'I learned to play guitar with one arm after a stroke'

 Why? Because your doctor and therapists were complete fucking failures at getting you recovered?

'I learned to play guitar with one arm after a stroke'

1 day ago

Jonathan Geddes

BBC Scotland News

Tony Romaine

Tony Romaine spent seven months in hospital recovering from his stroke

An Inverness man has been able to resume his music career despite suffering a stroke that left him unable to speak or walk - by teaching himself to play the guitar one-handed.

Tony Romaine spent seven months in hospital recovering from a stroke that hit him "out of the blue" two years ago.

The 49-year-old dad of four was found by his wife Lynn lying on their couch unable to move or even cry for help after a clot caused the blood supply to his brain to be interrupted.

However, earlier this year he took to the stage to play his first gig since the incident, with plans for further shows in 2025.

"I couldn't imagine not doing music in my life," says Tony, who was initially unable to even swallow after the stroke happened.

"When people said I probably wouldn't be able to play again, I wasn't going to listen to that. There was probably a part of me that was like 'I'll prove you wrong' but I just had to get back to playing again."

Tony Romaine

Tony had to relearn how to walk, talk and eat after his stroke

A music lover from childhood, Tony regularly played gigs around Inverness. In 2022 he forced himself to play a couple of shows despite feeling unwell - not realising that within days doctors would be telling his family to prepare for the worst.

"The day after the gig I had a rest day, so I was sitting on the couch and ordering a takeaway.

"By the time the takeaway got there, I was finding it difficult to move around but I just thought I was tired and under the weather. I never thought it would be anything like a stroke.

"By the time everyone was going to bed I was saying I would just stay there a bit longer, and I lay down. Next thing I knew, I couldn't move at all. I went to shout out, and realised I couldn't speak either.

"I was lying there all night, wide awake and thinking 'what the hell is going on?'."

'I might not be here tomorrow'

Tony's wife Lynn came downstairs early the next morning and discovered her husband, quickly phoning for an ambulance.

However, doctors said they could not do anything to break up the clot to his brain stem that caused the stroke.

"My family were told the day I went in that I might not be here tomorrow. I was having trouble breathing and had tubes going in and out of me."

The stroke was so severe that Tony had to be fed through tubes for several weeks while being cared for at at Inverness's Raigmore Hospital, firstly in the ICU and then the stroke unit.

Tony Romaine

Tony never lost hope that he would be able to make music again

He then moved to the RNI Community Hospital, for a further five months of rehab and physio.

Although the initial targets were focused simply on helping Tony to walk again, he was already thinking about how to play guitar.

"The first thing the physiotherapist said to me was that she just wanted me to sit up. I said to them 'I don't know how to do that', so she helped me, and eventually I managed to sit at the edge of the bed," he says.

"That was the start. But to be honest, I was thinking about music from the first day I was in hospital.

"There was so much stuff going through my head at that point but I was thinking that I'd have to cancel gigs and I was trying to figure out how I was going to do it."

Progress was slow at times, and Tony recalls being told how his brain needed to be "taught" that his leg was still there and could work.

As he continued to make progress with his body, he was able to start trying to play guitar again as well, even though his left hand and arm were out of action.

"I had no idea how I was going to do it," he recalls.

"It's not like I could just go to a guitar teacher, but once I figured out a couple of techniques it became a case of practicing them, which was easier."

The first song he re-learned was Eleanor Rigby by the Beatles, with a stripped-back arrangement to make it easier on him.

He could find inspiration in the likes of Edywn Collins, the former Orange Juice singer who suffered a stroke following a cerebral haemorrhage in 2005 but later returned to performing and making music.

Soon Tony was not just re-learning old songs but working on new material too, and in August the song Standing Stone was released on streaming services.

Another milestone came the same month when he played a gig for the first time in two years, taking the stage at the Rose Street Foundry in Inverness for 30 minutes.

"I was absolutely exhausted," he recalls.

"I stood out of my wheelchair at the end and my legs were shaking. But I'm growing in stamina all the time – I'm hoping to do an hour and a half, maybe split in two 45 minute sets, for my next gigs."

Charity support

Those upcoming gigs will be aimed at helping others, too.

He is hoping fundraise for Chest Heart and Stroke Scotland in the coming months, after they helped him with his rehab after the stroke, while his next show at the Tooth and Claw in Inverness will be to benefit the Oxygen Works charity in the city.

"When I was in hospital I saw people who had given up, and that made me really sad," he explains.

"I understand it, it's a terrible thing to go through but I wouldn't want anyone to give up - I want people to know that you can come through this."  

Psychedelic Therapy Begins in Colorado, Amid Tension Between Conservatives, Veterans

 Is your competent? doctor ensuring both MDMA and psychedelic drugs are available for treatment in your state?

Since there is a 23% chance of stroke survivors getting PTSD what is your doctor's treatment plan?

Maybe these?

Microbiome and Diet Could Mitigate PTSD Symptoms October 2023 

Psychoactive Ibogaine and Magnesium Show Promise for PTSD January 2024

Harnessing Psilocybin to Treat PTSD

Treating PTSD With Ecstasy? You Might Have Some Questions. May 2018

Ecstasy Was Just Labelled a 'Breakthrough Therapy' For PTSD by The FDA August 2017

But this negative action:

FDA Rejects MDMA-Assisted Therapy for PTSD

Decision largely expected after agency advisors voted against psychedelic's safety and efficacy.

The latest here: Seems like you are totally on your own to figure out how to treat your mental problems! Good luck.

Psychedelic Therapy Begins in Colorado, Amid Tension Between Conservatives, Veterans

Colorado is the second state to legalize psilocybin therapy

by Associated Press January 2, 2025

(AP Photo/David Zalubowski)

As Colorado becomes the second state to legalize psychedelic therapy this week, a clash is playing out in Colorado Springs, where conservative leaders are restricting the treatment over objections from some of the city's 90,000 veterans, who've become flagbearers for psychedelic therapy to treat post-traumatic stress disorder.

Colorado residents voted to legalize the therapeutic use of psilocybin, the chemical compound found in psychedelic mushrooms, in a 2022 ballot measure, launching 2 years of rulemaking before it could be used to treat conditions such as depression and post-traumatic stress disorder (PTSD).

This week, companies and people will be able to apply for licenses to administer the mind-altering drug, though treatment will likely not be available for some months as applications are processed.

Colorado joined Oregon in legalizing psilocybin therapy, though the drug remains illegal in most other states and federally. Over the last year, a growing number of Oregon cities have voted to ban psilocybin. While Colorado metros cannot ban the treatment under state law, several conservative cities have worked to preemptively restrict what are known as "healing centers."

At a city council meeting in Colorado Springs this month, members were set to vote on extending the state prohibition on healing centers from 1,000 feet to 1 mile from certain locations, such as schools. From the lectern, veterans implored them not to.

"We have an opportunity to support veterans, and it's a really easy one to say 'yes' to," said Lane Belone, a special forces veteran who said he's benefited from his own psychedelic experiences. Belone argued that the restrictions effectively limit the number of centers and would mean longer waiting lists for the treatment.

Veterans have pulled in some conservative support for psychedelic therapy, managing to set it apart from other politically charged drug policies such as legalizing marijuana.

That distinction was made clear by council member David Leinweber, who said at the council meeting both that marijuana is "literally killing our kids" and that he supported greater access to psilocybin therapy.

Psilocybin is far more restricted in Colorado than marijuana, which the state legalized in 2014. Psilocybin is decriminalized but there won't be recreational dispensaries for the substance, which will be largely confined to licensed businesses and therapy sessions with licensed facilitators.

Patients will have to go through a risk assessment, preliminary meetings, then follow-up sessions and remain with a facilitator while under the drug's influence. The psilocybin will also be tested, and the companies that grow them regulated by a state agency.

Still, allowing broader access to the treatment hasn't been easy for most of the city council members, including three who are veterans. Colorado Springs is home to several military installations, including the U.S. Air Force Academy, and local leaders have touted it as an ideal community for retired service members.

"I will never sit up here and criticize a veteran for wanting to find a medical treatment to fix or to help with the issues that they carry," said Council President Randy Helms, a veteran himself.

Still, he continued, "Do I think that it's helpful to not just veterans but to individuals? Probably so. Do I think it still needs to be tested under strict requirements? Yes."

The Colorado Springs City Council passed the proposed restrictions.

While research has shown promise for psychedelic drugs such as psilocybin and MDMA, also known as molly, in helping people with conditions such as alcoholism, depression, and PTSD, the scientific field remains in its relatively early stages.

"I'm very positive about the potential value, but I'm very concerned that we've gotten too far ahead of our skis," said Jeffrey Lieberman, MD, a professor of psychiatry at Columbia University in New York City, who's been involved in studies of psychedelic drugs' therapeutic efficacy.

The risks, said Lieberman, include customers being misled and paying out of pocket for expensive treatments. He also said there are cases where the drugs can exacerbate some extreme mental health conditions, such as schizophrenia.

In Oregon, where the treatments started in June 2023, costs can reach $2,000 for one session. Of the over 16,000 doses administered in the state, staff have only called 911 or taken a patient to the hospital five times.

Other Colorado Springs city council members raised concerns that the FDA has not approved psilocybin to treat mental health conditions and, in August, rejected the psychedelic MDMA to treat PTSD. A number of clinical trials are still underway for both drugs.

Some researchers, advocacy groups, and veterans worry that waiting on slow-moving bureaucracy -- namely the FDA -- carries its own risks as people continue to struggle with mental illnesses. Advocates argue that psychedelic therapy offers an option to those for whom talk therapy alone and antidepressants have not helped.

"This is a crisis that we are in, and this is a tool that we can add to our toolbox," said Taylor West, executive director of the Healing Advocacy Fund, which advocates for psychedelic therapy.

Belone said he's carried his military experience long after leaving the special forces. It started when he first heard artillery sirens wailing in a U.S. base in Iraq, his breath catching with fear for a few thudding moments.

That fear kept him on edge when he returned stateside and found himself always keeping his back to the wall, looking for exits to the room he was in, never quite able to give himself fully to the music at a concert.

A psychedelic experience with psilocybin, said Belone, helped him connect the fear that attached to him in the war zone to the ceaseless anxiety at home. It didn't solve everything overnight, he said, but it allowed him to better identify when that humming fear was getting in the way of a joyful life.

‘Please talk about it’: Patients with heart disease want more guidance on sexual health

 Did you get ANY information about sex from your doctor post-stroke?

Like maybe all this?

All this is why you need to be doing lots of sex, why the hell can't your doctor get you fucking again? In fact you should be doing it in the hospital.

Sexual Frequency Predicts Greater Well-Being, But More is Not Always Better

 

Sex after stroke

 

Sex linked to better brain power in older age

Sex: The Ultimate Full Body Workout

 

Better Memory From This Extremely Pleasurable Activity - Sex

 

WHY SEX IS BETTER FOR YOUR BRAIN THAN SUDOKU 

 

Sex linked to better brain power in older age

 

Good News About Sex- It Doesn't Cause a Stroke

 

Sex Does Not Increase Heart Attack Risk - What about stroke?

 

Frequent orgasms may protect against heart attacks

Sex linked to better brain power in older age  (Put this in here twice because it's so important!)

 

An orgasm a day keeps the doctor away!

In case you don't have a partner she could prescribe this.

Electrosex

And the benefits of marijuana for sex here:

Sex, Marijuana and Baby Booms

New study highlights the benefit of touch on mental and physical health

The latest here:

‘Please talk about it’: Patients with heart disease want more guidance on sexual health

Key takeaways:

• Patients with heart disease want more information about their sexual health, according to survey results.
• Only 5% of survey respondents reported receiving this information.

CHICAGO — Results from a new survey highlight a gap between patients’ information needs about sexual health and the actual support provided by health care professionals.

In a small survey of patients with CVD in Sweden, 78% expressed a need for information about sexual health, but only 5% reported receiving this information.

Patients with heart disease want more information about their sexual health, according to survey results. Image: Adobe Stock

“A large number of patients, independent of age and gender, really feel that their condition is [affecting] their sexual health and that they currently do not get enough information and support,” Tiny Jaarsma, PhD, professor of nursing at Linköping University, Sweden, told Healio.

Three-quarters of respondents reported that their sexual health was impacted by their CVD and also had an effect on their overall mood and well-being, Jaarsma reported at the American Heart Association Scientific Sessions. Men were more likely than women to say their CVD impacted their sexual health (65% vs. 35%; P = .02) and that sexual health affected their mood and well-being (64% vs. 36%; P < .01), according to the survey results.

Eighty-seven percent of men and 64% of women cited a desire for information on sexual health (P = .02 for comparison).

Topics that patients with CVD most want to discuss included:

• adverse events of medications (60%);
• erectile dysfunction (50%);
• impact of sex on relationships (47%);
• anxiety before sex (35%); and
• pain during sex (13%).

Overall, patients wanted to receive information on sexual health from a health care professional (79%), particularly during annual check-ups (57%) and/or upon diagnosis (51%) or medication follow-ups (40%).

“People with a cardiac illness ... want to know more about sexual health. Please talk about it!” Jaarsma told Healio.

The results are based on anonymous survey questions about access to sexual health information and perceptions about connections to CV health. Jaarsma reported information from 135 respondents aged 30 to 89 years (mean age, 65 years) in Sweden. Half (47%) had hypertension, 35% had an MI, 30% had atrial fibrillation and 24% had HF.

Jaarsma told Healio the researchers “were curious to know what the current status of providing [sexual health] information is, and what patients want and need.”

The survey was administered only to patients in Sweden, so the results may not be generalizable elsewhere.

The AHA recommends that people who have had an MI or who have a diagnosis of CVD and/or stroke should check with a health care professional before resuming sexual activity, according to a press release from the AHA.

Looking ahead, we need “more studies on how to equip patients better to be able to ask their questions and health care professionals on how to bring up the subject in a professional and safe way,” Jaarsma told Healio.

Published by:

Sources/Disclosures

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Source:

Jaarsma T, et al. Abstract MDP1162. Presented at: American Heart Association Scientific Sessions; Nov. 16-18, 2024; Chicago.

Disclosures: Jaarsma reports no relevant financial disclosures.       

Sugar substitute erythritol linked to elevated risk for blood clot formation

 Has your competent? doctor ensured that the dietician has guaranteed that this doesn't exist anywhere in the hospital? Including vending machines and stores in the hospital?

Sugar substitute erythritol linked to elevated risk for 

Key takeaways:

• Erythritol, a common artificial sweetener, was linked to thrombotic risk in healthy volunteers.
• The nonnutritive sweetener is commonly found in chewing gum, jams and jellies, and sugar substitutes.

Erythritol, a nonnutritive sweetener generally recognized as safe by the FDA, demonstrated fast-acting prothrombotic properties not observed with traditional glucose in a small study.

In the FDA’s generally recognized as safe (GRAS) notice, erythritol is used as a flavor enhancer, formulation aid, nonnutritive sweetener in products including baked goods, breakfast cereals, chewing gum, jams and jellies, sugar substitutes and much more.

Stanley L. Hazen, MD, PhD, co-section head of preventive cardiology and chair of cardiovascular and metabolic sciences at the Cleveland Clinic Lerner Research Institute, and colleagues conducted an interventional study to assess the impact of erythritol intake compared with glucose on indices of platelet reactivity in healthy volunteers.

“Our earlier studies with erythritol showed in large-scale clinical observation studies that elevated blood erythritol levels were associated with incident risk of MI, stroke and death. Mechanistic studies — animal model, and blood based — all pointed to a prothrombotic effect with erythritol as the underlying mechanism,” Hazen, a Healio | Cardiology Today Editorial Board Member, told Healio.

As Healio previously reported, Marco Witkowski, MD, cardiologist and graduate student in Hazen’s laboratory at the Cleveland Clinic Lerner Research Institute, and Hazen had found associations between erythritol intake increased risk for heart attack and stroke.

Erythritol — which belongs to the family of sugar alcohols called polyols — occurs naturally in the human body, in small amounts, and can be found abundantly in grapes, mushrooms and fermented foods. Erythritol is the only polyol not made by reduction but by fermentation and is 60% to 80% as sweet as sucrose, according to data published in Applied Microbiology and Biotechnology.

“Later, studies with a related sugar alcohol — xylitol — showed similar patterns of clinical and mechanistic risks,” Hazen said. “Here, we wanted to both directly test in humans, comparing before vs. after ingestion in the subject. We also wanted to directly test in head-to-head comparison with a sugar-sweetened drink to see if glucose caused the same effects.”

In June, Hazen and colleagues published research in the European Heart Journal that indicated that xylitol, another low-calorie sugar substitute commonly found in gum and toothpaste, had prothrombotic properties, raising risk for major adverse CV events.

For their present analysis, published in Arteriosclerosis, Thrombosis, and Vascular Biology, the researchers conducted a prospective interventional study to evaluate the impact of erythritol intake compared with glucose consumption on indices of stimulus-dependent platelet reactivity in 20 healthy volunteers. The average age was about 30 years and nearly half were men.

All participants were nonsmokers without CVD, hypertension or diabetes, with normal renal function, no recent antiplatelet medication and no clinical history of bleeding, bruising or documented bleeding disorder.

Blood was drawn after an overnight fast and 30 minutes after intake of water mixed with 30 g erythritol or glucose. This quantity was based on levels found in common erythritol-sweetened foods and daily intake of some participants based on the 2013-2014 National Health and Nutrition Examination Survey and FDA documentation.

Hazen stated that diets high in erythritol may include “anything with artificial sweeteners in it. Erythritol is often used as a carrier for other artificial sweeteners because it looks like sugar, tastes like sugar and is, thus, often mixed with other artificial sweeteners.

“Processed foods, ranging from baking goods, condiments, drinks and many confectionaries, diabetes-safe labeled, keto-friendly or ‘low calorie’ all are foods often enriched in erythritol for enhanced sweetness without the calories,” he said.

For the analysis, plasma levels of erythritol and glucose were measured using liquid chromatography-mass spectrometry, and platelet function was evaluated using aggregometry and analysis of granule markers.

Among participants who drank the erythritol mixture, the researchers measured levels of circulating erythritol of more than 1,000-fold compared with baseline (median, 6,480 µmol/L vs. 3.8 µmol/L; P < .0001).

Among those who drank the glucose mixture, Hazen and colleagues observed similar erythritol levels compared with baseline, whereas glucose levels modestly increased (87 mg/dL vs. 127 mg/dL; P = .002).

Moreover, the researchers recorded significantly increased stimulus-dependent release of the platelet-dense granule marker serotonin and platelet alpha-granule marker CXCL4 in participants who consumed erythritol, whereas glucose intake conferred no significant change in stimulus-dependent release of serotonin or CXCL4.

“This to me makes it very clear glucose is a safer alternative,” Hazen told Healio. “This paper adds to that growing cumulative body of work [and] — with multiple different approaches and different methods — all point to concern with use of erythritol as an artificial sweetener.

“I am recommending to all of my patients, if your loved one has heart disease especially, I strongly recommend you advise them to avoid erythritol, xylitol and other sugar alcohols,” he said.

The researchers noted that a limitation of this study was the absence of long-term analysis of change in platelet function after erythritol intake. Previous research showed that erythritol is rapidly absorbed, with elevated plasma levels within 15 minutes, and data on the effects of chronic erythritol intake are needed.

For more information:

Stanley Hazen, MD, PhD, can be reached at 9500 Euclid Ave., Mail Code NC-I O, Cleveland, OH 44195.

References:

• Artificial sweetener erythritol’s major health risks. https://health.clevelandclinic.org/erythritol. Published March 7, 2023. Accessed Aug. 7, 2024.
• Cleveland Clinic study adds to increasing evidence that sugar substitute erythritol raises cardiovascular risk. Link. Published Aug 8, 2024. Accessed Aug. 8, 2024.
• FDA. GRAS Notices: GRN No. 789, Erythritol. https://cfsanappsexternal.fda.gov/scripts/fdcc/index.cfm?set=GRASNotices&id=789. Last updated Aug. 2, 2024. Accessed Aug. 7, 2024.
• Regnat K, et al. Appl Microbiol Biotechnol. 2018;doi:10.1007/s00253-017-8654-1.
• Witkowski M, et al. Nat Med. 2023;doi:10.1038/s41591-023-02223-9.

Published by:

Sources/Disclosures

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Source:

Witkowski M, et al. Arterioscler Thromb Vasc Biol. 2024;doi:10.1161/ATVBAHA.124.321019.

Psychological Interventions to Improve Upper Limb Motor Dysfunction Post-stroke: A Scoping Review

 You wouldn't need psychological interventions if you had 100% RECOVERY PROTOCOLS! Do the correct research: 100% recovery and you don't need to waste time on all these secondary problems because your survivor didn't get 100% recovered! Do you people have two functioning neurons to rub together?

My conclusion is you don't understand ONE GODDAMN THING ABOUT SURVIVOR MOTIVATION, DO YOU? You create EXACT 100% recovery protocols and your survivor will be motivated to do the millions of reps needed because they are looking forward to 100% recovery. GET THERE!

There would be no need for this useless research.

Psychological Interventions to Improve Upper Limb Motor Dysfunction Post-stroke: A Scoping Review 

Published: January 02, 2025 >

DOI: 10.7759/cureus.76784

Peer-Reviewed

Cite this article as: Iwamoto Y, Imura T, Mitsutake T, et al. (January 02, 2025) Psychological Interventions to Improve Upper Limb Motor Dysfunction Post-stroke: A Scoping Review. Cureus 17(1): e76784. doi:10.7759/cureus.76784

• Article
• Authors etc.
• Metrics
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Abstract

Cognitive strategies in post-stroke patients significantly influence upper limb motor function recovery. Integrating upper extremity and psychological interventions may enhance rehabilitation outcomes. This scoping review aimed to summarize studies evaluating the effectiveness of combining these approaches to improve upper extremity motor dysfunction in patients with post-stroke syndrome. Randomized controlled trials (RCTs) comparing combined upper extremity and psychological interventions versus upper extremity interventions alone were included. Studies published between November 25, 2024, and the study’s conclusion were retrieved from PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Physiotherapy Evidence Database (PEDro), and Cumulative Index to Nursing and Allied Health Literature. Only English-language studies were reviewed. Three RCTs met the inclusion criteria. Two studies utilized cognitive orientation to daily occupational performance (CO-OP), while one employed cognitive-oriented strategy training augmented rehabilitation (COSTAR). The CO-OP studies demonstrated that combined psychological and physical interventions significantly improved motor function compared to physical interventions alone. However, the COSTAR-based study reported greater efficacy for upper extremity interventions alone. This review highlighted the mixed efficacy of combined interventions. While CO-OP showed potential benefits, the COSTAR findings suggest variability in the effectiveness of different cognitive strategies. Both approaches prioritized activity and goal setting rather than directly targeting motor recovery. Although the findings are inconclusive, this is the first review to explore the role of combined psychological and upper extremity interventions for post-stroke motor dysfunction, providing a foundation for further research.

Introduction & Background

Improving upper extremity motor dysfunction is crucial in post-stroke rehabilitation. Severe sequelae in the upper extremity affect 43%-69% of patients with post-stroke motor dysfunction [1,2]. Post-stroke upper extremity motor dysfunction limits activities of daily living [3] and social reintegration [4] and causes an economic burden [5]. Furthermore, post-stroke upper extremity dysfunction is correlated with anxiety, low quality of life, and a higher incidence of disability [6,7]. Only 5%-20% of patients achieve complete improvement in upper extremity motor dysfunction six months post-stroke despite the importance of improving upper extremity motor dysfunction [8,9]. Therefore, clinicians are required to select and provide patients with appropriate interventions to improve upper limb motor dysfunction.

Various upper limb interventions have improved upper limb motor dysfunction in stroke patients. Upper extremity motor dysfunction improvement, which requires sufficient physical activity and high-quality upper limb interventions, involves the basal ganglia, cerebellum, and cerebral cortex [10]. Upper limb interventions induce structural plasticity changes in the nervous system, which develops compensatory neural networks and improves motor dysfunction [11]. A previous guideline has determined constraint-induced movement therapy, electrical stimulation, and mirror therapy with a high evidence level to improve upper extremity motor dysfunction [12]. Therefore, interventions with a high evidence level aimed at enhancing upper limb motor dysfunction have already been determined.

Stroke patients often experience not only motor dysfunction but also mental status changes, such as post-stroke depression [13] and cerebrovascular dementia [14]. These mental status changes influence participation in rehabilitation and the overall recovery process [15-17]. Accordingly, it is hoped that improvements in mental state will lead to improvements in motor function and ADL, as well as improvements in the effectiveness of rehabilitation. Therefore, interventions addressing upper limb motor dysfunction also need to consider psychological aspects. Psychological interventions that use cognitive strategies have been recommended for improving skill transfer and subsequent functioning and participation [18-20]. Previous research on cognitive strategies has described them as goal-oriented, consciously controllable processes that facilitate or support performance as subjects develop internal procedures for them to perform desired skills [21]. Interventions using cognitive strategies have helped improve motor dysfunction [22,23]. However, evidence for psychological interventions to enhance post-stroke upper extremity motor dysfunction is inconsistent in previous guidelines [12]. Consistent evidence on psychological interventions remains lacking despite the importance of psychological interventions in improving motor dysfunction.

Previous systematic reviews revealed the effects of psychological interventions on improving mental health in patients with post-stroke syndrome, but not on improving motor dysfunction [24]. However, the usefulness of combining upper extremity interventions with psychological interventions for post-stroke upper extremity motor dysfunction remains unclear. Furthermore, various psychological intervention methods, including emotional [13], cognitive [25], motivation [26,27], planning and executing [28] aspects, are available, and summarizing the interventions that are effective when combined with upper extremity interventions is important. This scoping review aimed to comprehensively investigate and summarize the usefulness of a combination of upper extremity and psychological interventions for upper extremity motor dysfunction in stroke patients. Our overarching research questions were “Is it useful to combine upper extremity interventions with psychological interventions for upper extremity motor dysfunction post-stroke?” and “What psychological interventions are useful?”

More at link.

Effects of Intensive Impairment-Oriented Arm Rehabilitation for Chronic Stroke Survivors: An Observational Cohort Study

 Wrong objective: it should have been; Create protocols based on this study.  This is useless.

Effects of Intensive Impairment-Oriented Arm Rehabilitation for Chronic Stroke Survivors: An Observational Cohort Study

 ³

¹

Neurorehabilitation Research Group, University Medical Centre, 17475 Greifswald, Germany

²

BDH-Klinik Greifswald, Institute for Neurorehabilitation and Evidence-Based Practice, “An-Institut”, University of Greifswald, 17491 Greifswald, Germany

³

Hand and Occupational Therapy Outpatient Service Laborn, 80802 München, Germany

^*

Author to whom correspondence should be addressed.

J. Clin. Med. 2025, 14(1), 176; https://doi.org/10.3390/jcm14010176

Submission received: 28 November 2024 / Revised: 15 December 2024 / Accepted: 21 December 2024 / Published: 31 December 2024

(This article belongs to the Special Issue Rehabilitation and Management of Stroke)

Download keyboard_arrow_down Versions Notes

Abstract

Objective: 

To assess the effects of a two-week course of intensive impairment-oriented arm rehabilitation for chronic stroke survivors on motor function. 

Methods: 

An observational cohort study that enrolled chronic stroke survivors (≥6 months after stroke) with mild to severe arm paresis, who received a two-week course of impairment-oriented and technology-supported arm rehabilitation (1:1 participant–therapist setting), which was carried out daily (five days a week) for four hours. The outcome measures were as follows: the primary outcome was the arm motor function of the affected arm (mild paresis: BBT, NHPT; severe paresis: Fugl-Meyer arm motor score). The secondary outcomes were measures of finger strength, active ROM, spasticity, joint mobility/pain, somatosensation, emotional distress, quality of life, acceptability, and adverse events. 

Results: 

 One hundred chronic stroke survivors (≥6 months after stroke) with mild to severe arm paresis were recruited. The training was acceptable (drop-out rate 3%; 3/100). The clinical assessment indicated improved motor function (SMD 0.42, 95% CI 0.36–0.49; n = 97), reduced spasticity/resistance to passive movement, and slightly improved joint mobility/pain and somatosensation. The technology-based objective measures corroborated the improved active range of motion for arm and finger joints, reduced finger spasticity/resistance to passive movement, and the increased amount of use in daily life, but there was no effect on finger strength. The patient’s emotional well-being and quality of life were positively influenced. Adverse events were reported by the majority of participants (51%, 49/97) and were mild. 

Conclusions: 

 Structured intensive impairment-oriented and technology-supported arm rehabilitation can promote(NOT GOOD ENOUGH! Exact protocols need to be created to get survivors recovered! This would be cause for firing in the business world! Namby-pamby shit like this would never fly!) motor function among chronic stroke survivors with mild to severe arm paresis and is an acceptable and tolerable form of treatment when supervised and adjusted by therapists.

Keywords:

rehabilitation; training; arm; stroke; clinical trial

1. Introduction

Stroke is the third leading cause of death and disability, combined, in the world, and the burden it places on the healthcare system has increased substantially over the last few decades [1]. As a major cause of chronic impaired arm function, it frequently affects many activities of daily living. Between forty to seventy percent of those affected by stroke suffer from arm paresis initially [2,3]. Among those, two thirds have severe arm paresis [3]. Six months after stroke, the affected arm of approximately half of all stroke survivors, who initially had severe arm paresis, still remains without function [4]. Different training- and technology-based interventions have been shown to improve arm function after stroke [5,6] and are recommended for stroke rehabilitation [7]. Most spontaneous recovery and the best course of treatment in terms of improvements can be expected early after stroke, i.e., within the first three months, and when arm paresis is not severe [8,9]. And, while there is the potential for stroke survivors in the chronic phase to improve their motor function [10], it remains controversial how improvements to arm motor function can still be gained through training and whether improvements at this stage are related to the recovery of function, the enhancement of compensatory strategies, or a reversal of learnt non-use (only) [11].

This study followed the rationale (and hypothesis) that motor recovery, i.e., the improvement of motor control, such as selective movement control (rather than improved function due to compensatory behaviour), is still achievable by stroke survivors in the chronic stage when therapy offers training that explicitly, specifically, intensively, and comprehensively addresses the motor control to be regained, i.e., the ability to move the arm in regard to its various segments selectively for stroke survivors with moderate to severe arm paresis, or the level of performance related to different sensorimotor abilities for stroke survivors with mild arm paresis [12].

This cohort study aimed to investigate whether stroke survivors in the chronic stage of their condition (i.e., ≥6 months post-stroke) with various degrees of arm paresis, i.e., from mild to severe, could benefit from a two-week course of intensive impairment-oriented arm rehabilitation. For this purpose, the participants received daily therapy as either Arm Basis Training (moderate to severe arm paresis) or Arm Ability Training (mild arm paresis) [12], combined with individually selected technology-based arm rehabilitation, for a total of 4 h per weekday, for two consecutive weeks (ten sessions). Both standardised clinical assessments and technology-based measures were used to evaluate to what degree the patient’s motor function improved and whether other body functions (strength, spasticity/resistance to passive movement, somatosensation, or passive joint mobility) were affected in parallel, whether more use of the affected limb in the community was promoted, and whether the patient-reported emotional well-being and quality of life changed. In addition, acceptability in terms of the drop-out rate and safety, based on documented adverse events, were addressed.

More at link.

Evidence of a logarithmic relationship between motor capacity and actual performance in daily life of the paretic arm following stroke

 Absolutely useless by not creating an intervention protocol to get survivors recovered!

Evidence of a logarithmic relationship between motor capacity and actual performance in daily life of the paretic arm following stroke

Marian E. Michielsen, MSc†, Ruud W. Selles, PhD, Henk J. Stam, MD, PhD Gerard M. Ribbers, MD, PhD, Johannes B. Bussmann, PhD 

Arch Phys Med Rehabil 2012;93: 1975-81.

ABSTRACT.   

Objective: To quantify uni- and bimanual upper-limb use in patients with chronic stroke in daily life compared with healthy controls. 

Design: 

Cross-sectional observational study. Setting: Outpatient rehabilitation center. Participants: Patients with chronic stroke (n=38) and healthy controls (n=18). 

Intervention: 

Not applicable. 

Main Outcome Measures: 

Upper-limb use in daily life was measured with an accelerometry-based upper-limb activity monitor, an accelerometer based measurement device. Uni- manual use of the paretic and the nonparetic side and bimanual upper-limb use were measured for a period of 24 hours. Out- comes were expressed in terms of both duration and intensity. 

Results: 

Patients used their unaffected limb much more than their affected limb (5.3h vs 2.4h), while controls used both limbs a more equal amount of time (5.4h vs 5.1h). Patients used their paretic side less than controls used their nondominant side and their nonparetic side more than controls their dominant side. The intensity with which patients used their paretic side was lower than that with which controls used their nondominant side, while that of the nonparetic side was higher than that of the dominant side of controls. Finally, patients used their paretic side almost exclusively in bimanual activities. During bimanual activities, the intensity with which they used their affected side was much lower than that of the nonaffected side. 

Conclusion: 

Our data show considerable nonuse of the paretic side, both in duration and in intensity, and both during unimanual and bimanual activities in patients with chronic stroke. Patients do compensate for this with increased use of the nonparetic side. 

Eliminating these 14 risk factors may prevent nearly half of dementia cases

 Your competent? doctor is responsible for eliminating 3 of these by having EXACT 100% RECOVERY PROTOCOLS! Depression, social isolation and physical inactivity

Eliminating these 14 risk factors may prevent nearly half of dementia cases

Key takeaways:

• The Lancet Commission identified high cholesterol and vision loss as new risk factors for dementia.
• The commission outlined 13 recommendations for individuals and governments to prevent dementia.

Perspective from Claire Sexton, DPhil

PHILADELPHIA — Tackling 14 risk factors for dementia beginning in childhood could prevent or delay nearly half of cases worldwide, according to a report from the Lancet Commission presented at the Alzheimer's Association International Conference.

These include two risk factors — high cholesterol and vision loss — newly identified by the commission on dementia prevention, intervention and care.

Gill Livingston

An estimated 57 million people were living with dementia in 2019, Gill Livingston, MD, a professor of psychiatry at University College London, and colleagues wrote in the report. This number is expected to increase to 153 million by 2050, highlighting the need for risk reduction strategies.

The new report is an update to the commission’s 2020 report. Members of the commission adopted a triangulation framework that prioritized systematic reviews and meta-analyses. They also conducted new meta-analyses when necessary.

The researchers said their review supports the 12 potentially modifiable risk factors that were identified in the 2020 report: air pollution (RR = 1.1; 95% CI, 1.1-1.1); depression (RR = 2.2; 95% CI, 1.7-3); diabetes (RR = 1.7; 95% CI, 1.6-1.8); excessive alcohol use (RR = 1.2; 95% CI, 1-1.5); hearing loss (RR = 1.4; 95% CI, 1-1.9); hypertension (RR = 1.2; 95% CI, 1.1-1.4); lower education level (RR = 1.6; 95% CI, 1.3-2); obesity (RR = 1.3; 95% CI, 1-1.7); physical inactivity (RR = 1.2; 95% CI, 1.2-1.3); smoking (RR = 1.3; 95% CI, 1.2-1.4); social isolation (RR = 1.6; 95% CI, 1.3-1.8); and traumatic brain injury (RR = 1.7; 95% CI, 1.4-1.9).

The evidence also supports the addition of high LDL cholesterol (RR = 1.3; 95% CI, 1.3-1.4) and vision loss (RR = 1.5; 95% CI, 1.4-1.6).

If these 14 risk factors are eliminated, “nearly half of dementias could theoretically be prevented,” Livingston and colleagues wrote.

This has important implications for physicians, particularly family physicians, Livingston told Healio. She noted that diabetes, excessive alcohol use, hearing impairment, high LDL, hypertension, obesity, vision loss and smoking account for about one-quarter of all dementias.

“If we add depression, traumatic brain injury and physical inactivity, which family physicians also advise on, then it is a third of dementias,” she said. “Their active vigilance and advice potentially make a huge difference.”

Based on their findings, the researchers outlined 13 recommendations for individuals and governments to prevent dementia:

• ensure children have access to good-quality education and encourage individuals in midlife to participate in “cognitively stimulating activities;”
• reduce harmful noise exposure and make hearing aids accessible to those with hearing impairment;
• treat depression;
• promote helmets and other head protection during contact sports and when riding bicycles;
• encourage exercise;
• reduce smoking through education and by implementing policies that aim to control the cost of cigarettes;
• prevent or reduce high blood pressure;
• diagnose and treat high LDL;
• maintain a healthy weight and treat obesity early;
• reduce excessive alcohol use through price control and raising awareness about the risks of overconsumption;
• reduce social isolation by encouraging activities and living with other people, prioritizing an “age-friendly and supportive community, environments and housing”;
• ensure access to vision loss screening and treatment; and
• decrease air pollution exposure.

“Although addressing risk factors at an early stage of life is desirable, there is also benefit from tackling risk throughout life; it is never too early or too late to reduce dementia risk,” Livingston and colleagues wrote.

References:

• Livingston G, et al. Lancet standing commission on dementia prevention, intervention and care. Scientific advances in the 2024 commission. Presented at: Alzheimer’s Association International Conference; July 28-Aug. 1, 2024; Philadelphia.
• The Lancet: Nearly half of dementia cases could be prevented or delayed by tackling 14 risk factors starting in childhood, including two new risks — high cholesterol and vision loss. www.eurekalert.org/news-releases/1052982. Published July 31, 2024. Accessed July 31, 2024.

Perspective

Back to Top

Claire Sexton, DPhil

Dementia risk reduction is an important area of research. In this latest Lancet Commission report, they're adding two more risk factors — high cholesterol and vision loss — to the list and calculating that, together, these 14 factors could account for around half of all worldwide cases of dementia. This illustrates the importance of our awareness of these types of risk factors.

It’s important for our understanding that these reports are not just informed by epidemiological studies, but further interventional studies. One of those, which is ongoing, is the U.S. POINTER study. Recruiting is complete, but evaluating the results of the study is still underway. They will be reported next year at AAIC 2025 in Toronto. This study is looking at multiple risk factors, including modifying diet, exercise, cognitive activities, social engagement and the management of heart health status, and whether these factors in combination can protect cognitive health.

Of note, for right now, the Alzheimer’s Association provides 10 Healthy Habits for Your Brain, which is a great resource for anybody who is thinking about their risk.

Claire Sexton, DPhil

Senior director of scientific programs and outreach

Alzheimer’s Association

Disclosures: Sexton reports no relevant financial disclosures.

Sources/Disclosures

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Source:

Livingston G, et al. Lancet. 2024;doi:10.1016/S0140-6736(24)01296-0.

Disclosures: Healio was unable to confirm relevant financial disclosures at the time of publication.       

New Guidelines Update Alzheimer's and Dementia Evaluations

 

With your chances of getting dementia post stroke, your competent? doctor needs to be monitoring this and provide dementia prevention solutions. Over a decade to accomplish that! Was it done? NO? So, you DON'T have a functioning stroke doctor, do you? YOUR DOCTOR IS RESPONSIBLE FOR PREVENTING THIS!

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

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

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

4. Dementia Risk Doubled in Patients Following Stroke September 2018 

The latest here:

New Guidelines Update Alzheimer's and Dementia Evaluations

Clinical practice recommendations cover both primary and specialty care

by Judy George, Deputy Managing Editor, MedPage Today December 31, 2024

A three-step process underscores new clinical practice guidelines for primary and specialty care clinicians to evaluate patients who may have cognitive impairment or dementia due to Alzheimer's or a related disease.

In broad terms, the evaluation should establish a patient's cognitive functional status, cognitive-behavioral syndrome, and the likely etiology of impairments, said Brad Dickerson, MD, of the Massachusetts General Hospital and Harvard Medical School in Boston, and colleagues of the Diagnostic Evaluation, Testing, Counseling, and Disclosure Clinical Practice Guideline (DETeCD-ADRD CPG) workgroup.

As part of a comprehensive evaluation, the clinician should set goals with a patient and care partner, obtain risk profile information including family and health history, describe symptom history and its effects on daily life, evaluate the patient's performance on cognitive tests, and include a brain MRI or CT along with lab tests.

The diagnostic formulation should be disclosed clearly, Dickerson and colleagues wrote in Alzheimer's & Dementia. If primary care clinicians do not have high confidence in the etiology, the patient should be referred to a dementia specialist.

The DETeCD-ADRD CPG -- which outlines separate recommendations for primary careo and specialty care -- is the first update in decades, Dickerson and colleagues said.

"If clinicians use this guideline and healthcare systems provide adequate resources, outcomes should improve in most patients in most practice settings," they wrote.

The guidance summarizes the process of characterizing and diagnosing people who may have Alzheimer's, Lewy body disease, frontotemporal lobar degeneration, vascular cognitive impairment and dementia, or similar disorders. It does not propose new diagnostic or staging criteria for these diseases.

"With this guideline, we expand the scope of prior guidelines by providing recommendations for practicing clinicians on the process from start to finish," Dickerson said in a statement.

"We recommend that medical professionals begin by making sure their thinking about the goals of the evaluation aligns with that of the patient, which usually requires a discussion to educate the patient on the specific steps of the process," he pointed out. "Then we outline the steps involved in obtaining information about symptoms and examination, followed by a variety of diagnostic tests tailored to the patient, and summarize best practices regarding the diagnostic disclosure process."

The guidance emphasizes the importance of having a care partner for most patients, since cognitive symptoms may compromise a patient's ability to process the information discussed, Dickerson added.

The DETeCD-ADRD guidelines were developed by an expert workgroup from multiple disciplines convened by the Alzheimer's Association. The group based its recommendations on a review of 133 publications.

"The workgroup provides rigorous, evidence- and practice-informed foundational steps that capture the core elements of a high-quality evaluation and disclosure process," Dickerson said. "The guidelines are formulated into 19 practical recommendations that are applicable to any practice setting, including primary care, along with additional guidance for specialists and subspecialists."

The guidelines were supported by companion articles in Alzheimer's & Dementia that included a review of validated clinical assessment instruments and information about disclosing diagnoses of mild cognitive impairment and dementia.

The guidance provides a foundation for a "personalized process within which specific tests are slotted and can be updated as the field evolves," noted co-author Alireza Atri, MD, PhD, of Banner Sun Health Research Institute and Banner Alzheimer's Institute in Sun City, Arizona. Some guideline details may be modified as new tools and biomarkers become validated for clinical practice, he added.

The goal of the evaluation process is to provide timely and accurate diagnosis, disclosure, and counseling, the DETeCD-ADRD authors said. The recommendations help clinicians evaluate cognitive problems which could have a number of etiologies, observed co-author Maria Carrillo, PhD, chief science officer of the Alzheimer's Association.

"That is the necessary start for an early and accurate Alzheimer's diagnosis," Carrillo pointed out. "In addition, these guidelines provide clinicians information about other underlying causes that may contribute to the memory complaints."

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

Disclosures

This work was funded by the Alzheimer's Association.

Dickerson reported relationships with Acadia, Alector, Arkuda, Biogen, Eisai, Med Learning Group, Quanterix, Eli Lilly, Merck, Cambridge University Press, Elsevier, Oxford University Press, and Up To Date.

Atri disclosed relationships with Acadia, AriBio, AZ Therapies, Biogen, Eisai, JOMDD, Lundbeck, Life Molecular Imaging, Merck, ONO, Prothena, Roche/Genentech, Novo Nordisk, Qynapse, Vaxxinity, and Oxford University Press.

Carrillo is an employee of the Alzheimer's Association.

Co-authors reported relationships with pharmaceutical companies and other groups.

Primary Source

Alzheimer's & Dementia

Source Reference: Atri A, et al "Alzheimer's Association clinical practice guideline for the Diagnostic Evaluation, Testing, Counseling, and Disclosure of Suspected Alzheimer's Disease and Related Disorders (DETeCD-ADRD): Executive summary of recommendations for primary care" Alzheimer's Dement 2024; DOI: 10.1002/alz.14333.

Secondary Source

Alzheimer's & Dementia

Source Reference: Dickerson BC, et al "The Alzheimer's Association clinical practice guideline for the Diagnostic Evaluation, Testing, Counseling, and Disclosure of Suspected Alzheimer's Disease and Related Disorders (DETeCD-ADRD): Executive summary of recommendations for specialty care" Alzheimer's Dement 2024; DOI: 10.1002/alz.14337.

The Battle Over What to Tell Americans About Drinking from the NYTimes

 

Ah well, not going to change my mind, I'm using the social connections at jazz and trivia nights to ensure that I won't get dementia.

Not for me, I'm using social connections to prevent dementia and that means going to bars with friends for live music.  

What about this?

Men must drink with male friends twice a week to stay healthy, study finds

 Do not bring this to your doctor's attention, you don't want to be responsible for an exploding head.

The Battle Over What to Tell Americans About Drinking

Fatigue After Stroke Educational Recovery Program: A Prospective, Phase III, Randomized Controlled Trial

 Fatigue should be prevented with 100% recovery protocols:  NOT EDUCATIONAL INTERVENTATION! Solve the correct problem, 100% recovery, instead of this secondary problem of fatigue!

Fatigue After Stroke Educational Recovery Program: A Prospective, Phase III, Randomized Controlled Trial

Kelly Jones, PhD https://orcid.org/0000-0001-5692-653X kelly.jones@aut.ac.nz, Rita Krishnamurthi, PhD https://orcid.org/0000-0003-0869-2083, Suzanne Barker‐Collo, PhD https://orcid.org/0000-0002-8659-0202, Sulekha De Silva, PhD, Nathan Henry, PhD https://orcid.org/0000-0002-4299-1442, Irene Zeng, PhD https://orcid.org/0000-0001-8100-3120, Anja Vorster, PhD https://orcid.org/0000-0001-7301-0240, Braden Te Ao, PhD https://orcid.org/0000-0002-1050-200X, Geoff Green, MBChB https://orcid.org/0000-0001-7123-0899, Yogini Ratnasabapathy, MPH https://orcid.org/0000-0002-3933-3684, and Valery Feigin, MD, PhD https://orcid.org/0000-0002-6372-1740Author Info & Affiliations

Journal of the American Heart Association

New online

https://doi.org/10.1161/JAHA.124.034441

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Abstract

Background

Poststroke fatigue affects ≈50% of patients with stroke, causing significant personal, societal, and economic burden. In the FASTER (Fatigue After Stroke Educational Recovery) study, we assessed a group‐based educational intervention for poststroke fatigue.

Methods and Results

Two hundred patients with clinically significant fatigue were included and randomized to either a general stroke education control or fatigue management group (FMG) intervention and assessed at baseline, 6 weeks, and 3 months. The FMG involved weekly psychoeducation sessions over 6 weeks. Coprimary outcomes were the Fatigue Severity Scale and Multidimensional Fatigue Inventory‐20 total scores. Adjusted mean total Fatigue Severity Scale scores at 6 weeks (primary end point) were nearly identical for the education control and FMG groups. The adjusted mean difference between treatment groups was −0.13 (SE, 1.4; P=0.92) at 6 weeks and 1.67 (SE, 1.4; P=0.26) at 3 months. Although there were no significant effects, Fatigue Severity Scale outcomes were in the direction of a treatment effect based on the estimated change. Adjusted mean total Multidimensional Fatigue Inventory‐20 scores at 6 weeks (primary end point) were similar for the education control and FMG groups. The adjusted mean difference between treatment groups was −0.91 (SE, 1.54; P=0.55) at 6 weeks and −1.26 (SE, 1.8; P=0.49) at 3 months. Both groups had similar secondary outcomes (eg, Multidimensional Fatigue Inventory‐20 subscales, sleep, pain, mood, quality of life) at 6 weeks and 3 months.

Conclusions

We found no evidence of significant group‐level benefits of FMG over and above general stroke education. Educational group‐based interventions for poststroke fatigue should continue to be refined and examined, including consideration of potential impacts at an individual level.

Registration

URL: https://www.anzctr.org.au/; UnIque identifier: ACTRN12619000626167.