Use the labels in the right column to find what you want. Or you can go thru them one by one, there are only 33,273 posts. Searching is done in the search box in upper left corner. I blog on anything to do with stroke. DO NOT DO ANYTHING SUGGESTED HERE AS I AM NOT MEDICALLY TRAINED, YOUR DOCTOR IS, LISTEN TO THEM. BUT I BET THEY DON'T KNOW HOW TO GET YOU 100% RECOVERED. I DON'T EITHER BUT HAVE PLENTY OF QUESTIONS FOR YOUR DOCTOR TO ANSWER.
Changing stroke rehab and research worldwide now.Time is Brain!trillions and trillions of neuronsthatDIEeach day because there areNOeffective 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.
Motor impairment is a determinant of long-term disability after acute ischemic stroke (AIS), even in patients achieving reperfusion through mechanical thrombectomy. However, evidence regarding rehabilitation after thrombectomy, particularly for patients with moderate-to-severe hemiparesis, remains limited.
Methods
We conducted a single-center retrospective propensity score–matched cohort study comparing early Bobath-based neurorehabilitation with conventional rehabilitation in AIS patients with moderate-to-severe hemiparesis after anterior-circulation mechanical thrombectomy. Patients aged ≥18 years initiated rehabilitation within 30 days after the procedure, and complete discharge and follow-up data were required for inclusion in the matched cohort. The primary outcome was change in Fugl–Meyer Assessment (FMA) motor score from baseline to discharge. Secondary outcomes included Modified Barthel Index (MBI), Modified Ashworth Scale (MAS), modified Rankin Scale (mRS), quality of life, and safety outcomes during 12-month follow-up.
Results
After matching, 206 patients (103 per group) were included. At discharge, the Bobath group showed greater improvement in motor function and daily living ability than the conventional group (adjusted mean difference: FMA 5.7 points, 95% CI 3.4–8.0; MBI 6.6 points, 95% CI 4.0–9.3; both P < 0.001). Improvements remained significant at 3 months but not at 12 months. Functional independence (mRS ≤2) at 3 months was more frequent in the Bobath group (82.5% vs 73.8%; P = 0.05). Complication rates were similar between groups.
Conclusions
Early Bobath-based neurorehabilitation is associated with better short-term motor and functional recovery without increased adverse events after mechanical thrombectomy. The between-group differences attenuated by 12 months; therefore, further multicenter prospective studies are needed to confirm durability and long-term benefit.
OBJECTIVE:To investigate the concurrent validity between the Action Research Arm Test (ARAT) and the Wolf Motor Function Test (WMFT) and to compare their reproducibility, internal consistency and floor and ceiling effects in the same sample of stroke patients. METHODS:Forty patients participated in this study. Concurrent validity was determined with Spearman's rank correlation coefficients. Reproducibility was assessed with intraclass correlation coefficients (ICCs) and Bland-Altman plots, internal consistency by means of Cronbach's alphas, and floor and ceiling effects were considered to be present if more than 20% of patients fell outside a preliminary set lower and upper boundary. RESULTS:Spearman's rank correlation coefficients ranged from 0.70 to 0.86. ICCs for inter-rater and intra-rater reliability ranged from 0.92 to 0.97. Bland-Altman plots showed a less stable way of scoring for the WMFT, compared with the ARAT. Cronbach's alpha was > 0.98 for both scales. No floor and ceiling effects were found. CONCLUSION:The present study showed good clinimetric properties for both assessments. The high concurrent validity suggests that ARAT and WMFT have significant overlap with regard to the underlying construct that is being measured.
Thinking stroke 'care' is an honor IS THE HEIGHT OF STUPIDITY! Survivors want 100% recovery or are you too fucking dumb to understand that?
You're basically admitting to the world you are a COMPLETE FAILURE at stroke recovery! if you were successful at recovery you would broadcast that, but no, you chose to broadcast your failure points!
Hospital’s sixth major international award or ranking this year
Award recognizes rapid treatment and stroke innovation
RIYADH: King Faisal Specialist Hospital and Research Centre (KFSH) has earned Diamond status in the World Stroke Organization Awards, the latest in a string of international recognitions that have reinforced the Saudi institution’s standing among the world’s leading academic medical centers.
According to a news release published on KFSH’s official website, the award recognizes the hospital’s Neuroscience Center of Excellence for meeting advanced international standards in stroke care, including providing clot-dissolving treatment within 60 minutes to at least 75 percent of eligible stroke patients.
The World Stroke Organization’s Diamond designation is awarded to medical centers that demonstrate high performance in emergency response, treatment efficiency, patient safety and specialized stroke care. Assessments are based on independent clinical and operational indicators, including treatment times and the effectiveness of catheter-based interventions.
KFSH said a key factor behind the recognition was the launch of the Middle East’s first Mobile Stroke Unit, equipped with a CT scanner and staffed by a specialized neurology team. The unit allows diagnosis and treatment to begin at a patient’s location and continue during transport to the hospital, reducing delays that can worsen stroke-related complications.
The hospital said the award also reflects close coordination among emergency, neurology, interventional radiology and stroke-care teams, supported by systems designed to improve response times and patient outcomes.
The recognition is the sixth major international award, ranking or institutional honor announced by KFSH so far this year, underscoring its growing profile in healthcare, medical research and clinical innovation.
Among the other distinctions announced in 2026:
• Ranked first among Saudi healthcare institutions in the Nature Index 2025 for research output and scientific contribution.
• Named the most valuable healthcare brand in Saudi Arabia and the Middle East for a fourth consecutive year by Brand Finance, with a brand value exceeding $1.7 billion.
• Honored by the American Heart Association for excellence in CPR education and community awareness programs.
• Admitted to the Global Alliance for Genomics and Health (GA4GH), one of the world’s leading genomics and precision medicine networks.
• Ranked first in the Middle East and North Africa and 12th globally in Brand Finance’s Top 250 Academic Medical Centers 2026.
KFSH has also been listed by Newsweek among the World’s Best Hospitals 2026, the World’s Best Smart Hospitals and the World’s Best Specialized Hospitals.
The latest recognition comes as Saudi Arabia seeks to strengthen its position as a regional hub for advanced healthcare, medical research and innovation under Vision 2030.
According to KFSH, the hospital is ranked first in the Middle East and North Africa and 12th globally among the world’s top academic medical centers, reflecting its growing international reputation in specialized care, research and medical education.
THIS is the major problem in stroke; GUIDELINES, NOT PROTOCOLS! With this EXACT OBJECTIVE DIAGNOSIS you deliver THESE EXACT PROTOCOLS which deliver recovery! See how simple it is to state; getting there is going to a bitch, with all their closed off and entrenched minds in stroke!
The 2026 guideline for early management of acute ischemic stroke (AIS) retains many foundational recommendations while introducing clinically meaningful updates spanning imaging, broader inpatient management, and reperfusion strategies including intravenous thrombolysis (IVT) and endovascular therapy (EVT). Notably, it provides expanded guidance for medium vessel occlusions and introduces pediatric recommendations that were largely absent from prior iterations. Given their impact on imaging workflows in AIS, the authors present a focused review of the updated guidelines for the radiologist.
REFERENCES
The 2026 AHA/ASA Guideline Updates to Management of Patients with Acute Ischemic Stroke: A Guide for Radiologists.
Rai P, Benson JC, Ahmed S, Mark IT, Rajeev R, Lakhani DA, Lanzino G, Klaas JP.
AJNR Am J Neuroradiol. 2026 Jun 4 [Epub ahead of print]
Doesn't your competent? doctor have you already drinking coffee for all these benefits? And still incompetently hasn't created a 24 hour coffee station! The hospital my Mom is at has a 24 hour station down the hall, so it's doable when you get competent persons installed!
Or is your board of directors so incompetent they don't know they have incompetent persons working for them?
Will your DOCTOR GUARANTEE that the benefits listed below will definitely occur with only 3-4 cups? Why not?
I do coffee all day, takes that long to
get in a 12 cup pot of coffee. This won't change my habit, it's mainly
to reduce my dementia and Parkinsons risk and no one knows the amounts
for that.
I'm still doing a 12 cup pot of coffee daily to prevent Parkinsons
and frailty! Much more important than any problems it can cause.
I'm doing a 12 cup pot
of coffee a day with full fat milk to lessen my chances of dementia and Parkinsons. Tell me
EXACTLY
how much coffee to drink for that and I'll change. Yep, that is a lot
more than the 400mg. suggested limit, I don't care! Preventing dementia
and Parkinsons is vastly more important than whatever problems it can
cause!
Of course, your fuckingly incompetent? doctor did
nothing with this from 2+ years ago! And still hasn't created a 24 hour
coffee station
This line is great: The findings indicate that even the Espresso Martini cocktail contains the espresso's beneficial compounds - and can contribute to staving off dementia.
Coffee may do more than just provide a morning boost, according to new research.
The study, conducted by Texas A&M University and published in the journal Nutrients, identified a biological pathway that could help explain links between coffee and healthier aging.
The researchers found that compounds in brewed coffee may activate NR4A1, a receptor involved in stress response, inflammation, metabolism and tissue repair.
“Coffee is consumed by large segments of the world population,” study collaborator Robert S. Chapkin, a distinguished fellow at the American Society for Nutrition, told Newsweek in an email. “It has well-documented salutary effects in humans, similar to the Mediterranean diet.”
Why It Matters
Coffee is one of the most widely consumed drinks in the world, and earlier research has linked it to lower risks of chronic diseases. The new findings may help explain why.
The researchers say their work offers “one of the first direct connections” between coffee and NR4A1, a protein studied often for its role in aging and disease.
“Coffee has well-known health-promoting properties,” Dr. Stephen Safe, distinguished professor at the Texas A&M College of Veterinary Medicine and Biomedical Sciences, said in a press release.
“What we’ve shown is that some of those effects may be linked to how coffee compounds interact with this receptor, which is involved in protecting the body from stress-induced damage.”
Chapkin told Newsweek that NR4A1 is a “nuclear receptor,” with which small molecules in coffee can engage. Chapkin compared it to a key being inserted into a lock.
“NR4A1 is the lock and coffee contains the keys,” Chapkin said. “Once NR4A1 is bound by coffee-derived small molecules, e.g., caffeic acid, chlorogenic acid and ferulic acid, its ability to bind to DNA and regulate the expression of select genes (in the cell nucleus) is modulated.
“This partly explains how coffee can improve human health and reduce the risk of several chronic diseases of aging.”
What To Know
Researchers found that multiple compounds in coffee, including caffeic acid and other polyphenolic compounds, bind to NR4A1 and affect its activity.
Those compounds reduced cellular damage and slowed cancer cell growth in laboratory models. When NR4A1 was removed from cells, the protective effects disappeared.
“If you damage almost any tissue, NR4A1 responds to bring that damage down,” Safe explained in the release. “If you take that receptor away, the damage is worse.”
The findings do not mean coffee prevents aging or disease in humans. The researchers said their work was mechanistic, meaning it examined biological processes rather than proving direct cause-and-effect in people.
Caffeine may not be the main factor, with the researchers noting that other naturally occurring compounds in coffee appeared more active in their models.
“What we’re saying is that at least part of coffee’s health benefits may come through binding and activating this receptor,” Safe added.
Chapkin said that he isn’t a coffee drinker, but he added that Safe is.
“I’m a tea drinker, and tea also contains bioactive small molecules which can modulate NR4A1 function,” Chapkin added.
What’s Next
Safe’s team is studying synthetic compounds that target NR4A1 more effectively than natural dietary compounds, with the aim of developing possible treatments for cancer and other diseases.
“There’s still a lot of work to be done,” Safe cautioned. “We’ve made the connection, but we need to better understand how important that connection is.”
'Assessments' DO NOTHING FOR RECOVERY! You need EXACT REHAB PROTOCOLS FOR THAT! And you're too fucking incompetent to figure that out? You're all fired!
Biomarkers do nothing for recovery unless you are mapping EXACT RECOVERY PROTOCOLS to them!
We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply.
Abstract
Background
Persistent upper limb deficits after stroke necessitate reliable candidate biomarkers to support precision rehabilitation. While electroencephalogram (EEG) provides a highly accessible tool to characterize post-stroke neurophysiology, its clinical translation is hindered by fragmented evidence. This systematical review critically synthesizes the directional associations between EEG biomarkers and upper limb outcomes, and introduces a novel functional framework to classify these biomarkers into assessment, prognostic, and monitoring roles for natural upper limb recovery under conventional rehabilitation.
Methods
A systematic search was conducted in MEDLINE, SCOPUS, EMBASE, EBSCO CINAHL, and IEEE Xplore up to March 10, 2026. Studies investigating associations between quantitative EEG measures and upper limb motor outcomes in stroke adults were included. Two reviewers independently screened studies and assessed risk of bias. Data extraction classified EEG biomarkers by assessment, prognosis, and monitoring roles.
Results
Forty-two studies were included, comprising 23 cross-sectional and 19 longitudinal designs. We categorized the evidence into three biomarker roles: (i) assessment, where measures like the brain symmetry index (BSI), β-band interhemispheric connectivity, and network efficiency correlated with impairment severity; (ii) prognostic, where baseline asymmetry and functional connectivity showed predictive potential; and (iii) monitoring, where longitudinal changes in oscillatory power, connectivity, and network topology paralleled functional gains. Across roles, the BSI emerged as one of the most frequently reported candidate metrics.
Conclusion
EEG-derived metrics, particularly the BSI, serve as frequently reported candidate biomarkers for potential clinical application in stroke rehabilitation. However, their immediate clinical translation is currently limited by the predominantly fair methodological quality of the underlying evidence. Our proposed framework helps to bridge the gap between current observational findings and future clinical utility. Future progress hinges on standardizing protocols and validating these biomarkers in large-scale rehabilitation trials to facilitate their transition toward potentially clinically useful tools.
So what? What is needed is EXACT PROTOCOLS THAT PREVENT THIS! Are you really that blitheringly stupid?
Oops, I'm not playing by the polite rules of Dale Carnegie, 'How to Win Friends and Influence People'.
Telling your supposedly smart stroke medical 'professionals' they know nothing about stroke is a no-no even if it is true.
Politeness
will never solve anything in stroke. Yes, I'm a bomb thrower and proud
of it. Someday a stroke 'leader' will try to ream me out for making them look bad by being truthful, I
look forward to that day.
Metabolite Score Improves Ischemic Stroke Risk Prediction Among Women
A 4-metabolite stroke score independently predicted incident ischemic stroke and improved risk prediction beyond traditional risk factors, suggesting potential utility for earlier identification of women at elevated stroke risk.
A stroke metabolite score comprising 4 validated metabolites is associated with incident stroke and improves ischemic stroke risk prediction beyond traditional risk factors, according to a study published in Neurology.Women have a higher lifetime risk for stroke than men, and metabolic factors appear to be more strongly associated with stroke risk among women. Although key stroke risk factors in women are well established, a gap remains between identified risk factors and the biological processes that mediate this risk.
To discover and validate metabolomic profiles associated with incident ischemic stroke risk after adjustment for traditional stroke risk factors, researchers applied liquid chromatography-tandem mass spectrometry (LC-MS) to measure 519 plasma metabolites in a discovery set of women from the Nurses’ Health Study, including 454 women who developed incident ischemic stroke and 454 control individuals. Validation was performed in 2 independent prospective cohorts: Prevención con Dieta Mediterránea (PREDIMED), which included 118 participants who developed stroke and 791 participants who did not, and Nurses’ Health Study 2, which included 49 women who developed incident ischemic stroke and 49 control individuals.
Further research to identify the mechanisms responsible for these findings, as well as to replicate other metabolites, is needed.
In the Nurses’ Health Study, 23 metabolites were significantly associated with incident ischemic stroke after adjustment for traditional risk factors (q<0.05). Of these, 14 metabolites were available in PREDIMED, and 3 were significantly associated with incident stroke: methionine sulfoxide, N6-acetyllysine, and sucrose/lactose/trehalose (q<0.05). In Nurses’ Health Study 2, glucuronate was significantly associated with incident ischemic stroke (q<0.05).
Higher levels of all 4 metabolites were associated with increased risk, and the metabolites were used to create a stroke metabolite score. Per 1-standard deviation increase in the stroke metabolite score, the odds ratio for incident stroke was 4.12 (95% CI 2.26-7.51) in PREDIMED after adjustment for traditional risk factors.
In PREDIMED, the area under the receiver operating characteristic curve increased from 0.65 to 0.70 when the stroke metabolite score was added to traditional risk factors, corresponding to a 5% improvement in risk prediction (P <.005).
Study limitations include that metabolomics profiling was obtained at a single point in time, imaging was available for only 69% of participants who developed stroke in Nurses’ Health Study 2, and the discovery dataset in the Nurses’ Health Study was predominantly composed of postmenopausal White women.“We identified 23 metabolites associated with incident ischemic stroke in women, and validated 4 of these in independent cohorts. A score comprising the 4 validated metabolites resulted in significant improvement in stroke risk prediction,” noted the authors. “Further research to identify the mechanisms responsible for these findings, as well as to replicate other metabolites, is needed.”
Then where is THE EXACT PROTOCOL to do that from your doctor? Oh NO, you have a doctor that doesn't know how or won't do that task, right ? Will this get rid of your visceral fat and all the problems that causes?
Oh sorry, you DON'T have a functioning stroke doctor that knows anything about this, do you? Well, fire them and request someone competent! Or is your board of directors so incompetent they don't know they have incompetent persons working for them?
Participants
who were overweight or living with obesity wore the accessories for two
hours every morning for six weeks and lost an average of two pounds. The
researchers suspect showering or swimming in frigid water could have
similar effects
Ice baths, frigid showers and cold plunges seem to be all over social
media, with people claiming that exposure to chilly water has seemingly
endless health benefits.
Proposed
gains include boosting the immune system, increasing libido,
kickstarting the metabolism, improving circulation and even making new
friends, said James Mercer, a biologist at the Arctic University of Norway, to Healthline’s Nancy Schimelpfening in 2023.
Growing scientific evidence hints that some of these supposed
benefits are real. Now, preliminary research presented in May at the European Congress on Obesity
adds to the conversation after finding that consistent cold exposure
via cooling vests might help people lose body fat. The results suggest
that the accessories could be an easy weight-loss lifestyle strategy
that people could incorporate with traditional approaches like
exercising and eating healthy.
“This is one of the first studies looking at the impact of cold
exposure over a prolonged period of time, involving people with
overweight and obesity,” study co-author Mariëtte Boon, an obesity physician at Leiden University Medical Center in the Netherlands, said at the conference, reports the Guardian’s Anna Bawden.
The study involved 47 adults who were overweight or living with
obesity in the Netherlands. About half of them wore a cooling vest and
waist wrap for two hours every morning for six weeks. The cold-exposure
participants shed an average of 2 pounds over the experiment period,
while those in the control group gained an average of 1.3 pounds, the
researchers found.
Report Ad
Cooling vests are somewhat common. Athletes, construction workers and other people wear them.
Con Chronis / Getty Images
How does this happen? Study co-author Helen Budge,
a biologist at the University of Nottingham School of Medicine in
England, explained that “daily cold exposure activates brown fat, which
uses body fat stores to produce heat,” per the Guardian.
“It is possible that wearing a cooling vest trains brown fat to be
more active and has a healthy effect on lipids, glucose and inflammation
in the body. All those things are preventative in cardiovascular
disease,” she added.
Analysis revealed that much of the weight loss in the cold-exposure
group compared with the control group did come from a reduction in body
fat, and lean mass—made of components like muscle and bone—remained
relatively unchanged. That’s important because dropping pounds often
comes with muscle loss.
Cold vests are probably a more practical at-home approach than having
to find a corner for a bathtub full of ice water. Budge said that the
clothing is not uncomfortable, and that people in the construction
industry already make use of them to keep cool, reports the London Times’ Eleanor Hayward.
University of Pittsburgh School of Medicine researchers reported the final outcomes of a pioneering pilot clinical trial using electrical stimulation of the spinal cord to improve arm and hand mobility in people with chronic stroke.
The study, published June 4 in Nature Medicine, focused on investigating safety and preliminary efficacy. It showed that seven participants with profound muscle weakness due to stroke experienced an average 32% increase in arm strength, along with improvement in overall arm mobility and reduction in muscle spasticity. Importantly, the intervention required fewer than nine hours of movement-based training over four weeks and did not cause discomfort or serious adverse events.
“This approach is designed to rapidly help people move their arms better, even years after a stroke,” said cosenior author Marco Capogrosso, assistant professor of neurological surgery, Pitt, and director of the spinal cord stimulation laboratory at Rehab Neural Engineering Labs,UPMC Rehabilitation Institute. “The stimulation works mostly as an assistive technology—when it’s on, people can move better. By stimulating the spinal cord, we can immediately allow residual connections between the brain and the spinal cord to work more efficiently, enabling better movement.”
Stroke is the leading cause of adult arm paralysis in the United States, with approximately 400,000 people developing chronic arm and hand weakness each year. Many stroke survivors rank recovery of arm function as their top unmet clinical need, yet standard rehabilitation rarely drives meaningful improvement.
To address this gap, Pitt researchers launched a first-of-its-kind pilot clinical study to test whether epidural spinal cord stimulation delivered to the region controlling arm and hand movement could help stroke survivors regain arm function. The project, which the National Institute of Neurological Disorders and Stroke, a part of the National Institutes of Health, spotlighted as one of the most significant innovations it supported in its 75th anniversary report, relies on implanting thin electrodes along the neck.
Stimulation sends targeted electrical signals to sensory nerve fibers in the spinal cord to enhance communication between the brain and weakened muscles. The same class of device has been used for decades to treat chronic pain, but it had not been used to restore arm function after stroke. The newly published study expands on earlier findings the teamreportedin 2023 and confirms that the approach is safe and feasible regardless of age, sex or race. Over the four-week study period, all seven research participants experienced immediate improvements in strength when stimulation was turned on, regardless of how severe their impairment was at baseline. Additionally, spasticity—abnormal muscle stiffness caused by stroke-damaged nerve pathways—was reduced in all seven participants.
“From a clinical perspective, even modest improvements in arm strength or control can make a meaningful difference in daily life of stroke survivors,” said study coauthor George Wittenberg, professor of neurology and of physical medicine and rehabilitation at Pitt’s School of Medicine. “Some of the improvements we measure may look small from the outside, but many stroke survivors are just on the verge of being able to do something important. Even a small change in motor function can be very significant if it helps someone button a shirt, open their hand or return to an activity they care about.
While improvements were immediate, the researchers found that lasting gains depended on continued use of stimulation. Follow-up assessments showed that motor function declined when stimulation was discontinued, underscoring the potential of spinal cord stimulation as an assistive neuroprosthetic technology rather than a short-term rehabilitation aid.
“This study represents the conclusion of our initial feasibility phase and an important step toward real-world clinical application,” Capogrosso said. “Our goal is to develop a technology that could eventually be used in everyday life, not just in the clinic. These results give us confidence that spinal cord stimulation could become a practical, implantable option for helping stroke survivors use their arms when it matters most.”
Building on these findings, the research team has begun recruiting participants for an extended clinical trial to evaluate the effects of longer-term spinal cord stimulation, both alone and in combination with physical therapy.
University of Pittsburgh authors of this research include Roberto de Freitas, Shovan Bhatia, Erynn Sorensen, Erick Carranza, Scott Ensel, Amy Boos, Lee Fisher, Daryl Fields, Marc Powell, Jeffrey Balzer, Robert Friedlander, Peter Gerszten and Elvira Pirondini. Additional coauthors are from Carnegie Mellon University, Columbia University, the Veterans Affairs Pittsburgh Healthcare System and Johns Hopkins University.
In my 16 years writing this blog, I SEE NOTHING THAT SUGGESTS ANY GUARANTEED WAY TO GET RECOVERY! Hope is NOT GOOD ENOUGH! Do the work that delivers recovery!
The neurologist Orlando Swayne doesn’t suggest everyone can recover.(That's the problem in a nutshell, advocating the tyranny of low expectations to dumb down the survivor goals to what can currently be delivered! THAT IS GIVING UP BEFORE THE SURVIVOR EVEN STARTS! 100% recovery is the only goal in stroke! GET THERE!) But he does argue that early, targeted and intense therapy can sometimes bring about life-changing improvements – and we have a moral obligation to provide it
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Claire was in bad shape. She had been brought to the ward on a stretcher and hoisted on to a bed where she lay curled up in a ball. She was unable to speak, her eyes flat and face expressionless. While she could move her right arm a little, her left arm and both legs were immobile.
Life had changed dramatically for Claire, a mother of three in her late 30s, many months earlier, when she collapsed while on a night out with friends. A weakness in an artery at the base of her brain had ruptured, spilling blood around her frontal lobe. She was taken to hospital, where surgeons removed two side plate-sized pieces of bone from her skull to relieve the pressure on her brain. She spent months in intensive care.
Can a patient with such profound impairment improve in any meaningful way, especially so long after the event? That was the question for Orlando Swayne, a consultant neurologist and co-lead of the pioneering neurorehabilitation unit at the National hospital for Neurology and Neurosurgery, a Victorian redbrick building in Queen Square, central London.
(If your doctor doesn't reference
Pedro Bach-y-Rita who recovered fully back in 1958 with only a partial brain! Aren't you smart enough to duplicate that? Then you DON'T have a functioning stroke doctor! Get rid of them!)
It was a few years before the pandemic when Swayne first met Claire on the ward. She made eye contact but showed no other response. He knew from the referring hospital that she could write single-word answers to queries, but these revealed characteristic signs of the brain damage she had sustained. Before leaving her bedside to tend to other patients, Swayne asked if she had any questions. With a pencil clenched in her right hand, she wrote: “Questions, questions, questions,” and then tailed off into a wiggly line. The pathological repetition comes from a failure in the frontal lobe to keep actions moving along in sequence.
“There are some patients who start off, when we first work with them, severely impaired – and I mean very severely impaired,” says Swayne. Claire (not her real name) was one such patient.
If he had trusted only his lectures at medical school, Swayne might have considered Claire beyond help. Dogma held that broken brains didn’t mend. A brief flirtation with neurosurgery did nothing to dispel the view. “You see patients in a really terrible state and you think that’s them for life,” he says, “but you don’t see them for very long.”
Swayne quickly decided against a career in neurosurgery, perhaps for the best. “I’m a bit clumsy,” he says, though this wasn’t the only reason. “Neurosurgery is all about the craft, and I’m not really a craft person. I like the people. I like the relationships and the human aspects, which you don’t get so much in neurosurgery.”
He moved into general medicine, then into neurology and stroke medicine, and over the next 20 years or so started to see patients long after their original admission. “I began to realise that some of these patients were improving. And the ones who were improving were the ones working with therapists,” he says. “I thought: ‘OK, I didn’t realise that was a thing. How does it work?’”
The answer, it seems, is to be found in the brain’s capacity for neuroplasticity, its ability to make new connections and reorganise in the face of changed circumstances. In his new book, How to Use a Fork: Stories of Mending the Broken Brain, Swayne argues that recent discoveries in this area have “profound implications” for patients and the therapy and care we owe them.
Swayne is at the piano murdering Chopin – his words, not mine – when I arrive at his north London home. Our chat clashes with his daughter leaving for gap year travels, a milestone I’d assumed would be infused with chaos, but a calmness prevails. A small black dog bounds over and then scoots away, before finding a spot on the kitchen sofa.
My copy of his book is a mess of folded corners, underlined passages and notes in the margin, but I confess, unfairly in retrospect, that I hadn’t relished reading it. For there is history here. Doctors have written books on neuroplasticity before and some made me deeply uncomfortable. To my mind, they peddled false hope through portrayals of miraculous recoveries. At worst, they seemed to imply that patients with severe brain injuries could rise up from their wheelchairs, speak fluently once again and overcome deep cognitive impairment if only they put their mind to it. I feared more of the same: show me a publisher that wants stories of patients whose lives are destroyed and remain so.
Swayne, it turns out, has read the same books and shares the concern. To be clear, he is not suggesting that everyone who suffers a huge stroke or brain injury can recover. His argument is that early, targeted and intense therapy can bring about life-changing improvements, and that we have a moral obligation, not to mention an economic one, to provide such care. “The perception of brain injury is that it is irreversible and irrecoverable from, and this is a corrective to that view,” he says. “There is hope, but clearly you have to balance that. Some people just don’t recover.”(Discounting
Pedro Bach-y-Rita who recovered fully back in 1958 with only a partial brain!)
Stroke is a leading cause of adult disability in the UK. It happens when a blood vessel, typically an artery, becomes blocked or bursts, and starves the brain of oxygen and nutrients. Within minutes, brain cells in the affected region begin to die. Depending on the location, a stroke can cause paralysis, loss of speech, blindness and other vision problems, impaired thinking, memory loss, personality changes, an inability to swallow, and more. Of the 12 million or so people globally who suffer a stroke each year, one in five dies within 30 days.
Many stroke patients show small improvements in the first few weeks, as swelling and inflammation subside. According to old-school thinking, that was as much as you could hope for. But it’s not the full story. The damage caused by stroke or brain injury drives chemical changes in the brain. These trigger neuronal growth processes that were last active in the developing brain. Surviving neurons are spurred into making new connections and to work around the dead tissue.
Of course, the brain constantly demonstrates some level of neuroplasticity. To learn a foreign language, or how to play a new instrument or fly a helicopter, your brain must forge new connections. The process redraws the functional maps in the brain, the neural territory called upon to perform particular tasks. So it is that black-cab drivers in London have more grey matter in the hippocampus after learning the Knowledge. Likewise, the amount of brain dedicated to using the index finger expands when people learn to read braille with it. But the process is sluggish in adults compared with children and those who have suffered recent stroke or brain injury.
After such events, neuroplasticity ramps up for several months. This is when intense, targeted therapy can have the most impact. “Even though the capacity for plasticity is greatest in the first few months, it doesn’t just switch off,” Swayne says. In one study, intensive therapy improved upper limb movement in patients 18 months after their strokes.
Claire’s early therapy sessions focused on positioning and stretching – to enable her to sit comfortably – and mouth, tongue and voice box exercises. But they were tough, and she quickly became too tired to continue. In time, though, her stamina improved and she engaged more with the therapists. Her gaze began to follow people walking past and she would sometimes move her mouth to speak in response to questions.
Her improvement gathered pace with music therapy. In those sessions, Claire used her stronger right hand to pluck guitar strings and shake maracas. Her therapists noticed more spontaneous facial expressions and she began to point to instruments, choosing, being proactive. Session after session, for four months, she was drilled to make choices, identify objects, to engage her mouth and tongue.
Swayne hadn’t caught up with the therapists in a while, but one day as he headed past Claire’s bay and said hello, she looked up and said: “What happened to your hair?” Swayne stopped dead. “That was an amazing moment,” he says. “If you work with a patient who’s not spoken for a year, and you do an intervention and they start speaking, it’s got to be a response to the therapy.”
Swayne confided in Claire about his disastrous encounter with a barber and later learned from the speech therapist that her language had been coming for a week or so. First it was single words, then phrases and short sentences. She had made progress with her right hand, too. Before long, she was playing Connect 4 with her boys and fellow patients on the ward, though her left side and right leg remained lifeless.
“She started communicating with her kids and with us, and that was enormous,” Swayne says. “Her left side will always remain weak because it’s very badly damaged, but she started using her right arm to do things, like use a phone and use a power chair. We had her cooking, and that was huge. She will always need help, but for quality of life it was transformational.”
There’s plenty still to learn about the brain’s ability to work around dead tissue, but details of some mechanisms are emerging. Delve into the motor cortex in the brain’s frontal lobe and you’ll find specialised neurons that drive limb movement. These are arranged vertically to send their messages to the spinal cord. But they are also linked by a mesh of horizontal connections. Normally, these horizontal connections are suppressed, but in the event of brain damage, the inhibition is relaxed and the connections activate. Surviving neurons can now recruit neighbours to their cause, though they need time and training to learn the new job.
There’s more to neuroplasticity than this, but the mechanism explains some of the stark limitations that doctors and their patients witness. When neural connections are completely lost, it seems no amount of therapy can bring them back. And while the brain can reorganise to some extent, there’s no evidence that a specialised region of the cortex can take on an entirely different role. If a stroke leaves your right arm limp, your visual cortex cannot take control of it any more than your kettle can make the morning toast. That said, movement, language, sensation and vision are not confined to small brain regions: they are distributed across networks that provide for some flexibility. For example, most people do the bulk of their language processing in the left side of the brain, but if it is damaged, there’s evidence that parts of the language network on the right side can take on some of the work.
Much of the immediate work with new stroke patients is to identify their impairments and the causes. If they are unable to use a fork, what is stopping them? Can they feel it? Are they too weak on that side? Can they coordinate their movements?
Therapists take impairments and break them down into steps that patients can be drilled on. There is, so far, no shortcut to the gruelling hours put in by the patients described in Swayne’s book. Thomas, a vicar who couldn’t speak after a stroke at the pulpit, had intensive speech therapy to retrain his swallowing and tongue movements. Christian, a mixologist at a swanky London hotel, relearned how to brush his teeth: turn the tap on, get the toothbrush, add the toothpaste. Vikas, a roofer who fell from three storeys up, had sessions in the kitchen to learn how to pay attention and multitask again.
It’s not just the direct damage that therapists have to contend with. The brain can create its own problems. Patricia, a catering assistant, had lost the use of her right arm. When asked to point to it, she would move it out of the way and keep searching among the bedclothes. She later believed the arm was a baby and became inconsolable when she thought it had died.
The therapy a patient receives after stroke is the most important determinant of how well they recover: will they be dependent on others or able to fend for themselves? Yet what most patients receive is grossly inadequate, Swayne says. Every working day, patients at stroke units in the UK should receive 45 minutes each of physio, occupational therapy and speech therapy. In 2020, an audit found that most patients received only 14, 13 and seven minutes per day, respectively.“It’s shocking,” says Swayne.
It is even worse when people leave hospital. Stroke units used to pass patients on to the community therapy team in their local area, but those networks were demolished by austerity economics. “It’s a real postcode lottery. There are some boroughs where you’re relieved you’re discharging the patient to that borough because they’ve actually got a speech therapist, whereas another borough is a desert,” Swayne says. “It’s frustrating, having worked with these patients for months, to then send them into the wilderness.” It’s common for patients to return a year or two later with complications, having had no therapy since leaving hospital.
The argument that proper rehabilitation is a luxury we cannot afford does not add up, Swayne adds. Early intensive therapy pays for itself by reducing the cost of long-term care. This will become ever more important as first-time strokes rise in the coming years. Today, strokes cost the UK economy an estimated £27bn a year, but only £3bn of that is driven by direct hospital care. The rest is lost economic productivity and the invisible costs of care. By 2035, the cost is predicted to more than triple to £75bn.
“People talk about the cost of these interventions, but if you do the maths, an admission might cost something like £40,000,” Swayne says. “That sounds like a lot of money, but if you look at the change in care costs, it isn’t, because it pays itself back pretty quickly.” Swayne did the sums for one patient: during his time in the rehabilitation unit, his care costs fell to £2,640 per week, meaning the cost was offset within four months of him going home, and would save tens or hundreds of thousands of pounds in the longer term.
uble. Care for traumatic brain injury is also badly neglected. Each year, more than 1 million people in England and Wales attend emergency departments for head injuries. Of the 200,000 or so who are admitted to hospital, about 40,000 have evidence of traumatic brain injury.
Many such patients are discharged within a couple of weeks. Superficially, they seem better: they can walk and talk. But often, important problems are simply not spotted. “What we now realise is that a majority of those patients have got cognitive changes that haven’t been picked up,” Swayne says. “You can see them walking down the street and they look fine, but they cannot function normally. There’s an invisible disability. It affects their relationships, their employment and they get into trouble with the police.”
And so, the hidden damage left by brain trauma can lead to lives falling apart. In one 2025 study, researchers found that nearly 90% of adult men in Scottish prisons had experienced severe head injury. That doesn’t mean that brain injury triggered their crimes: violent men experience more violence. But damage to specific brain regions might contribute to criminal behaviour, by making it harder for people to control their impulses, feel empathy and anticipate the consequences of their actions.
Researchers are looking at ways to make therapy more effective and – the holy grail – to reopen the window of enhanced neuroplasticity. New drugs, brain stimulation and virtual reality are all in the mix. If they succeed, patients could receive more beneficial therapy to boost their recovery. But for now, perhaps the best we can do is keep our brain healthy and protected.
“We all know what to do for brain health,” says Swayne. “We should exercise. We should be in a stimulating environment and have social interactions. We shouldn’t smoke or drink too much alcohol. There’s really strong evidence that all these things help with brain maintenance. By looking after your brain you’re giving yourself the best chance of recovery should you need it.”
How to Use a Fork: Stories of Mending the Broken Brain is published by Pan Macmillan on 4 June (£20). To support the Guardian, order a copy from guardianbookshop. Delivery charges may apply
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