Use the labels in the right column to find what you want. Or you can go thru them one by one, there are only 33,991 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.
This is pretty much pie in the sky, assuming that the motor cortexes are viable and the only problem is white matter damage preventing the signals from getting through. Wouldn't work for me at all with dead motor and pre-motor cortexes. Where is my dead brain rehab protocol?
Stroke
is a leading cause of paralysis, most frequently affecting the upper
limbs and vocal folds. Despite recent advances in care, stroke recovery
invariably reaches a plateau, after which there are permanent
neurological impairments. Implantable brain-computer interface devices
offer the potential to bypass permanent neurological lesions. They
function by (1) recording neural activity, (2) decoding the neural
signal occurring in response to volitional motor intentions, and (3)
generating digital control signals that may be used to control external
devices. While brain-computer interface technology has the potential to
revolutionize neurological care, clinical translation has been limited.
Endovascular arrays present a novel form of minimally invasive
brain-computer interface devices that have been deployed in human
subjects during early feasibility studies. This article provides an
overview of endovascular brain-computer interface devices and critically
evaluates the patient with stroke as an implant candidate. Future
opportunities are mapped, along with the challenges arising when
decoding neural activity following infarction. Limitations arise when
considering intracerebral hemorrhage and motor cortex lesions; however,
future directions are outlined that aim to address these challenges.
At that price there better be an exact protocol on number of steps needed in the machine to recover walking completely. But that is a pie in the sky hope,all you'll get is better walking NOT recovery. Looks like a Lokomat.
University Hospitals Dorset NHS Charity has introduced an innovative
£365,000 walking robotics device called Walkerbot, which will be used to
help stroke patients at the Royal Bournemouth Hospital as they relearn
to walk.
The Walkerbot appeal began in 2020, and thanks to generous donations
from individuals, local businesses and community supporters, the robotic
device was funded by the charity in 20 months.
This cutting-edge piece of technology is the only one of its kind in
an NHS hospital in England and is now in use at the Royal Bournemouth
Hospital Stroke Unit, helping patients to take the thousands of steps
needed a day to allow their brains to rewire during recovery.
Dr Louise Johnson, Consultant Therapist for Stroke at University
Hospitals Dorset, said: “I can’t quite believe the Walkerbot campaign
has come to an end and that we are now able to offer people in East
Dorset access to such an incredible piece of technology as part of their
rehabilitation with us. The science behind what we do in stroke
rehabilitation is always evolving, along with our understanding of how
best to support patient recovery.
“It’s fantastic for patients, but equally exciting for our staff who
are committed to providing excellent care. I’m looking forward to
working with the team over the coming weeks and months as we embed this
within our stroke and neuro rehab services.”
The Walkerbot comprises of a treadmill and a harness that straps
around individual so they stay safe while walking. It also has robotics
that attach to the user’s legs, which enables the person who is
otherwise unable to take steps to take steps as part of their
rehabilitation post-stoke at the hospital.
The idea is that the robot helps stroke patients take steps earlier,
so that they spend less time in hospital, are able to leave the hospital
less dependent and can do more for themselves.
Another benefit of the assistive device is that it requires less
therapy staff to treat patients. Where two or three therapists might
normally be needed to help someone stand and walk as part of a
rehabilitation programme, once Walkerbot is up and running it only takes
one staff member to operate. This is more efficient for the hospital,
according to the BBC, as it means the therapy team can deliver more rehabilitation to more patients.
Karen Smith, Fundraising Manager at University Hospitals Dorset NHS
Charity, commented: “The Walkerbot appeal has been such an exciting
project for us and we are delighted that stroke patients now have access
to such an incredible piece of technology. The support we’ve received
during this campaign has been phenomenal and I cannot thank each and
every supporter enough for making donations, taking on challenges and
doing what they can to support the hospital.”
Studying
the human brain during interpersonal interaction allows us to answer
many questions related to motor control and cognition. For instance,
what happens in the brain when two people walking side by side begin to
change their gait and match cadences? Adapted from the neuroimaging
techniques used in single-brain measurements, hyperscanning (HS) is a
technique used to measure brain activity from two or more individuals
simultaneously. Thus far, HS has primarily focused on healthy
participants during social interactions in order to characterize
inter-brain dynamics. Here, we advocate for expanding the use of this
electroencephalography hyperscanning (EEG-HS) technique to
rehabilitation paradigms in individuals with neurological diagnoses,
namely stroke, spinal cord injury (SCI), Parkinson’s disease (PD), and
traumatic brain injury (TBI). We claim that EEG-HS in patient
populations with impaired motor function is particularly relevant and
could provide additional insight on neural dynamics, optimizing
rehabilitation strategies for each individual patient. In addition, we
discuss future technologies related to EEG-HS that could be developed
for use in the clinic as well as technical limitations to be considered
in these proposed settings.
Introduction
Studying
the human brain in social settings has revealed task-specific
activation of various brain regions involved in cognition as discussed
in multiple review papers [1,2,3].
Furthermore, functional and structural connectivity analyses have
allowed researchers to examine relationships across these activated
regions, providing insight on how an individual may process and
interpret information. These findings have led to numerous theories on
the characterization of neural systems, namely the mentalizing system
(MS) and mirror neuron system (MNS) [4,5,6].
The MS, which primarily involves the temporal-parietal junction (TPJ)
and medial prefrontal cortex (mPFC), plays a role in the anticipation of
others intentions [4].
In order to code the neural representations of these intentions, the
mPFC regulates and plans higher cognitive function while the TPJ
provides context to a given situation. The MNS, on the other hand, is
activated when preparing one’s own actions and imitating the actions of
others and has been associated with the left inferior frontal and
premotor cortices as well as the inferior parietal lobe [7, 8].
Evidence
of these neural systems has been further explored in the context of
inter-brain dynamics while recording from multiple subjects [9]. Hyperscanning (HS) is a technique that allows one to record the brain activity of two or more subjects simultaneously [10].
The first effort to record the activity of two brains simultaneously
with electroencephalography (EEG) was performed by Duane and Behrendt [11]. However, the technique started to gain importance two decades ago [12].
Several HS studies have been carried out in healthy participants to
understand changes in brain activity due to social interactions [12,13,14,15], including motor tasks [16, 17], speech [18], and musical performance [19,20,21].
However,
most of the published studies have been limited to describing
interactions between individuals performing simple tasks or under simple
stimuli restricting the use of the technique beyond the laboratory.
Therefore, to reach a deeper comprehension of the mechanisms involved in
social interactions during “normal” life situations with peers it is
necessary to generate experimental paradigms that are as “natural” as
possible. As noted in a review by Hari and Kujala [1];
“much of the fleeting, moment-to-moment information of social
interaction remains beyond the reach of studies involving limited
stimuli and tasks. The current challenge for brain imaging is to bring
every day human interaction, occurring in a complex natural environment
between two or more subjects, into the laboratory”.
With a similar
interest in studying interpersonal interactions, group dynamics have
also been explored in the context of motor rehabilitation. Group
therapy, defined as two or more individuals participating in specialized
activities mediated by clinicians, has been used as a supplement to
traditional therapy in rehabilitation settings [22, 23].
This approach to treatment provides greater peer support, resulting in
improvements such as increased physical function, engagement, and
quality of life in patients with various neurologic diagnoses [24,25,26,27].
Notably, group therapy settings share many parallels with the HS
contexts that have been studied in dyads or groups of healthy
individuals.
Consequently, HS studies have not been explored in
patient populations due to the complexity of the clinical environment
and the different technical challenges that need to be addressed. Thus,
how motor recovery during social interactions in patients is reflected
through changes in brain connectivity, for instance in a group therapy
setting, has yet to be investigated. In this paper, we propose an
approach to study EEG-HS in different patient populations, such as
stroke, spinal cord injury (SCI), Parkinson’s disease (PD), and
traumatic brain injury (TBI). In addition, we address different
combinations of dyads during motor rehabilitation such as
Patient–Patient, Patient–Therapist, Patient–Healthy and Patient–Machine.
Here we focus only on EEG-HS because of its high temporal resolution,
affordability and high mobility in comparison to other neuroimaging
techniques such as functional near-infrared spectroscopy (fNIRS),
functional magnetic resonance imaging (fMRI), or magnetoencephalography
(MEG).
Our therapists should be able to immediately use this to objectively determine our gait problems and then create protocols to fix those gait problems. I know, pie in the sky; will never occur. Oh, you have spasticity in these three specific muscles, these are the protocols that will fix them. But no, we get shitty guidelines that have no specificity. If your therapists don't immediately see the possibilities of using this to get you recovered, you need new therapists.
Benign
paroxysmal positional vertigo (BPPV) is one of the most common
peripheral vestibular disorders leading to balance difficulties and
increased fall risks. This study aims to investigate the walking
stability of BPPV patients in clinical settings and propose a
machine-learning-based classification method for determining the
severity of gait disturbances of BPPV.
Methods
Twenty-seven BPPV outpatients and twenty-seven healthy subjects
completed level walking trials at self-preferred speed in clinical
settings while wearing two accelerometers on the head and lower trunk,
respectively. Temporo-spatial variables and six walking stability
related variables [root mean square (RMS), harmonic ratio (HR), gait
variability, step/stride regularity, and gait symmetry] derived from the
acceleration signals were analyzed. A support vector machine model
(SVM) based on the gait variables of BPPV patients were developed to
differentiate patients from healthy controls and classify the
handicapping effects of dizziness imposed by BPPV.
Results
The
results showed that BPPV patients employed a conservative gait and
significantly reduced walking stability compared to the healthy
controls. Significant different mediolateral HR at the lower trunk and
anteroposterior step regularity at the head were found in BPPV patients
among mild, moderate, and severe DHI (dizziness handicap inventory)
subgroups. SVM classification achieved promising accuracies with area
under the curve (AUC) of 0.78, 0.83, 0.85 and 0.96 respectively for
differentiating patients from healthy controls and classifying the three
stages of DHI subgroups. Study results suggest that the proposed gait
analysis that is based on the coupling of wearable accelerometers and
machine learning provides an objective approach for assessing gait
disturbances and handicapping effects of dizziness imposed by BPPV.
Introduction
Benign
paroxysmal positional vertigo (BPPV) is considered to be the most
common peripheral vestibular disorder with a lifetime prevalence of
2.4 % [1].
The vestibular system senses the linear and angular acceleration of the
head during movement, and this plays a critical role in stabilizing
gaze, head, and trunk during movement in order to maintain balance. Due
to the impaired vestibular system in BPPV, patients usually suffer from
transient vertigo and nystagmus leading to balance difficulties,
increased risk of falls, and generally reduced quality of life [1, 2].
The
Dix-Hallpike (DH) test is regarded as the gold standard diagnostic test
for BPPV, which is performed by moving the patient position to trigger
nystagmus [3].
However, there are some limitations to the DH test. During the DH test,
patients need to passively recline their upper body and extend their
head and neck into the intense vertigo-provoking position. Further,
patients must tolerate at least 30-seconds of head hanging supported
only by the hands of an examiner, while withstanding vertigo. This
inevitably causes severe fright and discomfort in the patient, thus
patients with any cervical spine or neck problem cannot participate in
the test [4].
The Dizziness Handicap Inventory (DHI), a 25-item self-assessment scale
designed to measure the self-perceived level of handicap associated
with the symptom of dizziness, has been proposed to assist in the
diagnosis of BPPV and quantify the handicapping effects of dizziness in
vestibular disorders [5, 6]. Previous studies have shown that there are significant differences in DHI scores between healthy people and BPPV [5, 7].
However, DHI is based on self-perception of disease and therefor there
is still a lack of an objective tool to assess the severity of BPPV
disease associate with dizziness handicapping.
Walking is a
precision task and highly related to dynamic balance ability, which
requires the maintenance of a stable gaze as well as a stable head and
trunk movement to avoid falls. However, a stable gait remains a
challenge in BPPV due to their impaired vestibular system. Previous
studies have evaluated the walking performance of BPPV patients during
normal gait and tandem walk, and impaired temporospatial variables were
observed in these studies [8,9,10].
These results could only indicate a conservative gait adopted in BPPV
to avoid falls but could not answer why they are still at high risk of
falling. Another limitation of previous studies is that the measurement
was conducted in laboratory settings and required sophisticated
equipment such as 3D motion capture system, which could not truly
reflect the gait disturbances during transient vertigo in BPPV patients.
Walking
stability during natural walking have been used to quantify the balance
ability and disease severity, which can be accessed using wearable
sensors without the limitations of a gait laboratory environment [11,12,13].
The sensor-based measurements of walking stability include acceleration
root mean square (RMS) harmonic ratio (HR), gait variability, gait
symmetry and gait regularity [14].
Previous studies have found that BPPV patients have impaired abilities
in controlling static posture balance in mediolateral and
anteroposterior axes [15, 16],
thus it may help us to gain insights into the BPPV disease better by
analyzing the walking stability in various axes rather than purely
studying the temporospatial gait variables. Furthermore, previous
studies have found the significant associations between the vestibular
dysfunction and the changes of gait and balance, thus offering a
possibility to objectively assess the severity of gait disturbances
imposed by BPPV disease [17,18,19].
Therefore,
the aim of this study was to quantitatively analyze the walking
stability of patients with BPPV using accelerometers in clinical
settings, and further to explore a method for the assessment of
handicapping effects of dizziness imposed by BPPV. We hypothesized that
patients with BPPV would exhibit impaired walking stability compared
with healthy controls even if a conservative gait was adopted. We
further hypothesized that the impaired gait variables are associated
with the DHI scores, and a machine learning-based model may objectively
assess the handicapping effects of dizziness imposed by BPPV.
This completely and totally exemplifies the stupidity in the stroke medical world for not having a database of all stroke research and protocols where these reviews would never be needed because the database would be up-to-date all the time. And survivors could then use it to train their doctors and therapists in the appropriate 100% recovery rehab. I know pie in the sky but with survivors in charge it would get accomplished.
These later ones shouldn't have been needed? Or didn't you and your mentors know about this 2015 one?
Anneli Wall1,2*, Jörgen Borg1,2 and Susanne Palmcrantz1,2
1Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
2Department of Clinical Sciences, Karolinska Institute, Stockholm, Sweden
Objective:
The aim of this study was to review the literature on clinical applications of the Hybrid Assistive Limb system for gait training. Methods:
A systematic literature search was conducted using Web of Science, PubMed, CINAHL and clinicaltrials.gov and additional search was made using reference lists in identified reports. Abstracts were screened, relevant articles were reviewed and subject to quality assessment. Results:
Out of 37 studies, 7 studies fulfilled inclusion criteria. Six studies were single group studies and 1 was an explorative randomized controlled trial. In total, these studies involved 140 participants of whom 118 completed the interventions and 107 used HAL for gait training. Five studies concerned gait training after stroke, 1 after spinal cord injury (SCI) and 1 study after stroke, SCI or other diseases affecting walking ability. Minor and transient side effects occurred but no serious adverse events were reported in the studies. Beneficial effects on gait function variables and independence in walking were observed. Conclusions:
The accumulated findings demonstrate that the HAL system is feasible when used for gait training of patients with lower extremity paresis in a professional setting. Beneficial effects on gait function and independence in walking were observed but data do not allow conclusions. Further controlled studies are recommended.
Background
Normal gait depends on the functional integrity and interactions in sensory-motor neural networks at spinal and supraspinal levels (Bowden et al., 2013). This complex system may be disturbed in many neurological conditions such as stroke or spinal cord injury (SCI) resulting in limited mobility and impaired gait function, which are major challenges in neuro rehabilitation. Intensive, repetitive task specific training may drive beneficial neuroplasticity, enhance functional restitution and improve final outcome (Kwakkel et al., 2004; Langhorne et al., 2009, 2011; Peurala et al., 2014). However, there is a need for further development of training methods in response to an increasing understanding of the individual capacity for regaining functioning (Krakauer et al., 2012; Bowden et al., 2013).
Approaches to improve gait function after stroke and SCI include treadmill training with or without use of partial body weight support (BWS), yet the evidence to support this is inconclusive (Schwartz and Meiner, 2013; Dobkin et al., 2014). Gait machines (GM) may allow more reproducible gait movements compared to conventional training and reduce the burden on the therapist. GM work according to the end-effector principle (foot plates move the feet in a controlled gait pattern) or as exoskeletons, which have joints matching the limb joints and motors that drive movements over these joints to assist, e.g., leg movements (Hesse et al., 2010). A recent Cochrane review concluded that electromechanically assisted gait training in combination with physiotherapy after stroke increases the odds of achieving independent walking and most so when applied for severely impaired patients in the first 3 months after stroke (Mehrholz et al., 2013) but less clear after SCI (Mehrholz et al., 2012).
The importance of incorporating more active participation than allowed by gait machines to enhance training effects and the need for new concepts and devices are recognized (Dobkin, 2009; Pennycott et al., 2012). One new approach is represented by the Hybrid Assistive Limb system (HAL). HAL is an exoskeleton with a hybrid system allowing both a voluntary and an autonomous mode of action to support training of gait. HAL comprises a control algorithm and supporting devices, where each knee and hip joint can be controlled separately. Key features of the HAL system have been reported in detail (Kawamoto, 2002; Suzuki et al., 2007; Kawamoto et al., 2010). Movements are triggered by use of either the “Cybernic Voluntary Control” (CVC), which is based on the users voluntary activation of gait muscles as recorded by surface electromyography (EMG), or by the “Cybernic Autonomous Control” (CAC), which is based on the users weight shifting and input from force pressure sensors in the shoes. The CVC mode allows the operator to adjust the degree of support for each joint and reduce the support as training progress and to adjust settings to achieve a gait pattern that is as close as possible to normal gait. In case of complete loss of voluntary activation of gait muscles the CAC mode may be used. Gait is then initiated and sustained by input from force-pressure sensors in the shoes. HAL is manufactured in single-leg and double-leg versions and training with HAL may be performed with or without BWS.
A number of clinical studies with HAL have been conducted and there is a need for an evaluation of available data to guide further trials. The aim of this report was to provide a systematic review in order to evaluate current evidence with regard to feasibility (i.e., usability and safety) and effects and to make recommendations for further studies.
If this is a surprise then that original hospital was a complete failure at getting him recovered. There should be no surprises. After an objective damage diagnosis you select the exact stroke rehab protocols proven to get to recovery. Yes, this is pie in the sky right now but until we get there survivors will be screwed with just fucking lazy rehab guidelines.
The first sign that Tyler
Henshaw’s life was about to change, to become something he’d likely
never even conceived as a possibility in his 19 years, was a headache.
The
2018 graduate of Southwest High School who loves math and science and
history had just started his second quarter at Southeast Community
College on that first day of February when he told his mom his head
hurt.
Kerri Henshaw remembers
her son holding the right side of his head, and she gave him something
for a migraine, because it looked bad and she figured Tylenol might not
do it.
She told him to go
downstairs to his room, that she’d check on him in a half-hour or so.
She heard the door shut. Thirty seconds later, she heard him bang
against the bookshelves and wall.
She ran downstairs, saw
her son on the floor, vomiting. She called 911, turned him on his side,
tried to calm his twin 3-year-old brothers standing in the doorway
crying. She remembers their new puppy going nuts.
“It was scary,” she said. “It was terrifying.”
It would get worse.
At
the hospital, doctors told her and her husband that her son had
suffered a debilitating stroke and there were no neurological responses
in his brain.
Essentially, Kerri Henshaw said, doctors were saying their son was brain-dead.
Doctors could perform surgery, the outcome unknown, or let him go.
Tyler, now 20, is the
oldest of James and Kerri Henshaw's six children, including 17-year-old
twin boys, a 13-year-old daughter and the 3-year-olds.
Doctors told them Tyler was young, healthy and strong and surgery seemed like a reasonable option. His parents did not hesitate.
Operate, they said.
A
condition he’d had since birth but no one had known about caused the
stroke: arteriovenous malformation, or AVM, involves an abnormal tangle
of blood vessels connecting arteries and veins in the brain. The tangle
disrupts the process of arteries taking oxygen-rich blood from the heart
to the brain and veins taking the oxygen-depleted blood back to the
heart and lungs.
During surgery, doctors
removed the tangled blood vessels and stopped the bleeding. They
drained more than a liter of blood from Tyler's brain, his mom said.
He
made it through surgery, but doctors worried he wouldn’t survive, said
Dr. Matthew Driewer, one of the medical directors at Madonna
Rehabilitation Hospital in Lincoln.
Three days after the surgery, they saw some slight movement of Tyler's extremities. Three days after that, he opened his eyes.
* * *
Today —
nearly 11 months after his stroke — Tyler is living at home with his
parents. He's beginning to speak and communicates by pointing to letters
on a whiteboard. He'll soon get an electronic pad to help him
communicate. He’s regained the use of his right arm, which allows him to
maneuver his wheelchair on his own. He can get up without the use of a
lift and he’s taken a few steps.
He’s doing the
college-level calculus he’d been doing before the stroke. His
personality is poking through the wreckage of the trauma, his dry wit,
his humor, as Tyler hangs out with his 3-year-old siblings at Madonna,
where he spends three days a week doing physical, occupational, vision,
recreation and speech therapy.
“R-U-G-R-A-T-S,”
he spells out on his white board for a visitor, throwing a glance to
Alex and Landon lying on the mats next to him.
His recovery, doctors say, has been remarkable.
“It
happens, but not very often. Most of the time the story is very sad,
and it takes a long time for families to understand they aren’t making
any progress,” Driewer said. “He’s the shining star.”
It’s been a long road, though.
Doctors had to
do surgery to put in tubes for feeding and medication, and a day later
nurses cleaning the wound nicked the feeding tube. The subsequent
leaking caused Tyler to become septic, which led to another surgery.
Then
he had surgery to remove a cyst and later, surgery to drain an abscess.
During that procedure, his lung was punctured, which led to more
infection doctors attacked with high doses of antibiotics. That was
followed by surgery to remove his gall bladder.
He's struggled with sickness that causes him to aspirate, though it's getting better.
“It’s just been a roller-coaster,” said his mom.
Along with the lows,
there were highs: When Tyler first opened his eyes, Kerri Henshaw
remembers thinking "I just hope he remembers us." During therapy at
Madonna about a month later, therapists told him to look at his mom, and
he turned his head, slowly, to look at her.
In
July — five months after the stroke — Tyler moved from Madonna’s
specialty hospital to its acute rehabilitation hospital, and the rate of
his progress sped up.
"There was something new every week," his mom said.
He
operated his first wheelchair by pressing his head against a headrest,
but, within weeks, he could use his arm well enough to drive a
wheelchair with a joystick.
The first words he pointed out on the whiteboard: "I love you, mom."
He
has gaps — he doesn’t remember starting school at SCC, or getting a new
puppy three months before the stroke, nor does he remember the five
months in the specialty hospital.
But his mom is keeping a journal — just in case he wants to read it someday.
He’s doing college-level schoolwork and likes to talk politics with his dad.
“He’s just as sharp as he ever was,” his mom said.
* * *
In October, doctors determined there were no more tangles of arteries and veins that caused the earlier stroke — good news.
On Oct. 9, Tyler moved home.
The
family’s living room has turned into his bedroom, though his family
hopes to renovate the home so that ultimately he can have his own space.
His
parents had to learn how to fill and clean his feeding tube, suction
his tracheostomy and give him medication. Until recently, his mom slept
nearby on the couch.
For Kerri
Henshaw, who brings her son to Madonna's rehabilitation day program —
along with the young twins — three times a week and is his primary
caregiver at home, it’s hard to recognize the progress sometimes. But
then she thinks back to where they started and where her son is now.
They take one day at a time, she said, and don’t take the good stuff for granted.
“You never think
something like this can happen. Life can change in an instant,” she
said. "The little dumb stuff doesn't matter anymore."
Tyler’s siblings help out, and the young twins play with him, their toys helping him with his fine motor skills.
His
mom thinks Tyler's plans before the stroke — to apply to engineering
college at the University of Nebraska-Lincoln — could still be in his
future.
"It might take a little longer, but, hey, that's OK," she said.
Driewer thinks Tyler's parents, who fought for him relentlessly, are a big part of his progress.
“I think it has a lot
to do with the person and a lot to do with their attitude and grit,” he
said. “For Tyler, it has a lot do with the grit of his parents, because
they were by his side all the time — even with the twins.”
Tyler's mom thinks her son's stubborn streak is one of the things that helps him keep pushing.
And he knows exactly what he wants for Christmas. He spells it out, without hesitation.
Our great stroke association would be following this up to see exactly how this is being accomplished to see which stroke survivors could still take advantage of it. But that is pie in the sky thinking that will never occur with our fucking failures of stroke associations.
What if your car knew you were braking a few milliseconds before your foot pressed down on the brake?
That possibility may become a reality in the next decade thanks to
new technology being developed by Nissan that will enable vehicles to
interpret brain signals from a driver that will speed up reaction times.
The new technology—dubbed Brain-to-Vehicle (B2V)—could lead to cars
that adapt to the driver, to making the driving experience more
enjoyable.
“What we built is a connection between our brain and the smart system
in the vehicle,” Lucian Gheorghe, Ph.D., a senior innovation researcher
at the Nissan Research Center in Japan, said in an interview with R&D Magazine.
“In the future, developing smart systems is not done to replace the
human being. We want to just increase the experience of the driver.”
For the system to work, the driver wears a helmet-like device that
measure brain wave activity, which is then analyzed by an autonomous
system.
The device has two primarily functions—using brain waves to decipher
when the driver is about to make a driving action like braking and
turning, and using brain waves to enhance the comfort of the driver by
adjusting things like temperature control.
By catching signals that the user’s brain is about to initiate a
movement, including turning the steering wheel, braking or pushing the
accelerator, the technologies can begin the action quicker.
By anticipating intended movement, the systems can take actions—such
as turning the steering wheel or slowing the car—0.2 to 0.5 seconds
faster than the driver, while remaining largely imperceptible.
“We can start moving the tires before the steer by the driver,” Gheorghe said.
Other usages include the ability to adjust the vehicle’s internal
environment, including adjusting what the driver sees and creating a
more relaxing environment by changing the seat position or the
temperature of the vehicle.
Gheorghe explained that the new technology could be used for both manual drivers and autonomous vehicles.
The system uses artificial intelligence to detect and evaluate driver
discomfort, and changes to the driving configuration or driving style
when in autonomous mode.
Nissan demonstrated the capabilities of the new technology at the CES
2018 trade show in Las Vegas, which is running from Jan. 9 to Jan. 12.
The Japan-based company is using a driving simulator to demonstrate some
elements of the technology at CES.
In a statement, Nissan Executive Vice President Daniele Schillaci
explained that the purpose of the technology is to give more control to
the driver in autonomous vehicles. The technology is designed to improve
reaction times and enhance manual driving.
“When most people think about autonomous driving, they have a very
impersonal vision of the future, where humans relinquish control to the
machines,” Schillaci said. “Yet B2V technology does the opposite, by
using signals from their own brain to make the drive even more exciting
and enjoyable.
“Through Nissan Intelligent Mobility, we are moving people to a
better world by delivering more autonomy, more electrification and more
connectivity,” he added.
Gheorghe predicted that the technology could become commercially viable in five to 10 years.
With all this earlier research our researchers should be able to put this all together and create real human brains that can be damaged by stroke and show how to stop and reverse such damage. But that is way too pie in the sky for our stroke medical professionals to understand and implement.
Scientists in Australia have used a 3D printer to create nerve cells
found in the brain using a special bio-ink made from stem cells.
Key points:
Stem cells from adult cells used to make "bio-ink"
Bio-ink printed into 3D scaffold and then stem cells turned into nerve cells found in the brain
Process could be used in the future to make replacement brain tissue from patient's own skin cells
The research takes us a step closer to making replacement
brain tissue derived from a patient's own skin or blood cells to help
treat conditions such as brain injury, Parkinson's disease, epilepsy and
schizophrenia.
The bio-ink is made of human induced pluripotent
stem cells (iPSC), which have the same power as embryonic stem cells to
turn into any cell in the body, and possibly form replacement body
tissues and even whole organs.
Jeremy Crook, who led the research,
said the ability to customise brain tissue from a person's own body
tissue was better for transplantation.
"That circumvents issues of
immune rejection, which is common in organ transplantation," said Dr
Crook, from the University of Wollongong and ARC Centre of Excellence
for Electromaterials Science.
Correcting chemical imbalances
Dr Crook said many
neuropsychiatric disorders result from an imbalance of key chemicals
called neurotransmitters, which are produced by specific nerve cells in
the brain.
For example, he said, defective serotonin and
GABA-producing nerve cells are implicated in schizophrenia and epilepsy
while defective dopamine-producing cells are implicated in Parkinson's
disease.
The team used 3D printing to make neurones involved in
producing GABA and serotonin, as well as support cells called neuroglia,
they reported in the journal Advanced Healthcare Material.
In the future, they plan to print neurones that produce dopamine.
"That's absolutely achievable."
To make the neurones,
Dr Crook and colleagues used their bio-ink to print layers of a hatched
pattern to create a 5 millimetre-sized cube.
They then "crosslinked" the cube into a firm jelly-like substance.
Growth
factors and nutrients were then fed into the holes of this spongey
"scaffold", encouraging the stem cells to grow and turn into neurons and
support cells, linking up to form tissue.
Waste was also removed via the holes in the scaffold.
Dr
Crook said once scaled up, blood vessels would be needed, but small
transplants could be theoretically possible using the tissue developed
so far.
Impressive but risky too
Tissue engineer Makoto Nakamura from Toyama University in Japan said the study was "very impressive".
"This
article indicates the good feasibility of 3D bioprinting with human iPS
cells to engineer neural tissues," said Professor Nakamura, who
recently wrote an overview on the use of 3D bioprinting in the journal
Tissue Engineering.
But he said there were also risks with the technology.
(Supplied: Gu et al/Advanced Healthcare Materials)
One of the challenges of using iPSCs is that, like embryonic
stem cells, they have the potential to develop into teratomas —
disturbing looking tumours that contain more than one type of tissue
type (think toenails growing in brain tissue, or teeth growing in ovary
tissue).
According to Professor Nakamura, it would be important to
ensure all the stem cells had turned into nerve cells in the final
transplanted material.
"Undesired tissue may grow if even only one immature [stem] cell contaminates [the tissue to be transplanted]," he said.
Dr
Crook said the team was currently carrying out animal experiments to
test if teratomas developed from the 3D printed nerve cells.
3D brains?
While
this is a first step towards 3D printing of whole organs, Dr Crook said
a whole functioning brain would be a much more complex task.
"That's
a whole different scale. The tissue we print is uniform, and not made
up of different regions like a brain," said Dr Crook.
Still, it is a goal the researchers are heading towards.
Apart from providing customised transplants, 3D printed tissue could be useful for medical research.
For
example, tissue from a patient with epilepsy or schizophrenia could be
created, specifically to study their particular version of the
condition.
"You can compare how neuronal networks form differently compared to healthy patient," said Dr Crook.
And the tissue could also be used to screen for effective drugs or electrical stimulation treatments.
Purpose of review: An important challenge in neurology is
identifying the neural mechanisms underlying behavioral deficits after
brain injury. Here, we review recent advances in understanding the
effects of focal brain lesions on brain networks and behavior.
Recent findings: Neuroimaging studies indicate that the
human brain is organized in large-scale resting state networks (RSNs)
defined via functional connectivity, that is the temporal correlation of
spontaneous activity between different areas. Prior studies showed that
focal brain lesion induced behaviorally relevant changes of functional
connectivity beyond the site of damage. Recent work indicates that
across domains, functional connectivity changes largely conform to two
patterns: a reduction in interhemispheric functional connectivity and an
increase in intrahemispheric functional connectivity between networks
that are normally anticorrelated, for example dorsal attention and
default networks. Abnormal functional connectivity can exhibit a high
degree of behavioral specificity such that deficits in a given
behavioral domain are selectively related to functional connectivity of
the corresponding RSN, but some functional connectivity changes allow
prediction across domains. Finally, as behavioral recovery proceeds, the
prestroke pattern of functional connectivity is restored.
Summary: Investigating changes in RSNs may shed light on
the neural mechanisms underlying brain dysfunction after stroke.
Therefore, resting state functional connectivity may represent an
important tool for clinical diagnosis, tracking recovery and
rehabilitation.
