A fine balance of hope and reality in stroke recovery

 The reality is only 10% fully recover and NOBODY in the world knows how to get you there!  THAT'S HOW FUCKING BAD THE STROKE MEDICAL WORLD IS!

A fine balance of hope and reality in stroke recovery

Dr Jessica Beavan on the challenges of providing effective treatment and support to patients, and Sara Hazzard on the stark impact of inadequate physiotherapy services. Plus letters from Sally Simpson and Edward Rosen

Tue 20 May 2025 11.58 EDT

Thank you for Sheila Hale’s long read about her family experience of stroke (My husband and son suffered strokes, 30 years apart. Shockingly little had changed, 15 May). I remember reading her book as a junior doctor and despairing at the differences between the stroke and neurorehabilitation units that I worked on. This drove my career to stroke medicine, particularly rehabilitation.

In 2021, without the technology to give thrombolysis beyond four and a half hours after a stroke, Sheila’s son was unfortunately one hour over time and the risks of severe brain bleeding outweighed the benefit. CT perfusion techniques mean that this time constraint is reducing, and mechanical thrombectomy is becoming more individually based and more available.

Sheila is right to highlight that delivering the intensity of rehabilitation required in the NHS is a huge challenge – the inpatient and community teams I work with continually change what they do to use what resources they have, but we are constantly told there is no more money.

The attitudes of doctors reflected in Sheila’s article sadden me, as prognostication in early stages is difficult and younger brains show greater capacity for recovery and adaptation. There is, however, that delicate balance of hope, uncertainty and reality. Perhaps this article will spark a campaign for post-discharge neurorehabilitation gyms in every locality. The evidence supports it. A stroke is often not the end, but it is a difficult journey to a new type of life.
Dr Jessica Beavan
Consultant stroke physician, Derby

Sheila Hale highlights a tragic and unacceptable truth. For decades, rehabilitation has remained the poor cousin of surgery and medication in the NHS. Physiotherapy services are starved of the staff and equipment to deliver effective rehab. They are told to limit the number of times they can see a patient, and for how long. In effect, they are prevented from doing their jobs. The impact on patients is stark, as seen in this article. The impact is also harsh on physiotherapy staff themselves, who must explain this reality each day and go home every night feeling they have let their patients down.

The NHS wouldn’t tell a surgeon to stop an operation halfway through. A pharmacist wouldn’t hand out 40% of a course of antibiotics. So why is it OK for patients to be denied a full course of rehabilitation?
Sara Hazzard
Assistant director, the Chartered Society of Physiotherapy; co-chair, the Community Rehabilitation Alliance

Sheila Hale mentions mechanical thrombectomy, a procedure to remove blood clots from the brain. This is available at 24 hospitals in the country, but can be done 24/7 at only six of them. So in York if you have a stroke that is suitable for this procedure, it is only available at the hospital in Hull Monday to Friday 8am to 4pm. I wrote to our local MP, Luke Charters, about this and he contacted the Department of Health, which said there were no plans to bring the service to the York and Scarborough Trust. Maybe when the NHS is sued for negligence in not providing this, things may change.
Sally Simpson
York

It is true that many stroke patients feel abandoned by the NHS, as Sheila Hale states. But our work with patients at the Pulross Centre in Brixton, a rehabilitation unit that is part of St Thomas’ hospital in London, is reducing that. We deliver a weekly gardening session for patients, and when they are discharged, we gift them a plant to grow at home. If they don’t have a garden, we try to link them to a community garden or gardening group in a local healthcare setting.

We introduced this during the pandemic when our gardens were closed and stroke patients were self-isolating; several felt alone and forgotten. We have used the gift of a plant or seeds as an expression of connectedness between all of us and to let our stroke patients know they are not abandoned by the NHS.
Edward Rosen
London

Depression after stroke can seriously affect health for a decade, new research shows

 Post stroke depression is best prevented by EXACT 100% RECOVERY PROTOCOLS! Since the stroke medical world has completely failed at that task, they should all be fired for extreme incompetence and never allowed near anything medical again!

Depression after stroke can seriously affect health for a decade, new research shows

People who experience depression following a stroke may face a higher risk of poor health and even death for up to a decade afterward, new research finds.

A study by researchers from King's College London has found that post-stroke depression (PSD) can have serious long-term effects on stroke survivors, lasting up to 10 years after the initial stroke. The findings emphasize a need for long-term mental health support in stroke rehabilitation.

Researchers tracked more than 2,500 stroke survivors using data from the South London Stroke Register, a population-based register recruiting stroke patients living within Lambeth and Southwark. They examined the participants' health for up to 10 years to understand the long-term consequences of depression for stroke survivors.

Published in The Lancet Regional Health—Europe, the study found that 36% of participants showed signs of depression three months after their stroke and survivors with PSD were nearly three times more likely to develop long-term physical disability compared to those without depression. They also faced a 30% higher risk of death in the decade following their stroke and were more likely to struggle with daily tasks and have a reduced quality of life.

Continued depression at one or five years after the stroke was associated with higher risks of death, more physical disability and lower quality of life. In contrast, survivors who recovered from PSD within the first year had a similar risk of death to those who never experienced depression.

Recovery during this period was also linked to a lower risk of another stroke, better functional outcomes, and improved quality of life. Although the timing of depression onset didn't appear to affect long-term health risks, recovering from depression was associated with better physical and mental well-being.

Mortality up to 10-years after stroke by depression status at 3-months. Credit: The Lancet Regional Health - Europe (2025). DOI: 10.1016/j.lanepe.2025.101324

Lu Liu, a Ph.D. student at King's College London and lead researcher on the study, said, "Post-stroke depression is linked to higher mortality and worse functional outcomes, but most previous studies have only followed patients for less than a year. Our study examined the long-term impact of depression after a stroke. These findings show how important it is to recognize and treat depression as part of stroke recovery."

Depression was identified using a questionnaire, and participants' ability to perform daily activities, their physical independence, and their overall quality of life, both physical and mental, were also assessed.

The South London Stroke Register has been collecting data since 1995, but follow-up typically ends after 10 years, as tracking patients beyond this point becomes increasingly difficult due to cognitive decline or communication challenges, which can affect the reliability of the data.

Professor Yanzhong Wang, Professor of Statistics in Population Health at King's College London and co-senior author of the study, added, "People often take depression seriously in the first few months after a stroke, but years later it can be overlooked. Just because the stroke happened five or six years ago doesn't mean the depression is any less serious.

"Our findings show that post-stroke depression remains a major risk factor long after the initial stroke and needs ongoing attention from clinicians."

Dr. Matthew O'Connell, Senior Lecturer in Health Services Research and Population Health Sciences at King's College London and co-senior author of the study, said, "The South London Stroke Register is unique in following stroke survivors for so many years after their stroke. Encouragingly, our data show those recovering from depression experience better outcomes in the longer term, suggesting effectively treating these symptoms could have broader-ranging health benefits."

Currently, post-stroke care primarily focuses on physical recovery, with depression often only screened in the early stages. The researchers hope their findings will encourage the inclusion of long-term mental health support in stroke rehabilitation programs. While more research is needed to develop effective treatments for PSD, these results underline the need for continued care that addresses both physical and mental health.

More information: Lu Liu et al, Long-term outcomes of depression up to 10-years after stroke in the South London Stroke Register: a population-based study, The Lancet Regional Health - Europe (2025). DOI: 10.1016/j.lanepe.2025.101324

Provided by King's College London

The No-Reflow Paradox: Unblocking the Vessel, Not the Damage?

 Well shit, you're describing Capillaries that don't open due to pericytes;

 known since September 2011. The whole stroke medical world IS COMPLETELY FUCKING INCOMPENT FOR NOT SOLVING THAT PROBLEM!

The No-Reflow Paradox: Unblocking the Vessel, Not the Damage?

• Shravan Sivakumar , MD , @sshravanMD

Rivet S, Churilov L, Yassi N, Kleinig TJ, Thijs V, Wu T, Dewey H, Desmond PM, Parsons MW, Donnan GA, et al. Persistent Tissue-Level Hypoperfusion (No-Reflow) Negates the Clinical Benefit of Successful Thrombectomy. Stroke. 2025.

In real-world clinical practice, a substantial number of ischemic stroke patients fail to achieve functional independence, even after technically successful thrombectomy with excellent angiographic reperfusion scores (TICI 2C-3). This discordance has been described as futile recanalization and may be attributable to a phenomenon referred to as “no-reflow.” This has been conceptualized as the failure of downstream microvascular reperfusion at the tissue level despite successful macrovascular recanalization. Several mechanisms including microvascular obstruction by microthrombi, edema-related microvascular compression, and pericyte-induced capillary contraction may be at play.¹ Its clinical relevance is magnified in the context of recent trials expanding thrombectomy to patients with large core infarcts and perfusion mismatch — groups where optimizing tissue-level perfusion may be especially crucial. Prior research supports use of CTP imaging as a better predictor of outcomes following successful recanalization than CT angiogram alone and was even utilized as an indicator of therapeutic success in recent thrombolytic trials.

The authors Rivet et al. aimed to investigate the clinical impact of this no-reflow mechanism on functional outcomes by comparing patient characteristics between patients with “no-reflow” mechanism on perfusion imaging and varying degrees of angiographic recanalization (TICI scores). They conducted a post hoc analysis on the data from three clinical trials: EXTEND-IA (Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging Selection) and EXTEND-IA TNK (Tenecteplase Versus Alteplase Before Thrombectomy for Ischemic Stroke) part 1 and 2 trials. Both qualitative and quantitative evidence of tissue perfusion evaluation for “no-reflow” were evaluated in a two-step process through application of commercially available fully automated software (RAPID; iSchemaView, Menlo Park, CA) on post-thrombectomy follow-up 24-hour perfusion imaging (CTP or MR Perfusion). The authors identified 2 distinct regions of interest (ROI) which were superimposed into perfusion maps and excluded signals associated with hemorrhagic transformation of infarct. No-reflow was defined when both qualitative and quantitative criteria were met — that is, visually demonstrable reduced intralesional rCBV or rCBF and >15% interside reduction in median rCBV or rCBF value² (Figure 1). It is worth noting that since the primary studies were not primarily designed to evaluate for this phenomenon, not all patients had both MRP and CTP.

Figure 1. Imaging analysis method.

They compared both clinical and radiological characteristics of patients with combinations of no-reflow or completeFlow with different levels of angiographic success (full-TICI 2c3, partial-2b, unsuccessful-0-2a). No significant difference in the rate of no-reflow detection according to imaging modality (CT perfusion 13.6% [n=9/66] versus MRP 25.0% [n=21/84]; P=0.10) was observed. No-reflow mechanism occurred more frequently in successful angiographic recanalization (TICI 3) (n=17/30, 56.7%). Among patient characteristics across varying degrees of technical success, it is worth noting a statistically significant difference among time of onset and proportion of patients receiving thrombolytic (alteplase or tenecteplase).

The primary outcome of functional independence (mRS score of 0–2) was achieved in 43.33% (n=13/30) of patients with eTICI 2c3–NoReflow, versus 67.50% (n=81/120) of patients with eTICI 2c3–CompleteFlow, 63.03% (n=150/238) of patients with eTICI 2b and 50.00% (n=34/68) of patients with unsuccessful thrombectomy. In unadjusted analysis, patients with no-reflow  were less likely to experience functional independence despite technical success, TICI 2c-3 compared to completeFlow (odds ratio [OR], 0.37 [95% CI, 0.16–0.83]; P=0.02) or those with eTICI 2b (OR, 0.45 [95% CI, 0.21–0.97]; P=0.04) but had similar rate to patients with unsuccessful thrombectomy (OR, 0.76 [95% CI, 0.32–1.82]; P=0.54). When adjusted for age, premorbid mRS, baseline NIHSS, and baseline core volume, multivariable analysis confirmed lower odds of functional independence with no-reflow and full/partial recanalization, and similar odds of functional independence with unsuccessful thrombectomy. Furthermore, exploratory analysis of functional infarct volumes (FIV) showed that despite similar volumes, patients with no-reflow had worse outcomes despite full recanalization compared to partial recanalization.

These findings suggest that “no-reflow” phenomenon negates benefit of macrovascular recanalization in achieving favorable clinical outcome. The authors further caution that no-reflow mechanism tends to occur more frequently with prolonged periods of ischemic injury, suggesting that this prevalence could be underestimated by this study given the inclusion of patients within the 4.5-hour time window. Their major strength includes use of prospectively collected data from clinical trials. As we push the boundaries of thrombectomy eligibility, tackling the no-reflow phenomenon may be the next frontier in improving patient-centered outcomes — representing a crucial step not only in restoring macrovascular blood flow but also in minimizing downstream ischemic injury, thereby broadening the therapeutic benefit for patients with acute ischemic stroke.

Carboxylic Acid- and Amine-Modified Pluronic F127-Based Thermoresponsive Nanogels as Smart Carriers for Brain Drug Delivery

WHOM among the incompetent idiots in the stroke medical world can look at this and suggest maybe safer clot busting delivery? Reduced bolus of both alteplase and Tenecteplase vastly reducing the hemorrhage risk. Well, if you're not idiots you can tell me EXACTLY where I'm wrong: oc1dean@gmail.com, Looking forward to your hate mail.

Oops, I'm not playing by the polite rules of Dale Carnegie,  'How to Win Friends and Influence People'. 

Telling your supposedly smart stroke medical 'professionals' they know nothing about stroke is a no-no even if it is true. 

Politeness will never solve anything in stroke. Yes, I'm a bomb thrower and proud of it. Someday a stroke 'leader' will try to ream me out for making them look bad by being truthful, I look forward to that day.

Carboxylic Acid- and Amine-Modified Pluronic F127-Based Thermoresponsive Nanogels as Smart Carriers for Brain Drug Delivery

Authors Andrgie AT , Liao CH, Wu TY, Yang HH, Harn HJ, Lin SZ , Chen YS , Tsai HC

Received 5 December 2024

Accepted for publication 15 April 2025

Published 7 May 2025 Volume 2025:20 Pages 5893—5905

DOI https://doi.org/10.2147/IJN.S507362

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Prof. Dr. RDK Misra

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Abegaz Tizazu Andrgie,¹ Cheng-Han Liao,² Tsung-Yun Wu,^2,3 Hsueh-Hui Yang,⁴ Horng-Jyh Harn,^5,6 Shinn-Zong Lin,^5,7 Yu-Shuan Chen,^4,5,8 Hsieh-Chih Tsai<sup>2,3,9

1</sup>Department of Biotechnology, Debre Berhan University, Debre Berhan, Ethiopia; ²Graduate Institute of Applied Science and Technology, National Taiwan University of Science and Technology, Taipei, 106, Taiwan, Republic of China; ³Advanced Membrane Materials Center, National Taiwan University of Science and Technology, Taipei, 106, Taiwan; ⁴Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 970, Taiwan; ⁵Bioinnovation Center, Buddhist Tzu Chi Medical Foundation, Hualien, 970, Taiwan; ⁶Department of Pathology, Hualien Tzu Chi Hospital, Tzu Chi University, Buddhist Tzu Chi Medical Foundation, Hualien, 970, Taiwan; ⁷Department of Neurosurgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 970, Taiwan; ⁸Center for General Education, Tzu Chi University, Hualien, 970, Taiwan; ⁹R&D Center for Membrane Technology, Chung Yuan Christian University, Taoyuan, 320, Taiwan

Correspondence: Yu-Shuan Chen, Email yushuanchenxie@gmail.com Hsieh-Chih Tsai, Email h.c.tsai@mail.ntust.edu.tw

Introduction: The blood-brain barrier (BBB) is a critical protective barrier that regulates the exchange of substances between the circulatory system and brain, restricting the access of drugs to brain tissues. Developing novel delivery strategies across the BBB is challenging but crucial. Multifunctional nanogels are promising drug carriers for delivering therapeutic agents to their intended target areas in the brain tissue.
Methods: This study introduced carboxylic acid- and amine-modified Pluronic F127 (ADF127 and EDF127)-based thermoresponsive nanogel systems as drug nanocarriers for brain tissues. The release profiles of 3-butylidenephthalide (BP) from the nanogels were investigated in vitro in phosphate-buffered saline (pH 7.4) at 37 °C for 48 h. Additionally, the accumulation of DiR-labeled nanogels in vital organs was observed using fluorescence imaging.
Results: A relatively sustained BP release (27%) from ADF127, followed by rapid BP release (39%) from Pluronic F127 within the first 4 h were observed. In vivo studies using the C57BL/6JNarl mouse model showed that intravenously administered BP-loaded copolymeric nanogels exhibited a rapid BP distribution to the liver, spleen, heart, and kidney. DiR fluorescence intensity in the brain increased in the order Pluronic F127 < ADF127 < EDF127 copolymeric nanogels. Although the fluorescence intensity of DiR in the brain tissue was relatively lower than those in other vital organs, the DiR-labeled EDF127 copolymeric nanogels showed approximately 10-fold higher fluorescence intensity.
Conclusion: Positively charged drug carrier nanomaterials demonstrate a higher propensity for transfer through the BBB, significantly expanding the applicability of positively charged EDF127 nanogels as nanocarriers for in vivo brain tissue treatment and imaging. Therefore, owing to their increased permeability across the BBB, carboxylic acid- and amine-modified Pluronic F127 nanogels (EDF127 and ADF127) will also offer a promising approach for brain tissue treatment and imaging.

Keywords: blood-brain barrier, DiR labeling, permeability, sustained release, nanogels

Introduction

Numerous brain diseases have poor prognoses and low survival rates, with limited diagnostic and therapeutic options owing to the presence of the blood-brain barrier (BBB). The BBB regulates the exchange of substances between the circulatory system and brain, limiting the access of drugs to the brain parenchyma.^1–3 Surgical techniques are commonly used to overcome the limitations associated with the BBB and circumvent this natural biological barrier.⁴ However, these invasive approaches present a risks, including nerve damage and local inflammatory reactions. Recent research has focused on developing minimally invasive approach to deliver therapeutics through the BBB to brain tissues.^5,6 Among these, injectable thermosensitive hydrogels have gained attention as promising carriers owing to their unique properties of existing as free-flowing fluids at room temperature and converting into viscous gels at body temperature. Owing to their unique properties for minimally invasive administration, hydrogels in their liquid state can be administered anywhere behind biological barriers using a small needle, eliminating the need for invasive surgery.^7–10 The In situ gel-forming materials form a depot for the sustained release of therapeutic agents.

In particular, in situ gel-forming thermosensitive nanogel systems have emerged as promising nanocarriers for therapeutic delivery. With advancements in nanotechnology, nanocarriers offer a promising solution owing to their small size, high surface-to-volume ratios, and tunable multifunctional properties, enabling injectable structures to penetrate physiological barriers.¹¹ The most interesting characteristics of nanocarriers as drug delivery systems are their high loading capacity, long-term stability, and responsiveness to different stimuli, leading to increased drug concentration in target tissues by prolonging drug diffusion time and increasing the possibility of drug penetration through physiological barriers.¹²

Thermoresponsive injectable nanogels composed of polymers can form gels in situ in response to various stimuli. Among the various thermoresponsive polymers, Pluronic F127 (PF 127) is a synthetic polymer that has been extensively investigated as an injectable nanogel for drug delivery applications.^13–16 PF 127 is an amphiphilic triblock copolymer composed of hydrophilic poly(ethylene oxide) (PEO) and hydrophobic poly(propylene oxide) (PPO).¹⁷ Owing to its amphiphilic properties, PF127 can self-assemble into small micelle structures in aqueous solutions and undergo a sol-gel phase transition with increasing environmental temperature.¹⁸ At low temperatures, the PPO blocks exhibit weak hydrophobicity, and with increasing temperature, the PEO groups become dehydrated and aggregate to form micelles.^8,19 The gelation temperature of PF127 can be controlled by adjusting the individual concentrations of the polymer blocks or by chemically modifying PF127 to increase its mechanical performance. This is because the native PF127 hydrogels exhibit low mechanical strength and stability despite their thermosensitive properties,²⁰ posing challenges in brain-targeting studies because the hydrogel might degrade too rapidly to effectively reach the brain. To address this issue, native and terminal-functionalized PF127 have been investigated for improved performance in brain-targeting applications. Modified PF127 polymers exhibit good mechanical properties as hydrogels and can encapsulate hydrophobic drugs in the hydrophobic core, providing stability and protection from external conditions.

In this study, the PF127 polymer was chemically modified using β-alanine (ADF127) and ethylenediamine (EDF127) for crosslinking the polymer chain through highly directed and intense hydrogen bonding interactions to improve the mechanical properties of the hydrogel. The intermolecular hydrogen bonding between the carboxyl and amine groups of β-alanine (ADF127) and ethylenediamine (EDF127) provides sufficient mechanical properties for the material to behave as a controlled drug carrier or to enable the sustained release of 3-butylidenephthalide (BP), an anticancer drug. The mechanical properties and thermo-response behavior of the copolymers were investigated using a rheometer in the dynamic oscillation mode, as reported in our previous work.²¹ Structural observations using scanning electron microscopy and the investigation of drug release and drug entrapment efficiency allowed the evaluation of the mechanical structure and stability of the modified nanogels. The in vivo biodistribution patterns of the DiR-loaded copolymeric hydrogels were investigated in a mouse model after intravenous injection using an in vivo imaging system (IVIS). This study further investigated the use of DiR-loaded EDF127 and ADF127 copolymeric nanogels to quantify and visualize their biodistribution in the brain tissue.

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Disparities in post-stroke rehabilitation: an African perspective

 It's incredibly obvious the SOLUTION IS 100% RECOVERY PROTOCOLS! But the whole fucking stroke medical world is so blitheringly stupid that such a simple solution escapes them! Your only solution is to not have a stroke until that exists.

Disparities in post-stroke rehabilitation: an African perspective

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• Open access
• Published: 04 May 2025

• Volume 22, article number 218, (2025)
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Disparities in post-stroke rehabilitation: an African perspective

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• Nicholas Aderinto,
• Gbolahan Olatunji,
• Emmanuel Kokori,
• Israel Charles Abraham,
• Ikponmwosa Jude Ogieuhi,
• Ibukunoluwa Ogunbowale,
• Ikpembhosa Esangbedo,
• Adetola Emmanuel Babalola,
• Abdulrahmon Moradeyo,
• Adegbesan Abiodun Christopher,
• Wuraola Awosan,
• Owolabi Samuel,
• Tejiri Napoleon &
• Jonathan Oluwafemi Adeola 

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Abstract

Stroke is a leading cause of disability and death globally, with a disproportionate burden on Africa. Despite the increasing prevalence, access to post-stroke rehabilitation remains limited. This review explores disparities in post-stroke rehabilitation access and outcomes in Africa. The continent faces a dual challenge of low stroke awareness and limited healthcare infrastructure, particularly in rural areas. Consequently, stroke survivors often experience delayed or inadequate rehabilitation, leading to poorer functional outcomes and reduced quality of life. This review highlights the critical need for increased investment in rehabilitation services, the training of healthcare professionals, and the development of sustainable models of care. By addressing these challenges, it is possible to improve the lives of stroke survivors and reduce the overall burden of stroke in Africa.

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Healthcare Settings for Rehabilitation After Stroke

Chapter © 2021

Post-stroke care after medical rehabilitation in Germany: a systematic literature review of the current provision of stroke patients

Article Open access 19 June 2018

Title: State of Stroke Rehabilitation in Australia: A WHO STARS Assessment to Identify Strengths and Gaps Across Policy, Practice and Funding

Article Open access 12 March 2025

1 Introduction

Stroke is a leading cause of disability and death globally, with a disproportionate burden on low and middle-income countries (LMICs) like those in Africa [1, 2]. While the incidence and prevalence of stroke are increasing in the region, access to essential healthcare services, including post-stroke rehabilitation, remains limited [3, 4]. This disparity is compounded by a myriad of factors such as socioeconomic inequalities, geographical barriers, and a shortage of skilled healthcare professionals [5].

Effective post-stroke rehabilitation is paramount for optimizing functional recovery, minimizing disability, and enhancing the quality of life for survivors [6, 7]. Timely and comprehensive rehabilitation has been shown to reduce dependency, improve participation in social and economic activities, and prevent secondary complications [8]. Consequently, it is a cornerstone of stroke care, contributing significantly to the overall burden of disease [9]. However, the landscape of post-stroke rehabilitation in Africa is marked by substantial disparities. A paucity of research on this critical aspect of stroke care has hindered a comprehensive understanding of the challenges faced by stroke survivors in the region. Preliminary evidence suggests that factors such as geographical location, socioeconomic status, gender, age, availability of a skilled rehabilitation workforce, and access to healthcare infrastructure significantly influence the availability and accessibility of rehabilitation services [10,11,12,13]. These disparities ultimately impact the functional outcomes and long-term well-being of stroke survivors [14]. This review aims to describe disparities in access to and outcomes of post-stroke rehabilitation in Africa.

2 Methodology

This paper is a narrative review aimed at examining disparities in post-stroke rehabilitation in Africa. A search of relevant literature was conducted across PubMed, Embase, Scopus, Web of Science, Google Scholar, and African Journals Online (AJOL). A combination of Medical Subject Headings (MeSH) terms and free-text keywords was used to identify relevant articles. The primary search terms included"stroke rehabilitation,""stroke recovery,""disparities in stroke care,""rehabilitation access,""health inequities,"and"Africa."Boolean operators (AND, OR) were applied to refine the search results.

Studies were selected based on the following criteria:

Inclusion Criteria:

• Articles published in peer-reviewed journals.

• Studies focusing on post-stroke rehabilitation access, outcomes, and disparities in African countries.

• Publications from database inception to September 2024

Exclusion Criteria:

• Non-English publications due to language constraints.

Two independent reviewers [NA and GO] screened titles and abstracts to determine eligibility. Full-text articles meeting the inclusion criteria were retrieved for further review. Key information, including study design, population, interventions, and findings related to disparities in rehabilitation, was extracted and synthesized narratively.

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Development of a Computerized Assessment Tool for Hand-arm Function After Stroke: Test-retest Reliability and Convergent Validity

 Assessments are completely worthless unless they point directly to the 100% recovery protocols. I see nothing here that suggests you go from the assessment to the chosen 100% recovery protocol. When the hell will the stroke medical world do ANYTHING TO GET STROKE SOLVED? I'd have you all fired! A lot of dead wood needs to removed in stroke and until that occurs stroke will never be solved! The only use of the word protocol in here is for testing; NOT RECOVERY! I'd have the faculty supervising this fired!

Development of a Computerized Assessment Tool for Hand-arm Function After Stroke: Test-retest Reliability and Convergent Validity

One-Year Outcome After Endovascular Thrombectomy for Basilar Artery Occlusion With Mild Deficits

 Your favorable functional outcome (a modified Rankin Scale score of 0–3) is still a COMPLETE FUCKING FAILURE! Survivors expect 100% recovery and you're not measuring that! GET THERE! YOU need to rid the stroke medical world of all these incompetent persons!

Well, since no one is measuring 100% recovery, you'll never get there.

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

The latest useless shit here:

One-Year Outcome After Endovascular Thrombectomy for Basilar Artery Occlusion With Mild Deficits

Yingjie Xu, MD https://orcid.org/0000-0002-4181-7450, Lulu Xiao, PhD https://orcid.org/0000-0002-5942-0902, Pan Zhang, MD https://orcid.org/0000-0001-6320-6987, Weiliang Shi, PhD, Shidong Tan, PhD, Miaomiao Hu, MD https://orcid.org/0009-0006-1821-0534, Zhanglin Li, MD https://orcid.org/0009-0001-6813-8589, … Show All … , and Wen Sun, PhD https://orcid.org/0000-0002-7268-2085 sunwen_medneuro@163.comAuthor Info & Affiliations

Stroke

New online

https://doi.org/10.1161/STROKEAHA.124.050389

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Abstract

BACKGROUND:

The long-term benefits of endovascular thrombectomy (EVT) for basilar artery occlusion (BAO) in patients with low National Institutes of Health Stroke Scale scores upon admission remain unclear. This study aimed to compare the 1-year clinical follow-up outcomes of best medical management (BMM) alone versus BMM plus EVT.

METHODS:

Patients with BAO and admission National Institutes of Health Stroke Scale score of ≤10 at 65 stroke centers in China from December 2015 to June 2022 were retrospectively enrolled. The primary outcome was favorable functional outcome (a modified Rankin Scale score of 0–3 at 1 year). Early (door-to-puncture time ≤120 minutes) and late EVT (door-to-puncture time >120 minutes) classifications were defined as surrogates for comparing initial treatment with EVT versus late (potentially rescue) EVT after initially being treated with BMM only. Multivariable logistic regression and propensity score matching analyses were used to assess the association between treatment and outcomes.

RESULTS:

Among 1232 patients who had 1-year follow-up data, 856 (69.5%) were male, and the mean (SD) age was 65 (12) years. After adjustment for confounders, there were no significant differences between EVT and BMM in favorable functional outcome (odds ratio, 0.96 [95% CI, 0.71–1.29]; P=0.778). The cumulative 1-year mortality rate was 16.4% in the EVT group versus 13.7% in the BMM group (odds ratio, 1.23 [95% CI, 0.86–1.77]; P=0.262). Predefined subgroup analyses revealed that late EVT was inferior to early EVT (odds ratio, 0.47 [95% CI, 0.28–0.79]; P=0.005), while no significant difference was observed between BMM and early EVT in 1-year outcomes (odds ratio, 0.87 [95% CI, 0.63–1.21]; P=0.421).

CONCLUSIONS:

In this long-term follow-up study among patients with BAO admitted with a National Institutes of Health Stroke Scale score of ≤10, there were no significant differences in functional outcomes and mortality at 1 year between BMM plus EVT and BMM alone.

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New Coalition Calls for Urgent Action to Address Rising Stroke Crisis

 A lot of members are already the fucking failures of stroke associations, so this is already a failure! None of them are working on 100% recovery!  You have to get survivors in charge, the existing stroke medical world is a complete shitshow! As proven by 'care'(NOT RECOVERY!) in their recommendations.

New Coalition Calls for Urgent Action to Address Rising Stroke Crisis

GENEVA--(BUSINESS WIRE)--Launching today, the world’s first multisector advocacy movement dedicated to stroke - the Global Stroke Action Coalition - has issued an urgent call to action to address growing inequities in stroke. Already a leading cause of death and disability, without intervention, the global burden of stroke is projected to rise by a further 50% over the next 25 years, claiming 100 million lives and costing US$1.6 trillion each year.

Despite the clear opportunities, prevention, treatment and rehabilitation services are only available to a fraction of stroke patients.

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At this afternoon’s launch, health and economic policy specialists, clinical experts and people with lived experience of stroke, will highlight key data and recommendations for action to address human and financial impact of stroke. Drawing on both data and the lived experiences of people affected by stroke, the Coalition will share their inaugural policy document Stroke Action Now which sets out evidence-based examples of interventions that can significantly advance progress on a disease that is largely:

• Preventable: 80% of the current stroke burden is linked to 10 modifiable risk factors. Identifying and managing hypertension alone could cut the rate of stroke in half.
• Treatable: Advances in clot removal and clot-busting technologies (thrombectomy and thrombolysis) can dramatically improve patient health outcomes, minimizing disability and reducing the economic impact of stroke.(NO, it's not, you have zero evidence for that statement! Treatable to a survivor is 100% recovery)

• I don't need to hear any lies about this meme from World Stroke Day a couple of years ago.

  

  What a lying piece of shit.

   

  
  

• Recoverable: Access to rehabilitation helps people regain independence and reduces the risk —and cost— of long-term disability.

Despite the clear opportunities, prevention, treatment and rehabilitation services are only available to a fraction of stroke patients. For example, only 3% of medically eligible patients currently receive thrombectomy, with 20-40% of healthcare settings worldwide yet to implement basic stroke rehabilitation services.

“The global burden of stroke has doubled in the past 30 years,” explains Coalition co- Chair, Professor Bo Norrving. “During that same period huge advances have been made across the care(NOT RECOVERY!) pathway that offer us an incredible opportunity to reduce inequitable health outcomes and make significant progress towards global health and development targets. Committing to the development of National Stroke Plans should be a key priority for governments as part of their forward strategy for prevention and control of NCDs. We can’t afford to wait another 30 years to turn this around. Millions of lives depend on governments taking action now.”

Coalition leaders are calling on governments attending the 4th High-Level UN Meeting on NCDs in September this year, to commit to five actions:

1. Making stroke a priority in NCD prevention and control strategies so that it becomes an explicit and integral part of national and internal health agendas.
2. Developing National Stroke Action Plans that address the entire care(NOT RECOVERY!) pathway and include measurable targets that respond to in-country needs.
3. Committing to funding evidence-based interventions and exploring innovative financing models, such as taxing harmful substances, to build domestic resources.
4. Implementing robust stroke monitoring systems that measure changes in the stroke burden and the provision and outcomes of stroke care(NOT RECOVERY!)

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5. Including stroke survivors and caregivers in policy development and prioritize meaningful representation at all levels of decision-making.(They should be in charge, all your members have proven to be failures in solving stroke! Why are they even included?)

The Coalition’s call comes at a defining moment. The upcoming UN High-Level Meeting is a rare opportunity for world leaders to shape the next 25 years of action on NCDs. Stroke must not be overlooked. The Coalition urges governments to seize this moment and ensure that stroke is recognized, prioritized, and acted upon.

Notes

Members of the Coalition include the World Stroke Organization, American Stroke Association, Asia Pacific Stroke Organization, Bayer, Boehringer Ingelheim, European Stroke Organisation, Heart & Stroke Foundation South Africa, Ipsen, March of Dimes Canada, Medtronic, Philips, Stroke Association UK and Society of Vascular and Interventional Neurology.  

Two decades of vagus nerve stimulation for stroke: a bibliometric analysis

 The research is out there, just write up protocols on it!

That has to be pure incompetency of the mentors and senior researchers! Let's see how long vagus nerve stimulation has been out there. And do the non-invasive types.

• vagus nerve (67 posts to July 2012)

• • paired vagus nerve stimulation (2 posts to April 2022)

Two decades of vagus nerve stimulation for stroke: a bibliometric analysis

Jiao Deng¹Zhen Yang²Qing Mei Wang³Zhi Gang Lv^1*

• ¹Department of Rehabilitation Medicine, Changzhou Hospital of Traditional Chinese Medicine, Changzhou, China
• ²Physical Activity, Sports & Health Research Group, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
• ³Stroke Biological Recovery Laboratory, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, The Teaching Affiliate of Harvard Medical School, Boston, MA, United States

Background: Stroke is a major global health concern, imposing significant medical and social burdens. Vagus nerve stimulation (VNS), an emerging neuromodulation technology, has shown potential in the treatment of stroke. This bibliometric analysis aims to explore the knowledge structure and research trends in the field of VNS for stroke from 2004 to 2024.

Methods: Publications were retrieved from the Web of Science Core Collection. CiteSpace and VOSviewer were used to conduct bibliometric analyses, including author productivity, institutional contributions, and emerging research themes etc.

Results: A total of 191 eligible publications were analysed. Kilgard, M. P., and Hays, S. A. were the most prolific authors, each contributing 26 publications. The USA (96 publications), China (69 publications), and Scotland (17 publications) were the most prolific countries. The University of Texas at Dallas (33 publications) was the most prolific institution, followed by Chongqing Medical University (19 publications) and the University of Glasgow (15 publications). Future research is expected to focus on: (1) neurophysiological mechanisms of VNS in stroke recovery; (2) synergistic effects of VNS with other rehabilitation therapies; (3) comparative efficacy of non-invasive transauricular VNS versus invasive VNS; (4) safety and effectiveness of VNS for post-stroke functional impairments beyond motor rehabilitation; and (5) optimisation of VNS parameters for stroke treatment.

Conclusion: The field of VNS for stroke has experienced steady growth over the past two decades. This bibliometric analysis provides valuable insights to guide future research, clinical applications, and policy developments.(Stop with the analysis paralysis and just create protocols! My God the fucking stupidity in the stroke medical world is mind-boggling!)

1 Introduction

Globally, stroke has been recognized as the second leading cause of death and the third leading cause of disability (1). Evidence from the Global Burden of Disease study shows that the number of patients with strokes increased by 70% from 1990 to 2019 (2), with a rising incidence among young and middle-aged people under 55-years-old. Moreover, The Lancet Neurology Commission estimate that global stroke-related deaths will increase by 50% from 2020 to 2050, with the number of people living with disabilities expected to rise by about 30% (3). As the aging population increasing, the burden of stroke will escalate significantly, presenting serious challenges to governments and healthcare globally. However, despite continuous advancements in rehabilitation treatments, effectively restoring patients’ functional abilities remains a major issue in stroke management.

Recently, vagus nerve stimulation (VNS), as an innovative neuromodulation technology, has shown potential in stroke rehabilitation by stimulating the vagus nerve to regulate central nervous system function. In 2021, the US Food and Drug Administration (FDA) approved the application of VNS combined with rehabilitation exercises for the treatment of chronic stroke (4). VNS can be administered through either invasive or non-invasive approaches. Invasive VNS (iVNS) involves costly surgery to implant electrodes in the left cervical vagus nerve, which are then stimulated by a pulse generator. Non-invasive VNS, also known as transauricular VNS (tVNS), typically includes transcutaneous VNS via the ear (taVNS) or cervical VNS (tcVNS) (5). Ventureyra (6) first identified tVNS as a novel non-invasive brain modulation technology. tVNS involves the using low-frequency pulse currents to stimulate the auricular branch of the vagus nerve. Moreover, safety, cost-effectiveness, easy to administer, and high acceptability are the advantages of tVNS (7). Recently, a recent randomized controlled trial found that the relative growth of ischemic lesions on 24-h diffusion-weighted magnetic resonance imaging (MRI) was 63% in the tVNS group, while it was 184% in the sham stimulation group (p = 0.109). This suggests that tVNS has a neuroprotective effect in acute stroke (8). Moreover, other studies have shown that taVNS combined with motor rehabilitation can enhance motor function (9), proprioception, and light touch sensation (10) in chronic stroke patients.

Bibliometric analysis holds a significant place in medical research, primarily due to its ability in generating broad evidence synthesis in a specific research field. In the research evolution framework, studies can be categorized into two types: original research and evidence synthesis. Evidence synthesis can be further divided into two forms: deep synthesis (i.e., systematic reviews and meta-analyses) (11) and broad synthesis (i.e., bibliometric analysis) (12). Deep synthesis is typically used to address specific research questions, for example, focusing on the effectiveness of a particular intervention on certain health-related outcomes, thus providing a precise conclusion. In contrast, broad synthesis is suited for analysing the overall knowledge structure of a research field and predicting future research trends.

In the field of stroke, while there have been numerous deep syntheses on VNS technology, there is a lack of broad synthesis as bibliometric analyses. Therefore, it is necessary to conduct a comprehensive bibliometric analysis in the field of VNS for stroke. The current study aims to provide a deep understanding of current research hotspots, trends, and the overall knowledge structure. This work will not only identify key research directions and potential gaps but also serve as a valuable reference for future research collaborations (13).

More at link.