A robot-based interception task to quantify upper limb impairments in proprioceptive and visual feedback after stroke

It's actually vastly more important to fix these impairments than quantify them. Solve the correct problem!

 A robot-based interception task to quantify upper limb impairments in proprioceptive and visual feedback after stroke

Journal of NeuroEngineering and Rehabilitation. Volume 20(137)

NARIC Accession Number: J93143. What's this?
Author(s): Park, Kayne, Ritsma, Benjamin R., Dukelow, Sean P., Scott, Stephen H..
Publication Year: 2023.
Abstract: Study developed a novel robotic task to quantify rapid feedback processing in healthy controls and compared this performance with individuals with stroke to (more) efficiently identify impairments in rapid feedback processing. A total of 135 healthy controls and 40 individuals with stroke were evaluated in the Fast Feedback Interception Task (FFIT) using the Kinarm Exoskeleton robot. Participants were instructed to intercept a circular white target moving towards them with their hand represented as a virtual paddle. On some trials, the arm could be physically perturbed, the target or paddle could abruptly change location, or the target could change color requiring the individual to now avoid the target. Most participants with stroke were impaired in reaction time and end-point accuracy in at least one of the task conditions, most commonly with target or paddle shifts. Of note, this impairment was also evident in most individuals with stroke when performing the task using their unaffected arm. Comparison with upper-limb clinical measures identified moderate correlations with the FFIT. The FFIT was able to identify a high proportion of individuals with stroke as impaired in rapid feedback processing using either the affected or unaffected arms. The task allows many different types of feedback responses to be efficiently assessed in a short amount of time.
Descriptor Terms: FEEDBACK, LIMBS, MOTOR SKILLS, REHABILITATION TECHNOLOGY, ROBOTICS, STROKE, TASK ANALYSIS.


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Citation: Park, Kayne, Ritsma, Benjamin R., Dukelow, Sean P., Scott, Stephen H.. (2023.) A robot-based interception task to quantify upper limb impairments in proprioceptive and visual feedback after stroke. Journal of NeuroEngineering and Rehabilitation., 20(137) Retrieved 1/30/2024, from REHABDATA database.

Predictors of futile recanalization after endovascular treatment in acute ischemic stroke: a multi-center study

So you're predicting failure. What the fuck is your solution to prevent that failure?  You're supposed to solve problems, not just describe them.  I'd fire all of you for running away from the problem. COWARDS!

Predictors of futile recanalization after endovascular treatment in acute ischemic stroke: a multi-center study

Yu Sun¹ Eric Jou² Thanh N. Nguyen³ Mohammad Mofatteh⁴ Qingjia Liang^1,5 Mohamad Abdalkader⁶ Zile Yan¹ Mingzhu Feng¹ Xinyuan Li^7,8 Guilan Li¹ Lanzhu Luo¹ Yuzheng Lai⁹ Shuiquan Yang¹ Sijie Zhou¹⁰ Zhiming Xu^11,12* Xiaodong Cai^13,14* Yimin Chen^1,15*

• ¹Department of Neurology and Advanced National Stroke Center, Foshan Sanshui District People's Hospital, Foshan, China
• ²Kellogg College, University of Oxford, Oxford, United Kingdom
• ³Department of Neurology, Radiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
• ⁴School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
• ⁵Department of Internal Medicine, Foshan Sanshui District People's Hospital, Foshan, China
• ⁶Department of Radiology, Boston University Chobanian & Avedsian School of Medicine, Boston, MA, United States
• ⁷The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
• ⁸Medical Intern, Foshan Sanshui District People's Hospital, Foshan, China
• ⁹Department of Neurology, Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine (Nanhai District Hospital of Traditional Chinese Medicine of Foshan City), Foshan, China
• ¹⁰Department of Surgery of Cerebrovascular Diseases, First People's Hospital of Foshan, Foshan, China
• ¹¹Advanced Stroke Center Management Committee, Foshan Sanshui District People's Hospital, Foshan, China
• ¹²Dean Office, Foshan Sanshui District People's Hospital, Foshan, China
• ¹³Department of NeurologyThe Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
• ¹⁴Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
• ¹⁵Neuro International Collaboration (NIC), Foshan, China

Background and objectives: Endovascular thrombectomy (EVT) improves long-term outcomes and decreases mortality in ischemic stroke patients. However, a significant proportion of patients do not benefit from EVT recanalization, a phenomenon known as futile recanalization or reperfusion without functional independence (RFI). In this study, we aim to identify the major stroke risk factors and patient characteristics associated with RFI.

Methods: This is a retrospective cohort study of 297 consecutive patients with ischemic stroke who received EVT at three academic stroke centers in China from March 2019 to March 2022. Patient age, sex, modified Rankin Scale (mRS), National Institute of Health Stroke Scale (NIHSS), Alberta stroke program early CT score (ASPECTS), time to treatment, risk factors and comorbidities associated with cerebrovascular diseases were collected, and potential associations with futile recanalization were assessed. RFI was successful reperfusion defined as modified thrombolysis in cerebral infarction (mTICI) ≥ 2b without functional independence at 90 days (mRS ≥ 3).

Results: Of the 297 initial patients assessed, 231 were included in the final analyses after the application of the inclusion and exclusion criteria. Patients were divided by those who had RFI (n = 124) versus no RFI (n = 107). Older age (OR 1.041, 95% CI 1.004 to 1.073; p = 0.010), chronic kidney disease (OR 4.399, 0.904–21.412; p = 0.067), and higher 24-h NIHSS (OR 1.284, 1.201–1.373; p < 0.001) were independent predictors of RFI. Conversely, an mTICI score of 3 was associated with a reduced likelihood of RFI (OR 0.402, 0.178–0.909; p = 0.029).

Conclusion: In conclusion, increased age, higher 24-h NIHSS and lack of an mTICI score of 3 were independently associated with RFI and have potential prognostic values in predicting patients that are less likely to respond to EVT recanalization therapy.

Incidence and Association of Reperfusion Therapies With Poststroke Seizures

 SO WHAT THE FUCK IS THE SOLUTION TO PREVENT THOSE SEIZURES? You are supposed to solve problems, not just lazily describe them.

Earlier research says this:

Following stroke, 3–6% of patients develop acute symptomatic seizures within the first 7 days

 

Post-injury epilepsy (PIE) is a devastating, unpreventable consequence of traumatic brain injury (TBI) and stroke, which develops in 10 to 40 percent of survivors months, or even years later 

 

seizures occur in about 10% of stroke patients.  

Just maybe you want your doctor to try these solutions.

Cannabidiol May Reduce Seizures by Half in Hard-to-treat Epilepsy

Or maybe the nasal spray referred to in here:

Preventing Seizure-Caused Damage to the Brain

The answers are out there, does your doctor know about them? 

Mozart may reduce seizure frequency in people with epilepsy

 

A dietary supplement dampens the brain hyperexcitability seen in seizures or epilepsy

 

The latest here: 

Incidence and Association of Reperfusion Therapies With Poststroke Seizures

A Systematic Review and Meta-Analysis

Alain Lekoubou

,

Jonah Fox

,

Paddy Ssentongo

Originally published10 Aug 2020https://doi.org/10.1161/STROKEAHA.119.028899Stroke. 2020;51:2715–2723

Abstract

Background and Purpose:

We performed a systematic review and meta-analysis to assess the incidence and risk of seizures following acute stroke reperfusion therapy (intravenous thrombolysis [IVT] with r-tPA [recombinant tissue-type plasminogen activator], mechanical thrombectomy or both).

Methods:

We searched major databases (MEDLINE, SCOPUS, and Cochrane Library) for articles published between 1995 and October 28, 2019. The primary outcome was the overall and treatment specific pooled incidence of poststroke seizures (PSS) following acute reperfusion therapy. We also computed the pooled incidence of early poststroke seizures and late poststroke seizures separately for all studies. We derived the risk of PSS associated with IVT in the pooled cohort of patients who received only IVT. The small number of studies (<3) that reported on the risk of PSS associated with mechanical thrombectomy alone or in combination with IVT did not allow us to compute an estimate of the risk of seizures associated with this therapy.

Results:

We identified 13 753 patients with stroke, of which 592 had seizures. The pooled incidence of PSS was 5.9 % (95% CI, 4.2%–8.2%). PSS incidence rates among patients with stroke treated with IVT, mechanical thrombectomy, and both were respectively 6.1% (95% CI, 3.6%–10.2%), 5.9% (95% CI, 4.1%–8.4%), and 5.8 % (95% CI, 3.0%–10.9%). The incidence of late PSS was 6.7% (95% CI, 4.01%–11.02%) and that of early PSS was 3.14% (95% CI, 2.05%–4.76%). The pooled odds ratio for the association between IVT and PSS was 1.24 (95% CI, 0.75–2.05).

Conclusions:

The findings of this meta-analysis suggest that about one in 15 ischemic stroke patients treated with IVT, mechanical thrombectomy, or both develop seizures independently of the specific reperfusion treatment that they received.

Footnotes

For Sources of Funding and Disclosures, see page 2722.

The Data Supplement is available with this article at https://www.ahajournals.org/doi/suppl/10.1161/STROKEAHA.119.028899.

Correspondence to: Alain Lekoubou, MD, MSc, Department of Neurology, Penn State University, 30 Hope Dr, Hershey, PA, 17033. Email alekouboulooti@pennstatehealth.psu.edu

 

Caffeine boosts problem-solving ability but not creativity, study indicates

YOU have a massive problem to solve. How to get 100% recovered. Since your doctor knows absolutely nothing about that, you are completely on your own, including how much caffeine to consume to solve that problem. My 12 cups of daily coffee is not enough for me, still haven't even got anywhere close to 100% recovery. 

Caffeine boosts problem-solving ability but not creativity, study indicates

MedicalXpress Breaking News-and-Events | March 05, 2020

Caffeine increases the ability to focus and problem solve, but a new study by a University of Arkansas researcher indicates it doesn't stimulate creativity.

"In Western cultures, caffeine is stereotypically associated with creative occupations and lifestyles, from writers and their coffee to programmers and their energy drinks, and there's more than a kernel of truth to these stereotypes," wrote Darya Zabelina, assistant professor of psychology and first author of the study recently published in the journal Consciousness and Cognition.

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While the cognitive benefits of caffeine—increased alertness, improved vigilance, enhanced focus, and improved motor performance—are well established, she said, the stimulant's affect on creativity is less known.
In the paper, Zabelina differentiates "convergent" from "divergent" thinking. The former is defined as seeking a specific solution to a problem, for example, the "correct" answer. The latter is characterized by idea generation where a large set of apt, novel or interesting responses would be suitable. Caffeine was shown to improve convergent thinking in the study, while consuming it had no significant impact on divergent thinking.
For the study, 80 volunteers were randomly given either a 200mg caffeine pill, equivalent to one strong cup of coffee, or a placebo. They were then tested on standard measures of convergent and divergent thinking, working memory and mood. In addition to the results on creativity, caffeine did not significantly affect working memory, but test subjects who took it did report feeling less sad.
"The 200mg enhanced problem solving significantly, but had no effect on creative thinking," said Zabelina. "It also didn't make it worse, so keep drinking your coffee; it won't interfere with these abilities."

To read more, click here.

Factors associated with post-stroke suicidal death

Well this is the likely outcome of the fact that our doctors do not have anything positive to help us on our recovery path. Only 10% get to almost full recovery. NO stroke rehabilitation protocols are provided. Nothing provided to solve our fatigue. Nothing provided to solve our spasticity. Nothing done to prevent our likely dementia. In simplest terms our doctors DO NOTHING.  Wouldn't you be fucking depressed? The solution is to solve the problems in stroke,
I got the talk while in the hospital, 'Have you ever thought about committing suicide? Also got the question, 'Do you blame your body for failing you?'

http://www.journalofpsychiatricresearch.com/article/S0022-3956(17)30461-2/fulltext?rss=yes

Jin Pyo Hong¹

,

Subin Park¹

,

Sung-Ho Ahn

,

Jong S. KimCorrespondence information about the author Jong S. Kim

¹These authors equally contributed to this work.

DOI: http://dx.doi.org/10.1016/j.jpsychires.2017.10.005

Full Text

References

Abstract

Background and purpose

The aim of this study was to estimate the relative risk of suicidal death compared to the general population and to identify risk factors for suicidal death among stroke patients.

Methods

Our sample consisted of 7175 patients who were diagnosed with stroke and admitted at Asan Medical Center from January 2005 to December 2012. Information on suicidal death was obtained from the database of the Korean National Statistical Office. The standardized mortality ratio (SMR) for post-stroke suicide was estimated. Additionally, we conducted a 1:6 case-control study using patients who did not commit suicide.

Results

Thirty patients committed suicidal death, with the mean time interval between hospital admission and suicide being 1.9 ± 1.8 years. The SMR for suicide was 2.14 (95% confidence interval [CI], 1.44–3.05). Case-control analysis revealed that diabetes mellitus, depression, and large ischemic lesions in the subcortex and brainstem were significantly associated with suicidal death.

Conclusions

The risk of suicidal death is approximately 2 times higher than that in the general population. Depression, diabetes, and large lesions in specific locations should be considered in the implementation of suicide prevention strategies in stroke patients.(100% recovery would be the solution preferred, Solve the primary problem, not the secondary problem)

Increasing access to rehabilitation therapy after stroke - Cambridge, UK

Who the fuck cares about 'access'? Survivors want to know your RESULTS on getting to 100% recovery. NOTHING LESS!  Pull your heads out of your asses and solve the correct problem, 100% recovery. 'Access' doesn't deliver recovery, does it?

Increasing access to rehabilitation therapy after stroke - Cambridge, UK

A regional group to support rehabilitation following a stroke – Aiming to Transform Life After Stroke (ATLAS) – has been given a £35,000 grant from Addenbrooke’s Charitable Trust to help provide wider access to therapy across the region through investment in up-to-date technology. 
A stroke can change lives, but for most patients its effects can be addressed with a programme of rehabilitation. Rehabilitation after stroke is enhanced by repeated and intensive practice of exercises, but due to limited resources people often find it difficult to practice their rehabilitation techniques alone after they have been discharged from hospital.
Unfortunately, this can limit their recovery, which can lead to isolation, mood disorders and stress for carers. That’s why staff at Addenbrooke’s Hospital are trialling a project that embraces technology, which can be introduced at the hospital and support rehabilitation post-discharge.
By using current technology such as computer tablets and apps, people will be able to access therapy remotely, and online games can increase their enjoyment of rehabilitation.
The county-wide two-year pilot project will trial technology across primary, secondary and voluntary sectors, using a personalised gaming program ‘Neuro at Home’ to self-administer cognitive and motor rehabilitation programs prescribed by therapists; QR code technology to support people with cognitive deficits to regain independence; and occupational therapy home-visit software – to improve accuracy of home visit reports.
This project, once completed and rolled-out county wide has the potential to benefit 1500 stroke patients every year.
Diana Day, Consultant Nurse for Stroke, said: “By embracing technology and sharing learnings with colleagues and service users, we hope to increase satisfaction for stroke patients, as they will be able to self-administer part of their rehabilitation and increase their independence. It will also enhance clinical competencies and skills of therapy staff across the regional group of clinicians, and enable staff to deliver the same standard of care across the county, therefore improving clinical outcome and saving costs.”
To find out more about changing patients’ lives, please contact Addenbrooke’s Charitable Trust on 01223 217757 or see www.act4addenbrookes.org.uk 

Tomato and lycopene supplementation and cardiovascular risk factors: A systematic review and meta-analysis

Why the fuck was a meta-analysis needed? What was needed was exact amounts to consume to provide benefits. This absolute stupidity is because we have NO stroke strategy to solve problems rather than just describe them. This is totally fucking useless.  And your mentors and senior researchers don't know how to run research!

Tomato and lycopene supplementation and cardiovascular risk factors: A systematic review and meta-analysis

Atherosclerosis, 01/19/2017

Cheng HM, et al. – This study suggests a positive influence of tomato products and lycopene supplementation on blood lipids, blood pressure and endothelial function. These outcomes support the development of promising individualised nutritional strategies involving tomatoes to tackle cardiovascular diseases (CVD).

Methods

• Researchers searched 3 databases including Medline, Web of science, and Scopus from inception to August 2016.
• Inclusion criteria were: intervention randomised controlled trials reporting effects of tomato products and lycopene supplementation on CV risk factors among adult subjects >18 years of age.
• The outcomes of interest included blood lipids (total-, HDL-, LDL-cholesterol, triglycerides, oxidised-LDL), endothelial function (flow-mediated dilation (FMD), pulse wave velocity (PWV)) and blood pressure (BP) inflammatory factors (CRP, IL-6) and adhesion molecules (ICAM-1).
• They used random-effects models to determine the pooled effect sizes.

Results

• Data showed that out of 1189 publications identified, 21 fulfilled inclusion criteria and were meta-analysed.
• Overall, findings demonstrated that interventions supplementing tomato were associated with significant reductions in LDL-cholesterol (-0.22 mmol/L; p = 0.006), IL-6 (standardised mean difference -0.25; p = 0.03), and improvements in FMD (2.53%; p = 0.01); while lycopene supplementation reduced Systolic-BP (-5.66 mmHg; p = 0.002).
• Additionally, it was noted that no other outcome was significantly affected by these interventions.

Go to PubMed Go to Abstract Print Article Summary Cat 2 CME Report

Contralesional Cortical Structural Reorganization Contributes to Motor Recovery after Sub-Cortical Stroke: A Longitudinal Voxel-Based Morphometry Study

Who gives a shit about what might help us recover, we want to know what will help us recover. Damn it all solve the problem, don't just describe the problem. 

Contralesional Cortical Structural Reorganization Contributes to Motor Recovery after Sub-Cortical Stroke: A Longitudinal Voxel-Based Morphometry Study

Jianxin Cai¹, Qiling Ji², Ruiqiang Xin¹, Dianping Zhang¹, Xu Na¹, Ruchen Peng^1* and Kuncheng Li^3*

• ¹Department of Radiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
• ²Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
• ³Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China

Although changes in brain gray matter after stroke have been identified in some neuroimaging studies, lesion heterogeneity and individual variability make the detection of potential neuronal reorganization difficult. This study attempted to investigate the potential structural cortical reorganization after sub-cortical stroke using a longitudinal voxel-based gray matter volume (GMV) analysis. Eleven right-handed patients with first-onset, subcortical, ischemic infarctions involving the basal ganglia regions underwent structural magnetic resonance imaging in addition to National Institutes of Health Stroke Scale (NIHSS) and Motricity Index (MI) assessments in the acute (<5 days) and chronic stages (1 year later). The GMVs were calculated and compared between the two stages using nonparametric permutation paired t-tests. Moreover, the Spearman correlations between the GMV changes and clinical recoveries were analyzed. Compared with the acute stage, significant decreases in GMV were observed in the ipsilesional (IL) precentral gyrus (PreCG), paracentral gyrus (ParaCG), and contralesional (CL) cerebellar lobule VII in the chronic stage. Additionally, significant increases in GMV were found in the CL orbitofrontal cortex (OFC) and middle (MFG) and inferior frontal gyri (IFG). Furthermore, severe GMV atrophy in the IL PreCG predicted poorer clinical recovery, and greater GMV increases in the CL OFG and MFG predicted better clinical recovery. Our findings suggest that structural reorganization of the CL “cognitive” cortices might contribute to motor recovery after sub-cortical stroke.

Introduction

Brain damage after ischemic stroke can cause a greater variety of functional deficits. These deficits can be caused by direct damage to the cortices or fiber tracts, For example, injuries to the right inferior parietal lobe, superior temporal gyrus and inferior frontal gyrus (IFG) are frequently associated with neglect (Corbetta and Shulman, 2011), and lesions to the corticospinal tract (CST) can cause hemiplegia (Lo et al., 2010). In addition to the direct damage caused by lesions, indirect atrophy of lesion-related remote cortices has also been reported (Rowan et al., 2007; Gauthier et al., 2012; Fan et al., 2013; Zhang et al., 2014; Cheng et al., 2015). For example, a recent research has demonstrated that cortical atrophy in remote cortices is also correlated with the magnitude of residual motor deficits in chronic sub-cortical stroke patients (Gauthier et al., 2012). In addition to the evidence of secondary cortical atrophy, many early studies also reported secondary degeneration of remote white matter tracts after damage to the motor pathway due to sub-cortical stroke (Thomalla et al., 2004, 2005; Liang et al., 2008; Yu et al., 2009; Rüber et al., 2012), and the severity of the degeneration predicts poor motor recovery (Yu et al., 2009; Lindenberg et al., 2010). These findings indicate that the secondary neurodegeneration of the motor pathways might be responsible for the atrophy of remote cortical regions and might consequently influence motor performance.

Although secondary structural impairment of remote cortex has frequently been reported, the structural plasticity of the remaining cortex after stroke has yet to be fully clarified. In a review of previous neuroimaging literature that focused on the cortical changes after stroke, we found that the majority of studies adopted either a retrospective or cross-sectional design, and heterogeneities in lesion location and duration were frequently present (Schormann and Kraemer, 2003; Kraemer et al., 2004; Schaechter et al., 2006; Rowan et al., 2007; Stebbins et al., 2008; Gauthier et al., 2012). Individual variability in cross-sectional studies might mask subtle changes in the cortex or induce some false positive results, and lesion heterogeneity increases the complexity of interpreting the underlying neuronal mechanism. In a recent study of longitudinal changes in cortical thickness 3 months after sub-cortical stroke (Brodtmann et al., 2012), the authors found thickening of the contralesional (CL) cortices; however, these authors did not find any atrophy of the ipsilesional (IL) cortices. In another similar longitudinal study, Cheng et al. (2015) failed to identify any changes in cortical thickness in the CL lesion-connected or lesion-unconnected cortices, although they observed a strong decrease in the cortical thickness of the IL lesion-connected cortex. The discrepancy between the two studies may have been caused by the following factors: (1) the relative shorter follow-up duration (3 months after stroke); (2) the insensitivity of the region-of-interest (ROI) analysis method; and (3) the constraint of the cortical thickness in completely characterizing cortical atrophy and plasticity without accounting for changes in cortical surface area.

In this study, we recruited a subset of motor-deficit stroke patients with first onset, subcortical ischemic infractions that involved the basal ganglia regions. In contrast to early longitudinal studies (Brodtmann et al., 2012; Cheng et al., 2015), we used a whole-brain voxel-based morphometry (VBM) method to identify the potential changes in gray matter volume (GMV) after stroke. Moreover, the follow-up duration in the present study was extended to 1 year. Because the GMV contains information about both cortical thickness and cortical surface area, any changes in these two metrics can be reflected by the GMV. Based on the features of the VBM method and the longer follow-up duration, we hoped to identify both atrophy and augment in the GMV of the remote cortices after 1 years. Specifically, based on early studies that revealed secondary cortical atrophy of the IL cortices and its association with clinical performance, we hypothesized that the GMVs of the IL motor-related cortices would be decreased after 1 year, and the severity of the atrophy of these cortices would be associated with clinical recovery. Because early studies also demonstrated wide-spread of functional reorganization of multiple brain network (Wang et al., 2010, 2014; Rehme et al., 2012), we also hoped to observed increases in the GMVs of the remaining cortices and significant association between GMV increases and clinical recovery.

Training in positivity for stroke? A qualitative study of acceptability of use of Positive Mental Training (PosMT) as a tool to assist stroke survivors with post-stroke psychological problems and in coping with rehabilitation

So rather than finding recovery solutions for survivors we have persons researching coping skills. You wouldn't need so many fucking coping skills if you solved the problems in stroke, like the neuronal cascade of death or how to make neuroplasticity and neurogenesis repeatable processes. Solve the root cause, dead and damaged neurons, not the aftereffects. This is all a stupid result of NO stroke leadership or stroke strategy. People researching this stuff should be laughed out of the profession, survivors don't want coping skills they want recovery you fucking idiots. Use those two neurons in your head.

Training in positivity for stroke? A qualitative study of acceptability of use of Positive Mental Training (PosMT) as a tool to assist stroke survivors with post-stroke psychological problems and in coping with rehabilitation

Citation

Mavaddat, N., Dobbin, A., Ross, S., Williams, K., Graffy, J., & Mant, J. (2016). Training in positivity for stroke? A qualitative study of acceptability of use of Positive Mental Training (PosMT) as a tool to assist stroke survivors with post-stroke psychological problems and in coping with rehabilitation. NeuroRehabilitationhttp://dx.doi.org/10.17863/CAM.1245

Description

This is the author accepted manuscript. It is currently under an indefinite embargo pending publication by IOS Press.

Abstract

BACKGROUND: Post-stroke psychological problems predict poor recovery, while positive affect enables patients to focus on rehabilitation and may improve functional outcomes. Positive Mental Training (PosMT), a guided self-help audio shows promise as a tool in promoting positivity, optimism and resilience. OBJECTIVE: To assess acceptability of training in positivity with PosMT for prevention and management of post-stroke psychological problems and to help with coping with rehabilitation. METHODS: A modified PosMT tool consisted of 12 audio tracks each lasting 18 minutes, one listened to every day for a week. Survivors and carers were asked to listen for 4 weeks, but could volunteer to listen for more. Interviews took place about experiences of the tool after 4 and 12 weeks. Subjects: 10 stroke survivors and 5 carers from Stroke Support Groups in the UK. RESULTS: Three stroke survivors did not engage with the tool. The remainder reported positive physical and psychological benefits including improved relaxation, better sleep and reduced anxiety after four weeks. Survivors who completed the programme gained a positive outlook on the future, increased motivation, confidence and ability to cope with rehabilitation. No adverse effects were reported. CONCLUSIONS:The PosMT shows potential as a tool for coping with rehabilitation and overcoming post-stroke psychological problems including anxiety and depression.

Care pathways and healthcare use of stroke survivors six months after admission to an acute-care hospital in France in 2012

Of course our fucking failures of stroke associations will not follow the recommendation here and create a database of stroke care, treatments and results. If you don't know what didn't work you can NEVER fix your problems. Since 90% of survivors do not fully recover there is an abundance of information to be collected as to why they didn't recover.With 10 million yearly stroke survivors  there is vast amounts of data waiting to be analyzed. Only lazy and stupid people don't want to correct that failure.

Has your stroke hospital analyzed why all of their patients did not fully recover? WHY THE HELL NOT? STUPIDITY? LAZINESS? NOT INTERESTED?

Care pathways and healthcare use of stroke survivors six months after admission to an acute-care hospital in France in 2012

Tuppin P¹, Samson S², Fagot-Campagna A², Woimant F³.

Author information

Abstract

INTRODUCTION:

Care pathways and healthcare management are not well described for patients hospitalized for stroke.

METHODS:

Among the 51 million beneficiaries of the French national health insurance general scheme (77% of the French population), patients hospitalized for a first stroke in 2012 and still alive six months after discharge were included using data from the national health insurance information system (Sniiram). Patient characteristics were described by discharge destination-home or rehabilitation center (for < 3 months)-and were followed during their first three months back home.

RESULTS:

A total of 61,055 patients had a first admission to a public or private hospital for stroke (mean age; 72 years, 52% female), 13% died during their stay and 37% were admitted to a stroke management unit. Overall, 40,981 patients were still alive at six months: 33% of them were admitted to a rehabilitation center (mean age: 73 years) and 54% were discharged directly to their home (mean age 67 years). For each group, 45 and 62% had been previously admitted to a stroke unit. Patients discharged to rehabilitation centers had more often comorbidities, 39% were highly physically dependent and 44% were managed in specialized neurology centers. For patients with a cerebral infarction who were directly discharged to their home 76% received at least one antihypertensive drug, 96% an antithrombotic drug and 76% a lipid-lowering drug during the following month. For those with a cerebral hemorrhage, these frequencies were respectively 46, 33 and 28%. For those admitted to a rehabilitation center, more than half had at least one visit with a physiotherapist or a nurse, 15% a speech therapist, 10% a neurologist or a cardiologist and 15% a psychiatrist during the following three months back home (average numbers of visits for those with at least one visit: 23 for physiotherapists and 100 for nurses). Patients who returned directly back home had fewer physiotherapist (30%) or nurse (47%) visits but more medical consultations. The 3-month re-hospitalization rate for patients who were discharged directly to their home was 23% for those who had been admitted to a stroke unit and 25% for the others. In rehabilitation centers, this rate was 10% for patients who stayed < 3 months.

CONCLUSIONS:

These results illustrate the value of administrative databases to study stroke management, care pathways and ambulatory care. These data should be used to improve care pathways, organization, discharge planning and treatments.

High Burden of Brain Microbleed May Up tPA Bleeding Risk

I would think the solution to this is reduce the size of the bolus substantially and direct the tPA directly to the clot. I could see no solution that was presented to fix this problem. Don't just tell me there is a problem, suggest a solution. What a waste of research dollars otrherwise.

Magnetic nanoparticles could stop blood clot-caused strokes

High Burden of Brain Microbleed May Up tPA Bleeding Risk

Stroke patients with cerebral microbleeds had a twofold greater risk for intracerebral hemorrhage following intravenous thrombolysis (tPA), and bleeding risk increased by as much as 12-fold among patients with the highest (>10) microbleed burden, according to a meta-analysis.
The risk of symptomatic brain bleeds after treatment was found to be higher in patients with evidence of cerebral microbleeds compared with patients without cerebral microbleeds (risk ratio 2.36, 95% CI 1.21-4.61, P=0.01), reported Georgios Tsivgoulis, MD, of the University of Athens School of Medicine in Greece, and colleagues
Nine studies were included in the analysis, which showed high cerebral microbleed (CMB) burden, identified through MRI, to be a significant independent risk factor for symptomatic brain bleeds in stroke patients treated with tPA, they wrote in JAMA Neurology.
The findings suggest that pre-treatment MRI assessment of cerebral microbleed burden can serve as an independent predictor of brain bleeding risk in ischemic stroke patients receiving tPA, the authors wrote.
They added that the reliance on CT scans, and not MRI, for patient assessment in the stroke emergency care setting remains a significant challenge to identifying cerebral microbleed burden.
While cerebral microbleeds are considered an independent predictor of higher cerebral bleeding risk, earlier studies assessing their clinical impact on brain bleed risk in stroke patients treated with tPA have been mixed and many have not assessed the impact of cerebral microbleed burden, the researchers noted.
"The potential association of CMB presence with the risk of symptomatic intracerebral hemorrhage in patients with acute ischemic stroke treated with intravenous thrombolysis remains controversial," they wrote.
In an effort to better understand the impact of a high cerebral microbleed burden detected by MRI scan prior to tPA treatment on symptomatic intracerebral hemorrhage risk in the ischemic stroke setting, the researchers analyzed studies reporting intracerebral bleeding rates in ischemic stroke patients with known pre-tPA cerebral microbleed burden.
The meta-analysis, which included a total of 2,479 patients, confirmed a higher risk for symptomatic brain bleeds following treatment with tPA in patients with a cerebral microbleed burden of more than 10, compared with patients with zero to 10 cerebral microbleeds or one to 10 cerebral microbleeds on pretreatment MRI.
The authors also reported a higher risk for symptomatic intracerebral hemorrhage after tPA treatment was detected in patients with high cerebral microbleed burden (>10) when compared with patients with zero to 10 cerebral microbleeds (RR 12.10, 95% CI 4.36-33.57, P<0.001) or one to 10 cerebral microbleeds (RR 7.01, 95% CI 3.20-15.38, P<0.001) on pretreatment MRI.
In an individual-patient data meta-analysis, high cerebral microbleed burden was associated with increased likelihood of symptomatic brain bleeding before (unadjusted odds ratio 31.06, 95% CI 7.12-135.44, P<0.001) and after (adjusted OR 18.17, 95% CI 2.39-138.22, P=0.005) adjusting for potential confounders.
A study limitation was the lack of data on brain bleed risk by cerebral microbleed count stratification in four of the nine studies included in the meta-analysis and lack of information on key baseline characteristics in three of the nine studies. There was also incomplete information on antithrombotic medications taken before hospital admission for stroke treatment.
Despite these limitations, the researchers concluded that cerebral microbleed burden should be considered in the stroke, pre-tPA risk stratification setting.
"The challenge remains in identifying CMB burden without MRI in the setting of acute ischemic stroke management where only a noncontrast computed tomography is standard of care," they stated.
In an accompanying editorial, Mark Fisher, MD, of the University of California Irvine School of Medicine, noted that cerebral microbleeds have been shown to be present in more than 20% of older people, while they are rare in younger populations.
"Cerebral microbleeds have received enormous attention in the literature," he wrote. "Nevertheless, the nature of the underlying lesion of cerebral microbleeds has proved elusive."
Fisher noted that despite the meta-analysis findings, the critical factor relevant to tPA treatment "appears to be not the microbleeds themselves, but the arteriolar injury contributing to micro hemorrhage development."
"The principal challenge for the clinician addressing microbleeds in acute ischemic stroke will be to distinguish primary from secondary microbleeds," he wrote. "It is the disseminated processes of primary microbleeds that create the substrate of the brain vulnerable to arteriolar ischemic necrosis and development of intracerebral hemorrhage. The more restricted process or prior ischemic injury producing secondary microbleeds will be of far less concern in this context. Ultimately, the number of cerebral microbleeds present will be less important than the nature of the process driving microbleed development."

• Primary Source

  JAMA Neurology

  Source Reference: Tslvgoulis G, et al "Risk of symptomatic intracerebral hemorrhage after intravenous thrombolysis in patients with acute ischemic stroke and high cerebral microbleed burden: a meta-analysis" JAMA Neurol 2016; DOI: 10.1001/jamaneurol.2016.0292.

• Secondary Source

  JAMA Neurology

  Source Reference: Fisher M "Cerebral microbleeds and thrombolysis: Clinical consequences and mechanistic implications" JAMA Neurol 2016; DOI: 10.1001/jamaneurol.2016.0576.

A prediction model for activities of daily living for stroke patients in a convalescent rehabilitation ward

Rather than useless crap research like this our stroke leaders should be focusing on SOLVING  the problems in stroke. Not just predicting the problems.
https://www.jstage.jst.go.jp/article/jalliedhealthsci/7/1/7_1/_article

Atsushi Sato¹⁾, Takaaki Fujita^{2) 3)}, Yuji Ohashi⁴⁾, Yuichi Yamamoto⁴⁾, Kyouichi Suzuki⁵⁾, Koji Otsuki⁴⁾

1) Department of Physical Therapy, Yachiyo Rehabilitation College 2) Department of Rehabilitation, Tohoku Fukushi University 3) Department of Rehabilitation Sciences, Gunma University Graduate School of Health Sciences 4) Department of Rehabilitation, Northern Fukushima Medical Center 5) Department of Neurosurgery, Fukushima Red Cross Hospital

Released 20160401  

Keywords: activities of daily living, convalescent rehabilitation ward, prediction model

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PURPOSE: To create a model to predict independence in the activities of daily living at discharge in stroke patients in the convalescence stage. The study also examined whether the predictability of functional independence at discharge would be improved by creating a specific prediction model for each rehabilitation facility. METHODS: To create the prediction model, data of 65 first stroke patients were analyzed using stepwise multiple regression analysis. Age, time post-stroke, Functional Independence Measure motor subscale score, Functional Independence Measure cognitive subscale score, Stroke Impairment Assessment Set, Berg Balance Scale, and Vitality Index at admission were selected as predictor variables of Functional Independence Measure motor subscale score at discharge. The accuracy of this model was compared with an existing prognosis model using data from 98 first-stroke patients, comparing the difference between actual and predicted Functional Independence Measure motor subscale score at discharge for each model. RESULTS: The prediction formula created included admission Functional Independence Measure motor subscale score, Vitality Index, age, and Stroke Impairment Assessment Set score. The adjusted R square value was 0.60. The prediction errors of the new and previous models were −2.5 ± 10.8 and −18.3 ± 18.7, respectively, which were significantly different. CONCLUSION: Our results suggest that prediction accuracy may be improved by creating prediction formulas specifically for each institution.

Problem-Solving Therapy During Outpatient Stroke Rehabilitation Improves Coping and Health-Related Quality of Life

So rather than finding recovery solutions for survivors we have persons researching coping skills. You wouldn't need so many fucking coping skills if you solved the problems in stroke, like the neuronal cascade of death or how to make neuroplasticity a repeatable process. Solve the root cause, dead and damaged neurons, not the aftereffects. This is all a stupid result of NO stroke leadership or stroke strategy. 

Problem-Solving Therapy During Outpatient Stroke Rehabilitation Improves Coping and Health-Related Quality of Life

1. Marieke M. Visser, MSc;
2. Majanka H. Heijenbrok-Kal, PhD;
3. Adriaan van‘t Spijker, PhD;
4. Engelien Lannoo, PhD;
5. Jan J.V. Busschbach, PhD;
6. Gerard M. Ribbers, MD, PhD

+ Author Affiliations

1. From the Department of Rehabilitation Medicine (M.M.V., M.H.H.-K., G.M.R.) and Department of Psychiatry, Section Medical Psychology and Psychotherapy (A.v.S., J.J.V.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Rotterdam Neurorehabilitation Research Department (RoNeRes), Rijndam Rehabilitation Center, Rotterdam, The Netherlands (M.M.V., M.H.H.-K., G.M.R.); and Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium (E.L.).

1. Correspondence to Majanka H. Heijenbrok-Kal, PhD, Rotterdam Neurorehabilitation Research (RoNeRes), Rijndam Rehabilitation Center, PO Box 23181, 3001 KD, Rotterdam, The Netherlands. E-mail mheijenbrok@rijndam.nl

Abstract

Background and Purpose—This study investigated whether problem-solving therapy (PST) is an effective group intervention for improving coping strategy and health-related quality of life (HRQoL) in patients with stroke.

Methods—In this multicenter randomized controlled trial, the intervention group received PST as add-on to standard outpatient rehabilitation, the control group received outpatient rehabilitation only. Measurements were performed at baseline, directly after the intervention, and 6 and 12 months later. Data were analyzed using linear-mixed models. Primary outcomes were task-oriented coping as measured by the Coping Inventory for Stressful Situations and psychosocial HRQoL as measured by the Stroke-Specific Quality of Life Scale. Secondary outcomes were the EuroQol EQ-5D-5L utility score, emotion-oriented and avoidant coping as measured by the Coping Inventory for Stressful Situations, problem-solving skills as measured by the Social Problem Solving Inventory-Revised, and depression as measured by the Center for Epidemiological Studies Depression Scale.

Results—Included were 166 patients with stroke, mean age 53.06 years (SD, 10.19), 53% men, median time poststroke 7.29 months (interquartile range, 4.90–10.61 months). Six months post intervention, the PST group showed significant improvement when compared with the control group in task-oriented coping (P=0.008), but not stroke-specific psychosocial HRQoL. Furthermore, avoidant coping (P=0.039) and the utility value for general HRQoL (P=0.034) improved more in the PST group than in the control after 6 months.

Conclusions—PST seems to improve task-oriented coping but not disease-specific psychosocial HRQoL after stroke >6-month follow-up. Furthermore, we found indications that PST may improve generic HRQoL recovery and avoidant coping.

Clinical Trial Registration—URL: http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2509. Unique identifier: CNTR2509.

A cycling lane for brain rewiring

Well fucking stupidity. We've known for years that neuroplasticity exists, we just don't specifically know how to make it repeatable. Solve that repeatability problem instead of just reporting on neuroplasticity crapola again.
http://www.cell.com/current-biology/abstract/S0960-9822%2815%2901288-9?

Claudia Lunghi

,

Alessandro Sale

DOI: http://dx.doi.org/10.1016/j.cub.2015.10.026

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Summary

Brain plasticity, defined as the capability of cerebral neurons to change in response to experience, is fundamental for behavioral adaptability, learning, memory, functional development, and neural repair. The visual cortex is a widely used model for studying neuroplasticity and the underlying mechanisms. Plasticity is maximal in early development, within the so-called critical period, while its levels abruptly decline in adulthood [1] . Recent studies, however, have revealed a significant residual plastic potential of the adult visual cortex by showing that, in adult humans, short-term monocular deprivation alters ocular dominance by homeostatically boosting responses to the deprived eye [2–4] . In animal models, a reopening of critical period plasticity in the adult primary visual cortex has been obtained by a variety of environmental manipulations, such as dark exposure, or environmental enrichment, together with its critical component of enhanced physical exercise [5–8] . Among these non-invasive procedures, physical exercise emerges as particularly interesting for its potential of application to clinics, though there has been a lack of experimental evidence available that physical exercise actually promotes visual plasticity in humans. Here we report that short-term homeostatic plasticity of the adult human visual cortex induced by transient monocular deprivation is potently boosted by moderate levels of voluntary physical activity. These findings could have a bearing in orienting future research in the field of physical activity application to clinical research.
(Whoop-de-doo)

Coping, Problem Solving, Depression, and Health-Related Quality of Life in Patients Receiving Outpatient Stroke Rehabilitation

This has been researched many times before and we still don't seem to have a protocol for this. Just like we have NO protocols for anything to do with stroke. So rather than actually  coming up with solutions to deficits from stroke we are told how to cope with them better. What a fucking waste of time.

Supporting Family Caregivers in Stroke Care - A Review of the Evidence for Problem Solving  2005

Telephone Intervention With Family Caregivers of Stroke Survivors After Rehabilitation 2002

Escitalopram and Problem-Solving Therapy for Prevention of Poststroke Depression  2008

 The latest here:

Coping, Problem Solving, Depression, and Health-Related Quality of Life in Patients Receiving Outpatient Stroke Rehabilitation

Presented as an oral presentation to Neuropsychological Rehabilitation Special Interest Group of the World Federation for NeuroRehabilitation, July 14–15, 2014, Limassol, Cyprus.

Marieke M. Visser, MSc

,

Majanka H. Heijenbrok-Kal, PhD

,

Adriaan van't Spijker, PhD

,

Kristine M. Oostra, MD

,

Jan J. Busschbach, PhD

,

Gerard M. Ribbers, MD, PhD

DOI: http://dx.doi.org/10.1016/j.apmr.2015.04.007

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Published Online: April 25, 2015

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Abstract

Objectives

To investigate whether patients with high and low depression scores after stroke use different coping strategies and problem-solving skills and whether these variables are related to psychosocial health-related quality of life (HRQOL) independent of depression.

Design

Cross-sectional study.

Setting

Two rehabilitation centers.

Participants

Patients participating in outpatient stroke rehabilitation (N=166; mean age, 53.06±10.19y; 53% men; median time poststroke, 7.29mo).

Interventions

Not applicable.

Main Outcome Measures

Coping strategy was measured using the Coping Inventory for Stressful Situations; problem-solving skills were measured using the Social Problem Solving Inventory–Revised: Short Form; depression was assessed using the Center for Epidemiologic Studies Depression Scale; and HRQOL was measured using the five-level EuroQol five-dimensional questionnaire and the Stroke-Specific Quality of Life Scale. Independent samples t tests and multivariable regression analyses, adjusted for patient characteristics, were performed.

Results

Compared with patients with low depression scores, patients with high depression scores used less positive problem orientation (P=.002) and emotion-oriented coping (P<.001) and more negative problem orientation (P<.001) and avoidance style (P<.001). Depression score was related to all domains of both general HRQOL (visual analog scale: β=−.679; P<.001; utility: β=−.009; P<.001) and stroke-specific HRQOL (physical HRQOL: β=−.020; P=.001; psychosocial HRQOL: β=−.054, P<.001; total HRQOL: β=−.037; P<.001). Positive problem orientation was independently related to psychosocial HRQOL (β=.086; P=.018) and total HRQOL (β=.058; P=.031).

Conclusions

Patients with high depression scores use different coping strategies and problem-solving skills than do patients with low depression scores. Independent of depression, positive problem-solving skills appear to be most significantly related to better HRQOL.

Problem-Solving Therapy During Outpatient Stroke Rehabilitation Improves Coping and Health-Related Quality of Life

So rather than finding recovery solutions for survivors we have persons researching coping skills. You wouldn't need so many fucking coping skills if you solved the goddamned problems in stroke. God I hate stupid people. 

Problem-Solving Therapy During Outpatient Stroke Rehabilitation Improves Coping and Health-Related Quality of Life

Randomized Controlled Trial

1. Marieke M. Visser, MSc,
2. Majanka H. Heijenbrok-Kal, PhD,
3. Adriaan van‘t Spijker, PhD,
4. Engelien Lannoo, PhD,
5. Jan J.V. Busschbach, PhD and
6. Gerard M. Ribbers, MD, PhD

+ Author Affiliations

1. From the Department of Rehabilitation Medicine (M.M.V., M.H.H.-K., G.M.R.) and Department of Psychiatry, Section Medical Psychology and Psychotherapy (A.v.S., J.J.V.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Rotterdam Neurorehabilitation Research Department (RoNeRes), Rijndam Rehabilitation Center, Rotterdam, The Netherlands (M.M.V., M.H.H.-K., G.M.R.); and Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium (E.L.).

1. Correspondence to Majanka H. Heijenbrok-Kal, PhD, Rotterdam Neurorehabilitation Research (RoNeRes), Rijndam Rehabilitation Center, PO Box 23181, 3001 KD, Rotterdam, The Netherlands. E-mail mheijenbrok@rijndam.nl

Abstract

Background and Purpose—This study investigated whether problem-solving therapy (PST) is an effective group intervention for improving coping strategy and health-related quality of life (HRQoL) in patients with stroke .

Methods—In this multicenter randomized controlled trial, the intervention group received PST as add-on to standard outpatient rehabilitation, the control group received outpatient rehabilitation only. Measurements were performed at baseline, directly after the intervention, and 6 and 12 months later. Data were analyzed using linear-mixed models. Primary outcomes were task-oriented coping as measured by the Coping Inventory for Stressful Situations and psychosocial HRQoL as measured by the Stroke-Specific Quality of Life Scale. Secondary outcomes were the EuroQol EQ-5D-5L utility score, emotion-oriented and avoidant coping as measured by the Coping Inventory for Stressful Situations, problem-solving skills as measured by the Social Problem Solving Inventory-Revised, and depression as measured by the Center for Epidemiological Studies Depression Scale.

Results—Included were 166 patients with stroke, mean age 53.06 years (SD, 10.19), 53% men, median time poststroke 7.29 months (interquartile range, 4.90–10.61 months). Six months post intervention, the PST group showed significant improvement when compared with the control group in task-oriented coping (P=0.008), but not stroke-specific psychosocial HRQoL. Furthermore, avoidant coping (P=0.039) and the utility value for general HRQoL (P=0.034) improved more in the PST group than in the control after 6 months.

Conclusions—PST seems to improve task-oriented coping but not disease-specific psychosocial HRQoL after stroke >6-month follow-up. Furthermore, we found indications that PST may improve generic HRQoL recovery and avoidant coping.

Clinical Trial Registration—URL: http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2509. Unique identifier: CNTR2509.