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.

Showing posts with label 'access'. Show all posts
Showing posts with label 'access'. Show all posts

Saturday, October 10, 2026

“Success will be measured by access”: health leaders advocate equitable care for acute stroke during UN General Assembly Week

 You'd be fired immediately in any business setting for access to the products for sale rather than actually providing the product. The product in stroke is 100% recovery! Don't understand that? GET THE HELL OUT and do some basket weaving! That might be in your wheelhouse! 'Access' doesn't get you recovered you fucking blithering idiots! If you recognize anyone in this picture, shame them mercilessly, they deserve condemnation for absolute stupidity!

“Success will be measured by access”: health leaders advocate equitable care for acute stroke during UN General Assembly Week


Government officials, global health leaders, clinicians, patient advocates, professional societies and industry partners recently gathered during United Nations (UN) General Assembly Week (18–28 September 2026, New York, USA) for a meeting titled, ‘From resolution to action: investing in acute stroke care’, which focused on translating global commitments on stroke into concrete improvements in prevention, acute treatment, rehabilitation, and access to care.

The 22 September reception was convened through the Society of Vascular and Interventional Neurology’s (SVIN) Mission Thrombectomy in partnership with the Business Council for International Understanding (BCIU), Philips, and Medtronic Neurovascular.

The event brought together representatives from international cardiovascular, stroke, neurointerventional and neurosurgical organisations, including the American Heart Association (AHA), World Stroke Organization (WSO), World Federation of Interventional and Therapeutic Neuroradiology (WFITN), Society of NeuroInterventional Surgery (SNIS), and International Society for Global Neurosurgery (ISGNS), alongside ministries of health and other global health stakeholders. Together, these entities brought perspectives spanning public health, stroke systems, neurointervention, global neurosurgery, policy and implementation, as noted in an SVIN press release.

The release adds that this gathering came at “a pivotal moment for global stroke policy”; WHA79.10, adopted by the World Health Assembly in May 2026, represents a “landmark global commitment” to addressing stroke comprehensively, covering prevention, acute care, rehabilitation, and health-system readiness.

WHA79.10 was championed by the Egyptian Ministry of Health and Population with support from the Global Stroke Action Coalition (GSAC)—which comprises organisations and industry leaders dedicated to advancing stroke prevention, treatment, rehabilitation, and access to care worldwide. The resolution represents an “important example” of how governments, professional organisations, patient advocates and industry “can work together to elevate stroke on the global health agenda”, the SVIN release also states.

Debates during UN General Assembly Week

Discussions centred on a fundamental challenge: scientific advances have made highly effective stroke treatments possible, including mechanical thrombectomy for large vessel occlusion (LVO), but millions of eligible patients worldwide still cannot access these treatments in a timely manner.

The conversation was opened by Fawaz Al-Mufti (New York Medical College, New York, USA), global chair of SVIN’s Mission Thrombectomy, who shared ‘the clinical and economic case for acute stroke treatment’, highlighting the “extraordinary effectiveness” of mechanical thrombectomy for eligible patients with LVO stroke. Drawing on global data and an economic analysis spanning six countries, Al-Mufti emphasised that investing in access to thrombectomy can represent a fraction of the societal cost associated with stroke-related disability.

“We are already paying for stroke,” he commented. “The question is whether we choose to pay for recovery today or disability for years to come. A timely thrombectomy can offset a lifetime of disability and its associated costs. We need to stop viewing thrombectomy simply as a procedural expense and recognise access to effective stroke treatment as an investment in people, families, and national capacity.”

The patient perspective was then brought into focus by Margaret O’Neil Wheeler, who shared “a moving account of resilience and fortitude” following an LVO stroke. Accompanied by her husband, whose prompt recognition and action helped get her to lifesaving care in time, Wheeler was reunited at the event with Al-Mufti—who performed her emergency thrombectomy at Westchester Medical Center (New York, USA). Their reunion offered a “powerful reminder” of what timely access to advanced stroke care can mean: not simply survival, but recovery, independence, and the opportunity to return to life after stroke.

Dileep Yavagal (University of Miami, Coral Gables, USA), founder and global chair emeritus of SVIN’s Mission Thrombectomy, followed this with a presentation titled, ‘From global advocacy to global action’. Yavagal described stroke as a “long-neglected pandemic” and emphasised that solving the global access gap requires more than simply building additional thrombectomy centres. Sustainable systems require public and prehospital education, government advocacy, technology, financing, trained teams, and implementation strategies tailored to individual countries, he added.

“We have crossed the scientific frontier—we know thrombectomy can profoundly alter the course of a devastating stroke,” Yavagal commented. “The frontier before us now is access.”

Clinician, industry and health-policy voices

“Stroke does not respect borders, and access to lifesaving treatment should not be determined by where a patient lives,” stated SVIN president Santiago Ortega-Gutierrez (University of Iowa, Iowa City, USA). “The science is clear, the therapies exist, and the global community has recognised stroke as an urgent health priority. Our responsibility now is to turn that recognition into action. Through Mission Thrombectomy, SVIN is committed to measurable progress in access, treatment, and recovery, with the goal that every eligible patient has a meaningful opportunity to survive stroke without preventable disability.”

“Recognition is important, but ultimately our success will be measured by access,” added Mission Thrombectomy vice-chair Kaiz Asif (Endeavor Health, Chicago, USA). “Our goal is to translate this global momentum into a simple reality: that more patients, regardless of where they live, can reach lifesaving thrombectomy in time.”

“The science has given us the ability to dramatically change the outcome of a devastating stroke. The next challenge is ensuring that this opportunity is not defined by geography or resources. That will require sustained collaboration among clinicians, health systems, governments and communities to translate what we know into meaningful access for patients worldwide,” commented SVIN president-elect Robin Novakovic-White (UT Southwestern Medical Center, Dallas, USA).

The proceedings during the UN’s General Assembly Week also aw industry partners underscore the fact that innovation must be accompanied by the systems required to deliver treatment.

“Innovation alone is not enough,” said Signe Haughton, senior director of medical, government and societal affairs, and chief of staff, at Medtronic Neurovascular. “Devices and therapies make a meaningful difference only when patients can reach the right facility, receive timely diagnosis, and be treated by trained teams within an integrated system of care.”

“For people experiencing stroke, every minute matters,” added Felipe Basso, chief executive officer, Latin America, Philips. “Better-connected data, technologies and clinical workflows can help healthcare professionals make timely decisions, support rapid diagnosis and appropriate treatment, and expand access to the right care when patients need it most.”

Finally, Mohamed Fawzi—radiology advisor to the minister of health and population in the Arab Republic of Egypt’s Ministry of Health and Population—provided a country-specific perspective on building a national stroke system.

Egypt’s progress includes 206 stroke units and centres—58 certified through the General Authority for Healthcare Accreditation and Regulation (GAHAR)—free thrombolysis, reimbursement for thrombectomy, approval of tenecteplase, and a prehospital hotline linking approximately 100 hospitals. A national electronic stroke registry is also being launched, with plans to expand the network to 440 units, strengthen certification, establish a national rehabilitation pathway, and publish national treatment rates and treatment times.

According to the SVIN’s press release, the message emerging from the convening was clear: a resolution creates momentum; implementation is what changes outcomes for patients.

“The science exists. The therapies exist. The opportunity now is to build the systems that ensure every eligible patient—regardless of geography or resources—can reach lifesaving stroke treatment in time,” the release adds.

Tuesday, August 4, 2026

Perspectives of stroke survivors, caregivers and healthcare providers on improving access to stroke care services in Tanzania: A qualitative study

 Access to services that don't provide 100% recovery is still failure by ANY MEASUREMENT! Referring to 'care' that many times is complete failure of understanding the needs of stroke survivors! This is true across the world. Failure is endemic in stroke, so you better plan on not having one. 

Perspectives of stroke survivors, caregivers and healthcare providers on improving access to stroke care services in Tanzania: A qualitative study


  • Yingjuan Cao
  • Abstract

    Background

    Stroke is a leading cause of death and disability worldwide, with the greatest burden occurring in in low- and middle-income countries. In Tanzania, delayed hospital presentation, weak referral systems, high out-of-pocket costs, shortages of stroke-ready facilities, and limited rehabilitation services contribute to preventable deaths and long-term disability. Although previous qualitative studies have described barriers to accessing stroke care(NOT RECOVERY!) services, there remains limited evidence on strategies for improving access across the continuum of stroke care(NOT RECOVERY!). Therefore, this study explored strategies to ensure equitable access to stroke care(NOT RECOVERY!) services in Tanzania, focusing on the perspectives of healthcare providers, stroke survivors, and family caregivers.

    Materials and methods

    A descriptive qualitative study was conducted at Muhimbili National Hospital– Mloganzila, a national tertiary referral hospital and designated stroke center in Tanzania. A purposive sample of 45 participants was recruited, including 15 healthcare providers, 15 stroke survivors, and 15 caregivers. In-depth semi-structured interviews were conducted between June and September 2024. Interviews were transcribed verbatim and analyzed using thematic analysis guided by the WHO health system building blocks framework.

    Results

    Thematic analysis identified six themes aligned with the WHO health system building blocks. These include: (1) raise public awareness on stroke risks, prevention and treatment; (2) strengthen stroke care(NOT RECOVERY!) resources and infrastructures at primary care(NOT RECOVERY!) facilities; (3) increase healthcare financing and stroke services insurance coverage; (4) integrate health information systems in stroke care(NOT RECOVERY!); (5) train multidisciplinary teams in stroke care(NOT RECOVERY!) and effective communication; and (6) improve stroke care(NOT RECOVERY!) services delivery across care(NOT RECOVERY!) continuum.

    Conclusion

    Improving access to stroke care(NOT RECOVERY!) requires both patient-centered and health system–level interventions across the continuum of care(NOT RECOVERY!). Strengthening public awareness, healthcare infrastructures, referral pathways, service delivery, rehabilitation access, workforce capacity, and health insurance coverage may reduce inequities in accessing stroke care(NOT RECOVERY!) services in Tanzania.

    Wednesday, July 8, 2026

    World Stroke Organization (WSO) rehabilitation certification program

     Useless! Where is the RECOVERY CERTIFICATION that survivors want? Since you're not doing anything survivors want, just turn it over to survivors so recovery protocols can be created!

    World Stroke Organization (WSO) rehabilitation certification program

    Abstract

    Background:

    Rehabilitation(NOT RECOVERY! That is how fucking incompetent the WSO is!) has been identified by the World Stroke Organization (WSO) as a key priority to reduce the global burden of stroke. Global access to rehabilitation('Access is useless if you don't have recovery protocols! Or are you OK with your tyranny of low expectations? Survivors aren't!) is inconsistent and is particularly limited in low-and-middle-income countries. Progress in rehabilitation has not been as well evidenced as progress in acute care(NOT RECOVERY!). The WSO certification program, which commenced in 2021, focuses on acute interventions. A rehabilitation certification program, applicable in both inpatient and outpatient rehabilitation settings, has been developed to complement the acute certification program to address global implementation of evidence-based stroke care(NOT RECOVERY!).

    Aim:

    To develop globally applicable, evidence-based, stroke rehabilitation recommendations and performance metrics for use in a stroke rehabilitation certification program.

    Methods:

    Strong recommendations were extracted from high-quality stroke rehabilitation Clinical Practice Guidelines, systematic reviews and syntheses of clinical practice guidelines, and from the defining criteria of the International Stroke Recovery and Rehabilitation Alliance (ISRRA) Centers of Clinical Excellence. The WSO Rehabilitation Implementation Committee led the development of the recommendations and invited input from three international, multidisciplinary consultation groups. Group 1 compared strong recommendations from the Australia/New Zealand Living Guidelines with other international guidelines to identify consistent, high-quality recommendations. Group 2 mapped recommendations from global guideline syntheses against the Australia/New Zealand Living Guidelines. Group 3 reviewed and adapted the ISRRA Center of Clinical Excellence recommendations. Recommendations were consolidated through consensus meetings involving representatives from each workgroup, including people from high, upper-middle, and lower-middle-income countries. Strong recommendations that were consistent across teams, alongside additional recommendations based on certainty of evidence, anticipated risk versus benefit, and relevance across settings, were included as patient-level recommendations in the implementation certification program. Service-level recommendations were generated through consensus or derived from existing guidelines. An implementation manual, outlining “what,” “who,” and “how,” as well as indicators to demonstrate performance of each recommendation, was developed to support clinical implementation and to facilitate assessment for certification. The criteria were piloted between November 2024 and September 2025 at 15 centers in six upper- and lower-middle-income countries (three continents) and subsequently refined. Expectations (mandatory or recommended) for each level of certification (Minimal, Essential and Advanced) were set post-pilot through rating strength of evidence, a series of group discussions and review of pilot data.

    Results

    Fifty-five recommendations were included. Nine recommendations address service-level indicators, and 46 address patient-level indicators. Service-level indicators address defining features of rehabilitation services that are not apparent in individual patient medical record audits. Patient-level indicators address management of swallowing impairment, nutrition and hydration, information provision and goal setting, amount and timing of rehabilitation, exercise and motor rehabilitation, visual function, communication, mood and cognition, management of complications, and discharge planning and support. An implementation manual complements the recommendations to guide clinical care(NOT RECOVERY!) and consistent assessment.

    Conclusions

    The WSO rehabilitation recommendations and performance metrics incorporate the most current evidence and have been refined following pilot-testing. The recommendations are globally relevant and support both resource-limited and high-income settings in participating in the rehabilitation certification program to advance international stroke rehabilitation delivery.

    Wednesday, February 18, 2026

    More younger Scots dying from stroke

     If your hospital isn't measuring 30-day deaths and putting together protocols to prevent those deaths; 

    THEY ARE TOTALLY FUCKING INCOMPETENT! 

    No excuses allowed, everyone needs to be fired! Why would you go to a failed hospital?

    More younger Scots dying from stroke

    The number of people aged under 65 dying from a stroke across Scotland is increasing, despite an overall reduction in stroke rates and deaths across all ages. The charity Chest Heart & Stroke Scotland says there is a widening health inequality gap, with deprivation emerging as one of the strongest predictors of stroke-related death.

    The Scottish Stroke Statistics issued by Public Health Scotland report on patient numbers and incidence of cerebrovascular disease in Scotland, including stroke, brain haemorrhage and Transient Ischaemic Attacks, or ‘mini strokes’.

    The incidence rate for cerebrovascular disease decreased over the decade between 2015/16 and 2024/25 by 12%. Incidence was consistently 25% higher in males than females.

    The overall death rate reduced by 28% in the ten years to the end of 2024.

    However, Chest Heart & Stroke Scotland (CHSS) says the overall picture hides a worrying trend of 16% more deaths in younger people under the age of 65 from stroke and wider cerebrovascular conditions over those ten years.

    CHSS says there is a ‘stark gap’ in outcomes for people in more disadvantaged areas, with the 2024 death rate in the most deprived areas of Scotland 52% higher than in the least deprived.

    Of the 19,098 people who died from cerebrovascular disease between 2020 and 2024, 1,871 were under 65. 35% of those deaths occurred in the most deprived areas of Scotland, compared to 19% of those aged 65 and over living in these communities.

    The charity is calling for a fundamental shift in how the country tackles the root causes of stroke, and the impact on outcomes of deprivation, lack of early intervention and uneven access to rehabilitation.

    Chief Executive, Jane-Claire Judson says politicians need to focus on these gaps as a matter of urgency:

    “This isn’t just a statistical anomaly, it's a wake-up call. People under 65 should not be dying from strokes in increasing numbers in 2026.

    “Behind every one of these deaths is a story of lost potential, devastated families, and avoidable tragedy.

    “What this trend shows us is that progress isn’t being felt equally. If we don’t act to reverse this now, more families will face the heartbreak of losing loved ones far too soon.”

    Focus on five factors

    In its manifesto ahead of May’s Holyrood elections, CHSS calls on the next Scottish government to focus on five key areas: prevention and early detection, acute care – included access to 24/7 thrombectomy services – rehabilitation, support beyond healthcare, and prioritising lived experience.(But not 100% recovery! Are you that fucking stupid? YOU have to call out their incompetence!)

    The organisation says a failure to invest in these areas will see the current cost of stroke to the NHS in Scotland increase beyond £1 billion a year.

    Former MP Amy Callaghan survived a haemorrhagic stroke in 2020 aged 28.

    Now Strategic Political Advisor at CHSS, she says delivering on the 2017 promise of universal access to 24/7 thrombectomy services, must be a priority:(YOU are that stupid! Access does not deliver recovery; ONLY EXACT PROTOCOLS DO!  My god, the absolute stupidity in stroke is appalling!)

    “If someone has a blood clot in their brain, they need to get on the table to receive a thrombectomy within three hours.(And the failure rate of that is 88% Right now, that simply isn’t happening.

    “If you arrive just minutes too late you may miss the service and could be left with a lifelong disability.”

    This contrasts, CHSS says, with outcomes for those receiving timely access to thrombectomy treatment, who are three times more likely to return to independent lives.

    Jane-Claire Judson says uniform national access to cardiovascular risk detection, timely diagnosis and treatments such as thrombectomy, with stronger support for rehabilitation, can help address the growing number of deaths of younger people from more deprived communities, adding:

    “Too many lives are being half lived, or lost entirely, because we are failing to make the right decisions now. The data is clear. The solutions exist. What’s needed is political will.”

    Thursday, November 20, 2025

    Understanding Access to Rehabilitation for Stroke Survivors: Talya Fleming, MD

     'Access' to something that doesn't work is mostly useless. Or don't you even acknowledge all the failures in stroke? Look at all these problems in stroke needing solutions but none exist and no one seems to be working on them.

    Check out these 13 problems in stroke with nothing to address them. Survivors are just supposed to accept that stroke is so fucking hard to solve that your disability for life is an acceptable consequence. Everybody in stroke needs to be fired, specially when they put out back patting articles like this.  

    Understanding Access to Rehabilitation for Stroke Survivors: Talya Fleming, MD


    Talya Fleming, MD Louie PasculliFact checked by: Marco Meglio The medical director of the stroke recovery program at JFK Johnson Rehabilitation Institute at Hackensack Meridian Health provided clinical insights into her presentation focused on expanding rehab care(NOT RECOVERY!) for stroke survivors across settings. [WATCH TIME: 5 minutes](I'm certainly not wasting 5 minutes listening to this.)

    Tuesday, August 12, 2025

    The Scottish Government Has Failed Stroke Survivors

     Every single government IS COMPLETELY FAILING SURVIVORS! Nobody is working on 100% recovery protocols!

    Survivors don't want just  'access'; they want recovery! Everyone in stroke who isn't working towards that goal is a fucking blithering idiot!

    Send me personal hate mail on this: oc1dean@gmail.com. I'll print your complete statement with your name and my response in my blog. Or are you afraid to engage with my stroke-addled mind? No excuses are allowed! You're medically trained; it should be simple to precisely state EXACTLY WHY you haven't worked at all on 100% recovery with NO EXCUSES! Your definition of competence in stroke is obviously much lower than stroke survivors' definition of your competence! Swearing at me is allowed, I'll return the favor. Don't even attempt to use the excuse that brain research is hard.


    'care' and access are not the solution needed. You need to CREATE EXACT 100% RECOVERY PROTOCOLS!

    The Scottish Government Has Failed Stroke Survivors

    For the seventh straight year the Scottish Government has failed to meet its own stroke care(NOT RECOVERY!) bundle target. Just over half of  the 11,341 Scots who had a stroke last year got access(That's the bare minimum, you need EXACT RECOVERY PROTOCOLS AFTER YOUR ACCESS!) to necessary standards of treatment. Scotland is lagging even further behind other nations when it comes to the delivery of life-changing thrombectomy  The Scottish Government has failed to meet its own targets for stroke care(NOT RECOVERY!) bundle delivery for the seventh successive year.  Figures released today from Public Heath Scotland’s Scottish Stroke Improvement Programme reveal the country is falling unacceptably short of its own target of 80% of stroke patients receiving an inpatient bundle. The bundle, which includes aspirin, access(That's the bare minimum, you need EXACT RECOVERY PROTOCOLS AFTER YOUR ACCESS!)to a stroke unit, brain imaging, and a swallow screening was given to just 52.9 per cent of Scotland’s 11,341 stroke patients. Chest Heart & Stroke Scotland, the country’s largest health charity, is urging the Scottish Government to make stroke care(NOT RECOVERY!) an urgent priority as well as demanding widespread improvements for the delivery of thrombectomy, a potentially life-changing procedure.Only 212 thrombectomy procedures were delivered in 2024, which is just 2.2% of eligible ischaemic stroke patients. Although this is an increase from 153 in 2023, this is still well below other comparable nations. The Scottish Stroke Improvement Plan sets a target of 10%, underscoring the urgent need to accelerate progress. Stroke is still one of the biggest causes of long-term adult disability in Scotland, and the quality of care(NOT RECOVERY!) is crucial for recovery.  Allan Cowie, chief operating officer at Chest Heart & Stroke Scotland, said: “Unfortunately, once again, the statistics laid out by Public Health Scotland make for grim reading. “This is the seventh straight year that the Scottish Government has failed to hit its own targets for stroke care(NOT RECOVERY!). This government has failed stroke survivors and is failing our NHS colleagues who are doing the absolute best they can with the inadequate resources they’re currently being given. Scotland is also falling further behind similar-sized nations, such as the Republic of Ireland, in the delivery of potentially life-changing thrombectomy procedures. Just 1.6% of suitable stroke patients in Scotland received a thrombectomy in 2023, rising only slightly to 2.2% in 2024, compared to 10.8% in the Republic of Ireland. While Scotland’s rate has improved marginally, the disparity remains stark. This is unacceptable. “CHSS has consistently called for vast improvements in stroke care(NOT RECOVERY!) for years and we campaigned for the national thrombectomy service rollout in 2017, but it is still not being delivered consistently.“While we recognise the financial constraints facing the government, the continued underinvestment in stroke care(NOT RECOVERY!) is resulting in significantly higher long-term costs – both through prolonged hospital stays and the extensive support required for individuals living with stroke-related disabilities. This ongoing shortfall is not only economically unsustainable but is also costing lives. Immediate action is imperative.” “It’s frustrating and it makes me feel really sad to see people in that situation.”That disparity in stroke care(NOT RECOVERY!) is being felt on the front lines.Katie Lambert, a CHSS stroke nurse, knows how important critical stroke care(NOT RECOVERY!) can be in a person’s health outcome. When patients get home from hospital, CHSS stroke nurses will speak to the stroke survivor after discharge and give them information, advice and support related to their stroke. But longer waiting times for services such as blood pressure checks are increasing the stress in stroke survivors. Katie said: “I think we have all noticed changes in the times people are having to wait for services like social services, rehabilitation, home care services and GPs. This is increasing stress in stroke survivors. People seem to be more stressed, anxious, and they find it harder to get routine appointments with GPs. “That can have a knock-on effect on a person’s ongoing stroke prevention risk because if you can’t get an appointment with your doctor to talk about your worries, then it’s obviously going to have a detrimental effect to your health. “I think there’s just a general sense of more worry, distress, anxiety and people are feeling less confident in the services.”Katie added: “I think it would be helpful for there to be more funding in general for stroke services. “In our CHSS nurse service, we’re fortunate we do get to spend more time with people than a lot of other services do. But stroke services would benefit from more funding, particularly community rehabilitation and making sure people have access to the services they need in a timely manner. “It certainly doesn’t feel good when you come off a phone call, or leave a home visit, where somebody who’s been incredibly distressed because they need a service to help them but there’s a long waiting list. That person is stuck in the system waiting. Afterwards you feel like you can’t do any more. “It’s frustrating and it makes me feel really sad to see people in that situation.” “Thrombectomy is a gamechanger” Michael Macdonald, 33, lives in Newton Mearns and is a two-time stroke survivor.  Through quick treatment, intensive rehabilitation and support from Chest Heart & Stroke Scotland, Michael was able to make a good recovery. At 33, Michael received a thrombectomy after his first stroke and feels “lucky” to have received the procedure.Michael said: “I didn’t realise this procedure is only available 9-5, Monday to Friday. I got to hospital at 4.30 in the afternoon, and I was lucky that the stroke team decided I needed to be treated right away, and they all stayed to do that. “Now, knowing the difference thrombectomy can make in recovery, I think it’s essential that this procedure is available to everyone, no matter where you live or what time you are admitted to hospital. It’s a gamechanger where stroke recovery is concerned.”  People are leaving hospital feeling scared and alone. 

    Thursday, August 7, 2025

    US Stroke Rehab System Not Serving Patient Needs, Societies Say

     Blindingly obvious when only 10% get to full recovery and 12% get to full recovery with tPA. With some actual leadership this could be easily solved!

    US Stroke Rehab System Not Serving Patient Needs, Societies Say

    Access(WRONG, WRONG, WRONG! EXACT REHAB PROTOCOLS ARE REQUIRED! Access is the tyranny of low expectations, meaning you don't expect to help patients get fully recovered! I'd fire anyone with that mindset!) to rehabilitation is a “lifeline” for patients that needs to be protected and preserved to ensure their recovery.
    US Stroke Rehab System Not Serving Patient Needs, Societies Say

    Apatient’s ability to obtain timely and adequate access to rehabilitation services after a stroke is often dictated by racial, ethnic, socioeconomic, and geographic issues rather than their own needs, according to a joint policy statement from the American Heart Association (AHA) and the American Stroke Association (ASA).

    Committee chair Nneka L. Ifejika, MD, MPH (University of Texas Southwestern Medical Center, Dallas), noted to TCTMD that the majority of the committee members who authored the statement are active practitioners of stroke rehabilitation and recovery who have become increasingly concerned about the widening gaps they see in access to postacute care (PAC) services. The policy statement represents the first time the AHA and ASA have taken an advocacy approach to address these issues.

    “Ideally, stroke rehabilitation starts in the hospital and there’s a good continuity of care to the postacute realm,” Ifejika added. Whether the patient transitions to inpatient rehab, a skilled nursing facility, an outpatient rehab center, or even telerehabilitation, the committee says there’s no standardized framework in place to ensure equitable continuity of care after a stroke.

    In the policy statement published recently in Stroke, Ifejika and colleagues pinpoint some of the major gaps and issue a call for action to preserve and improve access to stroke rehab, which they term “a lifeline of hope” not just for patients, but also for their families, caregivers, and communities.

    “We’ve made all these wonderful strides in acute stroke treatment, but we’re not making similar strides in stroke rehabilitation and recovery,” Ifejika said.

    Unlike cardiac rehab, which is focused on helping the patient improve functional endurance after an acute cardiac event, stroke rehab can be directed at more subtle issues that nevertheless interfere with patients getting back to daily routines like self-care and work and regaining their sense of independence and identity.

    “Patients may have cognitive impairments, they may have sensory impairments, they may have motor impairments,” Ifejika noted. “They may have difficulty with depression or anxiety, and so it’s a more of a multifactorial rehabilitation that we’re addressing after a stroke.”

    Payers, Unmet Needs, and Advocacy

    In looking at what’s driving the types of poststroke care that patients receive, the committee notes that among other things, partnerships among health corporations, hospitals, health systems, and physician groups can have a big impact.

    “Such partnerships can result in a conflict of financial interest between the needs of these organizations and the patient’s clinical needs,” they write. “In some areas of the United States, the reach of large healthcare systems or conglomerates limits access to PAC options.” They also cite a lack of transparency regarding the factors used to make determinations on behalf of patients about their options.

    According to Ifejika and colleagues, a congressional subcommittee recently investigated three Medicare Advantage programs that they say disproportionately select against patients having access to PAC.

    The US Senate Permanent Subcommittee on Investigations detailed in a 2024 report how all three programs—UnitedHealthcare, Humana, and CVS—use artificial intelligence (AI), predictive models, and automation to deny access to PAC. Using these methods, the subcommittee said, Humana’s denial rate for long-term acute hospitals increased by 54% between 2020 and 2022, UnitedHealthcare’s prior authorization denial rate for PAC increased from 10.9% in 2020 to 22.7% in 2022, and CVS admitted to saving $660 million in 2018 by denying prior authorizations submitted for Medicare Advantage beneficiaries for inpatient PAC.

    Patients tend to get lost to follow-up because they look normal, when in fact they aren’t.Nneka L. Ifejika

    Delving into unmet needs, the new document’s committee says stroke survivors and their families need more thorough education during the acute hospitalization about all PAC options and should be provided with consistent follow-up at 30 and 90 days that includes documentation of modified Rankin Scale score. In addition to addressing the needs of the patient, PAC can also help family members who are becoming first-time caregivers to understand a host of things they will need to do, from assisting in activities of daily living to preventing falls.

    Throughout the policy statement, Ifejika and colleagues note the importance of advocacy to improve the stroke rehabilitation system and give patients and caregivers information they need to make informed decisions. That includes developing performance measures as well as public policy guidance to ensure that the PAC matches the needs of all patients, including those who are under- or uninsured so could get lost to care and follow-up once they leave the hospital.

    Among the priorities that the committee sees as being crucial going forward are:

    • More resources for the study of stroke rehab with research questions that directly reflect practical, day-to-day challenges of clinicians, families, and patients
    • An open-access surveillance system for collecting data across the full spectrum of stroke type, severity, demographics, health systems, hospitals, and payers
    • Better understanding of how variability in rehab care is influenced by health systems, hospitals, insurance, and alternative payment models
    • A comprehensive inventory of coverage policies of all major payers/insurers in the US and field surveys of discharge planners at acute hospitals to uncover barriers to PAC recommendations
    • Comparative effectiveness and cost-effectiveness studies of different rehabilitation strategies
    • Expansion of clinical training programs to improve understanding of patient, family, and caregiver needs after discharge, including the role of social determinants of health as they relate to medical care and access to community resources for PAC
    • More research into the transition from hospital to home

    Importantly, Ifejika said, there is still much to be learned not only about which services patients need after a stroke, but when they need them, because each recovery is different and may not be linear.

    “There has to be an understanding that when they’re in the hospital, they may present as having no additional neurologic deficits, or they may present as being normal. You haven’t seen them out in the community yet, so you really don’t know whether they have additional impairments,” she said. “Patients tend to get lost to follow-up because they look normal, when in fact they aren’t. Unfortunately, that contributes to increased costs because they [may not be] able to go back to work . . . or someone has to stay home or a caregiver has to be hired.”