Health officials urge preventative care during Stroke Awareness Month

All because your stroke medical 'professionals' are complete fucking failures at 100% recovery!  And the AHA/ASA refuses to actually solve stroke to 100% recovery. It's doable, existing research just needs to be followed!

Health officials urge preventative care during Stroke Awareness Month

BURLINGTON, Vt. —

Every 40 seconds, the American Heart Association estimates someone has a stroke in the U.S. -- and that's one of the reasons recognizing the warning signs and acting fast can be so critical.

According to the Centers for Disease Control and Prevention, at least one in three Americans have a condition that puts them at risk of stroke.

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Nancy Malhotra, a nurse practitioner at UVM Medical Center, says knowing the warning signs in advance can be life-saving -- and to remember the acronym 'BE FAST.'

B stands for sudden loss of balance, E for sudden change of vision, F is for facial drooping, A stands for arm numbness, S for speech difficulties, and T is a reminder that if you experience any of these symptoms, it's time to call 911.

Malhotra said many strokes can be prevented with simple lifestyle changes.

“There are what we call modifiable risk factors. High blood pressure, diabetes, you know, your diet, exercise, all of those things that can make an impact of prevention for you not to have a stroke," she said.

But there are also non-modifiable risk factors, that depend on gender and race.

Regular checkups can catch conditions like high blood pressure or diabetes, before they become a serious threat.

“A lot of people don’t know they have high blood pressure until they have their first stroke," Malhotra said. "Knowing what your baseline blood pressure is and having that conversation with your primary care provider is very important.”

She also warns that certain heart conditions can put people at higher risk and when a stroke does occur, treatment isn’t over when the patient leaves the hospital.

“We want to be able to get them some semblance back to their baseline of function," Malhotra said. "A lot of times patients don't go to acute rehab or to a rehab facility after their stroke, so sometimes it falls on the caregivers to do a lot of the stroke rehabilitation."

Officials say education and early intervention are the best tools to improve recovery.

Hospital wins Primary Stroke Center status; East Georgia Regional Medical Center, Statesboro,GA

And just why the fuck should we go to a 'care' center rather than a 'results' center? If you can't tell us your results you are hiding how fucking bad you are. We have to completely change how stroke is discussed, every single article on stroke should be mentioning exactly what the failures are and what is being done to fix them.   Notice they don't tell us;

1. tPA full recovery better than 12%?

2. Full stroke recovery better than 10%?

3.  30 day stroke deaths better than your competitors?

 

Hospital wins Primary Stroke Center status;  East Georgia Regional Medical Center, Statesboro,GA

After a year of refining and monitoring its stroke care processes and with the addition of a tele-stroke program, East Georgia Regional Medical Center recently won certification as a Primary Stroke Center by The Joint Commission and the American Stroke Association.

Primary Stroke Center status indicates that the Statesboro hospital provides rapid, consistent primary stroke treatment, meeting Joint Commission and America Stroke Association standards, said EGRMC Stroke Program Coordinator Bryan Realiza.

“It means that we have put forth the time, energy, resources and funding to create a set of processes here at our facility that should happen every time a stroke patient comes into our hospital,” Realiza said. “So in terms of efficiency and reductions in variation of care, this is what we want to see for our community.”

 

Stroke-prone area

The hospital serves Bulloch County and some neighboring counties which have higher rates of strokes and stroke deaths than Georgia overall.

In fact, a Centers for Disease Control and Prevention online report ranks Bulloch eighth among Georgia’s 159 counties in hospitalizations of Medicare beneficiaries over age 65 for strokes. The rate in Bulloch, from 2015-17, was 15.8 stroke hospitalizations per 1,000 Medicare beneficiaries, compared to 12.4 statewide and 11.6 stroke hospitalizations per 1,000 Medicare beneficiaries nationally.

“We’re the eighth-highest county in stroke hospitalizations in Georgia, which is a big deal,” Realiza said. “A lot of stroke patients are coming here, and prior to this, there were no strict guidelines on what we should do. So there was probably a little bit more variation until we came in and said, no, this is what we want to do every single time.”

Like many hospitals across the country, East Georgia Regional Medical Center also maintains its general accreditation through The Joint Commission. In the collaborative stroke center certification program, the Joint Commission awards its trademarked Gold Seal of Approval while the America Stroke Association, or ASA, awards a Heart-Check mark.

A number of the standards require meeting time limits in diagnosis and treatment. For example, a head CT scan, blood work and an electrocardiogram are all supposed to be done within 45 minutes of a patient arriving with stroke symptoms.

 

‘Time is brain’

“Making sure that things happen quickly” is important because “with a stroke, there’s a common saying that ‘Time is brain,’” Realiza said.

In other words, without treatment, more brain tissue can die with the passage of time, leading to permanent disability or even death. So EGRMC is now committed to making sure that these standards of timeliness are met.

The hospital had to monitor these and other goals and standards for four months to even request a Primary Stroke Center evaluation, but ended up monitoring for a full year. This was partly because the evaluation process was delayed by the COVID-19 pandemic.

Realiza created flow charts of the hospital’s newly standardized processes for evaluation and treatment of strokes. He said he strived to make these easy to understand so that they can be given to new EGRMC employees, such as nurses, and provide them quick guidance on what is expected.

The ASA and Joint Commission surveyor who visited the hospital complimented him on accomplishing that, Realiza said.

After visiting EGRMC Nov. 13, the surveyor reported back to the certification board, and the hospital administration was notified of the certification Nov. 29.

“We congratulate East Georgia Regional Medical Center for this outstanding achievement,” American Stroke Association CEO Nancy Brown said in a media release. “This certification reflects its commitment to providing the highest quality of care for stroke patients.”

Realiza said the required standards were the same for East Georgia as they would be for a Mayo Clinic or the Cleveland Clinic. However, he also noted that what EGRMC has achieved is Primary Stroke Center certification. A hospital with more resources could be certified as Comprehensive Stroke Center.

“A Comprehensive Stroke Center means you have a neurosurgeon on site that can intervene surgically if a stroke is happening,” Realiza said. “Now, we don’t have any neurosurgeons here at our hospital. So what we do is we try to stabilize them with medicine.”

In particular, a medication called Alteplase, which some people know as TPA, can sometimes be given as an infusion to stop a stroke.

However, a number of contraindications can prevent Alteplase from being administered. Additionally, some other conditions can mimic a stroke, and Alteplase has to be given within four and a half hours after symptoms appear.

 

Tele-stroke

Evaluating whether a patient is actually having a stroke and can benefit from Alteplase or will need surgery at another facility is where EGRMC’s tele-stroke program helps, Realiza said.

The hospital launched this program in January, contracting with the multispecialty telemedicine group Access Physicians to provide a 24-hour, seven-days-a-week connection to neurologists specializing in stroke treatment.

“We needed a neurologist to really be there quickly to make that call, and so that’s what our tele-neurology, tele-stroke program does,” he said. “We are able to get a neurologist in front of that patient in 15 minutes to make the call.”

That 15-minute target is not one of the standards for a Primary Stroke Center but was the hospital’s own goal.

Each tele-stroke cart carries a very high-resolution digital camera that the neurologist can use to look closely at a patient’s eyes and check the reactivity of the pupils. A nurse at bedside positions a microphone-backed stethoscope for the neurologist to listen to heartbeat and blood flows.

Three neurologists in Texas, Florida and Michigan provide the Access Physicians tele-stroke services, appearing on screen.

 

Local neurologists

But two Statesboro-based neurologists, Dr. Kashyap Patel and Dr. Michael Taormina, are affiliated with EGRMC and provide in-person, day-to-day care.

“With our stroke patients, both our tele-neurologists and our local neurologists work together as a group,” Realiza said. “What happens is, the tele-neurologists take on the front end, getting there quickly, identifying what’s going on, and once they’ve decided that patient is able to stay here in our facility, they’ll pass the baton to our local neurologists … and they’ll do the follow-up care.”

Realiza is not a doctor himself but holds master’s degrees in healthcare administration and business administration and serves as the hospital’s stroke program coordinator and chest pain program coordinator. Before the stroke center certification work, he guided the effort that resulted in East Georgia’s accreditation as a Chest Pain Center by the American College of Cardiology in August 2019.

 

Support and education

He also launched a stroke support group for patients and family caregivers at the beginning of 2020. Only two monthly meetings were held before COVID-19 halted the project. Realiza and EGRMC Marketing Director Erin Spillman said they hope the group will be able to hold quarterly meetings in 2021.

They also hope to bring more community education programs, such as those for awareness of stroke symptoms, to events such as health fairs, when COVID-19 relents. Incidentally, stroke was the fifth leading cause of death in the United States, in CDC reports, before the coronavirus moved ahead of some of the usual top causes.

 

Role of EMS

In his statement about the stroke center certification, the hospital’s CEO, Stephen Pennington, thanked area Emergency Medical Service agencies for working with EGRMC in improving stroke response.

“Our relationship with local EMS encourages the use of field assessment tools and communication prior to transporting patients with stroke-like symptoms to our Emergency Department,” Pennington said. “As a Primary Stroke Center, this joint effort allows the best possible outcome for all patients.” (But that outcome must not be good because you tell us no factual statistics on recovery.)

 

Midland hospital's stroke center recognized for quality care - Midland, MI

And just why the fuck should we go to a 'care' center rather than a 'results' center? If you can't tell us your results you are hiding how fucking bad you are. We have to completely change how stroke is discussed, every single article on stroke should be mentioning exactly what the failures are and what is being done to fix them.   Notice they don't tell us;

1. tPA full recovery better than 12%?

2. Full stroke recovery better than 10%?

3.  30 day stroke deaths better than your competitors?

Midland hospital's stroke center recognized for quality care - Midland, MI

Patients who are experiencing warning signs of a stroke have one more reason to make MidMichigan Medical Center – Midland their go-to place for treatment. The medical center was awarded Primary Stroke Center Certification by HFAP, the nation’s original independent, accreditation program. This certification confirms that the program is providing high quality care as determined by an independent, external process of evaluation.

“We’re proud to achieve this prestigious certification that recognizes our commitment to excellent patient outcomes,” said Faith Fuentes, neurohospitalist and medical director for the stroke program at MidMichigan Health. “We’ve built a comprehensive program based on the latest clinical protocols and our team of experts includes emergency medicine physicians, neurohospitalists, neurologists, neurosurgeons, critical care specialists and rehabilitation specialists. Through the Telestroke program, all of MidMichigan’s Emergency Departments have 24/7 access to collaborate with highly specialized stroke experts from Michigan Medicine. Together, we provide rapid diagnosis and treatment planning that can save lives and preserve vital functionality.”

According to Fuentes, the medical center’s stroke team also provides community outreach to help patients and their families recognize the warning signs of stroke so they can take action quickly when every second counts.

“MidMichigan clearly demonstrates a commitment to quality and patient safety,” said HFAP Vice President Meg Gravesmill. “We based our decision on the findings of an extensive and thorough onsite review of their stroke capabilities against standards for organizational operations and clinical services that drive patient safety and continuous quality improvement. MidMichigan has earned the distinction of HFAP certification through its performance in successfully meeting those standards.”

Those who would like to learn more about MidMichigan’s options for care and treatment of stroke may visit www.midmichigan.org/stroke or contact Gordon Siu, stroke program director, and Tammy Albrecht, neuroscience services manager, via email at stroke@midmichigan.org.

 

Plastic container failures

 It is nigh impossible to resnap the lid on these one handed. You have to hold one corner down while you snap the opposite corner in place. And I don't carry multiple locking pliers with me wherever I go. Zero planning for this with any of my therapists. This has an interior rim from Costco.

New Chapter in NWI Stroke Recovery Begins with $40M Stroke and Rehabilitation Center Project Completion - Crown Point, IN

But are you going to provide the same results of FAILURE, FAILURE, FAILURE? Your choice, ask them the hard questions or accept fucking failures. All I see is 'care' which means absolutely nothing.

Three measurements will tell me if the stroke hospital is possibly not completely incompetent; DO YOU MEASURE ANYTHING?

1. tPA full recovery? Better than 12%?
2. 30 day deaths? Better than competitors?
3. rehab full recovery? Better than 10%?

 

New Chapter in NWI Stroke Recovery Begins with $40M Stroke and Rehabilitation Center Project Completion

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leslie

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March 25, 2020

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Community Stroke and Rehabilitation Center located at 10215 Broadway in Crown Point, IN

Patients regaining their strength after strokes and other medical conditions have a brand-new state-of-the-art facility for their recovery.
The Pangere Corporation, a commercial and industrial contractor based in Gary, IN, recently announced the construction of Community Healthcare System’s new specialty hospital in Crown Point. The $40 million Community Stroke & Rehabilitation Center recently has been completed and is now serving the community.
“This beautiful new building is a great place for recovery, rehabilitation and already has a reputation for tough therapists,” joked one recent stroke survivor. His goal is to walk unassisted by this summer, a little over a year after his stroke. Medical staff at the new building are working to see that he does.
“That’s why we do what we do,” said Steve Pangere, President of the Pangere Corp. “We’re proud to deliver project outcomes that serve people well. The new Community Stroke & Rehabilitation Center is going to improve the quality of life for a lot of people for years to come.”
Crown Point Mayor David Uran said, “The builders of this facility had the future in mind. We’re thrilled with the outcome, and the expansion of world-class care in our city.”
Four Floors of Healing
The facility is a four-story, 129,000-square-foot multispecialty center that features inpatient rehabilitation, therapy gyms, and living-skills space. In addition, outpatient services include immediate care, a full lab, diagnostic testing and imaging services, and a Women’s Diagnostic Center.
Community Care Network specialists in cardiology, internal medicine, neurology, obstetrics and gynecology, orthopedics, and pulmonary medicine broaden the scope of wellness and preventative care.
The first floor of the new Stroke & Rehabilitation Center contains immediate care, radiology, CT, MRI, non-invasive cardiology testing, laboratory services, and outpatient therapy services including physical therapy, occupational therapy, speech therapy, and physician offices.
The second floor houses the Women’s Diagnostic Center which offers bone density scanning, mammography, ultrasound, and other services.
The third and fourth floors have 40 private rooms for inpatient rehabilitation care. Among those are apartment-themed rooms where patients can practice daily living activities. Therapies provided on these floors are for complex stroke, traumatic brain injury, neurological conditions, and spinal cord treatments.
The building also has a healing garden, a visitors’ café and an abundance of natural lighting.
High-Quality Craftsmanship 
Hundreds of union craft workers helped bring the facility to life. The Pangere Corp. worked with a team of about 38 subcontractors and numerous suppliers. Only the most modern building materials, equipment and finishes were incorporated into the building’s design. The architect for the project was Design Alliance Architects from Hammond, IN.
All Pangere Corp. carpenters are certified in Infection Control Risk Assessment (ICRA) and are accredited fire stop installers. Additionally, the company recently became one of just a few midwestern contractors to earn Door Safety Inspector (DSI) certifications from the National Fire Protection Association (NFPA).
For details and information about services offered at the Community Stroke & Rehabilitation Center, visit: https://www.comhs.org/about-us/community-stroke-and-rehabilitation-center.

Lower-Limb Robotic Rehabilitation:Literature Review and Challenges

You can read the 11 pages on your own. It doesn't sound like anything close to a protocol came out of it.  So you are still completely on your own to figure out your recovery. Your stroke medical 'professionals' know absolutely nothing specific. By guess and by golly seems to be their mantra.  We need survivors in charge, failure will continue without that.

Lower-Limb Robotic Rehabilitation:Literature Review and Challenges

B cells migrate into remote brain areas and support neurogenesis and functional recovery after focal stroke in mice

What the hell are your doctors and stroke hospital doing to ensure that human testing occurs? Waiting for SOMEONE ELSE TO SOLVE THE PROBLEM is pure incompetency.  I'd suggest having survivors run that stroke hospital. We finally would get stroke solved. Current stroke leaders have been failing for 50+ years, we can't do worse. 

B cells migrate into remote brain areas and support neurogenesis and functional recovery after focal stroke in mice

Sterling B. Ortegaa,b,c,1, Vanessa O. Torresb,c,1, Sarah E. Latchneyd,e, Cody W. Whooleryd, Ibrahim Z. Noorbhaib,c, Katie Poinsatteb,c, Uma M. Selvarajb,c, Monica A. Bensonb,c, Anouk J. M. Meeuwissenb,c, Erik J. Plautzb,c, Xiangmei Kongb,c, Denise M. Ramirezb,c, Apoorva D. Ajayb,c, Julian P. Meeksb,c,f, Mark P. Goldbergb,c, Nancy L. Monsonb,c, Amelia J. Eischd,g,h, and Ann M. Stoweb,c,i,2
aDepartment of Pathology, University of Iowa, Iowa City, IA 52242; bDepartment of Neurology and Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX 75390; cPeter O’Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, TX 75390; dDepartment of Psychiatry, UT Southwestern Medical Center, Dallas, TX 75390; eDepartment of Biology, St. Mary’s College of Maryland, St. Mary’s City, MD 20686; fDepartment of Neuroscience, UT Southwestern Medical Center, Dallas, TX 75390; gDepartment of Neuroscience, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104; hDepartment of Anesthesiology and Critical Care, Children’s Hospital of Philadelphia, Philadelphia, PA 19104; and iDepartment of Neurology, University of Kentucky, Lexington, KY 40506
Edited by Lawrence Steinman, Stanford University School of Medicine, Stanford, CA, and approved January 16, 2020 (received for review August 1, 2019)
Lymphocytes infiltrate the stroke core and penumbra and often exacerbate cellular injury. B cells, however, are lymphocytes that do not contribute to acute pathology but can support recovery. B cell adoptive transfer to mice reduced infarct volumes 3 and 7 d after transient middle cerebral artery occlusion (tMCAo), independent of changing immune populations in recipient mice. Testing a direct neurotrophic effect, B cells cocultured with mixed cortical cells protected neurons and maintained dendritic arborization after oxygen-glucose deprivation. Whole-brain volumetric serial two-photon tomography (STPT) and a custom-developed image analysis pipeline visualized and quantified post stroke B cell diapedesis throughout the brain, including remote areas supporting functional recovery. Stroke induced significant bilateral B cell diapedesis into remote brain regions regulating motor and cognitive functions and neurogenesis (e.g., dentate gyrus, hypothalamus, olfactory areas, cerebellum) in the whole-brain datasets. To confirm a mechanistic role for B cells in functional recovery, rituximab was given to human CD20+ (hCD20+) transgenic mice to continuously deplete hCD20+-expressing B cells following tMCAo. These mice experienced delayed motor recovery, impaired spatial memory, and increased anxiety through 8 wk poststroke compared to wild type (WT) litter mates also receiving rituximab. B cell depletion reduced stroke induced hippocampal neurogenesis and cell survival. Thus, B cell diapedesis occurred in areas remote to the infarct that mediated motor and cognitive recovery. Understanding the role of B cells in neuronal health and disease-based plasticity is critical for developing effective immune based therapies for protection against diseases that involve recruitment of peripheral immune cells into the injured brain.

Application Values of Six Scoring Systems in the Prognosis of Stroke Patients

Have you ever asked a stroke patient the usefulness of these scoring systems?  

They are completely useless. NOTHING here will help survivors to 100% recovery. Quit hiding behind the current failures of the stroke status quo.

Application Values of Six Scoring Systems in the Prognosis of Stroke Patients

Qun-Xi Li¹, Xiao-Jing Zhao^2*, Hai-Yan Fan², Xiang-Nan Li¹, Da-Li Wang², Xiu-Jie Wang², Jiang Zhang², Rui-Ying Chen² and Li Zhang²

• ¹Department of Neurosurgery, Affiliated Hospital of North China University of Science and Technology, Tangshan, China
• ²Department of Neurology, Affiliated Hospital of North China University of Science and Technology, Tangshan, China

Objective: The present study aimed to evaluate the prognostic value of Acute Physiology and Chronic Health Evaluation (APACHE; II and III), Chinese Stroke Scale (CSS), National Institutes of Health Stroke Score (NIHSS), activities of daily living (ADL) (Barthel index, BI), and Glasgow Coma Scale (GCS) scores for stroke patients.

Methods: A total of 352 stroke patients were evaluated using APACHE II, APACHE III, CSS, NIHSS, ADL, and GCS scores within 24 h after admission. And these patients were consecutive admissions to the hospital. The endpoint was in-hospital death. The scores of these scales were compared between the survival group and death group, and the receiver operating characteristic (ROC) curves were drawn. The ability of each scoring system to predict the prognosis of patients was evaluated using the area under the ROC curve, and the areas under the curves (AUCs) of these six scales were compared.

Results: The AUCs of the APACHE II, APACHE III, CSS, NIHSS, ADL, and GCS scores were 0.882, 0.867, 0.832, 0.859, 0.838, and 0.819, respectively.

Conclusion: APACHE II, APACHE III, CSS, NIHSS, ADL, and GCS scores have good predictive values in the prognosis of stroke patients. APACHE II is superior among the other five scales.

There are two objects of medical education: To heal the sick, and to advance the science. Dr. Charles H. Mayo

Well, I think your stroke hospital is totally failing at both. If they are failing at both:  Why the fuck are they even calling themselves a stroke hospital? I blame the boards of directors for not having the correct goals for the hospital. The status quo in stroke is a complete failure and is not defensible.

1. Heal the sick failures here:

12% tPA full recovery? 

Only 10% rehab full recovery?

13 stroke problems with no cure

2. Advance the science failures here:

Has your stroke hospital contacted researchers to get any of the thousands of research articles followed up with human testing that suggested efficacy in animals? 

Has your stroke hospital implemented ANY  stroke rehab research into protocols? 

And if we had a great stroke association run by survivors then every stroke hospital would be contacted to see how they are solving stroke. But we have instead: NO STROKE STRATEGY AND NO STROKE LEADERSHIP.

"There are two objects of medical education: To heal the sick, and to advance the science."  Dr. Charles H. Mayo

Help plan the future of stroke care in County Durham

YOU can't let the medical staff decide this, they will not even set a goal of 100% recovery.   The title, using the word 'care' already means they have given up on solving stroke. You need to replace whomever set this up.  They are OK with the current status quo of complete failure.

Help plan the future of stroke care in County Durham

STROKE, despite often being a preventable disease, is the fourth single leading cause of death in the UK and the single largest cause of complex disability in adults.

In County Durham and Darlington stroke affects around 1,000 people each year. When a stroke strikes, what matters is getting the right treatment quickly in the right place.

Since centralising immediate stroke care services at University Hospital North Durham, we have seen increased improvements in the outcomes for patients, but we recognise that stroke rehabilitation could still be improved.
At present when patients are discharged from the immediate stroke care ward into a community setting, they receive varying levels of therapy input. A proportion of patients, approximately 20 per cent, require longer inpatient specialist rehabilitation and are currently transferred to Bishop Auckland Hospital’s stroke rehabilitation unit, with an average stay of 20 days.
Dr Stewart Findlay, NHS Durham Dales, Easington and Sedgefield CCG and NHS North Durham CCG chief officer
Our aim is to create improvements across the whole of County Durham and Darlington so more patients are discharged in a timely manner, with seamless care and rehabilitation during their hospital stay, before returning earlier to their own home to be looked after in their own surroundings. As part of this we have invested significantly into community services across the local area.
In our public consultation we have put forward two proposals for the future of stroke rehabilitation services at Bishop Auckland Hospital:
• Keep the service as it is(That is totally unacceptable, the current service is a total fucking failure. They don't get you to 100% recovery , do they?)
• Combine immediate stroke care and in-patient rehabilitation under one roof at University Hospital of North Durham, with all staff on one specialist site, providing continuity of care(You don't want 'care', DEMAND 100% RECOVERY.) and ensuring a robust pathway between hospital and community.

A third option is the only one to consider. Get to 100% RECOVERY FOR ALL.

Because they gave you two bad options they need to be fired and not allowed in the discussion. 

As part of this consultation we want to know what you think. We will be holding four public events. These will provide opportunities for you to hear about the options presented and share your views. They are on:
Saturday, January 25: 10am-noon at Bishop Auckland Football Club, DL14 9AE
Tuesday, February 4: 6pm-8pm at Durham Town Hall, DH1 3NJ
Thursday, February 6: 10am-noon at The Witham, Barnard Castle, DL12 8LY
Tuesday, February 11: 1pm-3pm at St Augustine Parish Centre, Darlington DL3 7TG.
Share your comments and register for our public events by e-mailing my.view@nhs.net or calling our answerphone service on 0191 3898609.

The Impact of Severity, Timing, and Sex on Outcomes of Inpatient Stroke Rehabilitation

What is so wrong about this is that it assumes the failures of stroke rehab status quo can't change. CHANGE THE STATUS QUO!

There should be rehab protocols for stroke severity and time to intervention, don't just throw up your hands in defeat because this is going to be difficult. Try recovering from a stroke with NOTHING USEFUL from your stroke medical 'professionals'.  

The Impact of Severity, Timing, and Sex on Outcomes of Inpatient Stroke Rehabilitation

Abstract

Stroke severity and time to rehabilitation admission (Quit using your fucking lazy excuses as to why you can't get survivors recovered.)are important factors in influencing stroke rehabilitation outcomes. We aimed to determine the impact of: (1) stroke severity and timing to inpatient rehabilitation admission on length of stay, functional gains, and discharge destination; and (2) age and sex differences in time to rehabilitation, length of stay in rehabilitation, and discharge destination for stroke patients in Alberta. The first manuscript offers a discussion of post-positivist critical multiplism and its value for nursing research and describes the steps for conducting critical multiplist nursing research using stroke rehabilitation as an example. We identify that post-positivist critical multiplism offers a useful, rigorous approach that relies on a step-by-step method and a collaboration with a team of scholars who offer different perspectives, open questioning and critique, and rigorous attention to minimize biases throughout the research process. We examined a large retrospective cohort to address the research aims. In the second paper, we identified that length of time to rehabilitation admission was not significantly different between stroke severities. Individuals with moderate and severe stroke made significantly larger FIM gains than mild stroke during inpatient rehabilitation. LOS was longer with increasing stroke severity. Time to inpatient rehabilitation admission had small, but significant impacts on functional gains and LOS. Patients with shorter times to rehabilitation admission and those with mild stroke were more likely to be discharged home without needing health services. In the third paper, we identified that mean length of time from acute care admission to inpatient rehabilitation admission was not significantly different between males and females. There was no significant difference in mean FIM change between males and females during inpatient rehabilitation. Mean LOS in rehabilitation was slightly longer among females compared to males. Male patients and those of younger age were more likely than females and those of older age to be discharged home without needing homecare. In conclusion, stroke severity had a significant impact on the conduct of inpatient rehabilitation. The impact of timing on functional gains and LOS was small. Differences in LOS and discharge destination based on sex and age were significant.

Citation

Tanlaka, E. F. (2020). The Impact of Severity, Timing, and Sex on Outcomes of Inpatient Stroke Rehabilitation (Unpublished doctoral thesis). University of Calgary, Calgary, AB.

Faculty

Nursing

Institution

University of Calgary

Uri

http://hdl.handle.net/1880/111454

Collections

• The Vault: Electronic Theses and Dissertations

Plastic bag failures

I absolutely hate using plastic bags.

1. Problem #1, getting it open with one hand.

2. Problem # 2, keeping it open with one hand while filling it. Teeth sometimes work.

3. Problem #3, keeping it open with one hand while emptying it.

Understanding gait control in post-stroke:Implications for management

So NOTHING IS KNOWN ABOUT GAIT CONTROL, and by implication your doctor and therapists have NO EXACT information on how to get your gait 100% recovered. Aren't you glad that absolutely everything in stroke is a complete failure? Stroke is at rock bottom and can only go up from here. Maybe?

How are your children and grandchildren going to recover from a stroke? Only by putting in place competent stroke leadership and strategy.

Understanding gait control in post-stroke: Implications for management

Author links open overlay panelRajeshVermaDM (Neurology), DNB (Neurology)(Professor)Kamal NarayanAryaMOT, PhD (Scholar)(Sr. Occupational Therapist)

PawanSharmaMD (Medicine), Sr. Resident, DM (Neurology)-IIIR.K.GargDM (Neurology)(Professor & HOD)

https://doi.org/10.1016/j.jbmt.2010.12.005Get rights and content

Summary

The role of the brain in post-stroke gait is not understood properly, although the ability to walk becomes impaired in more than 80% of post-stroke patients. Most, however, regain some ability to walk with either limited mobility or inefficient, asymmetrical or unsafe gait. Conventional intervention focuses on support of weak muscles or body part by use of foot orthosis and walking aids. This review provides an overview of available evidence of neuro-kinesiology & neurophysiology of normal and post-stroke gait. The role of the spinal cord has been explored, more in animals than humans. Mammalian locomotion is based on a rhythmic, “pacemaker” activity of the spinal stepping generators. Bipedal human locomotion is different from quadripedal animal locomotion. However, knowledge derived from the spinal cord investigation of animals, is being applied for management of human gait dysfunction. The potential role of the brain is now recognized in the independent activation of muscles during walking. The brain modifies the gait pattern during the complex demands of daily activities. Though the exact role of the motor cortex in control of gait is unclear, available evidence may be applied to gait rehabilitation of post-stroke patients.

Stroke rehabilitation: what works?

My question is totally different; 'What doesn't work?' Nothing works in stroke, there is NO PATH to 100% recovery. 

EVERYTHING IS A FAILURE IN STROKE!

The current state of stroke is a complete failure. None of the following have cures. 

1. 30% get spasticity NOTHING THAT WILL CURE IT.

2. At least half of all stroke survivors experience fatigue Or is it 70%?

Or is it 40%?

NOTHING THAT WILL CURE IT.

3. Over half of stroke patients have attention problems.

NOTHING THAT WILL CURE IT.

NO PROTOCOLS THAT WILL CURE IT.

4.  The incidence of constipation was 48%.

NO PROTOCOLS THAT WILL CURE IT.

5. No EXACT stroke protocols that address any of your muscle limitations.

6. Poststroke depression(33% chance)

NO PROTOCOLS THAT WILL ADDRESS IT. 

7.  Poststroke anxiety(20% chance) NO PROTOCOLS THAT WILL ADDRESS IT. 

8. Posttraumatic stress disorder(23% chance)  NO PROTOCOLS THAT WILL ADDRESS IT.

  9.  12% tPA efficacy for full recovery NO ONE IS WORKING ON SOMETHING BETTER.

10.  10% seizures post stroke NO PROTOCOLS THAT WILL ADDRESS IT. 

11. 21% of patients had developed cachexia NO PROTOCOLS THAT WILL ADDRESS IT. 

 

12. You lost 5 cognitive years from your stroke  NO PROTOCOLS THAT WILL ADDRESS IT.

13.  33% dementia chance post-stroke from an Australian study?

       Or is it 17-66%?

       Or is it 20% chance in this research?

NO PROTOCOLS THAT WILL ADDRESS THIS

But your excuses here. The tyranny of low expectations in grand display here.

Stroke rehabilitation: what works?

World Stroke Day - October 29

All you will hear is prevention and awareness crapola. No one will tell you about everything wrong in stroke. EVERYTHING IS A FAILURE IN STROKE!

The current state of stroke is a complete failure. None of the following have cures. 

1. 30% get spasticity NOTHING THAT WILL CURE IT.

2. At least half of all stroke survivors experience fatigue Or is it 70%?

Or is it 40%?

NOTHING THAT WILL CURE IT.

3. Over half of stroke patients have attention problems.

NOTHING THAT WILL CURE IT.

NO PROTOCOLS THAT WILL CURE IT.

4.  The incidence of constipation was 48%.

NO PROTOCOLS THAT WILL CURE IT.

5. No EXACT stroke protocols that address any of your muscle limitations.

6. Poststroke depression(33% chance)

NO PROTOCOLS THAT WILL ADDRESS IT. 

7.  Poststroke anxiety(20% chance) NO PROTOCOLS THAT WILL ADDRESS IT. 

8. Posttraumatic stress disorder(23% chance)  NO PROTOCOLS THAT WILL ADDRESS IT.

  9.  12% tPA efficacy for full recovery NO ONE IS WORKING ON SOMETHING BETTER.

10.  10% seizures post stroke NO PROTOCOLS THAT WILL ADDRESS IT. 

11. 21% of patients had developed cachexia NO PROTOCOLS THAT WILL ADDRESS IT. 

 

12. You lost 5 cognitive years from your stroke  NO PROTOCOLS THAT WILL ADDRESS IT.

13.  33% dementia chance post-stroke from an Australian study?

       Or is it 17-66%?

       Or is it 20% chance in this research?

NO PROTOCOLS THAT WILL ADDRESS THIS

 

Reducing the energy cost of walking in older adults using a passive hip flexion device

WHOM do we contact to get this tested for stroke survivors? Since no one knows, that just proves that everything in stroke is a complete failure. 

Reducing the energy cost of walking in older adults using a passive hip flexion device

• Fausto A. Panizzolo,
• Chiara Bolgiani,
• Laura Di Liddo,
• Eugenio Annese &
• Giuseppe Marcolin 

Journal of NeuroEngineering and Rehabilitation volume 16, Article number: 117 (2019) | Download Citation

Abstract

Background

Elevated energy cost is a hallmark feature of gait in older adults. As such, older adults display a general avoidance of walking which contributes to declining health status and risk of morbidity. Exoskeletons offer a great potential for lowering the energy cost of walking, however their complexity and cost often limit their use. To overcome some of these issues, in the present work we propose a passive wearable assistive device, namely Exoband, that applies a torque to the hip flexors thus reducing the net metabolic power of wearers.

Methods

Nine participants (age: 62.1 ± 5.6 yr; height: 1.71 ± 0.05 m; weight: 76.3 ± 11.9 kg) walked on a treadmill at a speed of 1.1 m/s with and without the Exoband. Metabolic power was measured by indirect calorimetry and spatio-temporal parameters measured using an optical measurement system. Heart rate and ratings of perceived exertion were recorded during data collection to monitor relative intensity of the walking trials.

Results

The Exoband was able to provide a consistent torque (~ 0.03–0.05 Nm/kg of peak torque) to the wearers. When walking with the Exoband, participants displayed a lower net metabolic power with respect to free walking (− 3.3 ± 3.0%; p = 0.02). There were no differences in spatio-temporal parameters or relative intensities when walking with or without the Exoband.

Conclusions

This study demonstrated that it is possible to reduce metabolic power during walking in older adults with the assistance of a passive device that applies a torque to the hip joint. Wearable, lightweight and low-cost devices such as the Exoband have the potential to make walking less metabolically demanding for older individuals.

Background

The reduction in walking function experienced by older adults impacts quality of life, health status, and predicts life expectancy. As adults age, difficulty walking affects relative independence and the ability to execute daily tasks in an autonomous way [1], also representing a major burden to their health status and risk of morbidity. As a consequence, reduced walking in older adults is a major contributing factor to a variety of medical issues such as high blood pressure, obesity, and more severe conditions such as cardiovascular diseases and diabetes [2,3,4].
Elevated energy cost is a hallmark feature of gait in older adults and is most likely caused by multiple factors, including changes in neuromuscular and gait mechanics [5]. Elevated walking energy costs have also been shown to result in a general avoidance of walking and other activities in older adults [6]. Activity avoidance increases morbidity and mortality risk [7]. As such, lowering walking energy cost in older adults is predicted to significantly improve health, quality of life and life expectancy in older adults.
Recent engineering advancements coupled with musculoskeletal research have resulted in novel solutions to assist human walking. Exoskeletons offer great potential for lowering the energy cost of walking, reducing fatigue and mitigating mechanical stress on joints and bones [8,9,10,11,12]. Yet despite significant advancements in this field, exoskeletons that reduce metabolic cost of walking still present several shortcomings and are not widely adopted by consumers. Current devices are heavy, cumbersome to wear, and require trained personnel to be operated and maintained [13, 14]. They are also powered by large batteries that drain quickly and these, together with the electronic components needed to implement different control architectures, can be very costly. To overcome some of these limitations, recent studies have shown the potential of passive exoskeletons (devices that do not include motors and batteries) to assist walking [8] and running [15, 16]. These studies highlighted that, despite years of human evolution, it is possible to reduce the metabolic cost of gait by means of passive devices that store and release mechanical energy generated by the body during specific phases of the gait cycle.
Building on the foundation of this previous work, this manuscript presents a passive hip device composed of textile, thus making it extremely lightweight and easy to wear. The aim of this study is to determine whether a simple device that assists hip flexion can reduce the metabolic cost of walking in older adults. The choice to design a device helping hip flexion in the elderly was decided for two main reasons. The first is that it has been established previously that aging causes an increased reliance on the hip rather than on the ankle to power walking [17, 18]; the second is that a relevant simulation study on powered exoskeletons [19] indicated that assisting hip flexion provides greater metabolic savings with respect to other joints. Research in the exoskeleton field has also highlighted that physiological and neurological differences between individuals can cause divergent metabolic responses to the same device [20,21,22], and that responses can change considerably during the course of adaptation [23, 24], thus underlining the importance of an individualized level of assistance applied by the device [25, 26]. As such, we evaluated three different levels of assistance associated with a specific force index: LOW (0.3 N/kg), MED (0.5 N/kg) and HIGH (0.7 N/kg) applied by our device in a group of healthy community dwelling older adults.

 

Occupational therapy leadership: promoting an autonomy-supportive environment based on self-determination theory, to improve patient outcomes in acute and post-acute stroke rehabilitation

I see nothing in stroke healthcare that suggests a rapid and successful rehabilitation process. All I see is complete failure.  What parallel universe are you living in? 

The current state of stroke is a complete failure. None of the following have cures. 

1. 30% get spasticity NOTHING THAT WILL CURE IT.

2. At least half of all stroke survivors experience fatigue Or is it 70%?

Or is it 40%?

NOTHING THAT WILL CURE IT.

3. Over half of stroke patients have attention problems.

NOTHING THAT WILL CURE IT.

NO PROTOCOLS THAT WILL CURE IT.

4.  The incidence of constipation was 48%.

NO PROTOCOLS THAT WILL CURE IT.

5. No EXACT stroke protocols that address any of your muscle limitations.

6. Poststroke depression(33% chance)

NO PROTOCOLS THAT WILL ADDRESS IT. 

7.  Poststroke anxiety(20% chance) NO PROTOCOLS THAT WILL ADDRESS IT. 

8. Posttraumatic stress disorder(23% chance)  NO PROTOCOLS THAT WILL ADDRESS IT.

  9.  12% tPA efficacy for full recovery NO ONE IS WORKING ON SOMETHING BETTER.

10.  10% seizures post stroke NO PROTOCOLS THAT WILL ADDRESS IT. 

11. 21% of patients had developed cachexia NO PROTOCOLS THAT WILL ADDRESS IT. 

 

12. You lost 5 cognitive years from your stroke  NO PROTOCOLS THAT WILL ADDRESS IT.

13.  33% dementia chance post-stroke from an Australian study?

       Or is it 17-66%?

       Or is it 20% chance in this research?

NO PROTOCOLS THAT WILL ADDRESS THIS 

The wishful thinking here:

 

Occupational therapy leadership: promoting an autonomy-supportive environment based on self-determination theory, to improve patient outcomes in acute and post-acute stroke rehabilitation

Permanent Link

https://hdl.handle.net/2144/38178

Abstract

A major dilemma that is being addressed in the current project is the discrepancies between healthcare system's expectations for a rapid and successful rehabilitation process and patients after having a stroke ability to meet these expectations while striving to adapt to the calamitous event in their life. Emphasizing a more biomedical approach and under implementation of psychosocial approaches, poor acknowledging of patients' basic psychological needs lead to poor motivation, therapeutic disengagement and may lead to a rehabilitation failure. To cope with this gap in the process of stroke rehabilitation, an educational program aiming for occupational therapists working with patients after having a stroke in their acute and post-acute rehabilitation phases was constructed. The program guides practitioners for effective communication with their patients, building a needs-supportive environment and addressing their patients' basic psychological needs in light of the selfdetermination theory, theories of adaptation from occupational therapy perspectives and considering occupational justice and the ICF model. A clinical reasoning, step-by-step problem solving is introduced using adaptation of known models and innovated models for interventions that were created for this purpose. Program delivery through a series of 4-webinar modules is illustrated with their learning objectives, assignments and discussions. The program evaluation and implementation are expected to be the initiator of a change in the health and rehabilitation climate and in Israel.

Rights

Attribution-NonCommercial-NoDerivatives 4.0 International

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• Boston University Theses & Dissertations [5826]