nanoparticles and stroke rehab

Since I think too much about all things stroke related I came across nanoparticles and tried to envision what use they could be for stroke rehab.
They have several interesting abilities;
1. They can cross the blood-brain barrier
http://www.ncbi.nlm.nih.gov/pubmed/16154222
2. They are already used to treat thrombi in parts of the body.
http://www.springerlink.com/content/vj1528n166147410/
3. They can be magnetically directed.
http://www.redorbit.com/news/video/health/4/magnetic_nanoparticles_remotely_control_neurons_and_animal_behavior/32320/
For our purposes they could be used to deliver a clot-busting drug directly to the clot using the magnetic properties to guide it. And since the amount could be sized to the clot size the risk of bleeding could be lowered significantly and the 3-4.5 hour window for tPA ignored.
The more interesting delivery mechanism would be to deliver neuronal growth factors, c3a peptides and NOGO receptors to the penumbra and dead brain areas. Or deliver stem cells to the most likely place for them to survive and start working.
And after we deliver these growth factors or stem cells we can use connectomics to find out if they are working as we expected.

This could be incredibly useful for those who need some magical properties in order to recover, not all of us are willing to spend the rest of our lives working on recovery or have the mental cognition to understand the work needed to recover.

stroke guidelines around the world

best practices in stroke rehab
Canada has several
Strokengine
http://www.strokengine.ca/index.php
http://www.strokebestpractices.ca/
Canadian Stroke strategy for 2010
http://canadianstrokestrategy.com/
Australian stroke strategy
http://www.strokefoundation.com.au/images/stories/stroke%20support%20strategy%20low%20res.pdf
Britain stroke strategy
http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Healthcare/Longtermconditions/Vascular/Stroke/DH_099065
Stroke guidelines of the Royal College of Physicians
http://www.nice.org.uk/nicemedia/live/12018/41363/41363.pdf
Scottish Intercollegiate Guidelines Network
http://www.sign.ac.uk/pdf/sign118.pdf
And what the World Stroke Organization lists as international stroke guidelines for countries.
http://www.world-stroke.org/guidelines_hb02.asp
You will notice that the United states doesn't even have an entry
One would think that the WSO would put together a single guideline but that obviously will not occur until a survivor gets in power in the WSO.
Most of these have probably been put together with limited survivor input so take them with a grain of salt.
If your country has some please post them in the comment section.

late start to stroke therapy ok

http://www.medgadget.com/archives/2010/04/robotassisted_post_stroke_therapy_beneficial_even_for_late_starters_1.html
A late start to stroke therapy has been thought to be detrimental to getting much benefit out of it, so exercises must begin as soon as possible. A new study, published in the New England Journal of Medicine, has now shown that even late starters can see substantial improvement when using robotically assisted therapy.
This belief is represented in most stroke associations and doctor/therapist statements. I don't believe this is limited to only robotically assisted. I bet it takes 10-15 years before this statement shows up in these places and 30 years before it is taught in schools. So now when you see articles extolling starting therapy immediately reply to them and quote this article back to them

Stroke blogging - do it now!

Start your own stroke blog. Stroke survivors as a whole are invisible, we need to change that.
http://www.baltimoresun.com/news/opinion/oped/bs-ed-stroke-20101028,0,4151798.story I don't want to find out 20 years from now that survivors still do not have a voice in their stroke associations and a way to direct where the future of stroke rehab leads.
Even if all we do is document our own case study that can immeasureably help another survivor.
You can create one here on Google, just click on the CreateBlog link at the top of this blog. Its free and I am sure there are other sites that allow free blogging.
Create a Blog for Free
Start Blogging & Share with Friends
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KaBlog.com
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HubPages.com
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Pictures, text, privacy controls
Free, easy, fun & safe. Start today
http://www.experienceproject.com/
WordPress.com — Get a Free Blog HereFree blogs managed by the developers of the WordPress software. Includes custom design templates, integrated statistics, automatic spam protection and other ...
wordpress.com/

When you have created one and posted a few entries please send me a link. I want to see thousands/millions out there. If it is not in English please tell me what language it is in. I will add yours to my blog list for others to find. If you want to be found by google read my posting on how to stay informed of stroke rehab


Do it now!!!!!!!

caffeine and stroke/alzheimers risk

I was having an Q&A at a stroke forum on Alzheimers and the worry was getting it and what possibly could prevent that from happenning. I responded with this research.

Caffeine Treats Alzheimer's?
http://www.everydayhealth.com/alzheimers/specialists/coffee-for-alzheimers-prevention.aspx

This just came in.
Upping your coffee intake 'doubles the risk of a stroke'
http://www.dailymail.co.uk/health/article-1337684/Upping-coffee-intake-doubles-risk-stroke.html?ito=feeds-newsxml
or if you're a woman can coffee cut a womans stroke risk?
So do you want to prevent Alzheimers but have the greater possibility of a stroke? In my opinion/case my stroke was not a bleed so I will take the extra risk, anyway I need the caffeine in order to function during the day. This is the perfect question to ask your doctor and see if they are following the latest news. Depends on which research you believe in.

REM sleep and stroke fatigue

A theory of mine, I don't think I have dreamed since my event and was wondering if that was causing some of my fatigue. As the episode Night Terrors in Star Trek Next Generation shows what happens when you don't dream. Please respond if you have or have not dreamed and list the fatigue you have. I can easily fall asleep anytime during the day even with 12 hours of sleep.
SYMPTOMS: A person lacking REM sleep will show all the general symptoms of sleep deprivation, such as reduced productivity in the workplace, daytime sleepiness, and not handling stress well. Losing REM sleep makes people more sensitive to pain, too. In addition, REM sleep seems to be necessary for verbal skills. A lack of it will cause a person to not be as creative in using language, and they will not do too well on language tests.
As both these articles state; The success of a stroke patients rehabilitation plan is heavily dependent on sleep.
http://strokerehabonline.com/2010/06/sleeping-and-sleep-for-stroke-recovery-speed-up/comment-page-1/#comment-503
http://ezinearticles.com/comment.php?Sleep-is-an-Important-Aid-to-Stroke-Recovery&id=3866857
What are your dreams like and do you have them? Do you dream pre-stroke or after stroke abilities?
I have now changed both my zocor and zoloft from evening meds to morning meds and I now dream. Don't do that without your doctors ok.

bowling and stroke rehab

Today our unit at work had a bowling outing. I had not done this since my
event and my main worry was needing to ask a co-worker to tie the bowling
shoes. Luckily that wasn't a problem because they had velcro straps.
Bowling went fairly well. I would limp/shuffle to the line and just use
arm motion to throw the ball. By the time I planted my left foot there
was no momentum to my swing. I started out with a 15lb. ball but that was
too heavy, so I managed to get a 13 lb. ball instead, lighter ones are
obviously meant for smaller fingers. Scores were 124, 119, 113 about 10
points less than pre-stroke. All-in-all a successful outing, I'll have to
do it again.

split-belt treadmill and stroke rehab

Physical Therapists Use A Split-belt Treadmill To Help Stroke Patients Walk More Easily
The other problem is that it looks like it will be very expensive so that few clinics will be able to afford them, similar to Lokomat training. Luckily I moved to a clinic with the Lokomat and thought that using it was probably the most helpful in getting somewhat of a normal gait.
When the legs move at speeds different from one another, the brain receives an error signal and the brain and nervous system use the feedback to adjust. The cerebellum recalls this message even after the treadmill stops and for a few minutes, stroke patients can walk easier.
Split-belt treadmill training poststroke: a case study.
BACKGROUND AND PURPOSE: Even after rehabilitation, many individuals with strokes have residual gait deviations and limitations in functional walking. Applying the principles of motor adaptation through a split-belt treadmill walking paradigm can lead to short-term improvements in step length asymmetry after stroke. The focus of this case study was to determine whether it is possible to capitalize on these improvements for long-term gain.
CASE DESCRIPTION: The participant was a 36-year-old woman who was 1.6 years poststroke. She had a slow walking speed and multiple specific gait deviations, including step length asymmetry.
INTERVENTION: The participant walked on a split-belt treadmill 3 d/wk for 4 weeks, with the paretic leg on the slower of the two treadmill belts. The goal was 30 minutes of split-belt treadmill walking each day, followed by overground walking practice to reinforce improvements in step length symmetry.
OUTCOMES: With training, step length asymmetry decreased from 21% to 9% and decreased further to 7% asymmetry 1 month after training. Self-selected walking speed increased from 0.71 m/s to 0.81 m/s after training and 0.86 m/s 1 month later. Percent recovery, measured by the Stroke Impact Scale (SIS), increased from 40% to 50% posttraining and to 60% 1 month later.
DISCUSSION: Improvements in step length symmetry were observed following training and these improvements were maintained 1 month later. Concomitant changes in clinical measures were also observed, although these improvements were modest. The outcomes for this participant are encouraging given the relatively small dose of training. They suggest that after stroke, short-term adaptation can be capitalized on through repetitive practice and can lead to longer-term improvements stroke.

There should be a way to duplicate this without having the split-belt treadmill but no one will research this since nothing could be sold as part of it.

student doctor network and stroke knowledge

This was from the student doctor network

I've found plenty of TBI and SCI textbooks but was wondering if anyone knows of a good stroke rehab textbook, or do they not exist?
http://forums.studentdoctor.net/showthread.php?p=10337446#post10337446

Boy is this disgusting, our doctor instructors don't even have good textbooks. here was my reply;

as a stroke survivor, I've spent years looking for decent stroke rehab information. Personally I don't think it exists. Actually there is one book that is good; Stronger After Stroke by Peter Levine Go to any of the stroke forums and it is obvious that survivors are not given any useful information. Therapists don't know any basis for their treatment.
http://informahealthcare.com/doi/abs/10.3109/09593989409036399
As in the Swedish study, although the respondents were able to describe their treatment choices, they had difficulty explaining the underlying theoretical basis for their choice.
All I can say is that you had better not get a stroke because no one can tell you anything useful.


The World Stroke Organization is trying but we are 2400 years in the past when Hippocratic dictum that ‘It is impossible to cure a severe attack of apoplexy and difficult to cure a mild one’
Good luck you have reached the black hole of stroke knowledge.
To stump your teachers ask for the difference in therapies needed for penumbra damage vs. dead brain damage. I opine at www.oc1dean.blogspot.com, try not to be offended by my postings.

God, our doctors know nothing, our future doctors will know nothing, our therapists don't have any basis for their treatment. When will someone actually take charge and learn something about stroke rehab?

PT forums and stroke rehab

I read PT forums. This one on stroke rehab was appalling.
http://www.physiobob.com/forum/neuro-physiotherapy/4992-stroke-rehab.html
The posting has been deleted but the following was copied before it was gone. I guess criticizing PTs is not allowed.

Dear fellow physios,

i think i need a helping hand with a stroke patient.

He has had a RIGHT CVA about 20 days ago. Unfortunately, they let him go from hospital 10 days after the stroke.

I started seeing him last week and has no movement at all on LEFT arm.I read that no shoulder shrug or finger movements are not good prognosis.I am using electrical stimulation, massage with a brush, passive movements and PNF patterns to re-learn the movements.Last Monday he had spontaneous adduction of LEFT SHOULDER that's gone again.Do you think his arm will recover?

As for his LEFT LEG, he has no control of knee extension.How can we manage locking of the knee?

Thank you all

Not a single one of the answers even suggested that they look at the brainscan or diagnosis to see if the functions they were trying to get the patient to do were even possible. Every answer just assumed that all they had to do was to tell the patient to move this way and if the patient couldn't do that, well then obviously the patient is slacking. As Charlize says,'All you have to do is raise your voice'. Boy what lack of knowledge. This corresponds to my earlier post on theoretical basis of stroke rehab.
You will also notice that this PT is still under the impression that immediate therapy is required. See this for the latest;
Late start to stroke therapy

I haven't quite decided yet if I should stick my neck out and take them to task, if I do I will create another id because that reply would probably get me kicked out.

Plugged arteries to the brain - Stroke risk

I have probably answered dozens of questions like this on stroke forums. The medical staff is doing a lousy job explaining this.

Your doctor is quite remiss in not telling you about the physiology of the brain. There is a Circle_of_Willis that supplies blood to the brain. That is fed by four arteries, two carotid and two vertebral. Just because one or more arteries are blocked does not directly cause a stroke. The usual case is that the narrowed artery tears, clots and the clot lets go, traveling to the brain. You normally do not clean out a totally plugged artery because of the high risk of sending debris to the brain. I had a totally blocked right carotid artery for four years now and I don't worry about getting a stroke from that. Ask your doctor about this to see if s/he understands basic brain matters. I have heard of survivors who developed feeder arteries around the blockages.
But then I am a stroke-addled survivor, so don't listen to what I have to say, your doctor is infallible, listen to them.

2010 top stroke blogs

From Licensed Practical Nurse -  no longer running these awards

Know-Stroke.org http://knowstrokeblog.my-physical-therapy-coach.com/

Surviving a Strokehttp://survivingastroke.blogspot.com/

The Stroke Recovery Blog http://recoverfromstroke.blogspot.com/ Peter Levines' blog, read all of his posts they're better than mine

Barb’s Recovery http://barbpolansrecovery.blogspot.com/

Recovering Stroke Survivor http://lori-recoveringstrokesurvivor.blogspot.com/ I'm not sure what language this one is in but I'll figure it out eventually.

Stroke of Faithhttp://stroke-of-faith.blogspot.com/

So what are you doing reading this one?

Array tomography and stroke research

This along with the wiring diagram of the brain seem like useful tools for researchers to figure out what occurs during neuroplasticity and neurogenesis of stroke rehabilitation.
My initial reading of this assumes that the mouse is alive when doing this scanning.
Touring Memory Lane Inside The Brain

This is obviously something I as a non-scientist should not even be suggesting as a use for this.

men and drinking, nothing on stroke rehab

"it was a woman that drove me to drink and I forgot to write and thank her"
W.C.Feilds

“Men are like a fine wine. They all start out like grapes, and it's our job to stomp on them and keep them in the dark until they mature into something you'd like to have dinner with.”
Kathleen Mifsud

Okay, brain. You don't like me, and I don't like you, but let's get through this thing and then I can continue killing you with beer.
Homer Simpson

Bart, a woman is like a beer. They look good, they smell good, and you'd step over your own mother just to get one!
Homer Simpson

Instant decrepitude and stroke effects

 I originally thought I would become decrepit over many years. But no, I hit the wall at age 50 with my stroke. Now I am spending years to get back to some semblance of normalness so I can work on becoming decrepit over many years like I thought would originally happen. As someone said to me. 'You hit a pothole in the road of life'. Actually it turned out to be a sinkhole that swallowed me.  Yes, but I am fixing the flat in preparation for 40 more years and rebuilding the car besides. And I will go speeding down that road again.

What therapy-exercise worked best for your stroke rehab?

Therapists ask me what therapies have worked in my rehab. I can understand why because they want to add that therapy to their roster of abilities.

Survivors ask me what exercises worked in my rehab. They are hoping that if they can just find the right exercise to do they will recover.

Both of these questions are invalid because the first thing to understand is how recovery occurs and where you are in the process. Until you know that can you select a therapy or exercise to work on. If you are working on penumbra recovery in the first 6-12 months then you take the little pieces of movement you do have and keep extending them longer and farther. If you are trying to get back functions that were in the dead brain area then you need to work on neuroplastic therapies that move those functions; try passive movement, mental imagery, thermal stimulation, action observation. All of these are discussed in other posts on my blog.

Until we get the whole concept of what needs to be done to recover changed from this specific therapy or exercise will we finally come up with a therapy model for stroke rehab. So don't enable the doctors and therapists by accepting a therapy or exercise without them specifying how it meets the protocol of recovery. See my blog on restructure stroke rehab model and theoretical basis of stroke rehab for my ideas. I actually think they are pretty good.

No boundary stroke rehab

I loved this, it came from from penngwyn on stroke network.


But the reason I mention that here is that one of my classmates was a doctor who turned out to be a specialist in rehabilitation. He told me that in his experience, the most powerful tool in recovery/rehabilitation was to convince ones brain that there was no boundary, no impairment or limitation. "Act like you can do everything, and your brain and body will find ways to make it work." he said.
This corresponds to a saying that is engraved on a plaque above my wifes' desk.
'What would you attempt to do if you knew you could not fail?'

Wiring diagram of the brain

This sounds like something every stroke researcher should be doing after the protocols they are testing, mainly to figure out where the changes are occurring. The other thing to work on would be to find those survivors that have completely recovered and scan their brains with this to find out where neuroplasticity has moved the dead functions. If only I could figure out a way to get this type of question in front of those stroke researchers. If anyone has a clue please email me. I will stick my neck out to anyone including the stroke associations.
A Wiring Diagram of the Brain
New technologies that allow scientists to trace the fine wiring of the brain more accurately than ever before could soon generate a complete wiring diagram--including every tiny fiber and miniscule connection--of a piece of brain. Dubbed connectomics, these maps could uncover how neural networks perform their precise functions in the brain, and they could shed light on disorders thought to originate from faulty wiring, such as autism and schizophrenia.
The brain is essentially a computer that wires itself up during development and can rewire itself," says Sebastian Seung, a computational neuroscientist at MIT. "If we have a wiring diagram of the brain, that could help us understand how it works." For example, scientists previously identified the part of the songbird's brain that is important in the birds' ability to generate songs. Seung would ultimately like to develop a wiring diagram of this structure in order to elucidate the features underlying its unique capability.
I know this is probably decades away but if we(survivors) don't start putting future goals out there like President Kennedy did for the moon landing we won't ever get there. Stay tuned, I'll figure out some way to get a set of goals started.
I  sent an email to Mr. Seung thanking him for his work on this and pointing out the usefulness of using this for stroke rehabilitation research. We have to get stroke  rehab research in front of everyone possible so if you see an opportunity to suggest something that may help  stroke research please point it out to the persons involved. The squeaky wheel does get oiled and I plan on screeching like Red River oxcarts.

Interviewing your stroke rehab doctor

When you interview the doctors here is a good set of questions to ask them. Remember they are working for you so you need to find out how good they are. You can modify them slightly for your therapists

1. How many patients has he/she seen fully recovered and what did they do to recover? This is not the ADL recovery.
2. What has been done and still needs to be done to prevent another stroke?
3. What area of the brain was disabled by the stroke? What functions did they cover?
4. What type of stroke, clot or bleed? Show me a 3d map.
5. How big was the penumbra? What areas did it affect?
6. What clinical trials are going on right now that the patient would be a good candidate for?
7. What treatment options have been discovered in the last 5-10 years for stroke rehabilitation? Of these options which ones are available in your clinic? This is to determine if he/she is up-to-date or if you will have to do all this research yourself.
8. Who are the best therapists working in your clinic for stroke rehabilitation and why do you consider them to be the best?
9. Who do I work with if depression takes hold?
10. What books on stroke recovery do you recommend? I recommend Stronger After Stroke by Peter Levine and healing into Possibility by Alison Shapiro
11. What stroke related magazines do you recommend?
12. What internet sites do you recommend about stroke? There are at least 15 stroke forums out there. If Canadas' Strokengine is not mentioned I would ask why.

For therapists -
1. What is the theoretical basis for your therapy recommendations?
2. Have you mapped the damage as seen from my scans to your therapy recommendations? Why not?

As always make sure you ask your doctors for permission to ask these questions of your doctor. Circular reasoning is great unless this is a Mobius strip. Be careful that you don't fall off the strip when it turns upside down.

Is your stroke rehab half-full or half-empty?

I use this analogy in some of my posts and just today I was discussing this very topic with the owner of the lunch spot I was at.  The best comment I can give you is something my OT said to me. She said I was looking at my abilities all wrong, I was looking at what I could do the days before my stroke and comparing my current abilities to that. She was looking at my abilities in comparison to the first day she saw me lying paralyzed in a hospital bed. Her
viewpoint was that my glass was half full whereas my view was that the glass was half empty. I'm not a type A personality but all my planned recovery points were never met but I do feel more positive about my recovery because I try now to see how far I have risen rather than how far I have yet to go.
I try now to look down to see how far I have climbed rather than always looking ahead to see what is left to climb.
But hey, what do I know. Your psychiatrist should be doing this type of analysis, so ask them. Onward and upward my happy pills are coming. Woo hoo.
 This is a T-shirt from
http://www.snorgtees.com/t-shirts/technically-the-glass-is-always-full