Use the labels in the right column to find what you want. Or you can go thru them one by one, there are only 34,245 posts. Searching is done in the search box in upper left corner. I blog on anything to do with stroke. DO NOT DO ANYTHING SUGGESTED HERE AS I AM NOT MEDICALLY TRAINED, YOUR DOCTOR IS, LISTEN TO THEM. BUT I BET THEY DON'T KNOW HOW TO GET YOU 100% RECOVERED. I DON'T EITHER BUT HAVE PLENTY OF QUESTIONS FOR YOUR DOCTOR TO ANSWER.
Changing stroke rehab and research worldwide now.Time is Brain!trillions and trillions of neuronsthatDIEeach day because there areNOeffective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.
What this blog is for:
My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.
Showing posts with label 5 steps to solve stroke. Show all posts
Showing posts with label 5 steps to solve stroke. Show all posts
Why are you doing something as stupid as this when the correct solution is 100% recovery protocols? Your mentors don't know how to solve stroke? YOU don't know what survivors want? Like 100% recovery!
Damn it all: stroke is easy; 5 steps. 1. Describe the problems exactly. There are tens of
thousands of pieces of research already hinting at solutions, just need
followup.
2. Write thousands of RFPs to researchers/MIT grads to solve those problems.
3. Fund them with foundation grants.
4. Write stroke rehab protocols based on the research.
5. Get the Nobel prize in medicine.
Modified-Mindfulness-Based Stress Reduction as a Treatment for Cognitive Recovery in Patients with Minor Stroke: a Randomized Controlled Pilot Study
Sophia GirgentiSophia Girgenti1Isabella DallastaIsabella Dallasta1Erin LawrenceErin Lawrence1Dawn MerbachDawn Merbach1Jonathan Z SimonJonathan Z Simon2Rafael H LlinasRafael H Llinas1Neda F GouldNeda F Gould1Elisabeth Breese MarshElisabeth Breese Marsh1*
1Johns Hopkins Medicine, Johns Hopkins University, Baltimore, Maryland, United States
2University of Maryland, College Park, College Park, Maryland, United States
The final, formatted version of the article will be published soon.
Background:
Well-developed rehabilitation paradigms exist for post-stroke language and motor impairments. However, no such recovery program has been identified for commonly disabling cognitive deficits in patients following minor stroke. Mindfulness Based Stress Reduction (MBSR) is thought to engage the frontal lobes, improving concentration and attention, and therefore may be an effective option.We prospectively enrolled a cohort of patients with subacute minor stroke and randomized them to either an 8-week online modified-MBSR course or online traditional Stroke Support Group (SSG). All patients underwent a battery of cognitive tests and measures of patient reported outcomes (PROs) pre-and post-intervention. ANOVA was used to compare changes in scores over time across both groups, along with a third group of control patients having received neither intervention (n=128).
Results:
A total of 30 patients were randomized (n=16 for m-MBSR; n=14 for SSG). The average age of the cohort was 65.9 years. Post-intervention, both groups demonstrated significantly improved T-scores on cognitive tasks, regardless of intervention. Compared to SSG, the m-MBSR group showed a larger degree of improvement in processing speed, executive, and global cognitive function; however, the difference between groups was not statistically significant. Engagement level was not associated with better clinical scores, though was unexpectedly low for both groups.
Conclusions:
m-MBSR may modestly improve frontal lobe activity and demonstrates some success in increasing cognitive performance. However, further studies are needed to determine if it is more efficacious in the chronic stage of recovery when more patients are able to fully engage and actively participate.
* Correspondence: Elisabeth Breese Marsh, Johns Hopkins Medicine, Johns Hopkins University, Baltimore, 21218, Maryland, United States
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Damn it all: stroke is easy; 5 steps. 1. Describe the problems exactly. There are tens of
thousands of pieces of research already hinting at solutions, just need
followup.
2. Write thousands of RFPs to researchers/MIT grads to solve those problems.
3. Fund them with foundation grants.
4. Write stroke rehab protocols based on the research.
5. Get the Nobel prize in medicine.
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Editorial: Innovative approaches to promote stroke recovery
Stroke remains a leading global cause of disability and death [1] and a substantial body of research is actively exploring various strategies to support its recovery. However, despite this extensive effort, only a limited number of findings are successfully translated into clinical practice. This gap is not solely due to the high cost of equipment or the need for specialized personnel, but also stems from a lack of robust clinical evidence demonstrating clear recovery outcomes. Additionally, the wide range of adjustable parameters within many interventions, makes it difficult to draw definitive conclusions about their effectiveness. Most studies also involve small, heterogeneous patient groups, which further limits the generalizability of their results.
In this research topic, we explore innovative approaches to enhance recovery following a stroke. We gathered a total of 18 manuscripts that together provide an overview of the most studied clinical challenges and proposed solutions in stroke rehabilitation. Half of these manuscripts are review articles focused on specific topics, allowing for an in-depth examination of various options, while the original research primarily involves exploratory strategies, with only two manuscripts reporting clinical trials.
The majority of studies concentrate on treatments for post-stroke symptoms, with only three addressing assessment methods. Broadly, the studies can be categorized into five groups (Fig. 1, left panel): brain stimulation (6 studies – 5 of which are reviews), peripheral stimulation (3 studies – 2 of which are reviews), motor control strategies (5 studies – 1 of which is a review), patient-led rehabilitation (2 studies – 1 of which is a review), and stratification and assessment methods (3 studies). Some studies span multiple categories.
Most research targets the chronic or sub-acute phases of stroke recovery, with only one study focusing on the acute phase within the first 24 hours. Regarding symptoms, ten manuscripts focus on motor impairments—two specifically on the lower limb and four on the upper limb. Additionally, two studies address central post-stroke pain, two focus on aphasia, one on dysphagia, and one on post-stroke fatigue.
While patient ethnicity is not reported in the manuscripts, it is likely that most studies involve populations from their respective regional contexts, suggesting a lack of diversity and limited information on other ethnic groups. This is an important factor, as technology-based solutions are typically developed and validated within specific demographic groups, and their effectiveness and translational potential may not readily extend to other populations [2].
Brain stimulation
Non-invasive brain stimulation (NIBS) techniques perform modulation of the central nervous system by electrically activating neurons in the brain and are used to influence cortical excitability, neuroplasticity, and behavior [3]. Their use in stroke rehabilitation has grown significantly over the past decades [4], [5], [6], [7], and the studies included in this research topic add valuable insights to the existing body of knowledge in the field.
Liu et al. 2024 present a review on the effects of repetitive transcranial magnetic stimulation (rTMS) on central post-stroke pain (CPSP). By analysing 6 randomized controlled trials (RCTs), the authors concluded that TMS can alleviate pain in CPSP patients and provide greater upper limb motor function improvement with respect to control groups, receiving either sham stimulation or conventional therapy. No significant effect of rTMS was found for treatment of cognitive symptoms such as depression and anxiety.
In their systematic review and meta-analysis, Gurdiel-Álvarez et al. 2024 also agree that rTMS could be considered a useful tool for CPSP treatment. However, they warn that there is low quality evidence for the effectiveness of rTMS on CPSP and that further and more rigorous studies are needed.
Wang et al. 2024a compared and analyzed the effects of different rTMS protocols on lower extremity motor function in stroke patients using network meta-analysis (NMA). They analyzed 38 studies and concluded that rTMS over the motor cortex benefits lower limb recovery using high frequency protocol for post-stroke time > 1 month and low frequency for longer post-stroke times. However, they advise further analysis and validation by high-quality RCTs to support their conclusion.
Wang et al. 2025 explored the potential of cerebellar TMS for improving limb function after stroke. By reviewing clinical studies using this technique, they investigated its effectiveness, safety, and underlying mechanisms, highlighting advances in TMS and its combination with physiotherapy. The authors also examined the cerebellum’s role in motor control, cognitive effects, and stimulation challenges, indicating that cerebellar TMS is a promising but complex tool for stroke rehabilitation, with recommendations for future research.
In their review, Yang et al. 2024 examined the potential of transcranial alternating current stimulation (tACS) as an alternative treatment for enhancing functional abilities in stroke patients. The studies reviewed indicated that tACS contributed to improvements in overall functional recovery, sensorimotor deficits, aphasia, and hemispatial neglect. Nonetheless, the exact mechanism through which tACS exerts its effects remains unclear.
Kwong Tang et al. 2024 propose a large double-blind randomized control trial in which transcranial direct stimulation (tDCS) will be assessed for treatment of post-stroke fatigue (PSF). Subjects will receive either active or sham stimulation over the motor cortex in two 20-min sessions per day for 5 days. A 4 weeks follow-up will evaluate change in fatigue severity using modified fatigue impact scale (MFIS). This study will demonstrate the benefits of tDCS in PSF treatment, paving the way for further research on optimal tDCS parameters.
Collectively, all these studies call for high-quality, evidence-based studies to support the potential of NIBS techniques in clinical applications to promote recovery from stroke.
Peripheral stimulation
In addition to NIBS, other non-invasive techniques targeting stimulation of body periphery have recently emerged in the stroke field, with specific focus on promoting motor recovery.
In their review, Wang et al. 2024b investigate the effects of transcutaneous electrical acupoint stimulation (TEAS) for stroke rehabilitation. TEAS is a non-invasive technique that combines Chinese acupuncture and transcutaneous electrical nerve stimulation, which is delivered with low-frequency pulses to peripheral acupoints. By analysing 16 trials, they found that indeed TEAS can promote upper limb function recovery. However, due to the limited number and low methodological quality of included trials, larger, high-quality multi-center studies are needed to confirm the results.
Hyeon Jeong et al. 2024 have developed an experimental protocol to examine the effects of combining peripheral nerve electrical stimulation (PES) with brain-computer interface-based action observation (BCI-AO) tasks on corticospinal plasticity after stroke, exploring how different PES pairings influence motor cortex activation. They found that task-driven corticospinal plasticity was higher when PES was applied synchronously with a highly attentive brain state during the action observation task, compared to continuous or asynchronous application. Although promising, their protocol only monitored corticospinal plasticity immediately after the task and did not assess retention. Further research is thus needed to evaluate the impact of this paradigm on long-term functional recovery after stroke.
Recently, transcutaneous vagal nerve stimulation (tVNS) has been used as a promising technique in neurorehabilitation context. Fan et al. 20204 have reviewed recent literature and confirmed that tVNS intervention is both effective and safe in treating stroke. However, the mechanism of action is still not fully understood and requires further exploration in the future.
Similar to brain stimulation research, peripheral stimulation techniques also need larger, well-controlled clinical trials to evaluate their effectiveness in stroke rehabilitation and how they might be integrated with standard therapies.
Motor control strategies
Some studies leverage motor control theories and models to develop strategies that enhance movement recovery. For instance, brain-computer interfaces (BCIs) utilize neural activity to stimulate neuroplasticity [8]. Within this research topic, there are two original studies focused on BCIs. One is the previously mentioned work by Hyeon Jeong et al. 2024, while the other was carried out by Sebastián-Romagosa et al. 2023, who examined a 25-sessions BCI treatment aimed at gait rehabilitation. This intervention proved effective in producing long-lasting improvements in gait speed among chronic stroke survivors. As a result, patients experienced increased lower limb movement, leading to improved and safer walking abilities, retained one-month post intervention.
Constraint-induced movement therapy (CIMT) has been employed for decades as an effective method to promote motor recovery by restricting the movement of the less-affected arm. CIMT improves upper extremity function by discouraging learned non-use and harnessing use-dependent neuroplasticity [9]. Xu et al. 2024 reviewed CIMT research in the last 30 years and concluded that CIMT holds significant potential for further development in rehabilitation. Key focus areas include its combined use with other therapies, understanding its effects on motor cortex plasticity, optimizing intervention timing and dosage, and exploring new settings such as robot-assisted, telemedicine, and home-based rehabilitation.
An alternative approach involves suppressing abnormal motor activation to facilitate proper motor output. In their study Dewald et al. 2024 blocked undesirable and abnormal hand flexor contractions in persons post-stroke using local anesthesia of the median and ulnar nerves. Their findings indicate that many stroke survivors could experience better hand-opening when wrist and finger flexor activity was reduced through nerve block, particularly when functional electrical stimulation (FES) was applied to activate the typically weakened finger and wrist extensor muscles. This type of nerve block shows potentiality for stroke rehabilitation and could effectively overcome some of the limitations previously observed in FES treatments for stroke patients.
Recently, there has been growing interest in muscle strengthening, especially through eccentric training (ET), a well-established technique commonly used to enhance muscle strength in athletes, which involves contracting the muscle while it lengthens within the musculotendinous complex. Belghith et al. 2025 propose a novel comparison between ET and conventional therapy for improving outcomes in sub-acute stroke survivors. While preliminary evidence suggests ET can enhance muscle strength, stiffness, and walking performance, the specific biomechanical changes in paretic muscles remain unclear. This study will fill that gap, potentially guiding more effective early-stage stroke rehabilitation.
Patients-led therapy
All manuscripts in this research topic focus on technological approaches as alternatives to standard therapy, but two of them stand out because they require patient-led actions.
Jiang et al. 2024 review the impact of mobile application-based interventions on post-stroke aphasia. They analyzed 15 studies, highlighting the potential of mobile app-based interventions to improve speech-language function in individuals with aphasia. However, more high-quality research is necessary to confirm their effectiveness across different areas and to explore the comparative benefits of various treatment methods.
Wei et al. 2024 describe a clinical study on 90 patients who received intravascular stent implantations immediately after ischemic stroke. They were interested in assessing the influence of a step-by-step inpatient rehabilitation program (SIRP) on the self-care capability and quality of life of patients. The observation group received SIRP in addition to routine nursing care, while the control group received only routine care. At admission, there were no significant differences between the groups. However, three months postoperatively, the observation group demonstrated significant improvements and also reduced complications and hospital stay duration. These results highlight the value of integrating structured rehabilitation programs into standard treatment procedures.
Assessment methods
Throughout the rehabilitation intervention, the training program is continuously adjusted and monitored to optimize the patient’s functional independence. This highlights the crucial role of assessment, emphasizing the need to go beyond traditional clinical scales [10].
Park et al. 2024 analyzed 60 post-stroke individuals to determine whether conventional stratification strategies could improve the prediction of upper limb motor outcomes. They found that baseline upper limb motor impairment alone best predicted outcomes for less impaired or non-cortical subgroups, while combining it with brain structural damage improved predictions for others. Their conclusion is that applying stratification strategies, especially by initial impairment, enhances prediction accuracy beyond generic models, moving toward personalized prognoses for upper limb motor recovery after stroke.
Saab et al. 2023 present an original study focusing on predicting dysphagia treatment outcomes using speech recordings. The researchers developed a proof-of-concept model for automated dysphagia screening and tested its performance on training and validation cohorts. Their findings demonstrate that deep learning can effectively screen post-stroke dysphagia based solely on vocalizations. This approach paves the way for future non-invasive, objective, and rapid screening tools, potentially enhancing patient care, improving outcomes, and making swallowing assessments more accessible.
Wang et al. 2022 applied microstate analysis to compare EEG patterns between stroke patients and healthy controls, and examined correlations between microstate features and clinical scales in patients. They identified significant differences in resting-state EEG microstate features between stroke and healthy groups. Their findings suggest that EEG microstate analysis could offer valuable neurological insights for stroke rehabilitation and support its use as a potential neurological marker in clinical diagnosis and assessment.
Perspective on current trends in stroke rehabilitation
This research topic provides valuable insight into current trends in stroke rehabilitation research and still unmet needs of current studies (Fig. 1 central panel). While significant progress is being made in developing various treatment methods targeting different symptoms, there remains a notable lack of focus on assessment [10]. This is a critical gap, as rehabilitation relies on a continuous cycle of assessment and treatment [11]. Improved assessment tools are essential for accurately identifying patient needs, leading to more personalized therapies and ultimately better outcomes [12]. The rise of machine learning and digital technologies (Fig. 1 left panel) presents a major opportunity to enhance assessment methods and make them more precise and effective, as indicated by the studies by Park et al. 2024, Saab et al. 2023, Wang et al. 2022.
Among treatment approaches, there is growing enthusiasm for non-invasive stimulation techniques—both central and peripheral—which aligns with the broader interest toward electroceuticals [13]. BCIs and other plasticity promoting techniques are still being investigated and there is also a growing interest for patient-led rehabilitation strategies. However, there is a need for additional and larger studies in all these contexts.
Motor symptoms remain the most extensively studied aspect of stroke, yet stroke affects the brain as a network, leading to concurrent impairments in both motor and cognitive domains—the latter often being overlooked. In fact, cognitive aspects received only limited attention in this research topic.
Additionally, most studies tend to target individual symptoms rather than considering stroke location, cause, and other clinical factors. It remains to be addressed whether this approach overlooks critical factors and we advocate for future research to adopt holistic approaches incorporating comprehensive, objective assessments of patient function, supported by improved evaluation tools and personalized treatment strategies.
In this perspective, machine learning and digital tools present a valuable opportunity to develop more accurate and comprehensive models of stroke recovery [14], [15], [16] (Fig. 1 left panel). Importantly, future research should account for patients' ethnic and cultural diversity to accurately link health status to individual-specific factors [17] . These elements may influence recovery outcomes and should be integrated into health models to enhance their relevance and effectiveness. Moreover, future studies should prioritize tailoring rehabilitation sessions to individual patient needs, exploring how to integrate various aspects of recovery.
In conclusion, this research topic provides a comprehensive overview of stroke rehabilitation at the intersection of laboratory investigation and clinical application. It not only highlights key areas of ongoing research but also outlines potential pathways to transition from the lab to clinical practice.
Keywords: Neurorehabiliation, Non Invasive Brain Stimulation (NIBS), Peripheral stimulation, motor control, Rehabilitation assessment, Digital technologies (DTs)
* Correspondence: Marianna Semprini, Istituto Italiano di Tecnologia, Genoa, Italy
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
I consider Dr. Carmichael a rock star. Followup on this is step 4 below if our stroke medical 'professionals' are competent! You'll have to hope like hell your stroke leadership steps up and gets stroke protocols written following all research. But there is NO STROKE LEADERSHIP ANYWHERE!
Damn it all: stroke is easy; 5 steps. 1. Describe the problems exactly. There are tens of
thousands of pieces of research already hinting at solutions, just need
followup.
2. Write thousands of RFPs to researchers/MIT grads to solve those problems.
3. Fund them with foundation grants.
4. Write stroke rehab protocols based on the research.
5. Get the Nobel prize in medicine.
Researchers
at the University of California Los Angeles have developed a
groundbreaking new drug that could change stroke recovery forever.
Called DDL 920, the medication is the first to fully restore motor function without the need for long term physical therapy.
Dr Thomas Carmichael, Chair of UCLA’s Department of Neurology and
lead researcher, said the drug marks a new era in stroke rehabilitation,
one led by molecular medicine rather than conventional therapy.
In trials on mice, DDL 920 successfully repaired brain damage and restored lost neural connections.
The team is now preparing to begin human testing.
Every year, strokes affect more than 15 million people worldwide, and
many survivors are left with long term physical impairments.
Current treatments mainly focus on preventing further strokes and
improving quality of life—but none directly reverse the damage already
done.
Though the drug is still in its early stages, its potential has already sparked excitement across the medical community.
Experts believe it could transform the way we approach not just
stroke recovery, but also other brain injuries and degenerative
conditions in the future.
I expect NOTHING in the next 35 years that will allow me to recover. With NO STROKE STRATEGY AND NO STROKE LEADERSHIP nothing will happen.
Your children and grandchildren will be screwed if they have a stroke, they will recover as poorly as you have.
Damn it all: stroke is easy; 5 steps. 1. Describe the problems exactly. There are tens of
thousands of pieces of research already hinting at solutions, just need
followup.
2. Write thousands of RFPs to researchers/MIT grads to solve those problems.
3. Fund them with foundation grants.
4. Write stroke rehab protocols based on the research.
5. Get the Nobel prize in medicine.
So instead of throwing up your hands in defeat create a strategy and you can solve the neuroprotection problem also. Here is my take and I'm not medically trained and a stroke survivor so I don't accept defeat. And I considered Dr. Carmichael a rock star.
Damn it all: stroke is easy; 5 steps. 1. Describe the problems exactly. There are tens of
thousands of pieces of research already hinting at solutions, just need
followup.
2. Write thousands of RFPs to researchers/MIT grads to solve those problems.
3. Fund them with foundation grants.
4. Write stroke rehab protocols based on the research.
5. Get the Nobel prize in medicine.
The
repair and recovery of the brain after stroke is a field that is
emerging in its preclinical science and clinical trials. However, recent
large, multicenter clinical trials have been negative, and conflicting
results emerge on biological targets in preclinical studies. The
coalescence of negative clinical translation and confusion in
preclinical studies raises the suggestion that perhaps the field of
stroke recovery faces a fate similar to stroke neuroprotection(Wrong name, it really is theneuronal cascade of death; words matter, use the term that signifies immediate action needed!), with
interesting science ultimately proving difficult to translate to the
clinic. This review highlights improvements in 4 areas of the stroke
neural repair field that should reorient the field toward successful
clinical translation: improvements in rodent genetic models of stroke
recovery, consideration of the biological target in stroke recovery,
stratification in clinical trials, and the use of appropriate clinical
trial end points.
Footnotes
The opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.
For Sources of Funding and Disclosures, see page 3172.
Correspondence to: S. Thomas Carmichael, MD, PhD, David Geffen School of Medicine at UCLA, Los Angeles, CA. Email scarmichael@mednet.ucla.edu
Investing in improving stroke care now will deliver $15.6B total economic benefit in 2021-2050. Our research plan will save lives and deliver new imaging technologies, digital telehealth across the nation, education programs and thousands of jobs in medical technology industries.
Notice the word 'care' NOT cure. Unless survivors change that tyranny of low expectations mindset, stroke will never be solved.
Until we get some effective leadership and
a strategy stroke will never be solved even though the process to solve
stroke is quite easy.
I'll simplify it for you in 5 steps:
Damn it all: stroke is easy; 5 steps. 1. Describe the problems exactly. There are tens of
thousands of pieces of research already hinting at solutions, just need
followup.
2. Write thousands of RFPs to researchers/MIT grads to solve those problems.
3. Fund them with foundation grants.
4. Write stroke rehab protocols based on the research.
5. Get the Nobel prize in medicine.
This is rich, the WSO abdicating any responsibility they have to solve stroke.
RUN AWAY!
they pulled the get out of responsibility card
. THIS IS WHY WE NEED TO DESTROY the fucking failures of stroke associations and have them run by survivors. Until we get some effective leadership and a strategy stroke will never be solved even though the process to solve stroke is quite easy.
I'll simplify it for you in 5 steps:
Damn it all: stroke is easy; 5 steps. 1. Describe the problems exactly. There are tens of
thousands of pieces of research already hinting at solutions, just need
followup.
2. Write thousands of RFPs to researchers/MIT grads to solve those problems.
3. Fund them with foundation grants.
4. Write stroke rehab protocols based on the research.
5. Get the Nobel prize in medicine.
You wouldn't need to work on this secondary issue if you would solve the primary problem of having protocols for 100% recovery. Does no one in stroke understand one damn thing about what needs to be done for stroke recovery? The only goal in stroke is 100% recovery, everything depends on that. Return to work IS NOT A GOAL IN STROKE. And until we drill that into the heads of the stroke medical world stroke will never be solved.
I'll simplify it for you in 5 steps:
Damn it all: stroke is easy; 5 steps. 1. Describe the problems exactly. There are tens of
thousands of pieces of research already hinting at solutions, just need
followup.
2. Write thousands of RFPs to researchers/MIT grads to solve those problems.
3. Fund them with foundation grants.
4. Write stroke rehab protocols based on the research.
5. Get the Nobel prize in medicine.
Ulla Johansson a,b ,
Therese Hellman c ,
Annika Ost Nilsson b
and Gunilla Eriksson a,d
a Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden;
b Centre for Research & Development, Uppsala University/Region of G€avleborg, G€avle, Sweden; c Department of Medical Sciences,
Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden;
d Department of Neuroscience, Rehabilitation
Medicine, Uppsala University, Uppsala, Sweden
ABSTRACT
Background:
About half of those that have had stroke in working age return to work (RTW).
Few rehabilitation programmes exist focussing RTW after stroke. Aim:
To produce a clear replicable description of the ReWork-Stroke rehabilitation programme
targeting RTW for people of working age who have had stroke. Materials and methods:
The Template for Intervention Description and Replication 12 item
checklist was used to describe the ReWork-Stroke programme developed 2013–2014. This paper
presents the development, rationale and processes in the programme to enable replication and
provide evidence for implementation. Results:
Occupational therapists (OTs) skilled in stroke rehabilitation contribute knowledge
about consequences of stroke and coordinate stakeholders involved. The ReWork-Stroke is person-centred, includes individual plans and generic components, consists of a preparation and a
work trial phase. During the preparation phase, resources and hindrances for RTW are mapped
and a plan for work trial is elaborated. During the work trial phase, the intervention is located
at the workplace. The OT conducts recurrent follow-ups and collaborates with employers/coworkers. Conclusions:
A person-centred programme has advantages in its flexibility to meet different
needs between people and by this thorough description of ReWork-Stroke, others can replicate
the programme and its fidelity and evidence can be strengthened.
You don't know what to do to solve stroke, so you are GIVING UP? GET THE HELL OUT OF THE WAY and lets survivors solve it. You're OK with leaving tens of millions of stroke survivors living with their disabilities for the rest of their lives? Shame on you. Leaders don't
RUN AWAY!
from problems, they make plans to solve them. Are you leaders or mice? Never mind, you already answered that question.
I'll simplify it for you in 5 steps:
Damn it all: stroke is easy; 5 steps. 1. Describe the problems exactly. There are tens of thousands of pieces of research already hinting at solutions, just need followup.
2. Write thousands of RFPs to researchers/MIT grads to solve those problems.
3. Fund them with foundation grants.
4. Write stroke rehab protocols based on the research.
5. Get the Nobel prize in medicine.
The
World Stroke Organization (WSO) has published a radical strategic
framework that aims to transform prevention of stroke and dementia.
Published in latest edition of The Lancet Neurology, the WSO Declaration
on Global Prevention of Stroke and Dementia, recognizes the commonality
and reciprocity of stroke and dementia risk and calls for urgent action
by governments and healthcare policy bodies to address the limitations
of current prevention strategy.
News and blog > News > Global Stroke Leaders Launch Radical Prevention Strategy
NEWS RELEASE 29th May 2020, Geneva GLOBAL STROKE LEADERS LAUNCH RADICAL STROKE AND DEMENTIA PREVENTION STRATEGY
The World Stroke Organization (WSO) has published a radical strategic
framework that aims to transform prevention of stroke and dementia.
Published in latest edition of The Lancet Neurology, the WSO Declaration
on Global Prevention of Stroke and Dementia, recognizes the commonality
and reciprocity of stroke and dementia risk and calls for urgent action
by governments and healthcare policy bodies to address the limitations
of current prevention strategy.
Over the past ten years the adult lifetime risk of stroke has
increased from 1 in 6, to 1 in 4. Without new evidence-based
interventions, the WSO projects a current trajectory of disease that
will lead to an annual death toll of 12 million stroke deaths and 5
million dementia deaths by 2050.
Highlighting the need for action in low- and medium-risk populations,
who will ultimately represent 80% of the stroke and cardiovascular
disease burden, the Declaration identifies four interdependent
interventions that will significantly reduce the incidence and
prevalence of stroke and dementia. The strategy also takes into account
the specific challenges experienced by governments and communities in
Low- and Middle- Income countries, putting in place a lower cost
alternative to current prevention approaches. Key principles of the Declaration
1 Adoption of population wide strategies that reduce exposure to
stroke risk factors such as tobacco, alcohol and food policies, as well
as action to address environmental risk factors, including air
pollution, across the lifespan of the whole population.
2 Implement and promote the adoption of motivational mobile
technologies, e.g. the WSO endorsedStrokeRiskometer to identify
individual risks and support action on lifestyle risk factors among
adults.
3 Access to low dose combination of generic blood pressure and
lipid-lowering therapies in one polypill for middle age and older adults
with at least two behavioural or clinical stroke risk factors.
4 Investment, training and deployment of community health workers to facilitate implementation.
WSO presents combined research evidence that shows a combination of
these interventions would lower the incidence and of stroke by 50% and
dementia incidence by 30% while contributing to decrease in incidence of
other non-communicable diseases which share common risk factors.
Another proposed shift of approach is to change the way risk is
communicated to patients, by health professionals. Current
categorisation into low-, medium- and high-stroke risk can give a false
sense of security for those who are told they are low or medium risk and
may not take into account all risk factors that are present. The global
stroke body instead calls for a more holistic approach, that places
stroke risk on a continuum and encourages early intervention and a
life-course approach to risk reduction.
WSO President Prof Michael Brainin,(You need to be removed and someone competent put in charge) who champions the organization’s
prevention effort said ‘COVID-19 has spurred previously inconceivable
levels of government intervention and individual behaviour change around
the world, but we have been effectively living with a stroke pandemic
and a failing prevention strategy for years.
The need for radical action is clear and our prevention principles
provide low cost, evidence-based approaches that if implemented globally
would not only save millions of lives but would deliver savings of
hundreds of billions of dollars annually. This is money that will be
desperately needed to strengthen global health systems and to fuel
economic recovery in the wake of COVID-19.’
Do you even understand that most of the problems you are referring to are secondary to the stroke? Getting to 100% recovery would eliminate all these problems. ARE YOU EVEN TRYING TO SOLVE THE 100% RECOVERY ISSUE? Or just sitting on your ass twiddling your thumbs because solving that would be hard work?
I'll simplify it for you in 5 steps:
Damn it all: stroke is easy; 5 steps. 1. Describe the problems exactly.
2. Write thousands of RFPs to researchers/MIT grads to solve those problems.
3. Fund them with foundation grants.
4. Write stroke rehab protocols based on the research.
5. Get the Nobel prize in medicine
Juliet Bouverie, Chief Executive of the Stroke Association explores the challenges around recovery from stroke
When stroke strikes, part of your brain shuts down.
The impact is devastating. It could be anything from wiping out speech
and physical abilities to affecting a person’s emotions and personality.
There’s no doubt that recovery from these effects takes time, a ton of
courage, determination and support.
Doctors, physiotherapists and speech therapists are a vital step in
helping stroke survivors rebuild their lives, but we need to know what
struggles stroke survivors
face that advances in medical knowledge cannot solve. This is why the
Stroke Association commissioned our largest ever survey of UK stroke
survivors to form our four-part Lived Experience of Stroke report.
Throughout 2018, over 11,000 stroke survivors and carers from across
the UK told us about their experience of stroke. They shared their
thoughts and feelings about the severity of their stroke, life after their stroke,
the things they have found challenging to adapt to, the support they
have received, and the areas in which they wish they had been better
supported.
Every day, my colleagues and I at the Stroke Association hear
upsetting stories which bring the research findings to life. We hear of
marriages broken and suicide attempts, of jobs lost, houses sold and
stroke survivors, their families and family carers becoming homeless.
When I first joined the Stroke Association, I was told about one man who
lamented that living with the effects of stroke wasn’t a life worth
living for him and that he’d rather have died in hospital. On the most
basic level, this is upsetting and speaks of the psychological trauma a
stroke can cause. We now have robust data to show what we knew
anecdotally, that the stroke population desperately needs emotional and
psychological support.
For too long now, the social and psychological impacts of stroke have
gone unnoticed and have been overshadowed by the importance of physical
rehabilitation. There are currently 1.2 million stroke survivors in the
UK. Alarmingly, we found that nearly a million stroke survivors have a
mental health problem as a consequence of their stroke. Three-quarters
of survivors face a battle with depression, anxiety, lack of confidence,
mood swings and even suicidal thoughts. Devastatingly, a quarter of
these people say they haven’t had the emotional support they should be
getting, and so desperately need, to rebuild their lives.
Overall, nine out of ten survivors experience at least one cognitive
effect including fatigue, problems with concentration, decision-making,
reading, writing and poor memory. These challenges are compounded by the
worry that another stroke may be on the way.
A stroke at any age can be devastating, but the condition is
particularly cruel when it hits people of working-age. One in every four
strokes happens to a person aged 18-65. We now know that nearly half
(43%) of working-age stroke survivors are faced with financial hardship
after their stroke and over half (51%) gave up work or reduced their
working hours following their stroke. Nearly one in six (15%)
working-age stroke survivors experienced discrimination, missed out on a
promotion or said their employer was not supportive.
Of course, the psychological and physical effects of stroke can be
heavily intertwined, as often the mental and therefore hidden impacts of
a stroke affect a stroke survivor’s ability to work as much as the
physical impacts. Employers often do not understand the breadth of
consequences that a stroke can have on a person; this is symptomatic of
the public’s overall lack of stroke knowledge. For example, 14 million
people who know a stroke survivor don’t even realise that stroke happens
in the brain.
Our stroke recovery teams provide stroke survivors and their families
with information and advice on how to rebuild their lives after stroke,
including signposting to other services and support with filling in
disability benefit application forms. The Stroke Association’s service
teams help stroke survivors get back to work and provide advice to
reduce the financial burden that a stroke can have on a survivor. We
have developed My Stroke Guide to help stroke survivors access vital
information and offer peer support online and we also run the Stroke
Helpline as further support for everyone affected by stroke.
The evidence highlights how important it is that families, friends
and health professionals who support stroke survivors understand what it
means to live with these ‘hidden effects’, ask how people are feeling
and provide appropriate social, emotional and psychological support. We
have pushed for psychological support to become a higher priority and
I’m pleased to see more holistic support included in the National Stroke
Programme. The programme aims to deliver on stroke goals in the Long
Term Plan
(Your long term plan is worthless.
Lousy plan for stroke. NOTHING on 100% recovery just 'care' and 'services'. Whomever wrote this up didn't talk to stroke survivors and did no planning on how to solve all the problems in stroke.
They assumed the status quo will continue and nothing new will be
found. That way there will be no hard and difficult work to be done. In
other words there are NO LEADERS to be found.)
and we are proud to be working closely with NHS England to
develop and deliver it. Please do refer your clients who may be affected
by stroke to the Stroke Association’s vital information and support
services (see below for details). We’re here to help rebuild lives after
stroke.
Does your doctor have enough gumption and brains to try this on stroke patients maybe as a preventative to your likely chance of getting dementia? Before it is totally proven out?
I would suggest that we just hand all the problems in stroke over to MIT graduates and let them get a Nobel prize early in their career. A competent stroke leader would look at all these incredibly smart people needing a project to graduate with and hand them all the nihilism in stroke problems. But that will never occur. We have NO STROKE LEADERSHIP, stroke is totally rudderless.
Damn it all: stroke is easy; 5 steps. 1. Describe the problems exactly.
2. Write thousands of RFPs to researchers/MIT grads to solve those problems.
3. Fund them with foundation grants.
4. Write stroke rehab protocols based on the research.
5. Get the Nobel prize in medicine
MIT researchers substantially reduced beta-amyloid plaques in Alzheimer’s, using LED lights flickering at a specific frequency.
Helps Cells That Destroy Alzheimer's Plaque
This treatment appears to work by inducing brain waves known as gamma
oscillations, which the researchers discovered help the brain suppress
beta amyloid production and invigorate cells responsible for destroying
the plaques.
Further research will be needed to determine if a similar approach
could help Alzheimer’s patients, says Li-Huei Tsai, the Picower
Professor of Neuroscience, director of MIT’s Picower Institute for
Learning and Memory, and senior author of the study, which appears in
the online edition of Nature.
Article continued below video...
Researchers in Li-Huei Tsai's laboratory at the Picower
Institute for Learning and Memory have shown that disrupted gamma waves
in the brains of mice with Alzheimer’s disease can be corrected by
a unique non-invasive technique using flickering light.
Video: The Picower Institute for Learning and Memory
“It’s a big ‘if,’ because so many things have been shown to work in
mice, only to fail in humans,” Tsai says. “But if humans behave
similarly to mice in response to this treatment, I would say the
potential is just enormous, because it’s so noninvasive, and it’s so
accessible.”
Tsai and Ed Boyden, an associate professor of biological engineering
and brain and cognitive sciences at the MIT Media Lab and the McGovern
Institute for Brain Research, who is also an author of the Nature paper,
have started a company called Cognito Therapeutics to pursue tests in
humans. The paper’s lead authors are graduate student Hannah Iaccarino
and Media Lab research affiliate Annabelle Singer.
“This important announcement may herald a breakthrough in the
understanding and treatment of Alzheimer's disease, a terrible
affliction affecting millions of people and their families around the
world,” says Michael Sipser, dean of MIT’s School of Science. “Our MIT
scientists have opened the door to an entirely new direction of research
on this brain disorder and the mechanisms that may cause or prevent
it. I find it extremely exciting.”
Brain wave stimulation
Alzheimer’s disease, which affects more than 5 million people in the
United States, is characterized by beta amyloid plaques that are
suspected to be harmful to brain cells and to interfere with normal
brain function. Previous studies have hinted that Alzheimer’s patients
also have impaired gamma oscillations. These brain waves, which range
from 25 to 80 hertz (cycles per second), are believed to contribute to
normal brain functions such as attention, perception, and memory.
In a study of mice that were genetically programmed to develop
Alzheimer’s but did not yet show any plaque accumulation or behavioral
symptoms, Tsai and her colleagues found impaired gamma oscillations
during patterns of activity that are essential for learning and memory
while running a maze.
Next, the researchers stimulated gamma oscillations at 40 hertz in a
brain region called the hippocampus, which is critical in memory
formation and retrieval. These initial studies relied on a technique
known as optogenetics, co-pioneered by Boyden, which allows scientists
to control the activity of genetically modified neurons by shining light
on them. Using this approach, the researchers stimulated certain brain
cells known as interneurons, which then synchronize the gamma activity
of excitatory neurons.
40% to 50% Reduction
After an hour of stimulation at 40 hertz, the researchers found a 40 to
50 percent reduction in the levels of beta amyloid proteins in the
hippocampus. Stimulation at other frequencies, ranging from 20 to 80
hertz, did not produce this decline.
Tsai and colleagues then began to wonder if less-invasive techniques
might achieve the same effect. Tsai and Emery Brown, the Edward Hood
Taplin Professor of Medical Engineering and Computational Neuroscience, a
member of the Picower Institute, and an author of the paper, came up
with the idea of using an external stimulus — in this case, light — to
drive gamma oscillations in the brain. The researchers built a simple
device consisting of a strip of LEDs that can be programmed to flicker
at different frequencies.
Using this device, the researchers found that an hour of exposure to
light flickering at 40 hertz enhanced gamma oscillations and reduced
beta amyloid levels by half in the visual cortex of mice in the very
early stages of Alzheimer’s. However, the proteins returned to their
original levels within 24 hours.
The researchers then investigated whether a longer course of
treatment could reduce amyloid plaques in mice with more advanced
accumulation of amyloid plaques. After treating the mice for an hour a
day for seven days, both plaques and free-floating amyloid were markedly
reduced. The researchers are now trying to determine how long these
effects last.
Furthermore, the researchers found that gamma rhythms also reduced
another hallmark of Alzheimer’s disease: the abnormally modified Tau
protein, which can form tangles in the brain.
Gamma Oscillations Clean Up
“What this study does, in a very carefully designed and well-executed
way, is show that gamma oscillations, which we have known for a long
time are linked to cognitive function, play a critical role in the
capacity of the brain to clean up deposits,” says Alvaro Pascual-Leone, a
professor of neurology at Harvard Medical School who was not involved
in the research. “That’s remarkable and surprising, and it opens up the
exciting prospect of possible translation to application in humans.”
Tsai’s lab is now studying whether light can drive gamma
oscillations in brain regions beyond the visual cortex, and preliminary
data suggest that this is possible. They are also investigating whether
the reduction in amyloid plaques has any effects on the behavioral
symptoms of their Alzheimer’s mouse models, and whether this technique
could affect other neurological disorders that involve impaired gamma
oscillations.
Two Modes of Action
The researchers also performed studies to try to figure out how
gamma oscillations exert their effects. They found that after gamma
stimulation, the process for beta amyloid generation is less active.
Gamma oscillations also improved the brain’s ability to clear out beta
amyloid proteins, which is normally the job of immune cells known as
microglia.
“They take up toxic materials and cell debris, clean up the environment, and keep neurons healthy,” Tsai says.
In Alzheimer’s patients, microglia cells become very inflammatory
and secrete toxic chemicals that make other brain cells more sick.
However, when gamma oscillations were boosted in mice, their microglia
underwent morphological changes and became more active in clearing away
the beta amyloid proteins.
“The bottom line is, enhancing gamma oscillations in the brain can
do at least two things to reduced amyloid load. One is to reduce beta
amyloid production from neurons. And second is to enhance the clearance
of amyloids by microglia,” Tsai says.
The researchers also sequenced messenger RNA from the brains of the
treated mice and found that hundreds of genes were over- or
underexpressed, and they are now investigating the possible impact of
those variations on Alzheimer’s disease.
MORE INFORMATION:
The research was funded by the JPB Foundation, the Cameron Hayden Lord
Foundation, a Barbara J. Weedon Fellowship, the New York Stem Cell
Foundation Robertson Award, the National Institutes of Health, the
Belfer Neurodegeneration Consortium, and the Halis Family Foundation.
In case you want to beat your head against a wall by trying to get the WSO to actually listen to survivors. 100% recovery, NOTHING LESS. I'm advocating for the WSO to put together a strategy for 100% recovery. This is just deflection from them actually doing the hard work of solving stroke. Survivors need to be in charge. A 5 step program for solving stroke here: See how easy it is? WSO, are you that fucking stupid that you don't understand how to solve stroke?
Damn it all: stroke is easy; 5 steps. 1. Describe the problems exactly.
2. Write thousands of RFPs to researchers to solve those problems.
3. Fund them with foundation grants.
4. Write stroke rehab protocols based on the research.
5. Get the Nobel prize in medicine
A
Nobel Prize awaits. Isn't that enough incentive? Or is this all just
too fucking hard for all these MDs and PhDs working on stroke? Do you need a stroke survivor to lead you?
The WSO Advocacy Toolkit is for individuals and organizations seeking
to advance stroke policy, elevate the issue of stroke to improve stroke
awareness, prevention, treatment and support by driving change through
governments and institutions.
This toolkit will help you advocate effectively for improvements in
the health system to address stroke (e.g. develop population based
policies that will reduce stroke, ensure better access to evidence based
stroke treatments, secure resources to develop stroke rehabilitation
and support services) in your region.
Meditation has been proven for years to help stroke recovery. Yet I bet your doctor has no protocol on it and this won't make one bit of difference. Ah well, no one cares to actually solve stroke. It is way too fucking hard for the existing stroke leadership to even know how to get survivors to 100% recovery.
Damn it all: stroke is easy; 5 steps. 1. Describe the problems exactly.
2. Write thousands of RFPs to researchers to solve those problems.
3. Fund them with foundation grants.
4. Write stroke rehab protocols based on the research.
5. Get the Nobel prize in medicine
A
Nobel Prize awaits. Isn't that enough incentive? Or is this all just
too fucking hard for all these MDs and PhDs working on stroke? Do you need a stroke survivor to lead you?
Neuroscientist Sara Lazar found that people who practiced meditation
had more gray matter in the part of the brain linked to decision-making
and working memory: the frontal cortex.
While most people
see their cortexes shrink as they age, 50-year-old meditators in the
study had the same amount of gray matter as those half their age.
Participants in the study averaged about 27 minutes of the habit a day,
but other studies suggest that you can see significant positive changes
in just 15 minutes a day.
Neuroscientist Sara Lazar, of Mass General and Harvard Medical School, started studying meditation
by accident. She sustained running injuries training for the Boston
Marathon, and her physical therapist told her to stretch. So Lazar took
up yoga.
"The yoga teacher
made all sorts of claims, that yoga would increase your compassion and
open your heart," said Lazar. "And I'd think, 'Yeah, yeah, yeah, I'm
here to stretch.' But I started noticing that I was calmer. I was better
able to handle more difficult situations. I was more compassionate and
open hearted, and able to see things from others' points of view."
Eventually, she looked up the scientific literature on mindfulness
meditation (a category into which yoga can fall). She found the
ever-increasing body of evidence that shows that meditation decreases
stress, depression, and anxiety, reduces pain and insomnia, and
increases quality of life.
So she started doing some neuroscience research of her own.
In her first study,
she looked at long-term meditators (those with seven to nine years of
experience) versus a control group. The results showed that those with a
strong meditation background had increased gray matter in several areas
of the brain, including the auditory and sensory cortex, as well as
insula and sensory regions.
This makes sense, since
mindfulness meditation has you slow down and become aware of the present
moment, including physical sensations such as your breathing and the
sounds around you.
However, the neuroscientists also
found that the meditators had more gray matter in another brain region,
this time linked to decision-making and working memory: the frontal
cortex. In fact, while most people see their cortexes shrink as they
age, 50-year-old meditators in the study had the same
amount of gray matter as those half their age.
That's remarkable.
Lazar and her team wanted to make sure this wasn't because the
long-term meditators had more gray matter to begin with, so they
conducted a second study. In it, they put people with no experience with meditation into an eight-week mindfulness program.
The results? Even just eight weeks of meditation changed people's
brains for the better. There was thickening in several regions of the
brain, including the left hippocampus (involved in learning, memory, and
emotional regulation); the TPJ (involved in empathy and the ability to
take multiple perspectives); and a part of the brainstem called the pons
(where regulatory neurotransmitters are generated).
Plus, the brains of the new meditators saw shrinkage of the amygdala, a
region of the brain associated with fear, anxiety, and aggression. This
reduction in size of the amygdala correlated to reduced stress levels in
those participants.
How long do you have to meditate to see such results? Well, in the
study, participants were told to meditate for 40 minutes a day, but the
average ended up being 27 minutes a day. Several other studies suggest that you can see significant positive changes in just 15 to 20 minutes a day.
As for Lazar's own meditation practice, she says it's "highly variable.
Some days 40 minutes. Some days five minutes. Some days, not at all.
It's a lot like exercise. Exercising three times a week is great. But if
all you can do is just a little bit every day, that's a good thing,
too."
Turns out meditating can give you the brain of a 25-year-old. Too bad it can't also give you the body of one.
I go to live performances of jazz at a bar. I can't properly clap my hands together. But I do have wonderful social connections and the balance therapy is incredibly effective. The protocol: 3 drinks on a high bar stool and then walk to the restroom thru a crowd of people
Various failure points;
Hand will not stay in the palm up position, due to spasticity.
Fingers and thumb will not lay flat, due to spasticity.
Hand will not sweep in mid-air to connect with the good hand, due to dead brain.
All of these failure points should be fixable by any therapist in the world, Just go to the public database of stroke rehab protocols and choose the one with the highest efficacy for the damage diagnosis. This is incredibly simple if we have anyone with brains in stroke leadership. A Nobel prize awaits the leader who follows thru and accomplishes what centuries of stroke persons have failed at.
Damn it all: stroke is easy; 5 steps. 1. Describe the problems exactly.
2. Write thousands of RFPs to researchers to solve those problems.
3. Fund them with foundation grants.
4. Write stroke rehab protocols based on the research.
5. Get the Nobel prize in medicine
A
Nobel Prize awaits. Isn't that enough incentive? Or is this all just
too fucking hard for all these MDs and PhDs working on stroke?
Oops, I'm not playing by the polite rules of Dale Carnegie, 'How to Win Friends and Influence People'. Politeness
will never solve anything in stroke.
