentors and senior researchers need re-education in the only goal in stroke: 100% recovery!

The association between inpatient rehabilitation intensity and outcomes after stroke in Ontario, Canada

Abstract

Background:

Several studies have demonstrated improved outcomes poststroke when higher intensity rehabilitation is provided. Canadian Stroke Best Practice Recommendations advise patients receive 180 min of therapy time per day; however, the exact amount required to reach benefit is unknown.

Aims:

The primary aim of this study was to determine the association between rehabilitation intensity (RI) and total Functional Independence Measure (FIM) Instrument change. Secondary aims included determining the association between RI and discharge location, 90-day home time, rehabilitation effectiveness, and motor and cognitive FIM change.

Methods:

A retrospective cohort study was conducted using available administrative databases of acute stroke patients discharged to inpatient rehabilitation facilities in Ontario, Canada, from January 2017 to December 2021. RI was defined as number of minutes per day of direct therapy by all providers divided by rehabilitation length of stay. The association between RI and the outcomes of interest were analyzed using regression models with restricted cubic splines.

Results:

A total of 12,770 individuals were included. Mean age of the sample was 72.6 years, 46.0% of individuals were female, and 87.6% had an ischemic stroke. Mean RI was 74.7 min (range: 5–162 min) per day. Increased RI was associated with an increase in mean FIM change. However, there was diminishing incremental increase after reaching 95 min/day. Increased RI was positively associated with motor and cognitive FIM change, rehabilitation effectiveness, 90-day home time, and discharge to preadmission setting. Higher RI was associated with a lower likelihood of discharge to long-term care.

Conclusions:

None of the patients met the recommended RI of 180 min/day based on the Canadian Stroke Best Practice Recommendations. Despite this, higher intensity was associated with better outcomes. Given that most positive associations were observed with a RI ⩾95 min/day, this may be a more feasible target.(But you could easily add action observation or mirror therapy to get to 180 minutes. Don't you people ever think?)

Introduction

Advances in acute stroke management have led to improved survival.1,2 Stroke rehabilitation progresses care further by optimizing functional recovery and quality of life. The Canadian Stroke Best Practice Recommendations (CSBPR) recommend higher rehabilitation intensity (RI) to aid recovery.3 Several studies have found an overall functional benefit of higher RI as measured by the Functional Independence Measure (FIM)4,5 while others have shown that higher RI improves specific outcomes, such as aphasia,6,7 dysphagia,8 lower or upper limb ability,9 balance,10 and gait.11,12 These previous studies have focused on specific impairments,68,1012 have been small,4 or have not examined RI on a continuous scale.5,9
Higher intensity can be defined in a variety of ways including heart rate and rate of perceived exertion, though it is most commonly defined by more minutes spent in active therapy.13 The exact duration to achieve maximum benefit is currently unknown.14 The CSBPR suggest at least 3 h per day, 5 days per week;3 however, this recommendation is based on limited data. Furthermore, local audits have suggested that most patients likely do not receive this amount due to lack of resources and prioritization of therapy. Our goal was to determine the association between RI and functional outcomes.

Aims

The primary aim was to determine the association between RI and total FIM® Instrument change. Secondary aims included determining the association between RI and discharge back to preadmission setting, discharge to long-term care (LTC), 90-day home time,15 rehabilitation effectiveness,16 as well as motor and cognitive FIM change.

Methods

Design and setting

This was a retrospective cohort study of individuals with stroke who were discharged from acute care in Ontario, Canada, between 1 January 2017 and 31 December 2021 and subsequently admitted to an inpatient stroke rehabilitation bed within 72 h. The observation window extended until 91 days postdischarge from inpatient stroke rehabilitation.

Data source

Administrative databases, including the Canadian Institute for Health Information’s acute care Discharge Abstract Database and the National Rehabilitation Reporting System (NRS), held at ICES were used. In Ontario, it is mandatory for rehabilitation facilities to report several data elements, such as admission and discharge FIM, to the NRS. Total therapy time delivered by each discipline (e.g. physiotherapy) during a rehabilitation stay was included as a mandatory reporting element in 2015. These data sets were linked using unique encoded identifiers and analyzed at ICES. ICES is an independent, nonprofit research institute whose legal status under Ontario’s health information privacy law allows it to collect and analyze health care and demographic data, without consent, for health system evaluation and improvement.

Participants

Individuals who had a subarachnoid hemorrhage (International Classification of Diseases (ICD) 10th version, code I60), intracerebral hemorrhage (ICD code I61), or ischemic stroke (ICD codes I63 and I64)17 were included. Individuals were aged 19–100 years, inclusive. Exclusion criteria included a rehabilitation length of stay (LOS) less than 3 days, admission from LTC, the presence of an acute stroke in the 5 years prior to stroke onset date, final discharge destination of acute care, RI <1st or >99th percentile, and individuals with missing RI, sex, or preadmission setting data. Patients with missing outcome data were also excluded. For individuals with more than one stroke during the observation period, we only included the first episode of care (acute care admission followed by inpatient rehabilitation).

Variables

The primary predictor variable was RI; the number of minutes per day of direct therapy by speech–language, occupational, and physiotherapy services for each patient divided by rehabilitation LOS. Other hypothesized predictors, based on previous research and clinical experience, included age; sex; Charlson co-morbidity index (CCI: low = 0–1 and high = ⩾2); rurality (residing in a community with a population ⩽10,000); whether the individual was admitted to acute care from home, assisted living, or other; whether they were living alone prior to acute care admission; and nearest census-based neighborhood income quintile. Acute care data included LOS and if the individual was treated on an acute stroke unit. Rehabilitation institution and admission total FIM were also included as potential predictors.

Outcomes

The primary outcome was total FIM change (total discharge FIM − total admission FIM). Additional outcomes included discharge back to preadmission setting, discharge to LTC, time spent at home in the first 90 days after stroke (90-day home time),15 rehabilitation effectiveness ((discharge FIM − admission FIM) / (126 − admission FIM) × 100%),16 as well as motor and cognitive FIM change (discharge motor—admission motor FIM and discharge cognitive—admission cognitive FIM, respectively).

Saturday, December 30, 2023

Brain Function Dramatically Boosted by Certain Fragrances During Sleep

Well, didn't your competent? doctor already have you diffusing lavender, rosemary and sage for years already? Oh, you don't have a functioning stroke doctor, do you? I didn't either. For proof, ask your doctor what a competent stroke doctor would provide. If it is not 100% recovery, then in my opinion you don't have a competent doctor. Don't accept excuses from your doctor about how hard the brain is to treat.

Brain Function Dramatically Boosted by Certain Fragrances During Sleep

Of all the senses we love to indulge, scent is often neglected – but the right smells could be just what your brain needs to keep it whirring in old age.

Researchers at the University of California, Irvine have uncovered strong evidence that enriching the air with fragrances improves cognitive performance by strengthening a critical connection between neurological areas involving memory and decision-making.

Their experiment, involving 43 men and women aged 60 to 85, suggests cognitive decline and conditions such as dementia might be slowed by simply diffusing a different choice of perfumes through the bedroom before bed each night.Keeping the old gray matter stimulated as we age is vital to maintaining good cognitive health. That doesn't just mean keeping up with the daily crossword – it means peppering our environment with all kinds of sights and sounds for the brain to chew on. For other animals, enriching the environment with odors has been shown to stimulate neuroplasticity, especially in tests It's not exactly a stretch to believe humans could also benefit from experiencing a complex 'scent-scape'. Physiologically speaking, our ability to detect smells deteriorates before our cognitive ability Boost Your Brainpower: 10 Age-Defying Foods for a Boost Your Brainpower: 10 Age-Defying Foods for a Sharper Mind
Losing this sense also correlates with a loss in brain cells, hinting at a strong connection between smell and neurological function. "The olfactory sense has the special privilege of being directly connected to the brain's memory circuits," said neurobiologist Michael Yassa when the results were revealed in August."All the other senses are routed first through the thalamus. Everyone has experienced how powerful aromas are in evoking recollections, even from very long ago. However, unlike with vision changes that we treat with glasses and hearing for hearing impairment, there has been no intervention for the loss of smell." To determine whether cognitive decline can be saved with this kind of sensory stimulation, Yassa and his colleagues provided 20 of the study's recruits with an assortment of natural oils containing fragrances of rose, orange, eucalyptus, lemon, peppermint, rosemary, and lavender.  The rest of the group were provided with a 'sham' that contained trace amounts of an odorant. All of the participants were required to use one of the oils with a diffuser to perfume their home for two hours every night over a six-month period, rotating through their menu of fragrances. A battery of neuropsychological tests was then used to compare the volunteers' memory, verbal learning, planning, and attention-switching skills before and after the six-month trial. Astonishingly, there was a clear 226 percent difference between the responses provided by those who were exposed to a variety of fragrances and individuals in the control group. A scan of their brains also revealed a significant change in the anatomy linking areas As all of the volunteers were of similarly sound mental health, the researchers aim to now see if the results continue to hold for people already diagnosed with a degree of cognitive loss.No matter what age or state of mind, giving your nose something to do when the lights go out and the silence sets in isn't exactly an unpleasant way to exercise the mind at night. An earlier version of this article was published in August 2023.

Blithering Idiot barleywine

 In preparation for New Years Eve I inadvertently found some blithering idiot barleywine. Appropos for me. Only 11.1% alcohol



Outside the Laboratory Assessment of Upper Limb Laterality in Patients With Stroke: A Cross-Sectional Study

 I see zero use for assessment. Why not deliver EXACT STROKE PROTOCOLS THAT DELIVER 100% RECOVERY,  instead of this lazy shit.

In neurology, laterality is used to specify which side of the body or which hemisphere of the brain is dominant.

Outside the Laboratory Assessment of Upper Limb Laterality in Patients With Stroke: A Cross-Sectional Study

Originally publishedhttps://doi.org/10.1161/STROKEAHA.123.043657Stroke. 2024;55:146–155

BACKGROUND:

The rehabilitation of upper limb sensorimotor performance after stroke requires the assessment of daily use, the identification of key levels of impairment, and monitoring the course of recovery(Where is the use of protocols that deliver recovery? Without that this research is useless!) . It needs to be answered, how laboratory-based assessments and everyday behavior are connected, which dimension of metrics, that is, volume, intensity, or quality, is most sensitive to reduced function, and what sensor, that is, gyroscope or accelerometer, is best suited to gather such data.

METHODS:

Performance in laboratory-based sensorimotor tests, as well as smartwatch-derived kinematic data of everyday life relative upper limb activity, during 1 day of inpatient neurorehabilitation (Germany, 2022) of 50 patients with stroke, was cross-sectionally assessed and resulting laterality indices (performance ratios) between the limbs were analyzed using ANCOVAs and principal component analysis.

RESULTS:

Laboratory-based tests revealed the strongest laterality indices, followed by smartwatch-based (intensity>quality>volume) metrics. Angular velocity-based metrics revealed higher laterality indices than acceleration-based ones. Laterality indices were overall well associated; however, a principal component analysis suggested upper limb impairments to be unidimensional.

CONCLUSIONS:

Our findings suggest that the use of sensors can deliver valid information of stroke-related laterality. It appeared that commonly used metrics that estimate the volume of use (ie, energy expenditure) are not the most sensitive. Especially reached intensities could be well used for monitoring, because they are more dependent on the performance of the sensorimotor system and less on confounders like age. The unidimensionality of the upper limb laterality suggests that an impaired limb with reduced movement quality and the inability to reach higher intensities will be used less in everyday life, especially when it is the nondominant side.

Past, Present, and Future of Intracranial Atherosclerosis Treatment

Is your hospital up-to-date on the past and present and preparing for the future? Or don't you have a functioning stroke hospital?

Past, Present, and Future of Intracranial Atherosclerosis Treatment

Originally publishedhttps://doi.org/10.1161/STROKEAHA.123.044270Stroke. 2023;0
First page image

Dual Antiplatelet Treatment up to 72 Hours after Ischemic Stroke

 How long before this is implemented in your hospital? If you don't ask it will probably never get there since I'm sure your hospital doesn't have a research analyst whose only job is to keep up with stroke research and get it implemented in the hospital.

Dual Antiplatelet Treatment up to 72 Hours after Ischemic Stroke

List of authors.
  • Ying Gao, M.D.,
  • Weiqi Chen, M.D.,
  • Yuesong Pan, Ph.D.,
  • Jing Jing, M.D., Ph.D.,
  • Chunjuan Wang, M.D., Ph.D.,
  • S. Claiborne Johnston, M.D., Ph.D.,
  • Pierre Amarenco, M.D.,
  • Philip M. Bath, D.Sc.,
  • Lingling Jiang, Ph.D.,
  • Yingying Yang, M.D.,
  • Tingting Wang, M.D.,
  • Shangrong Han, M.D.,
  • Xia Meng, M.D., Ph.D.,
  • Jinxi Lin, M.D., Ph.D.,
  • Xingquan Zhao, M.D., Ph.D.,
  • Liping Liu, M.D., Ph.D.,
  • Jinguo Zhao, M.D.,
  • Ying Li, M.D.,
  • Yingzhuo Zang, M.D.,
  • Shuo Zhang, M.D.,
  • Hongqin Yang, M.D.,
  • Jianbo Yang, M.D.,
  • Yuanwei Wang, M.D.,
  • Dali Li, M.D.,
  • Yanxia Wang, M.D.,
  • Dongqi Liu, M.D.,
  • Guangming Kang, M.D.,
  • Yongjun Wang, M.D.,
  • and Yilong Wang, M.D., Ph.D.

  • for the INSPIRES Investigators*

Abstract

Background

Dual antiplatelet treatment has been shown to lower the risk of recurrent stroke as compared with aspirin alone when treatment is initiated early (≤24 hours) after an acute mild stroke. The effect of clopidogrel plus aspirin as compared with aspirin alone administered within 72 hours after the onset of acute cerebral ischemia from atherosclerosis has not been well studied.

Methods

In 222 hospitals in China, we conducted a double-blind, randomized, placebo-controlled, two-by-two factorial trial involving patients with mild ischemic stroke or high-risk transient ischemic attack (TIA) of presumed atherosclerotic cause who had not undergone thrombolysis or thrombectomy. Patients were randomly assigned, in a 1:1 ratio, within 72 hours after symptom onset to receive clopidogrel (300 mg on day 1 and 75 mg daily on days 2 to 90) plus aspirin (100 to 300 mg on day 1 and 100 mg daily on days 2 to 21) or matching clopidogrel placebo plus aspirin (100 to 300 mg on day 1 and 100 mg daily on days 2 to 90). There was no interaction between this component of the factorial trial design and a second part that compared immediate with delayed statin treatment (not reported here). The primary efficacy outcome was new stroke, and the primary safety outcome was moderate-to-severe bleeding — both assessed within 90 days.

Results

A total of 6100 patients were enrolled, with 3050 assigned to each trial group. TIA was the qualifying event for enrollment in 13.1% of the patients. A total of 12.8% of the patients were assigned to a treatment group no more than 24 hours after stroke onset, and 87.2% were assigned after 24 hours and no more than 72 hours after stroke onset. A new stroke occurred in 222 patients (7.3%) in the clopidogrel–aspirin group and in 279 (9.2%) in the aspirin group (hazard ratio, 0.79; 95% confidence interval [CI], 0.66 to 0.94; P=0.008). Moderate-to-severe bleeding occurred in 27 patients (0.9%) in the clopidogrel–aspirin group and in 13 (0.4%) in the aspirin group (hazard ratio, 2.08; 95% CI, 1.07 to 4.04; P=0.03).

Conclusions

Among patients with mild ischemic stroke or high-risk TIA of presumed atherosclerotic cause, combined clopidogrel–aspirin therapy initiated within 72 hours after stroke onset led to a lower risk of new stroke at 90 days than aspirin therapy alone but was associated with a low but higher risk of moderate-to-severe bleeding. (Funded by the National Natural Science Foundation of China and others; INSPIRES ClinicalTrials.gov number, NCT03635749. opens in new tab.)


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RAPID aneurysm accurately measures aneurysm size on CT angiography compared to three-dimensional digital subtraction angiography

 But what will accurately describe the chances of that aneurysm rupturing which is vastly more important to know than size.

RAPID aneurysm accurately measures aneurysm size on CT angiography compared to three-dimensional digital subtraction angiography

Abstract

Background

Cerebral aneurysms are often identified and characterized on non-invasive CT Angiography (CTA) images, but digital subtraction angiography (DSA) is the gold standard for aneurysm evaluation.

Objective

We compared cerebral aneurysm size measurements as measured from CTA processed by a semi-automated artificial intelligence software program (RAPID Aneurysm) and three-dimensional rotational DSA (3D-DSA).

Methods

We performed a retrospective cohort study of consecutive patients with a cerebral aneurysm who underwent CTA and DSA with 3D reformations. CTA images were processed by RAPID Aneurysm to determine aneurysm height, width, and neck width. The reference standard was aneurysm measurements on 3D-DSA as measured by two neurointerventionalists. Both readers were blinded to RAPID Aneurysm measurements. Correlation and bias between these measurements were determined.

Results

Results from 50 patients with 50 aneurysms were compared. 32 patients (64%) were female. Median age was 65 (IQR: 56.25–71.75). 37 patients (74%) presented with ruptured aneurysms. The aneurysms represented a range of aneurysm sizes (1.9–33.3 mm; IQR 3.6–7.2 mm). RAPID Aneurysm size measurements showed excellent correlation and low bias (correlation, mean difference) when compared to the reference standard for aneurysm height (0.98, −0.9 mm), width (0.98, 0.1 mm), and neck width (0.94, 1.1 mm). The inter-reader comparison between the two neurointerventionalists was similarly excellent for aneurysm height (0.97, −0.4 mm), width (0.98, −0.2 mm), and neck width (0.89, 0.8 mm).

Conclusion

RAPID Aneurysm measurement of cerebral aneurysm height, width, and neck width on CTA is strongly correlated to expert neurointerventionalist measurements on 3D-DSA.

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Alzheimer's disease could be slowed by common cholesterol-lowering medicine, study shows

But didn't your competent? doctor immediately prescribe statins to help in your recovery?

Or don't you have a functioning stroke doctor who incompetently missed this research from 2011?

1. Statins.

tested in rats from 2003

http://Statins induce angiogenesis, neurogenesis, and synaptogenesis after stroke Statins induce angiogenesis, neurogenesis, and synaptogenesis after stroke  

Simvastatin Attenuates Stroke-induced Splenic Atrophy and Lung Susceptibility to Spontaneous Bacterial Infection in Mice

Or,

Simvastatin attenuates axonal injury after experimental traumatic brain injury and promotes neurite outgrowth of primary cortical neurons 

October 2012

tested in humans, March, 2011

http://www.medwirenews.com/39/91658/Stroke/Acute_statin_therapy_improves_survival_after_ischemic_stroke.html

And now lost even to the Wayback Machine

So I think this below is the actual research;

Association Between Acute Statin Therapy, Survival, and Improved Functional Outcome After Ischemic Stroke April 2011

The latest here:

Alzheimer's disease could be slowed by common cholesterol-lowering medicine, study shows

A new groundbreaking study showed that a common cholesterol-lowering blood pressure medication could slow cognitive decline in Alzheimer's patients.researchers, who conducted the study based on data from the Swedish Registry for Cognitive/Dementia Disorders and some other national data registries, studied the effects of statins, drugs that reduce cholesterol, including in the brain. Statins are defined by the U.S. Food & Drug Administration (FDA) as "a class of prescription drugs used together with diet and exercise to reduce blood levels of low-density lipoprotein (LDL) cholesterol ('bad cholesterol')."

READ MORE: But how does the drug reduce the cognitive decline of Alzheimer's and even some other forms of dementia?The answer lies in its ability to reduce congestion in blood pathways in the brain that can become filled with proteins, lipids like cholesterols or the beta amyloid amino acid that has recently been linked to Alzheimer's. When blood pathways get clogged, they can kill off brain cells. The National Institute on Aging states: "Abnormal levels of this naturally occurring protein clump together to form plaques that collect between neurons and disrupt cell function." And when cell function is disrupted, a person's cognitive ability can be drastically reduced. But one of the authors of the study, Sara Garcia-Ptacek, who is an associate professor of neuroscience at the Karolinska Institute in Stockholm, emphasized that the study isn't concrete and that more research needs to be done to determine the true correlation between the drugs and their ability to slow Alzheimer's disease. Garcia-Ptacek said another study is in order to confirm the results — the one that was published on Dec. 20 was observational, looking at past data and not deriving new data from an actual planned study that examines this particular link. The team looked at over 15,500 cases of people in Sweden who were diagnosed with dementia and who also had heart issues that required them to take statin or other blood pressure drugs. Of the group, about 4,500 did not use the drugs, while the other 11,000 or so did, and comparisons were drawn between both groups.Statin use was associated with a slower cognitive decline over time compared to no use of statins," the study concluded, but the authors added: "Some patients with AD [Alzheimer's disease] or mixed dementia with indication for lipid-lowering medication may benefit cognitively from statin treatment; however, further research is needed to clarify the findings of sensitivity analyses." Garcia-Ptacek added in a news release obtained by ScienceDaily: "The results of the study do not mean that we now have evidence that people with dementia should be treated with statins. But on the other hand, we can't see any support for not doing so. So, if a person needs statins for high blood lipids, a dementia diagnosis should not stop the treatment."

Friday, December 29, 2023

Mechanisms of Post-Stroke Fatigue: A Follow-Up From the Third Stroke Recovery and Rehabilitation Roundtable

The point is to solve the fatigue problem! HOW EXACTLY ARE YOU GOING TO ACCOMPLISH THAT? 

Survivors don't want to 'cope' They want to have fatigue cured! GET THERE!

Well, post stroke fatigue has been proven for years! Don't you keep up-to-date on research? 

 This post stroke fatigue has been known forever. SOLVE THE FUCKING PROBLEM!

At least half of all stroke survivors experience fatigue Known since March 2017

Or is it 70%? Known since March 2015

Or is it 40%? Known since September 2017

I'd have you all fired for incompetence for not solving the problem of fatigue! Telling us it exists does nothing for survivor recovery!

The latest here:

 

Mechanisms of Post-Stroke Fatigue: A Follow-Up From the Third Stroke Recovery and Rehabilitation Roundtable

Abstract

Background

Post-stroke fatigue (PSF) is a significant and highly prevalent symptom, whose mechanisms are poorly understood. The third Stroke Recovery and Rehabilitation Roundtable paper on PSF focussed primarily on defining and measuring PSF while mechanisms were briefly discussed. This companion paper to the main paper is aimed at elaborating possible mechanisms of PSF.

Methods

This paper reviews the available evidence that potentially explains the pathophysiology of PSF and draws parallels from fatigue literature in other conditions. We start by proposing a case for phenotyping PSF based on structural, functional, and behavioral characteristics of PSF. This is followed by discussion of a potentially significant role of early inflammation in the development of fatigue, specifically the impact of low-grade inflammation and its long-term systemic effects resulting in PSF. Of the many neurotransmitter systems in the brain, the dopaminergic systems have the most evidence for a role in PSF, along with a role in sensorimotor processing. Sensorimotor neural network dynamics are compromised as highlighted by evidence from both neurostimulation and neuromodulation studies. The double-edged sword effect of exercise on PSF provides further insight into how PSF might emerge and the importance of carefully titrating interventional paradigms.

Conclusion

The paper concludes by synthesizing the presented evidence into a unifying model of fatigue which distinguishes between factors that pre-dispose, precipitate, and perpetuate PSF. This framework will help guide new research into the biological mechanisms of PSF which is a necessary prerequisite for developing treatments to mitigate the debilitating effects of post-stroke fatigue.(WHOM is doing the followup to solve the fatigue problem? Specific names only!

Introduction

Post-stroke fatigue (PSF) is a significant symptom for stroke survivors with few effective, evidence-based interventions currently available. The lack of evidence-based interventions is largely a result of poor understanding of the phenomenon, with little agreement on its definition and measurement. Fatigue is a complex phenomenon with multiple driving factors, which requires a systematic deconstruction of the phenomenon to propel advances in the field. This aim was pursued following the recent Stroke Recovery and Rehabilitation Roundtable (SRRR) consensus process involving experts in the field, which has produced a comprehensive definition and guidelines for measurement of PSF alongside a brief exposition on the possible mechanisms of fatigue and available interventions.1
In this companion SRRR paper we have put forward a clear definition of fatigue that incorporated both expert consensus and personal experience of stroke survivors. PSF is not mere tiredness, but a “feeling of exhaustion, weariness or lack of energy that can be overwhelming, and which can involve physical, emotional, cognitive and perceptual contributors, which is not relieved by rest and affects a person’s daily life.” Previous studies of PSF have frequently been confounded by other conditions such as depression, anxiety, and sleep disorders which often associate with fatigue.2 While these conditions might contribute to the feeling of fatigue, they are dissociable and need to be identified at the time of diagnosis. For example, Fluoxetine relieves depression but not fatigue.3 The consensus view of our SRRR working group was that the Fatigue Severity Scale-7 (FSS-7) represented the most commonly used fatigue measure. Despite its wide usage, this scale has several drawbacks as it does not distinguish between different domains and does not measure fatigue severity or the impact of fatigue on communication ability. It primarily captures impact and interference of fatigue in daily life. For research purposes nuanced interpretations of findings will require the use of domain specific scores from other elaborate fatigue scales summarized in the main paper.1 Clinically, in order to ensure that PSF does not continue to be an invisible symptom, it is important that it is detected as soon as possible following stroke. We have recommended that the Stroke Fatigue Clinical Assessment Tool (SF-CAT) best meets this need. The SF-CAT can be administered via interview and should be part of clinical follow up for all stroke survivors.
The primary goal of the current current paper is to elaborate on mechanisms of PSF briefly discussed in a companion SRRR paper on PSF.1 Here, we present a more comprehensive description of the potential processes that drive PSF in order to guide future research into the biological mechanisms of PSF and ultimately the development of new therapeutic interventions. We draw from the literature both in stroke and other diseases where fatigue is a significant symptom and put forward a model of PSF that further highlights promising avenues of future research.
We begin by presenting the idea of PSF as a cluster of disorders with potentially dissociable mechanisms. We then discuss evidence that supports inflammation and immune dysregulation as a potential process that could underpin both acute PSF and long-term PSF. Next, we discuss how dopamine (DA), a neuromodulator with diverse functions including effort perception, motivation, and memory, could be implicated in PSF, with evidence supporting dopaminergic pathways as a potential therapeutic target. Finally, we discuss whole brain neural network changes and exercise induced multi-system dynamics in the context of PSF, both mechanistically and therapeutically. Furthermore, throughout the manuscript, we present evidence from other human diseases where fatigue is a significant symptom, to identify possible overlapping mechanisms with PSF. This is based on the premise that fatigue, in the chronic stages of a disease is delinked from the primary etiopathology of the disease and commonalities in the experience of chronic fatigue indicate a common disease-independent mechanism. Finally, we present a single framework (Figure 1) that links the available evidence and identifies the gaps in our knowledge about PSF.
Figure 1. Unifying model of fatigue. This schematic illustrates factors that are associated with PSF and its potential role in development and maintenance of PSF. New and untested hypotheses previously proposed, are also included.
 
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Measures of Neuroplastic and Functional Rearrangements during Recovery of Motor Function during Post-Stroke Rehabilitation

Useless. No mention of any protocols that deliver recovery. What the fuck was this done for and what blithering idiot approved this waste?

Measures of Neuroplastic and Functional Rearrangements during Recovery of Motor Function during Post-Stroke Rehabilitation

Neuroscience and Behavioral Physiology Aims and scope Submit manuscript

This article reviews data on changes in indicators obtained from multichannel EEG, MRI, fMRI, and diffusion tensor tractography in poststroke patients during motor recovery. The main indicators most commonly analyzed in the literature on changes in the brain occurring both during traditional motor rehabilitation and during rehabilitation procedures using brain–computer interface technology are considered. Changes in the indicators discussed here reflect the dynamics of the involvement of the hemispheres, individual areas of the brain, and connections between them in solving motor tasks and constitute a manifestation of both instant functional rearrangements of the network and genuine neuroplastic (structural) changes in the brain. The functional roles of the hemispheres, individual areas, and connections between areas in the process of motor rehabilitation after stroke are discussed.

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Effects of Immersive Virtual Reality on Upper-Extremity Stroke Rehabilitation: A Systematic Review with Meta-Analysis

Didn't your competent?doctor prescribe this years ago? Oh, you don't have a functioning stroke doctor, do you?

Effects of Immersive Virtual Reality on Upper-Extremity Stroke Rehabilitation: A Systematic Review with Meta-Analysis

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Systematic Review

1
Healthcare Innovation Technology Lab, IRCCS San Camillo Hospital, 30126 Venice, Italy
2
Department of Physiotherapy, LUNEX International University of Health Exercise and Sports, L-4671 Differdange, Luxembourg
3
Doctoral School of the University of Rzeszów, University of Rzeszów, 35-959 Rzeszów, Poland
4
IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy
5
Luxembourg Health & Sport Sciences Research Institute ASBL, L-4671 Differdange, Luxembourg
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2024, 13(1), 146; https://doi.org/10.3390/jcm13010146
Submission received: 2 November 2023 / Revised: 7 December 2023 / Accepted: 22 December 2023 / Published: 27 December 2023
(This article belongs to the Special Issue Post-stroke Rehabilitation: Challenges and New Perspectives)

Abstract

Virtual reality (VR) is an innovative rehabilitation tool increasingly used in stroke rehabilitation. Fully immersive VR is a type of VR that closely simulates real-life scenarios, providing a high level of immersion, and has shown promising results in improving rehabilitation functions. This study aimed to assess the effect of immersive VR-based therapy for stroke patients on the upper extremities, activities of daily living (ADLs), and pain reduction and its acceptability and side effects. For this review, we gathered all suitable randomized controlled trials from PubMed, EMBASE, Cochrane Library, Scopus, and Web of Science. Out of 1532, 10 articles were included, with 324 participants. The results show that immersive VR offers greater benefits in comparison with conventional rehabilitation, with significant improvements observed in ADLs (SMD 0.58, 95% CI 0.25 to 0.91, I2 = 0%, p = 0.0005), overall function as measured by the Fugl-Meyer Assessment (MD 6.33, 95% CI 4.15 to 8.50, I2 = 25%, p = 0.00001), and subscales for the shoulder (MD 4.96, 95% CI—1.90–8.03, I2 = 25%, p = 0.002), wrist (MD 2.41, 95% CI—0.56–4.26, I2 = 0%, p = 0.01), and hand (MD 2.60, 95% CI—0.70–4.5°, I2 = 0%, p = 0.007). These findings highlight the potential of immersive VR as a valuable therapeutic option for stroke survivors, enhancing(But survivors want recovery. Where are the EXACT PROTOCOLS that deliver that?) their ADL performance and upper-limb function. The immersive nature of VR provides an engaging and immersive environment for rehabilitation.