What Stroke Recovery Looks Like Today

 Stroke recovery today is a shitshow! Nobody knows one damn thing about 100% recovery!

What Stroke Recovery Looks Like Today

Though it can vary significantly, Tufts medical experts share what patients can expect after they’ve had a stroke

Grace van Deelen

April 2, 2025

Tags: Health , Health Care , School of Medicine

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You may be familiar with the common signs and symptoms of a stroke: loss of vision, drooping face, weak limbs, and slurred speech. But what happens during the recovery phase, once a patient has spent time in the hospital and their brain has begun to recover?

Lester Leung, a vascular neurologist at Tufts Medical Center and associate professor at Tufts University School of Medicine, Gabriele Moriello, a physical therapist and associate professor in the Department of Rehabilitation Sciences at the School of Medicine, and David Thaler, a vascular neurologist at Tufts Medical Center and professor at the School of Medicine, recently shared how stroke patients recover and what factors may help or hinder the process.

The Shape of Recovery

There are two main categories of strokes: ischemic strokes and hemorrhagic strokes. Most strokes, about 87%, are ischemic strokes, caused by the blockage of a blood vessel in the brain. Hemorrhagic strokes, about 13% of strokes, are caused by bleeding in the brain.

Both types of strokes can damage healthy brain tissue. But the two types have slightly different trajectories of recovery. A patient with an ischemic stroke will see their brain function and mobility drop down after a stroke, then begin to improve starting as soon as 24 hours after their stroke.

A person with a hemorrhagic stroke also loses brain function quickly after a stroke. But because there is blood in the brain, hindering its function, it takes longer for that person’s function to return. As blood reabsorbs into the brain, “there’s a very steep potential incline in terms of regaining function, but it’s delayed,” Leung said.

For both ischemic and hemorrhagic strokes, the potential for improvement is high, Thaler said. The “shape” of recovery is also similar: People improve quickly early on, then their progress begins to slow. And while the severity of a stroke doesn’t typically change the shape of recovery, it does affect the extent to which a person will ultimately improve, he said—a person with a mild stroke may regain all their functions, while someone with a severe stroke, such as one that paralyzed them, may not ever recover completely.

“Recovery is different for every single person,” Moriello said.(What a fucking excuse for not knowing how to get survivors recovered! I'd have you fired for that defeatist attitude!)

The Exciting Frontier of Neuroplasticity: Innovations in Brain Health and Recovery

How can it be exciting if neuroplasticity is not repeatable on demand?

We don't SPECIFICALLY know why a neuron gives up its' current job and takes on a neighbors.  Thus nothing on neuroplasticity is scientifically repeatable on demand. So, DEMAND your doctor give you EXACT PROTOCOLS to use. Don't allow your doctor to give you generalities or guidelines. 

The latest here:

 The Exciting Frontier of Neuroplasticity: Innovations in Brain Health and Recovery

Rishabh Saha
Advanced Surgery Center, Rockville, MD, USA.
DOI: 10.4236/jbbs.2025.153003   PDF    HTML   XML   15 Downloads   96 Views  

Abstract

Neuroplasticity is the brain’s ability to reshape itself by constructing new neural connections throughout life, enabling adaptation to change, learning new information, and recovering from injuries. Neuroplasticity mechanisms underline a range of neurologic and psychiatric disorders, including Alzheimer’s disease, Parkinson’s disease, stroke, traumatic brain injury, depression, anxiety, and Schizophrenia. In any given year, approximately 20% of adult humans in the United States experience mental illness. The modification of structural and functional activities in the brain, encompassing synaptic plasticity, dendritic remodeling, neurogenesis, and shifts in neurotransmitter systems, significantly influence the progression of these diseases and the manifestation of their symptoms. Clinical trials evaluating therapeutics and biologics are crucial for advancing mental health care, while personalized medicine enhances treatment efficacy for individual patients. These developments hold substantial promise for improving mental health outcomes. Continued research into neuroplasticity is vital for the evolution of therapeutic strategies. This review delves into synaptic, structural, and functional plasticity and its impact on brain injury, neurodegenerative diseases, and psychiatric disorders.(This said absolutely NOTHING USEFUL!)

Revisiting the core principles of physical rehabilitation after stroke: It’s not only what you do but how you do it that matters

 I'm not wasting my time critiquing this. Suffice to say this is all still guidelines:NOT PROTOCOLS!

Revisiting the core principles of physical rehabilitation after stroke: It’s not only what you do but how you do it that matters

Rachel C Stockley https://orcid.org/0000-0003-4441-6860 rstockley1@uclan.ac.uk, Louise Clark, and Kate KellyView all authors and affiliations

OnlineFirst

https://doi.org/10.1177/03080226251330757

• Background
• Repetitive task practice and motor learning
• Conclusions and implications for research and practice
• Acknowledgments
• Research ethics
• Consent
• Declaration of conflicting interests
• Funding
• ORCID iD
• Data availability statement
• References

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Background

In the second of two linked editorials, we build on the discussion of interventions for motor rehabilitation after stroke recommended by the UK 2023 National Clinical Guidelines for Stroke (Royal College of Physicians, 2023). Specifically, we will explore the key elements of motor learning (Carr and Shepherd, 2000) which underpins repetitive task practice, one of two principal rehabilitation approaches (the other being exercise) recommended in the UK Guidelines for motor recovery.

Repetitive task practice, which appears synonymous to task-oriented training (French et al., 2016), can enable individuals with some activity in their upper-limb to actively practice movements and is informed by skilled movement analysis (as discussed in editorial 1). For patients with no activity or those who are unable to select or activate movement without significant assistance (apraxia, significant sensory loss, inattention(and most importantly spasticity!)), the approach would be different and so will not be explored in this editorial.(So, you're only working with the higher functioning survivors. There is this thing called: 'Leave no survivors behind! Don't you believe in that?)

You'll want 100% recovery when you are the 1 in 4 per WHO that has a stroke so, you better start working on it now. 

Repetitive task practice and motor learning

Repetitive task practice is frequently recognised as including many hundreds of repetitions of task or goal-oriented movements. Importantly, these repetitions are not identical but comprise incremental challenge and should be engaging to build on previous attempts to refine existing and generate new strategies for movement. This explicitly recognises that repetitive task practice requires a detailed understanding of how someone moves, rather than a sole focus on task completion, and an engaging environment conducive to intensive practice (Carr and Shepherd, 2000).

In addition to promoting a high number of repetitions, the motor learning theories that underpin repetitive task practice highlight that interventions should include five other key elements (Maier et al., 2019):

Specific – training should be goal-directed with clear parameters targeting the chosen element of movement. Ongoing skilled movement analysis enables the design of an exercise or a task set-up that directly links to an individual’s specific goals and function to ensure they are meaningful to each individual and that patients are motivated to practice intensively; accordingly, some goals can be targeted to achieve in a session, whilst others may span weeks or months.

Graded – the level of difficulty should be frequently altered so that individuals are continually challenged, yet it is possible to achieve a threshold of success. This adaptation may include altering accuracy requirements, distance reached or repetitions within a timeframe. Practice should be designed to restrict degrees of freedom and provide stability as required. Whilst therapists can use their hands to provide feedback and physical support, the ultimate aim is for the patient to practice independently and so configuring the environment (such as positioning against a wall) and use of external supports or devices to limit compensatory movements is ideal. Compensations can cause complications such as pain, non-use, contractures, may limit real-world arm use and are characterised by decreased movement speed, increased variability of the movement and a loss of spatial and temporal inter-joint coordination (Levin et al. 2009; Lum et al., 2009). Their presence is often indicative of an exercise or set-up needing alteration, muscle weakness or fatigue. In addition to configuring the environment to limit unwanted compensations, patients can use technologies that provide real-time feedback on movements, can be trained to govern their own movement patterns (e.g. using mirrors) or therapists can provide feedback and manual guidance.

Active – individuals should be actively engaged in their training and not rely upon passive assistance to move whenever possible. The majority of people after stroke will have some cognitive deficits in the first weeks and months after stroke and may need demonstration and physical, graded guidance at least initially, plus simple task set-ups and clear feedback (Lowder et al., 2022; Milosevich et al. 2024). If possible, the environment should be arranged so that an individual with stroke can undertake training with no, or limited assistance so they can practice frequently, outside of therapist delivered sessions. Enlisting the help of others (e.g. carers) may also facilitate practice. Whilst the rehabilitation environment can initially be adapted to enable function (e.g. using adapted cutlery), ultimately it should provide the spatial and temporal challenges of a real-world setting, (e.g. using cutlery in a busy restaurant).

Variable – in addition to titrating difficulty to maintain challenge, the training objects and goal should be varied to provide ‘flexibility’ of performance (such as varying plane or speed of movement). Movements can be practiced in their entirety or in parts which enable concentration upon a difficult part of a movement before being incorporated into a whole goal-oriented movement.

Feedback – clear feedback to highlight that a movement has been successful is vital to underpin learning and continued motivation. Feedback can be provided by therapists (i.e. video and verbal feedback) during the session using a coaching approach; however, attention and planning are required to ensure patients receive feedback intrinsically or environmentally when practicing outside of therapist-delivered sessions. This could be provided by carers, technology (e.g. virtual reality gaming, biofeedback or sensors) or by features included in the task set-up.

Conclusions and implications for research and practice

This editorial highlights that whilst completion of many repetitions of movements is important, inclusion of the other core principles of motor learning (comprising specific, graded, variable, active practice and the provision of feedback) is also needed to elicit motor recovery after stroke. This relies upon skilled movement analysis (discussed in our first editorial) to guide therapy planning and the provision of tailored support to actively engage patients in their own rehabilitation wherever possible. These approaches can also be augmented by adjuncts recommended in the guidelines, including electrical stimulation, mental imagery and mirror box (Royal College of Physicians, 2023).

We hope that these editorials provide occupational and physiotherapists with a succinct summary of the core principles which guide how the currently recommended rehabilitative interventions for motor recovery can be delivered to provide the greatest benefit for people after stroke. To ensure relevance to, and impact upon clinical practice, we recommend that future research of treatments for motor recovery after stroke must clearly articulate the principles upon which interventions are designed and how interventions were delivered (e.g. by using existing resources such as the TIDieR checklist and frameworks for recovery and dose; Bernhardt et al., 2017; Hoffmann et al., 2014). This clarity empowers therapists to accurately utilise effective interventions in clinical practice to provide the most favourable outcomes for the many thousands of people who require rehabilitation after stroke.

Acknowledgments

The authors would like to acknowledge Prof Nick Ward, Dr Kate Hayward and Dr Kathryn Jarvis for their comments on this work.

Revisiting the core principles of physical rehabilitation after stroke: Recapping the guidelines and underlining the importance of assessment

 Assessments are completely worthless unless they point directly to the 100% recovery protocols. I see nothing here that suggests you go from the assessment to the chosen 100% recovery protocol. When the hell will the stroke medical world do ANYTHING TO GET STROKE SOLVED? I'd have you all fired! A lot of dead wood needs to be removed in stroke and until that occurs stroke will never be solved!

Look how bad this is; NOT EVEN MEASURING 100% RECOVERY!

Are you that blitheringly stupid? 100% recovery is the only goal in stroke, if you don't measure that you'll never get there!

 You measure RESULTS AND RECOVERY! Not assessments! 

Revisiting the core principles of physical rehabilitation after stroke: Recapping the guidelines and underlining the importance of assessment

Rachel C Stockley https://orcid.org/0000-0003-4441-6860 rstockley1@uclan.ac.uk, Louise Clark, and Kate KellyView all authors and affiliations

https://doi.org/10.1177/03080226251330756

Background

Both the UK National Clinical Guideline for Stroke and the NICE Guideline for Stroke Rehabilitation in Adults were published in 2023 and provide an important resource for healthcare professionals working in the field of stroke rehabilitation (Intercollegiate Stroke Working Party, 2023; National Institute for Health and Care Excellence, 2023). These guidelines are based upon a substantial body of current evidence, reviewed and interpreted by groups of experts, and distilled into concise recommendations. Guidelines aim to improve patient care(NOT RECOVERY!) by summarising the evidence-base to empower healthcare professional and patient decisions about appropriate healthcare interventions but are not designed to provide rigid rules that dictate practice (Brouwers et al., 2010; Intercollegiate Stroke Working Party, 2023; Rethnam et al., 2021). Exact protocols to deliver the recommended interventions are not described in either NICE or UK National Clinical guidelines(THAT IS YOUR WHOLE FUCKING PROBLEM: NOT WRITING PROTOCOLS! Guidelines are fucking worthless! I'd fire all of you!); however, the guidelines do reference professional consensus documents and protocols to inform clinical implementation.

This is the first of two linked editorials in which we seek to complement the guidelines by focusing on the core principles that underpin several of the key interventions they recommend, to support their optimal delivery. In this first editorial, we will precis the guidelines’ recommendations for motor interventions after stroke, using upper limb rehabilitation as a critical example. We will then summarise some of the key elements of assessment, which forms the bedrock for goal setting and treatment selection. The second editorial will build on these discussions by drawing upon theories of motor learning and research from preclinical and clinical studies that inform how selected physical rehabilitation interventions for the upper limb after stroke can be delivered to provide maximal benefit.

Despite a clear focus on how, it is beyond the scope of these editorials to provide a step-by-step guide for specific interventions for clinicians. Nonetheless, we hope they will provide occupational and physiotherapists with a useful clinically relevant summary of the core principles that support the optimal delivery of recommended physical rehabilitative interventions for people after stroke.

What do the guidelines tell us?

Where robust research evidence of effectiveness is available, guidelines articulate the main elements of treatment (what), subtypes of presentation (who), location of therapy (where), the timeframe in which interventions are likely to be effective (when) and how much therapy (dose) may be beneficial. In addition to the much-discussed increase in the daily dose of therapy articulated in both guidelines, the 2023 National Clinical Guideline for Stroke has a large section dedicated to motor recovery, with a focus on exercise, motor retraining and repetitive task practice as the primary approach of targeted therapy. The guidelines recommend that rehabilitation services are needs-led, removing the time constraint to community stroke services, and reflect the significant time course of recovery. Methods to support personalised care(NOT RECOVERY!) and practice are particularly prominent in the UK National Clinical Guideline, including a focus on patient education, self-directed and semi-supervised practice where possible, as well as group work and telerehabilitation when appropriate. The recommendations acknowledge fatigue, patient activation and preference are crucial elements to be considered in designing treatment plans.

There are nine recommendations for the upper-limb based upon the current evidence base in the 2023 UK National Clinical Guideline (Intercollegiate Stroke Working Party, 2023). These include recommendations for use of repetitive task training, self-directed training, consideration of constraint-induced movement therapy, electrical stimulation, mental practice, mirror box for appropriate patients, and for the first time, a recommendation to consider transcutaneous vagal nerve stimulation for those with mild or moderate upper-limb weakness. Recommendations pertaining to sensation, shoulder pain and spasticity, which are all important features of upper-limb rehabilitation are also covered and remain largely unchanged from previous editions.

The importance of assessment(Boy are you wrong)

It is recognised that accurate assessment of impairment and function forms the bedrock of treatment planning. Skilled clinicians frequently begin by analysing movement, to identify impairments including musculoskeletal, neurological and non-motor limitations to function. Observation and physical assessment are used to guide reasoning of the cause of limits to range of movement, assess weakness and movement accuracy, smoothness, speed and pattern which will, in turn, direct treatment priorities. As we do not yet have readily available kinematic tools that can reliably assess motor control in clinical settings (Kwakkel et al., 2017), skilled therapists rely on skilled observation and physical assessment to guide detailed movement analysis. Particularly during the assessment, the clinicians use of their hands can provide valuable information about muscle activation (Bolognini et al., 2016). It may also give useful somatosensory input to the person with stroke, with afferent sensory information thought to enhance the person’s ability to activate muscles, although this has yet to be established empirically (Bolognini et al., 2016). The skilled analysis of movement enables prioritisation of the key components of movement to target to improve performance. In concert with individual’s goals, these data are vital to guide treatment selection, starting points and titrate the level of challenge.

We hope that this first editorial has provided a useful summary of some of the recommendations for motor recovery in the latest UK guidelines for stroke and highlighted the importance of several features of assessment that are vital to guide treatment. In the next editorial, we will consider the theories that underpin some of the recommended interventions from the guidelines and provide a summary of the core principles of motor rehabilitation which inform their optimal delivery.

American Heart Association program leads to substantial improvements in stroke care

 

This is the whole problem in stroke enumerated in one word; 'care'; NOT RECOVERY!

YOU have to get involved and change this failure mindset of 'care' to 100% RECOVERY! Survivors want RECOVERY, NOT 'CARE'!

I don't see progress in 100% recovery! I consider the AHA/ASA a complete fucking failure for not even attempting to solve stroke to 100% recovery!

ASK SURVIVORS WHAT THEY WANT, THEY'LL NEVER RESPOND 'CARE'! This tyranny of low expectations has to be completely rooted out of any stroke conversation!

RECOVERY IS THE ONLY GOAL IN STROKE! GET THERE!

American Heart Association program leads to substantial improvements in stroke care

For two decades now, the American Heart Association (AHA) Get With The Guidelines-Stroke program has been focused on improving stroke care(NOT RECOVERY! in the United States. Established in 2003, the initiative has contributed to a dramatic enhancement in adherence to evidence-based stroke treatment, leading to better patient outcomes, according to a recent study of data from 2003 to 2022 among stroke patients.

To learn more, Cardiovascular Business spoke with Gregg C. Fonarow, MD, director of the Ahmanson-UCLA Cardiomyopathy Center, co-director of UCLA's preventative cardiology program and the Eliot Corday Chair in Cardiovascular Medicine and Science at UCLA. He said the program has grown to include nearly 3,000 U.S. hospitals, capturing data on over 75% of all acute ischemic strokes.

"The rate of patients being treated we started off with was around 20%, and we rapidly got that up to over 75%. In hospitals, we started to treat acute ischemic stroke with high-intensity statin therapy for those with stroke of atherosclerotic origin. That started off in single digits and is up above 80% with discharge antiplatelet therapy ... and there was chronic undertreatment of atrial fibrillation with anticoagulation, and with the Get With the Guidelines-Stroke program, we were able to get to rates that previously had not been described, above 90% of eligible patients without contraindications being discharged on oral anticoagulation," Fonarow explained.

Rather than focusing on isolated aspects of care(NOT RECOVERY!, he said the initiative takes a comprehensive approach, improving early diagnosis, acute treatment, in-hospital secondary prevention measures and rehabilitation referrals. These efforts have transformed stroke care(NOT RECOVERY! on a scale and duration never seen before, Fonarow said.

Key findings for measurable and lasting stroke care(NOT RECOVERY! progress

The study assessed 43 well-validated quality measures over time. Remarkably, Fonarow said 41 of the 43 measures showed rapid and sustained improvement, demonstrating the effectiveness of the program’s interventions. This included faster treatment with intravenous thrombolytics, where the percentage of eligible patients receiving clot-busting treatment within the critical 60-minute window increased from 20% to more than 75%.

Reduced in-hospital mortality rates also declined significantly for acute ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage.

Addressing stroke treatment delays and disparities

While the program has driven significant progress, challenges remain, particularly in early stroke recognition and emergency response times. Delays in seeking care(NOT RECOVERY!, often due to a lack of symptom recognition, continue to be a concern.

“Every minute counts in stroke care(NOT RECOVERY!,” emphasized Fonarow. “Public awareness and swift emergency activation are crucial to improving outcomes.”

Additionally, disparities persist in treatment timing based on race, ethnicity, sex and age. Ongoing efforts focus on identifying and addressing these gaps through targeted interventions.

Fonarow said the sustained success of the Get With The Guidelines-Stroke program underscores the power of data-driven quality improvement.

“Providing hospitals with real-time feedback, setting clear benchmarks and sharing best practices have been instrumental in driving progress,” he explained.

Data to Real-World Impact: GWTG-Stroke Driving Two Decades of Sustained Improvement in Clinical Stroke Care

 

This is the whole problem in stroke enumerated in one word; 'care'; NOT RECOVERY!

YOU have to get involved and change this failure mindset of 'care' to 100% RECOVERY! Survivors want RECOVERY, NOT 'CARE'!

ASK SURVIVORS WHAT THEY WANT, THEY'LL NEVER RESPOND 'CARE'! This tyranny of low expectations has to be completely rooted out of any stroke conversation!

RECOVERY IS THE ONLY GOAL IN STROKE! GET THERE!

Data to Real-World Impact: GWTG-Stroke Driving Two Decades of Sustained Improvement in Clinical Stroke Care

• Chloe Mutimer , MD, BBMed , @drchloemutimer

Xian Y, Li S, Jiang T, Beon CD, Poudel R, Thomas K, Reeves MJ, Smith EE, Saver JL, Sheth KN, et al. Twenty Years of Sustained Improvement in Quality of Care and Outcomes for Patients Hospitalized With Stroke or Transient Ischemic Attack: Data From The Get With The Guidelines-Stroke Program. Stroke. 2024;55:2599–2610.

The Get With The Guidelines (GWTG)-Stroke program was established by the American Heart Association/American Stroke Association in 2003, to address the gap between evidence-based treatments and clinical practice. With now over >2800 participating sites, this dataset captures >75% of incident stroke in the United States. The GWTG-Stroke program has led to sustained improvements in quality care, leading to improved compliance with guidelines, the development of a nationwide stroke systems-of-care model, and promotion of local, national, and international quality improvement programs.¹ In a review by Xian et al. of the last two decades of data, they aimed to assess performance measures and clinical outcomes of patients who were admitted to participating sites with acute stroke (ischemic or hemorrhagic), subarachnoid hemorrhage, or transient ischemic attacks over the timeframe of the project. Data was reviewed from 7,837,849 patient records from hospitals who participate in the GTWG-Stroke program from April 2003 to December 2022. Several hyperacute, acute, and discharge quality metrics were assessed.

The impact of the GWTG-Stroke program on outcomes in ischemic stroke is summarized in Figure 2 of the article. The increasing adoption of thrombolysis as standard of care for eligible patients presenting in the hyperacute period (within 3.5 hours from symptom onset) was seen with rates increasing from 15.2% in 2003 to 92.9% in 2022. The time from presentation to thrombolysis administration also significantly improved with door-to-needle times of less than 60 minutes achieved in over 75% of patients in 2022. Since the advent of endovascular thrombectomy, data has been collected about door-to-puncture and door-to-reperfusion times since 2016. Modest improvements in door-to-puncture times over time were seen (54.7% in 2016 compared to 62.8% in 2022, aOR 1.03 [95%CI 1.01-1.05]) with significant improvement in time to reperfusion (aOR 1.19 [95%CI 1.14-1.24]). Rates of substantial reperfusion (defined as TICI2b-3) were also modestly improved (aOR 1.03 [95%CI 1.02-1.05]). Change in this rate likely reflects the expansion of thrombectomy criteria over time (up to 24 hours after 2018) and thus the complexity of the procedure.² Similarly, improvement in acute prescription of secondary prevention medication and strategies (antithrombotic or anticoagulation if atrial fibrillation detected, intensive statin therapy and smoking cessation advice) during admission was also seen (Supplementary Table S2). Despite significant improvement in hyperacute time metrics and subsequent acute care, a composite of in-hospital mortality and discharge to hospice remained relatively constant over time (aOR 1.01 [95%CI 1.00-1.01]). The authors attributed this to hyperacute therapies predominantly reducing disability, rather than necessarily improving mortality.

Figure 2. Temporal trends in acute ischemic stroke care over time.

For patients presenting with a transient ischemic attack, there was significant improvement in the use of early antithrombotic therapy, as well as discharge intensive statin therapy, smoking cessation and stroke education on discharge. Prescription of antithrombotic therapy at discharge remained similar over time, reflecting already high levels of compliance (>93%). The impact of these measures is difficult to ascertain from this dataset given the lack of long-term outcomes, such as recurrent event, reported.

No specific intervention for management of intracerebral or subarachnoid hemorrhage was reported, likely due to the lag in a strong evidence base for hyperacute management of these conditions. However, important safety measures were improved for both conditions, including rates of VTE prophylaxis and dysphagia screening, as well as access to rehabilitation. This was reflected in the in-hospital mortality rate for these conditions, which was reduced from 2003 to 2022.

This data supports the use of GTWG-Stroke as a nationwide quality improvement strategy that results in not only substantial improvement to patient care, but also sustained improvements over time. This study has shown that improvements in these quality metrics have translated to short-term benefit in patients in regard to length of stay and in-hospital mortality. While a limitation of this study is that it cannot exclude the influence of other quality improvement strategies on patient outcomes, it is unlikely that local or regional strategies would be able to influence care across the entirety of the US.

As outlined, GTWG-Stroke is an important nationwide registry and quality improvement project that helps support participating sites in the USA with access to up-to-date research, education opportunities, and quality improvement resources. However, as the landscape of stroke care continues to evolve, there are opportunities to further refine and expand the program’s scope to enhance its impact.

One key area for improvement is the inclusion of more comprehensive data collection for hemorrhagic stroke, particularly intracerebral hemorrhage and subarachnoid hemorrhage. There is a growing body of evidence to support disease-specific interventions — such as blood pressure control and anticoagulation reversal in ICH — and integrating these metrics could provide valuable insight into real-world application of these practices. For subarachnoid hemorrhages, rates of intervention (endovascular or neurosurgical) and complications such as delayed cerebral ischemia would enhance the program’s ability to inform best practice for this patient population.

Another important addition would be the inclusion of long-term patient outcomes. Understanding the impact of GWTG-Stroke beyond in-hospital care would provide a more complete picture of how these benefits translate into real-world benefit for stroke patients, as well as identify gaps where further intervention may be needed.

Risk of Recurrent Stroke After TIA or Minor Stroke Is High, 10% of Which May Be Fatal

 How is your competent? doctor GUARANTEEING NO STROKE after your current one?

Risk of Recurrent Stroke After TIA or Minor Stroke Is High, 10% of Which May Be Fatal

Within 10 years of experiencing a transient ischaemic attack (TIA) or minor stroke, approximately 1 in 5 patients were at risk of having another stroke and 10% of all subsequent stroke events were likely to be fatal, according to a systematic review and meta-analysis published in JAMA.

The annual risk of stroke decreased from 5.9% in the first year to an average of 1.8% per year thereafter. However, the cumulative risk of stroke continued to increase over time. Notably, half of all subsequent strokes occurred after the first year.

“This risk of subsequent stroke events is high but is not readily apparent in routine clinical practice due to its gradual onset over time,” wrote Faizan Khan, PhD, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, and colleagues. “Given that many secondary prevention clinics only monitor patients for the first 90 days, with long-term preventive care often transitioning to primary care physicians and internists, the current findings emphasise the importance of ongoing vigilant monitoring and risk reduction strategies beyond the initial high-risk period.”

The analysis involved 171,068 patients from 38 studies. The patient population consisted of TIA or minor stroke in 17 studies, TIA only in 20 studies, and minor stroke only in 1 study. There were 24 studies that reported the primary outcome of stroke beyond 1 year of follow-up, 12 studies that reported stroke beyond 5 years of follow-up, and 10 studies that reported stroke up to 10 years of follow-up

The pooled rate of stroke per 100 person-years was 5.94 events (38 studies; I2 = 97%) in the first year; 1.80 events (25 studies; I2 = 90%) annually in the second through fifth years; and 1.72 events (12 studies; I2 = 84%) annually in the sixth through tenth years.

Based on an analysis of 32 included studies with data available for the first 90 days, and day 91 through 365 separately, 2,932 of 4,749 (61.7%) subsequent stroke events in the first year occurred within the initial 90 days. The pooled rate of stroke per 100 person-years was 16.09 events in the first 90 days and 3.04 events between 91 and 365 days.

Among the 10 included studies with a maximum follow-up duration of 10 years, 1,707 of 3,390 (50.4%) subsequent stroke events occurred after the first year. The 5- and 10-year cumulative incidences of stroke were 12.5% and 19.8%, respectively.

Based on an analysis of 17 included studies with data available on both fatal stroke (n = 269) and any stroke (n = 2,737), the pooled case-fatality rate of subsequent stroke was 10.4%.

Stroke rates were higher in studies conducted in North America and Asia compared with Europe, in cohorts recruited in or after 2007, and in studies that used active versus passive outcome ascertainment methods. According to the authors, the fact that the risk of subsequent stroke after a TIA or minor stroke appears to have increased in the modern era deserves attention and further research.

“Patients who have had a TIA or minor stroke are at a persistently high risk of experiencing a subsequent stroke,” the authors concluded. “TIA or minor stroke events also portend a significant risk of long-term disability and death. Findings from this study underscore the need for improving long-term stroke prevention measures in this patient population.”

Reference: https://jamanetwork.com/journals/jama/fullarticle/2832005

SOURCE: JAMA

Medtronic inks stroke AI partnership with European developer Methinks

 You'll notice that they are working on stroke 'care' tools; NOT RECOVERY! That is the fucking incompetent state of stroke leadership!

Medtronic inks stroke AI partnership with European developer Methinks

                         By Conor HaleApr 2, 2025 11:54am

Medtronic stroke Artificial Intelligence digital imaging

Medtronic said its goal is to help streamline the triage process and care(NOT RECOVERY!) coordination, starting in stroke centers and regional hospitals across Central and Eastern Europe, Africa, Türkiye and the Middle East. (iStock / Getty Images Plus)

Medtronic has inked a neurovascular partnership with Methinks AI, a Barcelona, Spain-based developer of programs to detect and alert providers of strokes from patient imaging scans. 

The medtech giant plans to integrate Methinks AI’s apps with its portfolio of ischemic stroke treatment hardware, including blood clot aspiration systems and stent-based retrievers. 

The company said its goal is to help streamline the triage process and care(NOT RECOVERY!) coordination, starting in stroke centers and regional hospitals across Central and Eastern Europe, Africa, Türkiye and the Middle East. The financial terms of the partnership were not disclosed. 

“This partnership reinforces our commitment to support healthcare professionals with advanced stroke care(NOT RECOVERY!) tools, ensuring faster and more effective treatment for patients across the region and transforming stroke care(NOT RECOVERY!) by combining breakthrough AI assessment with world-class medical device solutions,” Maria Zvereva, Medtronic’s neurovascular strategic marketing leader for the CEMA region, said in a statement.

Related

RapidAI racks up $75M for software to spot strokes, aneurysms

Methinks’ CE-marked software is designed to spot large vessel occlusions and intracranial hemorrhages from standard, non-contrast CT scans, and works with Microsoft Teams and the cloud to notify healthcare providers with real-time alerts. 

According to Medtronic, this allows providers who may not have access to advanced imaging equipment to reduce delays in stroke therapy, where time is essential.

“We are honored to collaborate with Medtronic, a company that shares our commitment to increasing the number of stroke treatments available to those that urgently need them,” said Methinks CEO Pau Rodríguez. “Together, we aim to bring our AI-driven solutions to more hospitals to benefit from early triage and efficient coordination.” 

Medtronic previously signed up to distribute stroke-spotting software from Viz.ai in 2019, which links with CT scanners to spot large vessel occlusions. 

Novel Blood Test Tracks Alzheimer's Progression

 

With your chances of getting dementia post stroke, your competent? doctor needs to be testing this for a baseline and providing EXACT dementia prevention solutions. 

 You will likely need them, so ask your incompetent doctor why they don't exist!

Check out how many years your doctor has had to prepare dementia prevention protocols! Incompetence in inaction! No excuses allowed! 

With your extra risk of dementia your competent? doctor needs to find prevention solutions! Is your doctor even working on that? NO? So, your doctor is in the process of being fired? 

1. A documented 33% dementia chance post-stroke from an Australian study?   May 2012.

2. Then this study came out and seems to have a range from 17-66%. December 2013.`    

3. A 20% chance in this research.   July 2013.

4. Dementia Risk Doubled in Patients Following Stroke September 2018  

The latest here:

Novel Blood Test Tracks Alzheimer's Progression

      MTBR-tau243 biomarker linked with tau PET and cognitive performance

by Judy George, Deputy Managing Editor, MedPage Today April 1, 2025

Key Takeaways

• A new blood-based test reflected Alzheimer's tau tangle pathology.
• The assay measured a new plasma tau species known as endogenously cleaved MTBR-tau243.
• The test distinguished various stages of Alzheimer's and separated it from non-Alzheimer's tauopathies.

A novel plasma-based assay was more strongly associated with tau tangle pathology in Alzheimer's disease than other established blood biomarkers, researchers said.

The assay measured a new plasma tau species known as endogenously cleaved, microtubule-binding region containing residue 243 (MTBR-tau243), which specifically reflected tau tangle pathology, reported Randall Bateman, MD, of Washington University School of Medicine in St. Louis, and co-authors.

Plasma MTBR-tau243 was associated with tau PET binding (β=0.72, R²=0.56) and cognitive performance (β=0.60, R²=0.40), outperforming other markers like phosphorylated tau 217 (p-tau217) and p-tau205, Bateman and colleagues said in Nature Medicine.

The assay was tested in three cohorts. It distinguished between early- versus later-stage Alzheimer's disease and separated Alzheimer's disease from non-Alzheimer's tauopathies.

The results suggested that plasma MTBR-tau243 could help estimate the tauopathy load in Alzheimer's disease, improving diagnostic evaluations of Alzheimer's in clinical practice and monitoring the efficacy of tau-targeted therapies in clinical trials, the researchers noted.

"This blood test clearly identifies Alzheimer's tau tangles, which is our best biomarker measure of Alzheimer's symptoms and dementia," Bateman said in a statement. The test also provides a good indication about whether a patient's symptoms are due to Alzheimer's or another disorder, he noted.

Insoluble tau aggregates within neurofibrillary tangles are a defining feature of Alzheimer's disease and closely correlate with clinical symptoms. In earlier research, Bateman and colleagues showed that the MTBR-tau243 in cerebrospinal fluid (CSF) was a specific biomarker of tau aggregate pathology. The current study extended this analysis to plasma.

The researchers tested the assay in two pilot cohorts: a sample of 55 people in the Knight Alzheimer Disease Research Center(ADRC) at Washington University, and a group of 108 people from the Swedish BioFINDER-2 cohort. They validated the assay in a larger cohort of 739 people from the Swedish BioFINDER-2 study.

In both pilot cohorts, plasma MTBR-tau243 levels were significantly increased in Alzheimer's disease dementia compared with mild cognitive impairment or very mild Alzheimer's dementia. Plasma MTBR-tau243 levels also were strongly correlated with CSF levels in the BioFINDER-2 (Spearman's ρ=0.92, P<0.001) and the Knight ADRC (Spearman's ρ=0.79, P<0.001) groups.

The validation cohort included people with Alzheimer's disease, Parkinson's disease, Lewy body dementia, progressive supranuclear palsy (PSP) or corticobasal syndrome (CBS), vascular dementia, frontotemporal dementia (FTD), and others. Plasma MTBR-tau243 levels were not elevated in non-Alzheimer's tauopathies; levels in people with PSP or CBS and FTD were similar to those in controls.

Among amyloid-positive participants, plasma MTBR-tau243 consistently demonstrated a significantly higher area under the curve (AUC) compared with p-tau217 and p-tau205 across nearly all tau PET regions. Plasma p-tau217, however, outperformed MTBR-tau243 (AUC 0.97 vs 0.80) in predicting amyloid positivity across all participants.

"I believe we will use blood-based p-tau217 to determine whether an individual has Alzheimer's disease, but MTBR-tau243 will be a highly valuable complement in both clinical settings and research trials," noted co-author Oskar Hansson, MD, PhD, of Lund University in Sweden.

"When both of these biomarkers are positive, the likelihood that Alzheimer's is the underlying cause of a person's cognitive symptoms increases significantly, compared to when only p-tau217 is abnormal," he said. "This distinction is crucial for selecting the most appropriate treatment for each patient."

Study limitations include the relatively large volume of plasma (1.5 ml) needed for this first version of the MTBR-tau243 assay, Bateman and co-authors said. Plasma MTBR-tau243 should be further validated in larger populations, including people with higher frequencies of other neurodegenerative or psychiatric diseases, medical comorbidities, and those with a wider range of race and ethnicity.

• Judy George covers neurology and neuroscience news for MedPage Today, writing about brain aging, Alzheimer’s, dementia, MS, rare diseases, epilepsy, autism, headache, stroke, Parkinson’s, ALS, concussion, CTE, sleep, pain, and more. Follow

Disclosures

This work was supported by the Charles F. and Joanne Knight Alzheimer Disease Research Center, the Tracy Family SILQ Center, the National Institutes of Health, the Hope Center for Neurological Disorders, the Department of Neurology at the Washington University School of Medicine, and a Zenith award.

Bateman reported being an unpaid scientific advisory board member of Roche and Biogen, and received research funding from Avid Radiopharmaceuticals, Janssen, Roche or Genentech, Eli Lilly, Eisai, Biogen, AbbVie, Bristol Myers Squibb, and Novartis.

Co-authors reported relationships with nonprofit groups, pharmaceutical companies, and other entities. Hansson also is a part-time remote employee of Eli Lilly.

Primary Source

Nature Medicine

Source Reference: Horie K, et al "Plasma MTBR-tau243 biomarker identifies tau tangle pathology in Alzheimer's disease" Nat Med 2025; DOI: 10.1038/s41591-025-03617-7.

Aspirus Ironwood Hospital earns honors for quality of stroke patient care

This is the whole problem in stroke enumerated in one word; 'care'; NOT RECOVERY!

YOU have to get involved and change this failure mindset of 'care' to 100% RECOVERY! Survivors want RECOVERY, NOT 'CARE'!

ASK SURVIVORS WHAT THEY WANT, THEY'LL NEVER RESPOND 'CARE'! This tyranny of low expectations has to be completely rooted out of any stroke conversation!

RECOVERY IS THE ONLY GOAL IN STROKE! GET THERE!

Aspirus Ironwood Hospital earns honors for quality of stroke patient care

IRONWOOD, Mich. (WBUP/WJMN) — The Aspirus Ironwood Hospital has earned a high-level certification for readiness in the case of an acute stroke after rigorous on-site review.

This is The Joint Commission's Gold Seal of Approval and the American Stroke Association's (ASA) Heart-Check Mark for Acute Stroke Ready Certification. 

Review of the hospital was held in July. During the visit, a team of joint commission reviewers conducted observations and interviews, evaluating the hospital's compliance with related certifications standards including program management, process for delivering clinical care and performance improvement. 

“Acute Stroke Ready Certification recognizes a health care organization committed to striving for excellence and fostering continuous improvement in patient safety and quality of care,” said Ken Grubbs, executive vice president of Accreditation and Certification Operations and chief nursing officer with The Joint Commission.

“We commend Aspirus Ironwood Hospital for using The Joint Commission certification process to reduce variation in clinical processes and to strengthen its clinical program to drive safer, higher quality, and more compassionate care for individuals served," Grubbs added.

CEO of ASA Nancy Brown congratulated the hospital for the "outstanding achievement." 

"This certification reflects the hospital’s commitment to providing the highest quality of care for stroke patients," Brown said. 

"Achieving Acute Stroke Ready Certification is a remarkable accomplishment," said Julie Monville, director of nursing for Aspirus Health. "I am incredibly proud of our dedicated team of staff and physicians who work tirelessly to deliver lifesaving education and treatment to our community. Our Stroke Team remains committed to educating both our patients and the public on stroke recognition, as well as providing timely, evidence-based stroke care in accordance with best practices and guidelines."

The hospital's chief administrative officer, Rae Kaare, called the certification a "significant milestone" for Aspirus Health. 

Aspirus Health encourages everyone to use BE FAST to recognize the signs of a stroke:

• Balance; sudden loss of coordination
• Eyes; sudden change in vision
• Face; sudden weakness on one side or facial droop
• Arm; sudden arm or leg numbness or weakness
• Speech; sudden slurred speech
• Terrible Headache or Time to call 9-1-1

Pharmacogenetics polygenic response score predicts outcomes in aspirin-treated stroke patients

 Will your competent? doctor use this to predict the usefulness of aspirin in preventing the next stroke?

Pharmacogenetics polygenic response score predicts outcomes in aspirin-treated stroke patients

Rui-Nan Ma1†, Dong Zhang1†, Zhi-Zhang Li1†, Ying Ding1, Xiao-Guang Zhang1, Jie Xue1, Dan-Zhuoma Ci1, Yue-Ying Bai2, Liang Hu1*, Dai-Zhan Zhou1* and Yun-Hua Yue1*

1Department of Neurology, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China

2Biology Department, Boston College, Chestnut Hill, MA, United States

Edited by:

Farhad Kamali, Newcastle University, United Kingdom

Reviewed by:

Andy R. Eugene, Larned State Hospital, United States

Katy Sanchez-Pozos, Hospital Juárez de México, Mexico

* Correspondence: Liang Hu, 13585696649@163.com; Dai-Zhan Zhou, zhoudaizhan@163.com; Yun-Hua Yue, Yunhua.Yue@tongji.edu.cn

†These authors have contributed equally to this work and share first authorship

Received: 29 October 2024

Accepted: 19 February 2025

Published: 01 April 2025

Citation: Ma R-N, Zhang D, Li Z-Z, Ding Y, Zhang X-G, Xue J, Ci D-Z, Bai Y-Y, Hu L, Zhou D-Z and Yue Y-H (2025) Pharmacogenetics polygenic response score predicts outcomes in aspirin-treated stroke patients. Front. Pharmacol. 16:1519383. doi: 10.3389/fphar.2025.1519383

Background: 

Aspirin is a cornerstone medication for acute ischemic stroke (AIS), but its efficacy varies significantly among individuals. This study aimed to develop a pharmacogenetic polygenic response score (PgxRS) to predict the incidence of adverse outcomes in aspirin-treated AIS patients.

Methods: 

We conducted a retrospective study involving 828 AIS patients who received aspirin therapy. Fifteen candidate single nucleotide variants (SNPs) in genes related to aspirin’s mechanism of action, transport, metabolism, and platelet function were genotyped. The association between SNPs and the risk of unfavorable prognosis (defined as modified Rankin Scale score >1 at 90 days) was assessed using logistic regression analysis. Multivariable models incorporating SNPs and clinical factors were developed to predict adverse outcomes.

Results: 

The rs1045642GG genotype in the ABCB1 gene was significantly associated with a lower risk of unfavorable prognosis, while the rs1371097T allele in the P2Y1 gene was linked to a higher risk. A prediction model incorporating these two SNPs along with clinical variables demonstrated moderate diagnostic accuracy for predicting unfavorable prognosis (AUC = 0.78, 95% CI: 0.74–0.81).

Conclusion: 

Our findings suggest that rs1045642 and rs1371097 genotypes contribute to variability in aspirin response among AIS patients. The developed PgxRS, incorporating these SNPs and clinical factors, can potentially aid in risk stratification and guide personalized antiplatelet therapy decisions. However, further validation in larger, diverse cohorts is warranted.

More at link.