Saturdays News - Cognitive Therapy + Exercise

Cognitive Therapy + Exercise Relieves Stroke Fatigue

       The persistent fatigue that can linger for months and even years following a stroke currently has no treatment.

A new study suggest a combination of talk therapy and exercise might help. Researchers in the Netherlands recruited 83 stroke patients suffering from chronic fatigue and assigned them to one of two groups: one group underwent 12 weeks of cognitive therapy that was conducted in small groups; the other group underwent cognitive therapy plus exercise training.

At the end of the 12 weeks, 58% of the participants in the cognitive therapy plus exercise group experienced a "clinically relevant" improvement in fatigue, compared to only 24% in the group that received just cognitive therapy.

Once again, exercise to the rescue. Frankly it only makes sense that the benefit of exercising in reawakening and invigorating the mind and body can help many people no matter what their condition.

Peter Langhorne: Post Stroke Complications
Keywords: Depression, anxiety, emotionalism, fatigue, pain, musculoskeletal pain, shoulder pain, spasticity, central post stroke pain.

(SSTattler: It takes about 15 minutes by Dr. Langhorne.  It is worth it if you have "fatigue").

Minimally Invasive Maze Procedure Prevents Stroke
       Bruce MacDonald, an avid cyclist, learned after his stroke that his fatigue, shortness of breath and increased heart medication doses were all symptoms of atrial fibrillation. To prevent another stroke, Bruce underwent the minimally invasive Maze procedure at Beth Israel Deaconess Medical Center's Cardiovascular Institute in Boston.

Saturday Comics - April 7th / 2012

For Better and For Worse by Lynn Johnston / 2006-11-06 ... I'll write and I'll call.	Dilbert by Scott Adams / 2012-04-02 So, it's the entire world's fault..
Garfield by Jim Davis / 2012-04-06 ... I am no longer a loser.	Pickles by Brian Crane / 2012-04-03 ...and my hubby-wubby!

* 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.

** I tried to get low or free price at the people http://www.UniversalUclick.com/ 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 GoComics.com and Dilbert.com.

Saturday News Articles - April 7th / 2012

Bicycle Lanes 2012 Information Session

Tuesday, April 10, 2012 at 4pm to 7pm
Stantec, New York Boardroom, 10160 - 112 Street

Bicycle Lanes 2012 Information Session

• 121 Street (100 Avenue to 106 Avenue)
• 100 Avenue (102 Street to 121 Street - Proposed 2013 Project) 

The City of Edmonton is hosting a second public information session for the 121 Street bike route.  This information session will be an opportunity to learn more  about on-street bike lanes and provide your feedback on route design elements.

Project Background

The City plans to install close to 500 km of on-street cycling facilities over the next several years.  This is part of a larger goal to create an integrated bicycle network, as envisioned in the Bicycle Transportation Plan.  Bike lane installation will include dedicated bike lanes and sharrow markings.

Where we are today --> BUILD Phase.

For More Information visit online at www.Edmonton.ca/cycling.

Fatigue Is Very Common After Stroke

Fatigue is very common after stroke.  Forty (40%) to 74% of people experience fatigue after stroke. In one study there was a significant decrease in fatigue up to three months post stroke, but from then on fatigue stayed constant.

Sometimes people will have no other symptoms or visible signs of stroke other than fatigue. They will be told by others, “you are so lucky you aren’t disabled.” But post-stroke fatigue is disabling.   It  is different from ordinary tiredness and seems to be a significant problem as stroke survivors’ struggle to regain a new normalcy (Kirkevold et al, 2012)

Persisting pathological fatigue was associated with a lower chance of returning to paid work.

Kirkevold (2012) asked 30 stroke survivors to describe their fatigue. Patients clearly described and differentiated their experience between: (1) tiredness as an ordinary life event and (2) fatigue as a post-stroke life condition.  This is very similar to Dr. Karin Olsen’s research about fatigue in cancer treatment.

Kirkevold (2012) identified three strategies that stroke survivors use to handle post-stroke fatigue:

• being on a mission, 
• settling for less and 
• stalling.

Stalling seemed to put the stroke survivors in a particularly vulnerable situation. Over time, some participants moved between tiredness and fatigue and their range of strategies.

Is stroke location in the brain associated with fatigue?

In an analysis of 17 studies on stroke fatigue, there was no association between white matter lesions, brain atrophy or pathological type of stroke and fatigue (seven studies, stroke survivors n = 4746). The data on relationship between lesion location and fatigue were inconclusive: four (n = 675) of 13 studies (n = 1613) showed associations between fatigue and infratentorial lesion location (brainstem area shaded in pink) or basal ganglia stroke.

Inflammation associated with fatigue? 

One study reported C-reactive protein levels and found an association with fatigue.

Links to references:

• Andersen G, Christensen D, Kirkevold M, Johnsen SP.  Fatigue and Return To Work, Acta Neurol Scand: 2012: 125: 248–253.
•  Marit Kirkevold1, Doris Christensen, Grethe Andersen, Søren Paaske Johansen & Ingegerd Harder.  Fatigue Manifestations and Strategies, Disability & Rehabilitation, 2012; 34(8): 665–670.
• Kutlubaev MA, Duncan FH, Mead GE.  Biological Coordinates of Post stroke Fatigue, Acta Neurol Scand: 2012: 125: 219–227.

Health Rationing

On radio this week, Dr. Brian Goldman talked about health rationing—it is important to listen to what he says Rationing Coming Soon To A Hospital Near You.

It is important to talk about life and death issues with your family and your values and wishes so that they don’t know what you would want and have to make those decisions in an emergency room.

The other issue that Dr. Goldman did not discuss is that rehabilitation and home care are currently being rationed.

Rationing of Rehabilitation Services

Rehabilitation and homecare don’t have the same press coverage as emergency wait times and patients waiting in hospital corridors, but both homecare and rehabilitation can significantly improve your quality of life.

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