Mirror therapy for severe hemiparesis in the acute phase of stroke recovery: A pilot study utilizing a brief interventional protocol

When the fuck are our stroke medical professionals going to take charge and create a publicly written protocol for mirror therapy? This has been circulating for years. Who the hell is going to step up to the plate and write one?
Matt Lopez, president of the NSA?
Dr. Mariel Jessup, president of the ASA?
WSO President - Steve Davis (Australia)?
http://gradworks.umi.com/15/94/1594781.html

by Soles, Will, M.S., STATE UNIVERSITY OF NEW YORK AT BUFFALO, 2015, 76 pages; 1594781

Abstract:
The debilitating effects of strokes continue to be a public health concern. Hemiparesis of the upper extremity (UE) associated with this condition is a disabling long-term result that continues to be a rehabilitation focus for occupational therapy (OT) practitioners. Mirror therapy (MT) is an emerging method used by therapists to address UE hemiparesis. Despite its expanded use, much is still not known about MT, including when in the rehabilitation process it is best to use and what methods will result in a beneficial outcome. This pilot study investigated the effect of a brief (2 week in duration) MT protocol for improving severe hemiparesis, as compared to a control protocol of UE bilateral exercise. Recruitment of participants from an acute population of stroke survivors in an inpatient rehabilitation setting (n=3) was not sufficient to complete the planned statistical comparison. However, information about protocol design was gleaned from this study’s results, which could prove valuable for future studies. From this information, an alternative protocol was developed and is provided to advance research into the use of MT as an intervention in acute inpatient stroke rehabilitation. The proposed MT protocol utilizes a task-based approach well suited to the profession of OT.

Adviser	Mary M. Matteliano
School	STATE UNIVERSITY OF NEW YORK AT BUFFALO
Source Type	Thesis
Subjects	Physical therapy; Occupational therapy; Public health
Publication Number	1594781

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Deciding Factors: Answering the Questions of When, How, and Why When Individualizing Multiple Sclerosis Treatment

I'm sure the hundreds of employees of NSA,ASA, and WSO could put something like this CME together for stroke protocols in no time if their management would direct them. Although YOU probably have to call those presidents directly since I haven't seen any survivor useful initiatives come from any of the stroke associations. The standard reply is: 'All strokes are different, all stroke recoveries are different.' This stroke CME would fit right in with that fuckingly stupid statement.
Matt Lopez, president of the NSA
Dr. Mariel Jessup, president of the ASA
WSO President - Steve Davis (Australia)
Deciding Factors: Answering the Questions of When, How, and Why When Individualizing Multiple Sclerosis Treatment 

Research in mice shows potential value of antidepressant in some stroke victims

Well shit, this has been known since January, 2013, wrong, since 2011.
Antidepressants may help people recover from stroke even if they are not depressed
What the fuck is it going to take to create a stroke protocol on this and help survivors?.
Our stroke associations have obviously done absolutely nothing.
You as a stroke survivor are fucking screwed since  no one is willing to do anything useful for survivors. You may as well  contact each stroke association president and ream them out for their absolute incompetence. Maybe comeuppance will occur to those presidents. We can only hope.
If your hospital doesn't do something about this in the next month you need to call the board of directors and have them fire the president and stroke department head. This needs to be a fireable offense.
Matt Lopez, president of the NSA?
Dr. Mariel Jessup, president of the ASA?
WSO President - Steve Davis (Australia)?  

 http://medicalxpress.com/news/2015-08-mice-potential-antidepressant-victims.html
Working with mice, researchers at Johns Hopkins have added to evidence that a commonly prescribed antidepressant called fluoxetine helps stroke victims improve movement and coordination, and possibly why.Specifically, the researchers say, their experiments suggest the drug, often sold under the trade name Prozac, prolongs the time after a stroke during which physical therapy remains effective for recovering lost motor function.

The study, which may help explain the benefit of selective serotonin reuptake inhibitors already seen in stroke patients, holds potentially great value for those too ill immediately after an ischemic stroke to start the intensive rehabilitation therapy needed to recover lost motor functions. Ischemic strokes are marked by the sudden loss of blood circulation to the brain caused by a clot.
"For rehabilitation to be effective, it needs to start as soon after a stroke as possible," says Steven Zeiler, M.D., Ph.D., assistant professor of neurology at the Johns Hopkins University School of Medicine and lead author of the study reported in the October issue of the journal Stroke. "But with this study, we've shown that in mice, we can extend the time period during which rehabilitative intervention has an effect on meaningful recovery."
An estimated 65 percent of stroke survivors experience some weakness or paralysis of their limbs, and difficulty in walking and moving due to the death of brain cells from lack of blood flow. Rehabilitation involves retraining other parts of the brain to take over and restore lost functions. Zeiler worked with John Krakauer, M.D., who directs the Brain, Learning, Animation and Movement Lab, to show that in mice, such behavioral efforts work best when they begin early and at high dosages. Numerous research studies have reached similar conclusions, Zeiler says.
For the current study, his team tested whether mice with induced strokes given fluoxetine would get the same recovery results even when rehab was delayed.
A 2011 study of patients who took fluoxetine after an ischemic stroke—called "Fluoxetine for motor recovery after acute ischemic stroke," or FLAME—suggested that the strategy could work. "We took the results of the success found in the FLAME study and reverse-engineered it to look at what fluoxetine may be doing," says Zeiler. "Nobody knows how fluoxetine worked in those patients' stroke recovery—only that it did and it does."
The mouse model the researchers used involved training mice to do a task they don't normally do: reach through a slit to grab a food pellet. "As primates, we make this motion all the time," says Zeiler, "but quadrupeds, like cats, dogs and mice, aren't so good at it." Once the trained mice became good at it, the researchers induced a stroke in the motor area that affected the mice's ability to do that task.
To test whether the mice properly modeled human stroke patients, Zeiler started rehab with some of the mice immediately after the induced stroke. As with human stroke patients, early intervention made a difference: Those mice soon recovered the lost motor function. Mice for which rehab was delayed by a week showed incomplete recovery, gaining back a little less than one-half of their former ability.
"For patients," says Zeiler, "incomplete recovery means weakness or a loss of control in the affected body part or region." For the mice, it meant that they knocked the food pellet from the holder, dropped it or otherwise lost control of it.
When the researchers administered fluoxetine daily to the mice beginning 24 hours after inducing stroke, however, the mice recovered the ability to do the learned task even if they started rehab after a week's delay.
Zeiler emphasizes that the precise cause of fluoxetine's effect on stroke recovery is not yet known, but he says that after looking at brain tissue from his study's mice, he thinks the drug changed the way their brains responded to retraining. "We believe the drug is changing plasticity," says Zeiler, "changing the way individual neurons are responding to sensory input after the stroke."
"There are some who believe fluoxetine can reduce the amount of brain tissue that dies after a stroke," says Zeiler, but his team's findings do not bear that out. "In fact," Zeiler says, "there was more—not less—brain tissue death in the animals that got fluoxetine than in those that did not. We didn't predict that, but the fact that the animals actually got better—despite increased cell death—tells us that fluoxetine is having some pretty amazing effects."
"Time still matters; it's key," cautions Zeiler. The mice that fully recovered motor function were started on fluoxetine immediately after the induced stroke; if fluoxetine administration was delayed by one week after stroke, instead of 24 hours, the mice did not fully recover.
Like all drugs, Zeiler notes, fluoxetine can have negative side effects. Still, Zeiler says, stroke doctors at Johns Hopkins recommend it for stroke patients, especially those who suffer motor loss. "But it's not something that a patient would be prescribed forever," he adds.

So much that can be done and no one doing anything to help survivors

If anyone is working to actually solve problems that survivors have it is totally invisible.
So much to do and so many possibilities yet everyone is WAITING FOR SOMEONE ELSE TO SOLVE THE PROBLEM!

This lack of initiative is causing 10 million survivors a year to be badly served.
And I see nothing from the following:
Matt Lopez, president of the NSA?
Dr. Mariel Jessup, president of the ASA?
WSO President - Steve Davis (Australia)?  
 

Clinical neurorestorative progress in amyotrophic lateral sclerosis

Where the fucking hell is the similar article for stroke? My God, I assume that our stroke associations employ at least a few doctors or researchers that are up to date on the latest in stroke research. But maybe that is too much to ask for from our fucking failures of stroke associations.

Your response:

Matt Lopez, president of the NSA?
Dr. Mariel Jessup, president of the ASA?
WSO President - Steve Davis (Australia)?

Clinical neurorestorative progress in amyotrophic lateral sclerosis

BHAG - Big Hairy Audacious Goal

What is a BHAG?

BHAG (pronounced 'bee-hag') stands for 'Big Hairy Audacious Goal' first written about by James Collins and Jerry Porras in their great book 'Built to Last'.
It is a goal that really stretches the organisation way beyond most people's imagination of what is possible. A very good example would be the 'Moon' mission. It should be clear and compelling and act as a great focal point for everyone in the organisation. It should engage people and stimilate them.
It is a powerful mechanism to stimulate progress, but it does carry great risks.
In some ways it is similar to a vision statement.
The following examples come from the site rapid business intelligence success
Here are some examples:

• the creation of the IBM 360 mainframe computer. IBM nearly ran out of money to pay their staff, but it was breakthrogh that lifted IBM into the next era of computing


• the creation by Boeing in the fifties of their large commerical jet aircraft. Up till that point Boeing had just been a military aircraft manufacturer. It was a bold transformation. Again the sixties the built the biggest jet imaginable - the Jumbo jet.


• in the eighties Jack Welch the CEO of General Electric set his company a huge goal - 'To become No. 1 or No. 2 in every market we serve and revolutionise this company to have the speed and agility of a small company.' By the late nineties...he had succeeded.


• In 1990 Sam Walton of Wal-Mart set a new goal: to double the number of stores and increase the sales volume per square foot by 60% (specifically $ 125 billion) by the year 2000. At that time the largest retailer in the world had only reached $30 billion.


• In 1934 Walt Disney aimed to do something that had never been done before: to create a full length animated feature film - Snow White. He committed most of the company's resources. People in the industry called it 'Disney's folly', but history proved them wrong. It created a new industry or market. He later went on to produce 'Bambi', and 'Pinocchio' and 'Fantasia'. All were outstanding box office successes.


• Again in the fifties, Walt Disney set another risky goal(one of 'Walts's screwy ideas') to build a radically new kind of amusement park...known as Disneyland. He repeated again with the EPCOT center in the sixties. Walt Disney's maxim was 'DREAM, BELIEVE, DARE, DO'


It is important to note that from the outside of these companies, these BHAG goals seemed impossible, wild and unachievable, but within these companies they had the confidence in their resouces, know-how, and capability to achieve them, even though they were going to be stretched to the limit.
A BHAG certainly act as a stimulus and unifying force or goal for the people within the organisation.

For stroke the BHAG is 100% recovery for all stroke patients that survive.
There is absolutely no reason this can't be achieved with all the initial research already out there that just needs to be proven in humans and translated into stroke protocols. All you have to do is read my 8000 posts, everything is there, our stroke medical professionals are willfully being blind to the possibilities.
If Matt Lopez, president of the NSA doesn't have this as a goal the board of directors needs to be fired.
If Dr. Mariel Jessup, president of the ASA doesn't have this as a goal the board of directors needs to be fired.
If WSO President - Steve Davis (Australia) doesn't have this as a goal the board of directors needs to be fired.
Once again I am not following 'How to win friends and influence people' by Dale Carnegie.  I don't care, I'm supposedly a psychopath and follow my own drummer.

Development of a Questionnaire to Investigate Study Design Factors Influencing Participation in Gait Rehabilitation Research by People with Stroke: A Brief Report

So instead of actually doing something useful like solving the problems in stroke, they developed a fucking questionnaire. The mentors of these researchers need to be publicly chastised. Matt Lopez and Dr. Mariel Jessup please do the honors.
http://www.utpjournals.press/doi/abs/10.3138/ptc.2014-12
Kara K. Patterson, PT, PhD Nicole Gallant, MPT Tracey Ormiston, MPT Chad Patience, MPT Mandy Whitechurch, MPT Avril Mansfield, PhD Janet Brown, PT, MEd

ABSTRACT

Purpose: The main objective of this study was to evaluate the feasibility of a newly developed questionnaire to assess the influence of study design on participation in gait rehabilitation research in a pilot test with individuals with stroke. A secondary objective was to investigate the relationship between participation in gait rehabilitation research and social and clinical factors of interest after stroke.
Methods: A questionnaire was developed with expert opinion and guidance from related previous research. The questionnaire was pilot tested in a group of 21 people with stroke, and social and clinical factors (including gait function) were collected. Gait function was assessed using a pressure-sensitive mat; social and clinical characteristics were extracted from patient charts. Correlations were performed to investigate relationships between questionnaire responses and gait function, motor impairment, and chronicity; t-tests were used to examine response differences between people with a caregiver at home and those without.
Results: A total of 21 people with stroke completed the questionnaire without difficulty; mean completion time was 7.2 (SD 3.5) minutes, with a range of responses across participants. Borderline significant associations were found between gait function and the number of studies in which a person would participate and between stroke chronicity and the location of studies in which a person would participate.
Conclusions: A questionnaire to investigate the influence of study design factors on participation in rehabilitation research is feasible for administration in the post-stroke population and has potential to inform the design of future studies.

Adding Brain Stimulation Enhances Stroke Rehab

This is probably going to be hard to figure out how to do this yourself, but ask your therapist and doctor how. I do wonder how useful this is for those that have extensive dead areas in the motor cortex like me? I bet the researchers have no idea on what exact damage their subjects had to even figure out which patients will do better with this. There is nothing mentioned here that would leave me to believe that this is anything other than some patients had less damage and so looked like they recovered better.  The presidents of the ASA and NSA should be verifying research results to see if they even make sense. I don't know who made up surrogate markers but I don't think they should be used.
http://www.medscape.com/viewarticle/847174
Combining brain stimulation with a challenging motor training task may improve poststroke rehabilitation, according to a new randomized, double-blind, crossover study.
The study showed that compared with sham stimulation, a single session of dual transcranial direct-current stimulation (dual-tDCS) enhanced skill retention and produced lasting increases in resting-state functional MRI functional connectivity (FC) in the somatomotor network of stroke patients.
Because FC is considered a potential surrogate marker of poststroke recovery, the study findings are promising for neuro-rehabilitation, lead author Professor Yves Vandermeeren, MD, PhD, Neurology Department, Université catholique de Louvain, Brussels, Belgium, told Medscape Medical News.
"It's possible that within the next 5 or 10 years, every rehabilitation session will start with the placement of some electrodes to focus brain function, with the aim of enhancing the effect of training."
But Dr Vandermeeren stressed that brain stimulation won't work if the exercise that stroke patients are performing is "just repetitive training" and that the task needs to be "complex" and "challenging" to patients.
The research was presented here at the first Congress of the European Academy of Neurology (EAN).
Disrupted Connectivity
Research on resting-state fMRI has shown that FC is disrupted in stroke patients. This connectivity, said Dr. Vandermeeren, correlates with recovery. Motor learning, too, plays a key role in poststroke neuro-rehabilitation. With repeated training, movements become faster and more accurate, he added.
The new study included 22 patients with chronic hemiparetic stroke (18 men and 4 women). They ranged in age from 45 to 82 years.
Fifteen patients had sustained a subcortical stroke, while the rest had had a cortical stroke. All had some difficulty with hand function.
Their modified Rankin Scale score ranged from 1 to 4. Their National Institutes of Health Stroke Scale score was 0 to 12.
After completing a baseline resting-state fMRI session, patients entered the randomized, double-blind, placebo-controlled, crossover phase of the study. In each of the two parts of the study, patients received real or sham dual tDCS, applied over 30 minutes, while they completed the motor skill learning task.
Designed by the researchers, the task involves moving a mouse across a circuit as fast and as accurately as possible. For some patients, their paretic hand had to be taped to the computer to carry out the task, said Dr Vandermeeren.
Sixteen of the patients performed the task in a supine position, and the other 6 did so in front of a computer.
A week later, the patients returned for the "retention" session. A run of resting-state fMRI was carried out at the beginning of the retention session in each of the two study sections.

Researchers quantified FC with whole-brain independent component analysis.
The study found that compared with sham treatment, dual-tDCS enhanced motor skill retention (8% vs 64% for sham; P = .0004).
From the ICA, there were no changes between baseline and sham sessions in the somatomotor network, whereas FC was increased 1 week after dual-tDCS compared with baseline (qFDR < 0.05; t(63)  = 4.15).
Dr. Vandermeeren emphasized that the task has to be challenging.
"It's not just repetitive movements, but training that requires the subject to be focused, with increasing difficulty, raising the attention of the subject, and providing feedback and rewards."
He predicted that within about a decade, noninvasive brain stimulation might be added to poststroke exercises to enhance the rehabilitation effects. "Maybe patients can recover faster; maybe they can recover better, and maybe for a longer time," he told the session audience. As a quip, he added "It's a little bit like aspirin; it's good for everything…so far."
In responding to a query from a delegate about whether the data were sufficiently strong to suggest that a single brain stimulation could produce lasting results, Dr Vandermeeren said this was the first time that researchers were able to observe such a long-term effect with a single session of dual tDCS. Most effects from previous research with a single stimulation bout have been short-term.
Encouraging Findings
Commenting on the findings for Medscape Medical News, Gereon Fink, MD, PhD, director, Department of Neurology, University Hospital Cologne, Germany, who co-chaired the session on neurotraumatology and rehabilitation, said that the study is encouraging to those in the field.
"Given the importance of promoting brain plasticity to ameliorate neurological deficits, the results are very promising but nevertheless need to be replicated before one can really judge whether or not the approach used here may represent the future of post-stroke rehab."
It's important to keep in mind, said Dr Fink, that despite multiple studies reporting positive neuromodulatory effects of transcranial magnetic stimulation (TMS) or TDCS, many studies failed to find significant effects.
"Thus, at present, current evidence does not support the routine use of rTMS [repetitive TMS] or TDCS for the treatment of stroke. Further trials with larger sample sizes are needed to determine suitable rTMS or TDCS protocols and the long-term functional outcome."
Dr Vandermeeren and Dr Fink have disclosed no relevant financial relationships.
Congress of the European Academy of Neurology (EAN). Abstract 01124 Presented June 20, 2015.

I absolutely hate stroke awareness campaigns

This is just a way for stroke associations and other supposedly helpful people to do conscience laundering without actually doing a damn thing to solve any of the problems in stroke. And if our fucking failures of stroke associations would write up a stroke strategy we could actually go down the route of actually solving stroke problems instead of fake solving them.

Matt Lopez, president of the NSA. Your reply?
 Dr. Mariel Jessup, president of the ASA. Your reply?

Are you or a loved one living with heart disease or stroke? We want to hear from you! - Canada

At least the Canadians are trying to engage survivors. As compared to the ASA and NSA in the US who don't even seem to be making any attempt at all with survivors, except to plead for money and contacting your legislators to plead for money for research. Matt Lopez, Dr. Mariel Jessup are you listening?
http://www.heartandstroke.com/site/c.ikIQLcMWJtE/b.9284895/k.AF62/Are_you_or_a_loved_one_living_with_heart_disease_or_stroke.htm?
Please share your voice, your insights and your experience with us as we build better ways to help you – and other Canadians who will experience heart disease or stroke – to reach the best recovery possible.
You are invited to attend one of a series of focus groups being organized across Canada for stroke survivors, people living with heart disease, and family members and friends who provide them support.
There are three ways that we’d welcome your input:

• You can join us in person. We are planning in-person focus groups in communities across the country (with some opportunity for both French and English participation). Please watch this page for updates as we confirm these locations.
• You can join us by phone. We will be holding two national teleconference focus groups. You can join from anywhere in the country, however these two teleconferences will be in English only. See below for dates and times.
• You can provide your thoughts and feedback online. See below for links to surveys in English and French.

Register your interest to participate in a 1½ hour focus group by:

• Emailing focusgroupsHSF@rogers.com
• OR calling 1-866-211-0569.

Let us know how you would like to take part – in person, by phone or online. You will receive a confirmation by email or phone, along with the specifics on location, phone number and/or the survey link.

Online Survey
Survey in English	Click here
Survey in French	Click here

Teleconference Focus Groups	Date	Time
National teleconference for survivors/caregivers – any age	June 24, 2015	3 to 4:30 p.m. EST

In-person Focus Group	Date	Time
Alberta – Calgary	June 19, 2015	11:00 to 12:30 p.m.
Alberta – Calgary	June 19, 2015	1:00 to 2:30 p.m.
Alberta – Red Deer	June 18, 2015	12:30 to 2:00 p.m.
British Columbia - Burnaby (COMPLETED)	June 3, 2015
British Columbia - Chilliwack (COMPLETED)	June 5, 2015
British Columbia - Surrey (COMPLETED)	June 5, 2015
Manitoba – Brandon (COMPLETED)	June 12, 2015	2 to 3:30 p.m.
Manitoba – Winnipeg	June 25, 2015	10:30 a.m. to 12 noon
Newfoundland and Labrador – Gander	June 23, 2015	2 to 3:30 p.m.
Newfoundland and Labrador – St. John’s	June 22, 2015	2 to 3:30 p.m.
Nova Scotia – Halifax	June 17, 2015	1:30 to 3 p.m.
Nova Scotia – Sydney, Cape Breton (COMPLETED)	May 28, 2015
Ontario – Cornwall (COMPLETED)	June 3, 2015	1:30 to 3 p.m.
Ontario – Milton (FULL)	June 25, 2015	7:00 to 8:30 p.m.
Ontario – Ottawa – in French	June 25, 2015	1:30 to 3 p.m.
Ontario – Owen Sound (COMPLETED)	May 28, 2015
Ontario – Toronto	June 24, 2015	1:30 to 3 p.m.
Prince Edward Island – Montaque (COMPLETED)	June 12, 2015	12:30 to 2 p.m.
Quebec – Laval – in French (COMPLETED)	June 16, 2015	10 to 11:30 a.m.
Quebec – Montreal – in French (COMPLETED)	June 16, 2015	2 to 3:30 p.m.
Quebec – Quebec City – in French (COMPLETED)	June 15, 2015	5 to 6:30 p.m.
Saskatchewan – Prince Albert (COMPLETED)	June 16, 2015	10:30 to 12:00 noon
Saskatchewan – Saskatoon (COMPLETED)	June 15, 2015	10 to 11:30 a.m.
Saskatchewan – Saskatoon (COMPLETED)	June 16, 2015	5:30 to 7:00 p.m.

The visual amplification of goal-oriented movements counteracts acquired non-use in hemiparetic stroke patients

I'm quite sure this is damned important to your recovery. If it is not in your hospital in a week, call your hospital president and ask why their stroke department is so f*cking incompetent. The beatings will continue until your hospital is updating stroke protocols on a weekly basis. This is really the responsibility of the presidents of the ASA and NSA to ride herd on stroke hospitals to make sure they are up-to-date on all the latest and are running research to prove the next breakthrough.
Your replies:
Matt Lopez, president of the NSA
 Dr. Mariel Jessup, president of the ASA

http://www.jneuroengrehab.com/content/12/1/50 

Belén Rubio Ballester^1*, Jens Nirme¹, Esther Duarte², Ampar Cuxart³, Susana Rodriguez³, Paul Verschure¹⁴ and Armin Duff¹

• * Corresponding author: Belén R Ballester belen.rubio@upf.edu

Author Affiliations

¹ Laboratory of Synthetic Perceptive, Emotive and Cognitive Systems, Center of Autonomous Systems and Neurorobotics, Pompeu Fabra, Roc Boronat, Barcelona, Spain
² Servei de Medicina Física I Rehabilitació, Hospitals del Mar I l’Esperanç, Institut Hospital del Mar d’Investigacions Médiques, Barcelona, Spain
³ Servei de Medicina Física i Rehabilitació, Hospital Universitari Vall dHebron, Barcelona, Spain
⁴ ICREA, Institució Catalana de Recerca i Estudis Avançats, Passeig Lluís Companys, Barcelona, Spain

For all author emails, please log on.

Journal of NeuroEngineering and Rehabilitation 2015, 12:50  doi:10.1186/s12984-015-0039-z
The electronic version of this article is the complete one and can be found online at: http://www.jneuroengrehab.com/content/12/1/50

Received:	5 February 2015
Accepted:	13 May 2015
Published:	9 June 2015

© 2015 Rubio Ballester et al.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Formula display:

Abstract

Background

Stroke-induced impairments result from both primary and secondary causes, i.e. damage to the brain and the acquired non-use of the impaired limbs. Indeed, stroke patients often under-utilize their paretic limb despite sufficient residual motor function. We hypothesize that acquired non-use can be overcome by reinforcement-based training strategies.

Methods

Hemiparetic stroke patients (n = 20, 11 males, 9 right-sided hemiparesis) were asked to reach targets appearing in either the real world or in a virtual environment. Sessions were divided into 3 phases: baseline, intervention and washout. During the intervention the movement of the virtual representation of the patients’ paretic limb was amplified towards the target.

Results

We found that the probability of using the paretic limb during washout was significantly higher in comparison to baseline. Patients showed generalization of these results by displaying a more substantial workspace in real world task. These gains correlated with changes in effector selection patterns.

Conclusions

The amplification of the movement of the paretic limb in a virtual environment promotes the use of the paretic limb in stroke patients. Our findings indicate that reinforcement-based therapies may be an effective approach for counteracting learned non-use and may modulate motor performance in the real world.

Strokes steal eight years' worth of brain function, new study suggests

I lost nothing on my brain cognitive functions. So there! This is why we need a great stroke association, so that president can correct all the research problems in stroke. I'm sure Matt Lopez(NSA) or Dr. Mariel L. Jessup(ASA) are not calling these people up to tell them what they are doing wrong.

 But other research suggests this:

Your 5 lost years of brain cognition due to your stroke

Why doesn't YOUR FUCKINGLY INCOMPENT? DOCTOR KNOW NOTHING ON FIXING THIS PROBLEM?

Strokes steal eight years' worth of brain function, new study suggests

Having a stroke ages a person's brain function by almost eight years, new research finds - robbing them of memory and thinking speed as measured on cognitive tests. In both black and white patients, having had a stroke meant that their score on a 27-item test of memory and thinking speed had dropped as much as it would have if they had aged 7.9 years overnight.
For the study, data from more than 4,900 black and white seniors over the age of 65 was analyzed by a team from the University of Michigan U-M Medical School and School of Public Health and the VA Center for Clinical Management Research. The results will be published in the July issue of Stroke.
Researchers married two sources of information for their analysis: detailed surveys and tests of memory and thinking speed over multiple years from participants in a large, national study of older Americans, and Medicare data from the same individuals.
They zeroed in on the 7.5 percent of black study participants, and the 6.7 percent of white participants, who had no recent history of stroke, dementia or other cognitive issues, but who suffered a documented stroke within 12 years of their first survey and cognitive test in 1998.
By measuring participants' changes in cognitive test scores over time from 1998 to 2012, the researchers could see that both blacks and whites did significantly worse on the test after their stroke than they had before.
Although the size of the effect was the same among blacks and whites, past research has shown that the rates of cognitive problems in older blacks are generally twice that of non-Hispanic whites. So the new results mean that stroke doesn't account for the mysterious differences in memory and cognition that grow along racial lines as people age.
The researchers say the findings underscore the importance of stroke prevention.(Wrong, Wrong, Wrong; you need to stop the neuronal cascade of death you damned idiots) Going down the prevention route just means you will sit on your fucking asses and just pump out press releases.
"As we search for the key drivers of the known disparities in cognitive decline between blacks and whites, we focus here on the role of 'health shocks' such as stroke," says lead author and U-M Medical School assistant professor Deborah Levine, M.D., MPH. "Although we found that stroke does not explain the difference, these results show the amount of cognitive aging that stroke brings on, and therefore the importance of stroke prevention to reduce the risk of cognitive decline."
Other research on disparities in cognitive decline has focused on racial differences in socioeconomic status, education, and vascular risk factors such as diabetes, high blood pressure and smoking that can all contribute to stroke risk. These factors may explain some but not all of the racial differences in cognitive decline.
Levine and her colleagues note that certain factors - such as how many years a person has vascular risk factors, and the quality of his or her education, as well as genetic and biological factors - might play a role in racial differences in long-term cognitive performance.
But one thing is clear: strokes have serious consequences for brain function. On average, they rob the brain of eight years of cognitive health. Therefore, people of all racial and ethnic backgrounds can benefit from taking steps to reduce their risk of a stroke. That includes controlling blood pressure and cholesterol, stopping or avoiding smoking, controlling blood sugar in diabetes, and being active even in older age.

Explore further: Slowing brain functions linked to increased risk of stroke, death

More information: Stroke, DOI: 10.1161/STROKEAHA.114.008156

Journal reference: Stroke

Provided by University of Michigan Health System

Bill Gates once said, "Your most unhappy customers are your greatest source of learning."

 Matt Lopez, president of the NSA
 Dr. Mariel Jessup, president of the ASA
WSO President - Steve Davis (Australia)
Have any of you ever talked to any survivors at all about your services to survivors?
I'm incredibly f*cking unhappy about what should be services to survivors from your organizations. 

Thanks for your heroic effort! - American Stroke Association

With no information on what they have actually done the past year they is no way they will be getting any money from me. Total failure. Dr. Mariel L. Jessup I expect better.

Your American Stroke Month donation does a lot. It helps fund research(really? what?) and advances in stroke treatment. It also helps us teach more Americans to spot stroke F.A.S.T. Currently, only two out of three Americans can identify all the F.A.S.T. stroke warning signs, so your gift and its power to educate would-be stroke heroes might just make a life-or-death difference to someone you know. Or to you.

Mr. Lopez, Dr. Stephen Davis, Dr. Mariel Jessup "What evidence would you need to see to change your mind about how to solve the stroke problem?"

Stroke survivors are not getting anywhere with help for us, so we need to change the conversation from F.A.S.T. and prevention to something more useful.
A great description from Seth Godin;

Seth's Blog : How to win an argument with a scientist

The person you're arguing with now (who might be a scientist during the day, even, but is merely being a person right now) is not going to be swayed from a firmly held opinion by your work to make better science. It's more likely that it will take cultural pressure, shame, passion, humor, connection and a host of unreliable levers to make your point.

Does this place exist to maintain and perpetuate the status quo, or am I here to do the work that the radical founder had in mind when we started?

When the founders of our stroke associations started did they think that the production of press releases was going to become the highest calling? Do YOU want to change that?
Call Matt Lopez, president of the NSA
Call Dr. Mariel Jessup, president of the ASA
Call these WSO Executive Committee Members
President - Steve Davis (Australia)
Vice-President - Michael Brainin (Austria)
Vice-President - Natan Bornstein (Israel)
Immediate Past-president - Bo Norrving (Sweden)
Treasurer - Bernard Yan (Australia)
Co-Treasurer - Marc Fisher (USA)
Secretary - Ka Sing Lawrence Wong (Hong Kong S.A.R.)
Member at large - Erin Lalor (Australia)
Member at large - Sheila Martins (Brazil)
Member at large - Shinichiro Uchiyama (Japan)
Ex Officio Member - Warner Hacke, Chairman of the Congress Oversight Committee
Ex Officio Member - Geoffrey Donnan, Editor of IJS
Ex OOfficio Member - Marc Fisher, Co-Treasurer for the US Accounts

WSO Executive Committee Members

President - Steve Davis (Australia)

Vice-President - Michael Brainin (Austria)

Vice-President - Natan Bornstein (Israel)

Immediate Past-president - Bo Norrving (Sweden)

Treasurer - Bernard Yan (Australia)

Co-Treasurer - Marc Fisher (USA)

Secretary - Ka Sing Lawrence Wong (Hong Kong S.A.R.)

Member at large - Erin Lalor (Australia)

Member at large - Sheila Martins (Brazil)

Member at large - Shinichiro Uchiyama (Japan)

Ex Officio Member - Warner Hacke, Chairman of the Congress Oversight Committee

Ex Officio Member - Geoffrey Donnan, Editor of IJS

Ex OOfficio Member - Marc Fisher, Co-Treasurer for the US Accounts

- See more at: http://www.world-stroke.org/about-wso/wso-board#sthash.NF2lX7KI.dpuf

All generalizations are false, including this one.

Mark Twain.  I do tend to generalize a lot, but for some unknown reason not a single stroke medical person has written to me to complain. I wish they would, it would make for an interesting discussion as to why their profession has such a horrible record on getting survivors to recovery.
I'm unrepentant on thinking that my ideas are worth exploring in depth.

ASA - Dr. Mariel Jessup, 

NSA - Mr. Matt Lopez, 

WSO - Dr. Stephen Davis

I challenge you to tell me exactly where I'm wrong, with research backing you up. It will only take you 351 days to read my whole blog. Or you can have your minions read and critique it.

Stem cells for neonatal stroke- the future is here

When is the future for the rest of us survivors?

ASA - Dr. Mariel Jessup,  Whom are you going to assign to this task?

NSA - Mr. Baranski, Whom are you going to assign to this task?

WSO - Dr. Stephen Davis, Whom are you going to assign to this task?

http://journal.frontiersin.org/Journal/10.3389/fncel.2014.00207/full?

Stem Cells

In recent years stem cell therapy has emerged as a potential treatment for neonatal ischemic brain injury. The efficacy of cell- based therapies in restoring damaged brain tissue has been tested in a multitude of models for different CNS diseases. Several different stem and progenitor cell populations have been utilized as cell-based therapy, including neural stem cells, embryonic stem cells, human umbilical cord blood cells (HUBCs), hematopoietic stem and progenitor cells, and mesenchymal stem cells (MSCs). Most stem cell types appear to enhance recovery to some extent (Pimentel-Coelho and Mendez-Otero, 2010). However, because of their low immunogenicity, availability and positive results obtained from preclinical studies, MSCs are a particularly promising candidate to repair the devastating effects that are associated with neonatal stroke. MSCs were first isolated and identified in bone marrow, but can now be isolated from many tissues, including adipose tissue, muscle, skin and extraembryonic tissues like the placenta, umbilical cord and Wharton's jelly. The latter sources are of particular interest for neonates that experience an ischemic event around the time of birth, at which time cells can be harvested and transplanted from an autologous source. MSCs derived from different sources have slightly different characteristics, but as of yet it is unknown whether this influences their therapeutic potential.

Our group and others have shown that administration of MSCs reduces lesion volume, provides positive effects on the white matter and improves motor function (van Velthoven et al., 2012). Numerous studies have been done under the premise that transplanted stem cells contribute to brain repair by directly replacing damaged or lost tissue. While there is evidence that transplanted cells undergo differentiation toward neuronal lineages, improved outcomes have been observed even when survival of transplanted cells is low and engrafted cells are absent. This suggests that rather than replacing damaged cells, transplanted cells may improve outcome via indirect mechanisms. For example, MSCs have been shown to secrete many factors that can influence important processes like apoptosis, neurogenesis, angiogenesis and synaptogenesis.

More pages at link.

American Heart Association, American Stroke Association recognize Lexington Medical Center for exceptional care

It's not exceptional care if you don't tell us the results that prove your point.
Big f*cking whoopee. The measurements say nothing about 30-day deaths or 100% recovery so as such are useless for survivors.
http://coladaily.com/2014/05/05/american-heart-association-american-stroke-association-recognize-lexington-medical-center-for-exceptional-care/

Excellence would be reducing 30-day deaths every month and increasing the number getting to 100% recovery. No one gives a shit about procedures, You measure results. Hasn't anyone taken any Business 101 courses?

Guidelines here: You can see how this is nothing to be impressed about. This is all indirect action, not results.
http://www.heart.org/HEARTORG/HealthcareResearch/GetWithTheGuidelinesHFStrokeResus/GetWithTheGuidelinesStrokeHomePage/Get-With-The-Guidelines-Stroke-Overview_UCM_308021_Article.jsp 

If you want to be useful you will create Get With The Results.
How about that Dr. Mariel L. Jessup, President American Heart Association/American Stroke Association.

Developing drugs to reduce brain impairment after stroke

Whom is going to write a request for proposal to researchers to solve this problem in humans? Dr. Jessup, Mr. Baranski? Isn't that exactly what a stroke association should be doing? Doesn't your board of directors have the best interests of stroke survivors at the top of the reasons for your organization existence?
http://medicalxpress.com/news/2014-03-drugs-brain-impairment.html
Current treatment for ischaemic stroke, which results from a blood clot, aren't very effective. But research published by my colleagues and I today in the journal Nature Communications shows an emerging drug treatment is effective in mice and could one day reduce the neurological impact in people who've suffered an ischaemic stroke.
By 2020, the World Health Organization predicts that worldwide, the number of years lost to disability resulting from stroke will reach 61 million. The economic burden is similarly massive, costing Australia $49.3 billion a year. So finding better treatments is crucial.
Brain inflammation after stroke
Quick treatment is one way to enhance the prospect of recovering from a stroke.
If patients are treated within around three hours of the stroke, the stroke-inducing clots can be broken down relatively efficiently using a substance called tissue plasminogen activator (tPA). This allows the blood to start flowing again, supplying the brain with the oxygen required to keep the tissue alive.
But after the clot is removed and blood starts flowing, the body produces an unwanted neuroimmune response. This occurs because the damaged brain tissue contains elevated levels of molecules known as proinflammatory cytokines, which regulate the body's response to infection, inflammation and trauma.
These cytokines are able to recruit many other immune cells to the area, leading to further cell death.
Limiting the initial release of these cytokines should therefore help to decrease the excessive local inflammatory response, leading to a decrease in tissue damage and better patient outcomes.

More at link.