How Long Does It Take To Recover From A Stroke? by Flint Rehab

I'm 17 years out and I have given up on consistent stroke rehab because it's pretty much useless until somebody cures spasticity. I don't need to beat my head against the wall when life is out there to live and useless rehab doesn't get me anywhere better.

 How Long Does It Take To Recover From A Stroke? by Flint Rehab

Odds of cognitive impairment increase after stroke in certain populations

It is your doctor's responsibility to ensure you don't have cognitive impairment post stroke. Don't let your doctor weasel out of that responsibility by quoting the craptastic saying: 'All strokes are different, all stroke recoveries are different'.  That statement means your doctor has given up on solving stroke

Odds of cognitive impairment increase after stroke in certain populations

History of stroke was associated with increased odds of cognitive impairment in both non-Hispanic white and Mexican American individuals, researchers reported.

The magnitude of the impact of stroke on cognition was less in Mexican American participants than in non-Hispanic white participants, according to the researchers.

Source: Adobe Stock

The association between stroke and dementia is well established, but less is known about the prevalence in underrepresented ethnic groups, according to the study background.

Christopher J. Becker, MD, neurologist in the University of Michigan Health System, and colleagues conducted a population-based, cohort study in Nueces County, Texas; residents younger than 65 years were recruited via telephone or door-to-door from May 2018 to December 2021. The county is a bi-ethnic community with a primarily Mexican American population. Participants lived in the community for at least 6 months of the year, were aged 65 years or older, spoke English or Spanish and were living in the community or a nursing-care facility.

Of the 1,801 participants, 50% were Mexican American, 44% were non-Hispanic white and 6% were another race/ethnicity. Crude prevalence of stroke history was 12% for Mexican Americans, 12.3% for non-Hispanic white participants and 17.2% for participants of other races/ethnicities (P = .34).

Becker and colleagues found stroke was associated with cognitive impairment in each race/ethnicity, but the magnitude of effect was greater in non-Hispanic white participants (cumulative OR = 3.81; 95% CI, 2.37-6.12) than in Mexican American participants (cumulative OR = 1.58; 95% CI, 1.04-2.41).

Older age and lower educational attainment were also associated with cognitive impairment in all races/ethnicities, the researchers wrote.

“Overall, our findings underscore the importance of aggressive stroke prevention measures not only to minimize the morbidity of poststroke cognitive impairment for patients and caregivers, but also to reduce the burden of dementia at a population level,” Becker and colleagues wrote.

Recovery after stroke: the severely impaired are a distinct group

So what? They still require 100% recovery protocols. Or have you given up on them? So when you have a stroke make damn sure it is a mild one that maybe your doctors know how to treat. YOUR RESPONSIBILITY!

Recovery after stroke: the severely impaired are a distinct group

1. http://orcid.org/0000-0002-5927-1089Anna K Bonkhoff1,
2. http://orcid.org/0000-0003-0714-8545Tom Hope2,
3. Danilo Bzdok3,4,5,
4. Adrian G Guggisberg6,
5. Rachel L Hawe7,8,
6. Sean P Dukelow8,
7. François Chollet9,
8. David J Lin10,
9. Christian Grefkes11,12,
10. Howard Bowman13,14

1. Correspondence to Dr Anna K Bonkhoff, J. Philip Kistler Stroke Research Center, Boston, MA 02114, USA; abonkhoff@mgh.harvard.edu

Abstract

Introduction Stroke causes different levels of impairment and the degree of recovery varies greatly between patients. The majority of recovery studies are biased towards patients with mild-to-moderate impairments, challenging a unified recovery process framework. Our aim was to develop a statistical framework to analyse recovery patterns in patients with severe and non-severe initial impairment and concurrently investigate whether they recovered differently.

Methods We designed a Bayesian hierarchical model to estimate 3–6 months upper limb Fugl-Meyer (FM) scores after stroke. When focusing on the explanation of recovery patterns, we addressed confounds affecting previous recovery studies and considered patients with FM-initial scores <45 only. We systematically explored different FM-breakpoints between severe/non-severe patients (FM-initial=5–30). In model comparisons, we evaluated whether impairment-level-specific recovery patterns indeed existed. Finally, we estimated the out-of-sample prediction performance for patients across the entire initial impairment range.

Results Recovery data was assembled from eight patient cohorts (n=489). Data were best modelled by incorporating two subgroups (breakpoint: FM-initial=10). Both subgroups recovered a comparable constant amount, but with different proportional components: severely affected patients recovered more the smaller their impairment, while non-severely affected patients recovered more the larger their initial impairment. Prediction of 3–6 months outcomes could be done with an R²=63.5% (95% CI=51.4% to 75.5%).

Conclusions Our work highlights the benefit of simultaneously modelling recovery of severely-to-non-severely impaired patients and demonstrates both shared and distinct recovery patterns. Our findings provide evidence that the severe/non-severe subdivision in recovery modelling is not an artefact of previous confounds. The presented out-of-sample prediction performance may serve as benchmark to evaluate promising biomarkers of stroke recovery.

Data availability statement

Data are available upon reasonable request. Data is available from the authors on reasonable request. Jupyter notebook scripts (python 3.7, predominantly pymc3) is openly available: https://github.com/AnnaBonkhoff/to_be_added_upon_acceptance.

http://dx.doi.org/10.1136/jnnp-2021-327211

Pre-treatment lesional volume in older stroke patients treated with endovascular treatment

Lesional volume makes not one whit of difference in the requirement for 100% recovery for all.  My directors never allowed excuses for not performing my work. No excuses are allowed for not getting to 100% recovery.  Predicting failure to recover research is fucking stupid.

Pre-treatment lesional volume in older stroke patients treated with endovascular treatment

Show all authors

Gauthier Duloquin*, Marc Ferrigno*, Wagih Ben Hassen, ...

First Published February 28, 2022 Research Article 

https://doi.org/10.1177/17474930211068657

Article information

Abstract

Background:

Recent studies in the general stroke population treated with endovascular treatment (EVT) reported that higher pre-treatment lesional volumes were independently associated with poor neurological outcome and functional dependence after stroke. However, it has been not evaluated in older patients.

Aim:

We test the association between the pre-treatment lesional volume on diffusion-weighted magnetic resonance imaging and relevant outcome measures in older adults with stroke treated with EVT.

Methods:

We included consecutive older adults with stroke (⩾80 years old) treated with EVT in two academic comprehensive stroke centers. The association between pre-treatment lesional volume and relevant outcome measures (poor outcome (modified Rankin scale 4–6), 3-month mortality and symptomatic intracerebral hemorrhage (sICH)) was evaluated using univariate and multivariable models.

Results:

Five hundred seventy-nine patients were included (mean age: 85.6 ± 4.1, median lesional volume was 10 ml; interquartile range: 3–30 ml). Pre-treatment lesional volume was associated with poor functional outcome (adjusted odds ratio (aOR): 1.87, 95% confidence interval (CI): 1.60–2.20, for +1 logarithmic increase of lesional volume), 3-month mortality (aOR: 1.50, CI: 1.28–1.76), and sICH (aOR: 1.67, CI: 1.27–2.20). A threshold lesional volume >35 ml predicted 90% of patients with poor functional outcome and a cut-off >51 ml predicted 90% of patients dead at 3 months.(Do you tell your patients they're going to be dead in 3 months? That you've given up on them?)

 

Pre-treatment lesional volume might contribute, in association with other relevant clinical features, to the selection of older stroke patients who will benefit from EVT.

Keywords

Older stroke patients, endovascular treatment, pre-treatment lesional volume

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Stroke of undetermined source most commonly followed by another embolic stroke

If this is you, you are pretty much on your own since researchers seem to have given up.

Stroke of undetermined source most commonly followed by another embolic stroke

After an initial embolic stroke of undetermined source, or ESUS, the most prevalent recurrent infarct was another ESUS, according to an analysis of the NAVIGATE-ESUS trial.
Researchers also noted that atrial fibrillation was strongly associated with morbidity and mortality among patients with recurrent ischemic stroke.

Source: Adobe Stock.

“The predominance of embolic features in most of the recurrent strokes after ESUS found in our analysis supports the validity of the ESUS construct in terms of embolism as the pathogenic mechanism,” Roland Veltkamp, MD, of the department of neurology at Alfried Krupp Krankenhaus, Germany, and colleagues wrote. “However, even with the additional knowledge of recurrent stroke subtype in the present analysis, it is not possible to identify patient characteristics that are associated with the mechanism of recurrence at the time of the qualifying ESUS.”
The NAVIGATE-ESUS trial was a randomized controlled trial that assessed the safety and efficacy of rivaroxaban (Xarelto, Janssen) compared with aspirin in patients with recent ESUS.
For this secondary analysis, published in JAMA Neurology, investigators assessed the data of patients who experienced ischemic stroke during the median 11-month follow-up after initial ESUS (n = 309; 66% men; mean age, 68 years).
Of the classifiable cases of ischemic strokes, researchers determined that 58% were ESUS and the other 42% were identified as cardioembolic (32%), atherosclerotic (23%), lacunar (31%) or other determined cause (14%). The risk for stroke recurrence did not differ by subtype between patients who received rivaroxaban or aspirin, according to the study.
Although AF was identified in 9% of cohort, it was associated with greater morbidity (median change in modified Rankin Scale score, 2 vs. 0) and mortality (15% vs 1%) compared with other causes.
“Although covert atrial fibrillation may not underlie most recurrent strokes after ESUS, its particularly grave consequences warrant a more extensive search for atrial fibrillation in patients with ESUS than mandated in the originally proposed criteria for ESUS,” the researchers wrote.
In other findings, for both the index and recurrent strokes, location of infarct was more often in the left hemisphere (46% index; 54% recurrent) compared with the right hemisphere (40% index; 37% recurrent) or brain stem or cerebellum (14% index; 9% recurrent).
“The persisting uncertainty regarding the embolic source after stroke recurrence in a large proportion of our patients with ESUS suggests that the search for an underlying source may remain futile in many cases with ESUS, given the limitations of widely used diagnostic testing at present,” the researchers wrote. “Consequently, addressing a specific embolic source by targeted antithrombotic stroke prevention remains an unresolved dilemma for many patients with ESUS.”

Very Early MoCA Can Predict Functional Dependence at 3 Months After Stroke: A Longitudinal, Cohort Study

What are you doing to change that trajectory to full recovery? Or is this your 'get out of jail free' card to allow you to do nothing?  I care absolutely nothing about these disability predictions and you should scream in their faces for anyone using them. It means they have given up on your recovery.

Very Early MoCA Can Predict Functional Dependence at 3 Months After Stroke: A Longitudinal, Cohort Study

Tamar Abzhandadze^1*, Lena Rafsten^1,2, Åsa Lundgren Nilsson^1,2, Annie Palstam¹ and Katharina S. Sunnerhagen^1,2

• ¹Institute of Neuroscience and Physiology, Rehabilitation Medicine, University of Gothenburg, Gothenburg, Sweden
• ²Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden

Introduction: After a stroke, cognitive impairment is commonly associated with poor functional outcomes. The primary aim of this study was to investigate if cognitive function, assessed with the Montreal Cognitive Assessment (MoCA) 36–48 h after stroke, could predict functional dependence 3 months later. The secondary aim was to identify an optimal threshold for the MoCA score that could predict functional dependence.

Materials and Methods: This was a longitudinal cohort study. The research database from a stroke unit at the Sahlgrenska University Hospital was linked with the Swedish Stroke Register—Riksstroke. Cognitive function and activities of daily living (ADL) were assessed with the MoCA and the Barthel Index (BI), respectively, 36–48 h after stroke. Functional outcome 3 months after stroke was studied with the modified Rankin Scale. The predictive characteristics of the MoCA were investigated using logistic regression analyses. Receiver operating characteristic curves (AUC) were used for identifying the optimal cutoff score on the MoCA for predicting functional dependence. The MoCA score that had equal sensitivity and specificity was chosen as the optimal score for predicting functional dependence.

Results: A total of 305 participants were included in the study (mean age: 68.8 years, n = 179 men). The MoCA quartiles were a significant predictor of functional dependence 3 months after stroke as an individual variable (p < 0.001, AUC = 0.72) and when adjusted for covariates such as age at stroke onset, living arrangement prior to stroke, and ADL measured with BI within 36–48 h after stroke (p = 0.01, AUC = 0.84). The MoCA score of ≤ 23 for impaired cognition had equal sensitivity and specificity for predicting functional dependence 3 months after stroke.

Discussion and Conclusion: Cognitive function assessed with the MoCA within 36–48 h after stroke could predict functional dependence 3 months later. The participants with MoCA scores ≤ 23 for impaired cognition were more likely to be functionally dependent.

15 Inspirational Quotes That Will Shift Your Mindset To Not Give Up

Or would you rather get this opposite information? I just recently gave up my job because it was so toxic and I didn't need to prove to the youngster that he was wrong.

Wharton's No. 1 professor Adam Grant: 'Never give up is bad advice.'

 

Why "Never Give Up" Is Bad Advice - Heleo

 

Why "Never Give Up" is a Bad Motto - The Berkeley Science Review

 

3 reasons why "Never Give Up" is really bad advice - The Chief

 

15 Reasons "Never Give Up" Is Terrible Advice | TheTalko

 

When "Never Give Up" is Bad Advice - The Meaning Movement

The latest here:

 15 Inspirational Quotes That Will Shift Your Mindset To Not Give Up

Has this ever happened to you?

You get really excited and motivated to accomplish your goal then all of a sudden….bang! You hit your head up against a wall and something happens where you either get distracted or feel like you won’t make it. 

No matter how positive of a person you might be, there are those moments in life where you’re in a mindset that leaves you feeling like giving up, forgetting that you are still a work in progress.

It happens to the best of us even the most celebrated gurus like Tony Tobbins or Jim Rohn.

However, the key difference between successful people and those who never get what they want in life is “how” they face adversity.

Your mind is an amazing tool that can make you believe in an instant that something will or will not work out for you. As cliche as it may sound, “Whether you think you can or you can’t, you’re right”.

It’s the ability to have the presence of mind to not give into the negative side when something goes wrong that changes your entire situation.

This is why it is so crucial that you feed your mind daily with positive thoughts about why things are going to work out for you.

People who feed their minds on a regular basis are more prone to believe in themselves and that everything is going to go their way no matter what the circumstances may look like.

And one of the best ways to keep your mind sharp is by reading inspirational quotes about success. These powerful words have the ability to quickly shift your mindset from thinking negative to positive.

Here are 15 quotes you can read the next time you feel like giving up:

1. Doing the best at this moment puts you in the best place for the next moment. – Oprah Winfrey

2. Everything you’ve ever wanted is on the other side of fear. — George Addair

3. Things don’t go wrong and break your heart so you can become bitter and give up. They happen to break you down and build you up so you can be all that you were intended to be. ― Charles Jones

4. Believe in yourself, take on your challenges, dig deep within yourself to conquer fears. Never let anyone bring you down. You got to keep going. – Chantal Sutherland

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5. Limitations live only in our minds. But if we use our imaginations, our possibilities become limitless. — Jamie Paolinetti

6. Your hardest times often lead to the greatest moments of your life. Keep going. Tough situations build strong people in the end. ― Roy T. Bennett

7. Too many of us are not living our dreams because we are living our fears. – Les Brown

8. Our greatest glory is not in never falling, but in rising every time we fall. — Confucius

9. Success means doing the best we can with what we have. Success is the doing, not the getting; in the trying, not the triumph. Success is a personal standard, reaching for the highest that is in us, becoming all that we can be. – Zig Ziglar

10. Most of the important things in the world have been accomplished by people who have kept on trying when there seemed to be no hope at all. ― Dale Carnegie

11. When sore trials come upon us, it’s time to deepen our faith in God, to work hard, and to serve others. Then He will heal our broken hearts. He will bestow upon us personal peace and comfort. – Russell M. Nelson

12. In essence, if we want to direct our lives, we must take control of our consistent actions. It’s not what we do once in a while that shapes our lives, but what we do consistently. – Tony Robbins

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13. I will persist until I succeed. Always will I take another step. If that is of no avail I will take another, and yet another. In truth, one step at a time is not too difficult. I know that small attempts, repeated, will complete any undertaking. – Og Mandino

14. We don’t develop courage by being happy every day. We develop it by surviving difficult times and challenging adversity. – Barbara De Angelis

15. Hardships often prepare ordinary people for an extraordinary destiny. – C.S. Lewis

 

 

 

 

 

Baylor Scott & White stroke coordinator emphasizes awareness, early detection

So you've given up on recovery for stroke survivors? Setting the tyranny of low expectations even lower? Why the hell are you even in this profession? Someone contact her and ask these questions.  A great stroke association president would ream her out for such blatant laziness.

Baylor Scott & White stroke coordinator emphasizes awareness, early detection

While people tend to associate holiday health hazards with the long-term effects of all the junk food and lack of exercise on their waistline, there is a more immediate, life-threatening danger for thousands of Americans this time of year: stroke.

A stroke occurs when a blood vessel in the brain either becomes blocked or ruptures. It is a leading cause of disability and death in the United States.

“Studies have shown that there are typically more strokes around the holidays,” explained Stephanie Milam, BSN, RN, CEN, stroke coordinator for Baylor Scott & White Medical Center - Waxahachie.

The precise reason for the uptick in strokes around the holidays is not settled science. However, many healthcare professionals believe that the stress of the holidays leads to higher blood pressure, which is a crucial risk factor for stroke.

IN CASE OF STROKE

Most strokes occur in people ages 65 to 85, but anyone can be at risk. Symptoms of a potential stroke include numbness or weakness of the face, arms or legs (especially on one side of the body), sudden confusion or difficulty speaking, sudden dizziness, sudden severe headache, and trouble seeing.

Preventing Stroke

According to the National Stroke Association, 80 percent of strokes are preventable. Risk factors include:

• Poor diet
• Lack of physical activity
• Smoking
• Excessive drinking
• Diabetes
• High blood pressure
• High cholesterol

“It is important to work with your healthcare provider to identify your own personal risk factors to reduce risk of stroke,” said Milam.

“The acronym F.A.S.T. is the most important thing people can remember,” says Milam, referring to the acronym to help people recognize and react to a potential stroke:

F – face drooping

A – arm weakness

S – speech problems

T – time to call 911

“With a stroke, time matters,” stressed Milam. “If you are having a stroke, you only have a three-hour window from when the symptoms start to get the medication that can prevent even more serious, possibly permanent damage to the brain.” If someone is having a stroke, it is best to get to the hospital as soon as symptoms start and to remember the time that symptoms began.

Although time is a critical factor, people should still call 911 rather than drive the person experiencing symptoms to the closest hospital. That’s because getting the right diagnosis and treatment is essential. Paramedics can begin this process before even arriving at the hospital. Moreover, not every hospital has the same capabilities to treat stroke. Paramedics can help ensure potential stroke patients are taken to the hospital best equipped to manage stroke and not merely the closest.

For instance, Baylor Scott & White – Waxahachie holds Advanced Certification for Primary Stroke Centers, which is a national certification recognizing the hospital’s commitment to having the processes, people and tools in place to provide quality care to stroke patients.

“As a Primary Stroke Center, we’ve invested the time and resources into stroke care, and to getting patients the medication, they need sooner,” according to Milam.

During the holidays – or any time of year – recognizing the signs of stroke and knowing what to do could prove to be the best, and longest lasting, gift of all.