Deans' stroke musings: Does pre-existing cognitive impairment impact on amount of stroke rehabilitation received? An observational cohort study

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective 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.

Tuesday, April 30, 2019

Does pre-existing cognitive impairment impact on amount of stroke rehabilitation received? An observational cohort study

My conclusion is you better not be cognitively impaired because YOU are going to need to research how to recover.

Does pre-existing cognitive impairment impact on amount of stroke rehabilitation received? An observational cohort study

Verity Longley1,2, Sarah Peters3, Caroline Swarbrick4, Sarah Rhodes2,5 and Audrey Bowen1,2

Abstract

Objective: To examine whether stroke survivors in inpatient rehabilitation with pre-existing cognitive impairment receive less therapy than those without.
Design: Prospective observational cohort.Setting: Four UK inpatient stroke rehabilitation units.Participants: A total of 139 stroke patients receiving rehabilitation, able to give informed consent/had an individual available to act as personal consultee. In total, 33 participants were categorized with pre-existing cognitive impairment based on routine documentation by clinicians and 106 without.
Measures: Number of inpatient therapy sessions received during the first eight weeks post-stroke, referral to early supported discharge, and length of stay.Results: On average, participants with pre-existing cognitive impairment received 40 total physiotherapy and occupational therapy sessions compared to 56 for those without (mean difference = 16.0, 95% confidence interval (CI) = 2.9, 29.2), which was not fully explained by adjusting for potential confounders (age, sex, National Institutes of Health Stroke Scale (NIHSS), and pre-stroke modified Rankin Scale (mRS)). While those with pre-existing cognitive impairment received nine fewer single-discipline physiotherapy sessions (95% CI = 3.7, 14.8), they received similar amounts of single-discipline occupational therapy, psychology, and speech and language therapy; two more non-patient-facing occupational therapy sessions (95% CI = –4.3, –0.6); and nine fewer patient-facing occupational therapy sessions (95% CI = 3.5, 14.9). There was no evidence to suggest they were discharged earlier, but of the 85 participants discharged within eight weeks, 8 (42%) with pre-existing cognitive impairment were referred to early supported discharge compared to 47 (75%) without.
Conclusion: People in stroke rehabilitation with pre-existing cognitive impairments receive less therapy than those without, but it remains unknown whether this affects outcomes.1Division of Neuroscience and Experimental Psychology, MAHSC, The University of Manchester, Manchester, UK2CLAHRC Greater Manchester, Manchester, UK3Manchester Centre for Health Psychology, MAHSC, The University of Manchester, Manchester, UK4Division of Health Research, Lancaster University, Lancaster, UK843984CRE0010.1177/0269215519843984Clinical RehabilitationLongley et al.research-article2019Original Article5Centre for Biostatistics, MAHSC, The University of Manchester, Manchester, UKCorresponding author:Verity Longley, Division of Neuroscience and Experimental Psychology, MAHSC, The University of Manchester, Oxford Road, Manchester M13 9PL, UK. Email: verity.longley@manchester.ac.uk; twitter handle: @veritylongley