A New Stroke Paradigm
Premise and Promise
Usually, attention to stroke is focused on the sudden event and then for three to six months afterwards. To effectively reduce the incidence and impact of stroke, and enhance recovery, we should think of it as an evolving process on a continuum over many years.
First, there is a lifetime of behaviors and risk factors that protect or predispose; next, at stroke onset, there is emergency and acute treatment; then, there is a finite period of structured inpatient and outpatient rehabilitation; followed by the ongoing experience of living with the effects; finally, there are health practices to avoid a subsequent stroke.
A new stroke paradigm would address all phases of the stroke continuum. At the community level, education and social support for wellness and prevention practices are essential, both before and after stroke. Also, training is needed for the public to understand and fulfill its role in stroke emergencies.
Improved treatment could begin with a change of thinking. An outdated belief is that progress in recovery ends at six months, which is contrary to what is known about neuroplasticity. Similarly, most stroke programs provide services for a few months and then effectively stop, even though the potential for recovery does not.
Also, stroke causes serious psychological trauma and social disruption that should be treated concurrently during the first months, with the same concern as for physical effects. In the first six months, a patient may have thirty to fifty rehabilitation sessions, but zero to five sessions to address the psychological and social problems of recovery.
Continuity of care is an important medical concept. Concurrent physical, psychological and social treatments are needed because progress in one area stimulates recovery in another. Also, too many stroke patients and families pass from one strong phase of treatment to a weak one. Each phase of treatment should get the support it needs.
Low-cost, yet effective recurrent pulse therapy and weekly recovery groups can provide coordinated and simultaneous physical, psychological and social therapies that go beyond current limits to support the continuous process of recovery. (See attached documents)
Here is the promise of a new stroke paradigm. Individuals and families who practice routines of wellness and prevention have fewer strokes than those who don’t. Survivors and caregivers who participate in well-planned physical, psychological and social therapies that emphasize education, guidance, interpersonal support, empowerment, practice of recovery skills and self-care, make more progress in functional recovery, have fewer subsequent strokes, and have a better quality of life than those who do not.
This is what integrated and coordinated stroke services can look like.
- Individuals and families are protected against stroke and other illness by participation in ongoing universal wellness and prevention teams.
- An informed public knows the signs and symptoms of stroke and calls 911 immediately, which is critical to restoration of blood flow to the brain.
- Emergency and acute care is provided at accredited stroke centers.
- Coordinated physical, psychological and social therapies are provided during the first six months of treatment, because each therapy reinforces the others.
- Recurrent pulse therapy and ongoing weekly recovery groups are provided after initial rehabilitation because capacity for recovery continues.
- Survivors and families prevent subsequent strokes and other illness through education, support and practice in universal wellness and prevention teams.
- Each phase of treatment gets the support it needs. There are no gaps in care. Patients and families receive coordinated transition from one phase to the next.