Monday, December 15, 2014

Emerging Stroke Recovery Treatments? Yeah NO.





Just caught this over at Dean's stellar stroke-recovery site:

An article called "Emerging Treatments for Motor Rehabilitation After Stroke."  They include:
1. mirror therapy
2. motor imagery or mental practice
3. constraint-induced movement therapy
4. noninvasive brain stimulation 
5. selective serotonin reuptake inhibitor medications

A coupla itzy problems: These treatment options have been around for at least a decade and at least one has little proven efficacy.

Let's get the 5th one out of the way; these meds (SSRIs) are things like prozak and paxil and they usually treat depression. They've been used forever to treat depression in survivors. Do they help depression, yeah. Do they help you recover, no. SSRI's effectiveness-- if you take JAMA's word for it: meh. BTW, Mild to moderate depression is probably better treated with exercise. (A review here from Harvard.) And exercise is what survivors ought to be doing anyway, so its a two-fer! 

The 2nd and 3rd I've been involved in published clinical trials and have written about in my book, blog entries and magazine articles. In fact, our group, led by our fearless leader Stephen J. Page, was the first to do a modification of constraint induced therapy, and the first to look at motor imagery post stroke. And this goes back to the late 90s. "Emerging Treatments." Yeah. No. I've written about it extensively in every edition of my book as well as magazine articles, journal articles and every talk I've ever done.

Mirror therapy has been around for stroke, again, since the late 90s. I've written about it in this blog, in my book and in every talk.

Noninvasive brain stimulation is nonspecific but they're talking about Transcranial Magnetic Stimulation (TMS), which has been around for quite some time. Our group has done
a lot of work with the "next gen" of this called Navigated Transcranial Magnetic Stimulation -- basically its more accurate. But there is no research that shows that sapping the "stroked" brain with TMS does anything--yet. Promising, maybe, but not much there...yet.



So we have 3 "emerging" treatment option that have been around for more than a decade, one option that probs does not work and one that we're not sure what it does or how to use it. 

1 comment:

Dogon Sirius said...

Before taking SSRI's check out ssristories.com. Amanda Todd, Tony Scott, Robin Williams - all reportedly on antidepressants, not to mention many notable lone gunmen who went on shooting rampages over the past two decades.

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