AHA Award’s St. Joseph’s Medical Center(Yonkers,NY) for Quality Stroke Care

Big fucking whoopee.

 

 But you tell us NOTHING ABOUT RESULTS. They remind us they 'care' about us multiple times but never tell us how many 100% recovered.  You have to ask yourself why they are hiding their incompetency by not disclosing recovery results. ARE THEY THAT FUCKING BAD?

Three measurements will tell me if the stroke hospital is possibly not completely incompetent; DO YOU MEASURE ANYTHING?  I would start cleaning the hospital by firing the board of directors, you can't let incompetency continue for years at a time.

There is no quality here if you don't measure the right things.

1. tPA full recovery? Better than 12%?
2. 30 day deaths? Better than competitors?

3. rehab full recovery? Better than 10%?

 

You'll want to know results so contact Jolene below.  RESULTS are; tPA efficacy, 30 day deaths, 100% recovery. Because there is no point in going to that hospital if they are not willing to publish results.

 The latest invalid chest thumping here:

 

AHA Award’s St. Joseph’s Medical Center(Yonkers,NY) for Quality Stroke Care

 

Saint Joseph’s Medical Center recently received the American Heart Association/American Stroke Association’s Get With The Guidelines®-Stroke Gold Plus Quality Achievement Award. The award recognizes the hospital’s commitment to ensuring stroke patients receive the most appropriate treatment according to nationally recognized, research-based guidelines based on the latest scientific evidence.

Saint Joseph’s Medical Center earned the award by meeting specific quality achievement measures for the diagnosis and treatment of stroke patients at a set level for a designated period. These measures include evaluation of the proper use of medications and other stroke treatments aligned with the most up-to-date, evidence-based guidelines with the goal of speeding recovery and reducing death and disability for stroke patients. Before discharge, patients should also receive education on managing their health, get a follow-up visit scheduled, as well as other care transition interventions.

“Saint Joseph’s Medical Center is dedicated to improving the quality of care for our stroke patients by implementing the American Heart Association’s Get With The Guidelines-Stroke initiative,” said Saint Joseph’s Medical Center President and CEO Michael Spicer. “The tools and resources provided help us track and measure our success in meeting evidenced-based clinical guidelines developed to improve patient outcomes,” he added.

“We are pleased to recognize Saint Joseph’s Medical Center for their commitment to stroke care,” said Lee H. Schwamm, M.D., national chairperson of the Quality Oversight Committee and Executive Vice Chair of Neurology, Director of Acute Stroke Services, Massachusetts General Hospital, Boston, Massachusetts. “Research has shown that hospitals adhering to clinical measures through the Get With The Guidelines quality improvement initiative can often see fewer readmissions and lower mortality rates.”

According to the American Heart Association/American Stroke Association, stroke is the No. 5 cause of death and a leading cause of adult disability in the United States. On average, someone in the U.S. suffers a stroke every 40 seconds and nearly 795,000 people suffer a new or recurrent stroke each year.

Effect of thrombectomy on oedema progression and clinical outcome in patients with a poor collateral profile

Well what are you doing to get those with poor collateral profile to 100% recovery? Don't just lazily state a problem and offer no solution. 

You can guess what FCT stands for in medical terms:

FCT Stands For: All acronyms (248) Airports & Locations (5) Business & Finance (10) Common (2) Government & Military (18) Medicine & Science (25) Education Schools (9) Technology, IT etc. (15) Rank Abbreviation Meaning ***** 

FCT Flux-Corrected Transport ***** 

FCT Face Centered Tetragonal **** 

FCT Fundação para a Ciência e a Tecnologia *** 

FCT Fundamentals of Computation Theory ** 

FCT Fibrous Connective Tissue ** 

FCT Film-Coated Tablet ** 

FCT Field Control Therapy * 

FCT Fraction of Commercial Power Supplied by Traditional Sources * 

FCT Foundations of Computation Theory * 

FCT Faculdade de Ciências e Tecnologia * 

FCT Fever Clearance Time * 

FCT Fuel Cell Technology * 

FCT Fecal chymotrypsin * 

FCT fluorescein clearance test * 

FCT functional CT * 

FCT food composition table * 

FCT Fractional Component Thereof * 

FCT fecal chymotrypsin test * 

FCT Forestry Commission Tasmania Geographic * 

FCT Filtrate catch tank * 

FCT Full Covariance Transform * 

FCT Family Centered Treatment * 

FCT Federal Capitol Territory * 

FCT Functional Communication Training * 

FCT Fountainhead College of Technology 

Read more at http://acronymsandslang.com/meaning-of/medicine-and-science/FCT.html

T Stands For: All acronyms (248) Airports & Locations (5) Business & Finance (10) Common (2) Government & Military (18) Medicine & Science (25) Education Schools (9) Technology, IT etc. (15) Rank Abbreviation Meaning ***** FCT Flux-Corrected Transport ***** FCT Face Centered Tetragonal **** FCT Fundação para a Ciência e a Tecnologia *** FCT Fundamentals of Computation Theory ** FCT Fibrous Connective Tissue ** FCT Film-Coated Tablet ** FCT Field Control Therapy * FCT Fraction of Commercial Power Supplied by Traditional Sources * FCT Foundations of Computation Theory * FCT Faculdade de Ciências e Tecnologia * FCT Fever Clearance Time * FCT Fuel Cell Technology * FCT Fecal chymotrypsin * FCT fluorescein clearance test * FCT functional CT * FCT food composition table * FCT Fractional Component Thereof * FCT fecal chymotrypsin test * FCT Forestry Commission Tasmania Geographic * FCT Filtrate catch tank * FCT Full Covariance Transform * FCT Family Centered Treatment * FCT Federal Capitol Territory * FCT Functional Communication Training * FCT Fountainhead College of Technology Read more at http://acronymsandslang.com/meaning-of/medicine-and-science/FCT.html

***** FCT Flux-Corrected Transport ***** FCT Face Centered Tetragonal **** FCT Fundação para a Ciência e a Tecnologia *** FCT Fundamentals of Computation Theory ** FCT Fibrous Connective Tissue ** FCT Film-Coated Tablet ** FCT Field Control Therapy * FCT Fraction of Commercial Power Supplied by Traditional Sources * FCT Foundations of Computation Theory * FCT Faculdade de Ciências e Tecnologia * FCT Fever Clearance Time * FCT Fuel Cell Technology * FCT Fecal chymotrypsin * FCT fluorescein clearance test * FCT functional CT * FCT food composition table * FCT Fractional Component Thereof * FCT fecal chymotrypsin test * FCT Forestry Commission Tasmania Geographic * FCT Filtrate catch tank * FCT Full Covariance Transform * FCT Family Centered Treatment * FCT Federal Capitol Territory * FCT Functional Communication Training * FCT Fountainhead College of Technology Read more at http://acronymsandslang.com/meaning-of/medicine-and-science/FCT.html

***** FCT Flux-Corrected Transport ***** FCT Face Centered Tetragonal **** FCT Fundação para a Ciência e a Tecnologia *** FCT Fundamentals of Computation Theory ** FCT Fibrous Connective Tissue ** FCT Film-Coated Tablet ** FCT Field Control Therapy * FCT Fraction of Commercial Power Supplied by Traditional Sources * FCT Foundations of Computation Theory * FCT Faculdade de Ciências e Tecnologia * FCT Fever Clearance Time * FCT Fuel Cell Technology * FCT Fecal chymotrypsin * FCT fluorescein clearance test * FCT functional CT * FCT food composition table * FCT Fractional Component Thereof * FCT fecal chymotrypsin test * FCT Forestry Commission Tasmania Geographic * FCT Filtrate catch tank * FCT Full Covariance Transform * FCT Family Centered Treatment * FCT Federal Capitol Territory * FCT Functional Communication Training * FCT Fountainhead College of Technology Read more at http://acronymsandslang.com/meaning-of/medicine-and-science/FCT.html

 The latest here:

***** FCT Flux-Corrected Transport ***** FCT Face Centered Tetragonal **** FCT Fundação para a Ciência e a Tecnologia *** FCT Fundamentals of Computation Theory ** FCT Fibrous Connective Tissue ** FCT Film-Coated Tablet ** FCT Field Control Therapy * FCT Fraction of Commercial Power Supplied by Traditional Sources * FCT Foundations of Computation Theory * FCT Faculdade de Ciências e Tecnologia * FCT Fever Clearance Time * FCT Fuel Cell Technology * FCT Fecal chymotrypsin * FCT fluorescein clearance test * FCT functional CT * FCT food composition table * FCT Fractional Component Thereof * FCT fecal chymotrypsin test * FCT Forestry Commission Tasmania Geographic * FCT Filtrate catch tank * FCT Full Covariance Transform * FCT Family Centered Treatment * FCT Federal Capitol Territory * FCT Functional Communication Training * FCT Fountainhead College of Technology Read more at http://acronymsandslang.com/meaning-of/medicine-and-science/FCT.html

Effect of thrombectomy on oedema progression and clinical outcome in patients with a poor collateral profile

1. Gabriel Broocks1,
2. Andre Kemmling2,3,
3. Tobias Faizy4,
4. Rosalie McDonough1,
5. Noel Van Horn1,
6. Matthias Bechstein1,
7. Lukas Meyer1,
8. Gerhard Schön5,
9. Jawed Nawabi6,
10. Jens Fiehler1,
11. Helge Kniep1,
12. Uta Hanning1

Author affiliations

Abstract

Background and purpose The impact of the cerebral collateral circulation on lesion progression and clinical outcome in ischaemic stroke is well established. Moreover, collateral status modifies the effect of endovascular treatment and was therefore used to select patients for therapy in prior trials. The purpose of this study was to quantify the effect of vessel recanalisation on lesion pathophysiology and clinical outcome in patients with a poor collateral profile.

Materials and methods 129 patients who had an ischaemic stroke with large vessel occlusion in the anterior circulation and a collateral score (CS) of 0–2 were included. Collateral profile was defined using an established 5-point scoring system in CT angiography. Lesion progression was determined using quantitative lesion water uptake measurements on admission and follow-up CT (FCT), and clinical outcome was assessed using modified Rankin Scale (mRS) scores after 90 days.

Results Oedema formation in FCT was significantly lower in patients with vessel recanalisation compared with patients with persistent vessel occlusion (mean 19.5%, 95% CI: 17% to 22% vs mean 27%, 95% CI: 25% to 29%; p<0.0001). In a multivariable linear regression analysis, vessel recanalisation was significantly associated with oedema formation in FCT (ß=−7.31, SD=0.015, p<0.0001), adjusted for CS, age and Alberta Stroke Program Early CT Score (ASPECTS). Functional outcome was significantly better in patients following successful recanalisation (mRS at day 90: 4.5, IQR: 2–6 vs 5, IQR: 5–6, p<0.001).

Conclusion Although poor collaterals are known to be associated with poor outcome, endovascular recanalisation was still associated with significant oedema reduction and comparably better outcome in this patient group. Patients with poor collaterals should not generally be excluded from thrombectomy.

http://creativecommons.org/licenses/by-nc/4.0/

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http://dx.doi.org/10.1136/svn-2020-000570

Body Weight–Supported Treadmill Training Is No Better Than Overground Training for Individuals with Chronic Stroke: A Randomized Controlled Trial

In the six years since this came out has your stroke hospital gotten rid of these machines? I hated BWSTT since it did nothing to control my spasticity. But then since this is for chronic instead of acute your hospital ignored it. Chronic stroke survivors have no way to get therapy other than what they figure our for themselves.

Body Weight–Supported Treadmill Training Is No Better Than Overground Training for Individuals with Chronic Stroke: A Randomized Controlled Trial

 2014, Topics in Stroke Rehabilitation
  Addie Middleton, DPT, 1
 Angela Merlo-Rains, PhD, DPT, 2
 Denise M. Peters, DPT, 1
 Jennifaye V. Greene, PhD, MS, PT, NCS, 1
 Erika L. Blanck, DPT, ATC,  3
 Robert Moran, PhD, 4
 and Stacy L. Fritz, PhD, PT 1
 

1 Department of Exercise Science, Physical Therapy Program, University of South Carolina, Columbia, South Carolina;
 2 College of Health and Human Services, Physical Therapy Program, Northern Arizona University, Phoenix, Arizona;
3 Department of Cell Biology and  Anatomy, University of South Carolina, School of Medicine, Columbia, South Carolina;
4 Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina
Background:
Body weight–supported treadmill training (BWSTT) has produced mixed results compared with other therapeutic techniques.
Objective:
The purpose of this study was to determine whether an intensive intervention (intensive mobility training) including BWSTT provides superior gait, balance, and mobility outcomes compared with a similar intervention with overground gait training in place of BWSTT.
Methods:
 Forty-three individuals with chronic stroke (mean [SD] age, 61.5 [13.5] years; mean [SD] time since stroke, 3.3 [3.8] years), were randomized to a treatment (BWSTT,n = 23) or control (overground gait training,n = 20) group. Treatment consisted of 1 hour of gait training; 1 hour of balance activities; and 1 hour of strength, range of motion, and coordination for 10 consecutive weekdays (30 hours). Assessments (step length differential, self-selected and fast walking speed, 6-minute walk test, Berg Balance Scale [BBS], Dynamic Gait Index [DGI], Activities-specific Balance Confidence [ABC] scale, single limb stance, Timed Up and Go [TUG], Fugl-Meyer [FM], and perceived recovery [PR]) were conducted before, immediately after, and 3 months after intervention.
Results:
 No significant differences (α = 0.05) were found between groups after training or at follow-up; therefore, groups were combined for remaining analyses. Significant differences (α = 0.05) were found pretest to post test for fast walking speed, BBS, DGI, ABC, TUG, FM, and PR. DGI, ABC, TUG, and PR results remained significant at follow-up. Effect sizes were small to moderate in the direction of improvement.
Conclusions:
 Future studies should investigate the effectiveness of intensive interventions of durations greater than 10 days for improving gait, balance, and mobility in individuals with chronic stroke.
Key words:
balance, gait, mobility, rehabilitation, stroke, treadmill training

Auckland DHB opens New Zealand’s first integrated stroke and rehabilitation unit

Better outcomes is NOT GOOD ENOUGH! Since you don't tell us actual results I'm assuming they are pitiful. You don't want to go here if they don't tell you EXACTLY how good they are.

Auckland DHB opens New Zealand’s first integrated stroke and rehabilitation unit

Today Auckland DHB launched Taiao Ora, or Ward 51, at Auckland City Hospital, the first integrated stroke and rehabilitation unit in the country.

The project was initiated in 2019, when former Health Minister David Clark announced the investment of $30 million for the unit.

Taiao Ora, which was built in what was previously an administration suite on Level 5 of Auckland City Hospital, adds a much-needed 41 new beds to the hospital. It enables stroke patients to have all their care delivered in a single, specially designed facility, from hyper-acute (including clot retrieval) and acute care to rehabilitation.

The ward will also accommodate acute neurology patients and people under 65 years of age who require intensive rehabilitation and will benefit from the rehabilitation environment and specialist expertise of the clinical team.

Auckland DHB Neurologist Professor Alan Barber says: “We’re delighted to be opening Taiao Ora which will care for people from Auckland and around New Zealand.

“We know from research that stroke patients treated in an integrated unit have much better outcomes. Recovering from a stroke can be a daunting experience for patients and their whānau, but the journey will be that much easier in our world-class unit(NO proof of this claim), which is one of a kind in New Zealand.”

Anna McRae, Allied Health Director for Adult Community and Long-Term Conditions at Auckland DHB, says: “Stroke is the third largest killer in New Zealand. Every year in our country around 9,000 people have a stroke and about 2,500 people die of a stroke. Stroke is also a leading cause of long-term disability. It’s vital for us as clinicians to optimise rehabilitation opportunities for our stroke patients to give them the best chance of recovery.

“We’ve created Taiao Ora, meaning a wellness environment, as a safe, healing space to support patients on their rehabilitation journey to improved health and well being; as well as a number of shared spaces to encourage whānau involvement. We’ve brought in natural elements – including harakeke, kawakawa, tui, pōhatu and awa through the use of large murals, colours, textures, lighting and flooring.”

Barry Snow, Director of Adult Medical for Auckland DHB, says: “I’m proud of our team who have led and contributed to Taiao Ora, which puts patients and whānau at the centre and enables our patients to have the very best recovery journey. Every part of the design has been clinically led with input from patients and whānau and draws on international best practice.”

Taiao Ora is the first project in Building for the Future, Auckland DHB’s programme of work to create sufficient hospital capacity to continue to provide safe, high quality care for Auckland’s rapidly growing and aging population.

The Auckland Health Foundation, which fundraises for Auckland DHB’s adult health services, has contributed more than $188,000 to Taiao Ora for additional state-of-the-art equipment to accelerate patient recovery, and help create spaces to improve the physical and mental health of patients.

 

Risk factors for mortality in adult COVID-19 patients; frailty predicts fatal outcome in older patients

 You are at high risk for dying if you get COVID-19, so maybe you want to check your Clinical Frailty Scale here.

I think I fall under #1.

1 Very Fit – People who are robust, active, energetic and motivated. These people commonly exercise regularly. They are among the fittest for their age

Risk factors for mortality in adult COVID-19 patients; frailty predicts fatal outcome in older patients

Tehrani S, Killander A, Åstrand P, et al

International Journal of Infectious Diseases|October 30, 2020

Researchers sought to determine the demographics, co-morbidities as well as mortality rate among hospitalized patients with verified COVID-19. Additionally, they investigated whether poor outcome in patients aged 65 years and older is better predicted by functional status, according to Clinical Frailty Scale (CFS), vs age and co-morbidities. For 60 days, 255 randomly selected hospitalized COVID-19 patients with age ranged between 20 and 103 years were observed. The three most prevalent co-morbidities were hypertension, diabetes mellitus and obesity. Significant contributors to a fatal outcome in hospitalized patients with COVID-19 were: higher age, chronic kidney disease and previous stroke. CFS was identified as the strongest prognostic factor for death in patients aged 65 years and older.

Read the full article on International Journal of Infectious Diseases.

 

Association between statin use and cognitive function: A systematic review of randomized clinical trials and observational studies

 

Does this mean you are going to change the FDA warning?

FDA adds diabetes, memory loss warnings to statins - Reuters But did your doctor account for these?

Taking statins raises the risk of Type 2 diabetes by nearly a third: Findings reopens debate about the pills benefits and side effects

In a database study of nearly 26,000 beneficiaries of Tricare, the military health system, those taking statin drugs to control their cholesterol were 87 percent more likely to develop diabetes.

Or is your doctor using coffee to try to prevent diabetes? Making the assumption that it will translate from mice to humans.

Substance in coffee delays onset of diabetes in laboratory mice Your doctor can also consider this:

High-intensity statin therapy alters the progressive nature of diabetic coronary atherosclerosis, yielding regression of disease in diabetic and nondiabetic patients.

 

The latest here:

 

Association between statin use and cognitive function: A systematic review of randomized clinical trials and observational studies

Adhikari A, Tripathy S, Chuzi S, et al

Journal of Clinical Lipidology|November 2, 2020

Researchers conducted the study for analyzing the connection between statin use and cognitive status in a population age ≥ 60. Twenty-four studies were included in the review. The sample consisted of 1,404,459 participants. No evidence of adverse cognitive effects, including dementia incidence, global cognition deterioration, or particular cognitive domains associated with statin use, has been identified in people aged 60 or older.

Read the full article on Journal of Clinical Lipidology.

 

Racial Differences in Atrial Cardiopathy Phenotypes in Ischemic Stroke Patients

 Please go back to school and figure out the real reason for the differences.

Genetically Speaking, Race Doesn't Exist In Humans October 1998 

The latest here:

Racial Differences in Atrial Cardiopathy Phenotypes in Ischemic Stroke Patients

Hooman Kamel, Kathleen Alwell, View ORCID ProfileBrett M. Kissela, Heidi J. Sucharew, Daniel Woo, Matthew Flaherty, Simona Ferioli, Stacie L. Demel, Charles J. Moomaw, Kyle Walsh, Jason Mackey, De Los Rios La Rosa, Felipe, View ORCID ProfileAdam Jasne, Sabreena Slavin, Sharyl Martini, Opeolu Adeoye, Tehniyat Baig, Monica L. Chen, View ORCID ProfileEmily B. Levitan, Elsayed Z. Soliman, Dawn O. Kleindorfer

First published November 25, 2020, DOI: https://doi.org/10.1212/WNL.0000000000011197

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Abstract

Objective: To test the hypothesis that thrombogenic atrial cardiopathy may be relevant to stroke-related racial disparities, we compared atrial cardiopathy phenotypes between Black versus White ischemic stroke patients.

Methods: We assessed markers of atrial cardiopathy in the Greater Cincinnati/Northern Kentucky Stroke Study, a study of stroke incidence in a population of 1.3 million. We obtained ECGs and reports of echocardiograms performed during evaluation of stroke during the 2010/2015 study periods. Patients with atrial fibrillation (AF) or flutter (AFL) were excluded. Investigators blinded to patients’ characteristics measured P-wave terminal force in ECG lead V₁ (PTFV₁), a marker of left atrial fibrosis and impaired inter-atrial conduction, and abstracted left atrial diameter from echocardiogram reports. Linear regression was used to examine the association between race and atrial cardiopathy markers after adjustment for demographics, body mass index, and vascular comorbidities.

Results: Among 3,426 ischemic stroke cases in Black or White patients without AF/AFL, 2,391 had a left atrial diameter measurement (mean, 3.65 ±0.70 cm). Black race was associated with smaller left atrial diameter in unadjusted (β coefficient, -0.11; 95% CI, -0.17 to -0.05) and adjusted (β, -0.15; 95% CI, -0.21 to -0.09) models. PTFV₁ measurements were available in 3,209 patients (mean, 3,434 ±2,525 μV*ms). Black race was associated with greater PTFV₁ in unadjusted (β, 1.59; 95% CI, 1.21 to 1.97) and adjusted (β, 1.45; 95% CI, 1.00 to 1.80) models.

Conclusions: We found systematic Black-White racial differences in left atrial structure and pathophysiology in a population-based sample of ischemic stroke patients.

Classification of Evidence: This study provides class II evidence that the rate of atrial cardiopathy is greater among Black people with acute stroke compared to White people.

• Received May 15, 2020.
• Accepted in final form October 23, 2020.

• © 2020 American Academy of Neurology

 

'13 Things Mentally Strong People Don’t Do' by Amy Morin

 You will need this since your doctor will leave you totally hanging on your recovery.

The author's website with the shortened version or get the book with 8-20 pages per topic.
'13 Things Mentally Strong People Don’t Do' by Amy Morin

Or a two minute video here: 

13 Things Mentally Strong People Don't Do | Amy Morin

Vagus Nerve Stimulation Paired With Upper-Limb Rehabilitation After Stroke: One-Year Follow-up

What will it take to change may improve to will improve using these protocols?

Vagus Nerve Stimulation Paired With Upper-Limb Rehabilitation After Stroke: One-Year Follow-up

Show all authors

Jesse Dawson, MD, Navzer D. Engineer, PhD, Cecília N. Prudente, PhD, ...

First Published June 1, 2020 Research Article Find in PubMed 

https://doi.org/10.1177/1545968320924361

Article information

   

Abstract

Background. 

Vagus nerve stimulation (VNS) paired with rehabilitation may improve upper-limb impairment and function after ischemic stroke. 

Objective. 

To report 1-year safety, feasibility, adherence, and outcome data from a home exercise program paired with VNS using long-term follow-up data from a randomized double-blind study of rehabilitation therapy paired with Active VNS (n = 8) or Control VNS (n = 9).  

Methods. 

All people were implanted with a VNS device and underwent 6 weeks in clinic therapy with Control or Active VNS followed by home exercises through day 90. Thereafter, participants and investigators were unblinded. The Control VNS group then received 6 weeks in-clinic Active VNS (Cross-VNS group). All participants then performed an individualized home exercise program with self-administered Active VNS. Data from this phase are reported here. Outcome measures were Fugl-Meyer Assessment—Upper Extremity (FMA-UE), Wolf Motor Function Test (Functional and Time), Box and Block Test, Nine-Hole Peg Test, Stroke Impact Scale, and Motor Activity Log.  

Results. There were no VNS treatment–related serious adverse events during the long-term therapy. Two participants discontinued prior to receiving the full crossover VNS. On average, participants performed 200 ± 63 home therapy sessions, representing device use on 57.4% of home exercise days available for each participant. Pooled analysis revealed that 1 year after randomization, the FMA-UE score increased by 9.2 points (95% CI = 4.7 to 13.7; P = .001; n = 15). Other functional measures were also improved at 1 year.  

Conclusions. 

VNS combined with rehabilitation is feasible, with good long-term adherence, and may improve arm function after ischemic stroke.

Keywords vagus nerve, stroke, rehabilitation, neuromodulation

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Asymmetric atrophy of the multifidus in persons with hemiplegic presentation post-stroke

 No clue. 

The multifidus (multifidus spinae : pl. multifidi ) muscle consists of a number of fleshy and tendinous fasciculi, which fill up the groove on either side of the spinous processes of the vertebrae, from the sacrum to the axis.

Asymmetric atrophy of the multifidus in persons with hemiplegic presentation post-stroke

Wookyung Park , Jongwook Kim , MinYoung Kim & Kyunghoon Min

Received 27 Jun 2020, Accepted 31 Oct 2020, Published online: 21 Nov 2020

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• https://doi.org/10.1080/10749357.2020.1846932

 

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ABSTRACT

Objective: To identify the asymmetry of fatty infiltration and cross-sectional areas (CSAs) of individual paravertebral muscles in persons with hemiplegic presentation post-stroke.

Methods: We retrospectively reviewed 26 patients with unilateral hemiplegia who underwent lumbar magnetic resonance imaging post-stroke. CSAs and functional CSAs (FCSAs) of individual paraspinal muscles (multifidus, erector spinae, quadratus lumborum, and psoas major) at the mid-disc level were bilaterally measured from L1-L2 to L5-S1 on T2-weighted lumbar axial images. The FCSA-to-total CSA ratio of each paraspinal muscle was also calculated. These parameters were compared between the more-affected and less-affected sides, and between the less chronic and chronic phases.

Results: FCSA (p = .049) and FCSA-to-total CSA ratio (p = .044) were significantly smaller at the L5-S1 multifidus on the more-affected side than on the less-affected side in the chronic phase. Other muscles showed no meaningful changes. The erector spinae on the more-affected side and the multifidus on the less-affected side significantly increased in size in the chronic phase compared with the less chronic phase.

Conclusions: Persons with hemiplegic presentation may have unilateral atrophy and fatty infiltration of the multifidus on the more-affected side during the chronic phase. The comparison between the less chronic and chronic phases suggested that the recovery pattern of the trunk muscles could differ between sides in unilateral hemiplegia: increased size of the multifidus, a tonic stabilizer, on the less-affected side and of the erector spinae, a phasic muscle, on the more-affected side. This finding could be applied to trunk rehabilitation strategies for persons post-stroke.

 

Long-term functional decline of spontaneous intracerebral haemorrhage survivors

And why are you researching recovery failure predictions rather than researching how to prevent this problem?

 Long-term functional decline of spontaneous intracerebral haemorrhage survivors

 

1. Marco Pasi1,
2. Barbara Casolla2,
3. Maeva Kyheng3,
4. http://orcid.org/0000-0001-8422-9205Grégoire Boulouis4,
5. Gregory Kuchcinski5,
6. Solène Moulin6,
7. Julien Labreuche7,
8. Hilde Henon8,
9. http://orcid.org/0000-0003-4408-4392Didier Leys9,
10. Charlotte Cordonnier1

Author affiliations

Abstract

Objective To identify in patients who survived 6 months after a spontaneous intracerebral haemorrhage (ICH) baseline characteristics and new clinical events associated with functional decline.

Methods In a single-centre study, we prospectively included 6-month survivors with a modified Rankin Scale (mRS) score 0–3. We defined functional decline by a transition to mRS 4–5. We evaluated associations of baseline characteristics and new clinical events with functional decline, using univariate and multivariable models.

Results Of 560 patients, 174 (31%) had an mRS score 0–3 at 6 months. During a median follow-up of 9 years (IQR 8.1–9.5), 40 (23%) converted to mRS 4–5. Age, diabetes mellitus, ICH volume and higher mRS scores at 6 months were independently associated with functional decline. Among baseline MRI markers, presence of strictly lobar cerebral microbleeds (CMBs), and mixed lobar and deep CMBs were independently associated with functional decline. When new clinical events occurring during follow-up were added in multivariable models, age (cause-specific HR (CSHR): 1.07; 95% CI: 1.03 to 1.11), ICH volume (CSHR: 1.03; 95% CI: 1.01 to 1.06), mRS score at 6 months (CSHR per 1 point increase 1.61, 95% CI 1.07 to 2.43), occurrence of dementia (CSHR: 3.81, 95% CI: 1.78 to 8.16) and occurrence of any stroke (CSHR: 4.29, 95% CI: 1.80 to 10.22) remained independently associated with transition to mRS 4–5.

Interpretation Almost one-fourth of patients with spontaneous ICH developed a functional decline over time. Age, ICH volume, higher mRS score at 6 months and new clinical events after ICH are the major determinants.

Machine learning improves prediction of cerebral ischemia after subarachnoid hemorrhage

Do you really think survivors want better prediction of ischemia or better prevention of such ischemia?    THIS is why we need survivors in charge, they would stay focused on the only goal in stroke;100% recovery.

Machine learning improves prediction of cerebral ischemia after subarachnoid hemorrhage

Machine learning models significantly outperformed standard models in predicting delayed cerebral ischemia and functional outcomes at 3 months after a subarachnoid hemorrhage, according to findings published in Neurology.

“After subarachnoid hemorrhage (SAH), delayed cerebral ischemia (DCI) is the biggest contributor to poor functional outcomes,” Jude P.J. Savarraj, PhD, a bioinformatics postdoctoral fellow in the department of neurosurgery at McGovern Medical School, and colleagues wrote. “Previous studies show that several [electronic medical record] parameters, including white blood count panel, measures of coagulation and fibrinolysis, serum glucose and sodium and vital signs (including ECG and BP) are either marginally or strongly associated with DCI and functional outcomes.”

The researchers hypothesized that machine learning models would be able to learn these associations and accurately predict DCI and functional outcomes and outperform standard models.

To test this, Savarraj and colleagues performed a retrospective analysis of outcomes among 451 patients [women, 290; average age, 54 years; median modified Rankin Scale score (mRS) at discharge = 3; median mRS at month 3 = 1] who had a subarachnoid hemorrhage between July 2009 and August 2016. They selected the machine learning model with the best average area under the curve on the training set, using a 10-fold cross-validation approach. The model they used, artificial neural networks, demonstrated a 10-fold cross-validation AUC of 0.78±0.16 on the ”training set,” according to the study results.

The researchers trained machine learning models and standard models to predict DCI and functional outcomes with data collected within 3 days of admission. They compared predictions of standard models with the machine learning model for each outcome measure, including DCI (n = 399), outcome at discharge (n = 393) and outcome at 3 months (n = 240). A clinician prognostication team prospectively predicted the 3-month outcome for 90 patients, which Savarraj and colleagues also compared with the machine learning and standard models.

Machine learning models resulted in predictions with the following AUC curves: DCI = 0.75±0.07 (95% CI, 0.64-0.84), discharge outcome = 0.85±0.05 (95% CI, 0.75-0.92) and 3-month outcome = 0.89±0.03 (95% CI, 0.81-0.94) for 3-month outcomes. Machine learning models outperformed standard models, with improved AUC scores in delayed cerebral ischemia (0.2; 95% CI, –.02 to 0.4), discharge outcomes (0.07±0.03; 95% CI, 0.0018-0.14) and 3-month outcomes (0.14; 95% CI, 0.03 to –0.24). According to the researchers, the physician team’s 3-month outcome prediction performance matched the machine learning model.

“[Machine learning] improves prediction of DCI and functional outcomes compared to standard models. It matches attending physician’s performance in predicting 3-month outcomes,” the researchers wrote. “Their performance must be evaluated in patient cohorts from other centers. In the future, the model can be expanded to include other variables, including imaging and specimen biomarkers to improve performance.”

 

14 Foods That Can Reduce Your Risk of Stroke

 Well, at least some of them have amounts

14 Foods That Can Reduce Your Risk of Stroke

14. Salmon

13. Oatmeal 

12. Black Beans

11. Sweet Potatoes

9. Low-Fat Milk

Some difference in opinion on this:

Or maybe this one?

Higher dairy intake may lower CVD, mortality risks

September 2018

Confusion reigns.

More here:

Consuming high-fat dairy tied to less metabolic syndrome, diabetes, hypertension

8. Bananas

7. Pumpkin Seeds

6. Kale

5. Spinach

4. Almonds

3. Psyllium Husk

2. Garlic 

1. Dark Chocolate

Effects of robot viscous forces on arm movements in chronic stroke survivors: a randomized crossover study

No clue what viscosity is. Ask your doctor.

Effects of robot viscous forces on arm movements in chronic stroke survivors: a randomized crossover study

• Yazan Abdel Majeed,
• Saria Awadalla &
• James L. Patton 

Journal of NeuroEngineering and Rehabilitation volume 17, Article number: 156 (2020) Cite this article

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Abstract

Background

Our previous work showed that speed is linked to the ability to recover in chronic stroke survivors. Participants moving faster on the first day of a 3-week study had greater improvements on the Wolf Motor Function Test.

Methods

We examined the effects of three candidate speed-modifying fields in a crossover design: negative viscosity, positive viscosity, and a “breakthrough” force that vanishes after speed exceeds an individualized threshold.

Results

Negative viscosity resulted in a significant speed increase when it was on. No lasting after effects on movement speed were observed from any of these treatments, however, training with negative viscosity led to significant improvements in movement accuracy and smoothness.

Conclusions

Our results suggest that negative viscosity could be used as a treatment to augment the training process while still allowing participants to make their own volitional motions in practice.

Trial registration

This study was approved by the Institutional Review Boards at Northwestern University (STU00206579) and the University of Illinois at Chicago (2018-1251).

Background

Stroke neurorehabilitation often uses the unique aspects of technology to improve motor recovery. While some researchers endeavored to simply assist movement to more closely resemble healthy patterns [1,2,3], others have attempted to exploit unique capabilities of robotics or graphic feedback to encourage neuroplasticity by augmenting error [4,5,6,7,8]. Even some traditional physical therapy exercises use mirrors to get the paretic side of the body to imitate the non-paretic side [9]. These are beneficial but far from a complete cure, and it remains to be seen what strategies emerge as optimal and what might still be left undiscovered.

An alternative strategy is to first uncover the attributes associated with better clinical movement outcomes, and then target training around these [10, 11]. Our previous work [12] employed a data-driven approach to model participant improvement using metrics derived from the movements themselves. We found that participant movement speed during the initial evaluation was most predictive of clinical changes. This speed was also the most strongly correlated with changes in the Wolf Motor Function Test (WMFT), making heightened speed a possible intervention for stroke. However, before such an intervention might be tested in clinical trials, we need to establish effective methods for speeding up participants.

There are multiple possible training conditions that may achieve this increase, and here we compare three candidate classes of conditions. One approach to affect movement speed is to directly increase it with a negative viscous field; previous work [13,14,15,16] showed that training with negative viscosity can improve participant movement and movement generalization abilities. Another possibility is to leverage the motor control mechanisms of error augmentation and after effects. Under this paradigm, participants would train with positive viscosity, under the expectation that their speed would increase as an aftereffect of that training when these resistive forces are removed [6, 17]. Finally, some research has shown that combining a resistive paradigm with a reward mechanism [18] may help participants learn better. In this case, participants will move in a positive viscosity field that attempts to slow them down, but moving above a certain speed is rewarded by a “breakthrough” where resistance vanishes. Participants may bias movements towards higher speeds to avoid the resistance.

Though it is somewhat understandable why these training conditions would change participant movement speed, the change being an increase is less obvious, especially when it comes to positive viscosity and breakthrough. Many research studies have demonstrated that training under certain conditions that alter normal movement - or perception of it - will induce an aftereffect in the opposite direction. This was shown to be true for primates [19] and humans [20]. Our reasoning for including positive viscosity is that the aftereffect of slowing movement speed would be an increase in speed when the slowing forces are removed. The breakthrough condition leverages the idea of limit-push. There is some evidence that introducing a “penalty” for participant movements that are undesired, and removing that penalty when participants conform to desired movements will bias subsequent motion towards these desired patterns, this was demonstrated using robotic forces [21] and purely visual distortions [22]. By penalizing slower movements in our breakthrough condition, and rewarding faster movements with removal of that penalty, we hope to bias participant motion towards these higher speeds.

In this preliminary clinical study, we simply compared the effects of these three paradigms on participant speed. Our modest goal was to determine if it was possible to influence participants’ speed. If speed is something that can be changed, we will explore the more difficult question of its influence on functional recovery for a later trial. Chronic stroke survivors participated in a single-visit crossover trial, where they trained for a short time under these three conditions. While we were mainly interested in the direct- and after-effects of these force paradigms on participant movement speed, we examined their effects on other movement metrics as well, such as error, efficiency, and smoothness.