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 438 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:http://oc1dean.blogspot.com/2010/11/my-background-story_8.html

Sunday, August 31, 2014

If it were not for this continuous stream of motor impulses, we would collapse like a bunch of broccoli

A direct quote from Young Frankenstein. What exactly does your doctor have to say  about why you didn't collapse like broccoli when you had your stroke?
And this series of quotes is probably more explanation of your brain than your doctor told you about.
http://www.subzin.com/quotes/M70032530/Young+Frankenstein

The Option of Doing Nothing and Its Impact on Postchoice Persistence

Does your doctor understand this in figuring out how to motivate you post-stroke to do therapy that only has a 10% chance of getting you to full recovery? Does your doctor understand anything at all about recovery? What exactly are his/her written stroke protocols to do exactly that?
http://pss.sagepub.com/content/25/3/772.short
  1. Rom Y. Schrift1
  2. Jeffrey R. Parker2
  1. 1Wharton Business School, University of Pennsylvania
  2. 2J. Mack Robinson College of Business, Georgia State University
  1. Rom Y. Schrift, The Wharton School, 700 Jon M. Huntsman Hall, University of Pennsylvania, Philadelphia, PA 19104 E-mail: roms@wharton.upenn.edu
  1. Author Contributions R. Y. Schrift and J. R. Parker jointly developed the studies’ concepts and contributed equally to the design. Both authors performed the testing and data collection, and both approved the final version of the manuscript for submission.

Abstract

Individuals regularly face adversity in the pursuit of goals that require ongoing commitment. Whether or not individuals persist in the face of adversity greatly affects the likelihood that they will achieve their goals. We argue that a seemingly minor change in the individual’s original choice set—specifically, the addition of a no-choice option—will increase persistence along the chosen path. Drawing on self-perception theory, we propose that choosing from a set that includes a no-choice (do nothing) option informs individuals that they both prefer the chosen path to other paths and that they consider this path alone to be worth pursuing, an inference that cannot be made in the absence of a no-choice option. This unique information strengthens individuals’ commitment to, and increases their persistence on, their chosen path. Three studies employing incentive-compatible designs supported our predictions and ruled out several rival accounts.

Saturday, August 30, 2014

Sailing as Stroke Rehabilitation Strategy

I'm sure this will never occur. But it would make for fantastic balance training. I would volunteer for such a research study. It would be even better with no safety harness because that would require you to pay attention.
http://books.google.com/books?hl=en&lr=&id=woRYBAAAQBAJ&oi=fnd&pg=PA86&ots=Q8TT0FB3wi&sig=BMPfxPf9S3D5QR5lPFHrfg7S1SA#v=onepage&q&f=false

Friday, August 29, 2014

Where we donate vs. how we die (a real infographic)

Stroke as the 4th leading cause of death is not listed. I wouldn't donate to any of the current stroke charities until they actually listen to and are run by survivors.  They are currently worthless.
From

Embedded image permalink 

This is Your Brain's Blood Vessels

I would think that your doctor would like to know the exact blood flow problems in your brain. That way your doctor could start compiling stroke protocols that fix or compensate those problems. But that will never occur with the current set of stroke medical personnel.
http://www.biosciencetechnology.com/news/2014/08/your-brains-blood-vessels-drugs?
A new method for measuring and imaging how quickly blood flows in the brain could help doctors and researchers better understand how drug abuse affects the brain, which may aid in improving brain-cancer surgery and tissue engineering, and lead to better treatment options for recovering drug addicts. The new method, developed by a team of researchers from Stony Brook University in New York, USA and the U.S. National Institutes of Health, was published today in The Optical Society’s (OSA) open-access journal Biomedical Optics Express.

Playing table tennis to enhance mental health

This would be so cheap to install in the hospital recreation room and much cheaper than a pool table. Think of all the benefits of requiring you to balance as you lunge after the balls. But something as smart and easy as this will never ever get into your hospital therapy department, because they will never do anything outside the bun.
http://sharpbrains.com/blog/2014/08/27/trend-playing-table-tennis-to-enhance-brain-fitness-and-mental-health/
If this guy can play ping pong then anyone can.
Armless Table Tennis Player Takes on the Sport's Best Players

Pharma puts Watson brain to work to speed up R&D, cut drug development costs

If we had anything approaching even a mediocre stroke association they would be working with Dr. Watson to identify drugs that need further testing to stop the neuronal cascade of death.  I know I'm pretty smart but I've only identified 177 possibilities and I can't hold a candle to Dr. Watson.  F*ck it all, you damned lazy stroke medical people, do something to solve all the problems in stroke.  Quadrilllions of neurons are dying every day because you are sitting on your ass waiting for somebody else to solve the difficult problems in stroke. Schadenfreude will eventually get you after you have your stroke and you have to try to recover with the existing pathetic non-protocols.
http://medcitynews.com/2014/08/pharma-puts-watson-brain-work-rd/?utm_source=MedCity+News+Subscribers&
Johnson & Johnson and Sanofi are using IBM Watson’s computer brain/big data cruncher to support research and development. It will be used to identify new applications for drugs that have already been developed and to leaf through scientific papers that detail clinical trial outcomes, according to a statement from IBM. The partnerships follow a new development in Watson’s evolution that help it visually uncover patterns and pinpoint connections in related data to accelerate the discovery process and advance science research.
“Watson now has the ability to understand the language of chemistry, biology, legal and intellectual property, giving scientists the ability to make connections with data that others don’t see, which can lead to rapid breakthrough in discoveries,” the statement said.

More at link.

Thursday, August 28, 2014

Shortages hamper stroke care - Marlborough, NZ

I hate to sound callous but they are looking at this all wrong. Only 10% of stroke patients get to full recovery under the current therapy guidelines. With that in mind the better option would be to solve the neuronal cascade of death resulting in vastly less dead and dying neurons.
http://www.stuff.co.nz/marlborough-express/news/10433143/Shortages-hamper-stroke-care
And yes, until we get there the current batch of stroke survivors is royally screwed.

Coffee napping

This is just great, thanks Barb. More proof for you Amy. I could have used this for the few minutes I had between therapy sessions while in the hospital. But I bet you are going to have to scream this into your doctors ear before anything as simple as this gets used in your hospital.
http://www.vox.com/2014/8/28/6074177/coffee-naps-caffeine-science
If you're feeling sleepy and want to wake yourself up — and have 20 minutes or so to spare before you need to be fully alert — there's something you should try. It's more effective than drinking a cup of coffee or taking a quick nap.
It's drinking a cup of coffee and then taking a quick nap. This is called a coffee nap.
Explanation at the link.

7 Reasons Why Smoothies Can Change Your Life

And I bet our hospitals will never  give us smoothies post-stroke. Not to be done without your doctors ok, you know how dangerous smoothies are.
http://www.onegreenplanet.org/natural-health/why-smoothies-can-change-your-life/

How Long To Nap For The Biggest Brain Benefits

You do expect your doctor to know exactly how you should be napping during the day to have the best stroke recovery? Don't you? Or does your doctor tell you nothing about how your recovery will go? Mine told me absolutely nothing about my recovery, he should never have gotten paid for any time he spent with me.
http://www.spiritscienceandmetaphysics.com/how-long-to-nap-for-the-biggest-brain-benefits/



Explanations at the link.

Vasa concept - Is there a connection between increased degrees of freedom from flaccidity following stroke, and development of passive tissue contracture and spasticity?

I noticed a lot of hits on my blog for this. Rajul Vasa has a 66 page paper on this if you want to wade thru it.  She totally lost me in the clinically drawn conclusion section. I don't know whom this is written for but I'd be willing to bet not a single stroke survivor is going to be able to understand this and apply it to their recovery. And probably few therapists.
Great word salad though. Maybe the whole point is to increase your cognitive abilities of reading comprehension.
My earlier post on it here including pros and cons.
Vasa concept

Is there a connection between increased degrees of freedom from flaccidity following stroke, and development of passive tissue contracture and spasticity?

I'm kinda smart and I have absolutely no clue what the following gibberish is supposed to mean.


Clinically Drawn Conclusion:
1. Increased degrees of freedom of paretic flail MSS (Musculoskeletal system) of one side of the body from a small lesion in CNS make self-organizing dynamic system unstable from within. (And what the hell does this mean?)
2. For safety reasons brain switches off the control on Centre of Mass [COM] from affected hemisphere and solves the problem of safety of COM by steering the control on COM exclusively to good side of MSS that is to non-lesioned hemisphere. This is positive instant plasticity that facilitates good side to control COM but is functionally negative plasticity on a long run with adaptation of good side of the body to control COM exclusively making it hard for the stroke subject to use affected side despite natural recovery of brain tissue.  (Wow, just Wow?)
3. Action plans of self-organizing stroke CNS and MSS to re-stabilize the system and to combat external invariant forces like gravity to control and defend COM [a priority of all living organisms] becomes the added constraint to restoration of lost control besides the presence of lesion.
a. Self-organizing stroke CNS exploits anticipatory postural activity and Spino-Spinal interlimb sensory motor neuronal connectivity [left side of the spine to right side of the spine and from cranial to caudal and caudal to cranial connections] to induce muscle contraction in a chain of paretic muscles during functional acts with slightest movement of COM to restrict increased degrees of freedom from paresis that poses threat to safety of COM.
b. Synergic activity in chain of paretic muscles in paretic limbs is considered as pathological abnormal movement and associated reaction, when in fact it is uninterrupted extended anticipatory activity in chain of paretic muscles with slightest movement of COM. This extended anticipatory activity is the result of uninterrupted control on COM by good side of body that renders paretic side as an automatic follower of good side with interlimb Spino-Spinal connectivity.
(Wow, just Wow?)
c. Self-organizing brain exploits anticipatory postural control to induce uninterrupted continuous contraction in Paretic weak muscles to turn them stiff and spastic in order to reduce degrees of freedom in paretic limbs to reduce threat to the safety of global COM by inducing so called abnormal pathological synergic movement that remain constant in one direction only towards the central axis to remain within narrow base of support [BOS] and do not allow any variability in direction for safety reasons.
d. Spasticity, synergic grouping and contracture act optimally not only to reduce increased degrees of freedom from flaccidity but act as a “BRAKE” on the fluid movement of COM for safety a priority.
e. In my view, Spasticity in stroke patients is in fact the resultant effect of uninterrupted muscle activity from anticipatory postural control with slightest movement of COM whereas muscle’s velocity dependent spastic behavior well described by neurophysiologists in laboratory set up in unloaded condition when the limb segment is moved passively by examiner is a reflex action.
f. Self organizing stroke CNS promotes automatic central postural control of global COM with synergic grouping of chain of muscles in priority over the development of voluntary selective control on segmental COM.
g. Automatic postural gravicentric muscle activities allow segmental COM to move only in the direction towards the central axis and do not yield in any other direction for safety of COM and for COM to remain within the narrow Base of Support [BOS].
4. Microscopic morphological changes like contracture, loss of viscosity, stiffness in paretic muscles, in connective tissue and in basic fabric (the fascia) that binds the entire skeleton together at the central axis, ‘the spine’ enable the paretic side MSS anatomically connected to non paretic MSS to get mechanically bound together for a macroscopic change in behavior of paretic MSS for, “The whole is bigger than sum total of its individual parts”. Meaning that the system as a whole determines in an important way how the parts behave.  (Wow, just Wow?)
o Macroscopic change in behavior of paretic MSS can be compared with passive ‘Towing’ by non-paretic MSS when muscle motors of paretic MSS fail.
(what the hell is this?)
o Towing the huge mass of paretic MSS by non-paretic MSS becomes easy with contracture in widely spread Thoraco-lumbar fascia that spans both sides of the central axis and houses large trunk muscles bilaterally with bilateral innervation helping to bind both paretic and non-paretic MSS together at the central axis with contracture and contraction.  (Wow, just Wow?)
5. Contracture in muscles of limbs that has an origin on the central axis the trunk [Lattissimus, Pectoral and Iliopsoas] enable the limbs to get bound to the trunk with microscopic morphological changes like stiffness, loss of viscosity, loss of sarcomere, thus binding entire paretic MSS with non paretic MSS.
o Lattissimus muscle is anatomically well placed in terms of connecting scapula and the pelvic girdle together and is attached on to Humerus bone and is in continuity with the gluteus maximus on the opposite side (Vleming & Wingerden, 1996). It is interesting to see that self organizing brain exploits anatomical advantage of Lattissimus to bind two girdles together like a log by turning it spastic to restrict dissociation between two girdles for safety of COM, a priority for all living organism.
2. To make the lattissimus muscle spastic or to induce extended continuous contraction with anticipatory activity in lattissimus muscle, brain exploits anatomical continuity of left paretic lattissimus with the right normal gluteus maximus on the opposite side. With every step of walking and standing up using good leg hip extensor muscles, paretic lattissimus gets stretched with its own inertial mass and anticipatory extended continuous contraction becomes inevitable in paretic Lattissimus turning it spastic.
3. Self-organizing stroke brain exploits un-opposing pull of normal trunk muscles pulling the torso away from paretic leg to sustain the head, arm and trunk mass (HAT) onto the normal hip thereby off-loading / reducing weight bearing on paretic limb for safety of COM. This steering of good torso away from paretic hip by selforganizing brain fails therapeutic efforts to permanently shift weight on paretic LL.
4. Reduced weight bearing on paretic leg is a huge problem in therapeutics. Forced feedback / verbal commands / visual feedback / weight training / treadmill training / force plate sensory training etc. does not get permanent shift of weight on paretic leg unless paretic LL relearns to gain control on COM in all 3 Cartesian coordinates with paretic muscles in many different basic postures and selforganizing brain feels secure and trusts paretic leg’s ability to control and restore COM.
5. In my experience, Restoration of sensory motor control of the paretic UL is dependent on the restoration of control on COM by paretic Lower Limb. With poor loading of paretic limb, stroke subject is almost hopping on single good leg making spino-spinal neuronal connections to make paretic upper limb to go in flexion posture as is seen when you and me hop on single leg.
Anatomical Coupling of paretic Lattissimus muscle with opposite normal gluteus and inertial mass of paretic lattissimus helps it get stretched with each step of walking standing up and in sitting down.
6. New functional behavior; “Towing” of paretic MSS by non-paretic MSS makes exchange of dominance between two MSS impossible. This makes “Normally Abnormal, to be Normal”.
7. “Towing” wherein one side MSS leads and the other side MSS follows automatically, it disturbs spatiotemporal efficiency, coplanar economy of hip knee actions important for energy savings.
8. Towing of paretic MSS makes it dependent on non-paretic MSS for geocentric reference. This allows non paretic MSS to lead uninterruptedly with paretic MSS turning supportive by trailing behind and acting optimally as a “brake” on COM movement to ensure further safety.
9. New functional integration between two MSS, one leading and controlling the COM all the time and the other trailing behind and following all the time ensure safety of COM, always a priority during postural and supra postural tasks.
10. Added safety to COM is provided by passive inertia of paretic mass.
11. Impedance to movement from spasticity, rigidity and stiffness in muscle and contracture in passive tissue and muscle is a defensive strategy of the self-organizing CNS in prioritizing safety of COM when it cannot control and restore COM to safety.
12. Associated reactions apparently seem to be helping to tow paretic MSS.
13. Paretic UL can be abused (with sub-cortical postural reorganization, spino-spinal reorganization and physiological constraint inter limb coupling) at every step taken by paretic LL ( that moves like a prop without coplanar movement economy at hip and knee, with poor loading and without its ability to control COM in all 3 Cartesian coordinates.
14. Poor loading on paretic leg reduces sensory input from under the paretic foot and ankle foot geography gets influenced by adjoining segments like knee joint, femur and trunk posture etc. making self-organizing brain to depend on vision with sensory reweighting.
15. Depending on vision for balance is, an automatic solution by self-organizing brain at a heavy cost of making “Normally Abnormal, to be Normal” wherein cortical vision is used for balance instead of sub-cortical proprioceptive sensation.
16. This makes the availability of vision to gauge the threat and obstacle in space only if, balance is taken care of by stopping to walk to look or by holding the wall or holding onto people around.
This makes multi-tasking a problem for stroke subject that could cause frustration / depression /
and self-image problems.
17. Power of self-organizing brain is mightier compared to any therapeutic efforts made by rehabilitation team unless therapeutics are designed to Reorganize the self-organized brain by exploiting the priority of self-organizing brain, to control and restore COM using paretic MSS.(Holy cow!)
18. Human body is the direct window to the brain. Paretic MSS itself can be therapeutically exploited to channelize the dialogue between brain, body and the external environment; ‘the gravity’ to re-organize self-organized brain to restore lost sensory-motor control on paretic side.

Amy, help please!