Use the labels in the right column to find what you want. Or you can go thru them one by one, there are only 34,102 posts. Searching is done in the search box in upper left corner. I blog on anything to do with stroke. DO NOT DO ANYTHING SUGGESTED HERE AS I AM NOT MEDICALLY TRAINED, YOUR DOCTOR IS, LISTEN TO THEM. BUT I BET THEY DON'T KNOW HOW TO GET YOU 100% RECOVERED. I DON'T EITHER BUT HAVE PLENTY OF QUESTIONS FOR YOUR DOCTOR TO ANSWER.
Changing stroke rehab and research worldwide now.Time is Brain!trillions and trillions of neuronsthatDIEeach day because there areNOeffective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.
What this blog is for:
My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.
Having to do this is directly the result of MASSIVE INCOMPETENCE OF OUR FUCKING FAILURES OF STROKE ASSOCIATIONS IN NOT CREATING A DATABASE OF ALL RESEARCH AND THE CREATED PROTOCOLS!
Background: Stroke is a leading cause of disability, commonly resulting in difficulty completing basic and instrumental activities of daily living. Rehabilitation is recommended to improve functional performance; however, it remains unknown whether early (hospital-based) intervention is effective; nor is it known what intervention components should be delivered.
Objective: We propose a systematic review to summarize the evidence for the effectiveness of activity-based interventions, led by occupational therapists, for improving performance of basic activities of daily living (b-ADL) or simple cognitive instrumental activities of daily living (C-IADL) among adults with stroke. Reviewing simple C-IADLs as opposed to instrumental activities of daily living will allow us to review interventions for activities with similar executive functioning demands. By identifying effective interventions, we aim to improve outcomes for stroke survivors by maximizing independence during hospitalization.
Methods: Searches will be conducted in MEDLINE, CINAHL, EMBASE, and Cochrane Central Register of Controlled Trials. We will include randomized controlled trials and quasi-randomized controlled trials that include adult stroke survivors and tested interventions (delivered in the hospital setting) aiming to improve or promote independence in b-ADLs or C-IADLs. Two reviewers will independently screen full-text articles, and one reviewer will extract data, with a second reviewer providing confirmation. The Physiotherapy Evidence Database (PEDro) scale will be used to assess the methodological quality of studies. The Cochrane Q test will assess heterogeneity among studies, and where appropriate, meta-analysis will then be performed. Measures of outcomes may include global ratings of function (such as the Functional Independence Measure) or specific task performance assessments (such as the Nottingham Dressing Assessment).
Results: Results will be presented based on subgroup analyses where possible, including activity type (activity or occupation level), time after stroke (within or after 1 week), and delivery of intervention (group or individualized).
Conclusions: This systematic review will address the current gap in the literature regarding activity-based interventions for stroke survivors in the inpatient setting and provide clinical guidance on the most effective methods, if any, for improving independence early after stroke.
The American Stroke Association celebrates 25 years of progress. (American Heart Association)
Power. Speed. Agility. For a 25-year-old athlete, those qualities are key to a winning performance.
As
it turns out, they're also vital as a 25-year-old organization works to
turn the tide on stroke — in an era that may be among the most pivotal
in the field's history.
"The rapid change in stroke care now is
similar to what was seen 20 or more years ago around heart attacks in
cardiology," said neurologist Mitchell Elkind, M.D., M.S., FAHA, the
American Heart Association's chief clinical science officer.
The
American Stroke Association, launched in 1998 as the AHA's Stroke
Division, is driven by people power. That means millions of volunteers
and donors are working to ensure equitable health care in all
communities, funding innovative research, advocating for the public's
health and providing lifesaving resources.
Every day, the actions
of the ASA are a powerful force in ensuring that mothers and fathers,
sisters and brothers, daughters and sons who have a stroke get timely,
optimal care, support, essential rehabilitative services and more.(NOT RESULTS!)
Speed is an ever-present priority in the ASA's work — from teaching the public to recognize strokes F.A.S.T.
and call for help, to comprehensive systems-of-care initiatives that
can shave off hours, minutes and seconds between when a stroke starts
and when patients receive the therapies most likely to help them.(So when are you going to get tPA delivered in 3 minutes? NEVER? Then you'll need to
"The
ASA taught everyone that 'Time Is Brain'" — that is, the longer a
stroke goes untreated, the more damage the brain is likely to sustain,
Elkind said.
The pandemic, meanwhile, has stress-tested the ASA's
agility with unprecedented challenges. Scientists had to grasp — and
quickly disseminate findings about — the particular dangers of strokes associated with COVID-19, along with the virus's systemic, cerebrovascular and long-term effects. As anxiety and the COVID-19 death toll escalated, the public had to be persuaded
not to neglect lifesaving cardiovascular care. And as the leading venue
for stroke experts to share their knowledge, the International Stroke
Conference had to march on, fully virtual in 2021 and in a hybrid
in-person/online format since.
Decades of stroke focus
This
year's International Stroke Conference is a culmination of nearly 70
years of AHA interest in stroke, beginning with the organization's
leading role in developing the first Princeton Conference on
cerebrovascular disease in 1954 – organized and chaired by Irving
Wright, M.D., the AHA's 1952-53 president.
Within a decade, the
AHA had formed an ad hoc coordinating committee for a nationwide stroke
program, with Wright as chairman. By 1970, the committee had evolved
into the Council on Cerebrovascular Disease (later the AHA's Stroke
Council), and the journal Stroke was launched. In 1993, while stroke was
already part of the AHA's mission statement, the organization added it
to its motto ("Fighting Heart Disease and Stroke.")
In
the mid-1990s, the AHA's leadership in stroke science was unmistakable,
said Stroke Council Chair Patrick Lyden, M.D., FAHA. Lyden was one of
the investigators in the National Institute of Neurological Disorders
and Stroke rt-PA Stroke Study Group — and helped draft the protocol and
main results of a landmark 1995 trial that established intravenous recombinant tissue plasminogen activator as a vital treatment for ischemic stroke.(And that is the problem, you stopped looking for something better after tPA was approved. You rested on your laurels and allowed stroke survivors to continue to be disabled because there was NO leadership there trying to solve stroke to 100% recovery!)
Oops, I'm not playing by the polite rules of Dale Carnegie; 'How to Win Friends and Influence People'.
Telling supposedly smart stroke medical persons they know nothing about stroke is a no-no even if it is true.
Politeness
will never solve anything in stroke. Yes, I'm a bomb thrower and proud
of it. Someday a stroke 'leader' will try to ream me out for making them look bad by being truthful, I
look forward to that day.
"Two years before the ASA was created, the AHA strongly endorsed
the use of intravenous tPA in appropriately selected patients with
acute ischemic stroke," Lyden said. "This was a bold and controversial
position, but it was based on hard science that has since been
replicated many times."
Subsequent publications on thrombolytic
therapies "provide the medical community with the best, most informative
updates on using this landmark therapy," added Lyden, a professor of
physiology and neuroscience and neurology at the University of Southern
California's Keck School of Medicine.
When the AHA's Stroke
Division was renamed the American Stroke Association, a Division of the
American Heart Association, in 1999, then-AHA President Dr. Valentin
Fuster wrote in Stroke, "The new name demonstrates that the AHA's
passion in the fight against death and disability from stroke is as
strong as its fight against death and disability from heart disease."
Guidance and insight
One
way that passion takes flight is in the form of ASA consensus
publications providing health care professionals and community leaders
the latest expert guidance on stroke. The first such publication,
predating the ASA, appeared in 1994 as a special report in Stroke on managing patients with acute ischemic stroke.
As
the principal oversight committee for stroke-related activity of the
ASA and AHA, the Stroke Council, through the work of several science
subcommittees, commissions and approves such consensus publications.
High
among the ASA's current priorities is health equity — ensuring that all
people learn about stroke, receive preventive care and can access the
best treatments for acute stroke, Elkind said. "This focus is driven by
the recognition that stroke mortality is twice as high in Black as white
people, and elevated in other communities with limited resources,
including rural communities."
Rural residents, along with
American Indians, face the longest distances between their homes and
certified stroke care, research has shown. Compared with people who live
in urban areas, residents of rural areas are less likely to get the
most advanced treatments for stroke and are more likely to die in the
hospital.
The ASA also continues to highlight the importance of
identifying and controlling high blood pressure, a condition affecting
nearly 47% of U.S. adults. It's the most important modifiable stroke
risk factor, Elkind noted, responsible for half of all strokes and
perhaps as many as 80% of bleeding strokes. (Breaking new ground in that
fight is the AHA's National Hypertension Control Initiative,
a sweeping effort focusing on local health centers and community-based
organizations to reduce high blood pressure in under-resourced areas.)
Other
priority areas include evidence-based practice for stroke
rehabilitation to improve recovery after stroke, and stroke risk factors
such as atrial fibrillation — an irregular heart rhythm — and sickle
cell disease, which is especially important as a cause of stroke in
children.
Work in progress
Over a
quarter-century, the ASA continually has proved that an association in
motion stays in motion. The organization's more recent achievements
include:
Phase III of Target: Stroke,
setting more aggressive targets for timely treatment with alteplase as
well as targets for prompt treatment with endovascular therapy.
More
than 3,600 hospitals have participated in Get With The
Guidelines-Stroke since the program was launched with pilot testing in
24 hospitals in 2001. Currently through the program, about 86% of
ischemic stroke patients have access to quality stroke care.
A future of possibilities
Back
in the 1950s, the impetus for that first Princeton Conference came from
medical activist and philanthropist Mary Lasker, who provided $25,000
in funding for the event with the aim of setting a national stroke
agenda. Lasker's parents both had experienced strokes and — as she
recalled to neurologist James Toole, M.D. — a friend who had recently
suffered a stroke was told there was no treatment besides bed rest.
Fast
forward to today, where treatment approaches for stroke are multiple,
treatment plans are multi-faceted and possibilities appear myriad. Among
the developing areas Elkind finds most exciting are:
Mobile
stroke units, essentially ambulances with CT scanners, specialized lab
equipment and access to a stroke specialist. These are designed to
shorten the window between when a stroke begins and when patients
receive crucial clot-busting care.
The increasing use of
therapy with stent-retrievers, which allow physicians to extract blood
clots that cause strokes, thereby limiting resulting brain damage. "We
are beginning to see the next stage in the evolution of these treatments
to a wider group of patients: those with bigger strokes, those with
strokes more than a day old, those who may be older or have other
medical conditions," Elkind said.
A growing understanding of
factors other than neurodegeneration that may contribute to cognitive
decline — including tiny strokes, blood vessel disease, inflammation and
even viral infections like COVID-19. Elkind sees a future where experts
with more diverse backgrounds and skills collaborate on research into
dementia. "The ASA," he said, "will play a major role."
Picture the people
Ultimately,
progress against stroke relies on harnessing not just research data,
but hearts and minds. Consider the untold volunteers participating in
cerebrovascular clinical trials, on top of the 8 million stroke patients
represented in the Get With The Guidelines-Stroke registry.
Or the legions who champion stroke policy priorities — such as
increased federal research funding or broader Medicare coverage for
stroke — through the yourethecure.org grassroots advocacy network.
Add in the Stroke Heroes the ASA has celebrated, starting in 2020. And the 79,000-plus readers of its Stroke Connection magazine.
Then
there are the millions of people educated by Together to End Stroke® or
other awareness programs, the survivors and caregivers who have taken
part in more than 1,300 ASA-registered stroke support groups, the tens of thousands of people aided by the Stroke Family Warmline and Support Network, and the more than two-thirds of adults who know at least one stroke warning sign.
All
this, as researchers press on at the vanguard of stroke discovery. They
include investigators who have contributed to the more than 3,000
stroke-related research projects funded by the AHA/ASA since 1998, and
the variety of stroke experts assembled today for the International
Stroke Conference.
"Here I have made lifelong working
collaborations and friendships," said Lyden, who has been an ASA member
attending ISC since 1985. "The ASA provides the hub that brings together
all spokes of stroke care and research."
