15 Truths About Life After Stroke (That the Doctors Didn’t Mention) by Flint Rehab

One truth only:  Your doctor KNOWS NOTHING ABOUT 100% RECOVERY!

Even Flint Rehab is ignoring the elephant in the room! 

My first post  in this blog was:

What my doctor should have told me about stroke recovery

Still has the same relevance today. And I'm still as arrogant and opinionated as ever. Arrogance is only true if you don't know what you're talking about! I do know what I'm talking about! 

Your doctor really knows nothing SPECIFIC AND EXACT to get you recovered. Ask him/her; you'll get dissembling rather than specifics! Or you'll get the craptastic saying: 'All strokes are different, all stroke recoveries are different'. In my opinion, that is the comment of a totally incompetent doctor!

15 Truths About Life After Stroke (That the Doctors Didn’t Mention)

A stroke can change your life in an instant. One day everything feels normal, and the next you are navigating a world that suddenly works very differently. Doctors and therapists often focus on the most urgent parts of recovery: stabilizing your health, preventing another stroke, and starting rehabilitation. And, those steps are incredibly important.  However, many survivors and caregivers discover that life after stroke includes many emotional, mental, and practical challenges that were never fully explained. If you are feeling surprised by what recovery actually looks like, you’re not alone. In this article, we’ll explore 15 truths about life after stroke that many survivors discover along the way. Some may feel difficult at first, while others may offer reassurance and hope. But most importantly, understanding these realities can help you move forward with more confidence, patience, and self-compassion. 

Truth #1: Recovery Takes Longer Than Most People Expect

 One of the most common surprises for survivors and their life after stroke is how long recovery can take. Many people assume that recovery happens within weeks or a few months. While some improvements may happen quickly, the brain often continues healing for months and even years. This happens because of neuroplasticity, the brain’s ability to reorganize and form new neural pathways. With consistent practice and therapy, your brain can slowly relearn lost skills. That said, progress may feel slow at times. Some weeks you may notice big improvements. Other weeks may feel like nothing is changing. Both experiences are normal. Recovery is rarely a straight line. Instead, it often looks like gradual progress over time with occasional plateaus along the way.

Truth #2: Fatigue After Stroke Is Real

Many survivors are surprised by how tired they feel after a stroke. This includes both their everyday life after stroke as well as throughout rehab and recovery activities. Even simple activities such as talking, concentrating, or walking around the house can feel exhausting. This type of exhaustion is often called post-stroke fatigue, and it can happen even if you are getting enough sleep. There are a few reasons for this:Your brain is working harder to complete everyday tasks The body is using extra energy to heal Cognitive and physical functions often require more effort than before Because of this, pacing yourself becomes an important part of recovery.

Helpful ways to manage fatigue include:

 Prioritizing the most important tasks each day Breaking large tasks into smaller steps Over time, many people find that their energy gradually improves.

Truth #3: Your Emotions May Feel Different

 Emotional changes are very common after a stroke and it can affect everybody differently. Some survivors may feel more sensitive, while others may experience mood swings, frustration, anxiety, or sadness. In some cases, emotional responses may feel stronger or harder to control. While adjusting to life after stroke can bring a wide range of feelings, emotional changes can also happen when a stroke affects the parts of the brain responsible for emotional regulation. For example, you may feel: Grief about lost abilities Fear about the future Gratitude for survival and support All of these emotions are valid. However, it is important to find a way to effectively express and process your emotions.  Talking with a counselor, support group, or trusted loved one can make a big difference during this stage of recovery.

Truth #4: Small Wins Become Huge Milestones

Before a stroke, everyday tasks often happen automatically. But after a stroke, even simple achievements can feel like major victories.  For example, it may feel like a major accomplishment to: Button a shirt Hold a utensil Take a few independent steps Say a word clearly These moments may seem small to others, but they represent real neurological progress. Celebrating these milestones is important. Each one reflects your brain adapting and learning, keeping you motivated to hit the next goal. Some survivors enjoy keeping a recovery journal so they can really see and celebrate how much progress they’ve made.

Truth #5: Some Friends May Not Understand Your Life After a Stroke

 One difficult reality many survivors face is that not everyone understands what recovery looks like. Some people may assume that because you look “better,” you are fully recovered. Others may not realize how much effort daily tasks require. This can feel isolating. However, it may help to remember that most people simply do not understand stroke unless they have experienced it themselves. To them, the invisible symptoms of stroke – like fatigue, sensory sensitivities, and pain – are just that: invisible. Connecting with others who share similar experiences can be incredibly helpful. Stroke support groups, online communities, and rehabilitation programs often provide a space where people truly understand what you are going through. In addition, talking with your friends and family to help them understand what you might be going through can be helpful for both you and them!

Truth #6: Therapy Does Not End When Rehab Ends

 This might be the most important truth that many survivors learn in their life after a stroke. Many survivors believe therapy ends once formal rehabilitation sessions stop. In reality, recovery can continue at home long after discharge. The brain changes through repetition and practice, which means continuing exercises at home can play a powerful role in recovery. Examples of ongoing practice may include: Hand and arm exercises Walking practice Speech exercises Cognitive games Even small daily practice sessions can encourage the brain to keep adapting. Staying consistent is what allows survivors to continue recovering even years later.

Truth #7: Progress May Happen in Unexpected Ways

 Stroke recovery rarely follows a predictable pattern. For instance, you may spend weeks working on hand movement without seeing improvement. Then suddenly, one day you notice your fingers can move slightly more than before. These breakthroughs often happen because the brain has been slowly building new connections behind the scenes. Progress can also show up in surprising ways. For example: Improved balance Better coordination Increased endurance Faster thinking Even if the changes feel subtle, they are signs that your brain is continuing to adapt.

Truth #8: Cognitive Changes Are Common

 Stroke does not only affect physical movement. It can also influence thinking skills.Some survivors notice changes in: Memory Problem solving Multitasking These cognitive challenges can feel frustrating, especially when tasks that once felt simple suddenly require more effort. However, the brain can often improve these skills with practice. Activities that stimulate the brain may help, such as: Puzzles or word games Reading Strategy games Memory exercises&nnbsp;Over time, many survivors see gradual improvements in cognitive function.

Truth #9: Caregivers Also Experience a Major Adjustment

 When someone has a stroke, their loved ones often take on new roles as caregivers.Caregivers may help with: Transportation to therapy Household tasks Medication management Emotional support While caregiving can be deeply meaningful, it can also be physically and emotionally demanding. Because of this, caregivers also need support.

Taking breaks, asking for help, and connecting with caregiver support groups can help prevent burnout and improve long-term well-being.

Truth #10: Motivation Can Come and Go

 Recovery requires persistence, but motivation may fluctuate. Some days you may feel energized and hopeful. Other days you might feel discouraged or overwhelmed. This is completely normal. Recovery is not just physical. It also involves emotional and mental resilience. During difficult days, it can help to: Focus on one small goal Remind yourself how far you have come Lean on support from family or friends Remember, even small steps forward still count as progress.

Truth #11: Your Identity May Shift

 Many survivors describe feeling like they are rediscovering themselves after stroke. Activities, careers, or hobbies that once defined daily life may temporarily change. While this adjustment can feel unsettling, it can also open the door to new perspectives and priorities. Some people discover new hobbies, new routines, or new ways to connect with others during recovery. Your identity is not defined by what you lost. It continues to evolve as you move forward.

Truth #12: Plateaus Are Part of the Process

 At times, recovery may feel like it has stopped. You might practice the same exercises for weeks without noticeable improvement. These periods are often called recovery plateaus. Although plateaus can feel discouraging, they do not necessarily mean recovery has ended. In many cases, the brain is still strengthening neural pathways beneath the surface. Trying new exercises, increasing repetition, or changing therapy strategies can sometimes help stimulate progress again. Patience during these periods is key.

Truth #13: Hope Is Still Very Real

 While stroke recovery can be challenging, many survivors continue improving far beyond what they initially expected. Research and real-world experiences show that the brain remains capable of change long after the early recovery phase. With consistent therapy, adaptive strategies, and the right support system, meaningful improvements can continue to happen. Hope does not mean ignoring the challenges. Instead, it means recognizing that progress remains possible.

Truth #14: Technology Can Support Recovery at Home

 One encouraging development in stroke rehabilitation is the growing availability of home-based recovery tools. These tools can help survivors practice exercises more consistently outside of traditional therapy sessions. Interactive therapy devices, such as the MusicGlove

Rehabilitation devices like Flint Rehab’s FitMi

Guided exercise programs

By making therapy more engaging and accessible, these tools can help encourage the repetition that the brain needs for neuroplasticity.

For many survivors, home therapy becomes a powerful complement to clinical rehabilitation.

Truth #15: You Are Stronger Than You Realize

 Perhaps the most important truth about life after stroke is this: Survivors often discover strength they never knew they had. Recovery requires patience, persistence, courage, and resilience. Every therapy session, every exercise, and every small milestone represents determination and progress. Even on the hardest days, the effort you are putting into recovery matters. And each step forward, no matter how small it may seem, is a meaningful part of your journey.

Moving Forward After Stroke

 Life after stroke rarely unfolds exactly the way anyone expects. There are challenges, adjustments, and moments of uncertainty along the way. However, there are also moments of growth, resilience, and hope. Understanding these truths can help you approach recovery with greater patience and compassion for yourself or your loved one. Progress may take time, but every effort you make is helping your brain adapt and heal. If you are navigating life after stroke right now, remember that you are not alone. Many survivors and caregivers are walking this same path, discovering strength and progress one step at a time. And with continued support, practice, and perseverance, recovery can keep moving forward. Here are some additional articles you might find helpful:

1. 8 Proven Ways to Overcome Post Stroke Fatigue: If Truth #2 hit home, these tips can help you manage exhaustion without feeling guilty about resting.
2. Emotional Changes After Stroke: A Complete Guide to Understanding and Coping: Learn why mood swings and grief happen after stroke, and healthy ways to work through them.
3. How to Find the Right Stroke Support Group Near You or Online: Connect with people who truly get what daily life after stroke feels like.
4. How to Prevent and Overcome Caregiver Burnout: Practical strategies and resources for the loved ones supporting your recovery.
5. Stroke Recovery Timeline: Understanding Milestones on the Road to Recovery: A clearer picture of what progress typically looks like month by month and year by year.

Flint Rehab is leading the way in neuro-rehabilitation with products 

that are backed by research and clinically proven to help you 

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TBI, and SCI.

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The association between triglyceride-glucose index and its combination with post-stroke depression: NHANES 2005–2018

 Why are you ignoring the elephant in the room explaining post stroke depression? It's incredibly simple; NO 100% RECOVERY PROTOCOLS!

You create EXACT 100% recovery protocols and your survivor will be motivated to do the millions of reps needed because they are looking forward to 100% recovery. GET THERE!

There would be no need for this useless research and no survivor depression.

The association between triglyceride-glucose index and its combination with post-stroke depression: NHANES 2005–2018

• Fengjiao Liang,
• Xiaoqian Shan,
• Xiang Chen &
• Banghua Yang 

BMC Psychiatry volume 25, Article number: 243 (2025) Cite this article

• Metrics details

Abstract

Background

Growing evidence indicates a link between insulin resistance and post-stroke depression (PSD). This study employed the triglyceride glucose (TyG) index as a measure of insulin resistance to investigate its relationship with PSD.

Methods

This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (2005–2018). PSD was assessed using data from patient health questionnaires, while the TyG index was calculated based on fasting venous blood glucose and fasting triglyceride levels. The formula used for the TyG index is ln[triglycerides (mg/dL) × fasting blood glucose (mg/dL)/2]. Participants were categorized into four groups according to the TyG index quartiles. A weighted multivariable logistic regression model was applied to examine the relationship between the TyG index and PSD.

Results

A total of 1217 patients were included in the study, of which 232 were diagnosed with PSD. The TyG index was divided into quartiles (Q1-Q4) for analysis. After adjusting for potential confounders, we found a significant positive association between the highest quartile of the TyG index (Q4: ≥9.33) and PSD (OR = 2.51, 95% CI: 1.04–6.07, p = 0.041). This suggests that in the U.S. adult stroke population, individuals with higher TyG indices are more likely to experience depressive symptoms. Subgroup analysis further confirmed a stable and independent positive association between the TyG index and PSD (all trend p > 0.05).

Conclusion

In this large cross-sectional study, our results suggest that among US adults who have experienced a stroke, those with higher TyG index levels are more likely to exhibit depressive symptoms. This provides a novel approach for the clinical prevention of PSD. Patients with higher TyG indices in the stroke population may require closer psychological health monitoring and timely intervention. Additionally, since the TyG index is calculated using only fasting blood glucose and triglyceride levels, it can help identify high-risk PSD patients, particularly in regions with limited healthcare resources.

Peer Review reports

Introduction

Post-stroke depression (PSD) is one of the most prevalent complications following a stroke, marked by high incidence, mortality, and disability rates. A meta-analysis by Hackett et al., which included 51 studies, revealed that the comorbidity rate of PSD is approximately 33% [1]. Jianglong Guo summarized several representative studies and found that the incidence of PSD ranges from 11 to 41% [2]. Overall, about one-third of stroke patients experience depression. In recent years, the number of PSD patients has been gradually increasing due to the sharp rise in the number of stroke patients [1,2,3]. The occurrence of PSD significantly impacts the daily life and rehabilitation of stroke patients, increasing the burden on their families. Researches indicate that the development of PSD is closely related to various factors, including social factors and individual characteristics [4, 5].

Insulin resistance (IR) refers to the reduced sensitivity of insulin target cells to insulin concentration. It is not only associated with the occurrence of various metabolic-related diseases but also closely linked to the development of cardiovascular and cerebrovascular diseases [6, 7]. A longitudinal analysis of the Netherlands Study of Depression and Anxiety (NESDA) cohort by researchers from Stanford University revealed that individuals with insulin resistance exhibited a two-fold increased risk of developing major depressive disorder (MDD) compared to their insulin-sensitive counterparts. Notably, even among participants without baseline depressive symptoms, those with insulin resistance demonstrated a substantially elevated MDD incidence during follow-up [8]. Fernandes BS and colleagues have proposed that insulin resistance may serve as a biomarker for acute depressive states, with their meta-analysis demonstrating significant associations between IR and depression severity scores [9]. Studies have shown that for each unit increase in the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), the risk of PSD in stroke patients increases accordingly [10, 11]. This confirms the positive correlation between insulin resistance and the risk of PSD, suggesting that insulin resistance is an independent risk factor for PSD. The HOMA-IR is useful for the early prediction and assessment of PSD. However, the calculation of HOMA-IR requires fasting serum insulin, which is not a routine biochemical indicator and is thus limited in clinical application (it is not practical in clinical practice).

The triglyceride-glucose index (TyG index) is also an effective means of assessing insulin resistance [12]. Compared to the HOMA-IR, the TyG index offers distinct advantages in clinical applicability. Its calculation does not require fasting insulin measurements, relying solely on triglycerides and fasting glucose levels, thereby simplifying implementation and reducing costs in routine practice [13]. Furthermore, the TyG index exhibits high sensitivity and specificity for identifying insulin resistance, outperforming HOMA-IR in detecting individuals with reduced insulin sensitivity across diverse populations [14]. Critically, the TyG index demonstrates superior predictive performance for metabolic abnormalities compared to HOMA-IR, with consistent efficacy observed in key subgroups such as older adults and individuals with obesity [15]. To date, no studies have directly indicated a correlation between the TyG index and the risk of PSD. Therefore, our research team used a cross-sectional design based on data from the National Health and Nutrition Examination Survey (NHANES) to evaluate whether there is an association between the TyG index and the risk of PSD. The aim of this study is to provide a potential new method for clinically identifying PSD, which could be used for the early detection of high-risk groups, thereby guiding targeted interventions to mitigate the burden of PSD and improve patient outcomes.

More at link.

When someone has a stroke, every second delayed is critical

Well in one second 31,666 neurons will die. ABSOLUTELY NOTHING COMPARED TO THE BILLIONS THAT WILL DIE THE FIRST WEEK, because your doctor and hospital have nothing for stopping the 5 causes of the neuronal cascade of death in the first week. I lost 5.4 billion neurons that first week. If I'd only lost 177 million neurons in the 90 minutes it took to get tPA I'd easily be recovered by now. They are not even focusing on the humongous elephant in the room, just swatting mites on the gnats.

When someone has a stroke, every second delayed is critical

Where does the Indian government stand on its statement made by Prime Minister Narendra Modi in his speech at the UN Sustainable Development Summit in September 2015? stroke Sentinel Digital DeskBy : Sentinel Digital Desk | 10 Oct 2021 12:54 AM Follow Us on Google News Dr Praveen Aggarwal & Dr Manorama Bakshi (The authors, Dr Praveen Aggarwal is co-founder and Director of Consocia Advisor, while Dr Manorama Bakshi is Public Health Expert, Head Health care and Advocacy of Consocia Advisory.) Where does the Indian government stand on its statement made by Prime Minister Narendra Modi in his speech at the UN Sustainable Development Summit in September 2015? To quote him: "Much of India's development agenda is mirrored in the Sustainable Development Goals (SDGs). Our national plans are ambitious and purposeful, sustainable development of one-sixth of humanity will be of great consequence to the world and our beautiful planet." Also Read - Securing land from 'land-hungry' migrants India along with many other countries is tumbling behind on global commitments to tackle premature deaths from chronic diseases, such as strokes, diabetes, lung cancer and heart disease. The NCD Countdown to 2030 report states that the pace of change is too slow to achieve SDG 3.4 in most countries. It may be noted that non-communicable diseases (NCDs) kill 41 million people each year, equivalent to 71 per cent of all deaths globally. Each year, more than 15 million people die from NCD between the ages of 30 and 69 years; 85 per cent of these "premature" deaths occur in low- and middle-income countries.

https://www.sentinelassam.com/editorial/when-someone-has-a-stroke-every-second-delayed-is-critical-558437

 

Where does the Indian government stand on its statement made by Prime Minister Narendra Modi in his speech at the UN Sustainable Development Summit in September 2015? stroke Sentinel Digital DeskBy : Sentinel Digital Desk | 10 Oct 2021 12:54 AM Follow Us on Google News Dr Praveen Aggarwal & Dr Manorama Bakshi (The authors, Dr Praveen Aggarwal is co-founder and Director of Consocia Advisor, while Dr Manorama Bakshi is Public Health Expert, Head Health care and Advocacy of Consocia Advisory.) Where does the Indian government stand on its statement made by Prime Minister Narendra Modi in his speech at the UN Sustainable Development Summit in September 2015? To quote him: "Much of India's development agenda is mirrored in the Sustainable Development Goals (SDGs). Our national plans are ambitious and purposeful, sustainable development of one-sixth of humanity will be of great consequence to the world and our beautiful planet." Also Read - Securing land from 'land-hungry' migrants India along with many other countries is tumbling behind on global commitments to tackle premature deaths from chronic diseases, such as strokes, diabetes, lung cancer and heart disease. The NCD Countdown to 2030 report states that the pace of change is too slow to achieve SDG 3.4 in most countries. It may be noted that non-communicable diseases (NCDs) kill 41 million people each year, equivalent to 71 per cent of all deaths globally. Each year, more than 15 million people die from NCD between the ages of 30 and 69 years; 85 per cent of these "premature" deaths occur in low- and middle-income countries.

https://www.sentinelassam.com/editorial/when-someone-has-a-stroke-every-second-delayed-is-critical-558437

 Where does the Indian government stand on its statement made by Prime Minister Narendra Modi in his speech at the UN Sustainable Development Summit in September 2015? stroke Sentinel Digital DeskBy : Sentinel Digital Desk | 10 Oct 2021 12:54 AM Follow Us on Google News Dr Praveen Aggarwal & Dr Manorama Bakshi (The authors, Dr Praveen Aggarwal is co-founder and Director of Consocia Advisor, while Dr Manorama Bakshi is Public Health Expert, Head Health care and Advocacy of Consocia Advisory.) Where does the Indian government stand on its statement made by Prime Minister Narendra Modi in his speech at the UN Sustainable Development Summit in September 2015? To quote him: "Much of India's development agenda is mirrored in the Sustainable Development Goals (SDGs). Our national plans are ambitious and purposeful, sustainable development of one-sixth of humanity will be of great consequence to the world and our beautiful planet."

https://www.sentinelassam.com/editorial/when-someone-has-a-stroke-every-second-delayed-is-critical-558437

Where does the Indian government stand on its statement made by Prime Minister Narendra Modi in his speech at the UN Sustainable Development Summit in September 2015? stroke Sentinel Digital DeskBy : Sentinel Digital Desk | 10 Oct 2021 12:54 AM Follow Us on Google News Dr Praveen Aggarwal & Dr Manorama Bakshi (The authors, Dr Praveen Aggarwal is co-founder and Director of Consocia Advisor, while Dr Manorama Bakshi is Public Health Expert, Head Health care and Advocacy of Consocia Advisory.) Where does the Indian government stand on its statement made by Prime Minister Narendra Modi in his speech at the UN Sustainable Development Summit in September 2015? To quote him: "Much of India's development agenda is mirrored in the Sustainable Development Goals (SDGs). Our national plans are ambitious and purposeful, sustainable development of one-sixth of humanity will be of great consequence to the world and our beautiful planet."

https://www.sentinelassam.com/editorial/when-someone-has-a-stroke-every-second-delayed-is-critical-558437

Where does the Indian government stand on its statement made by Prime Minister Narendra Modi in his speech at the UN Sustainable Development Summit in September 2015? stroke Sentinel Digital DeskBy : Sentinel Digital Desk | 10 Oct 2021 12:54 AM Follow Us on Google News Dr Praveen Aggarwal & Dr Manorama Bakshi (The authors, Dr Praveen Aggarwal is co-founder and Director of Consocia Advisor, while Dr Manorama Bakshi is Public Health Expert, Head Health care and Advocacy of Consocia Advisory.) Where does the Indian government stand on its statement made by Prime Minister Narendra Modi in his speech at the UN Sustainable Development Summit in September 2015? To quote him: "Much of India's development agenda is mirrored in the Sustainable Development Goals (SDGs). Our national plans are ambitious and purposeful, sustainable development of one-sixth of humanity will be of great consequence to the world and our beautiful planet."

https://www.sentinelassam.com/editorial/when-someone-has-a-stroke-every-second-delayed-is-critical-558437

Where does the Indian government stand on its statement made by Prime Minister Narendra Modi in his speech at the UN Sustainable Development Summit in September 2015? stroke Sentinel Digital DeskBy : Sentinel Digital Desk | 10 Oct 2021 12:54 AM Follow Us on Google News Dr Praveen Aggarwal & Dr Manorama Bakshi (The authors, Dr Praveen Aggarwal is co-founder and Director of Consocia Advisor, while Dr Manorama Bakshi is Public Health Expert, Head Health care and Advocacy of Consocia Advisory.) Where does the Indian government stand on its statement made by Prime Minister Narendra Modi in his speech at the UN Sustainable Development Summit in September 2015? To quote him: "Much of India's development agenda is mirrored in the Sustainable Development Goals (SDGs). Our national plans are ambitious and purposeful, sustainable development of one-sixth of humanity will be of great consequence to the world and our beautiful planet." Also Read - Securing land from 'land-hungry' migrants India along with many other countries is tumbling behind on global commitments to tackle premature deaths from chronic diseases, such as strokes, diabetes, lung cancer and heart disease. The NCD Countdown to 2030 report states that the pace of change is too slow to achieve SDG 3.4 in most countries. It may be noted that non-communicable diseases (NCDs) kill 41 million people each year, equivalent to 71 per cent of all deaths globally. Each year, more than 15 million people die from NCD between the ages of 30 and 69 years; 85 per cent of these "premature" deaths occur in low- and middle-income countries.

https://www.sentinelassam.com/editorial/when-someone-has-a-stroke-every-second-delayed-is-critical-558437

When someone has a stroke, every second delayed is critical

https://www.sentinelassam.com/editorial/when-someone-has-a-stroke-every-second-delayed-is-critical-558437

Longer term patient management following stroke: A systematic review

You're completely missing the elephant in the room. Long term patient 100% recovery is a disastrous 10% and nothing you even talk about here is going to change that. All because you have NO STRATEGY AND NO LEADERSHIP THAT IS TRYING FOR 100% RECOVERY.

Longer term patient management following stroke: A systematic review

Show all authors

Christian Boehme, Thomas Toell, Wilfried Lang, ...

First Published May 20, 2021 Review Article Find in PubMed 

https://doi.org/10.1177/17474930211016963

Article information

Abstract

Background

Tremendous progress in acute stroke therapy(Really? tPA has only a 12% full recovery rate.) has improved short-term outcome but part of this achievement may be lost in the long run. Concepts for a better long-term management of stroke survivors are needed to address their unmet needs and to reduce the burden of post-stroke complications, residual deficits, and recurrent vascular events.

Aims

This review summarizes current knowledge on post-hospital care and the scientific evidence supporting individual programs.

Summary of review

A systematic search of electronic databases according to PRISMA guidelines identified 10,374 articles, 77 of which met the inclusion criteria. One large randomised controlled trial on a multifaceted care program delivered by the multidisciplinary stroke team reduced recurrent vascular events and improved quality of life and functional outcome one year after the event, while a number of studies offer solutions for individual components of post-hospital disease management like patient education, counselling, and self-management or the management of post-stroke complications and residual deficits. A majority of studies, however, was small in size and limited by a short follow-up. Most initiatives with a narrow focus on risk factor control failed to lower the risk of recurrent events. The caregivers’ central role in post-stroke patient management is broadly neglected in research.

Conclusions

Over the past years, first knowledge on how to best organize post-hospital care of stroke patients has emerged. Comprehensive and pragmatic programs operated by the multidisciplinary stroke team hold promise to reduce the long-term health burden of stroke. There is a clear need for further high-quality studies with both clinical endpoints and patient-reported outcomes to establish sustainable solutions in different settings and regions to improve life after stroke, a key priority of the Stroke Action Plan for Europe 2018–2030.

Keywords Stroke, post-stroke care, disease management, complication, follow-up, review

Background

Structured follow-up programs are a well-established standard of care for myocardial infarction and cancer but so far not for stroke.^1,2 In coronary and cancer patients, there is compelling evidence that standardized disease pathways positively affect risk factor profiles, quality of life (QoL), and functional status,^1,2 whereas high-quality studies testing follow-up programs for stroke patients have not been available until recently.

Stroke is a leading cause of death and disability globally. The current lifetime risk of stroke is 25% for both men and women.³ There are 14 million new strokes each year and over 80 million stroke survivors with a strong upwards trajectory given the continuous ageing of societies, population growth, and declining stroke fatality.⁴ Exciting recent advances in acute stroke therapy translate into improved short-term outcome⁵ which, however, may be lost in the long run through unmet needs in post-stroke care, post-stroke complications, residual deficits, and recurrent vascular events. Stroke is considered preventable by guideline-compliant control of risk factors and adequate vascular prevention may also be effective in preserving cognitive abilities. However, there is a significant gap between recommended preventive measures and real-world target level achievement of risk factors, especially in secondary stroke prevention.⁶

Concepts for a better long-term management of stroke patients are urgently needed and the Stroke Action Plan for Europe 2018–2030 has declared life after stroke a key priority.⁷ We herein report a systematic review of randomised controlled trials and rigorous scientific evaluations of structured multimodal intervention programs targeting longer term care of stroke patients.

More at link.

 

This Is How Much Every Second Counts in Stroke Thrombectomy

 You are completely missing the massive elephant in the room. Saving a few million neurons here is miniscule compared to the billions your doctor is letting die because s/he is doing nothing to stop the 5 causes of the neuronal cascade of death in the first week. I lost 5.4 billion neurons in the first week because my doctor did nothing

This Is How Much Every Second Counts in Stroke Thrombectomy

Delays until reperfusion cost years of healthy life, meta-analysis suggests

by Nicole Lou, Staff Writer, MedPage Today May 3, 2021

Every delay in endovascular thrombectomy (EVT) translated into life lost after stroke, according to a patient-level meta-analysis that underscored the importance of fast reperfusion.

For stroke patients receiving EVT early (i.e., with last known well-to-puncture [LKWTP] times within 4 hours) who had substantial reperfusion, times to puncture and reperfusion were indicators of subsequent clinical outcome, reported Mohammed Almekhlafi, MD, MSc, of the University of Calgary in Alberta, Canada, and colleagues of the HERMES group.

For example, every hour of delay in LKWTP was tied to a loss of 0.81 healthy life-years, a "substantial" number that translates to "1.6 months per 10-minute delay, 4.9 days per 1-minute delay, and 2.0 hours per 1-second delay," the group wrote in JAMA Neurology.

Similarly, each second of delay in door-to-puncture (DTP) time and door-to-reperfusion (DTR) time amounted to 2.2 hours and 2.4 hours of healthy life lost, respectively. However, symptom onset-to-door times had no statistically significant time-benefit association.

"Delays, particularly after arrival to the hospital until reperfusion is achieved, may result in substantial losses in years of healthy life for patients. Efforts to optimize workflow and eliminate barriers preventing timely patient evaluation and treatment within health care systems are warranted," the authors concluded.

It has long been established that "time is brain" in stroke thrombectomy. Efforts are ongoing to shorten door-to-intervention times worldwide, with the American Heart Association and American Stroke Association recommending certain workflow targets to accelerate care delivery.

Almekhlafi and colleagues performed a meta-analysis of seven randomized trials testing EVT within 12 hours of acute ischemic stroke onset due to large vessel occlusion. They rated disability according to the utility-weighted modified Rankin Scale score, and based age-specific life expectancies on the 2017 U.S. National Vital Statistics.

The HERMES collaboration allowed investigators to gather patient-level data on participants for their study. There were 781 EVT-treated patients, of whom 52% had early thrombectomy and the rest had late thrombectomy with LKWTP times of 4-12 hours.

The early group had a median LKWTP time of 188 minutes and DTP time of 105 minutes. Of the 78.4% who had successful reperfusion in this cohort, it was achieved after a median last known well-to-reperfusion time of 234 minutes and DTR time of 145 minutes.

An explanatory analysis of the late-treated population -- a cohort more likely to have strokes with unwitnessed onset and symptoms first observed on awakening, but fewer patients with fast progression -- showed no significant relationship between times to puncture (or reperfusion) and life lost.

Heterogeneous entry criteria and imaging methods across trials were study limitations, Almekhlafi's group acknowledged. Findings also may not be generalizable to patients with pre-existing disability or those treated after 12 hours, two groups that were not included in the seven trials of the meta-analysis.

• 

  Nicole Lou is a reporter for MedPage Today, where she covers cardiology news and other developments in medicine. Follow

Disclosures

The study was funded by a grant from Medtronic to the University of Calgary HERMES Coordinating Center.

Almekhlafi is a member of the scientific advisory board of Palmera Medical.

Primary Source

JAMA Neurology

Source Reference: Almekhlafi MA, et al "Healthy life-year costs of treatment speed from arrival to endovascular thrombectomy in patients with ischemic stroke: a meta-analysis of individual patient data from 7 randomized clinical trials" JAMA Neurol 2021; DOI: 10.1001/jamaneurol.2021.1055.

 

New guidelines back device for treating strokes

Neither one of these reports gives ANY factual objective basis that these prevent disability. They may save your life but once again the elephant in the room is not being treated. The neuronal cascade of death.
http://www.timesfreepress.com/news/national/business/story/2015/jun/29/first-new-guidelines-back-device-treating-str/312117/

http://www.alphagalileo.org/ViewItem.aspx?ItemId=154075&CultureCode=en