3D Exoskeleton Therapy Boosts Upper Limb Outcomes After Subacute Stroke

 'Boosts' is NOT GOOD ENOUGH! What will it take to get to 100% recovery? The only goal in stroke! Send these researchers back to the drawing board. 

3D Exoskeleton Therapy Boosts Upper Limb Outcomes After Subacute Stroke

Upper limb robot-assisted therapy using a 3-dimensional exoskeleton significantly improves motor recovery in patients with moderate-to-severe subacute stroke.

Upper limb robot-assisted therapy (UL-RAT) with a 3-dimensional (3D) exoskeleton significantly improves upper limb motor recovery when administered within the first month after a stroke, according to study findings published in Stroke.The multicenter randomized controlled trial evaluated the efficacy of RAT using a 3D exoskeleton to improve upper limb motor recovery in inpatients with subacute stroke and moderate-to-severe arm deficits.

Inpatients were enrolled from 8 stroke neurorehabilitation units between December 2020 and March 2024. The participants were aged 18 to 85 years and had a first-ever ischemic stroke confirmed with brain imaging. They were assigned to the robotic group, receiving UL-RAT, or the control group, which received conventional upper limb rehabilitation.

The patients were evaluated at baseline, end of treatment, and at 6 months after stroke onset. The primary outcome was the motor component of the Fugl-Meyer Assessment for Upper Limb (FM-UL), with a minimal clinically important difference (MCID) of 10.

 

These findings underscore the importance of early intensive intervention in the subacute phase and support the integration of exoskeleton-assisted therapy into rehabilitation programs…

A total of 94 patients with subacute stroke were enrolled, and 82 completed the treatment. The robotic group had 38 participants (mean age, 62 years; 31% women), and the control group had 44 participants (mean age, 63 years; 36% women). At 6 months, 49 participants were available for reassessment. A significant difference was observed in the FM-UL motor part, with higher values in the robotic group at the end of treatment (P <.001), in the between-group analysis.

Sensory score was significantly increased at the end of treatment compared with baseline in the robotic and control groups (P <.001). The joint passive range of motion did not significantly vary in the robotic group (P =.888), although it did in the control group (P =.005).

The proportion of patients who overcame the MCID of the FM score was 68.4% in the robotic group, which was more than double that occurring in the control group (31.8%), and this difference was statistically significant (P <.001). The relevant odds ratio was 4.64 (95% CI, 1.83-11.8).The interaction between time onset (≤30 and >30 days) and the participants’ severity in the robotic group compared with the control group was evaluated in a Kruskal-Wallis analysis, which did not find any statistically significant differences at baseline (P =.338) among the groups. Significant differences were found at the end of treatment (P =.008).

Limitations of the study include a relatively high dropout rate, especially at 6 months (52%), and baseline imbalances in the groups may have affected the results.

“These findings underscore the importance of early intensive intervention in the subacute phase and support the integration of exoskeleton-assisted therapy into rehabilitation programs, particularly for individuals with moderate-to-severe impairments,” the study authors concluded.

Sony gamifies home rehab with new medical venture

The bar for this is set impossibly low; 'improve mobility'; rather than recover lost movements. Until stroke survivors demand 100% recovery we get baby steps like this. I consider this a complete failure, back to the drawing board.

Sony gamifies home rehab with new medical venture

Smartphone app guides users through stroke recovery with help from AI

The new rehab smartphone app from Sony and M3 uses AI to help users improve their mobility. (Photo courtesy of Sony)

KOHEI YAMADA, Nikkei staff writerApril 27, 2022 00:47 JST TOKYO -- Sony Group and affiliate M3 have combined their gaming and medical know-how to help patients manage their own rehabilitation at home through a mobile app and wearable device.

SapplyM, a 51-49 joint venture between medical portal operator M3 and Sony, on Tuesday launched a service to help people recover their mobility after experiencing a stroke. The smartphone app lets users train at their own pace following exercises that meet their needs, enlisting artificial intelligence to gauge how well the patient is moving.

The service draws upon posture and motion analysis technology used by Sony in robots, together with experience gained from more than 100,000 rehab cases from M3 subsidiary Y's.

SapplyM also plans to provide remote training with physical therapists, as well as paid services along with its current free option. Other offerings in the works include home cardiac rehab using wearable devices and a service encouraging older people to walk more to avoid frailty.

"Medical care in outlying areas and at home is becoming more important as our society ages," Yoichi Katayama, a senior director at M3, said during a virtual news conference, adding that "we'll contribute by helping people have fun" with medical services like rehab.

"We will work with various partners to provide safety, health and peace of mind," said Toshimoto Mitomo, Sony's executive vice president in charge of business incubation.

The Sony Group once had an unwritten rule against involving itself in products that could seriously affect people's lives, but its stance has shifted over the past several years.

In addition to its foray into electric vehicles, the company has been developing medical devices such as endoscopes through a joint venture with Olympus. In 2016, Sony acquired Belgium-based eSaturnus, which provides video technology for operating rooms.

The group mostly classifies its medical equipment and health operations in the "other" category of its electronics products and solutions segment. Sony reported 182.6 billion yen ($1.42 billion at current rates) in sales in this area for fiscal 2020, a fraction of its estimated total fiscal 2021 sales of 9.9 trillion yen. But it has high hopes for its health business as a future profit center

How many push-ups can you do? Study finds men who can do 40 have lower risk of heart disease

Well, right now not any. Same reason as not being able to do missionary style sex.  Even before my stroke even though I was extremely fit I would never have gotten to 40 pushups.  I don't see the direct correlation between upper body strength and heart disease.  Go back to the drawing board and find a direct correlation.

Problems:

1.  Fingers and thumb will not stay flat.
2. Wrist collapses.
3. Elbow collapses.
4. Bicep spasticity pulls everything out of line.

What is your doctors' protocol to get pushups done? 

 

How many push-ups can you do? Study finds men who can do 40 have lower risk of heart disease

N'dea Yancey-Bragg

,

USA TODAY•February 17, 2019

The number of push-ups a man can do may be a good indicator of his risk for heart disease, a new study found.

The study, conducted by researchers at the Harvard T.H. Chan School of Public Health, compared the heart health of male firefighters over a 10-year period. Those who could do more than 40 push-ups during a timed test at a preliminary examination were 96 percent less likely to have developed a cardiovascular problem compared to those who could do no more than 10 push-ups, according to the report published Friday in the medical journal JAMA Network Open.

Nearly half of U.S. adults deal with some form of cardiovascular disease as of 2016, according to the American Heart Association.The study's authors believe push-ups may be an easy way to test men's risk for heart disease.

“Our findings provide evidence that push-up capacity could be an easy, no-cost method to help assess cardiovascular disease risk in almost any setting,” study author Justin Yang said in a statement. “Surprisingly, push-up capacity was more strongly associated with cardiovascular disease risk than the results of submaximal treadmill tests.”

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The men, who had an average age of 40 and an average body mass index (BMI) of 28.7 at the start of the study, performed both the push-up test and an exercise tolerance test on the treadmill. The participants were instructed to do push-ups in time with a metronome set at 80 beats per minute until they “reached 80, missed 3 or more beats of the metronome, or stopped owing to exhaustion.”

Over the following decade, the men underwent physical examinations and filled out health surveys. Among the 1,104 participants, 37 heart health problems were reported, such as coronary artery disease, heart failure, or sudden cardiac death.

The study found significantly lower rates of cardiovascular problems among those with higher push-up capacity compared with the lowest baseline push-up capacity. 

Though men who could do 40 or more push-ups had the lowest risk, participants able to perform 11 or more push-ups also showed reduced risk of subsequent heart health problems.

The study authors note that more research needs to be done before the findings can be generalized to other groups, like women, older people and those who are less active.

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Contributing: Brett Molina, USA TODAY

Follow N'dea Yancey-Bragg on Twitter: @NdeaYanceyBragg

This article originally appeared on USA TODAY: How many push-ups can you do? Study finds men who can do 40 have lower risk of heart disease

Pioglitazone therapy in patients with stroke and prediabetes: A post hoc analysis of the IRIS randomized clinical trial

Research speak so useless for survivors needing to train their doctors. Send them back to the drawing board and have them create 8th grade English so the average US citizen can understand.  

Wasn't this from Feb. 2016 good enough to write a protocol on it and prevent waste of further money on duplicate research? Once again researchers not keeping up-to-date in their field. I blame the mentors and senior researchers for such incompetency.

Pioglitazone after Ischemic Stroke or Transient Ischemic Attack - insulin resistance Feb. 2016

The latest here, was it needed?

Pioglitazone therapy in patients with stroke and prediabetes: A post hoc analysis of the IRIS randomized clinical trial

JAMA — Spence JD, et al. | February 11, 2019

Researchers assessed the impact of pioglitazone and the intention-to-treat effects of pioglitazone in prediabetes patients. In patients with stroke/transient ischemic attack and prediabetes, especially in those with good adherence, pioglitazone might be effective for secondary prevention.

Methods

• The IRIS study was a randomized multicenter clinical trial in patients with previous stroke or transient ischemic attack and insulin resistance, but not diabetes.
• From February 2005 to January 2013, patients were enrolled; median follow-up was 4.8 years.
• From June to September 2018, the post hoc analyses reported here were performed.
• Per American Diabetes Association criteria, prediabetes was characterized as having a hemoglobin A1c level of 5.7% to 6.4% or fasting plasma glucose level of 100 mg/dL to 125 mg/dL (to convert to mmol/L, multiply by 0.0555).
• Researchers defined good adherence as taking 80% or more of the protocol dose.
• Participants in the study were randomized to 15 mg of pioglitazone, with dose titrated to target of 45 mg daily, or matching placebo.
• Recurrent stroke or MI was the primary outcome; stroke, acute coronary syndrome, stroke/MI/hospitalization for heart failure, and progression to diabetes were included secondary outcomes.

Results

• Among 3,876 participants analyzed in the IRIS trial, 2,885 were involved in this analysis (1,456 in the pioglitazone cohort; 1,429 in the placebo cohort).
• It was noted that the mean (SD) age of patients was 64 (11) years, and 974 (66.9%) and 908 (63.5%) of patients were in the pioglitazone and placebo cohort, respectively.
• The hazard ratios (95% CI) were 0.57 (0.39-0.84) for stroke/MI, 0.64 (0.42-0.99) for stroke, 0.47 (0.26-0.85) for acute coronary syndrome, 0.61 (0.42-0.88) for stroke/MI/hospitalization for heart failure, and 0.18 (0.10-0.33) for progression to diabetes in the prediabetic population with good adherence (644 of 1,456 individuals [44.2%] in the pioglitazone group and 810 of 1,429 [56.7%] in the placebo group).
• The data presented in this work showed a nonsignificant reduction in overall mortality, cancer, and hospitalization, a slight increase in serious bone fractures, and an increase in weight gain and edema.
• Intention-to-treat outcomes also demonstrated significant reduction of events, though to a lesser degree.
• Investigators found that hazard ratios (95% CI) were 0.70 (0.56-0.88) for stroke/MI, 0.72 (0.56-0.92) for stroke, 0.72 (0.52-1.00) for acute coronary syndrome, 0.78 (0.63-0.96), for stroke/MI/hospitalization for heart failure, and 0.46 (0.35 to 0.61) for progression to diabetes.(Whatever the hell this means!)

Read the full article on JAMA

Endovascular Thrombectomy Appears to be Effective Treatment for Acute Ischemic Stroke Associated with Cervical Artery Dissection

Nothing here tells me that your definition of effective is anything close to 100% recovery. Go back to the drawing board and GET THERE! 

Endovascular Thrombectomy Appears to be Effective Treatment for Acute Ischemic Stroke Associated with Cervical Artery Dissection

Muhammad Zeeshan Memon, MD

Li S, Zi W, Chen J, Zhang S, Bai Y, Guo Y, et al. Feasibility of Thrombectomy in Treating Acute Ischemic Stroke Because of Cervical Artery Dissection. Stroke. 2018
Acute ischemic stroke associated with cervical artery dissection is traditionally treated with anticoagulants or antiplatelet agents. However, hyperacute stroke patients with large artery occlusion because of cervical artery dissection may not have good outcomes even if treated with intravenous thrombolysis. The feasibility of thrombectomy in treating acute ischemic stroke because of cervical artery dissection has not been probed well.
In this multicenter study from China, the investigators compared outcomes of 48 patients treated with endovascular treatment matched by propensity score to 48 historical control managed with medical treatment only. Patients were included in the study if they had a large artery occlusion (ICA,M1) which was attributed to cervical artery dissection. The diagnosis of cervical artery dissection was based on typical radiologic characteristics, on magnetic resonance angiography, CT angiography, or digital subtraction angiography. Only patients with thrombectomy performed within 6 hours with stent retrievers were included in the interventional arm. For single artery occlusion, a stent retriever was usually used first; for tandem artery occlusions, priority to treat the proximal or the distal occlusion was decided by the operator depending on the lesion profiles. The authors reported that the proportion of favorable outcome (modified Rankin Scale score of 0–2) was higher in patients with thrombectomy than in those without (66.7% versus 39.6%; P=0.008). There were no significance differences about the incidence of symptomatic intracranial hemorrhage (8.3% versus 4.2%; P=0.677) and the 90-day mortality (10.4% versus 6.3%; P=0.714) between matched patients with and without thrombectomy.

Previous studies comparing medical treatment with mechanical thrombectomy have shown mixed results. From the SWISS Registry which compared the endovascular therapy versus intravenous thrombolysis in 62 cervical artery dissection patients, there was no superiority of endovascular treatment over intravenous thrombolysis. The current study also observed a higher ratio of SICH (8.3%) compared with previous studies, which the authors attribute to longer mean time onset to puncture and puncture to recanalization.
It is important to point out several limitations of this study, including retrospective design and multiple participating centers without uniform protocols, which may have increased the heterogeneity of the study. Lastly, thrombectomy patients were compared with historical controls several years earlier, and only stent retrievers were used for thrombectomy, which can lead to selection and treatment bias in this cohort.
Nevertheless, the results are promising, and feasibility and efficacy of thrombectomy in stroke patients because of cervical artery dissection should be investigated further in a large prospective study.

PinnacleHealth’s new technology helps protect patients from risk of stroke during TAVR

63% reduction and 99% capture rate is still not good enough, better than nothing but send them back to the drawing board. We let the known failure rate of tPA being 88% last for decades without being challenged. Demand better, your doctors probably won't, it is not their problem if you get a stroke. OR ARE WE WAITING FOR SOMEONE ELSE TO SOLVE THE PROBLEM?     

PinnacleHealth’s new technology helps protect patients from risk of stroke during TAVR

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August 24, 2017

PinnacleHealth is the first hospital in Pennsylvania and one of the first 10 in the country to introduce new technology shown to help protect patients from the risk of stroke during transcatheter aortic valve replacement (TAVR).
Minimally invasive TAVR is proven effective in treating aortic stenosis without open heart surgery for patients at too high of a risk for surgery. However, during TAVR, calcium deposits from the heart valve or tissue can be dislodged and may travel to the brain, which can create a stroke risk. Based on clinical trial results and major TAVR registry data, the reported risk of stroke for TAVR patients varies between 1-5 percent.

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PinnacleHealth is implementing the Sentinel Cerebral Protection System, the first FDA-cleared device available in the U.S., to capture and remove this debris before it reaches the brain. The device has been shown to reduce strokes by 63 percent during the procedure and in the first 72 hours post-procedure, when most strokes occur.
In the U.S. clinical trial of the technology, the device captured debris in 99 percent of TAVR cases,⁶ with no added risk for the overall procedure. The Sentinel device is inserted through the catheter before the TAVR device and comes out after the valve is deployed. It is shaped like a butterfly net, collapsing around the debris and allows the debris to be removed from the body after the procedure.
"Any stroke is one stroke too many," says Hemal Gada, MD, MBA, medical director of structural heart at PinnacleHealth CardioVascular Institute.
"We are proud to be on the vanguard of offering the most advanced medical technology to keep our patients safe and value the added layer of protection this device brings to our patients," says Mubashir Mumtaz, MD, FACS, FACC, chief of cardiothoracic surgery and surgical director of structural heart at PinnacleHealth CardioVascular Institute.
More than 3,500 patients worldwide have been protected with the innovative technology to-date.

Source:

http://www.pinnaclehealth.org/our-health-system/news-and-announcements/article/new-technology-helps-protect-pinnaclehealth-patients-from-risk-of-stroke-during-heart-valve-replacement