Stroke Awareness Month, observed each May, is intended to increase public and clinician awareness of stroke prevention, early recognition, and timely intervention for a condition that remains a leading cause of long-term disability and mortality.1,2 Campaigns during the month emphasize education around modifiable vascular risk factors, including hypertension, diabetes, smoking, obesity, and atrial fibrillation, as well as rapid identification of symptoms using the B.E. F.A.S.T. framework (Balance loss, Eye changes, Face drooping, Arm weakness, Speech difficulty, Time to call 911).2,3 The observance also highlights secondary prevention strategies, with estimates suggesting that up to 80% of strokes may be preventable through risk-factor modification and evidence-based cardiovascular care.1 Rehabilitation care is another key focus of the awareness month.
To highlight ongoing priorities in stroke awareness, prevention, and recovery, NeurologyLive® sat down with Andrew Abdou, DO, attending physician of neurorehabilitation at Burke Rehabilitation Hospital. The discussion revolved around the evolving landscape of stroke rehabilitation and emerging therapeutic innovations aimed at improving long-term outcomes for survivors.
In the conversation, Abdou highlighted the importance of raising awareness around stroke prevention, recurrent stroke risk, and the often-overlooked challenges patients and caregivers face after hospital discharge. He emphasized the critical role of neuroplasticity, continuity of care, and lifestyle interventions in optimizing recovery. Abdul also detailed several novel rehabilitation approaches, underscoring growing optimism around technologies that may help patients continue making functional gains even years after a stroke.
NeurologyLive: What is the importance of Stroke Awareness Month, and what significance does it hold for individuals at risk of stroke or those who have already experienced one?
Andrew Adbou, DO: This is an important time of year to recognize stroke survivors and the real day‑to‑day challenges they face, and to learn more about what the overall quality of life looks like for them. We want to raise awareness not only about those challenges, but also about prevention, especially reducing the risk of the first stroke and the risk of recurrent strokes among stroke survivors.
Beyond that, we want to highlight the importance of early treatment and ongoing rehab. Often, what we see with stroke survivors is feeling overwhelmed, feeling lost, and it’s important for them to know that there is a place they can go, a place where they can come to continue to heal, whether it be months after the stroke or years after the stroke. We also want to have a place for their caregivers, their families, their loved ones, to better understand how to support these survivors through this very critical time when they’re healing.
Are there any new therapeutic agents for stroke that clinicians should be aware of?
Especially here at Burke Rehab, there are a growing number of clinical trials that are focused specifically on stroke recovery. I'm a principal investigator on the Brain Q clinical trial (NCT06386874) which is a non‑invasive brain stimulation. In addition, there are our Vivistim options in the outpatient setting. It’s a program where patients have an implanted device to help with upper limb recovery through vagal nerve stimulation, and this is a great opportunity for patients in the chronic stroke phase to continue to recover even after they've been told they've plateaued or there will be limited to no recovery in those chronic years. There’s now a chance for them to continue to recover, whether it be through our current clinical trials or through their stim program as well.
In addition, there are advances in spasticity management that we're implementing. Often, the mainstay of intervention would be oral medications or botulinum toxin injections. We also have cryoneurolysis, which is one of the emerging treatment strategies for spasticity after stroke, with more immediate and longer‑lasting effects. There are a lot of exciting stuff that’s currently happening, and we really have options for those in the chronic phase to continue to recover and get stronger.
How can clinicians optimize stroke care or rehabilitation for some of these patients?
The core of recovery after stroke is neuroplasticity, and it's really about how we get more hours in the day or time in the week to continue with this repetition. We address this in the outpatient setting, but also with well-organized home exercise programs, and by having good continuity of care over the long term to ensure that patients are maintaining both repetition and continuity of their stroke recovery program in therapy.
What’s great is that because we have inpatient rehab and outpatient rehab, we can really track these patients. I see my patients from day one of their inpatient rehab all throughout their stay on inpatient, and then continue to see them in the outpatient setting. So, we’re monitoring these patients closely and maintaining continuity of care, because those first 3-, 6-, and 12-month windows are where the highest rate of recovery occurs, and we want to optimize that as much as we possibly can.
Ways we can optimize outside of direct therapy, in addition to some of the emerging technologies we mentioned, include lifestyle medicine. I myself am certified in lifestyle medicine. It’s an emerging field, but it relies on the core tenets of health: nutrition, exercise, sleep, avoiding risky substances, as well as mental health, and ensuring that patients have strong relationships with their family, friends, and community. If we can optimize all of these, it helps make for better recovery overall and a better quality of life.
What is your perspective on the role of exercise and broader lifestyle changes in supporting recovery after stroke?
There are many mechanisms as to why lifestyle changes support recovery. There is the overall health piece: having better cardiovascular health and minimizing other risk factors such as diabetes and high cholesterol. That in itself confers a better prognostic outcome and helps with stroke prevention.
That’s one pathway, but then you also have neuroplastic pathways that are enhanced. Exercise alone is known to release certain neurotrophic factors, such as brain‑derived neurotrophic factor, which can help enhance neurorecovery. The repetition of exercise improves plasticity as well, because that repetition of the exercise itself is a pathway of neurorecovery. Through all these different mechanisms, it amounts to improved function and overall health status.
Are there any new pathways to treat stroke that are currently being studied?
I want to talk a little bit more about some of the novel interventions, devices, and clinical trials that we're doing here at Burke. Again, I'm the principal investigator on Brain Q, which is our EMAGINE trial. It uses non‑invasive brain stimulation—Brain Q—for patients to recover. We're doing trials in both acute and chronic stroke. Patients wear a device that they’ll use about 45 minutes a day, 3 to 5 days a week, along with a tablet of guided exercises. The idea is that this will enhance their neurorecovery, even in the chronic phase. It's really exciting that we get to be part of this clinical trial, and we're really hoping for it to become more commonplace. Often, patients do their rounds of therapy, and when they’re in this chronic phase, the recovery slows down. We want to jumpstart that recovery and give them an opportunity to continue to make gains.
The other device I mentioned previously was Vivistim. This is a vagal nerve stimulation implanted device that patients can turn on and off while they’re in therapy, doing a structured program with our occupational therapists for upper limb recovery. We’re seeing patients who had not made gains in years start making gains again, and that is huge. You can think of it as sparking a match to get that recovery going again and reactivating those pathways. It’s exciting, both for stroke patients with ischemic strokes and for what we hope to continue with in future clinical trials.
What are some technological advances in the stroke field that are exciting to you?
What’s exciting to me is the field of non‑invasive brain stimulation with all the emerging technologies. Non‑invasive brain stimulation can range from transcranial magnetic stimulation to transcranial direct current stimulation.
In fact, there is another trial at Burke that we're doing for patients with aphasia, utilizing transcranial direct current stimulation. I think this is a field that’s really emerging in many different areas of rehab, whether it be stroke, brain injury, spinal cord injury, or pain management.
These non‑invasive approaches and the broader field of neuromodulation are very exciting. Patients are often overloaded with oral medications and have gone through many rounds of therapy. They’re really looking for something new, something novel, something different, ways to jumpstart their recovery after months or years of slow progress. I think this is a really exciting opportunity.
Beyond that, as I alluded to earlier with our other treatments for spasticity: the mainstay currently is chemo‑denervation with botulinum toxin or implanted baclofen pump devices. Cryoneurolysis is one of the newer, novel treatments that we provide here at Burke. It has immediate effects and lasts twice as long as botulinum, and for some patients that really opens up a lot of options for managing their spasticity.
What gives you the most optimism in the Stroke field?
Greater access to these innovative therapies and clinical trials for patients is really an exciting thing. I can't tell you how many times I have patients who have gone from facility to facility, looking for more. These are motivated people with simple goals. For example, patients with their Vivistim device, some patients all they want to do is hug their spouse again or hold their grandchild, and these devices can help them do that.
It’s also about our ability, as a community here, to increase empowerment and education for caregivers and patients alike and to let them know what opportunities they have. It doesn't just end after discharge from the hospital. There is a community. There is an opportunity for everyone here to make gains, to grow, and to improve their quality of life. That makes me proud to be at an institution like Burke, leading those advancements while maintaining patient‑centered care.
Transcript edited for clarity.
