Use the labels in the right column to find what you want. Or you can go thru them one by one, there are only 34,155 posts. Searching is done in the search box in upper left corner. I blog on anything to do with stroke. DO NOT DO ANYTHING SUGGESTED HERE AS I AM NOT MEDICALLY TRAINED, YOUR DOCTOR IS, LISTEN TO THEM. BUT I BET THEY DON'T KNOW HOW TO GET YOU 100% RECOVERED. I DON'T EITHER BUT HAVE PLENTY OF QUESTIONS FOR YOUR DOCTOR TO ANSWER.
Changing stroke rehab and research worldwide now.Time is Brain!trillions and trillions of neuronsthatDIEeach day because there areNOeffective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.
What this blog is for:
My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.
Just in case you have this device contact your doctor for an evaluation of risks. http://dgnews.docguide.com/label-use-device-prevent-stroke-patients-af-prevalent-dangerous?
The Lariat device, which has been cleared by the US Food and Drug
Administration (FDA) for soft tissue approximation during surgical
procedures, is associated with a significant incidence of death and
urgent cardiac surgery during its frequent off-label use to prevent
stroke in patients with atrial fibrillation.
Following a systematic review of case reports and an FDA safety
database, researchers at the University of Pennsylvania Perelman School
of Medicine, Philadelphia, Pennsylvania, are calling for formal
controlled investigations into the safety and efficacy of off-label use
of the Lariat device, which has never been approved for treatment of
this condition.
Their findings are published this week in JAMA Internal Medicine.
“Not only do we believe that high-quality, randomised clinical trials
are necessary to determine the safety of the Lariat device for
off-label procedures, but our analysis raises broader issues with the
FDA 510(k) clearance protocol for medical devices,” said senior author
Jay Giri, MD, University of Pennsylvania. “We believe there needs to be a
method for reassessing the safety of a device that has been cleared for
one use but is being frequently used for a different purpose in
real-world practice."
“The 510(k) clearance protocol is providing a regulatory loophole
that allows manufacturers to avoid full safety and efficacy testing of
devices cleared for one purpose, but used in practice for another
higher-risk application,” he said. “”In addition to the Lariat, this
issue could be important for other devices used in complex procedures
that have been cleared through the 510(k) pathway.”
The current study consisted of 2 sources: a systemic review of
published reports, and an analytic review of the FDA Manufacturer and
User Facility Device Experience (MAUDE) database. For the systematic
review, the researchers searched PubMed, EMBASE, CINAHL, and the
Cochrane Library for any reports of outcomes associated with the use of
the Lariat device for left atrial appendage exclusion.
The researchers found 7 cases of urgent need for cardiac surgery
following use of the device (2.3% of the 309 procedures reviewed) and 1
death (0.3% of the 309 procedures), with an overall procedural success
rate of 90.3%. The analytic review of the FDA MAUDE database identified 5
adverse event reports that noted death and another 23 reports of cases
necessitating urgent cardiac surgery.
“The Lariat is an ingenious piece of engineering for closing the left
atrial appendage, but ingenuity does not guarantee safety and
efficacy,” said Dr. Giri. “The Lariat must be assessed as a device for
left atrial appendage exclusion with randomised, controlled trials
before widespread use is adopted by the medical community.”
SOURCE: University of Pennsylvania School of Medicine
So what healthy diet does your doctor have you on while in the hospital? I didn't consider any of the meals I had in the hospital healthy. http://dgnews.docguide.com/healthy-diet-linked-lower-risk-memory-thinking-decline?
People who eat a healthy diet with lots of fruits and vegetables,
nuts, fish, moderate alcohol use, and not much red meat may be less
likely to experience declines in their memory and thinking skills,
according to a study published in the May 6, 2015, online issue of the
journal Neurology.
“Adoption of a healthy diet probably begins early in life, and a
healthy diet might also go along with adoption of other healthy
behaviours,” said Andrew Smyth, McMaster University, Hamilton, Ontario.
For the study, 27,860 people in 40 countries were followed for an
average of about 5 years. All participants were aged 55 years or older
and had diabetes or a history of heart disease, stroke or peripheral
artery disease. People who had experienced a recent stroke, congestive
heart failure, and other serious conditions were not included in the
study.
Participants’ thinking and memory skills were tested at the start of
the study, after two years and after about five years. Participants were
asked at the beginning of the study how often they ate certain types of
foods, including fruits and vegetables, nuts and soy proteins, whole
grains, deep fried foods and drank alcohol, as well as the ratio of fish
to meat and eggs in their diet.
The study participants were followed until they experienced a
myocardial infarction (MI), stroke, hospitalisation for congestive heart
failure or death from cardiovascular disease or until the end of the
study.
The thinking and memory tests yielded total scores with a maximum of
30 points. Participants were considered to have declined in their skills
if their scores dropped by 3 or more points during the study. A total
of 4,699 people had a decline in their thinking and memory skills. People with the healthiest diets were 24% less likely to have
cognitive decline than people with the least healthy diets. Among the
5,687 people with the healthiest diet, 782 (14%) had cognitive decline,
compared with 987 (18%) of the 5,459 people with the least healthy
diets.
The results were the same when researchers accounted for other
factors that could affect the results, such as physical activity, high
blood pressure, and history of cancer.
If she can write this, why hasn't your doctor created a stroke protocol diet? And as an expert has your doctor consulted her about any stroke rehabilitation protocols?
http://www.prweb.com/releases/2015/04/prweb12687806.htm
The Neuroscience Institute at Memorial Regional Hospital
has achieved two designations for its excellence in treatment and care
of stroke patients, and for promoting a streamlined approach aimed to
achieve consistently positive outcomes for stroke patients from the time
of arrival in the emergency room.
For the 12th year in a row, Memorial Regional Hospital’s
multidisciplinary stroke team has received the American Heart
Association/American Stroke Association (AHA/ASA) Get With The
Guidelines®- Stroke Gold Plus Achievement Award. In addition to this
recognition, the Neuroscience Institute has been given the highest level
of designation known as the Target: Stroke Honor Roll Elite Plus
Designation.
To achieve the Stroke Gold Plus Award, hospitals must reach a goal of
treating stroke patients with 85 percent or higher compliance with all
Get With The Guidelines-Stroke Achievement Measures for two or more
consecutive years. They must also have attained 75 percent or higher
compliance with five of eight of the program’s quality measures.
http://www.nbc29.com/story/28981103/uva-stroke-program-earns-national-quality-awards
The University of Virginia Health System's stroke program now has one of
the highest distinctions from the American Heart Association.
UVA
received both the 2015 Get With The Guidelines®-Stroke Gold-Plus
Achievement Award and made the Target: Stroke Honor Roll Elite.
Neurologists
are working on a number of treatment options including what is called
clot-retrieval. This approach will streamline UVA stroke guidelines
going forward.
Knowledge
regarding neuroplasticity post-stroke is increasingly expanding. In
spite of this, only a few physiotherapy interventions have been able to
demonstrate effectiveness in achieving recovery of lost sensorimotor
control. The aims of this review article are to highlight and discuss
challenges for physiotherapists working with patients post-stroke, to
question some current assessment methods and treatment approaches, and
to pose critical questions indicating a possible new direction for
physiotherapists in stroke rehabilitation. Differentiation between
recovery and compensation post-stroke is increasingly being emphasized.
Implementation of this goal in the clinic is insufficient, with a lack
of assessment tools with potential to discriminate between the concepts.
Large-scale reviews are performed without considering whether
functional gains are achieved through “more effective” compensatory
strategies or through recovery. Cortical plasticity in
neurorehabilitation research and voluntary control in contemporary
treatment methods are in focus. Challenges for physiotherapists in
stroke rehabilitation consist of rethinking, including looking upon the
body under the influence of gravity, focusing on implicit factors that
impact movement control and developing new assessment tools. The
introduction of a new assessment and treatment concept aiming at
expanding the boundaries of center of mass movements towards the paretic
side is proposed. In conclusion, we need to assume our responsibilities
and step forward as the experts in movement science that we have the
potential to be.
This is interesting but it doesn't address brain injury. So if we had a great stroke association we could ask them to add this to the strategy list to see if doing this would help stroke patients. But we don't have a great stroke association so this question will probably never be answered.
Iwata, Akiko PhD; Morrison, Michael L. PhD; Blackwood, Jennifer E. MPH; Roth, Mark B. PhD
Published Ahead-of-Print
Abstract: Since blood selenium levels decrease after
ischemia and reperfusion injury, and low blood selenium correlates with
negative outcome, we designed and performed experiments to determine how
selenium distribution is affected by ischemia reperfusion injury.
Furthermore, we tested whether different chemical forms of selenium
would affect outcome after ischemia and reperfusion injury. We also
examined the metabolic effects of selenide administration.
Design: Laboratory investigation.
Setting: Animal research laboratory.
Subjects: Adult male C57BL/6 mice.
Interventions:
To determine selenium localization, we
administered tracer doses of radioactive selenium 75 in the form of
selenite or selenide and measured blood and tissue selenium levels after
ischemia and reperfusion injury. Anesthetized mice were subjected to
myocardial ischemia reperfusion injury (coronary artery occlusion for 60
min followed by 5 min of reperfusion after occlusion was removed) or
hindlimb ischemia reperfusion injury (left leg tourniquet for 90 min
followed by 5 min reperfusion after tourniquet removal). To determine
whether exogenous selenium administration could reduce ischemia
reperfusion injury, we synthesized and administered sodium hydroselenide
and sodium selenite solutions (0.05-2.4 mg/kg). Solutions were
administered at the end of coronary artery occlusion but before
reperfusion. In order to determine the metabolic effects of selenide
administration, we exposed mice to hydrogen selenide gas (0-5 ppm) mixed
into air (20.95% oxygen) for up to 3 hours.
Measurements and Main Results: In targeting assays, we
measured blood and tissue selenium levels. We observed that blood
selenium decreases after myocardial ischemia reperfusion and displays an
inverse correlation with injury severity; selenium accumulation in
heart correlates directly with injury severity. We also measured whether
oxidized selenium, selenite, and reduced selenium, selenide, would
target to injured heart tissue in myocardial ischemia reperfusion and
injured leg muscle in a hindlimb model of ischemia reperfusion. Only
selenide targets to injured tissue. We also measured damage after
myocardial ischemia reperfusion injury using morphometry, neutrophil
accumulation, blood cardiac troponin levels, and echocardiography and
observed in all assays that selenide reduced damage to the heart;
selenite was not effective. And finally, to assay metabolism, we
measured oxygen consumption, carbon dioxide production, and body core
temperature before, during, and after hydrogen selenide administration.
All measurements indicate that selenide decreases metabolism.
Conclusions:
Selenide targets to reperfusing tissue and reduces reperfusion injury perhaps by affecting oxygen metabolism.
Cannella, G., Laila, D.S. and Freeman, C. T. (2015) Mechanical Design of an Affordable Adaptive
Gravity Balanced Orthosis for Upper Limb Stroke
Rehabilitation.Mechanics Based Design of Structures and Machines, An International Journal (In Press).
In this
paper a novel design of non-powered orthosis for stroke rehabilitation
is reported. Designed for home based use, it is the first low-cost,
passive design to incorporate an assistive level that can be adaptively
varied within a closed-loop control scheme. This allows the device to be
integrated with a dual robotic and electrical stimulation control
scheme, to thereby enable full exploitation of the motor relearning
principles which underpin both robotic therapy and Functional Electrical
Stimulation (FES) based stroke rehabilitation. This embeds the
potential for more effective treatment. The paper focuses on the
mechanical design of the non-powered orthosis, providing detailed design
and dynamics analysis and evaluation.
This should mean that our stroke associations will be contacting all the insurance companies out there and making sure that therapy is not limited until recovery is achieved. And pigs fly. Plateau is not a medical term, it is just used to limit therapy and save money for the companies insuring you. http://www.nrcresearchpress.com/doi/abs/10.1139/apnm-2014-0523#.VUqK4WONqYk
Yao Sun, Joanne Boots, E. Paul Zehr
Published on the web 30 April 2015.
Received November 27, 2014.
Applied Physiology, Nutrition, and Metabolism, 10.1139/apnm-2014-0523
Abstract
It
was once falsely believed that neurological and functional recovery
after stroke occurred only in the first six months after lesion. The
perception of this "6 month myth" continues to negatively impact the
attitudes of patients towards their rehabilitation and on the clinicians
and therapists making optimal training plans. Here we briefly outline
some evidence that debunked the “6-month myth”, where the concept of
this temporal limit may have originated, and the lingering
misunderstanding that individuals with stroke reach a plateau of
recovery after six months even with rehabilitation training. We present
evidence that significant functional improvement can occur years after
stroke when rehabilitation training is applied. We frame the concepts of
active and passive neurological recovery and that active neurological
recovery continues far beyond any temporal limit. Because the effects
of this busted “6 month myth” persist, we aim to remind active
physicians, therapists, exercise professionals and people with stroke to
continuously seek opportunities for active rehabilitation training.
Meanwhile, trained and certified exercise professionals can play
critical roles in facilitating rehabilitative training for
community-dwelling stroke survivors.
There is absolutely nothing in here that tells me that the RESULTS are better in this hospital than other hospitals. I don't give a crap about how well you do processes. Big f*cking whoopee.
You can check out Joint
Commission standards here:
I saw absolutely
nothing about what should be done the first week or anything about measuring
30-day deaths and 100% recovery. God, these people are worse than
worthless. Complacent good-for-nothings. http://www.prnewswire.com/news-releases/st-jude-earns-national-recognition-as-an-advanced-comprehensive-stroke-center-300077137.html
St. Jude Medical Center (SJMC) has been
certified by The Joint Commission as an Advanced Comprehensive Stroke
Center, a level of recognition reserved for an elite group of hospitals
capable of treating the most complex stroke cases. SJMC is one of only
10 hospitals in the state to have earned this advanced designation.
"From
mild stroke to the most severe and challenging types of stroke and
cerebrovascular disease, we are creating outcomes that were unthinkable a
decade ago," says Johnson Moon,
MD, Medical Director, Stroke Program, SJMC. "This honor highlights our
ability to consistently meet and exceed national standards and
benchmarks."
The
certification recognizes the significant differences in expertise,
resources and training that are necessary for the treatment of complex
stroke cases. Fewer than 100 of the nation's hospitals offer this level
of care.
"With
the advances in technology and expertise available here, we are
increasingly able to go beyond simply treating a stroke – and actually
prevent or reverse its effects," explains Hamed Farid,
MD, Medical Director, Interventional Neuroradiology, SJMC. "Stroke
remains a leading cause of death and the number one cause of disability,
yet the care available at a handful of hospitals, like St. Jude, is
making a significant improvement in the outcomes."
The
Joint Commission, an independent, not-for-profit organization that
accredits and certifies more than 19,000 health care organizations and
programs in the United States,
conducted a rigorous on-site review of the hospital's stroke program in
February, collecting data and evaluating performance in areas from
stroke research and neuro-interventional capabilities, to patient
outcomes and post-hospital care.
The
Joint Commission allows hospitals to apply for two advanced
certifications in stroke care, "primary" or "comprehensive."
Comprehensive Stroke Centers offer the highest level of care, including
dedicated neurointensive unit, complicated neurosurgical interventions,
and advanced brain and blood-vessel imaging, as well as a staff with the
unique education and competencies to care for complex stroke patients.
"This
designation reflects the extraordinary dedication and talent of our
neurologists, neurosurgeons, interventional neuroradiologists,
neurointensivists, physiatrists, specially-trained nurses, and clinical
and support staff – who offer expert care around-the-clock, for stroke
from any cause, whether a blocked artery, ruptured aneurysm, or brain
hemorrhage," explains Lee Penrose, President and CEO, SJMC.
St.
Jude Medical Center's Stroke Program includes the most advanced
neurosurgical capabilities in the state, as well as a cutting-edge
neurointervention lab. It also provides the combined expertise of nearly
a dozen specialties, including Southern California's largest group of board-certified neurocritical care experts and a CARF accredited stroke recovery program.
The
hospital's highly-rated stroke program is part of the newly created St.
Jude Medical Center Neurosciences Institute, which brings together
widely respected services in spine, sleep disorders, brain injuries,
pain medicine, brain and spinal tumors, neurorehabilitation and movement
disorders.
The
Joint Commission developed the criteria for Advanced Certification for
Comprehensive Stroke Centers in collaboration with the American Heart
Association/American Stroke Association, including recommendations from
the Brain Attack Coalition and a multidisciplinary advisory panel of
experts in complex stroke care.(not results)
I bet your doctor has no cognitive protocol for you post-stroke. You'll have to figure this out on your own. http://www.alphagalileo.org/ViewItem.aspx?ItemId=152318&CultureCode=en
Strokes are the second leading cause of death worldwide; they kill
more than one million people in Europe each year accounting for 14% of
all deaths. About a third of the 8 million stroke survivors in the EU
are left with some degree of physical or cognitive impairment affecting
their ability to plan and carry out actions.
While there are already many rehabilitation ICT systems focused on
treating the physical symptoms of stroke, such as hemiparesis, there
aren’t many for the rehabilitation of cognitive impairments. The
EU-funded COGWATCH project has developed a rehabilitation system to help
improve the cognitive functions of stroke survivors.
Stroke patients can have trouble performing ordered sequences of
movements, such as those required to brush their teeth or to make a cup
of tea. These are often symptoms of Apraxia or Action Disorganisation
Syndrome (AADS). COGWATCH is using intelligent tools and objects,
portable and wearable devices as well as ambient systems to provide
support at home to patients with AADS symptoms.
‘We take it for granted that we can perform these activities of daily
life,’ says Professor Alan Wing, the project’s coordinator and a
faculty member of the School of Psychology at the University of
Birmingham. "Yet many of these seemingly simple tasks are actually
complex and involve a large number of small steps that must be performed
in the correct sequence."
As simple – or complex – as brewing a cup of tea
The COGWATCH scientists customised a prototype that helps stroke
patients brew a cup of tea – a complex sequential daily task. The system
consists of two tablet computers, one for the patient and one for his
clinician, and sensors attached to the bottom of objects such as the
cup, milk jug and kettle that track the objects’ movement, while a video
camera records the entire process from overhead. On the tablet, the
patient can choose an action, for example he will prepare a cup of tea
with milk and sugar.
A action-recognition system is then activated: it receives the
information from the sensors, compares those with the task model
corresponding to the steps of preparing a milk and sugar cup of tea. If
the patient makes an error in preparing the tea, then system prompts the
correct action using any combination of video, audio, text or vibration
to suggest the right step.
Professor Wing, ‘As a patient, it is as if there is someone beside
you to tell you what to do, but they allow you to act independently if
you want to be independent.’
Tea-making results
To test the system, the COGWATCH researchers conducted a randomised
study with 30 patients. Compared with the control group, participants
who were trained using the COGWATCH system, showed statistically
significant improvements in tea-making performance; they made 54% fewer
errors and showed a 20% reduction in time taken to make a cup of tea.
Better care
Apart from helping stroke patients regain independence, the COGWATCH
system could also enable occupational therapists to work with more
patients or develop more of each patient’s skills. The system already
provides useful information on the patient’s task performance over time.
Longer-term, COGWATCH could facilitate the earlier discharge of
patients, thus lowering their risk of infection, allowing them to return
to their familiar home environment, and freeing bed space.
COGWATCH ran from1 November 2011 through 28 February 2015 and received EUR 3.7 million in EU funding.
‘We would eventually like to offer systems that are affordable enough
for home use so that, for example, every hospital could loan them out
to its patients,’ concludes Professor Wing. http://cordis.europa.eu/result/rcn/162534_en.html
1
Interdisciplinary Division of Biomedical Engineering, The Hong Kong
Polytechnic University, Hong Kong, S.A.R., China
2
Department of Electronic Engineering Division of Biomedical Engineering,
The Chinese University of Hong Kong, Hong Kong, S.A.R., China
Journal of NeuroEngineering and Rehabilitation 2015, 12:42
doi:10.1186/s12984-015-0033-5
The electronic version of this article is the complete one and can be found online at: http://www.jneuroengrehab.com/content/12/1/42
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0),
which permits unrestricted use, distribution, and reproduction in any
medium, provided the original work is properly credited. The Creative
Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data
made available in this article, unless otherwise stated.
Abstract
Background
While constraint-induced movement therapy (CIMT) is one of the most promising techniques
for upper limb rehabilitation after stroke, it requires high residual function to
start with. Robotic device, on the other hand, can provide intention-driven assistance
and is proven capable to complement conventional therapy. However, with many robotic
devices focus on more proximal joints like shoulder and elbow, recovery of hand and
fingers functions have become a challenge. Here we propose the use of robotic device
to assist hand and fingers functions training and we aim to evaluate the potential
efficacy of intention-driven robot-assisted fingers training.
Methods
Participants (6 to 24 months post-stroke) were randomly assigned into two groups:
robot-assisted (robot) and non-assisted (control) fingers training groups. Each participant
underwent 20-session training. Action Research Arm Test (ARAT) was used as the primary
outcome measure, while, Wolf Motor Function Test (WMFT) score, its functional tasks
(WMFT-FT) sub-score, Fugl-Meyer Assessment (FMA), its shoulder and elbow (FMA-SE)
sub-score, and finger individuation index (FII) served as secondary outcome measures.
Results
Nineteen patients completed the 20-session training (Trial Registration: HKClinicalTrials.com
HKCTR-1554); eighteen of them came back for a 6-month follow-up. Significant improvements
(p < 0.05) were found in the clinical scores for both robot and control group after
training. However, only robot group maintained the significant difference in the ARAT
and FMA-SE six months after the training. The WMFT-FT score and time post-training
improvements of robot group were significantly better than those of the control group.
Conclusions
This study showed the potential efficacy of robot-assisted fingers training for hand
and fingers rehabilitation and its feasibility to facilitate early rehabilitation
for a wider population of stroke survivors; and hence, can be used to complement CIMT.
Importance
Acute ischemic stroke is a major cause of mortality and
morbidity in the United States. We review the latest data and evidence
supporting catheter-directed treatment for proximal artery occlusion as
an adjunct to intravenous thrombolysis in patients with acute stroke. Objective
To review the pathophysiology of acute brain ischemia and
infarction and the evidence supporting various stroke reperfusion
treatments. Evidence Review
Systematic literature search of MEDLINE databases published
between January 1, 1990, and February 11, 2015, was performed to
identify studies addressing the role of thrombolysis and mechanical
thrombectomy in acute stroke management. Studies included randomized
clinical trials, observational studies, guideline statements, and review
articles. Sixty-eight articles (N = 108 082 patients) were selected for
review. Findings
Intravenous thrombolysis is the mainstay of acute ischemic
stroke management for any patient with disabling deficits presenting
within 4.5 hours from symptom onset. Randomized trials have demonstrated
that more patients return to having good function (defined by being
independent and having slight disability or less) when treated within
4.5 hours after symptom onset with intravenous recombinant tissue
plasminogen activator (IV rtPA) therapy. Mechanical thrombectomy in
select patients with acute ischemic stroke and proximal artery
occlusions has demonstrated substantial rates of partial or complete
arterial recanalization and improved outcomes compared with IV rtPA or
best medical treatment alone in multiple randomized clinical trials.
Regardless of mode of reperfusion, earlier reperfusion is associated
with better clinical outcomes. Conclusions and Relevance
Intravenous rtPA remains the standard of care for patients
with moderate to severe neurological deficits who present within 4.5
hours of symptom onset. Outcomes for some patients with acute ischemic
stroke and moderate to severe neurological deficits due to proximal
artery occlusion are improved with endovascular reperfusion therapy.
Efforts to hasten reperfusion therapy, regardless of the mode, should be
undertaken within organized stroke systems of care.
Will your doctor finally use this as a basis for a stroke diet? In-hospital and out? Because somebody else did the work s/he seemed to be too lazy to do?
You can read this to see if you trust Dr. Fuhrman.
Nutritional Research Foundation, Flemington, New Jersey
Joel Fuhrman, MD, Nutritional Research Foundation, 4 Walter Foran Blvd, Suite 409, Flemington, NJ 08822; e-mail: drfuhrman@nutritionalresearch.org.
Abstract
This article covers some important
concepts and controversies in modern nutritional science. It describes a
diet style designed
to maximize health, longevity, and disease
reversal—foundationally structured on the quality and comprehensive
adequacy of
nutrients rather than the balance of
macronutrients, as is more popular today. I call such a diet, which
attempts to optimize
micronutrients, a nutritarian diet. I will review a
small case series demonstrating typical results in diabetics and some
of my clinical observations over the last 25 years
treating people with a nutritarian diet, which could be either vegan or
flexitarian. I will also discuss health concerns
observed from an unsupplemented vegan diet, specifically the risk of
depression
and later life dementia in individuals with
enhanced need for long-chain omega-3 fatty acids.
'Time is brain' mantra forgotten for hospitalized patients.
Delays in the recognition and treatment of strokes occurring during
hospitalization are common, and in-hospital strokes tend to be more
severe and have worse outcomes than strokes occurring among those who
are not hospitalized, researchers reported.
Compared with community-onset strokes, patients with in-hospital
strokes generally waited longer for neuroimaging (median 4.5 vs 1.2
hours; P<0.001) and received thrombolysis less often (12% vs. 19% of ischemic strokes), researcher Moria K. Kapral, MD, of Toronto General Hospital, Ontario, Canada, and colleagues wrote in JAMA Neurology, published online May 4.
Advertisement
There was also a greater delay between stroke recognition
and thrombolysis (median 2 hours among in-hospital stroke patients vs.
1.2 hours for community-occurring stroke, P<0.001), but
after adjustment for relevant factors such as age and stroke severity,
mortality rates at 30 days and 1 year were similar between the two
groups.
"Patients with in-hospital strokes were really very different from
the community-onset stroke population," Kapral said in a press briefing.
Early
mobilisation after stroke is thought to contribute to the effects of
stroke-unit care; however, the intervention is poorly defined and not
underpinned by strong evidence. We aimed to compare the effectiveness of
frequent, higher dose, very early mobilisation with usual care after
stroke.
Methods
We did this
parallel-group, single-blind, randomised controlled trial at 56 acute
stroke units in five countries. Patients (aged ≥18 years) with ischaemic
or haemorrhagic stroke, first or recurrent, who met physiological
criteria were randomly assigned (1:1), via a web-based computer
generated block randomisation procedure (block size of six), to receive
usual stroke-unit care alone or very early mobilisation in addition to
usual care. Treatment with recombinant tissue plasminogen activator was
allowed. Randomisation was stratified by study site and stroke severity.
Patients, outcome assessors, and investigators involved in trial and
data management were masked to treatment allocation. The primary outcome
was a favourable outcome 3 months after stroke, defined as a modified
Rankin Scale score of 0–2. We did analysis on an intention-to-treat
basis. The trial is registered with the Australian New Zealand Clinical
Trials Registry, number ACTRN12606000185561.
Findings
Between
July 18, 2006, and Oct 16, 2014, we randomly assigned 2104 patients to
receive either very early mobilisation (n=1054) or usual care (n=1050);
2083 (99%) patients were included in the 3 month follow-up assessment.
965 (92%) patients were mobilised within 24 h in the very early
mobilisation group compared with 623 (59%) patients in the usual care
group. Fewer patients in the very early mobilisation group had a
favourable outcome than those in the usual care group (n=480 [46%] vs
n=525 [50%]; adjusted odds ratio [OR] 0·73, 95% CI 0·59–0·90; p=0·004).
88 (8%) patients died in the very early mobilisation group compared
with 72 (7%) patients in the usual care group (OR 1·34, 95% CI
0·93–1·93, p=0·113). 201 (19%) patients in the very early mobilisation
group and 208 (20%) of those in the usual care group had a non-fatal
serious adverse event, with no reduction in immobility-related
complications with very early mobilisation.
Interpretation
First
mobilisation took place within 24 h for most patients in this trial.
The higher dose, very early mobilisation protocol was associated with a
reduction in the odds of a favourable outcome at 3 months. Early
mobilisation after stroke is recommended in many clinical practice
guidelines worldwide, and our findings should affect clinical practice
by refining present guidelines; however, clinical recommendations should
be informed by future analyses of dose–response associations.
Funding
National
Health and Medical Research Council, Singapore Health, Chest Heart and
Stroke Scotland, Northern Ireland Chest Heart and Stroke, UK Stroke
Association, National Institute of Health Research.
Tudor G. Jovin, M.D., Angel Chamorro, M.D., Erik
Cobo, Ph.D., María A. de Miquel, M.D., Carlos A. Molina, M.D., Alex
Rovira, M.D., Luis San Román, M.D., Joaquín Serena, M.D., Sonia
Abilleira, M.D., Ph.D., Marc Ribó, M.D., Mònica Millán, M.D., Xabier
Urra, M.D., Pere Cardona, M.D., Elena López-Cancio, M.D., Alejandro
Tomasello, M.D., Carlos Castaño, M.D., Jordi Blasco, M.D., Lucía Aja,
M.D., Laura Dorado, M.D., Helena Quesada, M.D., Marta Rubiera, M.D.,
María Hernandez-Pérez, M.D., Mayank Goyal, M.D., Andrew M. Demchuk,
M.D., Rüdiger von Kummer, M.D., Miquel Gallofré, M.D., and Antoni
Dávalos, M.D. for the REVASCAT Trial Investigators
We
aimed to assess the safety and efficacy of thrombectomy for the
treatment of stroke in a trial embedded within a population-based stroke
reperfusion registry.
During
a 2-year period at four centers in Catalonia, Spain, we randomly
assigned 206 patients who could be treated within 8 hours after the
onset of symptoms of acute ischemic stroke to receive either medical
therapy (including intravenous alteplase when eligible) and endovascular
therapy with the Solitaire stent retriever (thrombectomy group) or
medical therapy alone (control group). All patients had confirmed
proximal anterior circulation occlusion and the absence of a large
infarct on neuroimaging. In all study patients, the use of alteplase
either did not achieve revascularization or was contraindicated. The
primary outcome was the severity of global disability at 90 days, as
measured on the modified Rankin scale (ranging from 0 [no symptoms] to 6
[death]). Although the maximum planned sample size was 690, enrollment
was halted early because of loss of equipoise after positive results for
thrombectomy were reported from other similar trials.
Thrombectomy
reduced the severity of disability over the range of the modified
Rankin scale (adjusted odds ratio for improvement of 1 point, 1.7; 95%
confidence interval [CI], 1.05 to 2.8) and led to higher rates of
functional independence (a score of 0 to 2) at 90 days (43.7% vs. 28.2%;
adjusted odds ratio, 2.1; 95% CI, 1.1 to 4.0). At 90 days, the rates of
symptomatic intracranial hemorrhage were 1.9% in both the thrombectomy
group and the control group (P=1.00), and rates of death were 18.4% and
15.5%, respectively (P=0.60). Registry data indicated that only eight
patients who met the eligibility criteria were treated outside the trial
at participating hospitals.
Among
patients with anterior circulation stroke who could be treated within 8
hours after symptom onset, stent retriever thrombectomy reduced the
severity of post-stroke disability and increased the rate of functional
independence. (Funded by Fundació Ictus Malaltia Vascular through an
unrestricted grant from Covidien and others; REVASCAT ClinicalTrials.gov
number, NCT01692379.)
From
Public Health, Department of Social Medicine, Osaka University Graduate
School of Medicine, Osaka, Japan (J.-Y.D., H.I.,
A.K.); and Department of Public Health,
Hokkaido University Graduate School of Medicine, Sapporo, Japan (A.T.).
Correspondence to Hiroyasu Iso, MD, PhD, Public Health, Department of Social Medicine, Osaka University Graduate School of
Medicine, 2-2 Yamadaoka, Suita, Osaka 565–0871, Japan. E-mail iso@pbhel.med.osaka-u.ac.jp
Abstract
Background and Purpose—An effect of multivitamin supplement on stroke risk is uncertain. We aimed to examine the association between multivitamin
use and risk of death from stroke and its subtypes.
Methods—A total of
72 180 Japanese men and women free from cardiovascular diseases and
cancers at baseline in 1988 to 1990 were followed
up until December 31, 2009. Lifestyles
including multivitamin use were collected using self-administered
questionnaires. Cox
proportional hazards regression models were
used to estimate hazard ratios (HRs) of total stroke and its subtypes in
relation
to multivitamin use.
Results—During a
median follow-up of 19.1 years, we identified 2087 deaths from stroke,
including 1148 ischemic strokes and 877 hemorrhagic
strokes. After adjustment for potential
confounders, multivitamin use was associated with lower but borderline
significant
risk of death from total stroke (HR, 0.87;
95% confidence interval, 0.76–1.01), primarily ischemic stroke (HR,
0.80; 95% confidence
interval, 0.63–1.01), but not hemorrhagic
stroke (HR, 0.96; 95% confidence interval, 0.78–1.18). In a subgroup
analysis, there
was a significant association between
multivitamin use and lower risk of mortality from total stroke among
people with fruit
and vegetable intake <3 times/d (HR, 0.80;
95% confidence interval, 0.65–0.98). That association seemed to be more
evident
among regular users than casual users.
Similar results were found for ischemic stroke.
Conclusions—Multivitamin use, particularly frequent use, was associated with reduced risk of total and ischemic stroke mortality among
Japanese people with lower intake of fruits and vegetables.
This should be easily replicated in stroke patients. So ask your doctor when they are going to start up a clinical research trial based on this. Survivors need to know exactly how our gait is not working properly and protocols to correct that. If no research is forthcoming call the hospital president and ask why the stroke department is not running clinical trials. This is worth going to the mat for.
1
Biomedical Technology Department, Found. Don C. Gnocchi Onlus, IRCCS,
Via Capecelatro 66, Milan, 20148, Italy
2
LaRiCe: Gait and Balance Disorders Laboratory, Department of
Neurorehabilitation, Found. Don C. Gnocchi Onlus, IRCCS, Via Capecelatro
66, 20148, Milan, Italy
3
Department of Electrical, Electronic, and Information Engineering -
Guglielmo Marconi (DEI), University of Bologna, Viale Risorgimento 2,
Bologna, 40136, Italy
Journal of NeuroEngineering and Rehabilitation 2015, 12:45
doi:10.1186/s12984-015-0038-0 The electronic version of this article is the complete one and can be found online at: http://www.jneuroengrehab.com/content/12/1/45
Step climbing is a demanding task required for personal autonomy in daily living.
Anticipatory Postural Adjustments (APAs) preceding gait initiation have been widely
investigated revealing to be hypometric in Parkinson’s disease (PD) with consequences
in movement initiation. However, only few studies focused on APAs prior to step climbing.
In this work, a novel method based on wearable inertial sensors for the analysis of
APAs preceding gait initiation and step climbing was developed to further understand
dynamic balance control. Validity and sensitivity of the method have been evaluated.
Methods
Eleven PD and 20 healthy subjects were asked to perform two transitional tasks from
quiet standing to level walking, and to step climbing respectively. All the participants
wore two inertial sensors, placed on the trunk (L2-L4) and laterally on the shank.
In addition, a validation group composed of healthy subjects and 5 PD patients performed
the tasks on two force platforms. Correlation between parameters from wearable sensors
and force platforms was evaluated. Temporal parameters and trunk acceleration from
PD and healthy subjects were analyzed.
Results
Significant correlation was found for the validation group between temporal parameters
extracted from wearable sensors and force platforms and between medio-lateral component
of trunk acceleration and correspondent COP displacement. These results support the
validity of the method for evaluating APAs prior to both gait initiation and step
climbing. Comparison between PD subjects and a subgroup of healthy controls confirms
a reduction in PD of the medio-lateral acceleration of the trunk during the imbalance
phase in the gait initiation task and shows similar trends during the imbalance and
unloading phase of the step climbing task. Interestingly, PD subjects presented difficulties
in adapting the medio-lateral amplitude of the imbalance phase to the specific task
needs.
Conclusions
Validity of the method was confirmed by the significant correlation between parameters
extracted from wearable sensors and force platforms. Sensitivity was proved by the
capability to discriminate PD subjects from healthy controls. Our findings support
the applicability of the method to subjects of different age. This method could be
a possible valid instrument for a better understanding of feed-forward anticipatory
strategies.
If your doctor isn't giving you something like this to prevent your 33% dementia chance post-stroke from an Australian study. Then your doctor is not doing everything they should be doing post-stroke to get you recovered and keep you recovered. http://www.alzheimersweekly.com/2013/02/sage-pen-paper-alzheimers-test.html The test is available free of charge to healthcare personnel at the following link: (You don't have to be a healthcare professional to download the test, although you might want one to interpret the results and give you protocols to prevent any further deterioration)
How to interpret the results: The SAGE Test download page
includes a click-to-open section entitled "For Physicians," which has
links in English, Spanish and Italian to physician scoring instructions
and scoring explanations.
The scientists were able to determine not only whether the stem cells
transplanted into living animals survived but whether they matured into
nerve cells, integrated into targeted brain circuits and, most
important, were firing on cue and igniting activity in downstream nerve
circuits.
The new monitoring technique could in principle be used to determine the
success of other kinds of stem cell transplantations. It promises in
the near term to improve researchers’ ability to optimize stem cell
therapies in animal experiments and, in the intermediate term, to speed
progress in human trials of stem cell replacement therapy, a promising
but problem-plagued medical intervention.
Many disorders of the central nervous system, such as Parkinson’s
disease, are characterized by defective nerve cells in specific brain
regions. This makes disorders such as Parkinson’s excellent candidates
for stem cell therapies, in which the defective nerve cells are
replaced. But the experiments in which such procedures have been
attempted have met with mixed results, and those conducting the
experiments are hard put to explain them. There’s been no good way to
evaluate what the transplanted stems cells are doing. So optimizing the
regimens becomes a matter of guesswork and luck.
“That’s the key missing step in stem cell therapy design: Once you’ve
transplanted the cells, you can’t tell exactly what they’re doing
afterwards,” said Jin Hyung Lee, Ph.D., assistant professor of
neurology, of neurosurgery and of bioengineering. In the case of
brain-oriented therapies, you have to look for behavioral changes, she
said. “And even when you see them, you still don’t know whether the
newly transplanted cells integrated into the right brain circuits and
are now functioning correctly there.”
Now there’s a way to tell.
Transplanted stem cells did what they were supposed to
Lee is the senior author of a paper, appearing online April 30 in NeuroImage,
detailing a series of experiments in which she and her colleagues
combined functional magnetic resonance imaging, or fMRI, with a
relatively new but increasingly widespread technology known as
optogenetics, which employs laser light to stimulate specific cells that
have been rendered sensitive to particular frequencies of light. The
combination let the scientists selectively stimulate only nerve cells
derived from newly transplanted neural stem cells, while simultaneously
assessing resulting nerve-cell activity at the site of the transplant
and elsewhere in the brain.
Jin
Hyung Lee, Ph.D., assistant professor of neurology, of neurosurgery and
of bioengineering at Stanford, is lead author on the paper. (Source:
Stanford University)The study showed that the
transplanted neural stem cells had indeed matured into nerve cells that
not only integrated into the brain’s circuitry at the transplantation
site but could be induced to fire electrical signals on command, and
that this signaling triggered activity in other areas of the brain. Lead
authorship of the study is shared by former graduate student Blake
Byers, Ph.D., now a general partner with Google Ventures; postdoctoral
scholar Hyun Joo Lee, Ph.D.; and Ph.D. students Jia Liu and Andrew
Weitz.
The researchers first created induced pluripotent stem cells, or iPS
cells, from the skin cells of a patient with Parkinson’s disease. Like
embryonic stem cells, iPS cells have the capacity to differentiate into
every cell type in the human body. Next, they inserted a gene coding for
a photosensitive protein into these iPS cells. The protein situates
itself on the cell’s surface and, in response to blue laser light,
induces electrical activity in the cell.
Then, in a dish, the researchers differentiated the genetically altered
iPS cells into neural stem cells. Unlike iPS cells, which can
differentiate into every cell type in the body, neural stem cells can
mature only into nerve cells or a few other cell types that populate the
brain.
The scientists transplanted these genetically altered human cells into
the brains of rats that were normal except for the fact that their
immune systems were compromised, reducing the chances of an immune
attack on the foreign cells.
The particular region of the brain into which the cells were injected is
called the striatum. In humans, deterioration of particular nerve cells
in this area is a hallmark of Parkinson’s disease, a progressive
neurodegenerative disorder profoundly affecting movement and,
frequently, mental function. Along with the new cells, the investigators
implanted into each rat’s brain a small cannula containing the end of a
thin optical fiber whose far end could be connected to a laser light
source.
From about three months to almost a full year after the procedure, Lee
and her associates conducted experiments in which, using fMRI, they
observed the rats’ brains before, during and after stimulating the
implanted cells with pulses of blue laser light or, as a control, yellow
laser light. Blue-light stimulation triggered activity not only within
the striatum but at several other areas in the brain. Yellow light had
no effect — proof that electrical activity in these cells had been
triggered by stimulating the genetically inserted protein, not merely by
shining light on them.
Recording electrical activity
To explore activity in those areas, the researchers turned to a
different observation method: electrophysiology. While fMRI has the
advantage of imaging large portions of the brain simultaneously, it
actually measures not electrical activity but blood flow in the small
vessels permeating the entire brain. Active nerve cells require more
nutrients, and increased blood flow in a specific location in the brain
is considered an excellent proxy of electrical activity at that
location.
But, having now identified specific brain areas where fMRI scans
indicated increased nerve-cell activity, Lee and her associates
proceeded to directly record electrical activity in these areas by
inserting electrodes there and watching what happened when they pulsed
blue light into the striatum, where the neural stem cells had been
transplanted. They saw, first, that the transplanted nerve cells had
clearly integrated into striatal circuitry and were firing there when
stimulated with blue light; and, second, that this triggered electrical
follow-on activity in remote regions of the brain.
Anatomical inspections of the rats’ brains confirmed that the new cells
had integrated into the striatum and, in many cases, had grown long
projections to the remote areas where follow-on activity had been
observed.
“I’m hopeful that this monitoring approach could work for all kinds of
stem cell-based therapies,” Lee said. “If we can watch the new cells’
behaviors for weeks and months after we’ve transplanted them, we can
learn — much more quickly and in a guided way rather than a
trial-and-error fashion — what kind of cells to put in, exactly where to
put them, and how.”
The study was funded by the National Institutes of Health, the Okawa
Foundation, a National Science Foundation Early Faculty Development
Program award, an Alfred P. Sloan Research Fellowship and the California
Institute for Regenerative Medicine.
But why are you reading this from me? Go ask your damned doctor. And this doesn't even mention my two main reasons for using it. 1. Helps me handle my stroke fatigue. 2. Coffee May Lower Your Risk of Dementia
New research has brought us closer to being able to understand the health benefits of coffee.
Monash Univ. researchers, in collaboration with Italian coffee
roasting company Illycaffè, have conducted the most comprehensive study
to date on how free radicals and antioxidants behave during every stage
of the coffee brewing process, from intact bean to coffee brew.
The team observed the behavior of free radicals—unstable molecules
that seek electrons for stability and are known to cause cellular and
DNA damage in the human body—in the coffee brewing process. For the
first time, they discovered that under certain conditions coffee can act
as an antioxidant, a compound found in foods that helps stabilize free
radicals.
The findings, published in PLOS ONE, will lead to a deeper understanding of the brewing process, as well as the potential health benefits of coffee.
Chief Chemist of Illycaffè, Dr. Luciano Navarini, approached Monash
physicist Dr. Gordon Troup, School of Physics and Astronomy, and his
team in 2012 to conduct the research using state-of-the-art EPR
(Electron Paramagnetic Resonance) Spectroscopy.
“Dr. Troup was one of the first scientists to discover free radicals
in coffee in 1988 and so it made sense for Illycaffè—a world-leading
coffee roasting company actively involved in coffee research—to
collaborate with Dr. Troup and his team on this significant piece of
research into free radical and antioxidant behavior in coffee,” Dr.
Navarini said.
“The most important aim of this research was to better understand the
development of stable free radicals during the roasting process and the
possible influence exerted by developed radicals on the well-documented
coffee antioxidant properties. We also wanted to evidence possible
coffee constituents as a source of antioxidant activity.”
Dr. Troup worked with a team of researchers including Monash alumnus
Dr. Simon Drew from the Univ. of Melbourne, who carried out the
spectroscopy at the Univ. of Melbourne.
“Our research studied both the Arabica coffee bean itself and what
happens to its stable free radical and antioxidant properties during the
brewing process,” Dr. Troup said.
“The findings provide a better understanding of the potential health
benefits of coffee, as well as a deeper knowledge of the roasting
process—ultimately leading to the highest quality cup of coffee.”
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