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[WEB] Science Explains 10 Ways to Stop A Panic Attack Before It Happens

panic attack

For those that suffer from panic attacks, they can be a terrible thing. Often, they are misunderstood, and those that suffer from panic attacks are often accused of just being dramatic. This is far from the case though, panic attacks are far from pleasant experiences and to those in the grips of one, they are a very real thing.

Panic attacks are a physical response as a result of a perceived threat, real or otherwise, that is characterized by such symptoms as sweating, shivering, shallow breathing, a racing heart, shaking, and just overall unpleasant feelings. Try to remember how you felt the last time you had a near miss while driving; hydroplaning on a wet road, or nearly colliding with another driver. That feeling you likely experienced, the rush of adrenaline, and the fear is what it feels like to be in the midst of a panic attack.

Some time or another, everyone is likely to experience a panic attack at some point in their lives. Whether it be due to an actual dangerous situation or threat, or just from an extremely stressful situation. If you find yourself getting panic attacks regularly for no real reason, and it ends up negatively affecting your life then you may, unfortunately, have a panic disorder.

To help you get through life uninhibited by panic attacks, continue reading for 10 ways to stop your panic attacks before they get out of control:

1. TRY SELF-MASSAGING THE SCALP

Who wouldn’t want a nice massage every time things got a bit stressful or you were feeling nervous? Research has found that a massage provides real benefits and can shift a person’s biochemistry. According to one study, cortisol levels were able to be significantly reduced while dopamine and serotonin were increased dramatically as a result of massage therapy!

If you find yourself in a situation where a panic attack might occur, consider self-massage in the form of a nice scalp massage. Scalp massages reduce the tension you feel in your neck and at the back of your head andprovidingd increased blood flow to the brain. With a little reading and some practice, giving yourself a scalp massage is easy!

2. TAKE DEEP BREATHS

Nearly every technique used to relieve stress and induce relaxation incorporates deep breathing in some fashion or another. It’s amazing how something as basic as slow controlled breathing could have such a calming effect on our whole nervous system!

Some stress relieving techniques that incorporate deep breathing include resistance breathing, breath moving, and coherent breathing, all of which work by stimulating our vagus nerve which provides relief due to the release of hormones and enzymes such as prolactin, acetylcholine, oxytocin, and vasopressin.

If you find yourself in the heat of the moment and think a panic attack may come on, don’t worry about stick to the above techniques to a T; just try to simply take slow, full, lung-filling breaths. Hold it in for a few seconds and then, just as slowly, exhale. You’ll likely notice relief pretty quickly!

3. GIVE IT A SHAKE

Shaking is a natural response of most animals after they’ve escaped from a dangerous situation, though seems to have been lost on us humans due to the decrease in environmental risks we face. The next time you’re feeling a bit nervous, try to shake about a little bit and you’ll likely find the tension start to easy and as a result, you’ll likely overcome panic attack!

4. LISTEN TO BINAURAL BEATS OR WAVES

Binaural beats are a type of technology that can have profound effects on your ability to control pain and also your mood. Utilizing low-frequency tones, binaural beats have been shown to significantly reduce anxiety in those prone to it and may even alleviate symptoms of children suffering from ADHD!

Consider downloading a few binaural beats, or even just some ocean sounds to your phone so if you find yourself in a situation conducive to a panic attack, you can try to relax and let the sounds calm your mind. Try to really focus on the sounds and imagine yourself in a nice safe place. You’ll likely feel much better after a few minutes of this.

5. CARRY EMERGENCY DARK CHOCOLATE

This technique is a lot more appealing for most, I’m sure, and will likely be hard to pass up once you find it works for you! By consuming dark chocolate with 85 percent or more cocoa content, you’ll enjoy an infusion of magnesium in your system. Magnesium has a profound calming effect and chocolate is one of the best sources of this miracle mineral.

Besides containing magnesium in significant amounts, dark chocolate also contains theobromine, which also helps better your mood, and tryptophan, which is an amino acid that is a precursor to the hormone serotonin.

Try carrying around a couple squares of dark chocolate with you and the next time you feel like a panic attack might come on, try eating a few. You’ll likely find the panic passes without an attack and you’ll also have the added benefit of a tasty treat!

6. TRY SPLASHING COLD WATER ON YOUR FACE

A splash of cold water to the face offers a jarring change of perspective! Studies have found that the parasympathetic system is stimulated by the cold-water immersion of one’s face. As a result, physiological changes occur that stimulate the vagus nerve, significantly reducing our heart rate, and also activating our immune and digestive systems. Splashing water on your face works extremely well at stimulating the vagus nerve due to the area behind our eyes being especially responsive.

7. DISTRACT YOURSELF

Panic attacks usually occur as a result of our own anxious thinking. If you can distract yourself from these anxiety-inducing thoughts, a panic attack can be avoided. Getting these anxious thoughts under control is a great way to overcome panic attack!

Reading a book, playing a game, organizing or cleaning up the house, having a phone call with a friend, or simply counting are all great ways of distracting yourself from anxious thoughts. Anything that you can do to take your mind off the anxious thoughts swimming around in your head will likely result in an end to stressful feelings and allow you to overcome panic attack. Distracting your mind from these thoughts is a skill that can be practised, so the better you become at it the better you’ll be at overcome panic attack.

If simple distracting thoughts aren’t doing it for you, try more sensory experiences such as the previously mentioned splash of cold water to the face, strong smells or tastes, or ice. Anything that you can use to distract yourself from the anxious thoughts and feelings that trigger your panic attacks is fine, though sensory experiences are most effective.

8. TRY YOGA: RABBIT POSE

If you happen to be a practitioner of yoga, give the Rabbit Pose a shot. If you’ve got a little time and are in a more private setting, the Rabbit Pose, where you sit on your heels, knees and feet together, and reach behind you to grab your heels, can provide relief from stress and anxiety. This pose is great for relieving tension in your back, neck, and shoulders where stress is often pent up. The Rabbit Pose is purported to be especially beneficial for suffers from anxiety and depression due to the resulting compression of the parathyroid and thyroid glands. This pose also promotes blood flow to the brain, all of which offer panic-mitigating effects!

9. TRY WARMING YOUR HANDS

When we start to feel stressed, our bodies start to feed blood to the more tense areas of our bodies such as our hips and shoulders due to the fight-or-flight response. As a result, our hands will typically become cold! By warming our hands, the stress response can be reversed and parasympathetic relaxation is triggered! There has been a lot of research on this that have found that blood pressure can be reduced significantly by warming our hands.

Physically warming our hands under hot water, in a warm bath, holding onto a nice hot cup of coffee or tea are all great ways to warm up our hands and experience relief but visualization techniques are also effective for this. By imagining yourself in a warm situation such as in bed, under warm blankets, or sitting in front of a nice cozy fire can all benefit us by triggering a relaxing response from our bodies!

10. TRY ICE PACKS

If you find yourself having panic attacks while home a lot, consider keeping a few ice packs at the ready in your freezer. If you feel like an attack might be coming on, place a couple against your lower back while holding a few more in your hands and you’ll likely notice relief from the stress and anxiety that is coming over you. By doing this you might notice immediate relief as the tightness and tension in your upper body moves down to where the cold sensations produced by the ice packs are centered. After a minute of this you can move on to some slow breathing and within a couple more minutes the panic and anxiety will likely to have passed!

CONCLUSION

Panic attacks are terrible experiences and a panic disorder is a debilitating condition to have to deal with! With a few stress and anxiety-relieving techniques in your belt, panic attacks do not have to rule your life! Keep these techniques in the back of your mind and the next time you feel panic start to set in, give them a go and you’ll likely feel the stress start to melt away!

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[BLOG POST] Stopping The Hero And Victim Narratives For Disabled People

Chloe Tear stood outdoors with her back facing the camera

Disabled people are regularly perceived as inspirational superhumans who can overcome anything and can defy all the odds. They can also be seen as people who are suffering or battling their disability and should be pitied.

However, the disability community wants to stop this narrative and just be treated like everyone else.

Chloe Tear, a disability blogger who has cerebral palsy and a visual impairment, recently published this blog post, in which she explains why society thinks disabled people are heroes or victims and how this narrative should be stopped.

When you hear the word disabled, what do you think of?

Chances are it will fall in one of these categories – a victim or a hero. Someone who is struggling and battling on, or someone who had overcome the odds and is an inspiration to all.

We cannot be blamed for these views, but we do have the power to change them. Within society I’m either portrayed as a hero or a victim, yet I am neither of those things. I hope to explain why the hero vs victim narrative needs to stop, but also why it is harmful to disabled people.

The hero

Hero (noun): “a person who is admired for their courage, outstanding achievements, or noble qualities.”

Aside from this looking like a compliment, the hero narrative can take on many forms. For example:

  • inspirational
  • overcoming
  • superhuman
  • defied the odds

I know comments like these come from a good place. They are well-meaning and often serve as a compliment. But let’s unpick what they mean.

By using the word “overcoming”, it suggests the problem is my condition and that needs to change. Overcoming also implies it is something within my control.

If I did choose to hide my condition to overcome challenges, I’m not giving myself the best chance possible. Whether I like it or not, I am disabled, even if this means society sees me as less.

When people use the word “overcome” in reference to disability, they are more accurately describing the barriers that society puts in our way.

Similarly, the word “inspirational” is known for grating on the disabled community. I believe this is partly down to inspiration porn and how society view disability. I know I cannot do this topic justice, without pointing you towards Stella Young’s TED Talk; I’m not your inspiration, thank you very much.

You might see images of disabled people with captions like:

  • What’s your excuse?
  • The only disability in life is a bad attitude.
  • Before you quit, try.

Disabled people’s existence is not to make you feel better about your life. It’s not heroic to brush our teeth or simply sit there. Yet disabled people are seen as incapable. If we achieve, it has to be possible for a non-disabled person. I believe this completely invalidates our own achievements.

The victim 

Victim (noun): “a person harmed, injured, or killed as a result of a crime, accident, or other event or action.”

The victim narrative can take on many forms, for example:

  • suffering
  • pitied
  • battling

Victim suggests that something very bad happened. Some people are born disabled; their existence isn’t a bad thing. If we’re a victim of anything, again, it’s the inaccessible society that we live in. I’m not saying it’s easy, but our mere existence isn’t to suffer. We want to live and thrive just like everyone else.

The pandemic has seen us as vulnerable and something to be protected. While this might have been the case when it came to getting coronavirus, I hope this isn’t something we generalise to every aspect of life.

Disabled people can be pitied, but what does that say about you? That you can’t imagine anything worse than being disabled? I’ll tell you now, I can think of much worse.

It’s complicated 

Being disabled can stop us from doing things, and that’s ok for us to talk about.

It’s complicated, but it’s allowed to be. We’re not a box to be contained or a simple solution that allows non-disabled people the ability to comprehend aspects of our lives.

Disabled people are often portrayed in the media as positive, grateful and happy. Again, this stereotype has made it hard for disabled people to say how they feel.

As someone who talks about their disability online, I am often hesitant of being negative. To appear ungrateful or to perpetuate the belief that having a disability is the worst thing in the world just seems like I’m doing a disservice.

Not only that, to show a weakness makes us out to be the most vulnerable within society and we don’t want that sympathy. We get patted on the head for living day to day, and that’s when we’re being positive!

But this is why we need to continue normalising disability. We’re people, just like everyone else. As Martyn Sibley put it, “disabled people can be arseholes”.

https://www.instagram.com/p/COqQk41ptzm/embed/captioned/?cr=1&v=13&wp=683&rd=https%3A%2F%2Fdisabilityhorizons.com&rp=%2F2021%2F07%2Fstopping-the-hero-vs-victim-narrative-for-disabled-people%2F%3Fml_subscriber%3D1738358138454677050%26ml_subscriber_hash%3Do6l1%26utm_source%3Dnewsletter%26utm_medium%3Demail%26utm_campaign%3Dtokyo_2020_two_more_pa#%7B%22ci%22%3A0%2C%22os%22%3A2521.7999999821186%2C%22ls%22%3A1806.2999999821186%2C%22le%22%3A1839%7D

At the end of the day, we want to be treated like everyone else. Not shamed into being a poor victim or celebrated as a hero for simply living our lives.

“You can’t say anything these days!”

Seeing disability as a victim or a hero makes society feel better and allows them to process this way of living. But where does that leave us? The ones who are “inspirationally battling on”.

Normalising disability is critical. Not only in the hope of raising awareness, but so disabled people don’t feel the pressure to perform to the societal norms.

Also, so that someone who becomes disabled (it really can happen to anyone) doesn’t see it as a life sentence. It’s a huge and often devastating thing to be diagnosed with a disability. It can take time to accept and adapt to a new way of living, but it’s not the worst thing imaginable.

We don’t want disability to become a topic that people cannot talk about or something they fear. I also appreciate that disabled people won’t always get it right.

Language and the words we use are ever evolving, something that is deemed acceptable today might not be in five years’ time. It’s complicated.

I think the most important things is a willingness to learn and an open mind to listen and respect those with lived experiences. That’s all we can ask for.

By Chloe Tear

Check out Chloe’s blog Chloe Tear and follow her on FacebookTwitter and Instagram.

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[WEB] Focusing on the Cause of Neurological Symptoms of COVID-19 – Video

WRITTEN BY: Carmen Leitch

We now know that COVID-19 can cause a range of problems in the brain. Some of these problems are taking months to clear up in patients, or they are still lingering. They may be on the milder side, like disruptions in the ability to sense smells or tastes, or they may be far more severe, with some patients complaining of memory problems and brain fog. Researchers have been trying to learn exactly how these symptoms are arising; for example, is the virus infecting the brain directly? Or is the brain impacted in a secondary way?

This scanning electron microscope image shows SARS-CoV-2 (round red particles) emerging from the surface of a cell cultured in the lab. SARS-CoV-2, also known as 2019-nCoV, is the virus that causes COVID-19. Image captured and colorized at Rocky Mountain Laboratories in Hamilton, Montana. / Credit: NIAID
This scanning electron microscope image shows SARS-CoV-2 (round red particles) emerging from the surface of a cell cultured in the lab. SARS-CoV-2, also known as 2019-nCoV, is the virus that causes COVID-19. Image captured and colorized at Rocky Mountain Laboratories in Hamilton, Montana. / Credit: NIAID

The blood-brain barrier seems to do a pretty good job of protecting the brain from the SARS-CoV-2 virus; viral levels seem to be very low in infected individuals. However, the virus can get into cells that make up the olfactory epithelium, a border that lines the nasal cavity and is also very close to the brain. The virus may be able to infect cells in the brain called astrocytes, which have a variety of roles. Astrocytes were once thought to work primarily to support neurons, but research has indicated that have other functions as well.

recent preprint, not yet peer-reviewed, has suggested that SARS-CoV-2 can infect astrocytes in brain organoids, which are small, miniature models of human brains. Preliminary work by researchers in Brazil proposed that five people out of a group of 26 who had died from COVID-19 had evidence of SARS-CoV-2 infection in their brain cells; 66 percent of the infected cells in these patients were astrocytes. Another report compared gene expression in patients that had died of SARS-CoV-2 to controls, and determined that gene expression in astrocytes was disrupted even though the virus was not found there.

There may be no simple answer to the question of how many brain cells have to be infected for a problem to occur, Arnold Kriegstein, a neurologist at the University of California, San Francisco and a co-author on the organoid study told Nature. He explained that damaged cells in some regions of the brain might cause more problems than others.

There may also be another way that the virus causes neurological symptoms. Since the early days of the pandemic, clinicians and researchers noticed unusual blood clots in patients. Blood flow to the brain might be disrupted in some COVID-19 patients. Capillaries, which are vessels that move blood to small places in the body, also contain a type of cell called pericytes. According to a pre-print, SARS-CoV-2 can infect pericytes, and pericyte-like brain cells.

Another possibility is that the immune system overreaction induced by COVID-19 is also battering the brain. Some people generate autoantibodies, which attack their own cells, during the course of a serious infection. There is evidence that suggests these autoantibodies can pass through the blood brain barrier and play a role in neurodegenerative disorders.

Researchers are now working to earn more about autoantibodies in COVID-19 patients. One study has found that eleven of these critically ill patients all carried autoantibodies that could attach to neurons.

Treating these problems may be very complicated; clinicians might have to determine which mechanism is most likely causing a patient’s problems, or researchers may have to focus on creating a treatment that targets the one that’s most common.

Sources: Journal of Neurology, Neurosurgery, and PsychiatryNature

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[ARTICLE] Treatments for sleep disturbances in individuals with acquired brain injury: A systematic review – Full Text

Abstract

Objective:

To systematically review the evidence on the treatments of sleep disturbances in individuals with acquired brain injury.

Data sources:

PubMed, Embase, Web of Science, and PsycINFO were searched from inception to January 2021.

Review method:

Eligibility criteria were (1) participants with mild to severe acquired brain injury from traumatic brain injury and stroke (⩾three months post-injury), (2) individuals aged 16 years and older, (3) participants with self-reported sleep disturbances, (4) controlled group studies and single case (experimental) studies, and (5) interventions aimed at treatment of sleep disturbances. Two researchers independently identified relevant studies and assessed their study quality using the revised Cochrane assessment of bias tool (RoB 2.0) and the risk-of-bias in N-of-1 trials (RoBiNT) scale.

Results:

The search yielded 655 records; 11 studies met the inclusion criteria and were included, with a total of 227 participants (207 individuals with traumatic brain injury, 20 stroke patients). Two studies included pharmacological therapy, six studies examined the effects of cognitive behavioral therapy and three studies investigated alternative interventions such as acupuncture.

Conclusion:

Although there was heterogeneity in the study quality of the included studies, their outcomes suggest that cognitive behavioral therapy is recommended as treatment of choice for improving sleep in individuals with acquired brain injury, especially for patients with mild to severe traumatic brain injury. Future research should examine the effects of cognitive behavioral therapy in more high-quality randomized controlled designs.

Introduction

Sleep disturbances are commonly reported following acquired brain injury and have a negative impact on functioning.1 In the context of this review, acquired brain injury includes traumatic brain injury and stroke. It is estimated that fifty to seventy percent of individuals with traumatic brain injury (50%) or stroke (67%) in the chronic phase of recovery suffer from sleep disturbances, which is much higher than the incidence in the general population.24 Up to a third of the persons with acquired brain injury experience insomnia, which is defined as an inability to sleep, particularly associated with problems of falling asleep and maintaining sleep.57 Since many studies did not diagnose sleep complaints as sleep disorders, this review focuses on sleep disturbances refering to sleep problems that occur at night and are characterized by the inability to initiate and maintain sleep. Several studies have reported a poorer sleep quality and a reduced sleep efficiency (ratio of time spent asleep compared with time spent in bed) due to more frequent awakenings at night.810 Following acquired brain injury, sleep disturbances can exacerbate other injury-related symptoms (e.g. cognitive functioning and fatigue) and have a negative impact on recovery.11,12 The high prevalence of sleep disturbances, its negative outcomes and also the persisting nature of sleep disturbances stress the need for effective sleep interventions for individuals with acquired brain injury.

Available treatment options for sleep disturbances in the general population could be divided into pharmacological treatment, cognitive behavioral therapy (CBT) or other, alternative interventions (e.g. acupuncture).13 Although clear guidelines exist for treatment of sleep disturbances, little research has been done on the effects of these treatments in people with acquired brain injury. As a result, sleep disturbances are often not part of standard care within the longer-term outpatient rehabilitation of patients with acquired brain injury.3,14

Recently, a systematic review on non-pharmacological treatment for insomnia showed beneficial effects of cognitive behavioral therapy in patients with acquired brain injury.15 However, a general overview including both pharmacological and non-pharmacological treatments for sleep disturbances following acquired brain injury is lacking. Our review aims to systematically review the evidence on the treatments of sleep disturbances in individuals with acquired brain injury. Specific aims are to evaluate the effectiveness of pharmacological treatment, cognitive behavioral therapy and other interventions in sleep disturbances and to discuss the implications of the findings for clinical practice, based on the study quality of the included studies.[…]

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[Infographic] PTSD

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[WEB] Living in a Poor Neighborhood May Impede Stroke Recovery

By Susan Fitzgerald

Article In Brief

New research suggests living in neighborhoods with lower socioeconomic status may hinder stroke recovery.

The chances that a stroke patient will have a good recovery after leaving the hospital may depend on where they live, according to a new study of stroke patients in Texas.

At 90 days post-stroke, patients who lived in lower socioeconomic neighborhoods had more disability, and more depressive symptoms compared with stroke survivors whose neighborhoods had a higher socioeconomic status.

Prior studies have reported that living in low socioeconomic neighborhoods is associated with an increased risk for stroke and stroke mortality, and now the new study, published online April 28 in Neurology, suggests it may be a barrier to stroke recovery as well.

“A lot of care planning goes into [working with] stroke survivors,” said study coauthor Lynda Lisabeth, PhD, professor of epidemiology at the University of Michigan School of Public Health. Dr. Lisabeth said she hoped the findings would help stroke care providers “to really understand not just what the person’s deficits might be at discharge, but what their neighborhood environment looks like.”

Relevant factors, for instance, could be whether the stroke survivor has friends or family nearby for support or whether their home is hard to navigate with a cane or walker; whether they have access to parks, green spaces, places to walk, sidewalks, and community centers, and a sense of social connection in the neighborhood.

The authors noted that there is a “growing body of literature suggesting neighborhood context significantly influences post-stroke outcomes beyond individual-level factors.”

While the study did not delve into specific factors, it noted that lower neighborhood SES (nSES) “environments have lower levels of perceived safety, fewer physical activity facilities, poorer walking environments, and lower social cohesion. These neighborhood factors are likely relevant in the recovery process following a sudden and dramatic change in life state that occurs following a stroke.”

The study authors noted that the prevalence of stroke in the US is expected to double by 2050 as the population gets older. More people also are surviving stroke, making it even more critical to understand the factors that can affect recovery, much of which occurs outside the hospital, Dr. Lisabeth said.

Texas-Based Study

The study involved participants from the Brain Attack Surveillance in Corpus Christi (BASIC) Project, a population-based surveillance study among persons 45 and older in a bi-ethnic community in Nueces County, TX. The study, which identified stroke patients between 2010 and 2015 included people with primary stroke (hemorrhagic or ischemic) who identified as non-Hispanic White or Mexican American, were living in a non-institutionalized setting prior to stroke. They had agreed to participate in the interview portion of the BASIC project and survived through 90 days after stroke.

The current analysis included 776 stroke survivors, of whom 53 percent were men, 62 percent were Mexican American, and 53 percent were 64 or older.

To capture socioeconomic status at the neighborhood level, the researchers determined a “nSES” for each participant based where they lived at the time of stroke. nSES, a standardized composite, was calculated from six census tract variables representing wealth/income, education, and occupation, including median household income; median value of owner-occupied housing units; proportion of households receiving interest, dividend or net rental income; proportion of adults 25 or older with a high school diploma; proportion of adults in that age group with a college degree; and proportion of people employed in executive, managerial, or professional occupations. Those living in neighborhoods with worse nSES indexes were more likely to be Mexican American, have less education, and have more comorbidities.

The researchers determined the stroke survivor’s functional status at 90 days by averaging the score of a 22-item questionnaire designed to assess seven activities of daily living and 15 instrumental activities of daily living. Participants self-reported their level of difficulty with each item using an ordered scale with a range of one (no difficulty) to four (can only do with help).

They assessed self-reported psychosocial health by using results of the 12-item Stroke Specific Quality of Life Scale (SS-QOL). Participants also self-reported depressive symptoms using the Patient Health Questionnaire Eight (PHQ-8). The researchers also considered the severity of stroke.

“If you are not doing well (mentally) then maybe you are not motivated to take your medicines, or follow-up with doctor appointments or do rehab.”—DR. VIRGINIA HOWARD

“Residence in areas with higher nSES (the 75th percentile versus the 25th percentile) was associated with significantly better post-stroke functional status and biopsychosocial health when analyzing all stroke survivors as one group,” the study found, though the association was stronger for participants with a moderate-to-severe stroke. “Higher nSES was associated with significantly less post-stroke depressive symptoms in those with moderate-to-severe stroke but not in those with mild stroke.”

“Our results suggest that those living in lower nSES neighborhoods and with moderate-to-severe strokes were most susceptible to poor outcomes,” the study reported.

Dr. Lisabeth said that the home/neighborhood environment may play a less critical role for patients with mild stroke because their “distance” to recovery is less and they might be able, for instance, to drive themselves or be mobile enough to get to places for physical or social activity. Less than 20 percent of those in the study went to an inpatient rehabilitation facility.

“Integrating information on a patient’s neighborhood context within the demographic information on the medical chart would assist with hospital discharge and deposition planning,” the researchers said. They said the findings also have public policy implications.

Dr. Lisabeth said she and her colleagues hope to use the data from the BASIC Project to identify specific aspects of lower socioeconomic neighborhoods that might contribute to worse post-stroke outcomes.

A study limitation is that it was done in one community, the Corpus Christi area, an urban area with mostly non-Hispanic Whites and Mexican-Americans. Whether the findings apply to other settings or groups, such as rural America or the Black community, is not known.

Stages of Stroke Care

Jeremy Ader, MD, MBA, a neurologist and researcher at Columbia University, said the new study is noteworthy. “We know that socioeconomic status has an impact on stroke before people get to the hospital, but this study is very interesting because it identifies the fact that SES impacts people’s outcomes after they leave the hospital,” he said.

Dr. Ader said more attention has been paid recently to heightening public awareness of stroke symptoms and the need to get to the hospital quickly to potentially qualify for treatment with tissue plasminogen activator (tPA), but he said those messages need to be reinforced in the most vulnerable communities.

Dr. Ader coauthored a study published in August 2019 in Neurology that found that lower patient SES was associated with longer onset-to-treatment time and in-hospital mortality from stroke. SES did not seem to play a role in onset-to-arrival time (at a hospital) or whether the stroke patient was given tPA, according to the study’s data derived from American Heart Association GWTG-Stroke, a voluntary national registry.

Dr. Ader said stroke discharge planning is often focused largely on safety issues (such as having to navigate steps, for instance), which he said is different than assessing whether the person is returning to an environment that provides nearby social connections or a park to which they can walk. Dr. Ader said a significant amount of functional recovery can occur in the several months following stroke, even for patients in bad shape at two weeks.

“Certainly not everyone has to go to a rehabilitation center,” Dr. Ader said, though “we often have a strong focus on rehabilitation after patients leave the hospital to take advantage of early neuroplasticity after stroke.”

Gustavo Saposnik, MD, MPH, PhD, associate professor of neurology and director of the Outcomes Research & Decision Neuroscience Unit at St. Michael’s Hospital at the University of Toronto, said he thought the findings on the association between nSES and stroke recovery are not particularly surprising given previous stroke outcomes research. But he said the paper could still have impact if it helps “increase public and policymakers’ awareness of what happens after stroke.”

He said putting in place standard out-of-hospital programs for stroke recovery would likely be more difficult in the US, with its multipayer insurance system, compared to Canada, where there is a single-payer system where care is organized at the provincial level. He said his patients benefit from a case-manager, community-based approach to post-stroke care that incorporates not just a physical rehabilitation plan and other medical components but also non-medical assistance such as house cleaning.

Virginia Howard, PhD, FSCT, FAHA, Distinguished Professor of Epidemiology at the School of Public Health at the University of Alabama at Birmingham, said the new study on stroke recovery illustrates what’s been made clear by the COVID-19 pandemic—that lower socioeconomic condition is associated with poorer outcomes.

She said one particularly concerning finding in the stroke recovery study was that people with moderate-to-severe stroke who lived in lower SES neighborhoods reported more depression after being discharged from the hospital.

“If you are not doing well (mentally) then maybe you are not motivated to take your medicines, or follow-up with doctor appointments or do rehab,” which could impede recovery and increase the risk for another stroke, said Dr. Howard, one of the lead epidemiologists for the REGARDS (REasons for Geographic and Racial Differences in Stroke) study.

She said that in general low SES status and all the factors that go along with it means there is “less opportunity to protect yourself,” whether it’s from COVID or chronic conditions such as stroke.

Disclosures

Drs. Lisabeth and Ader had no disclosures. Dr. Saposnik disclosed receiving unrestricted grants from Roche and CME compensation from Servier Canada and Roche, which have no relationship with the current publication.

Link Up for More Information

• Stulberg EL, Twardzik E, Kim S, et al. Association of neighborhood socioeconomic status with outcomes in patients surviving stroke https://n.neurology.org/content/early/2021/04/28/WNL.0000000000011988Neurology 2021; Epub 2021 Apr 28.

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[BLOG POST] Weighted Blankets: Uses, Benefits, Risks, and Safety

What Is a Weighted Blanket?

Pros and Cons About the Popular “Pressure Therapy” Device

By Martta Kelly  Medically reviewed by Steven Gans, MD

on December 03, 2020

Weighted blankets, also known as gravity blankets, have been used for years by mental health professionals as a form of pressure therapy. Today, they have gained mainstream popularity with those who believe that the pellet-filled blankets, which weigh anywhere from 5 to 30 pounds, can relieve stress, improve sleep, calm children with attention deficit hyperactivity disorder (ADHD) or autism spectrum disorder (ASD), and aid in the treatment of anxiety disorders.

Although many people report improvements in their health and well-being from these popular blankets, there remains considerable debate as to whether they offer the benefits that proponents claim.

child with weighted blanket
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Uses

Many adults associate snuggling under a comfy blanket with a sense of security, which harkens back to “security blankets” they may have had as a child. Blankets are often referred to as “comfort objects” by child psychologists—that is, an item used to ease frustration or anxiety at times of stress.1

An older study by psychologist and security object expert Richard Passman, now retired from the University of Wisconsin at Milwaukee, found that approximately 60% of children are attached to a toy, blanket, or pacifier during the first three years of life.2

More recent studies have examined adult attachment to transitional objects, such as blankets and stuffed animals. In one study using a non-clinical community sample of 80 participants, researchers found that people who reported intense attachments to objects were significantly more likely to meet the criteria for borderline personality disorder than those who did not; they also reported more childhood trauma.3

Weighted blankets aim to evoke the same therapeutic effects of a security blanket by intensifying the sensation of being held, stroked, cuddled, or squeezed.

The science behind using a weighted blanket is a well-known and proven relaxation therapy that is frequently used for people with stress and anxiety. Known by various names, it is commonly referred to as deep pressure stimulation (DPS).

DPS, offered by trained practitioners who apply pressure to certain parts of the body, stimulates what is known as the parasympathetic nervous system. The nervous system reacts to stressful situations naturally, by inducing its sympathetic or “alert” state, which can produce anxiety and stress. The parasympathetic system counterbalances this sympathetic activation.

DPS and weighted blankets can stimulate the parasympathetic response. When the parasympathetic nervous system kicks in, it can instill feelings of calm, slowing many of the body’s autonomic functions. There are also psychological calming effects, akin to being cocooned in your favorite duvet on a cold winter night, knowing you are protected from the outside world.4

Weighted blankets may help adults and children with sensory processing disorder feel calmer and more relaxed.5 Persons with this disorder have difficulty processing sensory information such as textures, sounds, smells, tastes, brightness, and movement.

These difficulties can make ordinary situations overwhelming, interfere with daily living, and even isolate individuals and their families. Sensory integration therapy uses activities in ways designed to change how the brain reacts to various stimuli.6

Applying deep pressure has also been shown to be beneficial for children with high levels of anxiety or arousal due to sensory overload. According to research, the application of deep pressure provided by a weighted vest or blanket can produce a calming or relaxing effect in children with certain clinical conditions who have sensory processing issues.5

Benefits

Although more studies are needed, research has been conducted on the use of weighted blankets to treat the following conditions:

General Anxiety

Some studies show that the use of weighted blankets may help reduce nighttime levels of cortisol, a stress hormone that can contribute to anxiety.7 Cortisol is best known for being involved in the “fight or flight” response, a reaction that evolved as a means of survival, enabling people to react to what could be a life-threatening situation.

Over time, however, elevated cortisol levels can have a negative impact on a person’s physical and mental health.8 By providing deep pressure, weighted blankets can promote relaxation and help break this cycle. For example, one study examined the use of a 30-pound weighted blanket in a sample of 32 adults; 63% reported lower anxiety after using the blanket.9

Anxiety During Certain Medical Procedures

A 2016 study, believed to be the first one investigating the effect of deep pressure stimulation during wisdom tooth extraction, examined heart rate variability and anxiety in healthy adults using weighted blankets while undergoing the procedure. Researchers found that the weighted blanket group experienced lower anxiety symptoms than the control group.10

A similar follow-up study was performed a few years later on healthy adolescents using a weighted blanket during a molar extraction. Those results also found less anxiety in those using a weighted blanket.11

Since medical procedures tend to cause anxiety symptoms, such as increased heart rate, researchers concluded that weighted blankets may be beneficial in calming those symptoms.12

Insomnia

Most research on weighted blankets and insomnia has focused on their use in children with clinical disorders, such as ASD, as discussed below. However, the majority of these studies do not examine sleep objectively.

A Swedish study published in the Journal of Sleep Medicine & Disorders concluded that the use of weighted blankets had a positive impact on sleep, both objectively and subjectively, where a number of physiological and behavioral measures were improved in a cohort of 31 adults. However, the study was biased in that it was conducted by a blanket manufacturer and had design limitations, such as the lack of a control group.5

A systematic literature review, which evaluated eight studies, concluded that while weighted blankets have the potential to be beneficial in limited settings and populations and may be an appropriate therapeutic tool in reducing anxiety, there is not enough evidence to suggest that they are beneficial in alleviating insomnia.13

Insomnia in Children with ASD

Children with ASD sleep poorly compared with their peers. A study published in Pediatrics involving 67 children with ASD found that the use of a weighted blanket did not help them fall asleep significantly faster, sleep for a longer period of time, or awaken less often.14

Sleep Problems in Children with ADHD

Similarly to children with ASD, many children with ADHD have sleep disturbances, such as trouble falling asleep and waking up several times throughout the night. Unlike children with ASD, however, weighted blankets proved useful in some instances in children with ADHD who had difficulty sleeping.

A study involving 21 children ages 8 to 13 years with ADHD and 21 healthy controls found that the use of a weighted blanket improved the time it took to fall asleep and the number of awakenings.15

A more recent study examined 120 patients who were randomized (1-to-1) to either a weighted metal chain blanket or a light plastic chain blanket for four weeks. Researchers found that weighted chain blankets are an effective and safe intervention for insomnia in patients with ADHD and other psychiatric disorders.16

It is important to note that, despite positive findings in several of these studies, they are limited by their small size, short duration, and/or lack of diverse subjects. Further research on the benefits of weighted blankets is needed in all of these therapeutic areas.

Other Conditions

Although there have been studies on the benefits of massage therapy for osteoarthritis and chronic pain, there is currently no evidence that weighted blankets are effective in the treatment of these conditions.

Some manufacturers make unsubstantiated claims about weighted blankets benefiting certain health and psychological conditions, but, ultimately, it’s up to the consumer to do their own research and make an educated decision.

Risks

As a general rule, weighted blankets are safe for healthy adults, older children, and teenagers. Weighted blankets, however, should not be used for toddlers under age 2, as they may pose a suffocation risk. Even older children with developmental disabilities or delays may be at risk of suffocation.

There have been at least two reports of deaths in children due to weighted blankets, one in a 7-month-old baby and one in a 9-year-old boy who had autism.17 Parents should consult their pediatrician before using a weighted blanket for children of any age.

People with certain health conditions should also avoid weighted blankets. These include chronic respiratory conditions, such as asthma, chronic obstructive pulmonary disease (COPD), and obstructive sleep apnea.

In addition, a weighted blanket may also be unsuitable for those people who are claustrophobic, as it may cause anxiety rather than ease it.

Safety

As a general rule, a weighted blanket should be 10% of an adult person’s body weight, according to most manufacturers’ websites. Other guidelines include:18

  • Adults can use medium-to-large weighted blankets ranging from 12 to 30 pounds.
  • For a 30- to 70-pound child, a small weighted blanket should weigh from 5 to 8 pounds.
  • For a 30- to 130-pound child, a medium-weighted blanket should weigh from 5 to 15 pounds.

Young children should never be left unsupervised with a weighted blanket, particularly those made for an adult.18

A Word From Verywell

While there is no conclusive evidence that weighted blankets are effective for the treatment of any health condition, they are popular with many people due to the comfort they provide.

Some studies have shown positive results in reducing anxiety and helping children with ADHD get a good night’s sleep. If you are a healthy adult, there is little risk of trying one—other than to your wallet, as they start around $100.

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[BLOG POST] Invisible or Hidden Disabilities: What are they? – Collection Spotlight from NARIC

According to the Invisible Disabilities Association, invisible disabilities are physical, mental, or neurological conditions that are not visible from the outside, “yet can limit or challenge a person’s movements, senses, or activities.” These disabilities include symptoms or limitations that may not be obvious to an onlooker, such as debilitating pain, fatigue, dizziness, or cognitive dysfunctions. Examples of invisible disabilities include brain injuries, learning disabilities, mental health disorders, as well as hearing and visual disabilities. Invisible disabilities may limit daily activities, vary from person to person, and range from mild challenges to severe limitations.

Are you a person with an invisible disability, a family member or friend, or a service provider and would like to learn more? NIDILRR has and continues to fund research and development activities related to different types of invisible disabilities, including visual disabilitiesautism spectrum disorderstraumatic brain injury (TBI)mental health disorders, and more. NARIC’s information specialists searched the NARIC collection and found over 40 articles related to invisible disabilities and over 60 articles related to hidden disabilities, in addition to hundreds of publications on individual disabilities such as TBI or autism. Are you interested in learning about how invisible or hidden disabilities are covered under the Americans with Disabilities Act (ADA)? Contact your Regional ADA Center to learn more about your rights and responsibilities under the ADA. To learn more about invisible or hidden disabilities and to find resources in your area, contact NARIC’s information specialists by phone, email, or chat.

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[BLOG POST] Information for the stroke community about COVID-19 vaccination

Published: February 15, 2021

The information below is general in nature guided by the Stroke Foundation Clinical Council. If you are considering getting vaccinated or have concerns, please talk to your doctor.

It is important even with the vaccine to continue to be COVIDSafe. Everyone still needs to:

Why should I get vaccinated?

Having the vaccine means you are much less likely to become seriously ill or die from COVID-19.

It is your choice to have the vaccine. Everyone will have access to the vaccine, and it is free.

Survivors of stroke are among those most vulnerable to COVID-19 meaning vaccinating against it is very important. Talk to your doctor about the vaccine.

Having the vaccine could also benefit those around you. Although it doesn’t mean you can’t spread the virus, it may make it less likely. More people vaccinated also reduces the potential for the virus changing and stopping a vaccine from working.

Is the coronavirus (COVID-19) vaccine safe for people who have had a stroke?

If you have concerns about the vaccine or other medications, please talk to your doctor.

The vaccine is safe for people who have had a stroke.

It was approved for use in Australia by the Therapeutic Goods Administration (TGA) because independent, robust evidence showed it was safe and worked. The TGA looks at evidence of its safety and effectiveness for a range of different ages, health conditions and lifestyle factors before approving its use. This includes survivors of stroke and older people.

In fact, older people and people with an underlying medical condition or disability including stroke are among those who will received the vaccine first because of vulnerability to COVID-19.

The TGA is actively monitoring COVID-19 vaccine development both in Australia and around the world, and is also part of a network of international regulators that meet regularly to discuss the development of COVID-19 vaccines.

Are there things I need to tell my health professional before having the vaccine?

Tell your doctor, pharmacist or nurse beforehand if any of the below apply you. Your health and wellbeing is their priority. It may mean there may are thing the health professional needs to check or discuss with you before vaccinating, or it may mean you cannot have the vaccine:

Your immune system does not work properly (immunodeficiency) or you are taking medicines that weaken the immune system (such as high-dose corticosteroids, immunosuppressants or cancer medicines).

You have ever had a severe allergic reaction (anaphylaxis) after any other vaccine injection.

You currently have a severe infection with a high temperature (over 38°C).

You have a problem with bleeding or bruising, or if you are taking a blood thinning medicine (anticoagulant).

What if I am on blood thinners like warfarin or other anticoagulants?

Talk to your doctor or health professional before having the vaccine.

Generally, the vaccine is safe for people on blood thinners, however there is some risk of mild bleeding as with any injection.

Like most vaccines, the coronavirus vaccine is injected into the muscle of your upper arm. Injections into your muscle may bleed a little more than injections that are given under the skin, but less than those that are given into a vein.

If you are taking a blood thinner the bleeding may take a little longer to stop and you may get more bruising on your upper arm.

What if I am taking blood thinners like clopidogrel or other antiplatelet drugs?

Yes, the vaccine is safe for people taking clopidogrel and other antiplatelet medications. You may experience a little more bruising around the injection site.

Which vaccines are available in Australia?

Australian Government Department of Health information on the vaccine program.

Are there any side effects to the vaccines?

Like all medicines, vaccines can cause side effects, although many people don’t get any side effects at all. If you have concerns talk to your doctor or health professional.

The vast majority of side effects from a vaccination are mild and short-term. The most common are pain at the injection site, feeling generally unwell, tiredness, headache, muscle pain and joint pain. You can take paracetamol to treat any of these side effects.

Often the side effects are just a sign that the vaccine is doing its job: it can happen with many vaccines that some people might feel slightly unwell because their immune system is responding to the vaccination, but this is not a COVID-19 illness.

The vaccine cannot give you COVID-19.

One of the side effects to all vaccines can be an allergic reaction the majority of which are mild but can be more severe. All vaccinations are given in centres staffed by doctors and nurses and you will be asked to wait for 15 minutes after you have had the vaccination to monitor you for any reaction.

Will I be able to pass on the virus to others if I’ve had the vaccine?

We don’t yet know for sure, but it may be possible for you to pass the virus on even if you’ve been vaccinated.

The vaccine will reduce your risk of getting seriously ill or dying from the virus, it may not stop you from getting it and giving it to others.

So, even if you’ve been vaccinated, it’s really important to continue to be COVID-19 safe. This means continuing to:

Wear a mask when needed.

I’ve already had COVID-19, do I still need to get vaccinated?

Yes, it’s really important to get the vaccine, even if you’ve already had COVID-19. You may have some level of immunity if you’ve had the disease, but this varies and may not last long.

Can the vaccine give me COVID-19?

The vaccine cannot give you COVID-19.

You may feel unwell after the vaccination, often the side effects of a vaccine are a sign the vaccine is doing its job, but this is not a COVID-19 illness.

When will I get the vaccine?

Survivors of stroke are among those most vulnerable to COVID-19 and as such will be among those vaccinated early. For more information see the Australian Government Department of Health website.

Do I have to pay for the vaccine?

The COVID-19 vaccine is free.

Which vaccine will I get?

The vaccine you get will depend on which vaccines are available in your area and to your priority group.

All vaccines made available through the Australian Government’s immunisation program are safe and effective.

How does the vaccine work?

Can I have two different vaccines?

Your first and second dose should be of the same type of vaccine.

If you do not receive a second dose or your second dose is from a different vaccine you may not be protected from the virus.

Under exceptional circumstances you may receive different vaccines, this must be discussed with your doctor or health professional.

Do I still need to have a flu vaccine?

Flu is caused by a different virus to the virus which causes COVID-19. It is important to have both vaccines if you are offered them.

The flu vaccine will be rolled out from April.

Importantly, There must be a 14 day gap between having a COVID-19 vaccine and the flu vaccine.

Talk to your doctor or healthcare professional about the timing of the vaccinations.

How quickly does the vaccine work?

Protection from the virus starts after 12-14 days. This is because your immune system needs to generate a response, and people’s immune systems can vary.

How long does the vaccine last?

We don’t yet know exactly how long protection will last, because the vaccines haven’t been around for long enough.

The second dose is more important for longer-lasting protection, so it’s really important to get your second dose.

The length of protection may vary between different vaccines. It is likely to be at least several months, but it may be that repeat vaccinations are needed. Researchers are studying this closely.

Disclaimer

This information provided by the Stroke Foundation Clinical Council is general in nature. For individualised advice please talk to your doctor or health professional.

For the latest information about the Australian Government’s coronavirus (COVID-19) vaccine program

National coronavirus and COVID-19 vaccine helpline 1800 020 080.

For the latest on the COVID19 health alert.

For information and advice on stroke prevention, treatment and recovery contact StrokeLine 1800 787 653.

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