The limits of neuroplasticity - or are there any?

Right now, neuroplasticity is not repeatable on demand. 

When your incompetent? doctor uses this word ask then to EXPLAIN EXACTLY what needs to happen for a neuron to drop a current task and take on a neighbors! 

NO explanation; PURE FUCKING INCOMPETENCE! Not knowing that makes neuroplasticity non repeatable on demand!

 The limits of neuroplasticity - or are there any?

Katerina Poprelka1  · Maria Stefanatou1 · Stylianos Gatzonis1 Received: 9 May 2026 / Accepted: 26 September 2026 © Fondazione Società Italiana di Neurologia 2026 

To the Editor, Cases demonstrating discordance between marked structural brain abnormalities and preserved clinical function are rare but informative. We report such a case in a 52-year old woman, highlighting the limits and resilience of neuro plastic adaptation. The patient presented to the outpatient neurology clinic following two witnessed generalized tonic-clonic seizures, both associated with a postictal phase of impaired awareness, drowsiness, and confusion, with gradual recovery over several minutes. On examination, she was alert and oriented, with no focal neurological deficits. However, deep tendon reflexes were brisk throughout, and plantar responses were indifferent bilaterally. Her past medical history was notable for childhood men ingitis, the exact etiology of which was not documented, and longstanding macrocephaly. No prior neurosurgical intervention has been reported. Despite these early neuro logical factors, she achieved normal developmental mile stones, completed secondary education, and maintained consistent employment, indicating a high level of functional adaptation. She had no history of epilepsy until the age of 43, when she began experiencing focal seizures characterized by impaired awareness, automatisms, and behavioral arrest, consistent with focal impaired awareness seizures. These were managed with lacosamide at a dose of 150 mg twice daily. In 2023, she experienced an episode of status epilepticus, precipitated by poor medication adherence. Fol lowing this, brivaracetam was added to her treatment regi men, resulting in improved seizure control. Neuroimaging revealed striking abnormalities. A CT scan demonstrated marked enlargement of the lateral and third ventricles, consistent with severe ventriculomegaly, along with significant thinning of the cortical mantle. Brain 1 Katerina Poprelka katerinapop@med.uoa.gr First Department of Neurosurgery, Evangelismos Hospital, National & Kapodistrian University of Athens, 45-47 Ipsilantou Str., Athens 10676, Greece MRI (Fig. 1) provided further detail, showing diffuse cere bral atrophy, most prominently involving the corpus cal losum, which appeared significantly thinned. Additionally, an empty sella turcica was noted. Electroencephalogra phy showed generalized slowing with predominant theta activity, intermittent epileptiform discharges, and bilateral temporo-occipital slowing, more prominent over the left hemisphere. We believe that the observed ventricular enlargement most likely reflects a long-standing developmental or post inflammatory process, rather than active hydrocephalus. The available clinical and imaging data do not allow a clear distinction between chronic post-infectious hydrocephalus, arrested hydrocephalus, and long-standing overt ventriculo megaly in adults (LOVA). The degree of ventricular enlarge ment is disproportionate to the observed cortical atrophy, making hydrocephalus ex vacuo less likely. We therefore favor a multifactorial explanation involving chronic ventric ulomegaly with secondary cerebral atrophy, while acknowl edging the inherent diagnostic uncertainty. A comprehensive neuropsychological assessment was conducted to evaluate cognitive functions in greater depth. Mild executive dysfunction was observed, particularly affecting cognitive flexibility, planning, and processing speed, as evidenced by reduced performance on Stroop Neuropsychological Screening Test, Trail Making Test Part B, and Digit Symbol Coding. Memory performance was dis proportionately affected, with severe impairments in verbal and visual learning and delayed recall on the Rey Auditory Verbal Learning Test and the Rey-Osterrieth Complex Fig ure Test, suggesting deficits across encoding, consolidation, and retrieval processes. Increased susceptibility to interfer ence was also observed. The non-modality-specific pattern, affecting both verbal and visual memory, points to dysfunc tion within distributed memory networks rather than a focal deficit. Despite these objective deficits, the patient did not report significant subjective cognitive complaints in daily life. However, cognitive fatigue was observed during test ing, which may have contributed to reduced performance and suggests limited cognitive reserve under sustained  demand. Importantly, there was no evidence of coexisting mood or anxiety disorders that could otherwise explain or exacerbate cognitive findings. The prevalence of hydrocephalus in the adult population is estimated at roughly 1 per 10,000, with aqueductal steno sis accounting for approximately 10% of cases [1]. Additional common etiologies include congenital abnormalities, infec tious processes, head trauma, and space-occupying obstructive lesions. Among these etiologies, long-standing hydrocepha lus, including cases secondary to early-life insults such as infection, is of particular interest, as it may be associated with severe anatomical distortion yet relatively preserved clini cal function. This case demonstrates a marked dissociation between extensive structural brain abnormalities and func tional outcome. Although the degree of ventriculomegaly, cor tical thinning, and diffuse atrophy would typically be expected to result in significant neurological and cognitive impairment, the most striking feature in this patient is the preservation of functional independence despite objectively significant neu ropsychological deficits, including severe memory impair ment and mild executive dysfunction. Notwithstanding these findings, she maintained autonomy in everyday activities for decades, underscoring a complex and non-linear relationship between cognitive impairment and real-world functioning. Similar cases have been described in the literature, particularly in individuals with long-standing or congenital hydrocepha lus, in whom profound anatomical distortion is accompanied by relatively mild clinical manifestations [2, 3]. A 44-year-old man with a history of childhood hydro cephalus and shunt placement demonstrated severe ventricu lomegaly and a markedly thin cortical mantle, accompanied by low-average intellectual functioning; nevertheless, he maintained functional independence and relatively stable neurological status over time, with cognitive deficits that appeared chronic rather than progressive [2]. Similarly, in a (C) Sagittal and coronal views illustrating the marked expansion of the ventricular system and compression of the brain parenchyma 72-year-old woman with overt ventriculomegaly, preserved independence and normal cognitive screening were reported despite severe structural abnormalities, with seizures emerg ing late in life in the context of otherwise minimal neurolog ical impairment [3]. Compared with these cases, the present patient shares the characteristic dissociation between severe structural brain changes and preserved daily functioning; however, she is distinguished by more pronounced memory impairment on formal neuropsychological testing despite long-term independence. These observations may be considered within the frame work of developmental plasticity, whereby cognitive func tions developing in the context of early neurodevelopmental abnormalities may adapt to an atypical neural substrate. In this context, adaptation is more appropriately conceptual ized as the development of cognitive functions within exist ing structural constraints rather than as “reorganization” of previously established networks. Such developmental adaptation may partly account for the preservation of func tional independence despite severe structural abnormalities, although the mechanisms underlying this dissociation can not be established from the present case. The presence of significant memory impairment and milder executive dys function, together with the later emergence of epilepsy, nev ertheless suggests that this adaptation may be incomplete and may not fully protect against cognitive and neurological vulnerability. Cognitive reserve may also have contributed to the relatively preserved everyday functioning; however, available proxies are limited to educational attainment and sustained employment, precluding stronger conclusions regarding its role. Age-related changes, increasing network inefficiency, and reduced cognitive reserve have been pro posed as factors that may reveal previously compensated vulnerabilities over time; however, their contribution in the present case remains speculative 

In summary, this case highlights that functional outcome in chronic structural brain disease is not determined solely by anatomical integrity. Instead, the marked dissociation between structural abnormalities and everyday functioning may reflect the influence of developmental adaptation and individual differences in cognitive reserve, although their respective contributions cannot be established in this case. While the brain demonstrates remarkable adaptability in the context of longstanding structural abnormalities, cognitive deficits and neurological complications may still emerge, underscoring the importance of comprehensive evaluation and long-term follow-up. 

Author Contribution Credit authorship contribution statement Kateri na Poprelka: Conceptualization, Investigation, Formal Analysis, Writ ing Original Draft. Maria Stefanatou: Validation, Writing- Review & Editing. Stylianos Gatzonis: Supervision, Writing- Review & Editing. Funding No funding was received to assist with the preparation of this manuscript. Declarations Ethics approval The authors have obtained patient consent. Competing interest The authors have no competing interests to de clare that are relevant to the content of this article. References 1. 2. 3. Oi S, Shimoda M, Shibata M, Honda Y, Togo K, Shinoda M, Tsu gane R, Sato O (2000) Pathophysiology of long-standing overt ventriculomegaly in adults. J Neurosurg 92:933–940. h t t p s : / / d o i . o r g / 1 0 . 3 1 7 1 / j n s . 2 0 0 0 . 9 2 . 6 . 0 9 3 3 Feuillet L, Dufour H, Pelletier J (2007) Brain of a white-collar worker. Lancet 370:262. h t t p s : / / d o i . o r g / 1 0 . 1 0 1 6 / S 0 1 4 0 - 6 7 3 6 ( 0 7 ) 6 1 1 2 7 - 1 Persad AR, Bass V, Meguro K (2021) Asymptomatic hydrocepha lus. CMAJ 193:E480. https: //d oi. or g/10 .150 3/cmaj.200889 Publisher’s Note Springer Nature remains neutral with regard to juris dictional claims in published maps and institutional affiliations

The question doctors could ask to estimate death risk in old patients

 Don't let your incompetent? doctor let you leave the hospital until you have 100% recovered your walking. My fall risk still exists because my hamstring does not fire properly to lift the foot high enough to clear obstacles. And spasticity still has me circumducting a fair amount yet, which is only useful on flat surfaces.

COMPLETE DOCTOR FAILURE THERE!

My doctor always asks me that question; 'Do you fall?'  My answer; 'Of course I do, I challenge myself a lot in walking on unimproved trails in the nearby woods. That challenge is what is going to keep me walking everywhere well into my nineties.' S/he doesn't like that answer. Just like not liking my purchase of a 4 level condo.

The question doctors could ask to estimate death risk in old patients

“Do you have trouble walking?” could be one of the most important questions doctors could ask older patients to evaluate their mortality risk, according to a new large-scale research review.

Healthcare systems worldwide seek to find simple ways to identify older adults with a high need for hospitalisation.

Hospitals also need to assess whether their healthcare response is distributed according to need rather than social position.

Previous studies have established that grip strength, gait, and balance can predict the risk of chronic diseases in older people.

Now, a new study reveals that walking difficulty can also be a practical sign of higher mortality risk and health need.

In the research, scientists assessed data from six of the world’s largest ageing studies, including health information from older adults living in China, England, the United States, South Korea, Mexico, and continental Europe.

The studies collectively followed hundreds of thousands of older adults using comparable questionnaires, which included questions about walking difficulty.

By analysing this data, scientists could probe whether walking difficulty indeed determined health status in older people across economies, cultures, and health systems.

Walking difficulty is inexpensive to ascertain and widely harmonisable across ageing cohorts, but its value as a denominator for healthcare equity assessment has been less well characterised,” researchers wrote.

They found that walking difficulty could be used to identify populations with substantially greater measured health need.

Scientists found that older adults who reported walking difficulty faced nearly double the death risk during follow-up than those who walked comfortably.

“Walking difficulty was associated with morbidity, falls, depressive symptoms, disability, and hospitalisation,” they wrote in the study published in the journal BMC Medicine.

“In clinical and community-facing settings, the value of a walking-difficulty question lies in its simplicity rather than in technological precision. It can be asked quickly, requires no equipment, and identifies a group in which multi-morbidity, depressive symptoms, falls, disability, and hospitalisation are more common,” researchers explained.

However, they caution that the study does not estimate a causal effect of walking difficulty.

“Taken within these boundaries, walking difficulty offers a practical way to move from risk recognition to health-system auditing in older populations,” researchers said.

“It identifies a high-need group using a low-cost functional question and makes it possible to ask whether response among those with evident need remains socially patterned,” they explained.

The Independent is the world’s most free-thinking news brand, providing global news, commentary and analysis for the independently-minded. We have grown a huge, global readership of independently minded individuals, who value our trusted voice and commitment to positive change. Our mission, making change happen, has never been as important as it is today.

Will We Ever Understand Dementia?

 A writeup in the NYTimes.

Will We Ever Understand Dementia?

“Success will be measured by access”: health leaders advocate equitable care for acute stroke during UN General Assembly Week

 You'd be fired immediately in any business setting for access to the products for sale rather than actually providing the product. The product in stroke is 100% recovery! Don't understand that? GET THE HELL OUT and do some basket weaving! That might be in your wheelhouse! 'Access' doesn't get you recovered you fucking blithering idiots! If you recognize anyone in this picture, shame them mercilessly, they deserve condemnation for absolute stupidity!

“Success will be measured by access”: health leaders advocate equitable care for acute stroke during UN General Assembly Week

9 October 2026

Government officials, global health leaders, clinicians, patient advocates, professional societies and industry partners recently gathered during United Nations (UN) General Assembly Week (18–28 September 2026, New York, USA) for a meeting titled, ‘From resolution to action: investing in acute stroke care’, which focused on translating global commitments on stroke into concrete improvements in prevention, acute treatment, rehabilitation, and access to care.

The 22 September reception was convened through the Society of Vascular and Interventional Neurology’s (SVIN) Mission Thrombectomy in partnership with the Business Council for International Understanding (BCIU), Philips, and Medtronic Neurovascular.

The event brought together representatives from international cardiovascular, stroke, neurointerventional and neurosurgical organisations, including the American Heart Association (AHA), World Stroke Organization (WSO), World Federation of Interventional and Therapeutic Neuroradiology (WFITN), Society of NeuroInterventional Surgery (SNIS), and International Society for Global Neurosurgery (ISGNS), alongside ministries of health and other global health stakeholders. Together, these entities brought perspectives spanning public health, stroke systems, neurointervention, global neurosurgery, policy and implementation, as noted in an SVIN press release.

The release adds that this gathering came at “a pivotal moment for global stroke policy”; WHA79.10, adopted by the World Health Assembly in May 2026, represents a “landmark global commitment” to addressing stroke comprehensively, covering prevention, acute care, rehabilitation, and health-system readiness.

WHA79.10 was championed by the Egyptian Ministry of Health and Population with support from the Global Stroke Action Coalition (GSAC)—which comprises organisations and industry leaders dedicated to advancing stroke prevention, treatment, rehabilitation, and access to care worldwide. The resolution represents an “important example” of how governments, professional organisations, patient advocates and industry “can work together to elevate stroke on the global health agenda”, the SVIN release also states.

Debates during UN General Assembly Week

Discussions centred on a fundamental challenge: scientific advances have made highly effective stroke treatments possible, including mechanical thrombectomy for large vessel occlusion (LVO), but millions of eligible patients worldwide still cannot access these treatments in a timely manner.

The conversation was opened by Fawaz Al-Mufti (New York Medical College, New York, USA), global chair of SVIN’s Mission Thrombectomy, who shared ‘the clinical and economic case for acute stroke treatment’, highlighting the “extraordinary effectiveness” of mechanical thrombectomy for eligible patients with LVO stroke. Drawing on global data and an economic analysis spanning six countries, Al-Mufti emphasised that investing in access to thrombectomy can represent a fraction of the societal cost associated with stroke-related disability.

“We are already paying for stroke,” he commented. “The question is whether we choose to pay for recovery today or disability for years to come. A timely thrombectomy can offset a lifetime of disability and its associated costs. We need to stop viewing thrombectomy simply as a procedural expense and recognise access to effective stroke treatment as an investment in people, families, and national capacity.”

The patient perspective was then brought into focus by Margaret O’Neil Wheeler, who shared “a moving account of resilience and fortitude” following an LVO stroke. Accompanied by her husband, whose prompt recognition and action helped get her to lifesaving care in time, Wheeler was reunited at the event with Al-Mufti—who performed her emergency thrombectomy at Westchester Medical Center (New York, USA). Their reunion offered a “powerful reminder” of what timely access to advanced stroke care can mean: not simply survival, but recovery, independence, and the opportunity to return to life after stroke.

Dileep Yavagal (University of Miami, Coral Gables, USA), founder and global chair emeritus of SVIN’s Mission Thrombectomy, followed this with a presentation titled, ‘From global advocacy to global action’. Yavagal described stroke as a “long-neglected pandemic” and emphasised that solving the global access gap requires more than simply building additional thrombectomy centres. Sustainable systems require public and prehospital education, government advocacy, technology, financing, trained teams, and implementation strategies tailored to individual countries, he added.

“We have crossed the scientific frontier—we know thrombectomy can profoundly alter the course of a devastating stroke,” Yavagal commented. “The frontier before us now is access.”

Clinician, industry and health-policy voices

“Stroke does not respect borders, and access to lifesaving treatment should not be determined by where a patient lives,” stated SVIN president Santiago Ortega-Gutierrez (University of Iowa, Iowa City, USA). “The science is clear, the therapies exist, and the global community has recognised stroke as an urgent health priority. Our responsibility now is to turn that recognition into action. Through Mission Thrombectomy, SVIN is committed to measurable progress in access, treatment, and recovery, with the goal that every eligible patient has a meaningful opportunity to survive stroke without preventable disability.”

“Recognition is important, but ultimately our success will be measured by access,” added Mission Thrombectomy vice-chair Kaiz Asif (Endeavor Health, Chicago, USA). “Our goal is to translate this global momentum into a simple reality: that more patients, regardless of where they live, can reach lifesaving thrombectomy in time.”

“The science has given us the ability to dramatically change the outcome of a devastating stroke. The next challenge is ensuring that this opportunity is not defined by geography or resources. That will require sustained collaboration among clinicians, health systems, governments and communities to translate what we know into meaningful access for patients worldwide,” commented SVIN president-elect Robin Novakovic-White (UT Southwestern Medical Center, Dallas, USA).

The proceedings during the UN’s General Assembly Week also aw industry partners underscore the fact that innovation must be accompanied by the systems required to deliver treatment.

“Innovation alone is not enough,” said Signe Haughton, senior director of medical, government and societal affairs, and chief of staff, at Medtronic Neurovascular. “Devices and therapies make a meaningful difference only when patients can reach the right facility, receive timely diagnosis, and be treated by trained teams within an integrated system of care.”

“For people experiencing stroke, every minute matters,” added Felipe Basso, chief executive officer, Latin America, Philips. “Better-connected data, technologies and clinical workflows can help healthcare professionals make timely decisions, support rapid diagnosis and appropriate treatment, and expand access to the right care when patients need it most.”

Finally, Mohamed Fawzi—radiology advisor to the minister of health and population in the Arab Republic of Egypt’s Ministry of Health and Population—provided a country-specific perspective on building a national stroke system.

Egypt’s progress includes 206 stroke units and centres—58 certified through the General Authority for Healthcare Accreditation and Regulation (GAHAR)—free thrombolysis, reimbursement for thrombectomy, approval of tenecteplase, and a prehospital hotline linking approximately 100 hospitals. A national electronic stroke registry is also being launched, with plans to expand the network to 440 units, strengthen certification, establish a national rehabilitation pathway, and publish national treatment rates and treatment times.

According to the SVIN’s press release, the message emerging from the convening was clear: a resolution creates momentum; implementation is what changes outcomes for patients.

“The science exists. The therapies exist. The opportunity now is to build the systems that ensure every eligible patient—regardless of geography or resources—can reach lifesaving stroke treatment in time,” the release adds.

Seizure Rates Rise After Mechanical Thrombectomy for Stroke

 What the hell are YOU doing to stop this problem? NOTHING? Then get the hospital reconstituted with some competent stroke rehab persons!

What is your competent? doctors EXACT PROTOCOL  to prevent post-stroke epilepsy and seizures? And they have been working on this for over a decade, right?

• 10% seizures post stroke (19 posts to April 2017)
• 5% epileptic seizures after stroke (10 posts to April 2021)

• epileptic seizures (6 posts to December 2015)

• post-stroke epilepsy (24 posts to December 2016) 

Seizure Rates Rise After Mechanical Thrombectomy for Stroke

The incidence of in-hospital seizures and status epilepticus following mechanical thrombectomy for acute ischemic stroke has risen significantly, with specific vascular territories and patient comorbidities driving the increased risk.

The rate of in-hospital seizures after mechanical thrombectomy has increased over time, according to study results published in Neurology Open Access.

Mechanical thrombectomy is a cornerstone therapy for acute ischemic stroke caused by large vessel occlusion (LVO), particularly after its endorsement by the American Heart Association/American Stroke Association in 2015. Patients undergoing mechanical thrombectomy typically present with severe LVO strokes involving extensive vascular territories and frequent cortical involvement. These are both established risk factors for seizures.

Researchers analyzed data from the National Inpatient Sample from 2016 to 2022 to evaluate in-hospital seizures among adults hospitalized with ischemic stroke who underwent mechanical thrombectomy. The analysis included 632,485 patients.

Overall, 1.88% of patients (n=11,903) had a seizure diagnosis recorded during the index hospitalization. The rate of seizures increased from 1.60% in 2016 to 2.34% in 2022. Rates of both status epilepticus and nonstatus seizures increased during the study period, from 0.079% to 0.206% and from 1.52% to 2.13%, respectively.

Several independent risk factors identified in this study are common and potentially modifiable early in the stroke course, highlighting opportunities for targeted metabolic and medical optimization.

Patients with status epilepticus had longer hospital stays than patients with nonstatus seizures and those without seizures (mean, 17.32 vs 7.86 vs 5.03 days, respectively; P <.001). They also had higher mean hospital charges ($371,485.72 vs $164,213.88 vs $119,561.20, respectively; P <.001) and in-hospital mortality (25% vs 6.7% vs 4.6%, respectively; P <.001).

In multivariable analyses of vascular territory and thrombectomy location, seizure risk was associated with intracranial artery thrombectomy (odds ratio [OR], 1.39; P =.016), left internal carotid artery thrombectomy (OR, 1.39; P =.014), right internal carotid artery thrombectomy (OR, 1.35; P =.026), right vertebral artery thrombectomy (OR, 2.46; P =.003), and left vertebral artery thrombectomy (OR, 2.06; P =.016). Among patients with status epilepticus, only left vertebral artery thrombectomy remained independently associated with risk (OR, 5.65; P =.002). Right anterior cerebral artery stroke was also associated with increased seizure risk (OR, 2.40; P =.002).

Comorbidities independently associated with seizure risk included the following:

• Psychoses (OR, 2.88; P <.001);
• Depression (OR, 1.65; P <.001);
• Lymphoma (OR, 1.80; P =.044); 
• Fluid and electrolyte disorders (OR, 1.43; P <.001);
• Alcohol abuse (OR, 1.40; P =.001);
• Chronic pulmonary disease (OR, 1.30; P <.001); and,
• Complicated diabetes (OR, 1.15; P =.030)

Obesity was associated with lower seizure risk (OR, 0.84; P =.011). Among patients with status epilepticus, significant associations included fluid and electrolyte disorders (OR, 2.20; P <.001), uncomplicated hypertension (OR, 1.97; P =.013), complicated diabetes (OR, 1.65; P =.016), coagulopathy (OR, 1.63; P =.038), and brain herniation (OR, 2.18; P =.002).

Study limitations include the lack of detailed procedural and stroke-severity data and the inability to determine whether seizures were procedure-related. Also, seizure diagnoses were based on in-hospital coding, preventing assessment of seizure timing or postdischarge recurrence.

The study authors concluded, “Several independent risk factors identified in this study are common and potentially modifiable early in the stroke course, highlighting opportunities for targeted metabolic and medical optimization.”

Proposal for a Robot Rehabilitation Strategy Tailored to the Recovery Stage of Gait Impairment After Subacute Stroke: A Preliminary Case Report

 But NO protocol created; SO FUCKING USELESS! Doesn't anyone in stroke have two neurons to rub together?

Proposal for a Robot Rehabilitation Strategy Tailored to the Recovery Stage of Gait Impairment After Subacute Stroke: A Preliminary Case Report

Cite this article as: Tamiya F, Tateishi T, Shimoda S, et al. (October 08, 2026) Proposal for a Robot Rehabilitation Strategy Tailored to the Recovery Stage of Gait Impairment After Subacute Stroke: A Preliminary Case Report. Cureus 18(10): e117654. doi:10.7759/cureus.117654

Abstract

Robot-assisted gait training (RAGT) has been increasingly applied as an intervention method for stroke hemiplegia patients' abnormal gait patterns. We describe an intervention strategy that attempts the precise adjustment of tasks' difficulty according to the severity of gait impairment by progressively adapting two types of robots in accordance with the subject's recovery process. This case report describes a 53-year-old man who presented with left hemiplegia due to a right lacunar infarction. He was admitted to our rehabilitation hospital 14 days after stroke onset and underwent a staged gait-training program from days 14 to 77 after stroke onset, including treadmill-driven RAGT from days 16 to 28 and orthosis-mounted RAGT from days 55 to 69. At his initial assessment, the patient required assistance with walking due to moderate motor paralysis. In the early stages of intervention, a treadmill-driven robot was introduced(Why not the split-belt treadmill?) with the goal of improving the patient's walking independence. Subsequently, after supervised walking had been achieved and residual gait abnormalities persisted during conventional gait training, the patient transitioned to flat-ground walking practice using an orthosis-mounted robot with the goal of optimizing walking patterns. The sequential intervention was associated with improvement in walking independence, with the Functional Ambulation Category increasing from 1 to 5 by discharge, and improvements in stiff-knee gait and toe clearance were also observed. These findings suggest that stage-specific selection of robotic devices according to therapeutic goals may be a feasible approach for addressing both walking independence and residual gait abnormalities after stroke.

Subjective Social Status and Outcomes After Stroke: A Prospective Cohort Study

 

Useless generalities! Survivors want EXACT 100% RECOVERY PROTOCOLS, you blithering idiots! And Steven Cramer is a rock star stroke researcher. Sorry about the dis, Dr. Cramer but you will want 100% recovery when you are the 1 in 4 per WHO that has a stroke and if I have to insult you to get you working on that, so be it! Contact me at oc1dean@gmail.com and we can discuss how to get there. But off to Japan and South Africa so mostly incommunicado for the next couple months. Looking forward to our discussions in person.

• Dr. Steven Cramer (28 posts to October 2011)

Subjective Social Status and Outcomes After Stroke: A Prospective Cohort Study

Doo Young Kim, MD https://orcid.org/0000-0003-1327-5348, E. Alison Holman, PhD, FNP https://orcid.org/0000-0001-5076-8403, and Steven C. Cramer, MD, MMSc https://orcid.org/0000-0002-6214-6211 sccramer@mednet.ucla.eduAuthor Info & Affiliations

Stroke

New online

https://doi.org/10.1161/STROKEAHA.126.056914

 

Abstract

BACKGROUND:

Subjective social status (SSS) represents self-perceived social position and may affect poststroke recovery. Despite impacting various medical outcomes, SSS remains understudied in stroke. We hypothesized that higher SSS is associated with better stroke recovery at 3- and 12 months poststroke.

METHODS:

In this prospective cohort study, patients were enrolled between October 2016 and February 2020. We examined associations between 3-month SSS score and clinician-reported, performance, and patient-reported outcomes at 3- and 12-month assessments. Ordinal multivariable regression analysis evaluated 3-month SSS score as a predictor of 12-month modified Rankin Scale score.

RESULTS:

The 494 participants had a median age of 63.5 years; 200 (41%) were female, and median (interquartile range) acute National Institutes of Health Stroke Scale score was 4 (2–8). Scores on SSS showed no meaningful associations with performance outcomes and some associations with clinician-reported outcomes (eg, 3-month modified Rankin Scale: ρ, −0.12 [95% CI, −0.21 to −0.03], false discovery rate-adjusted P=0.017; 12-month modified Rankin Scale: ρ12mo, −0.18 [95% CI, −0.27 to −0.09], false discovery rate-adjusted P=0.001). Conversely, higher SSS showed strong, consistent correlations with patient-reported outcomes, including less psychological distress and higher Stroke Impact Scale-Activities of Daily Living (ρ3mo, 0.18 [95% CI, 0.09–0.26]; ρ12mo, 0.17 [95% CI, 0.07–0.26]; all false discovery rate-adjusted P<0.05). Item-level analyses of Stroke Impact Scale-Activities of Daily Living revealed that SSS remained most strongly and consistently linked to complex Stroke Impact Scale-Activities of Daily Living motor tasks over time. In ordinal multivariable regression adjusted for age, sex, stroke subtype, initial severity, and the selected objective socioeconomic status proxies (eg, educational attainment, employment, and marital status), 3-month SSS score significantly predicted 12-month modified Rankin Scale score (β, 0.14 [95% CI, 0.02–0.26]; P=0.014).

CONCLUSIONS:

In patients with predominantly mild stroke, 3-month SSS score may serve as a significant social determinant of health that is associated with long-term functional recovery, a relationship closely linked with psychological distress. SSS scores at 3 months poststroke may identify vulnerable patients, enabling development, validation, and targeted application of interventions that optimize stroke recovery.

Graphical Abstract

Get full access to this article

New Research Review Highlights Potential Sleep Benefits of Pistachios

 What is your incompetent? doctors EXACT PROTOCOL ON NUTS?

Doesn't have one; PURE INCOMPETENCE!

Your incompetent? doctor failed to create protocols from all this earlier research, right?

• nuts (23 posts to May 2015)
• hazelnuts (1 posts to June 2026)
• tree nuts (1 post to May 2018)
• pine nuts (1 post to June 2026)
• peanuts (7 posts to May 2017)
• walnuts(22 posts to October 2014)
• pistachios (3 posts to November 2017)

The latest here:

New Research Review Highlights Potential Sleep Benefits of Pistachios

Global Leaders Meet to Discuss Equitable Access to Life-Saving Mechanical Thrombectomy, Acute Stroke Care

 

Big fucking whoopee.

 

  You delivered NOTHING that gets survivors recovered! 'Care' doesn't deliver recovery you blithering idiots! There is NO leadership anywhere in stroke. How many funerals need to occur before we get great stroke leadership?

Neils Bohr who famously said science progresses one funeral at a time. 

Hope you enjoy NOT RECOVERING from your stroke when you become the 1 in 4 per WHO that has a stroke.  Everyone at this is TOTALLY FUCKING INCOMPETENT!

'Care' NOT RECOVERY! I'd have you all fired!

Global Leaders Meet to Discuss Equitable Access to Life-Saving Mechanical Thrombectomy, Acute Stroke Care

"From Resolution to Action: Investing in Acute Stroke Care" took place during United Nations General Assembly week. The meeting focused on translating global commitments on stroke into concrete improvements in prevention, acute treatment, rehabilitation and access to care(NOT RECOVERY!).

Oct. 8, 2026 — Government officials, global health leaders, clinicians, patient advocates, professional societies and industry partners gathered during United Nations General Assembly week for "From Resolution to Action: Investing in Acute Stroke care(NOT RECOVERY!)," a convening focused on translating global commitments on stroke into concrete improvements in prevention, acute treatment, rehabilitation and access to care(NOT RECOVERY!). The September 22 reception was convened through the Society of Vascular and Interventional Neurology's (SVIN) Mission Thrombectomy in partnership with the Business Council for International Understanding (BCIU), Philips and Medtronic Neurovascular. 

Photo: Society of Vascular and Interventional Neurology

The event brought together representatives from leading international cardiovascular, stroke, neurointerventional and global neurosurgical organizations, including the American Heart Association (AHA), World Stroke Organization (WSO), World Federation of Interventional and Therapeutic Neuroradiology (WFITN), Society of NeuroInterventional Surgery (SNIS), and International Society for Global Neurosurgery (ISGNS), alongside Ministries of Health and other global health stakeholders. Together, they brought perspectives spanning public health, stroke systems, neurointervention, global neurosurgery, policy, and implementation.

From Resolution to Action

The gathering came at a pivotal moment for global stroke policy. WHA79.10, adopted by the World Health Assembly in May, represents a landmark global commitment to addressing stroke comprehensively, including prevention, acute care(NOT RECOVERY!), rehabilitation, and health-system readiness.

Importantly, WHA79.10 was championed by the Egyptian Ministry of Health and Population, with support from the Global Stroke Action Coalition (GSAC), a coalition comprising global organizations and industry leaders dedicated to advancing stroke prevention, treatment, rehabilitation, and access to care(NOT RECOVERY!) worldwide. The resolution represents an important example of how governments, professional organizations, patient advocates, and industry can work together to elevate stroke on the global health agenda.

The discussion centered on a fundamental challenge: scientific advances have made highly effective stroke treatments possible, including mechanical thrombectomy for large-vessel occlusion, but millions of eligible patients worldwide still cannot access these treatments in time.

Strokenomics: Investing in Recovery

Dr. Fawaz Al-Mufti, Global Chair, SVIN-Mission Thrombectomy, opened the clinical discussion with "The Clinical and Economic Case for Acute Stroke Treatment," highlighting the extraordinary effectiveness of mechanical thrombectomy for eligible patients with large-vessel occlusion stroke. 

Drawing on global data and an economic analysis spanning six countries, Al-Mufti emphasized that investing in access to thrombectomy can represent a fraction of the societal cost associated with stroke-related disability.

"We are already paying for stroke," said Al-Mufti. "The question is whether we choose to pay for recovery today or disability for years to come. A timely thrombectomy can offset a lifetime of disability and its associated costs. We need to stop viewing thrombectomy simply as a procedural expense and recognize access to effective stroke treatment as an investment in people, families and national capacity."

A Riveting Stroke Story of Resilience

The patient perspective was brought into sharp focus by Margaret O'Neil Wheeler, who shared a moving account of resilience and fortitude following a large-vessel-occlusion stroke. Accompanied by her husband, whose prompt recognition and action helped get her to life-saving care(NOT RECOVERY!) in time, Wheeler was reunited at the event with Dr. Fawaz Al-Mufti, who performed her emergency mechanical thrombectomy at Westchester Medical Center. Their reunion put a human face on the numbers, offering a powerful reminder of what timely access to advanced stroke care(NOT RECOVERY!) can mean: not simply survival, but recovery, independence, and the opportunity to return to life after stroke.

From Global Advocacy to Global Access

Dr. Dileep Yavagal, Founder and Global Chair Emeritus, SVIN-Mission Thrombectomy, followed with "From Global Advocacy to Global Action."

Yavagal described stroke as a "long neglected pandemic" and emphasized that solving the global access gap requires more than simply building additional thrombectomy centers. Sustainable systems require public and pre-hospital education, government advocacy, technology, financing, trained teams, and implementation strategies tailored to individual countries.

"We have crossed the scientific frontier - we know thrombectomy can profoundly alter the course of a devastating stroke," said Yavagal. "The frontier before us now is access."

Turning Recognition Into Action

The urgency expressed at the convening reflects a broader commitment from SVIN leadership to translate scientific progress and global policy recognition into measurable improvements in stroke care(NOT RECOVERY!) worldwide.

Santiago Ortega-Gutierrez, MD, President of the Society of Vascular and Interventional Neurology, framed this as a responsibility for SVIN and the broader stroke community:

"Stroke does not respect borders, and access to life-saving treatment should not be determined by where a patient lives. The science is clear, the therapies exist, and the global community has recognized stroke as an urgent health priority. Our responsibility now is to turn that recognition into action. Through Mission Thrombectomy, SVIN is committed to measurable progress in access, treatment, and recovery—with the goal that every eligible patient has a meaningful opportunity to survive stroke without preventable disability."

Kaiz Asif, MD, Vice Chair of SVIN–Mission Thrombectomy, focused on the ultimate measure of that progress: whether treatment reaches patients:

"Recognition is important, but ultimately our success will be measured by access. Our goal is to translate this global momentum into a simple reality: that more patients, regardless of where they live, can reach life-saving thrombectomy in time."

Robin Novakovic-White, MD, President-Elect of the Society of Vascular and Interventional Neurology, emphasized the collaboration required to translate scientific advances into equitable access:

"The science has given us the ability to dramatically change the outcome of a devastating stroke. The next challenge is ensuring that this opportunity is not defined by geography or resources. That will require sustained collaboration among clinicians, health systems, governments, and communities to translate what we know into meaningful access for patients worldwide."

Building Systems 

Industry partners underscored that innovation must be accompanied by the systems required to deliver treatment.

"Innovation alone is not enough. Devices and therapies make a meaningful difference only when patients can reach the right facility, receive timely diagnosis, and be treated by trained teams within an integrated system of care(NOT RECOVERY!)," said Signe Haughton, Senior Director of Medical, Government, & Societal Affairs and Chief of Staff at Medtronic Neurovascular

Philips emphasized the role of connected technologies and workflows:

"For people experiencing stroke, every minute matters. Better-connected data, technologies, and clinical workflows can help healthcare professionals make timely decisions, support rapid diagnosis and appropriate treatment, and expand access to the right care(NOT RECOVERY!) when patients need it most," said Felipe Basso, Chief Executive Officer, Latin America, Philips.

What Implementation Can Look Like

Dr. Mohamed Fawzi, Radiology Advisor to the Minister of Health and Population, Ministry of Health and Population, Arab Republic of Egypt, provided a country perspective on building a national stroke system.

Egypt's progress includes 206 stroke units and centers, 58 certified through GAHAR, free thrombolysis, reimbursement for thrombectomy, approval of tenecteplase, and a prehospital hotline linking approximately 100 hospitals. A national electronic stroke registry is also being launched, with plans to expand the network to 440 units, strengthen certification, establish a national rehabilitation pathway, and publish national treatment rates and treatment times.

The message emerging from the convening was clear: a resolution creates momentum; implementation is what changes outcomes for patients.

The science exists. The therapies exist. The opportunity now is to build the systems that ensure every eligible patient - regardless of geography or resources - can reach life-saving stroke treatment in time.

To learn more about the meeting,  go to www.svin.org/

FDA sees promise in remote robotic-assisted stroke device

 With NO RECOVERY RESULTS mentioned; how do you tell if it even works?

Not telling us RECOVERY RESULTS is incompetence!

“What's measured, improves.” So said management legend and author Peter F. Drucker !   

If you don't measure it, you can't improve it and make it repeatable! 

FDA sees promise in remote robotic-assisted stroke device

Vitor Mendes Pereira, MD, performs the first telerobotic procedure of its kind on a stroke patient 120 miles away. Fred Moll, chairman of XCath Robotics, looks on. Image courtesy of XCath Robotics.

XCath Robotics has received the FDA's breakthrough device designation for its Iris surgical robotic system that performs remote robotic-assisted mechanical thrombectomy in acute ischemic stroke patients.

This represents a significant step forward for the Houston-based medtech company. The FDA's breakthrough devices drogram helps support the development of medical devices that have the potential to provide more effective treatment for patients with life-threatening or irreversibly debilitating conditions. This provides XCath Robotics with more opportunities to interact with FDA experts and receive support as the company works toward U.S. regulatory approval for the Iris system.

Back in March, the Iris system was used to complete the world’s first telerobotic stroke thrombectomy. Neurosurgeon Vitor Mendes Pereira, MD, chair of advanced neurovascular interventions at the University of Toronto, used the system to perform the historic procedure in Santiago, Panama, while the patient was 120 miles away in Panama City.

XCath Robotics said the Iris technology could open the door to breaking down the geographic barriers to specialist stroke care. Mechanical thrombectomy is widely regarded as the gold standard treatment for patients suffering a large vessel occlusion (LVO) stroke, which is the deadliest and most disabling type of ischemic stroke. However, access to the procedure remains limited outside of major cities, both in the U.S. and internationally.

The global median rate of access to mechanical thrombectomy is only about 2.79%. LVO strokes, similar to heart attacks, have a limited window for treatment before irreversible damage is caused as brain tissues dies. About 77% of patients either die or are left with severe disability.

The U.S. government has recently shown interest in expanding access to robotic stroke thrombectomy. This includes funding through the Advanced Research Projects Agency for Health (ARPA-H) to accelerate the development of an autonomous, remote endovascular robotic system that perform mechanical thrombectomy on stroke patients. Siemens Healthineers was awarded $31.1 million to accelerate the development of an autonomous, remote endovascular robotic system that can perform thrombectomy on stroke patients. Philips Healthcare was also awarded $33.7 million to develop an autonomous robotic system with partners Johns Hopkins University, Boston University and Weill Cornell Medicine.

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