Saturday, February 23, 2013

Pain in Your Brain

SSTattler: There are many ways of a definition of "Pain" or "Pain Syndrome" especially after a stroke. We will take two definition from Wikipedia: 1) "Central Pain Syndrome", 2) "Chronic Pain" - A popular alternative definition of chronic pain, involving no arbitrarily fixed durations is "pain that extends beyond the expected period of healing."

SSTattler: The last two YouTube, "Intramuscular Electrical Stimulation for Post-Stroke Pain" and "Pain and the Brain", are excellent lectures but it takes 1 hour and a half  each -- I think most people will like it.

Central Pain Syndrome from Wikipedia, the Free Encyclopedia.

Central pain syndrome is a neurological condition caused by damage or malfunction in the Central Nervous System (CNS) which causes a sensitization of the pain system. The extent of pain and the areas affected are related to the cause of the injury, which can include trauma, spinal cord injury, tumors, stroke, Multiple Sclerosis, Parkinson's disease, or epilepsy. Pain can either be relegated to a specific part of the body or affect the body as a whole.


Pain is typically constant, may be moderate to severe in intensity, and is often made worse by touch, movement, emotions, and temperature changes, usually cold temperatures. Burning pain is the most common sensation, but patients also report pins and needles, pressing, lacerating, aching, and extreme bursts of sharp pain. Individuals may have reduced sensitivity to touch in the areas affected by the pain. The burning and loss of touch are usually most severe on the distant parts of the body, such as the feet or hands.


Treatment includes pharmacological interventions (amitriptyline, mexiletine, lamotrigine) followed by neuromodulation (cortical stimulation, intrathecal drugs such as midazolam and clonidine). Opioids are scarcely effective for CPS and should be reserved to highly selected cases. Ziconotide is sometimes effective but patients should find experienced physicians for treatment.

See the original article Central Pain Syndrome from Wikipedia, the Free Encyclopedia.

Chronic Pain from Wikipedia, the Free Encyclopedia.

Chronic pain is pain that has lasted for a long time. In medicine, the distinction between acute and chronic pain has traditionally been determined by an arbitrary interval of time since onset; the two most commonly used markers being 3 months and 6 months since onset, though some theorists and researchers have placed the transition from acute to chronic pain at 12 months. Others apply acute to pain that lasts less than 30 days, chronic to pain of more than six months duration, and subacute to pain that lasts from one to six months. A popular alternative definition of chronic pain, involving no arbitrarily fixed durations is "pain that extends beyond the expected period of healing."


Chronic pain may be divided into "nociceptive" (caused by activation of nociceptors), and "neuropathic" (caused by damage to or malfunction of the nervous system).

Nociceptive pain may be divided into "superficial" and "deep", and deep pain into "deep somatic" and "visceral". Superficial pain is initiated by activation of nociceptors in the skin or superficial tissues. Deep somatic pain is initiated by stimulation of nociceptors in ligaments, tendons, bones, blood vessels, fasciae and muscles, and is dull, aching, poorly-localized pain. Visceral pain originates in the viscera (organs). Visceral pain may be well-localized, but often it is extremely difficult to locate, and several visceral regions produce "referred" pain when damaged or inflamed, where the sensation is located in an area distant from the site of pathology or injury.

Neuropathic pain is divided into "peripheral" (originating in the peripheral nervous system) and "central" (originating in the brain or spinal cord). Peripheral neuropathic pain is often described as “burning,” “tingling,” “electrical,” “stabbing,” or “pins and needles.”


Under persistent activation nociceptive transmission to the dorsal horn may induce a wind up phenomenon. This induces pathological changes that lower the threshold for pain signals to be transmitted. In addition it may generate nonnociceptive nerve fibers to respond to pain signals. Nonnociceptive nerve fibers may also be able to generate and transmit pain signals. In chronic pain this process is difficult to reverse or eradicate once established.

Chronic pain of different etiologies has been characterized as a disease affecting brain structure and function. Magnetic resonance imaging studies have shown abnormal anatomical and functional connectivity, even during rest involving areas related to the processing of pain. Also, persistent pain has been shown to cause grey matter loss, reversible once the pain has resolved.

These structural changes can be explained by the phenomenon known as neuroplasticity. In the case of chronic pain, the somatototic representation of the body is inappropriately reorganized following peripheral and central sensitization. This maladaptative change results in the experience of allodynia and/or hyperalgesia. Brain activity in individuals suffering from chronic pain, measured via electroencephalogram (EEG), has been demonstrated to be altered, suggesting pain-induced neuroplastic changes. More specifically, the relative beta activity (compared to the rest of the brain) is increased, the relative alpha activity is decreased, and the theta activity both absolutely and relatively is diminished.


Complete and sustained remission of many neuropathies and most idiopathic chronic pain (pain that extends beyond the expected period of healing, or chronic pain that has no known underlying pathology) is rarely achieved, but much can be done to reduce suffering and improve quality of life.

Pain management is the branch of medicine employing an interdisciplinary approach to the relief of pain and improvement in the quality of life of those living with pain. The typical pain management team includes medical practitioners, clinical psychologists, physiotherapists, occupational therapists, and nurse practitioners. Acute pain usually resolves with the efforts of one practitioner; however, the management of chronic pain frequently requires the coordinated efforts of the treatment team.

The emergence of studies relating chronic pain to neuroplasticity also suggest the utilization of neurofeedback rehabilitation techniques to resolve maladaptive cortical changes and patterns. The proposed goal of neurofeedback intervention is to abolish maladaptive neuroplastic changes made as a result of chronic nociception, as measured by abnormal EEG, and thereby relieve the individual's pain. However, this field of research lacks randomized control trials, and therefore requires further investigation.


In a recent large-scale telephone survey of 15 European countries and Israel, 19% of respondents over 18 years of age had suffered pain for more than 6 months, including the last month, and more than twice in the last week, with pain intensity of 5 or more for the last episode, on a scale of 1(no pain) to 10 (worst imaginable). 4839 of these respondents with chronic pain were interviewed in depth. Sixty six percent scored their pain intensity at moderate (5–7), and 34% at severe (8–10); 46% had constant pain, 56% intermittent; 49% had suffered pain for 2–15 years; and 21% had been diagnosed with depression due to the pain. Sixty one percent were unable or less able to work outside the home, 19% had lost a job, and 13% had changed jobs due to their pain. Forty percent had inadequate pain management and less than 2% were seeing a pain management specialist.

In a systematic literature review published by the International Association for the Study of Pain (IASP), 13 chronic pain studies from various countries around the world were analyzed. (Of the 13 studies, there were three in the United Kingdom, two in Australia, one each in France, the Netherlands, Israel, Canada, Scotland, Spain, and Sweden, and a multinational.) The authors found that the prevalence of chronic pain was very high and that chronic pain consumes a large amount of healthcare resources around the globe. Chronic pain afflicted women at a higher rate than men. They determined that the prevalence of chronic pain varied from 10.1% to 55.2% of the population.

In the United States, the prevalence of chronic pain has been estimated to be approximately 30%. According to the Institute of Medicine, there are about 116 million Americans living with chronic pain. The Mayday Fund estimate of 70 million Americans with chronic pain is slightly more conservative. In an internet study, the prevalence of chronic pain in the United States was calculated to be 30.7% of the population: 34.3% for women and 26.7% for men. These estimates are in reasonable agreement and indicate a prevalence of chronic pain in the US that is relatively comparable to that of other countries.


Two of the most frequent personality profiles found in chronic pain patients by the Minnesota Multiphasic Personality Inventory (MMPI) are the conversion V and the neurotic triad. The conversion V personality, so called because the higher scores on MMPI scales 1 and 3, relative to scale 2, form a "V" shape on the graph, expresses exaggerated concern over body feelings, develops bodily symptoms in response to stress, and often fails to recognize their own emotional state, including depression. The neurotic triad personality, scoring high on scales 1, 2 and 3, also expresses exaggerated concern over body feelings and develops bodily symptoms in response to stress, but is demanding and complaining.

Some investigators have argued that it is this neuroticism that causes acute pain to turn chronic, but clinical evidence points the other way, to chronic pain causing neuroticism. When long term pain is relieved by therapeutic intervention, scores on the neurotic triad and anxiety fall, often to normal levels. Self-esteem, often low in chronic pain patients, also shows striking improvement once pain has resolved.

Effect on Cognition

Chronic pain's impact on cognition is an under-researched area, but several tentative conclusions have been published. Most chronic pain patients complain of cognitive impairment, such as forgetfulness, difficulty with attention, and difficulty completing tasks. Objective testing has found that people in chronic pain tend to experience impairment in attention, memory, mental flexibility, verbal ability, speed of response in a cognitive task, and speed in executing structured tasks. In 2007, Shulamith Kreitler and David Niv advised clinicians to assess cognitive function in chronic pain patients in order to more precisely monitor therapeutic outcomes, and tailor treatment to address this aspect of the pain experience.

See the original article Chronic Pain from Wikipedia, the Free Encyclopedia.

Understanding Pain: 

       What to Do About It in Less Than Five Minutes?

New evidence based approaches to chronic pain management. For more detailed information visit the Hunter Integrated Pain Service website

Creative Commons Attribution license @ Hunter Medicare Local

A Message from Hell

This film has been entered into the 2012 Neuro Film Festival from the American Academy of Neurology Foundation at Let's put our brains together and support brain research. A message from the Central Pain Syndromes sufferers of the CPS Alliance. Central Pain Syndrome is the worst pain known to man. It effects approximately one and a half million Americans, most of whom don't know that CPS is the name of the diseases ruining their lives. We want you to recognize that Central Pain exists: what are its symptoms, it treatments, its effects, and its astonishing frequency. We want you to support research into the causes, treatments and cures of CPS, and to demand that America respect it citizens who are living in Hell on Earth.

Standard YouTube License @ centralpainsyndrome's channel

Central Pain Syndrome "Message from Hell #1: How Are You?"

As a Central Pain Syndrome survivor I suffer constant intense pain. I am on the Board of Directors of the newly-formed Central Pain Syndrome Foundation:

Standard YouTube License @ Doug Sharp

A Day in the Life of Central Pain Syndrome

While this term/diagnosis might be unfamiliar to many of you... the symptoms or complaints are possibly painfully familiar. Central pain syndrome remains a bit like a "mystery diagnosis", in that there are few doctors identifying this syndrome. There are likely greater numbers of survivors suffering in pain alone because doctors have failed to identify CPS. Even once the culprit of the pain is identified, there are few treatment options today. :( My dear friend, Patti G, is not only afflicted with multiple cavernous angiomas but she also has been afflicted with this monster and she is doing her best to "get the word out" that CPS will not longer be such a mystery... and hopefully some day there will be a solution to this terrible pain. Please help spread awareness by sharing the fantastic video that she put together. Watching this really puts my fatigue in perspective.  As much as I hate being tired all the least I can escape it while sleeping. Pain is truly the worst deficit imaginable to me.
replicantplanet I live in England and have had CPS almost 10 years now after a massive stroke aged 42 I did try to cope but after many visits to my doctor i've ended up having a DBS implant only last year to reduce my symptoms, it has helped but only by 20% which is amazing in it's-self but I then get really bad headaches from the DBS when I switch it on so Devil and deep blues sea situation, steam cell is the way forward but I don't think in my lifetime, God bless everyone who has this condition. 
Kirsty Hartland I have had CPS 5 years in my left side the next time someone asks how I feel, I will be directing them to this fantastic video. Its the ME I cant put into words for others. Thank you. 
..... and many more comments on YouTube.

Standard YouTube License @ MrsPattiG1

The Anatomy and Function of the Parietal Lobe (Pain)

In this video, Leslie Samuel talks about the regions within the parietal lobe and how they function. The parietal lobe is involved in perceiving and processing somatosensory events like touch, temperature, body position and pain. It also receives input from the visual and auditory cortices and contains the Wernicke's area, which is involved in understanding spoken language.

Standard YouTube License @ Interactive Biology TV

Mary: Post Stroke Pain (Post Trial Occipital NeuroModulation)

Fifteen years of pain and failed treatments would make a skeptic out of anyone. After her successful one-month trial, Mary describes her experience on the eve of her implant surgery. She does not go along with the suggestion that it's a placebo response. She enjoyed a renewed relationship with her children, as well as renewed energy.
"It is the best thing I have done in my entire life."
This procedure is performed by Dr. Joshua Greenspan at the PainCare Somersworth NH facility.

For more information, visit

Standard YouTube License @ PainCare

Dr P Neuromodulation Desktop

Standard YouTube License @ johnpetraglia's channel

Intramuscular Electrical Stimulation for Post-Stroke Pain

October 10, 2008

The Cleveland FES Center and the APT Center
FES Seminar - John Chae, M.D., M.E.
SSTattler: This video is about 1 hour and 15 minutes, i.e. very long, but it is excellent lecture. 

Standard YouTube License @ Case Western Reserve University

Pain and the Brain

Jan 3, 2008 Take a look into our current understanding of the function of the human brain and some of the important diseases that cause nervous system dysfunction. On this edition, Allan Basbaum, UCSF department of anatomy, explores pain and the brain. Series: "UCSF Mini Medical School for the Public"
SSTattler: This video is about 1 hour and 27 minutes, i.e. very long, but it is excellent lecture. 

Standard YouTube License @ UCTV, University of California Television

Saturdays Comics

For Better and For Worse
Lynn Johnston - 2007-10-10

"Jim's resting again ..."
Scott Adams - 2013-02-22

"The low bidder for ... asteroid intercept missile!"

Jim Davis - 2013-02-22

"My exceptional flossing?"

Delainey & Rasmussen - 2013-02-17

"Megan likes fuzzy cats, ..., ...., ..."   

*For Better and For Worse" is a serious topic of stroke but with a very nice cartoons. It is all about Grandpa Jim had a stroke and 88 further cartoon "strips" that happened to Grandpa Jim. (See as well 
 the author Lynn Johnston).
** I tried to get low or free price at the people for the images for the cartoons. It was too high for Stroke Survivors Tattler i.e. we are not a regular newspaper and our budget is very low. Fortunately, you will have to do only 1-click more to see the cartoon image, it is legit and it is free using and
*** Changed from "Pickles" to "Betty" -- "Betty" is a excellent cartoon and Gary Delainey & Gerry Rasmussen are authors/artists/cartoon-strips and they live in Edmonton.

Eclectic Stuff & Articles

Definition: Eclectic(noun) a person who derives ideas, style, or taste from a broad and diverse range of sources.

Central Pain Ruined My Sleep

Rebecca Dutton
Home After a Stroke
February 18, 2012

After my second stroke my hemiplegic leg lost the ability to distinguish between hot and cold and acquired a constant burning sensation.  The burning sensation turned into a sharp pain when I took my brace and shoe off.  I had to grit my teeth and endure the pain to get undressed at night.  It also felt like I had a rubber band around the base of my big toe at all times.  I didn't know these were symptoms of central pain.  Central pain is constant pain created by damage to the central nervous system (e.g. the brain).  Symptoms include constant burning, pain caused by normally non-painful stimuli, shooting or electric shock-like pain, muscle cramps, stinging, tingling, and a pins-and-needles sensation.  These abnormal sensations can be widely distributed but are usually localized to one body part, especially the hands or feet.

After 1 year the sharp pain I felt when I removed my brace and shoe disappeared.  After 2 years the burning sensation in my leg shrank to affect just my foot.  However, the sheet touching the end of my big toe intensifies the constant burning that ruins my sleep.  Taking Tylenol before bed helps but I'm taking aspirin to thin my blood so I don't see this as a good long-term solution.  A few years ago I placed an object under the sheet near my foot to keep the covers away, but the object kept slipping out of position.

Two months ago something made me look at the ball I use to stretch my hand before I get up in the morning.  I picked up the ball and put it under the covers at the foot of my bed.  In the photo a second ball placed outside the covers shows you what the ball looks like.  This rubbery ball creates friction so the ball stays put and keeps the covers off the end of my big toe all night long.  These balls are made for children so they are cheap.  I bought an extra ball just for my foot. I'm relieved that falling asleep is easier.

Posted by Rebecca Dutton at 8:36 AM

Anonymous February 18, 2012 at 6:43 PM
You are so creative! And you keep teaching me names for my symptoms. My "central pain" isn't excruciating, but it is constant and annoying. You have given me hope that it will eventually subside. At this point I feel it in my hand and below my knee.
- Marcelle
See the original article Central Pain Ruined My Sleep
                                       in Home After a Stroke

And Then...

The Pink House On The Corner
Wednesday, February 13, 2013

Yesterday, I got up at 4:00 a.m. I say "got up" as that's when I physically got out of bed. I had been awake since 3:00 a.m. I had gone to bed at midnight. So that's how little sleep I had gotten. Mostly, I laid in the bed thinking...

On Monday, I had a long discussion with the vascular surgeon, who told me that he had never seen a polyp the size of the polyp on Bob's gallbladder. The thing, he said, was nearly 2 inches long. Shaped like a walnut. There was a big chance that such an enormous polyp would be cancerous, and even if it wasn't now cancerous, it certainly had the potential become malignant and needed to be taken out. He did tell me that gallbladder cancer was "extremely rare", however, when it occurred it was "usually fatal". We also discussed the warfarin situation, and he told me he would switch Bob over to a heparin drip which would keep Bob's blood thin until the surgery and be restarted after surgery. This way, there would only be a 4 hour window that Bob would be unprotected. We talked too about the difference between doing the surgery with a scope or opening Bob up. The scope would be easier, but might not be impossible because of old scar tissue on Bob's stomach. Opening him up would take longer and have more risk factors. Before commencing with the surgery, he would be running some tests.

Monday night, I had left the hospital at 9:30 p.m. when they began preparing to take Bob down for a CAT scan. I left right after a discussion with a curly blonde haired doctor with a heavy foreign accent and an unpronounceable name. The vascular surgeon had ordered the CAT plus a bunch of blood work plus another test called something or other, which sounded like "hyper-supersonic-scan" and this scan, the nurse had explained to me, was a sort of hi-tech super-ultrasound and would look at all of Bob's internal organs. The doctor, the nurse said, were searching for anything that might complicate the surgery. They were looking to see if any bile ducts or arteries near the gallbladder were occluded. They were looking for other "masses" on any nearby organs. They were also reading for "chemical levels" coming from each of Bob's organs. In order to do this test, they had to discontinue all Bob's narcotic pain medications for eight hours.

And this is why I was talking to the unpronounceable named doctor with a heavy foreign accent and curly blonde hair. Because I did not want them to take Bob off his pain medication. Especially cold turkey. Especially for eight hours. I mean, Bob has some heavy duty pain meds, i.e.: Fentynal and oxycodone. And knocking those off, just like that, were going to cause some serious drug withdrawal.

Dr. Curly Blonde Hair,  however, assured me that they could give Bob morphine, on a drip, and that would keep his pain in check plus stop any withdrawal from happening. That's when I left the hospital, went home and laid in bed--my mind churning about things like masses on nearby organs (cancer!) and occluded arteries (stroke!). These thoughts interrupted with feverent prayers for Bob's healing. Funny how I revert back to my Catholic upbringing in times of crisis.

So back to yesterday, which was Tuesday, I arrived around 6:00 a.m. to find Bob, drenched in sweat, screaming in pain and trying like heck to pee. When Bob saw me enter the room, he glared at me and pointed an accusing finger as if I were the cause of all this distress. I immediately asked the nurse, "where's the morphine drip?" And was told that another doctor nixed the morphine and Bob had been stripped of his Fentynal patches and oxycodone at 2:00 a.m. He was scheduled for the hyper-sonic-thingy test at 7:30 a.m. and she assured me, she had Fentynal patches on standby and would put them on immediately when he arrived back in the room.

It was a long wait for 7:30 a.m. With Bob screaming and trying to pee. When Bob returned, he was in even worse shape. His whole hospital gown was soaked with sweat, as was his hair. He was red-faced and trembling and shaking. His legs kicking out, arms flopping. And still trying like heck to pee. I grabbed the nurse but the Fentynal patches were nowhere to be found. She checked the computer and found the order was not due to be filled until noon. I asked if they could catch Bob so he could pee, but she needed a "doctor's order" for that. So that sent me on a mad and fruitless dash in search of a doctor. Who finally arrived around 10:30 and finally ordered patches and morphine, which arrived around 11:00 a.m. And, at my request, the doctor put in an order for a foley catheter, which was inserted into Bob around noon. And he immediately peed 1400 mls of urine. No kidding.

With pain meds and peeing, Bob fell asleep. Nothing much happened, except Bob got moved to a different room on the surgery wing. Then, I got, first, word that the CAT scan showed Bob's lower lung lobes were collapsed and an antibiotic was being ordered. Later, word came down that the hyper-sonic-thingy test results were normal. Then, word that the vascular surgeon was ordering another ultrasound.

At around 6:30 p.m., the vascular doctor arrived with test results in hand. He showed me the results of the new ultrasound that he had run on Bob's gallbladder. The results read, in part, :
one unremarkable 3 mm polyp... no sign of abnormality... no inflammation... plus several tiny barely visible polyps, the type normally seen in a patient of this age....

And he said, Well. Either the first ultrasound was read by a complete idiot who maybe mistook a shadow for a gigantic polyp. Or the thing magically disappeared within 5 days.

Bottom line: No need for surgery. No more cancer scare. Bob does has lung pleurisy. This, I'm told, will easily clear up with an antibiotic.

Big sigh of relief here. Jeepers. What they put us through.

And a big thank you to all of you for your comments, support, prayers, white healing light, and good intentions and karma.  That doctor did say, the giant polyp may have magically disappeared.... hmmm...

Of course, it could just have been an idiot misreading an ultrasound.

I am off to the hospital. Not sure when they will discharge Bob. Right now, he is getting an IV antibiotic.

See the original article And Then...
                                       in The Pink House On The Corner

DIY Stroke Recovery

Peter G Levine
The Stroke Recovery Blog
Saturday, February 9, 2013

There is a common suggestion among many in the "alternative medicine" industry expressed in the question: "If it means less business, why would your doctor want you to be healthy?" A strict emphasis on healthy lifestyle including diet and exercise would be like the proverbial "apple a day" - keeping the doctor away.

Doctors who do this - who keep themselves away as much as they can - are the best doctors. And therapists who "keep themselves away" are the best therapists.

Many pathologies allow for a definitive discharge point. The patient who has had a knee replacement gets therapy, and then goes home to live the rest of his life. But neurological disorders are different. Many, from Parkinson's disease to multiple sclerosis, are progressive. But what of non-progressive neurological disorders like stroke and traumatic brain injury? Does this "apple a day" philosophy work? Is there a point at which these populations no longer need therapists?

Many patients with brain injury (including stroke) believe that they will always need therapists. Most see therapists as essential to the recovery process, no matter how long (months, years, decades) it takes for them to achieve their highest level of potential recovery. But this view is incorrect.

There is a point at which therapists are no longer the fulcrum for recovery. Nor should they be, for reasons that range from financial to practical. At discharge stroke survivors are, and should be, in complete control of their own recovery. During the chronic phase of recovery from stroke, the speed of recovery slows. The physiological action of recovery is based on a lot of self-directed hard work. Much of what is required is relatively simple, and revolves around the broad concept of repetitive practice. In order to take charge, stroke survivors need to be given the tools to initiate and follow an "upward spiral of recovery." This term is used to describe the path to the highest level of potential recovery. The "upward spiral of recovery" is driven by real-life demands for everything from coordination to cardiovascular strength.


The Liberal Capitalist said...
I am 16 months post-stroke. I had a month of inpatient rehab and a month of out-patient, and that's all I needed. I walk well, drive, and have returned to work. In fact, if it wasn't for this cursed spasticity, I would say I'm in better physical condition than pre-stroke, since my blood pressure is now under control, I eat better and exercise regularly. I attribute most of my recovery to the fact that I never suffered from the debillitating fatigue that most stroke survivors complain of. I truly wish that there was a serious research effort undertaken to understand why some survivors are spared.
February 10, 2013 at 9:32 AM

Kadima said...
5711 frdiatI don't think there is any science backing your claim. i think the rich do better than the poor having more and longer therapy. I'm not sure what your 'discharge point is:' acute rehab? when the outpatient therapist says you've plateaued? Do you think speech therapy should end also? What if you can't find resources, are unable to do math? New therapy tools like the Tibion? I think Medicare must be following your philosophy in their recent reduction of outpatient therapy.
February 11, 2013 at 3:35 PM

Grace Carpenter said...
Hi Pete, I respect you a lot, but I had to comment about this.

  1. “Discharge” often comes way too early, in my experience. Especially people who have serious cognitive and language deficits. 
  2. If people know that they can come back when they get “stuck”—for instance, an especially spastic muscle group, or a particular task they want to do but can’t figure out a way to start working on it—more people might feel OK with stopping therapy for a while. But usually, once you’re discharged, that’s it: you can’t come back. 
  3. My best experiences in therapy have been group therapy (language and OT), at about a year or two post-stroke. The rules about reimbursement were even more complicated than one-on-one therapy. I didn’t participate in another group because I would have to be discharged, and I wouldn’t surrender the choice to keep going with therapy if I needed it. Instead I opted to have therapy about once a month (after I won an appeals process).
  4. Many survivors in the chronic phase are still very isolated—there are so many, many obstacles to have a social life. Therapists are often the only people who have any idea what survivors are going through. My answer? Insurers need to make group therapy (PT, OT, and Speech) much more accessible and affordable, and that way, the survivors have a built-in support network.

- Grace
February 13, 2013 at 9:09 AM

See the original article DIY Stroke Recovery
                                        in The Stroke Recovery Blog

Training the Brain Could Help Reduce Pain

Dean Reinke
Deans' Stroke Musing
Saturday, May 26, 2012

Another use for neuroplasticity - Training the Brain Could Help Reduce Pain. -- Deans' Stroke Musing

Training the brain to reduce pain could be a promising approach for treating phantom limb pain and complex regional pain syndrome, according to an internationally known neuroscience researcher speaking May 17 at the American Pain Society's Annual Scientific Meeting.

G. Lorimer Moseley, PhD, professor of clinical neurosciences at University of South Australia and Neuroscience Research Australia, and head of the Body in Mind research team, told the plenary session audience that the brain stores maps of the body that are integrated with neurological systems that survey, regulate, and protect the integrity of the body physically and psychologically. These cortical maps govern movement, sensation and perception, and there is growing evidence, according to Moseley, showing that disruptions of brain maps occur in people with chronic pain. The best evidence is from those with phantom limb pain and complex regional pain syndrome, but there is also data from chronic back pain.

Moseley's research is focused on the role of the brain and mind in chronic and complex pain disorders. Through collaborations with clinicians, scientists and patients, the Body in Mind team is exploring how the brain and its representation of the body change when pain persists, how the mind influences physiological regulation of the body, how the changes in the brain and mind can be normalized with treatment.

"We're learning that chronic pain is associated with disruption of brain maps of the body and of the space around the body. When the brain determines the location of a sensory event, it integrates the location of the event in the body with a map of space. Disruption of these processes might be contributing to the problem," said Moseley. He added that it is possible for the body to be unharmed but the brain will respond by causing pain because it misinterpreted a benign stimulus as an attack. "We want to gradually train the brain to stop trying to protect body tissue that doesn't need protecting."

Moseley said the brain can "rewire" itself, a process called neuroplasticity. Often painful stimuli triggered by a broken bone or other trauma cause the brain to rewire and, as a result, the damage signal is never switched off after the initial body trauma is resolved. The result: Chronic pain. So if the brain is capable of changing to cause persistent pain, can it be changed back to normal to alleviate pain?
"The brain is the focal point of the pain experience, but the plasticity phenomena can be harnessed to help alleviate pain," Moseley said.

He further stated that disrupted cortical body maps may contribute to the development or maintenance of chronic pain and, therefore, could be viable targets for treatment. One treatment approach involves targeting motor systems through a process Moseley calls graded motor imagery. It relies on using visual images to help the brain change its perceptions of the body after prolonged pain stimuli. "For someone with phantom limb pain, the brain's body map still includes the severed arm or leg, and without any real stimuli from the region, it continues to produce pain," Moseley explained.

He reported that studies with graded motor imagery have shown encouraging results in complex regional pain syndrome and in phantom limb pain.

"Our work shows that the complex neural connections in the brain not only are associated with chronic pain, they can be reconnected or manipulated through therapy that alters brain perceptions and produce pain relief," said Moseley.

American Pain Society (2012, May 17). Training the brain could help reduce pain. ScienceDaily. Retrieved May 26, 2012.

See the original article Training the Brain Could Help Reduce Pain
                                       in Dean's Stroke Musing

Sunday Stroke Survival ~ Missing My Old Life

Jo Murphey
The Murphey Saga
Saturday, February 16, 2013

Well  this week I performed the wedding ceremony for the family friend that wouldn't take "no" for an answer. I had been taping my reading of the ceremony since December to try and work on my aphasia issues. Yes, I wrote a special ceremony just for them using words I knew I would have no trouble with.

Even though it wasn't a paid for service, I was excited to go back to at least some of my old life. It was the beginning and the end of a nine-month hope of returning to my old life.

The couple chose the courthouse garden in between the historic courthouse and the new one. For February, it was a beautiful day. Not too cold or not too warm. No no-see-ems (gnats) or pesky mosquitoes to mar the ceremony. The couple chose this spot because it had easy access for me with ramps and paved walkways. There was no way I could walk through sandy beaches or tree roots to trip me up. They chose mid-afternoon so I could get my rest in. They dressed up a folding chair for me if I needed it, I didn't. In other words, they tailored the wedding according to my abilities which was sweet.

Everyone gathered around the bride and groom as is my custom. With my voice being low, I wanted everyone to hear. It started off well until my aphasia kicked it. There were long pauses as I searched for the words and how to pronounce them. I had the written text in front of me. I always print my ceremonies with double spaced lines in between the sections, break to sentences down to be read in one breath especially those where the couple has to repeat what I say, and in a 16-point font. You'd think that I had all the bases covered. I did except for my mind.

I'm just glad I was surrounded by friends and family! At one point the bride reached out her hand and gave me a reassuring smile and a wink. Of course, the giggles took over then. All of it came with my stroke. The difficulties- talking, reading and inappropriate responses. The bride made it worse by saying in a minister-like tone, "Let us pause, while the minister gets back her composure."

The witnesses, family, friends, and bridal party then joined in with raucous laughter which set me off for longer. Needless to say, all weddings have their little glitches and it went downhill from there. By the end of what was supposed to be a twenty-minute ceremony, it was closer to thirty-five minutes, they were officially married.

I realized that I've missed out on so much since my stroke because of my stroke. While I have spoken with the ladies at the courthouse and the probate judge, this was the first time I'd seen them in nine months. A far cry from the sometimes two to sixteen times a week I was seeing them.

They expressed their missing me with hugs. They cried and I cried. We'd had so many good times since I branched out to include weddings in my services provided two  years ago. So many stories and family events passed across that counter. Saddened by my lack of multilingual skills aside, they are my friends. I was one of the few ministers in town they could call to translate Spanish, Russian, Korean, Japanese, German, French, Singhalese, Mandarin Chinese, and even Latin for them at a moment's notice, and all in one person. Even with this loss, they can still count on me for laughs. In a job that's almost thankless. I am their fabulous go-to-girl for a smile.
Yes, I miss my old life and working. But, I realized with this part of my old life...I'm just not ready yet. I wish I were but my body is telling me otherwise. I remember my new year's resolution of sorts...I'm focusing this year on recovering what I lost. At least I had a glimpse of my old life. I know how impossible that is for most stroke survivors. All I can do is what's possible right now and keep pushing up against the boundaries of my life. But I'm not yet giving up on my old life.

You might have noticed that my progress on my book, Don't Get Your Panties in a Wad, has plateaued of sorts. That because since my dream, I've been trying to edit out the passive sentences, eliminate useless words, and edit including filling in those wicked little (xxx) as well as making some more while I write text. It's a challenge on good days. I won't go into the bad days. Everything is back and forth with stroke recovery. In fact I can't count on doing today what I was able to do yesterday or maybe be able to do more. There are no definites with recovery from a stroke.

Each day I'm reminded of how far I've come in my recovery. Just the fact that I can remember and type is a blessing.  Remind yourself everyday. As I used to tell my drug and alcohol counseling clients...everyday at least once a day and on bad days several times. Good advice if I do say so myself. I just have to keep reminding myself to practice what I preached.

Keep writing and loving the Lord.

Sweet Mama Dog Interacting with a Beautiful Child with Down Syndrome

Monty Becker
Stroke Survivors Tattler
Published on Sep 22, 2012

Jim Stenson, Life is full of special moments, open your eyes, open your mind and most of all, open your heart, you will see. I found this video online, I did not film it but I thought it was so special I had to put a song behind it. To me, the female Lab is trying so hard to befriend the child, I believe this is the first time they met, I DONT KNOW.

The boy is cautious but curious at the same time. The person who filmed the original video contacted me in January 2013 She is the mom, her name is Ana, her sons name is Hernan, and the dogs name is Himalaya.

Watch when the dog puts her paw on the boys shoulder as if to say, I love you, everything will be ok. If your heart doesn't melt your not human. FYI: The text in the video was inspired by a beautiful little DS girl I met that said "God didn't make a mistake when he made me" and her daddy said she was a "Gift from God". I had to edit the video to fit the song but its all original content and BTW this is my first VIDEO edit.

I'm just sayin :) If you saw it once, check it out again. I think you'll like it. Much love to all who appreciate it for what it is. BTW you can find the original uncut version on here by searching, Haciendose amigos! Thanks Ana.

Update: 2/5/2013. Ana told me, "Hernan, is a bit withdrawn and flees from physical contact. He does not like be touched, but Himalayan (the dog) insisted so patiently, and she was so soft that's why it is so moving, she is left to do anything. I do not think that Dios commit errors, (God doesn't make mistakes) everything happens for a reason. Best regards, Ana".

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Five Surgeons

Jackie Poff
Stroke Survivors Tattler
Five surgeons from big cities are discussing who makes the Best Patients to operate on.

The first surgeon, from Halifax , says, 'I like to see accountants on my operating table because when you open them up, everything inside is numbered.' 

The second, from Edmonton , responds, 'Yeah, but you should try electricians! Everything inside them is colour coded.' 

The third surgeon, from Toronto , says, 'No, I really think librarians are the best, everything inside them is in alphabetical order.' 

The fourth surgeon, from Vancouver chimes in: 'You know, I like construction workers... Those guys always understand when you have a few parts left over.'

But the fifth surgeon, from Ottawa shut them all up when he observed: 'You're all wrong. Politicians are the easiest to operate on. There's no guts, no heart, no balls, no brains, and no spine... Plus, the head and the ass are interchangeable.'

InterAct Reading Service, Supporting Stroke Recovery

Published on Feb 14, 2013

The work of award winning charity InterAct Reading Service ( The charity takes professional actors into hospitals and reads to stroke patients. It currently works in 21 hospitals and 50 stroke clubs nationally (UK). InterAct have won numerous awards including Best New Charity, two Tesco Community Awards, a GlaxoSmithKline Impact Award and a Guardian Newspaper Charity Award. For us, every penny really does count and we need your support, so please help us continue our work by donating at InterAct Reading Service - Donating.

How We Work

We currently have over 200 professional actors visiting hospitals and stroke clubs. In the hospitals the actors mainly read on a one-to-one basis at the patient's bedside. InterAct actors are professionally trained. They work for InterAct when not working in theatre, radio, film and television.

The reason for using professionally trained actors is that they have:
  • The dramatic skills to hold the concentration of somebody who is not only unwell but also in the hospital environment.  
  • The vocal stamina to sustain long periods of reading.  
  • The antennae to respond to unspoken reactions from the patients 
  • The technique to read for lengthy periods of time. 
"This is better than four months medicine" 
Patient, Charing Cross Hospital
They will sit with a patient, talking, reading and listening, the length of time spent on any one individual depending on the patient's wishes. We make every effort to provide reading material that will stimulate patients from every walk of life and that will suit their present level of comprehension.

The actors have a library of diverse stories of varying lengths and genres. They also carry numerous features, poetry and jokes.

Over the years InterAct has commissioned over 50 stories especially for the service, 21 of which have been published under the title 'Out Loud' written by Pete Barrett.

The charity also provides group readings, both in hospitals and at the various stroke clubs we work in. The important thing for InterAct is to treat each patient as an individual.

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Stroke Survivors Support Group Celebrates Fifth Anniversary

Published on Feb 15, 2013 

April 23 marks the fifth anniversary for the Stroke Survivors Support Group that meets once a month a the Talbot Senior Center in Maryland.

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Computer Game Helps Stroke Survivors

Published: 8:07PM Sunday February 17, 2013
Source: ONE News

Kiwi scientists have developed a computer game which will launch mid year, making a massive difference to the lives of stroke survivors. One participant is for the first time regaining movement in his fingers and arm. Almost a year ago, Tom Glenn survived a massive stroke but lost his ability to move his fingers and arms. But after four weeks playing the computer game he is making startling progress.

"Now I've got free flow of my arm really, I can move it out here," Glenn said, demonstrating stretching his arm. "I've lifted that hand a lot higher than what I've been able to do because previous to that it's been virtually clenched and closed," he said. "But now it's just outstanding. I put that down entirely to this process."

Scientists at the Callaghan Institute are launching games that help treat arm and finger paralysis after a stroke. The technology called Able Reach will soon be available worldwide. Human movement scientist Kimberlee Jordan said the games encourage stroke survivors to do a lot of reaching movements to help them remember how to use their arm properly.

The game has a strap-on mouse for wrists that seize or shake. In the "Mosquito Splat" game where you have to hit a moving target, each level gets faster and faster and more objects appear which complicate the path that you've got to choose.

Elliott Kernohan, IM Able CEOsaid: "It's movement and control of movement, concentration, decision making. And all of these together help the brain, so a stroke is about a brain injury."

Early results from a trial are promising with five out of seven cases showing noticeable improvements. The game and mouse costs less than $1000.

Copyright © 2013, Television New Zealand Limited - ONE News

Two Violins

John C Anderson
Stroke Survivors Tattler

Landmark Homes

and the

Edmonton Symphony Orchestra


Two Violins

Saturday, Feb 23, 2013, 7:15 – 10:15 PM

Location: Enmax Hall, Winspear Centre
          4 Sir Winston Churchill Square
City:     Edmonton
Event:    Winspear Centre
Details:  Two brothers – both rising stars
          – are featured alone and together in
          three violin masterpieces.
Category: Concerts / Performances, Performing Arts / Culture
Cost:     $79 Dress Circle, $69 Terrace, $56 Orchestra, 
          $38 Upper Circle, $28 Gallery, $20 Orchestra Front

Two brothers – both rising stars – are featured alone and together in three violin masterpieces. Works inspired by water, including a world premiere by Composer in Residence Robert Rival, complete this special night.

Featured Repertoire
JS BACH:     Concerto for Two Violins
SAINT-SAËNS: Rondo capriccioso
BRITTEN:     Four Sea Interludes from Peter Grimes
RIVAL:       Symphony No. 2 “Water”

William Eddins, conductor
Nikki Chooi,    violin
Timothy Chooi,  violin

Join us for Symphony Prelude at 7:15pm in the Upper Circle lobby for an informative presentation about the evening's program.


Saturday, February 16, 2013

Botulinum Toxin (Botox)

Botulinum Toxin (Botox) From Wikipedia, the free encyclopedia. 

Chemical Formula: C6760H10447N1743O2010S32 
Mol.Mass: 149.322,3223 kDa

SSTattler: This is a long article and I included a sub-set for stroke survivors.

Botulinum toxin is a protein and neurotoxin produced by the bacterium Clostridium botulinum. It is the most acutely toxic substance known, with an estimated human median lethal dose of 1.3–2.1 ng/kg intravenously or intramuscularly and 10–13 ng/kg when inhaled. Botulinum toxin can cause botulism, a serious and life-threatening illness in humans and animals. Popularly known by one of its trade names, Botox, it is used for various cosmetic and medical procedures.


Justinus Kerner described botulinum toxin as a "sausage poison" and "fatty poison", because the bacterium that produces the toxin often caused poisoning by growing in improperly handled or prepared meat products. It was Kerner, a physician, who first conceived a possible therapeutic use of botulinum toxin and coined the name botulism (from Latin botulus meaning "sausage"). In 1897, Emile van Ermengem found the producer of the botulin toxin was a bacterium, which he named Clostridium botulinum. In 1928, P. Tessmer Snipe and Hermann Sommer for the first time purified the toxin. In 1949, Arnold Burgen's group discovered, through an elegant experiment, that botulinum toxin blocks neuromuscular transmission through decreased acetylcholine release.

Therapeutic Research

In the late 1960s, Alan Scott, MD, a San Francisco ophthalmologist, and Edward Schantz were the first to work on a standardized botulinum toxin preparation for therapeutic purposes. By 1973, Scott (now at Smith-Kettlewell Institute) used botulinum toxin type A (BTX-A) in monkey experiments, and, in 1980, he officially used BTX-A for the first time in humans to treat "crossed eyes" (strabismus), a condition in which the eyes are not properly aligned with each other, and "uncontrollable blinking" (blepharospasm). In 1993, Pasricha and colleagues showed botulinum toxin could be used for the treatment of achalasia, a spasm of the lower esophageal sphincter. In 1994, Bushara showed botulinum toxin injections inhibit sweating. This was the first demonstration of non-muscular use of BTX-A in humans.

Blepharospasm and Strabismus

In the early 1980s, university-based ophthalmologists in the USA and Canada further refined the use of botulinum toxin as a therapeutic agent. By 1985, a scientific protocol of injection sites and dosage had been empirically determined for treatment of blepharospasm and strabismus. Side effects were deemed to be rare, mild and treatable. The beneficial effects of the injection lasted only 4–6 months. Thus, blepharospasm patients required re-injection two or three times a year. In 1986, Scott's micromanufacturer and distributor of Botox was no longer able to supply the drug because of an inability to obtain product liability insurance. Patients became desperate, as supplies of Botox were gradually consumed, forcing him to abandon patients who would have been due for their next injection. For a period of four months, American blepharospasm patients had to arrange to have their injections performed by participating doctors at Canadian eye centers until the liability issues could be resolved.

The global botox market is forecast to reach $2.9 billion by 2018. The entire global market for facial aesthetics is forecast to reach $4.7 billion in 2018, of which the US is expected to contribute over $2 billion. In December 1989, Botox, manufactured by Allergan, Inc., was approved by the US Food and Drug Administration (FDA) for the treatment of strabismus, blepharospasm, and hemifacial spasm in patients over 12 years old.

Upper Motor Neuron Syndrome

BTX-A is now a common treatment for muscles affected by the upper motor neuron syndrome (UMNS), such as cerebral palsy, for muscles with an impaired ability to effectively lengthen. Muscles affected by UMNS frequently are limited by weakness, loss of reciprocal inhibition, decreased movement control and hypertonicity (including spasticity). Joint motion may be restricted by severe muscle imbalance related to the syndrome, when some muscles are markedly hypertonic, and lack effective active lengthening. Injecting an overactive muscle to decrease its level of contraction can allow improved reciprocal motion, so improved ability to move and exercise. In June 2009, its use for treating hypertonic muscles helped an Australian man to walk again. He had required a wheelchair for mobility following a stroke 20 years prior.


Botulism toxins are produced by the bacteria Clostridium botulinum, C. butyricum, C. baratii and C. argentinense. Foodborne botulism can be transmitted through food that has not been heated correctly prior to being canned or food that was not cooked correctly from a can. Most infant botulism cases cannot be prevented because the bacteria that cause this disease are in soil and dust. The bacteria can be found inside homes on floors, carpet, and countertops even after cleaning. Honey can contain the bacteria that cause infant botulism, so children less than 12 months old should not be fed honey. Honey is safe for persons one year of age and older.

Food-borne botulism usually results from ingestion of food that has become contaminated with spores (such as a perforated can) in an anaerobic environment, allowing the spores to germinate and grow. The growing (vegetative) bacteria produce toxin. It is the ingestion of toxin that causes botulism, not the ingestion of the spores or the vegetative bacteria. Infant and wound botulism both result from infection with spores, which subsequently germinate, resulting in production of toxin and the symptoms of botulism.

Proper refrigeration at temperatures below 3°C (38°F) retards the growth of Clostridium botulinum. The organism is also susceptible to high salt, high oxygen, and low pH levels. The toxin itself is rapidly destroyed by heat, such as in thorough cooking. The spores that produce the toxin are heat-tolerant and will survive boiling water for an extended period of time.

Botulinum toxin can be absorbed from eyes, mucous membranes, respiratory tract or non-intact skin.

Botulinum toxin has been recognized and feared as a potential bioterror weapon.

Medical and Cosmetic Uses

Although botulinum toxin is a lethal, naturally occurring substance, it can be used as an effective and powerful medication. Researchers discovered in the 1950s that injecting overactive muscles with minute quantities of botulinum toxin type-A would result in decreased muscle activity by blocking the release of acetylcholine from the neuron by preventing the vesicle where the acetylcholine is stored from binding to the membrane where the neurotransmitter can be released. This will effectively weaken the muscle for a period of three to four months.

In cosmetic applications, a Botox injection, consisting of a small dose of botulinum toxin, can be used to prevent development of wrinkles by paralyzing facial muscles. As of 2007, it is the most common cosmetic operation, with 4.6 million procedures in the United States, according to the American Society of Plastic Surgeons. Qualifications for Botox injectors vary by county, state and country. Botox cosmetic providers include dermatologists, plastic surgeons, aesthetic spa physicians, dentists, nurse practitioners, nurses and physician assistants. The wrinkle-preventing effect of Botox normally lasts about three to four months, but can last up to six months.

In addition to its cosmetic applications, Botox is currently used in the treatment of spasms and dystonias, by weakening involved muscles, for the 60–70 day effective period of the drug. The main conditions treated with botulinum toxin are:
  • Cervical dystonia (spasmodic torticollis) (a neuromuscular disorder involving the head and neck)
  • Blepharospasm (excessive blinking) 
  • Severe primary axillary hyperhidrosis (excessive sweating)
  • Strabismus (squints) 
  • Achalasia (failure of the lower oesophageal sphincter to relax) 
  • Local intradermal injection of BTX-A is helpful in chronic focal neuropathies. The analgesic effects are not dependent on changes in muscle tone.
  • Migraine and other headache disorders, although the evidence is conflicting in this indication Other uses of botulinum toxin type A that are widely known but not specifically approved by the FDA (off-label uses) include treatment of: * Idiopathic and neurogenic detrusor overactivity.
  • Pediatric incontinence, incontinence due to overactive bladder, and incontinence due to neurogenic bladder 
  • Anal fissure 
  • Vaginismus to reduce the spasm of the vaginal muscles 
  • Movement disorders associated with injury or disease of the central nervous system, including trauma, stroke, multiple sclerosis, Parkinson's disease, or cerebral palsy 
  • Focal dystonias affecting the limbs, face, jaw, or vocal cords 
  • Temporomandibular joint pain disorders 
  • Diabetic neuropathy 
  • Wound healing 
  • Excessive salivation 
  • Vocal cord dysfunction, including spasmodic dysphonia and tremor 
  • Reduction of the masseter muscle for decreasing the apparent size of the lower jaw 
  • Painful bladder syndrome 
  • Detrusor sphincter dyssynergia and benign prostatic hyperplasia 
  • Treatment and prevention of chronic headache and chronic musculoskeletal pain are emerging uses for botulinum toxin type A. In addition, Botox may aid in weight loss by increasing the gastric emptying time.


In the United States, Botox is manufactured by Allergan, Inc. for both therapeutic and cosmetic use (100-unit). In 2011, Allergan required less than one gram of raw botulinum toxin neurotoxin to "supply the world's requirements for 25 indications approved by Government agencies around the world".

In the United States, Xeomin (manufactured in Germany by Merz) is available for both therapeutic and cosmetic use. Dysport, a therapeutic formulation of the type A toxin developed and manufactured in Ireland, is licensed for the treatment of focal dystonias and certain cosmetic uses in the US and worldwide in 100-, 300- and 500-unit packagess. Lanzhou Institute of Biological Products in China manufactures a BTX-A product, producing 50-unit and 100-unit type A toxin. Neuronox, a BTX-A product, was introduced by Medy-Tox Inc. of South Korea, in 2009. In America, Neuronox is also known as Siax. Merz manufactures the toxin and sells it under the trade name Xeomin. Solstice Neurosciences, LLC, a wholly owned subsidiary of US WorldMeds, LLC sells their product under the names Myobloc or Neurobloc, although it contains botulinum toxin type B, not the common type A found in Botox.

See the full article Botulinum Toxin (Botox) 

         From Wikipedia, the free encyclopedia. 

Spasticity Management: 

       Botox, Not Just for Wrinkles

Dr. Kenneth Ngo, Brain Injury Program Medical Director talks about the new spasticity management clinic being developed at Brooks Rehabilitation. Spasticity is a condition commonly seen in those who have had a stroke, spinal cord injury, brain injury, or are living with cerebral palsy or multiple sclerosis. Spasticity typically affects the limbs and causes them to be tight. The goal of the spasticity management clinic is to losen the limbs and improve function and quality of life. Treatments include physical therapy, occupational therapy as well as botox or implantable devices. Learn more about the spasticity management clinic at Brooks Rehabilitation.

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Stroke and Spasticity: 

      The Recovery Process (Botox)

Spasticity, a common and painful side effect of stroke, can lead to more serious complications if left uncontrolled. New research is making the recovery process a little easier to manage. Distributed by Tubemogul.

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Botox for the Brain

Botox, most commonly known as a cosmetic drug, could also help in brain recovery for patients who suffer a stroke. See more at

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Pediatric Botox — WVU Health Report

Botox is not just for people who want to look younger. Botox is now being used on the young -- to provide great relief for children with cerebral palsy, stroke and other muscle disorders.

In this West Virginia Health Report, Dr. Rolly Sullivan explains the use of pediatric Botox.

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Physiatrist M.D. Helps Stroke Victim Walk Again

Four years ago, Allyn Schwinn had a stroke. It paralyzed her left side and left her with pain in her arm and leg. Now she visits Atul Patel, M.D., a physical medicine and rehabilitation specialist with Kansas City Bone & Joint Clinic, a division of Signature Medical Group. Dr. Patel monitors her Baclofen Pump and also gives Allyn Botox injections to help with spasticity in her left arm. Allyn can now walk with the use of a cane. For more information on Dr. Atul Patel visit or

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Botox Helps Stroke Victims

When many people think about Botox, they may imagine injections to erase wrinkles. But Botox has much more serious and life-changing uses for stroke patients and others with neurological conditions.

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Botox for Stroke Victims

Henry Winkler and The Doctors explain how Botox can help those who have suffered a stroke.

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Botox for Stroke Patients

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Botox for Post-Stroke Spasticity

Many people who suffer a brain injury or stroke are left with severe muscle contractions that prevents them from using their limbs. Dr. Andrea Toomer at New Orleans' Culicchia Neurological Clinic is treating patients using Botox to loosen those contractions. Three patients share their stories.

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Botox Injections for Stroke & Spasticity Recovery

Sarah Abrusley discusses her recovery from a 2007 stroke and how Botox injections have relaxed the muscle tone and spasticity she was suffering in her left arm and hand. She is under the care of Dr. Andrea Toomer of Culicchia Neurological Clinic in New Orleans.

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Botox® for Urinary Incontinence

Dr. Paige White, Memorial Urologist, discusses an alternative treatment for urinary incontinence.

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Early Communication on Adverse Events from Botox and Myobloc

FDA has issued an early communication about serious adverse events, including respiratory failure and death, from Botox and Botox Cosmetic (Botulinum toxin Type A), and Myobloc (Botulinum toxin Type B). These events were related to how the product was used, and not to a defect in the manufacturing process. The events occurred one day to several weeks after treatment, and from a wide range of dosages.

In the affected patients, the botulinum toxin may have spread beyond the injection site and caused symptoms associated with botulism, including dysphagia and respiratory insufficiency. The most severe effects were seen in children, and the most commonly reported use in children was for limb spasticity in cerebral palsy, which is an unapproved use. Adverse reactions also occurred in patients receiving the drug for approved indications.

FDA is evaluating all the adverse event reports, as well as the medical literature in this area, and will let health professionals and the public know about any new information or conclusions.

In the meantime, healthcare professionals who use botulinum toxins should be alert to the potential for systemic effects from local injections, including dysphagia, dysphonia, weakness, dyspnea, or respiratory distress. They should tell patients and caregivers about the symptoms of botulism and to seek immediate medical attention if they occur.

Finally, practitioners should understand that the potency of botulinum toxin, which is expressed in "Units" ("U"), is not comparable from one botulinum toxin product to the next.

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