Use the labels in the right column to find what you want. Or you can go thru them one by one, there are only 27,826 posts. Searching is done in the search box in upper left corner. I blog on anything to do with stroke.DO NOT DO ANYTHING SUGGESTED HERE AS I AM NOT MEDICALLY TRAINED, YOUR DOCTOR IS, LISTEN TO THEM. BUT I BET THEY DON'T KNOW HOW TO GET YOU 100% RECOVERED. I DON'T EITHER, BUT HAVE PLENTY OF QUESTIONS FOR YOUR DOCTOR TO ANSWER.
Changing stroke rehab and research worldwide now.Time is Brain!trillions and trillions of neuronsthatDIEeach day because there areNOeffective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.
What this blog is for:
My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.
But you absolutely failed! No request for 100% recovery and a roadmap to get there! What the fuck are you going to do when YOU are the 1 in 4 per WHO that has a stroke?
Nothing about stroke is recoverable upon demand, quit lying to yourself. Vast amounts of research is needed to get to 100% recovery. And leaders would get there! But you're no leader, are you?
Never use the word neuroprotection, it has no meaning for survivors and lacks urgency. Use the term; neuronal cascade of death; if your doctor tells you they failed to stop the neuronal cascade of death in the first week resulting in the death of millions to billions of neurons, your correct response would be: 'WHY ARE YOU SO FUCKING INCOMPETENT IN NOT PREVENTING THAT?'
Despite
rapid and recent progress in our understanding of numerous new
mechanisms regulating neuronal cell physiology and responses to
ischemia, no neuroprotective agents have been developed as an adjunctive
treatment for acute ischemic stroke. However, with the widespread
deployment of acute tissue perfusion-based stroke imaging and
endovascular thrombectomy, there is a great therapeutic opportunity to
identify patients with salvageable ischemic tissue and provide
neuroprotective treatment along with recanalization that significantly
improves stroke outcome. In this chapter, we review seminal and recent
developments in our understanding of the mechanisms underlying ischemic
large vessel stroke injury including bioenergetic failure,
excitotoxicity, oxidative stress, regulated cell death, and
inflammation. Exciting developments in collaborative translational
research efforts will provide investigators with a blueprint for
systematically testing the most promising therapies preclinically
analogous to clinical trials. Together, these basic, translational, and
clinical advances hold the promise of developing novel neuroprotective
therapies and greatly improving stroke patient outcomes.
Because of your risk of dementia post stroke; is your competent? doctor and hospital closely following this? NO? So you have INCOMPETENT MEDICAL 'PROFESSIONALS'?
Your risk of dementia, has your doctor
told you of this? Your doctor is responsible for preventing this!
In Alzheimer’s disease, a buildup of sticky amyloid proteins in the brain clump together to form plaques, causing damage that gradually leads
to worsening dementia symptoms. A promising way to change the course of
this disease is with treatments that clear away damaging amyloid
plaques or stop them from forming in the first place. In fact, the Food
and Drug Administration recently approved the first drug for early
Alzheimer’s that moderately slows cognitive decline by reducing amyloid
plaques.1 Still, more progress is needed to combat this devastating disease that as many as 6.7 million Americans were living with in 2023.
Recent findings from a study in mice, supported in part by NIH and reported in Science Translational Medicine,
offer another potential way to clear amyloid plaques in the brain. The
key component of this strategy is using the brain’s built-in cleanup
crew for amyloid plaques and other waste products: immune cells known as
microglia that naturally help to limit the progression of Alzheimer’s.
The findings suggest it may be possible to develop
immunotherapies—treatments that use the body’s immune system to fight
disease—to activate microglia in the brains of people with Alzheimer’s
and clear amyloid plaques more effectively.2
In their report, the research team—including Marco Colonna,
Washington University School of Medicine in St. Louis, and Jinchao Hou,
now at Children’s Hospital of Zhejiang University School of Medicine in
Zhejiang Province, China—wrote that microglia in the brain surround
plaques to create a barrier that controls their spread. Microglia can
also destroy amyloid plaques directly. But how microglia work in the
brain depends on a fine-tuned balance of signals that activate or
inhibit them. In people with Alzheimer’s, microglia don’t do their job
well enough.
The researchers suspected this might have something to do with a
protein called apolipoprotein E (APOE). This protein normally helps
carry cholesterol and other fats in the bloodstream. But the gene encoding the protein
is known for its role in influencing a person’s risk for developing
Alzheimer’s, and in the Alzheimer’s brain, the protein is a key
component of amyloid plaques. The protein can also inactivate microglia
by binding to a receptor called LILRB4 found on the immune cells’
surfaces.
Earlier studies in mouse models of Alzheimer’s showed that the LILRB4
receptor is expressed at high levels in microglia when amyloid plaques
build up. This suggested that treatments targeting this receptor on
microglia might hold promise for treating Alzheimer’s. In the new study,
the research team looked for evidence that an increase in LILRB4
receptors on microglia plays an important role in the brains of people
with Alzheimer’s.
To do this, the researchers first studied brain tissue samples from
people who died with this disease and discovered unusually high amounts
of the LILRB4 receptor on the surfaces of microglia, similar to what had
been seen in the mouse models. This could help explain why microglia
struggle to control amyloid plaques in the Alzheimer’s brain.
Next, the researchers conducted studies of mouse brains with
accumulating amyloid plaques that express the LILRB4 receptor to see if
an antibody targeting the receptor could lower amyloid levels by
boosting activity of immune microglia. Their findings suggest that the
antibody treatment blocked the interaction between APOE proteins and
LILRB4 receptors and enabled microglia to clear amyloid plaques.
Intriguingly, the team’s additional studies found that this clearing
process also changed the animals’ behavior, making them less likely to
take risks. That’s important because people with Alzheimer’s may engage
in risky behaviors as they lack memories of earlier experiences that
they could use to make decisions.
There’s plenty more to learn. For instance, the researchers don’t know yet whether this approach will affect the tau protein, which forms damaging tangles inside neurons
in the Alzheimer’s brain. They also want to investigate whether this
strategy of clearing amyloid plaques might come with other health risks.
But overall, these findings add to evidence that immunotherapies of
this kind could be a promising way to treat Alzheimer’s. This strategy
may also have implications for treating other neurodegenerative
conditions characterized by toxic debris in the brain, such as
Parkinson’s disease, amyotrophic lateral sclerosis (ALS), and
Huntington’s disease. The hope is that this kind of research will
ultimately lead to more effective treatments for Alzheimer’s and other
conditions affecting the brain.
You could vastly reduce that by having 100% recovery protocols! Getting people directly back to their old life. But it will require destroying the existing stroke associations since they don't know what the fuck they are doing!
Juliet Bouverie, chief executive of the Stroke
Association, warned that the ‘demand for NHS services will be
unsustainable by 2035’ (PA)(Well, it's simple then, create 100% recovery protocols! ARE YOU THAT BLITHERINGLY STUPID? Please answer, I'll reply with your exact excuse in my blog. Here at: oc1dean@gmail.com))
The
number of people suffering a stroke for the first time is expected to
rise by more than 50% by 2035, costing the UK more than £75 billion for
care and lost productivity, a charity has said.
The Stroke Association urged the next government to invest more in
prevention, as well as addressing issues with stroke treatment and
rehabilitation services.
Failing to do so could risk demand on NHS services becoming “unsustainable” in 11 years’ time, it said.
A new manifesto published by the charity estimated
that stroke will cost the UK about £43 billion this year, with 100,000
new stroke hospital admissions per year.
This could rise to 151,000 admissions by 2035 – the equivalent of 414
per day – with the number of stroke survivors rising from 1.3 million
to 2.1 million.
Costs associated with the increase could top £75 billion, which
includes projected increases in health and social care costs, as well as
informal care costs.
About a quarter of strokes impact people of working age, with lost
productivity currently costing an estimated £1.6 billion per year.
This too is expected to rise by 136% by 2035, according to the report.
Juliet Bouverie, chief executive of the Stroke
Association, warned that the “demand for NHS services will be
unsustainable by 2035″.
“If the next government fails to tackle prevention, treatment, and
recovery at the root, then stroke will become the most avoidable burden
on the NHS,” she added.
The Stroke Association is calling on the Department of Health and
Social Care (DHSC) to publish a funded stroke prevention plan to support
people of all ages to reduce their risk of stroke.
This includes improving the way people detect and manage conditions
that increase the risk of stroke, such as high blood pressure.
The charity also wants all patients to have 24-hour access to thrombectomies – a surgery to remove blood clots from the artery.
The procedure is usually carried out up to six hours after stroke symptoms begin.
The Stroke Association estimates that making thrombectomies
universally available could save the health and care system £73 million
each year and would allow 1,600 more stroke survivors to be independent.
It also called for the Government to address issues in
access to rehabilitation and support services, such as the Life After
Stroke programme.
Stroke survivor Marwar Uddin, 24, from London, spoke about the
long-term impact of the condition and how support services have helped
him.
He said: “I need help to go to the toilet. I can’t even dress myself.
My voice is different now. I’m a different person. I cry myself to
sleep most days. It’s difficult for me.
“Thanks to Life After Stroke services, I’ve slowly been rebuilding
myself and I am also set to start a phased return to work later this
year.
“If I didn’t have any of this support, I think I would still be in a chair in my living room watching the world go by.”
Ms Bouverie added: “Every stroke is a tragedy, but 151,000 strokes
per year, and growing each year, will be a failure of leadership.
“In 2000, stroke was the second leading cause of death in the UK but
by making stroke a national priority reflected in local resources,
stroke mortality was halved by 2010. So, change is possible.”
A DHSC spokesperson said: “We’re committed to improving stroke prevention, treatment, and recovery for all.
“Over 90% of acute stroke care providers in England are equipped with
artificial intelligence, which can reduce the time it takes to access
treatment such as thrombectomy by more than 60 minutes.
“The first ever Long Term Workforce Plan will help to shift more care
into the community and invest more in prevention and early
intervention, and we’re rolling out a new digital NHS Health Check which
could prevent hundreds more strokes.
“We are also taking action to encourage better lifestyle choices,
including creating a smoke-free generation and reducing salt intake
through food to help prevent the risk of strokes.”
Not so
long ago, that task — and many others once taken for granted — were
nearly impossible. Following a stroke last summer, the Dalton resident
entered Regency Park Health and Rehabilitation, part of Hamilton Health
Care System, where he received intense therapy to help him recover from a
partially paralyzed right side.
The type of stroke he experienced
involving bleeding into the brain tissue is the second most common
cause of stroke — between 15 and 30% of all strokes — and the most
deadly. After being at Regency Park for several weeks, Silvers continued
to make daily improvements toward recovery but has also made
significant lifestyle changes, including incorporating exercise into his
routine, monitoring his blood pressure, taking medication as prescribed
and learning how to better manage stress.
“His
physical limitations have not stopped him from joining his wife with
daily walks and visits to their garden,” said Cherryl Berdos,
rehabilitation director at Regency Park. “Recovering from a stroke can
be a long and frustrating experience. It is normal to face difficulties
along the way, but Mr. Troy’s dedication and willingness to work toward
improvement helped him a lot.”
When he entered Regency Park,
Silvers struggled to stand, walk, dress, eat and perform other daily
tasks without assistance. Because his body was working so hard to
compensate for the impairments, once-simple tasks became an exercise in
frustration, and fatigue was a constant companion.
Berdos said he
was often tempted to use only his unaffected side to improve efficiency.(But didn't his competent? doctor tell him of the research on using the good side recovers the bad side? NO! So not a competent doctor?
At first, he needed a walker to get around, plus two individuals to
ensure safety. One would hold onto him while another followed with a
wheelchair.
Now he can walk, climb stairs, bathe, dress and eat all on his own,
and he continues to make daily efforts toward regaining more function.
Silvers said he especially wants to thank Robby Mickelson and Abagail
Roque who provided his physical and occupational therapy and worked with
his entire treatment team.
When Silvers started rehab, he felt
“100%” optimistic about his outcomes and was determined to get better
every day. Today, he advises anyone going through a similar situation to
“take care of your health, exercise (and) eat healthy.” Berdos said
Silvers has also become an encouragement for other patients.
All Regency Park patients receive intensive rehab aligned with their level of healing and as determined by their physician.
“We
create a personalized care plan, emphasizing your quality of life,
dignity and comfort, which will help you reach your goals or help you
manage an ongoing illness, chronic medical condition or disability,”
said Berdos.
Act FAST (for face, arms, speech, time)
Time
is of the essence when someone is experiencing stroke symptoms. If you
or someone you know is experiencing face drooping, arm weakness or
speech difficulty, call 911 immediately. By the time the ambulance
reaches the emergency department, the responders will have started an IV
and notified the medical facility that they are on the way with a
possible stroke patient.
THIS IS WHY STROKE NEVER GETS SOLVED! The WSO only works on 'care'. They need to be completely destroyed and run by survivors! Survivors would produce recovery and results instead of this lazy crapola. And for proof there is this shit:
I don't need to hear any lies about this meme from World Stroke Day a couple of years ago.
For stroke 100% recovery, it is incredibly simple, your stroke medical 'professionals' provide EXACT 100% RECOVERY PROTOCOLS and your patient will not stop until 100% recovery is achieved! The RESPONSIBILITY is on the 'professionals' to do this, not dump everything onto survivors! If your stroke medical 'professionals' don't understand and do this; FIRE THEM!
To
evaluate the implementation of a self-management program, My Therapy,
designed to increase inpatient rehabilitation therapy dosage via
independent practice.
Materials and methods
A
process evaluation of My Therapy for adult patients admitted for
rehabilitation for any condition supervised by physiotherapists and
occupational therapists across eight rehabilitation wards compared usual
care. Outcomes included reach, dosage, fidelity and adaptation.
Results
The mean (SD) age of the process evaluation sample (n = 123) was 73 (11) years with a mean (SD) length of stay of 14.0 (6.6) days. The My Therapy program reached 68% of participants (n = 632/928), and resulted in an average increase in therapy dosage of 26 (95% CI 12 to 40) minutes/day of independent practice. All My Therapy audited programs (n = 28) included body function/structure impairment-based exercises, and half (n = 13/28)
included activity/participation-based exercises. On average,
participants completed programs 1.8 (SD 1.2) times/day, which were
prescribed in accordance with the My Therapy criteria, demonstrating fidelity.
There were no between-group differences in daily steps or standing
time, however, My Therapy participants spent more time sitting (p ≤ 0.05). Implementation adaptations were minimal.
Conclusion
A
self-management rehabilitation program was implemented with fidelity
for two in three rehabilitation patients, resulting in increased therapy
dosage with minimal adaptations.
IMPLICATIONS FOR REHABILITATION
The
My Therapy self-management program was implemented with good reach (68%
of participants received My Therapy) across four public and private
inpatient rehabilitation services.
Under
My Therapy conditions, the dosage of inpatient rehabilitation therapy
participation increased by an average of 26 minutes per day, which will
help close the evidence-practice gap between the current rehabilitation
dosage of about 1-hour per day, and the recommended rehabilitation
dosage of 3-hours per day.
My Therapy
programs most frequently included impairment-based exercises that were
completed in sitting, and did not increase time spent standing and
walking.
Consideration should be given
to prescribing My Therapy (content and dosage) at an optimal level to
promote patient functional independence, while maintaining safety.
Adult
physical rehabilitation encompasses a range of services delivered
through multidisciplinary teams, aiming to deliver person centred care
using evidence based interventions and evaluating progression towards
meaningful goals [Citation1].
Rehabilitation can be delivered within traditional bed-based settings
in a hospital, as well as home-based services, whereby rehabilitation is
delivered to patients within the community environment [Citation1–3]. There is evidence that rehabilitation outcomes are influenced by the amount of therapy the person receives [Citation4] and one way to increase dosage is to increase therapy staffing levels [Citation5].
However budgetary constraints often limit additional staffing
resources, despite the known benefits and the ever increasing complexity
of the inpatient rehabilitation cohort [Citation6].
Clinicians, health service managers, and policy makers need to think
creatively of ways to increase the dosage of evidence-based therapy
interventions to promote functional recovery during rehabilitation. One
solution to the problem of providing a sufficient dosage of therapy is
through patient therapy self-management, that is, re-directing some of
the idle time rehabilitation patients have between supervised therapy
sessions into meaningful self-directed therapy activities [Citation7].
An
example of this is My Therapy, a consumer driven self-management
program, that focuses on occupational therapy and physiotherapy
exercises and tasks that can be completed outside of supervised therapy
sessions [Citation8]. Pilot work has shown that My Therapy can increase rehabilitation therapy participation by up to 14 min per day [Citation8].
In 2021-22, the My Therapy intervention was evaluated via a multi-site
stepped wedge cluster randomised control trial conducted over eight
wards at four health services (two public and two private). The trial
included 2550 (control conditions, n = 1458; My Therapy conditions n = 1092)
rehabilitation participants admitted to a rehabilitation ward, as well
as, 788 geriatric evaluation and management participants (control
conditions, n = 388; My Therapy conditions n = 400) admitted to a rehabilitation ward giving a total of 3,338 participants (unpublished data).
Process
evaluations are increasingly being used alongside clinical and economic
evaluations, to help understand the factors that may positively or
negatively influence trial results [Citation9,Citation10].
Guided by the Medical Research Council (MRC) framework, process
evaluations aim to: capture reach and determine the extent the intended
population came into contact with the intervention; determine the dosage
and quantity of intervention delivery; determine fidelity by
understanding if the intervention was delivered as intended and how it
was delivered; and determine if any adaptations were required to the
intervention from what was planned [Citation10].
Process evaluations, can provide valuable insights into unexpected or
unanticipated results (clinical or economic), and can provide a clear
description of intervention implementation to allow the intervention to
be scaled up or replicated elsewhere should desired results be achieved [Citation10].
The aim of this study was to evaluate the reach, dosage, fidelity and
adaptations of the implementation of My Therapy into inpatient
rehabilitation, as part of a larger stepped wedge cluster randomised
trial.
Methods
Context: My Therapy intervention
My
Therapy is a “consumer driven, self-management program designed to
increase the dosage of therapy participation during physical
rehabilitation, through independent practice of exercise and activity,
in addition to usual care” [Citation11].
Implementation was intended to be additional to usual care, and not as a
substitution of supervised therapy. My Therapy was delivered by
occupational therapists and physiotherapists on the ward through
provision of a subset of therapy activities to be practised
independently where safe and appropriate using an online exercise
prescription program PTX (www.physiotherapyexercises.com).
Discussion and input from the participants, alongside occupational
therapy and physiotherapy collaboration, were key to developing the
individualised My Therapy programs delivered in paper format. While a
recommended goal of exercise/additional therapy dosage was set by
prescribing therapists, the quantity and frequency to complete
activities were at the participant’s discretion [Citation11].
My Therapy is based on four criteria/pillars: i) the provision of a
written self-management program (delivered electronically or in paper
format); (ii) ensuring programs are documented by the therapist in the
medical record; (iii) providing a feedback mechanism between the patient
and the therapist (such as an activity/exercise completion tick sheet);
and (iv) ensuring programs are actively monitored and progressed, as
clinically indicated [Citation12].
At a practical level, My Therapy was designed to be provided to all
participants on the ward where deemed safe and appropriate by the
treating occupational therapist or physiotherapist. Any additional items
(such as weights) that were required for the participant to complete
their program were provided for use on provision of the My Therapy
program by the therapist. Recommendations were made to the participant
by their treating therapist to complete the My Therapy program outside
of structured therapy sessions with health professionals (e.g.
occupational therapists and physiotherapists).
In the
six weeks prior to cross over to My Therapy conditions, implementation
preparation occurred. This allowed for education of the My Therapy
intervention through formal verbal education to clinical staff,
interactive group discussions to co-design local implementation
strategies and provision of written explanatory materials for
occupational therapy and physiotherapy staff. Other members of the
rehabilitation team were engaged in the pre-implementation phase by
raising awareness with their role when under My Therapy conditions, but
this was limited to encouraging participants to complete their My
Therapy programs and not to supervise the program. To support
implementation at each of the four health services, there was regular
collaboration between site co-ordinators at each of the sites through
online meetings and email correspondence. This provided an opportunity
for shared resources between participating sites and tailoring to meet
local needs.
Study design and setting
This
observational process evaluation study, completed alongside a stepped
wedge cluster randomised trial, has been reported in accordance with the
STROBE checklist [Citation13].
The process evaluation was conducted from April 2021 to April 2022. The
protocol for the main clinical trial and the process evaluation have
been previously published [Citation11,Citation12].
For this process evaluation, a quantitative dominant design was used.
The evaluation was undertaken in eight rehabilitation wards across two
public and two private Victorian health networks in Australia, with two
of the public health wards located in the community (i.e., home-based
wards). Multi-site ethics approval was received from Alfred Hospital
Human Research Ethics Committee (HREC) (ID: 69610), followed by site
specific approvals at each of the participating health services (Alfred
Hospital, ID 758/20; Eastern Health, ID S21-004-69610; Cabrini Health,
ID 11-04-03-21; Healthscope via La Trobe HREC, ID 758/20).
The four study components aligned with the study aims are: i) capture reach and determine the extent the intended population came into contact with the intervention; ii) determine the dosage
and quantity of intervention delivery, including the amount of
supervised therapy participation as part of usual care, and My Therapy
program content, mapped to the International Classification of Function
(ICF) [Citation14]; iii) determine fidelity
(patient adherence as well as therapist engagement) by understanding if
the intervention was delivered as intended, how it was delivered and
physical activity levels in sitting, standing and stepping; and iv)
determine if any adaptations were required to the intervention from what was planned (Appendix A, Supplementary Material) [Citation11,Citation12].
All
participants included in this process evaluation were subgroups of the
participants included in the stepped wedge cluster randomised trial (
).
The first group (group 1), recruited to evaluate program reach,
included a subgroup of participants admitted in each block of the main
trial (n = 3,338). The second group (group 2) recruited for the
evaluation of dosage and fidelity were recruited over three time points
(month 1/block 1 (April 2021), 6/block 5 (September 2021) and 12/block 9
(March 2022) of the 12-month/block 9 clinical trial), and were a
subgroup of group 1. The third group (group 3) recruited for a detailed
evaluation of dosage were a subgroup of participants from group 2. The
fourth group (group 4) recruited for a detailed evaluation of fidelity
were a subgroup of participants from group 2.
Figure 1. Participant flow.
Group
1 (reach) included all eight participating rehabilitation wards in the
clinical trial, capturing all admitted participants including but not
limited to diagnoses, such as orthopaedic, neurological, reconditioning,
and respiratory, with and without a cognitive impairment. For group 2
(dosage and fidelity), the aim was to recruit a consecutive sample of
120 participants already consented to the main clinical trial, meeting
the eligibility criteria of being over 18 years, admitted for
rehabilitation for any reason and having access to Medicare (Australian
universal health care program). Participants in group 2 (dosage and
fidelity), met the additional eligibility criteria of not having a
cognitive impairment (limiting ability to complete data collection
tools) and being English speaking. Participants were approached by a
member of the research team, their involvement in the study explained
and written consent was gained. For groups 3 (dosage) and 4 (fidelity),
convenience sampling was used from participants already recruited in
group 2 with group 3 only including participants with a My Therapy
program. Participants under control conditions receiving usual care only
were included in groups 1 (reach), 2 (dosage and fidelity) and 4
(fidelity).
Outcomes
Data
were collected and managed using REDCap (Research Electronic Data
Capture) electronic data capture tools, that were hosted at Monash
University and managed by Helix [Citation15,Citation16].
For
this process evaluation, independent groups of participants were
classified as receiving usual care (during control blocks of the stepped
wedge cluster randomised trial, termed control conditions) or receiving
My Therapy plus usual care (during intervention blocks of the stepped
wedge cluster randomised trial, termed intervention conditions). If
participants completed a self-management program under the control
conditions this has been called a “self-management program”; if
participants completed a self-management program under the intervention
conditions this has been called a “My Therapy program” with both
self-management and My Therapy programs needing to meet the four My
Therapy criteria/pillars [Citation12].
It was recognised that some participants may not agree to participate
in a My Therapy program or be unable to be provided a program, for
example, due to safety considerations. However, the intention was that
every patient on the ward would be assessed for a My Therapy program
during the intervention blocks, and if appropriate, be provided with a
program.
Reach: Data collection was completed on eight
participating wards across the four health services over nine time
points (once every six-weeks midway through each block during the
12-month clinical trial by site co-ordinators/associate investigators).
To understand the reach of a self-management program under
control and intervention conditions, medical files were audited to
determine whether a self-management program had been prescribed,
supplemented with discussion with treating therapists (group 1 (reach)).
My Therapy was only considered to have been implemented when all four
My Therapy criteria/pillars were fulfilled. On a single day, the ward
audit was completed for the participating ward, capturing all admitted
participants. Within the ward audit, there were no exclusion criteria
applied, thereby capturing all participants on the ward. Individual
participants were not able to be identified within the ward audit. Data
were uploaded by the site co-ordinator to a customised form on REDCap
that was blinded to the researcher. An apriori target for reach was not
set. While a 100% reach would be ideal considering the whole of ward
approach, researchers recognised this may not always be achievable, and
note that the My Therapy feasibility study achieved a 72% reach [Citation8].
Dosage and fidelity
were measured over three time points (month 1/Block 1 (April 2021),
6/Block 5 (September 2021) and 12/Block 9 (March 2022) of the 12-month
clinical trial). Participants were classified as receiving usual care
(control conditions) or receiving My Therapy plus usual care
(intervention conditions).
Dosage:
Group 2 (dosage and fidelity) participants, were audited using the
therapy timetable by capturing the scheduled and completed duration of
occupational therapy and physiotherapy sessions and delivery mode. The
audit of the therapy timetable was completed by a researcher. If
provided a My Therapy program, participants completed a daily written
activity log capturing time spent and the number of times and the number
of activities/exercises completed, as well as the recommended amounts
from the therapist. The audit was completed midway through each block.
Fidelity:
Group 2 (dosage and fidelity) participants with a My Therapy program,
the activity log described above captured My Therapy patient adherence
to the prescribed program by recording the recommended amount and the
number of activities and amounts actually completed. For participants
with a My Therapy program, all My Therapy programs provided across the
seven-day data collection period were audited to capture therapist My
Therapy engagement (occupational therapy and physiotherapy prescription
and frequency of review of the program). The audit was completed midway
through each block.
Dosage: The
My Therapy programs of group 3 (dosage) participants was audited
capturing the focus of the exercise/activities recommended (classified
as an exercise) to address: i) body function/structure impairment tasks
(e.g. strengthening exercises); or ii) activity/participation based
tasks which were considered the practice of functional activities
repetitively (e.g. task specific training [Citation17] such as walking or dressing practice) according to the ICF [Citation14];
who recommended the activities/exercises (i.e. occupational therapy or
physiotherapy) and the position in which the activities were to be
completed (i.e. standing, sitting, lying). The audit was completed
midway through each block.
Fidelity:
Group 4 (fidelity) participants under control and intervention
conditions, wore activity monitors capturing physical activity levels in
sitting, standing and stepping. Participants were asked to wear an
accelerometer-based activity monitor (activPAL, PAL Technologies
Limited). Participants were asked to wear monitors for 24 hours per day
over seven consecutive days. Monitors were placed on the anterior middle
thigh in a zip lock bag, placed on a small piece of gauze to protect
the skin and covered by a waterproof dressing
Evaluation of adaptations: The adaptations
log was based on the service profile audit completed on each of the
participating wards which captured any major deviations to planned
implementation (once every six-weeks at the start of each block,
capturing information for the previous block, Appendix A, Supplementary Material).
Before your doctor goes to this training, make sure they understand they have to comeback with 100% RECOVERY PROTOCOLS! If they don't it was worthless!
Your full recovery is very unlikely, although your doctor won't tell you that! Your children and grandchildren won't recover any better since the stroke medical world isn't even trying to solve stroke to 100% recovery!
In March 2015, Doug Nichols and his family traveled to
Sanibel Island, Florida, for a spring getaway. During lunch on the
second day, Nichols’ speech became slurred. The left side of his face
drooped. While taking his dishes to the kitchen, he dropped a glass and
his phone.
“My wife sat me down and said, ‘You’re having a stroke,
and you need to go to the hospital.’” He couldn’t move the left side of
his body. Nichols stayed in the hospital for two weeks, until he was
medically stable enough to fly home to the Chicago metro area, where he
went straight to inpatient rehab for about a month followed by four
months of outpatient rehab.
“I really didn’t have any expectations,” says Nichols,
who was 59 at the time. “I was hoping to regain some functionality at a
basic level, but I didn’t really know what the journey ahead would look
like.”
It turned out to be long: With those five months of
rehab, Nichols partially regained the ability to move his left hand and
arm, and his speech improved. An additional boost came years after his
stroke, when he got a new procedure that further boosted movement of his
hand and arm.
Doug Nichols and his wife Patti on a 2017 boat cruise.
Courtesy Douglas Nichols
How much progress a person can make and the timeline for
their recovery depend on the type and location of the stroke and the
patient’s age and overall health, says Richard Harvey, M.D., clinical
chair of Shirley Ryan AbilityLab’s Brain Innovation Center in Chicago,
where Nichols did his outpatient rehab. For many survivors, it can be a
tough road. Stroke is a leading cause of serious long-term disability.
More than half of survivors 65 and over are left with reduced mobility,
according to the Centers for Disease Control and Prevention. Other
impacts, which can be long- or short-lasting, may include problems with
thinking, communicating, vision, emotions and behavior.
Still, many people regain at least some of the abilities
they lost. “I tell stroke patients that the path to recovery is not a
straight line,” says Nneka Ifejika, M.D., a professor of physical
medicine and rehabilitation and neurology at UT Southwestern Medical
Center in Dallas and a volunteer expert for the American Stroke
Association. “It has twists, turns, times of acceleration and times of
pause. The most important thing is not to lose hope.”
Most strokes occur because a clot forms in a blood vessel in the brain, blocking blood flow.
A smaller percentage are due to a blood vessel rupture in the brain. In
both cases, parts of the brain are deprived of oxygen and die. As you’d
imagine, a stroke affecting a large part of a crucial area of the brain
is more serious, and more difficult to recover from, than a smaller
stroke in a less important region.
Video: How to Spot Symptoms of a Stroke
Stroke rehab priorities
Rehab usually begins as soon as 24 hours after the
stroke, during the hospital stay. “As soon as people are medically
stable and able to participate, we start,” says Lindsy Williams, M.D., a
neurologist at Mayo Clinic in Jacksonville, Florida. Several
specialties get involved, including physical therapy, occupational
therapy, and speech and language therapy.
Each patient should leave the hospital with a plan in
hand for their longer-term rehab, Ifejika suggests. Ask your rehab
facility if you’re eligible for any clinical research trials, she adds.
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Most patients are out of the hospital within a week,
after they’ve been stabilized and given treatment to protect them
against a subsequent stroke. Some can go straight home, either because
they’ve recovered so much that they need no further therapy, or because
they can do home health therapy or outpatient therapy.
A multipronged approach to stroke rehab
Recovery may involve several types of therapy:
Physical therapy: Training and exercises to help stroke survivors relearn how to move — walk, maintain balance and increase range of motion.
Occupational therapy: Training and exercises to help patients
accomplish typical daily activities, such as eating, drinking, dressing,
bathing, cooking and using the toilet.
Speech therapy: Can help with swallowing, relearning language and developing new ways of communicating if speaking is difficult.
Psychological therapy: Talk therapy may help patients who
experience depression, anxiety or cognitive problems after a stroke. A
psychiatrist or other physician can prescribe antidepressants or other
medications if necessary.
Patients who can handle at least three hours per day of
intense therapy, five times a week, are eligible for inpatient
rehabilitation facilities. This is what the American Stroke Association
recommends for everyone who qualifies, when possible. At these
facilities, which may stand alone or be part of a larger hospital,
patients get an individualized rehabilitation plan that might include
physical therapy, occupational therapy, speech therapy and psychological
support. The average stay is about 15 days, according to the American
Academy of Physical Medicine & Rehabilitation.
Some patients are too fragile or unable to participate in
that kind of intense therapy and are discharged from the hospital to a
long-term acute care hospital or a skilled nursing facility, where they
can participate in therapy according to their ability. It’s worth noting
that some of these patients do improve enough to handle some therapy
and see progress.
Outpatient rehabilitation starts after inpatient
rehabilitation ends, or in some cases directly after the hospital stay.
Sessions are usually a few times per week. In addition to the kinds of
therapies available at an inpatient facility, patients may get
vocational rehab, pool therapy, driving evaluations, help with using a
wheelchair and the opportunity to use virtual reality or robotic
therapy, according to the American Academy of Physical Medicine &
Rehabilitation.
Ifejika suggests patients look into day rehab programs in
their area, as Nichols did. They are intense programs, five days per
week, some with transportation. And if you’re given exercises to do in
between appointments, Williams says, it’s important to do that
“homework” to maximize your recovery.
Regaining independence
Rehab aims to help people perform activities of daily
life. “The most important things are their ability to walk, to speak and
to swallow,” Ifejika says.
“Have open discussions with your therapy teams about
specific goals you may want to work towards,” Williams advises. If you
have a hobby you enjoy and want to continue, make sure your therapy team
knows it’s important to you. “It may not always be feasible, but it
should at least be discussed,” she says.
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Gains made during rehab are possible because of the
brain’s ability to adapt to the losses incurred in the stroke. To some
extent that happens because nerve cells can forge new connections,
Harvey says. But “the real reason why most people recover is that the
brain is very redundant, especially with movement,” he adds. You may
use a certain neural pathway, say, to grasp and release objects with
your hand, but if that pathway is injured, other pathways are available.
At first, they’re weak, but “as you practice performing functional
movements, those pathways begin to strengthen,” he says. Other systems,
such as language, have fewer backup systems. So function may be harder
to regain if those parts of the brain are extensively damaged.
How long will it take for stroke recovery?
“Hard work is your best strategy for maximizing your functional recovery,” Nichols says.
He recovered most of his lost capacity over several years. Some of his progress came eight years after his stroke, when a vagus nerve stimulator
implant helped him regain further use of his arm. He is now a peer
mentor for stroke survivors at the Shirley Ryan AbilityLab. Nichols
tells his fellow survivors to involve their support team — they can be a
great source of encouragement — and not to expect instant results.(But if your stroke medical 'professionals' had stopped the neuronal cascade of death in the first week, that would have saved millions to billions of neurons, thus making your recovery much more likely!)
Doug Nichols heads out for a walk with his dog, Gracie, in August 2023.
Courtesy Douglas Nichols
Be prepared for plateaus and setbacks. “A stroke is one
of the most difficult things to experience,” Ifejika says. When
frustration sets in and patients lose interest in continuing activities
that don’t seem to help, she often has them take a two-week break and
then get back to it.
Most progress will happen in the first three to four
months. But recovery, albeit at a slower pace, can persist long beyond
that. Even if you’re 80 percent recovered, you can continue to work on
areas that you need help with, Ifejika says. “Stroke recovery is a
marathon, not a sprint,” she says. “I’m a strong advocate for outpatient
and home therapy past the year mark.”
Because rehab is so crucial to recovery, Ifejika says
it’s important that a survivor — or their family members and support
team — advocate early on for all the services and therapies for which
they’re eligible. Check your insurance policy to make sure it covers
inpatient rehab. An insurer has 72 hours to determine whether an urgent
care request such as an inpatient rehab stay is approved or denied. If
it’s denied but the care team feels the patient qualifies, file an
immediate appeal, she says. Find out, too, whether there’s a cap on
outpatient or home health therapy visits. Receiving the appropriate
services “really affects the ability to have an optimal, functional
recovery.”
Stroke rehab timeline
Recovery from a stroke looks different for each person, but this
timeline may give you a sense of what to expect. It’s important to get
started as early as possible, keep up with the rehab program (including
any at-home exercises), and make sure your specific needs are being
addressed.
Day 1: Once the patient is stable in the hospital, rehab can
start as early as the next day. Brief “bedside” therapy sessions may
happen as often as six times a day.
After discharge: The typical hospital stay after a stroke is
five to seven days. If needed, rehab continues in a rehab facility or
outpatient basis.
Months 1 to 4: The first weeks and months after a stroke are
crucial for rehab to have an impact. This is the sweet spot for
inpatient rehab with intensive therapy or outpatient rehab to regain
abilities affected by the stroke. Some functions may return
spontaneously as the brain finds new ways to get tasks done, and others
require more therapy.
Month 4 and beyond: The most rapid recovery typically happens
in the first three to four months, according to the American Stroke
Association, but with therapy, patients can expect to continue to make
progress after that. With continued exercises, improvements are still
possible, even beyond a year. It’s important to continue to address your
psychological needs, since anxiety and depression
can affect quality of life and your participation in therapy, Ifejika
says. And follow up with your physician to make sure you’re getting
appropriate preventive care to stave off another stroke.
Katherine Hobson is a freelance writer focusing on health,
psychology, science and personal finance. She has been a staff writer
at The Wall Street Journal and U.S. News & World Report.
K. Michael Welch, M.D., is a vascular neurologist and oversaw the first
study establishing the effectiveness of the clot-busting drug tPA for
acute ischemic stroke. He was the principal investigator of the SPARCL
(Stroke Prevention by Aggressive Reduction in Cholesterol Levels) trial,
which established the importance of statins in secondary stroke
prevention. At retirement in 2018, Welch was president and CEO of
Rosalind Franklin University in North Chicago, Illinois.