Deans' stroke musings

Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 493 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:

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's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:

Tuesday, April 26, 2011

Plateau - a bad word @#()& in stroke recovery

There is probably not a single stroke patient who has not been told they have plateaued. It is not a true medical term. I would argue that is a term used by the medical insurance world to deny therapy and save themselves money.
This is one of the research results in NIH;
Recovery plateau following stroke: fact or fiction?
PURPOSE: 'Plateau' is an expression frequently used in relation to decisions to discharge patients from physiotherapy following stroke. This paper critically considers the concept of recovery plateau in stroke, exploring (i) the evidence for plateau, (ii) potential contributing factors, and (iii) the consequences for patients, therapists and services.

SEARCH STRATEGY: The concept of recovery plateau in stroke was reviewed drawing on standard critical appraisal methodology for the search strategy and critique. Electronic searches using Web of Knowledge, MEDLINE, CINAHL, Department of Health Website and the Cochrane Library from the earliest dates of coverage until February 2005 identified quantitative and qualitative literature related to stroke, plateau, recovery, outcome, rehabilitation and physiotherapy.

DISCUSSION: The concept of plateau is ambiguous. Recovery has been considered to plateau within the first 6 months, yet recent studies indicate later recovery is possible. We suggest that 'plateau' relates not only to the patient's physical potential, but is influenced by how recovery is measured, the intensity and type of therapy, patients' actions and motivations, therapist values, and service limitations.

CONCLUSION: 'Plateau' is conceptually more complex than previously considered. Current conceptualizations may limit potential recovery and hinder service development. Research into plateau which takes account of contextual issues of therapy provision is required.

Published in July, 2006
So since then no medical person should have used that term.

Stroke bloggers deny it exists;
The next ones from Peter Levine are required reading, especially the part where therapist=recovery is not true.
This one from the Phoenix written as a letter to another survivor is very very good. If you can't get in, please sign up, its an excellent stroke forum.

So if a therapist says you can't get any more therapy because you have plateaued, DEMAND a scientific backed research study to prove their point. Or point them here and let me correspond with them. It may be the only way they will ever crack open research papers on stroke rehab. They do work for you, you know.


  1. If based on 6 months I guess I plateaued (been almost 1 1/2 years). In reality my situation changed at 6-7 month mark and spasticity started to set in but thankfully still getting some therapy. However, not as much as beginning. Now, while having progress, the whole process is different after the first 6 months. My neurologist didn't think I would get where I am but I will keep at it no matter how long.

  2. I was told at Craig Rehabilitation Center over 38 years ago, that I could get everything back if I live long enough. I was told that my body will continue to keep on trying to heal itself.

    Anyone in the medical field shouldn't be telling a patient that they've gained all that they are going to.

    I do understand why an insurance company would say this although they should say it differently. An insurance company cannot keep on doling out the bucks for something that isn't showing a quick return. It's economics.

  3. It is true that the most rapid rate of recovery following stroke is in the first 6 months. After that, recovery tends to slow or level-out, hence the ridiculous term "plateau". During the initial 6 months, much of the swelling and irritation of the brain environment reduces. After that, begins the real recovery/neuroplasticity... I prefer to think of the term "plateau" as a level place to rest briefly before ascending to the next level of recovery. It is an ongoing process. I would encourage all survivors to set goals, and then gain information, and seek out tools available to help you reach those goals. ABJ - 25 years working as a therapist with stroke survivors..

  4. Everyone . . . the brain is consistently (as in all throughout our entire lives) adapting, rewiring, programming every single thing we do. Even as late as 30 years into the game (this is not my case yet, as I'm nine years in), progress can still be made. Do not give up! Half the time, even the doctors and therapists working with us don't even know what kinds of gains we can make -- perhaps the norm is that people quit their therapy along the way, so they supposedly "plateau." You don't have to be the norm ;)

    To our healing!

  5. My Mother was cut off from further therapies because they said she had "plateaued". She was 87 at the time and they kept saying "she has an 87 year old brain". The impression was to just let her languish and die as she was already elderly. I was confronted with this notion all through her recovery. They very people who were suppose to help her had a fatalistic attitude about her. She has done well since her insurance refused to pay any more therapy because we work out every day and do our own therapy. She is 92 now and can walk and talk. Things they never cared if she could do again. If you have a major ischemic stroke and you're elderly, your best hope is if you have an advocate.