Deans' stroke musings: Understanding the Evolving Care of Rehabilitation and Stroke Recovery

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, June 12, 2025

Understanding the Evolving Care of Rehabilitation and Stroke Recovery

In my 15 years of writing, I have seen NOTHING EXACT that helps recovery. It's all still useless guidelines!

Understanding the Evolving Care of Rehabilitation and Stroke Recovery

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June 1, 2025

Author(s):

Francois Bethoux, MD,Andrew Russman, DO

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Key Takeaways

Neurorehabilitation aims to enhance daily function and quality of life post-stroke through individualized strategies, emphasizing early and intensive rehabilitation.
Recent advancements include rehabilitation technology, telerehabilitation, community exercise programs, and neuromodulation, offering promising results in motor recovery.

Explore innovative neurorehabilitation strategies for stroke recovery, emphasizing personalized approaches and advanced technologies to enhance patient outcomes.

Francois Bethoux, MD

Neurorehabilitation is a well-established component of post-stroke medical management. Rehabilitation is described by the World Health Organization as “a set of measures that assist individuals who experience (or are likely to experience) disability to achieve and maintain optimal physical, sensory, intellectual, psychological, and social functioning in interaction with their environment.”¹ According to Francois Bethoux, MD, Chair, Department of Physical Medicine and Rehabilitation at Cleveland Clinic, “rehabilitation is a process rather than a discrete event, involves multiple disciplines, and follows the patient’s journey through many transitions and milestones.”

Guidelines recommend starting rehabilitation as early as possible (often within 48 hours after a stroke).² Rehabilitation is often more intensive in the first 6 to 12 months after a stroke, and may start in an inpatient rehabilitation facility, in the home, or in an outpatient setting.

The overall aim of neurorehabilitation is to maximize a person’s ability to perform daily activities and to optimize their quality of life(NOTICE NOT RECOVERY!) through an individualized approach. Mechanisms by which this goal(The only goal in stroke is 100% recovery! Why is no one working towards that?) is achieved include promoting brain plasticity, teaching compensatory strategies (for example, training a non-dominant limb or using an assistive device), managing symptoms that can hinder recovery such as post-stroke pain and spasticity, and empowering the person to maintain a healthy lifestyle.

Andrew Russman, DO

"Multimodal approaches tailored to the individual patient’s disability are necessary to optimize stroke recovery," according to Andrew Russman, DO, a vascular neurologist and Head, Cleveland Clinic Enterprise Stroke Program. Recent advances and new approaches to stroke rehabilitation include:

Rapidly growing use of rehabilitation technology, such as robotic devices, virtual reality, and instrumented treadmills
Easier access to rehabilitation in the home environment, for example with telerehabilitation and home monitoring
Development of community exercise programs that are accessible to individuals with disabilities.
Use of neuromodulation (transcranial magnetic stimulation or direct current stimulation, deep brain stimulation, vagal nerve stimulation) in combination with rehabilitation therapies focused on movement or task repetitions, with promising results in terms of motor recovery even years after a stroke in some individuals.

Mark Bain, MD

Mark Bain, MD, Head, Cerebrovascular Neurosurgery at Cleveland Clinic, recently began implanting an FDA-approved vagal nerve stimulation device³ in patients with moderate to severe upper limb weakness, to help improve their rehabilitation after stroke. Building upon their positive 2023 phase I trial,⁴ Andre Machado, MD, (Chief, Neurological Institute at Cleveland Clinic) and colleagues are leading the RESTORE study, a pivotal multi-center clinical study of deep brain stimulation combined with rehabilitation to augment post-stroke motor recovery.

Overall, stroke recovery is a long-term dynamic process that requires a holistic and personalized approach, adjusted over time depending on the person’s evolving needs.“We need to be a beacon for our patients striving for something more in their stroke recovery.Embracing these innovative approaches to stroke recovery is critical to expand the treatment options that our patients demand,” concluded Dr. Russman.