What is the future for stroke?

 Disastrous. I see nothing out there that even remotely suggests that the stroke medical world is prepared for the tsunami coming from the aging of the population. Nobody is even working on 100% recovery! 

The Next Step in the Treatment of Stroke

Hope you're OK with this disaster when you're the 1 in 4 per WHO that has a stroke.)

Other diseases and their plans:

The FDA unveiled its 5-year strategy and action plan for amyotrophic lateral sclerosis (ALS) and other rare neurodegenerative diseases.

Five-Year Plan Fulfills a Requirement of the Accelerating Access to Critical Therapies for ALS Act

The future of multiple sclerosis - Medical News Today

Prospects for Future Advances in Alzheimer's Disease

Focus Issue: The Future Of Cancer Research

The Future Of Diabetes Management - Family Medicine Austin

The future of cardiovascular research - Heart Matters magazine

 

 

 

 

Cortical Reshaping and Functional Recovery Induced by Silk Fibroin Hydrogels-Encapsulated Stem Cells Implanted in Stroke Animals

Far into the future with our non-existent stroke leadership.
Cortical Reshaping and Functional Recovery Induced by Silk Fibroin Hydrogels-Encapsulated Stem Cells Implanted in Stroke Animals 

Laura Fernández-García¹, José Pérez-Rigueiro^1,2,3, Ricardo Martinez-Murillo⁴, Fivos Panetsos^5,6, Milagros Ramos^1,3,7, Gustavo V. Guinea^1,2,3 and Daniel González-Nieto^1,3,7*

• ¹Center for Biomedical Technology, Universidad Politécnica de Madrid, Madrid, Spain
• ²Departamento de Ciencia de Materiales, Escuela Técnica Superior de Ingenieros de Caminos, Canales y Puertos, Universidad Politécnica de Madrid, Madrid, Spain
• ³Biomedical Research Networking Center in Bioengineering Biomaterials and Nanomedicine, Madrid, Spain
• ⁴Department of Translational Neuroscience, Instituto Cajal – Consejo Superior de Investigaciones Científicas, Madrid, Spain
• ⁵Neurocomputing and Neurorobotics Research Group, Faculty of Biology and Faculty of Optics, Universidad Complutense de Madrid, Madrid, Spain
• ⁶Neural Plasticity Research Group, Health Research Institute of the Hospital Clínico San Carlos, Madrid, Spain
• ⁷Departamento de Tecnología Fotónica y Bioingeniería, Escuela Técnica Superior de Ingenieros de Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain

The restitution of damaged circuitry and functional remodeling of peri-injured areas constitute two main mechanisms for sustaining recovery of the brain after stroke. In this study, a silk fibroin-based biomaterial efficiently supports the survival of intracerebrally implanted mesenchymal stem cells (mSCs) and increases functional outcomes over time in a model of cortical stroke that affects the forepaw sensory and motor representations. We show that the functional mechanisms underlying recovery are related to a substantial preservation of cortical tissue in the first days after mSCs-polymer implantation, followed by delayed cortical plasticity that involved a progressive functional disconnection between the forepaw sensory (FLs₁) and caudal motor (cFLm₁) representations and an emergent sensory activity in peri-lesional areas belonging to cFLm₁. Our results provide evidence that mSCs integrated into silk fibroin hydrogels attenuate the cerebral damage after brain infarction inducing a delayed cortical plasticity in the peri-lesional tissue, this later a functional change described during spontaneous or training rehabilitation-induced recovery. This study shows that brain remapping and sustained recovery were experimentally favored using a stem cell-biomaterial-based approach.

Introduction

Stroke represents the leading cause of disability and a main reason for premature mortality worldwide (Benjamin et al., 2017). The early recognition of symptoms and the rapidity of medical intervention influence the clinical evolution of each patient. In ischemic stroke, the most frequent form of stroke, the intravenous injection of the tissue plasminogen activator (tPA) and surgical procedures such as endovascular thrombectomy are currently the main advanced treatments for the early reestablishment of blood flow in the occluded vessel (Saver et al., 2015). However, a minority of stroke patients can really get benefits from these treatments due to the narrow time window for administration after the onset of symptoms and the risks of complications such as intracranial hemorrhage, major systemic hemorrhage, and angioedema. Thus, most of the patients who do not receive acute reperfusion therapies show long-term disabilities. Unfortunately, we do not have therapies to target the subacute and chronic phases of ischemic stroke and efficiently repair the damaged brain promoting a satisfactory degree of functional recovery in most patients (George and Steinberg, 2015).

A well-established observation in different species, including humans, is that the brain reorganizes itself under physiological and pathological conditions (Merzenich et al., 1984; Jenkins et al., 1990; Panetsos et al., 1995; Nudo et al., 1996b; Elbert et al., 1997; Traversa et al., 1997; Jaillard et al., 2005; Schaechter et al., 2006; Brown et al., 2009). During normal brain development, the emerging circuitry is organized to represent sensory, motor and variably distributed cognitive abilities. However, the initially established topographic and functional representations are not static and change dynamically in size and location throughout adult life in response to sensory input, experience and learning (Jenkins et al., 1990; Elbert et al., 1995; Nudo et al., 1996a). Brain reorganization also occurs after central or periphery injury (Merzenich et al., 1984; Calford and Tweedale, 1988; Elbert et al., 1997; Simoes et al., 2012). Reciprocal GABA-mediated inhibitory signals between distinct representations (Jacobs and Donoghue, 1991; Jones, 1993) and the regular activity of sensory/motor fields together with the maintenance of axonal pathways (Graziano and Jones, 2009) have been proposed to contribute to the mechanism defining topographic areas and preventing the functional invasion between surrounding representations (Calford and Tweedale, 1988; Jacobs and Donoghue, 1991).

The general principles that orchestrate the nascent brain circuitry during development are believed to be similar to those forming the compensatory circuits underlying functional recovery after brain damage. Based on accumulating evidence, motor and sensory representations are modified in the affected and non-affected hemispheres after unilateral brain damage (Nudo et al., 1996b; Brown et al., 2009; Harrison et al., 2013; Tennant et al., 2015). An evolutionarily conserved program exists in mammals to sustain the reorganization of non-affected areas surrounding the damaged regions that then perform the specific functions that were lost and initially depended of the injured areas. However, under spontaneous recovery, brain remapping in the undamaged surrounding tissue does not always correlate with functional outcomes (Nudo and Milliken, 1996; Xerri et al., 1998; Schaechter et al., 2006; Nishibe et al., 2015). A direct link between the post-stroke cortical changes and the temporal pattern of functional recovery has not been directly obtained in the majority of the studies, making a cause-effect relationship difficult to establish.

Stem cell therapy constitutes a promising approach to stimulate functional recovery after stroke (Chen et al., 2001a,b; Trounson and McDonald, 2015; Wang et al., 2016). Different types of stem cells have been used as a potential source of both replacement cells and neurotrophic factors although the precise mechanisms of action and the optimal administration route are unclear (Hermann et al., 2014; Gervois et al., 2016). Compared with the systemic delivery (Prasad et al., 2014; Hess et al., 2017), cerebral implantation requires fewer cells and provides a precision graft (Yang et al., 2011; Du G. et al., 2014; Du S. et al., 2014; Borlongan, 2016). However, the cerebral route has also reached relatively modest levels of post-stroke functional recovery, which has been associated with the severe loss of grafted cells that are generally not observed in the brain for more than 1–3 weeks after transplantation, as reported in several preclinical models (Kelly et al., 2004; Bliss et al., 2010; Mora-Lee et al., 2012; George and Steinberg, 2015; Wang et al., 2016). In patients, the cerebral implantation of stem cells has been reported to be safe and clinical improvements were observed, but the small sample size and heterogeneity between subjects currently preclude the use of this specific approach in clinical practice (Chen et al., 2014; Borlongan, 2016; Steinberg et al., 2016).

The use of biomaterials in tissue engineering is booming and has provided examples of how the integration of neurotrophic cells and factors in biomaterial-based polymers results in better post-stroke functional recovery compared to the implantation of therapeutic cells or factors alone (Guan et al., 2013; Jendelova et al., 2016; Nih et al., 2016). Different natural and synthetic polymers have been used to support stem cell engraftment including hyaluronic acid, collagen, hyaluronan-methylcellulose, polyethylene glycol, PLGA, alginate and matrigel among others (González-Nieto et al., 2018).

Although improved functional outcomes have been achieved in the majority of stroke models after the implantation of stem cells or stem cells plus different biomaterials, the mechanisms of recovery are in most cases unclear, but they might be associated with the reestablishment of the destroyed circuitry in damaged regions (Taguchi et al., 2004; Ramos-Cabrer et al., 2010; Wang et al., 2016). However, other tentative benefits of stem cell therapy could be related to the reorganization of the pre-existing circuitry in peri-lesional areas of the affected hemisphere, involving the reorganization of cortical maps (Dijkhuizen et al., 2001; Brown et al., 2009; Andres et al., 2011).

In the present study, we examined the ability of bone marrow mesenchymal stem cells (mSCs) to enhance functional outcomes after cortical stroke in mice. The mSCs were intracerebrally implanted together with a silk fibroin (SF)-based hydrogel (Fernandez-Garcia et al., 2016). We report evidence of cortical plasticity linked to functional recovery occurring late after treatment. To our knowledge, this study is unique because it shows that brain remapping and sustained recovery were experimentally favored using a stem cell-biomaterial-based approach.

More at link

BrainQ aims to cure stroke and spinal cord injuries through mind-reader tech

Way in the future.
https://www.yahoo.com/finance/news/brainq-aims-cure-stroke-spinal-183350884.html

Sarah Buhr,TechCrunch 1 hour 12 minutes ago

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Israel-based BrainQ is a new neurotech startup hoping to take on brain-computer interface (BCI) companies like Braintree founder Bryan Johnson's Kernel and Silicon Valley billionaire Elon Musk's Neuralink.
It's not clear yet what Musk's startup intends to do with the computer chips it plans to put in our heads, but Johnson's startup says it is focused on developing "technologies to understand and treat neurological diseases in new and exciting ways."
Whatever sector each company goes for, both plan to insert chips in our brains to connect us to computers -- the consequences of which could have dramatic effects on human memory, intelligence, communication and many other areas that could rocket humanity forward, should they work out.
But it's early days in this industry, including for BrainQ, which plans to use a non-surgically embedded EEG machine instead to gather data and help improve outcomes for stroke and spinal cord patients.
Aside from the brain implant options, BrainQ faces quite a bit of competition in this area. EEG machines are nothing new, not even in the spinal cord injury space. Missouri-based NeuroLutions is working on similar EEG type technology to improve and restore function to paralytics. NeuroPace, a Kleiner-funded startup, is focused on seizures rather than stroke and spinal cord injuries, but is based on the same idea.

BrainQ admits it is also a couple years out from being fully operational here. It still needs to get through clinical human trials and gain Food and Drug Administration approval to sell its services in the U.S.
So far, the company is in the process of conducting two human clinical trials for stroke patients in Israel and a spokesperson for the company, Assaf Lifshitz, says BrainQ will likely try to go to other markets first while waiting on the FDA. BrainQ tells TechCrunch it hopes to be available in the U.S. market by 2020.

Alzheimer's research is another area TechCrunch was told the company wants to get into soon, and possibly children's syndromes, as well.
There are a lot of different areas the company could go into with this type of tech but it's probably safest to bet on a few narrow areas in the beginning, as there is already so much competition in the space in just the U.S. For instance, NeuruLutions' Ipsihand device is already connecting stroke patients' brains to a moveable brace they can control with thought and help them move certain body parts again.

And, while Lifshitz believes BrainQ is at least ahead of the market as far as Kernel and Neuralink go, that's too easy of a comparison to make. EEG is a low-risk entry toward a BCI device gaining FDA approval. All the company needs to show, as many of these companies are either on their way to proving or have proved already, is that the device works. That is far from the same thing as a chip surgically inserted into your head.

BrainQ will continue to forge ahead, of course. Google's Launchpad Studio chose to work with the startup this last fall, based on what it thought was some interesting machine learning tech. The company also has raised about $3.5 million to date from various Israeli investors and angels, and presented previous clinical findings to the World Congress of Neuro Rehabilitation.

• This article originally appeared on TechCrunch.

Development of a robotic device for post-stroke home tele-rehabilitation

For far into the future.

Development of a robotic device for post-stroke home tele-rehabilitation

 

Show all authors

Iñaki Díaz, José María Catalan, Francisco Javier Badesa, ...

First Published January 13, 2018 Research Article

Download PDF	Article information

Abstract

This work deals with the complex mechanical design task of converting a large pneumatic rehabilitation robot into an electric and compact system for in-home post-stroke therapies without losing performance. It presents the new HomeRehab robot that supports rehabilitation therapies in three dimensions with an adaptive controller that optimizes patient recovery. A preliminary usability test is also conducted to show that its performance resembles that found in RoboTherapist 2D commercial system designed for hospitals. The mechanical design of a novel and smart two-dimensional force sensor at the end-effector is also described.

10 Reasons to Be Hopeful About the Future of Alzheimer’s Disease

I see zero hopefulness about the future of stroke. I can't point to ANYTHING AT ALL that our fucking failures of stroke associations have done in 2016 that has helped stroke survivors get any closer to 100% recovery.  This is where those presidents could chime in and prove me wrong, but they won't.

10 Reasons to Be Hopeful About the Future of Alzheimer’s Disease

Alzheimer’s disease and good news? Somehow these two terms don’t fit.
After all, more than five million Americans are afflicted with Alzheimer's disease, the sixth leading cause of death in the U.S., which kills more of us than breast and prostate cancer combined. Some experts estimate that as many as 16 million could be afflicted by 2050.
In 2016 alone, Alzheimer’s and other related dementias have cost America an estimated $236 billion. While that figure is staggering, the real cost to families and caregivers is immeasurable.

As we face a new year of fighting Alzheimer’s, the reality is that so much about this disease is still unknown and there are more questions than answers. What drives disease progression? What treatments are most effective? How can we help afflicted families?
After looking into 2016 research findings, initiatives and information on treatment and prevention, I was heartened by what I found. Before we say farewell to 2016, let’s stop and look for hope on the horizon, not to make us complacent but to keep the positive momentum going forward.
Here are 10 reasons why I am feeling more hopeful about the future of Alzheimer’s.

1. Awareness grew in 2016

2. Dementia rates dropped

3. More progress on the tau-amyloid connection

4. Fighting chronic inflammation may be a key prevention tool

5. New Alzheimer’s marker offers hope for treatment

6. Joint Alzheimer’s-Parkinson’s research could mean new treatments for both conditions

7. Existing glaucoma and high cholesterol drugs may lower Alzheimer’s risk

8. 5 major clinical trials aimed at Alzheimer’s prevention

9. One South American country could offer clues for future prevention

10. Federal funding for research highest in history

More details at link.

The Most Exciting Medical Technologies of 2017

Nothing for stroke, unless we can get Dr. Watson involved.
http://medicalfuturist.com/the-most-exciting-medical-technologies-of-2017/

2016 was a rich year for medical technology. Virtual Reality. Augmented Reality. Smart algorithms analysing wearable data. Amazing technologies arrived in our lives and on the market almost every day. And it will not stop in the coming year.

The role of a futurist is certainly not making bold predictions about the future. No such big bet has taken humanity forward. Instead, our job is constantly analysing the trends shaping the future and trying to build bridges between them and what we have today. Still, people expect me to come up with predictions about medical technologies every year, and thus here they are.

The top technologies with the biggest promise for 2017

1) A new era in diabetes care

2) Precision medicine in oncology

3) Narrow artificial intelligence in US clinics - IBM Dr. Watson

4) Driverless trucks or cars will include health sensors

5) New service in nutrigenomics

6) SpaceX and NASA will realize they need a digital health masterplan to reach Mars

7) The genome editing method CRISPR in clinical trials

8) A big tech company will step into health

9) An insurance company launches a wearable sensor package

10) The surgical robot by Google and Johnson&Johnson will compete with daVinci

11) Vocal biomarkers: the future of diagnostic medicine

12) Pharma will start using massive AI in clinical trials and drug research

13) A company will make the 3D printed cast a real choice

It’s important to mention though that none of these will happen without individuals who understand what the technological advances can bring upon as. Those people who discuss the advantages and ethical issues today are the ones who will bring disruption to everyday life tomorrow. Because it’s always more important how we adjust to the changes than what developments will take place next year.

I hope 2017 will be the year when we acknowledge that a cultural revolution is on the way only triggered by new technologies.

Professor Charles Warlow - Emeritus Professor of Medical Neurology, Western General Hospital, Edinburgh - future on stroke

Professor Warlow talks about his view for the future on stroke. It includes absolutely nothing on solving any of the fucking problems in stroke. How the hell did he get to be Emeritus Professor when he seems to know nothing about stroke at all?
My view of the stroke future is incredibly bleak unless we destroy all the existing stroke medical leaders and replace them with stroke survivors.
http://www.healthtalk.org/peoples-experiences/nerves-brain/stroke/professor-charles-warlow

Brief outline: Is one of the UK's leading neurologists and stroke researchers.
Background: Emeritus Professor of Medical Neurology, Western General Hospital, Edinburgh

'We have a strategic plan, it's called doing things' - Herb Kelleher

Founder of Southwest Airlines. I know our stroke associations don't have any strategic plan at all, they are just letting all future survivors recover just as badly as you did.  But you can buy this print from gapingvoidart.com to remind you that your children and grandchildren are screwed unless WE change stroke leadership.

Whole Body Vibration Therapy

Some day in the far far future after all the existing stroke non leaders are dead, we will run research that will determine if this has any use for stroke rehab. But until then you and all future stroke survivors are screwed.

Whole Body Vibration Therapy

Brain recovery – what is the future?

All these questions but no answers and no protocols. 27 pages of basically nothing useful.

XXII World Congress of Neurology, Santiago, Chile, 2nd November 2015

https://www.ucl.ac.uk/ion/departments/sobell/Research/NWard/documents/wcn2015

Future of Quality and Outcomes Research in Stroke

All this blather and not one word on a strategy or planning on how to solve all the problems in stroke.
http://circoutcomes.ahajournals.org/content/8/6_suppl_3/S66.extract?etoc

1. Gregg C. Fonarow, MD,
2. Moira K. Kapral, MD, MSc and
3. Lee H. Schwamm, MD

+ Author Affiliations

1. From the Division of Cardiology, Geffen School of Medicine at UCLA, Los Angeles, CA (G.C.F.); Department of Medicine, University of Toronto, Toronto, Ontario, Canada (M.K.K.); and Department of Neurology, MGH Stroke Services, Fireman Vascular Center Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.).

1. Correspondence to Gregg C. Fonarow, MD, Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, 10833 LeConte Ave, Room 47-123 CHS, Los Angeles, CA 90095. E-mail gfonarow@mednet.ucla.edu

Stroke is a common and costly condition that affects 15 million people worldwide each year.¹ Globally, stroke results in nearly 6 million deaths, and another 5 million people are permanently disabled by stroke each year. Stroke is the fourth leading cause of death, the second most common reason for hospitalization in older adults, and the most common cause of long-term disability in the United States.² Although there have been important advances in stroke treatment and rehabilitation over the past few decades, stroke patients, care partners, and clinicians frequently still have too little information to determine which diagnostic tests, treatments, and strategies to apply and which to avoid in specific instances. There remain critical voids in knowledge about which approaches to stroke care are likely to produce optimal clinical outcomes for the greatest number of patients. In addition, despite well-developed repositories for the assessment of neurological quality of life and other patient-reported outcomes, the field of cerebrovascular disease has been slow to incorporate these measures into care planning and shared decision-making.^3,4 Even when strong evidence exists, there are frequently gaps, variations, and disparities in how that evidence is applied in clinical practice. Challenges remain in accurately capturing and reporting quality and outcomes, including functional outcomes, that are properly risk adjusted. Quality and outcomes research in stroke is essential to bridging these substantial gaps in knowledge, better informing clinical decision making, and driving further improvements in stroke care and outcomes.

Together, we’ll make neurological illness a thing of the past.

A quote from Michael J. Fox. Certainly not from one of our stroke associations, they wouldn't even know how to spell strategy much less plan for how to solve neurological problems.

We’ve come a long way since 1985. When Marty McFly and Doc Brown traveled 30 years into the future, we could only imagine the innovations we take for granted today -- new ideas and technologies that have completely changed the way we live, learn, and work. Back then, if you’d have told me that I’d go from talking on a cell phone to talking cell biology, I would never have believed you. But today, The Michael J. Fox Foundation  is helping to spearhead research collaborations to speed a future in which we can treat, cure, and even prevent brain diseases like Parkinson's. (Our stroke associations are doing absolutely nothing in this regard).  Are you ok with that? So what’s possible in another 30 years? Call me an optimist, but I believe that by 2045 we’ll find the cures we seek -- especially because of all the smart, passionate people working to make it happen. Doctors and researchers around the world are developing new tools to improve the diagnosis and treatment of brain diseases, to tailor treatments -- for all illnesses -- through precision medicine, and to make life better for millions of people. This truly is the stuff of the future. Today, on “Back to the Future Day,” I challenge you to imagine the world you want to live in thirty years from now. The White House is hosting a series of online conversations with innovators across the country all day long. Check it out and add your voice here. We can't all be brain scientists, but all of us can get involved. One reason Parkinson’s research has come so far in the past 15 years is that people and families living with the disease have stepped up as advocates and innovators themselves, working to build the future we all want. Together, we’ll make neurological illness a thing of the past. And if we all eventually get hoverboards, well -- that's a bonus. --Michael J. Fox This email was sent to . Unsubscribe | Privacy Policy Please do not reply to this email. Contact the White House The White House • 1600 Pennsylvania Ave NW • Washington, DC 20500 • 202-456-1111

s

Depression Caused By How People See The Future, New Study Finds

Think about this in regards to stroke. Our doctors give us no hope for recovery, there are no recovery stroke protocols, there is nothing to solve spasticity, there is nothing to solve fatigue. Only 10% of survivors get to almost full recovery. With all that information the future looks pretty damn bleak for a survivor. Your doctor should be telling you that you will be working harder that you ever have for the rest of your life just trying to get back to some semblance of normalcy. With such a bleak future for a survivor depression is likely to set in. And I don't see our doctors, stroke associations or anyone
trying to solve these problems in order to prevent depression.
http://www.spring.org.uk/2015/06/depression-caused-by-how-people-see-the-future-new-study-finds.php?utm_source=PsyBlog

Your Brain’s Future: The Good And Bad News

A blog post from The Best Brain Possible
You need to read the quotes from Dr. Michael Merzenich 
 My ideas here: Dementia prevention 19 ways

http://www.thebestbrainpossible.com/your-brains-future-the-good-and-bad-news 

Stem cells for neonatal stroke- the future is here

When is the future for the rest of us survivors?

ASA - Dr. Mariel Jessup,  Whom are you going to assign to this task?

NSA - Mr. Baranski, Whom are you going to assign to this task?

WSO - Dr. Stephen Davis, Whom are you going to assign to this task?

http://journal.frontiersin.org/Journal/10.3389/fncel.2014.00207/full?

Stem Cells

In recent years stem cell therapy has emerged as a potential treatment for neonatal ischemic brain injury. The efficacy of cell- based therapies in restoring damaged brain tissue has been tested in a multitude of models for different CNS diseases. Several different stem and progenitor cell populations have been utilized as cell-based therapy, including neural stem cells, embryonic stem cells, human umbilical cord blood cells (HUBCs), hematopoietic stem and progenitor cells, and mesenchymal stem cells (MSCs). Most stem cell types appear to enhance recovery to some extent (Pimentel-Coelho and Mendez-Otero, 2010). However, because of their low immunogenicity, availability and positive results obtained from preclinical studies, MSCs are a particularly promising candidate to repair the devastating effects that are associated with neonatal stroke. MSCs were first isolated and identified in bone marrow, but can now be isolated from many tissues, including adipose tissue, muscle, skin and extraembryonic tissues like the placenta, umbilical cord and Wharton's jelly. The latter sources are of particular interest for neonates that experience an ischemic event around the time of birth, at which time cells can be harvested and transplanted from an autologous source. MSCs derived from different sources have slightly different characteristics, but as of yet it is unknown whether this influences their therapeutic potential.

Our group and others have shown that administration of MSCs reduces lesion volume, provides positive effects on the white matter and improves motor function (van Velthoven et al., 2012). Numerous studies have been done under the premise that transplanted stem cells contribute to brain repair by directly replacing damaged or lost tissue. While there is evidence that transplanted cells undergo differentiation toward neuronal lineages, improved outcomes have been observed even when survival of transplanted cells is low and engrafted cells are absent. This suggests that rather than replacing damaged cells, transplanted cells may improve outcome via indirect mechanisms. For example, MSCs have been shown to secrete many factors that can influence important processes like apoptosis, neurogenesis, angiogenesis and synaptogenesis.

More pages at link.

Forecasting the Future of Stroke in the United States

A Policy Statement From the American Heart Association and American Stroke Association. We are going to get overwhelmed unless we prevent massive amounts of neuronal damage by stopping the neuronal cascade of death.

Forecasting the Future of Stroke in the United States

1. Bruce Ovbiagele, MD, MSc, MAS, FAHA, Chair;
2. Larry B. Goldstein, MD, FAHA;
3. Randall T. Higashida, MD, FAHA;
4. Virginia J. Howard, PhD, FAHA;
5. S. Claiborne Johnston, MD, PhD;
6. Olga A. Khavjou, MA;
7. Daniel T. Lackland, DrPH, MSPH, FAHA;
8. Judith H. Lichtman, PhD;
9. Stephanie Mohl, BA;
10. Ralph L. Sacco, MD, MSc, FAHA;
11. Jeffrey L. Saver, MD, FAHA;
12. Justin G. Trogdon, PhD
13. on behalf of the American Heart Association Advocacy Coordinating Committee and Stroke Council

Abstract

Background and Purpose—Stroke is a leading cause of disability, cognitive impairment, and death in the United States and accounts for 1.7% of national health expenditures. Because the population is aging and the risk of stroke more than doubles for each successive decade after the age of 55 years, these costs are anticipated to rise dramatically. The objective of this report was to project future annual costs of care for stroke from 2012 to 2030 and discuss potential cost reduction strategies.

Methods and Results—The American Heart Association/American Stroke Association developed methodology to project the future costs of stroke-related care. Estimates excluded costs associated with other cardiovascular diseases (hypertension, coronary heart disease, and congestive heart failure). By 2030, 3.88% of the US population >18 years of age is projected to have had a stroke. Between 2012 and 2030, real (2010$) total direct annual stroke-related medical costs are expected to increase from $71.55 billion to $183.13 billion. Real indirect annual costs (attributable to lost productivity) are projected to rise from $33.65 billion to $56.54 billion over the same period. Overall, total annual costs of stroke are projected to increase to $240.67 billion by 2030, an increase of 129%.

Conclusions—These projections suggest that the annual costs of stroke will increase substantially over the next 2 decades. Greater emphasis on implementing effective preventive, acute care, and rehabilitative services will have both medical and societal benefits.

The Future of Stroke Rehabilitation: recovery of language and vision

You'll have to compare this to what your therapists are doing for you, page 26-7.
http://scholar.google.com/scholar_url?hl=en&q=http://www.acnr.co.uk/wp-content/uploads/2014/02/ACNRJF14-reduced-PDF2.pdf%23page%3D26&sa=X&scisig=AAGBfm3m08fqF5KEAOuCDOfQVRonZLneCg&oi=scholaralrt

Thinking about beautiful past increases your positivity towards future

So this needs to be considered also;

Positive Attitude Boosts Exercise, Longevity Among Heart Disease Patients, Study Suggests

and this:

Pessimists May Live Longer

Thinking about beautiful past increases your positivity towards future
Have fun.
Is your doctor informing you about this or only being an asshole and telling you negative stories about non-recovery? Or like my case, nothing at all, it was like I didn't exist.

Sprinting towards a cliff of stroke

My regular readers  know this but the stroke medical world doesn't or their head is in the sand. The stroke medical teams are sprinting towards a cliff of vastly increased stroke patients. They don't have a low altitude parachute or a wingsuit and don't even know if there is water at the bottom. They must expect to build a glider of 100% effective stroke rehab with no preparation. We as patients will surely die or be severely disabled in the attempt.  Unless we start screaming about preparations nothing will get done. They have already proven in the last 20 years that the stroke medical world doesn't plan for the future.

That tsunami of stroke is coming and it's going to disable millions of survivors because the existing stroke protocols only have 10% fully recover. And that has nothing to do with the medical care received, just luck that those were small strokes.

Energy failure—does it contribute to neurodegeneration?

Your doctor should need to know the answer to this to prevent it in the next stroke patient.
http://onlinelibrary.wiley.com/doi/10.1002/ana.24014/abstract

1. Divya Pathak¹,
2. Amandine Berthet¹,
3. Ken Nakamura^1,2,*

DOI: 10.1002/ana.24014

ABSTRACT

Energy failure from mitochondrial dysfunction is proposed to be a central mechanism leading to neuronal death in a range of neurodegenerative diseases. However, energy failure has never been directly demonstrated in affected neurons in these diseases, nor has it been proved to produce degeneration in disease models. Therefore, despite considerable indirect evidence, it is not known if energy failure truly occurs in susceptible neurons, and if this failure is responsible for their death. This limited understanding results primarily from a lack of sensitivity and resolution of available tools and assays and the inherent limitations of in vitro model systems. Major advances in these methodologies and approaches should greatly enhance our understanding of the relationship between energy failure, neuronal dysfunction and death, and help us to determine if boosting bioenergetic function would be an effective therapeutic approach. Here we review the current evidence that energy failure occurs in and contributes to neurodegenerative disease, and consider new approaches that may allow us to better address this central issue. ANN NEUROL 2013. © 2013 American Neurological Association