Friday, November 2, 2018

This looks cool...

This blog gets a lot of attention from folks trying to sell stuff. Machines, products, services. I'm pretty selective about advocating anything where the balance between the manufacturer, book author, video producer, etc. and the best interest of stroke survivors does not exist. I got an email from the stroke survivor producing this video. It looks cool, and is deserving of support. 

Have a click, have a look!

Sunday, September 9, 2018

Do Bleed Strokes Have a Penumbra? Nope.

I explain what the penumbra after stroke is more fully here (with pictures!) and explain how important it is after stroke. 

But a question kept coming up in my clinical talks: Do hemorrhagic stroke have a penumbra?

Just some quick background:

After a block (ischemic) stroke, there is an area that the stroke kills (infarct) ("Stroked" in the image below). 

Then there's another LARGE area that, hopefully, comes back on line: The penumbra.












But what about a bleed stroke:? There is no penumbra in bleed (hemorrhagic) stroke.

There was a long debate about this, but as more experimentation was done, and as brain scanning has gotten better: Bleed stroke: No penumbra.

If you'd like a more science-y take:


Or even nerdier!:

Sunday, September 2, 2018

A Problem with the F.A.S.T test? Yes and no.

The FAST test (Face, Arm, Speech, Time) is used to tell if somebody is having a stroke. 
The problem is, it doesn't pick ~15% of strokes. Worldwide, that ~2 million stroke not captured. 
(Note: the article referenced above, written in 2014, essentially adopted my recommendations published in 2009. Except it added "leg" which involved a walking test. Which, you know, getting someone having a stroke to get up and walk may not be prudent?)
I have a long suggested another system, one I created. This is how it works: 

OK, more detail:

Just over a third of all stroke survivors will have a another stroke within 10 years of their first stroke – a one in three chance.

Every stroke survivor knows that if they're having a stroke time is brain. The quicker you can get to the emergency room, the more options the doctors have. More options = more brain saved.

But how do you know if you're having another stroke? What if the symptoms are different than the last stroke? What if last time you had numbness and weakness in your left arm, and this time you have a blinding headache? Will you know? Will caregivers know?

The common wisdom is to use the FAST test. 

But there's a problem with the fast test. 3/4 of all "block" (ischemic) strokes have sudden weakness or numbness on one side of the body. But that same symptom drops to less than half in "bleed" (hemorrhagic) strokes. On the other hand, headache happens in 40% of bleed strokes, but less than 20% of block strokes. 

Don't get me wrong, the FAST test has been useful and effective. For instance in the UK, after the FAST TV campaign was rolled out, the time to hospital was reduced. The time from the stroke (the first symptom) to the hospital dropped by 66 minutes. That's amazing. 

Another amazing fact: In 90% of all people having a stroke, medical attention was sought by a bystander! Yay bystanders! 

Maybe we should call them bydoers!


Adolf "Woody" Hitler: If I had a stroke in 1937
it woulda been a good thing schlieben!

Saturday, July 28, 2018

Had a stroke? Have daughters? You're in luck!

If you've had a stroke, and have daughters, you are more likely to go home than to an institution. (article here)


In fact, the more daughters you have, the more likely you are to go home!


As Sarah Silverman says: 
Sorry, its a boy!

Friday, June 22, 2018

You're welcome.

   (3rd ed.,      2nd ed.,     Malaysian,    1st ed.,   Japanese,  Korean.)

Since the 2nd edition (2012) of Stronger After Stroke, I've been advocating basing survivor's recovery plan on the phase of recovery they're in. So, you might do "Recovery option Y" with someone who is 2 months after the stroke. 

But if you did the same with someone 3 days after the stroke, you could make the infarct (brain killed by the stroke) worse. 

2 months, good; 3 days, bad.

There was only one problem: Nobody had defined the timing of the phases. I was able to do so after considerable research of textbooks, articles, and expert opinion. So far as I know, my book is the first and only resource that actually specifically delineates post-stroke phases. (The book outlines two ways; a "one size fits all timeline", and a more nuanced perspective based on the fact that survivors are never on the same timeline.) The best place to learn about the post-stroke phases is the book. But you can get a thumbnail here.

Its nice to know clinical research has caught up (where y'all been?). This article (2016)(It references an article on which I'm a coauthor jus' sayin') puts it this way: Rehabilitation interventions targeting at improving a stroke patients' performance should be implemented according to the phase of neurological recovery.

Even the word phases instead of the classic stages is telling, because that is the exact term Stronger used since the 1st edition-- 2008 (although I had not yet defined the phases). 

Stronger has changed the conversation, not only among survivors and caregivers (although motivated survivors were the first adopters). More recently researchers, and scientific organizations, have come aboard. This is the way I put it in the 3rd edition:

There has been another phenomenon surrounding this book as well: plagiarism. Either word for word plagiarism, or as a sort of reverse engineering of the whole sections of the book. Even the title has been ripped off. Since the first edition the Journal of the American Academy of Neurology, University of Tennessee Medical Center, and Emerson Hospital, and many others have all called articles in print or on line “Stronger After Stroke.” 

The fact that this book has a big footprint is a good thing because I have only one hope for this book. 

I hope it helps.

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