Late Thrombectomy Universally Helpful in DEFUSE 3

Not good enough. I see nothing here that suggests you have any followup to get these patients 100% recovered. DAMN IT ALL, that is the ONLY goal in stroke.  This is just an intermediate step. WHOM do we contact for followup to get to 100% recovery?

Late Thrombectomy Universally Helpful in DEFUSE 3

Magnitude of absolute benefit over standard medical therapy did vary among subgroups, however

• by Nicole Lou, Reporter, MedPage Today/CRTonline.org January 28, 2019

The generalizability of the DEFUSE 3 trial held up in a secondary analysis showing that late endovascular thrombectomy was beneficial for a broad patient population with acute ischemic stroke.
Predictors of better functional outcome(NOT good enough, 100% recovery is the goal.) at 90 days were younger age, lower baseline stroke severity, and lower serum glucose level among the 182 patients with evidence of salvageable tissue on brain perfusion imaging who were randomized in the trial.
However, endovascular therapy in the 6- to 16-hour time window still improved functional outcomes more than medical therapy did after accounting for these variables (adjusted OR 3.1, 95% CI 1.8-5.4), according to Maarten Lansberg, MD, PhD, of Stanford Stroke Center in Palo Alto, California, and fellow DEFUSE 3 investigators reporting online in JAMA Neurology.
Furthermore, this treatment effect was not modified by age, symptom severity, time to randomization, imaging modality, nor location of the arterial occlusion.
"However, this uniform proportional benefit does not imply that there also is a uniform absolute benefit," the authors cautioned.
"For example, patients with low NIHSS [NIH Stroke Scale] scores experienced a substantial absolute benefit in their chance of achieving functional independence but had no reduction in mortality, whereas patients with high NIHSS scores experienced a very limited benefit in functional independence but did have a reduction in mortality and severe disability," the researchers said.
That time didn't modify the benefit of stroke thrombectomy shouldn't be used to justify treating late-presenting patients with less urgency either, Lansberg's group emphasized.
"Since the ischemic core grows with time (albeit slowly in some instances) and the penumbra thus shrinks with time, a patient's chance of having a substantial volume of salvageable tissue that fulfills criteria for late-window endovascular therapy decreases if imaging is delayed," the team said.
Another group recently reported that reperfusion success after mechanical thrombectomy grew less likely with every passing hour from hospital arrival to groin puncture.
DEFUSE 3 investigators reported their main findings in early 2018. Study participants were a median age of 70 and scored a 16 on the NIH Stroke Scale. The group was evenly split between the sexes.
"Owing to the small sample size of this study, a pooled analysis of late time window endovascular stroke trials is needed to confirm these results," according to Lansberg and colleagues, adding that their data may also not be applicable to patients older than 90 or elderly patients with pre-existing disability who were excluded from the trial.

The study was funded by grants from the National Institute for Neurological Disorders and Stroke.
Lansberg disclosed no conflicts of interest.
Several co-authors reported significant ties to industry.

last updated 01.28.2019

• Primary Source

  JAMA Neurology

  Source Reference: Lansberg MG, et al "Association of thrombectomy with stroke outcomes among patient subgroups: secondary analysis of the DEFUSE 3 randomized clinical trial" JAMA Neurol 2019; DOI: 10.1001/jamaneurol.2018.4587.

Marine n-3 Polyunsaturated Fatty Acids and the Risk of Ischemic Stroke

Useless without giving us protocol amounts per weight and sex. And we have to figure out what EPA and DHA are. Why the fuck was this research done if not to accomplish helping those at risk for stroke? Damn it all, not your job?

Marine n-3 Polyunsaturated Fatty Acids and the Risk of Ischemic Stroke

Stine K. Venø

,

Christian S. Bork

,

Marianne U. Jakobsen

,

Søren Lundbye-Christensen

,

Peter L. McLennan

,

Flemming W. Bach

,

Kim Overvad

,

Erik B. Schmidt

Originally published3 Jan 2019https://doi.org/10.1161/STROKEAHA.118.023384Stroke. 2019;0:STROKEAHA.118.023384

Abstract

Background and Purpose—

We hypothesized that total marine n-3 polyunsaturated fatty acids (PUFA), in particular eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in the diet and in adipose tissue (biomarkers of long-term intake and endogenous exposure) were inversely associated with the risk of ischemic stroke and its subtypes.

Methods—

The Diet, Cancer and Health cohort consisted of 57 053 participants aged 50 to 65 years at enrolment. All participants filled in a food frequency questionnaire and had an adipose tissue biopsy taken at baseline. Information on ischemic stroke during follow-up was obtained from The Danish National Patient Register, and all cases were validated. Cases and a random sample of 3203 subjects from the whole cohort had their fatty acid composition of adipose tissue determined by gas chromatography.

Results—

During 13.5 years of follow-up 1879 participants developed an ischemic stroke. Adipose tissue content of EPA was inversely associated with total ischemic stroke (hazard ratio [HR], 0.74; 95% CI, 0.62–0.88) when comparing the highest with the lowest quartile. Also, lower rates of large artery atherosclerosis were seen with higher intakes of total marine n-3 PUFA (HR, 0.69; 95% CI, 0.50–0.95), EPA (HR, 0.66; 95% CI, 0.48–0.91) and DHA (HR, 0.72; 95% CI, 0.53–0.99), and higher adipose tissue content of EPA (HR, 0.52; 95% CI, 0.36–0.76). Higher rates of cardioembolism were seen with higher intakes of total marine n-3 PUFA (HR, 2.50; 95% CI, 1.38–4.53) and DHA (HR, 2.12; 95% CI, 1.21–3.69) as well as with higher adipose tissue content of total marine n-3 PUFA (HR, 2.63; 95% CI, 1.33–5.19) and DHA (HR, 2.00; 95% CI, 1.04–3.84). The EPA content in adipose tissue was inversely associated with small-vessel occlusion (HR, 0.69; 95% CI, 0.55–0.88).

Conclusions—

EPA was associated with lower risks of most types of ischemic stroke, apart from cardioembolism, while inconsistent findings were observed for total marine n-3 PUFA and DHA.

Footnotes

Presented in part at the European Atherosclerosis Society Congress, Lisbon, Portugal, May 8, 2018.
The online-only Data Supplement is available with this article at https://www.ahajournals.org/doi/suppl/10.1161/STROKEAHA.118.023384.

Correspondence to Stine Krogh Venø, MD, Department of Cardiology, Aalborg University Hospital, Søndre Skovvej 15, 9000 Aalborg, Denmark. Email s.venoe@rn.dk

Gait Rehabilitation Using Functional Electrical Stimulation Induces Changes in Ankle Muscle Coordination in Stroke Survivors: A Preliminary Study

Fuck, fuck, fuck. More studies, NOT a protocol created to help recovery.  Damn it all, survivors want results from studies not just kicking the can down the road. 

Gait Rehabilitation Using Functional Electrical Stimulation Induces Changes in Ankle Muscle Coordination in Stroke Survivors: A Preliminary Study

Jessica L. Allen^1*, Lena H. Ting^2,3 and Trisha M. Kesar²

• ¹Department of Chemical and Biomedical Engineering, West Virginia University, Morgantown, WV, United States
• ²Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States
• ³Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA, United States

Background: Previous studies have demonstrated that post-stroke gait rehabilitation combining functional electrical stimulation (FES) applied to the ankle muscles during fast treadmill walking (FastFES) improves gait biomechanics and clinical walking function. However, there is considerable inter-individual variability in response to FastFES. Although FastFES aims to sculpt ankle muscle coordination, whether changes in ankle muscle activity underlie observed gait improvements is unknown. The aim of this study was to investigate three cases illustrating how FastFES modulates ankle muscle recruitment during walking.

Methods: We conducted a preliminary case series study on three individuals (53–70 y; 2 M; 35–60 months post-stroke; 19–22 lower extremity Fugl-Meyer) who participated in 18 sessions of FastFES (3 sessions/week; ClinicalTrials.gov: NCT01668602). Clinical walking function (speed, 6-min walk test, and Timed-Up-and-Go test), gait biomechanics (paretic propulsion and ankle angle at initial-contact), and plantarflexor (soleus)/dorsiflexor (tibialis anterior) muscle recruitment were assessed pre- and post-FastFES while walking without stimulation.

Results:Two participants (R1, R2) were categorized as responders based on improvements in clinical walking function. Consistent with heterogeneity of clinical and biomechanical changes commonly observed following gait rehabilitation, how muscle activity was altered with FastFES differed between responders. R1 exhibited improved plantarflexor recruitment during stance accompanied by increased paretic propulsion. R2 exhibited improved dorsiflexor recruitment during swing accompanied by improved paretic ankle angle at initial-contact. In contrast, the third participant (NR1), classified as a non-responder, demonstrated increased ankle muscle activity during inappropriate phases of the gait cycle. Across all participants, there was a positive relationship between increased walking speeds after FastFES and reduced SOL/TA muscle coactivation.

Conclusion:Our preliminary case series study is the first to demonstrate that improvements in ankle plantarflexor and dorsiflexor muscle recruitment (muscles targeted by FastFES) accompanied improvements in gait biomechanics and walking function following FastFES in individuals post-stroke. Our results also suggest that inducing more appropriate (i.e., reduced) ankle plantar/dorsi-flexor muscle coactivation may be an important neuromuscular mechanism underlying improvements in gait function after FastFES training, suggesting that pre-treatment ankle muscle status could be used for inclusion into FastFES. The findings of this case-series study, albeit preliminary, provide the rationale and foundations for larger-sample studies using similar methodology.

How is the audit of therapy intensity influencing rehabilitation in inpatient stroke units in the UK? An ethnographic study

Useless since these are guidelines with NO effective rehab protocols supporting them. Damn it all, start demanding results, NOT just guidelines, processes or targets. RESULTS! 

How is the audit of therapy intensity influencing rehabilitation in inpatient stroke units in the UK? An ethnographic study

1. Elizabeth Taylor1,
2. Fiona Jones1,
3. Christopher McKevitt2

Author affiliations

1. Faculty of Health, Social Care and Education, Department of Rehabilitation Sciences, Kingston University and St George’s University of London, London, UK
2. School of Population Health and Environmental Sciences, King’s College London, London, UK

1. Correspondence to Dr Elizabeth Taylor; elizabeth.taylor@sgul.kingston.ac.uk

Abstract

Objectives Occupational therapy, physiotherapy and speech and language therapy are central to rehabilitation after a stroke. The UK has introduced an audited performance target: that 45 min of each therapy(So the doctor involved does absolutely nothing and is totally useless?) should be provided to patients deemed appropriate. We sought to understand how this has influenced delivery of stroke unit therapy.

Design Ethnographic study, including observation and interviews. The theoretical framework drew on the work of Lipsky and Power, framing therapists as ‘street level bureaucrats’ in an ‘audit society’.

Setting Stroke units in three English hospitals.

Participants Forty-three participants were interviewed, including patients, therapists and other staff.

Results There was wide variation in how therapy time was recorded and in decision-making regarding which patients were ‘appropriate for therapy’(I expect 100% recovery for all, don't cherry pick the less disabled patients. How would you feel if I told you were not good enough to get rehab? Or do you conveniently lie by omission?) or auditable. Therapists interpreted their roles differently in each stroke unit. Therapists doubted the validity of the audit results and did not believe their results reflected the quality of services they provided. Some assumed their audit results would inform commissioning decisions. Senior therapy leaders shaped priorities and practices in each therapy team. Patients were inactive outside therapy sessions. Patients differed regarding the quantity of therapy they felt they needed but consistently wanted to be more involved in decisions and treated as individuals.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

http://dx.doi.org/10.1136/bmjopen-2018-023676

APT Weighted MRI as an Effective Imaging Protocol to Predict Clinical Outcome After Acute Ischemic Stroke

Damn it all, stop with this prediction crapola. Survivors want 100% recovery, they need rehab protocols, NOT THIS SHIT.  GET THERE! A great stroke association president would ream these researchers out for not following the stroke strategy that leads to 100% recovery.  Just because we have NO strategy is no reason to do these useless prediction ones.

APT Weighted MRI as an Effective Imaging Protocol to Predict Clinical Outcome After Acute Ischemic Stroke

Guisen Lin¹, Caiyu Zhuang¹, Zhiwei Shen¹, Gang Xiao², Yanzi Chen¹, Yuanyu Shen¹, Xiaodan Zong¹ and Renhua Wu^1,3*

• ¹Department of Medical Imaging, The Second Affiliated Hospital, Medical College of Shantou University, Shantou, China
• ²Department of Mathematics and Statistics, Hanshan Normal University, Chaozhou, China
• ³Provincial Key Laboratory of Medical Molecular Imaging, Shantou, China

To explore the capability of the amide-proton-transfer weighted (APTW) magnetic resonance imaging (MRI) in the evaluation of clinical neurological deficit at the time of hospitalization and assessment of long-term daily functional outcome for patients with acute ischemic stroke (AIS). We recruited 55 AIS patients with brain MRI acquired within 24–48 h of symptom onset and followed up with their 90-day modified Rankin Scale (mRS) score. APT weighted MRI was performed for all the study subjects to measure APTW signal quantitatively in the acute ischemic area (APTW_ipsi) and the contralateral side (APTW_cont). Change of the APT signal between the acute ischemic region and the contralateral side (ΔAPTW) was calculated. Maximum APTW signal (APTW_max) and minimal APTW signal (APTW_min) were also acquired to demonstrate APTW signals heterogeneity (APTW_max−min). In addition, all the patients were divided into 2 groups according to their 90-day mRS score (good prognosis group with mRS score <2 and poor prognosis group with mRS score ≥2). In the meantime, ΔAPTW of these groups was compared. We found that ΔAPTW was in good correlation with National Institutes of Health Stroke Scale (NIHSS) score (R² = 0.578, p < 0.001) and 90-day mRS score (R² = 0.55, p < 0.001). There was significant difference of ΔAPTW between patients with good prognosis and patients with poor prognosis. Plus, APTW_max−min was significantly different between two groups. These results suggested that APT weighted MRI could be used as an effective tool to assess the stroke severity and prognosis for patients with AIS, with APTW signal heterogeneity as a possible biomarker.

Introduction

As a promising contrast mechanism, chemical exchange saturation transfer (CEST) has become an important tool in the field of molecular imaging (1). Recently, APTW MRI, one form of CEST technology, has been increasingly applied in capturing tissue acidosis as a research tool based on its capability to detect pH and mobile proteins content (2). APTW MRI has been used to assess the severity of tissue acidification in hyperacute and acute stroke (3, 4). For all these pre-clinical researches, the induced stroke studies were carried out under highly controlled environment and the animals were scanned during early stage of stroke within hours. Under this circumstance, the APTW imaging was called pH-weighted imaging since pH was the major factor to affect the APTW signal intensity, accounting for more than 90% (5). Clinical assessment using APTW imaging is considered promising given its ability to characterize pH of the stroke area within hours from the symptom onset. The enthusiasm of applying the APTW imaging to patients with none hyperacute stroke (within hours from symptom onset) might be decreased given the fact that many factors can affect the APTW signal (5). However, a considerable proportion of patients with stroke have delay in presentation to the hospital (6, 7). Applying of APTW imaging might be clinically useful given the large number of patients with relatively delayed presentation to the hospital. In this study, we would like to testify the capability of APTW MRI as a tool to assess stroke severity as well as to predict clinical outcome of patient of acute ischemic stroke (AIS) with symptom onset between 24 and 48 h by measuring the change of APTW signal intensity.

Treatment with exenatide in acute ischemic stroke trial protocol: A prospective, randomized, open label, blinded end-point study of exenatide vs. standard care in post stroke hyperglycemia

So all we need done is get this written up into a stroke protocol and distributed to every stroke hospital in the world. Hospitals not implementing this within a month need to be shut down. Damn it all, we need some action in stroke and that probably requires a lot of hospitals to be closed and stroke professionals fired.  Cleaning house will not be done by the stroke medical world, they are the cause of the problems. We need survivors to take charge.
http://journals.sagepub.com/doi/full/10.1177/1747493018784436?

Show all authors

Claire Muller, N Wah Cheung, Helen Dewey, ...

First Published July 18, 2018 Product Review

https://doi.org/10.1177/1747493018784436

Article information

Abstract

Rationale

Post-stroke hyperglycemia occurs in up to 50% of patients presenting with acute ischemic stroke. It reduces the efficacy of thrombolysis, increases infarct size, and worsens clinical outcomes. Insulin-based therapies have generally not been beneficial in treating post-stroke hyperglycemia as they are difficult to implement, may cause hypoglycaemia, possibly increase mortality and worsen clinical outcomes. Exenatide may be a safer, simpler, and more effective alternative to insulin in acute ischemic stroke.

Design

TEXAIS is a three year, Phase 2, multi-center, prospective, randomized, open label, blinded end-point trial comparing exenatide to standard of care. It aims to recruit 528 patients with a primary end point of major neurological improvement at 7 days defined as a ≥8-point improvement in NIHSS score, or NIHSS 0–1. Secondary outcomes of hyper- and hypoglycaemia at 5 days and NIHSS and mRS at 90 days will be measured. The treatment arm will receive exenatide 5 µg subcutaneously twice daily. The control arm will receive standard stroke unit care. Continuous glucose monitors will track the dynamic variability of glucose.

Conclusion

TEXAIS aims to show that exenatide is safe and effective in the treatment of post-stroke hyperglycemia. It has been designed to be highly generalizable with an ability to enroll a large percentage of patients with acute ischemic stroke, regardless of admission blood glucose level, diabetes status, or stroke severity, with very low risk of hypoglycemia.
Trial registration: ClinicalTrials.gov/ANZCTR NTA1127

Keywords Acute stroke therapy, incretin, glucagon-like peptide-1 analog, exenatide, hyperglycemia, ischemic stroke, neuroprotection

Background

The prevalence of post-stroke hyperglycemia (PSH) varies between 20 and 60% at admission, particularly in stroke patients with pre-existing diabetes.^1–4 In patients without a previous diagnosis of diabetes, PSH is associated with an up to five-fold increased risk of death.^2,5 Subsequent glucose normalization is associated with improved survival.^2,5,6 Persistent hyperglycemia on serial glucose monitoring is an independent determinant of infarct expansion and is associated with increased short-term and long-term mortality and morbidity.⁷ Despite this, PSH is often poorly recorded, and uncertainty remains regarding appropriate management.⁸ Insulin protocols are difficult to implement, can cause hypoglycemia, and most studies have failed to show that insulin therapy reduces mortality or improves clinical outcomes.^9–12 An Australian multi-centre, stroke care implementation study (n = 1086) using a clearly defined insulin regimen reported that protocol adherence was poor with only 40% of intervention group PSH patients being treated with insulin.⁸
The concept of hyperglycemic “neurotoxicity” has been suggested by both animal models of stroke and clinical trials that report accelerated penumbra-into-infarction conversion, and poor vessel recanalization.^2,5,13,14 Hyperglycemia promotes intracellular lactic acidosis, directly damaging ischemic tissue and increasing blood–brain barrier disruption which in turn augments further inflammation^6,15,16 and predisposes to symptomatic intracerebral hemorrhage.^17,18 PSH is an independent risk factor for reduced tPA recanalization,⁵ reduces fibrinolytic activity,^6,16 and increases oxidative stress and inflammation, all of which culminate in a state of relative hypercoagulation. These deleterious effects of PSH are more pronounced in patients who have early reperfusion,^5,19 highlighting the need for a prompt and early PSH intervention.
Exenatide is a short acting, synthetic, incretin hormone mimetic, i.e. a glucagon-like peptide-1 receptor (GLP-1R) agonist. Following subcutaneous injection, exenatide has a median peak plasma concentration of 2.1 h. It increases insulin secretion in a glucose-dependent manner such that the risk of hypoglycemia is very low.
In acute ischaemic stroke (AIS) animal models, exenatide attenuates oxidative-induced apoptosis, promotes anti-apoptotic proteins, and reduces infarct volume by more than 50%.^20,21 Small clinical trials in ST elevation myocardial infarction patients receiving percutaneous coronary intervention indicate periprocedural exenatide lowered glucose levels and increased myocardial salvage by 30%.²² Following a successful safety and feasibility pilot study,²³ our group undertook a larger randomized study of 17 consecutive patients with AIS comparing subcutaneous exenatide 5 µg twice daily for 5 days with routine standard of care. Exenatide was safe and simple to use, and well tolerated by all patients. The aim of TEXAIS is to confirm these findings, and test efficacy, in a larger Phase 2 study.
More at link. 

Novel Stent Retriever Is Quick to Restore Flow

Damn it all. Totally wrong endpoints, the endpoint should be 100% recovery. Not reperfusion. Will no one actually try and solve stroke? Or is everyone in stroke lazy? NO leadership. And you have to have the correct stroke. Leave no survivor behind.
https://www.medpagetoday.com/meetingcoverage/isc/70778?
More than half of recipients saw substantial reperfusion on first pass

    saved

    by Crystal Phend, Senior Associate Editor, MedPage Today
    January 26, 2018

LOS ANGELES -- A novel stent retriever device achieved high rates of rapid, substantial reperfusion for large vessel ischemic strokes without significant safety concerns, the pivotal ARISE II study showed.

With the EmboTrap device, 80% of recipients reached the primary endpoint of more than 50% flow restored (modified TICI 2b, 2c, or 3 flow) within three passes without aspiration or other rescue therapy, including 65% with near-complete or full flow.

Notably, 51.5% of those treated had this substantial flow restored on the first pass, Osama Zaidat, MD, of St. Vincent Mercy Hospital in Toledo, Ohio, reported here at the International Stroke Conference.

While the final rate of mTICI 2b-3 flow was 93%, on par with other mechanical thrombectomy trials, Zaidat noted that the high early-pass revascularization rate was a "remarkable" advance.

"That's what the trial is, it's pushing the limit," he said at a press conference. "The physicians are taking the right patients and they are taking them fast. And I think that's why I think we achieved one of the highest mRS 0-2 at 67%" compared with other studies.

The proportion of participants with a good functional outcome (modified Rankin Scale score 0-2) was 67.3% at 90 days.

J Mocco, MD, of Mount Sinai Hospital in New York City, who presented another trial at the same session reporting mRS 0-2 achieved in 52% of patients treated with an aspiration-first approach and 49% with a stentriever-first strategy, agreed that this is an important evolving area.

"Sooner and fewer is always better," he told MedPage Today at the press briefing, "although I think that more important right now is to focus on the time component to getting at least TICI 2b or greater. If you can do that with one pass, obviously that will be faster. If it's two passes and it's still very quick, that's just as important. We need to focus on the quality of reperfusion ... we need to move our conversation to 2c and 3, we need to be talking about 90% of the brain getting blood flow troonm1r more, not 52%."

"For one pass efficacy, that is something that seems to be clear but does not have clear proof," he added. "However, for achieving 2c or 3 versus TICI 2b, has overwhelming proof" of impact on clinical outcomes.

"The first pass is a nuance, I think," agreed Ralph Sacco, MD, of the University of Miami, and president of the American Academy of Neurology. "It may be a predictor of how fast you can then subsequently open up the vessel, I think that's the data they need to show."

The trial included 227 patients treated with the EmboTrap device for large vessel occlusions within 8 hours of last time known well before onset of symptoms. Median time from onset to puncture was 214 minutes; median time from puncture to revascularization was 35 minutes.

The primary safety endpoint of symptomatic intracranial hemorrhage within 24 hours of treatment or other serious adverse events occurred in 5.3%. No patients died related to the procedure in the first week, although 9.0% died from any cause by day 90.

Device developer Cerenovus has applied for FDA clearance of EmboTrap based on ARISE II.

ARISE II was sponsored by Neuravi (since acquired by Cerenovus, a Johnson & Johnson company).

Zaidat disclosed being a consultant for the company.

    Primary Source
    International Stroke Conference
    Source Reference: Zaidat O, et al "ARISE II trial result" ISC 2018; Abstract LB5.

Clinic opens 60-bed rehab hospital in Beachwood - Ohio

Damn it all, survivors don't want to be taken care of. They want results; 100% recovery. Don't be so fucking lazy. Scream at the administrators here, they are failing at their jobs.
The famed Cleveland Clinic should be better than this display of incompetency.
Call Dr. Toby Cosgrove, president and CEO of Cleveland Clinic and demand answers. 
https://www.clevelandjewishnews.com/news/local_news/clinic-opens--bed-rehab-hospital-in-beachwood/article_e10e1a40-aeaf-11e7-a750-035c51961f65.html

Cleveland Clinic opened its new 60-bed inpatient hospital, the Cleveland Clinic Rehabilitation Hospital Beachwood, on Oct. 8.

“If your family member has a stroke or a spinal cord injury or brain injury or amputation, they come right here to Beachwood, and we’ll know what to do with them and we’ll take care of them,” said Dr. Frederick Frost, chairman of physical medicine and rehabilitation at Cleveland Clinic, as he introduced the new hospital to members of Beachwood city government and other Clinic employees. “We’ll answer your questions.”

Clinic Rehabilitation Hospital Beachwood is intended for short-term rehabilitation. A patient’s typical length of stay will be 14 to 18 days, said Geoffery Hall, CEO of the Cleveland Clinic Rehabilitation Hospital Edwin Shaw in Cuyahoga Falls, which is scheduled to open next month and is a sister hospital to the Beachwood rehabilitation hospital.

Hall said brain injury patients and spinal cord injury patients could stay longer, and care is individualized for each patient. Patients will receive physical, speech and occupational therapy as their diagnosis warrants, and he said occupational therapy will help patients learn to care for themselves after an injury such as a stroke.

“Everything from cooking dinner, dressing themselves, a transition to that home environment,” Hall said of how occupational therapy will help those at Clinic Rehabilitation Hospital Beachwood. The hospital also features a room set up as a home environment, with a bed, oven and stove, refrigerator, washing machine and dryer, in order to get patients ready to transition back to living independently. Hall said the last day for many patients will be an “independence day,” where they’ll receive minimal assistance from the staff in order to prepare them for returning home.

Dr. Toby Cosgrove, president and CEO of Cleveland Clinic, congratulated the employees and the city of Beachwood on opening the rehabilitation hospital and said it filled a “critical need” in the hospital’s system.

“This hospital has been distinguished by quality, safety and the most advanced techniques,” Cosgrove said. “This will be a functional example of our mantra of putting patients first. The planning and construction of this facility was a model of collaboration. It gives me confidence in our vision for the future. We are creating an integrated, regional, health care delivery system that serves all of Northeast Ohio. We want to care for patients across the full spectrum of their care.”

MULTIDISCIPLINARY TEAM (MDT) APPROACH IN STROKE REHABILITATION

Fucking useless, 'care' NOT results. Damn it all, survivors want results you blithering idiots not the lazy 'care' you want to provide.
file:///C:/Users/oc1de/Downloads/64-1-126-1-10-20170922.pdf
Muhammad Naveed Babur1

A multidisciplinary team (MDT) is composed of members from different healthcare professions with specialized skills and expertise. The members collaborate together to make treatment recommendations that facilitate quality patient care. Multidisciplinary teams form one aspect of the provision of a streamlined patient journey by developing individual treatment plans that are based on 'best practice.(1) A recent systematic review examined a wide range of evidence for stroke rehabilitation, determining interventions that were or were likely to be serviceable, those of uncertain benefit and those where the effect was presently unknown.(2)The review drew attention to three areas where strong evidence existed.(3,4)Firstly, that rehabilitation should begin as early as possible after stroke. Secondly, that repetitive task-oriented training targeted at goals or activities admissible to the needs of patients can contribute to functional recovery, especially where training takes place in the patient’s own environment. Lastly, there was widespread consensus that increased ferocity of training is beneficial.(5) Reported benefits of effective multidisciplinary team working include more patient-centered decision making, a reduction in the disintegration of care and increased staff gratification, as well as more efficient and effective use of resources.(6) However, policies, guidelines and research evidence do not themselves bring about change in health professionals’ behavior; there has to be a commonly understood purpose and perceived or actual benefit at the individual and organizational level.(7) There is undeniable evidence of improved outcomes when patients are treated in a stroke unit by multi - disciplinary teams. When compared with traditional care, organized inpatient stroke care resulted in long-term reductions in death, outpost and the need for institutional care.(8)

A New World of Prevention and Treatment for Stroke?

Now to get this into a strategy that all doctors and researchers follow. But that won't occur because we have fucking failures of stroke associations. DAMN IT ALL, the answers are waiting to be found, if only their were two functioning neurons in the stroke medical leadership.  Leaders tackle the BHAGs(Big Hairy Audacious Goals) of 100% stroke recovery, not the fucking lazy press releases of prevention.

http://www.mdedge.com/neurologyreviews/article/76186/stroke/new-world-prevention-and-treatment-stroke

Neurology Reviews. 2013 June;21(6):11-14

HONOLULU—What if you could scan your patients for stroke-susceptibility loci or implant a device in their brains to repair stroke-damaged pathways?
Such forward-thinking concepts may be achievable, according to some leading researchers in the field of stroke medicine, who presented their ideas at the 2013 International Stroke Conference.

MD-IQ QUIZ: Stroke treatment & patient sex

Restorative Therapies
Two decades after investigators demonstrated the plasticity of the brain after stroke, the restorative processes that occur after the acute phase of stroke continue to be explored, opening up potential targets for new drugs. At the same time, neurotechnology is maturing.
“We’re quickly entering a brave new world of neuroengineering in the brain after stroke,” said Randolph J. Nudo, PhD, Director of the Center on Aging at the University of Kansas Medical Center, Kansas City.
In the emerging field of robotics, a neural interface system implanted in two humans with long-standing tetraplegia recorded neural signals from the brain as input commands to control a robotic arm. A miniaturized, closed-loop system implanted in the cerebral cortex of brain-injured rats has been shown to improve recovery. Dr. Nudo sees the potential of these advances for neurotransmitter sensing, open- and closed-loop drug delivery, and control of stem cell integration. Joel Stein, MD, Chair of Rehabilitative and Regeneration Medicine at Columbia University in New York City, said robotics are being used to deliver rehabilitation therapy. Exoskeletal workstations incorporate engaging games or virtual reality experiences to provide many repetitions for the patient without therapist fatigue. Wearable “bionic legs” provide external force to supplement muscle strength and improve motor skills through practice.

Not all robotic strategies have panned out, however. In a study of veterans, robot-assisted therapy provided only modest effects on poststroke upper-limb impairment. The robotic therapy also was somewhat more expensive than intensive human therapy ($9,977 vs $8,269).
Robotics may not always be better. But when they are as good as traditional approaches, they provide new efficiencies in terms of delivery, said Dr. Stein. “The bottom line is that robots are coming. We should prepare for them and expect them to become a key piece of clinical practice in this field in the future.”
Genetics
The search for genetic susceptibility loci for stroke is in its infancy, but researchers are getting closer to their goal, said Ralph Sacco, MD, Professor and Chair of Neurology at the Miller School of Medicine, University of Miami. The collaborative METASTROKE study offered some findings, and the big push now, as the cost of these studies declines, is moving from common variants to rare variants using next-generation sequencing and whole-genome studies.
Large family studies that use next-generation sequencing, such as the NIH-supported Life After Linkage study, should also help in smaller, more homogeneous groups.
“We really have to refine our phenotypes using extreme phenotypes, subgroups, and subclinical traits and make sure we get the phenotype right, so all this next-generation sequencing will make sense,” Dr. Sacco said.
The ability to identify rare variants may suggest novel pathways that could serve as targets for drug therapy. Someday, clinicians could use genetic testing to identify at-risk patients for ultra-early stroke prevention therapies. Pharmacogenomic profiles will be used to personalize stroke prevention treatments.
A Global Pre-Emptive Strike
Several speakers looked to a prevention model(Really? What fucking laziness) to reverse the increasing global burden of stroke. Valery Feigin, MD, PhD, Director of the National Institute for Stroke and Applied Neurosciences, AUT University, in Auckland, New Zealand, said that priority should be given to a population-based approach that includes legislative measures aimed at environmental risk factors, such as European countries’ attempts to reduce citizens’ salt intake.
“A small shift in the distribution of risk factors across the population will result in a major drop in stroke incidence,” he said, noting, for example, that smoking cessation alone can reduce stroke risk by 12% to 19%.
The suggestion elicited comments during the discussion period, including concerns about creating a “nanny state” and a reminder of the situation involving New York City Mayor Michael Bloomberg’s effort to reduce the size of soft drinks. Still others suggested that such measures need to be positively reinforced and that governments have a civil obligation to act, given the massive costs of poor public health.
Lewis Morgenstern, MD, an epidemiologist and Director of the Stroke Program at the University of Michigan, Ann Arbor, observed that even in the West, where stroke incidence and mortality are declining, “Stroke is becoming more and more a disease of the poor and underserved.”
He called on clinicians to address these disparities through global research agendas and advocacy, and to reach out locally to poor and underserved populations with stroke prevention and preparedness messages. As for what they should emphasize, he highlighted a recent estimate that the cost of an endovascular procedure is at least $10,000, whereas a one-month supply of the blood pressure–lowering diuretic hydrochlorothiazide 25 mg costs $4.

Getting on with the rest of your life following stroke: a randomized trial of a complex intervention aimed at enhancing life participation post stroke

So rather than actually solving ANY of the problems in stroke, lets research how to make the secondary problems better. Damn it all, go to the root cause and solve that. Solve the neuronal cascade of death by these 5 causes in the first week, resulting in much less disability.
http://journals.sagepub.com/doi/abs/10.1177/0269215514565396?

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Nancy E Mayo, Sharon Anderson, Ruth Barclay, ...

First Published January 27, 2015 Research Article

Download PDF	Article information

Abstract

Objective:

To enhance participation post stroke through a structured, community-based program.

Design:

A controlled trial with random allocation to immediate or four-month delayed entry.

Setting:

Eleven community sites in seven Canadian cities.

Subjects:

Community dwelling persons within five years of stroke onset, cognitively intact, able to toilet independently.

Interventions:

Evidence-based program delivered in three 12-week sessions including exercise and project-based activities, done as individuals and in groups.

Main measures:

Hours spent per week in meaningful activities outside of the home and Reintegration to Normal Living Index; Stroke-Specific Geriatric Depression Scale, Apathy Scale, gait speed, EuroQuol EQ-5D, and Preference-Based Stroke Index. All measures were transformed to a scale from 0 to 100. Assessments prior to randomization, after the first session at three months, six months, 12 months, and 15 months.

Results:

A total of 186 persons were randomized. The between-group analysis showed no disadvantage to waiting and so groups were combined and a within-person analysis was carried out at three time points. There were statistically significant increases in all study outcomes on average over all persons. Over 45% of people met or exceeded the pre-specified target of a three hour per week increase in meaningful activity and this most often took a full year of intervention to achieve. Greatest gains were in satisfaction with community integration (mean 4.78; 95% CI: 2.01 to 7.55) and stroke-specific health-related quality of life (mean 4.14; 95% CI: 2.31 to 5.97).

Conclusions:

Community-based programs targeting participation are feasible and effective, but stroke survivors require time to achieve meaningful gains.

Computational walking model could help stroke patients achieve optimal recovery

That model better get them to 100% recovery. From these comments(best possible recovery) they are already declaring defeat in the walking task.  Get them the hell out of this industry if they are declaring defeat so easily. We obviously have NO LEADERSHIP in stroke at all. Yes these are BHAGs(Big Hairy Audacious(or Assed) Goals) but they are doable if you set out to solve them. I would tackle them all.  Damnable Ph.Ds and not willing to do anything difficult.

http://www.news-medical.net/news/20170111/Computational-walking-model-could-help-stroke-patients-achieve-optimal-recovery.aspx

After a stroke, patients typically have trouble walking and few are able to regain the gait they had before suffering a stroke. Researchers funded by the National Institute of Biomedical Imaging and Bioengineering (NIBIB) have developed a computational walking model that could help guide patients to their best possible recovery after a stroke. Computational modeling uses computers to simulate and study the behavior of complex systems using mathematics, physics, and computer science. In this case, researchers are developing a computational modeling program that can construct a model of the patient from the patient's walking data collected on a treadmill and then predict how the patient will walk after different planned rehabilitation treatments. They hope that one day the model will be able to predict the best gait a patient can achieve after completing rehabilitation, as well as recommend the best rehabilitation approach to help the patient achieve an optimal recovery.
Currently, there is no way for a clinician to determine the most effective rehabilitation treatment prescription for a patient. Clinicians cannot always know which treatment approach to use, or how the approach should be implemented to maximize walking recovery. B.J. Fregly, Ph.D. and his team (Andrew Meyer, Ph.D., Carolynn Patten, PT., Ph.D., and Anil Rao, Ph.D.) at the University of Florida developed a computational modeling approach to help answer these questions. They tested the approach on a patient who had suffered a stroke.
The team first measured how the patient walked at his preferred speed on a treadmill. Using those measurements, they then constructed a neuromusculoskeletal computer model of the patient that was personalized to the patient's skeletal anatomy, foot contact pattern, muscle force generating ability, and neural control limitations. Fregly and his team found that the personalized model was able to predict accurately the patient's gait at a faster walking speed, even though no measurements at that speed were used for constructing the model.

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"This modeling effort is an excellent example of how computer models can make predictions of complex processes and accelerate the integration of knowledge across multiple disciplines,"says Grace Peng, Ph.D., director of the NIBIB program in Mathematical Modeling, Simulation and Analysis.
Fregly and his team believe this advance is the first step toward the creation of personalized neurorehabilitation prescriptions, filling a critical gap in the current treatment planning process for stroke patients. Together with devices that would ensure the patient is exercising using the proper force and torque, personalized computational models could one day help maximize the recovery of patients who have suffered a stroke.
"Through additional NIH funding, we are embarking with collaborators at Emory University on our first project to predict optimal walking treatments for two individuals post-stroke," says Fregly. "We are excited to begin exploring whether model-based personalized treatment design can improve functional outcomes."

Source:

National Institute of Biomedical Imaging and Bioengineering

Intervention methods of stroke need to focus on prevention for blacks to reduce stroke mortality

More blame the victim so the stroke world doesn't have to

tackle BHAGs(Big Hairy Audacious Goals) 

Damn them all for being so fucking lazy. 

Intervention methods of stroke need to focus on prevention for blacks to reduce stroke mortality

 

In a study recently published in the journal Stroke, investigators in the REasons for Geographical And Racial Differences in Stroke Study, or REGARDS, found that blacks are four times more likely to die of stroke at age 45 than their white counterparts because blacks have more strokes, not because blacks who have a stroke are more likely to die than whites who have a stroke. Important insights from the study and risk factors that lead to stroke indicate changes that are needed in Americans’ health habits and in primary health care to reduce the excess number of deaths from stroke in the black population. “Since the driving force of the racial difference in stroke deaths is the larger number of strokes in blacks, to reduce this disparity we have to focus on factors prior to the stroke’s ever happening,” said George Howard, Dr.P.H., lead author and professor of biostatistics at the University of Alabama at BirminghamSchool of Public Health. “We need to do more to focus on prevention and control of risk factors before they result in a stroke. While it is important to ensure that blacks and whites receive the same care once a stroke happens, any differences in care once the stroke happens do not appear to be the reason that blacks die more from stroke.”

Go to Abstract Print Article Summary Cat 2 CME Report

Run with Stroke Challenge and get a free training program - National Stroke Association

A completely small bore idea. and you wonder why nothing gets solved in stroke. Because nothing difficult is even tried. Put a challenge out there like; ' Donate to solve the excitoxicity neuron deaths in stroke' or 'Donate to solve the glutamate poisoning deaths in stroke'.
These would bring in money and actually solve some of the problems in stroke. But NO, let's do more stroke awareness because we don't want to solve stroke at all, we just want to have jobs for a while longer. DAMN THEM ALL. 

Run with Stroke Challenge and get a free training program - National Stroke Association

DONATE

Dear Dean, Sign up for the 2016 TCS New York City Marathon Stroke Challenge team and get a free marathon training program! We still have spots on our 2016 Stroke Challenge New York City Marathon team.  We want you to join us! Never run a marathon before? Intrigued by the idea but not sure where to start? Or maybe you’re an experienced runner looking to set a personal best. When you register with Stroke Challenge you have the opportunity to receive a 12-, 16-, or 20-week training program designed by New York Road Runners. Don’t delay. Spots are limited and the 20-week program starts June 20. Submit your application today. As a member of our Stroke Challenge team, you’ll have the experience of a lifetime running what is described as a 26.2 mile block party through the world’s most diverse city.  When you raise money for National Stroke Association, you are supporting compelling education and programs focused on prevention, treatment, rehabilitation, and support for all impacted by stroke. Join a community of teammates and volunteers and you’ll receive: Guaranteed entry into the sold-out, lottery-only race Dri-fit Stroke Challenge team t-shirt 12-, 16-, or 20-week training program provided by New York Road Runners An opportunity to earn a Stroke Challenge team jacket A personal fundraising page and fundraising support throughout the season Team dinner pre-event and weekend event staff support This lottery-only race is completely sold out. But you can still experience the excitement of TCS New York City Marathon with Stroke Challenge team. To join our 2016 TCS New York City Marathon team, please submit an application. Questions? Contact Betsy Hailstone at 303-754-0931 or events@stroke.org. Sincerely, Betsy Hailstone Sr. Coordinator, Development