Possibilities for Correcting Emotional and Behavioral Impairments in Stroke Patients during Rehabilitation Therapy

Possibility is not good enough. We need a protocol, NOT A GUESS OR GUIDELINE. 

Possibilities for Correcting Emotional and Behavioral Impairments in Stroke Patients during Rehabilitation Therapy

• Authors
• Authors and affiliations

• S. V. Kotov
• E. V. Isakova
• V. I. Sheregeshev

• S. V. Kotov
  • 1
  Email author
• E. V. Isakova
  • 1
• V. I. Sheregeshev
  • 1

1. 1.Vladimirskii Moscow Regional Research Clinical InstituteMoscowRussia

Article

First Online: 28 December 2019

Objectives. To assess the efficacy of a set of rehabilitation measures including use of mechanotherapy and cognitive stimulation using tablet PC technology in relation to emotional and behavioral impairments in patients during the acute phase of ischemic stroke.  

Materials and methods. The study included 100 patients with ischemic stroke admitted to hospital in the acute period. All patients were randomized to two groups: a study group and a control group. The study group (50 patients) received daily robot mechanotherapy using a MOTOmed bedside trainer and tablet PC technology for independent exercises for patients to develop memory, perception, reactions, and counting. Patients of the control group (50 patients) received standard therapy. Functional status was assessed using the modified Rankin scale. Objective evaluation of emotional and behavioral impairments was obtained using psychometric scales (Beck Depression and Anxiety Scales).  

Results. Use of complex rehabilitation programs in the acute period of ischemic stroke promoted regression of emotional and behavioral impairments (p = 0.0001). The severity of depressive disorders was decreased in patients of the study group by the end of the in-patient period, and further regression in these patients continued throughout the observation period, to the six-month point (p = 0.001). Measures of anxiety showed statistically significant decreases during the whole of the observation period in patients of the study group (p = 0.0001), in contrast to those of the control group, where no changes were seen. Functional recovery was better in patients of the study group, as evidenced by statistically significant changes in mean measures of changes on the Rankin scale. Conclusions. The rehabilitation program presented here, including mechanotherapy and cognitive stimulation using tablet PC technology, is a simple and accessible method for correcting emotional and behavioral impairments in patients in the acute period of ischemic stroke. The results achieved not only persisted over time, but were followed by further improvements in measures at three and six months.

Prospective, Blinded, Randomized Crossover Study of Gait Rehabilitation in Stroke Patients Using the Lokomat Gait Orthosis

Pretty much useless; no written protocol, no objective diagnosis of disability prior to start, done in the spontaneous recovery timeframe - 3 months. 

Prospective, Blinded, Randomized Crossover Study of Gait Rehabilitation in Stroke Patients Using the Lokomat Gait Orthosis

 Andreas Mayr,MS,Markus Kofler,MD,Ellen Quirbach,PT,Heinz Matzak,MD,Katrin Fröhlich,MD,and Leopold Saltuari,MD
 Objective
Treadmill training with partial body weight support has been suggested as a useful strategy for gait rehabilitation after stroke.This prospective,blinded,randomized controlled study of gait retraining tested the feasibility and potential efficacy of using an electromechanical driven gait orthosis(Lokomat) for treadmill training.
Methods
Sixteen stroke patients,mostly within 3 months after onset,were randomized into 2 treatment groups,ABA or BAB (A=3 weeks of Lokomat training,B=3 weeks of conventional physical therapy) for 9 weeks of treatment.The outcome measures were the EU-Walking Scale, Rivermead Motor Assessment Scale,10-mtimed walking speed,6-minute timed walking distance,Motricity Index,Medical Research Council Scale of strength,and Ashworth Scale of tone.
Results
The EU-Walking Scale,Rivermead Motor Assessment Scale,6-minute timed walking distance,Medical Research Council Scale,and Ashworth Scale demonstrated significantly more improvement during the Lokomat training phase than during the conventional physical therapy phase within each 3-week interval.
Conclusions
.Despite the small number of patients,the present data suggest that the Lokomat robotic assistive device provides innovative possibilities (We don't need possibilities, we need EXACT PROTOCOLS. DO YOU NOT UNDERSTAND?)for gait training in stroke rehabilitation while eliminating prolonged repetitive movements in a nonergonomic position on the part of the physical therapist.

Astrocytes found to transfer mitochondria to neurons after stroke

Never mind, more study is needed which will never occur under the current fucking failures of stroke associations. Unless you can personally fund researchers to find the answer All these possibilities and NO ONE is following up them to actually help stroke survivors. 
http://medicalxpress.com/news/2016-07-astrocytes-mitochondria-neurons.html
A combined team of researchers from Massachusetts General Hospital/Harvard Medical School in the U.S. and Xuanwu Hospital, Capital Medical University in China has found that when neurons in the mouse brain suffer mitochondrial damage astrocytes donate some of their own to help repair them. In their paper published in the journal Nature, the team describes how they conducted a series of tests designed to find out whether astrocytes donate mitochondria material and if so, whether it helps to restore health to damaged neurons.

Astrocytes are star-shaped glial cells that surround neurons, providing insulation and support—prior studies have shown that they are involved in carrying out removal of dead material. In this new effort, the researchers started with the results of experiments conducted by a team at Columbia University four years ago that showed that bone marrow stem cells provided mitochondria to damaged lung cells to help them recover—they wanted to know if the same might be true for astrocytes and neurons.
To find out, the researchers engineered mice to produce extra amounts of a signaling enzyme called CD38. They then found that when rodent astrocytes were mixed with them, they expelled some degree of mitochondrial material—neurons added to the mix were then found to absorb some of the mitochondrial material.
The next step was to find out if the same process actually happened in a living animal. They found that it did by causing brain injuries to mice and then injecting the sites with mitochondria they had retrieved from astrocytes—microscopic analysis showed the neurons had, indeed, absorbed the material and that as a result, the neurons were healthier than were injured cells that had not received injections.
The researchers also wanted to know if CD38 signaling was necessary for the process to work—to find out, they injected material that interfered with its function into test mice—those with such injections were found to have less astrocyte-donated mitochondrial material in their neurons than did those that did not receive such injections, which suggest that it is a necessary part of the process.
The overall results by the team suggest that human stroke patients might benefit from CD38 injections or drugs that cause the body to produce it, but the researchers are quick to point out that the protein is very active throughout the body, which means such therapies could cause a large number of unknown side effects. More study is needed, but the findings do offer hope for treating such injuries and perhaps maladies such as Parkinson's disease.

Explore further: Fight-or-flight chemical prepares cells to shift brain from subdued to alert

Journal reference: Nature

'Clot Picker' Rescues tPA Stroke Failures

Well, tPA is a failure most of the time anyway, only a 12% full success rate. So who the hell is finding something better?
Maybe these fourteen.
1. liposome-encapsulated hemoglobin written in Feb. 2010
2. bat saliva - Draculin  written in May, 2011, up to 9 hours
3. cardiac glycosides written in Feb. 2006 - up to 6 hours
4.inhalation of nitric oxide written in March, 2012 - 48 hours to 7 days
5. Nitric oxide written in 2006, to be tested in humans yet.
6. xenon gas written in Feb. 2006, to be tested yet
7. caffeinol irish coffee injection written in April 2003 to be tested in humans
8. Docosahexaenoic acid (DHA), a component of fish oil written in Nov. 2010, up to 5 hours
9. nicotine written in July 2005, to be tested in humans
10. Viagra written in 2002, to be tested in humans,  for 7 days
11. 11. Enzogenol  written in Nov. 2011 for New Zealand
12 edaravone approved in Japan since 2001
13. nitroglycerin instructions
14. benzodiazepine inverse agonist  written in Nov. 2010 
Don't they have any understanding that even if the clot is blown out via tPA or picked out that the neuronal cascade of death still occurs?
Is everyone stupid?
http://www.medpagetoday.com/MeetingCoverage/WCN/41792 
Treating ischemic stroke patients with endovascular therapy when initial tPA thrombolysis was unsuccessful led to good 3-month outcomes in most cases, a researcher said here.
Among 23 stroke patients in a prospective multicenter study, 15 were rated with modified Rankin scores of 2 or less when evaluated 3 months after failed thrombolysis followed by mechanical thrombectomy, according to Philippe Desfontaines, MD, of CHC St.-Joseph in Liege, Belgium.

More at link.

Guideline -Diagnosis and treatment of ischemic stroke.

From National Guideline Clearinghouse - Agency for Healthcare Research and Quality.

Guideline  -Diagnosis and treatment of ischemic stroke.

 

This is absolutely pathetic, written in 2001, updated in June 2010, currently being updated again. Does not have any hyperacute therapies like the following;
1. liposome-encapsulated hemoglobin written in Feb. 2010
2. bat saliva - Draculin  written in May, 2011, up to 9 hours
3. cardiac glycosides written in Feb. 2006 - up to 6 hours
4.inhalation of nitric oxide written in March, 2012 - 48 hours to 7 days
5. 5. 5. Nitric oxide written in 2006, to be tested in humans yet.
6. xenon gas written in Feb. 2006, to be tested yet
7. caffeinol irish coffee injection written in April 2003 to be tested in humans
8. Docosahexaenoic acid (DHA), a component of fish oil written in Nov. 2010, up to 5 hours
9. nicotine written in July 2005, to be tested in humans
10. Viagra written in 2002, to be tested in humans,  for 7 days
11.
11. Enzogenol  written in Nov. 2011 for New Zealand
12 edaravone approved in Japan since 2001
13. nitroglycerin instructions
14. benzodiazepine inverse agonist  written in Nov. 2010
Don't listen to me I have no medical standing at all.