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 493 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

Thursday, April 19, 2018

Constraint-induced movement therapy in stroke patients. A systematic review

These are a total waste of time until we finally get stroke protocols written up.  
https://search.naric.com/research/rehab/redesign_record.cfm?search=2&type=all&criteria=I243968&phrase=no&rec=243968&article_source=CIRRIE&international=1&international_language=&international_location=
Terapia por restricción del lado sano en pacientes con ictus. Revisión sistemática.  Rehabilitación , Volume 51(4) , Pgs. 234-246.

NARIC Accession Number: I243968.  What's this?
Author(s): M.J. Mateos-Serrano; I. Calvo-Mu˜noz.
Publication Year: 2017.
Abstract: The aim of this study was to determine the effectiveness of constraint-induced movement therapy (CIMT) in patients with hemiparesis/hemiplegia following stroke and to analyze the main characteristics of CIMT in patients with stroke. A literature review was performed of experimental studies published up to February 2016. Among other search procedures, a search was carried out in different electronic databases. Selection criteria were as follows: the included studies had to be randomized clinical trials, and individuals had to be older than 18 years and to have been treated with CIMT after being diagnosed with subacute or chronic stroke. Twelve articles were included, thus providing 12 treatment groups and 12 control groups. The total sample consisted of 435 individuals divided into 2 groups: 219 persons in treatment groups and 216 individuals in control groups. The oldest study was conducted in 2010 and the most recent in 2015. Results indicate that CIMT is an effective alternative treatment for the rehabilitation of stroke patients, and the benefits can be observed at both the physical and functional levels.
Descriptor Terms: Adults, Hemiplegia, Movement therapy, Stroke, Treatment.
Language: Spanish
Geographic Location(s): Europe, Spain.

Can this document be ordered through NARIC's document delivery service*?: Request Information.
Get this Document: http://dx.doi.org/10.1016/j.rh.2017.01.001.

Citation: M.J. Mateos-Serrano, I. Calvo-Mu˜noz. (2017). Constraint-induced movement therapy in stroke patients. A systematic review.  Terapia por restricción del lado sano en pacientes con ictus. Revisión sistemática.  Rehabilitación , 51(4), Pgs. 234-246. Retrieved 4/19/2018, from REHABDATA database.


* The majority of journal articles, books, and reports in our collection are only available by regular mail, rather than downloadable electronic format. Learn more about our digital collection and our document delivery service.

More information about this publication: There are no references related to this document.

A systematic review of mechanisms of gait speed change post-stroke. Part 2: Exercise capacity, muscle activation, kinetics, and kinematics

So still no clue as to what rehab creates functional gains. Once again everything in your recovery is up to you. You find the appropriate research and deduce what the protocol is. What the fuck is your doctor for?
https://search.naric.com/research/rehab/redesign_record.cfm?search=2&type=all&criteria=J78167&phrase=no&rec=136199&article_source=Rehab&international=0&international_language=&international_location=
Topics in Stroke Rehabilitation , Volume 24(5) , Pgs. 394-403.

NARIC Accession Number: J78167.  What's this?
ISSN: 1074-9357.
Author(s): Wonsetler, Elizabeth C.; Bowden, Mark G..
Publication Year: 2017.
Number of Pages: 10.
Abstract: This systematic review explored potential mechanisms of change that may explain improvements in gait speed and quantify motor recovery following physical therapy interventions in the stroke population. PubMed, Ovid, and CINAHL databases were searched relevant rehabilitation trials with a statistically significant change in self-selected walking speed post-intervention that concurrently collected mechanistic variables. Twenty-five studies met the inclusion criteria and examined. Methodological quality was assessed using Cochrane Collaboration’s tool. Walking speed changes, mechanistic variables, and intervention data were extracted. The physical therapy interventions used within the included studies that were found to produce improvements in gait speed were: cardiorespiratory function, muscle activation, force production, and movement analysis. Interventions included: aerobic training, functional electrical stimulation, multidimensional rehabilitation, robotics, sensory stimulation training, strength/resistance training, task-specific locomotor rehabilitation, and visually-guided training. No systematic approach or set of outcome measures to mechanistically explain changes observed in walking speed were identified. Nor is there a theoretical basis to drive the complicated selection of outcome measures, as many of these outcomes are not independent of walking speed. Since rehabilitation literature has not yet identified a causal, mechanistic link for post-stroke functional gains, a systematic, multimodal approach to stroke rehabilitation will be necessary in doing so.
Descriptor Terms: AMBULATION, BIOENGINEERING, ELECTROPHYSIOLOGY, EXERCISE, LITERATURE REVIEWS, OUTCOMES, PHYSICAL THERAPY, REHABILITATION SERVICES, STROKE, THERAPEUTIC TRAINING.


Can this document be ordered through NARIC's document delivery service*?: Y.

Citation: Wonsetler, Elizabeth C., Bowden, Mark G.. (2017). A systematic review of mechanisms of gait speed change post-stroke. Part 2: Exercise capacity, muscle activation, kinetics, and kinematics.  Topics in Stroke Rehabilitation , 24(5), Pgs. 394-403. Retrieved 4/19/2018, from REHABDATA database.


* The majority of journal articles, books, and reports in our collection are only available by regular mail, rather than downloadable electronic format. Learn more about our digital collection and our document delivery service.

More information about this publication:
Topics in Stroke Rehabilitation.

The effect of water-based exercises on balance in persons post-stroke: A randomized controlled trial

I loved my water based therapy that I did on my own at the 'Y'. The hospital pool was closed years prior to my stroke.  When I was in Ecuador I did several sessions of therapy just standing in knee deep water and adjusting to the waves pounding my legs. By putting my impaired leg in front and standing sideways I could get to mid-thigh water and still stay upright.
https://search.naric.com/research/rehab/redesign_record.cfm?search=2&type=all&criteria=J78153&phrase=no&rec=136185&article_source=Rehab&international=0&international_language=&international_location=
Topics in Stroke Rehabilitation , Volume 24(4) , Pgs. 228-235.

NARIC Accession Number: J78153.  What's this?
ISSN: 1074-9357.
Author(s): Chan, Kelvin; Phadke, Chetan P.; Stremler, Denise; Suter, Lynn; Pauley, Tim; Ismail, Farooq; Boulias, Chris.
Publication Year: 2017.
Number of Pages: 8.
Abstract: Study examined the effect of water-based exercises compared to land-based exercises on the balance of stroke patients discharged inpatient neurological rehabilitation and referred to outpatient physical therapy. Thirty-two patients with first-time stroke were randomized into water-based plus land (WL) or land only (L) exercise groups. Both groups attended therapy two times per week for six weeks. Initial and progression protocols for the water-based exercises (a combination of balance, stretching, and strengthening, and endurance training) and land therapy (balance, strength, transfer, gait, and stair training) were devised. Outcome measures included the Berg Balance Score, Community Balance and Mobility Score, Timed Up and Go Test, and 2-Minute Walk Test. Baseline characteristics of the WL and L groups were similar in age, side of stroke, time since stroke, and wait time between inpatient discharge and outpatient therapy on all four outcome measures. Pooled change scores from all outcomes showed that significantly greater number of patients in the WL group showed improvement post-training compared to the L group. More patients in the WL group showed change scores exceeding the published minimal detectable change scores. The results indicate that a combination of water- and land-based exercises has potential for improving balance. The findings of this study extend the research showing benefit of water-based exercise in chronic and less-impaired stroke groups to patients with sub-acute stroke.
Descriptor Terms: AMBULATION, EQUILIBRIUM, EXERCISE, MOBILITY IMPAIRMENTS, PHYSICAL THERAPY, POSTURE, STROKE.


Can this document be ordered through NARIC's document delivery service*?: Y.

Citation: Chan, Kelvin, Phadke, Chetan P., Stremler, Denise, Suter, Lynn, Pauley, Tim, Ismail, Farooq, Boulias, Chris. (2017). The effect of water-based exercises on balance in persons post-stroke: A randomized controlled trial.  Topics in Stroke Rehabilitation , 24(4), Pgs. 228-235. Retrieved 4/19/2018, from REHABDATA database.


* The majority of journal articles, books, and reports in our collection are only available by regular mail, rather than downloadable electronic format. Learn more about our digital collection and our document delivery service.

More information about this publication:
Topics in Stroke Rehabilitation.

The use of virtual reality for balance among individuals with chronic stroke: A systematic review and meta-analysis

Once again this should have been totally unnecessary since that public database of all continually updated stroke research would have this. But since we have NO stroke leadership and NO stroke strategy we get wastes of time like this all the time.
https://search.naric.com/research/rehab/redesign_record.cfm?search=2&type=all&criteria=J78141&phrase=no&rec=136173&article_source=Rehab&international=0&international_language=&international_location=
Topics in Stroke Rehabilitation , Volume 24(1) , Pgs. 68-79.

NARIC Accession Number: J78141.  What's this?
ISSN: 1074-9357.
Author(s): Iruthayarajah, Jerome; McIntyre, Amanda; Cotoi, Andreea; Macaluso, Steven; Teasell, Robert.
Publication Year: 2017.
Number of Pages: 12.
Abstract: Study evaluated the evidence on the effectiveness of virtual reality interventions for improving balance among individuals with chronic stroke (≥6 months). Pubmed, Scopus, CINAHL, Embase, Psycinfo, and Web of Science databases were searched for randomized controlled trials published in English up to September 2015 assessing balance with virtual reality in chronic stroke participants. Mean and standard deviations from outcome measures were extracted. Pooled standard mean differences were calculated for the Berg Balance Scale (BBS) and the Timed Up and Go test (TUG). In total, 20 of the 984 articles identified met inclusion criteria: 7 examine the Nintendo® Wii Fit balance board, 7 examined treadmill training and virtual reality, and 6 examined postural training using virtual reality. The results from the meta-analyses demonstrate that patients receiving virtual reality treatment improved significantly on the BBS and the TUG compared to those receiving conventional rehabilitation. Furthermore, static balance outcomes significantly improved following virtual reality rehabilitation. Altogether, these results suggest that virtual reality interventions promote the recovery of impaired balance in chronic stroke patients more effectively than conventional rehabilitation.
Descriptor Terms: AMBULATION, COMPUTER APPLICATIONS, EQUILIBRIUM, LITERATURE REVIEWS, MOBILITY TRAINING, OUTCOMES, POSTURE, REHABILITATION TECHNOLOGY, STROKE.


Can this document be ordered through NARIC's document delivery service*?: Y.

Citation: Iruthayarajah, Jerome, McIntyre, Amanda, Cotoi, Andreea, Macaluso, Steven, Teasell, Robert. (2017). The use of virtual reality for balance among individuals with chronic stroke: A systematic review and meta-analysis.  Topics in Stroke Rehabilitation , 24(1), Pgs. 68-79. Retrieved 4/19/2018, from REHABDATA database.


* The majority of journal articles, books, and reports in our collection are only available by regular mail, rather than downloadable electronic format. Learn more about our digital collection and our document delivery service.

More information about this publication:
Topics in Stroke Rehabilitation.

The effect of self-management education following mild stroke: An exploratory randomized controlled trial.

Every stroke survivor has to do self management of their recovery. Your doctor and therapists have no clue how to get you 100% recovered. You are completely on your own, but your doctor won't tell you that. 
https://search.naric.com/research/rehab/redesign_record.cfm?search=2&type=all&criteria=J78164&phrase=no&rec=136196&article_source=Rehab&international=0&international_language=&international_location=
Topics in Stroke Rehabilitation , Volume 24(5) , Pgs. 345-352.

NARIC Accession Number: J78164.  What's this?
ISSN: 1074-9357.
Author(s): Wolf, Timothy J.; Spiers, Meredith J.; Doherty, Meghan; Leary, Emily V..
Publication Year: 2017.
Number of Pages: 8.
Abstract: Study evaluated the feasibility and preliminary effects of the Chronic Disease Self-Management Program (CDSMP) for use with individuals immediately post mild-stroke. The CDSMP is an education program based on the concept of self-management and is focused on three primary goals: medical management; (2) role management; and (3) emotional management. Participants were randomized to either receive the CDSMP intervention or to an inactive control group. The CDSMP was delivered by two licensed occupational therapists who were certified facilitators. Primary outcomes were self-reported health and self-efficacy and were obtained at baseline, post-intervention (treatment group only), and at six months post-baseline. Wilcoxon signed rank tests were used to compare change score differences for all participants and effect size was computed using effect size for non-parametric data. There were no differences between groups in demographics or baseline data with the exception of how participants felt they are able to manage their health in general. At follow-up, effect sizes ranged from 0 to 0.35 (no effect to medium effect); however, while the treatment group reported improvements in several areas of health at follow-up, the results are not compelling when compared to the control group over the same time period. This study did not identify a positive effect that would support the use of the CDSMP with individual’s post-mild stroke; however, the generalizability of these results is limited secondary to several limitations in this exploratory study.
Descriptor Terms: DISABILITY MANAGEMENT, FEASIBILITY STUDIES, OCCUPATIONAL THERAPY, PATIENT EDUCATION, PROGRAM EVALUATION, REHABILITATION SERVICES, SELF CARE, STROKE.


Can this document be ordered through NARIC's document delivery service*?: Y.

Citation: Wolf, Timothy J., Spiers, Meredith J., Doherty, Meghan, Leary, Emily V.. (2017). The effect of self-management education following mild stroke: An exploratory randomized controlled trial.  Topics in Stroke Rehabilitation , 24(5), Pgs. 345-352. Retrieved 4/19/2018, from REHABDATA database.


* The majority of journal articles, books, and reports in our collection are only available by regular mail, rather than downloadable electronic format. Learn more about our digital collection and our document delivery service.

More information about this publication:
Topics in Stroke Rehabilitation.

Validating accelerometry as a measure of physical activity and energy expenditure in chronic stroke.

If your doctor and therapists aren't doing this they have no objective idea of the movements you are doing. With NO objective diagnosis of your disability they will never be able to map protocols to recovery. 
https://search.naric.com/research/rehab/redesign_record.cfm?search=2&type=all&criteria=J78135&phrase=no&rec=136167&article_source=Rehab&international=0&international_language=&international_location=
Topics in Stroke Rehabilitation , Volume 24(1) , Pgs. 18-23.

NARIC Accession Number: J78135.  What's this?
ISSN: 1074-9357.
Author(s): Serra, ; Balraj, Elizabeth; DiSanzo, Beth L.; Ivey, Frederick M.; Hafer-Macko, Charlene E.; Treuth, Margarita S.; Ryan, Alice S..
Publication Year: 2017.
Number of Pages: 6.
Abstract: Study determined count thresholds for the Actical brand accelerometer specific to stroke disability in order to more accurately estimate time spent at differing activity levels. Eighteen men and 10 women with chronic hemiparetic gait participated in the study. Actical accelerometers were placed on the participants’ non-paretic hip to obtain accelerometry counts during eight activities of varying intensity: (1) watching TV; (2) seated stretching; (3) standing stretching; (4) floor sweeping; (5) stepping in place; (6) over-ground walking; (7) lower-intensity treadmill walking (1.0 mph at 4-percent incline); and (8) higher-intensity treadmill walking (2.0 mph at 4-percent incline). Simultaneous portable monitoring enabled quantification of energy cost for each activity in metabolic equivalents (oxygen consumption in multiples of resting level). Measurements were obtained for 10 minutes of standard rest and 5 minutes during each of the eight activities. Regression analysis yielded the following new stroke-specific Actical minimum thresholds: 125 counts per minute (cpm) for sedentary/light activity, 667 cpm for light/moderate activity, and 1,546 cpm for moderate/vigorous activity. The authors conclude that the standard, commonly applied Actical thresholds are inappropriate for this unique population. The revised cut points better reflect activity levels after stroke and suggest significantly lower thresholds relative to those observed for the general population of healthy individuals.
Descriptor Terms: AMBULATION, BODY MOVEMENT, CARDIOPULMONARY FUNCTION, EVALUATION TECHNIQUES, EXERCISE, MEASUREMENTS, MEDICAL TECHNOLOGY, PERFORMANCE STANDARDS, STROKE.


Can this document be ordered through NARIC's document delivery service*?: Y.

Citation: Serra, Validating accelerometry as a measure of physical activity and energy expenditure in chronic stroke.  Topics in Stroke Rehabilitation , 24(1), Pgs. 18-23. Retrieved 4/19/2018, from REHABDATA database.


* The majority of journal articles, books, and reports in our collection are only available by regular mail, rather than downloadable electronic format. Learn more about our digital collection and our document delivery service.

More information about this publication:
Topics in Stroke Rehabilitation.

Research indicates there is not enough patient centricity and patient engagement in research protocols for kidney disease.

I haven't seen any calls for stroke survivor involvement in any stroke research. Until that occurs most stroke research is totally fucking useless. All primary measures should be set by survivors.
https://patientengagementhit.com/news/patient-engagement-low-in-patient-centered-research-protocol

Haemostatic therapies for acute spontaneous intracerebral haemorrhage

No clue what this means. 
http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD005951.pub4/full?platform=hootsuite



Authors

Abstract



Background

Outcome after spontaneous (non-traumatic) intracerebral haemorrhage (ICH) is influenced by haematoma volume; up to one-third of ICHs enlarge within 24 hours of onset. Early haemostatic therapy might improve outcome by limiting haematoma growth. This is an update of a Cochrane Review first published in 2006, and last updated in 2009.

Objectives

To examine 1) the effectiveness and safety of individual classes of haemostatic therapies, compared against placebo or open control, in adults with acute spontaneous intracerebral haemorrhage, and 2) the effects of each class of haemostatic therapy according to the type of antithrombotic drug taken immediately before ICH onset (i.e. anticoagulant, antiplatelet, or none).

Search methods

We searched the Cochrane Stroke Trials Register, CENTRAL; 2017, Issue 11, MEDLINE Ovid, and Embase Ovid on 27 November 2017. In an effort to identify further published, ongoing, and unpublished randomised controlled trials (RCT), we scanned bibliographies of relevant articles and searched international registers of RCTs in November 2017.

Selection criteria

We sought randomised controlled trials (RCTs) of any haemostatic intervention (i.e. pro-coagulant treatments such as coagulation factors, antifibrinolytic drugs, or platelet transfusion) for acute spontaneous ICH, compared with placebo, open control, or an active comparator, reporting relevant clinical outcome measures.

Data collection and analysis

Two authors independently extracted data, assessed risk of bias, and contacted corresponding authors of eligible RCTs for specific data if they were not provided in the published report of an RCT.

Main results

We included 12 RCTs involving 1732 participants. There were seven RCTs of blood clotting factors versus placebo or open control involving 1480 participants, three RCTs of antifibrinolytic drugs versus placebo or open control involving 57 participants, one RCT of platelet transfusion versus open control involving 190 participants, and one RCT of blood clotting factors versus fresh frozen plasma involving five participants. We were unable to include two eligible RCTs because they presented aggregate data for adults with ICH and other types of intracranial haemorrhage. We identified 10 ongoing RCTs. Across all seven criteria in the 12 included RCTs, the risk of bias was unclear in 37 (44%), high in 16 (19%), and low in 31 (37%). Only one RCT was at low risk of bias in all criteria.
In one RCT of platelet transfusion versus open control for acute spontaneous ICH associated with antiplatelet drug use, there was a significant increase in death or dependence (modified Rankin Scale score 4 to 6) at day 90 (70/97 versus 52/93; risk ratio (RR) 1.29, 95% confidence interval (CI) 1.04 to 1.61, one trial, 190 participants, moderate-quality evidence). All findings were non-significant for blood clotting factors versus placebo or open control for acute spontaneous ICH with or without surgery (moderate-quality evidence), for antifibrinolytic drugs versus placebo (moderate-quality evidence) or open control for acute spontaneous ICH (moderate-quality evidence), and for clotting factors versus fresh frozen plasma for acute spontaneous ICH associated with anticoagulant drug use (no evidence).

Authors' conclusions

Based on moderate-quality evidence from one trial, platelet transfusion seems hazardous in comparison to standard care for adults with antiplatelet-associated ICH.
We were unable to draw firm conclusions about the efficacy and safety of blood clotting factors for acute spontaneous ICH with or without surgery, antifibrinolytic drugs for acute spontaneous ICH, and clotting factors versus fresh frozen plasma for acute spontaneous ICH associated with anticoagulant drug use.
Further RCTs are warranted, and we await the results of the 10 ongoing RCTs with interest.

Plain language summary

Treatments to help blood clotting to improve the recovery of adults with stroke due to bleeding in the brain
Review question
Do treatments to help blood clot reduce the risk of death and disability for adults with stroke due to bleeding in the brain?
Background
More than one-tenth of all strokes are caused by bleeding in the brain (known as brain haemorrhage). The bigger the haemorrhage, the more likely it is to be fatal. Roughly one-third of brain haemorrhages enlarge significantly within the first 24 hours. Therefore, treatments that promote blood clotting might reduce the risk of death or being disabled after brain haemorrhage by limiting its growth, if given soon after the bleeding starts. However, haemostatic drugs might cause unwanted clotting, leading to unwanted side effects, such as heart attacks and clots in leg veins.
Study characteristics
We found 12 randomised controlled trials, including 1732 participants, up to November 2017.
Key results
We found moderate-quality evidence of harm from platelet transfusion for people who had used antiplatelet drugs until they had a brain haemorrhage. We found no evidence of either benefit or harm from other haemostatic therapies for people with brain haemorrhage.
Quality of the evidence
Overall, the quality of the evidence was moderate to low.
More information will become available from the 10 trials that are ongoing.