This Wireless, Handheld, Non-invasive Device Detects Alzheimer’s and Parkinson’s Biomarkers

Does your doctor and hospital have enough functioning brain cells to see that this gets fully tested because of your risks of dementia and Parkinsons post stroke? Or will they sit on their asses doing nothing like usual?

Your chances of getting dementia.

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 

Parkinson’s Disease May Have Link to Stroke March 2017

The latest here:

This Wireless, Handheld, Non-invasive Device Detects Alzheimer’s and Parkinson’s Biomarkers

Next steps include testing saliva and urine samples with the biosensor

Published Date

November 13, 2023

By:

• Ioana Patringenaru - ipatrin@ucsd.edu

Article Content

An international team of researchers has developed a handheld, non-invasive device that can detect biomarkers for Alzheimer’s and Parkinson’s Diseases. The biosensor can also transmit the results wirelessly to a laptop or smartphone. 

The team tested the device on in vitro samples from patients. The tests showed the device is as accurate as the state of the art testing methods. Ultimately, researchers plan to test saliva and urine samples with the biosensor. The device could be modified to detect biomarkers for other conditions as well. 

Researchers present their findings in the Nov. 13, 2023 issue of the Proceedings of the National Academy of Science. 

The device relies on electrical rather than chemical detection, which researchers say is easier to implement and more accurate. 

“This portable diagnostic system would allow testing at-home and at point of care, like clinics and nursing homes, for neurodegenerative diseases globally,” said Ratnesh Lal, a bioengineering, mechanical engineering and materials science professor at the UC San Diego Jacobs School of Engineering and one of the paper’s corresponding authors.

By the year 2060, about 14 million Americans will suffer from Alzheimer’s Disease. Other neurodegenerative diseases, such as Parkinson’s, are also on the rise. Current state of the art testing methods for Alzheimer's and Parkinson’s require a spinal tap and imaging tests, including an MRI. As a result, early detection of the disease is difficult, as patients balk at the invasive procedures. Testing is also difficult for patients who are already exhibiting symptoms and have difficulty moving as well as those who have no early access to local hospitals or medical facilities. 

One of the prevailing hypotheses in the field, which Lal has focused on, is that Alzheimer’s Disease is caused by soluble amyloid peptides that come together in larger molecules, which in turn form ion channels in the brain. 

Lal wanted to develop a test that would be able to detect amyloid beta and tau peptides – biomarkers for Alzheimer’s – and alpha synuclein proteins – biomarker for Parkinson’s – non invasively, specifically from saliva and urine. He wanted to rely on electrical rather than chemical detection, as he believes it is easier to implement and more accurate. He also wanted to build a device that could wirelessly transmit the test results to the patient’s family and physicians. The device is the result of his three decades of expertise, as well as his collaboration with researchers globally, including those co-authors in this work from Texas and China.

“I am trying to improve quality of life and save lives,” he said. 

To realize Lal’s vision, he and colleagues adapted a device they developed during the COVID pandemic to detect the spike and nucleoprotein proteins in the live SARS-CoV-2 virus, which they described in PNAS in 2022. That breakthrough had been made possible by chip miniaturization and by large-scale automation of biosensor manufacturing. 
 

Bioengineering senior Armando Ramil holds the biosensor.
Photos: David Baillot/UC San Diego Jacobs School of Engineering

Photo gallery

How the device is made and how it works

The device described in the 2023 PNAS study, consists of a chip with a high sensitivity transistor, commonly known as a field effect transistor (FET). In this case, each transistor is made of a graphene layer that is a single atom thick (GFET, with the G standing for graphene) and three electrodes–source and drain electrodes, connected to the positive and negative poles of a battery, to flow electric current, and a gate electrode to control the amount of current flow.

Connected to the gate electrode is a single DNA strand, which serves as a probe that specifically binds to either amyloid beta, tau or synuclein proteins. The binding of these amyloids with their specific DNA strand probe, called an aptamer, changes the amount of current flow between the source and drain electrode. The change in this current or voltage is the signal used to detect the specific biomarkers, like amyloids or COVID 19 proteins. 

The research team tested the device with brain-derived amyloid proteins from Alzheimer’s and Parkinson’s deceased patients. The experiments showed that the biosensors were able to detect the specific biomarkers for both conditions with great accuracy, on par with existing state of the art methods. The device also works at extremely low concentrations, meaning that it needs small quantities for samples–down to just a few microliters.

In addition, the tests showed that the device performed well even when the samples analyzed contained other proteins. Tau proteins were more difficult to detect. But because the device looks at three different biomarkers, it can combine results from all three to arrive at a reliable overall result.

The technology has been licensed from UC San Diego to a biotechnology startup Ampera Life. Lal is the company’s chairman but does not receive financial support for his research from the company. 

Next steps include testing blood plasma and cerebro-spinal fluid with the device, then finally saliva and urine samples. The tests would take place  in hospital settings and nursing homes. If those tests go well, Ampera Life plans to apply for FDA approval for the device, hopefully in the next five or six months. The ultimate goal is to have the device on the market in a year. 

Funding for the research came from the National Institutes of Health, the University of California San Diego and the Chinese Academy of Sciences. In addition, researchers used facilities that are a part of the NSF-funded UC San Diego Materials Research Science and Engineering Center. 

In pursuit of degenerative brain disease diagnosis: dementia biomarkers detected by DNA aptamer-attached portable graphene biosensor

University of California San Diego: Tyler A. Bodily, Anirudh Ramanathan, Abhijith Karkisaval, Armando Rami, Prachi Heda. M. Leite, Ratnesh Lal
Shanghai Institute of Microsystem Information Technology Shahong Wei, Yi WAng, Tie Li, Jianlong Zhao

University of the Chinese Academy of Sciences Shahong Wei 

University of Texas Medical Branch, Galveston, Texas Nemil Bhatt, Cynthia Jerez, Md Anzarul Haque
University of Illinois Urbana-Champaign Sanjeev Kumar

Stroke survivor grateful for prompt medical care

This is an absolute outlier, don't expect this to happen to you.

Stroke survivor grateful for prompt medical care

BISMARCK — The combination of fast thinking, good fortune and prompt medical care at CHI St. Alexius Health all combined to turn what could have been a tragic day into a favorable outcome for Janel Buchholtz of Bismarck.

On Jan. 16, Buchholtz was drying her hair and getting ready for what initially appeared to be a “normal” day. However, when she repeatedly kept dropping her hairbrush, the 51-year-old mother of five knew something was amiss.

Still, Buchholtz continued trying to push through. Eventually, Buchholtz’s son saw her struggling to keep her balance as she walked down the hallway and told Buchholtz’s husband, Mike, as soon as he returned home from a dentist appointment.

“My husband came into the bedroom, looked at me and realized right away that I was having a stroke,” Buchholtz said. “I didn’t want him to at first, but he called 911 and, luckily, we have a neighbor from the fire department who lives right across the street, so we have somebody here almost immediately.

“The ambulance came shortly after that, so it was just a case where they were able to get me to the hospital so quickly that was really a big part of why I don’t have any residual symptoms,” she said.

Upon arriving at the St. Alexius Emergency Department, Buchholtz was unable to move her left arm or leg, had a left facial droop and was gazing toward her right. Her NIH Stroke Scale reading was an 11, which determines how severe her symptoms were on a scale of 0-42 with 42 being the most serious reading.

Once it was determined Buchholtz didn’t have a bleed in her brain, the telespecialists ordered the use of the clot-busting drug tenecteplase (TNK), which was administered within 20 minutes of arrival time. An interventional radiologist was consulted and saw Buchholtz during her CT scan and approved a thrombectomy – surgery to remove a blood clot – which occurred 59 minutes after Buchholtz arrived at St. Alexius.

A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts. When that happens, part of the brain cannot get the blood and oxygen it needs, so brain cells die.

The interventional radiologist physician was able to remove a clot and restore blood flow to Buchholtz’s brain. She was closely monitored for 24 hours and a reassessment showed Buchholtz was back to normal with a NIHSS reading of zero.

“Janel had only some minor deficits immediately after and it was amazing,” said Brannigan Hamrick, Stroke Program coordinator at St. Alexius. “Her story is remarkable and she is so lucky things fell into place the way they did.

Stroke is the No. 5 cause of death and a leading cause of disability in the U.S. Early stroke detection and treatment are key to improving survival, minimizing disability and accelerating recovery times.

CHI St. Alexius received the American Heart Association’s Get With the Guidelines-Stroke Gold Plus quality achievement award for its commitment to ensuring stroke patients receive the most appropriate treatment. Get With the Guidelines puts the expertise of the American Heart Association and American Stroke Association to work for hospitals nationwide, helping ensure patient care is aligned with the latest research- and evidence-based guidelines.

St. Alexius also received the American Heart Association’s Target: Stroke Elite Honor Roll award for meeting specific criteria that reduce the time between an eligible patient’s arrival at the hospital and treatment with the clot-buster alteplase. It received the American Heart Association’s Target: Type 2 Honor Roll award for efforts to ensure patients with Type 2 diabetes, who might be at higher risk for complications, receive the most up-to-date, evidence-based care when hospitalized due to stroke.

Buchholtz stayed in the hospital for five days, including three in the Intensive Coronary Care Unit, and had a leadless pacemaker implanted before her dismissal. While she continued to deal with some fatigue and struggles in occasionally finding the words she wants to say, she said she hasn’t had any other major physical issues.

“I feel just extremely blessed,” she said.

Effects of a soft robotic exosuit on the quality and speed of overground walking depends on walking ability after stroke

To increase my walking speed even more you'll have to cure my leg and foot spasticity that prevents a free swinging lower leg and angles my left foot outwards. 

 Effects of a soft robotic exosuit on the quality and speed of overground walking depends on walking ability after stroke

Journal of NeuroEngineering and Rehabilitation. Volume 20(113)

NARIC Accession Number: J92718. What's this?
Author(s): Sloot, Lizeth H., Baker, Lauren M., Bae, Jaehyun, Porcincula, Franchino, Clément, Blandine F., Siviy, Christopher, Nuckols, Richard W., Baker, Teresa, Sloutsky, Regina, Choe, Dabin K., O’Donnell, Kathleen, Ellis, Terry D., Awad, Louis N., Walsh, Conor J..
Publication Year: 2023.
Abstract: Study evaluated the effects of a portable ankle exosuit during continuous comfortable overground walking in 19 individuals with chronic hemiparesis. It also compared two speed-based subgroups: people poststroke with comfortable walking speeds less than 0.93 m/s (limited community ambulators) and those with comfortable walking speeds greater than 0.93 m/s (full community ambulators), to address poststroke heterogeneity. Analyses compared five minutes of continuous walking in a laboratory with the exosuit to walking without the exosuit in terms of ground clearance, foot landing and propulsion, the energy cost of transport, walking stability, and plantar flexor muscle slacking. Exosuit assistance was associated with improvements in the targeted gait impairments: 22 percent increase in ground clearance during swing, 5 degrees increase in foot-to-floor angle at initial contact, and 22 percent increase in the center-of-mass propulsion during push-off. The improvements in propulsion and foot landing contributed to a 6.7 percent increase in walking speed. This enhancement in gait function was achieved without deterioration in muscle effort, stability, or cost of transport. Subgroup analyses revealed that all individuals profited from ground clearance support, but slower individuals leveraged plantar flexor assistance to improve propulsion by 35 percent to walk 13 percent faster, while faster individuals did not change either.
Descriptor Terms: AMBULATION, BIOENGINEERING, MOBILITY IMPAIRMENTS, REHABILITATION TECHNOLOGY, ROBOTICS, STROKE.


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Citation: Sloot, Lizeth H., Baker, Lauren M., Bae, Jaehyun, Porcincula, Franchino, Clément, Blandine F., Siviy, Christopher, Nuckols, Richard W., Baker, Teresa, Sloutsky, Regina, Choe, Dabin K., O’Donnell, Kathleen, Ellis, Terry D., Awad, Louis N., Walsh, Conor J.. (2023.) Effects of a soft robotic exosuit on the quality and speed of overground walking depends on walking ability after stroke. Journal of NeuroEngineering and Rehabilitation., 20(113) Retrieved 11/30/2023, from REHABDATA database.

Rest-activity rhythm characteristics associated with depression symptoms in stroke survivors

It is your doctor's responsibility to ABSOLUTELY INSURE that your mental health post stroke is good.  And that is only possible with 100% recovery protocols. If you don't have those protocols, you don't have a functioning stroke doctor. Depression is a secondary problem that would not exist if you had 100% recovery protocols.

 Rest-activity rhythm characteristics associated with depression symptoms in stroke survivors

Archives of Physical Medicine and Rehabilitation. Volume 104(8), Pgs. 1203-1208.

NARIC Accession Number: J92708. What's this?
Author(s): Stahl, Sarah T., Skidmore, Elizabeth, Kringle, Emily, Shih, Minmei, Baum, Carolyn, Hammel, Joy, Krafty, Robert, Covassin, Naima, Li, Jingen, Smagula, Stephen F..
Publication Year: 2023.
Abstract: Study determined which 24-hour rest-activity rhythm (RAR) characteristics are associated with depression symptoms in stroke survivors. Participants included 63 stroke survivors recruited locally and a nationally representative probability sample of 280 stroke survivors from the National Health and Nutrition Examination Survey (NHANES). Objective RAR characteristics derived from accelerometer recordings including activity onset/offset times and non-parametric measures of RAR strength (relative amplitude), stability (inter-daily stability), and fragmentation (intra-daily variability). The presence of depression symptoms was categorized using Patient Health Questionnaire scores. In both samples, the only RAR characteristic associated with depression symptoms was intra-daily variability (fragmentation): local sample, odds ratio=1.96; NHANES sample, odds ratio=1.34. In the NHANES sample, which included both mild and moderate/severe depression, the association between 24-hour sleep-wake fragmentation and depression symptoms was driven by moderate-to-severe cases. Stroke survivors with higher levels of RAR fragmentation were more likely to have depression symptoms in both samples. These findings have implications, given prior studies in general samples linking RAR fragmentation with future depression and dementia risk. Research is needed to establish the potential consequences, mechanisms, and modifiability of RAR fragmentation in stroke survivors.
Descriptor Terms: DEPRESSION, SLEEP DISORDERS, STROKE.


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Citation: Stahl, Sarah T., Skidmore, Elizabeth, Kringle, Emily, Shih, Minmei, Baum, Carolyn, Hammel, Joy, Krafty, Robert, Covassin, Naima, Li, Jingen, Smagula, Stephen F.. (2023.) Rest-activity rhythm characteristics associated with depression symptoms in stroke survivors. Archives of Physical Medicine and Rehabilitation., 104(8), Pgs. 1203-1208. Retrieved 11/30/2023, from REHABDATA database.

Physical therapists use different motivational strategies for stroke rehabilitation tailored to an individual’s condition: A qualitative study

Motivation is extremely easy to understand and implement. 

Write up 100% recovery protocols on this and survivors will do the millions of reps needed, no external motivation required. You don't understand one goddamn thing about stroke survivors, DO YOU? The problem is stroke researchers are not motivated to solve stroke. What the fuck is your solution to that failure? We still don't know how to motivate stroke medical 'professionals' to solve stroke to 100% recovery!

 Physical therapists use different motivational strategies for stroke rehabilitation tailored to an individual’s condition: A qualitative study

Physical Therapy. Volume 103(6), Pgs. pzad034.

NARIC Accession Number: J92601. What's this?
Author(s): Oyake, Kazuaki, Sue, Keita, Sumiya, Motofumi, Tanaka, Satoshi.
Publication Year: 2023.
Abstract: Study explored how physical therapists use different motivational strategies for individuals in stroke rehabilitation programs. Fifteen physical therapists who have worked in rehabilitation for over 10 years and were interested in an individual’s motivation participated in one-on-one semi-structured online interviews. The interviews explored their perspectives and experiences regarding the motivational strategies used depending on each individual’s condition. The collected data were analyzed with thematic analysis. Participants used different strategies to encourage individuals’ active participation in physical therapy depending on their mental health, physical difficulties, level of cognitive function, personality, activities and participation, age, and human environment, and the type of rehabilitation service where the individual underwent treatment. For example, in cases where an individual lost self-confidence, participants offered practice tasks that the individual could achieve with little effort to make them experience success. The interviews also revealed motivational strategies used regardless of the individual’s condition. For instance, patient-centered communication was used to build rapport with individuals, irrespective of their condition. Results suggest that physical therapists use different strategies depending on the individual’s mental health conditions, physical problems, level of cognitive function, personality, activities and participation, age, human environment, and the type of rehabilitation service where the individual undergoes treatment to motivate individuals with stroke during physical therapy. The findings of this study can provide experience-based recommendations regarding the selection of motivational strategies for stroke rehabilitation.
Descriptor Terms: CLIENT CHARACTERISTICS, MOTIVATION, PHYSICAL THERAPY, PSYCHOTHERAPY, QUALITATIVE ANALYSIS, REHABILITATION, STROKE.


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Citation: Oyake, Kazuaki, Sue, Keita, Sumiya, Motofumi, Tanaka, Satoshi. (2023.) Physical therapists use different motivational strategies for stroke rehabilitation tailored to an individual’s condition: A qualitative study. Physical Therapy., 103(6), Pgs. pzad034. Retrieved 11/30/2023, from REHABDATA database.

Autonomy support encourages use of more-affected arm post-stroke

This is only useful for higher functioning survivors. For me with dead brain in what used to control the arm and hand this is totally useless. I need dead brain rehab and I see nothing out there that will help me recover.

 Autonomy support encourages use of more-affected arm post-stroke

Journal of NeuroEngineering and Rehabilitation. Volume 20(116)

NARIC Accession Number: J92739. What's this?
Author(s): Kim, Sujin, Shin, Yumi, Jeong, Yeonwoo, Na, Seungyoung, Han, Cheol E..
Publication Year: 2023.
Abstract: Study investigated whether autonomy support combined with an information technology device facilitated success in using the more-affected arm during training in individuals with stroke. Autonomy support, which involves providing individuals the ability to control their own behavior, is associated with improved motor control and learning in various populations in clinical and non-clinical settings. Twenty-six participants with stroke were assigned to the autonomy support or control group. Over a 5-week period, training and test sessions were conducted using the Individualized Motivation Enhancement System (IMES), a device developed specifically for this study. In the autonomy-support group, participants were able to adjust the task difficulty parameter, which controlled the time limit for reaching targets. The control group did not receive this option. The evaluation of the more-affected arm's use, performance, and impairment was conducted through clinical tests and the IMES. These data were then analyzed using mixed-effect models. In the IMES test, both groups showed a significant improvement in performance after the training period, without any significant intergroup differences. However only the autonomy-support group demonstrated a significant increase in the use of the more-affected arm following the training. Additionally, during the training period, the autonomy support group showed a significant increase in successful experiences with using the more-affected arm, while the control group did not exhibit the same level of improvement. Also, in the autonomy-support group, the increase in the use of the more-affected arm was associated with the increase in the successful experience significantly.
Descriptor Terms: ASSISTIVE TECHNOLOGY, HEMIPLEGIA, LIMBS, MOTIVATION, MOTOR SKILLS, SELF CONCEPT, STROKE, THERAPEUTIC TRAINING.


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Get this Document: https://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-023-01238-0(link is external).

Citation: Kim, Sujin, Shin, Yumi, Jeong, Yeonwoo, Na, Seungyoung, Han, Cheol E.. (2023.) Autonomy support encourages use of more-affected arm post-stroke. Journal of NeuroEngineering and Rehabilitation., 20(116) Retrieved 11/30/2023, from REHABDATA database.

Test-retest reliability and responsiveness of the computerized adaptive test of social functioning in persons with stroke

This does ABSOLUTELY NOTHING to get survivors recovered. Deliver social functioning for survivors by getting them 100% recovered. Will you work on proper stroke research for once.?

 Test-retest reliability and responsiveness of the computerized adaptive test of social functioning in persons with stroke

Archives of Physical Medicine and Rehabilitation. Volume 104(9), Pgs. 1432-1438.

NARIC Accession Number: J92762. What's this?
Author(s): Chiang, Hsin-yu, Chen, Po-Ting, Lee, Shih-Chieh, Shieh, Yun-Jer, Hsueh, I-Ping, Hsieh, Ching-Lin.
Publication Year: 2023.
Abstract: Study examined the test-retest reliability, minimal detectable change (MDC), responsiveness, and efficiency of the Computerized Adaptive Test of Social Functioning (Social-CAT) in patients with stroke. Participants were 31 patients with chronic stroke and 65 patients with subacute stroke. The National Institutes of Health Stroke Scale (NIHSS) was used to monitor the patients’ stroke severity. For the test-retest reliability study, the patients completed the Social-CAT twice on tablet computers by themselves, and the NIHSS was administered twice by the occupational therapist, both at 4-week intervals to minimize the effect of possible confounding variables such as memory effects. For the responsiveness study, the patients completed the Social-CAT, and the NIHSS was administered twice at 2 time points while they received inpatient rehabilitation: within 7 days of admission to and 7 days before discharge from rehabilitation wards. The Social-CAT showed acceptable test-retest reliability (intraclass correlation coefficient = 0.80) and small random measurement error (minimal detectable change percentage [MDC%] = 18.0 percent). However, heteroscedasticity was found (r between the means and the absolute change scores: 0.32), so the MDC% adjusted cut-off score is recommended for determining real improvement. Regarding responsiveness, the Social-CAT showed large differences (Kazis’ effect size and standardized mean response: 1.15 and 1.09, respectively) in subacute patients. Regarding efficiency, the Social-CAT required an average of 5 items and less than 2 minutes for completion. Findings indicate that the Social-CAT is a reliable and efficient measure with good test-retest reliability, small random measurement error, and good responsiveness. Therefore, the Social-CAT is a useful outcome measure for routine monitoring of the changes in social function of patients with stroke.
Descriptor Terms: COMPUTER APPLICATIONS, MEASUREMENTS, OUTCOMES, PERFORMANCE STANDARDS, SOCIAL SKILLS, STROKE.


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Citation: Chiang, Hsin-yu, Chen, Po-Ting, Lee, Shih-Chieh, Shieh, Yun-Jer, Hsueh, I-Ping, Hsieh, Ching-Lin. (2023.) Test-retest reliability and responsiveness of the computerized adaptive test of social functioning in persons with stroke. Archives of Physical Medicine and Rehabilitation., 104(9), Pgs. 1432-1438. Retrieved 11/30/2023, from REHABDATA database.

Three ways to improve arm function in the chronic phase after stroke by robotic priming combined with mirror therapy, arm training, and movement-oriented therapy

Good luck mimicking this for your recovery with no protocol provided.

 Three ways to improve arm function in the chronic phase after stroke by robotic priming combined with mirror therapy, arm training, and movement-oriented therapy

Archives of Physical Medicine and Rehabilitation. Volume 104(8), Pgs. 1195-1202.

NARIC Accession Number: J92709. What's this?
Author(s): Li, Yi-chun, Lin, Keh-chung, Chen, Chia-ling, Yao, Grace, Chang, Ya-ju, Lee, Ya-yun, Liu, Chien-ting, Chen, Wen-Shiang.
Publication Year: 2023.
Abstract: Study examined the effects of bilateral robotic priming combined with mirror therapy (R-mirr) vs bilateral robotic priming combined with bilateral arm training (R-bilat), relative to the control approach of bilateral robotic priming combined with movement-oriented training (R-mov)(What's this?) in patients with stroke. In a single-blind randomized controlled trial, 63 outpatients with stroke and mild-to-moderate motor impairment received 6 weeks of clinic-based R-mirr, R-bilat, or R-mov for 90 minutes a day, 3 days a week, plus a transfer package at home for 5 days a week. Outcomes included the Fugl-Meyer Assessment Upper Extremity subscale (FMA-UE), ABILHAND, and Stroke Impact Scale v3.0 scores obtained before, immediately after, and 3 months after treatment as well as lateral pinch strength and accelerometry before and immediately after treatment. The posttest results favored R-mirr over R-bilat and R-mov on the FMA-UE score. Follow-up analysis revealed that significant improvement in FMA-UE score was retained at the 3-month follow-up in the R-mirr over R-bilat or R-mov. Significant improvements were not observed in the R-mirr over R-bilat and R-mov on other outcomes. Between-group differences were only detected for the primary outcome, FMA-UE. R-mirr was more effective at enhancing upper-limb motor improvement, and the effect has the potential to be maintained at 3 months of follow-up.
Descriptor Terms: EXERCISE, LIMBS, MOTOR SKILLS, PHYSICAL THERAPY, REHABILITATION TECHNOLOGY, ROBOTICS, STROKE, THERAPEUTIC TRAINING.


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Citation: Li, Yi-chun, Lin, Keh-chung, Chen, Chia-ling, Yao, Grace, Chang, Ya-ju, Lee, Ya-yun, Liu, Chien-ting, Chen, Wen-Shiang. (2023.) Three ways to improve arm function in the chronic phase after stroke by robotic priming combined with mirror therapy, arm training, and movement-oriented therapy. Archives of Physical Medicine and Rehabilitation., 104(8), Pgs. 1195-1202. Retrieved 11/30/2023, from REHABDATA database.

Efficacy of robot-assisted training on rehabilitation of upper limb function in patients with stroke: A systematic review and meta-analysis

Your doctor and hospital are so incompetent they can't even get music therapy going. This is way beyond their abilities!

You can easily prove me wrong, so provide the EXACT MUSIC REHAB PROTOCOL  your hospital is using and proven results from that.

 Efficacy of robot-assisted training on rehabilitation of upper limb function in patients with stroke: A systematic review and meta-analysis

Archives of Physical Medicine and Rehabilitation. Volume 104(9), Pgs. 1498-1513.

NARIC Accession Number: J92766. What's this?
Author(s): Yang, Xinwei, Shi, Xiubo, Xue, Xiali, Deng, Zhongyi.
Publication Year: 2023.
Abstract: This review evaluated the effect of robot-assisted training (RAT) on upper-limb function recovery in patients with stroke, providing the evidence-based medical basis for the clinical application of RAT. Online electronic databases were searched up to June 2022, for randomized controlled trials (RCTs) examining the effect of RAT on upper-extremity functional recovery in patients with stroke. Fourteen RCTs involving 1,275 patients were included for review. Compared with the control group, RAT significantly improved upper-limb motor function and daily living ability. The Cochrane Collaboration Tool for Assessing the Risk of Bias was used to assess study quality and risk of bias. The overall differences were statistically significant, Fugl-Meyer Assessment for the Upper Extremity (FMA-UE; standard mean difference=0.69), modified Barthel Index (standard mean difference=0.95), whereas the differences in modified Ashworth Scale, Functional Independence Measure, and Wolf Motor Function Test scores were not statistically significant. Compared with the control group, the differences between FMA-UE and modified Barthel Index at 4 and 12 weeks of RAT, there were statistically significant, the differences of FMA-UE and modified Ashworth Scale in patients with stroke in the acute and chronic phases were statistically significant. This study showed that RAT can significantly enhance the upper-limb motor function and activities of daily life in patients with stroke undergoing upper-limb rehabilitation.
Descriptor Terms: LIMBS, LITERATURE REVIEWS, MOTOR SKILLS, REHABILITATION TECHNOLOGY, ROBOTICS, STROKE, THERAPEUTIC TRAINING.


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Citation: Yang, Xinwei, Shi, Xiubo, Xue, Xiali, Deng, Zhongyi. (2023.) Efficacy of robot-assisted training on rehabilitation of upper limb function in patients with stroke: A systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation., 104(9), Pgs. 1498-1513. Retrieved 11/30/2023, from REHABDATA database.

Endovascular Brain-Computer Interfaces in Poststroke Paralysis

This assumes you actually have functioning motor neurons that are still generating signals but can't get thru(Meaning your white mater is damaged, the solution to white matter damage is axon pathfinding and dendritic branching). Since most of my motor cortex and pre-motor cortex is dead this would be useless for me. What is your solution for me?

• axon pathfinding (35 posts to March 2012)

• dendritic branching (38 posts to February 2012)

• neurite outgrowth (29 posts to January 2012)

Endovascular Brain-Computer Interfaces in Poststroke Paralysis

Jamie F.M. Brannigan,

Adam Fry,

Nicholas L. Opie,

Bruce C.V. Campbell,

Peter J. Mitchell and

Thomas J. Oxley

Originally published29 Nov 2023https://doi.org/10.1161/STROKEAHA.123.037719Stroke. 2023;0

Abstract

Stroke is a leading cause of paralysis, most frequently affecting the upper limbs and vocal folds. Despite recent advances in care, stroke recovery invariably reaches a plateau, after which there are permanent neurological impairments. Implantable brain-computer interface devices offer the potential to bypass permanent neurological lesions. They function by (1) recording neural activity, (2) decoding the neural signal occurring in response to volitional motor intentions, and (3) generating digital control signals that may be used to control external devices. While brain-computer interface technology has the potential to revolutionize neurological care, clinical translation has been limited. Endovascular arrays present a novel form of minimally invasive brain-computer interface devices that have been deployed in human subjects during early feasibility studies. This article provides an overview of endovascular brain-computer interface devices and critically evaluates the patient with stroke as an implant candidate. Future opportunities are mapped, along with the challenges arising when decoding neural activity following infarction. Limitations arise when considering intracerebral hemorrhage and motor cortex lesions; however, future directions are outlined that aim to address these challenges.

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Automated Large Vessel Occlusion Detection Software and Thrombectomy Treatment Times

 You do realize the only goal in stroke is 100% recovery? I guess not since you didn't measure that.

“What's measured, improves.” So said management legend and author Peter F. Drucker 

Automated Large Vessel Occlusion Detection Software and Thrombectomy Treatment Times

Juan Carlos Martinez-Gutierrez, MD¹; Youngran Kim, PhD²; Sergio Salazar-Marioni, MD³; et al Muhammad Bilal Tariq, MD³; Rania Abdelkhaleq, MPH³; Arash Niktabe, DO³; Anjan N. Ballekere, MS³; Ananya S. Iyyangar, BS³; Mai Le, BS³; Hussain Azeem, BS³; Charles C. Miller, PhD⁴; Jon E. Tyson, MD, MPH⁵; Sandi Shaw, RN⁶; Peri Smith, RN⁶; Mallory Cowan, RN⁶; Isabel Gonzales, RN⁶; Louise D. McCullough, MD, PhD³; Andrew D. Barreto, MD³; Luca Giancardo, PhD⁷; Sunil A. Sheth, MD³

Author Affiliations Article Information

JAMA Neurol. 2023;80(11):1182-1190. doi:10.1001/jamaneurol.2023.3206

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Abstract

Key Points

Question  Does implementation of automated large vessel occlusion detection software for acute stroke triage decrease time to endovascular thrombectomy initiation?

Findings  In this cluster randomized trial including 243 patients treated with thrombectomy over a 1-year period, implementation of automated large vessel occlusion detection software led to a statistically significant reduction of 11 minutes in time to thrombectomy initiation.

Meaning  Artificial intelligence-enabled automated large vessel occlusion detection software for stroke triage can improve thrombectomy treatment times.

Abstract

Importance  The benefit of endovascular stroke therapy (EVT) in large vessel occlusion (LVO) ischemic stroke is highly time dependent. Process improvements to accelerate in-hospital workflows are critical.

Objective  To determine whether automated computed tomography (CT) angiogram interpretation coupled with secure group messaging can improve in-hospital EVT workflows.

Design, Setting, and Participants  This cluster randomized stepped-wedge clinical trial took place from January 1, 2021, through February 27, 2022, at 4 comprehensive stroke centers (CSCs) in the greater Houston, Texas, area. All 443 participants with LVO stroke who presented through the emergency department were treated with EVT at the 4 CSCs. Exclusion criteria included patients presenting as transfers from an outside hospital (n = 158), in-hospital stroke (n = 39), and patients treated with EVT through randomization in a large core clinical trial (n = 3).

Intervention  Artificial intelligence (AI)–enabled automated LVO detection from CT angiogram coupled with secure messaging was activated at the 4 CSCs in a random-stepped fashion. Once activated, clinicians and radiologists received real-time alerts to their mobile phones notifying them of possible LVO within minutes of CT imaging completion.

Main Outcomes and Measures  Primary outcome was the effect of AI-enabled LVO detection on door-to-groin (DTG) time and was measured using a mixed-effects linear regression model, which included a random effect for cluster (CSC) and a fixed effect for exposure status (pre-AI vs post-AI). Secondary outcomes included time from hospital arrival to intravenous tissue plasminogen activator (IV tPA) bolus in eligible patients, time from initiation of CT scan to start of EVT, and hospital length of stay. In exploratory analysis, the study team evaluated the impact of AI implementation on 90-day modified Rankin Scale disability outcomes.

Results  Among 243 patients who met inclusion criteria, 140 were treated during the unexposed period and 103 during the exposed period. Median age for the complete cohort was 70 (IQR, 58-79) years and 122 were female (50%). Median National Institutes of Health Stroke Scale score at presentation was 17 (IQR, 11-22) and the median DTG preexposure was 100 (IQR, 81-116) minutes. In mixed-effects linear regression, implementation of the AI algorithm was associated with a reduction in DTG time by 11.2 minutes (95% CI, −18.22 to −4.2). Time from CT scan initiation to EVT start fell by 9.8 minutes (95% CI, −16.9 to −2.6). There were no differences in IV tPA treatment times nor hospital length of stay. In multivariable logistic regression adjusted for age, National Institutes of Health Stroke scale score, and the Alberta Stroke Program Early CT Score, there was no difference in likelihood of functional independence (modified Rankin Scale score, 0-2; odds ratio, 1.3; 95% CI, 0.42-4.0).

Conclusions and Relevance  Automated LVO detection coupled with

Serum β-synuclein, neurofilament light chain and glial fibrillary acidic protein as prognostic biomarkers in moderate-to-severe acute ischemic stroke

Predicting something DOES ABSOLUTELY NOTHING to get survivors recovered! Will you try to solve stroke to 100% recovery, instead of this useless waste?

Serum β-synuclein, neurofilament light chain and glial fibrillary acidic protein as prognostic biomarkers in moderate-to-severe acute ischemic stroke

• Lorenzo Barba,
• Christoph Vollmuth,
• Samir Abu-Rumeileh,
• Steffen Halbgebauer,
• Patrick Oeckl,
• Petra Steinacker,
• Alexander M. Kollikowski,
• Cara Schultz,
• Judith Wolf,
• Mirko Pham,
• Michael K. Schuhmann,
• Peter U. Heuschmann,
• Karl Georg Haeusler,
• Guido Stoll,
• Hermann Neugebauer &
• Markus Otto 

Scientific Reports volume 13, Article number: 20941 (2023) Cite this article

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Abstract

We aimed to assess the prognostic value of serum β-synuclein (β-syn), neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP) in patients with moderate-to-severe acute ischemic stroke. We measured β-syn, GFAP and NfL in serum samples collected one day after admission in 30 adult patients with moderate-to-severe ischemic stroke due to middle cerebral artery (MCA) occlusion. We tested the associations between biomarker levels and clinical and radiological scores (National Institute of Health Stroke Scale scores, NIHSS, and Alberta Stroke Program Early CT Score, ASPECTS), as well as measures of functional outcome (modified Rankin Scale, mRS). Serum biomarkers were significantly associated with ASPECTS values (β-syn p = 0.0011, GFAP p = 0.0002) but not with NIHSS scores at admission. Patients who received mechanical thrombectomy and intravenous thrombolysis showed lower β-syn (p = 0.029) und NfL concentrations (p = 0.0024) compared to patients who received only mechanical thrombectomy. According to median biomarker levels, patients with high β-syn, NfL or GFAP levels showed, after therapy, lower clinical improvement (i.e., lower 24-h NIHSS change), higher NIHSS scores during hospitalization and higher mRS scores at 3-month follow-up. Elevated serum concentrations of β-syn (p = 0.016), NfL (p = 0.020) or GFAP (p = 0.010) were significantly associated with 3-month mRS of 3–6 vs. 0–2 even after accounting for age, sex and renal function. In patients with moderate-to-severe acute ischemic stroke, serum β-syn, NfL and GFAP levels associated with clinical and radiological scores at different timepoints and were able to predict short- and middle-term clinical outcomes.

Personalized health and lifestyle changes can delay memory loss in older adults

Drinking  lubricates my social connections(Jazz and trivia) which is going to prevent dementia. I travel internationally with 4 groups of friends. Don't follow me, I'm not medically trained.

Personalized health and lifestyle changes can delay memory loss in older adults

Study shows cognitive improvements when participants keep active and socially engaged, control blood pressure and diabetes.

As more medications move towards federal approval for Alzheimer's disease, a new study led by researchers at UC San Francisco and Kaiser Permanente Washington has found that personalized health and lifestyle changes can delay or even prevent memory loss for higher-risk older adults.

The two-year study compared cognitive scores, risk factors and quality of life among 172 participants, of whom half had received personalized coaching to improve their health and lifestyle in areas believed to raise the risk of Alzheimer's, such as uncontrolled diabetes and physical inactivity. These participants were found to experience a modest boost in cognitive testing, amounting to a 74% improvement over the non-intervention group.

Improvements were also noted between the two groups in measurements of risk factors and quality of life, translating approximately to 145% and 8%, respectively, the researchers reported. The study publishes Nov. 27, 2023, in JAMA IM.

Older adults highly motivated to make changes

The study, known as SMARRT, for systematic multi-domain Alzheimer's risk reduction trial, follows previous work from other researchers that has yielded contradictory results on the effects of health and lifestyle interventions. This study differed, though, in providing personal coaching that was customized to each participant.

This is the first personalized intervention, focusing on multiple areas of cognition, in which risk factor targets are based on a participant's risk profile, preferences and priorities, which we think may be more effective than a one-size-fits-all approach."

Kristine Yaffe, MD, first author and lead investigator, vice chair of research in psychiatry and professor in the UCSF departments of neurology, psychiatry, and epidemiology and biostatistics

"In an earlier survey of 600 older adults, we found that most were concerned about Alzheimer's disease and related dementias. They wanted to know their personal risk factors and were highly motivated to make lifestyle changes to lower dementia risk," said Yaffe, referring to her collaboration with co-lead investigator and co-author Eric B. Larson, MD, MPH, former vice president for research and health care intervention at Kaiser Permanente Washington.

Participants in the current study, as well as the earlier survey, were enrolled in Kaiser Permanente Washington and were between 70 and 89 years old. They had at least two of eight risk factors for dementia: physical inactivity, uncontrolled hypertension, uncontrolled diabetes, poor sleep, use of prescription medications associated with risk of cognitive decline, high depressive symptoms, social isolation and current smoking status.

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The intervention participants met with a nurse and health coach and selected specific risk factors they wanted to address. They received coaching sessions every few months to review their goals, which ranged from tracking hypertension to walking a certain number of steps per day or signing up for a class. The meetings started in person and switched to phone calls during the pandemic.

Non-intervention participants were similar in age, risk factors and cognitive scores and received educational material, mailed every three months, on dementia risk reduction.

Pandemic did not offset study's positive effects

"We were pleasantly surprised that the positive results of the trial were not offset by the impact of the pandemic," said Larson, who is currently professor of medicine at University of Washington. "We know that isolation from social distancing took a heavy toll on cognition, social lives, and mental and physical health in some older adults. But participants in the intervention group fared better cognitively and had fewer risk factors after the trial, during the pandemic, than they did before."

Unlike anti-amyloid medications, risk-reduction programs are not costly, nor do they have strict eligibility criteria or require extensive monitoring for side-effects, said Yaffe, who is also affiliated with the San Francisco VA Health Care System and the UCSF Weill Institute for Neurosciences.

"Hopefully in the future, treatment of Alzheimer's and related dementias will be like cardiovascular disease management, with a combination of risk-reduction and specific drugs targeted for disease mechanisms," she said.

Source:

University of California - San Francisco

Journal reference:

Yaffe, K., et al. (2023). Effect of Personalized Risk-Reduction Strategies on Cognition and Dementia Risk Profile Among Older Adults: The SMARRT Randomized Clinical Trial. JAMA Internal Medicine. doi.org/10.1001/jamainternmed.2023.6279.

Reducing cholesterol esters protects the brain against Alzheimer's-like damage

Your competent doctor and hospital will make sure that human testing gets done on this. You do have a competent doctor and hospital? I guess you don't since they didn't get you 100% recovered from your stroke.

Reducing cholesterol esters protects the brain against Alzheimer's-like damage

In Alzheimer's disease and related dementias, cognitive decline is driven by the overaccumulation of a normal brain protein known as tau. Wherever tau builds up, nearby brain tissue starts to degenerate and die.

Now, researchers at Washington University School of Medicine in St. Louis have found — in mice — that Alzheimer's-like tau deposits in the brain lead to the accumulation of a form of cholesterol known as cholesteryl esters, and that lowering cholesteryl ester levels helps prevent brain damage and behavioral changes.

This has important therapeutic implications. The compound we used in this study has side effects that make it unsuitable for use in people. But if you could develop a therapy that reduces cholesteryl esters inside brain cells without unacceptable side effects, it would be a promising candidate to test in neurodegenerative diseases."

David M. Holtzman, MD, Senior Author, the Barbara Burton and Reuben M. Morriss III Distinguished Professor of Neurology

The findings are published Nov. 22 in the journal Neuron.

The link between cholesterol and dementia is not as far-fetched as it might seem. The biggest genetic risk factor for Alzheimer's is APOE, a gene involved in activating the brain's immune cells. When such cells are activated in the wrong way or at the wrong time, they can damage brain tissue. But APOE also has another important job in the body: It carries cholesterol and other lipids around in the blood. In this capacity, it plays a role in atherosclerosis.

To investigate the connections between APOE, lipids and brain damage, Holtzman and first author Alexandra Litvinchuk, PhD, a postdoctoral researcher, studied mice with a high-risk tau gene that predisposes them to accumulate tau in their brains. Such mice start developing signs of neurodegeneration around 6 months of age. By 9½ months, their brains are severely damaged, and they no longer are able to complete ordinary tasks of mouse life such as properly building a nest. The mice also carried a second genetic modification: Their own APOE genes had been removed and either replaced with a variant of the human APOE gene — APOE3, which confers an average risk of Alzheimer's; or APOE4, which doubles or triples the risk of Alzheimer's — or not replaced at all.

Investigation revealed that APOE4 is linked to distorted lipid metabolism in the brain. In 9½-month-old tau mice carrying APOE4, the same brain areas that became atrophied and damaged also amassed excess lipids, and in a strange pattern. Levels of more than 180 kinds of lipids were altered. Among the most striking differences was that immune cells known as microglia in those areas were filled to the brim with cholesteryl esters. APOE3 did not have the same effect. The measurement of the brain lipids was done in collaboration with scientists at the company Denali Therapeutics led by Gilbert Di Paolo, PhD.

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"Microglia filled up with lipids become hyperinflammatory and start secreting things that are not good for the brain," Holtzman said.

Therefore, clearing out lipids potentially could reduce brain inflammation and neurodegeneration, he said. To find out, Litvinchuk and Holtzman used an LXR agonist, a member of an experimental class of drugs that lowers lipid levels in cells. The researchers fed the drug, called GW3965, to tau mice carrying APOE4, starting at 6 months of age. The mice were assessed at 9½ months, by which point their brains normally would have sustained considerable damage. Mice that had received the drug retained significantly more brain volume than those that had received a placebo. They also had lower levels of tau, fewer inflammatory cells and less inflammation, less loss of synapses in their brains, and were better at building nests.

Further investigation revealed that the LXR agonist works by upregulating a gene called Abca1 that helps move cholesterol and other lipids out of cells. Using genetic methods to increase Abca1 levels had the same effect as drug treatment: less lipid accumulation, lower levels of tau, less inflammation and reduced neurodegeneration.

"What's exciting is that we see all these effects in an animal model that shares a lot of features with human neurodegenerative diseases," Holtzman said. "It shows that this kind of approach could have a lot of promise."

One major obstacle stands in the way of translating this approach to people, Holtzman added. LXR agonists also affect lipid metabolism in the liver, and so they tend to cause fatty liver disease. Chemists are hard at work trying to design LXR agonists without that side effect. If they succeed, the resulting drugs may have benefits for heart disease as well as brain disease.

"There's a lot of similarity between the mechanism that's driving immune cells to damage the brain in Alzheimer's disease and the one that's driving the same kinds of immune cells to cause vascular damage in atherosclerosis," Holtzman said. "In both cases, lipids accumulate in immune cells, causing them to become hyperinflammatory and damage nearby tissues. Getting rid of that lipid accumulation may have double benefits for human health."

Source:

Washington University School of Medicine

Journal reference:

Litvinchuk, A., et al. (2023) Amelioration of Tau and ApoE4-linked glial lipid accumulation and neurodegeneration with an LXR agonist. Neuron. doi.org/10.1016/j.neuron.2023.10.023.