Antidepressants To Help Stroke Recovery

This is something that has been mentioned a few times of late. Although the study sizes are small and speculation still surrounds the mechanism of exactly how the antidepressants help the physical recovery of stroke. However, the improvements in physical disability show promising results.

While this is all well and good, it also  must be noted that you must be doing adequate stroke rehabilitation in the first place. This assumes you are consistent with your rehab, performing the correct exercises and being specific with your application.

Recuperating stroke patients treated with a short duration of antidepressants showed greater improvement in physical rehabilitation than stroke sufferers receiving a placebo, new investigation finds.

What’s more, the physical healing of the group taking antidepressants continued 9 months after the medication had been discontinued.

Researchers with the University of Iowa gave 54 patients antidepressants while twenty nine patients were given a placebo.

Every group took the pills for 3 months. Using the Rankin Scale, which measures general physical plus motor disability, scientists found that the group getting antidepressants encountered significant decrease in physical impairment over a one-year period of time. Individuals getting the placebo improved initially however their improvement leveled off.

Stroke experts say that existing stroke treatments concentrate on reestablishing blood circulation towards the brain rigtht after an acute ischemic attack. Frequently, however, those individuals miss the brief, post-stroke time frame for effective treatment.

“Early administration of an adjunctive medication, an antidepressant, might have an effect on improving outcomes independent of the medication’s actions on mood,” said the study’s co-author Harold Adams, M.D. The study was published online in the American Journal of Geriatric Psychiatry.

Other studies also suggest that the antidepressant medication is doing something separate from treating depression that increases physical recovery from stroke.

Senior study author, Robert Robinson, M.D., notes that even though mechanisms underpinning the effect aren’t yet known there’s evidence that antidepressants could inhibit a type of inflammatory protein that’s released inside the brain during stroke, and may promote development of new cells in specific parts of the brain.

This article is presented purely for interest sake and is not medical advice or suggesting you start taking antidepressants. Please consult your primary physician before doing anything like that.

Aphasia and Apraxia – What’s The Difference?

The main reason ambiguity and confusion take place in the minds from the broad community as well as people who are afflicted by aphasia and/or apraxia in regards to what these conditions signify is really because both situations involve expression skills and are quite often brought on after a stroke or an accident involving injury to the brain. Both conditions, however, are very different though they can co-exist inside a person.

Aphasia is owing to any injury, lesion, tumor or infection that has an effect on the left hemisphere of the brain in the frontal, temporal or parietal lobes. The left hemisphere in the brain is made up of Broca’s area, Wernicke’s area and the neurological paths that lie in between, which if damaged or detrimentally affected can lead to many conditions, one of these is the onset of aphasia.

Apraxia, on the other hand, might take place from impairment caused to the motor speech area also referred to as Broca’s area. That is located in the frontal lobe of the cerebrum.

Aphasia is a impairment with communication which involves how we use language. It affects the ability to process language. What this means is there is a problem in either of the 2 ways in which we communicate – obtaining of information (through reading, hearing plus visual) and also expression of information (through talking plus writing). So, an individual might have receptive aphasia in which they can hear what exactly is being said and can see it visually but are not able to comprehend it or they might have expressive aphasia by which he or she wants to express something but has trouble using writing skills or simply putting the correct words verbally to state that message. Alternatively, apraxia patients suffer from not from the capability to put together the right word/term but they are not able to trigger their conversation muscles to form those words and phrases. Therefore they may possibly fully understand precisely what they would like to say and have the word ready for this, but their speech motor abilities deceive them.

Thus the therapies together with approach to treatment also varies. Aphasia patients are recommended therapy which helps them restore their language skills by making the patients comprehend spoken language in addition to by stimulating the process of word finding.

The aphasia patients will also be taught ways of communication that will compensate their loss of language abilities.

Apraxia patients, on the other hand, are given therapy that enables them to produce sounds through repetition. The therapy also involves assisting the individual to produce words by watching the mouth-muscle movements from the therapist together with imitating them. Treatment for apraxia sufferers also aims to teach the patients to utilize alternative or augmentative conversation system that requires little or no talking such as writing or even software programs that create sounds on typing for the keypad.

Specialists Call For Increased Funding Of Stroke Research: Promising New Ideas Require Further Study For More Applicable Therapies

Cerebral stroke is among the most frequent reasons for death and life-long impairment worldwide, greatly burdening affected families and healthcare systems. “In the last decade, breathtaking advances have been made in understanding, among other aspects, the molecular and cellular mechanisms of such events,” Prof. José Manuel Ferro, chairman of Neuroscience with the University of Lisbon, said today at the Meeting of the European Neurological Society (ENS) in Lisbon. More than 3,200 neurological experts from everywhere are currently talking about the most recent advancements in all areas of their area of expertise in the Portuguese capital.

The breakthroughs presented at the ENS Meeting include several brand new findings. They relate to the mechanisms of so-called reperfusion injuries, or strokes that advance despite timely thrombolysis; to promising approaches for restoring the damage to regions of the brain by certain kinds of stem cells; to new observations in to the potentially lethal interplay between the central nervous system and the immune system during stroke; also to methods such as hypothermia to safeguard the stroke-stricken brain from lasting damage.

Searching for the causes of reperfusion injuries

Reperfusion injuries – the occurrence of a ongoing stroke despite the early opening of occluded vessels e.g. by thrombolytic medication – has been a long standing riddle. A new German study (University Wurzburg) provided at the ENS Meeting sheds some light on the hidden elements that could lead the path toward brand new therapies. Studies with mice strongly suggest that the opening of big vessels doesn’t impede the development of thromboses on the microvascular level combined with inflammatory processes. The study also identified multi purpose molecules crucial both in inflammation and in platelet gathering or amassing (the clots of blood designed to close an injury that similarly obstructs the blood-flow in little vessels). Influencing those molecules can lead to long term treatments for combating both thrombus development and inflammation.

Stem cells for damaged brain areas

As with other traumas, the human organism provides mechanisms to auto-repair brain injuries by proliferating stem cells produced in the bone marrow plus distinguishing them into new neurons, arteries and synapses. Researchers have pondered for quite some time that the application of additional stem cells might enhance in addition to accelerate these repair steps, mitigating the disabling effects of cerebral strokes. Brand new results offered at today’s ENS Meeting by the Madrid-based Foundation for Biomedical Research with the University Hospital La Paz bring this approach a huge step nearer to clinical use. Initially, injections of neuronal stem cells and bone marrow mesenchymal stem cells, hitherto tested only in animals, were confirmed harmless and practical for humans. Along with other research displaying a lowering of cell death and an increased production of neuronal and vascular cells following the application pursuing the injection of stem cells in mice, this opens up the path for promising phase III studies to evaluate the direct impact of stem cells for the results of stroke in human patients. Hopefully, this can lead to fresh therapeutic methods to support the brain’s self-repair process and reduce the long-term damage leftover after a stroke.

Research on hypothermia inhibition of lasting brain damage need fine tuning

Research into hypothermia as a treatment option to minimize the consequences of a stroke is sophisticated. The process involves slowing down the metabolism and thus the advancement of neuronal brain damage through cooling the patient’s blood to about 32-34°C. “Hypothermia has already proven its neuroprotective properties in improving the neurological outcome of survivors of cardiac arrest and of infants who suffered brain damage from an under-supply with oxygen,” Prof. Ferro reported. “At today’s meeting we heard the first promising results of applying hypothermia in acute ischemic stroke. As expected, it seems to be safe and feasible. But to optimally implement it in daily clinical routines, important details such as depth, duration, the best method for cooling and possible side-effects, including infections, are still being studied.”

Money being a key to applicability

The bottom line is the most important new observations which might produce innovative therapies and prevention strategies over the following few years. However financing these studies remains the crucial problem. Hopefully that this conference will assist to promote that. During times of economic crisis, we must remember that the current money in stoke research can prevent greater long term costs in addition to unnecessary individual suffering of those possibly impacted.

Innovative treatment safe and effective for patients with intracerebral hemorrhage

A new treatment that treats a subset of stroke patients by mixing minimally invasive surgery, an imaging method compared to “GPS for the brain,” and the clot-busting drug t-PA appears to be effective and safe, according to a multicenter medical trial led by Johns Hopkins researchers.

The novel treatment, detailed initially at this week’s European Stroke Conference in Hamburg, Germany, was developed for patients with intracerebral hemorrhage (ICH), a bleed within the brain that creates a clot to form inside brain tissue. This clot increases pressure and leaches inflammatory chemicals that induce irreversible brain damage, often resulting in fatality or extreme disability. The typical treatments for ICH-either general supportive care including blood pressure control plus ventilation, which is regarded as the current standard of care, or invasive surgeries which entail taking off portions from the skull to remove the clot-have similar mortality rates, which range from 30 to 80 % depending on the dimensions of the clot.

Seeking to enhance these death rates and surviving ICH patients’ quality of life, Daniel Hanley, M.D., professor of neurology at the Johns Hopkins University School of Medicine, and his fellow workers produced and analyzed the brand new treatment method on sixty individuals at 12 hospitals in the usa, Canada, the united kingdom as well as Germany. They compared their results to that from 11 individuals who received only supportive care.

After neurologists diagnosed individuals in the treatment group with ICH at these hospitals, operating specialists drilled dime-sized openings in patients’ skulls near to the clot area. Using high-tech neuro-navigational computer software that provides detailed brain images, the physicians threaded catheters through the holes and directly into the clots. They used these catheters to drip t-PA to the clot for about three days at 1 of 2 doses, either 0.3 mg or 1 mg, every 8 hrs.

The study discovered that clot size in patients given either dose shrunk by more than half, compared to only 1 percent in subjects who received only supportive care. Comparison of daily CT scans showed that patients in the treatment method group whose catheters were most accurately placed over the longest part of the clot had the very best clot size reduction.

Those in the treatment group and also the supportive care group had about a 10 percent mortality rate at 30 days after treatment, less than the typically high mortality rates expected with this condition. After pursuing the patients out for 6 months, the researchers found that the treated patients scored significantly greater over a test that calculates the ability to function in daily life in comparison to people who received supportive care.

All round, Hanley says, the new treatment method appears to be a viable and promising option to the current standard treatments of supportive care or invasive surgery.

New Research Gives At Home Stroke Therapy Thumbs Up

Can You Save Money with Stroke Therapy at Home But Still Get Results?

According to a new study, a rigorous home-exercise program which emphasizes flexibility, strength and balance ended up being just as effective as high-tech treadmill machines.

The home-based program in addition enjoyed a lower price tag plus a lower drop-out rate than the treadmill option, which in fact had to be done at a clinic.

The research released in Thursday’s New England Journal of Medicine also found that patients keep making strides in rehabilitation much longer than the typical small windows of believed recovery that are so commonly held to be true (e.g. recovery only happens in the first 3 months after a stroke).

Inside the largest stroke rehabilitation research ever conducted in the us, researchers discovered that stroke patients regain walking ability through at-home strength and balance exercise provided by a physical therapist – and that method worked equally efficiently as when they took part in programs that practice the specific task of walking, by using a treadmill and partial body weight support.

“For individuals who have suffered a stroke, the findings of this trial offer good news for improving walking within the first year post-stroke through intense physical therapy interventions,” said Andrea Behrman, co-principal researcher and an associate professor inside the department of physical therapy at the University of Florida College of Public Health and Health Professions.

The Locomotor Experience Applied Post-Stroke, or LEAPS, trial involved in excess of four hundred patients who were at random , assigned to a treadmill training group two or half a year after their stroke or to a home-based therapy program. Primary funding for the study originated from the National Institute of Neurological Disorders and Stroke.

Patients within the walking training group practiced walking inside a clinic, utilizing a treadmill using a system that gives partial body-weight support, also known as locomotor training. The home-based exercise treatment method program was closely watched by a physical therapist and centered on flexibility, ability to move, strength and balance.

At the one-year mark, fifty-two percent of all of the study contributors had made significant improvements within their walking ability. Both the walking training and exercise program individuals had similar advancements in walking rate, motor recuperation, balance, social participation and quality of life.

But the home-based exercise program may save on health-care costs and promote treatment adherence: Only 3 percent of individuals in the home-based therapy dropped out of the study while 13 % ceased the locomotor training.

“The home physical therapy program is more convenient and pragmatic,” said Pamela W. Duncan, the study’s principal investigator and a professor at Duke University School of Medicine. “Usual care should incorporate more intensive exercise programs that are easily accessible to patients to improve walking, function and quality of life.”

The study staff found that patients within the group who began the therapy half a year after their stroke likewise enhanced their walking. This discovery challenges the widely held belief that patients are only able to make gains in their rehabilitation within the first few months of a stroke, the study say.

“More than 4 million stroke survivors experience difficulty walking. Rigorously comparing available physical therapy treatments is essential to determine which is best,” said Dr. Walter Koroshetz, deputy director of National Institute of Neurological Disorders and Stroke. “The results of this study show that the more expensive, high-tech therapy was not superior to intensive home strength and balance training, but both were better than lower intensity physical therapy.”

Computer Video Games Improve After Stroke Recovery

Stroke patients end up finding it tough to recover hand plus arm movement, with 80-90 % of patients still having problems half a year later. A group of United states medical professionals have used computer games as well as robotic training aids to enhance function of both hand and arm movements simultaneously.

Twelve subjects — 8 male and 4 women, who had experienced a stroke at least 6 months in the past — were required to train 2-3 hrs every day for eight days. Games including Plasma Pong and Hammer Task were used to improve hand-arm co-ordination. At the same time Hummingbird Hunt plus Virtual Piano were utilised to enhance grip and individual finger movement. Following the eight days, all the individuals demonstrated advancements for movement and control of their hand and arm.

The individuals wore a force-reflecting exoskeleton (CyberGrasp) which fits over special robotic gloves (CyberGlove) to be able to assist as well as measure the hand movements. The games were adapted in order that they could be managed using the glove using different hand movements as opposed to a computer mouse.

Following the 8 days, all the individuals demonstrated improvements in mobility and control of their hand and arm. The subjects had greater stability, greater smoothness of motion as well as improved control over their fingers. There were no type of significant improvements within the arms of game players in a control team.

The writers mentioned that the intense training regime could have made the enhancements much more obvious. In standard robot-assisted raining, subjects average a lot more than 500 repetitions of actions per day. However, subjects within this research averaged a lot more than 2,200 repetitions during each two-to-three hour work out. The gaming simulations assisted to make sure that subjects focused on the job at hand. The writers mention previous research where it has been shown how the learning of motor task can be more effective when centered on externally instead of internally-based directions. The video games ensured that subjects focused on certain action goals, or the impact of their actions, rather than on the movements themselves.

Medication to Aid Stroke Recovery

Obtaining aid fast after having a stroke is probably the most effective tool in opposition to long-term disability and even loss of life.

For the most frequent type, ischemic stroke, which reduces blood flow to brain tissue, a strong clot buster called tissue plasminogen activator (tPA) may be used. And for a few it not only prevents damage, but reverses it, according to Kelly Anderson, the stroke program coordinator at Intermoutnain Medical Center, Alta View, LDS and Riverton hospitals.

The tPA isn’t for everyone, medical doctors state. People who are already on a blood thinner like warfarin (Coumadin) shouldn’t obtain it. Neither can those who have had stroke symptoms for more than three hours, because the longer it goes on, the more fragile and more likely to leak arteries become. That can trigger a hemorrhagic stroke, caused by bleeding in the brain. Someone who has just lately had surgical treatment most likely is not a candidate. And once it is given, the individual is going to be supervised in intensive care for a day, in which experts can look for neurological symptoms plus possible problems.

Call said some sufferers might have an additional 1 hour 30 minutes where tPA can be given. Individuals are usually younger patients that did not have a massive stroke and that do not possess diabetes or previous status for stroke.

From there, treatment could get very individual. In 90 % of strokes, Call said, doctors can do imaging in order to find the blocked vessel. That paves the way to running a catheter in to the brain and also putting it up against the clot, then administering tPA immediately, which is often done in smaller amounts after the time frame for IV tPA has gone by.

Alternatively, a MERCI device can be used towards the site in the clot, employing a corkscrew motion to punch through the clot as well as pull it back out and into a catheter.

An additional technique essentially vaccums out the clot, which can be helpful with bigger clots as well as strokes.

They also use imaging tools like multimode CT scans to see not only exactly what tissue has died, but what is at an increased risk, Call said. To save imperiled tissue, blood flow has to be re-established.

The human brain does make an effort to work around dead tissue. It really is similar to an accounting division right after 50 % its staff is fired: Difficult initially, Call said, but the leftover accountants find a way to pick up a lot of the work. But if the entire accounting division is dismissed, “it’s harder for the marketing team to take over. They can easily perform some, however, not all of it,” he said. The specialized parts of the brain are just like that, too.

The smaller the stroke, the better the possibility the rest of the brain will compensate.

Call said he is excited about a device that’s in trials known as the Stentreiver. It pops the blood vessel open and restores blood circulation. Since it does that, it squishes the clot into the mesh, where it can be pulled out.

And innovators will always be looking at much more adjunctive treatments, he said, like whether or not incorporating an additional medicine using the tPA enhances the chance of removing a clot. Some are trying to improve tPA’s effectiveness, because it doesn’t help everyone who receives it.

Among the best innovations, according to Anderson, can be a team approach like the one they will use. Multidisciplinary teams get plenty of eyes and expertise working toward a common goal — healing someone who has had a stroke.

Hormonal Link Key to Stroke Recovery

Researchers at the Sahlgrenska Academy have shown the very first time the fact that high amounts of a bodily hormone that’s linked to the growth hormone system are associated with better long-term recovery throughout the later phases associated with treatment after having a stroke.

Insulin-like growth factor I, IGF-I, is known as a hormone which is found in the bloodstream as well as contributes to, amongst other things, growth and bone mass. The levels of this hormone tend to be greater in people who get some exercise regularly and people with very good overall health.

This study is interesting for 2 reasons. The first is that individuals demonstrate that a bodily hormone is associated with improved long-term recovery, and thus there is certainly still the chance of development – even after three months after the stroke. The second is that levels of this hormone are known to be raised in those who exercise frequently.

It is, nevertheless, vital that you include that the amount of IGF-I are controlled also by other factors for example other growth hormones, inheritance and also nutrition.

The study is founded on 407 individuals aged 18-70 years that are impacted by stroke are followed up for two years following the occurrence.

Researchers have measured the amount of IFG-I in these 407 patients and observed that increased levels are associated with far better recovery, once the level of recuperation has had some rehab..

The research happens to be presented within an article in the Journal of Clinical Endocrinology and Metabolism.

New Sensory Technology Improves Stroke Rehab

Devices that could be used to rehabilitate the arms as well as hands of people which have experienced a stroke have been produced by researchers at the University of Southampton.

Dr Geoff Merrett from the School of Electronics and Computer Science (ECS) has worked with Dr Sara Demain through the University’s Faculty of Health Sciences along with Dr Cheryl Metcalf who operates throughout Health Sciences and ECS, to produce three ‘tactile’ devices which generate a realistic “sense of touch” and sensation which imitate those involved in everyday activity.

Most stroke rehabilitation methods disregard the role of sensation and they only permit individuals repetitive movements. The actual goal is to develop technologies which offers people with a sense of holding a thing or associated with experiencing some thing, like, for example, holding a hot cup of tea, and now we want to combine this together with enhancing motor function.

About three tactile devices have been developed and tried on patients which had had a stroke and also on healthy individuals. The units were: a ‘vibration’ tactile device, which people felt supplied a good indicator associated with touch but did not really feel as if they were holding anything; a ‘motor-driven squeezer’ system, that people said felt similar to they were holding something, similar to catching a ball; and a ‘shape memory alloy’ device which includes thermal attributes and fosters a sensation like lifting a cupful of tea.

This technological innovation may be used on its own as being a stand-alone program to assist with sensory rehabilitation or it may be employed together with existing health technologies including rehabilitation robots or perhaps video gaming technologies which help patient rehabilitation.

New Technology Called The Sensor Glove

Those who have had strokes are often still having physical problems, including partial or even total paralysis on one side of the body, so this means a reduction associated with muscle control. So that they can aid treatment, 4 McGill Engineering undergrads designed a biomedical sensing unit glove that can help stroke patients recover hand motion by playing video games.

The glove enables individuals to exercise hand movements in their households with very little supervision, and cuts down on hospital trips and charges. Associated software sends data directly to the doctor’s office. The program generates three dimensional models while the patient performs video games, enabling the patient to keep track of their own progress. Produced by students, this product was developed in reply to some design demand coming from startup company Jintronix Inc. who creates medical devices that make use of virtual reality technology to help the treatment of individuals struggling with motor impairments.

The glove can track the movements of the wrist, the palm and also the index finger using several inertial measurement units. Comparable gloves cost as much as $30,000, however the students employed more accurate and less expensive receptors, taking the cost down to $1000.

Jintronix, Inc. has submitted the venture to Grand Challenges Canada, a not-for-profit that operates to enhance the health regarding individuals in developing countries, hoping that they’ll acquire funding for further development. Grand Challenges Canada funds $100,000 CDN to an revolutionary concept that addresses persistent health challenges from the developing world. Stroke is a concern in lots of growing countries, not just North America. In India for example, the average annual occurrence rate of stroke is approximately a hundred forty five for every 100,000 people.

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