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.

Saturday, October 10, 2020

Trends in prevalence of acute stroke impairments: A population-based cohort study using the South London Stroke Register

Oh well, useless. ABSOLUTELY NOTHING ON HOW TO FIX THESE PROBLEMS.

Here is my list of stroke problems needing fixes. Which ones is your stroke hospital solving?

The current state of stroke is a complete failure. None of the following have cures. 

1. 30% get spasticity NOTHING THAT WILL CURE IT.

2. At least half of all stroke survivors experience fatigue Or is it 70%?

Or is it 40%?

NOTHING THAT WILL CURE IT.

3. Over half of stroke patients have attention problems.

NOTHING THAT WILL CURE IT.

NO PROTOCOLS THAT WILL CURE IT.

4.  The incidence of constipation was 48%.

NO PROTOCOLS THAT WILL CURE IT.

5. No EXACT stroke protocols that address any of your muscle limitations.

6. Poststroke depression(33% chance)

NO PROTOCOLS THAT WILL ADDRESS IT. 

7.  Poststroke anxiety(20% chance) NO PROTOCOLS THAT WILL ADDRESS IT. 

8. Posttraumatic stress disorder(23% chance)  NO PROTOCOLS THAT WILL ADDRESS IT.

  9.  12% tPA efficacy for full recovery NO ONE IS WORKING ON SOMETHING BETTER.

10.  10% seizures post stroke NO PROTOCOLS THAT WILL ADDRESS IT. 

11. 21% of patients had developed cachexia NO PROTOCOLS THAT WILL ADDRESS IT. 

 

12. You lost 5 cognitive years from your stroke  NO PROTOCOLS THAT WILL ADDRESS IT.

13.  33% dementia chance post-stroke from an Australian study?

       Or is it 17-66%?

       Or is it 20% chance in this research?

NO PROTOCOLS THAT WILL ADDRESS THIS

But the latest here:

Trends in prevalence of acute stroke impairments: A population-based cohort study using the South London Stroke Register

  • Amanda Clery, 
  • Ajay Bhalla, 
  • Anthony G. Rudd, 
  • Charles D. A. Wolfe, 
  • Yanzhong Wang
PLOS
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Methods and findings

Acute stroke impairments often result in poor long-term outcome for stroke
survivors. The aim of this study was to estimate the trends over time in
 the prevalence of these acute stroke impairments.

All first-ever stroke patients recorded in the South London Stroke Register (SLSR) between 2001 and 2018 were included in this cohort study. Multivariable Poisson regression models with robust error variance were used to estimate the adjusted prevalence of 8 acute impairments, across six 3-year time cohorts. Prevalence ratios comparing impairments over time were also calculated, stratified by age, sex, ethnicity, and aetiological classification (Trial of Org 10172 in Acute Stroke Treatment [TOAST]). A total of 4,683 patients had a stroke between 2001 and 2018. Mean age was 68.9 years, 48% were female, and 64% were White. After adjustment for demographic factors, pre-stroke risk factors, and stroke subtype, the prevalence of 3 out of the 8 acute impairments declined during the 18-year period, including limb motor deficit (from 77% [95% CI 74%–81%] to 62% [56%–68%], p < 0.001), dysphagia (37% [33%–41%] to 15% [12%–20%], p < 0.001), and urinary incontinence (43% [39%–47%) to 29% [24%–35%], p < 0.001). Declines in limb impairment over time were 2 times greater in men than women (prevalence ratio 0.73 [95% CI 0.64–0.84] and 0.87 [95% CI 0.77–0.98], respectively). Declines also tended to be greater in younger patients. Stratified by TOAST classification, the prevalence of all impairments was high for large artery atherosclerosis (LAA), cardioembolism (CE), and stroke of undetermined aetiology. Conversely, small vessel occlusions (SVOs) had low levels of all impairments except for limb motor impairment and dysarthria. While we have assessed 8 key acute stroke impairments, this study is limited by a focus on physical impairments, although cognitive impairments are equally important to understand. In addition, this is an inner-city cohort, which has unique characteristics compared to other populations.

Conclusions

In this study, we found that stroke patients in the SLSR had a complexity of acute impairments, of which limb motor deficit, dysphagia, and incontinence have declined between 2001 and 2018. These reductions have not been uniform across all patient groups, with women and the older population, in particular, seeing fewer reductions.

Author summary

Why was this study done?

  • Stroke is one of the top 5 causes of disability globally.
  • We do not know how the different types of disability caused by stroke have improved or changed over time.

What did the researchers do and find?

  • We analysed the changes in the prevalence of 8 different stroke impairments between 2001 and 2018 in a total of 4,683 stroke patients.
  • Over time, fewer people experienced limb impairment, dysphagia (swallowing difficulties), and incontinence, but the other 5 impairments did not decline over time. These were visual field defect, neglect, sensory loss, dysphasia, and dysarthria.
  • The people who tended to continue experiencing these impairments over time were older and female patients.

What do these findings mean?

  • The type and number of disabilities that stroke patients in our study population face has changed over time.
  • This has implications for how patients are cared for by clinicians in the short term and how the needs of stroke survivors are addressed by public health policy in the long term.

Citation: Clery A, Bhalla A, Rudd AG, Wolfe CDA, Wang Y (2020) Trends in prevalence of acute stroke impairments: A population-based cohort study using the South London Stroke Register. PLoS Med 17(10): e1003366. https://doi.org/10.1371/journal.pmed.1003366

Academic Editor: Joshua Z. Willey, Columbia University, UNITED STATES

Received: May 14, 2020; Accepted: August 31, 2020; Published: October 9, 2020

Copyright: © 2020 Clery et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: The raw data for this study contain both personally identifiable and confidential clinical data. The participants of the study did not consent to sharing the information publicly, and our ethical approvals require strict information governance procedures. Requests for data access for academic use should be made to the South London Stroke Register, where data will be made available subject to academic review and acceptance of a data-sharing agreement. Information can be found/requested through the following link: https://www.kcl.ac.uk/lsm/research/divisions/hscr/research/groups/stroke.

 
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