Novel design of a robotic hand exoskeleton device (PMHand) for the purpose of aiding post stroke rehabilitation

Have your therapist follow up on this to see if it is close to production or can be copied by the therapy department. We have so few useful hand rehab products that we have to grasp at any possibility.

Novel design of a robotic hand exoskeleton device (PMHand) for the purpose of aiding post stroke rehabilitation

Fig. 3. The Hand EXOskeleton SYStem (HEXOSYS)

Mark Deno Named CEO of Spalding Rehabilitation Hospital - Denver, CO

If you know him or go to this hospital. Ask these simple questions. And demand answers.
We have to start putting pressure on hospital presidents and stroke department heads because nothing will get done without someone screaming about it.

Problems in stroke;

1. There is no fast, easy and objective way to diagnose a stroke. Maybe when the Qualcomm Tricorder X Prize is available. A number of friends have waited hours in ERs until stroke symptoms have visibly manifested themselves.
http://oc1dean.blogspot.com/2013/11/34-teams-are-building-medical.html

2. Only 10% get to almost full recovery.
http://www.ninds.nih.gov/disorders/stroke/stroke_rehabilitation.htm
3. 12% tPA efficacy
http://wrkf.org/post/more-stroke-patients-now-get-clot-busting-drug
4. Nothing being done to stop the neuronal cascade of death during the first week.
http://newswire.rockefeller.edu/2009/01/15/discovery-could-help-scientists-stop-the-death-cascade-after-a-stroke/
5. No one knows how to cure spasticity.
6.  No one knows how to cure fatigue.
7. F.A.S.T is actually a failure because even at its best tPA is only delivered to 33% of those eligible and then of those that get it  it only works to completely reverse the stroke 12% of the time.
http://www.prnewswire.com/news-releases/mark-deno-named-ceo-of-spalding-rehabilitation-hospital-276202841.html

Western Diet Leads to Diminished Cognitive Performance

How precisely do they tell? This would then lead immediately to hospitals changing their food availability for all stroke survivors. Not doing so would mean that hospitals have no concern for their patients cognitive abilities.
http://www.biosciencetechnology.com/news/2014/09/western-diet-leads-diminished-cognitive-performance
I'm going to demand that my hospital at least consider these:

What would a post-stroke diet look like?

RheumReports: Swollen Ears and Enbrel

Be careful out there if you are planning on using Etanercept with Dr. Tobinick.  
http://www.medpagetoday.com/Rheumatology/GeneralRheumatology/47774?

Video explains why doctors don’t always know best

And in our case our doctors just punt because they just hand off 3 prescriptions to OT, ST, and PT just saying E.T. - Evaluate and Treat. And why they use the crappy answer, 'All strokes are different, all stroke recoveries are different'. With these two occurrences your doctor does not need to really know anything about stroke recovery at all.
http://scopeblog.stanford.edu/2014/09/23/video-explains-why-doctors-dont-always-know-best/

Managing ICH - A statin onboard may be a life-saver for intracerebral hemorrhage patients

You can have your doctors argue this out. As long as they get a stroke protocol written up prior to you  showing up at the hospital with another stroke. YOU are going to have to get on your stroke department head and force the issue to be solved because if you don't intervene I bet nothing will be done because this is somebody else's problem.
Good luck with getting your stroke medical world to take some f*cking responsibility for saving neurons.
http://www.medpagetoday.com/Cardiology/Strokes/47785?
Spontaneous intracerebral hemorrhage (ICH) patients did better on a statin during hospitalization, an observational study showed.
The likelihood of survival was 4.25-fold greater for ICH patients on a statin than among nonusers at 30 days after the hemorrhage (P<0.001), Alexander C. Flint, MD, PhD, of Kaiser Permanente Northern California in Redwood City, and colleagues found.
Inpatient statin users were also 2.57-times more likely to be discharged home or to an acute rehabilitation facility (P<0.001), the researchers reported online in JAMA Neurology.
However, statin users taken off the drug when entering the hospital for ICH showed a higher risk of both outcomes than statin users (OR 0.16 for 30-day survival and OR 0.26 for discharge home or to acute rehab, P<0.001 for both).
"The particular association between cessation of statin use and worsened outcomes merits careful consideration of the risk-benefit balance of discontinuing statin therapy in the acute setting of ICH," the researchers concluded.
However, there's more to consider than this single study, Marco A. Gonzalez-Castellon, MD, and Randolph S. Marshall, MD, both of Columbia University Medical Center in New York City, noted in an accompanying editorial.
"The controversy regarding statin use and ICH is far from settled," they wrote, although they agreed that "For now, however, it provides sufficient evidence to recommend at least the continuation of statin therapy after nonamyloid ICH for at least 30 days after the initial event."
Studies have come down on either side of the issue, and either direction of association is feasible mechanistically, they explained.

More at link.

19 crimes

A friend and I drank this wine while watching the movie, 'Dead in Tombstone'. Of course none of the crimes committed  in the movie were small enough to get you transported to Australia. You would have been executed. 

The following is the list of crimes that was punishable by transportation to Australia 1.) All theft above the value of one shilling.2.) Thefts under the value one shilling. 3.) Receiving stolen goods, jewels and plate. 4.) Stealing lead, iron or copper. 5.) Stealing ore from black lead mines. 6.) Stealing from furnished lodgings. 7.) Setting fire to underwood. 8.) Stealing letters.9.) Assault with intent to rob. 10.) Stealing fish from a pond or river. 11.) Stealing roots, trees or plants. 12.) Bigamy. 13.) Assaulting, cutting or burning clothes. 14.) Counterfeiting the copper coin. 15.) Clandestine marriage. 16.) Stealing a shroud from a grave. 17.) Watermen carrying too many passengers on the Thames , if any drowned. 18.) Incorrigible rogues who broke out of prison and persons reprieved from capital punishment. 19.) Embeuling naval stores. 

A few others that don't fall into these categories but were sent anyway;
http://www.convictcreations.com/history/crimes.htm

More Evidence That Vitamin D Protects Against Alzheimer’s -

Ask your doctor, and not politely, which intervention is more important in preventing dementia. And why doesn't your doctor know a damn thing about this? Your risk of dementia post-stroke is 33%.
My bet is on these; but then I'm medically untrained and should never be listened to.
My 3 legged milking stool ones are here:
Fish Oil Supplements Reduce Incidence of Cognitive Decline, Brain Atrophy
Leg two:
Coffee May Lower Your Risk of Dementia
Leg three:
Evidence-Based Medicinal Properties of Coconut Oil - brain boosting  
My complete list here:
Dementia prevention 19 ways


http://dana.org/News/More_Evidence_That_Vitamin_D_Protects_Against_Alzheimer_s/

Creatures of the night: Chronotypes and the Dark Triad traits

A winner of the 2014 Ig Nobel prize
PSYCHOLOGY PRIZE [AUSTRALIA, UK, USA]: Peter K. Jonason, Amy Jones, and Minna Lyons, for amassing evidence that people who habitually stay up late are, on average, more self-admiring, more manipulative, and more psychopathic than people who habitually arise early in the morning. 
I habitually stay up late, 1am on school nights, 3am on weekends.
Creatures of the night: Chronotypes and the Dark Triad traits

Abstract

In this study (N = 263) we provide a basic test of a niche-specialization hypothesis of the Dark Triad (i.e., narcissism, psychopathy, and Machiavellianism). We propose that in order to best enact a “cheater strategy” those high on the Dark Triad traits should have optimal cognitive performance and, thus, have a night-time chronotype. Such a disposition will take advantage of the low light, the limited monitoring, and the lessened cognitive processing of morning-type people. The Dark Triad composite was correlated with an eveningness disposition. This link worked through links with the “darker” aspects of the Dark Triad (i.e., Machiavellianism, secondary psychopathy, and exploitive narcissism); correlations that were invariant across the sexes. While we replicated sex differences in the Dark Triad, we failed to replicate sex differences in chronotype, suggesting eveningness may not be a sexually selected trait as some have argued but is a trait under natural selective pressures to enable effective exploitations of conspecifics by both sexes.

Measuring Walk in MS, Cheaply and Efficiently

An objective way to measure your walking problems. I would expect your therapist to have this within a year because without this there is no way to objectively determine that your walking protocols are working.
http://www.medpagetoday.com/MeetingCoverage/ECTRIMS/47703?xid=nl_mpt_AAN_confreporter_2014-09-18&
Pressure sensitive walkways and motion tracking devices provided reliable and quantitative measures of ambulation in multiple sclerosis patients, researchers said here
Researchers often rely on either visual inspection or motion capturing technology to determine how well a patient is walking. But the former is often inaccurate, and the latter can be expensive, said Jacob Sosnoff, PhD, of the University of Illinois in Urbana-Champaign, in a presentation at the European Committee for Treatment and Research in Multiple Sclerosis, held jointly this year with its North American counterpart.
Sosnoff and colleagues analyzed the walk of 86 ambulatory patients 6 months apart using GAITRite, a portable walkway sensitive to pressure. GAITRite -- whose products sell for $25,000 to $35,000 depending on the model, according to the company -- has previously been tested. In the current study, the researchers evaluated its reliability -- that is, whether results are similar in multiple tests during which the person's actual performance would not have changed substantially -- using intraclass correlation coefficients (ICC), which range from -1 to the perfectly correlated 1.
Five measures of walking were found to be reliable using the system:

• Gait velocity: 0.94, 95% CI .84-.97
• Functional ambulation profile: 0.94, 95% CI 0.90-0.96
• Cadence: 0.94, 95% CI 0.83-0.97
• Step time: 0.94, 95% CI 0.91-0.97
• Double support: 0.75, 95% CI 0.60-0.85

"Ultimately, the goal is to help people," Sosnoff told MedPage Today. "And what was unique about this study is that we were using a time period of 6 months, which is how often someone would go to their neurologist or physical therapist." There was no intervention in between those 6 months, he said.
Of the patients in Sosnoff's study, 77% were female, and the median age was 50 (range 27-60). All of them had MS for at least six months, and 78% reported relapsing remitting MS. They had a self-reported disability of 3 on the patient determined disease steps scale (0-6). Patients were asked to walk 4.9 meters at their own pace on the GAITRite.
Walking impairment was reported as a primary limitation by 85% of study participants, said Sosnoff. "We want to target gait in rehabilitation, but obviously, for us to target that, we need to have valid and reliable measures."
Currently, functional abilities in MS patients are most often assessed with the Expanded Disability Status Scale (EDSS), a categorical measure that relies on subjective evaluations that may vary between raters, and yet is insensitive to small changes.
A continuous measure that is less subjective and that can be relied on to show genuine decreases or increases in functional ability over time would be useful both for clinical research and for routine patient management.
In a separate study, researchers used Microsoft Kinect -- a motion-sensing input device designed mainly for home video gaming -- to perform a postural control assessment. The $200 device was found to be reliable in measuring the impairment of MS patients using short stance tests, said Sebastian Mertens, a medical student at the NeuroCure Clinical Research Center-Charité in Berlin, Germany.
Mertens and his colleagues performed a cross-sectional study comparing 100 patients with MS with 60 healthy controls. The speed of three types of movements -- pitch, roll, and 3D -- was measured and compared with the Expanded Disability Status Scale (EDSS), a timed 25-foot walk (T25W), a short maximum speed walk test (SMSW), and the WALK-12 evaluation. Participants did an open stance, a closed stance, and a tandem stance (i.e., with one foot in front of the other).
Participants in the study performed the test once with closed eyes and once with open eyes. ICC values for the three movements were 0.927, 0.900, and 0.943, respectively, with eyes closed, and 0.968, 0.933, and 0.971, respectively, with eyes open. In the closed stance, the 3D speed correlated modestly with the other measures:

• EDSS: 0.458 (P<0.001, eyes open) and 0.531 (P<0.001, eyes closed)
• SMSW: -0.332 (P<0.001) and no correlation with closed eyes
• T25W: 0.318 (P<0.01, eyes open) and 0.331 (P<0.001, eyes closed)
• WALK12: 0.340 (P<0.001, eyes open) and 0.478 (P<0.001, eyes closed)

Obvious impairment was observed in 30% of the MS patients, who also showed values outside the 99th percentile in the test with eyes closed.
There were no significant correlations with a patient's age, height, or body mass index. In the closed stance, MS patients were also found to have higher compensatory arm movements with eyes closed (P=0.001) and open (P=0.013) than in the control group.
"Kinect-based postural control assessment is fast and feasible," the researchers concluded.

Sativex Helps MS Spasticity in Objective Tests

Is your doctor following current research at all and are they willing to try this on you as an off-label use? Or do they believe that you shouldn't bother about spasticity like Dr. William M. Landau suggests. And you'd have to go to Europe to get it because we have absolute f*cking idiots in Congress  about marijuana.

Spasticity After Stroke: Why Bother?

Sativex Helps MS Spasticity in Objective Tests 

An objectively measured sign of spasticity in multiple sclerosis (MS) patients was relieved with Sativex, the oromucosal cannabinoid spray, in a small randomized trial reported here.

Mean scores on the modified Ashworth scale, which measures resistance to muscular stretching, for lower limb spasticity improved by 18.2% (SD 33.7%) in patients treated with Sativex for 4 weeks, compared with a 6.7% improvement (SD 26.6%) in patients using a placebo spray (P=0.029 for the between-group difference), according to Letizia Leocani, MD, PhD, of University Hospital San Raffaele in Milan.
Previous studies had shown that Sativex, which combines tetrahydrocannabinol and cannabidiol in equal parts, improved MS patients' self-reported symptoms of spasticity. But a systematic review and practice guideline released earlier this year by the American Academy of Neurology indicated that the product is "probably ineffective" for objective spasticity measures.
Hence, the current study -- presented at the European Committee for Treatment and Research in Multiple Sclerosis, held jointly this year with its North American counterpart -- provides new support for Sativex as a useful treatment for MS spasticity, an important manifestation that contributes to disability.
It randomized 43 patients to a 2-week titration period followed by 2 weeks of treatment at stable doses with either placebo or Sativex. Following a 2-week washout period, patients then crossed over to a second 4-week cycle with the other treatment.
Exclusion criteria were other medical or psychiatric illnesses that might interfere with treatment or symptomatology, contraindications to transcranial magnetic stimulation, or THC urine test results indicating previous cannabis use.
Patients must have had progressive MS for at least 1 year and modified Ashworth scores at screening of greater than 1 in at least one limb.
Mean patient age in the study was 48 (SD 7) and mean score on the Expanded Disability Status Scale was 5.7 (SD 0.9, range 3.5 to 6.5).
In addition to modified Ashworth score, patients were evaluated with timed 10-meter walks and neurophysiological measures including motor evoked potentials, intracortical inhibition/facilitation, and the so-called H/M ratio (maximal Hoffmann reflex versus the maximal motor response of the soleus muscle).
A responder analysis showed that, among those achieving at least 20% improvement in modified Ashworth scores, half of participants showed such responses only when receiving Sativex. The remainder were divided among patients responding to both the active drug and placebo and those who only responded to placebo.
Importantly, however, Sativex did not produce significant improvements on outcomes other than the modified Ashworth score. In addition to the objective measures, these included patient-reported pain, sleep, and fatigue.
Leocani said these results indicated that additional research is needed on "the relevance of other spinal and supraspinal mechanisms involved in the physiopathology of spasticity."
Sativex is not approved in the U.S.; it is available in several European countries for relief of MS spasticity.

 

DARPA Jetpack May Help Soldiers Run 4-Minute Mile - Useful for stroke rehab

You will need to demand your therapy department get this. It would force you to get your feet out in front of you quickly. Since we need to make therapy harder to increase the speed at which we recover this would be an excellent item. Much safer than my other ideas; Are willing to do bar stool rehab or chainsaw rehab  or bike rehab or canoe rehab?
http://www.ign.com/articles/2014/09/12/darpa-jetpack-may-help-soldiers-run-4-minute-mile

Coffee Drinkers Have Trouble Talking About Emotions?

I'm not too concerned even if this is true. I'm a guy, my emotions are bottled up most of the time anyway.

Coffee Drinkers Have Trouble Talking About Emotions?

Caffeine Use and Alexithymia in University Students

DOI:

10.1080/02791072.2014.942043

Michael Lyvers Ph.D.^a*, Natalija Duric G.Dip.Psych.^b & Fred Arne Thorberg Ph.D.^c

pages 340-346

Publishing models and article dates explained

• Published online: 04 Sep 2014

Article Views: 51

Alert me

Abstract

Alexithymia refers to difficulties with identifying, describing, and regulating one’s own emotions. This trait dimension has been linked to risky or harmful use of alcohol and illicit drugs; however, the most widely used psychoactive drug in the world, caffeine, has not been examined previously in relation to alexithymia. The present study assessed 106 male and female university students aged 18-30 years on their caffeine use in relation to several traits, including alexithymia. The 18 participants defined as alexithymic based on their Toronto Alexithymia Scale (TAS-20) scores reported consuming nearly twice as much caffeine per day as did non-alexithymic or borderline alexithymic participants. They also scored significantly higher than controls on indices of frontal lobe dysfunction as well as anxiety symptoms and sensitivity to punishment. In a hierarchical linear regression model, sensitivity to punishment negatively predicted daily caffeine intake, suggesting caffeine avoidance by trait-anxious individuals. Surprisingly, however, TAS-20 alexithymia scores positively predicted caffeine consumption. Possible reasons for the positive relationship between caffeine use and alexithymia are discussed, concluding that this outcome is tentatively consistent with the hypo-arousal model of alexithymia.

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Neural Basis of Confidence Uncovered in Mice

Do you still have this confidence  region in your brain post-stroke? If not, what the hell is your doctor doing to recover it?  You are going to need massive amounts of confidence that you will recover even though your doctor knows nothing about how to get you back to 100% recovery. I must still have it because even though 8 years later I still have quite a few deficits I know I will eventually recover. As compared to my doctor who told me nothing about my recovery prospects. He must have been confident that he was right. In my opinion he knew nothing and I'm confident in that opinion. I'm confident in my confidence, must be my arrogance showing. 

Neural Basis of Confidence Uncovered in Mice

Life is a series of decisions, ranging from the mundane to the monumental. And each decision is a gamble, carrying with it the chance to second-guess. Did I make the right turn at that light? Did I choose the right college? Was this the right job for me?

Our desire to persist along a chosen path is almost entirely determined by our confidence in the decision: when you are confident that your choice is correct, you are willing to stick it out for a lot longer. 

Confidence determines much of our path through life, but what is it? Most people would describe it as an emotion or a feeling. In contrast, scientists at Cold Spring Harbor Laboratory (CSHL) have found that confidence is actually a measureable quantity, and not reserved just for humans. The team, led by CSHL Associate Professor Adam Kepecs, has identified a brain region in rats whose function is required for the animals to express confidence in their decisions. 

How do we know when a rat is exhibiting confidence? The researchers devised a method to study decision making in these animals. The rats were offered an odor that they were trained to associate with one of two doors. When they chose the correct door, they were rewarded. This part was easy for the animals: their selections were almost always correct.­­ Things got trickier when Kepecs and his team offered a mixture of the two scents, with one dominating over the other by only a very small percentage. The rats now needed to choose the door representing the dominant odor in order to get their reward– a choice that reflects their best guess.

In work published today in Neuron, the team describes how confidence can be measured simply by challenging a rat to wait for the reward to be revealed behind the door. The time they are willing wait serves as a measure of the confidence in their original decision. “We found that the rats are willing to ‘gamble’ with their time,” Kepecs explains, sometimes waiting as much as 15 seconds, which is an eternity for these animals. “This is something that we can measure and create mathematical models to explain,” said Kepecs. “The time rats are willing to wait predicts the likelihood of correct decisions and provides an objective measure to track the feeling of confidence.”

The researchers hypothesized that a distinct region of the brain might control confidence. Previous work has suggested that the orbitofrontal cortex (OFC), a part of the brain involved in making predictions, might have a role in decision confidence. Kepecs and his team specifically shut off neurons in the OFC, inactivating it, and found that rats no longer exhibited appropriate levels of confidence in their decisions. 

“With an inactive OFC, the rats retained the ability to make decisions– their accuracy did not change,” said Kepecs. “And they spent the same amount of time waiting for a reward on average. The only difference is that animals’ willingness to wait for a reward was no longer guided by confidence. They would often wait a long time even when they were wrong.” 

The discovery offers a rare glimpse into the neuronal basis of a higher-level cognitive process, and is likely to have implications in human decision-making as well. As Kepecs describes, “we now know that the OFC is critical for making on-the-fly predictions in rats. The human OFC is just a more sophisticated version of the rodent counterpart.” The team is expanding their research to explore how the elusive feelings of confidence are based on objective predictions that influence human decisions as well. 

The study appeared online in Neuron.

New MRI Technique Helps Clinicians Better Predict Outcomes Following Mild Traumatic Brain Injury

When are our stroke doctors going to do something similar? With no objective diagnosis of the damage from a stroke there is absolutely no way to correlate successful stroke rehabilitation protocols to the damage location. And then maybe we can get away from the appallingly stupid saying of 'All strokes are different, all stroke recoveries are different'.
http://www.alphagalileo.org/ViewItem.aspx?ItemId=145423&CultureCode=en
Diffusion Tensor Imaging (DTI), a specialized magnetic resonance imaging (MRI) technique that detects microstructural changes in brain tissue, can help physicians better predict the likelihood for poor clinical outcomes following mild traumatic brain injury compared to conventional imaging techniques such as computed tomography (CT), according to a new study published in Journal of Neurotrauma, a peer-reviewed journal from Mary Ann Liebert, Inc., publishers. The article is available free on the Journal of Neurotrauma website until October 17, 2014.

The ability to predict which patients who experience an acute head injury such as mild traumatic brain injury (mTBI) are likely to suffer ongoing dysfunction 3 or 6 months post-injury is important for providing optimal care. Esther Yuh and coauthors from University of California, San Francisco, Erasmus MC-University Medical Center (Rotterdam, The Netherlands), Mount Sinai School of Medicine (New York, NY), Seton Brain and Spine Institute (Austin, TX), University of Pittsburgh Medical Center (PA), University of Texas (Austin), Antwerp University Hospital (Edegem, Belgium), and University of Cambridge Addenbrooke's Hospital (Cambridge, UK), present the results of the first published study that compares DTI to conventional imaging and clinical factors for outcome prediction in individual patients with mTBI. DTI showed significant differences between the white matter of mTBI patients who had positive versus negative findings on CT and MRI evaluation, as described in the article "Diffusion Tensor Imaging for Outcome Prediction in Mild Traumatic Brain Injury: A TRACK-TBI Study."

John T. Povlishock, PhD, Editor-in-Chief of Journal of Neurotrauma and Professor, Medical College of Virginia Campus of Virginia Commonwealth University, Richmond, notes that "this exceptionally well done study addresses an issue of continuing controversy and confusion. The authors make an extremely important observation that MRI studies, including DTI parameters, are integral in informing prognosis after mild TBI. When taken together with the other publications from the TRACK-TBI Study Group, these findings should prove invaluable in assessing the occurrence of mild TBI and informing patient outcome."

The management of spasticity in adults

You will notice they say manage, not cure. Dammit expend some intellectual energy and solve the f*cking problem. Point blank ask your doctor what the hell they are doing to solve the spasticity problem.  Screaming in their faces might be useful.  No spitting though. I don't give a damn for their excuse that nothing is clinically proven to work on spasticity. 
Solve it yourself!
http://www.bmj.com/content/349/bmj.g4737?

1. Krishnan Padmakumari Sivaraman Nair, consultant1,
2. Jonathan Marsden, professor2

Author affiliations

1. Correspondence to: K P S Nair siva.nair@sth.nhs.uk

Summary points

• Spasticity is a frequent and debilitating feature of common neurological conditions such as stroke, multiple sclerosis, and traumatic brain and spinal cord injuries
• The disorder is often associated with pain and discomfort and increased care needs
• Spasticity is difficult to manage and requires a collaborative approach involving multiple disciplines
• The evidence for both drug and non-drug treatments of spasticity is limited
• More research is required to determine the effectiveness of various treatments of spasticity

Spasticity is a common disorder affecting people with long term neurological conditions such as stroke, multiple sclerosis, and traumatic brain and spinal cord injuries. A systematic review of 24 studies on the epidemiology of leg spasticity reported a prevalence of 28-38% in patients with stroke, 41-66% in patients with multiple sclerosis, and 13% in patients with traumatic brain injury.1

Spasticity varies from a subtle neurological sign to a gross increase in tone causing immobility of joints. The disorder is associated with several complications, including falls, pain, pressure ulcers, infections, and contractures,2 although it is not clear whether these complications are caused by spasticity or co-exist independently.1 Spasticity increases care needs and utilisation of healthcare resources,3 and carers of patients with spasticity are more likely to experience anxiety and depression.4 Some patients may make use of their spasticity to sit, stand, walk, or transfer. Management of spasticity requires a balanced approach, weighing the benefits of treatment against the usefulness of the spasticity. Current interventions to treat spasticity lack a robust evidence base, and guidelines often depend on expert recommendations. This review discusses the assessment and treatment of spasticity in adults.

A great stroke association would be producing a stroke report like this every year. We have crap for stroke associations, but they do know how to put out press releases.

World Alzheimer Report 2014: Dementia and Risk Reduction