Daughter inspires stroke survivor to put down cane and take up running

The article here;
http://host.madison.com/news/local/health_med_fit/daughter-inspires-stroke-survivor-to-put-down-cane-and-take/article_b634e7fa-c047-558a-923e-0f280e7fc443.html?comment_form=true

Krissy blogs about her experiences here;
http://notfastjustfabulous.com/

I will run again. I keep rereading Teaching Me to Run by Tommye-K. Mayer.

Parasite makes mice fearless by hijacking immune cells

This seems like something that needs studying for stroke rehab. Most survivors are deathly afraid of falling because their therapists have put that fear into them. If you don't get close enough to falling you can't figure out what corrective action is needed to prevent falls. I'll have to find this issue since I do subscribe to this magazine.
http://www.sciencedirect.com/science/article/pii/S0262407912631704

New Scientist

Volume 216, Issue 2895, 15 December 2012, Pages 17

The parasite does its dirty work by getting immune cells to make a chemical normally found in the brain

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Stuart Firestein: The pursuit of ignorance

We have one hell of a lot of willful ignorance in the stroke world. That is not a good thing. But watch this TED talk anyway.
http://www.ted.com/talks/stuart_firestein_the_pursuit_of_ignorance.html?utm_source=newsletter_daily&utm_campaign=daily&utm_medium=email&utm_content=button__2013-09-24

The first step in fixing a problem is admitting it exists - stroke

Our stroke associations have their heads so deep in the ground you can't even tell they have a neck. I'll refrain from the other popular euphemism although that applies also.
They don't even acknowledge that absolutely everything to do with stroke  is failing.
Put me in charge and I'll at least work on solving the problems. That's an open invitation for you board of director types. Is your CEO worthy of continuing to fail while getting paid for it?
90% of strokes don't fully recover. That's failure.

walk faster than a yard per second

Ok, I might be normal in one regard.  I'm pretty much at a yard per second.
walk faster than a yard per second

Checking a person’s mobility is fairly simple. Dr. Salamon likes the Get Up and Go Test, where she asks a person to stand up from sitting in a chair, walk 10 feet, turn around, walk back to the chair, and sit down. “You look at how long that takes and how steady the person is,” she says. Another way is just to watch how quickly people walk. They should walk faster than a yard per second. If you walk that or faster, you’re normal; if you’re slower, you have a gait problem, which increases your chances of falling,” she says.

More at link

Google to apply expertise to health and aging project

I have to figure out how to contact them to see if they might take on some of the functions one would expect a stroke association to do. 

Google to apply expertise to health and aging project

Google has already had an immeasurable effect on our home lives and work, with its big data work and technological development. Their products may have an indirect effect on the health and well-being of the working population, but now the company is planning a new venture that will tackle health-related issues directly.
A new company founded by Google, called Calico, will investigate new health technologies and approach the issue of aging, and it's been driven by one of Google's founders own health problems.
Larry Page has spoken publically about how much health and aging affect family life - and it's the drive from senior levels of the organisation which has brought their new venture to life.

Google Inc., operator of the world’s most-popular search engine, is investing in a new company focused on health and well-being.

The business, called Calico, will address the challenge of aging and related diseases, Google said in a blog posting. The venture will be led by Arthur Levinson, chairman of Roche Holding AG Genentech unit and a former Google director.

The focus on health, which Google Chief Executive Officer Larry Page acknowledged was a “lot different from what Google does today,” comes as the co-founder himself battles with personal ailments. Earlier this year, he disclosed he was diagnosed with left vocal-cord paralysis, a condition that restricts vocal-cord movement, and is also experiencing impairment on the right side.

“Illness and aging affect all our families,” Page said in the posting. “With some longer term, moonshot thinking around health care and biotechnology, I believe we can improve millions of lives.”

Google is stepping up investments in areas outside its core online-advertising and consumer-services business. The search provider has already put money into health-related companies through its venture arm, called Google Ventures, among other sectors. The Mountain View, California-based company has also worked on longer-term bets through a research unit that’s unveiled plans for computerized eyeglasses and driverless cars.

Granulocyte Colony–Stimulating Factor in Patients With Acute Ischemic Stroke

Another failure.  Ask your doctor for exactly how this failure compares to the  1000 listed by Dr. Michael Tymianski. And if s/he doesn't know who Dr. Michael Tymianski is, you need to fire that doctor.
http://stroke.ahajournals.org/content/44/10/2681.abstract.html?etoc

Results of the AX200 for Ischemic Stroke Trial

Abstract

Background and Purpose—Granulocyte colony–stimulating factor (G-CSF; AX200; Filgrastim) is a stroke drug candidate with excellent preclinical evidence for efficacy. A previous phase IIa dose–escalation study suggested potential efficacy in humans. The present large phase IIb trial was powered to detect clinical efficacy in acute ischemic stroke patients.

Methods—G-CSF (135 µg/kg body weight intravenous over 72 hours) was tested against placebo in 328 patients in a multinational, multicenter, randomized, and placebo-controlled trial (NCT00927836; www.clinicaltrial.gov). Main inclusion criteria were ≤9-hour time window after stroke onset, infarct localization in the middle cerebral artery territory, baseline National Institutes of Health Stroke Scale score range of 6 to 22, and baseline diffusion-weighted imaging lesion size ≥15 mL. Primary and secondary end points were the modified Rankin scale score and the National Institutes of Health Stroke Scale score at day 90, respectively. Data were analyzed using a prespecified model that adjusted for age, National Institutes of Health Stroke Scale score at baseline, and initial infarct volume (diffusion-weighted imaging).

Results—G-CSF treatment failed to meet the primary and secondary end points of the trial. For additional end points such as mortality, Barthel index, or infarct size at day 30, G-CSF did not show efficacy either. There was, however, a trend for reduced infarct growth in the G-CSF group. G-CSF showed the expected peripheral pharmacokinetic and pharmacodynamic profiles, with a strong increase in leukocytes and monocytes. In parallel, the cytokine profile showed a significant decrease of interleukin-1.

Conclusions—G-CSF, a novel and promising drug candidate with a comprehensive preclinical and clinical package, did not provide any significant benefit with respect to either clinical outcome or imaging biomarkers.

Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifier: NCT00927836.

 

Stroke Thinking?

Does anybody in the stroke medical world do this? There are millions of cases every year. It should be relatively simple for anyone with a modicum of brains and access to a few survivors to come up with improvements.
Don't the ASA, NSA and WSO do anything at all except issue press releases?
You start with these simple statistics and determine what will make them better over time. You do the necessary research yourself instead of hoping a researcher thinks of the experiment and does something about it.
General recovery guidelines show:

•10 percent of stroke survivors recover almost completely

•25 percent recover with minor impairments - I think I'm here, even though my impairments are not minor

•40 percent experience moderate to severe impairments requiring special care

•10 percent require care in a nursing home or other long-term care facility

•15 percent die shortly after the stroke, I bet with hyperacute treatment stopping the cascade of death this could be reduced substantially.

This is totally pathetic, only 10% recover completely,
If we don't change this thinking for the better your kids and grandkids will have just as bad an experience with recovery as you did.

EORH hosting stroke awareness program - Martins Ferry, OH

Don't let them give you the generic eat healthy, exercise, blood pressure reduction, take care of cholesterol blather. Ask why they don't give you specific risk reduction steps like these 11 referenced and specific ideas.
And why don't they tell you about the 50% reduction of a marijuana bud a day?
Then you need to redirect the discussion to exactly what they are doing to prevent the neuronal cascade of death in the first week. My 30 actions in the immediate aftermath of my next stroke.
You have to put them on the spot and prove to them they know nothing about stroke prevention and rehab.
http://www.timesleaderonline.com/page/content.detail/id/549510/EORH-hosting-stroke-awareness-program.html?nav=5010 
Every four seconds someone in the United States suffers a stroke.
Every four minutes someone dies from a stroke in the U.S.
Strokes kill more people in the world every year than any other malady.
Those medical statistics are quite alarming.
With that in mind, two Eastern Ohio Regional Hospital nurses are taking the lead in championing the cause in getting vital stroke information out to the public.
Registered nurse Karen Wilkinson and ICU nurse Annette Ganz presented a program at last week's Martins Ferry's monthly Chamber of Commerce luncheon, hosted by the hospital. They outlined "F.A.S.T Times at EORH: A Stroke Awareness Health Fair."
It will be held on Wednesday, Oct. 9 from 6:30-8:30 p.m. in the Ruth Brant/RH Wilson Rooms at EORH. It is free to the public. From 6:30-7:30 p.m., those in attendance will be invited to visit tables from the hospital departments as well as a myriad of vendors.
East Ohio Regional Hospital has partnered with OhioHealth. It has spawned a much more comprehensive and efficient network in stroke prevention and treatment.
OhioHealth includes some of the first hospitals in the state to receive a Primary Stroke Center certification from the Joint Commission. That designation goes to hospitals that exceed national standards for stroke care which means those staffs respond quickly and works more effectively.
F.A.S.T stands for the four critical ingredients dealing with strokes.
F is for Face. If one side of the face is drooping or numb, that is likely a sign of a stroke.
A is for arms. If a person is unable to lift one arm or if it is weak or numb, a stroke may be occurring.
S is for speech. If a person's words are unintelligible or slurred, a stroke may be imminent.
T is for time. In the event of a stroke, every second counts to avoid the risk of brain damage. If you observe any of the aforementioned symptoms, call 9-1-1 for immediate medical assistance.
An impressive list of speakers are on tap for the Oct. 9 health fair. They include: Dr. John Freed (EORH emergency room); Dr. Kristin Johnson (neurologist at Riverside Methodist Hospital in Columbus); Dr. Fausto Lazo (medical director of long-term care at EORH); and Dr. Sarah Taylor (family practice at EORH).
Wilkinson and Ganz are hoping for a turnout of at least 200. Reservations are needed by calling 740-633-4179.
Refreshments will be served.
Kapral may be reached at bkapral@timesleaderonline.com

One more problem to correct. It bills itself as an objective scale. Testing secondary problems is not helpful. The best solution would be to quantify the dead area size and location, then quantify the penumbra size and location. The existing scale has absolutely no use in any type of comparison or usefulness in therapy. But our doctors continue down this stupidity. My score would have been 11 - moderate. That told no one anything useful.
http://en.wikipedia.org/wiki/National_Institutes_of_Health_Stroke_Scale

National Institutes of Health Stroke Scale

From Wikipedia, the free encyclopedia

Jump to: navigation, search

The National Institutes of Health Stroke Scale, or NIH Stroke Scale (NIHSS) is a tool used by healthcare providers to objectively quantify the impairment caused by a stroke. The NIHSS is composed of 11 items, each of which scores a specific ability between a 0 and 4. For each item, a score of 0 typically indicates normal function in that specific ability, while a higher score is indicative of some level of impairment.^[1] The individual scores from each item are summed in order to calculate a patient's total NIHSS score. The maximum possible score is 42, with the minimum score being a 0.^[2][3]

Score [3]	Stroke Severity
0	No Stroke Symptoms
1-4	Minor Stroke
5-15	Moderate Stroke
16-20	Moderate to Severe Stroke
21-42	Severe Stroke

Contents

• 1 Performing the scale
  • 1.1 1. Level of Consciousness
    • 1.1.1 A) LOC Responsiveness
    • 1.1.2 B) LOC Questions
    • 1.1.3 C) LOC Commands
  • 1.2 2. Horizontal Eye Movement
  • 1.3 3. Visual field test
  • 1.4 4. Facial Palsy
  • 1.5 5. Motor Arm
  • 1.6 6. Motor Leg
  • 1.7 7.Limb Ataxia
  • 1.8 8.Sensory
  • 1.9 9.Language
  • 1.10 10.SPEECH
  • 1.11 11.Extinction and Inattention
• 2 Usage
  • 2.1 NIHSS use in tPa eligibility
  • 2.2 NIHSS structure
• 3 Accuracy
  • 3.1 Effect of stroke location on NIHSS prediction of stroke severity
  • 3.2 NIHSS as predictor of patient outcomes
• 4 References
• 5 External links

Performing the scale

Throughout the NIHSS it is important that the examiner does not coach or help with the assigned task. The examiner may demonstrate the commands to patients that are unable to comprehend verbal instructions, however the score should reflect the patient's own ability. It is acceptable for the examiner to physically help the patient get into position to begin the test, but the examiner must not provider further assistance while the patient is attempting to complete the task. For each item the examiner should score the patients first effort, and repeated attempts should not affect the patient's score. An exception to this rule exist in the language assessment (Item 9) in which the patients best effort should be scored.^[1] Some of the items contain "Default Coma Scores", these scores are automatically assigned to patients that scored a 3 in item 1a.

1. Level of Consciousness

Level of consciousness testing is divided into three sections. The first LOC items test for the patients responsiveness. The second LOC item is based on the patients ability to answer questions that are verbally presented by the examiner. The final LOC sub-section is based on the patient's ability to follow verbal commands to perform simple task. Although this item is broken into three parts, each sub-section is added to the final score as if it is its own item.^[3]

A) LOC Responsiveness

Scores for this item are assigned by a medical practitioner based on the stimuli required to arouse patient. The examiner should first assess if the patient is fully alert to his or her surroundings. If the patient is not completely alert, the examiner should attempt a verbal stimuli to arouse the patient. Failure of a verbal stimuli indicates an attempt to arouse the patient via repeated physical stimuli. If none of these stimuli are successful in eliciting a response, the patient can be considered totally unresponsive.^[3]

Score	Test Results
0	Alert; Responsive
1	Not alert; Verbally arousable or aroused by minor stimulation to obey, answer, or respond.
2	Not alert; Only responsive to repeated or strong and painful stimuli
3	Totally unresponsive; Responds only with reflexes or is areflexic

Notes

• If patients scores a 3 in this factor, the default coma scores should be used when applicable

B) LOC Questions

Patient is verbally asked his or her age and for the name of the current month.^[3]

Score	Test Results
0	Correctly answers both questions
1	Correctly answers one question
2	Does not correctly answer either question

Notes

• Default Coma Score: 2
• The patient must answer each question 100% correct without help to get credit
• Patients unable to speak are allowed to write the answer
• Aphasic patients or patients in a stuporous state who are unable to understand the commands receive a score of 2
• Patients that are unable to talk due to trauma, dysarthria, language barrier, or intubation are given a score of 1

C) LOC Commands

The patient is instructed to first open and close his or her eyes and then grip and release his or hand^[3]

Score	Test Results
0	Correctly performs both tasks
1	Correctly performs 1 task
2	Does not correctly perform either task

Notes

• Commands can only be repeated once.
• The hand grip command can be replaced with any other simple one step command if the patient cannot use his or her hands.
• A patient's attempt is regarded as successful if an attempt is made but is incomplete due to weakness
• If the patient does not understand the command, the command can be visually demonstrated to him or her without an impact on his or her score
• Patients with trauma, amputations, or other physical impediments can be given other simple one-step commands if these commands are not appropriate

2. Horizontal Eye Movement

Assesses ability for patient to track a pen or finger from side to side only using his or her eyes. This is designed to assess motor ability to gaze towards the hemisphere opposite of injury. This item is tested because Conjugated eye deviation is present in approximately 20% of stroke cases. CED is more commons in right hemispheric strokes and typically in lesions effecting the basal ganglia and temporoparietal cortex. Damage to these areas can result in decreased spatial attention and reduced control of eye movements.^[4]

Score	Test Results
0	Normal; Able to follow pen or finger to both sides
1	Partial gaze palsy; gaze is abnormal in one or both eyes, but gaze is not totally paralyzed. Patient can gaze towards hemisphere of infarct, but cant go past midline
2	Total gaze paresis; gaze is fixed to one side

Notes

• If patient is unable to follow the command to track an object, the investigator can make eye contact with the patient and then move side to side. The patients gaze palsy can then be assessed by his or her ability to maintain eye contact.
• If patient is unable to follow any commands, assess the horizontal eye movement via the oculocephalic maneuver. This is done by manually turning the patient's head from midline to one side and assessing the eye's reflex to return to a midline position.
• If the patient has isolated peripheral nerve paresis assign a score of 1

3. Visual field test

Assess the patient's vision in each visual fields. Each eye is tested individually, by covering one eye and then the other. Each upper and lower quadrant is tested by asking the patient to indicate how many fingers the investigator is presenting in each quadrant. The investigator should instruct the patient to maintain eye contact throughout this test, and not allow the patient to realign focus towards each stimulus. With the first eye covered, place a random number of fingers in each quadrant and ask the patient how many fingers are being presented. Repeat this testing for the opposite eye.^[3]

Score	Test Results
0	No vision loss
1	Partial hemianopia or complete quadrantanopia; patient recognizes no visual stimulus in one specific quadrant
2	Complete hemianopia; patient recognizes no visual stimulus in one half of the visual field
3	Bilateral Blindness, including blindness from any cause

Notes

• If patient is non-verbal, he or she can be allowed to respond by holding up the number of fingers the investigator is presenting
• If patient is not responsive the visual fields can be tested by visual threat, this involves the investigator moving an object towards the eye and observing the patient's response.

4. Facial Palsy

Facial palsy is partial or complete paralysis of portions of the face. Typically this paralysis is most pronounced in the lower half of one facial side. However, depending on lesion location the paralysis may be present in other facial regions. While inspecting the symmetry of each facial expression the examiner should first instruct patient to show his or her teeth (or gums). Second, the patient should be asked to squeeze his or her eyes closed as hard as possible. After reopening his or her eyes, the patient is then instructed to raise his or her eyebrows.^[5]

Score	Test Results
0	Normal and symmetrical movement
1	Minor paralysis; function is less than clearly normal, such as flattened nasolabial fold or minor asymmetry in smile
2	Partial paralysis; particularly paralysis in lower face
3	Complete facial Hemiparesis, total paralysis in upper and lower portions of one face side

Notes

• If the patient is unable to understand verbal commands, the instructions should be demonstrated to the patient.
• Patients incapable of comprehending an commands may be tested by applying a noxious stimulus and observing for any paralysis in the resulting grimace.

5. Motor Arm

With palm facing downwards, have the patient extend one arm 90 degrees out in front if the patient is sitting, and 45 degrees out in front if the patient is laying down. If necessary, help the patient get into the correct position. As soon as the patient's arm is in position the investigator should begin verbally counting down from 10 while simultaneously counting down on his or her fingers in full view of the patient. Observe to detect any downward arm drift prior to the end of the 10 seconds. Downward movement that occurs directly after the investigator places the patient's arm in position should not be considered downward drift. Repeat this test for the opposite arm. This item should be scored for the right and left arm individually, denoted as item 5a and 5b.^[3]

Score	Test Results
0	No arm drift; the arm remains in the initial position for the full 10 seconds
1	Drift; the arm drifts to an intermediate position prior to the end of the full 10 seconds, but not at any point relies on a support
2	Limited effort against gravity; the arm is able to obtain the starting position, but drifts down from the initial position to a physical support prior to the end of the 10 seconds
3	No effort against gravity; the arm falls immediately after being helped to the initial position, however the patient is able to move the arm in some form (e.g. shoulder shrug)
4	No movement; patient has no ability to enact voluntary movement in this arm

Notes

• Default Coma Score: 8
• Test the non paralyzed arm first if applicable
• Score should be recorded for each arm separately, resulting in a maximum potential score of 8.
• Motor Arm assessment should be skipped in the case of an amputee, however a note should be made in the scoring of the amputation.
• If patient is unable to understand commands, the investigator should deliver the instructions via demonstration

6. Motor Leg

With the patient in the supine position, one leg is placed 30 degrees above horizontal. As soon as the patient's leg is in position the investigator should begin verbally counting down from 5 while simultaneously counting down on his or her fingers in full view of the patient. Observe any downward leg drift prior to the end of the 5 seconds. Downward movement that occurs directly after the investigator places the patient's leg in position should not be considered downward drift. Repeat this test for the opposite leg. Scores for this section should be recorded separately as 6a and 6b for the left and right legs respectively.^[3]

Score	Test Results
0	No leg drift; the leg remains in the initial position for the full 5 seconds
1	Drift; the leg drifts to an intermediate position prior to the end of the full 5 seconds, but at no point touches the bed for support
2	Limited effort against gravity; the leg is able to obtain the starting position, but drifts down from the initial position to a physical support prior to the end of the 5 seconds
3	No effort against gravity; the leg falls immediately after being helped to the initial position, however the patient is able to move the leg in some form (e.g. hip flex)
4	No movement; patient has no ability to enact voluntary movement in this leg

Notes

• Default Coma Score: 8
• This is performed for each leg, indicating a maximum possible score of 8
• Test the non paralyzed leg first if applicable
• Motor leg assessment should be skipped in the case of an amputee, however a note should be made in the score records
• If patient is unable to understand commands, the investigator should deliver the instructions via demonstration

7.Limb Ataxia

This test for the presence of a unilateral cerebellar lesion, and distinguishes a difference between general weakness and incoordination. The patient should be instructed to first touch his or her finger to the examiner's finger then move that finger back to his or her nose, repeat this movement 3-4 times for each hand. Next the patient should be instructed to move his or her heel up and down the shin of his or her opposite leg. This test should be repeated for the other leg as well.^[3]

Score	Test Results
0	Normal coordination; smooth and accurate movement
1	Ataxia present in 1 limb; rigid and inaccurate movement in one limb
2	Ataxia present in 2 or more limbs: rigid and inaccurate movement in both limbs on one side

Notes

• If significant weakness is present, score 0
• If patient is unable to understand commands or move limbs, score is 0
• Patient's eyes should remain open throughout this section
• If applicable, test the un-paretic side first

8.Sensory

Sensory testing is performed via pen pricks in the proximal portion of all four limbs. While applying pinpricks, the investigator should ask whether or not the patient feels the pricks, and if he or she feels the pricks differently on one side when compared to the other side.^[3]

Score	Test Results
0	No evidence of sensory loss
1	Mild-to-Moderate sensory loss; patient feels the pinprick, however he or she feels as if it is duller on one side
2	Severe to total sensory loss on one side; patient is not aware he or she is being touched in all unilateral extremities

Notes

• Default Coma Score: 2
• The investigator should insure that the sensory loss being detected is a result of the stroke, and should therefore test multiple spots on the body.
• For patients unable to understand the instructions, the pinprick can be replaced by a noxious stimulus and the grimace can be judged to determine sensory score.

9.Language

This item measures the patients language skills. After completing items 1-8 it is likely the investigator has gained an approximation of the patient's language skills; however it is important to confirm this measurement at this time. The stroke scale includes a picture of a picture of a scenario, a list of simple sentences, a figure of assorted random objects, and a list of words. The patient should be asked to explain the scenario depicted in the first figure. Next, he or she should read the list of sentences and name each of the objects depicted in the next figure. The scoring for this item should be based on both the results from the test performed in this item in addition to the language skills demonstrated up to this point in the stroke scale.^[3]

Score	Test Results
0	Normal; no obvious speech deficit
1	Mild-to-moderate aphasia; detectable loss in fluency, however, the examiner should still be able to extract information from patient's speech
2	Severe aphasia; all speech is fragmented, and examiner is unable to extract the figure's content from the patients speech.
3	Unable to speak or understand speech

Notes

• Default Coma Score: 3
• Patients with visual loss should be asked to identify objects placed in his or her hands
• This is an exception to recording only the patients first attempt. In this item, the patients best language skills should be recorded

10.SPEECH

Dysarthria is the lack of motor skills required to produce understandable speech. Dysarthria is strictly a motor problem, and is not related to the patient's ability to comprehend speech. Strokes that cause dysarthria typically effect areas such as the anterior opercular, medial prefrontal and premotor, and anterior cingulate regions. These brain regions are vital in coordinating motor control of the tongue, throat, lips, and lungs.^[6] To perform this item the patient is be asked to read from the list of words provided with the stroke scale while the examiner observes the patients articulation and clarity of speech.^[3]

Score	Test Results
0	Normal; clear and smooth speech
1	Mild-to-moderate dysarthria; some slurring of speech, however the patient can be understood
2	Severe dysarthria; speech is so slurred that he or she cannot be understood, or patients that cannot produce any speech

Notes

• Default Coma Score:2
• An intubated patient should not be rated on this item, instead make note of the situation in the scoring documents.

11.Extinction and Inattention

Sufficient information regarding this item may have been obtained by the examiner in items 1-10 to properly score the patient. However, if any ambiguity exist the examiner should test this item via a technique referred to as "double simultaneous stimulation". This is performed by having the patient close his or her eyes and asking him or her to identify the side on which they are being touched by the examiner. During this time the examiner is alternating between touching the patient on the right and left side. Next, the examiner touches the patient on both sides at the same time. This should be repeated on the patients face, arms, and legs. To test extinction in vision, the examiner should hold up one finger in front of each of the patient's eyes and ask the patient to determine which finger is wiggling or if both are wiggling. The examiner should the alternate between wiggling each finger and wiggling both fingers at the same time.^[3]

Score	Test Results
0	Normal; patient correctly answers all questions
1	Inattention on one side in one modality; visual, tactile, auditory, or spatial
2	Hemi-inattention; does not recognize stimuli in more than one modality on the same side

Notes

• Default Coma Score: 0
• Patient with severe vision loss that correctly identifies all other stimulations scores a 0

Usage

The NIHSS was designed to be a standardized and repeatable assessment of stroke patients utilized by large multi-center clinical trials.^[7] Clinical researchers have widely accepted this scale due to high levels of score consistency. Consistency of NIHSS scores has been demonstrated in inter-examiner and in test-retest scenarios.^[8] Clinical research use of the NIHSS typically involves obtaining a baseline NIHSS score as soon as possible after onset of stroke symptoms ^[9] .^[10] The NIHSS is then repeated at regular intervals or after significant changes in patient condition. This history of scores can then be utilized to monitor the effectiveness of treatment methods and quantify a patient’s improvement or decline.^[11][12]

Chainsaw stroke rehab - really

I got my battery powered 10 inch chainsaw and walked the trails until I got to the 8 limbed tree across the trail, cut thru 5 of the 8 6-8 inch limbs yesterday. Its only 5.5 lbs so it never feels out of control. My gas one had a 16 inch bar and weighed 18-20 lbs, that one had power and would be dangerous  to use right now. It only lasted about 20 minutes. On the walk out I brushed my arm on stinging nettle, too bad it was on my good arm, the bad arm could have used the extra burning sensation. Today I went out again and got thru 2 more limbs before running out of power. I got the bar stuck trying to get thru a 10 inch limb on the ground. Finally got it freed by leveraging one of the branches on top of my shoulder.
Went out again this afternoon after the 90 minute recharge, got the big tree fully cleared for skiing. Cleared 3 more small trees lying across the trail. Two more 8-10 inch trees to cut sections out of, then I can walk the far loop again to see what needs doing out there
This is all in preparation to be able to cross-country ski the trails.

Don't do this!!! Its stupid.


I'm not sure where  I found this graphic but it was used in my Dangerous Stroke Rehab presentation. And Chainsawing was not even the most dangerous, walking is.