School of Medicine Study Shows Laughter Helps Blood Vessels Function Better

Known for 11 years, has your doctor prescribed ANY funny movies or comedians? Are they that fucking far behind the times? 

School of Medicine Study Shows Laughter Helps Blood Vessels Function Better

For immediate release: March 07, 2005

Contact:

Bill Seiler

bseiler@umm.edu | 410-328-8919

Volunteers were shown funny and disturbing movies to test the effect of emotions on blood vessels

Using laughter-provoking movies to gauge the effect of emotions on cardiovascular health, researchers at the University of Maryland School of Medicine in Baltimore have shown for the first time that laughter is linked to healthy function of blood vessels. Laughter appears to cause the tissue that forms the inner lining of blood vessels, the endothelium, to dilate or expand in order to increase blood flow.
When the same group of study volunteers was shown a movie that produced mental stress, their blood vessel lining developed a potentially unhealthy response called vasoconstriction, reducing blood flow. That finding confirms previous studies, which suggested there was a link between mental stress and the narrowing of blood vessels.
The results of the study, conducted at the University of Maryland Medical Center, were presented at the Scientific Session of the American College of Cardiology on March 7, 2005, in Orlando, Florida.
The endothelium has a powerful effect on blood vessel tone and regulates blood flow, adjusts coagulation and blood thickening, and secretes chemicals and other substances in response to wounds, infections or irritation. It also plays an important role in the development of cardiovascular disease.
“The endothelium is the first line in the development of atherosclerosis or hardening of the arteries, so, given the results of our study, it is conceivable that laughing may be important to maintain a healthy endothelium, and reduce the risk of cardiovascular disease,” says principal investigator Michael Miller, M.D., director of preventive cardiology at the University of Maryland Medical Center and associate professor of medicine at the University of Maryland School of Medicine. “At the very least, laughter offsets the impact of mental stress, which is harmful to the endothelium.”
The study included a group of 20 non-smoking, healthy volunteers, equally divided between men and women, whose average age was 33. The participants had normal blood pressure, cholesterol and blood glucose levels. Each volunteer was shown part of two movies at the extreme ends of the emotional spectrum. They were randomized to first watch either a movie that would cause mental stress, such as the opening scene of “Saving Private Ryan” (DreamWorks, 1998), or a segment of a movie that would cause laughter, such as “King Pin” (MGM, 1996). A minimum of 48 hours later, they were shown a movie intended to produce the opposite emotional extreme.
Prior to seeing a movie, the volunteers fasted overnight and were given a baseline blood vessel reactivity test to measure what is known as flow-mediated vasodilation. For that test, blood flow in the brachial artery in the arm was restricted by a blood pressure cuff and released. An ultrasound device then measured how well the blood vessel responded to the sudden increase in flow.
Volunteers watched a 15-minute segment of the movie while lying down in a temperature-controlled room. After the movie was shown, the brachial artery was constricted for five minutes and then released. Again, ultrasound images were acquired. Changes in blood vessel reactivity after the volunteers watched a movie lasted for at least 30 to 45 minutes. A total of 160 blood vessel measurements were performed before and after the laughter and mental stress phases of the study.
There were no differences in the baseline measurements of blood vessel dilation in either the mental stress or laughter phases. But there were striking contrasts after the movies were seen. Brachial artery flow was reduced in 14 of the 20 volunteers following the movie clips that caused mental stress. In contrast, beneficial blood vessel relaxation or vasodilation was increased in 19 of the 20 volunteers after they watched the movie segments that generated laughter. Overall, average blood flow increased 22 percent during laughter, and decreased 35 percent during mental stress.
Several volunteers had already seen “Saving Private Ryan,” says Dr. Miller, but even so, some of them were among the 14 with reduced blood flow.
“The magnitude of change we saw in the endothelium is similar to the benefit we might see with aerobic activity, but without the aches, pains and muscle tension associated with exercise,” says Dr. Miller. “We don't recommend that you laugh and not exercise, but we do recommend that you try to laugh on a regular basis. Thirty minutes of exercise three times a week, and 15 minutes of laughter on a daily basis is probably good for the vascular system.”
Dr. Miller says this study was not able to determine the source of laughter's benefit. “Does it come from the movement of the diaphragm muscles as you chuckle or guffaw, or does it come from a chemical release triggered by laughter, such as endorphins?” he asks. Dr. Miller says a compound called nitric oxide is known to play a role in the dilation of the endothelium. “Perhaps mental stress leads to a breakdown in nitric oxide or inhibits a stimulus to produce nitric oxide that results in vasoconstriction,” says Dr. Miller.
The current study builds on earlier research Dr. Miller conducted on the potential benefits of laughter, reported in 2000, which suggested that laughter may be good for the heart. In that study, answers to questionnaires helped determine whether people were prone to laughter and ascertain their levels of hostility and anger. Three hundred volunteers participated in the study. Half of them had suffered a heart attack or had undergone coronary artery bypass surgery; the other half did not have heart disease. People with heart disease responded with less humor to everyday life situations than those with a normal cardiovascular system.
Dr. Miller says certain factors in the earlier study may have affected the results. For example, he says it may be that people who have already had a coronary event are not as laughter-prone as those who do not have heart disease.
He says the current study sought to eliminate that uncertainty by using volunteers whose cardiovascular system was healthy. The results of the brachial artery blood flow measurements, which are precise and objective, appear to make the connection between laughter and cardiovascular health even stronger, according to Dr. Miller.
Other researchers in the study included Charles Mangano, R.D.M.S; Young Park, M.D.; Radha Goel, M.D.; Gary Plotnick, M.D. and Robert A. Vogel, M.D., all from the University of Maryland School of Medicine. The study was supported by a grant from the National Institutes of Health and a Veterans Affairs Merit award to Dr. Miller.

Study shows regular sex improves the memory of young women

If you fall into this category, how is your doctor fulfilling the prescription for regular sex? You do want good memory post stroke, don't you? I guess

Electrosex is not a valid substitute.

http://medicalxpress.com/news/2016-12-regular-sex-memory-young-women.html
A team of researchers with McGill University in Canada has found evidence that suggests that young women who engage in frequent sex experience memory improvements. In their paper published in Archives of Sexual Behavior, the researchers outline their study, which included asking young female volunteers to fill out surveys regarding their sex lives and taking memory tests.

Prior research has shown that frequent sex (penile-vaginal intercourse between a male and female) leads to better memory in young men and also in males of other species—in this new effort, the researchers sought to learn if the same might be true for young women.
To find out, the researchers enlisted the assistance of 78 young women between the ages of 18 to 29—each was asked to fill out a questionnaire and then to take a series of tests designed to measure their ability to remember things. The tests included face and word recognition tasks—pictures of each were shown and then the volunteers were later asked if they could remember what they had seen.
The researchers report that the women who reported having the most frequent sex scored higher on the tests than did those that reported lower sex frequency. They noted also that the improvement occurred for both facial and word recognition but that it was much more pronounced for words.
Prior research has suggested that having frequent sex can bolster neurogenesis in the hippocampus, which has been found to be involved in memory retention, particularly when it involves verbal communications. Additionally, researchers have previously learned that frequent sex leads to higher levels of neurotransmitters associated with good feelings. The scientists still can't say for sure why sex might improve memory, but some theories suggest it has to do with the physical exertion involved, which causes increased blood flow and a heightened metabolism. Still unclear is whether the quality or duration of the sex (or whether having an orgasm) has any measurable impact on memory retention. The researchers add that their experiments were part of a larger study meant to better understand the underlying relationship between memory retention and various activities.

Explore further: Who has the better memory—men or women?

More information: Larah Maunder et al. Frequency of Penile–Vaginal Intercourse is Associated with Verbal Recognition Performance in Adult Women, Archives of Sexual Behavior (2016). DOI: 10.1007/s10508-016-0890-4
Abstract
Previous studies have identified a number of factors that contribute to improved cognitive function, and to memory function specifically, in cognitively normal individuals. One such factor, frequency of penile–vaginal intercourse (PVI), has been reported in a number of animal studies to be advantageous to memory for previously presented objects by increasing neurogenesis in the dentate gyrus of the hippocampus. However, studies investigating the potential benefits of frequent PVI on memory function in young women are to the best of our knowledge absent from the literature. The current study thus investigated whether the self-reported frequency of sexual intercourse was related to memory function in healthy female college students. To determine whether variation in PVI would be associated with memory performance, we asked 78 heterosexual women aged 18–29 years to complete a computerized memory paradigm consisting of abstract words and neutral faces. Results showed that frequency of PVI was positively associated with memory scores for abstract words, but not faces. Because memory for words depends to a large extent on the hippocampus, whereas memory for faces may rely to a greater extent on surrounding extra-hippocampal structures, our results appear to be specific for memory believed to rely on hippocampal function. This may suggest that neurogenesis in the hippocampus is higher in those women with a higher frequency of PVI, in line with previous animal research. Taken together, these results suggest that PVI may indeed have beneficial effects on memory function in healthy young women.

Journal reference: Archives of Sexual Behavior

Brain-derived neurotrophic factor protects against neurodegeneration in a mouse model of human tauopathy

What is your doctor doing to make sure your BDNF is high enough to prevent neurodegeneration? Or is s/he waiting for decades for human research to be done? Thus dooming you to dementia/Alzheimers. If you won't go down without a fight you will need to start screaming at your doctors for help in solving this problem. Now, not 50 years from now.
https://espace.library.uq.edu.au/view/UQ:413018
Jiao, S.-S., Shen, L.-L., Zhu, C., Bu, X.-L., Liu, Y.-H., Liu, C.-H., Yao, X.-Q., Zhang, L.-L., Zhou, H.-D., Walker, D. G., Tan, J., Götz, J., Zhou, X.-F. and Wang, Y.-J. (2016) Brain-derived neurotrophic factor protects against neurodegeneration in a mouse model of human tauopathy. Translational Psychiatry, 6 10: . doi:10.1038/tp.2016.186
Abstract Collection year 2017 Language

Author	Jiao, S.-S. Shen, L.-L. Zhu, C. Bu, X.-L. Liu, Y.-H. Liu, C.-H. Yao, X.-Q. Zhang, L.-L. Zhou, H.-D. Walker, D. G. Tan, J. Götz, J. Zhou, X.-F. Wang, Y.-J.
Title	Brain-derived neurotrophic factor protects against neurodegeneration in a mouse model of human tauopathy
Journal name	Translational Psychiatry   Check publisher's open access policy
ISSN	2158-3188
Publication date	2016-10-04
Sub-type	Article (original research)
DOI	10.1038/tp.2016.186
Open Access Status	DOI
Volume	6
Issue	10
Total pages	11
Place of publication	London, United Kingdom
Publisher	Nature Publishing Group
eng
Reduced expression of brain-derived neurotrophic factor (BDNF) has a crucial role in the pathogenesis of Alzheimer’s disease (AD), which is characterized with the formation of neuritic plaques consisting of amyloid-beta (Aβ) and neurofibrillary tangles composed of hyperphosphorylated tau protein. A growing body of evidence indicates a potential protective effect of BDNF against Aβ-induced neurotoxicity in AD mouse models. However, the direct therapeutic effect of BDNF supplement on tauopathy in AD remains to be established. Here, we found that the BDNF level was reduced in the serum and brain of AD patients and P301L transgenic mice (a mouse model of tauopathy). Intralateral ventricle injection of adeno-associated virus carrying the gene encoding human BDNF (AAV-BDNF) achieved stable expression of BDNF gene and restored the BDNF level in the brains of P301L mice. Restoration of the BDNF level attenuated behavioral deficits, prevented neuron loss, alleviated synaptic degeneration and reduced neuronal abnormality, but did not affect tau hyperphosphorylation level in the brains of P301L mice. Long-term expression of AAV-BDNF in the brain was well tolerated by the mice. These findings suggest that the gene delivery of BDNF is a promising treatment for tau-related neurodegeneration for AD and other neurodegenerative disorders with tauopathy.

Brain iron overload following intracranial haemorrhage

You'll have to ask your doctor what information from here will be used to treat the hemorrhage cascade of death.
http://svn.bmj.com/content/early/2016/11/29/svn-2016-000042

Thomas Garton, Richard F Keep, Ya Hua, Guohua Xi

DOI: 10.1136/svn-2016-000042 Published 29 November 2016

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Abstract

Intracranial haemorrhages, including intracerebral haemorrhage (ICH), intraventricular haemorrhage (IVH) and subarachnoid haemorrhage (SAH), are leading causes of morbidity and mortality worldwide. In addition, haemorrhage contributes to tissue damage in traumatic brain injury (TBI). To date, efforts to treat the long-term consequences of cerebral haemorrhage have been unsatisfactory. Incident rates and mortality have not showed significant improvement in recent years. In terms of secondary damage following haemorrhage, it is becoming increasingly apparent that blood components are of integral importance, with haemoglobin-derived iron playing a major role. However, the damage caused by iron is complex and varied, and therefore, increased investigation into the mechanisms by which iron causes brain injury is required. As ICH, IVH, SAH and TBI are related, this review will discuss the role of iron in each, so that similarities in injury pathologies can be more easily identified. It summarises important components of normal brain iron homeostasis and analyses the existing evidence on iron-related brain injury mechanisms. It further discusses treatment options of particular promise.

The Mirror Illusion Increases Motor Cortex Excitability in Children With and Without Hemiparesis

Can your doctor make the leap to apply this to adults? Or will this never get written into a protocol?
http://nnr.sagepub.com/content/early/2016/11/29/1545968316680483.abstract

1. Sebastian Grunt, MD, PhD1⇑
2. Christopher J. Newman, MD2
3. Stefanie Saxer, MSc1,3
4. Maja Steinlin, MD1
5. Christian Weisstanner, MD4
6. Alain Kaelin-Lang, MD, PhD5,6

1. ¹Division of Neuropaediatrics, Development and Rehabilitation, University Children’s Hospital Bern, Inselspital, Bern University Hospital, University of Bern, Switzerland
2. ²Paediatric Neurology and Neurorehabilitation Unit, Lausanne University Hospital, Lausanne, Switzerland
3. ³Institute of Human Movement Sciences and Sport, ETH Zürich, Switzerland
4. ⁴University Institute of Diagnostic and Interventional Neuroradiology, University Hospital, Bern, Switzerland
5. ⁵University Clinic of Neurology, University Hospital, Bern, Switzerland
6. ⁶Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland

1. Sebastian Grunt, Department of Neuropaediatrics, Development and Rehabilitation, University Children’s Hospital, Inselspital, Bern, Switzerland. Email: sebastian.grunt@insel.ch

Abstract

Background. Mirror therapy provides a visual illusion of a normal moving limb by using the mirror reflection of the unaffected arm instead of viewing the paretic limb and is used in rehabilitation to improve hand function. Little is known about the mechanism underlying its effect in children with hemiparesis. 

Objective. To investigate the effect of the mirror illusion (MI) on the excitability of the primary motor cortex (M1) in children and adolescents.  

Methods. Twelve patients with hemiparesis (10-20 years) and 8 typically developing subjects (8-17 years) participated. Corticospinal reorganization was classified as contralateral (projection from contralateral hemisphere to affected hand) or ipsilateral (projection from ipsilateral hemisphere to affected hand). M1 excitability of the hemisphere projecting to the affected (nondominant in typically developing subjects) hand was obtained during 2 different conditions using single-pulse transcranial magnetic stimulation (TMS). Each condition (without/with mirror) consisted of a unimanual and a bimanual task. Motor-evoked potentials (MEPs) were recorded from the abductor pollicis brevis and flexor digitorum superficialis muscles.  

Results. MEP amplitudes were significantly increased during the mirror condition (P = .005) in typically developing subjects and in patients with contralateral reorganization. No significant effect of MI was found in subjects with ipsilateral reorganization. MI increased M1 excitability during active movements only. This increase was not correlated to hand function.  

Conclusion. MI increases the excitability of M1 in hemiparetic patients with contralateral corticospinal organization and in typically developing subjects. This finding provides neurophysiological evidence supporting the application of mirror therapy in selected children and adolescents with hemiparesis.

Motor Imagery-Based Rehabilitation: Potential Neural Correlates and Clinical Application for Functional Recovery of Motor Deficits after Stroke

Your doctor should already have enough information for a protocol for this but if not you might be able to create one and check if your doctor oks it. Only 84 references in this paper so your doctor should have read them all.
Motor Imagery-Based Rehabilitation: Potential Neural Correlates and Clinical Application for Functional Recovery of Motor Deficits after Stroke
ABSTRACT: Motor imagery (MI), defined as the mental implementation of an action in the absence of movement or muscle activation, is a rehabilitation technique that offers a means to replace or restore lost motor function in stroke patients when used in conjunction with conventional physiotherapy procedures. This article briefly reviews the concepts and neural correlates of MI in order to promote improved understanding, as well as to enhance the clinical utility of MI-based rehabilitation regimens. We specifically highlight the role of the cerebellum and basal ganglia, premotor, supplementary motor, and prefrontal areas, primary motor cortex, and parietal cortex. Additionally, we examine the recent literature related to MI and its potential as a therapeutic technique in both upper and lower limb stroke rehabilitation.

Effects of pomegranate juice on blood pressure: A systematic review and meta-analysis of randomized controlled trials

What the fuck will it take to write up a protocol on this? This earlier research wasn't good enough so you had to repeat it? No mention of amounts so this was totally useless. God, the stupidity and waste of resources.

Pomegranate juice consumption for 3 years by patients with carotid artery stenosis reduces common carotid intima-media thickness, blood pressure and LDL oxidation  Aug. 2008

 And this one from 2006:

Regular pomegranate juice administered to hypertensive patients caused a significant drop in blood pressure [26], a reduction in carotid plaque development [27]  Aug. 2006 

And the latest here:

Effects of pomegranate juice on blood pressure: A systematic review and meta-analysis of randomized controlled trials

In this study, researchers systematically review and meta–analyze accessible proof from randomized placebo–controlled trials (RCTs) researching the impacts of pomegranate juice intake and blood pressure (BP). The present meta–analysis recommends consistent benefits of pomegranate juice intake on BP. This evidence recommends it might be prudent to include this fruit juice in a heart–healthy diet.

• A comprehensive literature look in Medline and Scopus was completed to distinguish qualified RCTs.
• A meta–analysis of qualified reviews was performed utilizing a random–effects model.
• Quality assessment, sensitivity analysisand publication bias assessments were led utilizing standard methods.
• Quantitative information synthesis from 8 RCTs indicated significant decreases in both systolic [weighed mean difference (WMD): –4.96 mmHg, 95% CI: –7.67 to –2.25, p < 0.001) and diastolic BP (WMD: –2.01 mmHg, 95% CI: –3.71 to –0.31, p = 0.021) after pomegranate juice intake.
• Consequences for SBP stayed stable to sensitivity investigations.
• Pomegranate juice diminished SBP regardless of the duration (>12 wks: WMD = –4.36 mmHg, 95% CI: –7.89 to –0.82, p = 0.016) and <12 wks: WMD = –5.83 mmHg, 95% CI: –10.05 to –1.61, p = 0.007) and dose consumed (>240 cc: WMD = -3.62 mmHg, 95% CI: –6.62 to –0.63, p = 0.018) and <240 cc: WMD = –11.01 mmHg, 95% CI: –17.38 to –4.65, p = 0.001, pomegranate juice per day) whereas doses >240 cc provided a borderline significant impact in lessening DBP.

Go to PubMed Go to Abstract Print Article Summary Cat 2 CME Report

Harnessing Big Data To Transform Patient Outcomes

Well shit, I've been talking about hiring Dr. Watson from IBM to analyze stroke data since April, 2014. What has taken everyone else so long to see this?

IBM's Watson Supercomputer May Soon Be The Best Doctor In The World

Harnessing Big Data To Transform Patient Outcomes

By August Calhoun, PhD, Senior Vice President, Services, North America Region, Siemens Healthineers
Big data has the potential to revolutionize healthcare, promising better patient outcomes and lower costs.
In the face of a rapidly changing healthcare market, population health management has become a critical focus area for providers. Population health management offers a holistic perspective on patient care to improve outcomes, including the coordination of all providers such as primary care, specialists, nutritionists and physical therapists, among others.
This population health management approach requires an understanding of how to leverage an extensive amount of data across multiple information technology sources, including the use of new personal health devices as they become more common. This patient engagement will ultimately help improve care, as studies have demonstrated¹ that “activated patients” --  those who  possess the knowledge, willingness, skills and ability to manage their health -- have better outcomes at a lower cost than less-activated patients.
The ability to quickly analyze this data is critical to improving both clinical and financial results, especially as new Medicare reimbursement models reward quality of care, not volume. The U.S. Department of Health and Human Services (HHS) announced² a goal to tie 85 percent of all traditional Medicare payments to the quality of care by 2016 and 90 percent by 2018.

Unfortunately, many providers lack the infrastructure to handle the sheer volume and variety of data for effective population health management. One survey³ found that almost two-thirds of physicians do not have the ability to view and use all the patient data they need, while little more than a third are satisfied with the limited abilities available to integrate big data into their daily routines. Another survey ⁴ found that only about one in six healthcare organizations are doing anything beyond simply “dabbling” in data.
Over the next few years, it is likely that there will be dramatic change in data analytics as the healthcare sector embraces population health management and providers are incentivized to improve quality of care and reduce cost. Here are some examples of how providers are establishing population health models and transforming healthcare:
Penn Medicine developed a platform for predictive analytics that could be applied to detect patients at risk of critical illnesses. One of the first applications focused on heart failure, which affects 5.7 million people in the US and costs the nation about $30.7 billion each year⁵. Penn Medicine estimated that between 20 to 30 percent of heart failure patients were not properly diagnosed with standard tools, so they created an improved algorithm that more accurately identified heart failure patients. As a result, a better treatment plan was assigned to patients and readmission rates dropped, improving outcomes and reducing costs.
Kaiser Permanente Southern California leveraged data analytics to demonstrate that a population health management program can lead to more efficient and reliable care and better patient outcomes for prostate cancer, the second-leading cause of cancer death among men⁶. Through data analysis, Kaiser Permanente showed that the introduction of robotic technology to assist surgeons led to better results versus traditional surgery. The men who received this robot-assisted procedure had a reduction in blood loss in surgery that obviated the need for transfusion and were more likely to report return of sexual function. In addition, population health analysis tied to osteoporosis prevention among prostate cancer patients -- including improved drug management, follow-up care, and standardized screening -- also resulted in a dramatic reduction in fracture rates in this high-risk population.
Parkview Medical Center in Colorado used population health analytics to enhance patient engagement. The program included email and video communication with patients who had undergone hip replacement surgery, which led to a 17 percent reduction in the length of stay and an average savings of $2,000 per patient. Ninety percent of patients who received the email and video communication went directly home after being discharged from the hospital and 10 percent went to a skilled nursing facility, while only 67 percent of those that did not receive the email and video communication went directly home after leaving the hospital, 29 percent went to a skilled nursing facility and 4 percent went to a nursing home. Not only did patients benefit but this also led to increased hospital referrals that resulted in 30 additional hip replacement surgery procedures a year, representing incremental revenue.
The adoption of analytics technology to find patterns, increase patient engagement and compliance, and more accurately pinpoint disease states is expected to accelerate rapidly. Given the growing volume and sheer diversity of healthcare data, an aging global population, the increasing prevalence of chronic disease, and shifting healthcare payment models, it cannot come soon enough.

ReNeuron: Stem-cell therapy helped stroke patients

Impossible to tell if this really works, not enough information is given to analyze. If this truly worked they would have enough detail for researchers to duplicate the results. Because they don't and are a profit making company I think this is puffery.
http://www.marketwatch.com/story/reneuron-stem-cell-therapy-helped-stroke-patients-2016-12-05
ReNeuron Group PLC (RENE.LN) said its stem-cell therapy aided the rehabilitation of patients who had been disabled by a stroke, adding to a small but growing body of evidence that such an approach holds promise.
U.K.-based ReNeuron said 15 patients in its 21-person study had a "clinically significant response" on at least one of the three commonly-used scales for assessing improvements following treatment.
Chief Executive Olav Hellebø said he was "particularly excited" that the treatment seemed to help patients perform daily tasks as this was the measure most prized by regulators in Europe and the U.S. The treatment, dubbed CTX, involves having stem cells injected into the brain near the site affected by the stroke.
The company said it would now apply to regulators in Europe and the U.S. to start a larger trial.

Stem-cell therapy, if proven successful, would constitute a rare breakthrough for stroke medicine. Blood-clot busting treatments given in the immediate aftermath of a stroke can minimize damage, but there are currently no other therapies available for stroke, according to Alessandra Granata, a researcher at the University of Cambridge.
Other groups are making progress. Earlier this year, a small clinical trials by researchers at Japanese biotech SanBio Co. suggested that stem-cell therapy had potential to aid stroke patients' rehabilitation. Another small study using SanBio's treatment, by researchers at Stanford University, had positive results.
Athersys Inc., a Cleveland, Ohio-based company using stem-cell therapy in stroke patients, plans to start enrolling patients into a phase-three clinical trial next year. Its therapy--given within 36 hours of a stroke--is aimed at preventing damage rather than rehabilitation.
-Write to Denise Rolande at denise.rolande@wsj.com

This is your brain on Scrabble: Neural correlates of visual word recognition in competitive Scrabble players as measured during task and resting-state

How do you relate this to stroke recovery?


http://www.sciencedirect.com/science/article/pii/S0010945215001069

• Andrea B. Protzner^{a, b, c, ,} ,
• Ian S. Hargreaves^{a, b,} ,
• James A. Campbell^a, ,
• Kaia Myers-Stewart^a, ,
• Sophia van Hees^{a, b},
• Bradley G. Goodyear^{b, c, d, e, f,} ,
• Peter Sargious^{g, h,} ,
• Penny M. Pexman^{a, b, c,}

 Show more

http://dx.doi.org/10.1016/j.cortex.2015.03.015

Get rights and content

Under a Creative Commons license

  Open Access

---

Abstract

Competitive Scrabble players devote considerable time to studying words and practicing Scrabble-related skills (e.g., anagramming). This training is associated with extraordinary performance in lexical decision, the standard visual word recognition task (Hargreaves, Pexman, Zdrazilova & Sargious, 2012). In the present study we investigated the neural consequences of this lexical expertise. Using both event-related and resting-state fMRI, we compared brain activity and connectivity in 12 competitive Scrabble experts with 12 matched non-expert controls. Results showed that when engaged in the lexical decision task (LDT), Scrabble experts made use of brain regions not generally associated with meaning retrieval in visual word recognition, but rather those associated with working memory and visual perception. The analysis of resting-state data also showed group differences, such that a different network of brain regions was associated with higher levels of Scrabble-related skill in experts than in controls.

Dietary tofu intake and long-term risk of death from stroke in a general population

Your doctor will need to decipher this to see if this means that tofu is added to you diet protocol.
https://www.mdlinx.com/internal-medicine/medical-news-article/2016/12/05/stroke-mortality-cohort-study-tofu-soy/6968690/?

Clinical Nutrition, 12/05/2016

Nguyen HN, et al. – In this study, the researchers inspected the relationship between the intake of tofu, the richest source of dietary soy, with stroke mortality in a general population cohort of Japanese men and women. It was observed in the findings that consumption of tofu was unrelated to the risk of stroke except for cerebral hemorrhage [CH] in women <65 years of age.

Methods

• In the present study, information involve 9,244 Japanese enrolled in the National Nutrition Survey of Japan in 1980.  
• Members were free of cardiovascular disease and followed for 24 years.
• Dietary intake was estimated from 3-day weighed food records.  
•  Multivariable Cox regression models were utilized to estimate hazard ratios across levels of tofu intake. 

Results

•  During follow-up, there were 417 passings because of stroke (88 cerebral hemorrhage [CH], 245 cerebral infarction [CI], and 84 of other subtypes).
• It was observed in the findings that among all men, and in women aged 65 years or more, tofu intake was unrelated to each form of stroke.  
• The results of this study showed that for young women (<65 years of age), a significantly lower risk of CH in the top versus bottom quartile of tofu intake was watched (Multivariable-adjusted HR=0.26, 95% CI: 0.08-0.85).
• No clue what this previous line means in standard English, especially with no idea of what quartile intake is.

Go to Abstract Print Article Summary Cat 2 CME Report

World class stroke care is achievable: Latest quarterly Sentinel Stroke National Audit Programme (SSNAP) results

What a pile of shit. Who gives a crap about care? Survivors want results you fucking idiots. Do the right thing or get out of the way. More fucking 'happy talk'. Your aspirational target should be 100% recovery. Contact Jessica Smith, Jessica.Smith@rcplondon.ac.uk and ask when the hell they will start measuring results instead of this stupid care and services metric. Do not be polite.
http://www.hqip.org.uk/news-events/news/latest-quarterly-sentinel-stroke-national-audit-programme-ssnap-results/

The thirteenth report from the Sentinel Stroke National Audit Programme (SSNAP) reveals today that 25 stroke services scored an overall ‘A’ score for the quality of care they provide for patients, demonstrating that a world class service is achievable.

It is evident that services are maintaining the improvements made in recent quarters as 26 services achieved this outstanding grade in the corresponding quarter last year. Achieving an ‘A’ score is a considerable accomplishment and these latest results show that, although the audit sets the bar high to attain a top grade, it is possible. The improvements in SSNAP results over the past number of quarters indicates the continued efforts made by clinicians to use SSNAP data as a tool for continuous quality improvement.

Though SSNAP has set stringent, aspirational targets, latest audit results reinforce our belief that the top score is achievable and sustainable over time. These standards have been set to encourage hospitals to both identify where improvements are needed and drive change. These changes reflect the continued efforts of providers to improve stroke care for patients in England, Wales, and Northern Ireland.

Professor Pippa Tyrrell, Associate Director of the RCP Stroke Programme, said:

"Measuring the quality of care is an essential component for quality improvement. The SSNAP provides very high quality information that can help professionals, patients, and commissioners use and develop their services for the future."  (Bullshit, you measure results not quality of care, which done correctly can lead to quality improvement) 

The report published today relates to patients admitted between January and March 2016 and includes named hospital results for the entire inpatient care pathway. The results are available online at the SSNAP Results Portal

As in the 12^th report, it is encouraging to see key improvements in the national results for stroke care both in the first 72 hours of care and in post-acute care processes.

Participation in the audit continues to be an unprecedented success. In the latest quarter, 20,991 patient records were submitted for analysis within the 72 hour results – this is over 100% of the expected stroke cases for this period – while the majority of stroke services are now achieving the highest case ascertainment band. This is testament to the honest self-reporting of SSNAP teams and their hard work in entering all stroke records to SSNAP ahead of each quarterly deadline. The genuine commitment to submitting timely and complete data, and acting on audit results to improve patient care, should be celebrated.

The power of SSNAP data is huge and has enabled a much stronger case to be made for improvements to stroke services, which is allowing commissioners and clinicians alike to offer the best possible care to patients.

However, there still remains unacceptable variation across the country. SSNAP uses an absolute measurement of results which means that all teams are capable of showing improvement.

SSNAP is commissioned by the Healthcare Quality Improvement Partnership (HQIP)*, as part of the National Clinical Audit Programme (NCA). The audit is led by the Royal College of Physicians, Clinical Effectiveness and Evaluation Unit on behalf of the Intercollegiate Stroke Working Party.

For more information, please contact Jessica Smith, Care Quality Improvement Department, Communications Advisor on 020 3075 1354 or email Jessica.Smith@rcplondon.ac.uk

Further information on the report can be found on the RCP website

Study: Watch for PSE in Chronic Stroke Patients - post-stroke epilepsy

I didn't have to worry about this problem. You will need to ask exactly what areas were damaged  so you can inform your doctor of this PSE possibility.

Study: Watch for PSE in Chronic Stroke Patients - post-stroke epilepsy

Physicians should be on the lookout for epilepsy after chronic stroke, particularly in younger stroke patients and those with more brain damage, researchers reported here.
In a retrospective U.K. study cohort, about 11% of stroke patients developed post-stroke epilepsy (PSE), according to Beate Diehl, MD, PhD, of University College London (UCL), and colleagues at the American Epilepsy Society meeting.
Those who developed PSE were younger (44 versus 56) and had more extensive brain damage on MRI scans, they added.
"Many physicians treating stroke patients don't realize that falls, episodes of confusion, and loss of consciousness may be signs of post-stroke epilepsy," Diehl said in a statement. "Post-stroke epileptic seizures can negatively affect stroke recovery and rehabilitation."
Epilepsy often goes undiagnosed in the elderly, the researchers said. The leading cause of epilepsy in these older patients is stroke, which accounts for as much as 45% of epilepsy in people over age 60.
Although some risk factors for PSE have been identified, the exact mechanisms by which stroke causes epilepsy aren't known, Diehl and colleagues said. So they looked at data from the Predicting Language Outcome and Recovery After Stroke (PLORAS) database of more than 1,000 stroke patients in the U.K.
About 450 of these patients had 1 mm 3-voxel T1-weighted anatomical whole-brain scans acquired with a 3T MRI scanner at the UCL Wellcome Trust Center for Neuroimaging. Patients also answered questions about having seizures.
Overall, the researchers found that of the 369 patients who had left hemisphere strokes, 42 of them (11.4%) developed PSE.
The figure was similar for the 81 who had right-hemisphere strokes: nine of these patients (11.1%) developed PSE.
Patients who developed PSE were significantly younger than those without PSE (44 versus 56, P<0.0001), and PSE patients had twice the extent of brain damage of those without epilepsy -- their lesions were significantly larger (148 cm3 versus 73 cm3, P<0.0001) -- suggesting that the frequency of epilepsy increases with the size of the lesion.
When comparing lesion locations between PSE and non-PSE patients with left hemisphere stroke, the researchers found a region that was damaged in 64% of those with PSE, but this area was also damaged in 17% of those without PSE.
The authors said the incidence of PSE after damage to this region was only 33%.
Among those who had left hemispheric stroke and developed PSE, the most commonly affected areas of the brain were the basal ganglia -- particularly the globus pallidus and caudate nucleus -- and most nuclei of the thalamus (the anterior and ventral nuclei, as well as posterior regions including the pulvinar). The authors noted that these are important areas for controlling movement, sensation, and consciousness.
Their findings are in line with recent reports of a higher percentage of stroke patients developing epilepsy, they said, and concluded that doctors treating stroke patients should keep in mind that PSE is common, so they should watch for risk factors, such as extent of brain damage and younger age.

The study was supported by Epilepsy Research UK and the National Institute for Health Research UCL Hospitals Biomedical Research Center.
Diehl and co-authors disclosed no relevant relationships with industry.

• Primary Source

  American Epilepsy Society

  Source Reference: Diehl B, et al "Risk factors to developing post stroke epilepsy: Epidemiology and lesion mapping" AES 2016; Abstract 1.008.

5 Articles to Watch from the European Stroke Journal - Professor Bo Norrving Editor-in-Chief

If Professor Bo Norrving did anything useful for survivors when he was president of the World Stroke Organization it is impossible to tell. I wonder how many stroke survivors he talked to personally?
Email from SAGE publishing.

What are the long-term risk factors for patients that suffer stroke at a young age? How effective is tranexamic acid for improving clinical outcome following intracerebral haemorrhage? Does a change in antiplatelet regimen increase risk of recurrent ischaemic stroke? These are some of the questions that recent papers from the journal have tackled. As Editor-in-Chief for the European Stroke Journal, I am really proud of the innovative research recently published in the journal. Five recent papers from the journal really caught my attention. As they are definitely papers to look out for, I really wanted to share them with you. That’s why I we have freed access to these papers until December 31st*. Get instant access to these papers now: How many stroke patients might be eligible for mechanical thrombectomy? The very long-term risk and predictors of recurrent ischaemic events after a stroke at a young age: The FUTURE study A role for autophagy in carotid atherosclerosis Antiplatelet therapy following ischaemic stroke – Continue or change pre-existing therapy? Treatment of intracerebral haemorrhage with tranexamic acid – A review of current evidence and ongoing trials Happy reading, Professor Bo Norrving Editor-in-Chief   p.s. Enjoyed these papers? Sign up for our table of content alerts to stay updated on all fields of clinical stroke research published in the journal, including clinical trials, epidemiology, prevention, diagnosis, acute management, guidelines, rehabilitation, stroke care, societal impact and much more.

Congress needs to pass a final budget by December 9 or funding for NIH and NSF could remain flat for the coming year.

This is the necessary reason that funding for stroke research needs to completely change. With a defined stroke strategy getting foundation grants and individual donors to step up and fund such research would be damned easy.  Asking for general funding for stupid stroke association press release funding is complete insanity. Asking for funding to solve glutamate poisoning in the neuronal cascade of death would be a concrete proposal people and foundations could get behind. I.E, 'I helped solve the glutamate poisoning piece of stroke neuron death'. You could send out certificates of appreciation suitable to being framed. This is so fucking easy to solve the funding problem but will require destroying our fucking failures of stroke associations and replacing them with a great stroke association. 
Email from here:

In the Spotlight

Don’t Let Congress Stall Research FundingCongress needs to pass a final budget by December 9 or funding for NIH and NSF could remain flat for the coming year. NIH Director Francis Collins warned Congress that passing another continuing resolution (CR) instead of a full budget will endanger biomedical research by further limiting resources. Specifically, he highlighted an increase in funding for Alzheimer’s disease research that will be unrealized under another CR.

Contact your senators to tell them to support biomedical research funding by passing a final budget.

A handful of nuts a day cuts the risk of a wide range of diseases

I bet this never makes it into a diet food protocol for you in the hospital or at home. You can't do this on your own, that would be extremely dangerous without your doctor knowing what you eat. The real problem is knowing more than your doctor does, don't do that.
http://medicalxpress.com/news/2016-12-nuts-day-wide-range-diseases.html

A large analysis of current research shows that people who eat at least 20g of nuts a day have a lower risk of heart disease, cancer and other diseases.

The analysis of all current studies on nut consumption and disease risk has revealed that 20g a day - equivalent to a handful - can cut people's risk of coronary heart disease by nearly 30 percent, their risk of cancer by 15 percent, and their risk of premature death by 22 percent.
An average of at least 20g of nut consumption was also associated with a reduced risk of dying from respiratory disease by about a half, and diabetes by nearly 40 percent, although the researchers note that there is less data about these diseases in relation to nut consumption.
The study, led by researchers from Imperial College London and the Norwegian University of Science and Technology, is published in the journal BMC Medicine.
The research team analysed 29 published studies from around the world that involved up to 819,000 participants, including more than 12,000 cases of coronary heart disease, 9,000 cases of stroke, 18,000 cases of cardiovascular disease and cancer, and more than 85,000 deaths.
While there was some variation between the populations that were studied, such as between men and women, people living in different regions, or people with different risk factors, the researchers found that nut consumption was associated with a reduction in disease risk across most of them.
Study co-author Dagfinn Aune from the School of Public Health at Imperial said: "In nutritional studies, so far much of the research has been on the big killers such as heart diseases, stroke and cancer, but now we're starting to see data for other diseases.
"We found a consistent reduction in risk across many different diseases, which is a strong indication that there is a real underlying relationship between nut consumption and different health outcomes. It's quite a substantial effect for such a small amount of food."
The study included all kinds of tree nuts, such as hazel nuts and walnuts, and also peanuts - which are actually legumes. The results were in general similar whether total nut intake, tree nuts or peanuts were analysed.
What makes nuts so potentially beneficial, said Aune, is their nutritional value: "Nuts and peanuts are high in fibre, magnesium, and polyunsaturated fats - nutrients that are beneficial for cutting cardiovascular disease risk and which can reduce cholesterol levels.
"Some nuts, particularly walnuts and pecan nuts are also high in antioxidants, which can fight oxidative stress and possibly reduce cancer risk. Even though nuts are quite high in fat, they are also high in fibre and protein, and there is some evidence that suggests nuts might actually reduce your risk of obesity over time."
The study also found that if people consumed on average more than 20g of nuts per day, there was little evidence of further improvement in health outcomes.
The team are now analysing large published datasets for the effects of other recommended food groups, including fruits and vegetables, on a wider range of diseases.

Explore further: Nuts and peanuts may protect against major causes of death

More information: Dagfinn Aune et al, Nut consumption and risk of cardiovascular disease, total cancer, all-cause and cause-specific mortality: a systematic review and dose-response meta-analysis of prospective studies, BMC Medicine (2016). DOI: 10.1186/s12916-016-0730-3

Journal reference: BMC Medicine
Provided by: Imperial College London

Meta-analysis of potassium intake and the risk of stroke

What the fuck was the point of this research? The earlier research was not enough to prove efficacy?

Daily potassium intake and sodium-to-potassium ratio in the reduction of blood pressure: a meta-analysis of randomized controlled trials  July 2015

Effect of high potassium diet on endothelial function  June 2014

Slash Risk of Stroke with More Potassium and Less Salt  June 2013

Why eat three bananas a day?    April 2012

This one is even more worthless, NO protocol, NO amounts and types of food to get to the dose suggested.

Meta-analysis of potassium intake and the risk of stroke

Journal of the American Heart Association, 11/04/2016 Vinceti M, et al.

For this study, researchers played out a systematic review and meta–analysis of existing studies and evaluated the dose–response connection between potassium consumption and stroke risk. Overall, this dose–response meta–analysis affirms the inverse relationship between potassium consumption and stroke risk, with potassium consumption of 90 mmol (≈3500 mg)/day connected with the lowest risk of stroke. Methods and Results

• In this study researchers looked into the observational cohort studies tending to the connection between potassium consumption, and incidence or mortality of total stroke or stroke subtypes published through August 6, 2016.
• They carried out a meta–analysis of 16 cohort concentrates on in view of the relative risk (RR) of stroke comparing the highest versus lowest consumption categories.
• They additionally plotted a pooled dose–response curve of RR of stroke according to potassium consumption.
• Investigations were performed with and without adjustment for blood pressure.
• Relative to the lowest category of potassium consumption, the highest category of potassium consumption was connected with a 13% diminished risk of stroke (RR=0.87, 95% CI 0.80–0.94) in the blood pressure–adjusted examination.
• Summary RRs tended to diminishing when original estimates were unadjusted for blood pressure.
• Examination for stroke subtypes yielded comparable results.
• In the spline examination, the pooled RR was lowest at 90 mmol of potassium daily consumption (RRs=0.78, 95% CI 0.70–0.86) in blood pressure–adjusted investigation, and 0.67 (95% CI 0.57–0.78) in unadjusted examination.

Go to PubMed Go to Abstract Print Article Summary Cat 2 CME Report

Marijuana Chokes Alzheimer's-Related Brain Regions

Another sky is falling piece of research. It is vastly more likely that people with low blood flow are self-treating themselves with marijuana to feel better. Taken from neuropsychiatric clinics which pretty much proves my point.  These doctors need to learn about cause and effect.  This all probably part of a concerted effort by the drug industry to prevent a non-patentable drug from entering the marketplace. Over 500,000 stroke survivors a year in the US could be treated better with marijuana.  Don't fall for these negative articles.

My 13 reasons for marijuana use post-stroke.  

But don't listen to me, I have absolutely no medical training. You are going to have to figure out how to dose yourself since your doctor will know nothing and no one will do translational research until our fucking federal legislators legalize it.

Marijuana Chokes Alzheimer's-Related Brain Regions

As the U.S. races to legalize marijuana for medicinal and recreational use, a new, large scale brain imaging study gives reason for caution. Published in the Journal of Alzheimer’s Disease, researchers using single photon emission computed tomography (SPECT), a sophisticated imaging study that evaluates blood flow and activity patterns, demonstrated abnormally low blood flow in virtually every area of the brain studies in nearly 1,000 marijuana compared to healthy controls, including areas known to be affected by Alzheimer’s pathology such as the hippocampus.



All data were obtained for analysis from a large multisite database, involving 26,268 patients who came for evaluation of complex, treatment resistant issues to one of nine outpatient neuropsychiatric clinics across the United States (Newport Beach, Costa Mesa, Fairfield, and Brisbane, CA, Tacoma and Bellevue, WA, Reston, VA, Atlanta, GA and New York, NY) between 1995-2015. Of these, 982 current or former marijuana users had brain SPECT at rest and during a mental concentration task compared to almost 100 healhty controls. Predictive analytics with discriminant analysis was done to determine if brain SPECT regions can distinguish marijuana user brains from controls brain. Low blood flow in the hippocampus in marijuana users reliably distinguished marijuana users from controls. The right hippocampus during a concentration task was the single most predictive region in distinguishing marijuana users from their normal counterparts. Marijuana use is thought to interfere with memory formation by inhibiting activity in this part of the brain.

According to one of the co-authors on the study Elisabeth Jorandby, M.D., “As a physician who routinely sees marijuana users, what struck me was not only the global reduction in blood flow in the marijuana users brains , but that the hippocampus was the most affected region due to its role in memory and Alzheimer’s disease. Our research has proven that marijuana users have lower cerebral blood flow than non-users. Second, the most predictive region separating these two groups is low blood flow in the hippocampus on concentration brain SPECT imaging. This work suggests that marijuana use has damaging influences in the brain – particularly regions important in memory and learning and known to be affected by Alzheimer’s.”

Dr. George Perry, Editor in Chief of the Journal of Alzheimer’s Disease said, “Open use of marijuana, through legalization, will reveal the wide range of marijuana’s benefits and threats to human health. This study indicates troubling effects on the hippocampus that may be the harbingers of brain damage.”  (No it doesn't, you don't know what the fuck you are looking at)

MORE INFORMATION:

• Amen DG, Darmal B, Raji CA, Bao W, Jorandby L, Meysami S, Raghavendra CS (2017) Discriminative Properties of Hippocampal Hypoperfusion in Marijuana Users Compared to Healthy Controls: Implications for Marijuana Administration in Alzheimer’s Dementia. J Alzheimers Dis, doi: 10.3233/JAD-160833.
• Figure legend: Example of a volume rendered brain SPECT image (top down view) of a healthy control compared to an 18-year old daily user of marijuana. While the control subject has symmetric activity, the marijuana user shows overall decreased perfusion.

SOURCE:

• IOS Press

Saturated fat could be good for you

Don't follow this until another 50 years have passed and your stroke doctors have finally come up with a diet protocol.
http://www.alphagalileo.org/ViewItem.aspx?ItemId=170594&CultureCode=en
A new Norwegian diet intervention study (FATFUNC), performed by researchers at the KG Jebsen center for diabetes research at the University of Bergen, raises questions regarding the validity of a diet hypothesis that has dominated for more than half a century: that dietary fat and particularly saturated fat is unhealthy for most people.
The researchers found strikingly similar health effects of diets based on either lowly processed carbohydrates or fats. In the randomized controlled trial, 38 men with abdominal obesity followed a dietary pattern high in either carbohydrates or fat, of which about half was saturated. Fat mass in the abdominal region, liver and heart was measured with accurate analyses, along with a number of key risk factors for cardiovascular disease.
"The very high intake of total and saturated fat did not increase the calculated risk of cardiovascular diseases," says professor and cardiologist Ottar Nygård who contributed to the study.
"Participants on the very-high-fat diet also had substantial improvements in several important cardiometabolic risk factors, such as ectopic fat storage, blood pressure, blood lipids (triglycerides), insulin and blood sugar."
High quality food is healthier
Both groups had similar intakes of energy, proteins, polyunsaturated fatty acids, the food types were the same and varied mainly in quantity, and intake of added sugar was minimized.
"We here looked at effects of total and saturated fat in the context of a healthy diet rich in fresh, lowly processed and nutritious foods, including high amounts of vegetables and rice instead of flour-based products," says PhD candidate Vivian Veum.
"The fat sources were also lowly processed, mainly butter, cream and cold-pressed oils."
Total energy intake was within the normal range. Even the participants who increased their energy intake during the study showed substantial reductions in fat stores and disease risk.
"Our findings indicate that the overriding principle of a healthy diet is not the quantity of fat or carbohydrates, but the quality of the foods we eat," says PhD candidate Johnny Laupsa-Borge.
Saturated fat increases the “good” cholesterol
Saturated fat has been thought to promote cardiovascular diseases by raising the “bad” LDL cholesterol in the blood. But even with a higher fat intake in the FATFUNC study compared to most comparable studies, the authors found no significant increase in LDL cholesterol. Rather, the "good" cholesterol increased only on the very-high-fat diet.
"These results indicate that most healthy people probably tolerate a high intake of saturated fat well, as long as the fat quality is good and total energy intake is not too high. It may even be healthy," says Ottar Nygård.
"Future studies should examine which people or patients may need to limit their intake of saturated fat," assistant professor Simon Nitter Dankel points out, who led the study together with the director of the laboratory clinics, professor Gunnar Mellgren, at Haukeland university hospital in Bergen, Norway.
"But the alleged health risks of eating good-quality fats have been greatly exaggerated. It may be more important for public health to encourage reductions in processed flour-based products, highly processed fats and foods with added sugar," he says.
The study was published online on November 30 2016 in The American Journal of Clinical Nutrition: Error! Hyperlink reference not valid.
Facts: The FATFUNC-study
* The Study is named (FATFUNC) and was performed by researchers at the KG Jebsen center for diabetes research, Department of Clinical Science at the University of Bergen.
* In the randomized controlled trial, 38 men with abdominal obesity followed a dietary pattern high in either carbohydrates (53 % of total energy, in line with typical official recommendations) or fat (71 % of total energy, of which about half was saturated).
* Fat mass in the abdominal region, liver and heart was measured with accurate analyses (computed tomography, CT), along with a number of key risk factors for cardiovascular disease.
http://www.uib.no/en/node/103172

Biem Butter sprayer

I can't spread butter on any piece of bread because left hand is of no use in holding bread steady, fingers are curled, arm is pulled in next to body. I bet your therapist doesn't have this as a recommended compensation tool. Quite pricey, $129
https://www.facebook.com/Insiderinventions/videos/941361599332718/
This device turns butter into mist.