Use the labels in the right column to find what you want. Or you can go thru them one by one, there are only 34,278 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.
It definitely is NOT the golden hour, persons are NOT GETTING TO 100% RECOVERY! Your tyranny of low expectations is showing; get the hell out of stroke!
So you're going to have to have vastly different plans to get your patients 100% recovered. There is no such thing as the golden hour. The requirement is still 100% recovery. Someplace amongst my 25,000+ posts there is research suggesting later(hours to days)interventions still do some good. Have your doctors find them, I'm not being paid, they are.
In this research in mice the needed time frame for tPA delivery is 3 minutes for full recovery.
IV thrombolysis, i.e. clot buster, can be given to patients
presenting within 4.5 hours of symptom onset. Currently, the golden hour
is 4.5 hours from time of stroke symptom onset; the earlier the
treatment, the better the outcome. The benefits of clot buster in
patients with acute ischemic stroke are time-dependent, and guidelines
recommend a door-to-needle time of 60 minutes or less.
Galen
Centre for Health and Social Policy chief executive Azrul Mohd Khalib
(first from left) at a symposium organised by the Galen Centre at the
sidelines of the Malaysia Stroke Conference 2022 in Penang on August 11,
2022. Picture by the Galen Centre.
KUALA LUMPUR, Dec 28 – A new report shows that the vast majority of
stroke patients in Malaysia do not get the necessary treatment within
the first crucial hours, when a stroke patient’s brain is being damaged
beyond repair.
Only 21 per cent of stroke patients were able to be treated at a
medical facility within three hours of the onset of symptoms, while the
median time from the onset of stroke symptoms to arrival at a hospital
was seven hours or more, according to a White Paper on acute stroke care
in Malaysia by the Galen Centre for Social Health and Policy that was
commissioned and funded by Boehringer Ingelheim (Malaysia).
The delays were attributable to a lack of awareness and recognition
of stroke symptoms, as well as accessibility to thrombolysis services.
Thrombolytic therapy
(or thrombolysis) is the use of “clot-busting” drugs to break up or
dissolve blood clots, which are the main cause of both heart attacks and
strokes.
The drugs greatly reduce the risk of death or severe disability in
people who suffer from ischaemic stroke, which occurs when a clot blocks
the blood flow to the brain. But these drugs must be given within 4.5
hours of symptom onset; otherwise, they are ineffective.
Thrombolytic therapy was first approved for use in public hospitals
across Malaysia in 2012. There are 77 hospitals nationwide – 39 in the
public sector and 38 in the private sector – providing thrombolysis
service.
However, only 11 public hospitals currently provide full access to
this treatment on a 24-hour, 7 days a week basis, including Seberang
Jaya Hospital in Penang, Queen Elizabeth Hospital in Sabah, Sultanah Nur
Zahirah Hospital in Terengganu, and Sarawak General Hospital.
Data from the National Stroke Registry showed that only 0.65 per cent
of stroke patients were treated with thrombolysis, out of a sample of
4,762 first-ever ischaemic stroke patients admitted to 13 government
hospitals from July 2009 to June 2015.
Galen Centre chief executive Azrul Mohd Khalib – during a symposium
held last August 11 at the sidelines of the Malaysia Stroke Conference
2022 in Penang – relayed the experience of a 43-year-old woman with
severe hypertension who was working at a bank and was stricken with a
stroke episode during a long meeting.
“It was not detected that she had a stroke, and as a result, it was
only at the end of the meeting that they realised that she was suffering
from a medical emergency, which was not known at the time.
“By the time she was admitted into some form of stroke care, which
was nearby, HKL (Kuala Lumpur Hospital) is not that far from where she
was working, but it was six hours after which, if you remember the
period which is best for patients to get thrombolysis, is 4.5 hours from
time of stroke symptom onset, and if possible, within the ‘golden
hour’,” Azrul said.
The 60 minutes after the onset of stroke symptoms are known as “the golden hour”.
The World Stroke Organisation proposes a door to needle time of 60
minutes to improve stroke patient outcomes. Sixty minutes is the
benchmark for stroke workflow from detection to delivery of treatment at
a hospital.
“For her, the debilitating situation resulted in her, for more than
two years, suffering from a deterioration in the quality of life,
limited mobility and almost complete dependence on other people for her
living,” Azrul added.
The patient died in July as a result of complications due to a respiratory infection.
“This is a situation that, really, when you look at the facts of the
case, could something have been done differently? Most importantly,
could she have been brought to treatment, especially thrombolytic
treatment, a lot earlier, perhaps, as a form of intervention?
“That’s one of the things when you look at the level of stroke care
that’s available today, one of the key issues that have been raised
again and again is where do we take a person who we know suffers from a
stroke episode to be treated?
“And a significant amount of time is spent wandering the Internet, I
kid you not – people Google-ing where to send a patient who is going
through a stroke for treatment.
“Very commonly people just send directly to the emergency departments
of any hospital for which there could be substandard care. In the end,
there is a missed opportunity because you then have to send the patient
to another hospital,” Azrul said.
Stroke Services Mostly Available In Klang Valley
More than 40,000 strokes are estimated to occur annually in Malaysia,
resulting in almost 14,000 deaths. It is the second leading cause of
death and disability in the country and the third most common cause of
mortality.
Based on current data with an expected 40,000 stroke admissions per
year, the cost of stroke management is estimated to be around RM213
million annually.
Despite the prevalence of stroke nationwide, services such as thrombectomy
– a procedure that mechanically removes a clot from the brain – are
concentrated in the Klang Valley, said Dr Irene Looi, a clinical
neurologist at Seberang Jaya Hospital in Penang.
“The majority of thrombectomy centres are in Kuala Lumpur, the Klang
Valley region. Even in the north zone, we only have one private and one
government centre, which is in Kedah – for the whole of Penang, Kedah,
Perlis, and Perak. So, there’s still room for improvement,” Dr Looi said
at the symposium.
In addition to thrombectomy centres, Dr Looi also expressed hope of
seeing more rehabilitation centres for stroke patients nationwide.
“We want to see more rehabilitation centres like the Cheras
Rehabilitation Centre to be in Kedah, in Penang – I’m talking about the
north zone because I’m from the north. I’m sure people on the East Coast
also have similar hopes, rather than everything being available only in
KL,” she said.
Dr Looi highlighted the importance of providing stroke patients with
either thrombolysis or thrombectomy treatment quickly to give them a new
lease on life.
“Once you have done hyper-acute stroke, you see your patient improve
in front of your eyes, your perspective changes,” Dr Looi said.
Acute stroke refers to the first 24 hours of a stroke event.
Hyper-acute stroke is when patients are presented within six hours of
stroke onset.
“I have been practising for the past 25 years. In the first 15 years
when we didn’t do hyper-acute stroke, if there’s a big stroke (patient)
that comes in, they will have paralysis of the body, then they lose
consciousness, they are paralysed, and they lose their ability to work
and to live a quality life – we know that this is the outcome.
“But in the last 10 years of my career, I’ve seen how thrombolysis works and how thrombectomy works,” Dr Looi added.
“If you do some procedure within that ‘golden’ period – undo the
clog, and open up the clog within that golden period – your patient, who
is supposed to be lying in bed, will just improve within two to three
days. They will not end up like what it was supposed to be.”
Among the recommendations made in the White Paper was to decentralise acute stroke care.
It was noted that the greatest improvements were seen when
hyper-acute stroke care has been decentralised to several better
equipped and staffed hospitals, placing care closer to the community,
rather than relying on a small number of regional health care
facilities.
“There should be more ‘stroke ready’ hospitals at least one per
state, providing 24-hour, seven days a week service through an acute
stroke unit (ASU). District hospitals are frequently unutilised and
could be used to deliver appropriate stroke care during the early
critical period,” the report stated.
More Specialists, Partnerships, and Awareness Of Stroke Can Improve Care
The White Paper further noted that out of 123 registered neurologists
in Malaysia, only 31 are practising in hospitals run by the Health
Ministry (MOH), while the remaining are attached to university hospitals
under the Higher Education Ministry and private health care facilities.
The report called for an increase in the number of neurologists and
multidisciplinary health care professionals who can treat stroke and
administer thrombolysis needs to fill the expertise gap.
Dr Wong Yee Choon, a consultant neurologist at Pantai Hospital
Penang, said while neurologists are aware of stroke, not all are experts
in the disease.
“Some may be interested in Parkinson’s, for example, so we should
call it neurologists who have a special interest in stroke or a stroke
neurologist. A physician who has gone for special training in stroke can
also help to fill the gap,” Dr Wong said.
Alternatively, Dr Wong said more public-private partnerships can be
established to address manpower and other resource shortages in public
health care facilities.
“I think it would be good if we could have some sort of collaboration
which is what we have been doing with Seberang Jaya [Hospital]. We can
fill the gaps quickly without having to wait for more specialists going
for training in the government sector,” Dr Wong said.
He added that the public also needs to be more aware of stroke symptoms and act fast.
The B.E.F.A.S.T acronym is used to check for the most common symptoms of a stroke.
Balance: Sudden loss of balance or difficulty to coordinate
Eyesight: Vision is impaired or changed
Face: Whether one side of the face droops and if it is possible to smile
Arms: Both arms are raised, and whether one arm drops down instead
Speech: Check for slurred or strange speech
Time: If the answer to any of these is yes, immediate medical attention is needed
An ischaemic stroke is caused by blockages or occlusion of the
arteries as a result of plaque build-up along the inner lining of
arteries. This type of stroke can happen in more than 80 per cent of
cases, often suddenly and without early signs or warning.
The typical presentation of an ischaemic stroke is hemiparesis, when one side of the body suddenly experiences weakness or is unable to move.
A hemorrhagic stroke is mainly caused by the rupture of cerebral
blood vessels, aneurysms, or as a result of physical trauma. Of those
who survive this type of stroke, more than half will experience
significant disabilities.
Since your doctor has never even tried to get you to 100% recovery. Yes your doctor should be replaced with Dr. Watson. Because rehabilitation will continue to be a failure until you save billions of neurons in the first week by stopping
I lost 5.4
billion neurons in the first week because my doctor did nothing.
Because rehab only gets you almost fully recovered 10% of the time.
So rehab is essentially a total failure and you are promoting more of
that failure. You're focusing on completely the wrong part of stroke.
Nik Nasihah Nik Ramli, Amhsavenii Asokan, Daniel Mayakrishnan, Hariharasudan Annamalai International Medical School, Management & Science University, Shah Alam, Selangor, Malaysia To cite this article: Nik Ramli NN, Asokan A, Mayakrishnan D, Annamalai H. Exploring stroke rehabilitation in Malaysia: are robots better than humans for stroke recuperation? Malays J Med Sci. 2021;28(4):14–23. https://doi.org/10.21315/mjms2021.28.4.3 To link to this article: https://doi.org/10.21315/mjms2021.28.4.3
Abstract
Ranked as the second leading cause of death and the primary factor to adult disability worldwide, stroke has become a global epidemic problem and burden. As a developing country, Malaysia still faces challenges in providing ideal rehabilitation services to individuals with physical disabilities including stroke survivors. Conventional post-stroke care is often delivered in a teambased approach and involves several disciplines, such as physical therapy, occupational therapy, speech and language therapy, depending on the nature and severity of the deficits. Robots are potential tools for stroke rehabilitation as they can enhance existing conventional therapy by delivering a precise and consistent therapy of highly repetitive movements. In addition, robot assisted physiotherapy could facilitate the effectiveness of unsupervised rehabilitation and thus, may reduce the cost and duration of therapist-assisted rehabilitation. Research on robot assisted physiotherapy for stroke in Malaysia is slowly coming into the limelight in the past two decades. This review explores the effectiveness of robot assisted physiotherapy particularly in improving motor functions of stroke survivors in Malaysia.
A
population-based study was conducted to distinguish recurrent ischemic
stroke (IS) predictors and to ascertain the possible effect of secondary
preventive medications on IS recurrence in non-elderly adults with or
without diabetes. Researchers extracted data of 3,386 patients < 60
years old who had a history of index IS from the Malaysian National
Neurology Registry from 2009 to 2016. Via SPSS version 22, multivariate
logistic regression analysis was performed. In non-elderly adults after
the index IS event, IHD was found as the main predictor of IS
recurrence, regardless of diabetes status. The data revealed that after
index IS, receiving antidiabetic and antiplatelet medications upon
discharge were significant predictors of recurrent IS in non-elderly
diabetic adults. A randomized clinical trial may be needed to ascertain
the effect of secondary preventive medication on IS recurrence,
especially in non-elderly adults.
There is limited research data on post-rehabilitation function and quality of life
despite the increasing role of rehabilitation in the care of stroke patients in Malaysia.
Outcome data is important in evaluating the effectiveness of stroke rehabilitation
services in the country.
Aims
The aim of this study was to assess function and quality of life in stroke patients
following intensive rehabilitation at a tertiary hospital.
Materials and methods
This was a cross-sectional study of 91 stroke patients; mean age 58.9±10.6 years,
79% male, median stroke duration 13 months who have completed intensive individual
rehabilitation at the Universiti Kebangsaan Malaysia Medical Centre in the years 2010
and 2011. Rehabilitation outcome was measured with the use of standardised tools;
Rivermead Mobility Scale (RMI), Berg’s Balance Scale (BBS), Sit to Stand Test (STS)
for lower limb strength and Timed 10 metre walk test for walking speed. Post-rehabilitation
disability level and quality of life were also assessed on a Modified Rankin Scale
(mRS) and Euro-Qol 5 Dimensions-Visual analogue Scale (EQ5D-VAS), respectively. All
data were analysed descriptively using SPSS version 18.
Results
The median duration of rehabilitation was 10.5 months (range 5-25) in the study patients
and post-rehabilitation mean mRS was 2.3±0.7. The median RMI was 13 (range 6-15),
median BBS 51 (range 20-56) and median STS 15.5 secs (range 7.9-83.9 secs). The EQ5D-VAS
mean score was 71.5±17 and mean walking speed at the completion of intensive rehabilitation
was 49.4±28.3 m/min; less 22 m/min when compared with the optimum walking speed required
for safe road crossing.
Conclusion
Although our stroke patients gained satisfactory levels of mobility, balance and strength
following intensive rehabilitation, they have not achieved optimum speed of walking
to enable effective community ambulation. Prolongation of rehabilitation programme
may assist in further functional and quality of life gain among the post-stroke patients.
