Showing posts with label John Krakauer. Show all posts
Showing posts with label John Krakauer. Show all posts
Thursday, May 1, 2025
High-Dose, High-Intensity Stroke Rehabilitation: Why Aren’t We Giving It?
From John Krakauer
Saturday, September 2, 2017
Broken Movement: The Neurobiology of Motor Recovery after Stroke (MIT Press) - by John W. Krakauer (Author), S. Thomas Carmichael (Author)
Both these guys are great. 8 posts on John Krakauer, 8 posts on Dr. Carmichael. But I'm not buying it until a reviewer comes back and says it has exact stroke rehab protocols in it with efficacy ratings. If it is generic garbage about neuroplasticity is the key to stroke recovery, that is well known and I don't need another general book on that.
https://www.amazon.com/dp/026203722X/ref=cm_sw_r_tw_dp_x_U1EQzbV7G8S58
https://www.amazon.com/dp/026203722X/ref=cm_sw_r_tw_dp_x_U1EQzbV7G8S58
Monday, April 17, 2017
Rethinking Recovery and Rehabilitation after Stroke - John Krakauer
I've got 7 posts on Dr. John Krakauer already, he has some great ideas, virtual dolphins, calls stroke rehab medieval. You in the first days after your stroke will need to see what your doctor knows about this. Krakauer mentions lots of problems in stroke that your doctor should already know about and be addressing.
https://smartech.gatech.edu/handle/1853/56529
There are critical differences in the potential for rehabilitation of impairment early and late after stroke. Early after stroke the proportional recovery rule for spontaneous biological recovery applies, as does the idea of a sensitive period. Late after stroke, rehabilitation relies on motor learning principles. We will need new behavioral treatments augmented by pharmacology and perhaps non-invasive brain stimulation to rectify the overall ineffectiveness of current neurorehabilitation
Go to the mp4 file, it contains a 1 hour lecture which is wonderful.
Some tidbits from there:
'No computational or algorithmic theory of practice'. So we know nothing about stroke rehab.
' I have no idea why we do robotics for rehabilitation'.
'Current rehab seems to have no impact whatsoever'.
'Sensitive period can be reset with second stroke' slide.
Fluoxetine slide is good, does your doctor know about that?
85% of time is spent in bed not moving.
https://smartech.gatech.edu/handle/1853/56529
There are critical differences in the potential for rehabilitation of impairment early and late after stroke. Early after stroke the proportional recovery rule for spontaneous biological recovery applies, as does the idea of a sensitive period. Late after stroke, rehabilitation relies on motor learning principles. We will need new behavioral treatments augmented by pharmacology and perhaps non-invasive brain stimulation to rectify the overall ineffectiveness of current neurorehabilitation
Go to the mp4 file, it contains a 1 hour lecture which is wonderful.
Some tidbits from there:
'No computational or algorithmic theory of practice'. So we know nothing about stroke rehab.
' I have no idea why we do robotics for rehabilitation'.
'Current rehab seems to have no impact whatsoever'.
'Sensitive period can be reset with second stroke' slide.
Fluoxetine slide is good, does your doctor know about that?
85% of time is spent in bed not moving.
Monday, January 2, 2017
Live webinar - Virtual Rehabilitation – How Feedback and Motivation Influence Neurological Therapy Outcome
You will notice that they are proposing trying to fix the effects of the stroke rather than preventing a lot of the damage by stopping the 5 causes of the neuronal cascade of death in the first week. Or delivering this:
My 31 ideas on hyperacute therapy I'm going to insist my doctor give me during the first week.
Or these needing a lot more research:
These 177 hyperacute therapies that need more research.
I've got 6 posts on Dr. John Krakauer already, he has some great ideas, virtual dolphins, calls stroke rehab medieval.
Live-Webinar on February 8, 2017,
Maarten Prins
VR Rehabilitation Therapist and Researcher, Military Rehabilitation Center, Doorn, NL
My 31 ideas on hyperacute therapy I'm going to insist my doctor give me during the first week.
Or these needing a lot more research:
These 177 hyperacute therapies that need more research.
I've got 6 posts on Dr. John Krakauer already, he has some great ideas, virtual dolphins, calls stroke rehab medieval.
Live webinar - Virtual Rehabilitation – How Feedback and Motivation Influence Neurological Therapy Outcome
Live-Webinar on February 8, 2017,
09:00 a.m. Baltimore (US) / 3:00 p.m. Berlin (GER) / 10:00 p.m. Hong Kong (CN)
Guest speakers:
Prof. Dr. John Krakauer
Professor of Neurology and Neuroscience, Johns Hopkins University School of Medicine, USVR Rehabilitation Therapist and Researcher, Military Rehabilitation Center, Doorn, NL
Key factors for successful recovery of neurological and neuromuscular
patients are, among others, motivation and engagement, feedback for both
patient and therapist, and having to do movement tasks in a varied
environment. Virtual reality can provide innovative therapeutic
solutions to enhance these factors in the rehabilitation field. What’s
more, virtual reality is already well integrated and established in many
clinics as a rehabilitation tool all over the world. In this exclusive
webinar, two experts will share their experiences on using virtual
reality in a rehabilitation setting.
Sunday, May 22, 2016
Could playing a dolphin in a video game help stroke patients recover?
This was originally written about on Oct. 2014 and I bet not a single stroke hospital has implemented this in their rehab department. That incompetence and complacency needs to be destroyed if stroke survivors are ever to get close to 100% recovery.
https://www.statnews.com/2016/03/25/after-a-stroke-reteaching-the-brain-by-gaming/
https://www.statnews.com/2016/03/25/after-a-stroke-reteaching-the-brain-by-gaming/
John Krakauer, a
neuroscientist at Johns Hopkins University, has spent much of his career
treating people with strokes. But he’s the first person to tell you
that stroke rehab can be really lousy. Sometimes he likes to use the
word medieval.
It’s not that stroke rehab involves bleeding a
patient or prescribing the eye of a newt. The problem is that current
treatments don’t take into account the latest research on what happens
to the brain during and after a stroke. Rehab is often focused on just a
few survival skills, like holding a spoon to eat. Many stroke victims
only make partial recoveries and are never the same again.
Krakauer, the director of Johns Hopkins’s Center
for the Study of Motor Learning and Brain Repair, wants to treat
patients in a fundamentally different way: using video games to reteach
the brain how to control the body.
I recently visited Krakauer and his colleagues at their lab
in Baltimore to see what they were up to. Their research is the focus of
the inaugural episode of “Science Happens,” a monthly video series in
which I’ll be exploring labs and diving into the latest findings.
If you’d like to suggest a lab where existing research is going on for a future episode of Science Happens, please drop me a note.
Wednesday, May 18, 2016
The proportional recovery rule for stroke revisited
I don't want proportional recovery, I want 100% recovery. Figure out a way to accomplish that!!!
With no abstract available I have no clue what this is about. Send your doctor after this to see which of your stroke protocols can be updated to get you to 100% recovery.
http://onlinelibrary.wiley.com/doi/10.1002/ana.24537/references
With no abstract available I have no clue what this is about. Send your doctor after this to see which of your stroke protocols can be updated to get you to 100% recovery.
http://onlinelibrary.wiley.com/doi/10.1002/ana.24537/references
Version of Record online: 13 NOV 2015
DOI: 10.1002/ana.24537
© 2015 American Neurological Association
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Thursday, January 21, 2016
Game doubles as stroke app using iPhone’s Force Touch & robotics to deliver rehab
All these positive statements but yet I never see any publicly published protocols on any of these. Because we have NO stroke leadership or strategy anywhere in stroke. If we had a great stroke association we would have cutting edge interviews asking where are the protocols and when will it be delivered to stroke departments? This won't occur in your lifetime, your childrens' lifetime or even your grandchildrens' lifetime. We are all fucking screwed basically forever.
I still prefer the cockroach stomping game.
Game doubles as stroke app using iPhone’s Force Touch & robotics to deliver rehab
A team of physicians, developers,
artists, and programmers are developing and testing a gaming app,
Bandit’s Shark Showdown, to both improve recovery in stroke patients and maybe even make it fun.
There are a lot of stroke apps out there, from aids to help patients recognizing potential stroke signs to decision support tools for diagnosis. Featured in a recent profile in The New Yorker, neurologist Dr. John Krakauer expressed his frustration with the limitations of traditional post-stroke rehabilitation and hopes to unlock the potential of robotic therapy combined with cutting-edge interactive entertainment. He has helped found the “Brain, Learning, Animation, Movement lab”(BLAM), a “Pixar-grade” team of engineers, designers, artists and programmers that work with clinicians to use the best of art and science further research on the brain.
One of their studies involves investigating motor recovery as part of stroke rehabilitation. This is done through utilizing a combination of the game, Bandit’s Shark Showdown, with a robotic arm, the Hocoma ArmeoPower, to encourage intensive game-based therapy. Instead of traditional rehabilitation where the focus is often task-based, the focus here is simply on movement in a virtual environment, directing a dolphin through various challenges like battling dangerous sharks and other enemies.
Three members of BLAM, who also own an indie gaming company called Max and Haley, designed Bandit’s Shark Showdown. In fact, it wasn’t really designed as a medical app. Rather, they had already been in the business of designing apps based on animal movements and were working with the National Aquarium in Baltimore to design a game based on dolphin movements.
They’re also testing the use of Force Touch in the game according to an interview in the Verge. Players (patients recovering from strokes) have to apply varying levels of pressure to control their dolphin as it goes after sharks. They hope that this can help users work on balancing force and dexterity, offering yet another tool for recovery.
After a cerebral vascular accident, several mechanisms have been traditionally postulated to allow to motor recovery. These include neural plasticity with periinfact reorganization (undamaged regions of the brain taking over for damaged regions), diaschisis (regions remote from infarcted location are initially deactivated but later recover), and ipsilateral/contralateral hemisphere activity (inhibition and excitability) 1. The majority of motor recovery after a stroke is thought to occur within the first 3 months. This is an ideal time for Acute Rehabilitation, where a team consisting of a rehabilitation physician, therapists (physical, occupational, and speech), neuropsychologist, nursing, social workers and more attempt to maximize functional outcomes for post-stroke survivors.
Current approaches to therapy during this time include increasing attention to the affected paretic region, while in the past having focused on compensatory strategies. Techniques such as Constraint-induced movement therapy (CIMT) have been utilized, supported by recently published clinical trials.
However, as noted by Dr. Krakauer, the ability to provide enough high-intensity and frequency of such therapy may be limited in some post-stroke care environments. Apps offer an opportunity here and while there are many available, the quality of these stroke apps has been found to be lacking. Robotics offer an intriguing avenue to increase the frequency of such therapy and combining this with an immersive game, such as Bandit’s Shark Showdown, may offer even more benefits. The upcoming clinical trial of this technology through BLAM, with stroke patients at Columbia University and a clinic in Zurich, is certainly exciting and is one to follow for all interested in neuro-rehabilitation.
Check out Bandit’s Shark Showdown on iTunes
There are a lot of stroke apps out there, from aids to help patients recognizing potential stroke signs to decision support tools for diagnosis. Featured in a recent profile in The New Yorker, neurologist Dr. John Krakauer expressed his frustration with the limitations of traditional post-stroke rehabilitation and hopes to unlock the potential of robotic therapy combined with cutting-edge interactive entertainment. He has helped found the “Brain, Learning, Animation, Movement lab”(BLAM), a “Pixar-grade” team of engineers, designers, artists and programmers that work with clinicians to use the best of art and science further research on the brain.
One of their studies involves investigating motor recovery as part of stroke rehabilitation. This is done through utilizing a combination of the game, Bandit’s Shark Showdown, with a robotic arm, the Hocoma ArmeoPower, to encourage intensive game-based therapy. Instead of traditional rehabilitation where the focus is often task-based, the focus here is simply on movement in a virtual environment, directing a dolphin through various challenges like battling dangerous sharks and other enemies.
Three members of BLAM, who also own an indie gaming company called Max and Haley, designed Bandit’s Shark Showdown. In fact, it wasn’t really designed as a medical app. Rather, they had already been in the business of designing apps based on animal movements and were working with the National Aquarium in Baltimore to design a game based on dolphin movements.
They’re also testing the use of Force Touch in the game according to an interview in the Verge. Players (patients recovering from strokes) have to apply varying levels of pressure to control their dolphin as it goes after sharks. They hope that this can help users work on balancing force and dexterity, offering yet another tool for recovery.
After a cerebral vascular accident, several mechanisms have been traditionally postulated to allow to motor recovery. These include neural plasticity with periinfact reorganization (undamaged regions of the brain taking over for damaged regions), diaschisis (regions remote from infarcted location are initially deactivated but later recover), and ipsilateral/contralateral hemisphere activity (inhibition and excitability) 1. The majority of motor recovery after a stroke is thought to occur within the first 3 months. This is an ideal time for Acute Rehabilitation, where a team consisting of a rehabilitation physician, therapists (physical, occupational, and speech), neuropsychologist, nursing, social workers and more attempt to maximize functional outcomes for post-stroke survivors.
Current approaches to therapy during this time include increasing attention to the affected paretic region, while in the past having focused on compensatory strategies. Techniques such as Constraint-induced movement therapy (CIMT) have been utilized, supported by recently published clinical trials.
However, as noted by Dr. Krakauer, the ability to provide enough high-intensity and frequency of such therapy may be limited in some post-stroke care environments. Apps offer an opportunity here and while there are many available, the quality of these stroke apps has been found to be lacking. Robotics offer an intriguing avenue to increase the frequency of such therapy and combining this with an immersive game, such as Bandit’s Shark Showdown, may offer even more benefits. The upcoming clinical trial of this technology through BLAM, with stroke patients at Columbia University and a clinic in Zurich, is certainly exciting and is one to follow for all interested in neuro-rehabilitation.
Check out Bandit’s Shark Showdown on iTunes
Tuesday, October 14, 2014
A Johns Hopkins Scientist is Using Virtual Dolphins to Rehab Stroke Patients [Video]
Will your doctor ever try anything newer than medical school?
I don't know I still like stomping roaches to get some aggression out.
A Johns Hopkins Scientist is Using Virtual Dolphins to Rehab Stroke Patients [Video]
"If you have a stroke in the United States in 2014, you're better off if you're a rodent than if you're a human being," Johns Hopkins University neuroscientist John Krakauer said when delivering his presentation "Motor Recovery After Stroke in Mice and Men" at a brain science research seminar. The rehabilitation therapies we use nowadays are medieval, he continued on to say, making it loud and clear that now, "it's time for a revolution."
The 47-year-old, whose medical career is nothing to be scoffed at, is ready to accept the challenge of redefining the world of physical therapy, too, with the creation of a new kind of healer equipped with a set of fins.
Krakauer, who studies movement and human obsession with movement, worked with Johns Hopkins software architects Omar Ahmad and Promit Roy as well as Baltimore artist Kat McNally to develop the video game "I Am Dolphin," which he believes could have applications in therapy, especially for stroke victims.
An accomplished neuroscientist, Krakauer first joined Johns Hopkins in 2010 to set up a center for stroke recovery research, including the BLAM lab (an acronym which stands for brain, learning, animation and movement), which explains why he would want to create a more effective post-stroke rehabilitation solution. His advanced knowledge of the disease that afflicts nearly 800,000 people across the United States each year and understanding of the economic burden associated with stroke victims (just about $37 billion in care a year) makes him the man best fit for the job.
That paired with his appreciation for "the beauty and braininess" of movement is what led Krakauer to create a simulated dolphin named Bandit for healing purposes.
Bandit is based on three real bottlenose dolphins housed in the National Aquarium that were studied for hundreds of hours and then transformed into digital form. According to National Geographic, the simple movement of a stroke patient's arm in a robotic sling will alter the movement of the virtual dolphin on the screen, allowing Bandit to swim, catch fish and then swallow its dinner just like a real dolphin in the wild.
The player feels as if they're one with the dolphin, Omar Ahmad, director of the Kata Project behind "I Am Dolphin," explained to National Geographic. "It's visceral feedback; every subtle movement you do is reflected in the dolphin," he said. Fair warning: it's addictive, too.
As for how an aquatic video game could help with brain healing, Krakauer says an injured brain from a stroke can reconfigure itself, but only during a sensitive post-stroke period window that lasts one to three months. (He may be smart but he's totally wrong here) So in the clinical trials with Bandit, the game will be used during that critical time of plasticity when the brain is actually capable of self-repair. And if successful in helping stroke patients recover lost motor function faster than traditional therapy used today, Krakauer's dream of revolutionizing conventional physical therapy practices could very well become a reality.
This isn't the first time video games has been used in rehab. In fact, another member of the Johns Hopkins community, Ph.D. student Xiaoxu Kang, launched her own startup Rehabtics in October 2012 that uses virtual technology to make the physical therapy experience more fun.
Rehabtics' new software program called ArmSPOT leverages gaming technology to better engage patients and make them more interested in their rehab exercises. Motion cameras transform patients into avatars onto their computer screens, allowing them to do their physical therapy routines in a relaxing atmosphere, like on the beaches of St. Lucia or in a jungle safari.
So perhaps there is promise for "I Am Dolphin." Try it out for yourself by purchasing the game released through iTunes October 9 for $2.99.
Friday, October 3, 2014
Stroke Victims Lose 'Crucial Functions' Because Hospitals Don't Properly Rehabilitate Them
This is so fucking bloody obvious. Stroke rehab is a complete and utter failure, only 10% get to almost full recovery.
From John Krakauer"If you have a stroke in the United States in 2014, you're better off if you're a rodent than if you're a human being."
Though humans unquestionably get excellent care(NOT RECOVERY!)
at the time of a stroke with the delivery of clot-busting drugs and
surveillance for complications, in Krakauer's opinion, standard
post-stroke care(NOT RECOVERY!) for humans is intolerably backward.
Current rehabilitation therapies are medieval, Krakauer, a
professor of neurology and neuroscience at Hopkins, told the audience of
science writers. "It's time for a revolution."
And because rehab is so fucking bad the only solution is to stop a lot of the damage by stopping the neuronal cascade of death.
It's so damned simple, why can't the stroke medical world see it? Are they all brain damaged worse than the stroke survivors they are supposed to be treating?
Whom the hell is going to take on this problem and solve it? It has only been festering for the last 30 years.
Tuesday, September 30, 2014
"If you have a stroke in the United States in 2014, you're better off if you're a rodent than if you're a human being."
A John Krakauer quote. Quite true because you are screwed if you have a stroke right now.
http://news.nationalgeographic.com/news/2014/09/140929-krakauer-medicine-stroke-neurology-rehabilitation/
http://news.nationalgeographic.com/news/2014/09/140929-krakauer-medicine-stroke-neurology-rehabilitation/
His presentation "Motor Recovery After Stroke in Mice and Men"
at a Johns Hopkins University seminar on brain science research got off
to this start: "If you have a stroke in the United States in 2014,
you're better off if you're a rodent than if you're a human being."
It was arresting, glib, and, based on what Krakauer has
learned through experiments with rats and mice, true. When receiving
intensive therapy in a stimulating environment—through interaction with
toys, chutes, mirrors, rodent friends, interesting areas to explore—lab
rats get better faster. Though humans unquestionably get excellent care(NOT RECOVERY!) at the time of a stroke with the delivery of clot-busting drugs and
surveillance for complications, in Krakauer's opinion, standard
post-stroke care(NOT RECOVERY!) for humans is intolerably backward.
Current rehabilitation therapies are medieval, Krakauer, a
professor of neurology and neuroscience at Hopkins, told the audience of
science writers. "It's time for a revolution."
A Rebel With a Cause
John Walter Krakauer
is 47 years old and wears narrow rectangular blue eyeglasses that
confer a kind of wry, postmodern look. The tone (British in accent) is
by turns ironic, questioning (science, he says, is all about doubts and
questions—not methodology), and supremely self-assured. To his patients
he is compassionate, respectful, and accessible. He does not wear a
white coat when making rounds and will unhesitatingly order a neurology
resident who is more focused on email than on the patient to leave the
room. (Related: "Virtual Dolphin on a Mission".)
More at link.
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