Understanding Access to Rehabilitation for Stroke Survivors: Talya Fleming, MD

 'Access' to something that doesn't work is mostly useless. Or don't you even acknowledge all the failures in stroke? Look at all these problems in stroke needing solutions but none exist and no one seems to be working on them.

Check out these 13 problems in stroke with nothing to address them. Survivors are just supposed to accept that stroke is so fucking hard to solve that your disability for life is an acceptable consequence. Everybody in stroke needs to be fired, specially when they put out back patting articles like this.  

Understanding Access to Rehabilitation for Stroke Survivors: Talya Fleming, MD

Talya Fleming, MD Louie PasculliFact checked by: Marco Meglio The medical director of the stroke recovery program at JFK Johnson Rehabilitation Institute at Hackensack Meridian Health provided clinical insights into her presentation focused on expanding rehab care(NOT RECOVERY!) for stroke survivors across settings. [WATCH TIME: 5 minutes](I'm certainly not wasting 5 minutes listening to this.)

Rehabilitation of Upper Limb Motor Impairment in Stroke: A Narrative Review on the Prevalence, Risk Factors, and Economic Statistics of Stroke and State of the Art Therapies

 One sentence could describe the complete failure of stroke rehab.  NOTHING RIGHT NOW WILL GET YOU FULLY RECOVERED! Stroke is a complete shitshow of failure!

This proves the complete failure:

1. tPA full recovery? Better than 12%?
2. rehab full recovery? Better than 10%?

Rehabilitation of Upper Limb Motor Impairment in Stroke: A Narrative Review on the Prevalence, Risk Factors, and Economic Statistics of Stroke and State of the Art Therapies

Saba Anwer 1 , Asim Waris 1 , Syed Omer Gilani 1 , Javaid Iqbal 1 , Nusratnaaz Shaikh 2 , Amit N. Pujari 3,4 and Imran Khan Niazi 2,5,6, * 1 School of Mechanical & Manufacturing Engineering, National University of Sciences and Technology (NUST), Islamabad 45200, Pakistan; sanwer.bmes19smme@student.nust.edu.pk (S.A.); asim.waris@smme.nust.edu.pk (A.W.); omer@smme.nust.edu.pk (S.O.G.); j.iqbal@ceme.nust.edu.pk (J.I.) 2 Faculty of Health & Environmental Sciences, Health & Rehabilitation Research Institute, AUT University, Auckland 0627, New Zealand; nusrat.shaikh@aut.ac.nz 3 School of Physics, Engineering and Computer Science, University of Hertfordshire, Hatfield AL10 9AB, UK; amit.pujari@ieee.org 4 School of Engineering, University of Aberdeen, Aberdeen AB24 3FX, UK 5 Center of Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand 6 Center for Sensory-Motor Interaction, Department of Health Science & Technology, Aalborg University, 9000 Alborg, Denmark * Correspondence: imran.niazi@nzchiro.co.nz 

Abstract: 

Stroke has been one of the leading causes of disability worldwide and is still a social health issue. Keeping in view the importance of physical rehabilitation of stroke patients, an analytical review has been compiled in which different therapies have been reviewed for their effectiveness, such as functional electric stimulation (FES), noninvasive brain stimulation (NIBS) including transcranial direct current stimulation (t-DCS) and transcranial magnetic stimulation (t-MS), invasive epidural cortical stimulation, virtual reality (VR) rehabilitation, task-oriented therapy, robot-assisted training, tele rehabilitation, and cerebral plasticity for the rehabilitation of upper extremity motor impairment. New therapeutic rehabilitation techniques are also being investigated, such as VR. This literature review mainly focuses on the randomized controlled studies, reviews, and statistical meta-analyses associated with motor rehabilitation after stroke. Moreover, with the increasing prevalence rate and the adverse socio-economic consequences of stroke, a statistical analysis covering its economic factors such as treatment, medication and post-stroke care services, and risk factors (modifiable and non-modifiable) have also been discussed. This review suggests that if the prevalence rate of the disease remains persistent, a considerable increase in the stroke population is expected by 2025, causing a substantial economic burden on society, as the survival rate of stroke is high compared to other diseases. Compared to all the other therapies, VR has now emerged as the modern approach towards rehabilitation motor activity of impaired limbs. A range of randomized controlled studies and experimental trials were reviewed to analyse the effectiveness of VR as a rehabilitative treatment with considerable satisfactory results. However, more clinical controlled trials are required to establish a strong evidence base for VR to be widely accepted as a preferred rehabilitation therapy for stroke.

Comprehensive Overview of Nursing and Interdisciplinary Rehabilitation Care of the Stroke Patient: A Scientific Statement From the American Heart Association

 So the wrong goals in stroke go back at least 14 years! 'Care' NOT RESULTS OR RECOVERY!

Comprehensive Overview of Nursing and Interdisciplinary Rehabilitation Care of the Stroke Patient: A Scientific Statement From the American Heart Association

Elaine L. Miller, PhD, RN, CRRN, FAHA, Chair; Laura Murray, PhD, CCC-SLP; Lorie Richards, PhD, OTR/L, OT, FAHA; Richard D. Zorowitz, MD, FAHA; Tamilyn Bakas, PhD, RN, FAHA; Patricia Clark, PhD, RN, FAHA; Sandra A. Billinger, PhD, PT, FAHA; on behalf of the American Heart Association Council on Cardiovascular Nursing and the Stroke Council I. 

2010, Stroke

 

Introduction  

 

In the United States, the incidence rate of new or recurrent stroke is approximately 795 000 per year, and stroke prevalence for individuals over the age of 20 years is estimated at 6.5 million. ¹ Mortality rates in the first 30 days after stroke have decreased because of advances in emergency medicine and acute stroke care. In addition, there is strong evidence that organized postacute, inpatient stroke care delivered within the first 4 weeks by an interdisciplinary healthcare team results in an absolute reduction in the number of deaths. ^2,3 Despite these positive achievements, stroke continues to represent the leading cause of long-term disability in Americans: An estimated 50 million stroke survivors worldwide currently cope with significant physical, cognitive, and emotional deficits, and 25% to 74% of these survivors require some assistance or are fully dependent on caregivers for activities of daily living (ADLs). ^4,5 Notwithstanding the substantial progress(I see NO progress anywhere in stroke. Everything is a complete failure! No one is working on 100% recovery!) in acute stroke care over the past 15 years, the focus of stroke medical advances and healthcare resources has been on acute and subacute recovery phases, which has resulted in substantial health disparities in later phases of stroke care. Additionally, healthcare providers (HCPs) are often unaware of not only patients’ potential for improvement during more chronic recovery phases but also common issues that stroke survivors and their caregivers experience. Furthermore, even with evidence that documents neuroplasticity potential regardless of age and time after stroke, ⁶ the mean lifetime cost of ischemic stroke (which accounts for 87% of all strokes) in the United States is an estimated $140 000 (for inpatient, rehabilitation, and follow-up costs), with 70% of first-year stroke costs attributed to acute inpatient hospital care ¹ ; therefore, fewer financial resources appear to be dedicated to providing optimal care during the later phases of stroke recovery. Because there remains a need to educate nursing and other members of the interdisciplinary team about the potential for recovery in the later or more chronic phases of stroke care, the present scientific statement summarizes the best available evidence and recommendations for interdisciplinary management of the needs of stroke survivors and their families during inpatient and outpatient rehabilitation and in chronic care and end-of-life settings. The guidelines for making decisions regarding classes and levels of evidence are listed in Table 1 and are the same as those used by previous American Heart Association (AHA) writing groups. ⁷ Before reviewing the evidence pertaining to stroke rehabilitation, we first briefly review the World Health Organization’s (WHO) international classification of functioning, disability, and health (ICF), ⁸ which serves as an organizational scaffold for the present statement; provide an overview of the interdisciplinary team approach to rehabilitation; and define the different care settings in which stroke survivors may receive services during the more chronic phases of their recovery. As a reference, a list of abbreviations used within this statement can be found in Table 2.

Non-Contrast CT Is Effective for Selecting Patients for Late-Window Thrombectomy

Your definition of effective is totally wrong.  mRS of 1 and 2 are not 100% recovery. GET THERE! Stop using your tyranny of low expectations to justify your failures in stroke.

Non-Contrast CT Is Effective for Selecting Patients for Late-Window Thrombectomy

By Kurt Samson

January 6, 2022

Article In Brief

Non-contrast CT was as effective as CT perfusion or MRI in triaging late-window patients diagnosed with proximal large vessel occlusion stroke. The more accessible use of non-contrast CT could help expand the selection of candidates for mechanical thrombectomy, the study authors and independent experts said.

Distribution of 90-Day modified Rankin Scale Score (mRS) in patients presenting in the window 6 to 24 Hours after time last seen well with internal carotid artery and middle cerebral artery M1/M2 occlusions, by imaging modality: Scores range from 0 to 6, with 0 indicating no symptoms; 1, no clinically significant disability; 2, slight disability (the patient is able to look after their own affairs without assistance but unable to carry out all previous activities); 3, moderate disability (patient requires some help but is able to walk unassisted); 4, moderately severe disability (patient is unable to attend to bodily needs without assistance and unable to walk unassisted); 5, severe disability (patient requires constant nursing care and attention); and 6, death. After adjustment of confounders, there was no difference in 90-day ordinal mRS shift between patients selected by CT vs CT perfusion.

Non-contrast CT appears to be as effective as CT perfusion (CTP) or MRI in selecting thrombectomy candidates among patients with proximal occlusion anterior circulation stroke who present within an extended treatment window of 24 hours, according to a multinational study of 90-day outcomes published November 8 in JAMA Neurology.

The CT for Late EndovasculAr Reperfusion (CLEAR) study questioned whether non-contrast CT is sufficient in the triage of late-window patients diagnosed with proximal large vessel occlusion stroke by CT angiography, as compared with the standard comparator of CTP or MRI.

The Findings

The sites across five countries in Europe and a multicenter cohort study involved 1,604 patients who presented within the extended window of six to 24 hours with large-vessel occlusion. Those selected by CT had comparable clinical and safety outcomes with patients chosen by CTP or MRI.

Most patients who were selected had little evidence of infarction, as quantified by the Alberta Stroke Program Early CT Score (ASPECTS), which determines middle cerebral arterial stroke severity using available CT data. The 90-day clinical outcomes of patients were not significantly different whether they were selected by CT, CTP, or MRI. Safety outcomes, including intracerebral hemorrhage and mortality, were also not different across the three modalities.

“Because advanced imaging is not widely available, the possible utility of non-contrast CT alone is a viable alternative to advanced imaging in selecting patients with late-presenting occlusion for mechanical thrombectomy,” said lead author Thanh N. Nguyen, MD, FRCPc, FSVIN, FAHA, professor of neurology, neurosurgery, and radiology at Boston University School of Medicine and director of interventional neurology/neuroradiology at Boston Medical Center.

Imaging studies are used to exclude hemorrhage in the acute stroke patient, to assess the degree of brain injury, and to identify the vascular lesion responsible for the ischemic deficit, Dr. Nguyen explained.

“The CLEAR study has the potential to broaden access of patients presenting with proximal anterior circulation large vessel occlusion in the late window to mechanical thrombectomy, especially in centers where there is no available CT perfusion or MRI,” she told Neurology Today.

“After this study, we received feedback from colleagues around the world, including Honduras, Colombia, Mexico, China, and the UK,” Dr. Nguyen added. “There are many patients who are not being offered any endovascular treatment when presenting in the late window, for lack of availability of advanced imaging. Or they are being delayed from treatment because of a standard-of-care step, or the perceived necessity of the patient undergoing an advanced imaging study to offer treatment.”

This disparity of access to advanced imaging exists not only in most low-to-middle-income countries, but also in well-developed countries such as the United States, Canada, the UK, and Germany, Dr. Nguyen explained. “Of note, we found faster times to treatment in patients selected with NCCT compared with CTP or MRI.”

Study Details

Study subjects were recruited at 15 sites in Europe and North America between January 1, 2014, and December 31, 2020. The primary endpoint was the distribution of modified Rankin Scale (mRS) scores at 90 days. Secondary outcomes included the rates of 90-day functional independence (indicated by mRS scores of 0-2), symptomatic intracranial hemorrhage, and 90-day mortality.

The median age of the patients was 70 years old and 52.9 percent were women. A total of 534 patients were selected to undergo mechanical thrombectomy by CT, 752 by CTP, and 318 by MRI. After adjustment of confounders, there was no difference in the 90-day ordinal mRS shift between patients selected by CT versus CTP.

The rates of 90-day functional independence (mRS scores 0-2 versus 3-6) were similar between patients selected by CT versus CTP, but lower in patients selected by MRI than CT. Successful reperfusion was more common in the CT and CTP groups compared with the MRI group, and symptomatic intracranial hemorrhage or 90-day mortality was not significantly different.

Expert Commentary

“Overall, this is an important and compelling study,” said Steven R. Messé, MD, FAAN, FAHA, professor of neurology at the Hospital of the University of Pennsylvania, who was not involved with the study.

“Early on, CT is not sensitive to acute infarct, whereas the areas of irreversible injury should be more conspicuous in this late window. In combination with a CTA to confirm that there is a proximal large vessel occlusion, the information on the volume of irreversible injury on non-contrast CT should allow for reasonable patient selection for thrombectomy beyond six hours. This study suggests that this relatively ‘low-tech’ approach works, at least as well as MRI or CT perfusion,” he told Neurology Today.

Asked if the findings might change emergency stroke practices, Dr. Messé said that he thinks that the findings allow centers that do not yet have ready access to MRI or CT perfusion to still pursue thrombectomy for patients presenting in the late window.

“It is not clear how many centers might benefit in the US, but I would imagine that in some regions or countries it will have an impact,” he said. “Additionally, for patients who are transferred for consideration of thrombectomy from centers that do not have perfusion imaging, there may be some centers that will feel comfortable skipping a CTP on arrival and going directly to angiogram, as this will clearly save time, and faster time to recanalization is key to achieving the best outcomes possible.”

Importantly, he continued, the study was an observational non-randomized retrospective cohort, and there are possible confounders and biases that may impact the validity of the results. For example, sites that used a specific modality likely were different than sites that used a different modality. Another issue is that it is not known what explicit criteria were used to select patients for thrombectomy, only that they used each modality, he said.

“It is also not clear if non-contrast CT excludes more or less patients than the other modalities who may also benefit from treatment,” he added. “We only know that the patients who were selected using CT did at least as well as patients selected using the other modalities.”

Hesham Masoud, MD, assistant professor of neurology, neurosurgery, and radiology at Upstate Medical University in Syracuse, NY, told Neurology Today that MRI/CTP provide certain advantages that non-contrast CT does not.

Increased sensitivity and sophistication of images, such as different MRI sequences and CT-perfusion maps, are advantages, and MRI-DWI and perfusion maps are sensitive for detecting stroke in ways that are superior to the basic non-contrast CT images currently obtained in practice, he said.

“Also, there can be issues with any imaging modality that employs post processing, which is a major consideration in stroke CT-perfusion imaging and the basic non-contrast head CT ‘purist’ approach has value in clean cut clinical-imaging (as determined by favorable ASPECTS scores) mismatch,” Dr. Masoud added.

He said that the biggest winners with CT imaging are stroke centers operating around the world with limited imaging resources but capability to perform life-saving mechanical thrombectomy. “Due to the wide availability of CT technology in lower and medium income regions of the world, this data can assist when engaging policymakers for resource allocation to expand access to this important stroke therapy,” Dr. Masoud said.

 

Advances in Epidemiology, Outcomes, and Population Science

 I'm not purchasing the rest of the paper but in my view  I see zero advances in stroke.  Everything in stroke is a failure and will continue that way until survivors are in charge.  Look at all these problems in stroke needing solutions but none exist and no one seems to be working on them.

Advances in Epidemiology, Outcomes, and Population Science

 

When a doctor turns patient: For years he helped people recover from strokes, then he had one.

 I don't think he has yet had the epiphany yet that everything in stroke is a failure.

When a doctor turns patient: For years he helped people recover from strokes, then he had one.

 

As a medical provider, Dr. Mahesh Ramachandran encouraged his patients to keep working as hard as they could in physical therapy, knowing that more effort could yield more results.

But then, he became a patient himself. And it left him with a new appreciation for the neurological work the patients put in every day as part of their rehabilitation.

Ramachandran, the chief medical officer of Marianjoy Rehabilitation Hospital in Wheaton, landed in recovery there after suffering a stroke over Memorial Day weekend.

It caused weakness to his left side, leaving him in need of therapy to help relearn things like getting dressed. “I had a very hard time buttoning a shirt, putting on a belt,” he said. “Tying shoelaces were pretty much impossible for me to do on my own. Day-to-day simple things like that, because you use both your hands for those tasks.”

Dr. Mahesh Ramachandran at his office at Marianjoy Rehabilitation Center in Wheaton on Oct. 21, 2021. Ramachandran experienced a stroke and recovered at his own hospital. (Antonio Perez / Chicago Tribune)

After stumbling in his backyard in May and feeling a bit confused, Ramachandran went inside. About half an hour later, he noticed his left arm felt weak. He grew alarmed and asked his wife to call 911.

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As a stroke specialist, he knows what feeling weak on one side could mean. And he also knew that speed mattered; by getting to the hospital quickly, he was able to be diagnosed and begin care.

Doctors told him he’d had a stroke on the right side of his brain. “Fortunately, it didn’t affect my speech, my cognition,” Ramachandran said.

But he still had a journey ahead.

He hoped to do outpatient therapy, coming to Marianjoy for appointments and sleeping at home. But it quickly became clear he would need to stay at the hospital, as he had difficulties walking and worried about his wife needing to lift and carry him at home.

Coming in as a patient through the doors of Marianjoy he’d so often entered as chief medical officer “was a completely different perspective,” he said.

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On a scientific level, he was familiar with the kind of stroke he’d had. “I felt very good about my chances of recovery,” he said. He noted many people assume all strokes are the same, but they vary in location, intensity and recovery.

A stroke happens when blood supply to part of the brain is interrupted, preventing the brain from getting oxygen or nutrients. According to the Mayo Clinic, symptoms include trouble speaking or understanding others, paralysis or numbness of the face, arm or leg, headache or problems seeing in one or both eyes. Getting care quickly is key.

Despite Ramachandran’s wealth of scientific knowledge about his body, the experience was still difficult for him. “The actual going through the symptoms and the therapy and being a patient was quite eye-opening,” he said.

His neurological recovery included physical therapy to strengthen muscles and improve balance, occupational therapy to relearn things like picking up cups, and speech therapy, where a therapist checked things like swallowing and speech production.

Mahesh Ramachandran, Marianjoy Rehabilitation Hospital chief medical officer, stands next to an ArmeoPower, a robotic exoskeleton for rehabilitation of the arm, which he used during his recovery at the hospital following a stroke. (Antonio Perez / Chicago Tribune)

Ramachandran remembers an exercise he found difficult — a type of video game where patients used one hand to maneuver a joystick. “Initially I had a very hard time moving objects,” he said. “After 10 to 15 seconds, I would just be exhausted, and my left arm would not move anymore.” Eventually he worked his way up to minutes at a time.

During frustrations and victories alike, he also saw a new side of his staff as one of their patients, he said, making him feel “both happy and proud to be part of the program.”

One of the big things he learned was how much of a barrier fatigue can be.

“It takes a lot more energy, because of the weakness you have on one side of the body, to do simple activities,” he said. “One of the things that I realized is that even though studies show the more therapy you do, the better you get, your body also needs to rest. … It’s probably not something that I realized as much as a physician.”

By August, he had returned to work full time. And his work feels different. He knows he will remember that fatigue, and balance that memory with his urge to motivate his patients.

“That’s kind of a change in my practice, that I’ll say: You need to work hard, but you also need to get that rest so your body can recharge,” he said.

Ramachandran also gained a new appreciation for how family and friends support sick relatives, and the mental aspect of recovering from a stroke.

“This is a life-altering event, so the emotional and psychological aspects of it are tremendous, because they don’t know if they can return back to their way of living. Can they go back to work? Can they go back to driving? And so on,” he said.

And, for the first time, he can tell those he treats how he, too, has been at Marianjoy as a patient. He hopes encouragement to keep going will hold more weight.

“I think sometimes if you just say that as a physician, it may not have the impact that I can have now,” he said.

Ramachandran can tell patients, “I’ve lived through it.”

abowen@chicagotribune.com

World Stroke Day Campaign; Octobr 29,2020

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 

 Notice absolutely nothing that will get survivors recovered. Stroke does not belong in their name. The WSO is worthless to survivors. NO survivor outreach. NO database of stroke research and protocols. NO STRATEGY TO SOLVE STROKE. ABSOLUTELY NOTHING. 

 

 World Stroke Day Campaign; Octobr 29,2020

 

Is resting-state EEG longitudinally associated with recovery of clinical neurological impairments early poststroke? A prospective cohort study

I can see zero reason to even ask this question. You fuckers don't understand that predictions based upon the current extreme failures in stroke rehab are criminally incompetent? WHY THE HELL WOULD YOU WANT TO PREDICT THE FAILURE OUTCOMES OF CURRENT STROKE REHAB? ARE YOU THAT BLITHERING IDIOT? Change the outcomes of stroke to 100% recovery. That is what leaders would do. Are you a leader or not?

Oops, I'm not playing by the polite rules of Dale Carnegie,  'How to Win Friends and Influence People'. 

Politeness will never solve anything in stroke. Yes, I'm a bomb thrower and proud of it. Someday a stroke 'leader' will ream me out for making them look bad by being truthful , I look forward to that day. 

The latest here:

Is resting-state EEG longitudinally associated with recovery of clinical neurological impairments early poststroke? A prospective cohort study

 Neurorehabilitation and Neural Repair (NNR) , Volume 34(5) , Pgs. 389-402.

NARIC Accession Number: J83839.  What's this?
ISSN: 1545-9683.
Author(s): Saes, Mique ; Zandvliet, Sarah B. ; Andringa, Aukje S. ; Daffertshofer, Andreas ; Twisk, Jos W. R. ; Meskers, Carel G. M. ; van Wegen, Erwin E. H. ; Kwakkel, Gert.
Publication Year: 2020.
Number of Pages: 14.
Abstract: Study investigated the time course of electroencephalography (EEG)-based spectral characteristics during awake rest and the development of these spectral characteristics in relation to global neurological and upper-limb motor recovery in the first 6 months poststroke. Resting-state EEG was measured serially in 41 patients after a first-ever ischemic stroke, within the first 3 weeks, and at 5, 12, and 26 weeks poststroke. The brain symmetry index (BSI) and directional BSI (BSIdir) were computed over different frequency bands (1-25 Hz, delta, theta) and delta/alpha ratio (DAR). The National Institutes of Health Stroke Scale (NIHSS) and Fugl-Meyer motor assessment of the upper extremity (FM-UE) were used as clinical reflections of spontaneous neurobiological recovery. Longitudinal changes in spectral characteristics and within- and between-subject associations with NIHSS and FM-UE were analyzed with linear mixed models. Spectral characteristics showed a gradual normalization over time, within and beyond 12 weeks poststroke. Significant within- and between-subject associations with NIHSS were found for DAR of the affected hemisphere (DARAH) and BSIdir-delta. BSIdir-delta also demonstrated significant within- and between-subject associations with FM-UE. Changes in spectral characteristics are not restricted to the time window of recovery of clinical neurological impairments. The findings suggest that decreasing DARAH and BSIdir-delta reflect improvement of global neurological impairments, whereas BSIdir-delta was also specifically associated with upper-limb motor recovery early poststroke.
Descriptor Terms: BRAIN, ELECTROPHYSIOLOGY, LIMBS, MOTOR SKILLS, STROKE.


Can this document be ordered through NARIC's document delivery service*?: Y.
Get this Document: https://journals.sagepub.com/doi/10.1177/1545968320905797.

Citation: Saes, Mique , Zandvliet, Sarah B. , Andringa, Aukje S. , Daffertshofer, Andreas , Twisk, Jos W. R. , Meskers, Carel G. M. , van Wegen, Erwin E. H. , Kwakkel, Gert. (2020). Is resting-state EEG longitudinally associated with recovery of clinical neurological impairments early poststroke? A prospective cohort study.  Neurorehabilitation and Neural Repair (NNR) , 34(5), Pgs. 389-402. Retrieved 7/18/2020, from REHABDATA database.

Op-Ed: Treating Stroke Requires a Team of Specialists

And yet those specialists fail 88% of the time in getting patients fully recovered when tPA is given.  And that doesn't even consider the fact that only a miniscule percentage of patients that should get tPA actually get tPA.  We haven't even mentioned that only 10% of stroke survivors get fully recovered. THIS IS WHY I CONSIDER EVERYTHING IN STROKE A FAILURE.  No one is addressing any of these massive failures in stroke.  Check out these 13 problems in stroke with nothing to address them. Survivors are just supposed to accept that stroke is so fucking hard to solve that your disability for life is an acceptable consequence. Everybody in stroke needs to be fired, specially when they write chest thumping articles like this. 

Op-Ed: Treating Stroke Requires a Team of Specialists

A multifaceted approach for a multifaceted disease

by Jeremy Payne, MD, PhD July 13, 2020

A woman experiencing progressive confusion, disorientation, and finally severe hallucinations was placed in a locked psychiatric unit, where she declined rapidly.
Only when the woman exhibited facial weakness and numbness did her physicians order brain imaging and discover she had experienced a series of small strokes.
When she was eventually brought to our stroke center, our team of specialists quickly made a diagnosis of vasculitis, a rare immune condition that attacks the arteries, ultimately damaging the brain. In retrospect, her symptoms were quite classic, but by then our diagnosis was too late.
While the woman's disease was rare, this outcome was not.
Too often, stroke patients are initially sent to the wrong place. Sudden loss of vision, for example, typically results in referral to an ophthalmology clinic, although this can be a common emergent stroke symptom, too.
When a patient presents to a physician's office with a history suggestive of stroke, a common community practice is to refer to a cardiologist. Only a fraction of strokes are actually directly related to the heart, however. Hypertension is a common disease but may not actually have a bearing on the reason any particular patient has a stroke.
While there is significant overlap in the risk factors for brain and cardiac vascular disease, there are many important exceptions.
Stroke can be particularly tricky because it can present with various symptoms that mask its true cause. The symptoms result from sudden loss of function in part of the brain when its blood supply is interrupted and can be as varied as the brain's function itself.
The ideal strategy for diagnosis and treatment of brain vascular disease requires a multidisciplinary team, preferably led by a vascular neurologist.
Stroke is a multifaceted disease. As we learn to better leverage connections across clinical disciplines, we will better serve these patients. I encourage all clinicians to reach out to vascular neurologists at primary and comprehensive stroke centers, both for emergent cases and for assistance in ensuring outpatients are afforded a thorough evaluation and plan of care.
Such centers are designed to harness the knowledge of multiple clinical disciplines under the direction of vascular neurology specialists. Certified comprehensive stroke centers, in particular, offer a complete range of diagnostic and treatment strategies.(The operative word here is strategies NOT RESULTS!)
Jeremy Payne, MD, PhD, is the director of the Comprehensive Stroke Center at the Banner-University Medicine Neuroscience Institute in Phoenix.

International Impact of Stroke journal

I consider this to be a complete fucking failure. This chest thumping does absolutely nothing to get survivors 100% recovered. Nowhere in here do they discuss how they are solving all these failure points. I actually consider all the previous presidents of the WSO to be complete failures, nothing they did helped survivors one whit towards 100% recovery. That is the ONLY METRIC TO BE USED IN STROKE.  But then my opinion is worthless since I'm just a stroke addled survivor, there is zero point in ever listening to the patients. THEY KNOW NOTHING! Your children and grandchildren will have the same fucked up recovery if we don't fire all the existing 'stroke leaders'. 

It is simple, solve these problems. Yep they will be hard but leaders tackle the big problems. Are you a leader or a mouse?

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.

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. Post stroke depression(33% chance)

NO PROTOCOLS THAT WILL ADDRESS IT. 

7.  Post stroke 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 useless back patting here, nothing here gets survivors recovered. 

International Impact of Stroke journal

Stephen M. Davis

,

Werner Hacke

,

Bo Norrving

,

Michael Brainin

,

Kennedy R. Lees

,

Geoffrey A. Donnan

Originally published19 Feb 2020https://doi.org/10.1161/STROKEAHA.119.028422Stroke. 2020;51:1036–1039

Origins—an American Journal

With the launch of the new journal Stroke in 1970, the first Editor-in-Chief, Dr Clark Millikan, stated that the journal would cover a wide range of specialties, “to fill a gap and to meet a responsibility.”¹ He commented on the kaleidoscope of people who could enter the room of a patient with cerebral infarction including medical specialists, nurses, allied health professionals, even a mortician—in a minor percentage. Stroke was an American journal. The Editor-in-Chief was supported by 2 Associate Editors and a 19-member Editorial Board. They were all from the United States. In the first year, 58 manuscripts were published: 56 from the United States, 1 from Denmark, and 1 from India.

Internationalization of Stroke

Over the subsequent 50 years, Stroke has become the standard bearer for the International Stroke Community, the craft journal for our field despite the burgeoning number of publications devoted to stroke and the cerebral circulation. It has become truly international in its scope of editors, authors, institutional affiliations, and readers, with many innovations introduced by successive editors. The journal has also played a major role in the development of the global stroke scene.
The second Editor-in-Chief, Fletcher McDowell, highlighted critical developments in stroke diagnosis during his term (1977–1981) that had a huge international impact. These included the widespread introduction of computed tomography in the 1970s, ultrasound, and then magnetic resonance imaging. Perhaps prophetically, he pointed out that “effective treatment remains elusive.”²
Ten years after the first edition, Stroke in 1980 had expanded to a 37-member Editorial Board. It was still chiefly American, with 31 of 37 board members from the United States. However, 6 other international stroke leaders represented the international community, including Henry Barnett (Canada), Cesare Fieschi (Italy), Fumio Gotoh (Japan), Konstantin-Alexander Hossman (Germany), Niels Lassen (Denmark), and Lindsay Symon (United Kingdom). Of the many pivotal papers published in the journal during this era, the early description of the ischemic penumbra and the potential for acute reperfusion strategies by Lindsay Symon’s team in London, United Kingdom, and coauthors Jens Astrup and Bo Siesjö was particularly prophetic.³ We all now know that the ischemic penumbral concept underpins the major treatment strategies for acute stroke used today, namely intravenous thrombolysis and endovascular thrombectomy. How our field has changed! In 1980, there was no proven acute therapy and only very limited stroke prevention strategies. An editorial on impending stroke recommended the use of heparin, coumadin, and aspirin at a dose of 1200 to 1800 mg daily.⁴ There were no trials of anticoagulants in atrial fibrillation, although their use in cardioembolic stroke was recommended in 1980. Usefully, key stroke abstracts from other journals were being published in Stroke. An indication of the gradual shift toward a more global contribution to the journal is shown in the 1980 volume where 35% of papers were from other parts of the World.
Henry Barnett was a pioneer and brilliant trialist, best known for his work on aspirin in stroke prevention, the validation and selection of patients for carotid endarterectomy, and the extracranial-intracranial bypass trial. He wrote that “the internationalization of the journal was reflected in all successive issues and was a factor in determining expansion.”⁵ He pointed out that between 1982 and 1987, there was increased enthusiasm on both sides of the Atlantic, in Japan, Taiwan, and down under.
This internationalization further increased over the subsequent decades, under the leadership of Oscar Reinmuth and Mark Dyken. Dr Dyken indicated that Stroke had become “a truly international journal.” By 1999, a remarkable 68% of its submissions were from outside the United States, although constituted only 42% of the subscribers.⁶ By this time, all the American Heart Association journals were being published online. Importantly, he also promoted the inclusion of women and minorities on the board.
The internationalization of Stroke was then greatly accelerated by the last 2 Editors-in-Chief of Stroke, both with major international research and leadership profiles, Vladimir Hachinski and Marc Fisher. Dr Hachinski is a renowned international leader and particularly recognized for his own research in autonomic dysfunction after stroke and major contributions to cognitive impairment and dementia. He has highlighted the importance of vascular contributions to all forms of dementia including Alzheimer disease and championed interventions to reduce the risk of dementia.⁷
Marc Fisher is a distinguished translational clinical scientist with particularly important contributions based on preclinical models and imaging of the ischemic penumbra. In the past 10 years under Dr Fisher, the leadership group was significantly expanded, making the impact of the journal even more global in its impact. He has also had a truly international perspective, greatly expanded the scope of the journal and the specialized sections, reflecting the diversity of stroke research and practice. This evolution of the journal has been illustrated by the publication metrics.
When one considers the 50 years of Stroke publications, more than half represent contributions from authors outside the United States. Of the top 15 authors publishing in Stroke over this period, with >100 published papers, 8 are from other countries (Table).

Table. The International Impact of Stroke Over 5 Decades (Web of Science)

Top 10 Institutions	No. of Articles	Top 15 Authors	>100 Articles	Top 10 Countries	No. of Articles
Harvard University	824	J.L. Saver (US)	176	US	7111
UCLA	408	R.L. Sacco (US)	145	UK	1764
University Utrecht (the Netherlands)	380	P.M. Rothwell (UK)	130	Germany	1578
Columbia University	366	A.M. Demchuk (Canada)	123	Japan	1359
University of London (UK)	362	M.D. Hill (Canada)	115	Canada	1153
University Toronto (Canada)	362	K.R. Lees (UK)	117	The Netherlands	831
Pennsylvania	358	M. Fisher (US)	116	France	774
Johns Hopkins University	356	J.C. Grotta (US)	113	Australia	636
Heidelberg University (Germany)	340	J.P. Broderick (US)	112	Sweden	586
Mayo Clinic	339	G.W. Albers (US)	110	Italy	582
		W. Hacke (Germany)	107	China	569
		H.S. Markus (UK)	103
		M. Kaste (Finland)	102
		G.A. Donnan (Australia)	101
		D.S. Liebeskind (US)	101

UCLA indicates University of California, Los Angeles; UK, United Kingdom; and US, United States.

In the early decades of publication, Japan, Canada, and Germany were the highest contributors, outside of the United States. Over the 5 decades, when one considers the top 10 national contributors after the United States, the United Kingdom and Germany have been the highest, followed by Japan, Canada, the Netherlands, France, Australia, Sweden, Italy, and China (Table).
There has been a further change over the past decade. In 2008/2009, 50% of the accepted manuscripts were from the United States (23% of submissions). The United States acceptance rate was followed by submissions of fairly equal proportions (6%–8%) from the United Kingdom, Germany, Canada, the Netherlands, and Japan. Germany and the United Kingdom have always been among the highest international contributors. In 2018/2019, the US proportion of accepted publications had fallen to 30%, while the next most published authors by country were the United Kingdom, the Netherlands, China, Germany, and Korea (all 6%–9%). Notably, the proportion of accepted manuscripts from China has increased substantially, from 2% to 8%, over the past decade.
In the first decade of Stroke, 1970 to 1979, 4 of the top 5 institutions of the published authors were from the United States, and the fifth was Kyushu University in Japan. The proportion of non-US institutions has greatly increased over the years. In the last decade, 2010 to 2019, Harvard and University of California, Los Angeles (UCLA) topped the list but were followed by the Universities of Toronto, Calgary, and Utrecht.
Of the top 10 institutions of the authors published in Stroke over its 5 decades, 4 are from outside the United States (University of Utrecht, University of Toronto, University of London [United Kingdom], and University of Heidelberg [Germany]; Table).
In 2019, the Editorial Board has grown to around 250, about half outside the United States. This is a truly comprehensive and international board, including many of the Section Editors.

Other International Innovations

Over the years, Stroke has been published in a number of languages. Foreign language editions were introduced by Mark Dyken, then in a major initiative of Vladimir Hachinski, expanded to include (at various times) Stroke in Spanish, Russian, Italian, Chinese, Japanese, Portuguese, Indian, Korean, and Turkish. Vladimir Hachinski also expanded the number of European Editors (including Markku Kaste, Werner Hacke, Joanna Wardlaw, Hugh Markus, and Bo Norrving). There were also Asian and Australasian/Oceanian Editors including Lawrence Wong and Graeme Hankey.
Vladimir Hachinski devised and chaired a critical meeting for international progress in stroke, a Synergium of global stroke leaders, and this prioritized stroke agenda was published in Stroke in 2010.⁸ This Synergium was aimed at devising new ways to accelerate and prioritize progress in reducing the risks, effects, and consequences of stroke. It promoted integration of knowledge into programs, coupled with careful evaluation to speed the pace of progress. This represented an important stimulus for the field.
The American Stroke Association/American Heart Association guidelines have been influential internationally and undoubtedly motivated the creation of many regional and national stroke guidelines around the world. They also influenced the development of the World Stroke Organization guidelines. These have cited particularly well over the past 2 decades. For example, the top 10 cited papers in Stroke from 2002 to 2019 were guidelines for management of acute ischemic stroke, stroke prevention, intracerebral hemorrhage, and an expert statement on cognitive impairment and dementia.
Other major journals devoted to stroke have included Cerebrovascular Diseases and the European Stroke Journal, both based in Europe, the International Journal of Stroke, which is published by the World Stroke Organization, Journal of Stroke and Cerebrovascular Diseases (Japan), Journal of Stroke (Korea), and Stroke and Vascular Neurology (China). Some of the editors of these journals have met over the years to establish synergies and periodically jointly publish key papers.

Formation of the World Stroke Organization

In 2006, the 2 previous international stroke bodies (the International Stroke Society and the World Stroke Federation) merged to form a new global body, aimed at representing “One World Voice for Stroke,” the World Stroke Organization (WSO) (Figure). There has been an incredibly close nexus between the leaders of the journal and the WSO. Vladimir Hachinski played a pivotal role and chaired the nominating committee for the first WSO President, and he, together with Geoffrey Donnan, were key drivers in this marriage. Dr Hachinski was the Editor-in-Chief of Stroke at that time, and his successor Marc Fisher is the President Elect of the WSO. Geoffrey Donnan served with Stephen Davis as co-editor of the Controversies section of the journal for a decade. Geoffrey Donnan has just completed 14 successful years as Editor-in-Chief of the International Journal of Stroke—the official journal of the WSO. All the other WSO Presidents have been major contributors to Stroke. Bo Norrving and Werner Hacke served as European Editors, Stephen Davis is a Consulting Editor, and the current President Michael Brainin is a Senior Consulting Editor. The new Editor-in-Chief of Stroke, Ralph Sacco, has contributed to the WSO Board and chaired our research committee for a number of years.

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Figure. WSO Presidents 2006 to 2020. From left, Stephen Davis, Geoffrey Donnan, Werner Hacke, Michael Brainin (current WSO President), and Bo Norrving, at the 2017 World Stroke Day Conference, Moscow. All WSO Presidents and the former European Stroke Organization President Kennedy Lees have made significant editorial contributions to Stroke. The WSO President Elect is Dr Marc Fisher, outgoing Editor-in-Chief of Stroke. WSO indicates World Stroke Organization.

There have also been strong synergies between Stroke and the European Stroke Organization. Werner Hacke, Michael Brainin, and Kennedy Lees have all been Presidents of European Stroke Organization. Michael Brainin is Senior Consulting Editor, and Kennedy Lees serves as an Associate Editor of Stroke. Bo Norrving, a former European Editor of Stroke, is the Editor-in-Chief of the official journal of the European Stroke Organization—the European Stroke Journal.

Looking Ahead

In 1970, there were no proven treatment or prevention strategies for stroke. There has been a steep trajectory in the proof and implementation of evidence-based therapies for stroke over the past 50 years. Stroke is now highly preventable and treatable(FUCKING BULLSHIT!). The journal Stroke remains our craft publication, linking together clinicians and scientists around the world. Under Ralph Sacco, the tradition continues of appointing an Editor-in-Chief of Stroke who is highly distinguished in relation to his own research achievements and leadership, with a major international profile and vision. An exciting future for the field and the journal lies ahead.

Disclosures

Dr Davis reports personal fees from Medtronic and Boehringer Ingelheim outside the submitted work. Dr Hacke reports grants and personal fees from Boehringer Ingelheim and personal fees from Cerenovus outside the submitted work. Dr Lees reports personal fees from Parexel, Boehringer Ingelheim, American Heart Association, and ONO Pharma outside the submitted work. The other authors report no conflicts.

Footnotes

Presented in part at the International Stroke Conference, Los Angeles, CA, February 19–21, 2020.

Correspondence to Stephen M. Davis, MD, FRACP, Melbourne Brain Centre, The Royal Melbourne Hospital, Parkville, Australia. Email stephen.davis@mh.org.au

Interaction between recovery of motor and language abilities after stroke

We need a protocol written up on this then. WILL NEVER OCCUR. No one in stroke actually thinks about what is best for the survivors. We will never get off the failed status quo in stroke until survivors are in charge.

Interaction between recovery of motor and language abilities after stroke

Ginex V, Gilardone G, Viganò M, et al

Archives of Physical Medicine and Rehabilitation|July 6, 2020

A retrospective cohort study was performed to examine the nature of the interaction between motor and language recovery in patients with motor impairment and aphasia following left hemispheric stroke and to evaluate prognostic factors of best recovery, that is, the significant recovery of both functions simultaneously. Researchers included a total of 435 individuals with left hemispheric stroke in the post-acute phase with motor impairment and aphasia. This research gives data about a possible interaction between motor and language recovery after stroke. There was no correlation between improvement in one function and deterioration in the other. The outcomes actually imply a synergic impact between the amelioration of the 2 functions, with an overall increased efficiency when the 2 recovery pathways are combined.

Read the full article on Archives of Physical Medicine and Rehabilitation.

Acute Neurofilament Light Chain Plasma Levels Correlate With Stroke Severity and Clinical Outcome in Ischemic Stroke Patients

ABSOLUTELY NOTHING here will help survivors recover.  Biomarkers and predictions are just functions of the complete failure of the status quo in stroke recovery. CHANGE THAT FAILURE!

Acute Neurofilament Light Chain Plasma Levels Correlate With Stroke Severity and Clinical Outcome in Ischemic Stroke Patients

Helle H. Nielsen^1,2,3, Catarina B. Soares^1,2, Sofie S. Høgedal¹, Jonna S. Madsen^4,5, Rikke B. Hansen^1,2, Alex A. Christensen¹, Charlotte Madsen¹, Bettina H. Clausen^1,3, Lars Henrik Frich^6,7, Matilda Degn⁸, Christian Sibbersen^3,9 and Kate L. Lambertsen^1,2,3,7*

• ¹Department of Neurology, Odense University Hospital, Odense, Denmark
• ²Department of Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
• ³BRIDGE - Brain Research – Inter Disciplinary Guided Excellence, Department of Clinical Research, Odense, Denmark
• ⁴Department of Biochemistry and Immunology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
• ⁵Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
• ⁶The Orthopaedic Research Unit, Department of Clinical Research, Odense, Denmark
• ⁷OPEN, Open Patient data Explorative Network, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
• ⁸Pediatric Oncology Laboratory, Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
• ⁹Mental Health Services in the Region of Southern Denmark, Odense, Denmark

Background: Ischemic stroke causes increased blood–brain barrier permeability and release of markers of axonal damage and inflammation. To investigate diagnostic and prognostic roles of neurofilament light chain (NF-L), we assessed levels of NF-L, S100B, interleukin-6 (IL-6), E-selectin, vascular endothelial growth factor-A (VEGF-A), vascular cell adhesion molecule-1 (VCAM-1), and intercellular adhesion molecule-1 (ICAM-1) in patients with acute ischemic stroke or transient ischemic attack (TIA) and healthy controls.

Methods: We studied neurofilament (NF) expression in 2 cases of human postmortem ischemic stroke, representing infarcts aged 3- to >7-days. In a prospective study, we measured plasma NF-L and inflammatory markers <8 h of symptom onset and at 72 h in acute ischemic stroke (n = 31), TIA (n = 9), and healthy controls (n = 29). We assessed whether NF-L, S100B, and IL-6 were associated with clinical severity on admission (Scandinavian Stroke Scale, SSS), diagnosis of ischemic stroke vs. TIA, and functional outcome at 3 months (modified Rankin Scale, mRS).

Results: NF expression increased in ischemic neurons and in the infarcted brain parenchyma after stroke. Plasma NF-L levels were higher in stroke patients than in TIA patients and healthy controls, but IL-6 levels were similar. Higher acute NF-L levels were associated with lower SSS scores at admission and higher mRS scores at 3 months. No correlation was observed between NF-L and S100B, NF-L and IL-6, nor between S100B or IL-6 and SSS or mRS. Compared to controls, stroke patients had significantly higher VEGF-A and VCAM-1 at <8 h that remained elevated at 72 h, with significantly higher VEGF-A at <8 h; ICAM-1 was significantly increased at <8 h, while S100B and E-selectin were unchanged.

Conclusions: Plasma NF-L levels, but not IL-6 and S100B, were significant predictors of clinical severity on admission and functional outcome at 3 months. Plasma NF-L is a promising biomarker of functional outcome after ischemic stroke.