Use the labels in the right column to find what you want. Or you can go thru them one by one, there are only 34,148 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.
Showing posts with label NOT GOOD ENOUGH!. Show all posts
Showing posts with label NOT GOOD ENOUGH!. Show all posts
The promise has been out there for well over a decade, WHOM will actually solve the problem? NO leadership and NO strategy is the result of our fucking failures of stroke associations!
Researchers from the University of Miami Miller School of Medicine and collaborating institutions have published a comprehensive review examining the rapidly evolving field of intra-arterial stem cell therapy for ischemic stroke, highlighting its potential to improve recovery for patients who continue to face disability despite major advances in stroke treatment.
Published in the American Heart Association Journal Stroke: Vascular and Interventional Neurology, the review, titled "Progress in Intra-arterial Stem Cell Therapy for Ischemic Stroke – A Review," examines decades of preclinical and clinical research and outlines a roadmap for translating regenerative therapies from the laboratory to the bedside.
Ischemic Stroke, in which blood supply to a part of the brain is cut off by suddenly by a clot blockage, remains one of the leading causes of death and long-term disability worldwide. While clot-busting medications and mechanical thrombectomy have transformed care for acute ischemic stroke, many patients are left with significant neurological deficits despite successful restoration of blood flow. The authors argue that stem cell therapies delivered directly into the brain's circulation via minimally invasive and widely available catheter angiographic techniques may complement existing treatments. The stem cells targeted this way to the stroke injured brain area work by promoting brain repair, reducing inflammation, and enhancing recovery.
"Mechanical thrombectomy has revolutionized stroke treatment, but half of the treated or more patients still do not regain full independence," said Dileep R. Yavagal, M.D., professor of clinical neurology and neurosurgery at the University of Miami Miller School of Medicine and senior author of the review. "Stem cell therapy represents a promising strategy to help the brain recover after injury and may become an important next step in improving outcomes(NOT GOOD ENOUGH!) for stroke patients."
(Likely a much better approach to full recovery is stopping the 5 causesof the neuronal cascade of death in the first week and thus saving hundreds of millions to billions of neurons! So you aren't even thinking of this properly!)
A Targeted Approach
Stem cells can be delivered through several different routes and optimal route in Stroke treatment is not yet established. The review focuses on intra-arterial delivery, an approach in which stem cells are infused directly into arteries supplying the injured region of the brain. Unlike intravenous administration, in which much of the cells are trapped in organs such as the lungs and liver, intra-arterial delivery into the affected artery allow a greater concentration of therapeutic cells to reach stroke-affected tissue. Surgical approaches such through a small hole in the skull are more invasive.
Researchers note that intra-arterial delivery is particularly attractive because it can potentially be performed during the same minimally invasive endovascular procedures and techniques used now as standard of care treatment, mechanical thrombectomy, avoiding the need for a new surgical access or additional intervention.
Preclinical studies, including from Dr. Yavagal's laboratory at the University of Miami Miller School of Medicine Interdisciplinary Stem Cell Institute, reviewed by the authors demonstrate that stem cells may reduce inflammation, promote formation of new blood vessels, support neural repair, and improve neurological outcomes following stroke. Multiple early-stage clinical trials have also established the feasibility and safety of stem cell administration across several delivery routes.
Strong safety record, more research needed
The review analyzes more than two decades of clinical development and notes that more than 40 randomized clinical trials have investigated stem cell therapies for stroke via many different routes of delivery. While safety has been consistently demonstrated, evidence for definitive functional benefit remains under investigation. Several ongoing studies are working to determine optimal cell type, dosing, timing, and patient selection strategies.
"The safety of IA stem cell therapy has been established by several preclinical and clinical studies and will continue to remain a critical endpoint for all future studies," said Roshni Thakkar, Ph.D., co-first author and research assistant professor in the Department of Neurology at the University of Miami. "The next challenge that the field is taking on is to identify the right cells, the right dose, the right patients, and the right time to intervene in order to maximize stroke recovery."
The authors emphasize that future studies should integrate advanced imaging, biological markers, and immune profiling to better understand how stem cells interact with the post-stroke brain and to identify patients most likely to benefit.
"Regenerative medicine has the potential to fundamentally reshape stroke treatment," said Nadia McMillan, M.D., Ph.D., co-first author, senior neuro-endovascular fellow and instructor . "The goal is not only to save brain tissue during a stroke but to help patients regain function and quality of life afterward."
Looking toward the future
According to the review, emerging therapies may eventually include bioengineered stem cells, extracellular vesicles and exosomes, and combination approaches that pair thrombectomy with regenerative treatments. Continued advances could ultimately transform stroke care from a model focused primarily on restoring blood flow to one that also actively promotes brain repair and recovery.
The authors conclude that while significant challenges remain, ongoing clinical trials and rapid advances in regenerative neuroscience provide reason for optimism that stem cell-based therapies may one day become an important adjunct to standard stroke treatment and achieve an outcome free of disability for the vast majority of stroke patients.
Public Release. This material from the originating organization/author(s) might be of the point-in-time nature, and edited for clarity, style and length. Mirage.News does not take institutional positions or sides, and all views, positions, and conclusions expressed herein are solely those of the author(s).View in fullhere.
That your doctor and therapists KNOW NOTHING ON GETTING YOU 100% RECOVERED! You'll need to fire them and look around the world and still won't find any competence anywhere!
Every year, hundreds of thousands of people in the U.S. live through a stroke. Survivors may face challenges with walking, eating, speaking and other essential parts of life.
"It can make all of the difference for stroke patients," said Dr. Nicole Mazwi, director of stroke rehabilitation at the University of Washington in Seattle. And it's about more than just helping improve thinking or physical abilities.
"First and foremost, rehab gives patients hope," she said.
These days, rehab can take many forms, said Dr. Lorie Richards, an associate professor in the Department of Occupational and Recreational Therapies at the University of Utah in Salt Lake City.
In some forms, rehabilitation is trying to help rewire pathways in the brain, said Richards, who led the group that wrote the guideline. "We try to make your arm work better. We try to have you walk better. We try to get your language better so you can talk and communicate with people."
(Better IS NOT GOOD ENOUGH! Survivors want full recovery! Are you that blitheringly stupid you don't listen to survivor requirements?)
In other forms, rehab is about learning to use tools that help someone adapt, she said: An occupational therapist might train someone with arm weakness on how to use a cutting board with spikes that hold food in place so a meal can be prepared with one hand.
Rehabilitation can also mean finding alternatives. A stroke survivor who enjoyed rock climbing might not be able to scale a cliff—but they might work with a recreational therapist to learn forms of adaptive skiing so they can still spend active time in the mountains.
"What we are really concerned with in rehabilitation is your ability to function and do the activities you want to do," Richards said.
The guideline, last updated in 2016, is filled with research-backed advice for health care professionals, but survivors and caregivers can benefit from these takeaways.
Stroke rehab can start within days
When Mazwi was a medical student in the 2000s, rehab usually started after someone had been discharged from the hospital. Now, she said, it might begin as early as the day after a stroke.
"In the best-case scenario, patients can start rehabilitation after day 1," if they are medically stable, Mazwi said.
"Acute stroke rehabilitation" refers to rehab done during the first week after a stroke. In this early phase, rehab might mean getting a patient to sit up in bed and practice brushing their teeth or washing their face, Richards said. Or it might include stretching to keep an arm limber.
It's an important phase for patients and caregivers to learn about what the stroke has done—and what possibilities lie ahead, Mazwi said.
Mental health is essential during recovery
For years, mental health was "highly under-addressed in post-stroke rehabilitation," Richards said. The guideline discusses its importance.
Adjusting to post-stroke life can involve grieving for the old, she said. "It's very natural that a person who's had a stroke might have depression," Richards said. "They've had a major crisis. They're going to be different than they were."
But depression and anxiety can reduce a stroke survivor's willingness to engage in rehab work, she said. It can also affect their loved ones. "Stroke doesn't just happen to the individual," she said. "It happens to the family unit they're in."
Experts have many ways to help, but more research is needed to understand how best to assess and treat post-stroke depression and anxiety, Richards said. "We don't know as much about how to treat post-stroke depression as we do in the general population."
Why sleep is important to stroke recovery
Stroke survivors often have sleep disorders or poor sleep quality. The guideline added a section on the importance of addressing such problems and poststroke fatigue.
Stroke can disrupt sleep in many ways, Mazwi said. "It can range from classic insomnia to sleep apnea or diagnoses like excessive daytime sleepiness and restless leg syndrome."
That can have a range of effects, she said. Lack of sleep can affect thinking and memory. It affects mood, which could affect whether someone wants to participate in therapy.
Sleep also is vital for learning, Mazwi said. If you learn something in therapy to help rewire your brain in the morning, that night your brain is working to tighten those wires.
The guideline says treatment options to help stroke patients sleep are limited, but the first step is to screen for trouble, Mazwi said, "because patients don't always recognize it themselves."
How can stroke rehab help with thinking and memory?
"Cognitive rehabilitation focuses on functions such as attention, memory, problem-solving skills and information processing," Mazwi said. "As you can imagine, it is quite complex, but it's incredibly important for patients."
A mail carrier, for instance, whose work requires organizational skills might be given tasks that involve detail-oriented activities like sorting a week's worth of pills into a pillbox, she said.
Technology is playing an increasing role in rehabilitation for thinking and memory problems after stroke, she said, "particularly technology that is paired very closely with a specific task or goal in mind."
An accountant who wants to return to work after a stroke, for example, might practice math and problem-solving exercises online.
Rehabilitation also can offer alternate ways to deal with an impairment, Richards said. Someone who has memory problems, for example, might be taught how to make lists on their phone.Why nutrition and exercise matter
The guideline emphasizes the need for physical activity and healthy eating as part of rehabilitation.
Physical activity is a good way to reduce the risk of another stroke, Richards said. More than that, "some studies have suggested that physical activity, aerobic exercise in particular, can help improve cognition."
Early in recovery, stroke survivors are at risk of being malnourished, particularly if they have trouble swallowing, Richards said. "That's why you usually have a dietitian on the team."
Mazwi said rehabilitation is an opportunity to embrace new habits that can help a survivor feel their best while doing everything they can to prevent a second stroke.
"And that's really what stroke recovery is about—stepping into this new life and moving forward with purpose and a healthy perspective," she said.
Stroke rehabilitation can make a difference
The world of neurorecovery, Mazwi said, "is just brimming with promise."
Early rehabilitation work is crucial, Richards said, because in the month after a stroke, genes get turned on that increase the brain's plasticity, or flexibility—almost to how it is in childhood.
The recovery process can be slow. People make most of their gains in motor skills in the first three months, Richards said. Language and cognition improvements can go on for much longer.
But Mazwi said the past decade has seen a fundamental shift in understanding survivors' capacity for recovery.
Adult brains are more flexible than once thought, she said, meaning patients can continue to see improvements decades after a stroke. "We now understand, better than we ever have, that there isn't an expiration date on one's potential for recovery."
Why stroke rehab is a team effort—and a lifelong process
Stroke rehabilitation can involve all kinds of experts—neurologists, nurses, occupational therapists, speech-language pathologists, psychologists and more.
That makes rehabilitation a time for patients and caregivers to educate themselves, Mazwi said.
"My No. 1 recommendation for patients as they start on this journey of stroke rehabilitation and recovery is to remember that they have an entire team behind them," she said.
Take advantage of that team, she urged. "We aren't here to tell patients what to do in a prescriptive way and then send them off. We're really here to partner, because this is a lifelong process."
Electromagnetic network-targeted field (ENTF) brain stimulation therapy is a promising approach to reduce poststroke disability. Two pilot, randomized, sham-controlled trials showed safety and signals of efficacy. The aim of this study was to perform a pooled analysis with greater statistical power to characterize with precision the effect of ENTF in promoting recovery and reducing disability.
METHODS:
We pooled individual patient-level data from 2 double-blind, randomized, sham-controlled studies, BQ3 (BrainQ3 Trial; Unique identifier: NCT04039178) and EMAGINE 1 (Electromagnetic Field Ischemic Stroke-Novel Subacute Treatment Trial; NCT05044507). Key entry criteria in both trials were (1) 4 to 21 days post-ischemic stroke and (2) Fugl-Meyer assessment-upper extremity score of 10 to 45. For EMAGINE 1, an additional criterion was a study entry modified Rankin Scale (mRS) score of 3 to 4. The primary outcome for this pooled analysis was freedom-from-disability (mRS score, 0–1) at 8 to 12 weeks. Secondary outcomes were level of disability (ordinal mRS score distribution), disability (mRS score) change from entry to 8 to 12 weeks, and 2 focused upper extremity motor end points.
RESULTS:
Altogether, 124 patients were included (active n=65; sham n=59). The mean age was 58.2±13.1 years, 31% were female, the study entry Fugl-Meyer assessment-upper extremity score was 25.3 (±10.6), and the therapy started 14.5 (±4.9) days poststroke. The study entry mRS score was 3.9 (±0.36), and 123/124 (99.2%) had a study entry mRS score of 3 to 4. Study entry features were well-balanced across treatment groups. At 8 to 12 weeks, freedom-from-disability was higher with active ENTF than sham stimulation (33.8% versus 11.9%; P=0.005). Ordinal shift across 3 disability strata (mRS score, 0–1, 2, and >2) also favored ENTF (P=0.009). Focused upper extremity motor end points nonsignificantly favored ENTF. Safety analyses showed no device- or procedure-related serious adverse events.
CONCLUSIONS:
In pooled data from 2 randomized, sham-controlled trials, treatment with ENTF compared with sham for patients with subacute ischemic stroke with moderate-severe study entry disability yielded increased achieved freedom-from-disability, greater disability improvement from study entry, and reduced final disability level. These findings, together with an attractive safety profile, support ENTF as a promising therapy for stroke recovery.
Around a third of people are able to almost fully rebuild their brains after a stroke and uncovering why is pointing the way to better treatments for everyone
A well-known actor who had experienced a stroke was treated by stroke specialist Sandor Nardai. The actor had been left with aphasia, or an impaired ability to speak – brutal for anyone, but “probably the most devastating thing that could happen to an actor”, says Nardai. After three months of recovery, though, the actor was able to say some words. After a year, he voiced a commercial. Remarkably, he eventually got well enough to return to live theatre, says Nardai, who is at Semmelweis University in Hungary.
For every happy story like this, though, there are many people who survive stroke but have less encouraging ones. Strokes send the brain into freefall, damaging areas that control cognitive and physical functions. Only an estimated 35 per cent of survivors make a full recovery or live with only minor impairments.(Nothing in the abstract references 35%! That number is still a colossal failure by your stroke medical 'professionals'!) The majority have profoundly life-altering issues, like aphasia, paralysis, behavioural changes or cognitive and sensory challenges. The numbers are dizzying: almost 100 million live with the after-effects of a stroke, making it one of the most common causes of disability globally.
As the actor’s story shows, the brain is capable of extraordinary transformation and restoration after a stroke, but some people reap more of those benefits than others. Now, we are learning why – and with that knowledge, developing new treatments that can help more of us recover.
Why some brains recover after a stroke
A stroke occurs when a blood vessel serving the brain either bursts or is blocked by a clot. That starves the brain of needed oxygen, killing off neurons, which can leave people with severely compromised abilities to reason, learn, communicate and move. In the aftermath, the immune system also cranks up inflammation, potentially causing further damage.
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
Prefer the Guardian on GoogleThe Guardian’s journalism is independent. We will earn a commission if you buy something through an affiliate link. Learn more.
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.”
You see patients in a really terrible state and you think that’s them for life
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
