Advances in Physiotherapy: Revolutionizing Recovery and Rehabilitation

 I see NOTHING IN STROKE REHAB that even remotely suggests survivors are getting to 100% recovery better than the 10% rate listed years ago!

Advances in Physiotherapy: Revolutionizing Recovery and Rehabilitation

Physiotherapy has evolved significantly over the years, incorporating cutting-edge technologies and innovative treatment approaches to enhance patient outcomes. From robotic-assisted rehabilitation to artificial intelligence-driven assessments, the field is experiencing a transformation that is improving mobility, reducing pain, and accelerating recovery.

• By TAAZ Apr 04, 2025 | 6:00 PM

Physiotherapy has evolved significantly over the years, incorporating cutting-edge technologies and innovative treatment approaches to enhance patient outcomes. From robotic-assisted rehabilitation to artificial intelligence-driven assessments, the field is experiencing a transformation that is improving mobility, reducing pain, and accelerating recovery. These advancements are not only benefiting patients with neurological and musculoskeletal disorders but also revolutionizing post-operative and sports rehabilitation.

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Technological Innovations in Physiotherapy
1. Robotic Rehabilitation Robotic-assisted therapy has become a game-changer, particularly for patients with neurological disorders such as stroke, spinal cord injuries, and Parkinson’s disease. Robotic exoskeletons and gait trainers help patients regain mobility by facilitating repetitive and precise movements, which are crucial for neuroplasticity and recovery.
2. Artificial Intelligence (AI) and Machine Learning AI-powered tools are transforming physiotherapy assessments and treatment planning. AI algorithms analyze patient data, predict recovery trends, and customize therapy sessions. Virtual reality (VR) combined with AI is also being used to engage patients in interactive rehabilitation exercises, making therapy more effective and engaging.
3. Wearable Technology The use of wearable sensors and smart devices has revolutionized physiotherapy monitoring. These devices track movement patterns, measure muscle activity, and provide real-time feedback to therapists and patients. This technology allows for remote rehabilitation, making physiotherapy accessible to individuals in remote locations.
4. Electrotherapy and Neuromuscular Stimulation Electrical stimulation devices are increasingly being used to activate weakened muscles, particularly in patients with paralysis or post-surgical muscle atrophy. Functional Electrical Stimulation (FES) is particularly effective in restoring movement in stroke and spinal cord injury patients.
5. Tele-rehabilitation The rise of telemedicine has extended to physiotherapy, enabling patients to receive guidance and treatment remotely. Through video consultations and mobile applications, physiotherapists can provide exercise prescriptions, monitor progress, and offer real-time feedback, improving accessibility and compliance.
Benefits of Modern Physiotherapy
1. Faster Recovery Advanced techniques, such as robotic therapy and AI-driven assessments, enable precise interventions that accelerate recovery timelines.
2. Pain Management Innovative treatments like dry needling, ultrasound therapy, and electrotherapy help alleviate chronic pain conditions, reducing dependency on medication.
3. Improved Mobility and Functionality Robotic-assisted therapy and targeted rehabilitation programs enhance movement and functional independence in patients with neurological and orthopedic conditions.
4. Personalized Treatment Plans AI and machine learning create customized treatment strategies tailored to individual patient needs, ensuring optimal recovery outcomes.
5. Enhanced Patient Engagement Virtual reality and interactive rehabilitation platforms make therapy sessions more engaging, improving patient motivation and adherence.
6. Remote Accessibility Tele-rehabilitation and wearable technology allow patients to continue therapy from home, reducing the need for frequent hospital visits and increasing accessibility in underserved areas.

Future of Physiotherapy
As technology continues to advance, the future of physiotherapy looks promising. The integration of AI, robotics, and digital health solutions will further enhance rehabilitation outcomes, making physiotherapy more effective and widely accessible. Research in regenerative medicine and biomechanics is also paving the way for new treatment approaches that will redefine recovery standards.

Vijay Battina
MPT,Fellow in Neuro rehab,Certi.Pain & Palliative care, Certi.Manual therapy ,Pgdhhm
Clinical Director & Head|Atharv Ability Rehab
Member.Board of studies | Kaziranga University
Assessor /Technical committee member – Quality accreditation Institute
+919848857464 |Vijaybathina.com

Integrating Body Schema and Body Image in Neurorehabilitation: Where Do We Stand and What’s Next?

 

Your competent? doctor put together protocols on body schemas for your recovery a long time ago, right? Oh no, you DON'T have a functioning stroke doctor, do you? Is it a vampire or a zombie? 

Since your doctor did nothing, they obviously missed reading the 13 references to support this article. THAT is pure incompetence!

body schema (2 posts to May 2016)

Integrating Body Schema and Body Image in Neurorehabilitation: Where Do We Stand and What’s Next?            

                                 by

Rocco Salvatore Calabrò

IRCCS Centro Neurolesi “Bonino-Pulejo”, Cda Casazza, SS 113, 98123 Messina, Italy

Brain Sci. 2025, 15(4), 373; https://doi.org/10.3390/brainsci15040373

Submission received: 20 February 2025 / Accepted: 7 March 2025 / Published: 3 April 2025

(This article belongs to the Section Neurorehabilitation)

Download keyboard_arrow_down Versions Notes

Given the widespread debate surrounding the definitions and functional roles of “Body Schema” and “Body Image”, these constructs have become central to understanding motor control and rehabilitation, particularly for individuals with neurological impairments [1]. Although often used interchangeably, body schema and body image represent distinct cognitive and sensorimotor phenomena with unique contributions to movement execution and perception. Body schema is an unconscious, sensorimotor representation that is crucial for spatial coordination and movement automation, while body image refers to a conscious, cognitive-perceptual representation that influences self-awareness and emotional states [2]. This distinction is particularly important in the context of rehabilitation, as the specific contributions of each representation can inform targeted therapeutic interventions. The growing number of neurological disorders that affect motor function, especially those impairing the upper limbs, underscores the need for a paradigm shift in rehabilitation strategies, in order to integrate both body schema and body image to optimize recovery [2].

Traditional rehabilitation approaches have predominantly focused on restoring muscle strength and joint mobility. However, contemporary research, as emphasized by Sattin et al. in their cutting-edge narrative review, suggests that interventions targeting both body schema and body image can significantly enhance motor recovery [3]. The authors highlight that understanding the role of these body representations is crucial for addressing motor deficits and developing effective rehabilitation techniques. In their work, they examine the different definitions and models of body schema and body image, and explore empirical settings used to test these theories, particularly focusing on interventions for upper limb impairments. They underscore the need for a new phenomenological approach to rehabilitation that places body schema at the forefront as a fundamental and intrinsic component of action in space. By better understanding these representations, rehabilitation efforts can be more effectively tailored to the needs of patients.

Recent studies have demonstrated the importance of sensorimotor retraining, virtual reality therapy, and brain–computer interfaces in recalibrating body schema to improve movement execution [4]. These innovative interventions engage body schema through immersive techniques, such as virtual reality, which provides patients with real-time, interactive environments that facilitate sensorimotor integration and recovery. Additionally, the mirror neuron system (MNS) has emerged as a crucial neurophysiological mechanism underpinning motor rehabilitation. Techniques such as action observation and motor imagery leverage MNS activation to facilitate motor learning, even in the absence of voluntary movement [4,5]. The role of the MNS in driving neural plasticity and motor recovery has been emphasized by Calabrò et al. [6], particularly in patients with severe motor impairments. The activation of the MNS during observed or imagined movements enhances motor pathway engagement, effectively priming the brain for movement execution. This neurophysiological framework provides a powerful avenue for rehabilitation, allowing patients to strengthen motor circuits and improve functional outcomes even when direct movement is not yet possible.

A particularly promising approach in neurorehabilitation is Action Observation Treatment (AOT), which involves patients watching goal-directed actions with the intention of replicating them. This technique has been shown to improve motor performance and foster neural reorganization in stroke patients who struggle with motor execution [7]. The subsequent practice of motor imagery (MI), or the mental simulation of movement, further strengthens the neural connections involved in movement planning and execution. By mentally rehearsing actions after observing them, patients can reinforce the motor pathways involved, even in the absence of physical movement. This combination of action observation followed by motor imagery provides a powerful mechanism for motor recovery, activating the same neural circuits used during actual movement, thus promoting neuroplasticity and improving motor function [8].

The integration of these techniques with neurophysiological methods like transcranial magnetic stimulation (TMS) and functional electrical stimulation (FES) offers additional avenues for enhancing motor recovery. TMS modulates cortical excitability, promoting neuroplasticity and facilitating motor learning [9]. FES, on the other hand, can provide external stimulation to impaired muscles, helping bridge the gap between neural intention and physical execution [10]. These approaches, combined with interventions targeting body schema and body image, are particularly beneficial for patients with severe motor impairments.

Moreover, Sattin’s work highlights the importance of addressing the psychological aspects of rehabilitation. The relationship between body image disturbances and psychological conditions like depression and anxiety as well as eating disorders is well-documented, particularly in individuals recovering from neurological injuries [11]. A negative body image can hinder recovery and reduce a patient’s engagement in therapy. Thus, integrating psychological interventions such as cognitive-behavioral therapy and mindfulness-based approaches alongside motor rehabilitation can foster a more positive body image, which ultimately supports motor recovery and enhances therapeutic outcomes [11].

The role of body schema in neurorehabilitation is crucial in conditions that disrupt spatial coordination and motor execution, such as stroke, traumatic brain injury, and spinal cord injury [2]. In these disorders, damage to brain regions responsible for processing body schema can impair movement accuracy and hinder body awareness. Rehabilitative techniques that recalibrate body schema, such as virtual reality, action observation, and motor imagery, help patients regain spatial awareness and improve voluntary movement quality [2,7,8]. A comprehensive rehabilitation approach must address both body schema and body image to ensure holistic recovery. Interventions targeting the body schema focus on restoring automatic motor functions through repetitive task practice and sensory integration, whereas therapies aimed at body image work to reshape the individual’s conscious perception of their body, often employing cognitive-behavioral techniques to improve self-awareness and emotional well-being. Body schema-based interventions are particularly effective for patients with hemiplegia, dysphagia, and motor deficits, as the integration of body schema is essential for restoring functional motor behavior and fostering independence [2]. Furthermore, conditions like hemispatial neglect and somatoagnosia, which affect body awareness and spatial attention, must be appropriately addressed to support recovery and improve the patient’s interaction with their environment. These combined efforts, targeting both unconscious motor functions and conscious body perceptions, offer the best potential for meaningful rehabilitation outcomes [12].

The rise in artificial intelligence (AI) and machine learning in rehabilitation is another promising development. AI-driven systems can analyze movement patterns and adapt therapy in real-time, offering personalized rehabilitation programs that are more responsive to individual patient needs. These technologies, in combination with wearable sensors and neurofeedback devices, ensure precise monitoring of motor function and rehabilitation progress, thereby optimizing recovery outcomes [13]. By tailoring interventions based on patient-specific data, AI can significantly improve the efficiency and effectiveness of rehabilitation programs.

The integration of these emerging technologies, combined with psychological and sensorimotor rehabilitation approaches, holds immense potential for improving patient outcomes. As Sattin’s review suggests, the interdisciplinary collaboration between neuroscientists, clinicians, and engineers is essential for developing innovative rehabilitation solutions [4]. By refining our understanding of body schema and body image, and leveraging these novel technologies, we can create more effective, patient-centered rehabilitation strategies that improve the quality of life for individuals with motor impairments.

In conclusion, integrating body schema and body image into neurorehabilitation represents a pivotal advancement in treatment strategies for neurological disorders. By addressing both sensorimotor and cognitive dimensions of recovery, rehabilitation can become more comprehensive and tailored to individual needs. The work by Sattin et al. not only deepens our theoretical understanding of body representations but also highlights the translational potential of this knowledge for developing evidence-based interventions. Future research should focus on refining assessment tools to better distinguish between impairments in body schema and body image, allowing for more targeted therapies. Additionally, there is a need to establish standardized, yet adaptable, rehabilitation protocols that can be personalized based on factors such as lesion location, neuroplastic potential, and individual cognitive profiles. Emerging technologies, including virtual reality, neurofeedback, and brain–computer interfaces, should be further explored to enhance rehabilitation outcomes by providing immersive and interactive training environments. Longitudinal studies are also essential to assess the durability of interventions and their impact on long-term functional recovery. By bridging theoretical insights with innovative clinical applications, future research can significantly advance neurorehabilitation, ultimately improving quality of life for individuals with neurological disorders.

References at link.

30,000 blog posts

 

When I first started writing this blog 15+ years ago as suggested by Peter Levine, my only goal was to beat him in number of views and find and report on useful rehab. Did that in about 1.5 years. The goal changed to document all the ways survivors could be treated better and get a lot more recovery. This would be quite easy to do if we had the strategy, leadership and foundation money to followup the thousands upon thousands of promising research trials and translate them into valid stroke rehab intervention protocols.
I can't tell if this blog is doing one damn bit of good, not a single doctor that I know of has even commented on this. And the presidents of our fucking failures of stroke associations  haven't contacted me.  I'm sure some employees of those associations know about this but are too scared to tell their president.
I know I have at least 10,000 more posts coming since stroke research is never correlated to any stroke strategy.  I don't see stroke being solved to 100% recovery in the 31 years I have left(age 100).

10,000 posts took from Sept. 2010 to May 2016

The next 10,000 took from May 2016 to Sept. 2020

The next 10,000 took from Sept. 2020 to April 2025  

Upper Limb Function 3 Months Post-Stroke: How Accurate Are Physiotherapist Predictions?

 With NO objective damage diagnosis, it is impossible to predict recovery! Predicting failure to recover is ABSOLUTELY FUCKING USELESS TO SURVIVORS!

Upper Limb Function 3 Months Post-Stroke: How Accurate Are Physiotherapist Predictions?

• April 2025
• Physiotherapy Research International 30(2):e70056

DOI:10.1002/pri.70056

• License
• CC BY-NC 4.0

Authors:

Sara Kjær Bastholm

Iris Charlotte Brunner

• Aarhus University

Camilla Lundquist

• Hammel Regional Hospital and Univerity Research Clinic

Download full-text PDF

Download full-text PDF

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References (28)

Abstract

Background 

A frequent sequela of stroke is upper limb (UL) impairment. Accurate UL function prognosis is crucial for targeted rehabilitation. (No it's not! You don't know what the fuck you're talking about!)

Objective 

To determine the accuracy of physiotherapists' predictions of UL function and investigate whether prediction accuracy is affected by physiotherapists' seniority within rehabilitation and/or their level of education. Physiotherapist predictions were compared with a prediction algorithm. 

Methods 

Data from 81 patients were included. Two weeks post‐stroke, physiotherapists predicted UL function based on clinical reasoning. ARAT scores ( poor , limited , good , or excellent ) at 3 months post‐stroke served to determine prediction accuracy. Prediction accuracy was calculated as correct classification rate (CCR). Logistic regression was used to explore the effect of seniority and education. McNemar's test was applied to compare physiotherapist predictions to an algorithm applied 2 weeks post‐stroke to the same patients. 

Results 

The overall correct classification rate (CCR) of physiotherapist predictions was 41% (95% CI: 30–51). Predictions were most accurate for the excellent (75%) and poor (71%) categories, but lower for limited (22%) and good (30%). No association was observed between prediction accuracy and physiotherapist seniority or education. There was a tendency, but not a statistically significant superiority, in the prediction accuracy of the algorithm compared to the physiotherapist predictions (Odds ratio 2 [95% CI: 0.96–4.39], McNemar p = 0.0455, exact McNemar p = 0.0652). 

Trial Registration: Project number: 628213.

Tenecteplase versus alteplase in patients with acute ischemic stroke: An updated meta-analysis of randomized controlled trials.

 And that efficacy is still a COMPLETE FAILURE TO 100% RECOVERY! Why has stroke leadership allowed failure in research to continue for decades at a time? 

The topline on this should been; 'Tenecteplase versus alteplase; Continued failure to get survivors recovered to 100%!'

 

Tenecteplase versus alteplase in patients with acute ischemic stroke: An updated meta-analysis of randomized controlled trials.

Maheen Sheraz, Nawal Asif, Ariba Khan, Muhammad Khubaib Khan

J Stroke Cerebrovasc Dis. 2025 Mar 27; 34(6): 108300 [Epub ahead of print]

INTRODUCTION 

Acute ischemic stroke (AIS) is a leading cause of morbidity and mortality worldwide. While alteplase has been widely used for acute management, recent clinical trials suggest that tenecteplase (TNK) may offer improved clinical outcomes. This study aims to compare the efficacy and safety of TNK compared with alteplase. 

METHODS A comprehensive literature search was conducted using PubMed, Embase and Cochrane Library from inception to October 2024 to identify randomized controlled trials that compared TNK at 0.25 mg/kg dosage with alteplase. Data about clinical outcomes was extracted from both groups and assessed by generating forest plots using the random-effects model and pooling odds ratios (ORs). 

RESULTS 

A total of 11 RCTs with 7,546 patients were included in the analysis. TNK showed statistically significant improvement in excellent functional outcome (mRS 0-1) compared with alteplase (OR= 1.14, 95 % CI= 1.03-1.25). No statistically significant difference was observed for good functional outcome (mRS 0-2) (OR= 1.11, 95 % CI= 0.9-1.25), early neurological improvement (OR=1.08, 95 % CI= 0.93-1.26), all-cause death (OR=0.99, 95 % CI= 0.81-1.19), symptomatic intracranial hemorrhage (OR=1.11, 95 % CI=0.81-1.52) and poor functional outcome (mRS=4-6) (OR=0.95, 95 % CI=0.79-1.14). 

CONCLUSION 

In patients with acute ischemic stroke, TNK demonstrated a significant advantage over alteplase in achieving excellent functional outcomes. The incidence of early neurological improvement, symptomatic intracranial hemorrhage, all-cause death, and poor functional outcome remained comparable across the two groups.

Source: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association

Rehabilitation of Upper Limb Motor Impairment in Stroke: A Narrative Review on the Prevalence, Risk Factors, and Economic Statistics of Stroke and State of the Art Therapies

 This just proves stroke rehab is a shitshow; NOTHING ON 100% RECOVERY! There are NO state of the ART therapies! State of the Art means 100% recovery; there are none!

Send me hate mail on this: oc1dean@gmail.com. I'll print your complete statement with your name and my response in my blog. Or are you afraid to engage with my stroke-addled mind? Your patients need an explanation of why you aren't working on survivor requirements of 100% recovery protocols. 

Rehabilitation of Upper Limb Motor Impairment in Stroke: A Narrative Review on the Prevalence, Risk Factors, and Economic Statistics of Stroke and State of the Art Therapies

Saba Anwer 1 , Asim Waris 1 , Syed Omer Gilani 1 , Javaid Iqbal 1 , Nusratnaaz Shaikh 2 , Amit N. Pujari 3,4 and Imran Khan Niazi 2,5,6, * 1 School of Mechanical & Manufacturing Engineering, National University of Sciences and Technology (NUST), Islamabad 45200, Pakistan; sanwer.bmes19smme@student.nust.edu.pk (S.A.); asim.waris@smme.nust.edu.pk (A.W.); omer@smme.nust.edu.pk (S.O.G.); j.iqbal@ceme.nust.edu.pk (J.I.) 2 Faculty of Health & Environmental Sciences, Health & Rehabilitation Research Institute, AUT University, Auckland 0627, New Zealand; nusrat.shaikh@aut.ac.nz 3 School of Physics, Engineering and Computer Science, University of Hertfordshire, Hatfield AL10 9AB, UK; amit.pujari@ieee.org 4 School of Engineering, University of Aberdeen, Aberdeen AB24 3FX, UK 5 Center of Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand 6 Center for Sensory-Motor Interaction, Department of Health Science & Technology, Aalborg University, 9000 Alborg, Denmark * Correspondence: imran.niazi@nzchiro.co.nz 

Abstract: 

Stroke has been one of the leading causes of disability worldwide and is still a social health issue. Keeping in view the importance of physical rehabilitation of stroke patients, an analytical review has been compiled in which different therapies have been reviewed for their effectiveness, such as functional electric stimulation (FES), noninvasive brain stimulation (NIBS) including transcranial direct current stimulation (t-DCS) and transcranial magnetic stimulation (t-MS), invasive epidural cortical stimulation, virtual reality (VR) rehabilitation, task-oriented therapy, robot-assisted training, tele rehabilitation, and cerebral plasticity for the rehabilitation of upper extremity motor impairment. New therapeutic rehabilitation techniques are also being investigated, such as VR. This literature review mainly focuses on the randomized controlled studies, reviews, and statistical meta-analyses associated with motor rehabilitation after stroke. Moreover, with the increasing prevalence rate and the adverse socio-economic consequences of stroke, a statistical analysis covering its economic factors such as treatment, medication and post-stroke care services, and risk factors (modifiable and non-modifiable) have also been discussed. This review suggests that if the prevalence rate of the disease remains persistent, a considerable increase in the stroke population is expected by 2025, causing a substantial economic burden on society, as the survival rate of stroke is high compared to other diseases. Compared to all the other therapies, VR has now emerged as the modern approach towards rehabilitation motor activity of impaired limbs. A range of randomized controlled studies and experimental trials were reviewed to analyse the effectiveness of VR as a rehabilitative treatment with considerable satisfactory results. However, more clinical controlled trials are required to establish a strong evidence base for VR to be widely accepted as a preferred rehabilitation therapy for stroke. 

Allegheny Health Network Neurosurgeon Performs the Region's First Vagus Nerve Stimulation Procedure to Enhance Stroke Recovery

That has to be pure incompetency on the doctors and hospital! Let's see how long vagus nerve stimulation has been out there. And why not the non-invasive types?

• vagus nerve (67 posts to July 2012)

• • paired vagus nerve stimulation (2 posts to April 2022)

 Allegheny Health Network Neurosurgeon Performs the Region's First Vagus Nerve Stimulation Procedure to Enhance Stroke Recovery

Innovative Therapy Helps Wexford Stroke Survivor Regain Hand Function and

Return to Playing Guitar

B-ROLL AND INTERVIEWS:  https://f.io/lpCCNeXD

VIDEO of Vivistim® Paired VNS System: microtransponder | Showpad

PITTSBURGH, Pa., April 3, 2025 /PRNewswire/ -- Stroke is a potentially debilitating neurologic injury which affects about 800,000 Americans annually and often results in a loss of mobility and motor function. A breakthrough therapeutic technology now being offered at Allegheny Health Network's (AHN) Allegheny General Hospital (AGH) however, is offering new hope to stroke patients who have lost strength and motor control of their arms and hands.  

The Vivistim® Paired Vagus Nerve Stimulation (VNS) System is an FDA-approved technology designed to help stroke survivors regain movement in their upper extremities by delivering mild, repeated electrical pulses to the vagus nerve, which runs from the brainstem through the neck and into the body.  Research has shown that stimulating the nervous system through the vagus nerve can create new pathways in the brain, allowing the patient to regain function and strength faster than through rehabilitation alone.

Alexander Whiting, MD, neurosurgeon and director of epilepsy surgery at AHN's Neuroscience Institute, recently performed the first VNS procedures for stroke recovery in western Pennsylvania. The technology, he said, offers a new pathway to recovery for patients who have reached the limits of traditional occupational and physical therapy.

Among the first to benefit from the innovative treatment is Scott Pavlot, 66, of Wexford, Pa.

Scott, a beloved community leader and musician suffered a life-altering ischemic stroke on Feb. 12, 2024, just two days after his birthday. The stroke left him with severe impairment on his left side, including paralysis of his arm and hand, threatening his ability to continue with his life's passions — playing bass guitar and running The West View HUB, a nonprofit he founded to support the community through free arts, education, and food-assistance programs.

According to the American Stroke Association, an ischemic stroke occurs when a vessel supplying blood to the brain is obstructed. It accounts for about 87% of all strokes.

"I got a brand-new bass for my birthday and only got to play it for one day before the stroke," Scott said. "At first, I couldn't move my arm or fingers at all, but I never saw myself as disabled, just temporarily compromised. That's why I jumped at the chance to try Vivistim. I wanted to push my recovery as far as I could."

Traditionally, stroke rehabilitation focuses on repetitive movement exercises to help the brain form new neural pathways by way of its "neuroplasticity," or the brain's ability to rewire and reorganize itself. However, after about two to three months of therapy, many patients plateau, struggling to make further improvements. The Vivistim System is designed to extend and enhance that window of recovery by delivering mild electrical pulses to the vagus nerve.

The procedure involves implanting a small device, similar to a pacemaker, in the patient's chest. A thin wire is then connected from the device to the vagus nerve in the neck, which serves as a direct communication highway between the brain and body.

"The VNS implant acts like a 'turbo boost' for the brain," said Dr. Whiting. "Every time Scott engages in therapy, whether it's practicing hand exercises or playing the bass, the device stimulates his vagus nerve, sending signals to the brain that tell it to 'wake up' and rewire itself more effectively. It accelerates the natural recovery process in a way that wasn't previously possible."

Once the device is implanted, patients use a handheld magnet to activate it during rehabilitation exercises and daily activities. For Scott, this meant using the device while practicing plucking strings on his bass, helping retrain his brain to restore fine motor control in his fingers.

"This isn't just about regaining movement, it's about reclaiming independence and identity," said Dr. Whiting. "For Scott, playing music is a part of who he is. Watching him recover and pick up his bass again has been incredible."

Since receiving the Vivistim implant in September 2024, Scott has made remarkable progress. Initially, his left arm was completely paralyzed, but through consistent therapy and the help of the VNS system, he has regained movement, finger articulation, and strength.

"The difference has been huge," Scott said. "Typically, stroke recovery hits a wall after a few months. But with the VNS, I've continued to improve well beyond that point. My hand control is getting stronger, and best of all — I can play music again."

The Vivistim System is a game-changer for stroke survivors who have not regained full hand and arm function. According to the American Stoke Association, stroke patients who use VNS therapy in combination with rehabilitation experience two to three times greater functional improvement than those who undergo therapy alone.

"For many stroke survivors, losing function in their hand means losing their ability to feed themselves, dress, or do the things they love," said Dr. Whiting. "With VNS therapy, we're seeing patients regain independence and hope. This is the first time we've been able to significantly change the trajectory of stroke recovery beyond the standard rehabilitation timeline."

Scott sees himself as proof that stroke recovery doesn't have to stop after a few months.

"You can't be defined by a stroke," he said. "I've always been active in my community, my faith, and my music. I laugh every day, I push myself every day, and now I have this incredible tool to help me keep improving. This isn't the end of my story — it's just a new chapter."

For more information about Vagus Nerve Stimulation for stroke recovery at Allegheny Health Network, please call 724-228-1414 and select option 2.

U−shaped association between the glycemic variability and prognosis in hemorrhagic stroke patients: a retrospective cohort study from the MIMIC-IV database

 Useless, describes a problem; provides NO solution!

U−shaped association between the glycemic variability and prognosis in hemorrhagic stroke patients: a retrospective cohort study from the MIMIC-IV database

Yuchen Liu^1†Houxin Fu^2†Yue Wang³Jingxuan Sun¹Rongting Zhang¹Yi Zhong¹Tianquan Yang¹Yong Han¹Yongjun Xiang¹Bin Yuan¹Ruxuan Zhou¹Min Chen¹Hangzhou Wang^1*

• ¹Department of Neurosurgery, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China
• ²Department of Pediatric Hematology and Oncology, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China
• ³Institute of Pediatric Research, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China

Background: Elevated glycemic variability (GV) is commonly observed in intensive care unit (ICU) patients and has been associated with clinical outcomes. However, the relationship between GV and prognosis in ICU patients with hemorrhagic stroke (HS) remains unclear. This study aims to investigate the association between GV and short- and long-term all-cause mortality.

Methods: Clinical data for hemorrhagic stroke (HS) patients were obtained from the MIMIC-IV 3.1 database. GV was quantified using the coefficient of variation (CV), calculated as the ratio of the standard deviation to the mean blood glucose level. The association between GV and clinical outcomes was analyzed using Cox proportional hazards regression models. Additionally, restricted cubic spline (RCS) curves were employed to examine the nonlinear relationship between GV and short- and long-term all-cause mortality.

Results: A total of 2,240 ICU patients with HS were included in this study. In fully adjusted models, RCS analyses revealed a U-shaped association between the CV and both short- and long-term all-cause mortality (P for nonlinearity < 0.001 for all outcomes). Two-piecewise Cox regression models were subsequently applied to identify CV thresholds. The thresholds for all-cause mortality in ICU, during hospitalization, and at 30, 90, and 180 days were determined to be 0.14, 0.16, 0.155, 0.14, and 0.14, respectively. These findings were consistent in sensitivity and subgroup analyses.

Conclusions: In HS patients, higher GV is associated with an increased risk of both short- and long-term all-cause mortality. Our findings suggest that stabilizing GV may improve the prognosis of HS patients.(Where the fuck is the protocol that does that? Your mentors and senior researchers need to be fired for incompetency?)

Background

Cerebrovascular disease (CVD) is the second leading cause of death worldwide, surpassed only by cardiovascular disease (1–3). Stroke, a major component of CVD, has been identified by the World Health Organization as the primary cause of long-term disability globally (4, 5). Although hemorrhagic stroke (HS) accounts for only 10–20% of all stroke cases, it is responsible for nearly half of all stroke-related deaths (6, 7). With an aging global population, the burden of stroke continues to rise, with HS patients in intensive care units (ICU) facing an elevated mortality risk (8). Consequently, identifying prognostic markers for predicting adverse outcomes in HS patients is essential. Historically, assessment tools such as the NIH Stroke Scale and the Canadian Neurological Scale have been widely utilized (9). Despite their utility, these scales are limited by their complexity, time requirements, and the need for specialized training.

Recently, glycemic variability (GV), a parameter of glycemic control, has emerged as a potential factor influencing the progression of cardiovascular and cerebrovascular conditions (10–13). GV reflects fluctuations in blood glucose levels relative to the mean and represents a key pattern of glycemic dysregulation observed in critically ill patients. Compared to persistent hyperglycemia, pronounced glycemic variability has been demonstrated to exacerbate endothelial dysfunction and trigger oxidative stress, potentially leading to more severe cerebrovascular damage (14–16). Moreover, both hyperglycemia and hypoglycemia were recognized as significant factors influencing stroke prognosis (16). Despite this, the impact of glycemic variability on HS patients has been understudied and remains a topic of debate in clinical practice (17, 18).

To address this gap, the present study examined the association between glycemic variability and short-term and long-term all-cause mortality in HS patients. The findings aimed to support clinicians in identifying high-risk individuals, facilitating closer monitoring and timely therapeutic interventions.

More at link.

Return to Work After Ischemic Stroke in Young Adults: A Multicenter Cohort Study, Systematic Review, and Meta‐Analysis

 And the blame for this problem lies directly on our stroke medical 'professionals' not creating 100% recovery protocols!

Return to Work After Ischemic Stroke in Young Adults: A Multicenter Cohort Study, Systematic Review, and Meta‐Analysis

Gabriel Yi Ren Kwok https://orcid.org/0000-0001-6849-6098, Nicole Yeong, Michelle Law, Zi Lun Kang, Arjun Achar, Xin Yuan Lim https://orcid.org/0000-0001-5088-8130, Megan B. J. Ng, BSc https://orcid.org/0000-0002-1196-6164, … Show All … , and Benjamin Y. Q. Tan, MBBS, MCI https://orcid.org/0000-0003-1824-9077 ben.tan@nus.edu.sgAuthor Info & Affiliations

Journal of the American Heart Association

New online

https://doi.org/10.1161/JAHA.124.036427

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Abstract

Background

Ischemic stroke incidence in young adults is increasing globally, with return to work (RTW) a key rehabilitation goal. We aimed to assess the overall proportions of and factors associated with RTW following young adult ischemic stroke.

Methods and Results

We performed a retrospective cohort study of all patients with ischemic stroke aged 18 to 50 years at 2 tertiary hospitals in Singapore from 2020 to 2022. We evaluated associations between patient characteristics and 3‐month RTW status, augmenting these findings with a systematic review and meta‐analysis of PubMed, Embase, Scopus, and Cochrane databases from January 2000 to November 2023. We pooled proportions for RTW and functional recovery (defined as a 90‐day modified Rankin Scale score of 0–2) and meta‐analyzed associations between patient characteristics and RTW using random‐effects models. In this multicenter cohort, 68.8% (249/362) of young patients with ischemic stroke returned to work, while 87.8% (318/362) achieved functional recovery. Multivariable logistic regression showed that patients with large‐artery atherosclerosis pathogenesis, diabetes, higher admission National Institutes of Health Stroke Scale scores, and higher 90‐day modified Rankin Scale had significantly lower odds of RTW. The systematic review and meta‐analyses of 1914 patients across 6 cohort studies identified significantly lower odds of RTW in patients with large‐artery atherosclerosis, diabetes, and admission National Institutes of Health Stroke Scale SCORE >15. The pooled proportion of RTW was 63.2% (984/1574 [95% CI, 56.0–69.9]) and functional recovery 84.7% (719/846 [95% CI, 81.1–87.8]).

Conclusions

Patients with large‐artery atherosclerosis, diabetes, and higher admission National Institutes of Health Stroke Scale score at baseline are less likely to RTW. While lower 90‐day modified Rankin Scale is significantly associated with RTW, many patients achieving functional recovery do not RTW. Well‐designed cohort studies are warranted to explore this disparity.(Exploring is not needed you BLITHERING IDIOTS! YOU CREATE 100% RECOVERY PROTOCOLS! ARE YOU THAT FUCKING STUPID?)