Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Monday, July 13, 2026

Subtype-specific optimal cut-off values of the Berg Balance Scale for predicting independent walking in inpatient stroke rehabilitation: a multicentre cohort study

 I consider the Berg Balance Scale ABSOLUTELY USELESS! There are NO protocols to address any failure points in it! Testing with no interventions available DOES NOTHING TO GET SURVIVORS RECOVERED! And you haven't figured that out yet?

Subtype-specific optimal cut-off values of the Berg Balance Scale for predicting independent walking in inpatient stroke rehabilitation: a multicentre cohort study

DOI:

https://doi.org/10.2340/jrm.v58.45663

Keywords:

balance, Berg Balance Scale, gait, prediction, rehabilitation, stroke

Abstract

Objective: To determine whether admission Berg Balance Scale score independently predicts independent walking on discharge after adjustment for major confounders, and to derive subtype-specific optimal cut-off values for ischaemic and haemorrhagic stroke.

Design: Multicentre retrospective cohort study.

Subjects/Patients: A total of 565 stroke patients (316 ischaemic, 249 haemorrhagic) admitted to 3 inpatient rehabilitation centres in the Republic of Korea.

Methods: Multivariable logistic regression was used to evaluate the independent predictive value of the Berg Balance Scale. Optimal cut-off values were derived using receiver operating characteristic curve analysis and the Youden index. Bootstrap internal validation, calibration analysis, and decision curve analysis were performed.

Results: Admission Berg Balance Scale was a significant independent predictor of independent walking (adjusted odds ratio 1.053, 95% confidence interval 1.030–1.076). The difference in discriminative ability between the Berg Balance Scale only and multivariable models was not statistically significant (p = 0.097). The overall optimal cut-off was 24 points; subtype-specific cut-offs were 33 for ischaemic and 12 for haemorrhagic stroke.

Conclusion: The Berg Balance Scale has different optimal cut-off values by stroke subtype and, as a standalone assessment, maintains discriminative ability equivalent to a multivariable model, providing clinical evidence for subtype-specific precision rehabilitation strategies.

Low Vitamin C Levels Linked to Poorer Brain Health in Older Adults

 

Has your competent? doctor ensured that the dietician has created the proper Vitamin C protocol at the hospital and for home use? NO? So, you DON'T have a functioning stroke doctor, do you?

Low Vitamin C Levels Linked to Poorer Brain Health in Older Adults


  • A new study found that older adults with lower vitamin C levels showed signs of poorer cognitive function.
  • Vitamin C may support brain health by protecting brain cells from oxidative stress and helping them communicate more effectively.
  • While the study only found an association, experts say vitamin C-rich foods can be part of a brain-healthy diet.

You might associate vitamin C with immune system support, but new research suggests it may play a key role in brain health. The study, published in PLOS One, found that older adults with lower vitamin C levels showed brain changes associated with cognitive decline.1

Exploring the Link Between Vitamin C and Brain Health

Previous studies have linked diets rich in vitamin C to a lower risk of cognitive decline.2 But little research has measured vitamin C levels in participants’ blood, and no studies have explored whether vitamin C levels affect the default mode network (DMN), a network of brain regions involved in internal thought processes such as memory and self-reflection.3

Declines in DMN connectivity have been linked to neurological conditions, including mild cognitive impairment, Alzheimer’s disease, and Parkinson’s disease.45

In the new study, researchers gathered data from about 2,000 Japanese adults aged 65 and older. Participants had MRI scans to measure their DMN connectivity and brain structure, including gray matter, white matter, and total brain volume. Researchers compared the results with vitamin C levels in participants’ blood samples.

People with lower vitamin C levels tended to have reduced DMN connectivity and less gray matter, which plays a key role in memory, decision-making, and other everyday functions.6

“Decreased gray matter and lower DMN connectivity are closely linked to age-related cognitive decline and are early signs of conditions like Alzheimer’s disease,” explained study author Tomohiro Shintaku, MD, PhD, an assistant professor of radiology at Hirosaki University Graduate School of Medicine.

The link between low vitamin C levels and signs of cognitive decline held true even after accounting for factors such as age, education level, lifestyle, and conditions like diabetes and hypertension. However, the research only found an association, not a cause-and-effect relationship, Shintaku told Health.

He also noted that the study relied on a single blood draw from each participant, which may not reflect long-term vitamin C levels. And while the researchers controlled for many variables, they did not account for factors like BMI and socioeconomic status that could influence the results.

Why Might Vitamin C Support Brain Function?

Vitamin C acts as an antioxidant throughout the body, helping neutralize free radicals that contribute to oxidative stress and inflammation. “The brain is highly vulnerable to oxidative stress, and vitamin C’s potent antioxidant properties likely help protect neurons from damage,” Shintaku said.

Lynette Gogol, DO, a board-certified neurologist and lifestyle medicine physician, who was not affiliated with the study, also noted that vitamin C helps enzymes carry out important functions in the brain and may support communication between brain cells, which could improve cognitive function.7

Although, Gogol told Health that many mechanisms could be behind vitamin C’s link to brain health, and further research may shed more light on the connection.

Should You Up Your Vitamin C Intake for Brain Health?

While the new study can’t prove that vitamin C protects brain health directly, experts said foods rich in vitamin C can contribute to a brain-healthy diet—and a nutritious diet overall.

The recommended daily intake of vitamin C for adults is 90 milligrams (mg) for men and 74 mg for women.8 “Most people can get enough vitamin C through their diet, as long as they eat a variety of fruits and vegetables,” Anne Danahy, MS, RDN, an Arizona-based dietitian and founder of Craving Something Healthy, told Health.

However, older adults are more likely to have insufficient vitamin C levels, Danahy said, since aging bodies absorb the nutrient less efficiently. People with certain conditions, such as diabetes, heart disease, or cancer, may also want to aim for a higher amount of vitamin C.

Danahy recommended citrus fruits, sweet peppers, kiwi, strawberries, broccoli, and Brussels sprouts as excellent sources of vitamin C. If you’re considering a vitamin C supplement, Danahy advised taking less than the safe upper limit of 2,000 mg per day.

“It’s in a wide range of fruits and vegetables,” Danahy added, “so the best way to cover your needs is to eat a few servings of fruits and vegetables each day.”

The Protein Threshold: Where Longevity Benefits Stop Climbing by Super Age

 Has your competent? doctor ensured that the dietician has created the proper protein protocol at the hospital and for home use? NO? So, you DON'T have a functioning stroke doctor, do you?

The Protein Threshold: Where Longevity Benefits Stop Climbing

Dexterity Test You Can Use for Stroke Patients

 Watching this; unless your are a high functioning stroke patient you will fail. I would fail at the reaching part due to spasticity, fail at hand opening due to spasticity, completely fail the whole test!

SO DEMAND YOUR THERAPIST CURE YOUR SPASTICITY FIRST!

Dexterity Test You Can Use for Stroke Patients

High-intensity interval training after stroke: a three-level random-effects meta-analysis with cluster-robust inference and exploratory dose-parameter signals

 

Did they sign a waiver acknowledging the risk of stroke from HIT?

Do you really want to do high intensity training?

Because Andrew Marr blames high-intensity training for his stroke. 

Can too much exercise cause a stroke?

The latest here:

High-intensity interval training after stroke: a three-level random-effects meta-analysis with cluster-robust inference and exploratory dose-parameter signals


  • 1. Department of Physical Education, Chengdu College of University of Electronic Science and Technology of China, Chengdu, China

  • 2. Faculty of Sport and Physical Education, University of Belgrade, Belgrade, Serbia

Abstract

Objective: 

To estimate the effects of high-intensity interval training (HIIT) on balance, walking outcomes, and physiological endpoints after stroke, and to generate hypotheses about whether training-load parameters may explain variability in intervention effects.

Methods: 

We searched PubMed, Web of Science, Embase, Scopus, and the Cochrane Library from inception to December 31, 2025, for English-language randomized controlled trials of HIIT in post-stroke populations. Two reviewers independently screened records and extracted data. Risk of bias was assessed using RoB 2, and certainty of evidence was assessed using GRADE. Effect sizes were calculated as Hedges' g using between-group change scores. When change-score standard deviations were unavailable, they were imputed using a pre–post correlation of r = 0.5, with sensitivity analyses varying r. Effects were pooled using three-level random-effects models to accommodate dependent effect sizes. Statistical inference, including 95% confidence intervals and p-values, was based on cluster-robust variance estimation with small-sample correction. Meta-regression and subgroup analyses were conducted as exploratory, hypothesis-generating analyses of heterogeneity rather than confirmatory tests of training-load effects. The protocol was registered in PROSPERO (CRD42027809778).

Results: 

Fourteen trials involving 717 participants were included. Pooled estimates suggested that HIIT may improve balance, as measured by the Berg Balance Scale, although the effect was small and the certainty of evidence was low (ES = 0.20, 95% CI 0.01 to 0.39, p = 0.039). HIIT may also improve walking endurance, as measured by the 6-min walk test, but the certainty of evidence was very low (ES = 0.41, 95% CI 0.22 to 0.61, p < 0.001). No statistically significant effect was observed for 10-meter walk test time (ES = 0.06, 95% CI−0.16 to 0.29, p = 0.579). Pooled estimates suggested a possible improvement in cardiorespiratory fitness, although the certainty of evidence was very low (ES = 0.36, 95% CI 0.05 to 0.66, p = 0.021). Effects on systolic blood pressure (ES = 0.05, 95% CI−0.25 to 0.36, p = 0.722) and diastolic blood pressure (ES = 0.25, 95% CI−0.05 to 0.56, p = 0.099) were not statistically significant. Evidence for stroke severity, assessed using the Scandinavian Stroke Scale, was sparse and uncertain (ES = 0.29, 95% CI−0.04 to 0.62, p = 0.084). Exploratory meta-regression and subgroup analyses identified preliminary signals of between-study variability, but these findings should be interpreted strictly as hypothesis-generating because of the small number of trials, limited outcome-specific effect sizes, and multiple comparisons. Overall, the certainty of evidence was low to very low across outcomes.

Conclusions: 

Low- to very-low-certainty evidence suggests that HIIT may improve balance, walking endurance, and cardiorespiratory fitness after stroke, whereas effects on short-distance walking speed or gait control, blood pressure, and stroke severity remain uncertain. Apparent associations between training-load parameters and outcomes should not be interpreted as evidence of optimal HIIT prescriptions. These exploratory findings require confirmation in adequately powered randomized trials with standardized HIIT definitions, rigorous reporting of achieved intensity, and longer follow-up.

Systematic review registration:

https://www.crd.york.ac.uk/prospero/, identifier: CRD42027809778.


More at link.

Early emotional interventions for post-stroke functional prognosis: a systematic review and meta-analysis

 Because your incompetent? doctor doesn't tell you of the lack of 100% recovery protocols you can't prepare properly for your life of disability!

Early emotional interventions for post-stroke functional prognosis: a systematic review and meta-analysis


  • Department of Rehabilitation Medicine, Suzhou Ninth People’s Hospital, Suzhou, Jiangsu, China

Abstract

Background: 

Post-stroke emotional disorders (PSEDs) impair functional recovery, but the optimal type and timing of early interventions remain unclear. This study aimed to determine the efficacy of early emotional interventions on functional outcomes in stroke patients and to examine whether benefits differ by intervention type and timing of initiation.

Methods: 

In this systematic review and meta-analysis, we searched seven databases for randomized controlled trials (RCTs) up to November 2025. We included adults with acute/subacute stroke (≤ 3 months) assigned to an emotional intervention (pharmacological, psychological, neuromodulation, or combined) versus control. The primary outcome was the change in Barthel Index (BI) at follow-up.

Results: 

Thirty-eight RCTs (n = 12,020 participants) were included. The weighted mean difference (WMD) in BI score improvement was 6.8 (95% CI: 5.2–8.4) favoring interventions over control. The WMD was 8.2 (95% CI: 5.7–10.7) for cognitive behavioral therapy [k = 12], 9.1 (95% CI: 6.5–11.7) for combined interventions [k = 5], 6.5 (95% CI: 4.1–8.9) for rTMS [k = 7], and 4.2 (95% CI: 1.8–6.6) for SSRIs [k = 14]. Initiation of intervention within 2 weeks post-stroke yielded a greater WMD of 10.3 (95% CI: 7.8–12.8) compared to 5.8 (95% CI: 3.6–8.0) for later initiation (p < 0.01).

Conclusion: 

Early emotional interventions significantly improve functional recovery after stroke, with the greatest benefit observed for cognitive behavioral therapy and combined interventions initiated within 2 weeks of stroke onset. These findings support the integration of targeted emotional interventions into early standard care.(You're ignoring the primary problem of 100% recovery, thus having to work on secondary problems! SOLVE THE CORRECT PROBLEM!)

Comparing the real-world effectiveness of botulinum toxin type A injections across distinct poststroke muscle hyper-resistance patterns

 

But botox DOES NOTHING TO CURE SPASTICITY!

Obviously these researchers don't think much of the ridiculous opinion of Dr. William M. Landau!

Spasticity After Stroke: Why Bother? Aug. 2004)

Comparing the real-world effectiveness of botulinum toxin type A injections across distinct poststroke muscle hyper-resistance patterns


  • 1. Department of Rehabilitation, The First Hospital of Jilin University, Changchun, Jilin, China

  • 2. Department of Pediatric Neurology, The First Hospital of Jilin University, Changchun, Jilin, China

Abstract

Background: 

Post-stroke muscle hyper-resistance is produced by both neurogenic (spasticity) and non-neurogenic (contracture) factors. BoNT-A is the most effective intervention for post-stroke spasticity, yet whether concomitant contracture alters its therapeutic benefit remains unclear.

Aims: 

To compare BoNT-A effectiveness in plantar-flexor hyper-resistance stratified by contracture.

Methods: 

We retrospectively reviewed stroke survivors with spastic hemiplegia and ankle plantar-flexor hyper-resistance who received BoNT-A injections. Patients were stratified into two groups according to the presence of restricted passive ankle dorsiflexion: the spasticity group (PROM limitation <7°) and the spasticity-with-contracture group (PROM limitation ≥7°). Outcomes were assessed at baseline and at 2, 4 and 12 weeks post-injection, including the Modified Ashworth Scale (MAS) for plantar-flexors, Brunnstrom Recovery Stage (BRS), Fugl–Meyer Assessment (FMA) lower-extremity subscore and Barthel Index (BI).

Results: 

A total of 107 patients were enrolled—54 in the spasticity group and 53 in the spasticity-with-contracture group. Baseline comparison revealed a significantly longer disease duration in the spasticity-with-contracture group; other characteristics were comparable. Both groups achieved improvements in MAS and BRS at all three follow-up visits. FMA and BI improved in the spasticity group at 4 and 12 weeks, whereas the spasticity-with-contracture group showed improvement only at 12 weeks. Between-group analyses indicated that MAS and BRS scores were consistently better in the spasticity group at each time point; although median FMA and BI were numerically higher in this group, the differences did not reach statistical significance.

Conclusion: 

BoNT-A markedly reduces(NOT CURES!) post-stroke hyper-resistance and enhances motor function and activities of daily living; by contrast, concomitant contracture is associated with delayed and attenuated improvement in MAS and BRS.


More at link.

Biomechanical and neural correlates of FastFES versus Fast gait training in individuals post stroke: a randomized control trial study protocol

 You're going to have to cure a lot of survivors of spasticity before you can even get to fast gait training! If I walk fast my left knee hyperextends and snaps, eventually knee replacement will be needed, all because of not doing anything about my spasticity.

30% get spasticity

Biomechanical and neural correlates of FastFES versus Fast gait training in individuals post stroke: a randomized control trial study protocol


  • 1. Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States

  • 2. Department of Physical Therapy, College of Allied Health Sciences, University of Illinois Chicago, Chicago, IL, United States

Abstract

Background: 

Fast gait training, individually and when combined with functional electrical stimulation (FastFES), has been shown to improve walking function in individuals post stroke. However, the neural mechanisms underlying the effects of these two gait training interventions are poorly understood. The purpose of this mechanism-focused gait rehabilitation randomized clinical trial is to assess the effects of Fast and FastFES gait training interventions on corticospinal neurophysiology, gait biomechanics, energy cost, and walking function in individuals with chronic post-stroke hemiparesis.

Methods: 

In this randomized clinical trial, participants with chronic stroke are recruited and randomized to receive one of two gait training interventions—FastFES or Fast. Participants in each intervention group receive 12 sessions of gait training, with each training session comprising 30 min of training. During FastFES training, electrical stimulation is delivered to ankle dorsi- and plantar-flexor muscles during paretic swing phase and late stance phase, respectively. Evaluations of clinical, gait biomechanics, neurophysiological, and energy cost outcomes are performed at baseline, after completion of 12 training session (post12), and at 3-weeks and 6-weeks after completion of training (3-week follow up, 6-week follow up), to measure longitudinal effects of gait training. Additional evaluations are performed at completion of 3 and 6 training sessions (post3 and post6) to measure the time course of change during gait training. Upon completion of the study, planned analyses will include between-group comparisons of FastFES versus Fast gait training on training-induced changes in corticomotor and spinal excitability, gait biomechanics outcomes such as peak anterior ground reaction force, as well as association of training-induced changes in corticospinal neurophysiology and gait biomechanics with clinical and energy cost measures.

Discussion: 

By elucidating the biomechanical and neural correlates underlying gait training-induced changes in locomotor function, this study promises to build on existing evidence supporting the clinical effects of FastFES and Fast gait training. The long-term goal of this study is to inform the development of neurobiology-informed, personalized, and innovative strategies to enhance the effectiveness of stroke gait rehabilitation.

Clinical trial registration:

clinicaltrials.gov, identifier NCT04380454.