"Like Having Family Nearby": An LLM-Powered Family-Resembling Avatar for offering Psychological Support and Training Guidance during Stroke Rehabilitatio

You still haven't figured out that EXACT 100% recovery protocols that obviate the need for psychological support? You're wasting research dollars better spent on recovery protocols!

You create EXACT 100% recovery protocols, and your survivor will be motivated to do the millions of reps needed because they are looking forward to 100% recovery.

 "Like Having Family Nearby": An LLM-Powered Family-Resembling Avatar for offering Psychological Support and Training Guidance during Stroke Rehabilitation

Peixuan Xiong Computational Media and Arts Thrust The Hong Kong University of Science and Technology (Guangzhou) Guangzhou, China pxiong843@connect.hkust-gz.edu.cn 

Zhenyu Wang Intelligent Transportation Thrust The Hong Kong University of Science and Technology (Guangzhou) Guangzhou, China zwang209@connect.hkust-gz.edu.cn Kaishun 

Wu Hong Kong University of Science and Technology (Guangzhou) Guangzhou, China wuks@hkust-gz.edu.cn Yuling Wang∗ 

Bingchen Guo The Hong Kong University of Science and Technology (Guangzhou) Guangzhou, China ucabbg1@ucl.ac.uk Xian Li School of Design Southern University of Science and Technology Shenzhen, Guangdong, China 12011010@mail.sustech.edu.cn 

Xian Li

School of Design

Southern University of Science and

Technology

Shenzhen, Guangdong, China

12011010@mail.sustech.edu.cn

Xian Li

The Sixth Affiliated Hospital, Sun

Yat-sen University

Guangzhou, China

sophielixian@163.com

Chao Liu The Hong Kong University of Science and Technology (Guangzhou) Guangzhou, China cliu009@connect.hkust-gz.edu.cn 

Nianci Zhao The Chinese University of Hongkong, Shenzhen Shenzhen, Guangdong, China niancizhao@link.cuhk.edu.cn 

Chen Gong The Sixth Affiliated Hospital, Sun Yat-sen University Sun Yat-sen University Guangzhou, Guangdong, China gongch33@mail.sysu.edu.cn The Hong Kong University of Science The Sixth Affiliated Hospital, Sun Yat-sen University Guangzhou, China 

Yuling Wang∗

Bingchen Guo

The Hong Kong University of Science

and Technology (Guangzhou)

Guangzhou, China

ucabbg1@ucl.ac.uk

wangyul@mail.sysu.edu.cn and Technology (Guangzhou) Guangzhou, China The Hong Kong University of Science and Technology Hong Kong, China 

Mingming Fan∗

Department of Rehabilitation

Medicine

and Technology (Guangzhou)

Guangzhou, China

The Hong Kong University of Science

and Technology

Hong Kong, China

mingmingfan@ust.hk

Figure 1: Personalized companion–coach system: (A) Avatar enrollment. Assembling a family-member avatar by reconstructing head avatars from a single photo and voice cloning from voice recording. (B)Runtime. The patient converses with the avatar. The avatar uses Gemini for dialogue and uses Qwen3-VL for action understanding. The avatar can simultaneously serve as a conversational companion and provide rehabilitation training guidance. 

Abstract 

Stroke rehabilitation is prolonged and emotionally demanding, yet family members cannot provide continuous companionship or coaching. We explore a family-resembling avatar that offers psy chological support and training guidance when relatives cannot be present. We conducted an empirical user study with six stroke patients and their family members (N=12). Our qualitative find ings suggest such companions may reduce loneliness and increase perceived warmth, while action-relevant guidance can comple mentcaregivers’ limited rehabilitation knowledge. Participants also raised concerns about emotional dependence, privacy, and the need for stronger clinical alignment to avoid inappropriate guidance. We discuss implications for designing family-resembling companion coach avatars with clear boundaries, privacy-preserving personal ization, and supervised deployment in rehabilitation workflows.

Prourokinase vs Standard Care for Patients With Mild Ischemic Stroke

 Safety concerns could easily be eliminated by this. No definition of mild stroke so bad research.

You wouldn't have to worry about hemorrhages if you vastly reduced the bolus by delivering it via magnetic nanoparticles. Or are you FUCKING INCOMPETENT in not knowing about that?

We should have been using magnetic nanoparticles to deliver tPA for years. Then you wouldn't have to waste money on research like this.

Maybe this solution from March, 2015

Magnetic nanoparticles could stop blood clot-caused strokes

Or this from May, 2012

Future of med devices: Nanorobots in your blood stream 

Send me hate mail on this: oc1dean@gmail.com. I'll print your complete statement with your name and my response in my blog. Or are you afraid to engage with my stroke-addled mind? No excuses are allowed! You're medically trained; it should be simple to precisely refute all my points with NO EXCUSES!! And what is your definition of competence in stroke? Swearing at me is allowed, I'll return the favor. Don't even attempt to use that brain research is hard.

The latest here:

Prourokinase vs Standard Care for Patients With Mild Ischemic Stroke

The PUMICE Randomized Clinical Trial

Yunyun Xiong, MD, PhD^1,2; Xia Meng, MD, PhD^1,2; Aoming Jin, MD, PhD²; et al Bruce C. V. Campbell, MBBS, PhD³; Anding Xu, MD, PhD⁴; Qiang Dong, MD, PhD⁵; Yun Xu, MD, PhD⁶; Yuesong Pan, PhD²; Yong Jiang, PhD²; Siying Niu, MD²; Zhiliang Li, MD⁷; Xianbo Zhuang, MD⁸; Na Guo, MD⁹; Zhimei Yuan, MD¹⁰; Zhenyu Kong, MD¹¹; Lixia Zong, MD, PhD¹; Chunmiao Duan, MD, PhD²; Zhixin Cao, MD¹; Liyuan Wang, MD¹; Manjun Hao, MD¹; Shuangzhe Wu, MD¹; Xueyan Feng, MD, PhD¹; Hao Li, PhD²; Na Wu, MD¹; Zixiao Li, MD, PhD^1,2; Xingquan Zhao, MD, PhD¹; Yongjun Wang, MD^1,2,12,13; for the PUMICE Investigators

Author Affiliations

JAMA Neurol. Published online January 21, 2025. doi:10.1001/jamaneurol.2024.4688

Abstract

Full Text

Key Points

Question  Does intravenous prourokinase benefit patients with ischemic stroke presenting with minor neurologic deficits?

Findings  In this randomized clinical trial that included 1446 patients with acute ischemic stroke, there was no significant difference in excellent functional outcome at 90 days between those treated with prourokinase vs standard care.

Meaning  Results demonstrate that prourokinase was not superior to standard care for the treatment of patients with mild ischemic stroke within 4.5 hours after symptom onset.

Abstract

Importance  Trials have not demonstrated superiority of alteplase or tenecteplase vs standard care in patients with mild stroke and have raised safety concerns. Prourokinase is an alternative fibrinolytic that may have a favorable safety profile, and the benefit-risk profile of prourokinase in mild stroke is unknown.

Objective  To investigate the efficacy and safety of prourokinase in mild ischemic stroke within 4.5 hours of symptom onset.

Design, Setting, and Participants  This was a multicenter, prospective, open-label, blinded–end point randomized clinical trial conducted from November 2022 through December 2023 with 3 months of follow-up. The trial was conducted at 89 hospitals in China. Patients with a baseline National Institutes of Health Stroke Scale score of 5 or less (scores range from 0-42, with higher scores indicating more severe neurological deficit) within 4.5 hours from the time the patient was last known to be well. Patients with intention to proceed to endovascular treatment were excluded.

Interventions  Eligible patients were randomly assigned in a 1:1 ratio to receive prourokinase, 35 mg (15-mg bolus + 20-mg infusion over 30 minutes) or standard care, including antiplatelet or anticoagulant therapy, at the discretion of local investigators.

Main Outcomes and Measures  The primary outcome was modified Rankin Scale score of 0 or 1 (range, 0-6, with higher scores indicating greater disability) at day 90. Safety outcomes were symptomatic intracranial hemorrhage and death.

Results  Of 3836 patients who underwent screening, 1446 (37.7%) were enrolled in the trial. Median (IQR) age was 65.9 (57.7-72.7) years, and 948 were male (65.5%). A total of 723 patients were assigned to prourokinase and 723 to standard care. The primary outcome occurred in 639 patients (88.5%) in the prourokinase group and 658 (91.0%) in the standard care group (relative risk, 0.97; 95% CI, 0.94-1.01; 2-sided P = .12). Symptomatic intracranial hemorrhage was 0.7% (5 of 723 patients) with prourokinase and 0% with standard care, and mortality at 90 days was 2.3% and 1.4%, respectively.

Conclusions and Relevance  Results of this randomized clinical trial demonstrate that prourokinase was not superior to standard care to improve the functional outcomes for patients with mild ischemic stroke within 4.5 hours after symptom onset but had a similar safety profile.

Trial Registration  ClinicalTrials.gov Identifier: NCT05507645

Full Text

Safe Implementation of Treatments in Stroke: a study on intravenous thrombolysis in patients over 80 years of age with acute ischaemic stroke.

You wouldn't have to worry about hemorrhages if you vastly reduced the bolus by delivering it via magnetic nanoparticles. Or are you FUCKING INCOMPETENT in not knowing about that?

We should have been using magnetic nanoparticles to deliver tPA for years. Then you wouldn't have to waste money on research like this.

Maybe this solution from March, 2015

Magnetic nanoparticles could stop blood clot-caused strokes

Or this from May, 2012

Future of med devices: Nanorobots in your blood stream 

Send me hate mail on this: oc1dean@gmail.com. I'll print your complete statement with your name and my response in my blog. Or are you afraid to engage with my stroke-addled mind? No excuses are allowed! You're medically trained; it should be simple to precisely refute all my points with NO EXCUSES!! And what is your definition of competence in stroke? Swearing at me is allowed, I'll return the favor. Don't even attempt to use that brain research is hard

Thelatest here:

Safe Implementation of Treatments in Stroke: a study on intravenous thrombolysis in patients over 80 years of age with acute ischaemic stroke.

Marius Matusevicius, Ana Paiva Nunes, Manju Krishnan, Jose Egido

BMJ Open. 2025 Jan 11; 15(1): e087454

OBJECTIVES

To investigate the safety and efficacy outcomes of intravenous thrombolysis (IVT) in patients aged >80 years with acute ischaemic stroke (AIS) after IVT was approved in this patient population in several European and non-European countries during 2018-2019.

DESIGN

This is an observational registry study using prospectively collected data from the Safe Implementation of Treatment in Stroke (SITS) registry. Comparisons will be performed between patients treated post-approval (July 2018 to December 2021) period with those treated pre-approval (June 2015 to June 2018) period using propensity score matching (PSM).

SETTING

This is a multicentre international study in hospitals treating AIS with IVT.

PARTICIPANTS

Patients aged >80 years who otherwise followed the IVT Summary of Product Characteristics of European countries as part of the mutual recognition procedure.

PRIMARY AND SECONDARY OUTCOMES

The main outcomes were symptomatic intracerebral haemorrhage per SITS monitoring study definition, death and functional independency as defined by a modified Rankin Scale score of 0-2 at 90 days.

RESULTS

After PSM, 614 patients remained in each group (mean age 87 years, 39% males). All baseline data were well balanced after PSM. There were no statistically significant differences in outcomes between pre- and post-approval patients for SICH (2.5% vs 2.3%, risk ratio (RR) 1.064, 95% CI 0.345-1.784), death (25.3% vs 28.4%, RR 0.889, 0.699-1.08) and functional independency at 90 days (40.3% vs 37%, RR 1.089, 0.942-1.237).

CONCLUSIONS

In this observational study of IVT treatment in patients >80 years of age with AIS before and after formal approval for this treatment, we did not find any difference in outcomes between the pre- and post-approval periods.

Source: BMJ open

Dementia risk may nearly triple in first year after a stroke

 And why was this research done when all this preceding research proved dementia risk is higher post stroke? Waste of time and money.

Your chances of getting dementia.

1. A documented 33% dementia chance post-stroke from an Australian study?   May 2012.

2. Then this study came out and seems to have a range from 17-66%. December 2013.`    

3. A 20% chance in this research.   July 2013.

4. Dementia Risk Doubled in Patients Following Stroke September 2018

The latest here:

Dementia risk may nearly triple in first year after a stroke

By American Heart Association News

(Rudzhan Nagiev/iStock via Getty Images)

Having a stroke may triple a person's risk for developing dementia within the following year, new research finds.

And while that risk begins to drop after the first 12 months, it remains elevated for up to 20 years, according to findings to be presented next week at the American Stroke Association's International Stroke Conference in Phoenix. The research is considered preliminary until full results are published in a peer-reviewed journal.

"Our findings show that stroke survivors are uniquely susceptible to dementia," lead researcher Dr. Raed Joundi said in a news release. Joundi is an assistant professor at McMaster University in Hamilton, Ontario, Canada, and an investigator at the Population Health Research Institute, a joint institute of McMaster University and Hamilton Health Sciences.

Roughly 610,000 people experience a first stroke each year, while 185,000 more have recurrent strokes, according to the American Heart Association. The Centers for Disease Control and Prevention estimates roughly 7 million people 65 and older in the U.S. had dementia in 2014, which could increase to nearly 14 million by 2060.

To determine post-stroke dementia risk, researchers analyzed data from hospital admissions, emergency department visits and pharmacies prescribing medications for dementia across Ontario. They identified 180,940 people who recently had either an ischemic stroke, caused by a blood clot, or one caused by bleeding in the brain, called an intracerebral hemorrhage. They matched the survivors to two control groups – people in the general population who had neither a heart attack nor a stroke, and those who had had a heart attack but not a stroke. They tracked new cases of dementia in all groups for up to 20 years.

Over an average follow-up of almost six years, nearly 19% of people who had strokes developed dementia. Compared to the general population, dementia risk was 80% higher among those who had a stroke, with the risk jumping to nearly 150% higher in those who had a bleeding stroke. Risk was nearly 80% higher in stroke survivors compared to heart attack survivors.

The risk of developing dementia was highest in the year immediately following a stroke. During the first 12 months, stroke survivors faced a nearly threefold increased risk for dementia, compared to their peers who did not have strokes. By five years after the stroke, that risk dropped to 1.5 times. The risk continued to decline over 20 years of follow-up but remained higher for people who had strokes than for those who had not.

The study showed people who had strokes faced a higher risk for dementia than they did for a subsequent stroke, Joudi said.

"Stroke injures the brain, including areas critical for cognitive function, which can impact day-to-day functioning," he said. "Some people go on to have a recurrent stroke, which increases the risk of dementia even further, and others may experience a progressive cognitive decline similar to a neurodegenerative condition."

A 2023 report from the AHA encourages screening stroke survivors for signs of cognitive decline and collaborative care from an interdisciplinary team to provide support to those who show the signs.

Joundi said the study shows there is a large burden of post-stroke dementia in Canada and called for more research to clarify why some stroke survivors develop dementia and others do not.

The findings, he said, "reinforce the importance of monitoring people with stroke for cognitive decline, instituting appropriate treatments to address vascular risk factors and prevent recurrent stroke, and encouraging lifestyle changes, such as smoking cessation and increased physical activity, which have many benefits and may reduce the risk of dementia."

Allogeneic Stem Cell Therapy for Acute Ischemic Stroke

But why go thru all the trouble of stem cells if exosomes are the reason for the benefits? Which must be why no one seems to be monitoring stem cell survival.

Application of stem cell-derived exosomes in ischemic diseases: opportunity and limitations

The latest here:

Allogeneic Stem Cell Therapy for Acute Ischemic Stroke

The Phase 2/3 TREASURE Randomized Clinical Trial

Kiyohiro Houkin, MD¹; Toshiya Osanai, MD²; Shinichiro Uchiyama, MD^3,4; et al Kazuo Minematsu, MD⁵; Akihiko Taguchi, MD⁶; Katsuhiko Maruichi, MD⁷; Yoshimasa Niiya, MD⁸; Katsuyuki Asaoka, MD⁹; Yoshihiro Kuga, MD¹⁰; Katsumi Takizawa, MD¹¹; Koichi Haraguchi, MD¹²; Shinichi Yoshimura, MD¹³; Kazumi Kimura, MD¹⁴; Koji Tokunaga, MD¹⁵; Atsuo Aoyama, MD¹⁶; Fusao Ikawa, MD¹⁷; Chikanori Inenaga, MD¹⁸; Tatsuya Abe, MD¹⁹; Atsushi Tominaga, MD²⁰; Shinichi Takahashi, MD²¹; Kohsuke Kudo, MD²²; Miki Fujimura, MD²; Taku Sugiyama, MD²; Masaki Ito, MD²; Masahito Kawabori, MD²; David C. Hess, MD²³; Sean I. Savitz, MD²⁴; Teruyuki Hirano, MD²⁵; for the TREASURE Study Investigators

Author Affiliations Article Information

JAMA Neurol. Published online January 16, 2024. doi:10.1001/jamaneurol.2023.5200

Key Points

Question  Is intravenous allogeneic multipotent adult progenitor cell (MultiStem) therapy safe and effective for patients with acute ischemic stroke?

Findings  In this randomized clinical trial with 206 participants, intravenous administration of MultiStem therapy within 18 to 36 hours of ischemic stroke onset was safe but did not improve short-term outcomes at 90 days compared with placebo. There were no grade 3 or 4 allergic reactions, including in older patients.

Meaning  The results of this study support the safety of MultiStem, but further research is needed to determine whether MultiStem therapy for ischemic stroke has a beneficial effect in patients who meet specific criteria.

Abstract

Importance  Cell therapy is a promising(Really? I just see a waste of money and time!) treatment approach for stroke and other diseases. However, it is unknown whether MultiStem (HLCM051), a bone marrow–derived, allogeneic, multipotent adult progenitor cell product, has the potential to treat ischemic stroke.

Objective  To assess the efficacy and safety of MultiStem when administered within 18 to 36 hours of ischemic stroke onset.

Design, Setting, and Participants  The Treatment Evaluation of Acute Stroke Using Regenerative Cells (TREASURE) multicenter, double-blind, parallel-group, placebo-controlled phase 2/3 randomized clinical trial was conducted at 44 academic and clinical centers in Japan between November 15, 2017, and March 29, 2022. Inclusion criteria were age 20 years or older, presence of acute ischemic stroke (National Institutes of Health Stroke Scale [NIHSS] score of 8-20 at baseline), confirmed acute infarction involving the cerebral cortex and measuring more than 2 cm on the major axis (determined with diffusion-weighted magnetic resonance imaging), and a modified Rankin Scale (mRS) score of 0 or 1 before stroke onset. Data analysis was performed between May 9 and August 15, 2022.

Exposure  Patients were randomly assigned to either intravenous MultiStem in 1 single unit of 1.2 billion cells or intravenous placebo within 18 to 36 hours of ischemic stroke onset.

Main Outcomes and Measures  The primary end points were safety and excellent outcome at day 90, measured as a composite of a modified Rankin Scale (mRS) score of 1 or less, a NIHSS score of 1 or less, and a Barthel index score of 95 or greater. The secondary end points were excellent outcome at day 365, mRS score distribution at days 90 and 365, and mRS score of 0 to 1 and 0 to 2 at day 90. Statistical analysis of efficacy was performed using the Cochran-Mantel-Haenszel test.

Results  This study included 206 patients (104 received MultiStem and 102 received placebo). Their mean age was 76.5 (range, 35-95) years, and more than half of patients were men (112 [54.4%]). There were no between-group differences in primary and secondary end points. The proportion of excellent outcomes at day 90 did not differ significantly between the MultiStem and placebo groups (12 [11.5%] vs 10 [9.8%], P = .90; adjusted risk difference, 0.5% [95% CI, −7.3% to 8.3%]). The frequency of adverse events was similar between treatment groups.

Conclusions and Relevance  In this randomized clinical trial, intravenous administration of allogeneic cell therapy within 18 to 36 hours of ischemic stroke onset was safe but did not improve short-term outcomes. Further research is needed to determine whether MultiStem therapy for ischemic stroke has a beneficial effect in patients who meet specific criteria, as indicated by the exploratory analyses in this study.

Trial Registration  ClinicalTrials.gov Identifier: NCT02961504

UK Stroke Forum 2023

You can check all you want, but NOTHING on 100% recovery or stroke protocols! So a complete waste of time and money! Almost as if stroke survivors have nothing to do with this stroke forum, no survivor speakers.

UK Stroke Forum 2023

Join us in Birmingham for the 18th edition of the UK Stroke Forum conference, hosted at ICC Birmingham from 4 to 6 December 2023.

The UK Stroke Forum 2023 At-a-glance programme is now available to view online. Timings and rooms are subject to change. A more comprehensive programme will be added once speaker presentations are finalised.

We look forward to welcoming you to ICC Birmingham later this year.

You can view the schedule for each day individually by clicking the below links.

Day 1

Day 2

ePoster session 1

ePoster session 2

Day 3

$20 million awarded to lead next century of heart disease and stroke scientific research

WHAT A FUCKING WASTE! Nothing on a strategy to get to 100% recovery!  Until we get survivors in charge, stroke recovery will never be a priority!

$20 million awarded to lead next century of heart disease and stroke scientific research

The American Heart Association’s Second Century of Science initiative will support more than 100 scientific researchers in their work to find new ways to fight the world’s leading causes of death

DALLAS, July 21, 2023 — More than 100 scientists from across the U.S. are receiving special grants to support their research work in finding innovative solutions to fight heart disease and stroke. The grants, totaling $20 million, are part of the Second Century of Science Initiative of the American Heart Association, the world’s leading voluntary organization dedicated to a world of longer, healthier lives. The financial awards are announced as the Association, the largest non-government supporter of heart and brain health research in the U.S., prepares to celebrate its 100^th anniversary in 2024 and will be funded for a three-year period from July 1, 2023 through June 30, 2026.

“When the American Heart Association was founded in 1924, heart disease was considered a death sentence and we knew even less about stroke and other types of cardiovascular diseases. It has only been through the dedication and passion of the thousands of scientific explorers who have come before us that we have learned so much about how to diagnose, treat and even prevent most of these conditions,” said Joseph C. Wu, M.D., Ph.D., FAHA, American Heart Association volunteer president, who is the director of the Stanford Cardiovascular Institute and the Simon H. Stertzer, M.D., Professor of Medicine & Radiology at the Stanford University School of Medicine. “Yet too many lives are still lost as these continue to be the leading causes of death around the world. Even with all the knowledge we have there are gaps, particularly in ensuring health and the delivery of health care for people in diverse and underrepresented populations. That is why research projects like the Second Century of Science Initiative are so important for our future.”

A total of 111 separate grants have been awarded in three different categories:

• AHA’s Second Century Implementation Science Award – 19 early- and mid-career investigators will each receive a total of $400,000 to further their research into groundbreaking strategies that can be implemented into clinical and community settings to ultimately improve the health of individuals and populations. These research projects may address policies, programs or individual clinical practice, with unique strategies to address critical barriers to or gaps in ensuring the health and well-being of all people.
• AHA’s Second Century Early Faculty Independence Award – 33 investigators in the early years of their first professional medical/research academic appointment will each receive a total of $300,000 for research focused on critical, emerging priorities of the next century. Those areas may include technology-driven health care and diagnostics (i.e., artificial intelligence/machine learning approaches, telemedicine, biosensors and wearables); novel and emerging therapeutics (i.e., genome editing therapies, regenerative therapies and bioengineered foods); environmental impacts on health (i.e., direct and indirect effects); and research and solutions for issues affecting aging populations and the shrinking health care workforce. Awardees will also have opportunities to serve on scientific and research councils and committees of the American Heart Association and engage with the Association’s scientific leadership for mentorship connections.
• Clinical Fellow Research Education Program – Directors of 59 accredited cardiology and neurology fellowship programs will receive funding to support training and mentoring opportunities for clinical fellows enrolled in their programs. A fellow is a medical doctor or a doctoral-level health professional who has completed their degree and general residency program and is now training or conducting research in a health specialty. The funding will allow up to five fellows per year from each program to attend the American Heart Association Scientific Sessions or the American Heart Association/American Stroke Association International Stroke Conference, as well engage in as other medical specialty events and activities that will help them gain knowledge and expertise as research scientists.

“Research has been the foundation of the American Heart Association from the beginning, and we recognize that scientific research continues to be our most critical path forward to ensuring longer, healthier lives for all,” said Mariell Jessup, M.D., FAHA, chief science and medical officer of the Association. “As we embark on our next century of lifesaving work, we are excited to support bold, innovative investigators like those leading this new initiative, to meet the challenges of today and of the future.”

The American Heart Association has funded more than $5 billion in cardiovascular, cerebrovascular and brain health research since 1949, making it the single largest non-government supporter of heart and brain health research in the U.S. New knowledge resulting from this funding benefits millions of lives in every corner of the U.S. and around the world.

Virtual reality and serious game therapy for post-stroke individuals: A preliminary study with humanized rehabilitation approach protocol humanized rehabilitation approach

 If you want to humanize your stroke therapy you'll create 100% recovery protocols.  Since you're not even attempting 100% recovery, you're just wasting time and money.

Virtual reality and serious game therapy for post-stroke individuals: A preliminary study with humanized rehabilitation approach protocol humanized rehabilitation approach

Author links open overlay panelIsabela AlvesMarques^af

Camille MarquesAlves^afAndressa RastreloRezende^aLuanne CardosoMendes^efThiago Sá dePaiva^aGabriel FernandesCyrino^bJúlia Tannús deSouza^bMarco Aurélio MaiaSilva^cLuciane Aparecida Pascucci Sande deSouza^dEduardo Lázaro MartinsNaves^a

https://doi.org/10.1016/j.ctcp.2022.101681Get rights and content

Abstract

Objective

The current study proposed the development and preliminary validation of a humanized training approach for upper limb rehabilitation of chronic post-stroke individuals, using serious game (SG) and virtual reality (VR) technologies.

Materials and methods

Ten individuals with chronic stroke participated in the study. Accompanied by a health professional, 15 sessions of the SG were performed in a laboratory, in a humanized way, lasting between 30 and 45 min each. The assessments were made pre- and post-intervention with the SG, and the following parameters were evaluated (considering the elbow joint): Modified Ashworth Scale (MAS), range of movement (ROM) and tonic stretch reflex threshold (TSRT). Global measures such as quality of life (QOL) were also assessed by the Stroke-Specific Quality of Life Scale (SSQL), Brunnstrom Recovery Scale (BRS) and General Health Questionnaire (GHQ-28). The following tests were applied to verify statistically significant differences: Shapiro-Wilk test, t-test, and Wilcoxon-Mann-Whitney test.

Results

The parameters ROM, TSRT, BRS, and SSQL showed statistically significant differences between pre- and post-intervention (p < 0.01). The ROM increase was about 8%. The objective evaluation of spasticity (provided by the TRST) showed an increase of 28% over the average pre- and post-intervention values. Three participants showed decreased resistance to passive stretching according to the results of the MAS, and seven participants moved to the next stage of the BRS. For QOL, the scores indicated around 20% of post-intervention improvement.

Conclusion

The intervention had no adverse effects, showed a high degree of compliance, provided increased ROM, improved QOL, reduced spasticity and allowed these individuals the opportunity to test a promising technology for upper limb rehabilitation with emphasis in humanized aspects of therapy.

Introduction

Approximately 16 million individuals worldwide are victims to stroke every year, making this condition one of the leading causes of mortality and disability [1]. It is estimated that 80% of people affected by stroke do not regain proper arm function even six months after the event [2,3]. This condition limits or prohibits the performance of several activities of daily living, such as eating, getting dressed, taking care of personal hygiene, among others, negatively impacting the quality of life [4].

Several studies have reported the difficulty of rehabilitating the motor function of the upper limbs (UL), especially for those individuals in chronic phase. For those individuals, spontaneous neuroplasticity has almost disappeared, leading to the necessity of constant rehabilitation activities with adequate intensity and volume of practice, variety, specificity, motivation and biofeedback [5]. Due to the monotony of traditional methods and slow improvement in patients' conditions, some of these individuals end up stopping the rehabilitation process altogether or are discharged from treatment in hospitals and rehabilitation clinics when the therapeutic possibilities are exhausted and the chances of functional recovery are diminished [2,6].

In this context, the implementation of technologies such as serious games (SG) and virtual reality (VR) provide an alternative strategy for the treatment of UL of people with chronic post-stroke conditions. Studies have shown that therapy using such technologies can contribute significantly in maintaining quality of life (QOL) and enable neurological rehabilitation in these individuals. These methods also provide greater engagement and efficiency in rehabilitation treatments [7,8], with proven clinical benefits [9].

In order to propose more efficient ways of interaction with SG and VR, researchers have been trying to underline important characteristics that contribute to the increase of engagement of individuals in therapy, increasing the chances of success of the rehabilitation program [10]. A humanized approach can reduce the barriers to seek help and reduce the suffering of the patient and his family from the first contact with the team [11]. However, the focus of each of those studies is generally restricted to aspects related to the construction and development of the SG such as visuals, music and goals ¹¹. The implementation of technological devices and the automation of healthcare services can bring an aspect of dehumanization to the relationship between the health professional and the patient, making it extremely necessary to propose a humanized approach, in which the health professional is able to make the patient feel truly well and welcome [12].

No studies were found that focused on evaluating whether the presence, support and adoption of a humanized treatment for the health professional towards patients positively influenced the clinical outcomes of a SG and VR therapy. Therefore, this study proposed a preliminary humanized approach protocol of application and interaction with the SG, incorporating actions by which the humanization of care can be understood and applied, aimed at individuals with chronic post-stroke. In addiction, the health professional was not only an adjuvant during the therapy sessions, but rather actively participated in creating a hospitable environment for the participants and provided social support through positive feedback and instructions on how to use the game. Motor aspects and global measures were registered in order to verify the impact of this intervention on the UL, and consequently in the QOL of chronic post-stroke individuals.

Reducing Abnormal Synergies of Forearm, Elbow, and Shoulder Joints in Stroke Patients with Neuro-rehabilitation Robot Treatment and Assessment

Quantifying something does nothing to help survivors recover.  Where is the protocol to fix these problems? No protocol, you just wasted time and money on this; you're fired!

Reducing Abnormal Synergies of Forearm, Elbow, and Shoulder Joints in Stroke Patients with Neuro-rehabilitation Robot Treatment and Assessment

 Pin-Cheng Kung 1
 Chou-Ching K. Lin 1,3
 Ming-Shaung Ju 1,2,*
 Shu-Min Chen 1,4
 
1  Medical Device Innovation Center, National Cheng Kung University, Tainan 701, Taiwan, ROC
2  Department of Mechanical Engineering, National Cheng Kung University, Tainan 701, Taiwan, ROC
3  Department of Neurology, National Cheng Kung University Hospital, Tainan 701, Taiwan, ROC
4  Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, Tainan 701, Taiwan, ROC
Received 10 Jul 2009; Accepted 8 Sep 2009;
 
doi: 10.5405/jmbe.894

Abstract

Chronic stroke patients are often unable to control their joint movements independently due to abnormal synergies. In our previous work, three robot-assisted therapy indices (two biomechanical indices and one electromyography assessment) were applied to quantify the abnormal synergies of upper limbs with the aid of a neurorehabilitation robot. In this study, these quantitative indices are employed to investigate the time course of abnormal synergies in the affected upper limbs of chronic stroke patients treated with the robot. Eight chronic stroke patients are recruited to perform rectilinear tracking movements in four directions (back-forth, two oblique movements at 45 degrees, and right-left) during robot-assisted treatments for 4 months and 4 months of follow-up. The robot-assisted therapy indices (variation of forearm pronation/supination torque, and co-activation of elbow and shoulder muscles) reveal a significant decrease of abnormal synergies after 4 months of robot-assisted treatment and a slight regression in the following 4 months. Significant recovery is found in motor outcomes evaluated using Brunnstrom stage and Fugl-Meyer assessments. Both the robot-assisted therapy indices and clinical scales indicate modifications in abnormal synergies. The rectilinear tracking movements along the contra-proximal to ipsidistal directions and the right-left directions are suitable for robot-assisted movement treatment for reducing abnormal synergies.

HCA Healthcare and the American Heart Association launch $15M national stroke initiative

You'll notice they are DOING NOTHING THAT SURVIVOR'S WANT, 100% RECOVERY.  

What a fucking waste of money.

HCA Healthcare and the American Heart Association launch $15M national stroke initiative

HCA Healthcare and HCA Healthcare Foundation have donated $15 million to the American Heart Association for its new national stroke initiative, Getting to the Heart of Stroke. The effort focuses on "preventing, treating and beating stroke by providing consumer and health care professional education nationwide, deepening collaboration between neurology and cardiology and equitably empowering communities about stroke risk to improve health outcomes." AHA staff and volunteer experts will work to educate 15 select communities across seven states on stroke risk factor awareness and more "through the lens of equitable health for all." (American Heart Association press release, 10/17; Taylor, Becker's Hospital Review, 10/18)

Vagus Nerve Stimulation Paired With Rehabilitation for Upper Limb Motor Impairment and Function After Chronic Ischemic Stroke: Subgroup Analysis of the Randomized, Blinded, Pivotal, VNS-REHAB Device Trial

Well you blithering idiots it has been proven to work a long time ago.  All your mentors and senior researchers had to do was to tell you to create a protocol on this and get it distributed to all 10 million yearly stroke survivors  now and into the future. And they completely failed at their job, thus wasting all this time and money.

• vagus nerve (59 posts to July 2012)

Vagus Nerve Stimulation Paired With Rehabilitation for Upper Limb Motor Impairment and Function After Chronic Ischemic Stroke: Subgroup Analysis of the Randomized, Blinded, Pivotal, VNS-REHAB Device Trial

Jesse Dawson, MD https://orcid.org/0000-0001-7532-2475 Jesse.dawson@glasgow.ac.uk, Navzer D. Engineer, PhD, […], Steven C. Cramer, MD https://orcid.org/0000-0002-6214-6211, Steven L. Wolf, PhD https://orcid.org/0000-0002-9446-8995, Rushna Ali, MD, Michael W. O’Dell, MD, David Pierce, MSEE, Cecília N. Prudente, PhD https://orcid.org/0000-0003-1296-8062, Jessica Redgrave, MD, Wuwei Feng, MD https://orcid.org/0000-0001-6230-4905, Charles Y. Liu, PhD, Gerard E. Francisco, MD, Benjamin L. Brown, MD, Anand Dixit, MD, Jen Alexander, MSc, Louis DeMark, DPT https://orcid.org/0000-0001-7998-0969, Vibor Krishna, MD, Steven A. Kautz, PhD https://orcid.org/0000-0003-3151-8235, Arshad Majid, MD, Brent Tarver, MSEE, Duncan L. Turner, PhD, and Teresa J. Kimberley, PhD https://orcid.org/0000-0001-6397-4054, +19 -19View all authors and affiliations

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https://doi.org/10.1177/15459683221129274

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Abstract

Background

Vagus Nerve Stimulation (VNS) paired with rehabilitation improved upper extremity impairment and function in a recent pivotal, randomized, triple-blind, sham-controlled trial in people with chronic arm weakness after stroke.

Objective

We aimed to determine whether treatment effects varied across candidate subgroups, such as younger age or less injury.

Methods

Participants were randomized to receive rehabilitation paired with active VNS or rehabilitation paired with sham stimulation (Control). The primary outcome was the change in impairment measured by the Fugl–Meyer Assessment Upper Extremity (FMA-UE) score on the first day after completion of 6-weeks in-clinic therapy. We explored the effect of VNS treatment by sex, age (≥62 years), time from stroke (>2 years), severity (baseline FMA-UE score >34), paretic side of body, country of enrollment (USA vs UK) and presence of cortical involvement of the index infarction. We assessed whether there was any interaction with treatment.

Findings

The primary outcome increased by 5.0 points (SD 4.4) in the VNS group and by 2.4 points (SD 3.8) in the Control group (P = .001, between group difference 2.6, 95% CI 1.03-4.2). The between group difference was similar across all subgroups and there were no significant treatment interactions. There was no important difference in rates of adverse events across subgroups.

Conclusion

The response was similar across subgroups examined. The findings suggest that the effects of paired VNS observed in the VNS-REHAB trial are likely to be consistent in wide range of stroke survivors with moderate to severe upper extremity impairment.

Introduction

Stroke is a leading cause of adult disability. Upper limb impairment and inability to effectively use the arm and hand for functional daily tasks are common and persists in approximately half of people who have upper limb impairment at onset.¹ These limitations have a detrimental impact on quality of life and improving upper limb impairment and function are a priority for stroke survivors.²

The use of vagus nerve stimulation (VNS) paired with rehabilitation to improve moderate to severe upper limb motor deficits associated with chronic ischemic stroke was recently approved the U.S. Food and Drug Administration. VNS augments task specific neuroplasticity by providing rapid cholinergic, noradrenergic, and serotonergic modulation.³ VNS paired with rehabilitation leads to greater recovery of forelimb function in rodent models than either motor training or VNS alone.^3,4 A combined analysis of data from 2 pilot feasibility trials of VNS paired with rehabilitation therapy^5,6 found an improvement in impairment following VNS in people with long-term arm weakness after ischemic stroke.⁷ In the recently published pivotal VNS-REHAB trial, there was a significant difference in change in Fugl–Meyer Assessment Upper Extremity (FMA-UE) score in favor of paired VNS following 6 weeks of in-clinic therapy.⁸ There was also a higher clinically important response rate, defined as a greater than 6-point improvement in the FMA-UE score, and improvements in functional measures with paired VNS at 90 days after completion of in-clinic therapy. However, participants did not have a uniform response to VNS, so identifying those with a higher chance of responding could optimize prescription of this therapy. Pooled analysis of data from both pilot trials did not find any clear relationship between baseline variables and change in FMA-UE score with VNS, although lower baseline Fugl–Meyer score was associated with greater improvement across both treatment groups.⁷ However, this analysis was based on a small sample size.

Here we perform a post-hoc subgroup analysis of data from the VNS-REHAB trial. We identified variables of interest based on known predictors of upper limb outcome. We examined whether the effect of paired VNS treatment differs by reported sex, age, time from stroke, severity of upper limb impairment, country of enrollment, paretic side, and whether there was cortical involvement of the index infarction.

 

More at link.

Safety and Efficacy of Remote Ischemic Conditioning Combined with Endovascular Thrombectomy for Acute Ischemic Stroke Due to Large Vessel Occlusion of Anterior Circulation: A Multicenter, Randomized, Parallel-Controlled Clinical Trial (SERIC-EVT): Study Protocol

 

And all this earlier research was not enough? So we had to waste more time and money better spent solving stroke problems?

• leg compressions (16 posts to September 2015)

  Remote ischemic conditioning (11 posts to July 2018)

   

• leg wraps (7 posts to May 2013)

   

   

  Leg wraps raise hopes of saved lives after strokes May 2013 

  
  

  Leg compressions may enhance stroke recovery August 2012

The latest here:

Safety and Efficacy of Remote Ischemic Conditioning Combined with Endovascular Thrombectomy for Acute Ischemic Stroke Due to Large Vessel Occlusion of Anterior Circulation: A Multicenter, Randomized, Parallel-Controlled Clinical Trial (SERIC-EVT): Study Protocol

Show all authors

Zhen-Ni Guo#, Reziya Abuduxukuer#, Peng Zhang, ...

First Published August 15, 2022 Research Article 

https://doi.org/10.1177/17474930221121429

Article information

Abstract

Rationale/Aim: 

Many patients undergoing successful recanalization after endovascular thrombectomy (EVT) do not have a good outcome; additional neuroprotection might benefit this group. Remote ischemic conditioning (RIC) stimulates endogenous protective mechanisms and may have a neuroprotective in acute brain ischemia. The SERIC-EVT trial is investigating the safety and efficacy of RIC for patients with acute ischemic stroke who underwent EVT due to large vessel occlusion of the anterior circulation.

Methods: S

ERIC-EVT is a multicenter, randomized, parallel-controlled, and blinded endpoint clinical trial. Patients are recruited from 10 hospitals in Jilin Province, Northeast China. Patients with anterior circulation acute ischemic stroke undergoing EVT due to large-vessel occlusion are randomized in a 1:1 ratio to RIC or sham-RIC. Participants will receive standard medical treatment and an inflation pressure of 200 mmHg (RIC group) or 60 mmHg (sham-RIC group) twice daily for seven consecutive days.

Study outcomes: 

The primary outcome is the proportion of patients with mRS score of 0–2 on day 90. Secondary outcome measures include the National Institute of Health Stroke Scale, Barthel Index, and mRS scores obtained at 24 h, 7 days, 30±3 days, and 90±3 days post-EVT, recanalization rate, expanded Thrombolysis in Cerebral Infarction score, and symptomatic intracranial hemorrhage post-EVT. Mortality and all adverse events, including skin changes and pain scores, within the first 90 days will be used as safety outcome measures.

Sample size estimates:  

Based on previous studies, we estimate a 14% difference in functional independence (the modified Rankin Score [mRS]≤2) between RIC and sham-RIC groups. Considering a significance level of 5% and power of 80%, and one-fifth of patients lost to follow-up, the planned sample size is 498 patients (249 per group).

Discussion: RIC might be a strategy that improves 3-month clinical outcomes in AIS patients who have undergone EVT due to large vessel occlusion of anterior circulation. SERIC-EVT will determine whether this is the case.

Clinical Trial Registration: Clinicaltrials.gov, identifier: NCT04977869.

Keywords

Remote ischemic conditioning, acute ischemic stroke, endovascular thrombectomy, anterior circulation occlusion, large-vessel occlusion, Acute stroke therapy

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