Barriers preventing post-stroke care

Every survivor that writes about recovery states it is extremely hard, repetitive and time-consuming. Don't doctors and therapists understand that that needs to be forcefully communicated to all survivors? Along with the fact that magic doesn't occur. If you don't do the work, you won't recover.
http://medicalxpress.com/news/2014-07-barriers-post-stroke.html
For stroke victims, rehabilitation is crucial to their recovery. But a Flinders University study conducted in Singapore found that rehabilitation rates following discharge from hospital are poor because of gaps in the continuum of stroke care.
The study – published last month in the International Journal of Therapy and Rehabilitation – identified five major barriers to post-stroke rehabilitation in Singapore including; difficulties accessing rehabilitative services; gaps in discharge coordination; the influence of family members; discrepancies in expectation; and the perception that rehabilitation is simple. As part of the research, interviews were conducted with 68 stroke victims who were discharged from a Singapore rehabilitation unit between December 2012 and April 2013. Of those, 31 participants reported not following recommendations to continue their rehabilitation. There was no difference in gender, age or type of stroke between those who did and not complete the rehabilitation.
Flinders Clinical Rehabilitation lecturer Dr Christopher Barr, a co-investigator of the study, said access barriers, including mobility difficulties and transport costs, along with affordability of services, were the chief obstacles precluding rehabilitation.
"The lack of transport means and the associated costs were the main barriers that hindered adherence to continuing post-stroke rehabilitation," Dr Barr said.
"Affordability of services also had a direct influence, with one participant's family member stating: 'money is a concern and also who [is going] to bring my dad to therapy'," he said.
"Gaps in the transition from hospital to outpatient services were also cited as a reason for not continuing rehabilitation – in some cases participants fell through the unnoticed gap and were left waiting for follow-up appointments."
Dr Barr said family members were either facilitators or inhibitors of rehabilitation: "One participant said they have to prompt their mother to go because they think it's good for her but another participant said they missed two appointments because their son forgot.
"It wasn't uncommon for patients and carers to feel stranded and helpless."
Dr Barr said most participants regarded rehabilitation as simple, common-sense knowledge that could easily be self-replicated or substituted without the help of a therapist, leading them to seek alternatives to their therapy recommendation.
He said the findings highlighted the need to review current goal-setting processes for rehabilitation and the need to establish a common understanding of rehabilitation practice between patients, carers and clinicians.
"Clinicians need to be more aware of their role in providing well-coordinated information about therapy, and goals need to be more patient-centred to reduce the discrepancies in expectations of rehabilitation.
"Carers also need to be more empowered and involved in discharge planning to minimise the dissatisfaction in care arrangements and information delivery."

Ditch the 10,000 hour rule! Why Malcolm Gladwell’s famous advice falls short

You will need to DEMAND your doctor respond to this about how many repetitions it takes for stroke recovery.
I like the statement, Massed practice leads to massed forgetting. What does your therapist have to say about this?
http://www.salon.com/2014/04/20/ditch_the_10000_hour_rule_why_malcolm_gladwells_famous_advice_falls_short/

Visualizing Cell Signaling: Current Trends and New Technologies

This sounds like something our doctors and researchers need to attend so they  can figure out how neurons neuroplastically get their neighboring neurons to help. And with that knowledge we could finally have repeatable stroke protocols for recovery of functions. Instead of todays' world where no one knows how it works and all we get is repetition, repetition, repetition.
http://webinar.sciencemag.org/webinar/archive/visualizing-cell-signaling

Wednesday, April 16, 2014

12:00 pm ET

06:23:55 Days Hrs Mins

Register Now

Techniques for the study of intracellular ions are used widely in biology, including for the tracking of calcium waves or ions affecting pH within living cells. The ability to monitor changes in intracellular ion concentrations over time is vital for our understanding of signaling and functional pathways in cellular systems. These pathways are central to many fundamental processes such as muscle contraction and synaptic nerve signal transmission. Ion channels that span the outer cell membrane open or close in response to extracellular and intracellular signals, potentially altering how the cell behaves. These fluctuations can be visualized and quantified using ratiometric microscopy and special fluorescent dyes designed to bind specific ions, such as the FURA-2 indicator dye specific to calcium ions. Changes in the photophysics of the dye as it binds to its target ion allows for quantitation of the bound and unbound ratio, and thus the concentration of the ion under investigation. This webinar will introduce the viewer to the current state of technology in this important field as well as cover the latest advances in microscopy for ion signaling research.
During the webinar, viewers will:

• Learn about current state-of-the-art ion signaling methodologies
• Discover what recent advances have been made in technologies for tracking ion changes, particularly calcium signaling
• Hear how experts in the field are applying these new technologies in the lab today
• Have the opportunity to ask questions of the expert panel live!

Speaker Bios

Mark Hollywood, Ph.D.

Dundalk Institute of Technology
Dundalk, Ireland

Dr. Hollywood undertook his Ph.D. at Queens University in Belfast, Ireland on the innervation of sheep mesenteric lymphatics. Following graduation in 1994, he commenced postdoctoral training in the Smooth Muscle Group and subsequently was offered a lecturer position in the Department of Physiology in 1995 and a senior lecturer post in 2001. In 2005, Dr. Hollywood together with his colleagues from the Smooth Muscle Group were recruited by Dundalk Institute of Technology to set up the Smooth Muscle Research Centre in Ireland, where he is currently a principal investigator. Dr. Hollywood’s research interests are focused on (1) developing novel ion channel modulators to treat overactive bladder and (2) examining the mechanisms underlying spontaneous activity in urethral pacemaker cells and how they modulate the bulk smooth muscle. His laboratory is currently developing a combined patch clamp/confocal microscopy system that will allow simultaneous imaging of whole-cell Ca2+ at frame rates in excess of 200 frames per second using back-illuminated EMCCD cameras, and enable correlation of this data to the resultant electrical activity observed in isolated urethral pacemaker cells.

C. Peter Bengtson, Ph.D.

University of Heidelberg
Heidelberg, Germany

Dr. Bengtson has a Ph.D. in neurophysiology from the Department of Physiology and Pharmacology at the University of Queensland, Australia.  He specializes in both patch clamp electrophysiology and wide-field microscopy from neurons in brain slices or dissociated cultures. He is currently a senior postdoctoral fellow in the Department of Neurobiology in the Interdisciplinary Center for Neuroscience (IZN) at Heidelberg University where he has worked for over a decade in the laboratory of Professor Hilmar Bading, primarily investigating the calcium signals and molecular mechanisms mediating long-term plasticity and memory.

Colin Coates, Ph.D.

Andor Technology
Belfast, Ireland

Dr. Coates holds a first-class degree in chemistry, with a postgraduate degree and postdoctoral research training from Queen’s University Belfast in Ireland, focusing primarily on time-resolved laser spectroscopic analysis of photophysical mechanisms. Dr. Coates also has experience in leading an industrial research and development team that was involved in developing novel DNA microarray technologies. Dr. Coates maintains overall product management responsibility for Andor's research and OEM camera/spectrograph business, encompassing imaging, spectroscopy, time-resolved, and X-ray product/market segments.

Moderator: Sean Sanders, Ph.D.

Science/AAAS
Washington, DC

Dr. Sanders did his undergraduate training at the University of Cape Town, South Africa, and his Ph.D. at the University of Cambridge, UK, supported by the Wellcome Trust. Following postdoctoral training at the National Institutes of Health and Georgetown University, Dr. Sanders joined TranXenoGen, a startup biotechnology company in Massachusetts working on avian transgenics. Pursuing his parallel passion for writing and editing, Dr. Sanders joined BioTechniques as an editor, before joining Science/AAAS in 2006. Currently Dr. Sanders is the Editor for Custom Publishing for the journal Science and Program Director for Outreach.

Gesture-control wearable inspired by a stroke survivor puts the power switch on your wrist

This goes against making it harder as Peter Levine writes;

What if you made it harder?

Which camp is your doctor in? Or more importantly, your insurance? 

I'm firmly in the harder camp, in order to recover you need repetitions and lots of them. This allows sedentary behavior which is not helpful in your recovery.

Gesture-control wearable inspired by a stroke survivor puts the power switch on your wrist

Imagine being able to turn off the alarm clock, start the coffee pot or flip a light switch with a simple arm movement.
That’s the vision Playtabase has for the new wearable it’s developed with people who have limited mobility in mind.
Called Reemo, the device is a wrist-worn band that interprets movements into gestures and communicates the corresponding commands to a software system via Bluetooth. The software then communicates with the electronic devices that have been linked to it through receivers.
Playtabase was one of three winners of the AgePower Tech Search initiative, a competition sponsored by senior housing nonprofit Ecumen and business growth engine MOJO Minnesota. For winning, the startup will get to work with MOJO on its business strategy and run a six-month pilot with Ecumen customers.
More at link.

Read more: http://medcitynews.com/2014/02/lights-lights-gesture-control-wearable-inspired-stroke-patient/#ixzz2sf8wjV64

Flee from zombies and giant boulders with the Race Yourself fitness app for Google Glass

This would be great for making our rehabilitation harder and getting more repetitions in. Hell I'd probably learn how to run again by using this, even if they caught me numerous times.
http://thenextweb.com/apps/2014/01/08/flee-zombies-giant-boulders-race-fitness-app-google-glass/#!sthRA
Fitness apps seem like a perfect fit for Google Glass, given that the head-mounted computer is devoid of wires and requires a minimal amount of input from your digits.
Race Yourself is a promising piece of Glassware that, using augmented reality, gives you an avatar to compete against in the real world. Over 30 game modes will have you racing against yourself, a giant Indiana Jones-style boulder and even hordes of zombies.
The app will also support multiple activities, so you can cycle against the Peloton in the Tour de France or skydive through virtual rings in the sky.

A changing stroke rehabilitation environment: Implications for upper limb interventions

These people are stuck in their own silo. The way to better upper limb recovery is through less dead and damaged neurons by stopping the neuronal cascade of death.
http://strathprints.strath.ac.uk/45672/1/Jones_PH_AuthorDraft.pdf
Abstract— Functional recovery of the upper limb is poor and as
many as 50% of stroke survivors still have impairments at 6
months post stroke, despite rehabilitation efforts. With the move
towards early supported discharge and community-based
rehabilitation, novel solutions are needed to deliver the amount of
quality therapy that is required for optimum recovery. We
propose a rehabilitation aid that provides patients with
augmented visual feedback of their motor performance during
task orientated upper limb therapy with the aim of facilitating
motor relearning and maximising patients functional outcomes.

Six pages of obvious conclusions.
In one word - repetition.

Counting Repetitions: An Observational Study of Video Game Play in People With Chronic Poststroke Hemiparesis

Find out from your doctor what this tells us about how many repetitions to do.
http://journals.lww.com/jnpt/Abstract/publishahead/Counting_Repetitions___An_Observational_Study_of.99905.aspx

Abstract

Background and Purpose: The use of video gaming as a therapeutic intervention has increased in popularity; however, the number of repetitions in comparison with traditional therapy methods has yet to be investigated. The primary purpose of this study was to document and compare the number of repetitions performed while playing 1 of 2 video gaming systems for a time frame similar to that of a traditional therapy session in individuals with chronic stroke.

Methods: Twelve participants with chronic stroke (mean age, 66.8 +/- 8.2 years; time poststroke, 19.2 +/- 15.4 months) completed video game play sessions, using either the Nintendo Wii or the Playstation 2 EyeToy. A total of 203 sessions were captured on video record; of these, 50 sessions for each gaming system were randomly selected for analysis. For each selected record, active upper and lower extremity repetitions were counted for a 36-minute segment of the recorded session.

Results: The Playstation 2 EyeToy group produced an average of 302.5 (228.1) upper extremity active movements and 189.3 (98.3) weight shifts, significantly higher than the Nintendo Wii group, which produced an average of 61.9 (65.7) upper extremity active movements and 109.7 (78.5) weight shifts. No significant differences were found in steps and other lower extremity active movements between the 2 systems.

Discussion and Conclusions: The Playstation 2 EyeToy group produced more upper extremity active movements and weight shifting movements than the Nintendo Wii group; the number and type of repetitions varied across games. Active gaming (specifically Playstation 2 EyeToy) provided more upper extremity repetitions than those reported in the literature by using traditional therapy, suggesting that it may be a modality to promote increased active movements in individuals poststroke.

Video Abstract available (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A50) for more insights from the authors.

Concurrent neuromechanical and functional gains following upper-extremity power training post-stroke

Another one suggesting high intensity training. Your doctor will know about this for incorporating your stroke protocol.
http://www.jneuroengrehab.com/content/10/1/1/abstract

Abstract (provisional)

Background

Repetitive task practice is argued to drive neural plasticity following stroke. However, current evidence reveals that hemiparetic weakness impairs the capacity to perform, and practice, movements appropriately. Here we investigated how power training (i.e., high-intensity, dynamic resistance training) affects recovery of upper-extremity motor function post-stroke. We hypothesized that power training, as a component of upper-extremity rehabilitation, would promote greater functional gains than functional task practice without deleterious consequences.

Method

Nineteen chronic hemiparetic individuals were studied using a crossover design. All participants received both functional task practice (FTP) and HYBRID (combined FTP and power training) in random order. Blinded evaluations performed at baseline, following each intervention block and 6-months post-intervention included: Wolf Motor Function Test (WMFT-FAS, Primary Outcome), upper-extremity Fugl-Meyer Motor Assessment, Ashworth Scale, and Functional Independence Measure. Neuromechanical function was evaluated using isometric and dynamic joint torques and concurrent agonist EMG. Biceps stretch reflex responses were evaluated using passive elbow stretches ranging from 60 to 180o/s and determining: EMG onset position threshold, burst duration, burst intensity and passive torque at each speed.

Results

Primary outcome: Improvements in WMFT-FAS were significantly greater following HYBRID vs. FTP (p = .049), regardless of treatment order. These functional improvements were retained 6-months post-intervention (p = .03).

Secondary outcomes: A greater proportion of participants achieved minimally important differences (MID) following HYBRID vs. FTP (p = .03). MIDs were retained 6-months post-intervention. Ashworth scores were unchanged (p > .05).

Increased maximal isometric joint torque, agonist EMG and peak power were significantly greater following HYBRID vs. FTP (p < .05) and effects were retained 6-months post-intervention (p's < .05). EMG position threshold and burst duration were significantly reduced at fast speeds (>=120o/s) (p's < 0.05) and passive torque was reduced post-washout (p < .05) following HYBRID.

Conclusions

Functional and neuromechanical gains were greater following HYBRID vs. FPT. Improved stretch reflex modulation and increased neuromuscular activation indicate potent neural adaptations. Importantly, no deleterious consequences, including exacerbation of spasticity or musculoskeletal complaints, were associated with HYBRID. These results contribute to an evolving body of contemporary evidence regarding the efficacy of high-intensity training in neurorehabilitation and the physiological mechanisms that mediate neural recovery.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.