Altered Sexual Function

October 2016: Brandstater & Kim (2016) The challenge of altered sexual function in stroke survivors undergoing rehabilitation. Topics in Geriatric Rehabilitation, 32 (3), 199-203

This is a topic which I’ve not posted about before and yet, it is so integral to enjoying life, particularly within our intimate relationships. As the authors state: “..poststroke changes have a profound effect on the way a stroke survivor shares intimacy with the spouse of significant other and participates in sexual activity”. I can’t imagine how challenging it must be to participate in sexual activities when one half of your body isn’t working that well and when you’re potentially prone to fatigue and depression! As the authors point out in their concluding statement: “Attention should be given to sexual counselling at an appropriate stage during the individual’s recovery”.

The full article is not publicly available, so don’t forget, if you’d like a copy, you can always request it from the corresponding author. To find “humble opinion”, go to Journal Club 2016 and Altered Sexual Function and scroll down to the comment section at the base of the page.

Shaping Early Reorganization

September 2016: Volz et al (2016) Shaping early reorganization of neural networks promotes motor function after stroke. Cerebral Cortex, 26(6), 2882-2894 10.1093/cercor/bhw034

This is such impressive research because it’s so “cutting edge”! These researchers are amoung some of the most influential in this field. The intervention they’ve investigated is intermittent theta-burst stimulation applied just before physiotherapy that’s targeting upper limb recovery. The outcomes they’ve assessed are hand function and cortical excitability. This is a multi-modal intervention which aligns with the recovery approach of the future.  To find out more, go to the abstract under Journal Club 2016. The full article is feely available at: http://cercor.oxfordjournals.org/content/26/6/2882.full

To find “humble opinion”, scroll down to the comment section at the base of this Journal Club page. I know that neuroplasticity literature can sometimes be hard to understand, but my advice is to read it anyway – an understanding of neuroplasticity and the brain’s response after stroke is just far, far to important to not be reading this literature!

Time spent Sitting

August 2016: English et al (2016) Sitting time and physical activity after stroke: physical ability is only part of the story. Topics in Stroke Rehabilitation, 23(1), 36-42 10.1179/1945511915Y.0000000009

OK, so what seemed like a good idea at the time, may not have been such a good idea! How oft’ is that the case? I was going to work through a series of consequences after stroke, but, when I did the maths, (which is probably what I should have done at the start,) I realise that, using my proposed plan, I would only get through four consequences a year. Considering how many there are after stroke, this was looking more and more like a 5-year plan!! I have to confess that my concentration span doesn’t reach that far!

So, back to one of my “soap-box” topics and an article first-authored by a friend and colleague, who, incidentally, is offering the Evidence Research Demystified in November 2016, Dr Coralie English. This month’s journal is all about what might, or might not contribute to the amount of hours people with stroke, spend sitting. As the authors hypothesized, you would think that level of disability, particularly physical disability, may be the main contributing factor. But what was interesting was that despite the various analyses they undertook, it only ever contributed to up to 30% of the variance. So, that leaves us with an really interesting question: what contributes to the other 2/3rds of variance?

As usual, you’ll find the abstract and “humble opinion” under Journal Club 2016. Only the abstract is freely available at http://www.tandfonline.com/doi/abs/10.1179/1945511915Y.0000000009

The Stroke TOTE Bag Project

It’s been a while since we’ve had a Changing Stroke Project; so here one for 2016! To find out more, go to the link under CS Projects.

Is this a slightly crazy idea? I don’t think so. My thanks to those who told me about this – here’s hoping you don’t mind that I’ve added my own twist! If you decide to give this project a go, please let us all know how it goes.

Cognition: Retraining after Stroke

July 2016: van de Ven, RM, Murr JMJ, Veltman DJ, Schmand BA (2016) Computer-based cognitive training for executive functions after stroke: A systematic review. Frontiers in Human Neuroscience, online early, DOI: 10.3389/fnhum.2016.00150

Well, what an interesting journey this has been. To be honest, I’ve never really had a good “look” at this body of evidence about cognitive recovery after stroke, and now I know why. It is full of small systematic reviews of small studies that only recruit small cohorts of participants and almost all of them conclude something similar to this one, which is: “The positive findings of most studies, including neural changes, warrant continuation of research in this field, but only if its methodological limitations”. This is a similar finding to other systematic reviews including one by Hoffman et al (Topics of Stroke Rehabilitation; 2010; 17,2) who have very similar conclusions. However, please don’t let this put you off reading the van de Ven et al (2016) article as not only does it provide a very thorough review of the potential contribution of computer-based interventions, the introduction provides a eloquent summary of the relevant evidence to date.

As usual, you’ll find the abstract and “humble opinion” under Journal Club 2016. This article is freely available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4837156/

If you have any suggestions of where to from here, please let me know before the August 2016 Journal Club is due!

Cognition: Assessing after Stroke

June 2016: Pendlebury et al (2012) Differences in cognitive profile between TIA, stroke and elderly research subjects: A comparison of MMSE and MoCA. Cerebrovascular Diseases, 34(1), 48-54 DOI: DOI:10.1159/000338905 available at http://www.karger.com/Article/Abstract/338905

So, staying with cognition after stroke; if you were to ask me what assessment I would recommend, my reply would be, the Montreal Cognitive Assessment or MoCA. Why? Because it is an assessment that’s been well researched in cohorts of patients recovering from stroke, and it seems to be one that more and more centres are adopting.

Sure, this month’s Journal Club article is not a very recent article, but I’ve selected it because the investigators compare the MoCA to the MMSE across three cohorts: memory research subjects and those with TIA and stroke. As almost all of the evidence is indicating, in patients with stroke, the MoCA is more sensitive to mild cognitive impairment than the MMSE.

As usual, you’ll find the abstract and “humble opinion” under Journal Club 2016. To view this article you’ll need access to the Cerebrovascular Disease journal or you can email the corresponding author.

Cognition after Stroke

May 2016: Munch et al (2016) Stroke location is an independent predictor of cognitive outcome (MoCA) at 3 months post stroke. Stroke, 47(1), 66-73 DOI: 10:1161/STROKEAHA.115.011242 available at http://www.ncbi.nlm.nih.gov/pubmed/26585396

I’m thinking about focusing on a particular outcome of stroke for two, if not three months in a row. That way, Journal Club could dig deeper into some issues for the rest of 2016. Let me know what you think!

If feasible, in Month 1, I’ll try to review recent evidence about pathophysiology; Month 2, evidence about assessment and Month 3, evidence about recovery and/or an effective intervention. For me, cognition after stroke keeps cropping up, so I’ve decided to start with this outcome. The May 2016 journal article reports on an investigation into the regions of the brain that, if lesioned by stroke, are most likely to result in cognitive dysfunction after stroke. The measure the researchers use is the Montreal Cognitive Assessment (MoCA) and that’s good, because I know that in Month 2, I’ll review an article reporting the MoCA’s clinical applicability in survivors of stroke.

You’ll find the abstract and “humble opinion” under Journal Club 2016. To view this article you’ll need access to the Stroke journal or you can email the corresponding author.