Feasibility of a novel web-based neuropsychological rehabilitation programme for stroke patients

 You wouldn't need psychological help if you had EXACT 100% RECOVERY PROTOCOLS! Don't you fucking idiots ever think at all?

Oops, I'm not playing by the polite rules of Dale Carnegie,  'How to Win Friends and Influence People'. 

Telling stroke medical persons they know nothing about stroke is a no-no even if it is true. 

Politeness will never solve anything in stroke. Yes, I'm a bomb thrower and proud of it. Someday a stroke 'leader' will try to ream me out for making them look bad by being truthful , I look forward to that day.

Feasibility of a novel web-based neuropsychological rehabilitation programme for stroke patients

Authors

• Outi VuoriDivision of Neuropsychology, HUS Neurocenter, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
• Heidi WikDivision of Neuropsychology, HUS Neurocenter, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
• Annamaria WikströmDivision of Neuropsychology, HUS Neurocenter, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
• Hanna JokinenDivision of Neuropsychology, HUS Neurocenter, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Psychology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
• Marja HietanenDivision of Neuropsychology, HUS Neurocenter, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
• Eeva-Liisa KallioDivision of Neuropsychology, HUS Neurocenter, University of Helsinki and Helsinki University Hospital, Helsinki, Finland

DOI: 

https://doi.org/10.2340/jrm.v57.43275

Keywords: 

cognition, neuropsychology, psychoeducation, rehabilitation, stroke, telerehabilitation, web-based rehabilitation

Abstract

Objective: To evaluate the implementation and feasibility of the Neuropsychological Digital Care Pathway (NP-DCP), a novel, professional-guided web-based rehabilitation programme for the rehabilitation of cognitive and emotional symptoms following stroke and to identify factors associated with adherence and user experience.

Design: Retrospective registry study.

Subjects: 133 stroke patients (≥ 18 years) with mild to moderate cognitive impairment at the Neurocenter, Helsinki University Hospital, Finland, referred to the NP-DCP between April 2019 and April 2020.

Methods: The NP-DCP adherence data (completers, dropouts, non-starters) and feedback from programme completers were analysed along with demographic and clinical characteristics.

Results: Of the referred patients, 114 (86%) started the programme; of these, 79 (68%) completed it. The average completion time was 82.3 days. Referral on discharge from acute care was associated with higher adherence (p = 0.019). Women were more likely to start the programme than men (p = 0.012). Usability and content were rated good to excellent (mean 4.1–4.4/5), with participants with basic education more satisfied than those with higher education (p = 0.033).

Conclusion: The NP-DCP demonstrated high engagement and user satisfaction, suggesting it is a feasible tool for stroke rehabilitation, thus adding a promising new method to existing services. Early referral may improve adherence.

The Stressed Gut: Region-specific Immune and Neuroplasticity Changes in Response to Chronic Psychosocial Stress

It is your doctor's responsibility to make sure you are under no stress as a result of your stroke. And the only way to do that is for your doctor to have EXACT STROKE REHAB PROTOCOLS LEADING TO 100% RECOVERY. Less than that and your doctor is incompetent.

 The Stressed Gut: Region-specific Immune andNeuroplasticity Changes in Response toChronic Psychosocial Stress

Beatriz Lobo,1,5,6,7
* Mónica Tramullas,1,8  

Beate-C Finger,1  

Kevin W Lomasney,1,3 

 Caroll Beltran,1,9  

Gerard Clarke,1  

Javier Santos,5,6,7,10
Niall P Hyland,1,2  

Timothy G Dinan,1,4 4

nd John F Cryan1,3 *
1
APC Microbiome Ireland, Departments of 2
Physiology, Anatomy and Neuroscience, Psychiatry and Neurobehavioural Science, University
College Cork, Ireland; 5
Digestive System Research Unit, Laboratory of Neuro-Immuno-Gastroenterology, Vall d’Hebron Institut de Recerca (VHIR),
Vall d’Hebron Hospital Universitari, Barcelona, Spain; 6
Department of Gastroenterology, Vall d’Hebron Hospital Universitari, Passeig Vall
d’Hebron Barcelona, Spain; 7
Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain; 8
Departamento de Fisiología
y Farmacología, Facultad de Medicina, Universidad de Cantabria, Santander, Spain (Current address); 9
Laboratory of Immunogastroenterology,
Gastroenterology Unit, Hospital Clinico Universidad de Chile, Faculty of Medicine Universidad de Chile, Santiago, Chile; and10
Centro de
Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
Background/Aims
Chronic psychological stress affects gastrointestinal physiology which may underpin alterations in the immune response and epithelial transport, both functions are partly regulated by enteric nervous system. However, its effects on enteric neuroplasticity are still unclear. This study aims to investigate the effects of chronic unpredictable psychological stress on intestinal motility and prominent markers of enteric function.
Methods
Adult male C57BL/6J mice were exposed to 19 day of unpredictable stress protocol schedule of social defeat and overcrowding. We investigated the effects on plasma corticosterone, food intake, and body weight. In vivo gastrointestinal motility was assessed by fecal pellet output and by whole-gastrointestinal transit (using the carmine red method). Tissue monoamine level, neural and glial markers, neurotrophic factors, monoamine signaling, and Toll-like receptor expression in the proximal and distal colon, and terminal ileum were also assessed.
Results
Following chronic unpredictable psychological stress, stressed mice showed increased food intake and body weight gain (P < 0.001), and reduced corticosterone levels (P < 0.05) compared to control mice. Stressed mice had reduced stool output without differences in
water content, and showed a delayed gastrointestinal transit compared to control mice (P < 0.05). Stressed mice exhibited decreased mRNA expression of tyrosine hydroxylase (Th), brain-derived neurotrophic factor (Bdnf) and glial cell-derived neurotrophic factor(Gdnf), as well as Toll-like receptor 2 (Tlr2) compared to control (P < 0.05), only proximal colon. These molecular changes in proximal colon were associated with higher levels of monoamines in tissue.
Conclusion
Unpredictable psychological chronic stress induces region-specific impairment in monoamine levels and neuroplasticity markers that may relate to delayed intestinal transit.
(J Neurogastroenterol Motil 2023;29:72-84)

THE SOCIAL AND ECONOMIC FACTORS OF THE REHABILITATION OF A POST-STROKE PATIENT in Russia

So rather than solving for 100% recovery, they went down the route of trying to address a secondary problem, psychological stress and depression.  The whole world of stroke doesn't understand that the only goal in stroke is 100% recovery.  These secondary problems wouldn't exist if you solved that. IS EVERYONE IN STROKE THAT FUCKING STUPID? Ask your stroke doctor how they plan on getting you to 100% recovery.

Oops, I'm not playing by the polite rules of Dale Carnegie,  'How to Win Friends and Influence People'. 

Politeness will never solve anything in stroke. Yes, I'm a bomb thrower and proud of it.

 

THE SOCIAL AND ECONOMIC FACTORS OF THE REHABILITATION OF A POST-STROKE PATIENT in Russia

Еlena Sevostyanova Chelyabinsk State University Bratiev Kashirinykh str., 129, Chelyabinsk, Russia elena-krka@mail.ru

Irina Trushina Chelyabinsk State University Bratiev Kashirinykh str., 129, Chelyabinsk, Russia trushina_ia@mail.ru

Мark Loskutnikov Iron&Steel Hospital Naberezhnaya str., 18, Magnitogorsk, Russia losmark@mail.ru

Natalia Kurenkova GBUZ Regional Clinical Hospital №3 Prospekt Pobedy, 287, Chelyabinsk, Russia nataliakurenkova@mail.ru

 

ABSTRACT 

Diseases in the circulatory system of the brain are not only a medical but also a social and economic problem at present, as a stroke patient needs long-term rehabilitation while remaining disabled until the restoration of the lost functions. The study identified psychological factors that prevent the rapid and complete rehabilitation of patients after the ischemic stroke. The neurologic status was assessed on the modified mRS Rankin Scale as well as on the NIHSS Bartel Scale. Beck Depression Inventory (BDI) has helped to identify features of depression in patients with various clinical manifestations of stroke. The practical significance of the work is the possibility of developing psychological support programs based on the results of the study, which would provide an optimized rehabilitation process for patients after ischemic stroke. Keywords: Psychological features of the post-stroke patients, rehabilitation, stroke