Deans' stroke musings

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.

Thursday, February 5, 2026

Grandparenting is good for the brain

Hopefully I won't ever need this, I'm having too much fun to be a grandparent. Definitely not enough time to fit this in.

Grandparenting is good for the brain

Washington — Helping to care for grandchildren may serve as a buffer against cognitive decline in older adults, according to research published by the American Psychological Association.“Many grandparents provide regular care for their grandchildren—care that supports families and society more broadly,” said lead researcher Flavia Chereches, MS, of Tilburg University in the Netherlands. “An open question, however, is whether caregiving for grandchildren may also benefit grandparents themselves. In this research, we wanted to see if providing grandchild care might benefit grandparents’ health, potentially slowing down cognitive decline.” The research was published in the journal Psychology and Aging To study this, Chereches and her colleagues examined data from 2,887 grandparents (all older than age 50, with a mean age of 67) who took part in the English Longitudinal Study of Ageing. Participants answered survey questions and completed cognitive tests three times between 2016 and 2022. The survey asked whether participants had provided care for a grandchild at any point in the past year. It also asked detailed questions about how frequently they provided care and what kinds of care they provided—including watching grandchildren overnight, caring for ill grandchildren, playing or engaging in leisure activities, helping with homework, driving grandchildren to school and activities, preparing meals and more. Overall, the researchers found that grandparents who provided childcare scored higher on tests of both memory and verbal fluency compared with those who didn’t, even after adjusting for age, health and other factors. This held true regardless of the frequency and type of care the grandparents provided. The researchers also found that grandmothers who provided care saw less decline on cognitive tests over the course of the study compared with those who didn’t. “What stood out most to us was that being a caregiving grandparent seemed to matter more for cognitive functioning than how often grandparents provided care or what exactly they did with their grandchildren,” said Chereches. “More research is needed to replicate these findings, yet, if there are benefits associated with caregiving for grandparents, they might not depend on how often care is provided, or on the specific activities done with grandchildren, but rather on the broader experience of being involved with caregiving.” Further work should also be done to explore the effects of family context and other variables, Chereches said. “Providing care voluntarily, within a supportive family environment, may have different effects for grandparents than caregiving in a more stressful environment where they feel unsupported or feel that the caregiving is not voluntary or a burden.” Article: “Grandparents Cognition and Caring for Grandchildren: Frequency, Type, and Variety of Activities,” by Flavia Chereches, MS, Gabriel Olaru, PhD, Nicola Ballhausen, PhD, and Yvonne Brehmer, PhD, Tilburg University. Flavia Chereches, MS, can be reached via email.

How personal background and brain health influence stroke recovery

Trying to blame the patient for lack of recovery, huh! YOU'RE FIRED FOR THAT CRAPOLA!

They are not recovering because YOU FUCKING FAILED TO PROVIDE 100% RECOVERY PROTOCOLS!

How personal background and brain health influence stroke recovery

5 February 2026

By Dr Margaret Moore

5 minute read

Collaboration and acknowledgements

The study was conducted with researchers at UQ, KU Leuven, the University of Oxford, NHS USL South-East Tuscany, and the Tuscany Rehabilitation Clinic.

Next-Generation Factor XIa Cuts Recurrent Stroke Risk by 26%

Do you really think your incompetent? stroke medical 'professionals' will get this into a protocol in your hospital? WOW, you're delusional!

Your so called competent? 'professionals' knew about Asundexian years ago and have been planning for its' use since then, right!

Asundexian (3 posts to April 2025)

Do you prefer your doctor, hospital and board of director's incompetence NOT KNOWING? OR NOT DOING? Your choice; let them be incompetent or demand action!

Next-Generation Factor XIa Cuts Recurrent Stroke Risk by 26%

Asundexian prevented repeat strokes without bleeding side effects by International Stroke Conference

"The difference between treatment arms began early and continued throughout the treatment period," he said. Moreover, he added, the benefit with asundexian was observed across subgroups by age, sex, geographic region, risk factors for stroke, the delivery of hyperacute treatment, stroke severity, and plans for single or dual antiplatelet therapy.

Safety results were also impressive, with major bleeding per International Society on Thrombosis and Haemostasis criteria occurring in 1.9% of asundexian patients versus 1.7% of placebo patients (HR 1.10, 95% CI 0.85-1.44).

"I am especially struck by the divergence of the event curves over the entire years-long study period," said Richard Bernstein, MD, PhD, of Northwestern University in Chicago, who was not involved with the study. "This is a long-term treatment that doesn't increase hemorrhagic risk by very much. I plan to start using this medication as soon as I can."

Secondary endpoints from the over 12,300-patient trial included a numerical reduction in ischemic stroke in the first 90 days with asundexian compared with placebo (3.0% vs 3.5%, HR 0.84, 95% CI 0.69-1.02) and a significant reduction in disabling/fatal strokes (2.1% vs 3.0%, HR 0.69, 95% CI 0.55-0.87). Symptomatic intracranial hemorrhage was similar between groups (0.7% vs 0.6%, HR 1.15, 95% CI 0.74-1.80), as was any definition of bleeding. Asundexian, an oral, direct, small-molecule inhibitor of FXIa, thus fulfills the promise of uncoupling hemostasis from thrombosis, with a lower risk of complications compared with available anticoagulants."This is a big win for our highest-risk stroke patients with a history of atherosclerotic or non-lacunae stroke," Bernstein said. "There is a dramatic reduction in all the ischemic endpoints patients care about, without any significant increase in major or clinically relevant non-major bleeding." "Clinicians will need guidance on managing common clinical situations, like perioperative management, reversal in the setting of bleeding emergencies, and thrombolysis, in patients taking this medication," he told MedPage Today. "That doesn't mean we need clinical trial-level answers to these scenarios. We need best practices and practical advice based on the best evidence we have available as we get used to using this valuable new tool." The phase III OCEANIC-STROKE trial was conducted across 702 sites on several continents. After an initial screening within 72 hours of stroke, 12,327 patients were randomized to asundexian 50 mg once daily or placebo. Mean age was 68 years, and about one in three participants were women; 21-22% had a previous history of stroke or TIA, and 27% were current smokers. Among all participants, 95% had an ischemic stroke and 5% had a high-risk TIA. This index event was most commonly related to large-artery atherosclerosis (43%), stroke of undetermined etiology (30%), or small-vessel occlusion (23%). The median NIH Stroke Scale score was 2 at randomization. Acute treatment of the index stroke included IV thrombolysis or endovascular therapy in 27.4% of cases. Dual antiplatelet therapy was planned for nearly 63% of patients. Of note, another FXIa inhibitor, milvexian, had failed to reduce recurrent strokes in the phase II AXIOMATIC-SSP trial. Nonetheless, milvexian remains a candidate for secondary prevention in the ongoing phase III Librexia STROKE study, scheduled for completion this calendar year.

Evoked potentials in stroke rehabilitation: current applications, emerging technologies, and future directions

I'd fire anyone proposing or doing research on motor evoked potentials! Do the fucking research that gets survivors recovered!

Evoked potentials in stroke rehabilitation: current applications, emerging technologies, and future directions

Zhe Wang¹

Xiaolin Liu²

Jingyang Xie¹

Yujun Lin^1*

¹Yantaishan Hospital - East Campus, Yantai, China
²Zibo 148 Hospital, Zibo, China

The final, formatted version of the article will be published soon.

Evoked potentials (EPs) are increasingly explored as objective neurophysiological biomarkers to complement scale-based assessment in stroke rehabilitation. This narrative review summarizes current evidence on the use of somatosensory evoked potentials (SEPs), motor evoked potentials (MEPs) and event-related potentials (ERPs) for monitoring recovery and guiding therapy. We first outline the physiological basis and stroke-relevant features of each modality, then synthesize data on how EP measures relate to motor, sensory, balance, cognitive and language outcomes, with particular emphasis on longitudinal changes during rehabilitation and responses to specific interventions, including neuromuscular electrical stimulation, robot-assisted training and non-invasive brain stimulation. Emerging applications such as perturbation-evoked cortical responses for postural control, EP-based brain–computer interfaces and EP-guided or closed-loop neuromodulation are discussed, together with advances in high-density recordings, connectivity analysis, and machine-learning–based multimodal prediction models. Finally, we highlight key methodological and practical challenges—protocol heterogeneity, small single-centre studies, limited trial evidence, feasibility constraints and gaps in clinical integration—and propose priorities for standardization and translational research. Overall, EPs hold substantial promise as pathway-specific, temporally precise biomarkers to enable more mechanism-informed and individualized stroke rehabilitation monitoring.

UT Health San Antonio researchers lead American Heart Association scientific statement on early recognition, intervention for post-stroke spasticity

NOTHING HERE GETS SPASTICITY CURED!

Hope they all get their comeuppance when they are the 1 in 4 per WHO that has a stroke? Then you just might want 100% recovery. Survivors don't want your fucking 'care' about spasticity; THEY WANT IT CURED! And somehow you don't understand that REQUIREMENT!

UT Health San Antonio researchers lead American Heart Association scientific statement on early recognition, intervention for post-stroke spasticity

Shared By: Steven Lee

February 4, 2026

An opportunity to reduce global burden of stroke-related disability

For many stroke survivors, recovery is derailed by painful muscle stiffness and involuntary spasms that limit movement, independence and quality of life. Often viewed as an unavoidable consequence of stroke, this condition – known as post-stroke spasticity – may instead represent a missed opportunity for earlier, more effective care(NOT RECOVERY!).

Two researchers at UT Health San Antonio led the writing group for a new scientific statement focused on post-stroke spasticity for the American Heart Association. The statement urges a shift in how post-stroke spasticity is recognized and treated, emphasizing early diagnosis, timely intervention and innovative therapies to reduce long-term disability and improve recovery after stroke.

Post-stroke spasticity causes abnormal muscle tightness and involuntary spasms that can interfere with walking, arm use, daily activities and participation in rehabilitation. It affects an estimated 30% to 80% of stroke survivors, contributing to higher healthcare costs, increased caregiver burden and preventable complications, such as pain, joint contractures and loss of mobility.

“I see patients every week whose recovery is limited not by the stroke itself, but by muscle stiffness and spasms that were never addressed early,” said Sujani Bandela, MD, a neurologist at UT Health San Antonio, the academic health center of The University of Texas at San Antonio. She also is vice chair of the Neural Repair and Rehabilitation Section at the American Academy of Neurology, first author of the heart association’s scientific statement and vice chair of its writing group. “When spasticity is recognized and treated sooner, we often have a real opportunity to preserve movement, reduce pain and help patients stay engaged in their rehabilitation.”

The heart association’s scientific statement highlights growing evidence that earlier recognition – often within the first three months after a stroke – combined with coordinated rehabilitation and medical therapies may improve functional outcomes and reduce long-term disability. Yet many patients experience delayed diagnosis or receive little or no rehabilitation support, particularly in rural areas and communities with fewer resources.

“Advances in neuroscience, rehabilitation and technology are giving us new tools to intervene earlier and more effectively after stroke,” said senior author of the statement and chair of its writing group, Mark P. Goldberg, MD, professor of neurology and Edward B. LeWinn M.D. Memorial Chair at UT Health San Antonio, and chair-elect of the heart association’s Rehabilitation and Recovery Committee within the Stroke Council. “This scientific statement reflects the growing evidence that earlier, targeted approaches to spasticity could meaningfully improve long-term outcomes for stroke survivors.”

The scientific statement advises:

Greater awareness among patients, caregivers and health care professionals
Proactive monitoring of patients at high risk for developing spasticity
Coordinated, multidisciplinary care(NOT RECOVERY!) including rehabilitation and medical therapy
Innovative care(NOT RECOVERY!) models, including telehealth, to improve access to specialized care(NOT RECOVERY!)

Access to specialized stroke rehabilitation remains limited in many parts of South Texas and other regions with fewer resources, contributing to persistent gaps in post-stroke recovery. Researchers note that expanding early spasticity care(NOT RECOVERY!) could help reduce long-term disability and improve quality of life for stroke survivors across the region.

“Stroke survivorship is increasing, but recovery is not equal for everyone,” Goldberg said. “Improving early access to spasticity care(NOT RECOVERY!) is an important step toward better short- and long-term stroke recovery for all patients.”

The statement, titled, “Early Recognition and Intervention for Poststroke Spasticity: A Scientific Statement from the American Heart Association,” published Jan. 29, 2026, in Stroke, the American Stroke Association’s flagship, peer-reviewed journal (the American Stroke Association is a division of the American Heart Association).

Goldberg is scheduled to present the statement at the association’s International Stroke Conference 2026 in New Orleans on Friday, Feb. 6. Bandela is scheduled to present a course session with a group on spasticity and different case presentations. See conference details, here: ISC26 Planner.

Early Recognition and Intervention for Poststroke Spasticity: A Scientific Statement from the American Heart Association

Sujani Bandela, Laura McPherson, Richard L. Harvey, Oluwole Awosika, Dipika Aggarwal, Charles Y. Liu, Preeti Raghavan and Mark P. Goldberg, on behalf of the American Heart Association’s Stroke Council, the Council on Cardiovascular and Stroke Nursing, the Council on Basic Cardiovascular Sciences, and the Council on Lifestyle and Cardiometabolic Health

The full scientific statement is available at:
https://www.ahajournals.org/doi/10.1161/STR.0000000000000515

ASA: More Social Constraints Tied to Poorer Long-Term Stroke Outcomes

Duh! You haven't figured out yet than 100% recovery would mean no social problems? YOU'RE THAT STUPID?

ASA: More Social Constraints Tied to Poorer Long-Term Stroke Outcomes

Not sharing thoughts and feelings shortly after stroke predicts greater loneliness and poorer functional and cognitive ability at one year.

With EXACT 100% RECOVERY PROTOCOLS all your survivor is going to be sharing is how far along in getting to 100% recovery they are!

(HealthDay News) — Expressing one’s thoughts and feelings following a stroke may be important to achieving good poststroke outcomes, according to a study scheduled to be presented at the annual American Stroke Association International Stroke Conference, held from Feb. 4 to 6 in New Orleans.

Alison Holman, Ph.D., from the University of California at Irvine, and colleagues examined whether early poststroke “social constraints” on sharing predict loneliness and functional and cognitive disability one-year poststroke. Analysis included 763 adults with a new stroke participating in the multisite Stroke, sTress, RehabilitatiON, and Genetics, or STRONG, study.

The researchers found that when controlling for age, gender, acute National Institutes of Health Stroke Scale (NIHSS) score, and acute stress, higher 90-day social constraints were associated with higher one-year loneliness (β = 0.27). Additionally, higher 90-day social constraints were a strong predictor of poorer one-year modified Rankin Scale scores (β = 0.21). Acute NIHSS score also predicted one-year modified Rankin Scale scores (β = 0.19). Furthermore, social constraints predicted poorer one-year Telephone Montreal Cognitive Assessment scores (β = −0.18).

“When trying to cope with major stress and trauma, a lot of people benefit from having a supportive social environment where they can talk about what they are going through,” Holman said in a statement. “However, when stroke survivors feel uncomfortable sharing their thoughts/feelings because they think talking about it will make others uncomfortable or that others won’t want to hear their concerns, these constraints on sharing can be harmful for their health.”

One author disclosed ties to the pharmaceutical and medical technology industries.

Press Release

More Information

New research shows improving blood flow to the brain in arteries with plaque did not improve cognitive skills

Why would you even think that? With the Circle of Willis being complete there are four arteries feeding the brain, a miniscule improvement in one artery won't bring more oxygen to the brain.

Doesn't ANYONE IN STROKE KNOW HOW TO THINK?

Proving once again we have blithering idiots in stroke! I would never do stenting or a carotid endarterectomy because of the possible bad consequences (i.e. stroke).

New research shows improving blood flow to the brain in arteries with plaque did not improve cognitive skills

Improving blood flow to the brain by opening a narrowed neck artery may not improve patients’ cognitive skills, according to a preliminary late-breaking science presentation at the American Stroke Association’s International Stroke Conference 2026.

“Whether patients undergo a procedure to remove plaque in the carotid artery, known as a carotid endarterectomy, stenting to insert a flexible tube to hold open the narrowed part of the artery, or a combination of medications and lifestyle guidance without a procedure, there should be no expectation that cognition will improve after the treatment,” said study lead author Ronald M. Lazar, Ph.D., a professor of neurology at the University of Alabama at Birmingham and director of the UAB Evelyn F. McKnight Brain Institute.

Carotid artery stenosis is a condition where the major blood vessels in the neck become narrowed, usually because of plaque buildup. Standard treatment focuses on strong medical therapy — such as aspirin to prevent blood clots, medicines to control blood pressure and cholesterol, and lifestyle changes like quitting smoking, being more active, eating a healthy diet and losing weight when needed. When the artery becomes severely narrowed, or more than 70 percent blocked, doctors may also recommend a procedure to reopen it, either through carotid endarterectomy or stenting.

The CREST‑2 Trial (Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis) compared how often strokes occurred in people who were randomly assigned to one of three groups: intensive medical therapy alone, medical therapy plus carotid endarterectomy or medical therapy plus stenting.

Earlier studies have generally shown that people with carotid stenosis tend to do worse on cognitive tests. To examine this more closely, CREST‑2 included a special “cognitive core” component. Participants completed cognitive testing before treatment and then once a year for up to four years. This was the first large randomized trial of carotid stenosis to include cognitive performance as a major outcome.

“The brain needs a steady flow of blood to get oxygen for its cells. When blood vessels can’t deliver enough blood, the brain doesn’t get enough oxygen, and the neurons can’t work properly, which impacts the brain’s ability to function properly. This often leads to changes in cognitive skills like attention, processing speed and decision-making skills,” Lazar said.

In 2021, Lazar and colleagues published results in Stroke, the journal of the American Stroke Association. They found that, before treatment, 786 patients in CREST‑2 with severe but symptom‑free carotid stenosis scored lower on cognitive tests — especially memory — compared with a separate group of people matched for age, sex and cardiovascular risk factors.

“The 2021 analysis indicated that revascularization might improve cognitive function,” said Lazar, who is the principal investigator of the Cognitive Core substudy and an overall co‑investigator for CREST‑2.

However, after an average of 2.8 years of follow‑up, the substudy found no meaningful differences in thinking or memory between people who had a procedure (stenting or surgery) and those who only received intensive medical therapy. “Even among participants with the lowest cognitive function at the start of the study, who were expected to gain the most from these treatments, there were still no differences in cognitive skills among the treatment groups,” Lazar said.

Participants who had a stroke during the study did show cognitive decline, confirming that the cognitive tests were sensitive enough to detect real changes in brain function.

These findings may influence how clinicians talk with patients about the potential benefits of surgery or stenting.

“Health care professionals can no longer assert that treatment of carotid stenosis will improve cognition. However, worsening cognition over time may be a signal that treatment may need to be reevaluated and possibly adjusted,” Lazar said.

The study could not determine whether reduced blood flow alone explains cognitive decline in people with carotid artery disease. “Some characteristics of a blockage can cause small particles to travel to the brain. These particles may, over time, affect how the brain functions. This is an area we plan to explore in our future research,” Lazar said.

The study had limitations. All cognitive testing was done by phone, which meant researchers could not assess visuo‑spatial skills or the full range of executive functions like complex decision‑making. In addition, only English‑speaking participants were included, which means the results may not apply to people from other language or cultural backgrounds.

At UAB, Lazar holds the Evelyn F. McKnight Endowed Chair for Learning and Memory in Aging.

Stroke Trial Tips Scale Further to Favor Intra-Arterial Lytic After EVT

This doesn't get you 100% recovered, so you're STILL APPROVING FAILURE AS A MATTER OF COURSE!

Stroke Trial Tips Scale Further to Favor Intra-Arterial Lytic After EVT

CHOICE-2 supports intra-arterial alteplase after successful reperfusion(Success is 100% recovery, quit trying to justify failure by using your tyranny of low expectations!)

NEW ORLEANS -- A stronger case could be made for intra-arterial (IA) alteplase after successful mechanical thrombectomy based on more randomized data, this time the CHOICE-2 trial from Spain.

In acute ischemic stroke patients with large vessel occlusions who achieved majority-complete reperfusion with endovascular therapy (EVT), adjunctive IA alteplase further increased the likelihood of good functional outcomes when given in the 24-hour window. Ninety-day modified Rankin Scale (mRS) scores of 0-1 were significantly more likely after alteplase treatment compared with EVT alone (57.5% vs 42.9%, P=0.002).

Moreover, alteplase improved the secondary outcomes of CT perfusion and patient-reported quality of life.

"Let me announce happily that CHOICE-2 is a positive clinical trial," said Ángel Chamorro, MD, PhD, of the University of Barcelona and Hospital Clinic of Barcelona, to applause at the International Stroke Conference.

With the number needed to treat being seven patients, "let me remind you that this is approximately the number needed to treat patients with IV thrombolysis within 3 hours from the onset of symptoms, compared to placebo. So I think this is a remarkable figure," he added.

As for the safety of IA alteplase, the results were mixed: no excess symptomatic intracerebral hemorrhage was detected at 36 hours (1.4% vs 0.5% for controls, P=0.33), but death at 90 days was significantly more likely in the treated group (12.1% vs 6.4%, P=0.04).

Chamorro argued that the apparent difference in mortality likely reflects an "extremely low" event rate among control patients in CHOICE-2. Indeed, in the older PEARL trial, all-cause mortality occurred in 17.1% of patients who received adjunctive IA alteplase and 11.3% of those who received EVT alone, a nonsignificant difference.

The benefit of using adjunctive IA thrombolytics is based on frequent observations that EVT patients often still have functional impairments; lingering microvascular hypoperfusion is believed to be the culprit.

The original CHOICE trial had been stopped early due to a shortage of the placebo, Chamorro said. However, it did suggest benefit with IA alteplase for stroke patients with successful angiographic reperfusion: there was an improvement in the mRS score at 90 days with alteplase 0.225 mg/kg, maximum 22.5 mg (a slightly different dose to CHOICE-2's maximum 20 mg over a 15-minute infusion).

More recently, promising results have been reported with clot-busters after successful EVT, namely IA tenecteplase in ANGEL-TNK and IA alteplase in PEARL, both presented last year. However, there's also been disappointing results in the POST-TNK and POST-UK trials in which adjunctive IA tenecteplase and urokinase, respectively, fell short in achieving longer survival without disability after EVT.

American stroke guidelines, updated last week, thus state that adjunctive IA thrombolytics with urokinase, alteplase, or tenecteplase "may be reasonable" to improve cerebral reperfusion and 90-day functional outcomes in stroke patients with complete or near-complete EVT (class IIb recommendation).

"The usefulness of administration of adjunctive intra-arterial thrombolytics, namely urokinase and tenecteplase, after successful thrombectomy remains uncertain, as data from four major [randomized controlled trials] are conflicting," the guideline authors reasoned.

The open-label CHOICE-2 trial was conducted at 14 Spanish centers with blinded assessment of clinical and imaging outcomes.

The study included stroke patients with large vessel occlusions with majority-complete reperfusion (expanded Thrombolysis in Cerebral Infarction grade [eTICI] 2b50-3) post-EVT who had been treated within 24 hours of stroke onset. The Alberta Stroke Program Early CT Score (ASPECTS) could not be below 6, and patients were excluded if they had an NIH Stroke Score of 25 or higher or if they had contraindications to alteplase.

Ultimately, 440 participants were randomized to EVT alone or with IA alteplase. The median cohort age was around 76 years, and the group was roughly split between the sexes. Median NIH Stroke Score was 15, about 64% had a preceding IV thrombolysis, and cause of stroke was cardioembolic in nearly half of cases.