Deans' stroke musings

Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 433 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:

Tuesday, July 22, 2014

Cognitive Reserve Boosts Traumatic Brain Injury Recovery

The same should be studied for stroke. I attribute my reasonable recovery to my cognitive reserve

Groundbreaking marijuana study canceled

Have at it, and let the University of Arizona know they need to support full legalization of marijuana.
Why it should be legalized so survivors can benefit;
13 reasons to use it post-stroke.

The University of Arizona fired Dr. Suzanne Sisley rather than let her study how medical marijuana can help veterans like me. Help me get her job back.

dean -
Doctor Suzanne Sisley is an amazing woman -- she's the only doctor in the country who has federal permission to conduct research on how medical marijuana can help veterans. Her study was supposed to be housed at the University of Arizona, but rather than let her conduct it, the university fired her with no explanation whatsoever. As an Iraq veteran and an Arizona alum, I'm fighting to help Doc Sisley get her job back so she can continue her groundbreaking research to help veterans.
I know firsthand how important Doc Sisley's work is, because I had severe PTSD when I came home from my tour of duty in Iraq. I experienced insomnia, anxiety, depression, panic attacks, and fits of rage. My doctors tried for years to cure my PTSD, gave me every pill they could think of. Nothing worked, until 2010, when I started using medical marijuana. 
I wish you could see how much medical marijuana changed my life, made it possible for me to do simple things like get some sleep at night. It gave me so much pride and hope that Doc Sisley was going to do research at my alma mater to bring this miracle to other veterans like me.
This isn't just a matter of one woman losing her job unfairly. Doc Sisley's study could be a matter of life or death for many veterans. Our veterans are committing suicide at an astonishing rate: 22 every single day. Medical marijuana is one of the most promising avenues of treatment for these at-risk veterans, and Doc Sisley's study could make the difference in getting that treatment to those who need it the most.
Our veterans risk their lives overseas. The least we can do for them is provide them with the best care possible when they come home.
The good news is that petitions really work in cases of unfair teacher firings. Already this year, two teachers have gotten their jobs back after petitions supporting them took off on I know that if enough people sign my petition, we can help Doc Sisley, too.
Thank you,
Ricardo Pereyda
United States Army VeteranTucson, Arizona

Eating probiotics regularly may improve your blood pressure

I'm sure your doctor will know exactly how to accomplish this. Hah?
Study Highlights
  • Probiotics – a bacteria in yogurt and supplements – appear to modestly lower blood pressure, according to a review of nine studies.
  • The blood pressure-lowering effect from probiotics was greatest among people with elevated blood pressure.
  • Additional studies are needed before doctors can confidently recommend probiotics for high blood pressure control and prevention.
Embargoed until 3 p.m. CT/4 p.m. ET MONDAY, JULY 21, 2014
DALLAS, July 21, 2014 — Eating probiotics regularly may modestly improve your blood pressure, according to new research in the American Heart Association journal Hypertension.
Probiotics are live microorganisms (naturally occurring bacteria in the gut) thought to have beneficial effects; common sources are yogurt or dietary supplements.
“The small collection of studies we looked at suggest regular consumption of probiotics can be part of a healthy lifestyle to help reduce high blood pressure, as well as maintain healthy blood pressure levels,” said Jing Sun, Ph.D., lead author and senior lecturer at the Griffith Health Institute and School of Medicine, Griffith University, Gold Coast, Queensland, Australia. “This includes probiotics in yogurt, fermented and sour milk and cheese, and probiotic supplements.”
Analyzing results of nine high-quality studies examining blood pressure and probiotic consumption in 543 adults with normal and elevated blood pressure, researchers found:
  • Probiotic consumption lowered systolic blood pressure (the top number) by an average 3.56 millimeters of mercury (mm Hg) and diastolic blood pressure (the lower number) by an average 2.38 mm Hg, compared to adults who didn’t consume probiotics.
  • The positive effects from probiotics on diastolic blood pressure were greatest in people whose blood pressure was equal to or greater than 130/85, which is considered elevated.
  • Consuming probiotics for less than eight weeks didn’t lower systolic or diastolic blood pressure.
  • Probiotic consumption with a daily bacteria volume of 109-10 12 colony-forming units (CFU) may improve blood pressure. Consumption with less than 109 CFU didn’t lower blood pressure. CFU is the amount of bacteria or the dose of probiotics in a product.
  • Probiotics with multiple bacteria lowered blood pressure more than those with a single bacteria.
“We believe probiotics might help lower blood pressure by having other positive effects on health, including improving total cholesterol and low-density lipoprotein, or LDL, cholesterol; reducing blood glucose and insulin resistance; and by helping to regulate the hormone system that regulates blood pressure and fluid balance,” Sun said.
“The studies looking at probiotics and blood pressure tend to be small,” Sun said. “Moreover, two studies had a short duration of three to four weeks of probiotic consumption, which might have affected the overall results of the analysis.
Additional studies are needed before doctors can confidently recommend probiotics for high blood pressure control and prevention, she said.
Co-authors are Saman Khalesi, M.Sc., Ph.D.; Nicholas Buys, Ph.D.; and Rohan Jayasinghe, Ph.D. Author disclosures are on the manuscript.
Additional Resources:
Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association’s policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at

Long-term three-stage rehabilitation intervention alleviates spasticity of the elbows, fingers, and plantar flexors and improves activities of daily living in ischemic stroke patients: a randomized, controlled trial

Your doctor will need to see the details of this in order to set up a stroke protocol to reduce your arm/finger spasticity. Good luck with that.

Bai, Yu-long; Hu, Yong-shan; Wu, Yi; Zhu, Yu-lian; Zhang, Bei; Jiang, Cong-yu; Sun, Li-min; Fan, Wen-ke

Supplemental Author Material
Published Ahead-of-Print


To investigate the effects of rehabilitation interventions on spasticity and activities of daily living (ADL) in ischemic stroke patients. A total of 165 ischemic stroke patients were recruited and assigned randomly to a control group (CG, n=82) or a therapeutic group (TG, n=83). Rehabilitation interventions were performed in the TG. The Modified Ashworth Scale was used to evaluate the severity of spasticity in the fingers, elbows, and plantar flexors, and the Modified Barthel Index (MBI) was used to measure ADL performance. Evaluations were performed at baseline (M0) and at the end of the first, third, and sixth months (M1, M3, M6) after enrollment. At M0, 20.8% (16/77) in the CG and 29.9% (23/77) in the TG developed spasticity, whereas at M6, the incidence of spasticity increased to 36.4% (28/77) in the TG and 42.9% (33/77) of patients in the CG. Fewer patients developed spasticity in the fingers, elbows, and ankles in the TG than CG, respectively. Both groups showed significant improvements in MBI scores (M6 vs. M0, P<0.01). MBI scores correlated negatively with the severity of spasticity in both groups at M6. Long-term standardized rehabilitation interventions alleviate spasticity and promote ADL with the presence of minor spasticity (Supplementary video, Supplemental digital content 1,

Falls and Use of Assistive Devices in Stroke Patients with Hemiparesis: Association with Balance Ability and Fall Efficacy

You will need to ask your therapist what fall efficacy is and whether it is something to try to accomplish.;jsessionid=FC6AD4F231695A31A89C7677B14E315B.f04t01?

  1. Oksoo Kim PhD, RN1 and
  2. Jung-Hee Kim PhD, RN Assistant Professor2,*
Article first published online: 17 JUL 2014
DOI: 10.1002/rnj.173


  • Fall;
  • balance;
  • self-help device;
  • stroke



This study investigates balance ability and the fall efficacy with regard to the experiences of stroke patients with hemiparesis.


The experience of falling, the use of assistive devices, and each disease-related characteristic were assessed using face-to-face interviews and a self-reported questionnaire. The Berg Balance Scale and Fall Efficacy Scale were used to measure balance ability and confidence.


The fall efficacy was significantly lower in participants who had experienced falls than those who had not. The participants who used assistive devices exhibited low balance ability and fall efficacy compared to those who did not use assistive devices.


Stroke patients with fall experience and walking aids might be considered at increased risk of falling.

Clinical Relevance

Preventive measures for individuals using walking aids may be beneficial in reducing the fall rate of community-dwelling stroke patients.

Fish Oil Supplements Reduce Incidence of Cognitive Decline, Brain Atrophy

This is one of the legs on my three-legged milking stool for preventing dementia. I bet it's more than your doctor is telling you about. So ask him/her.
Fish Oil Supplements Reduce Incidence of Cognitive Decline, Brain Atrophy
Leg two:
Coffee May Lower Your Risk of Dementia
Leg three:
Evidence-Based Medicinal Properties of Coconut Oil - brain boosting

Monday, July 21, 2014

CardioBuzz: Vegan Diet, Healthy Heart?

Talk to your doctor to see what s/he is saying. I bet they have no idea on the studies I refer to.
Something else to think about:

Quantitative analysis of dietary protein intake and stroke risk

Study: Protein from meat, fish may help men age well


What would a post-stroke diet look like per Dean?



Government needs to focus on stroke rehab - New Zealand

And you, Stroke Foundation CEO Mark Vivian, need to learn where the focus should be on stroke research. It's not rehab, that has only a 10% chance of getting to full recovery. It's stopping the neuronal cascade of death. You New Zealanders will need to educate him on what is the best way to reduce stroke disability. His pronouncements do not leave me with a warm feeling that he understands at all. He then joins the presidents of the ASA, NSA and WSO in being obtuse about where stroke research should be going. If only we had a survivor-driven organization, that would keep their eye on the correct goal.

And yes, I am damn arrogant in thinking that I know more that these 'supposed' stroke professionals.

How To Make Hot Pepper Cream

This is totally not to be followed unless your doctor approves. I however will do something like this after my next stroke because the extra sensation is good for prepping your motor recovery.  Like what Margaret Yekutiel wrote in the book, Sensory Re-Education of the Hand After Stroke in 2001.
And this:

Tingling sensation caused by Asian spice could help patients with chronic pain 


Never do anything I suggest, you would hate to prove your doctor doesn't know anything about stroke recovery newer than their medical school. 

Can ecstasy treat the agony of PTSD?

If we can't even get marijuana off the Schedule I drug list because our legislators are stupid we'll never get this approved.
And since stroke can cause PTSD your doctor will never stick their head out for a non standard of care to help any stroke patient.
Cannabis Effects on PTSD: Can Smoking Medical Marijuana Reduce Symptoms
Can ecstasy treat the agony of PTSD?
For almost 30 years, Rick Doblin has pushed the idea of using the drug MDMA, better known as ecstasy, in psychotherapy. The Multidisciplinary Association for Psychedelic Studies, which he founded, has funded two phase II trials of MDMA to treat post-traumatic stress disorder (PTSD), one with encouraging results, and is supporting several others. Doblin and some other scientists believe the drug may help PTSD patients relive their traumas with a therapist in a safe atmosphere without overwhelming emotions. Swiss neurobiologist Franz Vollenweider says Doblin has a political agenda and lacks the expertise or the money to organize a phase III study.

National Stroke Foundation (NSF) Australia is updating its research strategy - survey

Have them solve the neuronal cascade of death. Copy this wholesale into their what should we be doing box.
At least one of these 5 problems.
1.  glutamate poisoning
2.  excitotoxicity
3.  Capillaries that don't open due to pericytes
4.  Inflammatory action leaking through the blood brain barrier.
5. Lysosomal Membrane Permeabilization as a Key Player in Brain Ischemic Cell Death: a “Lysosomocentric” Hypothesis for Ischemic Brain Damage

Survey here: 

Sunday, July 20, 2014

Italian bubble football

Our stroke hospitals should have teams of stroke survivors playing this. You would be able to fall and not get hurt.

7 Ways to Prevent a Stroke

Look how simple stroke prevention is.

Almost nothing like my suggestions which should never be listened to.
11 Stroke risk reduction ideas

1. Watch your blood pressure.
2. Deal with diabetes.
3. Lose weight and exercise.
4. Quit smoking.
5. Drink in moderation.
6. Take aspirin.
7. Treat other conditions. Certain conditions can make having a stroke more likely. For instance, atrial fibrillation, a type of irregular heartbeat, can cause blood clots to form in the heart, then travel to the brain. If you have atrial fibrillation, you are five times more likely to suffer a stroke. Obstructive sleep apnea also increases stroke risk. Talk to your doctor about treatment options.

Cannabidiol – a glimmer of hope for Alzheimer’s disease?

From the Neuroscience Research Australia (NeuRA)blog.  Since we have complete idiots in our legislative process this will take 100 years to become legal.

I will however prevent my dementia by these totally unapproved ways.
Dementia prevention 19 ways

Cannabidiol – a glimmer of hope for Alzheimer’s disease?
NeuRA blog

How an iPod Can Fight Alzheimer’s and Dementia

I didn't see any research links documenting this. But so what, what is the dowside or negative side effects? Why isn't your hospital doing this for all stroke patients? Too expensive? Not in the standard of care? It changes the status quo? Your hospital can't figure out a way to charge daily for listening to music?

Saturday, July 19, 2014

Training modalities in robot-mediated upper limb rehabilitation in stroke: a framework for classification based on a systematic review

A doctor/therapist question. Is this framework better than the previous ones? Which one is your therapist using?

Framework for rehabilitation decisions after stroke - 1997 version


Optimal Strategies of Upper Limb Motor Rehabilitation after Stroke


The clinician's voice of brain and heart: A biopsycho-ecological framework for merging the biomedical and holistic

The newest one here: 

Angelo Basteris, Sharon M Nijenhuis, Arno HA Stienen, Jaap H Buurke, Gerdienke B Prange and Farshid Amirabdollahian

For all author emails, please log on.

Journal of NeuroEngineering and Rehabilitation 2014, 11:111  doi:10.1186/1743-0003-11-111
Published: 10 July 2014

Abstract (provisional)

Robot-mediated post-stroke therapy for the upper-extremity dates back to the 1990s. Since then, a number of robotic devices have become commercially available. There is clear evidence that robotic interventions improve upper limb motor scores and strength, but these improvements are often not transferred to performance of activities of daily living. We wish to better understand why. Our systematic review of 74 papers focuses on the targeted stage of recovery, the part of the limb trained, the different modalities used, and the effectiveness of each. The review shows that most of the studies so far focus on training of the proximal arm for chronic stroke patients. About the training modalities, studies typically refer to active, active-assisted and passive interaction. Robot-therapy in active assisted mode was associated with consistent improvements in arm function. More specifically, the use of HRI features stressing active contribution by the patient, such as EMG-modulated forces or a pushing force in combination with spring-damper guidance, may be beneficial.Our work also highlights that current literature frequently lacks information regarding the mechanism about the physical human-robot interaction (HRI). It is often unclear how the different modalities are implemented by different research groups (using different robots and platforms). In order to have a better and more reliable evidence of usefulness for these technologies, it is recommended that the HRI is better described and documented so that work of various teams can be considered in the same group and categories, allowing to infer for more suitable approaches. We propose a framework for categorisation of HRI modalities and features that will allow comparing their therapeutic benefits.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.



Don't ever give up

I've seen this image a few times over the last week. Even using I can't figure out who originated this.  This needs to be posted over every survivors bed.  I imagine the bird being my doctor.

It reminds me of the other frog story I've heard.
Two Frogs
By: Author Unknown
A number of frogs were traveling through the woods. Two of
them fell into a deep pit. All the other frogs gathered
around the pit. When they saw how deep the pit was, they
told the two frogs that they were as good as dead.
The two frogs ignored the comments and tried to jump up out
of the pit with all of their might. The other frogs kept
telling them to stop, that they were as good as dead.
Finally, one of the frogs took heed to what the other frogs
were saying and gave up. He fell down and died.
The other frog continued to jump as hard as he could.
Once again, the crowd of frogs yelled at him to stop the
pain and just die. He jumped even harder and finally made
it out.
When he got out, the other frogs said, "Did you not hear
us?" The frog explained to them that he was deaf. He
thought they were encouraging him the entire time.
This story teaches two lessons:
1. There is the power of life and death in the tongue. An
encouraging word to someone who is down can lift them up
and help them make it through the day.
2. A destructive word to someone who is down can be the
push over the edge. Be careful of what you say. Speak
life to those who cross your path. Anyone can speak
words that can rob another of the spirit to push forward
in difficult times.


This table is interesting. Your doctor should be closely following these trials. Which ones is your doctor willing to use on your next stroke? None? Then your doctor is actively allowing millions of neurons to die. Too bad for you.,d.cWc
Drugs to improve blood flow
    Nadroparin (low molecular weight heparin)
    Tinzaparin (low molecular weight heparin)
    Danaparoid (low molecular weight heparinoid, Org 10172)
Fibrinogen depleting
Improve capillary flow
     Tissue plasminogen activator
Drugs to protect brain tissue (neuroprotective agents)
     Calcium channel blockers
Free radical scavengers—antioxidants
GABA agonists
Glutamate antagonists
     AMPA antagonists
          GYKI 52466
          ZK-200775 (MPQX)
     Kainate antagonist
          SYM 2081
     NMDA antagonists
          Competitive NMDA antagonists
              CGS 19755 (Selfotel)
          NMDA channel blockers
              Aptiganel (Cerestat)
                   NPS 1506
               Glycine site antagonists
                   ACEA 1021
               Polyamine site antagonists
           Growth factors
                Fibroblast Growth factor (bFGF)
           Leukocyte adhesion inhibitor
                Anti-ICAM antibody (Enlimomab)
           Nitric oxide inhibitor
           Opioid antagonists
            Phosphatidylcholine precursor
                 Citicoline (CDP-choline)
            Serotonin agonists
                 Bay × 3072
            Sodium channel blockers
           Potassium channel opener

Oxaloacetate Activates Brain Mitochondrial Biogenesis, Enhances the Insulin Pathway, Reduces Inflammation, and Stimulates Neurogenesis

All these good things happening to strokes in mice. Whom is going to test this out in humans? Or are survivors going to have to become their own guinea pigs because the stroke medical world is too afraid to do anything other that the failed status quo?
  1. Russell H. Swerdlow1,2,5,7,*
+ Author Affiliations
  1. 1Department of Neurology
  2. 2University of Kansas Alzheimer's Disease Center
  3. 3Hoglund Brain Imaging Center
  4. 4Department of Rehabilitation Medicine
  5. 5Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, KS 66160 USA
  6. 6Department of Pharmacology and Toxicology, University of Kansas, Lawrence, KS 66045 USA
  7. 7Department of Biochemistry and Molecular Biology, University of Kansas Medical Center, Kansas City, KS 66160 USA
  1. *Corresponding author: Russell H. Swerdlow, MD, University of Kansas School of Medicine, MS 2012, Landon Center on Aging, 3901 Rainbow Blvd, Kansas City, KS 66160, E-mail:
  • Received May 31, 2014.
  • Revision received July 2, 2014.
  • Accepted July 8, 2014.


Brain bioenergetic function declines in some neurodegenerative diseases, this may influence other pathologies, and administering bioenergetic intermediates could have therapeutic value. To test how one intermediate, oxaloacetate (OAA), affects brain bioenergetics, insulin signaling, inflammation, and neurogenesis we administered intraperitoneal OAA, 1-2 g/kg once per day for 1-2 weeks, to C57Bl/6 mice. OAA altered levels, distributions, or post-translational modifications of mRNA and proteins (PGC1α, PRC, NRF1, TFAM, COX4I1, CREB, p38 MAPK, and AMPK) in ways that should promote mitochondrial biogenesis. OAA increased Akt, mTOR, and P70S6K phosphorylation. OAA lowered NFκB nucleus-to-cytoplasm ratios and CCL11 mRNA. Hippocampal VEGF mRNA, doublecortin mRNA, doublecortin protein, doublecortin-positive neuron counts, and neurite length increased in OAA-treated mice. 1H-MRS showed OAA increased brain lactate, GABA, and glutathione thereby demonstrating metabolic changes are detectable in vivo. In mice, OAA promotes brain mitochondrial biogenesis, activates the insulin signaling pathway, reduces neuroinflammation, and activates hippocampal neurogenesis.

The Effects of Poststroke Aerobic Exercise on Neuroplasticity: A Systematic Review of Animal and Clinical Studies

This just confirms the f*cking stupidity out there. We know neuroplasticity works but we know nothing about how to control it or make it repeatable.
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Aerobic exercise may be a catalyst to promote neuroplasticity and recovery following stroke; however, the optimal methods to measure neuroplasticity and the effects of training parameters have not been fully elucidated. We conducted a systematic review and synthesis of clinical trials and studies in animal models to determine (1) the extent to which aerobic exercise influences poststroke markers of neuroplasticity, (2) the optimal parameters of exercise required to induce beneficial effects, and (3) consistent outcomes in animal models that could help inform the design of future trials. Synthesized findings show that forced exercise at moderate to high intensity increases brain-derived neurotrophic factor (BDNF), insulin-like growth factor-I (IGF-I), nerve growth factor (NGF), and synaptogenesis in multiple brain regions. Dendritic branching was most responsive to moderate rather than intense training. Disparity between clinical stroke and stroke models (timing of initiation of exercise, age, gender) and clinically viable methods to measure neuroplasticity are some of the areas that should be addressed in future research.

Mind and brain in delay of gratification

We have to delay our gratification possibly for decades. What is your doctor doing to prepare you for that?


Database: PsycBOOKS
[ Chapter ]
Mind and brain in delay of gratification.
Zayas, Vivian; Mischel, Walter; Pandey, Gayathri
Reyna, Valerie F. (Ed); Zayas, Vivian (Ed), (2014). The neuroscience of risky decision making. Bronfenbrenner series on the ecology of human development., (pp. 145-176). Washington, DC, US: American Psychological Association, xviii, 222 pp. doi: 10.1037/14322-007


  1. A central focus of psychological and behavioral sciences is to identify the factors that enable and hinder delay of gratification. In this chapter, we review findings from the original preschool delay of gratification work that identify key attentional–cognitive control strategies that enable (vs. hinder) delay. We also describe recent behavioral and neuroscientific findings that investigate the link between preschool delay of gratification abilities and adult mechanisms of cognitive control. This work suggests that dispositional abilities to delay gratification are subserved by individual differences in the functioning of prefrontal cortical and limbic neural systems. We end by discussing the implications of this work for theory and future research. (PsycINFO Database Record (c) 2014 APA, all rights reserved)

Backers of medical marijuana in Florida seek to assuage concerns

More complete and total stupidity. Legalize it completely, otherwise stroke survivors will never be able to avail themselves of the benefits to recovery.

Why it should be legalized so survivors can benefit;
13 reasons to use it post-stroke.

You can read the full text of the amendment here:
It is very unlikely you would be able to get it for stroke.
Legislators need to stop trying to be medical doctors and do something they actually know about.

Florida Amendment 2 (2014), Full Text of Constitutional Changes


Friday, July 18, 2014

Together we can stop the evil spread of lite beer

From a t-shirt at the Winnipeg Folk Festival. And to prove it via research there is this:
Dark beer is good for you, in moderation

Self-control in school age children

In order for us survivors to get through the complete lack of knowledge on how to recover completely we need to have massive amounts of persistence and self control. I'm positive your doctor has no clue on how to instill this in you. But since you can't self prescribe reading dangerous articles like this you're screwed. Only 67 pages.,d.aWw


Conflicts between immediately rewarding activities and more enduringly valued goals abound in
the lives of school-age children. Such conflicts call upon children to exercise self-control, a
competence which depends in large part on the mastery of metacognitive, prospective strategies.
The process model of self-control organizes these strategies into five families corresponding to
sequential phases in the process by which undesired and desired impulses lose or gather force
over time: Situation selection and situation modification strategies involve choosing or changing
physical or social circumstances. Attentional deployment and cognitive change strategies involve
altering whether and how objective features of the situation are mentally represented. Finally,
response modulation strategies involve the direct suppression or elevation of impulses. The
process model of self-control predicts that strategies deployed earlier in the process of impulse
generation and regulation will generally be more effective than those deployed later.