Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 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:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. 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 lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Monday, March 18, 2024

Temperature management in acute brain injury: A narrative review

Is your competent? doctor and hospital going to contact stroke leadership to get this question solved in the form of creating a protocol? Or will they DO NOTHING LIKE USUAL?

Temperature management in acute brain injury: A narrative review

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https://doi.org/10.1016/j.medine.2024.03.001Get rights and content
Refers to
Medicina Intensiva, Available online 15 March 2024, Pages
Eva Esther Tejerina Álvarez, José Ángel Lorente Balanza

Abstract

Temperature management has been used in patients with acute brain injury resulting from different conditions, such as post-cardiac arrest hypoxic-ischaemic insult, acute ischaemic stroke, and severe traumatic brain injury. However, current evidence offers inconsistent and often contradictory results regarding the clinical benefit of this therapeutic strategy on mortality and functional outcomes. Current guidelines have focused mainly on active prevention and treatment of fever, while therapeutic hypothermia (TH) has fallen into disuse, although doubts persist as to its effectiveness according to the method of application and appropriate patient selection. This narrative review presents the most relevant clinical evidence on the effects of TH in patients with acute neurological damage, and the pathophysiological concepts supporting its use.

Two Cases Showing That Cilostazol Administration Leads to an Increase in Cerebral Blood Flow and Has a Positive Effect on Rehabilitation

Didn't your competent? doctor create a protocol on its' use a long time ago? NO? Then why are you seeing an incompetent doctor? And why is the board of directors still employing an incompetent doctor?

In my opinion competent doctors are up-to-date on ALL stroke research! No excuses allowed!

 

Two Cases Showing That Cilostazol Administration Leads to an Increase in Cerebral Blood Flow and Has a Positive Effect on Rehabilitation

Shuji Matsumoto Rintaro OhamaTakashi HoeiRyuji TojoToshihiro Nakamura

Published: March 18, 2024

DOI: 10.7759/cureus.56376 

  Peer-Reviewed

Cite this article as: Matsumoto S, Ohama R, Hoei T, et al. (March 18, 2024) Two Cases Showing That Cilostazol Administration Leads to an Increase in Cerebral Blood Flow and Has a Positive Effect on Rehabilitation. Cureus 16(3): e56376. doi:10.7759/cureus.56376

Abstract

Cilostazol is a drug that has both antiplatelet and vasodilatory effects. To examine the effects of cilostazol on cerebral blood flow and rehabilitation following stroke, cilostazol was administered to two patients with chronic atherothrombotic cerebral infarction. In both patients, cilostazol administration effectively increased cerebral blood flow and promoted rehabilitation. Therefore, cilostazol was considered to be a useful agent for improving the clinical condition of patients suffering from chronic cerebral infarction. Further clinical studies on the effective use of cilostazol for rehabilitation in stroke patients are needed.

Introduction

Although the mortality rate as a result of stroke is declining, the incidence of stroke itself is increasing. As a result, the number of patients with chronic cerebral infarction is also rising, such that the clinical management of this condition is likely to become a major future health issue. The global number of deaths from stroke is projected to increase from 2.04 million to 3.29 million between 1990 and 2019 and to 4.9 million by 2030 [1].

There is now widespread evidence that antiplatelet drugs are an effective treatment for atherothrombotic cerebral infarction [2], but there are currently no indices as to what types of antiplatelet drugs are most effective or at what stage they should be administered. In addition to an antiplatelet effect [3] due to cyclic guanosine monophosphate (cGMP)-inhibited phosphodiesterase, cilostazol also reportedly has pleiotropic and vasodilatory effects [4,5], improves vascular endothelial function [6] and suppresses vascular smooth muscle growth [7]. Cilostazol reportedly enhances cerebral blood flow in cases of chronic cerebral infarction [8]. However, its effects on physiological functions, the performance of activities of daily living (ADL), and cognitive function have not been investigated previously.

We administered cilostazol to two patients with chronic atherothrombotic cerebral infarction and evaluated the effects of the drug on cerebral blood flow and rehabilitation.

More at link.

Effects of Physical Rehabilitation With X-Sens Inertial Technology Feedback on Posterior Cerebral Artery Infarcts: A Case Study

FYI.

Effects of Physical Rehabilitation With X-Sens Inertial Technology Feedback on Posterior Cerebral Artery Infarcts: A Case Study

Anisha K. SawraH V Sharath Nitika Chavan

Published: March 18, 2024

DOI: 10.7759/cureus.56379 

  Peer-Reviewed

Cite this article as: Sawra A K, Sharath H, Chavan N (March 18, 2024) Effects of Physical Rehabilitation With X-Sens Inertial Technology Feedback on Posterior Cerebral Artery Infarcts: A Case Study. Cureus 16(3): e56379. doi:10.7759/cureus.56379

Abstract

Acute ischemic stroke (AIS) affecting the posterior cerebral artery (PCA) represents a unique clinical challenge, necessitating a multifaceted approach to rehabilitation. This review aims to provide a comprehensive overview of physiotherapeutic interventions tailored specifically for individuals with AIS involving the PCA territory. The PCA supplies critical areas of the brain responsible for visual processing, memory, and sensory integration. Consequently, patients with PCA infarcts often exhibit a distinct set of neurological deficits, including visual field disturbances, cognitive impairments, and sensory abnormalities. This case report highlights evidence-based physiotherapy strategies that encompass a spectrum of interventions, ranging from early mobilization and motor training to sensory reintegration and cognitive rehabilitation. Early mobilization, including bed mobility exercises and upright activities, is crucial to prevent complications associated with immobility. Motor training interventions target the restoration of functional movement patterns, addressing hemiparesis and balance impairments.

Introduction

Cerebrovascular diseases, with stroke in their first place, are the most common neurological diseases of adults. They belong to chronic, mass non-infectious diseases. Stroke is an illness in which one or more blood vessels supplying the brain with oxygen and nutrients are damaged by a pathological process, and consequently, there is damage to the brain parenchyma [1]. Despite the obvious improvements in the prevention, diagnosis, treatment, and rehabilitation of persons with stroke, it still holds third place as the cause of death, after cardiovascular and malignant diseases. New studies based on an examination of the global burden of illness, the incidence, and death brought on by this disease worldwide also support these statistics [2].

Each interruption of blood flow (ischemia) to the brain means the discontinuation of oxygen and nutrient flow, and since nerve cells do not have a stock of nutrients, the disruption of blood flow leads to the cell's energy crisis. Ischemia can be global or regional, but an important point is the degree of ischemia compared to the normal flow and duration of ischemia. The higher the degree of ischemia and longer lasting, is more likely to occur irreversible changes which end in death (necrosis) of nerve cells [3]. There are two primary artery systems that provide blood to the brain: the anterior and posterior circulations.

The deep branches of the anterior and middle cerebral arteries (ACA and MCA) and the internal carotid artery (ICA) make up the anterior carotid circulation system. This confluence blood supplies nourishment to the orbit and most of the cerebral hemispheres, excluding the occipital lobe and a small area of the thalamus [4]. The vertebral artery, basilar artery, rear cerebral artery, and its branches make up the posterior circulation. They nourish the occipital lobe, a portion of the thalamus, the medio-inferior temporal lobe, and the majority of the brain stem [5].

The major objective of stroke patients' rehabilitation is to help them regain their social and personal identities as well as their maximal functional ability in everyday activities. For those over 60, stroke is the primary cause of rehabilitation as well as the primary source of functional disability [6]. Studies have shown that 10-20% of those who experience an ischemic stroke die somewhat soon after the stroke. The purpose of this study is to assess anterior circulation syndrome patients' functional recovery following their original ischemic stroke, the acute and post-acute phases of posterior circulation syndrome, and the chronic phase of physical therapy and rehabilitation [7].

Case Presentation

Patient information

The patient, a 44-year-old woman with a dominant right extremity, said she was unable to move her lower limb limbs or trunk and was taken to the hospital. She was too weak to walk, sit, or stand, had visual disturbances, and also had trouble doing activities of daily living (ADLs). A year prior, the patient suffered an ischemic stroke that left her with a quick onset of headache, difficulty speaking, and collapse from loss of consciousness. Seven days back, the patient started complaining of bilateral lower limb weakness, unable to sit, stand, or walk and decreased vision, slurred speech. The patient was immediately rushed to the hospital where investigations like CT brain and MRI brain were done which revealed chronic lacunar infracts involving bilateral corona radiata and ganglio-capsular region involved. The patient was admitted to the neuro ICU for 10 days and the patient was on 2 liters of O2 via nasal prongs, she was referred to neuro physiotherapy for further management, where the assessment was done, and according to the problem list, tailored physiotherapy rehabilitation was given.

Clinical finding

After admitting to the neuro ICU, the patient appeared unconscious, so a thorough examination was done. At first, mental state examination was not possible since the patient was unable to communicate. She was unable to speak or communicate. The inability to speak additionally impeded the sensory evaluation. Comprehensive evaluations were conducted on motor assessment, spasticity, and soft tissue compliance. Bilateral lower limb spasticity was graded 1+ (hypotonia), In the case of the shoulder, elbow, wrist, and hip flexors, and grade 3+ (hypertonia), in the case of the knee and ankle plantar flexors (Table 1).

 

 
More at link.

A longevity expert shares 3 tips for a nutritious anti-aging breakfast

How long before your competent? doctor gets the dietician to incorporate this into your hospital diet?  NEVER? Then you don't have a functioning stroke doctor. I don't know what you have but it's not a stroke doctor you want to have.

A longevity expert shares 3 tips for a nutritious anti-aging breakfast

  • Longevity expert Valter Longo developed the longevity diet, which is essentially "vegan plus fish."
  • Here, he offers tips on putting together a longevity-boosting breakfast.
  • He recommends including lots of food groups and getting creative with ingredients.

An expert in longevity told Insider his three tips for making healthy, enjoyable breakfasts with anti-aging benefits.

Valter Longo is a professor in gerontology and director of the USC Longevity Institute who developed the longevity diet — a diet that he says is essentially "vegan plus fish." The longevity diet is rich in legumes, whole grains, nuts, and seeds, and relatively low in protein. The diet's principles are based on Longo's own research on populations around the world that live especially long lives.

It also includes periods of fasting, and encourages as much walking as possible to mimic the habits of centenarians living traditionally active lifestyles.

Here are Longo's tips for making nutritious breakfasts to help improve longevity.

Eat a breakfast that contains multiple food groups

First of all, "you have to have breakfast," Longo said.

A healthy breakfast on the longevity diet might contain whole grains, nuts, and fruit.

Longo himself likes to have friselle, a whole-grain bread from Italy, with a nut spread containing almond and cocoa, as well as an apple.

Almond butter is one of the healthiest nut butters as long as it doesn't contain added sugar, dietitian Allison Childress previously told Insider, because it contains vitamins and minerals such as vitamin E, magnesium, and calcium.

Make sure you eat things you enjoy

You shouldn't put pressure on yourself to eat things that you won't enjoy just because they are good for you; Longo said that whatever you eat should "be a version of what you like based on the general rules" of the longevity diet, not necessarily what he would eat.

For example, Longo's fig, nut, and cornmeal "cookies," or baked oats with fruit and nuts, could be good options.

Dietitian Danielle Smith previously told Insider that there's no point trying to force yourself to eat something if it doesn't make you feel good or you just don't like it, as this will make it harder to maintain the switch to a healthy diet over time. It's much better to "focus on other nutrient dense foods" that you do like, she said.

Don't be afraid of making changes to get more nutrients in your breakfast

In the same vein, Longo makes changes to his breakfasts to get more nutrients in without sacrificing taste.

He makes his morning cup of tea with two tea bags: one green tea bag and one black. This is because "the green doesn't taste as good as the black," he said, but he can still reap the nutritional benefits of the green tea.

Green tea has been linked to better brain function and heart health, lower cholesterol, improved bone strength, and even anti-aging skin effects.

Insider previously reported on healthy alternatives to popular breakfast items that you can easily switch out to make your favorite breakfast more nutritious

St. John's Rehab(Toronto, Ontario) Recognized as a Leading Practice for Optimizing Virtual Care in Outpatient Rehab

You do realize survivors want recovery NOT 'CARE'?  Or does this hospital not know that survivors want 100% recovery? Are they that fucking stupid? And their board of directors is OK with such incompetence? 12 references to 'care'; NOT a single reference to recovery!

Oops, I'm not playing by the polite rules of Dale Carnegie,  'How to Win Friends and Influence People'. 

Telling supposedly smart stroke medical persons they know nothing about stroke survivors is a no-no even if it is true. 

Politeness will never solve anything in stroke. Yes, I'm a bomb thrower and proud of it. Someday a stroke 'leader' will try to ream me out for making them look bad by being truthful, I look forward to that day.

St. John's Rehab(Toronto, Ontario) Recognized as a Leading Practice for Optimizing Virtual Care in Outpatient Rehab

March 18, 2024

In the face of the global pandemic, the Outpatient (OP) department at St. John’s Rehab took bold steps to ensure continuity in patient care by implementing virtual care for stroke patients. As the world slowly returned to in-person appointments, the department didn't just abandon virtual care; instead, they embarked on a ground-breaking journey to make virtual care a permanent fixture in their toolkit, leading to their recent recognition as a Leading Practice for Optimizing Virtual Care in Outpatient Rehab by Health Standards Organization.

The initiative was founded on the principles of patient-centeredness, appropriateness, goal-based care, efficacy, efficiency, and best practices for virtual care. Drawing from resources like the Canadian Stroke Best Practices Recommendations for Virtual Care (2020) and the Toronto Rehab Telerehab Toolkit V1 (2020), the OP team created an infrastructure that not only bridged the immediate challenges posed by the pandemic but also enhanced the way outpatient rehabilitation is delivered.

A steering committee was formed, comprising the OP patient care manager, project manager, OT/PT/SLP professional practice leaders, a patient partner, and a Toronto Stroke Network (TSN) representative. This committee conducted an extensive review of best practices, available resources, and an environmental scan, with feedback sought from current patients and clinicians through online surveys and follow-up meetings. The neuro team mapped the current and future states of the program, identifying 14 improvement opportunities that were prioritized using an effort-impact matrix.

These improvement opportunities were then distributed among four interprofessional working groups, ensuring a holistic approach with patient representation. Patient engagement was a key focus, aligning with Health Quality Ontario’s Patient Engagement Framework.

Post-implementation, the impact on clinicians was significant. Surveys and structured research interviews revealed increased knowledge and satisfaction with VC tools, leading to a greater willingness to provide VC. Clinicians noted the potential of VC in addressing transportation challenges, involving family/caregivers in therapy sessions, and extending geographical reach to patients residing farther from the hospital.

Patients echoed these sentiments, highlighting the flexibility in scheduling, improved patient-oriented care, and the unique advantage of assessments within their home environment. VC became a catalyst for earlier access, enhanced patient-centeredness, interprofessional collaboration, and effective discharge planning.

The success of this initiative aligns seamlessly with St. John’s Rehab’s Strategic plan under the "Innovating Our Work" section. With virtual care infrastructure in place, St. John’s Rehab’s OP team has set a new standard for outpatient rehabilitation, ensuring that the benefits of virtual care are maximized to deliver efficient, patient-centered, and holistic rehabilitation services.