How Your Brain Circuits Become Miswired

Our researchers should be able to follow this research to figure out how to guide axons around dead areas to reconnect up the various parts of the brain. It might be challenging to do but no more challenging than recovering from a stroke. And they have full use of their brains. No excuses allowed.
http://psychcentral.com/news/2013/06/08/how-your-brain-circuits-become-miswired/55790.html
How do the faulty brain circuits involved in mental disorders such as autism or retardation develop? Researchers at Weill Cornell Medical College have helped light the way to an answer with the discovery of a mechanism that guides the wiring of neural circuits in a developing brain.
The researchers discovered that faulty wiring occurs when RNA molecules embedded in a growing axon are not degraded after they give instructions that help steer the nerve cell.
For example, the signal that tells the axon to turn — which should disappear after the turn is made — remains active, interfering with new signals meant to guide the axon in other directions.
“Understanding the basis of brain miswiring can help scientists come up with new therapies and strategies to correct the problem,” said the study’s senior author, Samie Jaffrey, M.D., Ph.D.
“The brain is quite plastic and changeable in the very young, and if we know why circuits are miswired, it may be possible to correct those pathways, allowing the brain to build new, functional wiring.”
Disorders associated with faulty neuronal circuits include epilepsy, autism, schizophrenia, mental retardation and spasticity and movement disorders, he noted.
During brain development, neurons have to connect to each other, which they do by extending their long axons to touch one another, the researchers explain. Ultimately, the neurons form a circuit between the brain and the target tissue through which chemical and electrical signals are relayed.
In the new study, researchers looked at neurons that travel up the spinal cord into the brain.
“It is very critical that axons are precisely positioned in the spinal cord,” Jaffrey said. “If they are improperly positioned, they will form the wrong connections, which can lead to signals being sent to the wrong target cells in the brain.”
The way that an axon guides and finds its proper target is through “growth cones” located at the tips of axons, he said.
“These growth cones have the ability to sense the environment, determine where the targets are and navigate toward them,” he continued. “The question has always been — how do they know how to do this? Where do the instructions come from that tell them how to find their proper target?”
The researchers found that RNA molecules embedded in the growth cone are responsible for instructing the axon to move left or right, up or down. These RNAs produce antenna-like proteins that steer the axon like a self-guided missile.
“As a circuit is being built, RNAs in the neuron’s growth cones are mostly silent,” he explained. “We found that specific RNAs are only read at precise stages in order to produce the right protein needed to steer the axon at the right time. After the protein is produced, we saw that the RNA instruction is degraded and disappears.”
“If these RNAs do not disappear when they should, the axon does not position itself properly — it may go right instead of left — and the wiring will be incorrect and the circuit may be faulty,” he continued.
The researchers didn’t anticipate that the control of brain wiring is located in these RNA molecules that are “constantly being dynamically turned over,” Jaffrey said.
“This tells us that regulating these RNA degradation pathways could have a tremendous impact on brain development,” he said. “Now we know where to look to tease apart this process when it goes awry, and to think about how we can repair it.”
The study was published in the journal Cell.

Drug found to reduce damage caused by heart attack and stroke

But, but, have they accounted for the fact that mouse inflammation is not the same as human inflammation? 

Drug found to reduce damage caused by heart attack and stroke

Research has found that a new drug can reduce the damage that heart attacks and strokes cause to the body.
Scientists at the Medical Research Council Mitochondrial Biology Unit inside Cambridge University found that a drug known as MitoSNO could repair tissue that has been starved of oxygen when running tests on mice.
After a heart attack, tissue can be damaged when blood flow is suddenly restored after a period without air.
Researchers believe MitoSNO has the power to turn off harmful molecules known as free radicals, which are produced during this process.
"MitoSNO effectively flicks a switch in the mitochondria, slowing down reactivation during those critical first minutes when blood flow returns and protecting the heart tissue from further damage," Dr Mike Murphy, who led the study, said.
He added that trials will need to be conducted on humans before anything conclusive can be stated, but if successful the drugs could be used in other areas of treatment.

tPA for Stroke - The Story of a Controversial Drug

This book lays out how one person can push something to success.
I was really disappointed that there was no acknowledgement at the end that tPA does not stop the neuronal cascade of death  in lots of cases. There was no call to continue research to find a follow on drug  that does that.

Build your Cog­ni­tive Reserve: Inter­view with Yaakov Stern

I think I blew most of my reserve on my stroke. I need to rebuild it for the higher chance of getting dementia.
http://sharpbrains.com/blog/2007/07/23/build-your-cognitive-reserve-yaakov-stern/

"Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has."

From Margaret Mead. We have to change the stroke world.  The existing leaders have completely failed us for the past 20 years. Your doctors have failed you, stop putting them on a pedestal. Every time you talk to a therapist/doctor ask them when stroke recovery will be standard and what it will take to get there.

High-intensity cycling exercise after a stroke: a single case study

From 2000, have any of you ever had high-intensity exercise that your therapist pushed?
High-intensity cycling exercise after a stroke: a single case study

Abstract

Aerobic exercise training has demonstrated positive effects after brain injury. However, therapists express concern regarding the use of effortful exercise in individuals presenting with spasticity or involuntary muscle activity. This study aimed to address this concern and to evaluate whether an intervention of maximal intensity cycling exercise impaired an individual's ability to actively extend his hemiparetic elbow. Using a single case design, it was shown that active elbow extension improved during the period of this investigation, and was not impaired immediately following maximal cycling exercise.

Coalition aims to put patients in charge of cancer research

We absolutely need this for stroke. I have proven numerous times that researchers do not know what has gone on before in their field.
Excuses will be made by the medical stroke world but lets kick their useless asses out.
Campaign to prove value of cancer innovation kicks off

Day 1 - canoeing therapy

After the 208 rod(1046 meters, .65 miles) portage down to Little Gabbro lake. We packed the canoe with me sitting on top of a pack in the center of the canoe. Way too top heavy and embarked on 10 minutes of terror until we landed on Safety Island in 50 yards where I got into a kneeling position. We unsuccessfully attempted to run up the class I rapid from Gabbro to Little Gabbro. The Minnesota II Wenonah canoe is not meant to run rivers. We had looked at the map wrong and then embarked on the circumnavigation of the eastern bays. Two hours later after 3 deadends in swamps we realized that the rapids needed to be navigated since that was the approach to Gabbro Lake. I insisted on going up the right eddy and lining the canoe up(self-preservation and all). The campsite we wanted was occupied so we continued down the lake and found a wonderful sloping rock with improved kitchen area.

Day 0 - canoeing therapy

Came up a day early to stay with friends in Duluth, MN and walk 2 miles along Lake Superior to downtown. Got to relate college war stories of canoeing to his adult son, damn lucky I'm alive.

Day 2 - canoeing therapy

Lots of coffee and a leisurely egg breakfast we decided to explore the east end of the lake. I kneeled in the empty canoe, similar to my paddling position in my C1, except that the C1 at least had a 6 inch high seat. After only a half hour my ankles were useless, and getting me out of the canoe required both friends to haul on my arms and step out, trying to stay upright while my ankles recovered.  I waited on an island in the rain while they fished. We lunched on the island, three canoes passed by, the last one asked about camping and we replied that we were just there for lunch. They called the first 2 canoes back and gladly claimed the campsite. One guy was so thankful he gave us a Iowa Hawkeye hipflask of bourbon The half hour paddle back to camp was against a headwind. And a crawl into the tent and a 2 hour nap was needed to refresh ourselves, bourbon was liberally applied as medicine.

The Dagger Atom C1 in action, I used to paddle one of these, never got very good at it.

This is pretty close to the coloring I had

This is pretty close to the coloring I had

A gradient of childhood self-control predicts health, wealth, and public safety

This probably follows the research that should have occurred that points to better recoveries.
http://www.pnas.org/content/108/7/2693.short

Abstract

Policy-makers are considering large-scale programs aimed at self-control to improve citizens’ health and wealth and reduce crime. Experimental and economic studies suggest such programs could reap benefits. Yet, is self-control important for the health, wealth, and public safety of the population? Following a cohort of 1,000 children from birth to the age of 32 y, we show that childhood self-control predicts physical health, substance dependence, personal finances, and criminal offending outcomes, following a gradient of self-control. Effects of children's self-control could be disentangled from their intelligence and social class as well as from mistakes they made as adolescents. In another cohort of 500 sibling-pairs, the sibling with lower self-control had poorer outcomes, despite shared family background. Interventions addressing self-control might reduce a panoply of societal costs, save taxpayers money, and promote prosperity.

Doctor Dementia to test your skills

A forwarded email that was fun.

I've  seen this with the letters out of order, but this  is the first time I've seen it with numbers. Good  example of a Brain Study: If you can read this OUT LOUD,  you have a strong mind. And better than that:

Alzheimer's is a long long, way down the road before it ever gets anywhere near you.

7H15      M3554G3

53RV35      7O PR0V3

H0W      0UR M1ND5 C4N

D0      4M4Z1NG 7H1NG5!

1MPR3551V3      7H1NG5!

1N      7H3 B3G1NN1NG

17      WA5 H4RD BU7

N0W,      0N 7H15 LIN3

Y0UR      M1ND 1S

R34D1NG      17

4U70M471C4LLY

W17H      0U7 3V3N

7H1NK1NG      4B0U7 17,

B3      PROUD! 0NLY

C3R741N      P30PL3 C4N

R3AD      7H15.

PL3453      F0RW4RD 1F

U      C4N R34D 7H15.

To my 'selected' strange-minded friends: If you can read the following paragraph, forward it on to  your friends with 'yes' in the subject line. Only great minds can read this. This is weird, but interesting!

If you can read this, you have a strange mind, too.

Can you read this? Only 55 people out of 100  can.

I cdnuolt  blveiee  that I cluod aulaclty uesdnatnrd what I  was rdanieg. The phaonmneal pweor of   the hmuan  mnid, aoccdrnig to a rscheearch at Cmabrigde Uinervtisy, it  dseno't  mtaetr in what oerdr the ltteres in a word are, the olny iproamtnt  tihng is that the frsit and last ltteer be in the rghit pclae. The rset  can  be a taotl mses and you can still raed it  whotuit a pboerlm. This is  bcuseae the huamn mnid deos not raed ervey  lteter by istlef, but the word as  a wlohe.  Azanmig  huh?  Yaeh and I awlyas tghuhot slpeling was ipmorantt!

If  you can raed  this frowrad it. 

I passed, yeah

Ireland’s improving stroke care services

But its not good enough. You will need to force improvements by having them focus on measuring results rather than processes. They seem to think delivering tPA is the answer to stroke recovery. Its not, something better needs to be found that stops the neuronal cascade of death.
So contact them and give them the ideas on these 177 hyperacute therapies.
http://www.imt.ie/features-opinion/2013/06/irelands-improving-stroke-care-services.html
The 2010 Cost of Stroke Care in Ireland study estimated that approximately €5 million could be saved annually through the provision of stroke unit care to 95 per cent of admitted patients.
Up to 10,000 people in Ireland suffer a stroke every year and 2,000 people die from stroke annually, and up until the past couple of years, Ireland’s services for these patients were inadequate and piecemeal.
However, it has been widely acknowledged that one of the HSE’s most successful clinical care programmes to date is the National Stroke Programme, which since its launch in 2010 has led to a dramatic improvement in the level of specialised stroke care for patients and has seen Ireland go from being one of the worst countries in the world for successful thrombolysis to one of the best in the space of three years.
The over-arching key aims of the Programme are to: ensure national, rapid access to best-quality stroke services; prevent stroke, disability, and the death of one patient per day (370 per year); and spend existing funds better and reduce costs.
This is being achieved through a number of major service changes and upgrades to allow national 24/7 access to safe stroke thrombolysis, while stroke units have now been developed in all hospitals accepting stroke patients. These units include rapid transient ischaemic attack (TIA) assessment and early supported discharge programmes.
Significant progress has been made on the necessary changes to allow this, though there has been some criticism that not all the stroke units are adequately staffed or have their facilities ring-fenced and a number of posts still have to be filled.
While full national 24/7 thrombolysis cover is still a work in progress, it is now available in all Model 3 and Model 4 hospitals, either directly or via bypass protocols. The percentage of stroke patients who receive thrombolysis has increased from a baseline of 2.4 per cent to 9.5 per cent, and this was achieved ahead of the HSE’s delivery target. The Programme has also created a detailed bundle of evidence-based best practice care guidelines and protocols for the units and involved healthcare staff and ambulance services.
Telemedicine
One of the key parts of ensuring 24/7 thrombolysis access to patients across the country has been the development of the telemedicine stroke project — Telemedicine Rapid Access for Stroke and Neurological Assessment (TRASNA).
A TRASNA network is planned to link the smaller sites to the bigger centres and enables the provision of thrombolysis to all eligible stroke patients nationally under the supervision of a stroke physician. This development means Ireland will be the first country internationally to have a single integrated telemedicine service for stroke, and while it was due to be fully in place by the end of last year, its rollout has been delayed.
Director of Stroke Services in Tallaght Hospital Dr Ronan Collins helped spearhead the first telemedicine stroke pilot project in Ireland. In  2008 the project was awarded €250,000 of HSE Innovation Funding to finance the purchase of Remote Presence Solution (RP7) robots, which allowed doctors from a remote location to conduct video consultations and communicate with patients and staff and supervise thrombolysis for suitable patients.
The ‘robo-docs’ were originally trialled in Tallaght and, after well-publicised success, then extended to the Dublin Mid-Leinster network to incorporate Naas and Mullingar initially, with patients from as far as Tullamore and Portlaoise being able to avail of this service.
“Of those presenting with stroke out-of-hours in the Mid-Leinster network, about one-in-3.5 would be thrombolysed, which is a very high rate in comparison to one-in-five in most centres.
“One of the reasons for this is, firstly, what I’ve found in out-of-hours is that patients are more likely to present with a genuine stroke, and, secondly, they tend to present faster when coming in out-of-hours, as many daytime presenters would have gone to bed the night before not realising they would have had a stroke [and therefore are too late for thrombolysis],” Dr Collins told IMT.
“It marks a great step forward. This telemedicine technology is not only significant for stroke, but allows physicians to make accurate diagnoses in a range of other specialities. The great thing about the particular system we have set up is the flexibility it allows in diagnosing patients,” he commented.
While the initiative has been a great step forward for patients and was pushed for strongly by stroke consultants, it has meant adding to their heavy workload. Dr Collins’s network spent the first two years on a one-in-four rota, which was essentially a one-in-two rota during the summertime, to man the service to cover Tallaght and Naas. The telemedicine pilot project treated more than 230 patients up until the end of last October.
“We took this on without any ask that we take it on, and we have delivered on it and provided the information from it, which allowed proof of concept for the development of the national tender. There was a huge amount of extra work and personal sacrifice for those involved in the project and we didn’t ask for extra pay. Sometimes I think that Minister [for Health Dr James] Reilly forgets that all the new initiatives in health don’t come about because the Department of Health has dreamt them up, they come because we go to conferences and find out about them and think ‘yes, that’s a good idea, we should trial that and see if it would work’,” he told IMT.
The stroke telemedicine service finally went to national tender in 2011 and was to be put in place by the end of 2012. However, like so many HSE projects, it has not been without frustrating delays. IMT understands there have been difficulties linking-up the different radiology systems in the participating hospitals to the chosen telemedicine system, but it is hoped it will be fully in place in the coming months and the old system is still in operation in the pilot network.
Dr Collins said while the replacement technology sought under the national tender meant a number of challenges, as did the outdated ICT systems in Irish hospitals, he felt the HSE’s data concerns were a little excessive.
“I think the encryption they [HSE] were looking for was twice what the CIA and FBI look for. It would be the top encryption that you can get but that doesn’t mean it would be practical,” he commented.
Stroke Register
Another key aspect of the stroke programme is the National Stroke Register, which is being run off the HSE’s HIPE data system.
The primary aim of the National Stroke Register is the collection of key data items to provide information on the quality of care for individual patients with stroke and TIA admitted to Irish hospitals, in order to identify areas where improvements in quality of care should be prioritised. As of the end of January, the Register was operational in 25 acute hospitals, with the goal of including the remaining acute stroke hospitals by the end of this year. Data-wise, at the end of 2012 there were data entered for approximately 2,600 stroke and TIA patients.
To date, there has been wide variation in coverage across stroke subtypes, compared to HIPE principal diagnosis and wide variations across hospitals using the Register, with some incomplete data capture, so it is very much still a work in progress. The Steering Group has agreed several key changes to the Register for 2013, including that it is no longer mandatory to enter data on patients with subarachnoid haemorrhage and TIA into the Register.
“To finally have a fully operational National Stroke Register will be great, as we will for the first time be able to nationally produce figures on outcomes, access to care and quality of care. There will of course be comparisons on the units but I think what is important is assuring people on the standards of stroke care in general across the system that it is good and that it is comparable nationally, and that they should be reassured that stroke is moving in the right direction,” Dr Collins commented, adding that he is now confident that Ireland is finally giving stroke patients the care they deserve.
“In fact, I would say that the stroke care here in Tallaght and most of the other units is better than the stroke care in England… The stroke programme is going really well and you have great initiatives. The leads are to be congratulated — they’ve done a lot of good work, though there is still a lot left to do,” he concluded.

Apoptosis, not so quiet after all

A wonderful explanation of apoptosis. Our doctors should be following this to see how this process contributes to the neuronal cascade of death. Ask them.
Apoptosis, not so quiet after all

Achieving the Potential of Health Care Performance Measures

An analysis of pay for performance.
Their first recommendation directly impacts our stroke world.
1. Decisively move from measuring processes to outcomes.
 This means all those feel good press releases from hospitals that they are gold standard in meeting Joint Commission certification would need to completely change.
Mine would be complete recovery from stroke as a percentage of admitted patients.
 http://www.rwjf.org/en/research-publications/find-rwjf-research/2013/05/achieving-the-potential-of-health-care-performance-measures.html?cid=xem_hcpm5-21-13A&cid
Because right now Joint Commission certification is  almost worthless.
A bloggers take on this;
Finally an important policy paper against P4P 
I disagree, P4P can only help us in the stroke world. 

Cezanne Paints Inflammation by Regulating Ubiquitination

Your doctor can translate and give you a stroke protocol to stop inflammation during the hyperacute phase. And if you believe that, there is a Brooklyn bridge for sale.
The short version here;
 http://circres.ahajournals.org/content/112/12/1526.extract.html?etoc

Hypoxia–reoxygenation can induce inflammation by activating nuclear factor (NF)-κB. In endothelial cells, this process is critical for the pathogenesis of many chronic inflammatory conditions, such as atherosclerosis and autoimmune disease. Recent publication from Evans’s laboratory shows the critical role of deubiquitinating enzyme Cezanne, regulating its extent of NF-κB activation and expression of inflammatory genes.¹ In particular, they showed that the inhibition of polyubiquitination of TNF receptor associated factor (TRAF) 6 is a specific anti-inflammatory mechanism by Cezanne. In this editorial, we briefly review the TRAF6-mediated NF-κB signaling and other posttranslational modifications that play a key role in modulating endothelial cell inflammation.

Article, see p 1583

NF-κB transcription factor complexes consist of a heterodimer of p65 (RelA) and p50 or p52.² In most nonstimulated cells, p65-containing NF-κB complexes are kept in an inactive cytoplasmic form, bound to one family of inhibitor proteins, the inhibitory κBs (IκBs). Two IκB kinases, IKKα and IKKβ, target phosphorylation of IκB after hypoxia–reoxygenation, cytokine, or ultraviolet stress stimulation. Phosphorylation of IκBs promotes their ubiquitination and degradation by the proteasome, which releases the p65 complex, allowing it to translocate to the nucleus.³ An ubiquitin E2 conjugating enzyme of the ubiquitin-conjugating enzyme (Ubc)4/5 family and the SCF-βTrCP E3 ligase (Skp1-Cul1-F-box ligase containing the F-box beta protein βTrCP) execute ubiquitination of IκB. Once IκB is phosphorylated, p-transducin repeat containing protein 1 (βTrCP1) and βTrCP2 associate with phosphorylated IκB.^4,5 The polyubiquitinated IκB is selectively degraded by the 26S proteasome, and then mature p52 and
Full story here;
http://circres.ahajournals.org/content/112/12/1526.full

SPS3: Systolic BP <130 beneficial in lacunar stroke

Check with your hospital and see when they plan to implement. You do want them to save neurons, don't you?
http://www.theheart.org/article/1547245.do?utm_medium=email&utm_source=20130606_heartwire&utm_campaign=newsletter
Lowering systolic blood pressure to <130 mm Hg in patients with recent lacunar stroke is likely to be beneficial, results from the Secondary Prevention of Small Subcortical Strokes (SPS3) trial show [1].

Although the primary end point was not quite significant, it did suggest a reduction in stroke in the lower-BP group. In addition, the secondary end point of hemorrhagic stroke was significantly reduced.

"Our results are consistent with previous trials of blood-pressure lowering after stroke and support a treatment target of less than 130 mm Hg systolic for most patients with recent lacunar stroke," commented lead investigator Dr Oscar R Benavente (University of British Columbia, Vancouver).

Their findings were presented here at the European Stroke Conference 2013 on May 29, 2013 and published simultaneously online in the Lancet. Preliminary results of the blood-pressure-lowering arm of SPS3 were presented earlier this year at the International Stroke Conference 2013 in February and reported at that time.

A second arm of the trial, published previously in the New England Journal of Medicine, looked at antiplatelet regimens and showed no benefit from combined aspirin and clopidogrel over aspirin alone in this same population

Statins linked with risk of musculoskeletal injury

Be careful, especially if you are prescribed statins at a young age.
http://www.theheart.org/article/1547459.do?utm_medium=email&utm_source=20130606_heartwire&utm_campaign=newsletter
The use of statins appears to be associated with an increased risk of musculoskeletal injuries, including an increased risk of dislocations, strains, and sprains, according to a new analysis [1]. Researchers suggest the full range of musculoskeletal adverse events might not be fully known and that further studies are needed, especially in active individuals.

"These findings are concerning because starting statin therapy at a young age for primary prevention of cardiovascular diseases has been widely advocated," report Dr Ishak Mansi (VA North Texas Health Care System, Dallas) and colleagues in a paper published online June 3, 2013 in the Journal of the American Medical Association: Internal Medicine. "Moreover, the numbers needed to be exposed for one additional person to be harmed were 37 to 58 individuals for various outcomes."

The study included 6967 statin users propensity-matched with 6967 nonusers. Of the statin users, the majority was treated with simvastatin (73.5%) and approximately one-third had been prescribed maximum doses of the drugs, including simvastatin 80 mg, atorvastatin 80 mg, or rosuvastatin (Crestor, AstraZeneca) 40 mg. Simvastatin 80 mg is currently restricted on the US market because of concerns about muscle damage.

In the propensity-matched analysis, treatment with a statin was associated with a 19% increased risk of any type of musculoskeletal injury (p<0.001), a 13% increased risk of dislocations, strains, and sprains (p=0.001), and a 9% increased risk of musculoskeletal pain (p=0.02). There was a trend toward a 7% higher risk of osteoarthritis/arthropathies, but the association was not statistically significant in the propensity-matched analysis. There was an increased risk of osteoarthritis/arthropathies in two analyses that first adjusted for and then excluded patients with comorbidities at baseline.

In contrast, researchers observed no association between the number of years an individual took simvastatin and the risk of musculoskeletal injuries.

The group says that musculoskeletal adverse events with statins may represent a lesser known side effect of the drug class and should be studied further, especially in individuals who continue to be physically active. A better understanding of the full risks of statins will also "provide more complete data for cost/benefit and cost-effectiveness analyses of statin use," write Mansi et al.

Is Impaired Control of Reactive Stepping Related to Falls During Inpatient Stroke Rehabilitation?

Even though I never fell while an inpatient I would speculate that the inability to move my impaired arm enough to react to a fall would be a proximate cause. But I know nothing medical.
http://nnr.sagepub.com/content/27/6/526.abstract?etoc

Abstract

Background. Individuals with stroke fall more often than age-matched controls. Although many focus on the multifactorial nature of falls, the fundamental problem is likely the ability for an individual to generate reactions to recover from a loss of balance. Stepping reactions to recover balance are particularly important to balance recovery, and individuals with stroke have difficulty executing these responses to prevent a fall following a loss of balance. Objective. The purpose of this study is to determine if characteristics of balance recovery steps are related to falls during inpatient stroke rehabilitation. Methods. We conducted a retrospective review of individuals with stroke attending inpatient rehabilitation (n = 136). Details of falls experienced during inpatient rehabilitation were obtained from incident reports, nursing notes, and patient interviews. Stepping reactions were evoked using a “release-from-lean” postural perturbation. Poisson regression was used to determine characteristics of stepping reactions that were related to increased fall frequency relative to length of stay. Results. In all, 20 individuals experienced 29 falls during inpatient rehabilitation. The characteristics of stepping reactions significantly related to increased fall rates were increased frequency of external assistance to prevent a fall to the floor, increased frequency of no-step responses, increased frequency of step responses with inadequate foot clearance, and delayed time to initiate stepping responses. Conclusions. Impaired control of balance recovery steps is related to increased fall rates during inpatient stroke rehabilitation. This study informs the specific features of stepping reactions that can be targeted with physiotherapy intervention during inpatient rehabilitation to improve dynamic stability control and potentially prevent falls

Somatosensory-Related Limitations for Bimanual Coordination After Stroke

You'll have to ask your therapist for translation and a stroke protocol.
http://nnr.sagepub.com/content/27/6/507.abstract?etoc

Abstract

Background. Bimanual coordinated movements may be impaired after stroke, so an assessment of causes is necessary to optimize rehabilitation strategies.  
Objective. We assessed the role of afference-based sources of coordination, including phase entrainment and error correction based on visual and somatosensory feedback.  
Methods. In all, 10 persons with unilateral chronic stroke and 8 age-matched controls participated in a kinesthetic tracking protocol, in which the hemiparetic upper limb was passively driven by the machine. The task consisted of matching the trajectory of the driven limb as accurately as possible with the freely moving limb in 2 conditions: eyes closed and eyes open. We analyzed the continuous relative phase (CRP), the mean absolute difference between positions (ADP) between the positions of the 2 limbs, and the jerk of the matching limb.  
Results. Coordination instability (CRP standard deviation) and mean ADP were significantly higher for patients with eyes closed, compared with patients with eyes open, controls with eyes closed, and controls with eyes open. Moreover, the jerk was higher for the nonparetic limb of patients than for the control group. Thus, the nonparetic limb did not produce optimally smooth movements even as the motor-driven paretic limb did.  
Conclusion. Besides deficits caused by interhemispheric competition and motor execution of the paretic limb, somatosensory feedback is a limiting factor in bimanual coordination after stroke. The findings have clinical implications pertaining to the design and individualization of efficient bimanual movement therapy.

Catechol-O-Methyltransferase Polymorphism Influences Outcome After Ischemic Stroke

No clue here.
http://nnr.sagepub.com/content/27/6/491.abstract?etoc

Abstract

Background. To explore whether a polymorphism in dopamine metabolism influences the effectiveness of neurological rehabilitation and the outcome after ischemic stroke. Methods. The Barthel Index (BI) and the Rivermead Motor Assessment (RMA) were assessed in 78 moderately affected stroke patients (1) after they had entered a neurological inpatient rehabilitation, (2) after 4 weeks of rehabilitation therapy, and (3) 6 months later. Polymorphisms of the gene encoding catechol-O-methyltransferase (COMT) were determined. BI and RMA results were analyzed with respect to the genetic profiles of COMT. Results. Carriers of COMT Val/Val alleles showed better results in BI and RMA than COMT Met/Met carriers at all 3 time points. Val/Met carriers exhibited results in between the homozygotes, suggesting a gene–dose relationship. Altogether, BI and RMA results were highly correlated. Conclusion. Stroke patients with COMT Val/Val alleles had higher motor functions and abilities of activities of daily living even at the beginning of the rehabilitation period. All patient groups improved during the rehabilitation period to a similar degree, suggesting that physical therapy is comparably effective in all polymorphism subtypes.

Home-Based Nerve Stimulation to Enhance Effects of Motor Training in Patients in the Chronic Phase After Stroke

This sounds exactly like what Margaret Yekutiel wrote in the book Sensory Re-Education of the Hand after Stroke in 2001. They make it sound like a wonderful discovery. Wonderful stupidity to me. 

Home-Based Nerve Stimulation to Enhance Effects of Motor Training in Patients in the Chronic Phase After Stroke

Abstract

Background. Somatosensory stimulation in the form of repetitive peripheral nerve stimulation (RPSS) is a promising strategy to improve motor function of the upper limb in chronic stroke. Home-based RPSS may be an alternative to hospital-based RPSS. Objectives. To investigate the feasibility and safety of an innovative program of home-based RPSS combined with motor training and to collect preliminary data on the efficacy of this program to enhance hand motor function in patients in the chronic phase after stroke. Methods. Twenty patients were randomized to either active or sham RPSS associated with daily motor training performed at home over 4 consecutive weeks. All the patients were able to perform tasks of the Jebsen–Taylor Test (JTT). The primary outcome measures were feasibility, evaluated by self-reported compliance with the intervention, and safety (adverse events). Secondary outcomes comprised improvements in hand function in the JTT after end of treatment and after a 4-month follow-up period. Results. There were no relevant adverse events. Compliance with RPSS and motor training was significantly greater in the active group than in the sham group. Upper extremity performance improved significantly more in the active group compared with the sham group at the end of treatment. This difference remained significant 4 months later, even when differences in compliance with motor training were considered. Conclusions. Home-based active RPSS associated with motor training was feasible, was safe, and led to long-lasting enhancement of paretic arm performance in the chronic phase after stroke for those who can perform the JTT. These results point to the need for an efficacy trial.

Cholecalciferol (Vitamin D3) Improves Myelination and Recovery after Nerve Injury

This is a straight up question to your doctor. Did your stroke cause damage to the myelin sheaths in your white matter? What protocol is your doctor using to recover that loss?

Cholecalciferol (Vitamin D3) Improves Myelination and Recovery after Nerve Injury

Abstract

Previously, we demonstrated i) that ergocalciferol (vitamin D₂) increases axon diameter and potentiates nerve regeneration in a rat model of transected peripheral nerve and ii) that cholecalciferol (vitamin D3) improves breathing and hyper-reflexia in a rat model of paraplegia. However, before bringing this molecule to the clinic, it was of prime importance i) to assess which form – ergocalciferol versus cholecalciferol – and which dose were the most efficient and ii) to identify the molecular pathways activated by this pleiotropic molecule. The rat left peroneal nerve was cut out on a length of 10 mm and autografted in an inverted position. Animals were treated with either cholecalciferol or ergocalciferol, at the dose of 100 or 500 IU/kg/day, or excipient (Vehicle), and compared to unlesioned rats (Control). Functional recovery of hindlimb was measured weekly, during 12 weeks, using the peroneal functional index. Ventilatory, motor and sensitive responses of the regenerated axons were recorded and histological analysis was performed. In parallel, to identify the genes regulated by vitamin D in dorsal root ganglia and/or Schwann cells, we performed an in vitro transcriptome study. We observed that cholecalciferol is more efficient than ergocalciferol and, when delivered at a high dose (500 IU/kg/day), cholecalciferol induces a significant locomotor and electrophysiological recovery. We also demonstrated that cholecalciferol increases i) the number of preserved or newly formed axons in the proximal end, ii) the mean axon diameter in the distal end, and iii) neurite myelination in both distal and proximal ends. Finally, we found a modified expression of several genes involved in axogenesis and myelination, after 24 hours of vitamin supplementation. Our study is the first to demonstrate that vitamin D acts on myelination via the activation of several myelin-associated genes. It paves the way for future randomised controlled clinical trials for peripheral nerve or spinal cord repair.

INTRAVENOUS OMEGA-3 FATTY ACID COMPOSITIONS & METHOD OF USE

This is truly disgusting. A research finding  for stroke shows this as a promising approach and some one patents it.
http://www.freepatentsonline.com/y2013/0137770.html

Abstract:

The invention encompasses intravenous pharmaceutical compositions containing omega-3 fatty acids and methods of treating traumatic brain injury, traumatic spinal cord injury and/or stroke using these pharmaceutical compositions.

Yoga and Mindfulness as Therapeutic Interventions for Stroke Rehabilitation: A Systematic Review

 Yoga, be careful out there, it's dangerous doing this without your doctors knowledge.  The crow especially. Only 9 pages in total.
http://scholar.google.com/scholar_url?hl=en&q=http://downloads.hindawi.com/journals/ecam/2013/357108.pdf&sa=X&scisig=AAGBfm2IYv7N3_zqIQSaBOLypOImQOxauw&oi=scholaralrt
1. Introduction
Stroke is one of the most prevalent diseases worldwide
causing devastating impairments and negative consequences
for survivors [1]. Moreover, it is a main cause of adult onset
disability among people and the cost for care is among
one of the fastest-growing Medicare expenses [2]. Poststroke
therapy may improve recovery and reduce long-term disability
[3], but more psychological therapies for evaluating the
specific effects of rehabilitation are needed. Given that many
rehabilitation programs currently offer yoga as an option to
patients, and that yoga is included as a therapeutic option in
a number of rehabilitation medicine texts [4–6], a systematic
review of its importance warrants further investigation.
Yoga and mindfulness can be regarded as a main form
of alternative medicine therapy [7]. Yoga is an ancient
tradition coming from the Sanskrit word “yoga” meaning
union or one-pointed awareness. In the Yoga sutras, Patanjali
defined the word “yoga” in the first sutra as Atha yoga
anushasanam, which means “yoga” is a form of discipline [8].
The word “anushasan” can be broken down into two parts:
“anu” meaning “the subtle aspects of human personality,”
and “shasan” meaning to “rule over” or to “govern” [9].
Therefore, the concept of yogic discipline is knowledge of
the subtle dimensions, the aspects of human personality and
directing or governing the subtle nature. In the absence of
this discipline there will always be a search to find happiness
and harmony, a persistent sense of emptiness inside, and
a feeling of not fulfilling or deriving the best from life.
Yoga practices foster willpower, discipline, and self-control
and force the mind and body to work in perfect synergy.
Therefore, yoga exercises may have beneficial effects as a
stand-alone treatment on stress reduction and overall wellbeing
[10, 11]. In addition, yoga has been seen as a main
discipline and practice that has the potential to cultivate
mindfulness [12]. However, most literature has focused on
2 Evidence-Based Complementary and Alternative Medicine
mindfulness that is developed through yoga meditation [13], a
self-regulation practice that focuses on training attention and
awareness in order to exhibit a mental process that reinforces
mental health well-being and mental stability.
Dr. John Kabat Zinn, in late 1970, while teaching mindfulness
and hatha yoga in Boston, noticed that his trainees
were seeking both hatha yoga practices, including asanas
(physical exercises), and mindfulness meditation.Therefore,
he and his colleagues developed a clinical service that
used relatively intensive training in mindfulness meditation
practices based on the Vipassana and Zen traditions, along
with hatha yoga, for medical patients suffering from a wide
range of chronic disorders and diseases [14]. This program
evolved into an 8-week course, now known as mindfulness based
stress reduction (MBSR), which is taught worldwide in
different centers internationally [15]. Noticeably, practicing
mindfulness meditation does not confute the practices of
yoga [16]. One practice acts complementary to the other
depending on how it is taught and what the needs of the
trainees are.
Mindfulness can be defined as a cognitive process that
employs the creation of new categories, openness to new
information, and awareness of more than one perspective
[17]. Dr.Hirst suggests that being mindful requires the person
to attend, to be consciously aware of the emergent nature of
phenomena in consciousness, and to recognize the nature of
attachments made to these phenomena as they occur [18].
Mindfulness, according to Dr. Kabat-Zinn et al. [19], is based
on Eastern contemplative tradition and involves “bringing
one’s attention to the present experience on a moment by-
moment basis” [14, 15]. On the other hand, Professor
Langer discusses the cognitive model of mindfulness without
emphasis on the meditative part [17]. She believes that
mindfulness could be easier understood with the opposite
concept: a state of being as if on automatic pilot, involving
preoccupation, absent mindedness, carelessness, in attention,
disassociation from feelings, thoughts, actions, and habitual
responses. Meanwhile, there is now considerable evidence
of the effectiveness of mindfulness-based interventions at
reducing distress [20, 21] and rehabilitation [22, 23].
Notably, there are many different kinds of hatha yoga
and mainstreams based on the multiple traditions that they
follow [4, 11, 24]. Thus, the present review will attempt to
address this gap within the literature and synthesize the
existing research on the positive effects of yoga and relevant
meditative practices on stroke rehabilitation.

Robotic arm for unsupervised stroke rehabilitation: A pilot study using PID controller

Of course it should be unsupervised, daily life is unsupervised. How the hell do you expect survivors to recover?
http://ieeexplore.ieee.org/xpls/abs_all.jsp?arnumber=6521147&tag=1
troke is one of the leading causes of disability in the world and Post-stroke rehabilitation trainings are considered to be essential on helping stroke patients to regain the functionality of their body. However, most of the rehabilitation trainings can only be performed under professional supervision inside hospital or caring facilities and as a result, large number of expenditure is generated. In recent years, substantial amount of researches on Robot assisted rehabilitation systems have been carried out to find an alternate to the expensive and labor intensive conventional method that is currently in use. This paper proposed a novel robot assisted rehabilitation training system which utilized multiple feedback and PID control method to drive an upper limb exoskeleton that can help stroke patient to perform both predefined exercises and voluntary movements. Preliminary experiment has been conducted using a SCORBOT-ERIII robotic arm which was controlled by a SIMULINK model in XPC target environment.

Ankle robots help participants retrain gait in study at the Maryland VA

And its even for chronic.
http://articles.baltimoresun.com/2013-06-02/health/bs-hs-anklebots-20130602_1_stroke-survivors-ischemic-stroke-national-stroke-association

One night in 1999, a rash of frightening sensations hit Paul Titus all at once.
His left arm went numb. His left eye began twitching. He couldn't speak without slurring.
Unaware what the symptoms meant, he was slow to call for help. When his ischemic stroke was finally over, he was paralyzed on his left side and for 14 years he needed a leg brace and cane just to stay upright.

One morning last week, Titus smiled as he loped along on a treadmill in a makeshift gym. A high-tech, brace-like device wrapped his left ankle, monitoring his gait 200 times per second and supplying energy boosts as needed.
"I think I'm [finally] getting close to getting rid of my cane," he said, huffing as he went.
Titus, 47, of Middle River, is a participant in a two-year Veterans Health Administration study of the ankle machine — an $80,000 rehabilitative robot known as the Anklebot — and of how much it helps stroke survivors improve their gait even years after a disabling attack.
"It's too early to draw scientific conclusions, but, anecdotally, many participants are saying [the Anklebot] is a big help," said Larry Forrester, a rehabilitation scientist with the VA Maryland Health Care System and associate professor at the University of Maryland School of Medicine.
Forrester and Anindo Roy, a robotics engineer with the Baltimore Veterans Affairs Medical Center, are co-directors of the study, which will compare how participants fare while wearing the Anklebot on a treadmill with others who wear it in a seated position as they operate a foot-controlled video game.
A $199,000 pilot grant from the Veterans Health Administration is funding the project, which is scheduled to last through next summer. Twenty volunteers have taken part so far.
According to the National Stroke Association, a stroke occurs when a clot or rupture cuts off blood flow to the brain. This causes the death of cells in the brain. If the region happens to control a particular body function, that function can be permanently damaged.
Until about 20 years ago, according to Forrester, conventional wisdom in medical science held that stroke survivors who have persistent disabilities have about six months in which to improve. After that, the brain's neural pathways were thought to be more or less permanently re-established, and the best stroke survivors could hope for was to use exercise to maintain good overall health.
"Rehabilitation didn't fix you," Forrester said.
Starting in the early 1990s, though, researchers across several disciplines began to realize that exercise and other external changes could restore damaged connections and even generate new ones.
That included research teams at the Baltimore VA, where Forrester and a mentor, University of Maryland neurologist Richard Macko, proved during the early 2000s that stroke survivors who worked out on treadmills saw increased neural as well as motor improvement, each side apparently reinforcing the other.
This realization — that the brain is "plastic," not static — opened "huge new vistas," Roy said, for those in the rehabilitation sciences.

Statin Use Tied to Strains and Sprains

And why is your doctor prescribing you statins?
http://www.medpagetoday.com/Cardiology/Dyslipidemia/39590?
Muscle pain has been associated with statin use, but new evidence suggests a link with skeletal adverse events as well, a propensity-matched study found.
The chances for any musculoskeletal disease diagnosis in those taking statins was significantly higher when compared with nonusers (odds ratio 1.19), reported Ishak Mansi, MD, of the VA North Texas Health Care System in Dallas, and colleagues online in JAMA Internal Medicine.
Also, statin users had a higher chance of being diagnosed with musculoskeletal adverse events in two out of three musculoskeletal subgroups based on ICD-9-CM codes:

• Dislocation/strain/sprain: OR 1.13 (95% CI 1.05-1.21)
• Musculoskeletal pain: OR 1.09 (95% CI 1.02-1.18)

Researchers found no significant association with statin use and osteoarthritis/arthropathy in the primary analysis, they reported.
However, in secondary analyses, the association of statins with joint disease or osteoarthritis was statistically significant.

More at link.

Stroke survivors being treated against guidelines

See what guidelines your doctor is following.
http://www.newsfix.ca/2013/06/04/stroke-survivors-being-treated-against-guidelines/
According to a study, too many patients hospitalized for stroke are being treated for high blood pressure inappropriately.
High blood pressure is a risk factor for stroke so it’s right that medication is given for stroke prevention. However, once someone has had a stroke it’s a different matter. Only those with very high blood pressure ought to continue medication or be started on it in the days after the stroke has happened.
That’s because lowering of blood pressure can impede the flow of blood in the damaged part of the brain. Ten years ago, clinical guidelines on which patients should have blood pressure lowering drugs were issued. Researchers at Tufts University report on how the guidelines are being followed – or not. Looking at the medical records of 154 patients admitted to Bayside Medical Center for stroke, they learned that only a minority had high blood pressure serious enough to warrant medication. That is, 17 per cent of those who had previous medication continued and 35 per cent who had their medication intensified fell into this group. And only 26 per cent of those whose medication was started in hospital met the guideline criteria. In other words, there is too much treatment of high blood pressure in those who have had a stroke, which may be putting people at risk.

Statins Tame Plaque Inflammation

I'm sure  they followed the high-dose guidelines for 80 mg and didn't put anyone new on the drug.
And they decided against testing watermelon juice on plaque reduction.
Find out from your doctor if this was a well-run trial.
http://www.medpagetoday.com/Cardiology/Atherosclerosis/39499?

More intense statin therapy is associated with greater reductions in atherosclerotic plaque inflammation, which may or may not explain the drugs' effects on cardiovascular events, an imaging study showed.
Both 10-mg and 80-mg doses of atorvastatin reduced a marker of plaque inflammation on fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) imaging, but the reduction was 10.6% greater through 12 weeks with the higher dose (P=0.01), according to Ahmed Tawakol, MD, of Massachusetts General Hospital in Boston, and colleagues.
The reductions in inflammation were seen as early as 4 weeks into the study, the researchers reported online in the Journal of the American College of Cardiology.
"Taken together, these findings provide evidence of a rapid reduction in vascular inflammation with statin therapy and provide new insights regarding the graded reductions in vascular plaque activity as it relates to increases in statin doses," the authors wrote. "The results also confirm the ability of PET imaging as a tool to detect changes in vascular inflammation early in the course of treatment, something not as well validated with other non-invasive imaging methods."
In addition, "these data support the hypothesis that statin therapy may result in a reduction in cardiovascular benefit in part due to a rapid reduction in arterial inflammation," they wrote, noting, however, that it is not clear whether there is a clinical benefit to such a reduction.
The 10-center study recruited 83 adults who either had cardiovascular risk factors or established atherosclerosis and who were not taking high doses of statins (they could be taking low doses). The patients were randomized to atorvastatin 10 mg or 80 mg for 12 weeks.
Imaging of the ascending thoracic aorta and carotid arteries was performed at baseline, 4 weeks, and 12 weeks to assess the target-to-background ratio (TBR) of FDG uptake with the artery wall, a marker of plaque inflammation.
At 12 weeks, the patients receiving the higher dose had a significant 14.4% reduction in TBR (P <0.001), whereas those receiving the lower dose had a nonsignificant 4.2% reduction (P=0.2).
The changes in inflammation were not related to changes in the patients' lipid profiles -- which included dose-dependent reductions in total and LDL cholesterol and triglycerides -- or to changes in C-reactive protein.
"Besides demonstrating that atorvastatin has anti-inflammatory effects in a dose-dependent response in atherosclerotic patients, the present study nicely illustrates the usefulness of FDG-PET to study plaque inflammation and its inflection by drug treatment in vivo," according to Bernhard Gerber, MD, PhD, of the Université Catholique de Louvain in Belgium.
"Because of its high costs, it is unlikely that FDG-PET will be widely used to identify high-risk plaques and to monitor treatment response on targeted vessels in individual patients clinically," he continued in an accompanying editorial. "However, as shown by the present study, PET is attractive to study anti-inflammatory effects of various drugs in experimental trials."
The researchers acknowledged some limitations of their study, including the lack of a placebo group, of an assessment of drug effects beyond 12 weeks, and of complete information for 16 of the patients who were initially randomized.

Gene Variant in Blacks Alters Warfarin Response

I'm sure your doctor will tell you about this before you bring it up to them.
http://www.medpagetoday.com/Cardiology/Strokes/39631?
The first genome-wide association study to focus on warfarin dose in African Americans found a genetic variant that explains their variable response to the blood thinner.
African Americans with one copy of the rs12777823 variant would need to reduce their warfarin dosage by 6.92 mg per week to obtain its full benefits, according to Julie Johnson, PharmD, of the Center for Pharmacogenomics at the University of Florida in Gainesville, and colleagues.
Those of African descent with two copies of this single-nucleotide polymorphism (SNP) would require a dose reduction of about 9 mg/week, a good portion of the 40 mg average weekly dose for African Americans, researchers reported online in The Lancet.

Rest at link.

Two Biomarkers Predict Increased Risk For "Silent" Strokes

My competent? doctor told me I must have had a number of silent strokes, but of course he never showed me my scans and pointed out the locations.

Two Biomarkers Predict Increased Risk For "Silent" Strokes

Two biomarkers widely being investigated as predictors of heart and vascular disease appear to indicate risk for "silent" strokes and other causes of mild brain damage that present no symptoms, report researchers from The Methodist Hospital and several other institutions in an upcoming issue of Stroke (now online).
The researchers found high blood levels of troponin T and NT-proBNP were associated with as much as 3 and 3.5 times the amount of damaged brain tissue, respectively. The findings are part of the large-scale Atherosclerosis Risk in Communities (ARIC) study, funded by the National Heart, Lung, and Blood Institute.
"The concept of prevention is expanding," said principal investigator Christie Ballantyne, M.D., director of the Center for Cardiovascular Disease Prevention at The Methodist Hospital. "It's not good enough to simply do a few tests and try to assess risk for heart attack. What we need to do is assess the risk for heart attack, stroke, heart failure and also asymptomatic disease so we can start preventive efforts earlier. Waiting to correct problems until after a symptomatic stroke may be too late."
One possible outcome is that patients determined to be in high-risk groups could be started on anti-stroke medications sooner.
In another ARIC paper published two months ago in Stroke, Ballantyne and coauthors reported a strong association between blood levels of troponin T and NT-proBNP and more severe instances of stroke, called symptomatic stroke. The current study looked at the two biomarkers and "subclinical," asymptomatic events in the brain that are usually caused by a lack of blood flow.
"Taken together, these two papers show the biomarkers are effective at identifying people who are likely to have mild brain disease and stroke well before damage is done," said Ballantyne, who also is a Baylor College of Medicine professor. "This hopefully will give doctors more time to help patients take corrective steps to protect their brains."
For the subclinical brain disease study, researchers gleaned data from about 1,100 patient volunteers who agreed to have blood drawn and two MRI scans eleven years apart to look for silent brain infarcts and also white matter lesions (WMLs) caused by chronic inflammation.
Statistical analysis showed a strong relationship between high NTproBNP and the likelihood of brain infarcts and WMLs. Study participants with the highest levels of NT-proBNP had as much as 3.5 times the number of brain infarcts as participants with low NT-proBNP levels, and more WMLs. Those with the highest levels of troponin T had as much as 3.0 times the number of brain infarcts and more WMLs.
The protein troponin T is part of the troponin complex and its presence is often used to diagnose recent heart attacks. NT-proBNP is an inactive peptide fragment left over from the production of brain natiuretic peptide (BNP), a small neuropeptide hormone that has been shown to have value in diagnosing recent and ongoing congestive heart failure.
"The highly sensitive troponin T test we used is not approved for general clinical use in the US yet, but the NT-proBNP test is just now starting to be used more widely beyond making a diagnosis for heart failure," Ballantyne said.
The researchers found high blood levels of troponin T and NT-proBNP were associated with as much as 3 and 3.5 times the amount of damaged brain tissue, respectively. The findings are part of the large-scale Atherosclerosis Risk in Communities (ARIC) study, funded by the National Heart, Lung, and Blood Institute.
"The concept of prevention is expanding," said principal investigator Christie Ballantyne, M.D., director of the Center for Cardiovascular Disease Prevention at The Methodist Hospital. "It's not good enough to simply do a few tests and try to assess risk for heart attack. What we need to do is assess the risk for heart attack, stroke, heart failure and also asymptomatic disease so we can start preventive efforts earlier. Waiting to correct problems until after a symptomatic stroke may be too late."
One possible outcome is that patients determined to be in high-risk groups could be started on anti-stroke medications sooner.
In another ARIC paper published two months ago in Stroke, Ballantyne and coauthors reported a strong association between blood levels of troponin T and NT-proBNP and more severe instances of stroke, called symptomatic stroke. The current study looked at the two biomarkers and "subclinical," asymptomatic events in the brain that are usually caused by a lack of blood flow.
"Taken together, these two papers show the biomarkers are effective at identifying people who are likely to have mild brain disease and stroke well before damage is done," said Ballantyne, who also is a Baylor College of Medicine professor. "This hopefully will give doctors more time to help patients take corrective steps to protect their brains."
For the subclinical brain disease study, researchers gleaned data from about 1,100 patient volunteers who agreed to have blood drawn and two MRI scans eleven years apart to look for silent brain infarcts and also white matter lesions (WMLs) caused by chronic inflammation.
Statistical analysis showed a strong relationship between high NTproBNP and the likelihood of brain infarcts and WMLs. Study participants with the highest levels of NT-proBNP had as much as 3.5 times the number of brain infarcts as participants with low NT-proBNP levels, and more WMLs. Those with the highest levels of troponin T had as much as 3.0 times the number of brain infarcts and more WMLs.
The protein troponin T is part of the troponin complex and its presence is often used to diagnose recent heart attacks. NT-proBNP is an inactive peptide fragment left over from the production of brain natiuretic peptide (BNP), a small neuropeptide hormone that has been shown to have value in diagnosing recent and ongoing congestive heart failure.
"The highly sensitive troponin T test we used is not approved for general clinical use in the US yet, but the NT-proBNP test is just now starting to be used more widely beyond making a diagnosis for heart failure," Ballantyne said.

St Thomas' doctor appointed as NHS lead for stroke care

So contact him and give him the ideas on these 177 hyperacute therapies. Less damage means better recoveries. And he can be hailed as a hero for reducing the disability from stroke. This is way too important to leave to the medical blokes, they know way too little about the issue.
http://www.london-se1.co.uk/news/view/6873
Professor Tony Rudd, consultant stroke physician at St Thomas' Hospital, has been appointed as NHS England's national clinical director for stroke.
Professor Rudd said: "I'm really looking forward to being involved in improving stroke care across the country.
"I want to ensure that patients receive the best possible care so that they can live long and healthy lives despite the effects of a stroke."
In his new role he will be involved in making national decisions and developing policies for the care of people who have suffered a stroke.
Professor Rudd has worked at Guy's and St Thomas' NHS Foundation Trust since 1988 initially as a consultant geriatrician. In 2002 he began to focus solely on stroke and improving the care provided to these patients.
Professor Rudd is also the London clinical director for stroke, leads the stroke programme at the Royal College of Physicians, is vice chairman of the Stroke Association, and was a member of the group that developed the national stroke strategy at the Department of Health in 2007.
St Thomas' Hospital is home to an acute stroke unit which helps adult patients recover from a stroke after they have received emergency care.
On the unit, patients are treated by a wide range of staff including physiotherapists, occupational therapists, dietitians, speech and language therapists, doctors and nurses.
The Evelina London Children's Hospital at St Thomas' offers the only children's stroke rehabilitation service in the country.

Too Much Work Proves Tiring Despite Good Sleep

Our cognitive workload for recovering from stroke has to be massive. Ask your doctor if this is causing your fatigue.
http://www.medpagetoday.com/MeetingCoverage/SLEEPNeuro/39557?
One line here, rest at link.
Workers with a heavier cognitive workload experience fatigue and sleepiness regardless of how much rest they actually get, researchers reported here.

EBS Reports That Its NEXT WAVE(TM) Brain Stimulation Device Expanded the Visual Field by a Mean Average of 24% in a Clinical Study of 82 Patients with Impaired Vision Caused by Optic Nerve Neuropathy or Stroke

Contact if interested.
http://online.wsj.com/article/PR-CO-20130604-905592.html?mod=googlenews_wsj
EBS Technologies GmbH, an emerging medical device company developing the revolutionary NEXT WAVE(TM) brain stimulation platform for treatment of vision deficits caused by neurological disorders, announced today the results of a multi-center, 82-patient clinical trial of its NEXT WAVE(TM) brain stimulation device.
About one-half of the clinical trial patients were given a 40-minute treatment protocol for 10 consecutive days with the NEXT WAVE(TM) device. With a mean increase of 24%, NEXT WAVE(TM)-treated patients showed significantly better improvements in stimulation of their total visual field compared to patients in the control group, which did not receive NEXT WAVE(TM) stimulation. All patients had vision impairment lasting at least six months prior to the clinical trial and had exhausted all standard therapeutic options to improve their vision.
"There is a huge unmet clinical need for the treatment of vision impairment caused by a variety of different neurological disorders, such as neuropathy of the optic nerve, brain injury or stroke. For example, stroke alone is the world's third-leading cause of death as well as the leading cause of serious, long-term disability. There are more than 10.4 million stroke survivors with long-term disability in Europe and the U.S. Three out of five of these disabled persons are potentially treatable with our NEXT WAVE(TM) therapy once we commence commercialization," said Ulf Pommerening, CEO of EBS Technologies.
"We look forward to expanding the scientific evidence for the efficacy of our NEXT WAVE(TM) approach, especially in stroke patients, in an expanded clinical trial that will commence imminently," said Pommerening.

The canoe vacation as therapy

I just came back from 4 days in the BWCA in Minnesota. 2 friends hauled my ass in a canoe to a site on Gabbro Lake. We had a 208 rod portage to even get to the putin on Little Gabbro. My dorsiflexion has vastly improved since this episode in 2008. No smashed toes or falls. The portage was great therapy, up hills and down and having to correct ankle stability all the time while carying a 40 lb. pack. Because I was the duffer in the center of the canoe I sat on one of the packs. It was terrifying. Within 20 yards I knew we would tip over unless I lowered my center of gravity in the boat. 50 yards away was Safety Island, a 15 yard long rock with 4 10-15 foot pine and evergreen trees on it. I managed to get into a kneeling position when we grounded there. After 1 attempt to run up the class 1 rapids separating little Gabbro from Gabbro. I directed us to the right eddy where we lined the canoe up. When asked later what I rated the chances of making it thru the rapids safely, '50%'. With over 40 years of paddling canoes and much hairy whitewater, duffing it with no control over the course of the boat was excruciatingly depressing.

Mind, body, soul and alcohol - the four primary elements

I know I shouldn't be so blasphemous but considering who I was with it was quite appropriate. We only had 1 growler of local beer,  a 4 bottle box of chardonnay, 2 bottles of rum and an acquired flask of bourbon from appreciative canoeists we directed to an open campsite. We continued our blasphemy by creating a new religion - Fish Jesus, when we come up with the precepts we'll let the world know.

Wildlife

On the trip itself we saw seagulls harassing bald eagles that were picking up fish that the seagulls considered their own. On the drive back we saw a radio collared cow moose and 4 wolves crossing the road, not that close to each other.

Worm blowing

Its a fishing technique. When my friend Greg first told me about it, I envisioned him taking very small  pipettes and blowing air into the  worms. You attach a sinker to the line and the worms float about two feet higher. The rods are propped on shore with the bail left open to allow the fish to keep taking line. We ended up with 7 nice walleyes for wonderful additions to our meals.

Half tepid, vaguely forward, marginally better

Discussion topics during the trip. You would have had to be there to attempt understanding of our discussions.

Desserts

My contributions to the food preparation.
1.Soft baked chocolate chip cookies
2.Jello oreo no bake dessert - even though it said not to use powdered milk because the taste would not be as good I did, Ok, but the double serving was a bit much.
3. Jello chocolate instant pudding  - the temperature was not cold enough to set up the pudding, still a runny liquid.  We all broke out laughing at that fiasco.

Emergency services failed stroke victim

The failure here is actually the information put out by the stroke associations that getting to the hospital in time will reverse a stroke. Thats incorrect, tPA has an appalling efficacy.
http://www.northumberlandtoday.com/2013/05/29/emergency-services-failed-stroke-victim
Scott Beebe died March 11 after suffering a stroke May 5, and his spouse Colleen Fortier still has questions about how emergency services handled her 9-1-1 call.

Fortier said she accepts what happened and doesn’t blame anyone for Beebe’s death.
But she wants people to know what does and, unfortunately, doesn’t happen when you dial 9-1-1.
Beebe had complained at the end of January of a “funny feeling” in his head and went to Northumberland Hills Hospital, Fortier said. Staff examined him and said he may have had a small stroke. Tests included a CT scan and an MRI but found everything to be normal. But the numbness remained._
On March 5, Fortier arrived at the couple’s Forest Hill Drive home at about 6:45 p.m. and found Beebe on the basement floor, conscious, with a cordless phone nearby. She immediately called 9-1-1 to say her husband had slurred speech, couldn’t get up and was having a stroke.
Fortier has since checked text messages and believes Beebe had been lying there for about one hour.
While Northumberland County EMS refused to provide the times of Fortier’s calls, Fortier said she was given them.
Her first 9-1-1 call was received by EMS at 6:49 p.m., and she called again about 10 minutes later when no emergency services personnel had arrived.
The dispatcher told her it had only been six minutes since the first call, but Fortier could see it was longer.
While comforting her husband, Fortier kept running up the stairs to look for any sign of the paramedics. The ambulance arrived at 7:07 p.m. from the east — 18 minutes after the first 9-1-1 call.
(Driving from Northumberland County EMS headquarters on William Street in Cobourg to the home it took 5 minutes and 31 seconds under normal driving conditions, stopping at three red lights.)
Fortier said the emergency lights on the ambulance were activated, but she felt it was “weird” she didn’t hear any sirens. When she saw the ambulance pull into her driveway, it was with a sense of relief.
“But when two women came out of the bus (ambulance) my heart sank,” she said. “I thought, they’re not going to be able to lift him up the stairs, but I thought I’m sure it’s part of their job.”
It wasn’t that Beebe wasn’t a physically fit man; he was, weighing approximately 185 pounds.
Just for peace of mind, Fortier asked one of the paramedics, “do you want me to get my neighbours to help you lift him up the stairs?”
But the paramedic assured her they had a special chair to strap him in and lift him up the flight of stairs.
Fortier’s worst fears came true when they couldn’t carry him up the stairs.
It was only then that they radioed for the Baltimore Fire Department to attend for a lift assist.
“I just assumed the fire department would show up. It never dawned on me that I needed to ask for them,” said Fortier. “If I had known I would have said (to the 9-1-1 dispatcher) you need to send the fire department.”
Bob Grandy, freedom of information screening co-ordinator with the Port Hope Police Service whichdispatches Hamilton Township Fire Department, said the fire department was dispatched at 7:24 p.m. — 35 minutes after the initial 9-1-1 call.
The first fire truck arrived at the home at 7:33 p.m.
Fortier said it took four firefighters to lift Beebe up the stairs.
The ambulance left the house at 7:47 p.m., just shy of an hour from the initial 9-1-1 call.
Fortier believes both paramedics are trained for the positions, but contacted Northumberland Today to educate others about what happened so they know in an emergency.
Once Beebe was loaded into the ambulance, Fortier learned he would be taken to a hospital in Peterborough instead of Cobourg because Peterborough has special medicine to treat stroke victims.
They arrived in Peterborough at 8:22 p.m.
Looking back, Fortier said it would have been quicker for her to drive him to a hospital in Peterborough or Toronto than to call 9-1-1.
At the hospital, staff were hesitant to give Beebe the drug because there is a 4.5-hour window from the time of the stroke to when the drug is to be given.
“The danger is if you give it after you can actually cause brain bleeds,” Fortier said. “Getting to the hospital is crucial.”
Beebe was placed in the intensive care unit and Fortier was assured he was stable so she went home at about 2 a.m.
She returned the next morning to find his left side was completely paralyzed, but he asked if she had put the garbage out, so Fortier knew he was okay.
Beebe would have looked at his rehabilitation as a challenge, she said.
“In our minds we’re going to get to Cobourg and go for therapy,” she recalled. “The doctor called in Cobourg and said we’re ready for him when he is ready.”
But on Monday, March 11, Beebe had a seizure and never recovered.
The hospital had told her that stroke victims have a high risk of seizures.
“He wasn’t put on seizure medication (which would have been for life) because he was doing so well,” Fortier said. “He was so young, and he had no high blood pressure, no high cholesterol or family history of strokes.”
Looking back, it’s the “what-ifs” that remain with Fortier.
“I wish I had phoned some people to come to the house. I wish I’d known the fire services don’t show up to every call.
“If I, a 50-year-old untrained person, know they are not going to be able to lift him up the stairs why didn’t they know that right away?”
While Northumberland County chief director for Emergency Medical Services Tarmo Uukkivi said he can’t speak specifically about an incident because of privacy regulations he said this call was reviewed.
“We are confident that our responders followed correct procedures and that they provided the service that they are trained to provide, to the best of their ability,” Uukkivi stated in an e-mail. “In fact, the paramedics went above what was required of them.
“Our review of the call indicates that the actions of all emergency responder met or exceeded high service standards.”
Fortier has a different perspective.
“I think (people) have a lot of blind faith,” she said. “Now that I know, I would have asked a lot more questions.”
Fortier realizes that the fire department wouldn’t have been able to treat Beebe medically, but it haunts her that he sat at the bottom of the stairs for minutes as the paramedics waited for help.
“The only difference would have been the 10 minutes he had to wait for them to come,” Fortier said. “And I know that the 10 minutes might not have saved his life. I know that. But he had to sit there for 10 minutes more and suffer.”
Since getting the response from the Northumberland County EMS director, Fortier still has more questions than answers.
“If EMS feels they responded correctly and went above what was required, does that mean if my neighbour has a stroke tomorrow, they will handle it the same way?
“I hope not!”

AMES device helps the paralyzed regain movement

The vibration part sounds like what my OT would do to my muscles to encourage them to fire.
http://www.gizmag.com/ames-device-stroke-spinal-injury/27791/
Last week, the US Food and Drug Administration granted clearance to a new device that could be of considerable aid to stroke victims or people with partial spinal cord injuries. Created by Dr. Paul Cordo of the Oregon Health & Science University (OHSU) in collaboration with OHSU spinoff company AMES, the "AMES device" reportedly helps the brain get paralyzed muscles moving again.
Dr. Cordo had previously conducted research that involved manually moving the paralyzed limbs of test subjects, while simultaneously vibrating receptors in the associated muscle tendons – this served as an amplified simulation of the sensation that would ordinarily accompany such a movement. The subjects’ central nervous system detected the resulting sensory output from the buzzed muscles, essentially alerting the brain that movement was taking place. The brain responded by stepping in, and helping to guide that movement.
The AMES device is based on that same principle. It robotically moves a paralyzed or partially-paralyzed limb, while vibrating the muscle receptors that would be involved in that movement if it was initiated by the patient.

The device also measures how much of the patient’s own effort is going into the movement, and displays that data for them as real-time visual biofeedback. Additionally, it performs diagnostic tests on the patient during each session, to let clinicians track their progress over time.
Clinical trials of the device have been conducted at various sites in the US, using stroke victims and patients with chronic spinal cord injuries, most of whom were considered “very disabled.” The results indicated that the therapy did indeed improve the patients’ movement and strength, to the extent that some of them were subsequently able to carry out activities of which they were previously incapable.
The device is not intended for use in cases where the spinal cord has been completely severed, however.
With FDA approval now achieved, AMES plans on marketing the device, with delivery to hospitals and clinics anticipated for early next year.

Dimethyl sulfoxide provides neuroprotection in a traumatic brain injury model.

No self-prescribing, you do remember the problems when patients used an industrial form of it back in the 80s and 90s. 
http://www.ncbi.nlm.nih.gov/pubmed/19096138

Abstract

PURPOSE:

The objective of this study was to evaluate the neuroprotective potential of the antioxidant, curcumin compared to alpha-tocopherol in a rat model of traumatic brain injury (TBI).

METHODS:

Male Sprague-Dawley rats were administered curcumin (3, 30, 300 mg/kg), alpha-tocopherol (100 mg/kg), DMSO vehicle, or saline, 30 min prior to and 30 and 90 min after moderate lateral fluid percussion TBI. Rats were euthanized at 24 hours after injury and coronal brain sections were stained with Fluoro-Jade to identify degenerating neurons. Degenerating neurons in the CA2-3 sector of the dorsal hippocampus were quantified in 10 sections spaced 300 microm apart in each rat.

RESULTS:

One way ANOVA revealed a significant difference (p = 0.01) between groups. The curcumin, alpha-tocopherol, and DMSO groups had significantly reduced numbers of degenerating neurons compared to the saline-treated group. No significant differences were observed between any of the drug treatment groups or the DMSO group.

CONCLUSIONS:

Since protection in the DMSO vehicle group was equal to that of the experimental groups, no conclusions about neuroprotection regarding alpha-tocopherol or curcumin can be made from this study. The results suggest that DMSO may be acting as an overriding neuroprotectant in this experiment. We conclude that DMSO is a viable neuroprotective agent against secondary cell death in TBI.