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.

Showing posts with label blame the doctor. Show all posts
Showing posts with label blame the doctor. Show all posts

Saturday, April 13, 2024

Relationship Between Body-Specific Attention to a Paretic Limb and Real-World Arm Use in Stroke Patients: A Longitudinal Study

 

Damn it all, it is NOT learned nonuse. It is the actual inability to use it because of dead neurons. If you had dead brain rehab protocols, this fake learned nonuse idea would cease to exist! What multiverse do we need to send you back to where this research does ONE DAMN THING towards stroke recovery?

 

Quit blaming the patients for not recovering and blame the doctor and therapists for knowing nothing on how to get survivors recovered! 

Do you blithering idiots ever actually think about why stroke patients don't recover?

Relationship Between Body-Specific Attention to a Paretic Limb and Real-World Arm Use in Stroke Patients: A Longitudinal Study

Ryoji Otaki 1,2 , Yutaka Oouchida 1,3 , Naoki Aizu 1,4 , Tamami Sudo 1,5 , Hiroshi Sasahara 2 , Yuki Saito 6 , Sunao Takemura 6 and Shin-Ichi Izumi 1,7 * 1 Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan, 2 Department of Rehabilitation, Yamagata Saisei Hospital, Yamagata, Japan, 3 Department of Education, Osaka Kyoiku University, Osaka, Japan, 4 Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan, 5 Department of Computer and Information Sciences, Tokyo University of Agriculture and Technology, Tokyo, Japan, 6 Department of Neurosurgery, Yamagata Saisei Hospital, Yamagata, Japan, 7 Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Biomedical Engineering, Sendai, Japan  
 
Learned nonuse is a major problem in upper limb (UL) rehabilitation after stroke. Among the various factors that contribute to learned nonuse, recent studies have focused on body representation of the paretic limb in the brain. We previously developed a method to measure body specific attention, as a marker of body representation of the paretic limb and revealed a decline in body specific attention to the paretic limb in chronic stroke patients by a cross-sectional study. However, longitudinal changes in body specific attention and paretic arm use in daily life (real-world arm use) from the onset to the chronic phase, and their relationship, remain unknown. Here, in a longitudinal, prospective, observational study, we sought to elucidate the longitudinal changes in body specific attention to the paretic limb and real-world arm use, and their relationship, by using accelerometers and psychophysical methods, respectively, in 25 patients with subacute stroke. Measurements were taken at baseline (T BL ), 2 weeks (T 2w ), 1 month (T 1M ), 2 months (T 2M ), and 6 months (T 6M ) after enrollment. UL function was measured using the Fugl-Meyer Assessment (FMA) and Action Research Arm Test (ARAT). Real world arm use was measured using accelerometers on both wrists. Body specific attention was measured using a visual detection task. The UL function and real-world arm use improved up to T 6M . Longitudinal changes in body specific attention were most remarkable at T 1M . Changes in body-specific attention up to T 1M correlated positively with changes in real-world arm use up to T 6M , and from T 1M to T 6M , and the latter more strongly correlated with changes in real-world arm use. Changes in real-world arm use up to T 2M correlated positively with changes in FMA up to T 2M and T 6M . No correlation was found between body specific attention and FMA scores. Thus, these results suggest that improved body specific attention to the paretic limb during the early phase contributes to increasing long-term real world arm use and that increased real-world use is associated with the recovery of UL function. Our results may contribute to the development of rehabilitation strategies to enhance adaptive changes in body representation in the brain and increase real-world arm use after stroke.

Saturday, April 6, 2024

Quantifying Nonuse in Chronic Stroke Patients: A Study Into Paretic, Nonparetic, and Bimanual Upper-Limb Use in Daily Life

 

Damn it all, it is NOT learned nonuse. It is the actual inability to use it because of dead neurons. If you had dead brain rehab protocols, this fake learned nonuse idea would cease to exist! What multiverse do we need to send you back to where this does ONE DAMN THING towards stroke recovery?

 

Quit blaming the patients for not recovering and blame the doctor and therapists for knowing nothing on how to get survivors recovered! 

Do you blithering idiots ever actually think about why stroke patients don't recover?

Quantifying Nonuse in Chronic Stroke Patients: A Study Into Paretic, Nonparetic, and Bimanual Upper-Limb Use in Daily Life

Marian E. Michielsen, MSc, Ruud W. Selles, PhD, Henk J. Stam, MD, PhD Gerard M. Ribbers, MD, PhD, Johannes B. Bussmann, PhD ABSTRACT. Michielsen ME, Selles RW, Stam HJ, Ribbers GM, Bussmann JB. 
  Arch Phys Med Rehabil 2012;xx:xxx.  
Objective:  
 
To quantify uni- and bimanual upper-limb use in patients with chronic stroke in daily life compared with healthy controls.  
 
Design: 
 
 Cross-sectional observational study. Setting: Outpatient rehabilitation center. Participants: Patients with chronic stroke (n=38) and healthy controls (n=18).  
 
Intervention:  
Not applicable. (This is precisely why learned nonuse research should never be done! It does nothing to get survivors recovered! I'd have you all fired!)
 
Main Outcome Measures:  
 
Upper-limb use in daily life was measured with an accelerometry based upper-limb activity monitor, an accelerometer based measurement device. Uni- manual use of the paretic and the nonparetic side and bimanual upper-limb use were measured for a period of 24 hours. Outcomes were expressed in terms of both duration and intensity.  
 
Results:  
 
Patients used their unaffected limb much more than their affected limb (5.3h vs 2.4h), while controls used both limbs a more equal amount of time (5.4h vs 5.1h). Patients used their paretic side less than controls used their nondominant side and their nonparetic side more than controls their dominant side. The intensity with which patients used their paretic side was lower than that with which controls used their nondominant side, while that of the nonparetic side was higher than that of the dominant side of controls. Finally, patients used their paretic side almost exclusively in bimanual activities. During bimanual activities, the intensity with which they used their affected side was much lower than that of the nonaffected side.  
 
Conclusion:  
 
Our data show considerable nonuse of the paretic side, both in duration and in intensity, and both during unimanual and bimanual activities in patients with chronic stroke. Patients do compensate for this with increased use of the nonparetic side.(As they should since you incompetently don't know about the research that shows using the good side helps recover the bad side!

Exercising the good side to recover the 'bad' side. December 2012)

Key Words: Ambulatory monitoring; Motor activity; Rehabilitation; Stroke; Upper extremity. © 2012 by the American Congress of Rehabilitation Medicine  
 
FIFTY TO 70% OF PATIENTS with stroke suffer from long-term motor deficits of the upper limb, 1 with a decreased use of the paretic upper extremity in daily life. 2 Be- cause this latter may have a great impact on the manner in which a patient is able to participate in daily life activities, maximizing purposeful use of the upper extremity in daily life is a key factor in motor rehabilitation following stroke. While it is clear that a decreased motor capacity of the paretic arm influences the use of both extremities, the exact changes in upper-limb use following stroke are not yet fully understood. Regarding the paretic upper extremity, many studies have shown that there is no 1-on-1 relation between motor impairment and functional use. 3,4 This may be related to the phenomenon of learned nonuse, 5 which describes how patients will have “learned” not to use the paretic side to its full capacity. 6 Brain injury causes structural damage to motor path- ways as well as depression of neural excitability near the lesion. Decreasing activity of the upper extremity leads to a further reduction in excitability and as such starts a vicious circle of decreasing excitability and decreasing activity. 7 Even less is known about the consequences of stroke on the nonparetic side. Motor performance of the nonparetic side may be impaired compared with that in healthy subjects, showing, for instance, decreased speed and consistency of performance. 8 In addition, it has been shown that patients with acute stroke have a more reduced use of the nonparetic side in daily life than do healthy subjects. 9 On the other hand, it is generally assumed that post stroke the nonparetic side will be used more to compensate for the decreased use of the paretic side. However, to our knowledge, this has not been investigated in patients with chronic stroke. Overall many questions on techniques to optimize the function of the paretic extremity after stroke still need to be answered. The optimal rehabilitation technique is still not defined, and different approaches in reducing upper-extremity paresis are distinguished. 7 Several therapies have been developed to improve the use of the nonparetic arm in daily life. For example, constraint-induced movement therapy (CIMT), 10,11 or forced use, 12 reported as a beneficial treatment option for motor recovery of the arm, 13 prevents the use of the nonparetic upper limb and aims to counterbalance the learned nonuse. CIMT is an augmentative technique, 7 a high-intensity, uni- manual training aiming to counterbalance the vicious circle of decreasing excitability and decreasing activity. Furthermore, CIMT has aspects of task specific exercising. Bilateral training programs have also been developed, for example, with rhythmic
 
More at link.

Friday, March 15, 2024

Relationship Between Body-Specific Attention to a Paretic Limb and Real-World Arm Use in Stroke Patients: A Longitudinal Study

Well shit, research is still uselessly going on about nonuse. It's just a convenient way to blame the patient for not recovering when the doctor should be blamed for not getting 100% recovery protocols created.  I consider upper limb monitors absolutely fucking useless and any research into nonuse a fireable offense! They are only used to shame the survivor about not using the affected arm. I never use my affected arm, it is totally useless for any tasks!

Damn it all, it is NOT learned nonuse. It is the actual inability to use it because of dead neurons. If you had dead brain rehab protocols, this fake learned nonuse idea would cease to exist! Quit blaming the patient for not recovering and blame the doctor and therapists for knowing nothing on how to get survivors recovered! 

Do you blithering idiots ever actually think about why stroke patients don't recover?

 

Relationship Between Body-Specific Attention to a Paretic Limb and Real-World Arm Use in Stroke Patients: A Longitudinal Study


 
ORIGINAL RESEARCH
published: 22 February 2022doi: 10.3389/fnsys.2021.806257
 Edited by:
 Jun Ota,The University of Tokyo, Japan
 Reviewed by:
Hiroshi Imamizu,The University of Tokyo, Japan Anna Danielsson,University of Gothenburg, SwedenKohei Kaminishi,The University of Tokyo, Japan
*Correspondence:
Shin-Ichi Izumi  izumis@med.tohoku.ac.jp
 Received:
 31 October 2021
 Accepted:
 21 December 2021
 Published:
 22 February 2022
Citation:
Otaki R, Oouchida Y, Aizu N, Sudo T,Sasahara H, Saito Y, Takemura S and Izumi S-I (2022) RelationshipBetween Body-Specific Attention to aParetic Limb and Real-World ArmUse in Stroke Patients: A Longitudinal Study.Front. Syst. Neurosci. 15:806257.doi: 10.3389/fnsys.2021.806257
Relationship Between Body Specific Attention to a Paretic Limb and Real-World Arm Use in StrokePatients: A Longitudinal Study
Ryoji Otaki 1,2 , 
Yutaka Oouchida1,3, 
Naoki Aizu1,4, 
Tamami Sudo1,5, 
Hiroshi Sasahara 2,
Yuki Saito 6, 
Sunao Takemura 6 and  
Shin-Ichi Izumi 1,7*
1 Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan,
 2 Department of Rehabilitation, Yamagata Saisei Hospital, Yamagata, Japan,
 3 Department of Education, Osaka KyoikuUniversity, Osaka, Japan,
 4 Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan,
5 Department of Computer and Information Sciences, Tokyo University of Agriculture and Technology, Tokyo, Japan,
6 Department of Neurosurgery, Yamagata Saisei Hospital, Yamagata, Japan,
 7  Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Biomedical Engineering, Sendai, Japan
Learned nonuse is a major problem in upper limb (UL) rehabilitation after stroke. Among the various factors that contribute to learned nonuse, recent studies have focused on body representation of the paretic limb in the brain. We previously developed a method to measure body specific attention, as a marker of body representation of the paretic limb and revealed a decline in body specific attention to the paretic limb in chronic stroke patients by a cross-sectional study. However, longitudinal changes in body specific attention and paretic arm use in daily life (real-world arm use) from the onset to the chronic phase, and their relationship, remain unknown. Here, in a longitudinal, prospective, observational study, we sought to elucidate the longitudinal changes in body specific attention to the paretic limb and real-world arm use, and their relationship, by using accelerometers and psychophysical methods, respectively, in25 patients with subacute stroke. Measurements were taken at baseline (T BL), 2 weeks(T 2w), 1 month (T 1M), 2 months (T 2M), and 6 months (T 6M) after enrollment. UL function was measured using the Fugl-Meyer Assessment (FMA) and Action Research Arm Test (ARAT). Real-world arm use was measured using accelerometers on both wrists.Body specific attention was measured using a visual detection task. The UL function and real-world arm use improved up to T 6M. Longitudinal changes in body specific attention were most remarkable at T 1M. Changes in body specific attention up to T 1Mcorrelated positively with changes in real-world arm use up to T 6M, and from T 1M to T 6M,and the latter more strongly correlated with changes in real-world arm use. Changes in real world arm use up to T 2M correlated positively with changes in FMA up to T 2M and T 6M. No correlation was found between body specific attention and FMA scores. Thus,these results suggest that improved body specific attention to the paretic limb during the early phase contributes to increasing long-term real-world arm use and that increased real world use is associated with the recovery of UL function. Our results may contribute to the development of rehabilitation strategies to enhance adaptive changes in body representation in the brain and increase real world arm use after stroke.

Sunday, March 10, 2024

Quantifying Nonuse in Chronic Stroke Patients: A Study Into Paretic, Nonparetic, and Bimanual Upper-Limb Use in Daily Life

Well shit, research is still uselessly going on about nonuse. It's just a convenient way to blame the patient for not recovering when the doctor should be blamed for not getting 100% recovery protocols created.  I consider upper limb monitors absolutely fucking useless and any research into nonuse a fireable offense! They are only used to shame the survivor about not using the affected arm. I never use my affected arm, it is totally useless for any tasks!

Damn it all, it is NOT learned nonuse. It is the actual inability to use it because of dead neurons. If you had dead brain rehab protocols, this fake learned nonuse idea would cease to exist! Quit blaming the patient for not recovering and blame the doctor and therapists for knowing nothing on how to get survivors recovered! 

Do you blithering idiots ever actually think about why stroke patients don't recover?

 

Quantifying Nonuse in Chronic Stroke Patients: A Study Into Paretic, Nonparetic, and Bimanual Upper-Limb Use in Daily Life

Gerard Ribbers
2012, Archives of Physical Medicine and Rehabilitation
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ORIGINAL ARTICLE
Quantifying Nonuse in Chronic Stroke Patients: A Study Into Paretic, Nonparetic, and Bimanual Upper-LimbUse in Daily Life
 Marian E. Michielsen, MSc

 , Ruud W. Selles, PhD, Henk J. Stam, MD, PhD Gerard M. Ribbers, MD, PhD, Johannes B. Bussmann, PhD
ABSTRACT. Michielsen ME, Selles RW, Stam HJ, RibbersGM, Bussmann JB. Quantifying nonuse in chronic stroke patients: a study into paretic, nonparetic, and bimanual upper-limb use in daily life. Arch Phys Med Rehabil 2012;xx:xxx.
Objective:
 To quantify uni- and bimanual upper-limb use inpatients with chronic stroke in daily life compared with healthy controls.
Design:
 Cross-sectional observational study.
Setting:
 Outpatient rehabilitation center.
Participants:
 Patients with chronic stroke (n=38) and healthy controls (n=18).
Intervention:
 Not applicable.
Main Outcome Measures:
 Upper-limb use in daily life was measured with an accelerometry based upper-limb activity monitor, an accelerometer based measurement device. Uni-manual use of the paretic and the nonparetic side and bimanual upper limb use were measured for a period of 24 hours. Outcomes were expressed in terms of both duration and intensity.
Results:
 Patients used their unaffected limb much more than their affected limb (5.3h vs 2.4h), while controls used both limbs a more equal amount of time (5.4h vs 5.1h). Patients used their paretic side less than controls used their nondominant side and their nonparetic side more than controls their dominant side. The intensity with which patients used their paretic side was lower than that with which controls used their nondominant side, while that of the nonparetic side was higher than that of the dominant side of controls. Finally, patients used their paretic side almost exclusively in bimanual activities. During bimanual activities, the intensity with which they used their affected side was much lower than that of the nonaffected side.
Conclusion:
 Our data show considerable nonuse of the paretic side, both in duration and in intensity, and both during unimanual and bimanual activities in patients with chronic stroke. Patients do compensate for this with increased use of the nonparetic side.(As they should since you incompetently don't know about the research that shows using the good side helps recover the bad side!

Exercising the good side to recover the 'bad' side. December 2012)

Key Words:
 Ambulatory monitoring; Motor activity; Rehabilitation; Stroke; Upper extremity.©
 2012 by the American Congress of Rehabilitation Medicine
FIFTY TO 70% OF PATIENTS with stroke suffer from long term motor deficits of the upper limb,1with a de-creased use of the paretic upper extremity in daily life.2 Because this latter may have a great impact on the manner in which a patient is able to participate in daily life activities,maximizing purposeful use of the upper extremity in daily life is a key factor in motor rehabilitation following stroke.While it is clear that a decreased motor capacity of the paretic arm influences the use of both extremities, the exact changes in upper-limb use following stroke are not yet fully understood. Regarding the paretic upper extremity, many studies have shown that there is no 1-on-1 relation between motor impairment and functional use.3,4This may be related to the phenomenon of learned nonuse,5which describes how patients will have “learned” not to use the paretic side to its full capacity.6Brain injury causes structural damage to motor path-ways as well as depression of neural excitability near thelesion. Decreasing activity of the upper extremity leads to afurther reduction in excitability and as such starts a viciouscircle of decreasing excitability and decreasing activity.7Even less is known about the consequences of stroke on thenonparetic side. Motor performance of the nonparetic side maybe impaired compared with that in healthy subjects, showing,for instance, decreased speed and consistency of performance.8In addition, it has been shown that patients with acute stroke have a more reduced use of the nonparetic side in daily life thando healthy subjects.9On the other hand, it is generally assumed that post stroke the nonparetic side will be used more to compensate for the decreased use of the paretic side. However, to our knowledge, this has not been investigated in patients with chronic stroke. Overall many questions on techniques to optimize the function of the paretic extremity after stroke still need to be answered. The optimal rehabilitation technique is still not defined, and different approaches in reducing upper-extremity paresis are distinguished.7Several therapies have been devel-oped to improve the use of the nonparetic arm in daily life. Forexample, constraint-induced movement therapy (CIMT),10,11or forced use,12reported as a beneficial treatment option formotor recovery of the arm,13prevents the use of the nonparetic upper limb and aims to counterbalance the learned nonuse.CIMT is an augmentative technique,7a high-intensity, unimanual training aiming to counterbalance the vicious circle of decreasing excitability and decreasing activity. Furthermore,CIMT has aspects of task-specific exercising. Bilateral training programs have also been developed, for example, with rhythmic auditory cueing.14To evaluate and understand the effects of upper-extremity training in daily life conditions, detailed insight isneeded in unimanual and bimanual function of the arms in dailylife conditions. This is the topic of the current article.Several studies have included the measurement of upper-limb use in daily life. For example, Taub,11Mark,15and Wolf5and colleagues used the Motor Activity Log (MAL) in their studies. However, although validated against an objective measure,16the MAL still is a subjective instrument that focuses on how well and how much patients use their most impaired arm in a defined category of activities, and the MAL does not include data on the amount of use of the nonimpaired arm and bilateral use. Another method for assessing upper-limb use in a home setting is provided by accelerometers and other portable devices providing the opportunity to assess how much patientswith stroke use their upper limbs in daily life for longer periods.2However, so far, studies using these devices assessed only the upper-limb use overall and not in detail. For example,many studies express actual upper-limb use only as a ratio between the use of the affected and the use of the unaffected side,17thus omitting information about usage times of the paretic side and the nonparetic side separately. Second, current devices do not differentiate between arm movements resulting from general body movements such as walking and arm movements during sitting and standing. Third, most measurement devices cannot differentiate between the duration of use and the intensity of use, and finally, most devices cannot or do not differentiate between unilateral and bilateral usage of the arms.The aim of the present study was to quantify uni- and bimanual upper limb use in patients with chronic stroke in daily life and compare this with healthy controls. By using an accelerometry based upper limb activity monitor,18we were able to give an insight into both duration and intensity of upper-limb use and to discriminate between upper-limb movements caused by whole-body movements and movements independent of whole body movements, thus providing an insight into the amount of functional and purposeful upper limb use in daily life conditions.

Thursday, February 1, 2024

Where you live may be associated with more successful stroke recovery

 Duh! If you don't have the economic werewithal to spend hours each days looking for stroke rehab options, of course you're not going to recover as well. All due to the incompetence of your doctor not working towards getting 100% recovery rehab protocols. Blame your doctor, they are completely at fault for not solving stroke to 100 recovery!

Where you live may be associated with more successful stroke recovery

American Stroke Association International Stroke Conference 2024, Abstract Poster HUP3
Research Highlights:
  • Stroke survivors living in areas with high levels of unemployment, low income, low education levels and poor housing quality had twice the risk of poor recovery after a stroke compared to those living in areas with better conditions.
  • The researchers say this study may help promote awareness of how social determinants of health are as important as clinical variables and health information when trying to identify stroke survivors who are at particularly high risk for poor long-term outcomes.

Embargoed until 4 a.m. CT/5 a.m. ET, Thursday, Feb. 1, 2024

DALLAS, Feb. 1, 2024 — Stroke survivors living in areas with poor economic conditions were twice as likely to have a poor recovery compared to survivors living in areas with better conditions, according to a preliminary study to be presented at the American Stroke Association’s International Stroke Conference 2024. The meeting will be held in Phoenix, Feb. 7-9, and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

“This research was inspired by the people I work with daily,” said Leah Kleinberg, B.A., a postgraduate clinical research associate in the Falcone Lab in the department of neurology at Yale School of Medicine in New Haven, Connecticut. “Although stroke patients from differing socioeconomic backgrounds often have similar functional status at discharge, outcomes can vary dramatically a year later. As a clinical research associate, I get to interact with them far beyond the completion of their urgent treatment, which sparked my interest in exploring the long-term outcomes for these patients.”

Kleinberg and her colleagues found a significant correlation between functional outcomes after a stroke and the socioeconomic factors noted by census blocks.

“The magnitude of this impact is what was most surprising. We did not expect a large disparity in outcomes, yet we found patients in the most economically disadvantaged areas were twice as likely to have unfavorable outcomes compared to patients in areas with less unemployment, better housing quality and higher income and education levels,” she said.

In this study, researchers used data from Yale’s Longitudinal Study of Acute Brain Injury and  Area Deprivation Index (ADI) rates for the 2020 U.S. Census blocks to compare outcomes among stroke survivors by socioeconomic disadvantage factors. The ADI evaluates a neighborhood on levels of income, education, employment and housing quality and is specific to each zip code. It was developed by the U.S. Health Resources & Services Administration to inform health care delivery and policy for disadvantaged areas.

This analysis found:

  • Among 2,164 people with ischemic (clot-caused) stroke, the one-year unadjusted risk of poor outcomes was 35%, 40% and 46% for patients residing in neighborhoods with low, intermediate and high deprivation, respectively.
  • After considering the inability of the ADI to specifically measure each level of deprivation, researchers determined that those living in intermediate and high deprivation areas had 44% and 107% greater risk, respectively, of unfavorable outcomes, compared to patients living in neighborhoods with low deprivation levels.
  • The patients in the poor outcomes category were unable to look after their own affairs without assistance and required some help in daily activities. In the good outcomes category, patients could live independently, though some might have had residual symptoms or disability.

“We hope this study will help promote awareness of how social determinants of health are as important as clinical variables and health information when trying to identify patients who are particularly high risk for poor long-term outcomes,” she said.

Study details:

  • The Yale Longitudinal Study follows stroke survivors admitted to the Yale Health System, collecting outcome data at 3 months, 6 months and then yearly after hospital discharge. Zip code data was available for 2,164 patients enrolled in the Yale Longitudinal Study between 2018 and 2021. The average age was 69; 48% were women; 7.5% were Black adults and 7.7% were Hispanic adults.
  • Stroke outcomes were determined by trained assessors using the modified Rankin Scale, which measures disability severity after stroke on a scale of 0-6, from no disability (able to carry out all daily living tasks and duties without assistance) to severe disability (bed-ridden, incontinent, requiring constant nursing care and attention).

Study limitations are that the Area Deprivation Index relies on geographic blocks and does not evaluate each household separately. Also, due to the observational nature of the study, the findings can only note associations and cannot determine cause and effect.

When considered separately from other cardiovascular diseases, stroke ranks fifth among all causes of death, behind diseases of the heart, cancer, COVID-19 and unintentional injuries/accidents, according to the American Heart Association’s Heart Disease and Stroke Statistics 2024 Update. The Association also recognizes that considering the role of social determinants of health is essential in improving the cardiovascular health of all Americans.

“Access to quality care, nutritious foods, stable housing or other basic health needs are crucial for people recovering from stroke,” said Elizabeth A. Jackson, M.D., M.P.H., FAHA, immediate past chair of the Association’s Committee on Social Determinants of Health and a professor and director of the Cardiovascular Outcomes and Effectiveness Research Program at the University of Alabama at Birmingham, who was not involved in the research. “Unfortunately, these data are not surprising, rather, they support prior evidence suggesting health disparities are disproportionately experienced in areas where higher degrees of social vulnerability exist.”

Co-authors, disclosures and funding sources are listed in the abstract. 

Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers and the Association’s overall financial information are available here.

Additional Resources:

###

About the American Stroke Association

The American Stroke Association is devoted to saving people from stroke — the No. 2 cause of death in the world and a leading cause of serious disability. We team with millions of volunteers to fund innovative research, fight for stronger public health policies and provide lifesaving tools and information to prevent and treat stroke. The Dallas-based association officially launched in 1998 as a division of the American Heart Association. To learn more or to get involved, call 1-888-4STROKE or visit stroke.org. Follow us on Facebook, X.

For Media Inquiries and AHA Expert Perspective:

AHA Communications & Media Relations in Dallas: 214-706-1173; ahacommunications@heart.org

Karen Astle: 214-706-1392, Karen.Astle@heart.org


Friday, December 1, 2023

The 5 Longevity Exercises a Physical Therapist Recommends To Stay Strong and Pain-Free As You Age—No Equipment Required

If you can't do these post stroke; you can blame your doctors and therapists for not having decent enough EXACT RECOVERY PROTOCOLS! They will try to blame you for your lack of recovery; DO NOT ALLOW THAT DIVERSION OF RESPONSIBILITY!

The 5 Longevity Exercises a Physical Therapist Recommends To Stay Strong and Pain-Free As You Age—No Equipment Required

Newton was on to something (beyond just sheer physics) with the whole “a body in motion stays in motion” thing. Longevity experts are clear: If you hope to limit aches and pains as you age, remaining active now is key.But that doesn’t necessarily mean putting your body through grueling workout after grueling workout—in fact, it’s much simpler and less brutal than that.How to exercise for healthy aging When thinking holistically about exercise for longevity, there are some common themes to keep in mind.

Think about function first

Different workouts can address different facets of aging, like how high-impact workouts benefit bone strength, for instance. But nothing is quite as useful to healthy aging as functional fitness. This fitness buzzword essentially means training in a way that offers strength you can use in the movements you do in everyday life. And it doesn’t matter whether that’s cardio or lifting weights. “If an exercise yields an adaptation that helps someone become better able to do what they need to do, then it’s functional,” explains Ryan Chow, DPT, founder of Reload, a physical therapy and fitness practice, where he frequently works with aging and elderly populations. “Function is defined as ‘useful, ‘purposeful’—stuff like bending, twisting, lifting, loading, pushing, pulling, squatting, and hauling,” adds Ingrid Clay, CPT, a trainer on Centr, a personalized coaching app. Functional fitness often works on flexibility and balance, which are key components of healthy aging, as they help prevent falls and injuries, adds Clay. Functional exercises are designed to help you, say, get up out of a car, or safely walk down stairs—real-life movements we need to do to stay independent as we age.
Do it often enough It’s not just about how you move, but how much time you spend moving. Dr. Chow recommends following the physical activity guidelines set by the World Health Organization or American Heart Association
: 150 to 300 minutes of moderate to vigorous aerobic exercise throughout the week and progressive resistance training (aka strength training) targeting all major muscle groups twice a week. “The mounting evidence suggests that this can reduce all causes of mortality by 40 percent,” says Dr. Chow. “Maybe more importantly, reaching these guidelines is also giving you [greater] quality of life.”

Vary your workouts

For best results as you age, avoid doing the same type of exercise again and again. Instead, mix things up. Even if what you love most is walking, push yourself to try a yoga class or hop on a bicycle every so often. This ensures you’re moving your body in all planes of motion and maintaining a strong heart, lungs, and muscles. “Doing both resistance training and cardiovascular training can keep your metabolic and cardiovascular systems healthy, while maintaining the health and function of your muscles and joints so that you can be able-bodied as you get older,” says Dr. Chow.

Five strength exercises you can do at home for healthy aging

Whether you’re 25 or 75, these functional exercises recommended by Dr. Chow will help set you up for safe, comfortable movement for life. Add them to your weekly routine, along with regular bouts of aerobic exercise for a longevity-focused regimen.

Isometric split squat

 

“This exercise is related to balance, and getting up and down from the ground,” says Dr. Chow.With one foot in front and the other behind you, bend both knees coming into a 90-degree bend with both legs. Hold for as long as you can, with the goal of working up to two minutes.Modification: If 90-degrees is too deep to bend and hold comfortability, hold the position a bit higher or use a sturdy object to touch lightly for support.

Supported deep squat

 

“This exercise trains both strength and mobility in the hips and knees,” says Dr. Chow. Clay adds that the lower body strength you build with squats “is important for maintaining balance and mobility as we age.”Stand in front of a closed door that does not swing toward you. Feet should be slightly wider than hip-distance apart and toes slightly turned out.Grab the door handle for leverage to pull against as you bend both knees to slowly come into a squat, taking five seconds to get there.Pause at the bottom for one second.Slowly push through soles of the feet to return to standing, taking five seconds to get there. Form note: Keep tension on the door handle to engage the upper body, which helps maintain a straight back throughout the movement.

Wall sit with heel raise

 

“This exercise trains the soleus and the Achilles tendon to maintain the ability to be springy and absorb impact in the hips, knees, and ankles,” says Dr. Chow.tand with your back toward a wall. Press your head, upper back, and butt against the wall, as you walk your feet away from it and begin to slide into a sitting position, with knees and hips bent at 90 degrees. Raise your heels up without moving anything else. Aim to hold for 60 seconds.Progression: Once you’re able to hold the heel-elevated wall sit for a minute, try holding for as long as possible on one leg, then the next. “This exercise trains the muscles of the upper back to maintain the ability to stay upright,” says Dr. Chow. “These are your antigravity muscles to Begin standing with hands behind your ears, palms facing forward, and elbows out wide. Engage your lats (the large muscles on the sides and upper back) to pull your elbows down and in toward your sides, squeezing your shoulder blades together.Squeeze and hold for five seconds. Form tip: Don’t crunch inward when bringing elbows down to sides. Keep your chest lifted. Arms will mimic the letter W.

Beast crawl

“This move trains your shoulders, trunk, thighs, and most importantly, the toes,” says Dr. Chow. “It’s important to maintain the ability to land on the toes to allow for push-off during quick activities like running or walking fast, plus it controls stress to the big toe joint, which can prevent bunion development.” Start in a tabletop position on hands and knees, with your toes tucked under. Engage the core to lift knees off the ground in a hover.From here, crawl slowly forward, back, and side to side with the goal of staying moving and knees elevated for 30 seconds.Form tip: Try to keep your back flat and hips parallel to the ground.Newton was on to something (beyond just sheer physics) with the whole “a body in motion stays in motion” thing. Longevity experts are clear: If you hope to limit aches and pains as you age, remaining active now is key.But that doesn’t necessarily mean putting your body through grueling workout after grueling workout—in fact, it’s much simpler and less brutal than that.How to exercise for healthy aging When thinking holistically about exercise for longevity, there are some common themes to keep in mind.

Think about function first

Different workouts can address different facets of aging, like how high-impact workouts benefit bone strength, for instance. But nothing is quite as useful to healthy aging as functional fitness. This fitness buzzword essentially means training in a way that offers strength you can use in the movements you do in everyday life. And it doesn’t matter whether that’s cardio or lifting weights.“If an exercise yields an adaptation that helps someone become better able to do what they need to do, then it’s functional,” explains Ryan Chow, DPT, founder of Reload, a physical therapy and fitness practice, where he frequently works with aging and elderly populations.“Function is defined as ‘useful, ‘purposeful’—stuff like bending, twisting, lifting, loading, pushing, pulling, squatting, and hauling,” adds Ingrid Clay, CPT, a trainer on Centr, a personalized coaching app. Functional fitness often works on flexibility and balance, which are key components of healthy aging, as they help prevent falls and injuries, adds Clay. Functional exercises are designed to help you, say, get up out of a car, or safely walk down stairs—real-life movements we need to do to stay independent as we age.It’s not just about how you move, but how much time you spend moving. Dr. Chow recommends following the physical activity guidelines set by the World Health Organization or American Heart Association: 150 to 300 minutes of moderate to vigorous aerobic exercise throughout the week and progressive resistance training (aka strength training) targeting all major muscle groups twice a week.“The mounting evidence suggests that this can reduce all causes of mortality by 40 percent,” says Dr. Chow. “Maybe more importantly, reaching these guidelines is also giving you [greater] quality of life.”

Vary your workouts

For best results as you age, avoid doing the same type of exercise again and again. Instead, mix things up. Even if what you love most is walking, push yourself to try a yoga class or hop on a bicycle every so often. This ensures you’re moving your body in all planes of motion and maintaining a strong heart, lungs, and muscles. “Doing both resistance training and cardiovascular training can keep your metabolic and cardiovascular systems healthy, while maintaining the health and function of your muscles and joints so that you can be able-bodied as you get older,” says Dr. Chow.

Five strength exercises you can do at home for healthy aging

Whether you’re 25 or 75, these functional exercises recommended by Dr. Chow will help set you up for safe, comfortable movement for life. Add them to your weekly routine, along with regular bouts of aerobic exercise for a longevity-focused regimen.

Isometric split squat

“This exercise is related to balance, and getting up and down from the ground,” says Dr. Chow.With one foot in front and the other behind you, bend both knees coming into a 90-degree bend with both legs.Hold for as long as you can, with the goal of working up to two minutes.>Modification: If 90-degrees is too deep to bend and hold comfortability, hold the position a bit higher or use a sturdy object to touch lightly for support.Supported deep squat “This exercise trains both strength and mobility in the hips and knees,” says Dr. Chow. Clay adds that the lower body strength you build with squats “is important for maintaining balance and mobility as we age.”Stand in front of a closed door that does not swing toward you. Feet should be slightly wider than hip-distance apart and toes slightly turned out.Grab the door handle for leverage to pull against as you bend both knees to slowly come into a squat, taking five seconds to get there.Pause at the bottom for one second.Slowly push through soles of the feet to return to standing, taking five seconds to get there.

Wall sit with heel raise

This exercise trains the soleusand the Achilles tendon to maintain the ability to be springy and absorb impact in the hips, knees, and ankles,” says Dr. Chow.Stand with your back toward a wall. Press your head, upper back, and butt against the wall, as you walk your feet away from it and begin to slide into a sitting position, with knees and hips bent at 90 degrees.

Bat wing

 

“This exercise trains the muscles of the upper back to maintain the ability to stay upright,” says Dr. Chow. “These are your antigravity muscles to .”Begin standing with hands behind your ears, palms facing forward, and elbows out wide.Engage your lats (the large muscles on the sides and upper back) to pull your elbows down and in toward your sides, squeezing your shoulder blades together.Squeeze and hold for five seconds.

Beast crawl

Absolutely impossible for me to do; can't get hand into position, elbow and wrist collapse.

“This move trains your shoulders, trunk, thighs, and most importantly, the toes,” says Dr. Chow. “It’s important to maintain the ability to land on the toes to allow for push-off during quick activities like running or walking fast, plus it controls stress to the big toe joint, which can prevent bunion development.”Start in a tabletop position on hands and knees, with your toes tucked under.From here, crawl slowly forward, back, and side to side with the goal of staying moving and knees elevated for 30 seconds.Form tip: Try to keep your back flat and hips parallel to the ground.Newton was on to something (beyond just sheer physics) with the whole “a body in motion stays in motion” thing. Longevity experts are clear: If you hope to limit aches and pains as you age, remaining active now is key.

How to exercise for healthy aging

When thinking holistically about exercise for longevity, there are some common themes to keep in mind.

Think about function first

Different workouts can address different facets of aging, like how high-impact workouts benefit bone strength, for instance. But nothing is quite as useful to healthy aging as functional fitness. This fitness buzzword essentially means training in a way that offers strength you can use in the movements you do in everyday life. And it doesn’t matter whether that’s cardio or lifting weights.“If an exercise yields an adaptation that helps someone become better able to do what they need to do, then it’s functional,” explains Reload, a physical therapy and fitness practice, where he frequently works with aging and elderly populations.“Function is defined as ‘useful, ‘purposeful’—stuff like bending, twisting, lifting, loading, pushing, pulling, squatting, and hauling,” adds Centr, a personalized coaching app. Functional fitness often works on flexibility and balance, which are key components of healthy aging, as they help prevent falls and injuries, adds Clay. Functional exercises are designed to help you, say, get up out of a car, or safely walk down stairs—real-life movements we need to do to stay independent as we age.

Do it often enough

It’s not just about how you move, but how much time you spend moving. Dr. Chow recommends following the physical activity guidelines set by the American Heart Association: 150 to 300 minutes of moderate to vigorous aerobic exercise throughout the week and progressive resistance training (aka strength training) targeting all major muscle groups twice a week.“The mounting evidence suggests that this can reduce all causes of mortality by 40 percent,” says Dr. Chow. “Maybe more importantly, reaching these guidelines is also giving you [greater] quality of life.”

Vary your workouts

For best results as you age, avoid doing the same type of exercise again and again. Instead, mix things up. Even if what you love most is walking, push yourself to try a yoga class or hop on a bicycle every so often. This ensures you’re moving your body in all planes of motion and maintaining a strong heart, lungs, and muscles. “Doing both resistance training and cardiovascular training can keep your metabolic and cardiovascular systems healthy, while maintaining the health and function of your muscles and joints so that you can be able-bodied as you get older,” says Dr. Chow.Five strength exercises you can do at home for healthy agingWhether you’re 25 or 75, these functional exercises recommended by Dr. Chow will help set you up for safe, comfortable movement for life. Add them to your weekly routine, along with regular bouts of aerobic exercise for a longevity-focused regimen.

Isometric split squat

“This exercise is related to balance, and getting up and down from the ground,” says Dr. Chow. With one foot in front and the other behind you, bend both knees coming into a 90-degree bend with both legs.
Hold for as long as you can, with the goal of working up to two minutes.Stand in front of a closed door that does not swing toward you. Feet should be slightly wider than hip-distance apart and toes slightly turned out. Pause at the bottom for one second.Slowly push through soles of the feet to return to standing, taking five seconds to get there.Form note: Keep tension on the door handle to engage the upper body, which helps maintain a straight back throughout the movement.This exercise trains the soleusand the Achilles tendon to maintain the ability to be springy and absorb impact in the hips, knees, and ankles,” says Dr. Chow.Stand with your back toward a wall. Press your head, upper back, and butt against the wall, as you walk your feet away from it and begin to slide into a sitting position, with knees and hips bent at 90 degrees.Raise your heels up without moving anything else. Aim to hold for 60 seconds.Progression: Once you’re able to hold the heel-elevated wall sit for a minute, try holding for as long as possible on one leg, then the next.Bat wing“This exercise trains the muscles of the upper back to maintain the ability to stay upright,” says Dr. Chow. “These are your antigravity muscles to limit the negative effects of slouching and slumping.”Begin standing with hands behind your ears, palms facing forward, and elbows out wide.Engage your lats (the large muscles on the sides and upper back) to pull your elbows down and in toward your sides, squeezing your shoulder blades together.Squeeze and hold for five seconds.Form tip: Don’t crunch inward when bringing elbows down to sides. Keep your chest lifted. Arms will mimic the letter W.

Beast crawl

“This move trains your shoulders, trunk, thighs, and most importantly, the toes,” says Dr. Chow. “It’s important to maintain the ability to land on the toes to allow for push-off during quick activities like running or walking fast, plus it controls stress to the big toe joint, which can prevent bunion development.”
  • Start in a tabletop position on hands and knees, with your toes tucked under.
  • Engage the core to lift knees off the ground in a hover.From here, crawl slowly forward, back, and side to side with the goal of staying moving and knees elevated for 30 seconds.

    Tuesday, October 10, 2023

    Proven Ways to Recover from a Brain Stroke Efficiently

    Quit lying to yourself and stroke survivors. There are none. If something truly worked a Nobel prize would have been awarded. 

    Proven Ways to Recover from a Brain Stroke Efficiently

    A brain stroke, also known as a cerebrovascular accident (CVA), is a medical condition in which the blood supply to part of the brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients. This can damage or kill brain cells and can lead to a variety of physical and cognitive impairments.

    Brain stroke is one of the most common illnesses among adults over the age of 40.  It is a very time-sensitive illness which means that once you or someone close to you is having a stroke, every second counts. On-the-spot decisions and prompt medical attention can save a life. For such occasions when a person is about to have a stroke, it is necessary to spot the symptoms. Symptoms of a brain stroke are:

    • Sudden weakness or numbness on one side of the body, especially the face, arm, or leg.
    • Droopy facial muscles
    • Slur in speech or confusion
    • Partial blindness in one or both eyes
    • Sudden dizziness, trouble in walking, loss of balance
    • Severe headache or sharp recurring pangs of pain

    What to Do If a Brain Stroke Occurs?

    Source: medium.com

    Once a person is having a brain stroke, it is a race against time. Remember the word F.A.S.T:

    F (Face): ask the patient to smile. If he is unable to smile or his facial muscles are drooping on one side then it is a stroke.

    A (Arms): Ask the person to raise both their arms above their heads. See if both or one arm drifts downwards.

    S (Speech): Ask the person to repeat a simple word or just their name. Notice if the speech is slurred.

    T (Time): If you notice any of the above symptoms, call emergency medical services immediately.

    Tips for Recovery

    There are a number of things that stroke survivors can do to promote their recovery, including:

    1. Take Nutritious Meals

    It is very important to focus on a well-balanced nutritious diet. You need every bit of nutrition you can get, to empower your immune system. A well-balanced, healthy diet consisting of all major food groups in appropriate portions is very important to keep your nervous system healthy. Eat foods rich in omega-3 fatty acids such as seafood (tuna, salmon, mackerel, etc), vitamin D, and B12. Leafy green vegetables such as spinach, kale, and lettuce are also very beneficial. Eating a healthy diet is essential for overall health and well-being, but it is especially important for stroke survivors. A nutritious diet can help to improve energy levels, reduce inflammation, and boost the immune system. Stroke survivors should aim to eat plenty of fruits, vegetables, and whole grains, and limit processed foods, sugary drinks, and saturated and unhealthy fats.

    2. Don’t skip medicines

    Source: verywellhealth.com

    The aftereffects of brain stroke are severe but can be managed and decreased by medicines and therapy. Take regular doses of prescribed medicines through CanadianPharmacyOnline.com and try not to skip a single dose. Make someone in charge of your medications or set a daily reminder if you live alone. Stroke survivors may be prescribed a variety of medications to help manage their condition, such as blood thinners to prevent future strokes, blood pressure medications to lower blood pressure, and cholesterol-lowering medications to reduce cholesterol levels. It is important to take all prescribed medications as directed, even if you are feeling well.

    3. Diminish “Learned non-use”

    Damn it all, it is NOT learned nonuse. It is the actual inability to use it because of dead neurons. Quit blaming the patient for not recovering and blame the doctor and therapists for knowing nothing on how to get survivors recovered! 

    Do you blithering idiots ever actually think about why stroke patients don't recover?

     

    When a brain stroke occurs, one side of the body is affected. If during recovery, that affected side or affected limb is not used or moved much, the brain wires itself to think that the body does not need that limb much and so the affected limb starts to become paralyzed. This phenomenon is called, “learned non-use”. During the recovery phase, keep the movement in your affected limbs to avoid this.

    4. Try all rehabilitation methods

    There are many rehabilitation methods for stroke patients to recover such as therapy, mirror therapy, gait training, and electrical stimulation. Try to get at least two sessions of all these methods and choose the one you feel most comfortable doing and which is yielding efficient results.

    Rehabilitation is essential for helping stroke survivors to regain lost function and skills. Rehabilitation programs typically involve a combination of physical therapy, occupational therapy, and speech therapy. Physical therapy can help to improve strength, balance, and coordination. Occupational therapy can help to improve activities of daily living, such as dressing, bathing, and eating. Speech therapy can help to improve communication skills.

    5. Managing stress and fatigue

    Stress and fatigue can make it difficult to recover from a stroke. It is important to find ways to manage stress and fatigue, such as getting regular exercise, getting enough sleep, and practicing relaxation techniques.

    Additional Tips

    Source: thelecc.com

    In addition to the tips listed above, there are a number of other things that stroke survivors can do to promote their recovery, such as:

    1. Staying positive: Having a positive attitude can make a big difference in the recovery process. Stroke survivors should focus on their accomplishments and set realistic goals for themselves.
    2. Building a support system: Having a strong support system of family and friends is important for stroke survivors. Support can help to provide emotional support, practical assistance, and motivation.
    3. Educating yourself about stroke: Learning more about stroke can help stroke survivors understand their condition and make informed decisions about their care. Stroke survivors can find information about stroke from their healthcare providers, support groups, and online resources.
    4. Try different types of exercise: Exercise is important for everyone, but it is especially important for stroke survivors. Exercise can help to improve strength, balance, coordination, and cardiovascular health. Stroke survivors should talk to their doctor about what type of exercise is safe and appropriate for them.
    5. Find hobbies and activities that you enjoy: Engaging in hobbies and activities can help to improve mood, reduce stress, and promote social interaction. Stroke survivors should choose activities that are appropriate for their abilities and interests.

    Don’t give up. Recovery from a stroke takes time and effort. It is important to be patient and persistent. Stroke survivors should celebrate their accomplishments and keep working towards their goals.

    Conclusion

    Recovery from a stroke is a challenging process, but it is possible. By following the tips above, stroke survivors can improve their chances of making a full recovery. If you or someone you know has had a stroke, please know that you are not alone. There are many resources available to help you on your journey to recovery.

    Saturday, April 29, 2023

    Quantifying Nonuse in Chronic Stroke Patients: A Study Into Paretic, Nonparetic, and Bimanual Upper-Limb Use in Daily Life

    Damn it all, it is NOT learned nonuse. It is the actual inability to use it because of dead neurons. Quit blaming the patient for not recovering and blame the doctor and therapists for knowing nothing on how to get survivors recovered! 

    Do you blithering idiots ever actually think about why stroke patients don't recover?

    Quantifying Nonuse in Chronic Stroke Patients: A Study Into Paretic, Nonparetic, and Bimanual Upper-Limb Use in Daily Life

    Marian E. Michielsen, MSc

     , Ruud W. Selles, PhD, Henk J. Stam, MD, PhD Gerard M. Ribbers, MD, PhD, Johannes B. Bussmann, PhD
    ABSTRACT. Michielsen ME, Selles RW, Stam HJ, RibbersGM, Bussmann JB.  Arch Phys Med Rehabil 2012;xx:xxx.
    Objective:
     To quantify uni- and bimanual upper-limb use inpatients with chronic stroke in daily life compared with healthy controls.
    Design:
     Cross-sectional observational study.
    Setting:
     Outpatient rehabilitation center.
    Participants:
     Patients with chronic stroke (n

    38) and healthycontrols (n

    18).
    Intervention:
     Not applicable.
    Main Outcome Measures:
     Upper-limb use in daily life was measured with an accelerometry-based upper-limb activity monitor, an accelerometer based measurement device. Uni-manual use of the paretic and the nonparetic side and bimanual upper-limb use were measured for a period of 24 hours. Outcomes were expressed in terms of both duration and intensity.
    Results:
     Patients used their unaffected limb much more than their affected limb (5.3h vs 2.4h), while controls used both limbs a more equal amount of time (5.4h vs 5.1h). Patients used their paretic side less than controls used their nondominant side and their nonparetic side more than controls their dominant side. The intensity with which patients used their paretic side was lower than that with which controls used their nondominant side, while that of the nonparetic side was higher than that of the dominant side of controls. Finally, patients used their paretic side almost exclusively in bimanual activities. During bimanual activities, the intensity with which they used their affected side was much lower than that of the nonaffected side.
    Conclusion:
     Our data show considerable nonuse of the paretic side, both in duration and in intensity, and both during unimanual and bimanual activities in patients with chronicstroke. Patients do compensate for this with increased use of the nonparetic side.
    Key Words:
     Ambulatory monitoring; Motor activity; Reha-bilitation; Stroke; Upper extremity.©
     2012 by the American Congress of Rehabilitation Medicine
    F
    IFTY TO 70% OF PATIENTS with stroke suffer fromlong-term motor deficits of the upper limb,
    1
    with a de-creased use of the paretic upper extremity in daily life.
    2
    Be-cause this latter may have a great impact on the manner inwhich a patient is able to participate in daily life activities,maximizing purposeful use of the upper extremity in daily lifeis a key factor in motor rehabilitation following stroke.While it is clear that a decreased motor capacity of theparetic arm influences the use of both extremities, the exactchanges in upper-limb use following stroke are not yet fullyunderstood. Regarding the paretic upper extremity, many studies have shown that there is no 1-on-1 relation between motor impairment and functional use.
    3,4
    This may be related to the phenomenon of learned nonuse,
    5
    which describes how patients will have “learned” not to use the paretic side to its fullcapacity.
    6
    Brain injury causes structural damage to motor path-ways as well as depression of neural excitability near thelesion. Decreasing activity of the upper extremity leads to afurther reduction in excitability and as such starts a viciouscircle of decreasing excitability and decreasing activity.
    7
    Even less is known about the consequences of stroke on thenonparetic side. Motor performance of the nonparetic side maybe impaired compared with that in healthy subjects, showing,for instance, decreased speed and consistency of performance.
    8
    In addition, it has been shown that patients with acute strokehave a more reduced use of the nonparetic side in daily life thando healthy subjects.
    9
    On the other hand, it is generally assumedthat poststroke the nonparetic side will be used more to com-pensate for the decreased use of the paretic side. However, toour knowledge, this has not been investigated in patients withchronic stroke.Overall many questions on techniques to optimize the func-tion of the paretic extremity after stroke still need to be an-swered. The optimal rehabilitation technique is still not de-fined, and different approaches in reducing upper-extremityparesis are distinguished.
    7
    Several therapies have been devel-oped to improve the use of the nonparetic arm in daily life. Forexample, constraint-induced movement therapy (CIMT),
    10,11
    or forced use,
    12
    reported as a beneficial treatment option formotor recovery of the arm,
    13
    prevents the use of the nonpareticupper limb and aims to counterbalance the learned nonuse.CIMT is an augmentative technique,
    7
    a high-intensity, uni-manual training aiming to counterbalance the vicious circle of decreasing excitability and decreasing activity. Furthermore,CIMT has aspects of task-specific exercising. Bilateral trainingprograms have also been developed, for example, with rhythmic
     auditory cueing.
    14
    To evaluate and understand the effects of upper-extremity training in daily life conditions, detailed insight isneeded in unimanual and bimanual function of the arms in dailylife conditions. This is the topic of the current article.Several studies have included the measurement of upper-limb use in daily life. For example, Taub,
    11
    Mark,
    15
    and Wolf
    5
    and colleagues used the Motor Activity Log (MAL) in their studies. However, although validated against an objective mea-sure,
    16
    the MAL still is a subjective instrument that focuses on how well and how much patients use their most impaired arm in a defined category of activities, and the MAL does not include data on the amount of use of the non impaired arm and bilateral use. Another method for assessing upper-limb use in a home setting is provided by accelerometers and other portable devices providing the opportunity to assess how much patients with stroke use their upper limbs in daily life for longer periods.
    2
    However, so far, studies using these devices assessed only the upper-limb use overall and not in detail. For example,many studies express actual upper-limb use only as a ratio between the use of the affected and the use of the unaffected side,
    17
    thus omitting information about usage times of the paretic side and the nonparetic side separately. Second, currentdevices do not differentiate between arm movements resulting from general body movements such as walking and arm movements during sitting and standing. Third, most measurement devices cannot differentiate between the duration of use and the intensity of use, and finally, most devices cannot or do not differentiate between unilateral and bilateral usage of the arms.The aim of the present study was to quantify uni- and bimanual upper-limb use in patients with chronic stroke in daily life and compare this with healthy controls. By using an accelerometry based upper-limb activity monitor,
    18
    we were able to give an insight into both duration and intensity of upper-limb use and to discriminate between upper-limb movements caused by whole-body movements and movements independent of whole-body movements, thus providing an insight into the amount of functional and purposeful upper-limb use in daily life conditions.

    More at link.

    Thursday, March 9, 2023

    The reasons for not returning to work and health-related quality of life among young and middle-aged patients with stroke: A cross-sectional study

    Damn this is easy to explain. Your doctors and therapists have completely failed you by not providing 100% recovery protocols. So do the research on why doctors and therapists fail at their only task of 100% recovery. Don't you dare try to blame failure to recover on the patient!

    The reasons for not returning to work and health-related quality of life among young and middle-aged patients with stroke: A cross-sectional study

    Xi Pan1, Zhi Wang1, Lin Yao2 and Lan Xu2*
    • 1Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
    • 2Nursing Department, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China

    Objectives: This study aimed to explore the reasons and influencing factors for non-return to work (non-RTW) within 1 year among young and middle-aged patients with stroke and to assess their health-related quality of life (HRQoL) at 1 year across different reasons.

    Methods: The study was conducted as a telephone-based cross-sectional survey. Seven hundred eighty-nine young and middle-aged patients with stroke aged between 18 and 54 years for men and 18 and 49 years for women in the electronic medical system were included. Data collection included demographic characteristics, socioeconomic status, behavioral habits, history of chronic diseases, work status, reasons for non-RTW, and HRQoL.

    Results: Of 789 patients, 435 (55.1%) (mean [SD] age, 47.7 [7.8] years) did not return to work within 1 year after stroke. Among the patients who did not RTW, 58.9% were unable to work, 9.7% retired early, 11.03% became full-time homemakers or were unemployed, and 20.5% were reluctant to work. The disordered multiclass logistic regression model showed that the factors influencing the reasons for non-RTW included age, gender, education, income, health insurance, diabetes comorbidity, ability to perform activities of daily living, and mobility of the right upper extremity. Furthermore, patients who were unable to work had significantly lower HRQoL compared to those who had RTW, followed by those who retired early.

    Conclusions: More than half did not RTW within 1 year in our study. The results will help inform future research to identify interventions to promote RTW and improve HRQoL for young and middle-aged patients with stroke.

    1. Introduction

    Recent data show that the incidence of stroke is increasing among young and middle-aged people and is highest in Asians compared to that in other ethnic groups (1, 2). According to reports, nearly 40% of patients with stroke are of working age, an age group whose specific social characteristics dictate a higher willingness to return to work (RTW) after a stroke (3). RTW is the primary goal of the rehabilitation process for most working-age patients (4), and it is closely related to the patient's quality of life, physical and mental health, subjective wellbeing, and life satisfaction (5).

    Unfortunately, it can be challenging for stroke sufferers to return to work (6). Several studies have demonstrated that with proper rehabilitation, most young and middle-aged post-stroke survivors can achieve functional independence and high activity levels (1, 7). Nevertheless, the proportion of patients with stroke who do not return to work ranges from 25 to 50% (810). Exploring the reasons for non-RTW among young and middle-aged patients with stroke and the associated factors require clinical practice by identifying the types of non-RTW that may occur in different patients and that can be improved through rehabilitation (4, 11, 12). Although previous research has explored the factors impacting non-RTW after stroke, such as gender and advanced age (810), most studies have evaluated non-RTW as a whole and cannot differentiate between various non-RTW types and their associated factors. However, some qualitative studies have been conducted to explore the related causes and influencing factors (4, 11), but the researchers' opinions and thoughts may introduce bias in interpreting the results, resulting in a lack of objectivity and the inability to identify relevant influencing factors.

    To the best of our knowledge, no specific study has been conducted that quantitatively describes the reason for non-RTW following stroke, and its associated factors are mainly unclear. In addition, it is uncertain whether the reported reasons for non-RTW are related to health-related quality of life (HRQoL). Therefore, the aims of this study were to (1) quantify reasons for non-RTW among young and middle-aged patients with stroke; (2) identify factors predicting different reasons for non-RTW, focusing mainly on sociodemographic and clinical characteristics factors; and (3) investigate the impact of different reasons for non-RTW on HRQoL.