Making the right decisions when planning stroke rehab for yourself or a loved one starts with asking the right questions. Here’s a detailed list of the important things to ask:

The tyranny of low expectations is all over these questions. The most important question is not even in there. HOW DO I GET TO 100% RECOVERY?

Until stroke survivors start demanding an answer to that question your stroke team will stay with the failures of the status quo. Getting to 100% recovery is going to require massive amounts of brainpower and research that your doctors and stroke hospital have shown no interest in doing.  

Making the right decisions when planning stroke rehab for yourself or a loved one starts with asking the right questions. Here’s a detailed list of the important things to ask:

Long-term sitting affects vascular health

What EXACTLY is your responsible doctor doing to assure your time in the hospital is not spent sitting or lying in bed? Studies have shown stroke survivors spent vast amounts of time not doing anything. Of course your doctor can deflect this argument since the research was in healthy subjects. If s/he does that deflection you need to demand a competent doctor. 

Long-term sitting affects vascular health

Credeur DP, et al. Am J Cardiol. 2018;doi:10.1016/j.amjcard.2018.10.014.

January 3, 2019

Long bouts of uninterrupted sitting in relatively healthy patients negatively impacted markers of peripheral and central vascular health, according to a study published in The American Journal of Cardiology.
Daniel P. Credeur, PhD, assistant professor at The University of Southern Mississippi School of Kinesiology in Hattiesburg, and colleagues analyzed data from 20 patients (mean age, 26 years; 7 women; mean BMI = 30 kg/m²) free from any metabolic, CV or neurological diseases. Patients were also nonsmokers, not pregnant and were asymptomatic, as shown by a resting BP below 140 mm Hg systolic/90 mm Hg diastolic.

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After completing several assessments and measurements, patients rested for 15 minutes before they sat in a chair for 3 hours. During this time, patients were allowed to perform standard tasks. Tasks such as listening to heavy music and moving their legs were not permitted during the 3 hours.
CV measures were taken at 10 minutes and at every hour. Assessments after 3 hours were also performed, and patients were given a triaxial accelerometer to determine physical activity status over a 7-day period.
After patients sat for 3 hours, there was a significant increase in aortic pulse wave velocity (5.7 m/s to 6.1 m/s; P = .009) and a decrease in augmentation index (13% to 3%; P < .001).
Reflection magnitude did not significantly change during sitting (P = .13).
Decreases were also seen in flow-mediated dilation (0.5 mm to 0.3 mm; P = .014) and microvascular area under the curve (2,194 to 1,157; P = .003). Low-flow mediated constriction was unaffected during sitting (P = .85).
“Our data support the view that a single bout of prolonged, uninterrupted sitting may serve as a precursor for initiating the deleterious cardiovascular health response associated with long-term sedentarism,” Credeur and colleagues wrote. – by Darlene Dobkowski

Increased risk for dementia both before and after stroke: A population-based study in women followed over 44 years

Demand your doctor give you protocols to prevent such dementia. If you don't DEMAND this your doctor will do nothing and you will have to figure it out on your own. Isn't this exactly why you pay doctors?

Increased risk for dementia both before and after stroke: A population-based study in women followed over 44 years

 

Alzheimer's & Dementia — Guo X, et al. | October 22, 2018

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In a large population of women followed over 44 years, researchers studied the risk of dementia before and after stroke. From 1968 to 2012, a population sample of 1460 women without stroke or dementia at baseline was followed over 44 years. From neuropsychiatric examinations, key-informant interviews, hospital registry, and medical records, information on stroke and dementia was obtained. In women, the age-specific incidence of the stroke and dementia was comparable. Both before and after stroke, women with stroke had increased risk for dementia. They found that the increased risk of dementia continued more than 11 years after the stroke. The study findings might have important implications for understanding the link between stroke and dementia, for the prevention and treatment of dementia and stroke, and for the classification of subtypes of dementia disorders.

Dendritic spines provide cognitive resilience against Alzheimer's disease

You'll have to DEMAND your doctor provide you protocols that will create new dendritic spines.  And after s/he does that ask for proof that the protocols are working. You have to DEMAND accountability and responsibility from your doctors.
http://onlinelibrary.wiley.com/doi/10.1002/ana.25049/full

Authors

• Accepted manuscript online: 16 September 2017Full publication history
• DOI: 10.1002/ana.25049  View/save citation
• Cited by (CrossRef): 0 articles Last updated 23 September 2017

Abstract

Objective: Neuroimaging and other biomarker assays suggest that the pathological processes of Alzheimer's disease (AD) initiate years prior to clinical dementia onset. However some 30%-50% of older individuals that harbor AD pathology do not become symptomatic in their lifetime. It is hypothesized that such individuals exhibit cognitive resilience that protects against AD dementia. We hypothesized that in cases with AD pathology structural changes in dendritic spines would distinguish individuals that had or did not have clinical dementia.
Methods: We compared dendritic spines within layers II and III pyramidal neuron dendrites in Brodmann Area 46 dorsolateral prefrontal cortex using the Golgi-Cox technique in 12 age-matched pathology-free controls, 8 controls with AD pathology (CAD), and 21 AD cases. We used highly optimized methods to trace impregnated dendrites from brightfield microscopy images which enabled accurate three-dimensional digital reconstruction of dendritic structure for morphologic analyses.
Results: Spine density was similar among control and CAD cases but reduced significantly in AD. Thin and mushroom spines were reduced significantly in AD compared to CAD brains, whereas stubby spine density was decreased significantly in CAD and AD compared to controls. Increased spine extent distinguished CAD cases from controls and AD. Linear regression analysis of all cases indicated that spine density was not associated with neuritic plaque score but did display negative correlation with Braak staging.
Interpretation: These observations provide cellular evidence to support the hypothesis that dendritic spine plasticity is a mechanism of cognitive resilience that protects older individuals with AD pathology from developing dementia. This article is protected by copyright. All rights reserved.

National Stroke Center to be established in Mulleriyawa hospital - Sri Lanka

Time to contact them and DEMAND  that the goal of the hospital is 100% recovery for all stroke survivors. Anything less and they aren't even trying for the best interests of their stroke patients.  Dumbed down goals for the doctors and hospital are not to be tolerated. YOU have to be in charge of the goals not the self serving interests of the stroke medical professionals.
National Stroke Center to be established in Mulleriyawa hospital

Aug 23, Colombo: Sri Lanka's Minister of Health, Nutrition and Indigenous Medicine, Dr. Rajitha Senaratne has said that measures have been taken to establish the National Stroke Center in the Mulleriyawa hospital.
Minister Senaratne has disclosed this participating as the Chief Guest in an event held to launch the register of stroke patients in Sri Lanka recently at the Colombo National Hospital.
Speaking at the event, the Minister said that steps have been taken to establish stroke centers throughout the country.
The Minister of Health further said stroke has been identified as a major cause of paralysis among adults and care must be taken to eliminate the cause of strokes and the government has taken several steps.
According to the Health reports prevalence of stroke in Sri Lanka is 10 per 1000 people and is a leading cause of disability and death.
The Minister said the impact of stroke on the economy and families is very powerful, therefore, the hospital facilities have been upgraded for stroke patients.
"We must also focus on the rehabilitation of the patients after stroke. It is also important to educate the general public about the actions that need to be taken to curb the disease. That includes lifestyle changes and emergency management," the Minister said.
Director General of Health Services Dr. Jayasundera Bandara, Deputy Director General Dr. Champika Wickramasinghe, Colombo National Hospital Director Dr. Anil Jasinghe and a team of specialist doctors were present at the occasion.

Worcestershire Health and Care NHS Trust board approves plans to move stroke rehab services at Bromsgrove's Princess of Wales

You will have to DEMAND they provide RESULTS rather than just services or care. Start screaming at them, they are supposed to be working for your health/recovery. Demand they do that, rather than hiding behind care and services.
http://www.eveshamjournal.co.uk/news/regional/15088998.Board_approves_plans_to_move_Bromsgrove_s_stroke_rehab_beds_to_Evesham/
PEOPLE recovering from stroke in Bromsgrove will have to face an arduous 25-mile journey to Evesham for treatment, following controversial cuts to services at Princess of Wales Community Hospital.
Stroke rehabilitation beds are currently provided in three sites across the county - eight at Bromsgrove, eight at Timberdine Community Unit in Worcester and 16 at Evesham Community Hospital.
But Worcestershire Health and Care NHS Trust said it has become too difficult to manage all three, due to a shortage of consultants.
Last Wednesday, the NHS Trust's board approved plans to consolidate Worcestershire's stroke rehab services at Evesham, meaning stroke patients in Bromsgrove travelling around 25 miles further for treatment.
For those using public transport, the journey would involve at least two buses.
The trust's lead for community care in South Worcestershire Mel Roberts admitted the move was not 'a perfect solution', but said: "We have to make sure the service we provide is safe and gives the best care possible and we believe that, at this time, given the issues securing suitable consultant cover, this is best done on one site rather than being spread too thinly across three."
The trust has pledged to develop ideas to make it easier for patients across the county who will now be travelling to Evesham for rehab treatment.
This includes increasing visiting times for families travelling from elsewhere in the county, support with identifying public transport options, investigating digital options and supporting hospital volunteers in helping patients stay in touch with family while on the ward.
But residents have already expressed concerns about patients having to trek to Evesham for treatment.
Annalisa Yorke, who lives in Norton, takes both of her parents to the Princess of Wales for weekly rehab treatment and said the decision would be a 'huge loss to the area'.
She said: "This really saddens me. Dad went to Evesham for a short while after his stroke and it's was a nightmare to travel to and the visiting hours were very strict. I made a nuisance of myself just to get dad to Princess of Wales Community Hospital and the treatment he received was excellent."
Bernice Jones, regional director for the Stroke Association in Bromsgrove, said the charity supported the specialist care being provided in one place, but added: “We would like to see consideration in the future of a second stroke rehabilitation centre in the north of the county. Family support is hugely important to stroke survivors, and this would help ensure families and carers can visit their loved ones.”
The plans are set to come into effect in early April, but Evesham will start taking more new admissions from this week.

Nearest stroke unit to Redditch will transfer to Evesham - UK

You are going to have to DEMAND goals that lead to full 100% recovery results. Not this crap about just improving 'services'. Services are fucking useless in getting you recovered. Likely is never a term that should be used in the medical world, specify efficacy percentages. 

Nearest stroke unit to Redditch will transfer to Evesham - UK

HEALTH CHIEFS are planning to transfer Redditch’s nearest specialist stroke unit over to Evesham.
Bosses claim the eight-bed relocation of the service, at Bromsgrove’s Princess of Wales Community Hospital, is being done to improve services but the move will see Redditch patients and their families facing a round trip of 44 miles rather than 16 for treatment or to see loved ones.
The move comes after the county’s three stroke sites – in Bromsgrove, Evesham and Worcester – struggled to secure appropriate specialist consultants. As a result Evesham will now house 32 specialist stroke rehab beds.
Currently, stroke sufferers receive immediate treatment at the Worcestershire Royal’s Acute Stroke Unit before being transferred to one of the three specialist stroke rehabilitation wards. They are then discharged with support from the Community Stroke Service if needed.
The changes are expected to be introduced as soon as possible to support the wider system over winter when healthcare demand is highest.
Bernice Jones, regional director of The Stroke Association, said stroke patients needed to come to terms with its physical and emotional impact and were more likely to make a better recovery with specialist care from a co-ordinated team on a stroke unit and high quality rehabilitation.
She said the charity supported the decision but added: “I would like to see consideration in the future of a second stroke rehabilitation centre in the north of the county.
“Family support is hugely important to stroke survivors, and this would help ensure families and carers can visit their loved ones. “
Dr Carl Ellson, on behalf of the three Worcestershire CCGs, said the move would see patients have access to expert clinicians seven-days-a-week, helping them recover quicker and improving their long-term outcomes.
However the decision has alarmed local civic leaders and Redditch borough council leader Councillor Bill Hartnett is to write a joint letter with Coun Geoff Denaro, leader of Bromsgrove district council expressing their concern. Coun Hartnett said: “As far as I know there has been no consultation with the districts on this.”

HMC to open rehabilitation facility for stroke patients - Qatar Rehabilitation Institute

YOU are going to have to DEMAND that goals and objectives are set for stroke. 100% recovery.
'Best care' is not the answer. Best care allows the doctors and hospital to not even attempt to solve any of the problems in stroke. 

HMC to open rehabilitation facility for stroke patients - Qatar Rehabilitation Institute

Hamad Medical Corporation (HMC) will open the Qatar Rehabilitation Institute (QRI) in Hamad Bin Khalifa Medical City soon, offering best care in rehabilitation services(NOT RECOVERY!) for stroke patients and others.
The groundbreaking new facility will provide patients with world-class integrated rehabilitation services, including specialist stroke recovery. Multi-disciplinary teams of physicians and occupational, physical, paediatric and speech therapists will work together to offer advanced stroke and traumatic brain injury treatments and services.
These cutting-edge services and treatments will be tailored to each patient’s individual needs. For stroke patients, one of the services that will be offered is intensive gait training to help patients walk again. Additionally, QRI’s strength and endurance services will focus on helping patients’ neurologic, muscular, bone and joint recovery to help them regain their independence.
The QRI’s co-ordinated and collaborative interdisciplinary approach to treatment and therapy will be based on the most up-to-date research and practice and its foremost goal will be to help patients reach their maximum recovery potential so that they can return to living as normal a life as possible.
One crucial aspect of stroke care(NOT RECOVERY!) is rehabilitation, said Dr Wafaa al-Yazeedi, acting chairperson of the Physical Medicine and Rehabilitation Department at Rumailah Hospital. “Due to the prevalence of risk factors such as diabetes, smoking, high blood pressure and high cholesterol, the incidence of stroke in Qatar is rising. Each year, more than 1,000 acute stroke patients are admitted to HMC and many of these patients require long-term rehabilitative care(NOT RECOVERY!) to help them recover,” she said.
“The primary aim of stroke rehabilitation is to enable the patient to relearn the motor skills they have lost due to the stroke. HMC’s expert rehabilitation teams work together  by setting individual patient goals to overcome challenges and find innovative solutions that noticeably improve patient recovery,” said Dr al-Yazeedi.
“The rehabilitation process for patients at HMC begins as early as possible, often 24 to 48 hours after the stroke has occurred. It is important to start the patient’s recovery process as soon as possible to give them the best chance of recovery,” she noted.
Acute strokes often damage critical parts of the brain that control muscle strength, movement and co-ordination. When the blood supply to the brain is suddenly cut off due to an acute stroke, damage to these areas of the brain can lead to a loss of function and coordination in various parts of the body.

SaeboReJoyce is an upper extremity rehabilitation workstation

What stroke protocol is your doctor following to get your arm recovered? 'Winging it' or 'We'll see' is not allowed. You might need to start screaming at the lack of knowledge your doctors have about stroke recovery. DEMAND to know exactly how you are getting 100% recovery. They should feel damned uncomfortable not being able to answer that question. That embarrassment might be the only way they will contact their doctor associations to see what can be done to solve all the problems in stroke.
Do not let them off the hook if they start using the fuckingly stupid response, 'All strokes are different, all stroke recoveries are different'. That is a sign of incompetence.
http://www.saebo.com/saebo-rejoyce/
The SaeboReJoyce is an upper extremity rehabilitation workstation designed for orthopedic and neurological patients who exhibit impaired function of the arm and hand. The computerized task-oriented training system provides standardized upper limb exercises representing activities of daily living (ADL). The SaeboReJoyce was designed to be used in the clinic and in home-based settings.
View brochure

5 Practical Tips from Occupational Therapists

I quit reading on the first page  when they talked about you can learn ways to compensate.
 I really expect my therapists help me recover not just compensate.
But then this is from the NSA so I don't expect anything useful from them at all. WE have to demand recovery otherwise our stroke medical professionals will never get off their asses and do the right thing.

http://www.strokesmart.org/practical-tips?page=1&id=390