Supersmall lab-on-a-chip is superfast

This really seems like some excellent technology to prove what type of stroke you had. And if we are going to continue down the tPA route then we had better get a faster, less technology intensive and less education needed way of determining the type of stroke you had.
http://www.sciencenews.org/view/generic/id/343100/title/Supersmall_lab-on-a-chip_is_superfast
Looking for a specific protein in a drop of blood is like trying to find a notorious white whale on the seven seas — it takes some time. But a new device quickly filters the ocean of molecules in a blood sample, capturing proteins that may warn of an impending heart attack or out-of-whack insulin levels. Besides detecting potential emergencies, such devices could minimize the fraught days a patient spends waiting for lab results, providing them in mere minutes.
http://www.genomeweb.com//node/1119771?hq_e=el&
Researchers from Tel Aviv University in Israel have developed a nanowire-based device to separate and analyze protein biomarkers in blood samples. As they report in Nano Letters, the filtering, separation, and analysis all occurs on a single chip — and rapidly. The chip, adds ScienceNews, is made of two compartments, one that is full of a "forest" of densely packed nanowires coated with protein-specific antibodies and one that contains flat nanowires, also coated with antibodies, that are connected to electrodes. The researchers tested their device on its ability to detect troponin T, which it was able to do sensitively and in less than 10 minutes. "It's clever," Yale University's Tarek Fahmy tells ScienceNews. "They are doing separation and concentration on the same chip." 
http://pubs.acs.org/doi/abs/10.1021/nl3021889
Importantly, this is the first demonstration of an all-NWs device for the whole direct analysis of blood samples on a single chip, able to selectively collect and separate specific low abundant proteins, while easily removing unwanted blood components (proteins, cells) and achieving desalting effects, without the requirement of time-consuming centrifugation steps, the use of desalting or affinity columns.

Interactive cueing with walk-Mate for Hemiparetic Stroke Rehabilitation

This might be the walk-mate;
http://www.youtube.com/watch?v=gogzSan8EdQ

http://www.jneuroengrehab.com/content/9/1/58/abstract

Abstract (provisional)

Background

Many techniques that compensate for locomotion problems in daily life using externally controlled stimulation have recently been reported. These techniques are beneficial for effortlessly supporting patients' locomotive functions, but the users of such devices must necessarily remain dependent on them. It is possible that some individuals with gait impairment may be prevented recovering locomotive function. From a rehabilitation viewpoint, it may therefore be supposed that ideally, devices that can be used in daily life to improve the locomotive functions of the body itself should be proposed.

Methods

We evaluate the effectiveness of Walk-Mate, which has been used mainly as a gait compensation device, as a gait rehabilitation training device by analyzing improvement in locomotion before, during and after rehabilitation in hemiparetic patients and comparing it with a previous gait training method. Walk-Mate generates a model walking rhythm in response to a user's locomotion in real time, and by indicating this rhythm using auditory stimuli, provides a technology that supports walking by reducing asymmetries and fluctuations in foot contact rhythm. If patients can use the system to learn a regulated walking rhythm, then it may also be expected to fulfil the functions of a gait rehabilitation training device for daily life.

Results

With regard to asymmetry, significantly improvements were seen for compensatory movement during training using Walk-Mate, but improvements were not retained as rehabilitative results. Regarding fluctuations in the foot contact period, significant improvement was observed for compensatory movement during training and these significant improvements were retained as rehabilitative results. In addition, it became clear that such improvement could not be adequately obtained by the previously proposed training technique utilizing constant rhythmic auditory stimulation.

Conclusions

Walk-Mate effectively compensated for locomotion problems of hemiparetic patients by improving gait rhythm both during and after training, suggesting that locomotive function can be effectively recovered in some patients. The interactive mechanism of Walk-Mate may be capable of simultaneously achieving the aims of gait compensation and gait rehabilitation training methods previously developed under individual frameworks. Walk-Mate is a promising technology for assisting the reintegration of disabled persons into society.

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

ISway: a sensitive, valid and reliable measure of postural control

And with objective measurements our therapists could easily conduct research programs and maybe find out what works best. Ask your therapist and doctor for when they are going to start using this.
http://www.jneuroengrehab.com/content/9/1/59/abstract

Abstract (provisional)

Background

Clinicians need a practical, objective test of postural control that is sensitive to mild neurological disease, shows experimental and clinical validity, and has good test-retest reliability. We developed an instrumented test of postural sway (ISway) using a body-worn accelerometer to offer an objective and practical measure of postural control.

Methods

We conducted two separate studies with two groups of subjects. Study I: sensitivity and experimental concurrent validity. Thirteen subjects with early, untreated Parkinson's disease (PD) and 12 age-matched control subjects (CTR) were tested in the laboratory, to compare sway from force-plate COP and inertial sensors. Study II: test-retest reliability and clinical concurrent validity. A different set of 17 early-to-moderate, treated PD (tested ON medication), and 17 age-matched CTR subjects were tested in the clinic to compare clinical balance tests with sway from inertial sensors. For reliability, the sensor was removed, subjects rested for 30 min, and the protocol was repeated. Thirteen sway measures (7 time-domain, 5 frequency-domain measures, and JERK) were computed from the 2D time series acceleration (ACC) data to determine the best metrics for a clinical balance test.

Results

Both center of pressure (COP) and ACC measures differentiated sway between CTR and untreated PD. JERK and time-domain measures showed the best test-retest reliability (JERK ICC was 0.86 in PD and 0.87 in CTR; time-domain measures ICC ranged from 0.55 to 0.84 in PD and from 0.60 to 0.89 in CTR). JERK, all but one time-domain measure, and one frequency measure were significantly correlated with the clinical postural stability score (r ranged from 0.50 to 0.63, 0.01 < p < 0.05).

Conclusions

Based on these results, we recommend a subset of the most sensitive, reliable, and valid ISway measures to characterize posture control in PD: 1) JERK, 2) RMS amplitude and mean velocity from the time-domain measures, and 3) centroidal frequency as the best frequency measure, as valid and reliable measures of balance control from ISway.

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

Trial Will Test Methotrexate for MI, Stroke Prevention

If you're interested you'll have to go to the link in the second paragraph.
 http://www.medpagetoday.com/Cardiology/Prevention/34349
The possibility that the immunosuppressant drug methotrexate can prevent major cardiovascular events will be tested in a 7,000-patient randomized trial funded by the federal government.
Called the Cardiovascular Inflammation Reduction Trial (CIRT), the 4-year secondary prevention study is sponsored by the National Heart, Lung, and Blood Institute (NHLBI) and will be led by Paul Ridker, MD, of Brigham and Women's Hospital and Harvard Medical School in Boston, as principal investigator.

Can nasal spray help prevent military suicides?

So get our stroke researchers looking into this also since a good chunk of survivors are depressed. Our stroke associations should have statistics on survivor suicides.
http://news.blogs.cnn.com/2012/08/20/can-nasal-spray-help-prevent-military-suicides/?on.cnn=1
The Army counted 38 confirmed or suspected suicides in July, a tally that took into account both active- and non-active-duty members of the Army National Guard or Reserve. Three of those active-duty soldiers were deployed at the time of their deaths. Before July, the highest monthly level suicide rate for soldiers was 33 in June 2010 and July 2011, according to statistics released by the Army.
Kubek helped discover thyrotropin-releasing hormone, or TRH, which is known to have antisuicidal and antidepression effects. The problem is that the naturally occurring chemical cannot easily cross the “blood-brain barrier.” The barrier is meant to protect the nervous system by keeping out any substances in the blood that could injure the brain, including hormones and neurotransmitters. But it also makes it extremely difficult to get TRH to the brain, rendering normal methods of delivering the chemical, through pills or injection, largely unhelpful.

Treating TBI: Examining Optimal Treatment for those with Traumatic Brain Injuries

This sounds like a great dissertation that your doctor should be reading, and you should be influencing your doctoral students to write a similar paper on stroke. Except you should be interviewing the real professionals, the stroke survivors.
http://gradworks.umi.com/15/10/1510906.html

Abstract:

The question is often asked: What is the most effective treatment to recover from a Traumatic Brain Injury (TBI)? The answer to this question is sought in this position paper by interviewing professionals working in the field of TBI throughout the country and by dissecting the literature available on the efficacy of various treatments. The system currently in place throughout the VA network, Home and Community-Based Support (HCBS) TBI Medicaid Waivers facilitated in New York and 15 other states, as well as cognitive rehabilitation programs are examined to answer this question. While the very nature of TBI made it quite complicated to discern which approach would be most effective regardless of the type of brain injury sustained, the importance of contextual supports that are meaningful for the TBI survivor were determined to be the most effective.

A cannabinoid type 2 receptor agonist attenuates blood–brain barrier damage and neurodegeneration in a murine model of traumatic brain injury

Marijuana to you. So ask your doctors if they will get behind medical marijuana when its proven to help stroke rehabilitation. If we don't start now it won't be there for your next stroke, or your parents, or your kids. And do you want to tell them you did nothing to help stroke rehab along. It may be TBI but stroke research should easily follow this.
  http://onlinelibrary.wiley.com/doi/10.1002/jnr.23114/abstract

Abstract

After traumatic brain injury (TBI), inflammation participates in both the secondary injury cascades and the repair of the CNS, both of which are influenced by the endocannabinoid system. This study determined the effects of repeated treatment with a cannabinoid type 2 receptor (CB₂R) agonist on blood–brain barrier integrity, neuronal degeneration, and behavioral outcome in mice with TBI. We also looked for the presence of a prolonged treatment effect on the macrophage/microglial response to injury. C57BL/6 mice underwent controlled cortical impact (CCI) and received repeated treatments with a CB₂R agonist, 0-1966, or vehicle. After euthanasia at 6 hr or 1, 2, 3, or 7 days postinjury, brains were removed for histochemical analysis. Blood–brain barrier permeability changes were evaluated by using sodium fluorescein (NaF). Perilesional degenerating neurons, injury volumes, and macrophage/microglia cells were quantified by stereological methods. Rota-rod and open-field testing were performed to evaluate motor function and natural exploratory behavior in mice. 0-1966 Treatment resulted in a significant reduction in NaF uptake and number of degenerating neurons compared with the vehicle-treated group. 0-1966-Treated mice demonstrated improvement on rota-rod and open-field testing compared with vehicle-treated mice. These changes in CCI mice treated with 0-1966 were associated with a prolonged reduction in macrophage/microglia cell counts. In conclusion, repeated treatments with a CB₂R agonist, 0-1966, result in attenuated blood–brain barrier disruption and neuronal degeneration. In addition, repeated treatment with 0-1966 shows prolonged treatment effects on behavior and the macrophage/microglia cell response over several days.

No added value of CIMT in predicting stroke, MI risk

This is not the rehab CIMT.   The important 4 paragraphs are here, so ask your doctor about your risk.
http://www.theheart.org/article/1436919.do
Common carotid intima-media thickness (CIMT) measurement does not add clinically meaningful information to the Framingham risk score for predicting a person's 10-year risk of first MI or stroke, according to a meta-analysis of relevant studies [1].

"Our results suggest that common CIMT measurements should not routinely be performed in the general population, as the overall added value may be too limited to result in health benefits," the authors say.

"This will come as a surprise for a number of physicians: those who have applied the common CIMT measurement in their routine clinical practice and seen potential benefit," senior author Dr Michiel L Bots (University Medical Center Utrecht, the Netherlands) said in an interview. "Our findings, however, indicate that, on average, common CIMT does not help risk stratification when information of established risk factors is already available."

The study was published in the August 22, 2012 issue of the Journal of the American Medical Association.

Gilbert stem-cell study enrolls its first patient

It doesn't mention the three sites the study will take place at so you'll have to call them directly if interested.
http://www.azcentral.com/community/gilbert/articles/2012/08/14/20120814gilbert-stem-cell-study-enrolls-first-patient.html
Researchers at Mercy Gilbert Medical Center have enrolled their first patient into Stemedica Cell Technologies Inc.'s study to evaluate the safety of adult stem cells in stroke victims.
The study will involve 35 research volunteers at three U.S. centers. Dr. Nabil Dib, director of cardiovascular research at Mercy Gilbert and Chandler Regional medical centers, is the principal investigator for this facility.
The adult stem cells are obtained from the bone marrow of a single donor and are manufactured by Stemedica Cell Technologies in San Diego.
Dib believes these stem cells may have the ability to become different types of cells and may repair damaged and/or replace lost cells in the body due to disease.
"The information from this study may provide the data necessary to select safe and effective doses of adult stem cells to treat patients suffering from ischemic stroke or similar conditions," Dib said.
Strokes are the leading cause of serious, long-term disability in adults. Ischemic strokes account for 87 percent of all strokes.
"An ischemic stroke happens when blood vessels carrying oxygen and nutrients to the brain are blocked by a clot," said Dr. Jonathan Hodgson, medical director of Mercy Gilbert's Stroke Center. "The portion of the brain that is not getting oxygen begins to die very quickly." Paralysis, vision, balance and speech problems can result.
Tim Bricker, president and CEO of Chandler Regional and Mercy Gilbert medical centers, said, "By participating in research such as this may one day result in the means to reverse the neurologic, functional and motor deficits that oftentimes result in permanent disability for those who have suffered an ischemic stroke."
For details on becoming a donor call 480-728-5414 or go to mercygilbert.org/Research.

Read more: http://www.azcentral.com/community/gilbert/articles/2012/08/14/20120814gilbert-stem-cell-study-enrolls-first-patient.html#ixzz24JlTNeNx

Waking up the sleepers: shared transcriptional pathways in axonal regeneration and neurogenesis

This would be a great help  in getting around our dead areas. Ask your doctor what they are doing to speed this up. 

Waking up the sleepers: shared transcriptional pathways in axonal regeneration and neurogenesis

Abstract

In the last several years, relevant progress has been made in our understanding of the transcriptional machinery regulating CNS repair after acute injury, such as following trauma or stroke. In order to survive and functionally reconnect to the synaptic network, injured neurons activate an intrinsic rescue program aimed to increase their plasticity. Perhaps, in the attempt to switch back to a plastic and growth-competent state, post-mitotic neurons wake up and re-express a set of transcription factors that are also critical for the regulation of their younger brothers, the neural stem cells. Here, we review and discuss the transcriptional pathways regulating both axonal regeneration and neurogenesis highlighting the connection between the two. Clarification of their common molecular substrate may help simultaneous targeting of both neurogenesis and axonal regeneration with the hope to enhance functional recovery following CNS injury.

POU-III Transcription Factors (Brn1, Brn2, and Oct6) Influence Neurogenesis, Molecular Identity, and Migratory Destination of Upper-Layer Cells of the Cerebral Cortex

I like the migration destination. 

POU-III Transcription Factors (Brn1, Brn2, and Oct6) Influence Neurogenesis, Molecular Identity, and Migratory Destination of Upper-Layer Cells of the Cerebral Cortex

Abstract

The upper layers (II–IV) are the most prominent distinguishing feature of mammalian neocortex compared with avian or reptilian dorsal cortex, and are vastly expanded in primates. Although the time-dependent embryonic generation of upper-layer cells is genetically instructed within their parental progenitors, mechanisms governing cell-intrinsic fate transitions remain obscure. POU-homeodomain transcription factors Pou3f3 and Pou3f2 (Brn1 and Brn2) are known to label postmitotic upper-layer cells, and are redundantly required for their production. We find that the onset of Pou3f3/2 expression actually occurs in ventricular zone (VZ) progenitors, and that Pou3f3/2 subsequently label neural progeny switching from deep-layer Ctip2⁺ identity to Satb2⁺ upper-layer fate as they migrate to proper superficial positions. By using an Engrailed dominant-negative repressor, we show that sustained neurogenesis after the deep- to upper-layer transition requires the proneual action of Pou3fs in VZ progenitors. Conversely, single-gene overexpression of any Pou3f in early neural progenitors is sufficient to specify the precocious birth of Satb2⁺ daughter neurons that extend axons to the contralateral hemisphere, as well as exhibit robust pia-directed migration that is characteristic of upper-layer cells. Finally, we demonstrate that Pou3fs influence multiple stages of neurogenesis by suppressing Notch effector Hes5, and promoting the expression of proneural transcription factors Tbr2 and Tbr1.

Exendin-4 induced glucagon-like peptide-1 receptor activation reverses behavioral impairments of mild traumatic brain injury in mice

Some day we'll get past testing stuff in mice and rats.
http://www.springerlink.com/content/g91720178324113h/

Abstract

Mild traumatic brain injury (mTBI) represents a major and increasing public health concern and is both the most frequent cause of mortality and disability in young adults and a chief cause of morbidity in the elderly. Albeit mTBI patients do not show clear structural brain defects and, generally, do not require hospitalization, they frequently suffer from long-lasting cognitive, behavioral, and emotional problems. No effective pharmaceutical therapy is available, and existing treatment chiefly involves intensive care management after injury. The diffuse neural cell death evident after mTBI is considered mediated by oxidative stress and glutamate-induced excitotoxicity. Prior studies of the long-acting GLP-1 receptor agonist, exendin-4 (Ex-4), an incretin mimetic approved for type 2 diabetes mellitus treatment, demonstrated its neurotrophic/protective activity in cellular and animal models of stroke, Alzheimer’s and Parkinson’s diseases, and, consequent to commonalities in mechanisms underpinning these disorders, Ex-4 was assessed in a mouse mTBI model. In neuronal cultures in this study, Ex-4 ameliorated H₂O₂-induced oxidative stress and glutamate toxicity. To evaluate in vivo translation, we administered steady-state Ex-4 (3.5 pM/kg/min) or saline to control and mTBI mice over 7 days starting 48 h prior to or 1 h post-sham or mTBI (30 g weight drop under anesthesia). Ex-4 proved well-tolerated and fully ameliorated mTBI-induced deficits in novel object recognition 7 and 30 days post-trauma. Less mTBI-induced impairment was evident in Y-maze, elevated plus maze, and passive avoidance paradigms, but when impairment was apparent Ex-4 induced amelioration. Together, these results suggest that Ex-4 may act as a neurotrophic/neuroprotective drug to minimize mTBI impairment.

Stroke service rated among best in country - UK

In reading the article you will notice they didn't quantify anything so the title is totally misleading,. So if this is your area, 2 questions to ask them;
1. What percentage of patients get tPA in 3 hours?
2. What percentage of those patients fully recover?
 Put those 2 questions in the comments and they will never get published.
Only after answering those questions and comparing them to other hospitals can they make this type of claim.
http://www.berwick-advertiser.co.uk/news/local-headlines/stroke-service-rated-among-best-in-country-1-2478642
HOSPITAL services in Northumberland and North Tyneside for people who have suffered a stroke are among the best in the country.

Northumbria Healthcare NHS Foundation Trust’s dedicated stroke units at Hexham, Wansbeck and North Tyneside general hospitals have been rated among the top nationally in a clinical audit.
The trust’s three stroke units provide specialist acute care and rehabilitation, while Berwick and Alnwick infirmaries provide rehabilitation services.
Dr Stuart Huntley, consultant physician and head of the trust’s stroke services, said: “These excellent results show that the services we provide for our patients are among the best in the country and we are delivering a consistently high standard of care at our hospitals.(Who cares? What are your outcomes?)
“They are testament to the hard work and enthusiasm of our teams who are committed to providing high quality, patient-focussed care.
“Care delivered by a specialist team is the single biggest factor that can improve a person’s recovery. We provide acute care and rehabilitation with highly-skilled specialist teams of nurses, doctors and therapists.”
The Stroke Improvement National Audit Programme rates care provided to stroke patients in their first three days in hospital.

University of Glasgow Study Demonstrates the Ability of Oxycyte® to Supply Oxygen to Critical Penumbral Tissue in Acute Ischemic Stroke

Get the clinical trials ramped up, saving penumbral neurons is at least as important as preventing strokes in the first place. I bet it could have saved half of my dead brain.
http://www.businesswire.com/news/home/20120821005439/en/University-Glasgow-Study-Demonstrates-Ability-Oxycyte%C2%AE-Supply
Results presented at 2012 Gordon Conference on Brain Metabolism Energy & Blood Flow
 Oxygen Biotherapeutics, Inc. (“OBI”) (NASDAQ: OXBT) announced today that recent research conducted by its partner, Aurum Biosciences (“Aurum”), Glasgow, Scotland, has shown that Oxycyte^®, OBI’s proprietary perfluorocarbon-based intravenous emulsion, improves imaging of the penumbra following acute ischemic stroke in a rat model. The penumbra is the region of the brain where blood supply is inadequate to support normal brain function but sufficient to maintain tissue viability for a limited period of time following stroke. It represents potentially salvageable tissue which, if the oxygen supply can be restored, could lead to improved functional outcomes for stroke patients.
In the clinical management of stroke, it is important to accurately identify patients with potentially salvageable penumbral tissue. The development of neuroprotective agents continues to be complicated due to the absence of accurate diagnostic imaging as patients with no remaining penumbra are enrolled in clinical trials. The gold standard for identification of penumbra based on metabolism is PET; however, this technique has low resolution and involves injection of radioisotopes, making it impractical as a routine clinical tool. Aurum scientists have been working for a number of years to develop a rapid and sensitive MRI-based diagnostic technique.
Aurum’s T2* Oxygen Challenge (OC) MRI imaging technique is based on conversion of deoxyhemoglobin to oxyhemoglobin, a change made possible by Oxycyte’s ability to provide oxygen into areas otherwise inaccessible to red blood cells. The use of Oxycyte allows for greater efficiency in oxygen delivery, reducing the OC from 100% to 50% oxygen, thus avoiding potential toxicities associated with 100% oxygen inhalation. This work, conducted by researchers at the University of Glasgow Institute of Neuroscience & Psychology, was presented at the prestigious Gordon Research Conference on Brain Metabolism Energy & Blood Flow held at Colby College in Waterville, Maine on August 11-12, 2012.
The development of this improved diagnostic technique paves the way for follow-on research by Aurum scientists, in accord with a research agreement in place between Aurum Biosciences and Oxygen Biotherapeutics, to investigate the therapeutic potential of Oxycyte in the treatment of acute ischemic stroke. Planned preclinical studies will investigate the use of Oxycyte combined with normobaric hyperoxia to improve oxygen delivery to the ischemic brain tissue, limiting brain damage and extending the lifespan of potentially salvageable penumbra thereby increasing the therapeutic time window for thrombolytic therapy. The use of recombinant tissue plasminogen activator (rt-PA) thrombolytic therapy is currently the only licensed therapeutic option for ischemic stroke but few patients ( less than 5%) present early enough to receive treatment.
Timothy Bradshaw, Ph.D., Executive Vice President of Drug Development at OBI said, “We are excited by the data coming out of our partnership with Aurum Biosciences. Based on our clinical studies in traumatic brain injury, we already know of Oxycyte’s ability to supply oxygen to badly injured tissues. Developing the product for acute ischemic stroke is a rather obvious extension of that work. While there is still much to be done, the possibility of neurologists having both a diagnostic tool and an interventional drug in the same product is going to garner the attention of the medical community.”
Added Gerry McGettigan, Chief Executive Officer of Aurum: “This is another important piece of data to add to our growing body of evidence supporting the combined use of Oxycyte and Aurum’s MRI techniques in the management of acute stroke. We look forward to completing the research and preclinical development work with our colleagues at OBI, and moving towards clinical trials at the earliest opportunity.”
Acute Ischemic Stroke
An ischemic stroke occurs when a blood vessel that carries oxygen and nutrients to a particular region of the brain is blocked by a clot. Once this event happens, the affected part of the brain cannot get the oxygen it needs and, therefore, begins to die. The objective of all stroke treatments is to salvage as much of the surrounding ischemic penumbra as possible, the region of potentially viable tissue with critically low blood flow and oxygen supply. This could result in improved functional capacity in the stroke patient.
According to the American Stroke Association, approximately 795,000 Americans each year suffer a new or recurrent stroke. That means, on average, a stroke occurs every 40 seconds. Stroke kills more than 137,000 people a year in the United States alone and is the third leading cause of death behind diseases of the heart and cancer. On average, every 4 minutes someone dies of stroke. About 40 percent of stroke deaths occur in males, and 60 percent in females. According to The Stroke Association, an estimated 150,000 people have a stroke in the U.K. each year, accounting for around 53,000 deaths annually. Stroke is the third most common cause of death in England and Wales, after heart disease and cancer. Stroke accounts for 9 percent of all deaths in men and 13 percent of deaths in women in the U.K.

Psoriasis Drugs May Curb Heart Disease Risk

Remember the unproven  miracle drug etanercept from a year and a half ago? It supposedly reduced the TNF, tumor necrosis factor, just like this drug does. So contact your researcher  and have them see if reducing TNF actually helps in stroke rehab and then if this drug might help. No one else is going to push this so you have to. 

Psoriasis Drugs May Curb Heart Disease Risk

Treating psoriasis patients with biologic drugs that inhibit tumor necrosis factor (TNF) may cut risk of heart attack compared with other treatments, observational results suggested.
TNF-treated patients were half as likely to have a myocardial infarction (MI) as those treated with topical drugs after adjustment for other factors, Jashin J. Wu, MD, of the Kaiser Permanente Los Angeles Medical Center, and colleagues found in a retrospective cohort study.
Oral drugs and phototherapy were also significantly better than topical treatment in terms of MI risk, though rates tended to be even lower with the TNF inhibitors, the researchers reported online in the Archives of Dermatology.
"It seems that controlling psoriasis with aggressive therapy and, thus, lowering inflammation leads to a reduction in MI risk," they wrote.
As a systemic inflammatory disease, psoriasis is linked to many cardiovascular risks, from obesity and atherosclerosis to type 2 diabetes, stroke, MI, and cardiac death.
The same is true in rheumatoid arthritis, but a large observational study linked TNF blockers to reduced cardiovascular events in that disease.
To evaluate the effect in psoriasis, Wu's group retrospectively analyzed the Kaiser Permanente Southern California health plan databases.
Among the 8,845 members with multiple diagnostic claims codes for psoriasis or psoriatic arthritis and no history of MI at baseline:

• 19% took a TNF inhibitor for at least 2 months
• 24% were TNF-inhibitor naive and received other systemic agents, like methotrexate, or phototherapy
• 57% received none of the above and were classified as treated only topically

During a mean 4.3 years of follow-up, MI incidence was 3.05 per 1,000 patient-years in the anti-TNF-treated group compared with 3.85 in those on oral drugs or phototherapy and 6.73 in those on topical drugs.
That translated to an unadjusted 55% lower risk of MI with the TNF inhibitors and 43% lower risk with oral drugs or phototherapy compared with topical agents (both P less than 0 data-blogger-escaped-.001=".001" data-blogger-escaped-p="p" greater than TNF blockers were associated with 21% lower MI risk compared with other systemic drugs or phototherapy in that analysis, though the difference wasn't statistically significant.
In an age-stratified analysis, both treatments appeared more protective against MI in older adults. Compared with topical agents, the hazard ratios were:

• Among patients age ≤60, 0.46 with TNF inhibitors (95% CI 0.25 to 0.88) and a nonsignificant 0.60 with oral therapy and phototherapy
• Among patients age >60, 0.32 with TNF inhibitors (95% CI 0.14 to 0.73) and 0.35 with oral agents or phototherapy (95% CI 0.21 to 0.59)

"One reason for this is that older patients are more likely to have type 2 diabetes mellitus, and the benefits of TNF inhibitor use may be mediated through improving risk of type 2 diabetes," the researchers noted.
Alternatively, older patients may be less likely to get a TNF inhibitor because of lower coverage of prescription benefits through Medicare for these costly drugs, or because of recent history of cancer as a contraindication for TNF inhibitor therapy, they added.
The study didn't compare the individual TNF blockers -- infliximab (Remicade), etanercept (Enbrel), and adalimumab (Humira) -- used in psoriasis.
The study was limited by lack of data on psoriasis severity, which could have been a confounding factor if severe cases were more likely to receive no systemic therapy.
Other limitations were lack of adjustment for over-the-counter medications like nonsteroidal anti-inflammatory drugs and for duration and dosing of drugs analyzed in the study (statins, beta-blockers, or methotrexate).

Active robotic training improves locomotor function in a stroke survivor

I had this lokomat training and I thought it was wonderful.
http://www.jneuroengrehab.com/content/9/1/57/abstract

Abstract (provisional)

Background

Clinical outcomes after robotic training are often not superior to conventional therapy. One key factor responsible for this is the use of control strategies that provide substantial guidance. This strategy not only leads to a reduction in volitional physical effort, but also interferes with motor relearning.

Methods

We tested the feasibility of a novel training approach (active robotic training) using a powered gait orthosis (Lokomat) in mitigating post-stroke gait impairments of a 52-year-old male stroke survivor. This gait training paradigm combined patient-cooperative robot-aided walking with a target-tracking task. The training lasted for 4-weeks (12 visits, 3 [MULTIPLICATION SIGN] per week). The subject's neuromotor performance and recovery were evaluated using biomechanical, neuromuscular and clinical measures recorded at various time-points (pre-training, post-training, and 6-weeks after training).

Results

Active robotic training resulted in considerable increase in target-tracking accuracy and reduction in the kinematic variability of ankle trajectory during robot-aided treadmill walking. These improvements also transferred to overground walking as characterized by larger propulsive forces and more symmetric ground reaction forces (GRFs). Training also resulted in improvements in muscle coordination, which resembled patterns observed in healthy controls. These changes were accompanied by a reduction in motor cortical excitability (MCE) of the vastus medialis, medial hamstrings, and gluteus medius muscles during treadmill walking. Importantly, active robotic training resulted in substantial improvements in several standard clinical and functional parameters. These improvements persisted during the follow-up evaluation at 6 weeks.

Conclusions

The results indicate that active robotic training appears to be a promising way of facilitating gait and physical function in moderately impaired stroke survivors.

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

Breaking bad news in stroke rehabilitation: a consultation with a community stroke team

A much better use of their time would have been spent working on research that provides better outcomes rather than creating the nocebo effect.
http://informahealthcare.com/doi/abs/10.3109/09638288.2012.703757

Purpose: Within stroke care clinicians are frequently required to break bad news to patients, however, formal training and guidance remains limited. This article provides a case example of a multidisciplinary stroke rehabilitation team consultation, and aims to contribute towards an evidence base and a model of training for breaking bad news (BBN) in stroke care. Method: The stroke rehabilitation team requested clinical psychology consultation to help with difficulties they were experiencing in BBN to patients. The consultation comprised an assessment of the request, development of a proposal, delivery of a workshop on BBN and an evaluation of consultation impact. A collaborative consultation model underpinned the work, which aimed to empower and facilitate the team to generate solutions by drawing upon their existing expertise. Results: The consultation was found to meet the team’s expectations and needs. Consultees reported increased confidence to communicate difficult messages to patients and rated the consultation highly. A follow-up review indicated the consultation had led to changes in practice. Conclusions: Communication skills are central to BBN effectively. Clinicians may be supported to recognize their existing skill set and increase confidence in their ability to break bad news through a process of collaborative team consultation.

Implications for Rehabilitation

• Despite a lack of formal guidance stroke care clinicians are frequently required to break bad news to patients.
• Clinicians may be supported to increase confidence in their skills to break bad news through a process of collaborative team consultation.
• Developing an evidence base and training in breaking bad news should be considered a priority in stroke care.

So rather than coming up with good news, lets become better at delivering bad news. Complete failure.


Read More: http://informahealthcare.com/doi/abs/10.3109/09638288.2012.703757

Stroke disrupts how brain controls muscle synergies

Interesting premise, but where does the pre-motor cortex fit in with these results?
http://www.healthcanal.com/brain-nerves/31688-Stroke-disrupts-how-brain-controls-muscle-synergies.html
The simple act of picking up a pencil requires the coordination of dozens of muscles: The eyes and head must turn toward the object as the hand reaches forward and the fingers grasp it. To make this job more manageable, the brain’s motor cortex has implemented a system of shortcuts. (Isn't that what the pre-motor cortex is for?) Instead of controlling each muscle independently, the cortex is believed to activate muscles in groups, known as “muscle synergies.” These synergies can be combined in different ways to achieve a wide range of movements.

A new study from MIT, Harvard Medical School and the San Camillo Hospital in Venice finds that after a stroke, these muscle synergies are activated in altered ways. Furthermore, those disruptions follow specific patterns depending on the severity of the stroke and the amount of time that has passed since the stroke.

The findings, published this week in the Proceedings of the National Academy of Sciences, could lead to improved rehabilitation for stroke patients, as well as a better understanding of how the motor cortex coordinates movements, says Emilio Bizzi, an Institute Professor at MIT and senior author of the paper.

“The cortex is responsible for motor learning and for controlling movement, so we want to understand what’s going on there,” says Bizzi, who is a member of the McGovern Institute for Brain Research at MIT. “How does the cortex translate an idea to move into a series of commands to accomplish a task?”

Coordinated control

One way to explore motor cortical functions is to study how motor patterns are disrupted in stroke patients who suffered damage to the motor areas.

In 2009, Bizzi and his colleagues first identified muscle synergies in the arms of people who had suffered mild strokes by measuring electrical activity in each muscle as the patients moved. Then, by utilizing a specially designed factorization algorithm, the researchers identified characteristic muscle synergies in both the stroke-affected and unaffected arms.

“To control, precisely, each muscle needed for the task would be very hard. What we have proven is that the central nervous system, when it programs the movement, makes use of these modules,” Bizzi says. “Instead of activating simultaneously 50 muscles for a single action, you will combine a few synergies to achieve that goal.”

In the 2009 study, and again in the new paper, the researchers showed that synergies in the affected arms of patients who suffered mild strokes in the cortex are very similar to those seen in their unaffected arms even though the muscle activation patterns are different. This shows that muscle synergies are structured within the spinal cord, and that cortical stroke alters the ability of the brain to activate these synergies in the appropriate combinations.

However, the new study found a much different pattern in patients who suffered more severe strokes. In those patients, synergies in the affected arm merged to form a smaller number of larger synergies. And in a third group of patients, who had suffered their stroke many years earlier, the muscle synergies of the affected arm split into fragments of the synergies seen in the unaffected arm.

This phenomenon, known as fractionation, does not restore the synergies to what they would have looked like before the stroke. “These fractionations appear to be something totally new,” says Vincent Cheung, a research scientist at the McGovern Institute and lead author of the new PNAS paper. “The conjecture would be that these fragments could be a way that the nervous system tries to adapt to the injury, but we have to do further studies to confirm that.”

This is the first time that fractionation of muscle synergies identified by factorization has been seen in chronic stroke patients, says Simon Giszter, a professor of neurobiology and anatomy at Drexel University. “It raises the question of how this occurs and if it’s a compensatory process. If it is, we can use this measurement to study how the recovery process can be accelerated,” says Giszter, who was not involved in this study.

Toward better rehabilitation

The researchers believe that these patterns of synergies, which are determined by both the severity of the deficit and the time since the stroke occurred, could be used as markers to more fully describe individual patients’ impaired status. “In some of the patients, we see a mixture of these patterns. So you can have severe but chronic patients, for instance, who show both merging and fractionation,” Cheung says.

The findings could also help doctors design better rehabilitation programs. The MIT team is now working with several hospitals to establish new therapeutic protocols based on the discovered markers.

About 700,000 people suffer strokes in the United States every year, and many different rehabilitation programs exist to treat them. Choosing one is currently more of an art than a science, Bizzi says. “There is a great deal of need to sharpen current procedures for rehabilitation by turning to principles derived from the most advanced brain research,” he says. “It is very likely that different strategies of rehabilitation will have to be used in patients who have one type of marker versus another.”

The research was funded by the National Institutes of Health and the Italian Ministry of Health.

Repeated measurements of arm joint passive range of motion after stroke: interobserver reliability and sources of variation.

The conclusion after this should have been that subjective measurements are almost worthless and an objective measurement protocol needs to be defined. But what the hell do I know.

Repeated measurements of arm joint passive range of motion after stroke: interobserver reliability and sources of variation.

Background Goniometric measurements of hemiplegic arm joints must be reliable to draw proper clinical and scientific conclusions. Previous reliability studies were cross-sectional and based on small samples. Knowledge about the contributions of sources of variation to these measurement results is lacking. Objective The aims of this study were to determine the interobserver reliability of measurements of passive range of motion (PROM) over time, explore sources of variation associated with these measurement results, and generate smallest detectable differences for clinical decision making. Design This investigation was a measurement-focused study with a longitudinal design, nested within a 2-arm randomized controlled trial./b> Two trained physical therapists assessed 7 arm movements at baseline and after 4, 8, and 20 weeks in 48 people with subacute stroke using a standardized protocol. One physical therapist performed the passive movement, and the other read the hydrogoniometer. The therapists then switched roles. The relative contributions of several sources of variation to error variance were explored with analysis of variance./b> Interobserver reliability coefficients ranged from .89 to .97. The PROM measurements were influenced by error variance ranging from 31% to 50%. The participant � time interaction made the largest contribution to error variance, ranging from 59% to 81%. Smallest detectable differences were 6 to 22 degrees and were largest for shoulder movements. Limitations Verification of shoulder pain and hypertonia as sources of error variance led to a substantial number of unstable variance components, necessitating a simpler analysis./b> The assessment of PROM with a standardized protocol, a hydrogoniometer, and 2 trained physical therapists yielded high interobserver reliability indexes for all arm movements. Error variance made a large contribution to the variation in measurement results. The resulting smallest detectable differences can be used to interpret future hemiplegic arm PROM measurements with more confidence.

The usefulness of bladder reconditioning before indwelling urethral catheter removal from stroke patients.

This one is strictly for your doctor to explain to you, so ask him/her to compare it to reconditioning cars.
http://www.hubmed.org/display.cgi?uids=22660367
The aim of this study was to determine the effects of bladder reconditioning by indwelling urethral catheter (IUC) clamping before IUC removal in stroke patients.Sixty patients with stroke were randomized to 0-, 1-, and 3-day IUC clamping groups. IUCs were removed without clamping in the 0-day group. In the other two groups, IUCs were clamped for 4 hrs followed by 5 mins of urinary drainage, a cycle repeated over 24 hrs in the 1-day and over 72 hrs in the 3-day clamping groups. Time to first voiding (FV), first voided volume (FV-vol), residual urine volume after FV, mean void volume, and residual urine volume on the third day after IUC removal were measured. We also recorded the voiding method such as self-voiding or intermittent catheterization, incidence of urinary tract infection, subjective complaints, and other complications.Time to FV, FV-vol, residual urine volume after FV, voiding method, mean voided volume, and residual urine volume on the third day after IUC removal had no significant difference among three groups, nor between the 0-day and the other two clamping groups. We observed a strong negative correlation between age and FV-vol. Of the patients in the 1- and 3-day clamping groups, 3 (7.5%) had symptomatic urinary tract infection and 9 (22.5%) complained of urinary leakage during IUC clamping program.Bladder reconditioning through IUC clamping has no noticeable benefits in stroke patients and may induce additional problems. These findings suggest that IUC removal without clamping is superior to IUC clamping for bladder reconditioning in stroke patients

The PREP algorithm predicts potential for upper limb recovery after stroke

I hate the term they use - realistic rehabilitation goal-setting- they've already conceded that they aren't even trying for any recovery beyond the normal spontaneous recovery. We have to call them out on their backwards thinking, so send them an email. I will.
Correspondence to: Professor Winston Byblow, Department of Sport and Exercise Science and Centre for Brain Research, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand E-mail: w.byblow@auckland.ac.nz
 
http://brain.oxfordjournals.org/content/135/8/2527

Summary

Stroke is a leading cause of adult disability and the recovery of motor function is important for independence in activities of daily living. Predicting motor recovery after stroke in individual patients is difficult. Accurate prognosis would enable realistic rehabilitation goal-setting and more efficient allocation of resources. The aim of this study was to test and refine an algorithm for predicting the potential for recovery of upper limb function after stroke. Forty participants were prospectively enrolled within 3 days of ischaemic stroke. First, shoulder abduction and finger extension strength were graded 72 h after stroke onset to compute a shoulder abduction and finger extension score. Secondly, transcranial magnetic stimulation was used to assess the functional integrity of descending motor pathways to the affected upper limb. Third, diffusion-weighted magnetic resonance imaging was used to assess the structural integrity of the posterior limbs of the internal capsules. Finally, these measures were combined in the PREP algorithm for predicting an individual’s potential for upper limb recovery at 12 weeks, measured with the Action Research Arm Test. A cluster analysis was used to independently group patients according to Action Research Arm Test score at 12 weeks, for comparison with predictions from the PREP algorithm. There was excellent correspondence between the cluster analysis of Action Research Arm Test score at 12 weeks and predictions made with the PREP algorithm. The algorithm had positive predictive power of 88%, negative predictive power of 83%, specificity of 88% and sensitivity of 73%. This study provides preliminary data in support of the PREP algorithm for the prognosis of upper limb recovery in individual patients. PREP may enable tailored planning of rehabilitation and more accurate stratification(triage anyone) of patients in clinical trials.

Bring out ze dead brains.
But I'm not recovered yet, don't toss me on the wagon

The effects of the dopamine agonist rotigotine on hemispatial neglect following stroke

Ask your doctor if this will help your neglect, I had a mild case that resolved in a couple of weeks.
http://www.hubmed.org/display.cgi?uids=22761293
Hemispatial neglect following right-hemisphere stroke is a common and disabling disorder, for which there is currently no effective pharmacological treatment. Dopamine agonists have been shown to play a role in selective attention and working memory, two core cognitive components of neglect. Here, we investigated whether the dopamine agonist rotigotine would have a beneficial effect on hemispatial neglect in stroke patients. A double-blind, randomized, placebo-controlled ABA design was used, in which each patient was assessed for 20 testing sessions, in three phases: pretreatment (Phase A1), on transdermal rotigotine for 7-11 days (Phase B) and post-treatment (Phase A2), with the exact duration of each phase randomized within limits. Outcome measures included performance on cancellation (visual search), line bisection, visual working memory, selective attention and sustained attention tasks, as well as measures of motor control. Sixteen right-hemisphere stroke patients were recruited, all of whom completed the trial. Performance on the Mesulam shape cancellation task improved significantly while on rotigotine, with the number of targets found on the left side increasing by 12.8% (P = 0.012) on treatment and spatial bias reducing by 8.1% (P = 0.016). This improvement in visual search was associated with an enhancement in selective attention but not on our measures of working memory or sustained attention. The positive effect of rotigotine on visual search was not associated with the degree of preservation of prefrontal cortex and occurred even in patients with significant prefrontal involvement. Rotigotine was not associated with any significant improvement in motor performance. This proof-of-concept study suggests a beneficial role of dopaminergic modulation on visual search and selective attention in patients with hemispatial neglect following stroke.

Lab Notes: Brain Clutter May Be a Good Thing

 You can have your doctor match this to  keeping your brain clean. 

Lab Notes: Brain Clutter May Be a Good Thing

Taking Out the Neurotrash
On the face of it, cleaning out cellular waste products in the brain would seem to be a possible strategy for combating dementia, which is often linked to the accumulation of damaged proteins. But researchers led by Thomas Sudhof, MD, of the Stanford University School of Medicine in Stanford, Calif., have found that might not be the case.
Because protein misfolding has been implicated in a range of neurological diseases, it seemed possible that dysfunctional proteasomes -- structures that break down damaged proteins – might play a role. But in mice prone to neurodegeneration, inhibiting the proteasome activity unexpectedly slowed the degeneration and extended the animals' lifespan, Sudhof and colleagues reported in Science Translational Medicine.
In the study animals, proteasomal degradation of the unfolded form of a protein called SNAP-25 leads to the loss of a complex of proteins called SNARE. In turn, that leads to the death of brain cells and synapses -- but inhibiting the proteasomes prevented the deterioration.
In brain tissue samples from patients with Parkinson's or Alzheimer's disease, the SNARE complex was similarly impaired, suggesting that proteasome blockage might have a therapeutic value, the researchers argued.

Thick Cortex Offers Clue to Better Memory

Fascinating topic with no clues as to how to get that way. Read it all at the link.
http://www.medpagetoday.com/Geriatrics/GeneralGeriatrics/34269
Investigators have found no common environmental factors to explain the cortical thickening. Some patients smoked, others didn't. Some regularly consumed alcohol, others never drank. Some exercised regularly, some never exercised. Some were financially secure, and others had struggled financially throughout their lives.
"We can't say eat a cup of blueberries or drink a glass of wine and you'll have better memory," said Rogalski.
Investigators also have yet to analyze data on mind-stimulating activities that might account for differences in memory, such as reading or playing chess.


I wonder what the definition of thick is. Or did they have this better memory since birth. Inquiring minds want to know.  Stump your doctor with this question.

Importance of failure: why Olympians and A-level students all need to fail

We need to take this to heart. As part of our recovery we will need to fail  hundreds of thousands of times, and get up one more time.
From a UK teacher blog.
http://www.guardian.co.uk/teacher-network/2012/aug/16/a-level-student-success-failure?CMP=twt_gu

UK court rules against paralysed man in ‘right to die’ case

The dark side of locked-in syndrome. FYI only,  I'm not going to further comment on this.
http://tribune.com.ng/index.php/world-news/46119-uk-court-rules-against-paralysed-man-in-right-to-die-case
A British man left paralysed from the neck down by a catastrophic stroke seven years ago lost his High Court battle on Thursday to gain a legal right to end his life when he chooses.
Tony Nicklinson's condition means it is impossible for him to take his own life and he wants the legal right to have a doctor take his life without fear of prosecution.
Since he suffered the stroke in 2005, the former rugby player, now 58, has had to endure what is known as locked-in syndrome.
"This means that most of my body is paralysed but my mind is as it was before the stroke.
"All I can move is my head, and the stroke took away my power of speech.
"Now I talk to people with a perspex spelling board or a computer operated by my eye blinks," he told CNN in an interview in June.
But while expressing sympathy for his situation, the High Court ruled Thursday that such a significant change to the law involving
overturning the ban on voluntary euthanasia would have to be decided by lawmakers.

Event related desynchronization-modulated functional electrical stimulation system for stroke rehabilitation: A feasibility study

No clue what this is trying to say, so ask your doctor and therapists to translate it to your protocols for  recovery.
http://7thspace.com/headlines/419098/event_related_desynchronization_modulated_functional_electrical_stimulation_system_for_stroke_rehabilitation_a_feasibility_study.html
 We developed an electroencephalogram-based brain computer interface system to modulate functional electrical stimulation (FES) to the affected tibialis anterior muscle in a stroke patient. The intensity of FES current increased in a stepwise manner when the event-related desynchronization (ERD) reflecting motor intent was continuously detected from the primary cortical motor area.

Methods: We tested the feasibility of the ERD-modulated FES system in comparison with FES without ERD modulation.

The stroke patient who presented with severe hemiparesis attempted to perform dorsiflexion of the paralyzed ankle during which FES was applied either with or without ERD modulation.

Results: After 20 minutes of training, the range of movement at the ankle joint and the electromyography amplitude of the affected tibialis anterior muscle were significantly increased following the ERD-modulated FES compared with the FES alone.

Conclusions: The proposed rehabilitation technique using ERD-modulated FES for stroke patients was feasible. The system holds potentials to improve the limb function and to benefit stroke patients.

Experimental stroke therapy helps Illinois senator

Interesting work, I remember always being asked if I was tired and we never pushed anywhere close to exhaustion. This probably goes against decades  of institutional practice  and will take decades to get to general use if it works. But ask your therapist about it anyway.

http://www.journalreview.com/news/life/article_37d8f633-b91d-5a48-ad08-4536d500cdee.html

PhD Position in Stroke Rehabilitation Robot, University of Lübeck, Germany

I'm sure you could make a good impression with dozens of research possibilities from my blog.
http://www.scholarships-admissions.com/2012/08/13/phd-position-in-stroke-rehabilitation-robot-university-of-lubeck-germany/

Chemical in many antibacterial soaps linked with impaired muscle function

This rather alarmist headline should provoke some thinking on our part and our medical staff. When I was still doing therapy there were antibacterial stations into every therapy station and  we were expected to use them prior to any therapy. Myself being one-handed I would only ineffectually do my good hand. But that does lead to the question, should  survivors even use this stuff on their affected hands/arms? Research needed, but ask your doctor first.
http://www.foxnews.com/health/2012/08/14/chemical-in-many-antibacterial-soaps-linked-with-impaired-muscle-function/
Only 6 paragraphs here, rest at the link.
Introduced in the 1970s, the compound triclosan has become an increasingly popular ingredient in many antibacterial soaps and other personal-care items, such as deodorants and mouthwashes.  However, as the chemical’s popularity continues to grow, a recent report has raised concerns about some frightening risks that triclosan could pose to public health.
A new study published in the Proceedings of the National Academy of Sciences has revealed that exposure to triclosan is linked with muscle function impairments in humans and mice, as well as slowing the swimming of fish.  By reducing contractions in both cardiac and skeletal muscles, the chemical has the potential to contribute to heart disease and heart failure.
The researchers from the University of California, Davis, and the University of Colorado decided to examine the possible effects of triclosan due to recent literature raising health concerns about the chemical, as well as substantial increases in its production.
“We consider [triclosan] a high volume chemical,” Dr. Isaac Pessah, professor and chair of the Department of Molecular Biosciences in the UC Davis School of Veterinary Medicine, as well as the study’s lead author, told FoxNews.com.  “Its production levels are quite high, and the levels in humans have been increasing since it was first used as an antibacterial agent in the early ‘70s.  So the body levels in humans – including plasma, urine and breast milk – have been steadily increasing.”
“The levels in the environment have been increasing as well, because it can’t all be trapped in the treatment plants,” Pessah added about triclosan’s prevalence.  “[Companies] try to prevent some chemicals getting out past the water treatment plants so they can dispose of them in a different way, but they can’t capture all of [triclosan] because there is so much of it.”
Primarily used in antibacterial hand soaps, triclosan can also be found in a number of bath and household products, including mouthwashes, toothpastes, deodorants, bedding, washcloths and towels, kitchen utensils and toys.

Read more: http://www.foxnews.com/health/2012/08/14/chemical-in-many-antibacterial-soaps-linked-with-impaired-muscle-function/#ixzz23fGn1IRd

Scientists Discover How Brains Keep Clean

So our researchers need to follow this up to see if enhancing the cleaning or stopping the cleaning right after the stroke keeps more neurons  working. 

Scientists Discover How Brains Keep Clean

A couple really cool pictures at the link.

Therapy Combining Exercise and Neuroprotective Agent Shows Promise for Stroke Victims

I would love to see this in human clinical trials.
http://www.alphagalileo.org/ViewItem.aspx?ItemId=123207&CultureCode=en
New Research Published in Restorative Neurology and Neuroscience
In a study published in the current issue of Restorative Neurology and Neuroscience scientists report that a therapy combining exercise with the neurovascular protective agent S-nitrosoglutathione (GSNO) improved recovery from stroke in a rat model. GSNO is a compound found naturally in the body and it has no known side effects or toxicity.
“In our study, GSNO or motor exercise provided neuroprotection, reduced neuronal cell death, maintained tissue structure, and aided functional recovery by stimulating the expression of neuronal repair mediators,” says lead investigator Avtar K. Singh, MD, of the Medical University of South Carolina (MUSC) and the Ralph H. Johnson VA Medical Center, Charleston. “GSNO in combination with exercise accelerated the rate and enhanced the degree of recovery.”
Stroke is both an acute disease and a chronic condition. While the acute phase is associated with cell death and secondary injury, the chronic phase is characterized by insufficient neurorepair mechanisms. Most monotherapies fail because the drugs are not effective in the chronic phase. Rehabilitation has been used to improve neurofunction in the chronic phase, but its efficacy is slow and limited. An ideal therapy would ameliorate the injury in both phases and therefore include a combination of rehabilitation and an agent that provides both neuroprotection and repair, such as GSNO.
Dr. Singh and her colleagues from MUSC (Drs. Mushfiquddin Khan, Harutoshi Sakakima and Inderjit Singh) induced stroke in rats, which were then assigned to one of five treatment groups. The first group received no treatment; the second group was treated with exercise; the third group with GSNO; the fourth group received both exercise and GSNO treatment; and the fifth group received a sham treatment. In the exercise treatment, rats were required to run on a rotating rod motor unit at a constant speed for 20 minutes a day. GSNO was administered throughout the treatment period.
Animals in each group were evaluated for neurological function, motor behavior, and locomotor function before and after the procedure. The size of the infarct was measured. At 7 and 14 days after stroke was induced, brain tissue samples were removed and tested.
Administration of GSNO not only reduced brain injury but also improved neurological scores. Exercise alone could not significantly reduce infarct volume, because the exercise started 72 hours post procedure and infarctions occur before then. However, exercise did improve neurobehavioral functions. Combining the therapies had a synergistic effect, and provided greater functional improvement than either GSNO or exercise alone.
Analysis of the brain tissue found that GSNO accelerates the recovery of neurological and motor functions and enhances the benefit of exercise by stimulating the expression of neurotrophic factor BDNF and its receptors, which play critical roles in neurorepair processes, and by activating Akt, a protein involved in cell proliferation. Dr. Singh and her collaborators Drs. Mushfiquddin Khan and Inderjit Singh conclude, “GSNO is an attractive candidate to be investigated in humans for neurorepair and rehabilitation following stroke.”

Rockland Technimed Ltd. Presents Oxy-17® Metabolic Magnetic Resonance Imaging Technology at 2012 Brain Energy Metabolism and Blood Flow Gordon Research Conference

This sounds like a great way to get an objective representation of your stroke damage. So ask your doctor to map this to your stroke protocol. And then use it to map actual changes in your brain as you recover.

Rockland Technimed Ltd. Presents Oxy-17® Metabolic Magnetic Resonance Imaging Technology at 2012 Brain Energy Metabolism and Blood Flow Gordon Research Conference

Rockland Technimed Ltd., a pioneer in developing metabolic magnetic resonance imaging (MRI) media, today presented the latest research on the potential clinical applications of brain MRI performed with its patented imaging medium, Oxy-17^®.  The presentation highlighted the use of Oxy-17^® MRI to measure two key indicators of cerebral tissue function: cerebral metabolic rate of oxygen (CMRO₂) and oxygen extraction fraction (OEF). OEF is essential to the assessment of stroke risk (ischemic infarction risk) and the diagnosis and management of chronic cerebral steno-occlusive disease. The presentation was given at the 5^th Gordon Research Conference on Brain Energy Metabolism and Blood Flow at Colby College in Waterville, Maine.
"As a leading player in advancing the visualization and quantification of brain metabolism and function, we are pleased to renew our commitment to participate in and support the Gordon Research Conference," said Pradeep M. Gupte, chairman and CEO of Rockland Technimed, Ltd. "With its ability to directly measure brain oxygen metabolism, enable clinicians to localize and assess tissue viability during acute ischemic injury, and predict the chronic risk of ischemic injury with vascular stenosis, Oxy-17^® could  become a critical tool in the diagnosis and treatment of stroke and other neurodegenerative disorders."
The presentation titled "Potential Clinical Applications of Brain ¹⁷O MRI CMRO₂ and OEF" was given by Robert DeLaPaz, M.D., a board member of Rockland Technimed Ltd., and professor of radiology and neuroradiology at Columbia University - New York Presbyterian Hospital in New York. In addition to being widely known for his work in applications of functional MRI to analyze brain disorders and brain rehabilitation, Dr. DeLaPaz also served as the lead author on the American College of Radiology (ACR) expert panel on neurologic imaging to develop the appropriateness criteria for cerebrovascular disease.
"Today's acute stroke management model is moving towards rapidly identifying and targeting tissue on the verge of infarction, or death, to minimize irreversible damage. In addition, the reliable prediction of stroke risk with cerebrovascular stenosis is the holy grail of stroke prevention," said Dr. DeLaPaz. "Our research suggests that by providing direct measurements of the critical components of oxygen metabolism, an Oxy-17^® MRI could pinpoint ailing yet viable tissue in the acute phase, better predict the risk of stroke in chronic stenosis, and potentially improve treatment outcomes and prevent stroke."
About Oxy-17^®Oxy-17^® is the only non-radioactive imaging medium to measure real-time oxygen metabolism, oxygen extraction fraction and molecular oxygen consumption – key indicators of cell health and tissue viability.  Using an unaltered clinical MRI scanner, Oxy-17^® enables early detection of hypoxia (lack of available oxygen) in cardiac and cerebral tissue, potentially improving treatment outcomes in patients with suspected heart attack or stroke. Oxy-17^® technology has potentially vast clinical applications including tracking tumor response to radiation or chemotherapy, epilepsy loci mapping, and providing surrogate endpoints in drug discovery research.

Statins linked with development of cataracts

I know this is an alarmist headline so talk to your doctor.
http://www.theheart.org/article/1434435.do?utm_medium=email&utm_source=20120815_EN_Heartwire&utm_campaign=newsletter

More on chiropractic strokes

From Science Based Medicine blogger Harriet Hall. Read it all including the comments. Run, run, run away.
http://www.sciencebasedmedicine.org/index.php/chiropractic-strokes-again-an-update/

Machine Helps Military Veterans Recover From Brain Injuries

Video and  news report here;
http://latino.foxnews.com/latino/health/2012/08/14/machine-helps-military-veterans-recover-from-brain-injuries/
7 pages explaining it here:
http://dynavisiond2.com/articles/Therapy_Times_6.15.10.pdf
Interestingly, (All photos courtesy of Bioness Inc.)

Acute renal failure caused by severe coagulopathy induced by the interaction between warfarin potassium and levofloxacin: a case report

Talk to your doctor to see if this is something you need to be concerned about.
http://www.springerlink.com/content/6r4m60qx00277583/

Rehabilitation of the Upper Extremity after Stroke: A Case Series Evaluating REO Therapy and an Auditory Sensor Feedback for Trunk Control

Have your PT and doctor evaluate this for use in your stroke protocol.

You do have a stroke protocol, don't you?

Rehabilitation of the Upper Extremity after Stroke: A Case Series Evaluating REO Therapy and an Auditory Sensor Feedback for Trunk Control

Hot Cocoa May Boost Seniors' Brain Power

So is CV prevention with dark chocolate more important than brain power?
http://www.medpagetoday.com/Cardiology/Dementia/34179
Or do both because they taste good.

Coordination Patterns of Foot Dynamics in the Control of Upright Standing

So ask your PT  how they use this  to help you get back on your feet, with and without the AFO.
http://journals.humankinetics.com/mc-current-issue/mc-volume-16-issue-3-july/coordination-patterns-of-foot-dynamics-in-the-control-of-upright-standing

Global study shows brain damage from stroke can be minimised

Maybe this might become an objective way to measure damage.
http://www.healthcanal.com/brain-nerves/31529-Global-study-shows-brain-damage-from-stroke-can-minimised.html 

A new study from The University of Queensland shows monitoring the brain of stroke patients using Quantitative EEG (QEEG) studies could inform treatments and therefore, minimising brain damage of stroke victims.
EEG stands for electroencephalogram and is a medical test which is used to measure the electrical activity of the brain.

Dr Simon Finnigan from UQ's Centre for Clinical Research and Professor Michel van Putten from Medisch Spectr`um Hospital and University of Twente in the Netherlands, recently reviewed all published QEEG studies of stroke worldwide.

“The main goals of this research were to evaluate key findings, identify common trends and determine what the future priorities should be, both for research and for translating this to best inform clinical management of stroke patients,” Dr Finnigan said.

“Our studies have real potential to eventually contribute to better outcomes for stroke patients and for me this is the ultimate goal,” he said.

The review of outcomes from hundreds of patients has highlighted that QEEG indicators are particularly informative in two ways.

“Firstly they can help predict long-term deficits caused by stroke,” Dr Finnigan said.

“In addition, they could provide immediate information on how patients are responding to treatments and guide decisions about follow-on treatments, even before stroke symptoms change,” he said.

Currently, tissue plasminogen activator (TPA), a drug which can dissolve blood clots, is administered intravenously to stroke patients within 4.5 hours after the onset of symptoms and clinicians wait for visual signs that symptoms are improving.

If this doesn't occur after approximately one hour, follow-on treatments may be used.

“This is where QEEG could indicate whether or not the brain is responding to the drug. Plus, it could do so up to an hour before the symptoms might improve," Dr Finnigan said.

"This is a critical difference when “time is brain” and clinicians are trying to get blood back into the brain before it's too late. If QEEG can enable clinicians to start other treatments faster, this could help minimise brain damage and deficits," he said.

Dr Finnigan is working with neurologists, Dr Wong, Dr Read and Dr Sheikh and other clinicians at the Royal Brisbane and Women's Hospital (RBWH).

A Neuroplasticity (Brain Plasticity) Approach to Use in Artificial Neural Network

Only 9 pages for you to ask your researcher about and compare to your brain after stroke. 

A Neuroplasticity (Brain Plasticity) Approach to Use in Artificial Neural Network

Egg yolk consumption almost as bad as smoking when it comes to atherosclerosis

You will need to ask your doctor if your consumption of
Watermelon juice reverses hardening of the arteries is enough to reverse the egg yolks. 

Egg yolk consumption almost as bad as smoking when it comes to atherosclerosis 

Read this bloggers takedown of the science behind the report;
  http://www.sciencebasedmedicine.org/index.php/eggs-and-atherosclerosis/
Another criticism of the report;
 http://www.livestrong.com/blog/do-eggs-cause-heart-disease/?utm_source=newsletter&utm_medium=email&utm_campaign=08222012
A defense of the report here;
 http://www.theheart.org/article/1436479.do?utm_medium=email&utm_source=20120903_TopTen&utm_campaign=newsletter

LENS Neurofeedback offers hope to victims of stroke, brain trauma, and other conditions

I do wonder how documented the research is on the usefulness of this.
http://www.redwoodtimes.com/garbervillenews/ci_21304600

LENS neurofeedback provider Melissa Wessel drives from Windsor in Sonoma County to Humboldt County every other week to see her local clients, who include people recovering from brain damage, stroke, and a variety of neurological conditions, including post-traumatic stress disorder, attention deficit disorder, autism, anxiety, and depression.
LENS, which stands for "Low Energy Neurofeedback System," uses a low-powered electromagnetic field to carry feedback from specific sites on a client’s brain. This feedback, which is slightly different than the signal sent from the brain, "gently nudges" an injured or disordered brain toward better function.
The history of LENS began about 40 years ago when the public first became aware of biofeedback as a treatment for a variety of conditions including stress, depression, anxiety, and pain.
"If you remember, with biofeedback you would be hooked up with something on your hand or arm, and you would work at changing your body temperature or your heart rate, and you would learn how to control your body and your biological functions," Wessel recalled.
With neurofeedback, which was originally called "brain entrainment," the client was connected to a computer that read his or her brainwaves. The client then played a game, such as driving a virtual car down a road on the computer screen, using only feedback from his or her brain.
The brain produces several kinds of waves, including alpha waves, beta waves, and delta waves. In different illnesses or conditions, one or more categories of waves originating from various parts of the brain can be hyperactive or hypersuppressed, causing the client’s symptoms.
Rest at the link.

Climbing as post-stroke therapy

I could just see the mountains of lawyer release papers to get your therapists to take you to a climbing wall. And then you would have to be extremely high functional both prior to and after the stroke. I would suggest that these persons would recover well regardless of the therapy supplied. And the only way to prove that would be to get a detailed scan of their damage- dead brain and penumbra. I would bet that this therapist uses this as a warmup for his climbing exploits more than for the suggested stroke rehab usefulness. And when you peel off the wall you can tear your plaque due to the sudden stop at the end.
http://www.mb.com.ph/articles/369526/climbing-poststroke-therapy
  The grips and footholds of climbing can help patients recover more quickly from a stroke in which one side of the body has suffered paralysis.
Therapy based on climbing may also help multiple sclerosis sufferers retain control over their muscles, as climbing demands coordination of movement and concentration, Ute Repschlaeger of the association of German physiotherapists says.
Studies have provided evidence of positive effects, and neurologists believe that the exercises stimulate the brain to activate dormant cells and replace diseased cells. This kind of therapeutic climbing has little in common with the sport. The point is not to climb as high as possible, but to do the grips and footholds at a low level.

The Power of Positive Thinking

Another reason not to listen to your negative therapists and doctors about your recovery prospects. Remember the nocebo effect?


http://www.naturaltherapypages.com.au/article/the_power_of_positive_thinking
A couple paragraphs here, rest at the link.

What Is Positive Thinking?

Critics of the power of positive thinking often say it is a naive world view that refuses to look at the facts. "Life is hard and then you die" is their motto. Psychologists and others who have studied the subject in depth disagree. Truly positive thinkers, far from hiding their heads in the sand, face life's challenges head-on because they are able to learn and grow from negative experiences and take advantage of existing opportunities. An emerging field of psychology, positive psychology, takes a scientific approach to the power of positive thinking and has come up with some surprising revelations:

• Happiness is the cause of positive outcomes in life, not the result.
  

• Happy people tend to have deep religious or spiritual beliefs.
  

• Wealth does not bring happiness, but using one's wealth to benefit others does contribute to personal happiness.
  

• Altruism is a surer road to happiness than hedonism.
  

• Happiness (or positive thinking) is a "skill" that can be learned.

Read more: http://www.naturaltherapypages.com.au/article/the_power_of_positive_thinking#ixzz23MbdTKqK

New Device Makes Runners Lighter on Their Feet

While I don't think your therapist will be using this to get you running, the idea of body weight supported therapy is standard and this might  be cheaper and more applicable for your own gym use. Ask your doctor and therapist for how this might be useful for you.
See the picture and article at the link.
http://pttalker.com/2012/08/new-device-makes-runners-lighter-on-their-feet/

Home kit to help stroke patients

Another down under breakthrough, must be the Coriolis effect. They spin those brain cells in a more cerebral direction.
I've always thought that mechanistically opening and closing the fingers thousands of times a day would defeat spasticity and jumpstart the ability to control your fingers correctly.
http://www.stuff.co.nz/national/health/7458365/Home-kit-to-help-stroke-patients/

Stroke patients may soon be able to rehabilitate themselves from home thanks to the invention of a Wellington engineering student.
Victoria University masters student Abigail Rajendran, 23, has designed a stroke rehabilitation device and has a company working to patent and sell it.
Her device straps on to a person's hand to exercise it in an opening and closing motion, while a connected computer game activates and keeps both sides of the brain engaged.
Once the person regains the strength to do the motion themselves, they can increase the resistance from a special liquid in the device also used in Audi car suspensions.
Until now, stroke patients relied on expensive and large rehabilitation equipment available only in hospitals. But this new device would be something they could use regularly at home, Miss Rajendran said.
Im-Able, a New Zealand company specialising in stroke rehabilitation, saw the device's potential and got funding from the Science and Innovation Ministry so Miss Rajendran could develop a prototype.
Chief executive Sunil Vather said there were few, if any, home rehabilitation instruments available for people recovering from strokes.
"It's definitely innovative. The key issue is you have got technology but if it's not accessible to the people who need it you tend to lack a large chunk of the value for it."
New Zealand stroke patients would be lucky to get one or two hours of therapy time with a nurse a week, when it should be about 16 hours, he said.
Miss Rajendran said meeting with stroke victims had made it a lot more real.
"They want to start using it, to start getting better."
The tool was her "baby" that she would be glad to see made a reality.
Since being lured into engineering by a robot at a Victoria University open day, she aimed to build life-changing products rather than gadgets that were "cool".
"I guess it's building devices that are actually useful and necessary. The whole helping people out aspect of it."
One of Miss Rajendran's university supervisors, Dr Will Browne, was impressed by her infectious enthusiasm for creating practical applications.
"Her research into developing a stroke rehabilitation device has the potential to make a significant improvement to the lives of people affected by stroke."
Miss Rajendran will present her idea in Singapore later this month, and in Brisbane in October.

Mr Vather hoped the final product would be completed in about a year.

Risk of Falls and Major Bleeds in Patients on Oral Anticoagulation Therapy

You'll really have to see if your doctor agrees with this research. I know when I got a weekend pass after one month in the hospital, I mentioned to a nurse that I was going to watch a whitewater slalom race requiring walking down a rocky path to the waters edge. I later was visited by the doctor who very strongly forbade me to go because of the risk of falling and resulting bleeding. I ignored them and had a great time.
http://amjmed.blogspot.com/2012/08/risk-of-falls-and-major-bleeds-in.html
In this prospective cohort, patients, who were on oral anticoagulants and who had a high risk of falling, did not have a significantly increased risk of major bleeds. These findings suggest that falling risk is not a valid reason to avoid oral anticoagulants.


Abstract 


Background The risk of falls is the most commonly cited reason for not providing oral anticoagulation, although the risk of bleeding associated with falls on oral anticoagulants is still debated. We aimed to evaluate whether patients on oral anticoagulation with high falls risk have an increased risk of major bleeding.

Methods We prospectively studied consecutive adult medical patients who were discharged on oral anticoagulants. The outcome was the time to a first major bleed within a 12-month follow-up period adjusted for age, sex, alcohol abuse, number of drugs, concomitant treatment with antiplatelet agents, and history of stroke or transient ischemic attack.

Results Among the 515 enrolled patients, 35 patients had a first major bleed during follow-up (incidence rate: 7.5 per 100 patient-years). Overall, 308 patients (59.8%) were at high risk of falls, and these patients had a nonsignificantly higher crude incidence rate of major bleeding than patients at low risk of falls (8.0 vs 6.8 per 100 patient-years, P=.64). In multivariate analysis, a high falls risk was not statistically significantly associated with the risk of a major bleed (hazard ratio 1.09; 95% confidence interval, 0.54-2.21). Overall, only 3 major bleeds occurred directly after a fall (incidence rate: 0.6 per 100 patient-years).

Conclusions In this prospective cohort, patients on oral anticoagulants at high risk of falls did not have a significantly increased risk of major bleeds. These findings suggest that being at risk of falls is not a valid reason to avoid oral anticoagulants in medical patients.

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