Informal caregivers in stroke: Life impact, support, and psychological well-being—A Swedish Stroke Register (Riksstroke) study

This should lead directly into an investigation as to why the hospitals that these patients came from failed at getting them fully recovered. Lack of recovery is fully the hospitals responsibility. WHEN THE HELL will they accept that and fix the failures to full recovery? This is non-negotiable. Leaders solve problems, they don't blame patients for their lack of recovery. 

Informal caregivers in stroke: Life impact, support, and psychological well-being—A Swedish Stroke Register (Riksstroke) study 

Stefan Sennfält, Teresa Ullberg

First Published June 25, 2019 Research Article

https://doi.org/10.1177/1747493019858776

Article information

Abstract

Background

Informal caregivers provide a large amount of day-to-day assistance and are crucial for the ability of survivors to recover and adapt to life after stroke.

Aim

The development of caregiver support programs is limited by lack of large long-term follow-up studies. We present a comprehensive study of Swedish stroke caregivers' life situation in relation to degree of functional dependency of the survivor.

Patients and methods

In 2016, the Swedish Stroke Register, Riksstroke, conducted a long-term follow-up survey on caregivers to patients with stroke three and five years earlier. Items on psychological well-being were adapted from the 36-item short-form health survey and poor outcome was defined using the 36-item short-form health survey reference material. Survivor degree of dependency was indicated by the caregiver as independent, partially dependent, or completely dependent.

Results

A total of 5063 community dwelling dyads were included: 56.5% of survivors were independent, 33.4% partially dependent, and 10.1% completely dependent. Caregiver life impact, need of support, and proportion of poor psychological well-being increased incrementally with survivor degree of dependency. In the completely dependent group where 41.1% of survivors could not be left unattended for more than 1 h, 23.7% of caregivers expressed unmet need of caregiver support; 51.4% reported poor psychological well-being compared to 19.3% in the independent group.

Conclusion

The caregiver situation varies greatly with degree of survivor dependency which makes generalizations of caregiver needs difficult. Our results emphasize the need for integrating support aimed specifically at caregivers to survivors of stroke with a large degree of dependency.

Keywords Stroke, long-term, caregiver, support, psychological well-being

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Genetically Determined Risk of Depression and Functional Outcome After Ischemic Stroke

You are still approaching this wrong.  Solve the primary problem of 100% recovery and this secondary issue of depression likely goes away. 

Genetically Determined Risk of Depression and Functional Outcome After Ischemic Stroke

Mendelian Randomization Study

Dipender Gill

,

Nicole E. James

,

Grace Monori

,

Erik Lorentzen

,

Israel Fernandez-Cadenas

,

Robin Lemmens

,

Vincent Thijs

,

Natalia S. Rost

,

Rodney Scott

, … Show all Authors

Originally publishedhttps://doi.org/10.1161/STROKEAHA.119.026089Stroke. ;0

Abstract

Background and Purpose—

Psychosocial factors can have implications for ischemic stroke risk and recovery. This study investigated the effect of genetically determined risk of depression on these outcomes using the Mendelian randomization (MR) framework.

Methods—

Genetic instruments for risk of depression were identified in a discovery genome-wide association study of 246 363 cases and 561 190 controls and further replicated in a separate population of 474 574 cases and 1 032 579 controls. Corresponding genetic association estimates for risk of ischemic stroke were taken from 60 341 cases and 454 450 controls, with those for functional outcome 3 months after ischemic stroke taken from an analysis of 6021 patients. Following statistical power calculation, inverse-variance weighted MR was performed to pool estimates across different instruments. The Cochran Q heterogeneity test, weighted median MR, and MR pleiotropy residual sum and outlier were used to explore possible bias relating to inclusion of pleiotropic variants.

Results—

There was no MR evidence for an effect of genetically determined risk of depression on ischemic stroke risk. Although suffering low statistical power, the main inverse-variance weighted MR analysis was suggestive of a detrimental effect of genetically determined risk of depression on functional outcome after ischemic stroke (odds ratio of poor outcome [modified Rankin Scale, ≥3] per 1-SD increase in genetically determined risk of depression, 1.81; 95% CI, 0.98–3.35; P=0.06). There was no evidence of heterogeneity between MR estimates produced by different instruments (Q P=0.26). Comparable MR estimates were obtained with weighted median MR (odds ratio, 2.57; 95% CI, 1.05–6.25; P=0.04) and MR pleiotropy residual sum and outlier (odds ratio, 1.81; 95% CI, 0.95–3.46; P=0.08).

Conclusions—

We found no MR evidence of genetically determined risk of depression affecting ischemic stroke risk but did find consistent MR evidence suggestive of a possible effect on functional outcome after ischemic stroke. Given the widespread prevalence of depression-related morbidity, these findings could have implications for prognostication and personalized rehabilitation after stroke.

Footnotes

The online-only Data Supplement is available with this article at https://www.ahajournals.org/doi/suppl/10.1161/STROKEAHA.119.026089.

Correspondence to Dipender Gill, MD, Epidemiology and Biostatistics, School of Public Health, Medical School Bldg, St. Mary’s Hospital, Norfolk Pl, Imperial College London, London W2 1PG, United Kingdom. Email dipender.gill@imperial.ac.uk

Dean - the T-shirt

This is so me.

Age-related hearing loss and risk of dementia

For your doctor to test and set a baseline. I know this was one of the contributing factors to my Dad's dementia. 

Age-related hearing loss and risk of dementia

3 Studies That Show Cannabis Grows Brain Cells

It is cannabinoid based thus will never make it past our idiotic federal legislators having marijuana as a Class I drug.  I bet you have to go to Europe to try it. But ask your doctor how to take advantage of this. Bet you don't get an answer. 

 

3 Studies That Show Cannabis Grows Brain Cells

Abstract
Cannabidiol (CBD), the main non-psychotomimetic component of the plant Cannabis sativa, exerts therapeutically promising effects on human mental health such as inhibition of psychosis, anxiety and depression.
However, the mechanistic bases of CBD action are unclear.
Here we investigate the potential involvement of hippocampal neurogenesis in the anxiolytic effect of CBD in mice subjected to 14 d chronic unpredictable stress (CUS).
Repeated administration of CBD (30 mg/kg i.p., 2 h after each daily stressor) increased hippocampal progenitor proliferation and neurogenesis in wild-type mice. …
CBD administration prevented the anxiogenic effect of CUS in wild type but not in GFAP-TK mice as evidenced in the novelty suppressed feeding test and the elevated plus maze.
This anxiolytic effect of CBD involved the participation of the CB1 cannabinoid receptor, as CBD administration increased hippocampal anandamide levels and administration of the CB1–selective antagonist AM251 prevented CBD actions.
Studies conducted with hippocampal progenitor cells in culture showed that CBD promotes progenitor proliferation and cell cycle progression and mimics the proliferative effect of CB1 and CB2 cannabinoid receptor activation. …
These findings support that the anxiolytic effect of chronic CBD administration in stressed mice depends on its proneurogenic action in the adult hippocampus by facilitating endocannabinoid-mediated signalling.
http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=8930251

———————————————-
PLOS ONE (Public Library of Science)
May 2013
Activation of Type 1 Cannabinoid Receptor (CB1R) Promotes Neurogenesis in Murine Subventricular Zone Cell Cultures
Abstract
The endocannabinoid system has been implicated in the modulation of adult neurogenesis.
Here, we describe the effect of type 1 cannabinoid receptor (CB1R) activation on self-renewal, proliferation and neuronal differentiation in mouse neonatal subventricular zone (SVZ) stem/progenitor cell cultures.
Expression of CB1R was detected in SVZ-derived immature cells (Nestin-positive), neurons and astrocytes.
Stimulation of the CB1R … increased self-renewal of SVZ cells, as assessed by counting the number of secondary neurospheres … Moreover, … treatment for 48 h, increased proliferation …
Surprisingly, stimulation of CB1R … also promoted neuronal differentiation (without affecting glial differentiation), at 7 days, as shown by counting the number of NeuN-positive neurons in the cultures.
Moreover, by … a method that allows the functional evaluation of neuronal differentiation, we observed an increase in neuronal-like cells.
This proneurogenic effect was blocked when SVZ cells were co-incubated with … the CB1R antagonist AM 251, for 7 days, thus indicating that this effect involves CB1R activation.
In accordance with an effect on neuronal differentiation and maturation … also increased neurite growth …
Taken together, these results demonstrate that CB1R activation induces proliferation, self-renewal and neuronal differentiation from mouse neonatal SVZ cell cultures.
http://www.plosone.org/article/info%3Adoi/10.1371/journal.pone.0063529

——————————————-
The Journal of Clinical Investigation
November 2005
Cannabinoids promote embryonic and adult hippocampus neurogenesis and produce anxiolytic- and antidepressant-like effects
Abstract
The hippocampal dentate gyrus in the adult mammalian brain contains neural stem/progenitor cells (NS/PCs) capable of generating new neurons, i.e., neurogenesis.
Most drugs of abuse examined to date decrease adult hippocampal neurogenesis, but the effects of cannabis (marijuana or cannabinoids) on hippocampal neurogenesis remain unknown.
This study aimed at investigating the potential regulatory capacity of the potent synthetic cannabinoid HU210 on hippocampal neurogenesis and its possible correlation with behavioral change.
We show that both embryonic and adult rat hippocampal NS/PCs are immunoreactive for CB1 cannabinoid receptors, indicating that cannabinoids could act on CB1 receptors to regulate neurogenesis.
This hypothesis is supported by further findings that HU210 promotes proliferation, but not differentiation, of cultured embryonic hippocampal NS/PCs likely via a sequential activation of CB1 receptors …
Chronic, but not acute, HU210 treatment promoted neurogenesis in the hippocampal dentate gyrus of adult rats and exerted anxiolytic- and antidepressant-like effects.
… suggesting that chronic HU210 treatment produces anxiolytic- and antidepressant-like effects likely via promotion of hippocampal neurogenesis.

New Stanford Study: A Positive Attitude Literally Makes Your Brain Work Better

I am positive that stroke medical professionals will never solve stroke, 100% recovery. And because they never will I will have blog posts to write about for the next 30 years of my life, and that will keep me intellectually engaged and not prone to dementia. So should I hope they never solve anything because it is all about me, me, me? By then I should hit around 100,000 posts and 50 million views.  New Stanford Study: A Positive Attitude Literally Makes Your Brain Work Better

A new brain scan study has revealed exactly how positivity affects the brain (and it's impressive)

Inspirational posters featuring soaring eagles and sunlit mountain summits are easy to mock. But it turns out rousing slogans and uplifting images might not actually be pure cheese after all. When Stanford researchers recently peered into the brains of students to see how attitude affects achievement, they found something startling. Your outlook on learning, it turns out, matters just as much as your IQ.

This is your child's brain on positivity.

Scientists and educators have long noted that kids who have a positive attitude towards math do better in the subject, but is that just because acing tests naturally makes you enjoy something, or does the arrow of causation point the other way? Does starting off with the expectation that you'll enjoy and be good at math help you master numbers? To start to tease this out a research team out of Stanford recently analyzed the math skills and attitudes of 240 kids aged seven to ten, as well as running 47 of them through an fMRI machine while asking them to do some basic arithmetic. What did they find? As expected, kids who did well in math liked math more, both according to self reports and their parents, and kids who hated the subject did poorly. But the brain scans also turned up something much more fascinating. The images revealed that the hippocampus, a brain area linked with memory and learning, was significantly more active in kids with a positive attitude towards math. It appears it's not just that children like subjects they're good at. It's also that liking a subject helps students' brain actually work better. The researchers caution that their study can't pin down exactly how much achievement is down to prior math success and how much is because of the way positivity pumps up learning in the brain. "We think the relationship between positive attitude and math achievement is mutual, bi-directional," said Lang Chen, the study's lead author. "It's like bootstrapping: A good attitude opens the door to high achievement, which means you then have a better attitude, getting you into a good circle of learning." But whatever the exact weight of various factors turns out to be, it's already clear that attitude has a bigger impact on performance than the scientists expected. "Attitude is really important," said Chen, "Based on our data, the unique contribution of positive attitude to math achievement is as large as the contribution from IQ." You can improve your kid's brain after all. Many parents of kids who struggle in school have wished that they could somehow tinker with their kid's brain to fix whatever was holding them back and making them feel so miserable. This research suggests a way they can do just that. It may remain largely impossible to change your kid's natural intellectual gifts, but it is entirely doable to help them foster more positive attitudes towards a given subject and their own potential (here are some specific ideas). This research shows that this kind of attitude adjustment will literally change the way their brain works for their better, giving them a boost at school. Maybe it's time to stop laughing and break out those eagle posters then.   Published on: Feb 15, 2018 The opinions expressed here by Inc.com columnists are their own, not those of Inc.com.

The INTJ Personality Type, that's me

Described me in the past pretty well, it is why I will solve stroke.   Now however I seem to be ENTP and still will solve stroke.

Portrait of an ENTP - Extraverted iNtuitive Thinking Perceiving (Extraverted Intuition with Introverted Thinking)

The INTJ Personality Type, that's me

What is an INTJ?

INTJ is an acronym used to describe one of the sixteen personality types created by Katharine Briggs and Isabel Myers. It stands for Introverted, iNtuitive, Thinking, Judging. INTJ indicates a person who is energized by time alone (Introverted), who focuses on ideas and concepts rather than facts and details (iNtuitive), who makes decisions based on logic and reason (Thinking) and who prefers to be planned and organized rather than spontaneous and flexible (Judging). INTJs are sometimes referred to as Mastermind personalities because of their strategic, logical way of thinking.

How common is the INTJ personality type?

INTJ is the third rarest type in the population, and the rarest type among women (with ENTJ). INTJs make up:

• 2% of the general population
• 3% of men
• 1% of women

The INTJ Personality Type

INTJs are analytical problem-solvers, eager to improve systems and processes with their innovative ideas. They have a talent for seeing possibilities for improvement, whether at work, at home, or in themselves.
Often intellectual, INTJs enjoy logical reasoning and complex problem-solving. They approach life by analyzing the theory behind what they see, and are typically focused inward, on their own thoughtful study of the world around them. INTJs are drawn to logical systems and are much less comfortable with the unpredictable nature of other people and their emotions. They are typically independent and selective about their relationships, preferring to associate with people who they find intellectually stimulating.

How the INTJ Thinks

Introverted (I) and iNtuitive (N), INTJs are internal processors, disposed to see the world in terms of connections, patterns, abstract theories and concepts. As Introverts (I), they enjoy the space of their own minds and generate many interesting thoughts and ideas that they may not feel compelled to share with others. Future-focused, they have a knack for seeing possibilities and potential and will come up with the ideas and plans that will help people, products and processes achieve the potential that the INTJ so clearly envisions. As abstract, conceptual thinkers, INTJs understand things at a deep theoretical level and they operate comfortably in this realm. Their minds are ever active; as they focus on the global picture, they are taking in the data and exerting a great deal of mental energy toward solving problems and improving systems.
As Thinking (T) types, the information that the INTJ absorbs from his or her world, surroundings or area of study will then be submitted to and organized within his or her framework of logic. Analytical and rational, INTJs are dispassionate in dealing with data and processing information. As they move toward forming conclusions and making decisions, nothing is terribly personal for them. They aim for cool objectivity, truth and rational responses.
The INTJ’s Judging (J) component also factors into the way in which an INTJ thinks. People of this type aren’t content to endlessly take in information and let it swirl around. Though they think in big and broad strokes, these are people who want definition and action. Yes, they love the huge ideas and abstract concepts, but their J element wants the organization and structure that make these ideas useful. Thus abstract thinking should not be confused with chaos or haphazardness. The organization, and the clear placing of ideas and processes into boxes that can be moved and manipulated as necessary, is of value to them and a natural part of their thinking process.
Connected to the INTJ thinking process is strategy and long-range planning. People of this type tend to see life as a sort of chess game—every act is a strategic move, part of a bigger and more complex plan in the greater scheme of life. Thus they are continually exploring, plotting and thinking through possible moves while trying to predict the results. This helps them to formulate long-range plans but also gives them the adaptability to change, amend and reroute their strategies as necessary.
INTJs aren’t just smart, they know they are. While this can make some cocky, but it is a benefit for many. As they are confident in their knowledge, they don’t shy away from tackling the hard problems and the big questions. They retain information well and can access it at will. And they don’t question their mental capacities or the depth of their knowledge. INTJs are sharp minds with quick intellect and they relish mental challenges.
Curiosity is also a major player in the way that the INTJ thinks and learns. On the whole, people of this type ask a lot of questions and do their own investigation, not expecting anyone to spoon-feed them the answers they seek. And they are never content to simply take someone else’s word for it. INTJs get involved in the process, seeking the answers for themselves, developing a personal approach to discovery, and organizing and evaluating the information and conclusions with their own rational thinking capabilities. They always prefer to see and know for themselves, and they enjoy the processes of experimentation, trial and error as they investigate and evaluate possibilities.
INTJs relish ideas and the visualization of future potential, but they can also be very pragmatic. They synthesize complex ideas and concepts, organizing them into workable systems and then seeking to make those systems yet more efficient. They want their ideating and planning processes to be useful and to have purpose. As they think and develop ideas and plans, they are open-minded…to a point. They are willing to consider other ideas that promise some merit, but all potential solutions must pass their rigorous test of logic.
In general, INTJs are remarkably competent people mentally who have the potential to be high achievers. If they meet challenges in the classroom it is because they are often bored, or because they reject the detail, structure and busywork that typically accompanies the traditional education system. They may simply check out of the classroom discussions and homework because they are confident they can perform well on the exam when the time comes.

World Health Organization Recommends Reclassifying Marijuana Under International Treaties

When will your doctor reschedule marijuana for your use?

My 13 reasons for marijuana use post-stroke.  

Don't follow me, I'm not medically trained and I don't have a Dr. in front of my name.

 

World Health Organization Recommends Reclassifying Marijuana Under International Treaties

Tom Angell

Policy

Global health experts at the United Nations are recommending that marijuana and its key components be formally rescheduled under international drug treaties.

Getty

Getty

The World Health Organization (WHO) is calling for whole-plant marijuana, as well as cannabis resin, to be removed from Schedule IV—the most restrictive category of a 1961 drug convention signed by countries from around the world.
The body also wants delta-9-tetrahydrocannabinol (THC) and its isomers to be completely removed from a separate 1971 drug treaty and instead added to Schedule I of the 1961 convention, according to a WHO document that has not yet been formally released but was circulated by cannabis reform advocates.

Marijuana and cannabis resin would also remain in Schedule I of the 1961 treaty—they are currently dual-designated in Schedules I and IV, with IV being reserved for those substances that are seen as particularly harmful with limited medical benefits. (That's different from the U.S. federal system, under which Schedule I is where the supposedly most dangerous and restricted drugs—like marijuana, heroin and LSD—are classified.)
WHO is also moving to make clear that cannabidiol and CBD-focused preparations containing no more than 0.2 percent THC are "not under international control" at all. It had previously been the case that CBD wasn't scheduled under the international conventions, but the new recommendation is to make that even more clear.

Cannabis extracts and tinctures would be removed from Schedule I of the 1961 treaty under the recommendations, and compounded pharmaceutical preparations containing THC would be placed in Schedule III of that convention.
The practical effects of the changes would be somewhat limited, in that they wouldn't allow countries to legalize marijuana and still be in strict compliance with international treaties, but their political implications are hard to overstate.
Taken together, recommendations, if adopted, would represent a formal recognition that the world's governing bodies have effectively been wrong about marijuana's harms and therapeutic benefits for decades. WHO's new position comes at a time when a growing number of countries are moving to reform their cannabis policies. As such, a shift at the UN could embolden additional nations to scale back or repeal their prohibition laws—even though legalization for non-medical or non-scientific reasons would still technically violate the global conventions.
“The placement of cannabis in the 1961 treaty, in the absence of scientific evidence, was a terrible injustice," said Michael Krawitz, a U.S. Air Force veteran and legalization advocate who has pushed for international reforms. "Today the World Health Organization has gone a long way towards setting the record straight. "It is time for us all to support the World Health Organization’s recommendations and ensure politics don't trump science."
The WHO recommendations were initially expected to be released at a meeting in Vienna in December, but the announcement was delayed for unknown reasons. The proposals will next go before the UN's Commission on Narcotic Drugs, potentially as soon as March, where 53 member nations will have the opportunity to vote on accepting or rejecting them.
A number of countries that have historically opposed drug policy reforms, such as Russia and China, are expected to oppose the change in cannabis's classification.
Other nations like Canada and Uruguay, which have legalize marijuana in contravention of the current treaties, are likely to back the reform, as are a number of European and South American nations that allow medical cannabis.
It is not clear how the U.S. will vote. While the country has historically pressured other nations not to reform their own marijuana policies, the reality of legalization in a growing number of U.S. states has made that kind of pressure increasingly untenable in recent years.
The Trump administration moved last year to revoke Obama-era prosecutorial guidance that generally urged non-intervention with local marijuana laws. But the president himself has voiced support for letting states set their own cannabis policies without interference, and attorney general nominee William Barr said during his confirmation hearing that he would not "go after" companies relying on the now-rescinded cannabis guidance.
Thus, it remains to be seen how the administration will direct its UN representative when it comes time to weigh in on the proposed changes to marijuana's status under international law.
If the recommendation on CBD is adopted, however, it could potentially have far-reaching implications in the U.S. Last year, the Food and Drug Administration (FDA) determined that CBD does not meet the criteria for federal control—except for the fact that international treaties to which the U.S. is party could potentially be construed as requiring it.
“If treaty obligations do not require control of CBD, or if the international controls on CBD change in the future, this recommendation will need to be promptly revisited," FDA wrote, adding that the U.S. scheduling placement of CBD should be “revisited promptly” if international treaty obligations changed. Under the clarification being recommended by WHO, no one would be able to argue that CBD is globally scheduled.
The WHO's new cannabis rescheduling recommendations come in the form of a letter, dated January 24, from the Tedros Adhanom Ghebreyesus, the body's director general, to UN Secretary-General Antonio Guterres.
Guterres was Portugal's prime minister when the country enacted a policy of decriminalizing drug possession, a move he touted in a speech to the UN's Commission on Narcotics Drugs last year.

Coordination of reach-to-grasp in physical and haptic-free virtual environments

Unusable for stroke survivors, young and healthy. Your doctor will need to look at and use these to come up with stroke protocols. 

• reach-to-grasp (8)
• virtual reality (118)
• virtual reality games (7)
• virtual reality goggles (1)
• virtual reality training (13)
• haptics (26)

 Describes possible solution but lazily offers nothing specific, so useless. 'May be' and 'study' are not what stroke survivors need.

Coordination of reach-to-grasp in physical and haptic-free virtual environments

• Mariusz P. FurmanekEmail authorView ORCID ID profile,
• Luis F. Schettino,
• Mathew Yarossi,
• Sofia Kirkman,
• Sergei V. Adamovich and
• Eugene Tunik

Journal of NeuroEngineering and Rehabilitation201916:78

https://doi.org/10.1186/s12984-019-0525-9

©  The Author(s). 2019

• Received: 14 January 2019
• Accepted: 25 April 2019
• Published: 27 June 2019

Abstract

Background

Virtual reality (VR) offers unprecedented opportunity as a scientific tool to study visuomotor interactions, training, and rehabilitation applications. However, it remains unclear if haptic-free hand-object interactions in a virtual environment (VE) may differ from those performed in the physical environment (PE). We therefore sought to establish if the coordination structure between the transport and grasp components remain similar whether a reach-to-grasp movement is performed in PE and VE.

Method

Reach-to-grasp kinematics were examined in 13 healthy right-handed young adults. Subjects were instructed to reach-to-grasp-to-lift three differently sized rectangular objects located at three different distances from the starting position. Object size and location were matched between the two environments. Contact with the virtual objects was based on a custom collision detection algorithm. Differences between the environments were evaluated by comparing movement kinematics of the transport and grasp components.

Results

Correlation coefficients, and the slope of the regression lines, between the reach and grasp components were similar for the two environments. Likewise, the kinematic profiles of the transport velocity and grasp aperture were strongly correlated across the two environments. A rmANOVA further identified some similarities and differences in the movement kinematics between the two environments - most prominently that the closure phase of reach-to-grasp movement was prolonged when movements were performed in VE.

Conclusions

Reach-to-grasp movement patterns performed in a VE showed both similarities and specific differences compared to those performed in PE. Additionally, we demonstrate a novel approach for parsing the reach-to-grasp movement into three phases- initiation, shaping, closure- based on established kinematic variables, and demonstrate that the differences in performance between the environments are attributed to the closure phase. We discuss this in the context of how collision detection parameters may modify hand-object interactions in VE. Our study shows that haptic-free VE may be a useful platform to study reach-to-grasp movements, with potential implications for haptic-free VR in neurorehabilitation.

What Health Care Executives Can Learn From Taylor Swift - Stroke executives?

Have any of you 10 million yearly stroke survivors  ever been in communication with ANY stroke leader, your hospital president, your doctor, your stroke researchers, anyone in your stroke association? NO? Proving once and for all none of them care about solving stroke. You're screwed along with your children and grandchildren. The ONLY solution is to remove all the dead wood in stroke and have survivors in charge.  The incompetence is so baked into stroke that nothing but amputation will be a success. Someday a stroke leader will deign to talk to me and tell me I know nothing about stroke. That will be amusing.  If they aren't trying for 100% recovery for all they aren't leaders, just bureaucrats passing time until retirement.

What Health Care Executives Can Learn From Taylor Swift - Stroke executives?

In this world, change is an inevitable phenomenon. What one can learn from an impassioned entrepreneur, a sports executive or a Wall Street writer about the re-evaluation of the status quo and changing the game can go as far as opening the eyes of others and inspiring these individuals to make a move for themselves.

Before one can dismiss the idea of including pop princess Taylor Swift to the temple of modern-day business gurus, it is worth taking a look at some of these stats.

The accomplished singer has brought in a whopping $39.6 million in 2014. She is as successful as those prominent individuals who have built pillars in the technological industry and other areas.

When Swift reached the age of 18, she had already earned her first number one single and was named the Artist/Songwriter of the Year by the Nashville Songwriters Association. To add to that, she also won the CMA Horizon Award. Having said these, there really are a lot of lessons that one can learn from Swift, even health care executives can note a thing or two.
00:16 / 00:30
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Individuals who live and thrive in the health care world are taught about utmost safety. They are often not introduced to the creative side of life. Senator Bill Frist once said that health care has a lot of things to learn from the music world. These may include surrounding the self with passionate people. Even at such a young age, Swift was fond of familiarizing herself with a lot of people. She believes that individuals outside of her career have made a massive impact on her creativity and inspiration.

Health care executives should be willing to make tough decisions, like what Swift does with her music. The pop singer is not ready to contribute her life's work to an experiment that does not fairly compensate those working with her, which means that she chooses sincerity over instant success.

But above all, what others, not just those in the health care industry, should learn from Swift is her genuineness.

She engages with her fans and customers and personally communicates with them. She does an effective job of forming a close-knit community even if that same community is composed of geographically dispersed people.

Evaluation of the Application of APACHE II Combined With NIHSS Score in the Short-Term Prognosis of Acute Cerebral Hemorrhage Patient

You are forecasting using the status quo. The status quo in stroke is a complete failure. Survivors don't want the status quo, they want 100% RECOVERY. GET THERE! 

Nihilism in stroke for the complete list of what still needs to be fixed. Solve these, not fuckingly stupid predictions and forecasts. 

Evaluation of the Application of APACHE II Combined With NIHSS Score in the Short-Term Prognosis of Acute Cerebral Hemorrhage Patient

Xiao-Jing Zhao^1*, Qun-Xi Li², Li-Sha Chang¹, Jiang Zhang¹, Da-Li Wang¹, Hai-Yan Fan¹, Fu-Xia Zheng¹ and Xiu-Jie Wang¹

• ¹Department of Neurology, Affiliated Hospital of North China University of Science and Technology, Tangshan, China
• ²Department of Neurosurgery, Affiliated Hospital of North China University of Science and Technology, Tangshan, China

Objective: This study aims to evaluate the effects of combining Acute Physiology and Chronic Health Disease Classification System II (APACHE II) scores and the NIHSS score for short-term prognosis of cerebral hemorrhage patients.

Methods: APACHE II and NIHSS scores were respectively carried out for 189 acute cerebral hemorrhage patients who were admitted to the hospital for 24 h, and the area under ROC curve was used to measure the ability of these score systems to forecast the prognosis, in order to find the best dividing value. The discriminant analysis method should be used to carry out a comprehensive analysis of these two score methods and establish the mathematical model to provide a reasonable basis for accurately mastering these illness conditions, and its prognosis.

Results: The areas under the ROC curve of APACHE II and NIHSS scores in forecasting cerebral hemorrhage prognosis was 0.853 and 0.845, respectively, the dividing value was 15 and 17, respectively, and the forecasting accuracy was 77.2 and 79.9%, respectively; The forecasting accuracy of the combined discrimination model was 85.96%.

Conclusion: APACHE II and NIHSS scores have good forecasting value to the short-term prognosis of acute cerebral hemorrhage patients, and the combination of these two can provide a higher forecasting value.

More at link. 

Interpreting Prefrontal Recruitment During Walking After Stroke: Influence of Individual Differences in Mobility and Cognitive Function

I would prefer that you interpret this in a useful way. Creating stroke rehab protocols. 

Interpreting Prefrontal Recruitment During Walking After Stroke: Influence of Individual Differences in Mobility and Cognitive Function

Sudeshna A. Chatterjee^1,2, Emily J. Fox^2,3, Janis J. Daly^1,4, Dorian K. Rose^1,2, Samuel S. Wu⁵, Evangelos A. Christou⁶, Kelly A. Hawkins², Dana M. Otzel^1,7, Katie A. Butera^1,2, Jared W. Skinner⁸ and David J. Clark^1,7*

• ¹Brain Rehabilitation Research Center (BRRC), Malcom Randall VA Medical Center, Gainesville, FL, United States
• ²Department of Physical Therapy, University of Florida, Gainesville, FL, United States
• ³Brooks Rehabilitation, Jacksonville, FL, United States
• ⁴Department of Neurology, University of Florida, Gainesville, FL, United States
• ⁵Department of Biostatistics, University of Florida, Gainesville, FL, United States
• ⁶Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
• ⁷Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, United States
• ⁸Geriatric Research, Education and Clinical Center, Malcom Randall VA Medical Center, Gainesville, FL, United States

Background: Functional near-infrared spectroscopy (fNIRS) is a valuable neuroimaging approach for studying cortical contributions to walking function. Recruitment of prefrontal cortex during walking has been a particular area of focus in the literature. The present study investigated whether task-related change in prefrontal recruitment measured by fNIRS is affected by individual differences in people post-stroke. The primary hypotheses were that poor mobility function would contribute to prefrontal over-recruitment during typical walking, and that poor cognitive function would contribute to a ceiling in prefrontal recruitment during dual-task walking (i.e., walking with a cognitive task).
Methods: Thirty-three adults with chronic post-stroke hemiparesis performed three tasks: typical walking at preferred speed (Walk), serial-7 subtraction (Serial7), and walking combined with serial-7 subtraction (Dual-Task). Prefrontal recruitment was measured with fNIRS and quantified as the change in oxygenated hemoglobin concentration (ΔO₂Hb) between resting and active periods for each task. Spatiotemporal gait parameters were measured on an electronic walkway. Stepwise regression was used to assess how prefrontal recruitment was affected by individual differences including age, sex, stroke region, injured hemisphere, stroke chronicity, 10-meter walking speed, balance confidence measured by Activities-specific Balance Confidence (ABC) Scale, sensorimotor impairment measured by Fugl-Meyer Assessment, and cognitive function measured by Mini-Mental State Examination (MMSE).
Results: For Walk, poor balance confidence (ABC Scale score) significantly predicted greater prefrontal recruitment (ΔO₂Hb; R² = 0.25, p = 0.003). For Dual-Task, poor cognitive function (MMSE score) significantly predicted lower prefrontal recruitment (ΔO₂Hb; R² = 0.25, p = 0.002).
Conclusions: Poor mobility function predicted higher prefrontal recruitment during typical walking, consistent with compensatory over-recruitment. Poor cognitive function predicted lower prefrontal recruitment during dual-task walking, consistent with a recruitment ceiling effect. These findings indicate that interpretation of prefrontal recruitment should carefully consider the characteristics of the person and demands of the task.

Non-pulsed Sinusoidal Electromagnetic Field Rescues Animals From Severe Ischemic Stroke via NO Activation

I would expect immediate action from your doctors and stroke hospital to contact researchers and get human trials going.  Not really time dependent, 4 days for therapy. Or are there better ways to deliver nitric oxide?

• endothelial nitric oxide (1) 

• nitric oxide (94)

Non-pulsed Sinusoidal Electromagnetic Field Rescues Animals From Severe Ischemic Stroke via NO Activation

Lena P. Font^1,2, Miriam M. Cardonne², Hannelore Kemps¹, Raf Meesen¹, Oneida F. Salmon², Fidel G. González², Ivo Lambrichts¹, Jean-Michel Rigo¹, Bert Brône^1*† and Annelies Bronckaers^1*†

• ¹Faculty of Medicine and Life Sciences, BIOMED, UHasselt – Hasselt University, Diepenbeek, Belgium
• ²Centro Nacional de Electromagnetismo Aplicado, Universidad de Oriente, Santiago de Cuba, Cuba

Despite the high prevalence and devastating outcome, only a few treatment options for cerebral ischemic stroke exist. Based on the nitric oxide (NO)-stimulating capacity of Non-pulsed Sinusoidal Electromagnetic Field (NP-SEMF) and the possible neuroprotective role of NO in ischemic stroke, we hypothesized that NP-SEMF is able to enhance survival and neurological outcome in a rat model of cerebral ischemia. The animals, in which ischemic injury was induced by occlusion of both common carotid arteries, received 20 min of NP-SEMF of either 10 or 60 Hz daily for 4 days. NP-SEMF dramatically increased survival, reduced the size of the infarcted brain area and significantly improved the neurological score of the surviving rats. Corresponding to previous reports, NP-SEMF was able to induce NO production in vitro. The importance of NO as a key signaling molecule was highlighted by inhibition of the NP-SEMF beneficial effects in the rat stroke model after blocking NO synthase (NOS). Our results indicate for the first time that NP-SEMF exposure (13.5 mT at 60 and 10 Hz) improves the survival and neurological outcome of rats subjected to cerebral ischemia and that this effect is mediated by NO, underlining the great therapeutic potential of NP-SEMF as a therapy for ischemic stroke.

Introduction

Cerebral ischemic stroke is caused by the occlusion of a major artery in the brain, which results in extensive brain tissue loss. Cerebral ischemic stroke is a major cause of mortality and disability worldwide (Kissela et al., 2009; Feigin et al., 2014). Currently, the only available treatment options are tissue plasminogen activator and thrombectomy, which have significant effectivity after stroke. However, these therapies can only be used in a small subset of cases, indicating the clear need for new interventions (Zhang et al., 2013).

Nitric oxide (NO) is an important signaling molecule that is synthesized from its precursor L-arginine by nitric oxide synthase (NOS). Following stroke, NO produced by the neuronal and inducible isoforms of NOS exerts neurotoxic effects, while NO supplied by endothelial NOS (eNOS) is beneficial by stimulating several mechanisms such as vasodilation, angiogenesis, and neurogenesis. As a consequence of these later positive effects, NO donors display therapeutic effects in animal stroke models (Terpolilli et al., 2012; Garry et al., 2015). Extremely low frequency electromagnetic field () has been shown to induce NO production (Jelenkovic et al., 2006; Bragin et al., 2015). ELF-MF is defined by a magnetic flux below 20 mT with a frequency range of 1 to 300 Hz and is applied in a pulsed or non-pulsed fashion. Pulsed ELF-MF is intensively investigated and used in the clinic to treat delayed union bone fractures and wounds (Pesce et al., 2013). Furthermore, pulsed ELF-MF is beneficial in preclinical models of hind limb ischemia (Li et al., 2015), myocardial infarction (Yuan et al., 2010; Hao et al., 2014) and traumatic brain injury (Rasouli et al., 2012). In contrast, NP-SEMF is less studied but shows clinical promise in a rat model of Huntington’s disease (Tasset et al., 2012). Although the precise cellular mechanism activated by ELF-MF is poorly characterized, NO is induced by both pulsed ELF-MF and NP-SEMF in the brains of healthy rats (Jelenkovic et al., 2006; Bragin et al., 2015).

Because of the promising preclinical data of NO donors as a stroke therapy and the ability of NP-SEMF to induce NO production, we investigated the effect of NP-SEMF in a rat model of cerebral ischemia. We also studied the influence of NOS inhibition on NP-SEMF-induced neuroprotective effects. To our knowledge, this study is the first to show the therapeutic effect of NP-SEMF in brain ischemia and its NO-dependence.

More at link.

CHI St. Joseph receives national awards for heart and stroke care

Big fucking whoopee.

THIS is what is completely wrong about any article on stroke. 'Care' NOT RESULTS. This fucking tyranny of low expectations needs to stop, I suggest firing anyone using the term 'care' instead of results or recovery. 

 

 

CHI St. Joseph receives national awards for heart and stroke care

BRYAN, Tex. (KBTX) - Every year, the American Heart Association and the American Stroke Association recognize select hospitals for providing the best evidence-based care. In 2019, CHI St. Joseph was honored with four of those national awards.

"This shows the highest level of commitment to evidence-based care," said Ashley Ward, a registered nurse at St. Joseph Hospital. "So that means the latest in medical therapy for our patients. That's a lot of effort on the part of our physicians, our nursing staff, the whole hospital as a system."

HERO Glove helps restore basic hand movements to stroke patients

Your doctor can explain how this is not recovery but just compensation.   And then can explain how this compares to all these others and which one is best. That is what you expect your doctor to do?

But is it better than these other options? 

• EsoGlove (1)
• FES-Robotic Glove (1)
• glove (69)

• Gyroscopic glove (1)
• RAPAEL Smart Glove (4)
• Rapael Smart Gloves (1)
• SaeboGlove (1)

HERO Glove helps restore basic hand movements to stroke patients

New glove offers helping hand to stroke patients

 

The HERO glove is powered by a nine-volt battery and is meant to help stroke patients hold objects.

Pauline Chan, Health Reporter

Published Wednesday, June 26, 2019 2:37PM EDT
Last Updated Wednesday, June 26, 2019 8:12PM EDT

A robotic glove that helps restore movement and control to people affected by strokes or brain injuries is just one of the devices being showcased at rehab week in Toronto.
Stroke patient Ron Reddam says his left side was severely affected by a stroke in 2011. His left leg recovered well and fortunately he is right-handed, but tasks requiring two hands such as cutting up food or opening a bottle were almost impossible.
“Simple things,” he says with smile. “Fishing—kinda hard to hold a rod and reel it in with one arm.”

Photos

The HERO Glove is seen at the Metro Convention Centre on June 26, 2019.

The Hand Extension Robot Orthosis (HERO) Glove integrates robotic “tendons” into a sports-type glove and is powered by a nine-volt battery. It can be activated with either a shake of the hand, a tap on a sensor or the push of a button.
While it can’t be used for fine individual finger actions like typing, it can hold an object steady.
Inventor Aaron Yurkewich says people can custom order a glove for about $300 through the Toronto Rehabilitation Institute.
Yurkewich’s HERO Glove is among the dozens of inventions on display during rehab week at the Metro Convention Centre on Wednesday. Hundreds of researchers and entrepreneurs from around the world gather for the expo every other year and this is the first time it’s ever been held in Toronto.

Development and clinical validation of inertial sensor-based gait-clustering methods in Parkinson’s disease

This would seem to be extremely useful in objectively measuring gait in stroke. Then we could map stroke protocols that solve those gait problems. It will never occur. 

Development and clinical validation of inertial sensor-based gait-clustering methods in Parkinson’s disease

• An NguyenEmail authorView ORCID ID profile,
• Nils Roth,
• Nooshin Haji Ghassemi,
• Julius Hannink,
• Thomas Seel,
• Jochen Klucken,
• Heiko Gassner and
• Bjoern M. Eskofier

Journal of NeuroEngineering and Rehabilitation201916:77

https://doi.org/10.1186/s12984-019-0548-2

©  The Author(s) 2019

• Received: 18 December 2018
• Accepted: 6 June 2019
• Published: 26 June 2019

Abstract

Background

Gait symptoms and balance impairment are characteristic indicators for the progression in Parkinson’s disease (PD). Current gait assessments mostly focus on straight strides with assumed constant velocity, while acceleration/deceleration and turning strides are often ignored. This is either due to the set up of typical clinical assessments or technical limitations in capture volume. Wearable inertial measurement units are a promising and unobtrusive technology to overcome these limitations. Other gait phases such as initiation, termination, transitioning (between straight walking and turning) and turning might be relevant as well for the evaluation of gait and balance impairments in PD.

Method

In a cohort of 119 PD patients, we applied unsupervised algorithms to find different gait clusters which potentially include the clinically relevant information from distinct gait phases in the standardized 4x10 m gait test. To clinically validate our approach, we determined the discriminative power in each gait cluster to classify between impaired and unimpaired PD patients and compared it to baseline (analyzing all straight strides).

Results

As a main result, analyzing only one of the gait clusters constant, non-constant or turning led in each case to a better classification performance in comparison to the baseline (increase of area under the curve (AUC) up to 19% relative to baseline). Furthermore, gait parameters (for turning, constant and non-constant gait) that best predict motor impairment in PD were identified.

Conclusions

We conclude that a more detailed analysis in terms of different gait clusters of standardized gait tests such as the 4x10 m walk may give more insights about the clinically relevant motor impairment in PD patients.