Contralesional Hemisphere Control of the Proximal Paretic Upper Limb following Stroke

'May' and 'can' is not good enough. We need stroke protocols leading to 100% recovery.  This is extreme laziness. The whole point of stroke research is protocols leading to recovery. NOTHING LESS!  Talk to survivors sometime and see what they want without your assumption of tyranny of low expectations.

 

Contralesional Hemisphere Control of the Proximal Paretic Upper Limb following Stroke

Lynley V. Bradnam1,2, Cathy M. Stinear2,3, P. Alan Barber2,3 and Winston D. Byblow1,2 1Movement Neuroscience Laboratory, Department of Sport & Exercise Science, and 2Centre for Brain Research and 3Neurology Research Group, Department of Medicine, The University of Auckland, Auckland, New Zealand 1142.
Address correspondence to Winston D. Byblow, Movement Neuroscience Laboratory, Department of Sport & Exercise Science, The University of Auckland, Auckland, New Zealand 1142. Email: w.byblow@auckland.ac.nz.
Cathodal transcranial direct current stimulation (c-tDCS) can reduce excitability of neurons in primary motor cortex (M1) and may facilitate motor recovery after stroke. However, little is known about the neurophysiological effects of tDCS on proximal upper limb function. We hypothesized that suppression of contralesional M1 (cM1) excitability would produce neurophysiological effects that depended on the severity of upper limb impairment. Twelve patients with varying upper limb impairment after subcortical stroke were assessed on clinical scales of upper limb spasticity, impairment, and function. Magnetic resonance imaging was used to determine lesion size and fractional anisotropy (FA) within the posterior limbs of the internal capsules indicative of corticospinal tract integrity. Excitability within paretic M1 biceps brachii representation was determined from motor-evoked potentials during selective isometric tasks, after cM1 sham stimulation and after c-tDCS. These neurophysiological data indicate that c-tDCS improved selective proximal upper limb control for mildly impaired patients and worsened it for moderate to severely impaired patients. The direction of the neurophysiological after effects of c-tDCS was strongly related to upper limb spasticity, impairment, function, and FA asymmetry between the posterior limbs of the internal capsules. These results indicate systematic variation of cM1 for proximal upper limb control after stroke and that suppression of cM1 excitability is not a ‘‘one size fits all’’ approach.
 

Endovascular Thrombectomy as a Means to Improve Survival in Acute Ischemic Stroke

And just when are you going to change your definition of success to the expectation of success that stroke survivors have? 100% recovery. NOTHING LESS THAN THAT. Stop fucking around with your tyranny of low expectations of just survival. 

 

Endovascular Thrombectomy as a Means to Improve Survival in Acute Ischemic Stroke

A Meta-analysis

Yingfeng Lin, MD¹; Volker Schulze, MD¹; Maximilian Brockmeyer, MD¹; et al Claudio Parco, MD¹; Athanasios Karathanos, MD¹; Yvonne Heinen, MD¹; Michael Gliem, MD²; Hans-Peter Hartung, MD²; Gerald Antoch, MD³; Sebastian Jander, MD²; Bernd Turowski, MD³; Stefan Perings, MD¹; Malte Kelm, MD^1,4; Georg Wolff, MD¹

Author Affiliations

JAMA Neurol. Published online April 8, 2019. doi:10.1001/jamaneurol.2019.0525

Key PointsQuestion  Is there a benefit for short-term survival with endovascular thrombectomy vs medical therapy in acute ischemic stroke?
Findings  In this meta-analysis of all randomized clinical trials of endovascular thrombectomy vs medical therapy cited in the 2018 American Stroke Association/American Heart Association guidelines for acute ischemic stroke, endovascular thrombectomy significantly reduced the risk for 90-day mortality compared with medical therapy, without a difference in risk of intracranial hemorrhage.
Meaning  There is considerable evidence of the benefits of endovascular thrombectomy for survival during the first 90 days after acute ischemic stroke.

Abstract

Importance  Although endovascular thrombectomy (EVT) in acute ischemic stroke is recommended by guidelines to improve functional recovery, thus far there are insufficient data on its association with mortality.
Objective  To identify guideline-relevant trials of EVT vs medical therapy reporting 90-day mortality and perform a meta-analysis.
Data Sources  All randomized clinical trials cited for recommendations on EVT vs medical therapy in the latest 2018 American Stroke Association/American Heart Association guidelines.
Study Selection  Ten American Stroke Association/American Heart Association guideline–relevant randomized clinical trials of EVT vs medical therapy were selected for inclusion. Two EVT trials were excluded owing to infrequent use of EVT.
Data Extraction and Synthesis  Data were abstracted by 2 independent investigators and double-checked by 4 others. Singular study data were integrated using the Cochran-Mantel-Haenszel method and a random-effects model to compute summary statistics of risk ratios (RR) with 95% CIs.
Main Outcomes and Measures  Risk of 90-day mortality and 90-day intracranial hemorrhage was analyzed; sensitivity analyses were performed in early-window EVT trials (which included patients from the onset of symptoms onward) vs late-window EVT trials (which included patients from 6 hours after onset of symptoms onward).
Results  In 10 trials with 2313 patients, EVT significantly reduced the risk for 90-day mortality by 3.7% compared with medical therapy (15.0% vs 18.7%; RR, 0.81; 95% CI, 0.68-0.98; P = .03). Trends were similar in early-window (RR, 0.83; 95% CI, 0.67-1.01; P = .06) and late-window trials only (RR, 0.76; 95% CI, 0.41-1.40; P = .38). There was no difference in the risk for intracranial hemorrhage in EVT vs medical therapy (4.2% vs 4.0%; RR, 1.11; 95% CI, 0.71-1.72; P = .65). Limitations of the studies include trial protocol heterogeneity and bias originating from prematurely terminated trials.
Conclusions and Relevance  This meta-analysis of all evidence on EVT cited in the 2018 American Stroke Association/American Heart Association guidelines shows significant benefits for survival during the first 90 days after acute ischemic stroke compared with medical therapy alone.

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Wirral's Early Supported Discharge Service celebrates 10th birthday

In 10 years they should have been able to tell exactly how many patients fully recovered to determine if Early Supported Discharge is a success or not. Since they don't tell us that, they must not want us to know how bad this service is.  Better than when they left the hospital is not good enough. 100% recovery is the goal of all stroke patients. NOTHING LESS! How close are they to that goal?

Wirral's Early Supported Discharge Service celebrates 10th birthday

A WIRRAL hospital service that has helped thousands of stroke patients recover is celebrating the 10th anniversary of its launch this week.

The ESD (Early Supported Discharge) Service, run by Wirral University Teaching Hospital, helps stroke patients return to daily activities such as walking, shopping, reading, cooking and driving.
Among those praising it is Brian Lloyd, 81, who is back enjoying the things he loves just four months after suffering a serious stroke at his home is Eastham.
After waking one morning, Brian felt dizzy and fell down the stairs.
Despite being unable to talk, he managed to call a friend for help and was rushed to Arrowe Park Hospital by ambulance.
Medics responded quickly and after five days, Brian was well enough to leave hospital and began stroke rehabilitation in the comfort of his own home.
Since its launch a decade ago, the ESD has helped more than 3,000 people recover.
Its team of specialists provide occupational therapy, physiotherapy and speech and language therapy to eligible patients who have been discharged from the Acute Stroke Unit at Arrowe Park Hospital and Clatterbridge Hospital's Stroke Rehab Centre.
Brian explained: "I've had fantastic support from the ESD team who have made a huge difference to me, particularly with improving my speech and ability to write.
"I've had some physio and have been receiving occupational therapy and speech and language therapy at home since being discharged.
"It was important to me to avoid a lengthy hospital stay and I think it's helped me to get better sooner.
"I've been really impressed with the support I've had and it's been much easier not having to travel to the appointments."
Motoring enthusiast, Brian, has made huge progress since leaving hospital and is looking forward to driving again soon having recently passed his driving assessment.
He goes on his exercise bike every day and is continuing to do activities set by his therapists to further help his recovery.
Jenny Lawrence, ESD Clinical Lead for Occupational Therapy helped to set up the hospital's service when it was first launched ten years ago.
She said: "Our ESD team provides specialist rehabilitation in a community setting at levels comparable to that of a hospital in-patient stroke unit.
"No-one wants to be in hospital longer than necessary and evidence shows that providing this care brings real benefits to stroke patients including reducing disabilities and improving quality of life.
"We are very proud of how far the service has come in the last decade.
"Mr Lloyd has worked hard on his recovery and is a great example of the difference we can make to our patients."
To celebrate their 10th birthday, the ESD team is holding a cake sale in aid of WUTH Charity's Stroke Fund on Thursday, April 25 at Clatterbridge Hospital's rehabilitation centre from 10.30am to 12.30pm.

A quantitative taxonomy of human hand grasps

Your doctor needs to compare your hand grasps to these normal ones and use protocols to get from your disabled hand to full recovery. NOTHING LESS THAN THAT.  Your doctors' responsibility is to cure you, isn't it? Or is that too fucking hard? 

A quantitative taxonomy of human hand grasps

• Francesca Stival,
• Stefano MichielettoEmail authorView ORCID ID profile,
• Matteo Cognolato,
• Enrico Pagello,
• Henning Müller and
• Manfredo Atzori

Journal of NeuroEngineering and Rehabilitation201916:28

https://doi.org/10.1186/s12984-019-0488-x

©  The Author(s) 2019

• Received: 23 July 2018
• Accepted: 21 January 2019
• Published: 15 February 2019

Abstract

Background

A proper modeling of human grasping and of hand movements is fundamental for robotics, prosthetics, physiology and rehabilitation. The taxonomies of hand grasps that have been proposed in scientific literature so far are based on qualitative analyses of the movements and thus they are usually not quantitatively justified.

Methods

This paper presents to the best of our knowledge the first quantitative taxonomy of hand grasps based on biomedical data measurements. The taxonomy is based on electromyography and kinematic data recorded from 40 healthy subjects performing 20 unique hand grasps. For each subject, a set of hierarchical trees are computed for several signal features. Afterwards, the trees are combined, first into modality-specific (i.e. muscular and kinematic) taxonomies of hand grasps and then into a general quantitative taxonomy of hand movements. The modality-specific taxonomies provide similar results despite describing different parameters of hand movements, one being muscular and the other kinematic.

Results

The general taxonomy merges the kinematic and muscular description into a comprehensive hierarchical structure. The obtained results clarify what has been proposed in the literature so far and they partially confirm the qualitative parameters used to create previous taxonomies of hand grasps. According to the results, hand movements can be divided into five movement categories defined based on the overall grasp shape, finger positioning and muscular activation. Part of the results appears qualitatively in accordance with previous results describing kinematic hand grasping synergies.

Conclusions

The taxonomy of hand grasps proposed in this paper clarifies with quantitative measurements what has been proposed in the field on a qualitative basis, thus having a potential impact on several scientific fields.