Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective 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.

Saturday, September 4, 2021

Is Red Wine Good for You? What a Glass A Day Means for Your Health

You'll have to analyze this yourself because your doctor never will approve red wine regardless of the benefits. For your analysis:

Is Red Wine Good for You? What a Glass A Day Means for Your Health

It might often be touted as the healthiest beverage at the bar, but is red wine good for you? Yes and no. As the many intricate flavors of red wine can be complex, so too can the nutritional properties, leading to years of headline-making studies that would have you flip flopping between stocking up and swearing off the stuff. The bottom line: “Red wine has been shown to be beneficial in moderate amounts due to the resveratrol, which is an antioxidant that is protective of the heart,” says Maya Feller, M.S., R.D., CDN, founder of Maya Feller Nutrition in Brooklyn.

Red wine is produced from dark-skinned grape varieties, which are expertly harvested, pressed, and fermented with grape skins and juice inside a tank or vat. Consider fermentation to be the secret sauce—it transforms humble grapes into full-bodied, flavourful wines. Ah, to be the first, curious soul to realize the endless potential of fermented grape juice! While France and Italy are the countries most commonly associated with wine, the beverage has ancient origins in China, with archaeological records dating back to 7,000 years ago. Over the centuries wine has gradually (and fascinatingly) evolved with the cultures it originated in and become a culture of its own. These days, every occasion, meal, and gathering calls for a different variety of red—will you play it safe with a crowd-pleasing merlot? Or risk it all with a peppery shiraz?

Adding to the allure of a good glass of red is that red wine is often touted as a “healthy” type of alcohol because of the resveratrol content. Antioxidants = good for you, but at the end of the day, red wine is still alcohol, which should always be factored into the amount you enjoy. “One doesn’t need to start drinking red wine just because of these benefits—similar benefits are found in other foods such as pomegranates and grapes,” says Feller.

We asked Feller to help settle this once and for all: Is red wine good for you? Here’s everything you need to know about red wine benefits—and what experts mean by “moderation.”

Red wine benefits

Red wine has what Feller refers to as a health halo—meaning it has a reputation as being healthier than it really is. There are many many reasons for this. One of the most well-known is the French paradox, an 1980s term which references a scientific study that explored France’s low incidence of coronary heart disease. It incorrectly linked this lower incidence with their consumption of red wine, and its healthy reputation has continued to linger.

Still, small amounts of red wine have been said offering more health benefits than any other boozy beverage. Let’s take a look at a few.

Do the antioxidants in red wine make an impact?

Red wine contains polyphenolic substances, compounds responsible for the vino’s bitter flavor and deep color, as well as its antioxidant properties. According to a study reported in the International Journal of Angiology, the average glass of red contains 200 milligrams of total polyphenols—in comparison with 30 milligrams in a glass of white.

The polyphenol most commonly linked to red wine is resveratrol. “Resveratrol is the superstar of wine. It is a powerful antioxidant that also has anticarcinogenic properties and the potential to inhibit tumor formation and growth. It acts as a free radical scavenger and helps to slow the oxidation of LDL, or the ‘bad’ cholesterol responsible for cardiovascular disease,” says Feller.

However, there is only a small amount of polyphenols in red wine. If you are looking to increase your polyphenol intake, rather than topping up your wine glass, you might like to layer your cereal with berries or reach for a delicious plum, according to research, reported in the American Journal of Clinical Nutrition, since these fruits contain far more polyphenols than your vino of choice.

Is red wine good for your heart?

There is research to suggest that resveratrol is linked to a decreased risk of inflammation and blood clotting, which can reduce your risk of heart disease. But in other studies, this link has been disproven. “While there are potential benefits to drinking red wine in moderation, I would not put it at the top of a list of heart-healthy beverages,” says Feller.

Dietitians and doctors alike will say that drinking alcohol for its supposed heart benefits is not a wise idea—particularly if there is a history of alcohol dependence or addiction in your family. The considerable risks of excessive alcohol consumption far outweigh the minor benefits of the small amounts of antioxidants in red wine.

If you are interested in how to support your heart health, “I would rather suggest a heart healthy pattern of eating based on leafy greens, nuts, seeds, ancient grains, and heart-healthy proteins, rather than relying on red wine,” says Feller.

How much red wine is good for you?

According to the CDC, a standard drink is:

  • 12 ounces of beer (5% alcohol content)  

  • 8 ounces of malt liquor (7% alcohol content)  

  • 5 ounces of wine (12% alcohol content)  

  • 1.5 ounces of distilled spirits (40% alcohol content)

Next time you’re pouring wine, it helps to remember that a serving isn’t always the size of your glass (especially if it’s an Olivia Pope–sized goblet). Because of its health halo, red wine is often considered to dwell in a magical realm outside of these consumption suggestions. Unfortunately, it’s doesn’t. Booze is booze.

“The Dietary Guidelines for Americans suggest no more than 1 alcoholic drink maximum per day for women and 2 alcoholic drinks per day for men. It’s also important to reiterate that consumers do not need to take up drinking wine to reap the cardiovascular benefits. Just because red wine has a health halo does not mean you have to drink it,” says Feller.

Risks of drinking red wine

It is best to consume small amounts of red wine. “Drinking too much red wine poses similar risks to overconsuming other types of alcohol. Research has shown that individuals who over consume alcohol are at a higher risk for liver disease, certain cancers, hypertension, and heart disease. More short-term consequences include sleep disturbances and issues with detoxification,” says Feller.

As with any other alcohol, there are risks associated with consuming too much wine. Each year in the US, excessive alcohol use led to 95,000 deaths. Over a lifetime, excessive alcohol use can lead to the development of high blood pressure, heart disease, liver disease, colon cancer, breast cancer, throat cancer, a weakened immune system, plus a range of social problems including employment instability and impacted family relationships.

Selecting the healthiest red wine

Before you get a little wild about your wine habits and begin typing “healthiest red wine” into Google, let an experienced dietitian deliver the verdict. “I personally say go for the wine without lots of preservatives and additives. I prefer natural and biodynamic wines,” she says, though they’re not always as affordable or widely available, she adds.

It is also helpful to remember that it is not just about selecting a “healthy” wine but about choosing how you enjoy it. If you are thinking of enjoying a glass of red with dinner, opt for a balanced, well-rounded meal containing whole grains, vegetables, and heart-healthy fats. Food also works to protect the stomach lining and slow the body’s absorption of alcohol—something we all know too well after a big night out without any dinner.

Originally Appeared on Glamour

 

Exploring Stroke Rehabilitation in Malaysia: Are Robots Better than Humans for Stroke Recuperation?

Since your doctor has never even tried to get you to 100% recovery. Yes your doctor should be replaced with Dr. Watson. Because rehabilitation will continue to be a failure until you save billions of neurons in the first week by stopping

the 5 causes of the neuronal cascade of death in the first week.

 I lost 5.4 billion neurons in the first week because my doctor did nothing.

Because rehab only gets you almost fully recovered 10% of the time. So rehab is essentially a total failure and you are promoting more of that failure.  You're focusing on completely the wrong part of stroke.

 Exploring Stroke Rehabilitation in Malaysia: Are Robots Better than Humans for Stroke Recuperation?

 Nik Nasihah Nik Ramli, Amhsavenii Asokan, Daniel
Mayakrishnan, Hariharasudan Annamalai
International Medical School, Management & Science University, Shah Alam,
Selangor, Malaysia
To cite this article: Nik Ramli NN, Asokan A, Mayakrishnan D, Annamalai H. Exploring stroke rehabilitation
in Malaysia: are robots better than humans for stroke recuperation? Malays J Med Sci. 2021;28(4):14–23.
https://doi.org/10.21315/mjms2021.28.4.3
To link to this article: https://doi.org/10.21315/mjms2021.28.4.3

Abstract

Ranked as the second leading cause of death and the primary factor to adult disability
worldwide, stroke has become a global epidemic problem and burden. As a developing country,
Malaysia still faces challenges in providing ideal rehabilitation services to individuals with physical
disabilities including stroke survivors. Conventional post-stroke care is often delivered in a teambased approach and involves several disciplines, such as physical therapy, occupational therapy,
speech and language therapy, depending on the nature and severity of the deficits. Robots are
potential tools for stroke rehabilitation as they can enhance existing conventional therapy by
delivering a precise and consistent therapy of highly repetitive movements. In addition, robot assisted physiotherapy could facilitate the effectiveness of unsupervised rehabilitation and thus,
may reduce the cost and duration of therapist-assisted rehabilitation. Research on robot assisted
physiotherapy for stroke in Malaysia is slowly coming into the limelight in the past two decades.
This review explores the effectiveness of robot assisted physiotherapy particularly in improving
motor functions of stroke survivors in Malaysia.

 

Thursday, September 2, 2021

Orange Hospital(Orange NSW,Australia) wins gold award for high standard of stroke treatment and care

Nothing here gives me any sense that they are talking about delivering 100% recovery, treatment and care do not mean recovery. They mean the tyranny of low expectations is being applied.  You'll need to have this hospital reconstituted until it delivers recovery.

Orange Hospital(Orange NSW,Australia) wins gold award for high standard of stroke treatment and care

 

How to Establish the Outer Limits of Reperfusion Therapy

If you didn't get to 100% recovery it is your responsibility to initiate research that will get there.  This thinking small has to stop.

How to Establish the Outer Limits of Reperfusion Therapy

and on behalf of the XIth Stroke Treatment Academic Industry Roundtable
Originally publishedhttps://doi.org/10.1161/STROKEAHA.121.035022Stroke. ;0:STROKEAHA.121.035022

Reperfusion therapy with intravenous alteplase and endovascular therapy are effective treatments(I'm sure your definition of effective is not what your patient would consider effective. Did they get to 100% recovery? NO? Then it wasn't effective! Your fucking tyranny of low expectations is showing.) for selected patients with acute ischemic stroke. Guidelines for treatment are based upon randomized trials demonstrating substantial treatment effects for highly selected patients based on time from stroke onset and imaging features. However, patients beyond the current established guidelines might benefit with lesser but still clinically significant treatment effects. The STAIR (Stroke Treatment Academic Industry Roundtable) XI meeting convened a workgroup to consider the “outer limits” of reperfusion therapy by defining the current boundaries, and exploring optimal parameters and methodology for determining the outer limits. In addition to statistical significance, the minimum clinically important difference should be considered in exploring the limits of reperfusion therapy. Societal factors and quality of life considerations should be incorporated into assessment of treatment efficacy(100% recovery is the only consideration! If that is not your goal, GET THE HELL OUT OF STROKE!). The threshold for perception of benefit in the medical community may differ from that necessary for the Food and Drug Administration approval. Data from alternative sources such as platform trials, registries and large pragmatic trials should supplement randomized controlled trials to improve generalizability to routine clinical practice. Further interactions between industry and academic centers should be encouraged.

 

Thrombectomy for Patients With Large Infarct Core in Practice: Where Should the Pendulum Swing?

 Notice that they still don't know what to do in these cases. So two solutions:

1. Create research and solve this problem.

2. Don't have this type of stroke.

Thrombectomy for Patients With Large Infarct Core in Practice: Where Should the Pendulum Swing?

Originally publishedhttps://doi.org/10.1161/STROKEAHA.121.034754Stroke. ;0:STROKEAHA.121.034754
First page image
 

Wednesday, September 1, 2021

Design strategies to improve patient motivation during robot-aided rehabilitation

This is too easy to solve. The people that need motivation are stroke doctors, researchers, and hospitals to actually get off their asses and solve stroke. 100% recovery.

Survivors wouldn't need motivation if you had 100% recovery protocols. They would be too busy doing the reps needed to recover. Knowing EXACTLY what needs  to be done to recover would be motivation enough. Get away from useless guidelines and this motivation problem goes away.

 

Design strategies to improve patient motivation during robot-aided rehabilitation

 RobertoColombo*
1
, FabrizioPisano
2
, AlessandraMazzone
1
, CarmenDelconte
2
, SilvestroMicera
3
, M ChiaraCarrozza
3
, PaoloDario
3
 and GiuseppeMinuco
1
 Address:
1
Service of Bioengineering, Salvatore Maugeri Foundation, IRCCS Via Revislate 13, 28010 Veruno (NO), Italy,
2
Division of Neurology, Salvatore Maugeri Foundation, IRCCS Via Revislate 13, 28010 Veruno (NO), Italy and
3
 ARTS Lab Scuola Superiore Sant'Anna V.le Piaggio 34, 56025 Pontedera (PI), Italy Email: RobertoColombo*-rcolombo@fsm.it; FabrizioPisano-fpisano@fsm.it; AlessandraMazzone-amazzone@fsm.it; CarmenDelconte-cdelconte@fsm.it; SilvestroMicera-micera@sssup.it; M ChiaraCarrozza-carrozza@sssup.it; PaoloDario-dario@sssup.it; GiuseppeMinuco-gminuco@fsm.it * Corresponding author

Abstract

Background:
Motivation is an important factor in rehabilitation and frequently used as a determinant of rehabilitation outcome. Several factors can influence patient motivation and so improve exercise adherence. This paper presents the design of two robot devices for use in the rehabilitation of upper limb movements, that can motivate patients during the execution of the assigned motor tasks by enhancing the gaming aspects of rehabilitation. In addition, a regular review of the obtained performance can reinforce in patients' minds the importance of exercising and encourage them to continue, so improving their motivation and consequently adherence to the program. In view of this, we also developed an evaluation metric that could characterize the rate of improvement and quantify the changes in the obtained performance.
Methods:
Two groups (G1, n = 8 and G2, n = 12) of patients with chronic stroke were enrolled in a 3-week rehabilitation program including standard physical therapy (45 min. daily) plus treatment by means of robot devices (40 min., twice daily) respectively for wrist (G1) and elbow-shoulder movements (G2). Both groups were evaluated by means of standard clinical assessment scales and the new robot measured evaluation metric. Patients' motivation was assessed in 9/12 G2 patients by means of the Intrinsic Motivation Inventory (IMI) questionnaire.
Results:
Both groups reduced their motor deficit and showed a significant improvement in clinical scales and the robot measured parameters. The IMI assessed in G2 patients showed high scores for interest, usefulness and importance subscales and low values for tension and pain subscales.
Conclusion:
Thanks to the design features of the two robot devices the therapist could easily adapt training tothe individual by selecting different difficulty levels of the motor task tailored to each patient's disability. The gaming aspects incorporated in the two rehabilitation robots helped maintain patients' interest high during execution of the assigned tasks by providing feedback on performance. The evaluation metric gave a precise measure of patients' performance and thus provides a tool to help therapists promote patient motivation and hence adherence to the training program.
Published: 19 February 2007
 Journal of NeuroEngineering and Rehabilitation
 2007,
4
:3doi:10.1186/1743-0003-4-3Received: 31 March 2006Accepted: 19 February 2007This article is available from: http://www.jneuroengrehab.com/content/4/1/3© 2007 Colombo et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0
 
), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
Background:
Motivation is an important factor in rehabilitation and frequently used as a determinant of rehabilitation outcome. Several factors can influence patient motivation and so improve exercise adherence. Thispaper presents the design of two robot devices for use in the rehabilitation of upper limb movements, that canmotivate patients during the execution of the assigned motor tasks by enhancing the gaming aspects of rehabilitation. In addition, a regular review of the obtained performance can reinforce in patients' minds theimportance of exercising and encourage them to continue, so improving their motivation and consequentlyadherence to the program. In view of this, we also developed an evaluation metric that could characterize therate of improvement and quantify the changes in the obtained performance.
Methods:
Two groups (G1, n = 8 and G2, n = 12) of patients with chronic stroke were enrolled in a 3-week rehabilitation program including standard physical therapy (45 min. daily) plus treatment by means of robotdevices (40 min., twice daily) respectively for wrist (G1) and elbow-shoulder movements (G2). Both groups wereevaluated by means of standard clinical assessment scales and the new robot measured evaluation metric. Patients'motivation was assessed in 9/12 G2 patients by means of the Intrinsic Motivation Inventory (IMI) questionnaire.
Results:
Both groups reduced their motor deficit and showed a significant improvement in clinical scales and therobot measured parameters. The IMI assessed in G2 patients showed high scores for interest, usefulness andimportance subscales and low values for tension and pain subscales.
Conclusion:
Thanks to the design features of the two robot devices the therapist could easily adapt training tothe individual by selecting different difficulty levels of the motor task tailored to each patient's disability. Thegaming aspects incorporated in the two rehabilitation robots helped maintain patients' interest high duringexecution of the assigned tasks by providing feedback on performance. The evaluation metric gave a precisemeasure of patients' performance and thus provides a tool to help therapists promote patient motivation andhence adherence to the training program.

Brain Tissue Inflammation Is Key to Alzheimer’s Disease Progression

Your doctor is responsible for coming up with EXACT PROTOCOLS THAT PREVENT THIS NEUROINFLAMMATION.

Brain Tissue Inflammation Is Key to Alzheimer’s Disease Progression

 

Neuroinflammation is the key driver of the spread of pathologically misfolded proteins in the brain, and causes cognitive impairment in patients with Alzheimer’s disease, according to a study published in Nature Medicine.

For the first time ever, the researchers showed in living patients that neuroinflammation is not merely a consequence of disease progression; rather, it is a key upstream mechanism that is indispensable for disease development.

“Our research suggests that combination therapy aimed to reduce amyloid plaque formation and limit neuroinflammation might be more effective than addressing each pathology individually,” said Tharick Pascoal, MD, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.

Although studies in cultured cells and lab animals amassed ample evidence that microglial activation drives the spread of tau fibers in Alzheimer’s disease, this process has never been proven in humans.

The study findings suggest that targeting neuroinflammation might be beneficial for people with early-stage Alzheimer’s disease and that it might help reverse or at least slow down the accumulation of pathologic tau protein in the brain and stave off dementia.

To determine the mechanism by which disordered tangles of tau protein fibers and amyloid plaques spread across the brain and lead to dementia, the researchers used live imaging to look deep into the brains of people with various stages of Alzheimer’s disease and healthy aging individuals.

The researchers found that neuroinflammation was more prevalent in older people and that it was even more pronounced in patients with mild cognitive impairments and those with Alzheimer’s disease-associated dementia. Bioinformatics analysis confirmed that tau propagation depended on microglial activation -- it is a key element that links the effects of amyloid plaque aggregation to tau spread and, ultimately, cognitive impairment and dementia.

“Many elderly people have amyloid plaques in their brains but never progress to developing Alzheimer’s disease,” said Dr. Pascoal. “We know that amyloid accumulation on its own is not enough to cause dementia Our results suggest that it is the interaction between neuroinflammation and amyloid pathology that unleashes tau propagation and eventually leads to wide-spread brain damage and cognitive impairment.”

Focused Ultrasound With Blood Brain Barrier Opening Shows Benefits in Early Alzheimer’s Disease

Until much more research is done I can't see insurance paying for MRI use for this. And you would need early detection of Alzheimers.

Focused Ultrasound With Blood Brain Barrier Opening Shows Benefits in Early Alzheimer’s Disease

By Nancy Melville

VIRTUAL -- August 26, 2021 -- A magnetic-resonance (MR)-guided low-intensity focused ultrasound technique of opening the blood brain barrier shows efficacy in the potential treatment of early Alzheimer’s disease by removing amyloid-beta plaque and slowing cognitive decline, according to a small study presented at the Virtual 2021 American Association of Neurological Surgeons (AANS).

“Focused ultrasound mediated blood brain barrier opening is feasible, reversible, and safe in multiple large brain regions among persons with Alzheimer’s disease,” said Ali R. Rezai, MD, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia.

The procedure involves no incision or skull opening and a focal delivery of ultrasound energy, with live MR thermometry allowing for MR-targeted evaluation. A low-intensity focused ultrasound approach of temporarily opening the blood brain barrier for targeted therapeutics, still investigational, is being explored for applications including Alzheimer’s disease, Parkinson’s disease, and other applications.

“The ability to open the blood brain barrier on demand and allow antibodies and larger molecules or other chemotherapy agents in the brain opens up a tremendous opportunity for neurosurgeons,” explained Dr. Rezai.

For the current phase 2 trial, patients with mild Alzheimer’s disease with amyloid on positron emission tomography (PET) underwent the MRI-guided low intensity focused ultrasound technique (ExAblate Neuro) with concomitant intravenous microbubble (Definity) administration in 3 separate sessions, each 2 weeks apart, targeting the hippocampus, frontal lobes, and parietal lobes, with up to 30 cc of treatment volume.

The patients had a mean age of 64.1 years. Of the 15 patients treated for a total of 45 treatments, all had successful immediate opening of the blood brain barrier, observed with parenchymal intravenous gadolinium contrast enhancement, and subsequent closure within 24 to 48 hours.

There were no imaging adverse effects and no permanent clinical adverse effects. The treatments were all well tolerated and no neurological adverse events have been reported.

With more than 1 year of follow-up, 8 patients showed reductions in cognitive decline compared with a matched longitudinal Alzheimer’s Disease Neuroimaging Initiative (ADNI) cohort subset of 46 subjects, with a mean relative change score after 1 year of 2.2 versus 3.8, respectively.

However, Dr. Rezai noted that the limited sample size prevents a meaningful interpretation of the differences.

Furthermore, 8 of the patients showed a reduction in brain amyloid after 1 year in the regions of the brain treated with the focused ultrasound compared with the ADNI group, with a mean relative change score of 4.6 versus 5.6, respectively.

“The focused ultrasound group shows less cognitive decline than the corresponding age and sex-matched ADNI cohort subset,” said Dr. Rezai. “There was no meaningful cognitive or behavioural worsening with focused ultrasound as compared with the ADNI comparator group.”

Further evaluation of changes in beta-amyloid on the Centiloid Scale with PET quantification among 10 patients showed an average beta-amyloid reduction of 26% in the treated regions. One patient showed no significant increase or decrease in beta-amyloid.

Dr. Rezai noted that the study is ongoing and more participants will be needed with a longer follow-up.

Funding for this study was provided by Insightec.

[Presentation title: Focused Ultrasound Mediated Blood Brain Barrier (BBB) Opening of the Hippocampus, Frontal and Parietal Lobes in Mild Alzheimer’s Disease: Long-Term Safety and Clinical Outcome of a Multicenter Phase II Clinical Trial]

 

Guidelines for Adult Stroke Rehabilitation and Recovery

Notice the weasel word; 'guidelines' NOT PROTOCOLS. Until we get survivors in charge failures like this will continue to occur.  100% recovery is the only goal in stroke and this does nothing to get us there.
I don't give a crap about the educational value. WHAT THE FUCK ARE THE RECOVERY RESULTS? All these PhDs and still nothing useful.

Guidelines for Adult Stroke Rehabilitation and Recovery

Endorsed by the American Academy of Physical Medicine and Rehabilitation and the  American Society of Neurorehabilitation. The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists and the American Congress of Rehabilitation Medicine also affirms the educational value of these guidelines for its members
Carolee J. Winstein, PhD, PT, Chair; Joel Stein, MD, Vice Chair; Ross Arena, PhD, PT, FAHA; Barbara Bates, MD, MBA; Leora R. Cherney, PhD; Steven C. Cramer, MD; Frank Deruyter, PhD; Janice J. Eng, PhD, BSc; Beth Fisher, PhD, PT; Richard L. Harvey, MD; Catherine E. Lang, PhD, PT; Marilyn MacKay-Lyons, BSc, MScPT, PhD; Kenneth J. Ottenbacher, PhD, OTR; Sue Pugh, MSN, RN, CNS-BC, CRRN, CNRN, FAHA; Mathew J. Reeves, PhD, DVM, FAHA; Lorie G. Richards, PhD, OTR/L; William Stiers, PhD, ABPP (RP); Richard D. Zorowitz, MD; on behalf of the American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and Council on Quality of Care and Outcomes Research
Purpose
—The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke.
 Methods
—Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council’s Scientific Statement Oversight Committee and the AHA’s Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through 2014. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal and external peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee.
 Results
—Stroke rehabilitation requires a sustained and coordinated effort from a large team(Proof?), including the patient and his or her goals, family and friends, other caregivers (eg, personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others. Communication and coordination among these team members are paramount in maximizing the effectiveness and efficiency of rehabilitation and underlie this entire guideline. Without communication and coordination, isolated efforts to rehabilitate the stroke survivor are unlikely to achieve their full potential.

Neuroprotection in early stages of Alzheimer’s disease is promoted by transthyretin angiogenic properties

 No clue, for your doctor to explain to you.

Neuroprotection in early stages of Alzheimer’s disease is promoted by transthyretin angiogenic properties

Abstract

Background

While still controversial, it has been demonstrated that vascular defects can precede the onset of other AD hallmarks features, making it an important therapeutic target. Given that the protein transthyretin (TTR) has been established as neuroprotective in AD, here we investigated the influence of TTR in the vasculature.

Methods

We evaluated the thickness of the basement membrane and the length of brain microvessels, by immunohistochemistry, in AβPPswe/PS1A246E (AD) transgenic mice and non-transgenic mice (NT) bearing one (TTR+/−) or two (TTR+/+) copies of the TTR gene. The angiogenic potential of TTR was evaluated in vitro using the tube formation assay, and in vivo using the chick chorioallantoic membrane (CAM) assay.

Results

AD transgenic mice with TTR genetic reduction, AD/TTR+/−, exhibited a thicker BM in brain microvessels and decreased vessel length than animals with normal TTR levels, AD/TTR+/+. Further in vivo investigation, using the CAM assay, revealed that TTR is a pro-angiogenic molecule, and the neovessels formed are functional. Also, TTR increased the expression of key angiogenic molecules such as proteins interleukins 6 and 8, angiopoietin 2, and vascular endothelial growth factor, by endothelial cells, in vitro, under tube formation conditions. We showed that while TTR reduction also leads to a thicker BM in NT mice, this effect is more pronounced in AD mice than in NT animals, strengthening the idea that TTR is a neuroprotective protein. We also studied the effect of TTR tetrameric stabilization on BM thickness, showing that AD mice treated with the TTR tetrameric stabilizer iododiflunisal (IDIF) displayed a significant reduction of BM thickness and increased vessel length, when compared to non-treated littermates.

Conclusion

Our in vivo results demonstrate the involvement of TTR in angiogenesis, particularly as a modulator of vascular alterations occurring in AD. Since TTR is decreased early in AD, its tetrameric stabilization can represent a therapeutic avenue for the early treatment of AD through the maintenance of the vascular structure.

Introduction

Alzheimer’s disease (AD) patients undergo several neurovascular changes at different levels. Brain vascular dysregulation is the earliest and strongest factor during disease progression and is followed by amyloid-β (Aβ) peptide deposition, glucose metabolism dysregulation, functional impairment, and gray matter atrophy, in this order [1]. Decreased expression of the low-density lipoprotein receptor-related protein 1 (LRP-1) and P-glycoprotein (P-gp), as well as upregulation of the receptor for advanced glycation end products (RAGE), are mechanisms reported to be changed in AD patients, leading to Aβ accumulation in the brain [2, 3]. In addition to defective clearance mechanisms, increased endothelial pinocytosis, decreased number of mitochondria, decreased glucose transporter (GLUT)-1, and loss of tight/adherents junctions are features detected in AD [4]. The reduction of the capillary density is also characteristic of the AD brains [5]. This is due to an aberrant angiogenesis with premature pruning of capillary networks. This defective angiogenesis may be caused by a lack of angiogenic stimuli and unresponsive endothelium [6]. Although other authors describe increased vascular density in AD [7], the underlying angiogenic process has pathological characteristics. Some studies suggest that the promotion of angiogenesis results in concomitant blood-brain barrier (BBB) disruption and vessel leakiness [7]. Other studies defend that the vascular damage is a consequence of poor blood perfusion of the brain, leading to hypoperfusion/hypoxia causing the BBB dysfunction [8]. Other authors argue that the accumulation of Aβ in the walls of the capillaries can contribute to the reduced brain capillary density in AD via anti-angiogenic activity [9, 10]. Another observed alteration in AD is the increased thickness of the vascular BM in AD [11]. Since the increase in BM thickness occurs before Aβ deposition, it is speculated that it functions as a physical barrier to the Aβ clearance across the BBB [12]. Some studies have related this BM thickening with increased collagen IV content, in AD and aging [13, 14].

Transthyretin (TTR), a 55-kDa homotetrameric plasma and cerebrospinal fluid (CSF) protein, transports retinol through binding to the retinol-binding protein (RBP), which binds at the surface of TTR, and thyroxine (T4), which binds at a central hydrophobic channel formed at the dimer-dimer interface [15]. In the CSF, TTR is the main Aβ binding protein [16], providing neuroprotection by avoiding Aβ aggregation [16,17,18,19,20,21,22,23] and toxicity [17, 24], and by participating in Aβ brain efflux at the BBB [25]. TTR is early decreased in AD, both in plasma [26,27,28] and in the CSF [29], probably due to its tetrameric instability [26, 30], hypothesized to result in accelerated clearance and lower levels. TTR instability is also a key feature in familial amyloid polyneuropathy (FAP), a systemic amyloidosis that is usually caused by mutations in TTR. The amyloidogenic potential of the TTR variants is inversely correlated with its tetrameric stability [31], and the dissociation of the tetramer into monomers is at the basis of the events that culminate with TTR amyloid formation [32, 33]. TTR stabilization, used as a therapy in FAP [34, 35], can be achieved through the use of small-molecule compounds sharing molecular structural similarities with T4 and binding in the T4 central binding channel [36,37,38]. Although no TTR mutations have been found in AD patients [22], TTR stabilization has also been proposed as a therapeutic strategy to recover its ability to protect in AD [19, 39], and shown beneficial in a mouse model of AD [39, 40]. Iododiflunisal (IDIF), a potent TTR stabilizer, was administered to AD mice and bound plasma TTR displacing T4, resulting in decreased Aβ amyloid burden and total Aβ brain levels, and improved cognition [40]. Interestingly, TTR stabilization by IDIF improves TTR-assisted Aβ brain efflux in vitro and enhanced the expression of LRP-1 in vivo [30]. The formation of TTR-IDIF complexes enhances BBB permeability of both IDIF and TTR, in vivo [41].

TTR has also been implicated in angiogenesis and the first reports of its involvement have been described in diseases such as FAP [42]; in diabetic retinopathy (DR) [43, 44], and lately, in cancer [45]. As reported, a study investigated the effect of TTR in angiogenesis by treating human umbilical vein endothelial cells (HUVECs) with wild-type (WT) TTR or a common FAP TTR mutant, V30M. The authors concluded that the TTR mutant inhibited cell migration and decreased survival relative to the WT TTR, by down-regulating several pro-angiogenic genes for angiopoietin-2 (Ang-2), vascular endothelial growth factor (VEGF) receptors 1 and 2, basic fibroblast growth factor (bFGF), and transforming growth factor-beta 2 (TGF-β2) [42]. In another study, to investigate how TTR affects the development of new vessels in DR, human retinal microvascular endothelial cells (hRECs) were cultured with TTR in natural and simulated DR environments (hyperglycemia and hypoxia). In the DR environment, TTR inhibited cell proliferation, migration, and tube formation, by repressing the expression of the pro-angiogenic genes Ang-2 and VEGF receptors 1 and 2 [43]. Conversely, in a low glucose environment, these angiogenesis-related features were improved by TTR. Recently, it was reported that TTR levels were increased in human serum of lung cancer patients. Additionally, TTR was shown able to promote tumor growth by enhancing several lung ECs functions as permeability, migration, and tube formation [45]. However, TTR potential in angiogenesis has never been addressed in vivo and the possible participation of TTR in brain angiogenesis and vascular alterations has never been elucidated.

Taking these evidences into account, this work aimed at investigating the angiogenic potential of TTR and at assessing its involvement in the vascular impairment that occurs in AD.

 

Effects of Walnut Consumption for 2 Years on Lipoprotein Subclasses Among Healthy Elders: Findings From the WAHA Randomized Controlled Trial

Hope you have a scale that measures grams, but only if your doctor prescribes this.  But this would not be applicable to us as stroke survivors since we are not healthy.

Hell, your doctor should have been prescribing walnuts since October 2014.

  • walnuts (11 posts to October 2014)


Effects of Walnut Consumption for 2 Years on Lipoprotein Subclasses Among Healthy Elders: Findings From the WAHA Randomized Controlled Trial

Bilateral priming before Wii-based movement therapy enhances upper limb rehabilitation and its retention after stroke: a case-controlled study

Hopefully you can figure out what bilateral priming is so you can ask your therapists and doctor for it.  They've only had 7 years to understand it.

Bilateral priming before Wii-based movement therapy enhances upper limb rehabilitation and its retention after stroke: a case-controlled study

Winston Byblow
2014, Neurorehabilitation and Neural Repair
29 Views
11 Pages
1 File ▾
Cognitive Science,
Video Games,
Exercise therapy,
Activities of Daily Living,
Stroke
 ...more ▾

 


Abstract

Background.
 Motor deficits after a stroke are thought to be compounded by the development of asymmetric interhemispheric inhibition. Bilateral priming was developed to rebalance this asymmetry and thus improve therapy efficacy.
Objective.
 This study investigated the effect of bilateral priming before Wii-based Movement Therapy to improve rehabilitation after stroke.
 Methods.
 Ten patients who had suffered a stroke (age, 23-77 years; 3-123 months after stroke) underwent a 14-day program of Wii-based Movement Therapy for upper limb rehabilitation. Formal Wii-based Movement Therapy sessions were immediately preceded by 15 minutes of bilateral priming, whereby active flexion-extension of the less affected wrist drove mirror-symmetric passive movements of the more affected wrist through a custom device. Functional movement was assessed at weeks 0 (before therapy), 3 (after therapy), and 28 (follow-up) using the Wolf Motor Function Test (WMFT), upper limb Fugl-Meyer Assessment (FMA), upper limb range of motion, and Motor Activity Log (MAL). Case-matched controls were patients who had suffered a stroke who received Wii-based Movement Therapy but not bilateral priming.
Results.
 Upper limb functional ability improved for both groups on all measures tested. Post therapy improvement on the FMA for primed patients was twice that of the unprimed patients (37.3% vs 14.6%, respectively) and was significantly better maintained at 28 weeks (P = .02). Improvements on the WMFT and MAL were similar for both groups, but the pattern of change in range of motion was strikingly different.
Conclusions.
 Bilateral priming before Wii-based Movement Therapy led to a greater magnitude and retention of improvement compared to control, especially measured with the FMA. These data suggest that bilateral priming can enhance the efficacy of Wii-based Movement Therapy, particularly for patients with low motor function after a stroke.

Long-term Dietary Flavonoid Intake and Subjective Cognitive Decline in US Men and Women

 If you want to know what higher means and the quintiles you'll have to have your doctor get the research.  Any research with any federal backing should be freely available, we already paid for it.

Long-term Dietary Flavonoid Intake and Subjective Cognitive Decline in US Men and Women

Tian-Shin Yeh, Changzheng Yuan, Alberto Ascherio, Bernard Rosner, Walter Willett, Deborah Blacker

Abstract

Objective: To prospectively examine the associations between long-term dietary flavonoids and subjective cognitive decline (SCD).

Methods: We followed 49,493 women from the Nurses’ Health Study (NHS) (1984-2006) and 27,842 men from the Health Professionals Follow-up Study (HPFS) (1986-2002). Poisson regression was used to evaluate the associations between dietary flavonoids (flavonols, flavones, flavanones, flavan-3-ols, anthocyanins, polymeric flavonoids, and proanthocyanidins) and subsequent SCD. For the NHS, long-term average dietary intake was calculated from seven repeated food frequency questionnaires (SFFQs), and SCD was assessed in 2012 and 2014. For the HPFS, average dietary intake was calculated from five repeated SFFQs, and SCD assessed in 2008 and 2012.

Results: Higher intake of total flavonoids was associated with lower odds of SCD after adjusting for age, total energy intake, major non-dietary factors, and specific dietary factors. Comparing the highest versus the lowest quintiles of total flavonoid intake, the pooled multivariable-adjusted odds ratios (ORs) (95% CIs) of 3-unit increments in SCD was 0.81 (0.76, 0.89). In the pooled results, the strongest associations were observed for flavones (OR=0.62 [0.57, 0.68]), flavanones (0.64 [0.58, 0.68)]), and anthocyanins (0.76 [0.72, 0.84]) (p trend <0.0001 for all groups). The dose-response curve was steepest for flavones, followed by anthocyanins. Many flavonoid-rich foods, such as strawberries, oranges, grapefruits, citrus juices, apples/pears, celery, peppers, and bananas, were significantly associated with lower odds of SCD.

Conclusion: Our findings support a benefit of higher flavonoid intakes for maintaining cognitive function in US men and women.

  • Received February 7, 2021.
  • Accepted in final form June 10, 2021.