Use the labels in the right column to find what you want. Or you can go thru them one by one, there are only 34,358 posts. Searching is done in the search box in upper left corner. I blog on anything to do with stroke. DO NOT DO ANYTHING SUGGESTED HERE AS I AM NOT MEDICALLY TRAINED, YOUR DOCTOR IS, LISTEN TO THEM. BUT I BET THEY DON'T KNOW HOW TO GET YOU 100% RECOVERED. I DON'T EITHER BUT HAVE PLENTY OF QUESTIONS FOR YOUR DOCTOR TO ANSWER.
Changing stroke rehab and research worldwide now.Time is Brain!trillions and trillions of neuronsthatDIEeach day because there areNOeffective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.
What this blog is for:
My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.
A 'roadmap'; NOT A PROTOCOL! Fucking lazy bastards!
You didn't know about Margaret
Yekutiel writing a whole book about this in 2001, 'Sensory Re-Education
of the Hand After Stroke'. And couldn't piece together all the research after that to create a protocol for recovery?
Post-stroke somatosensory impairments, including deficits in touch and proprioception, are common. They alter body perception and can be a hidden cause of motor disability. They are often underrecognized in clinical care, highlighting the need for consensus recommendations.
The Somatosensory Roundtable aimed to provide:
A. A framework for understanding somatosensation
B. Expert-informed consensus recommendations for somatosensory interventions that have potential for use in clinical practice with stroke survivors
C. Consensus recommendations for research priorities to advance clinical practice and accelerate targeted research in somatosensory recovery and rehabilitation post-stroke.
Methods:
An international group of clinical, research, pre-clinical and lived experience experts was established. A systematic search of the literature and opinions of Somatosensory Roundtable members, clinicians, and people with lived experience of stroke, were used to generate lists of somatosensory interventions and research priorities for ranking in separate consensus ranking surveys. A structured consensus and voting process was adopted, with consensus ranks established through independent, individual ranking by Somatosensory Roundtable members.
Results:
An agreed definition and framework for understanding somatosensation was developed. Somatosensory discrimination training was ranked highest for perceived effectiveness and feasibility, with plantar tactile/proprioceptive stimulation and hands-on mechanoreceptor stimulation ranked second and third. Research priority consensus ranks were: 1) effectiveness of somatosensory interventions (highest); 2) standardized measures of impairment and impact; 3) somatosensation and recovery; 4) lived experience of sensory impairment and rehabilitation; 5) individualized therapy development; 6) knowledge translation; and 7) biomarkers.
Conclusions:
A framework for understanding somatosensation, and consensus-based recommendations for somatosensory interventions and for research priorities are provided to advance the science and practice of evidence-based rehabilitation of somatosensation after stroke.
Finally got around to thinking about implementing protocols from Margaret
Yekutiel writing a whole book about this in 2001, 'Sensory Re-Education
of the Hand After Stroke'.
Occupational therapists play a key role in assessing and treating somatosensory impairments post stroke including proprioception (limb position sense), touch, and temperature discrimination. Although research evidence and clinical guidelines offer strategies for assessing and treating this condition, there is limited information on how well these strategies are being implemented in routine practice. We aimed to describe the current practice of occupational therapists in somatosensory assessment and treatment of the upper limb of stroke survivors and to understand barriers and enablers to evidence‐based care.
Methods
This observational study encompassed (1) a cross‐sectional survey measuring self‐reported use of somatosensory assessment and treatment strategies and perceived barriers to implementation and (2) a medical file audit to report on the use of somatosensory assessment and treatment with stroke patients. Data were analyzed descriptively, with enablers and barriers to evidence use classified using the three domains of the Capability, Opportunity, Motivation–Behavior (COM‐B) change model.
Results
Of 50 files audited, 26 patients had documented upper limb impairment. Of these, 54% had sensation assessed. Treatment strategies were documented for 7 out of 12 patients with identified impairment. These findings aligned with therapist self‐report, indicating that most clinicians used sensory assessment and treatment strategies less than once per month. Therapists reported capability (lack of skills and skill confidence) and opportunity (lack of time and opportunity to practice skills) as barriers to evidence‐based practice. Occupational therapists expressed motivation to change and improve their skills in evidence‐based sensory assessment and treatment.
Conclusion
Our findings highlight ongoing gaps between evidence and practice. Therapists report being motivated to provide evidence‐based care but require support to overcome barriers, such as training and access to resources. Medical record audits aligned with survey findings; however, there were differences between reported and documented use and scope of sensory assessment and treatment in practice.
Didn't your competent? doctor create protocols for this way back in 2001?
Margaret
Yekutiel wrote a whole book about this in 2001, 'Sensory Re-Education
of the Hand After Stroke'.
Of course, your competent? doctor put
together somatosensory protocols from this earlier research a long time
ago, right? Oh no, you DON'T
have a functioning stroke doctor, do you? Too bad, it's your problem to
solve since your stroke hospital board of directors is fucking
incompetent in running their hospital! 25 years of incompetence! WOW, that's got to be a record for staying incompetent!
CNS continuously adapts to changed activity, environmental changes, learning, and injury - neuroplasticity.
•
Neuroplasticity is life-long and presents opportunities for therapeutic interventions.
•
Training should commence early after injury due to the rapid cortical changes following input changes.
•
Engagement and sense of meaningfulness are important in making training efficient.
Abstract
Background
Normal
hand function relies on a finely tuned interaction between the sensory
and motor systems within the central and peripheral nervous systems. The
central nervous system continuously adapts to changed activity,
environmental changes, learning, and injury — a phenomenon known as
neuroplasticity. The neuroplasticity is a life-long ability and presents
opportunities for therapeutic intervention; by directing it, lost or
impaired functions can be improved through a process called "guided
plasticity".
Purpose
To give an overview of methods of guided plasticity used in hand rehabilitation
Study design/Method
Expert review
Result
This
overview highlights the cortical process for neuroplasticity,
sensory-motor synergy, and its implications for hand function and
rehabilitation.
Sensory
and motor training should commence as early as possible after an injury
due to the rapid cortical changes following input changes — a cortical preparation.
Conclusion
As
research progresses, we can expect further refinements in
rehabilitation techniques and neuro engineering, potentially leading to
improved outcomes for patients with hand injuries.
Your competent? doctor has already figured out somatosenory protocols for your recovery, right? Oh no, your incompetent? doctor has nothing! Incompetent for over a decade; WOW! That's pretty impressive you can stay employed that long!
By
Daniela Casillas
Lesley Ruiz
A doctoral project submitted in partial fulfillment
of the requirements for the
Doctor of Physical Therapy
Department of Physical Therapy
School of Integrated Health Sciences
The Graduate College
University of Nevada, Las Vegas
May 2025
Abstract
Purpose/Hypothesis:
Individuals with post-stroke hemiparesis walk with significant
asymmetries, leading to slow, effortful walking, and a high risk of falls. One contributing factor
is altered sensation on the plantar surface. Studies examining altered somatosensory input
via insoles, vibration and other tactile stimuli observed improvements in hemiparesis gait. This
study investigates whether altering somatosensory input through different footwear can affect
kinetics, kinematics and muscle activity during walking post-stroke. We hypothesized the
barefoot conditions would have increased dorsiflexion (heel-strike, swing), increased
plantarflexion during toe-off, increased muscle activity and kinetics, compared to memory
foam conditions.
Participants: 13 individuals with chronic post-stroke hemiparesis (4F/9M, age=56.9±14.4yrs)
and 11 age-similar non-impaired controls (4F/7M, age=50.3±12.3yrs)
Materials and Methods: All participants were tested under 3 footwear conditions: self-selected
sneakers (SS), barefoot (BF), memory foam slippers (MF). Trunk and lower extremity
kinematics were collected utilizing a 12-camera Vicon motion analysis system. Ground
reaction forces were collected utilizing an instrumented treadmill. Medial gastrocnemius (MG)
and tibialis anterior (TA) activity was collected using surface EMG. Ankle angle at heel strike
(HS), ankle angle at toe-off (TO), peak dorsiflexion (DF) in swing, TA co-contraction index (TA
CCI), and peak propulsive impulsive were assessed using a 3 (limb: control, non-paretic (NP),
paretic (P)) x 3 (footwear condition: SS, BF, MF) mixed factorial ANOVA. A priori significance
was set at p ≤ .05.
Results: For ankle angle at HS, there was a statistically significant limb x footwear interaction
(p<.01), where in the control limb, we observed greater peak swing ankle dorsiflexion during
MF (p<.01) compared to SS (p=.05) and barefoot (p<0.01) conditions. For ankle angle at TO,
there was a statistically significant main effect of Footwear, where regardless of limbs, greater
iii
plantarflexion at TO was observed in SS than the other conditions. For the ankle angle during
swing, we observed a statistically significant main effect of Footwear, where regardless of
limbs, greater dorsiflexion was observed when wearing MF (p<.05) than other conditions. For
TA CCI, there was a significant main effect of Footwear (p < .01), where regardless of limbs,
wearing MF promoted greater TA activity at toe off compared to SS (p = .02) and barefoot (p =
.04). Statistically significant main effect of Footwear was observed for propulsive impulse,
where regardless of limbs, wearing SS generated greater propulsive impulse than barefoot
walking.
Conclusions: This study noted that altering plantar somatosensation through different shoes
had a significant effect on ankle kinematics and muscle activation during gait. Specifically,
foam slippers promoted ankle dorsiflexion angle at heel strike, during swing, and increased
TA muscle activity at toe off. These findings suggest that memory foam slippers can be
incorporated into post-stroke gait training to address commonly observed reduced ankle
dorsiflexion and insufficient TA muscle activity, which contribute to footdrop during gait.
However, if the goal is to increase propulsive impulse, memory slippers may not be an
appropriate choice. Hence, this study may provide clinicians with new ideas for facilitating
improved gait kinematics in stroke rehabilitation.
Acknowledgments
This work was supported by the Student Opportunity Research Grant, Department of Physical
Therapy, University of Nevada, Las Vegas.
The authors would like to thank Douglas Eck, PT, DPT, MHI for assistance with participant
recruitment
This would seem to be making the process that Margaret
Yekutiel wrote a whole book about this in 2001, 'Sensory Re-Education
of the Hand After Stroke' automatic.
Of course your competent? doctor put together somatosensory protocols from this earlier research a long time ago, right? Oh no, you DON'T have a functioning stroke doctor, do you? Too bad, it's your problem to solve since your stroke hospital board of directors is fucking incompetent in running their hospital!
Steven Barlow, Corwin Moore Professor in special
education and communication disorders, attaches the pTACS' thermoplastic
tactile "touch" capsules to the hand of Jacob Greenwood, doctoral
candidate in biological systems engineering.
Now,
a group of Husker researchers, led by Steven Barlow, has patented a
groundbreaking frontline treatment — the pTACS Somatosensory Biomedical
Device — for cerebrovascular accidents that is portable, making it a
versatile product for use in rehabilitation clinics, emergency rooms
and, potentially, transport ambulances.
“It's a very low-cost
device,” said Barlow, Corwin Moore Professor in special education and
communication disorders, affiliate faculty in biological systems
engineering and resident faculty in the Center for Brain, Biology and
Behavior. “That means centers and rehabilitation facilities all over the
country and beyond will be able to use this technology. Stroke is the
number one health problem worldwide, now surpassing other types of
diseases.”
The device includes a “smart” pneumatic controller and a
microprocessor that is packaged inside a small black toolbox case and
runs on rechargeable lithium-ion batteries — the same type and size of
battery in a smartphone. The pTACS is a more compact, portable and
precise successor to the Galileo,
which Barlow’s team developed more than a decade ago to research how
somatosensory treatment employing micro pulses of air could aid in
stroke therapy. With funding from the National Institutes of Health,
American Heart Association, Barkley Trust and Nebraska Research, Barlow
was able to develop and fine-tune the somatosensory therapy protocols
through individualized research trials at the University of Nebraska–Lincoln.
The
success of those clinical trials led Barlow and team member Jacob
Greenwood, a doctoral candidate in biomedical engineering, to focus the
design of the device on performance, portability and usability. Barlow
and Greenwood share inventor status on the U.S. patent.
Loren Rye | Pixel Lab
“We take advantage of the inherent anatomy of the human
brain — the way these sensory pathways are laid out — and by placing
these cells on different parts of the body, we can selectively drive
different parts of the brain with tremendous precision.
Steven Barlow
Corwin Moore Professor in special education and communication disorders
The pTACS biomedical device is a non-invasive method of brain
stimulation. It utilizes rapidly compressed air pulses that are
delivered through small plastic tubes into thermoplastic tactile "touch"
capsules adhered to the hands, face, feet or other area of the skin to
evoke repeated volleys of nerve responses. The pTACS stimulation has
been shown to increase blood flow in tissues of the cerebral cortex that
are near the damaged area of the brain. Animal models developed in the Frostig laboratory
at the University of California, Irvine (Lay, Davis, Chen-Bee, Frostig,
2010) have shown that repeated somatosensory stimulation delivered
during critical periods of recovery has the potential to save brain
cells from death, preventing the formation of cerebral infarct.
“We
take advantage of the inherent anatomy of the human brain — the way
these sensory pathways are laid out — and by placing these cells on
different parts of the body, we can selectively drive different parts of
the brain with tremendous precision,” Barlow said.
The toolbox
containing the pTACS hardware and firmware is attached to a small laptop
containing the software to run the machine, delivering a programmed set
of air pulses based on research Barlow and his students have conducted
in the Barkley Speech-Language and Hearing Clinic and the Center for
Brain, Biology and Behavior, and at other area institutions.
“The
connected computer allows the user to select the protocol you want to
run, and once that protocol is selected, it does everything,” Greenwood
said.
Receiving a patent for the pTACS is a step in the process of
getting FDA approval for the device. Barlow said he expects to receive
an additional patent for his stroke treatment protocol and is working
with NUtech Ventures to create a biomedical startup to manufacture and
commercialize the device. Barlow has previous success with developing
and commercializing groundbreaking medical devices. He developed and commercialized the NTrainer System 2.0, now sold and marketed internationally by Cardinal Health as the Kangaroo NTrainer System.
Frontline
stroke treatment could be just one of the pTACS’ therapeutic
possibilities. Barlow and his team are developing and seeking funding to
further research treatment protocols for post-stroke injury and
speech-language therapy functions, including for those on the autism
spectrum disorder.
Loren Rye | Pixel Lab
Jacob Greenwood (front) and Steven Barlow are co-inventors of the recently patented pTACS Somatosensory Biomedical Device.
“We’ve had some patients in the clinic, and they're at least six
months post injury. Some of them are two and three years after their
stroke, and we're still able to generate very significant improvements
in their function,” Barlow said. “This therapy could be administered by a
speech-language pathologist, physical therapist, nurse practitioner or
someone with a neuroscience background.
“In a current MRI study in
collaboration with UNO Department of Biomechanics (Dr. Mukul Mukherjee)
and UNMC Department of Neurology (Dr. Pierre Fayad), we use the pTACS
device to drive mechanosensory nerve endings in the feet to stimulate
the balance and gait system and activate related brain pathways.”
Barlow anticipates more therapeutic uses for the pTACS device will be uncovered through additional research.
“It's
got a really good trajectory,” he said. “And we have a vibrant team. We
have a lot of investigators, and many students interested in this.”
