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:

Saturday, October 25, 2014

Couples Say Relationships Damaged By Stroke

Duh. No kidding. It made my life so much better after the separation/divorce.
Dr Assumpta Ryan and Hilary Thompson recently published findings from a study involving 16 married stroke survivors -- nine males and seven females -- aged between 33 and 78.

The study found that sexual relationships were significantly affected after a stroke, gender roles became blurred and feelings like anger and frustration were confounded by a lack of independence and ongoing fatigue.
Dr Ryan from Ulster's Nursing Research Institute was co-author of the study alongside MSc student, Hilary Thompson, a Stroke Nurse Specialist within the Southern Health and Social Services Trust.
"All the participants perceived a stroke as a life-changing event. They faced a continuous daily struggle to achieve some sense of normality and that required huge amounts of physical and mental effort," said Dr. Ryan.
Key findings from the report, which were recently published in the Journal of Clinical Nursing, included:
  • Sexual relationships changed. A 35-year-old female stroke survivor summed up the general feeling well. "It's not a husband and wife role anymore" she said. "It's a carer and a patient and it's not very pleasant and it's not fair."
  • All but one of the respondents reported a reduction or total loss of sexual desire after their stroke. Some felt that this was down to medication and fear of another stroke. As one 61-year-old man told the researchers, "I want her there now as a friend but not really as my wife."
  • Most of the females lost interest in their appearance, regardless of their age. "No interest in clothes, no interest in make-up, no interest in hair. Weeks go by that I don't even wash my hair," said one 57-year-old woman.
  • All the respondents said they had changed since their stroke and irritability, anger, agitation and intolerance were frequently mentioned. "I'm normally easy going, but now the slightest little thing sets off the temper" said a 53-year-old man.
  • A lot of the survivors said their outbursts reflected their frustration at not being able to perform routine daily activities, such as making a cup of tea. One 67-year-old man said that that his wife was a "reasonably healthy person" and asked "why should she be lumbered with me?."
  • Over-protective spouses appeared to increase anger and feelings of frustration. One 78-year-old woman explained that her husband wouldn't give her time to do the things she could still do because "he's afraid of me falling".
  • Survivors said they felt safe and comfortable at home but were reluctant to resume social activities with their spouse because of swallowing problems, anxiety and fatigue. "I would be asked enough times but won't go" said a 46-year-old man.
  • Fatigue was a real issue for survivors and this was often associated with reduced independence and guilt. It made it difficult to plan ahead because they didn't know how they would feel from day to day.
"There is no doubt that strokes have a profound effect on relationships and our research showed many of the physical, psychological, social and emotional issues a stroke can raise," said Ms Thompson, who was named RCN Patient Choice Nurse of the Year 2009.
"It is important to point out that stroke can happen at any age and many of the survivors who took part in our study were relatively young. Four respondents were aged between 33 and 43, two between 44 and 54, six between 55 and 65 and four between 66 and 78. The time since their stroke ranged from two months to four years, with an average of 18 months.
"Work is currently in progress -- driven by the recent Northern Ireland Stroke Strategy -- throughout the province to address the gap in service provision for the promotion of long term psychological adjustment for stroke survivors and their carers."
As a result of the study, which was part funded by Northern Ireland Chest Heart and Stroke the researchers have come up with four key recommendations for health care professionals.
  • Nurse education should focus on both the physical and psychosocial effects of stroke so that nurses can provide holistic care to stroke survivors and their spouses.
  • Health care professionals and service providers must recognise and be sensitive to the profound impact of stroke on sexuality and sexual function.
  • Statutory counselling services should be available to people with stroke and their spouses on both an acute and long-term basis to help them cope with the complex issues described.
  • Evidence-based guidance is needed to demonstrate how nurses can address the psychosocial needs of stroke survivors most effectively.
University of Ulster. "Couples Say Relationships Damaged By Stroke." ScienceDaily. ScienceDaily, 30 December 2009.

Resveratrol Attenuates the Blood-Brain Barrier Dysfunction by Regulation of the MMP-9/TIMP-1 Balance after Cerebral Ischemia Reperfusion in Rats

I think this problem should be solved by giving red wine to newly arrived stroke patients. Don't ever listen to me.  You'll have to ask your doctor how many bottles it would take to match the intraperitoneally delivered amount to the rats.
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The collapse of the blood-brain barrier (BBB) is one of the fundamental pathophysiology changes during cerebral ischemia reperfusion injury. Resveratrol has been recently reported to reduce cerebral ischemic damage by regulating the matrix metalloproteinase-9 (MMP-9). But, more direct evidence for the explanation of the BBB protected by resveratrol against cerebral ischemia reperfusion is still lacking. Therefore, the present study was aimed to investigate the regulation of BBB integrity by resveratrol after cerebral ischemia reperfusion and to determine the role of the MMP-9 and its endogenous inhibitor TIMP-1 balance in this process. Cerebral ischemia was induced by middle cerebral artery occlusion in rats. The BBB function was evaluated by brain water content and the Evans blue dye extravasation; the activities of MMP-9 and TIMP-1 were detected by using gelatin zymography analysis, and cellular apoptosis was examined by TUNEL staining. We confirmed that resveratrol reduced the cerebral ischemia reperfusion damage, brain edema, and Evans blue dye extravasation. Moreover, we found that resveratrol improved the balance of MMP-9/TIMP-1 in terms of their expressions and activities. A TIMP-1 neutralizing antibody reversed those neuroprotective effects of resveratrol. In conclusion, resveratrol attenuated the cerebral ischemia by maintaining the integrity of BBB via regulation of MMP-9 and TIMP-1.

Detection and control of cavitation during blood–brain barrier opening: Applications and clinical considerations

How is your doctor going to use this knowledge of how to cross the blood brain barrier to deliver therapeutic interventions?
Applications and clinical considerations
Microbubble-mediated opening of the blood–brain barrier (BBB) using ultrasound is a targeted technique that provides a transient time window during which circulating therapeutics that are normally restricted to the vasculature can pass into the brain. This effect has been associated with increases in cavitation activity of the circulating microbubbles, and our group has previously described a method to actively control treatments in pre-clinical rodent models based on acoustic emissions recorded by a single transducer. Recently, we have developed a clinical-scale receiver array capable of detecting bubble activity through human skullcaps starting at pressure levels below the threshold for BBB opening. The use of this array to spatially map cavitation activity in the brain during ultrasound therapy will be discussed, including considerations for compensating for the distorting effects of the skull bone. Additionally, results from pre-clinical investigations examining safety and therapeutic potential will be presented, and receiver design considerations for both pre-clinical and clinical scale systems will be discussed.

Identification of Mood-Relevant Brain Connections Using a Continuous, Subject-Driven Rumination Paradigm

What is your doctor doing to make sure you aren't ruminating  on the depressing facts that your doctor hasn't given you any hope or pathway to 100% recovery?
  1. Michael D. Greicius3
+ Author Affiliations
  1. 1War Related Illness and Injury Study Center, VA Palo Alto Healthcare System, Palo Alto, CA, USA
  2. 2Department of Psychiatry and Behavioral Sciences
  3. 3Department of Neurology and Neurological Sciences, Functional Imaging in Neuropsychiatric Disorders (FIND) Laboratory, Stanford University School of Medicine, Stanford, CA, USA
  4. 4Parietal Team, INRIA Saclay, Gif-sur-Yvette, France
  5. 5Interdepartmental Program in Neuroscience, Northwestern University, Evanston, IL, USA
  1. Address correspondence to Michael Greicius, Mail Code 5420, Stanford, CA 94305, USA. Email:
  1. Anna-Clare Milazzo and Bernard Ng contributed equally.


Rumination, an internal cognitive state characterized by recursive thinking of current self-distress and past negative events, has been found to correlate with the development of depressive disorders. Here, we investigated the feasibility of using connectivity for distinguishing different emotional states induced by a novel free-streaming, subject-driven experimental paradigm. Connectivity between 78 functional regions of interest (ROIs) within 14 large-scale networks and 6 structural ROIs particularly relevant to emotional processing were used for classifying 4 mental states in 19 healthy controls. The 4 mental states comprised: An unconstrained period of mind wandering; a ruminative mental state self-induced by recalling a time of personal disappointment; a euphoric mental state self-induced by recalling what brings the subject joy; and a sequential episodic recollection of the events of the day. A support vector machine achieved accuracies ranging from 89% to 94% in classifying pairs of different mental states. We reported the most significant brain connections that best discriminated these mental states. In particular, connectivity changes involving the amygdala were found to be important for distinguishing the rumination condition from the other mental states. Our results demonstrated that connectivity-based classification of subject-driven emotional states constitutes a novel and effective approach for studying ruminative behavior.

Task-specific brain reorganization in motor recovery induced by a hybrid-rehabilitation combining training with brain stimulation after stroke

Ask your doctor if this is far enough along to be copied and made into a stroke protocol. You are going to have to force your doctor to do this. I bet it will require a phone call to the hospital president before it gets accomplished. 
Rant started
Yes I'm being a very bad cop but for years there has been research on rehab that looked promising but never seems to be translated into useable interventions for survivors.  Either we replace all the existing stroke medical doctors with newer ones that still have a sense of desire to help or we force our doctors to actually do their job.
Rant completed, I feel better now.
If I'm wrong about this, tell me exactly where I'm wrong and we can discuss it.
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We developed a new hybrid-rehabilitation combining rTMS and motor training for stroke.
We investigated the task-specific multi-regional brain reorganization induced by it.
We found reduced activities in ipsilesional SMC, contralesional CMC and PMC after it.
The findings were shown only for the trained movements but not for the untrained ones.
The clinical improvements were associated with the amount of activation change.


Recently, we have developed a new hybrid-rehabilitation combining 5 Hz repetitive transcranial magnetic stimulation and extensor motor training of the paretic upper-limb for stroke patients with flexor hypertonia. We previously showed that the extensor-specific plastic change in M1 was associated with beneficial effects of our protocol (Koganemaru et al., 2010). Here, we investigated whether extensor-specific multiregional brain reorganization occurred after the hybrid-rehabilitation using functional magnetic resonance imaging. Eleven chronic stroke patients were scanned while performing upper-limb extensor movements. Untrained flexor movements were used as a control condition. The scanning and clinical assessments were done before, immediately and 2 weeks after the hybrid-rehabilitation. As a result, during the trained extensor movements, the imaging analysis showed a significant reduction of brain activity in the ipsilesional sensorimotor cortex, the contralesional cingulate motor cortex and the contralesional premotor cortex in association with functional improvements of the paretic hands. The activation change was not found for the control condition. Our results suggested that use-dependent plasticity induced by repetitive motor training with brain stimulation might be related to task-specific multi-regional brain reorganization. It provides a key to understand why repetitive training of the target action is one of the most powerful rehabilitation strategies to help patients.

Growing a Blood Vessel in a Week

If we are going to have a blood supply for any new neurons created via neurogenesis then we also new blood vessels to supply them with nutrients.  What is your doctor doing to ensure that any neurons newly created will survive and become useful? Does your doctor have ANY stroke protocols for stroke rehabilitation?  This is something worth screaming over. If you don't question your doctor on this you're losing your chance to pay it forward to all the following stroke survivors.
The technology for creating new tissues from stem cells has taken a giant leap forward. Three tablespoons of blood are all that is needed to grow a brand new blood vessel in just seven days. This is shown in a new study from Sahlgrenska Acadedmy and Sahlgrenska University Hospital published in EBioMedicine.
Just three years ago, a patient at Sahlgrenska University Hospital received a blood vessel transplant grown from her own stem cells.
Suchitra Sumitran-Holgersson, Professor of Transplantation Biology at Sahlgrenska Academy, and Michael Olausson, Surgeon/Medical Director of the Transplant Center and Professor at Sahlgrenska Academy, came up with the idea, planned and carried out the procedure.
Missing a veinProfessors Sumitran-Holgersson and Olausson have published a new study in EBioMedicine based on two other transplants that were performed in 2012 at Sahlgrenska University Hospital. The patients, two young children, had the same condition as in the first case – they were missing the vein that goes from the gastrointestinal tract to the liver.
"Once again we used the stem cells of the patients to grow a new blood vessel that would permit the two organs to collaborate properly," Professor Olausson says.
Stroke of genius
This time, however, Professor Sumitran-Holgersson, found a way to extract stem cells that did not necessitate taking them from the bone marrow.
"Drilling in the bone marrow is very painful," she says. "It occurred to me that there must be a way to obtain the cells from the blood instead."
The fact that the patients were so young fueled her passion to look for a new approach. The method involved taking 25 milliliter (approximately 2 tablespoons) of blood, the minimum quantity needed to obtain enough stem cells.
Blood willingly cooperates
Professor Sumitran-Holgersson's idea turned out to surpass her wildest expectations – the extraction procedure worked perfectly the very first time.
"Not only that, but the blood itself accelerated growth of the new vein," Professor Sumitran-Holgersson says. “The entire process took only a week, as opposed to a month in the first case. The blood contains substances that naturally promote growth."
More groups of patients can benefit
Professors Olausson and Sumitran-Holgersson have treated three patients so far. Two of the three patients are still doing well and have veins that are functioning as they should. In the third case the child is under medical surveillance and the outcome is more uncertain.
They researchers have now reached the point that they can avoid taking painful blood marrow samples and complete the entire process in the matter of a week.
"We believe that this technological progress can lead to dissemination of the method for the benefit of additional groups of patients, such as those with varicose veins or myocardial infarction, who need new blood vessels," Professor Holgersson says. “Our dream is to be able to grow complete organs as a way of overcoming the current shortage from donors.”

Friday, October 24, 2014

Flint Rehabilitation Devices Introduces MusicGlove, World’s First FDA Approved, Clinically Validated Music-Based Hand Rehabilitation Device

It only took two years from concept to real life use.  This probably wouln't work for me, I don't have enough finger movement and there is no way I could get the glove on my spastic fingers. One drawback is that the game works best for patients who already have moderately high hand dexterity, so folks with more severe impairments will have a harder time playing the game and benefitting from it.
Flint Rehabilitation Devices today introduced MusicGlove™ (#musicglove), the world’s first FDA approved, clinically validated hand rehabilitation (#rehabilitation) device that uses music and gaming to make therapy (#therapy) fun and effective for the over six million people with stroke or other neurological or muscular injuries. The device, which helps increase users’ attention span, neuropsychological scores, cognitive functioning, well-being and recovery, empowers them to regain their independence by delivering a motivating therapy regimen that significantly restores hand function in just two weeks (Friedman et al., 2014). MusicGlove is now available for purchase at in both a Home Version from $1,149.00USD (or $99.00USD/month for twelve months) and a Clinic Version from $4,199.00USD.
“Engaging with music offers a form of therapy that will keep users motivated to continue their rehabilitation regimen, and facilitates a user’s hand’s ability to recover after a stroke”
The device features a sensorized glove that tracks a user’s hand movements. This allows them to play the included therapy-based game by completing specific movements along with scrolling notes displayed on a touch screen console that are timed to the rhythm of upbeat songs (similar to Guitar Hero). These movements, such as ‘pincer grasp’ and ‘key pinch grip,’ are vital to regaining the ability to use the hand after neural damage. MusicGlove motivates a high number of intensive and functional movements that have been proven1 to lead to clinically significant improvements in hand function.
MusicGlove is portable, easy-to-setup and easy-to-use so users can practice effective rehabilitation from the comfort of their home or on the go. Initial setup takes less than two minutes and requires no prior knowledge of how to use a computer. MusicGlove comes with everything needed to get started, right out of the box, including a dedicated 10-inch tablet (Home Version) or a 21-inch monitor (Clinic Version), the Glove, custom headphones, all connection cables and a user manual. MusicGlove is FDA approved for purchase without a prescription so users do not have to wait to start playing their way to a better life!
“Engaging with music offers a form of therapy that will keep users motivated to continue their rehabilitation regimen, and facilitates a user’s hand’s ability to recover after a stroke,” said Nizan Friedman, Ph.D., president and co-founder of Flint Rehabilitation Devices, LLC. “As music is naturally highly repetitive, people using MusicGlove typically make over 2,000 movements in a 45 minute session. In rehab, the number of repetitions is one of the most important factors for regaining hand function. Users involved in clinical studies with the device love MusicGlove and are laughing, singing along, and enjoying the experience while seeing measurable results in a short period of time.”
In addition to being fun and effective, MusicGlove changes the way clinics provide hand therapy. The device requires minimum intervention from a therapist while users play the game, so clinics can provide more intensive group therapy without increasing staff. MusicGlove also records accurate quantitative data that allows therapists to set goals for their patients and track functional improvements over time. The low price and ease of use of MusicGlove is a breath of fresh air for clinics that typically do not have access to other smart rehabilitation technology and equipment that can cost over $50,000USD and require advanced training to use.
Results of a randomized controlled trial of MusicGlove with individuals with stroke published in the Journal of Neuroengineering and Rehabilitation showed that people using MusicGlove had significantly greater improvements in hand function than people doing conventional hand exercises after only two weeks. Users reported regaining the ability to open doorknobs, type on a keyboard, wash dishes, use silverware, bathe and wash themselves, and use the restroom independently after exercising with the device.
“Options for hand therapy are typically limited to using things like play-dough, rubber bands or simply following a handout of exercises,” said Dr. David Reinkensmeyer, professor of Biomedical Engineering at the University of California in Irvine. “People lose motivation to do these exercises and do not recover to their full potential. With MusicGlove, they can have fun with their therapy while receiving quantitative feedback on their performance. This makes it easy for them to stick to their regimen, and when users get better in the game, they are actually improving their hand function.”
Another key unique benefit of MusicGlove is the continuity it provides between users’ home and clinic regimens. People with hand impairment typically only have access to therapy in outpatient clinics for one to two days per week. The rest of the time, they are left without any motivating tools to help them recover. With MusicGlove, users can continue their therapy on their own with ease. When users return to the clinic, therapists can see exactly how much exercise they did at home and how much they improved over the course of the week.
A video showing how MusicGlove works can be viewed at:

Speech and language therapist to trial innovative new technology for stroke rehabilitation based on patient needs

Something to ask your speech therapist about.
Of the 152, 000 individuals in the UK to survive a stroke each year, approximately 20-30% of them will experience slurred speech (dysarthria). Dysarthria is caused by muscle weakness and is known to impact significantly on psychological well-being and recovery after stroke.

The study, led by speech and language therapist Claire Mitchell at Manchester Royal Infirmary (MRI), will pilot an app called ReaDySpeech that Claire developed with funding from Central Manchester University Hospitals NHS Foundation Trust. The app is designed to provide with a more personalised speech and language , as it creates a tailored programme for each individual. The individual programme will then be adapted based on patient feedback, as they work through the programme, depending on how easy or hard they find tasks.
The app is a step away from the traditional therapy where paper worksheets are used, and can be accessed on any device with an internet or Wi-Fi connection, including tablets, PCs and mobile phones. This allows the patient to have more independence around following their rehabilitation programme.
Claire Mitchell, who is also Clinical Education Lead for Speech and Language Therapy at The University of Manchester, explains the reasons behind the ReaDySpeech app: "This study has only come about because of patient feedback to me as a clinician. After patients and families asked for alternatives to paper copies of exercises, I decided to look at other solutions. After consultation we decided we could use technology more broadly to support rehabilitation and this is when I first started to develop the app ReaDySpeech.
"Rehabilitation after a can often be a stressful and frustrating time for patients. I hope that by trialling this app, we have the potential to provide a more personalised therapy plan that will improve their journey to recovery."
By trialling the new technology with a small number of clinicians and patients, Claire aims to collate enough evidence to demonstrate whether the app is acceptable for patients as a form of therapy, and the feasibility of conducting a larger trial of the app therapy. Future research has the potential to reshape how speech therapy services are delivered to provide a better quality of provision with increased levels of support without increasing service costs.
63 year old Alan Moore suffered a serious stroke in 2005 and has since been an active member of the NIHR Clinical Research Network: Stroke speciality. Alan was one of a number of patients to input into the development of the app. Alan explains: "I wish this study and the new system had been available when I was recovering from my stroke.
"As part of my rehabilitation I used paper based resources, which worked well, but I was keen to recover my IT skills which I previously used in my day-to-day life. If this app had been around then, it would have been a perfect opportunity to combine both.
"As part of Claire's research I used the app and found it very user friendly. I was able to follow a course through the exercises at my own speed and progress through them as and when I was ready. I also found it very motivational because as I went through one stage, I really wanted to get on to the next.
Many people live a long way from a rehabilitation centre and this gives them the flexibility to progress in exercises between visits with their therapists, meaning patients have more control over their rehabilitation."

TSRI Scientists Create Mimic of ‘Good’ Cholesterol to Fight Heart Disease and Stroke

These people still don't know about cause and effect. If they would stop the inflammation in the first place you wouldn't have to worry about circulating cholesterol.
Scientists at The Scripps Research Institute (TSRI) have created a synthetic molecule that mimics “good” cholesterol and have shown it can reduce plaque buildup in the arteries of animal models. The molecule, taken orally, improved cholesterol in just two weeks.
This research, published in the October issue of Journal of Lipid Research, points scientists toward a new method for treating atherosclerosis, a condition where plaque buildup in the arteries can cause heart attacks and strokes.
“Atherosclerosis is the number one killer in the developed world,” said TSRI Professor M. Reza Ghadiri, senior author of the new study with TSRI Assistant Professor of Chemistry Luke Leman. “This research clears a big step toward clinical implementation of new therapies.”
Good vs. Bad Cholesterol
To combat atherosclerosis, researchers are looking for new ways to target and remove low-density lipoprotein (LDL) cholesterol (commonly known as “bad” cholesterol) from the body. Though the body needs some LDL to stay healthy, high levels lead to dangerous plaque buildups. In contrast, high-density lipoprotein (HDL) cholesterol (“good” cholesterol) is known for its protective effects.
“HDL is like a taxi in the bloodstream; it takes the LDL cholesterol out of the blood and delivers it to the liver,” said Yannan Zhao, a postdoctoral researcher in Ghadiri’s lab and first author of the new study. From the liver, the LDL is packaged for elimination from the body.
Using a method reported by the researchers last year in the Journal of the American Chemical Society, the team created a “nanopeptide” to have three arm-like structures that can wrap around cholesterol and fats in the blood.
Once the synthetic peptide wraps around LDL cholesterol, it removes it by mimicking the behavior of apoA-1, a protein of HDL, and carrying it to the liver for elimination.
A Surprising Finding
In collaboration with Linda Curtiss, formerly a faculty member at TSRI, and Bruce Maryanoff, formerly at Johnson & Johnson and currently a visiting scholar at TSRI, the researchers tested this synthetic peptide in a mouse model prone to atherosclerosis.
The team originally used the synthetic peptide in an experiment the researchers thought was a gamble. They gave it to mice in their drinking water, but assumed their digestive acids might break down the peptide before it got a chance to interact with its target and modify LDL cholesterol. To their surprise, it worked.
After 10 weeks of treatment, the mice had a 40 percent reduction in potentially harmful cholesterol in their blood and a 50 percent reduction in the size of plaque lesions in their hearts.
“We were definitely surprised at the results in the oral feeding studies,” said Leman. “We’ve repeated it many times.”
Many cholesterol treatments currently in development rely on an injection, not a pill. With the option of an orally effective peptide, Ghadiri believes researchers are closer to developing an accessible new therapy for atherosclerosis.
The researchers also reported no signs of increased inflammation in the blood or toxicity after 10 weeks of the peptide treatment.
Future Studies Point to Gut
Ghadiri and his team are now investigating exactly how the synthetic peptide works in the intestines and the possibility that it interacts with beneficial microbes. The researchers believe that finding new targets in the gastrointestinal tract could lead to new therapies for many more diseases.
“That’s one of the fun things in science—now we get to follow up on these different avenues,” said Leman.
In addition to Ghadiri, Leman, Zhao, Curtiss and Maryanoff, other contributors to the study, “In vivo efficacy of HDL-like nanolipid particles containing multivalent peptide mimetics of apolipoprotein A-1,” are Audrey S. Black and David J. Bonnet of TSRI.
Support for this study came from the National Institutes of Health (HL104462 and HL118114) and the American Heart Association Western States Affiliate. For access to this study, see; the Journal of Lipid Research also published a commentary on the work, available at

GERIATRIC APPLICATIONS OF CRANIOSACRAL THERAPY: Established allied health professionals’ use of a complementary modality

A couple of lines in here on stroke.
Post-stroke and transient ischemic attacks (TIAs)
Therapists spoke about treating clients who have completed their standard rehabilitation post-stroke,
and others who have experienced TIAs. The outcomes they reported included improved
communication, including articulation, as well as improvements in movement, balance and stability
standing, expression, sleep patterns, and elimination. Sometimes the results were striking; one
therapist described a client who took 15 minutes to walk 20 feet to the treatment room making the
return trip after treatment quickly.

Stroke patient with long-standing bursitis in the unaffected shoulder — the
combination resulted in functional limitations. Ultrasound treatments gave
temporary pain relief for the bursitis. CST achieved similar levels of pain
relief, but also improved shoulder mobility leading to increased function.
80-year-old WWII vet with severe bilateral foot pain secondary to multiple

Or another view of CST;

Craniosacral therapy may be helpful, but not curative


I personally can't see any possible way that cerebro spinal fluid could be moved by pressing on the skull without damaging the skull.

Health benefits of dance

Is this one of your doctors stroke protocols? Along with the music needed this could cover a lot of your deficits.

Warning over electrical brain stimulation

TDCS kits available to the public. I've written 20 posts on this so have your doctor tell you whether this is an appropriate intervention/stroke protocol for stroke rehab.
Given the option, would you want to think faster and have sharper attention? Research suggests that electrical brain stimulation kits could have just those effects. But now some companies are selling such devices online, leading to calls to regulate the technology.
It may sound too good to be true but scientists say the technology is promising.
Transcranial direct current stimulation (TDCS), which passes small electrical currents directly on to the scalp, stimulates the nerve cells in the brain (neurons).
It's non-invasive, extremely mild and the US military even uses TDCS in an attempt to improve the performance of its drone pilots.

Start Quote

You need to know how long to stimulate, at what time to stimulate and what intensity to use”
Dr Roy Cohen Kadosh University of Oxford
The idea is that it makes the neurons more likely to fire and preliminary research suggests electrical simulation can improve attention as well as have a positive impact on people with cognitive impairments and depression.
It has also been shown to increase performance in a maths task, an improvement which was still in place six months later.
The scientist behind this work is Dr Roy Cohen Kadosh from the University of Oxford. He uses TDCS to look at how cognitive functions improve.

More at link.

Relationship between zolpidem use and stroke risk and Parkinsons risk.

Check with your doctor on this. An insomnia drug.

Relationship between zolpidem use and stroke risk: a Taiwanese population-based case-control study.

OBJECTIVE: To evaluate the relationship between the use of zolpidem and risk of subsequent stroke in Taiwanese patients.

METHOD: This case-control study used data obtained from the National Health Insurance Research Database to determine whether the use of zolpidem is associated with an increased risk of stroke. The case group comprised 12,747 patients who were newly diagnosed with stroke between January 1, 2005, and December 31, 2009. We also randomly selected a 4-fold greater number of patients without stroke as a control group. Patients with ischemic and hemorrhagic stroke were frequency-matched with controls on sex, age, and year of index date. We measured the effect of zolpidem and determined the adjusted odds ratios (ORs) with 95% confidence intervals (CIs).

RESULTS: We found that exposure to zolpidem was associated with increased risk of ischemic stroke (OR = 1.37; 95% CI, 1.30-1.44). The risk of ischemic stroke increased significantly with increasing exposure to zolpidem; for average exposures of ≤ 70, 71-470, and > 470 mg per year, the ORs were 1.20, 1.41, and 1.50, respectively; the P value for the trend was <.0001. Regardless of whether people presented with a sleep disorder, the risk of stroke was still greatly increased with zolpidem exposure; the adjusted OR was 1.37 without sleep disorder and 1.41 with sleep disorder.

CONCLUSIONS: This population-based study positively associated the use of zolpidem with increased risk of ischemic stroke. Our findings warrant further large-scale and in-depth investigations in this area. 


Zolpidem and the risk of Parkinson's disease: A nationwide population-based study

Apathy and health-related quality of life in stroke

I lay this problem directly at the feet of your doctors. With no path and encouragement to 100% recovery who wouldn't be apathetic?
NARIC Accession Number: J68903.  What's this?
ISSN: 0003-9993.
Author(s): Taylor-Piliae, Ruth E.; Hoke, Tiffany M.; Hepworth, Joseph T.; Latt, L. Daniel; Najaafi, Bijan; Coull, Bruce M..
Publication Year: 2014.
Number of Pages: 9.
Abstract: Study examined the effect of a 12-week Tai Chi (TC) intervention on physical function and quality of life. A total of 145 community-dwelling survivors of stroke, aged 50 years or older, were randomly assigned to: (1) Yang style 24-posture short-form TC; (2) Silver Sneakers (SS), a program of strength and range of movement exercises for older adults; or (3) usual care (UC) for 12 weeks. The TC and SS groups attended a 1-hour class 3 times per week, whereas the UC group had weekly phone calls. Physical function was evaluated using the Short Physical Performance Battery, fall rates, and the 2-minute step test. Quality of life was assessed using the Medical Outcomes Study 36-Item Short-Form Health Survey, Center for Epidemiologic Studies Depression Scale, and Pittsburgh Sleep Quality Index. During the intervention, TC participants had two-thirds fewer falls (5 falls) than the SS (14 falls) and UC (15 falls) groups. There was a significant group-by-time interaction for the 2-minute step test. Post hoc tests indicated that the TC and SS groups had significantly better aerobic endurance over time, though not in the UC group. Intervention adherence rates were 85 percent. TC and SS led to improved aerobic endurance, and both are suitable community-based programs that may aid in stroke recovery and community reintegration. Results suggest that a 12-week TC intervention was more effective in reducing fall rates than SS or UC interventions. Future studies examining the effectiveness of TC as a fall prevention strategy for community-dwelling survivors of stroke are recommended.

In Stroke Rehab, Skip the ABC's - Bilingual Aphasia

People with damaged speech recover faster by focusing on harder words
When we learn, we usually begin with the basics and work our way up, mastering our do-re-mi’s before launching into an aria. But when people have difficulty speaking and understanding language after a stroke—a condition called aphasia—they seem to improve faster when they start at a harder level.
Speech researcher Swathi Kiran of Boston University works with bilingual aphasia patients to help them relearn words. She has found that when pa­tients practice the language they speak less fluently, their vocabulary grows in both languages. But when the patients study words in the language they are more comfortable in, only that language improves.
Although Kiran has not yet pub­lished a study on her bilingual patients, her observation is in line with her ear­lier, published papers and those of other researchers. These studies show that aphasics who speak only one language also benefit from more diffi­cult practice. When aphasics study unusual words in a category—such as “parsnip” and “rutabaga” when relearning vegetable names—they also improve their fluency with common words in that category (“pea” and “carrot”). Likewise, practicing complex sentences helps aphasics handle simple ones.

More behind the paywall.

A more detailed paper here;
Aphasia Therapy in the Age of Globalization: Cross-Linguistic Therapy Effects in Bilingual Aphasia

Cognitive control in the self-regulation of physical activity and sedentary behavior

Your doctor should be an expert at motivating you to get off your butt and exercise. Because unless YOU do the work you won't recover very well.
This might help your doctor create a stroke protocol on motivation. You can always hope your doctor is trainable.
Jude Buckley1, Jason D. Cohen2, Arthur F. Kramer2,3, Edward McAuley2,3 and Sean P. Mullen2,3*
  • 1School of Psychology, University of Auckland, Auckland, New Zealand
  • 2Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
  • 3Beckman Institute for Advanced Science and Technology, Urbana, IL, USA
Cognitive control of physical activity and sedentary behavior is receiving increased attention in the neuroscientific and behavioral medicine literature as a means of better understanding and improving the self-regulation of physical activity. Enhancing individuals’ cognitive control capacities may provide a means to increase physical activity and reduce sedentary behavior. First, this paper reviews emerging evidence of the antecedence of cognitive control abilities in successful self-regulation of physical activity, and in precipitating self-regulation failure that predisposes to sedentary behavior. We then highlight the brain networks that may underpin the cognitive control and self-regulation of physical activity, including the default mode network, prefrontal cortical networks and brain regions and pathways associated with reward. We then discuss research on cognitive training interventions that document improved cognitive control and that suggest promise of influencing physical activity regulation. Key cognitive training components likely to be the most effective at improving self-regulation are also highlighted. The review concludes with suggestions for future research.
For nearly half of a century, researchers have been trying to uncover how to motivate people to become more physically active (Trost et al., 2002; Schutzer and Graves, 2004; Buckworth et al., 2013) and, recently, more effort has been made to understand how to motivate people to be less sedentary (Hamilton et al., 2008). Despite resources devoted to these efforts, more than 30% of the world’s population remains physically inactive (Hallal et al., 2012) and, on average, people are sitting for more than 300 min/day (Bauman et al., 2011). Our understanding of the regulation of these behaviors has advanced, but these prevalence rates suggest that our knowledge of physical activity and sedentary behavior remains incomplete. Research supports theoretical proposals that health behavior is dependent, in part, on self-regulation capacities (Bandura, 1986; De Ridder and de Wit, 2006), but only recently has research attention been directed toward the preceding factors of self-regulation that influence physical activity and sedentary behavior.
Recent theory (e.g., Temporal Self-Regulation Theory; Hall and Fong, 2007, 2010, 2013) and evidence suggest that the relation between physical activity and cognitive control is reciprocal (Daly et al., 2013). Most research has focused on the beneficial effects of regular physical activity on executive functions-the set of neural processes that define cognitive control. Considerable evidence shows that regular physical activity is associated with enhanced cognitive functions, including attention, processing speed, task switching, inhibition of prepotent responses and declarative memory (for reviews see Colcombe and Kramer, 2003; Smith et al., 2010; Guiney and Machado, 2013; McAuley et al., 2013). Recent research demonstrates a dose-response relationship between fitness and spatial memory (Erickson et al., 2011), however the long-term effects of physical activity on working memory have been less consistent (Smith et al., 2010).
Positive physical activity effects on executive function have been found in children for both acute and regular activity (Chang et al., 2012; Hillman et al., in press). For example, findings from a 9-month randomized controlled trial in 221 prepubertal children attending an afterschool physical activity program (vs. a wait-list control group), showed improvements in fitness (VO2peak), cognitive control, and neuroelectrical activity (P3-ERP) during tasks that required significantly more cognitive control (Hillman et al., in press). In addition, a modest dose-response effect of program attendance on cognitive control measures was also found. Improvements in cognitive function are not always observed in older adults (Angevaren et al., 2008) or in children (Janssen et al., 2014) involved in physical activity programs. These findings suggest that the effects of physical activity on cognitive function may depend on the particular cognitive function being assessed. Taken together, this research suggests that physical activity training can enhance cognitive control abilities. The effects of physical activity on cognitive control appear to be underpinned by a variety of brain processes including: increased hippocampal volume, increased gray matter density in the prefrontal cortex (PFC), upregulation of neurotrophins and greater microvascular density (for a review see Voss et al., 2013). Much less is understood about the influence of cognitive control on physical activity but emerging evidence suggests that executive functions play an antecedent role in effective self-regulation of physical activity (Hall et al., 2008; Riggs et al., 2010; McAuley et al., 2011; Daly et al., 2013; Pentz and Riggs, 2013; Best et al., 2014).
The goals of this paper are (1) to review emerging evidence of the antecedence of cognitive control abilities in enabling successful self-regulation for physical activity, and in precipitating self-regulation failures that predispose individuals to remain sedentary; (2) to highlight neural networks that may underlie the cognitive control of physical activity and sedentary behavior; and (3) to review emerging research on training effects on cognitive and physical functioning and summarize components of training that may produce positive cognitive outcomes associated with increased physical activity engagement.

More at link.

Farm to patient food

Will your hospital actually supply healthy food to you while in the hospital?
My diet here: I'll have to add walnuts.

What would a post-stroke diet look like?

2014 Raising Awareness in Stroke Excellence (RAISE) Awards - NSA

More do nothing crap from the NSA. It's about raising awareness, not solving all the problems in stroke. More press release mentality crap.
Mr. Lopez, you have one hell of a lot of work to do to get your stroke organization on track.
Basic Stationery Top - Redesign 2010
Dear dean,
2014 RAISE Award medallionI am thrilled to share with you the 2014 Raising Awareness in Stroke Excellence (RAISE) Awards winners. This national program recognizes individuals and groups for taking stroke awareness activities to new heights.
This year we received 462 nominations, a 40 percent increase from last year! All the candidates represented wonderful happenings occurring across the country to increase stroke awareness.
And without further delay, here are this year’s winners:
  • Most Creative – Mount Carmel Stroke Outreach  
  • Most Impactful – Nancy Hermann
  • Most Impactful Fundraising Community Fundraising Event – Suridis Family
  • Outstanding Group – Bergan Stroke Team
  • Outstanding Individual – Susan Wilson
  • Outstanding Stroke Support Group – Marywood University Aphasia Group
  • Voter’s Choice – Winter Haven Hospital Stroke Support Group
I encourage you to read more about each winner.
We continue to be amazed at the passion and work put forth by everyone with regards to raising stroke awareness. We thank all the winners and nominees for their efforts and inspiration.
signed by Matt Lopez, CEO
Matt Lopez
Chief Executive Officer

New report on cardiovascular deaths reaffirms need for prevention - Australia

And by doing this they actually don't have to do any of the hard work of solving all of the problems in stroke. It's good to be able to 'blame the patient'. You don't have to actually do your job of figuring out how to solve the difficult problems in stroke. Damn you all to hell for sitting on the sidelines tut-tutting about the stroke you caused yourself.

Inspire Others with Your Story

More feel good crap email from the ASA. My inspiration for others is this blog post.
If you just had a stroke, You are F*cking screwed

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SC e-Extra / A Digital Monthly Newsletter from Strokeconnection Inspire Others with Your Story

October 24, 2014
Stroke connects many of us - perhaps it touched your life directly, or that of a family member or friend. Despite the challenging times, you can use your story and make a meaningful difference in the lives of others.
One in three Americans still cannot recall any of the stroke warning signs. We have made a lot of progress, but still have a ways to go to end stroke.
We need your help! This October 29th, in honor of World Stroke Day, we encourage you to inspire others with your story. Ask your family and friends to learn what a stroke looks like. Ask them to download our F.A.S.T. mobile app. It reminds them of the warning signs with an easy acronym-F.A.S.T. (Face drooping, Arm weakness, Speech difficulty, Time to call 9-1-1)-and shows them the nearest award-winning hospitals.