NABH(National Accreditation Board for Hospitals and Healthcare Providers - India) seeks public and stakeholders suggestions on first edition draft standards for stroke centres

Get involved and ask for 100% recovery protocols. And don't acknowledge their whining when they say it can't be done. Swearing may be required.  DO NOT BACK DOWN!

NABH seeks public and stakeholders suggestions on first edition draft standards for stroke centres

Shardul Nautiyal, Mumbai Wednesday, June 14, 2023, 08:00 Hrs  [IST]

The National Accreditation Board for Hospitals and Healthcare Providers (NABH) has sought suggestions and feedback from public at large, including the stakeholders like hospitals, clinical establishments, industry and consumer groups on first edition draft standards for stroke centres. NABH standards for stroke centres have been drafted in collaboration with World Stroke Organization (WSO). “The comments may be shared on the form within 20 days of publication of this notice on the website. Last date for receiving suggestions and feedback is June 20, 2023,” according to a NABH circular. According to the draft standards for stroke centres, “The stroke centre shall define and display the services that it provides. The services provided at the stroke centre shall be defined and be in consonance with the needs of the community. Each defined service shall have diagnostic and treatment services with suitably qualified personnel who provide out-patient, in-patient and emergency cover.” The draft standards further stipulate that the stroke centre’s defined services shall be prominently displayed. The stroke centre shall have a well-defined registration and admission process. The stroke centre shall use written guidance for registering and admitting patients. A unique identification number shall be generated at the end of registration. There shall be an appropriate mechanism for transfer out or referral of patients to a higher level of care. Transfer out or referral of patients to a higher level of care shall be done appropriately. If the stroke centre does transfer patients for neurosurgical emergencies, there shall be a written guidance for urgent transfer. The stroke centre shall have a written transfer protocol, transfer agreement or a memorandum of understanding (MoU) with at least one hospital being capable of providing timely and essential stroke related services immediately. The stroke centre shall give a summary of the patient’s condition and the treatment given. Patients in the stroke centre shall be appropriately assessed and documented. Assessments shall include initial assessment and periodic re-assessment as applicable and shall be appropriate for each patient. All patients (emergency and in-patients) shall undergo an assessment based on their needs. All assessments shall be documented and signed appropriately by staff. “The doctor and nursing staff shall develop a documented care plan for the admitted stroke patient, which includes identification of individual needs for the patient, based on their condition and the family’s needs,” as per the draft standards.

Temple researchers link brain injuries and curse words

One of the participants in our stroke group had aphasia pretty bad. But during bowling he could swear up a storm.

Temple researchers link brain injuries and curse words

A professor and his team studied taboo words to help brain injury patients regain language use.

18 February 2020 Ayooluwa Ariyo faculty, Features

Jamie Reilly, an associate professor and the Director of the Concepts and Cognition Lab at the College of Public Health, speaks with research associate Bonnie Zuckerman in the Eleanor M. Saffran Center for Cognitive Neuroscience in Ritter Annex on Feb. 5. | JEREMY ELVAS / THE TEMPLE NEWS

While working as a speech therapist, Jamie Reilly found people with brain injuries may lose the ability to use language, but can still curse.

“When you have a bad brain injury that affects the left side, sometimes people can lose all aspects of language but keep cursing,” Reilly said. “They basically won’t be able to name anything, picture of a dog, but they can say the F-word just fine.”

Reilly, a communication sciences and disorders professor and director of the Concepts and Cognition Laboratory in the College of Public Health, is researching the relationship between curse words and behavioral control in patients with strokes or aphasia, a language disorder due to brain injury. The laboratory’s first paper on the subject was published in this month’s issue of The Psychonomic Bulletin and Review, a psychology journal. 

Through a study and brain stimulation with curse words on participants, Reilly and his team found cursing is specially encoded in the brain. The team hopes to expand their research in the future to include how patients can gain more language control.

The research began in 2017 by studying a patient’s response to hearing curse words through his eye dilation, Reilly said. Normally, people’s eyes dilate very quickly when they hear curse words because of the words’ effect on the brain — this was not the case with their patient. 

“It’s an interesting effect where we experience this sort of arousal and this need to inhibit, he didn’t have that at all,” Reilly said. 

It led to a second study a year later on how taboo words are encoded in the brain so deeply people who have lost language can still use it, said Peter Twigg, a second-year neuroscience student, who also researches in the lab. 

The research team wants to provide more evidence on the formation of curse words and their taboo nature to inform caregivers on how to treat brain injury patients, Twigg said.

“When you’re treating somebody who has aphasia, or [traumatic brain injury] or stroke, these are issues that you would encounter on a daily basis,” he added. “So our research helps to inform us and the scientific community more largely about how to deal with that, how to understand that what’s happening in the brain and then hopefully in future studies, how we can help to treat it and alter it so that we can make life you know, more accommodating.”

Reilly and his team then carried out a third study on brain stimulation and measured the participants’ eye movement and responses while they read curse words. The team repeated the process after stimulating their brains for 20 minutes to check for changes. 

The process, called transcranial direct current stimulation, used a hat-like device, with negative and positive current and electrodes, attached to the head. The currents go through the brain and change the excitation level of the different parts of the brain it is on, Reilly said. 

“That study was more like proof of concept,” said Bonnie Zuckerman, the lab’s research associate. “Cursing is reported in the right hemisphere, which is also what damage has shown. Damage in their left, cursing happens more, damage in their right, cursing happens less.”

The research team used this process to help people with Alzheimer’s disease as it stimulates certain parts of their brain that are not working well, Reilly said. They are looking into the process as a therapy option to regulate emotions and language, Zuckerman added. 

Four journals previously rejected their published research, which may be because of the controversial nature of curse words, Reilly said.

They then removed some curse words and represented them as data points and codes instead, in order to get their research published, Twigg said. 

“Nobody really wants to deal with these words, but they are part of our lives all the time,” he added. “You have to deal with whether you include gendered speech and hate speech or you know, racial terms and things like that and all of those get very challenging to code and challenging to include.”

Reilly hopes their research starts a conversation about curse words in science, and use it to help people with brain injury.

“People who experience uncontrolled cursing experience fairly significant degree of distress, but we really don’t know anything about how to help them,” Reilly said. “Cursing is the subset of language really, a lot needs to be learned about and then developing interventions that can help people, I think is important.”

 

Swearing as a Response to Pain: Assessing Hypoalgesic Effects of Novel “Swear” Words

Would this work for CPSP(Chronic Post Stroke Pain)?

Your doctor should have had you swearing for 6 years already.

Or maybe your doctor can prescribe swearing in multiple languages.

People Good At Swearing Have This Major Advantage - larger vocabulary

December 2015

A rich vocabulary can protect against cognitive impairment October 2014

 The latest here:

Swearing as a Response to Pain: Assessing Hypoalgesic Effects of Novel “Swear” Words

Richard Stephens^1* and Olly Robertson^2,3

• ¹School of Psychology, Keele University, Keele, United Kingdom
• ²School of Psychology, Keele University, Keele, United Kingdom
• ³Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom

Previous research showing that swearing alleviates pain is extended by addressing emotion arousal and distraction as possible mechanisms. We assessed the effects of a conventional swear word (“fuck”) and two new “swear” words identified as both emotion-arousing and distracting: “fouch” and “twizpipe.” A mixed sex group of participants (N = 92) completed a repeated measures experimental design augmented by mediation analysis. The independent variable was repeating one of four different words: “fuck” vs. “fouch” vs. “twizpipe” vs. a neutral word. The dependent variables were emotion rating, humor rating, distraction rating, cold pressor pain threshold, cold pressor pain tolerance, pain perception score, and change from resting heart rate. Mediation analyses were conducted for emotion, humor, and distraction ratings. For conventional swearing (“fuck”), confirmatory analyses found a 32% increase in pain threshold and a 33% increase in pain tolerance, accompanied by increased ratings for emotion, humor, and distraction, relative to the neutral word condition. The new “swear” words, “fouch” and “twizpipe,” were rated as more emotional and humorous than the neutral word but did not affect pain threshold or tolerance. Changes in heart rate and pain perception were absent. Our data replicate previous findings that repeating a swear word at a steady pace and volume benefits pain tolerance, extending this finding to pain threshold. Mediation analyses did not identify a pathway via which such effects manifest. Distraction appears to be of little importance but emotion arousal is worthy of future study.

Introduction

Swearing, defined as the use of taboo language conveying connotative information (Jay and Janschewitz, 2008), is a near-universal feature of language (van Lancker and Cummings, 1999). Research has shown that repeating a swear word can be an effective way of increasing tolerance for the physical pain of an ice water challenge (Stephens et al., 2009; Stephens and Umland, 2011; Robertson et al., 2017) and the social pain associated with ostracism (Philipp and Lombardo, 2017).

In explaining how swearing brings about these pain reducing effects, one theory posits that swearing brings about a stress-induced analgesia (Stephens and Umland, 2011; Philipp and Lombardo, 2017) via increased autonomic arousal. Consistent with this theory, several studies have shown that swearing provokes an autonomic response, assessed via increased heart rate (Stephens et al., 2009; Stephens and Umland, 2011) and increased skin conductance (LaBar and Phelps, 1998; Jay et al., 2008; Bowers and Pleydell-Pearce, 2011). It is the emotion-provoking aspect of swearing that is thought to underlie this increase in autonomic arousal (Stephens and Allsop, 2012).

It would be of theoretical interest to further assess the importance of emotional arousal as a means by which swearing brings about pain relief. A novel way to assess this would be to test whether a newly made-up “swear” word, chosen because it has potential to elicit an emotional response, produces similar pain reducing effects as swearing.

An alternative theory explaining how swearing brings about pain reducing effects is via attention modulation (Wiech et al., 2008). It is established within the framework of the descending pain inhibitory system that cognitive processes, including distracting attention away from a pain stimulus, can reduce perceived pain (Edwards et al., 2009). The precise mechanism appears to be a combination of inhibiting sensory and emotional brain regions, while at the same time acting in an excitatory capacity on the periaqueductal gray region of the brain where endogenous opioids such as endorphins are produced (Sims-Williams et al., 2017).

One property of swearing that may usefully distract one’s attention from pain is if the word is perceived as humorous or novel. That swearing can be perceived as funny has been shown by Engelthaler and Hills (2018), who had 821 participants rate 5000 English words for humor. The word “fuck” was rated in the top 1% of funniest words. Similarly, swearing is perceived as a novel unit of language, evidenced by findings estimating that swear words make up less than 1% of all speech (Jay, 2009). Given that human attention appears biased toward detecting stimuli that occur less frequently over those occurring more frequently (Horstmann and Herwig, 2016), it would be of theoretical interest to further assess the importance of attention modulation as a means by which swearing brings about pain relief. A novel way to assess this would be to test whether a newly made-up “swear” word, chosen because it has potential to elicit distraction through humor, novelty, or some other aspect, produces similar pain reducing effects as swearing.

The aim of this research study was to generate two new “swear” words, defined as non-pre-existing words that can be used in place of swear words, and to assess the pain-relieving effects of repeating these new words in the context of a cold pressor (ice water) pain challenge. The study provided an opportunity to explore some of the properties of swear words that underlie their psychological effects. Including new “swear” words enabled isolation of some of the properties of swear words in the absence of learned associations that true swear words have been theorized to possess (Jay, 2009).

The new “swear” were generated by an agency working for Nurofen. They were selected for the experiment by a panel consisting of the lead author, a lexicographer, an independent scientist with expertise in swearing, and two lay members. The selection process for the new “swear” words is described later. The cold pressor experiment included the two new words, “fouch” and “twizpipe,” alongside a conventional swear word, “fuck,” included partly as a research replication paradigm. There was also a neutral word control condition to provide a reference against which to assess the effects of the conventional and new swear words. This was a word to describe a table in line with previous similar studies (e.g., Stephens and Umland, 2011). Key aspects of this study were pre-registered on aspredicted.org (#21777) (see Supplementary Materials). Hypotheses (i) to (vii) were included on the pre-registration document and should be considered confirmatory, although please note that, in error, we specified one-way unrelated ANOVAs rather than one-way related ANOVAs. Hypothesis (viii) was not included on the pre-registration document and consequently should be considered exploratory.

It was hypothesized: (i) that emotion ratings would be greater for “fouch” vs. neutral word; (ii) that humor and distraction ratings would be greater for “twizpipe” vs. neutral word; (iii) that emotion, humor, and distraction ratings would be greater for “fuck” vs. neutral word; (iv) that cold pressor pain onset latency (pain threshold) would be increased for “fuck,” “fouch,” and “twizpipe” vs. neutral word; (v) that cold pressor pain tolerance latency would be increased for “fuck,” “fouch” and “twizpipe” vs. neutral word; (vi) that pain perception would be decreased for “fuck,” “fouch” and “twizpipe” vs. neutral word; (vii) that change from resting heart rate would be increased for “fuck” and “fouch” vs. neutral word; and (viii) that the effects of swearing on pain tolerance would be mediated by one or more of the emotion rating, humor rating, or distraction rating scores.

 

Speech rehabilitation in post-stroke aphasia using visual illustration of speech articulators: A case report study

In case you need this.  I know little of aphasia, but this doesn't seem to be addressing the finding of correct words. I did know one person with this who when getting frustrated with bowling could properly and quickly produce elegant swearing.

Speech rehabilitation in post-stroke aphasia using visual illustration of speech articulators: A case report study

Célise Haldin , Hélène Loevenbruck , Thomas Hueber , Valérie Marcon , Céline Piscicelli , Pascal Perrier , show all

Received 17 Dec 2019, Accepted 06 Jun 2020, Published online: 22 Jun 2020

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• https://doi.org/10.1080/02699206.2020.1780473
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ABSTRACT

Recent studies on the remediation of speech disorders suggest that providing visual information of speech articulators may contribute to improve speech production. In this study, we evaluate the effectiveness of an illustration-based rehabilitation method on speech recovery of a patient with non-fluent chronic aphasia. The Ultraspeech-player software allowed visualization by the patient of reference tongue and lip movements recorded using ultrasound and video imaging. This method can improve the patient’s awareness of their own lingual and labial movements, which can increase the ability to coordinate and combine articulatory gestures. The effects of this method were assessed by analyzing performance during speech tasks, the phonological processes identified in the errors made during the phoneme repetition task and the acoustic parameters derived from the speech signal. We also evaluated cognitive performance before and after rehabilitation. The integrity of visuospatial ability, short-term and working memory and some executive functions supports the effectiveness of the rehabilitation method. Our results showed that illustration-based rehabilitation technique had a beneficial effect on the patient’s speech production, especially for stop and fricative consonants which are targeted (high visibility of speech articulator configurations) by the software, but also on reading abilities. Acoustic parameters indicated an improvement in the distinction between consonant categories: voiced and voiceless stops or alveolar, post-alveolar and labiodental fricatives. However, the patient showed little improvement for vowels. These results confirmed the advantage of using illustration-based rehabilitation technique and the necessity of detailed subjective and objective intra-speaker evaluation in speech production to fully evaluate speech abilities.

People Good At Swearing Have This Major Advantage - larger vocabulary

I knew a guy with aphasia from a stroke bowling group who could swear up a storm. I don't think this finding necessarily applies to him.
http://www.spring.org.uk/2015/12/people-good-at-swearing-have-this-major-advantage.php?
People who know more swear words also have stronger verbal abilities, a new study finds.
Knowing how to swear, then, is not a sign of a poor vocabulary — in fact it signals a better vocabulary.

The study tested how many different swear words people could think of in 60 seconds.
.......
One caveat: this study does not test or suggest that using lots of swear words is a sign of a larger vocabulary.
It only tested (and found) that knowing them is linked to a larger vocabulary.
The new study was published in the journal Language Sciences (Jay & Jay, 2015).

More at link.

Stroke victims able to move their arms again thanks to robot physiotherapist and retro ‘bat- and-ball’ computer game

I just wish our doctors and therapists would just write up damned stroke protocols for all the video games I've already written about. I don't give a shit if clinical trials haven't been run. Make a damned decision and propose something. It's not like a video game is going to kill or injure you.

Stroke victims able to move their arms again thanks to robot physiotherapist and retro ‘bat- and-ball’ computer game

Movement is being restored to the arms of patients paralysed by stroke – thanks to a robot physiotherapist and a retro ‘bat- and-ball’ computer game.

The method gives new hope to the 110,000 British victims who are left with difficulty moving hands, arms and shoulders due to brain damage after a stroke.

Robot-assisted rehab is a growing field of medical treatment. Usually the ‘robot’ takes the form of a kind of support that is worn in some way by the patient. The robot helps by ‘reading’ what the patient can and can’t do, and learns how and when to give support.

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In control: The robot helps by ‘reading’ what the patient can and can’t do, and learns how and when to give support

This gradual approach can encourage the muscle and nerve connections lost after a stroke to regrow.

Improvements have been seen in patients treated up to five years after their initial stroke.

Patients taking part in trials of the method sit at a table facing a computer screen and place their arm on to a specially designed support. Their arm moves a robot arm connected to the computer which in turn controls a spot or cursor that appears on the screen, enabling them to play games.

In one game, designed to strengthen the wrist, patients play a ‘bat-and-ball’ computer game. If the rehab-robot senses the user is struggling, it steps in and helps to move their arm to complete the task.

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In another game, which helps condition shoulder movement, they are asked to manoeuvre the spot to hit points on a clock, moving from a number and back to the centre repeatedly. Patients receive therapy for one hour, three times a week for 12 weeks.

Stroke consultant Dr Helen Rodgers at Northumbria NHS Trust, one of four trial centres, says: ‘It’s fun, and patients get immediate visual feedback that their arm is doing something, which is a huge motivator. 

But therapy like this means people regain the ability to dress themselves, eat with a knife and fork, and do ordinary things that stroke can rob people of the ability to do.’

Dr Rodgers, who is leading the trial, says that while stroke services in the UK are improving in terms of rapid treatment of strokes, rehabilitation still lags behind. 

And there is generally less attention paid to upper-body mobility, with most stroke rehabilitation focused on helping sufferers to walk again.

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Patients taking part in trials of the method sit at a table facing a computer screen and place their arm on to a specially designed support

Between 30 and 66 per cent of stroke victims regain their ability to walk, but only one in five recovers movement in the arms and shoulders.

The arm robot was developed at the Massachusetts Institute of Technology in the US. Researchers there have established that the technology is highly effective at recovering movement in the arm, taking over the work that would normally be performed by physiotherapists.

The robot is being put through its paces at Glasgow Royal Infirmary, Addenbrooke’s in Cambridge, Queen’s Hospital in London and Northumbria NHS Trust, Tyneside.

The trial, involving 700 patients, is split into three equal groups with one group on the robot, a second having intensive therapy from a physio and the third getting standard physiotherapy.

One benefit of using the robot is that it frees up physiotherapists to help more patients. The robot also collects data in its computer of how well the patient has done, allowing accurate charting of progress.

Dr Rodgers believes the robot will boost recovery rates for arms and shoulders to those achieved for walking recovery. A bonus is that it can help people who have had strokes many years ago. She said: ‘We are enrolling people who had strokes as far back as five years.

‘It’s best to start physiotherapy soon after a stroke but we know that movement can be improved even if there has been a delay.’

Tom Means, 61, has already taken part in the robot trial. The electrician from Newcastle had a stroke last year and spent about two months in hospital. Now back at home, he continues to receive physiotherapy twice a week.

Immediately after his stroke, Tom attended North Tyneside General Hospital for sessions with rehab robot as part of the trial.

He said: ‘After the stroke, my left arm was pretty useless – I couldn’t even feel it. Playing the old-fashioned computer games was actually quite fun and did get you moving.

‘After only a few sessions I really felt the difference. I haven’t recovered my arm mobility completely – I never will – but it’s vastly improved.’

Read more: http://www.dailymail.co.uk/health/article-3207133/Stroke-victims-able-arms-thanks-robot-physiotherapist-retro-bat-ball-computer-game.html#ixzz3jbROhQwc

A rich vocabulary can protect against cognitive impairment

So is your doctor prescribing vocabulary work? Or maybe your doctor can prescribe swearing in multiple languages.

People Good At Swearing Have This Major Advantage - larger vocabulary

December 2015

A rich vocabulary can protect against cognitive impairment

Some people suffer incipient dementia as they get older. To make up for this loss, the brain's cognitive reserve is put to the test. Researchers from the University of Santiago de Compostela have studied what factors can help to improve this ability and they conclude that having a higher level of vocabulary is one such factor.

'Cognitive reserve' is the name given to the brain's capacity to compensate for the loss of its functions. This reserve cannot be measured directly; rather, it is calculated through indicators believed to increase this capacity.

A research project at the University of Santiago de Compostela (USC) has studied how having a wide vocabulary influences cognitive reserve in the elderly.

As Cristina Lojo Seoane, from the USC, co-author of the study published in the journal 'Anales de Psicología' (Annals of Psychology), explains to SINC: "We focused on level of vocabulary as it is considered an indicator of crystallised intelligence (the use of previously acquired intellectual skills). We aimed to deepen our understanding of its relation to cognitive reserve."

The research team chose a sample of 326 subjects over the age of 50 - 222 healthy individuals and 104 with mild cognitive impairment. They then measured their levels of vocabulary, along with other measures such as their years of schooling, the complexity of their jobs and their reading habits.

They also analysed the scores they obtained in various tests, such as the vocabulary subtest of the 'Wechsler Adult Intelligence Scale' (WAIS) and the Peabody Picture Vocabulary Test.

"With a regression analysis we calculated the probability of impairment to the vocabulary levels of the participants," Lojo Seoane continues.
The results revealed a greater prevalence of mild cognitive impairment in participants who achieved a lower vocabulary level score.
"This led us to the conclusion that a higher level of vocabulary, as a measure of cognitive reserve, can protect against cognitive impairment," the researcher concludes.

Swear Your Pain Away

I've noticed anecdotally that some aphasia patients are able to fluently swear. Whom is going to research the reason for that? And can decent research be done to see if this helps those patients regain regular speech?
http://brainblogger.com/2014/10/06/swear-your-pain-away/

Why I hope every neurologist, PMR doctor for stroke hates me

Because doing the best for their patients is not occurring right now. If it was they would be having their doctor associations, Joint Commission and the WSO on high alert to get stroke research and rehab breathlessly talked about in any health discussion. And the way to do that is to have every single stroke survivor demand a protocol to get to 100% recovery. And threaten to not pay them until they do. Altruism hasn't worked, time to bring out the big guns.  Standard of care. Use all the links I've provided to prove they are not paying attention and thus failing in their standard of care responsibilities. Quote me liberally, I want Dean to be a swear word in the stroke medical world.
This may take 50 years but you have to start some time.

“Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has.” -- Margaret Mead

DAMN YOU DEAN

Learning to Speak Again

A great article from the Dana Foundation and a new word to understand - hypoperfusion.
http://dana.org/news/features/detail.aspx?id=42622 
The brain can regain language abilities even years after a stroke -- and training the toughest language tasks, not the easiest, first may be the best recovery strategy.

Rest at the link. I doubt the friends that I have that are aphasic will think much about working on tough language tasks first. Although if swearing is involved one guy will probably succeed.