SPRINGFIELD — Stroke survival and full recovery are dependent upon a number of factors, chief of which is how quickly you can get to a hospital — ideally within three to four hours of the onset of symptoms — to receive life-saving clot busting drugs or thrombectomy.
In addition to how fast you receive treatment, other important factors include the severity of your stroke, your age, overall health, and the type and intensity of the rehabilitation you receive as well as any treatment that you can start to prevent another stroke or another bleeding into your brain.
Unfortunately, once you have had a stroke, you are at high risk for another — one in four patients will experience another blood-clot stroke or another bleed within five years. Furthermore, approximately two thirds of all patients have an incomplete recovery after stroke, creating a huge burden for family, caregivers, and society/healthcare systems in general.
“You cannot recover from your first stroke if you immediately suffer another one. And when another stroke occurs, the functional results are usually worse for patients,” said Dr. Gottfried Schlaug, director of Stroke Research and Stroke Recovery, Department of Neurology, Baystate Health, and professor of Neurology, UMass Chan Medical School — Baystate.
“The question is how can we prevent a new stroke or a new bleed from happening and how can we increase someone’s chances for a more complete recovery? The answer is a good assessment of risk factors such as diabetes, high blood pressure, smoking, high cholesterol, lack of exercise, and heart disease,” he added. “We have secondary stroke prevention measures such as medications to help alleviate some of these factors, as well as other approaches such as weight loss and exercise programs. But the best approach is preventing your first stroke by improving your overall health, eating habits and exercise to reduce your risks.”
While not all the answers are known concerning how to optimize a patient’s best chances for preventing another stroke, Baystate is participating in a number of national and international clinical trials aimed at improving a stroke patient’s chances for more and better recovery after a stroke. Other trials are geared to make predictions about a patient’s outcome after a stroke or hemorrhage at three months — is a patient independent and can live by themselves at three months? Baystate researchers are also looking at reducing someone’s risk for more strokes or more bleedings. A very important trial assesses someone’s sleep health and obstructive sleep apnea to reduce the risk for second strokes as well as someone’s risk from a heart-related stroke, and to reduce the chances of someone suffering more strokes or more brain bleeds after their first brain bleeding, noted Schlaug.
“With so many patients enrolled here and around the country, and in some cases, around the world, the benefit is that in a few years we will know what works and what does not work, but while we are doing this, the majority of the patients in these trials already have a significant benefit from participating,” said Schlaug.
The most rapid recovery usually occurs during the first three months after a stroke. Although the brain has an enormous naturally repairing mechanism, that repair and recovery can be facilitated by a completely new approach that Schlaug is testing, which involves a particular very intense form of occupational therapy and non-invasive brain-stimulation. Twelve patients have already been enrolled into this trial at Baystate.
“We already have plenty of data which can help us determine what a particular patient’s outcome is going to be three months post-stroke,” said Schlaug. “But we want to get even better at making those predictions and answering our patients’ important questions about whether they will be able to move their arms again or talk again or do fine finger movements again such as playing the piano.”
He noted that Baystate is participating in several highly-regarded nationwide trials that typically include 30-200 centers depending on a medical centers expertise and ability to enroll in trials. Baystate has a lot of expertise and is quickly becoming one of the top enrollers.
“Patients also want to know what we can do to speed up the process and improve their chances for recovery, including trials that use singing or intonational-based forms of speech-therapy to improve someone’s ability to speak, particularly for those stroke patients who can’t speak at all, and others that involve intense occupational therapy and non-invasive brain stimulation to develop finer and better hand movements, for example,” he said.