Some of the concepts in this video could push the envelope a bit and change how we feel about what age the brain fully develops and how we can perhaps some day “upload” more brain function to ward off decline and perhaps correct insults.

By the way, if you took our poll and  just want the simple wiki answer to the brain development poll from a previous post then here it is:

By the Way:

I Just learned that the University of Rhode Island is hosting an upcoming Honors Colloquium beginning later this month called “Are You Ready for the Future?“  Go to http://www.uri.edu/hc to learn more.  Ed Boyden is one of the invited guests.  If you aren’t planning to travel to Little Rhody you can see all the lectures as they will be streamed live and archived.    I might just make the drive back to my old school to see this one “live”.  See the schedule of events, it looks good.

David Dansereau for know-stroke.org

Liz Bestic, a health reporter in the U.K. recently heard the words “You have Had a Stroke” .  I would otherwise have no reason to know this other than Google Alerts gives me a poke every time the words PFO (patent foramen ovale) and exercise (as well as a few other PFO/stroke combinations I follow) appear in the news and shortly thereafter in my email.  Mostly these days I don’t get through all the alerts but “PFO Exercise Guidelines” still are tops on my radar because it is an area where much uncertainty remains and physician/patient  EDUCATION still is lacking or non-existent depending upon who you ask.

Liz Bestic reveals in her great article about her stroke and  PFO diagnosis that she is exercising while she ponders a difficult decision on what to do next.  While this was the last interesting point made in her article and is what probably triggered the PFO/exercise/Google  “link” that now has me linking her to my blog I hope it isn’t the last on this important theme.  I do wish Miss Bestic well in her recovery and on her decision on how to best treat her PFO.  I also hope it may happen that she will find it timely to perhaps do another follow-up story as she now will no-doubt become an expert on the same PFO/stroke  journey many of us have already taken.   Miss Bestic may in fact be in a unique position as a survivor and health reporter to help improve this education gap. Who knows, perhaps Google may be able to help with this important alert too.  I welcome all your comments, and especially those of Miss Bestic if she happens to have her own name “tagged” and finds us here.

Here’s the link to her article and it is worth the read right away, don’t just bookmark it “for later”

David Dansereau for know-stroke.org

Here were some of the my highlights from ISC 2011:

• PFO/Heart/Brain/Research: MingMing  Ning, M.D., assistant professor of neurology, Harvard Medical School, vascular neurologist, Massachusetts general Hospital, Boston presented “How the Heart Whispers to the Brain: Serotonin as Neurovascular Mediator in Patent Foramen Ovale (PFO)-Related Stroke” With further investigation Dr. Ning’s important research may help explain and quantify how and why unfiltered blood which bypasses the detoxifying lung filters through a PFO may trigger oxidative stress to the brain by way of the heart. I hope we can get Dr. Ning on a call for the PFO Research Foundation soon because her exciting research might be the first to finally quantify and possibly confirm why the heart of a PFO patient could be guilty of “dumping trash” out the “back door to the brain (PFO)”.  I know many patients (including myself) would love to hear more about Dr. Ning’s research to gain a better understanding of the “why” (after PFO closure) they immediately report increased energy and cessation of headaches/migraine.  Congratulations Dr. Ning for your award and great work on this important and potentially ground breaking PFO/stroke-related research!

• Stroke Rehabilitation Research: The results of the largest stroke rehabilitation study ever conducted in the United States were announced at the International Stroke Conference. In this study stroke patients who had physical therapy at home improved their ability to walk just as well as those who were treated in a training program using a body-weight supported treadmill device, followed by walking practice.  The study found that earlier was better when it came to rehabilitation therapy. The patients who were not assigned to a study group until six months after their stroke recovered only about half as much as the participants who received one of the two therapy programs at two months. This finding suggests that either the treadmill training program or the at-home sessions are effective forms of physical therapy, and both are superior to usual care.  This is great news for stroke survivors and physical therapists to think “outside the box” when and how we deliver our services. [personal sidebar] I’m on the right track with my home stroke recovery guide.  For more on this rehab study click here.

David Dansereau wearing Tibion Bionic leg

• Great new technology for stroke recovery: I had the chance to try out the Tibion Bionic Leg as well as other great cutting-edge rehab technologies.  This promising technology (shown in this photo courtesy of Charlie Ungashick) can provide a robotic rehabilitation tool to help retrain impaired gait.  The challenge remains how to get these great tools in the hands of therapists and patients at an affordable price.

• The Food and Nutrition Connection with Stroke Risk: A report that was widely circulated in the news this week that came out of this conference was the increased stroke risk noted with users of diet soft drinks.  The increased risk of stroke was significant (61 percent higher risk of “vascular events”) with only one diet soda daily.  See more press on this study by clicking here.

• Dilemmas in Childhood Stroke: A study showed the symptoms and signs of acute ischemic and hemorrhagic stroke are similar in adults and children, but in children stroke is not considered early enough and patients do not receive brain imaging early enough. Rapid recognition, response and treatment of children with stroke will start with the development of pediatric brain attack protocols in the emergency department and pre-hospital setting. This presentation described how adults and medical professionals dismiss stroke warning signs in kids “because kids can’t have strokes” and points to the need for better awareness and community education as a first line defense in pediatric stroke.  [personal sidebar] ASA-Fund my grant and I’ll make it happen.  For the complete slide show of this presentation click here.

• Ok, what does Justin Bieber have to do with Stroke Awarness? Nothing as it turns out but my 10 year old daughter certainly thought this should be included as a highlight of my trip to LA.  When I arrived in LA I walked out the back door of my hotel and unexpectedly stepped right out on the LA premier of “the Bieb’s” new movie “Never Say Never” and along with it about a couple thousand screaming young girls.  BTW, I haven’t heard the end of it because I didn’t get a photo (or autograph) for my daughter, I just wanted to find a place to eat.

David Dansereau (Know-Stroke.org)

David Dansereau

Know-Stroke.org

“Stroke Recovery is  not easy, but as Jamie Coyle and her friend Tedy Bruschi will say, you have to start by adopting an attitude to “Never Give Up”!  - DP Dansereau, Know-Stroke.org

As a physical therapist one of my most important tasks is to motivate my patient, learn what their true goals are for recovery, and find out what may have motivated them to action in the past (prior to their stroke).

Speaking from personal experience during my own stroke recovery, the key to achieving the best possible outcome is to not  give in and listen to that part of the brain that says, “enough is enough” and instead push through barriers and adopt an attitude to “Never Giving Up”.  Jamie Coyle knew from the first day I met her in her hospital bed that she wanted to return to skating, and her goal was even more specific, she wanted to play hockey again.   As a hockey player myself, it was not hard to connect with her and respond to her question to me at that first meeting,  “Will I skate again”?   I mentioned to her she’d need to keep the faith, maintain focus and most important, do the work.   She has truly owned that message and invested everything into her recovery, and I am so proud to see her back on the ice with her peers doing something she loves.  Way to go Jamie!

Watch the video feature below by Varsity Life’s Melanie Pellowski on Cox  Sports and Channel 10 .  Melanie has been following Jamie’s recovery and in turn has has done a great job helping to spread the word about stroke awareness.

If video does not play from image above click here to play

According to About.com’s surgery blog Bret Michael’s is scheduled to undergo PFO closure in January.  In this quick poll, I’d like to know how you think VH1 and Bret Michael’s new show Life As I Know It will address the controversial medical topic of PFO closure.

Should VH1 show Bret’s PFO surgery and discuss the controversy?

According to VH1 Life as I Know It premires Monday October 18th

View trailers from  VH1′s  Life as I Know It

To learn more about PFO visit PFO Research Foundation.org

posted by David Dansereau for know-stroke.org

–DP Dansereau, MS,PT for know-stroke.org

First, here’s some quick background:

Plica syndrome, while being quite well known to physical therapists and physicians specializing in physical medicine and orthopedics, is not a common term people are aware of, unless perhaps they’ve been diagnosed as it being the possible source of their knee pain.  Plica-syndrome, often characterized by anterior knee pain, is most commonly found along the superomedial aspect of the knee.

The “plica” is due to remnant embryological tissue that compartmentalizes the knee during fetal development. The plica is sometimes considered  a “vestigial” structure, which means that it has lost its ability to function over time and does not functionally affect an individual whether it is present or absent.  It has been likened to the appendix, which can be a source of pain but lacks significant important function.

I’ll make a case here for quick comparison that a similar flap, or cardiac remnant in the atrial septum of the heart from fetal development exists.  In the case of this heart anomaly, this “vestigial” structure is often referred to as a patent foramen ovale or PFO.  This left-over fetal tissue  sometimes takes the shape of a flap in some hearts.  Some PFOs have been  described as “tunnel-like” in appearance under autopsy.

Patent foramen ovale has often been depicted as a defect or an incomplete closure in the walls of the chambers of the heart.  A patent foramen ovale can vary in size but the location is usually the same. As described in the literature, the flap like opening or hole is in the dividing wall (septum) between the upper two chambers of the heart – the left atrium and the right atrium.

Identifying a PFO is important because a PFO is a potential pathway for a blood clot to escape from the heart and travel to the brain, causing a stroke.   Similarly, the plica in the knee can get trapped and irritated to a point where it impairs normal joint ROM (range of motion) and can cause often less debilitating but still serious limitation to ADL’s (activities of daily living) when compared to the devastating effects of stroke.

How does this heart defect occur?

In the womb, all babies have a PFO. This is because a baby does not use its own lungs to filter and oxygenate its blood. Instead, it receives oxygen-rich blood from its mother via the umbilical cord. This blood has been filtered and oxygenated by the mother’s lungs. The PFO allows this blood to be sent directly to the brain, which has a high requirement for oxygen-rich blood during fetal development.

How common are PFO’s?

In most people, the two flap-like sections of septum which form the foramen ovale (or hole) fuse together after birth to form a solid dividing wall between the right and left atria. However, in an estimated 15-30% of the population, this area of the heart doesn’t fuse together and remains open or “patent”. This opening makes it possible for blood to cross from the right atrium to the left atrium—this is called a right-to-left shunt. The danger of blood shunting in this manner is that if it contains small debris or a clot it has bypassed the body’s natural filter (the lungs) and can pass directly up to the brain and cause a stroke.  Worldwide, it is estimated that approximately 500,000 people may suffer this type of stroke each year.

My Conclusion and the current Medical Paradox

When symptoms arise this is  where my comparison between PFO and Plica go down separate paths.   Here’s how current treatment differs:

Accurate diagnosis of both symptomatic plica and “symptomatic” PFO remains the predominant challenge.  The main difference is currently only with one syndrome the option of surgical treatment is widely accepted.   Why is symptomatic PFO not being fairly treated as a true medical syndrome?

I’d love for you to comment below.

DP Dansereau, MS,PT for know-stroke.org

More Information / References:

PFO Research Foundation

Plica Syndrome

Know-stroke.org-Exercise Guidelines for PFO Patients Needed

The PFO Research Foundation recently met in Washington, DC for its first PFO Summit.  I attended the event and was hoping for both practical and selfish reasons to get some clarity on exercise guidelines from some of the world’s top authorities on PFO.  Instead, what I learned in one of the breakout sessions aimed at developing better guideline documents and educational materials for patients with PFO disorders is that we have a great deal more work to do to get better patient information out there.  I reference a recent post to my blog from Sept. 28, 2010, at know-stroke.org to illustrate this point:

“I just found out I have a PFO after a cerebellar stroke and ministroke in 27 months. I am 45. Should I be scared to do cardio, how much, how long, what should I avoid? Thanks Dave, I appreciate reading something from someone who seems a lot like me.”

What should this person do?  Known PFO, positive TIA/stroke and would like to continue exercising/working out.  Is cardio fine?  Are weights OK?  What about swimming?  Climbing at altitude?  Diving?  We know these situations may present increased risk but where do you draw the line?

Patients are turning to the web and patient forums for guidance clearly because they are not getting answers from their physicians or device manufacturers.  It’s simply not enough to tell patients “you can’t avoid the valsalva maneuver*” in daily life.  No kidding doc, really?  Is that the best advice we can give?

I learned “off the record” after running a marathon that perhaps (running long distances) was not the best decision for me “down the road” with a PFO occluder on board.   This inside information was shared with me by a physician recently after my primary cardiac physician had cleared me and stated after more than one year post PFO closure “if my legs could carry me that far and my brain was crazy enough to talk my body into 26.2 miles then my heart would be fine”.  OK, so, what is safe?  What should PFO patients be doing for exercise  (or not doing) 1-3 weeks after closure?  How about after 6 weeks?  What is really so special about 6 weeks?  Why not 1 year (or more)?  Should every occluder device have its own post-op protocol based upon the design?  Perhaps.   What about exercise guidelines for known PFO/stroke confirmed without closure like the recent post on my blog I illustrated above.  What about known PFO, no stroke, no closure but enrolled in clinical trial related to migraines?  What about guidelines for that same patient sent home on meds or  following sham closure procedure.  Follow me?

[Personal Sidebar] I had contacted the device manufacturer that built my heart plug several years ago after I had PFO closure.   I asked them, -NO-I challenged them to get their patient education website completed and build a useful patient resource to assist patients that were in my shoes.  That was well over 3 years ago.  The result: Still no website for patient education.  Nothing.  I’m still waiting…

Who’s to Blame??

Blame the FDA, insurance companies, poor clinical trial enrollment, whatever excuse we want to make, this is certainly not “best medical practice”, it is not acceptable and is in fact poor medical practice. As a practicing physical therapist, if I sent someone home after a total hip replacement and didn’t remind them that there were clear post operative hip precautions that they should be aware of following their procedure (and based upon the technique and specific device they had implanted in their body), I could be fired and sued if they went home and blew out their hip because I didn’t educate them.  That is simply part of my job!  Why are heart plugs different?  The last time I checked they were still being inserted directly in the center of our most vital organ.

“Patients can’t continue to afford to be the pigs here.  Patients are literally putting their “hearts on the line” and deserve so much better.  When I ran the Boston Marathon in 2009  I didn’t recall any pigs passing me with a clinical trial advertisement on their bib.”-DP Dansereau

I certainly hope this post serves as a challenge to industry and physicians to be more responsible and get our collective acts together to set things straight for patients.  At least that is why I continue to write this blog, and yes, industry, this blog creation was and remains my direct response to your failure to step up and do something.  Truth is, I write most of my content on lunch breaks and late on Friday evenings after my responsibilities as a dad and business owner are complete. (This is at least my excuse why I frequently have typos in my posts.)  I write this blog because in some way it helps patients ask more educated questions and hopefully make their medical care takers stay on their toes, at least that’s what  I’ve been told.  I have no financial disclosures to report, don’t know any venture capitalists, and have no potential gain if PFO closure proves to be a slam dunk for stroke prevention or migraine relief.  I just own the peace of mind that I did something.  Now, I must get back to my patients, and then perhaps go out for a run later this evening when I get done here at work.

Or should I ?   Who knows?   I’d love for you to comment here if you do….

Better Exercise Guidelines for PFO Patients

By David P Dansereau

For know-stroke.org

* Valsalva maneuver: A maneuver in which a person tries to exhale forcibly with a closed windpipe so that no air exits through the mouth or nose as, for example, in strenuous coughing, straining during a bowel movement, or lifting a heavy weight. The Valsalva maneuver impedes the return of venous blood to the heart.

With 60,000 Australians expected to suffer from a stroke this year alone, a new study aims to find the best approach to rehabilitation to help sufferers recover more quickly and reduce their stay in hospital.

After a stroke, people going through rehabilitation need as much physical therapy as possible to achieve the best results. Now UniSA researchers have been awarded a grant by the National Health and Medical Research Council to investigate a variety of approaches so that patients recover independence and get home as quickly as possible.

Read the full stroke recovery article at HealthNews

Post by David Dansereau for Know-Stroke.org

This is one exercise I sometimes  still visualize in my sleep and continue to work on to improve my balance post  stroke.  I’ve since been able to give it a boost by trying it with heavier weights, with my front leg on a Total Gym glideboard,  and at times even successfully with my eyes closed.

Use caution and modify to your level of fitness / rehabilitation when needed*

Intensity Level:  Moderate Difficulty with disc as shown

Lunge with Balance Disc
1) Stand with feet hip width apart. Take leg and step back approximately 2 feet standing on the ball of the foot. Place the front foot on a balance disc (or use the floor without disc for beginners).
2) Start position: Feet should be positioned at a staggered stance with head and back erect and straight in a neutral position.  Hold medicine ball in front of your chest for added challenge.
3) Lower body by bending at hip and knee until thigh is parallel to floor. Body should follow a straight line down towards the floor.
4) Return to start position while raising the medicine ball overhead and repeat. Alternate or switch to other leg after prescribed reps.

5)Stroke Rehab Tip:  Use a mirror and focus on a central point straight in front of you and always train both sides

This exercise is from my PT coaching site-My-Physical-Therapy-Coach.com

*You should follow a rep and set sequence that makes sense for your level of rehab or conditioning.  If you are working with a physical therapist or qualified trainer consult with them first about adding this full body balance exercise to your  stroke recovery training.