Informing better care for post-stroke fatigue

 

Big fucking whoopee.

 

  You delivered NOTHING that gets survivors recovered! 'Care' doesn't deliver recovery you blithering idiots! There is NO leadership anywhere in stroke. How many funerals need to occur before we get great stroke leadership?

Neils Bohr who famously said science progresses one funeral at a time. 

Hope you enjoy NOT RECOVERING from your stroke when you become the 1 in 4 per WHO that has a stroke.  Everyone at this is TOTALLY FUCKING INCOMPETENT!

'Care' NOT RECOVERY! I'd have you all fired!

Informing better care for post-stroke fatigue

 Post-stroke fatigue causes persistent feeling of exhaustion, lack of energy or aversion to physical and mental activities, that does not get better with rest. It is a common condition affecting up to 70 per cent of stroke survivors.  A new paper from Sunnybrook, published in the Canadian Medical Association Journal, highlights key factors about post-stroke fatigue, how it is screened and treated.  

“Post-stroke fatigue is an incredibly common condition and can have significant impact on someone’s quality of life after experiencing a stroke,” explains Dr. Mark Boulos, Stroke and Sleep Neurologist in the Hurvitz Brain Sciences Program and Senior Author of the paper. “There are many different causes of post-stroke fatigue, which is why comprehensive, multidisciplinary care plays an important role in treating it.” The paper identifies five considerations for the management of post-stroke fatigue, helping inform and empower both clinicians and patients alike: Post-stroke fatigue is common, debilitating and underrecognized. 

Systematic screening during routine follow-up after stroke identifies post-stroke fatigue. 

Reversible contributors to post-stroke fatigue should be identified and addressed. 

Multidisciplinary nonpharmacological care is the cornerstone of treatment. 

Pharmacological options for treatment are limited. Risk factors for post-stroke fatigue can include depression, sleep disorders like sleep apnea, dehydration, nutrition, pain and medications. By managing reversible lifestyle and risk factors can help improve the effects of post-stroke fatigue.   “Counselling patients and caregivers about post-stroke fatigue plays a crucial role in recovery,” adds Dr. Boulos, who is also the Medical Director of the North & East GTA Stroke Network and Medical Director of the Sleep Laboratory apart of the Yuval & Lori Barzakay Brain Health Clinic, which works to diagnose and treat patients with complex sleep disorders. “There are many simple practices patients can add into their daily routine to help overcome post-stroke fatigue.”  Proper sleep hygiene, energy conservation, delegating and prioritizing activities and mindfulness practices can all support physical and mental recovery. The paper identifies that medications do not play a significant role in the treatment of post-stroke fatigue, highlighting the importance of holistic treatment and care.   Managing stroke and post-stroke fatigue treatment takes a village. Support from physicians, allied health professionals and loved ones, all play a key role in a patient’s recovery journey.  

Directional EMG patterns reveal impairment-related disruptions in upper-limb force control after stroke

 

Big fucking whoopee.

 

  You delivered NOTHING that gets survivors recovered!

Hope you enjoy NOT RECOVERING from your stroke when you become the 1 in 4 per WHO that has a stroke.  

Directional EMG patterns reveal impairment-related disruptions in upper-limb force control after stroke

• Sungjin Bae,
• Hyung-Soon Park,
• Jeong-Ho Park &
• William Z. Rymer 

We’re sharing this article early to provide faster access to peer-reviewed, accepted research. It is citable and carries a permanent DOI. This version is subject to further edits and will be replaced automatically by the final Version of Record. All legal disclaimers apply.

Abstract

Background

Hemiparetic stroke disrupts upper-limb motor control, leading to direction-specific deficits and abnormal compensatory strategies. By quantifying the angular range and preferred direction of muscle activation, directional electromyography (EMG) analysis has shown altered directional tuning in stroke survivors. However, it remains unclear how impairment severity affects direction-specific difficulty and compensation, and how these disruptions change with force level and task direction. This study used directional EMG mapping during a multi-directional isometric task at varying force levels to examine these issues in detail.

Methods

Eight chronic stroke survivors performed isometric force-matching tasks in eight directions (0°–315° at 45° intervals) in the plane orthogonal to the forearm at 20%, 40%, and 60% of maximum voluntary contraction (MVC) using a wrist fixture. All forces and torques applied to the fixture and surface EMG from eight upper-limb muscles were recorded. For each muscle, EMG vectors were calculated using EMG amplitudes and actual force directions to analyze directional tuning and angular concentration. Task accuracy was quantified as the angular error between the target and actual force directions, and compensatory strategies were estimated from off-axis forces and torques. Generalized linear mixed-effects models were applied to these metrics to examine the effects of force magnitude, task direction, and their interactions. Spearman correlations were used to assess muscle coactivation and the relationship between impairment severity, based on Fugl-Meyer Assessment in Upper Extremity (FMA-UE), and task accuracy.

Results

Severely impaired participants showed restricted force generation in lateral directions, and activation tuning constrained to a narrow medial range. These disruptions accompanied larger angular errors, which were negatively correlated with FMA-UE scores. Greater force demands progressively recruited the deltoid muscles, indicating significant directional tuning; however, task accuracy changed in a direction-specific manner, improving in some directions and deteriorating in others. Increasing force demand also produced direction-specific shifts in off-axis forces and torques that diverged from classic flexor/extensor synergies, suggesting enhanced shoulder-driven control that may promote more independent joint control. Coactivation analysis showed potential joint-stabilizing coactivation within the deltoids and triceps in nearly all directions. In contrast, severe impairment was associated with fewer significant coactivation pairs and loss of biceps–brachioradialis coupling.

Conclusions

These findings suggest that directional control deficits and compensatory strategies after stroke are modulated by complex interactions among impairment severity, force magnitude, and task direction, creating patient-specific vulnerable zones. Directional EMG mapping provides quantifiable directional targets that may be useful for designing personalized rehabilitation interventions.

Trial registration This study was retrospectively registered at ClinicalTrials.gov (NCT07113457) on 08 August 2025.

Tenecteplase Speeds Acute Ischemic Stroke Care

 

Big fucking whoopee.

 

  'Care'! But you tell us NOTHING ABOUT RESULTS. They remind us they are faster and shorter treatment times but never tell us how many 100% recovered.  You have to ask yourself why they are hiding their incompetency by not disclosing recovery results.  ARE THEY THAT FUCKING BAD? 

Tenecteplase Speeds Acute Ischemic Stroke Care

The thrombolytic agent tenecteplase was associated with shorter treatment and transfer times than alteplase in patients with acute ischemic stroke, a large US registry analysis showed.

“These workflow advantages provide support for broader use of tenecteplase for stroke thrombolysis,” said the investigators led by Steven J. Warach, MD, PhD, of Dell Medical School at The University of Texas at Austin.

Even modest reductions in treatment time may translate into clinically meaningful benefits because earlier reperfusion is strongly linked to improved stroke outcomes(Survivors want 100% recovery OR DON'T YOU CARE ABOUT THAT?), the investigators noted.

The findings were published online on July 13 in JAMA Network Open.

Key Points

• Tenecteplase ↓ DTN vs alteplase in AIS; mean difference 3.1 minutes.
• 30% achieved DTN ≤30 min with tenecteplase vs 20.4% with alteplase.
• Tenecteplase also improved DIDO and thrombectomy workflow times.
• Hospitals switching from alteplase to tenecteplase showed modest DTN improvement.
• Registry data support broader tenecteplase use; nonrandomized confounding remains possible.

Does tenecteplase improve functional stroke outcomes?

Which stroke subgroups benefit most from tenecteplase?

How does tenecteplase affect hemorrhagic transformation risk?

Faster Treatment Across Multiple Workflow Measures

Intravenous (IV) alteplase has long been the standard thrombolytic therapy for acute ischemic stroke, but tenecteplase has gained increasing acceptance because it can be administered as a single IV bolus rather than as a bolus followed by a 60-minute infusion.

Suggested for you

Previous randomized trials have shown tenecteplase has a safety and efficacy profile on par with alteplase, but whether its simpler administration translates into faster real-world treatment workflows has been uncertain.

To investigate, Warach and colleagues analyzed data from the American Heart Association (AHA) Get With The Guidelines-Stroke registry, which captures more than 75% of stroke admissions in the US.

The cohort included 133,228 adults treated with IV thrombolysis for acute ischemic stroke between July 2020 and June 2022 across 2092 hospitals. Of these, 13,988 patients (10.5%) received tenecteplase and 119,240 (89.5%) received alteplase.

Among patients treated at the presenting hospital, the average door-to-needle (DTN) time was 47.0 minutes with tenecteplase compared with 52.7 minutes with alteplase, a mean difference of 3.1 minutes favoring tenecteplase.

Patients receiving tenecteplase were also significantly more likely to achieve key DTN benchmarks. Nearly 30% of patients receiving tenecteplase were treated within 30 minutes compared with 20.4% of those receiving alteplase, whereas 58.3% vs 48.6% met the 45-minute target and 77.5% vs 70.7% achieved treatment within 60 minutes.

Hospitals that transitioned from alteplase to tenecteplase during the study period also experienced modest improvements in average DTN time after making the switch.

The benefits of tenecteplase extended to patients requiring transfer for higher-level care(NOT REOVERY!). Among likely mechanical thrombectomy candidates, mean door-in-door-out (DIDO) time was 108.3 minutes with tenecteplase vs 114.1 minutes with alteplase, an adjusted reduction of nearly 6 minutes. Patients transferred overall also had significantly shorter DIDO times with tenecteplase.

Tenecteplase was also associated with faster endovascular treatment once patients underwent thrombectomy. Compared with alteplase, tenecteplase was associated with shorter door-to-arterial puncture, door-to-device deployment, and door-to-reperfusion times among both transferred patients and those treated at thrombectomy-capable centers.

Support for Broader Use

The researchers acknowledged several limitations. Because it was based on a voluntary, nonrandomized registry, residual confounding cannot be excluded despite statistical adjustment.

The participating hospitals were largely early adopters of tenecteplase and tended to be higher-volume certified stroke centers, potentially limiting generalizability to smaller or less experienced hospitals. In addition, missing workflow data were not imputed and may not have occurred at random.

Despite these limitations, the findings suggest that tenecteplase may improve workflow efficiency for thrombolysis and interfacility transfer, further supporting its broader use in acute ischemic stroke, they concluded.

The study was funded in part by Get With the Guidelines-Stroke, AHA/American Stroke Association. Disclosures for study authors are available with the published article.

Online rehab ser­vice wins national award

 

Big fucking whoopee.

 

  'Care'! But you tell us NOTHING ABOUT RESULTS. They remind us they 'care' about us multiple times but never tell us how many 100% recovered.  You have to ask yourself why they are hiding their incompetency by not disclosing recovery results.  ARE THEY THAT FUCKING BAD? 

Online rehab ser­vice wins national award

Astera Health recognized for participation in post-acute care initiative for stroke patients

 

Big fucking whoopee.

A 'care' initiative; NOT A PLAN FOR 100% RECOVERY! You need to replace every person here with stroke survivors.

Astera Health recognized for participation in post-acute care initiative for stroke patients

The Stroke Association releases new Christmas campaign film with celebrities including Brian Cox, Alison Steadman and Nish Kumar

Big fucking whoopee.

An 'awareness' campaign; NOT A PLAN FOR 100% RECOVERY! You need to replace every member of this Stroke association with stroke survivors. Another stroke association proves it's a founding member of one of the fucking failures of stroke associations DOING NOTHING TO GET SURVIVORS 100% RECOVERED! 

The Stroke Association releases new Christmas campaign film with celebrities including Brian Cox, Alison Steadman and Nish Kumar

The Stroke Association has released its first ever Christmas campaign film, ‘Still Christmas’, to raise awareness of the devastation stroke can cause and the vital need for support this festive season.

This Christmas Day in the UK, another 240 people will wake up to the life-changing impact of a stroke. A stroke can leave survivors unable to move, see, speak, or even swallow, and can also lead to personality changes and depression.

The charity’s powerful new film features a poignant script delivered by high-profile supporters Brian Cox, Alison Steadman, Nish Kumar, Amanda Abbington, Nadia Sawalha, Christopher Chung, Jo Brand and Kiell Smith-Bynoe, intercut with Christmas home videos and photos shared by stroke survivors and their families.

The film is set to a new and contemporary cover of ‘White Christmas’, released by Universal and Irving Berlin’s estate, produced by Stream Media Group and directed by Stuart Hackshaw.

For the first time it puts the camera inside the homes of stroke survivors, at a time of year we can take fun and family for granted, illustrating not just the devastating reality of facing Christmas after a stroke, but also the hope that follows, as together they rebuild their lives and find strength through support.

The film will air on Channel 4 on 19 November 2025 and will be available to view online at stroke.org.uk/stillchristmas

To accompany the film, the Stroke Association also surveyed 1,000 stroke survivors about their experiences at Christmas, to understand the impact of stroke at this time of year. The research revealed that almost a third of stroke survivors (30%) feel like they are a burden to their family and friends at Christmas time1.

The study also found that almost half of stroke survivors (46%) said they now feel negatively about Christmas time due to the impacts of their stroke. Of those survivors who had experienced Christmas following their stroke2, two thirds (66%) feel frustrated about not being able to do things at Christmas that they could before they had their stroke.

The survey found that, of those people who had experienced a Christmas following their stroke, almost a third (28%) couldn’t cook Christmas dinner, and more than a quarter (26%) couldn’t visit friends and family or leave the house. Almost a quarter of stroke survivors (23%) couldn’t decorate the Christmas tree, while around a fifth (19%) couldn’t play with their children or grandchildren.

Juliet Bouverie OBE, CEO of the Stroke Association, said: “So many of us associate Christmas time with joy, being together with family and friends, and enjoying much loved traditions. But for another 85,000 people in the UK, this year will be their first Christmas after a stroke, and those things we all take for granted are no longer the same. However, with strength, determination and the right support, recovery is possible. That’s why we’ve created our powerful new film, to highlight the devastation stroke can cause, but remind people that we are here for them.

“Stroke support is crucial at any time of year for stroke survivors and their loved ones. We’re encouraging everyone to give the gift of stroke support this Christmas, whether as a donation, volunteering your time or fundraising, so that we can help more survivors and their loved ones find their strength and their way back to life after a stroke.”

The Stroke Association is the only charity in the UK providing lifelong support for all stroke survivors and their families. This Christmas, join us in raising awareness of the devastating impact of stroke and help the Stroke Association to support more stroke survivors at every step of their recovery. 

Give the gift of stroke support this Christmas – visit stroke.org.uk/stillchristmas  

An evidence map of clinical practice guideline recommendations and quality of non-pharmaceutical interventions for post-stroke emotional disorders

Big fucking whoopee.

Guidelines; NOT PROTOCOLS!  Guidelines don't guarantee recovery; properly constructed protocols do!

 An evidence map of clinical practice guideline recommendations and quality of non-pharmaceutical interventions for post-stroke emotional disorders

Ye Li1, Jing Zhang2, Jia-ji Li1, Dan Zhao1, Ling Tang1* and Ying-Hui Jin3*

1Nursing Department of Dong fang Hospital, Beijing University of Chinese Medicine, Beijing, China

2Department of Neurosurgery, Handan Central Hospital, Handan, China

3Center for Evidence-Based and Translational Medicine, Zhong nan Hospital of Wuhan University, Wuhan, Hubei, China

Edited by

Nicola Smania, University of Verona, Italy

Reviewed by

Valentina Varalta, University of Verona, Italy

Daniela Burguêz, Hospital São Lucas da PUCRS, Brazil

*Correspondence

Ling Tang, tangling@zxyjhhl.org.cn; Ying-Hui Jin, jinyinghuiebm@163.com

Received 28 February 2025

Accepted 26 May 2025

Published 09 June 2025

Citation

Li Y, Zhang J, Li J-j, Zhao D, Tang L and Jin Y-H (2025) An evidence map of clinical practice guideline recommendations and quality of non-pharmaceutical interventions for post-stroke emotional disorders. Front. Neurol. 16:1580799. doi: 10.3389/fneur.2025.1580799

Background: Clinical practice guidelines (CPGs) have an indispensable role in guiding the selection of various non-pharmaceutical interventions (NPIs) for post-stroke emotional disorders (PSED). However, little is known about their quality and recommendations. This study aims to critically appraise the quality of existing NPIs for PSED CPGs and extract relevant recommendations, present the research distribution of various NPIs in an evidence map, and assist clinicians in making decisions.

Methods: A systematic search was undertaken in PubMed, Embase, CINAHL, Web of Science, China National Knowledge Infrastructure, Wanfang, VIP, SinoMed, and international guideline developing institutions from origin to November 20, 2024, to identify the CPGs on NPIs for PSED. The CPGs finally selected were blindly evaluated by two reviewers using the Appraisal of Guidelines Research & Evaluation (AGREE) II instrument and the reporting quality was evaluated using the RIGHT statement. The overall agreement among reviewers was analyzed using intraclass correlation coefficient (ICC).

Results: Nine guidelines were included and evaluated. Two CPGs were grade A (recommended) and seven CPGs were grade B (recommended with modification). The reporting rate of RIGHT ranged from 40.00 to 80.00%. Nine NPIs were extracted, and there were similarities and differences between the recommendations.

Conclusion: This study provides specific direction for improving the quality of CPGs for NPIs for PSED, and provides useful information for clinicians and stakeholders, and provides a basis for clinical decision-making.

Keywords

cerebral stroke; emotional disorder; non-pharmacological intervention; clinical practice guidelines; evidence-based medicine

1 Introduction

Cerebral stroke is the second largest cause of death worldwide, accounting for 11.6% of the total number of deaths (1). It is characterized by a high incidence, high recurrence rate, high disability rate and high mortality rate, leading to an increased burden of disease around the world (1). Post-stroke emotional disorder (PSED) is one of the most common and serious complications, commonly occurring at all stages of the disease and its pathogenesis is still unclear (2). It includes post stroke depression (PSD), post-stroke anxiety (PSA), post-stroke comorbid anxiety and depression (PSCAD), post-stroke emotional imbalance (PSEI) and post-stroke anger proneness (PSAP) (3). Approximately one-third of stroke survivors develop some form of emotional disorder (2–4). Studies have shown (5, 6) that emotional disorders are closely related to patients’ prognosis. If patients are not treated in time, it will affect the recovery of neurological function and the ability to return to society, and even lead to increased mortality. There is no universally effective method for the treatment of PSED, and although drug therapy has a certain effect, there are many side effects (7). Some systematic reviews and meta-analyses have shown that non-pharmaceutical interventions (NPIs) can effectively reduce emotional symptoms and improve patient’s quality of life (7–9). Many authoritative organizations have issued a number of CPGs related to the treatment and rehabilitation of Stroke, which contain NPIs to help health care workers and patients to make local health care decisions (10).

The purpose of this study is to evaluate the quality of guidelines related to NPIs for PSED, to make relevant recommendations for NPIs use in PSED, to provide information for standardized practice and management, to identify potential directions that CPGs should focus on in the future, and to provide a reference for relevant policy development and clinical practice.

2 Materials and methods

2.1 Search strategy

We systematically searched the following databases: PubMed, Web of Science, Embase, CINAHL, China National Knowledge Infrastructure (CNKI), Wanfang, VIP, SinoMed, YiMaiTong. We also hand-searched 6 databases of international guideline developing institutions: Guideline International Network (GIN), Registered Nurses’ Association of Ontario (RNAO), Scottish Intercollegate Guidelines Network (SIGN), National Institute for Health and Care Excellence (NICE), National Guideline Clearinghouse (NGC), and New Zealand Guidelines Group (NZGG). Articles were retrieved by combining subject terms and free terms, from origin to November 20, 2024. The full search strategies are shown in Supplementary material 1.

2.2 Study selection

In our study, the inclusion criteria were: guidelines which provided recommendations regarding NPIs for PSED and included access to the full text. Both evidence-based clinical practice guidelines and consensus-based clinical practice guidelines (EB-CPGs and CB-CPGs) were included, and the guidelines had to at least contain details of evidence retrieval and literature evaluation. We have described both consensus statements and expert opinions as CB-CPGs (11). The CPGs had to include NPIs for PSED. The most commonly included NPIs were: psychotherapy, social support therapy, traditional Chinese medicine non-pharmacological therapies, and physical therapy (12). If guidelines were available in multiple languages (such as English and Chinese), only the version in the original language was eligible for inclusion. In cases of updated guidelines, only the most recent version was considered. Exclusion criteria were editorial or correspondence articles that summarized organizational clinical practice guidelines.

More at link.

Hospital awarded stroke certification

 

Big fucking whoopee.

 

 But you tell us NOTHING ABOUT RESULTS. They remind us they 'care' about us multiple times but never tell us how many 100% recovered.  You have to ask yourself why they are hiding their incompetency by not disclosing recovery results.  ARE THEY THAT FUCKING BAD?

Three measurements will tell me if the stroke medical world is possibly not completely incompetent; DO YOU MEASURE ANYTHING?  I would start cleaning the hospitals by firing the board of directors, you can't let incompetency continue for years at a time.

There is no quality here if you don't measure the right things.

1. tPA full recovery? Better than 12%?
2. 30 day deaths? Better than competitors?
3. rehab full recovery? Better than 10%?

 

You'll want to know results so call that hospital president(whomever that is) RESULTS are; tPA efficacy, 30 day deaths, 100% recovery. Because there is no point in going to that hospital if they are not willing to publish results.

In my opinion this certification allows stroke hospitals to continue with their tyranny of low expectations and justify their complete failure to get survivors 100% recovered. Prove me wrong, I dare you in my stroke addled mind. If your stroke hospital goal is not 100% recovery you don't have a functioning stroke hospital.

 

All you ever get from hospitals are that they are following guidelines; these are way too static to be of any use. With thousands of pieces of stroke research yearly it would take a Ph.D. level research analyst to keep up, create protocols, and train the doctors and therapists in their use. 

If your stroke hospital doesn't have that, you don't have a well functioning stroke hospital, you have a dinosaur. 

Read up on the 'care' guidelines yourself. Survivors want RECOVERY not 'care'

“What's measured, improves.” So said management legend and author Peter F. Drucker 

The latest invalid chest thumping here:

Hospital awarded stroke certification

The Joint Commission standards are developed in consultation with health care experts and providers, measurement experts and patients, officials said.

The reviewers also conducted onsite observations and interviews.

“Goal Seal of Approval Certification recognizes health care organizations committed to striving for excellence and fostering continuous improvement in patient safety and quality of care(NOT RECOVERY!),” said Ken Grubbs, executive vice president of accreditation and certification operations and chief nursing officer at the Joint Commission.

“We commend Onslow Memorial Hospital for using the Joint Commission certification process to reduce variation in clinical processes and to strengthen its clinical program to drive safer, higher quality and more compassionate care(NOT RECOVERY!)for individuals served.”

Nancy Brown, chief executive officer of the American Stroke Association, congratulated OMH on the achievement.

“This certification reflects its commitment to providing the highest quality of care(NOT RECOVERY!) for stroke patients,” she said.

“Delivering high-quality stroke care(NOT RECOVERY!) requires a collaborative, interdisciplinary team approach,” said Josephine Malfitano, associate vice president and patient safety officer at OMH. “Through ongoing process reviews, we ensure that our practices not only meet but sustain the evolving standards of care(NOT RECOVERY!).

“It’s a privilege to work alongside such a passionate and dedicated team committed to advancing these critical initiatives.”

To be eligible for stroke certification, hospitals must meet strict requirements and demonstrate a high standard of stroke care(NOT RECOVERY!).

In preparation for the process, OMH focused on establishing a multidisciplinary stroke team, developing stroke protocols and pathways, ensuring 24/7 availability of key services, providing staff education and training and engaging with the community.

Sub-acute stroke demonstrates altered beta oscillation and connectivity pattern in working memory

 

Big fucking whoopee.

 

 But you tell us NOTHING ABOUT A SOLUTION Useless!

Sub-acute stroke demonstrates altered beta oscillation and connectivity pattern in working memory

• Lin Mao,
• Xianwei Che,
• Juehan Wang,
• Xiaorui Jiang,
• Yifan Zhao,
• Liliang Zou,
• Shuang Wei,
• Shuyi Pan,
• Dazhi Guo,
• Xueqiong Zhu,
• Dongxia Hu,
• Xiaofeng Yang,
• Zuobing Chen &
• Daming Wang 

Journal of NeuroEngineering and Rehabilitation volume 21, Article number: 212 (2024) Cite this article

• Metrics details

Abstract

Introduction

Working memory (WM) is suggested to play a pivotal role in relearning and neural restoration during stroke rehabilitation. Using EEG, this study investigated the oscillatory mechanisms of WM in subacute stroke.

Methods

This study included 48 first subacute stroke patients (26 good-recovery, 22 poor-recovery, based on prognosis after a 4-week period) and 24 matched health controls. We examined the oscillatory characteristics and functional connectivity of the 0-back WM paradigm and assessed their associations with prognosis.

Results

Patients of poor recovery are characterised by a loss of significant beta rebound, beta-band connectivity, as well as impaired working memory speed and performances. Meanwhile, patients with good recovery have preserved these capacities to some extent. Our data further identified beta rebound to be closely associated with working memory speed and performances.

Conclusions

We provided novel findings that beta rebound and network connectivity as mechanistic evidence of impaired working memory in subacute stroke. These oscillatory features could potentially serve as a biomarker for brain stimulation technologies in stroke recovery.

Introduction

Stroke is the third most common cause of morbidity and the second most common cause of dementia [1]. The most common symptoms of stroke include physical deficits (such as paralysis, and sensory loss) and dysfunction in learning, memory, and executive functions. When it comes to cognitive function, working memory (WM) has a fundamental role in performing complex behaviours and is associated with poor functional outcomes after a stroke [2, 3].

An abrupt, cliff-like decline in brain function represents a key difference between acute stroke and neurodegenerative cerebral disorders. More importantly, this pattern of cognitive decline exhibits reversibility within a defined temporal framework [4], which is critical for both neural restoration and clinical rehabilitation. In clinical practices, there is also evidence supporting the ability to regain partial functions or develop compensatory skills through the process of learning [5]. Notably, working memory underpins the learning processes [2], making it critical for neural restoration and clinical rehabilitation. It is therefore important to investigate the behavioural and neural dynamics of WM, offering insights for the development of more effective rehabilitation strategies.(WHOM SPECIFICALLY DID YOU CONTACT TO GET THAT RESEARCH DONE? NO ONE? So, you're a complete failure at doing your job?)

Working memory is defined as a multi-component system involved in goal-directed behaviours that involve retaining and manipulating information [6]. N-back task is a well-validated and widely used means of manipulating working memory capacity and its response requirements [7]. Among them, 0-back requires less workload, which is highly suitable for post-stroke individuals with significant cognitive impairment. It includes components such as sustained attention to a stimulus and continuous memory of the instructions. It is noted that clinical assessment of vascular cognitive impairment (VCI) predominantly relies on cognitive scales, with a paucity of concurrent evidence from cognitive tasks such as WM.

Using an electroencephalogram (EEG), previous studies have established the oscillatory mechanisms of WM. Most of the studies have identified increased power in the fast oscillatory ranges such as beta (13–30 Hz) and gamma (30–100 Hz) [8, 9]. In terms of the functioning, gamma oscillation is suggested to store memories, while beta oscillation is closely associated with attention and response selection [9,10,11]. However, the effects of stroke on neural oscillations underlying WM are largely unclear. A recent scoping review indicated a correlation between decreased fast waves (such as beta) and poor cognition following a stroke [12].

This study was designed to investigate the oscillatory characteristics of working memory in subacute stroke patients. Patients in the subacute stroke underwent a visual-spatial WM 0-back with EEG recordings. They were further classified as good-recovery (n = 26) and poor-recovery (n = 22) according to the modified Rankin Score (mRS). We hypothesized that stroke patients would demonstrate lower power in beta and gamma range compared to healthy controls. Moreover, patients with a poor recovery would have a more prominent decrease in beta and gamma oscillation.

More at link.

Citizens Memorial Hospital receives Acute Stroke Ready Center certification from DNV

 

Survivors don't care about your 'care'; you FUCKING BLITHERING IDIOTS; they want 100% recovery! Why aren't you providing that?

Big fucking whoopee.

 

 But you tell us NOTHING ABOUT RESULTS. They remind us they 'care' about us multiple times but never tell us how many 100% recovered.  You have to ask yourself why they are hiding their incompetency by not disclosing recovery results.  ARE THEY THAT FUCKING BAD?

Three measurements will tell me if the stroke medical world is possibly not completely incompetent; DO YOU MEASURE ANYTHING?  I would start cleaning the hospitals by firing the board of directors, you can't let incompetency continue for years at a time.

There is no quality here if you don't measure the right things.

1. tPA full recovery? Better than 12%?
2. 30 day deaths? Better than competitors?
3. rehab full recovery? Better than 10%?

 

You'll want to know results so call that hospital president(whomever that is) RESULTS are; tPA efficacy, 30 day deaths, 100% recovery. Because there is no point in going to that hospital if they are not willing to publish results.

In my opinion this certification allows stroke hospitals to continue with their tyranny of low expectations and justify their complete failure to get survivors 100% recovered. Prove me wrong, I dare you in my stroke addled mind. If your stroke hospital goal is not 100% recovery you don't have a functioning stroke hospital.

 

All you ever get from hospitals are that they are following guidelines; these are way too static to be of any use. With thousands of pieces of stroke research yearly it would take a Ph.D. level research analyst to keep up, create protocols, and train the doctors and therapists in their use. 

If your stroke hospital doesn't have that, you don't have a well functioning stroke hospital, you have a dinosaur. 

Read up on the 'care' guidelines yourself. Survivors want RECOVERY not 'care'

“What's measured, improves.” So said management legend and author Peter F. Drucker 

The latest invalid chest thumping here:

Citizens Memorial Hospital receives Acute Stroke Ready Center certification from DNV

Citizens Memorial Hospital has received certification from DNV as an Acute Stroke Ready Center, recognizing its ability to handle strokes and stroke-related medical problems. CMH is also a designated Level III Stroke Center by the Missouri Department of Health and Senior Services.

Through a partnership with CoxHealth, CMH offers 24/7 telestroke coverage. This service connects CMH patients to neurologists at Cox South, the region's only DNV-certified Comprehensive Stroke Center. This allows treatment to begin within minutes of a patient's arrival at the hospital.

The Acute Stroke Ready certified program is especially important for communities where access to a larger hospital may be too far away.

“We know that ‘time is brain,’ and the faster a patient can get to a certified stroke center, the better,” says Sarah Bolton, Time Critical Diagnosis program manager at CMH. “This certification shows that we have the resources and dedication to provide the best possible stroke care(NOT RECOVERY!).”

When a patient arrives at CMH with stroke-like symptoms such as balance issues, vision loss, uneven smile, arm weakness, or slurred speech, emergency room staff act fast. They perform advanced brain scans and consult with neurologists at CoxHealth.

For patients who are eligible, tenecteplace (TNK), a medication to treat blood clots, must be given within a short window of time. Quick action is critical, which is why calling 911 right away when symptoms appear is essential.

“It’s a combination of the right equipment, personnel and training to quickly assess, identify and treat strokes,” Bolton said. “This certification validates the tremendous effort we have put into this program, ensuring the health and safety of our patients.”

The DNV Acute Stroke Ready Certification is based on standards from the Brain Attack Coalition and the American Stroke Association. It affirms that CMH provides initial diagnosis and treatment and, when necessary, quickly transfers patients to a specialized stroke center with a higher spectrum of stroke care(NOT RECOVERY!).

“Achieving certification shows a commitment to excellence,” says Kelly Proctor, president of DNV Healthcare USA Inc. “It helps demonstrate to your community that you are providing the highest level of care(NOT RECOVERY!) that this hospital is designed to offer.”

Stroke is a leading cause of death in the U.S., claiming nearly 130,000 lives each year, according to the American Stroke Association. It also causes serious, long-term adult disabilities. Quick treatment can save lives and limit long-term damage.

For more information about DNV, visit https://www.dnv.us/supplychain/healthcare/stroke-certs/.

About CMH

Citizens Memorial Hospital is a comprehensive rural healthcare system in Bolivar, Missouri, serving eight counties. CMH is an 86-bed acute care(NOT RECOVERY!) hospital and a Level III Trauma Center, Level II STEMI Center and Level III Stroke Center. In addition to hospital services, CMH includes 34 physician clinics, rehabilitation services, and ambulance services in four counties.

The CMH Foundation operates six long-term care facilities and a residential care center, retail pharmacies, an array of home care(NOT RECOVERY!) and hospice services, home medical stores, and a senior health center.

Currently, Citizens Memorial Hospital is undergoing a 117,000-square-foot expansion and a 25,000-square-foot renovation project that will enhance patient care(NOT RECOVERY!) with private rooms. The project is scheduled for completion in 2026.

Canberra Hospital Leading Way In Stroke Care

 

I wouldn't go there if all they are offering is 'care'; NOT RECOVERY!

Anytime I see 'care' in any stroke press release I know the stroke medical world is not willing to disclose actual results because they are so fucking bad, it wouldn't look good, so misdirection is used. Don't fall for that misdirection! By touting 'care' they are not telling you about results or recovery which survivors want! Survivors don't care about your 'care'; you FUCKING BLITHERING IDIOTS; they want 100% recovery! Why aren't you providing that?

Big fucking whoopee.

 

 But you tell us NOTHING ABOUT RESULTS. They remind us they 'care' about us multiple times but never tell us how many 100% recovered.  You have to ask yourself why they are hiding their incompetency by not disclosing recovery results.  ARE THEY THAT FUCKING BAD?

Three measurements will tell me if the stroke medical world is possibly not completely incompetent; DO YOU MEASURE ANYTHING?  I would start cleaning the hospitals by firing the board of directors, you can't let incompetency continue for years at a time.

There is no quality here if you don't measure the right things.

1. tPA full recovery? Better than 12%?
2. 30 day deaths? Better than competitors?
3. rehab full recovery? Better than 10%?

 

You'll want to know results so call that hospital president(whomever that is) RESULTS are; tPA efficacy, 30 day deaths, 100% recovery. Because there is no point in going to that hospital if they are not willing to publish results.

In my opinion this partnership allows stroke hospitals to continue with their tyranny of low expectations and justify their complete failure to get survivors 100% recovered. Prove me wrong, I dare you in my stroke addled mind. If your stroke hospital goal is not 100% recovery you don't have a functioning stroke hospital.

 

All you ever get from hospitals are that they are following guidelines; these are way too static to be of any use. With thousands of pieces of stroke research yearly it would take a Ph.D. level research analyst to keep up, create protocols, and train the doctors and therapists in their use. 

If your stroke hospital doesn't have that, you don't have a well functioning stroke hospital, you have a dinosaur. 

Read up on the 'care' guidelines yourself. Survivors want RECOVERY not 'care'

“What's measured, improves.” So said management legend and author Peter F. Drucker 

The latest invalid chest thumping here:

Canberra Hospital Leading Way In Stroke Care

Canberra Hospital has marked an exciting milestone, becoming the ACT's first hospital to receive stroke unit certification by the Australian Stroke Coalition.

The ASC Stroke Unit Certification Program certifies hospitals that consistently meet a stringent set of national criteria designed to deliver the best possible stroke care(NOT RECOVERY!) to patients. This includes caring for all stroke patients on a single dedicated ward, providing specialist staffing, regular training, data monitoring and improvement, and patient involvement in decision making.

Canberra Hospital is among only 23 Australian hospitals that are officially certified. These include:

• Latrobe Regional Hospital (VIC)

• Royal Melbourne Hospital (VIC)

• Austin Health (VIC)

• Northern Hospital (VIC)

• Alfred Hospital (VIC)

• Echuca Hospital (VIC)

• Box Hill Hospital (VIC)

• University Hospital Geelong (VIC)

• St John of God Midland Public and Private Hospitals (WA)

• Royal Adelaide Hospital (SA)

• Launceston General Hospital (TAS)

• Townsville Hospital (QLD)

• Logan Hospital (QLD)

• Toowoomba Hospital (QLD)

• Sunshine Coast University Hospital (QLD)

• Gold Coast University Hospital (QLD)

• Alice Springs Hospital (NT)

• Royal North Shore Hospital (NSW)

• Sydney Adventist Hospital (NSW)

• Gosford Hospital (NSW)

• Shoalhaven Hospital (NSW)

• Wagga Wagga Base Hospital (NSW)

• Canberra Hospital (ACT)

Stroke Foundation National Manager Stroke Treatment, Kelvin Hill, says this will improve outcomes for patients.

"Treatment in a dedicated stroke unit is proven to make the biggest overall difference of any intervention to patient outcomes following stroke, reducing the risks of both death and disability. Both Australian and international evidence suggests that rigorous stroke centre certification programs improve the quality of stroke care(NOT RECOVERY!) and patient outcomes."

The need for a certification system comes after Stroke Foundation's National Acute Services Audit 2024 found that not all Australian hospitals with a self-designated stroke unit meet the requirements for stroke unit care(NOT RECOVERY!).

"This means some people experiencing a stroke are being provided suboptimal care(NOT RECOVERY!) which impacts their recovery and leads to poorer health outcomes. This is unfair. All Australian survivors of stroke deserve the best quality of care(NOT RECOVERY!) regardless of where they are hospitalised. There should be no postcode lottery," Mr Hill said.

Participation in the program is voluntary and there is no penalty for hospitals that do not meet the criteria. However Australian and New Zealand Stroke Organisation President, Professor Tim Kleinig, is optimistic that all Australian hospitals with self-designated stroke units will apply for certification over time.

"This is an opportunity for all Australian hospitals treating patients with stroke to further enhance the already excellent work their stroke teams deliver. Quality stroke unit care(NOT RECOVERY!) is a human right and all Australians deserve nothing less. We must ensure everyone unfortunate enough to have a stroke has the best possible chance, not only of survival, but also a good post-stroke recovery."

"I applaud these hospitals for taking the necessary steps in ensuring they meet and maintain a high quality of stroke care(NOT RECOVERY!). Along with the World Health Organization and World Stroke Organisation, we hope all hospitals providing stroke care(NOT RECOVERY!) will participate in the certification process," Professor Kleinig said.

/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 full here.