The Real Problem with Stroke

It’s What Happens After “After”

Welcome to my first post back on my Know Stroke Blog for 2024!  

[Quick Background and Update]

I’ve been a bit quiet through January but I assure you it’s because I’ve been planning for the year ahead.  As part of my annual process of reflection, I looked back at what topics resonated the most from 2023 on this blog, on my YouTube channels and through downloads on our Know Stroke Podcast. Without even a close second, what resonated with visitors via comments and through search impressions and views was anything to do with the words exercise and stroke. 

Exercise: The Most Vital Link to Optimal Stroke Recovery 

A deeper dive into these searches revealed more granular queries for “stroke recovery exercises for mobility and fall prevention”, “home stroke rehab options”,”stroke rehab technology”, and finally “home exercise guidelines following a stroke” were all top searches.  In fact, one blog post I wrote back in 2010 still draws the most traffic every month -entitled  ‘Exercise Guidelines for Stroke/PFO Patient Needed’ (more on this later at the end of this article).

It is important to understand if you are new to stroke why these searches are nothing new to the stroke survivor and caregiver looking to fill in the care gaps.  Unfortunately, life after stroke can be full of twists and turns and once therapy ends so often does the structured rehabilitation and exercise sessions that helped keep the stroke survivor moving and on a path to home discharge (oftentimes well before they had time to optimize mobility outcomes due to insurance limitations).  

Movement is medicine to the stroke survivor and taking away access to this vital link to health is criminal. The downward spiral that begins at discharge to home for most survivors happens fast if exercise is discontinued, and what quietly occurs after stroke “after discharge” is what I’d like to discuss in this post.

David Dansereau,MSPT Know-Stroke.org

Sarcopenia: The Biggest Quiet Threat and Late Effect of Stroke on Mobility

The effects from stroke can be multifaceted and affect many body systems depending on the site of the brain lesion and result in profound effects, both physical and emotional, on various aspects of a person’s health. One lesser-known but critical silent consequence of stroke is the development of sarcopenia, the loss of muscle mass and strength. Sarcopenia can significantly impact a stroke survivor’s quality of life, hinder rehabilitation efforts, and increase the risk of further health complications. The goal of this post is to highlight the problem of sarcopenia after a stroke and suggest three crucial steps to reduce the risk and promote muscle health.

Understanding Sarcopenia After Stroke

Sarcopenia is a natural part of aging, but stroke survivors often experience an accelerated and more severe form of muscle loss. The reasons behind sarcopenia after a stroke are multifaceted and include factors such as immobility, inflammation, altered metabolism, and malnutrition. Loss of muscle mass can impede functional independence, decrease mobility, and contribute to an increased risk of falls.

Three Steps to Reduce the Risk of Sarcopenia

1. Early Mobilization and Rehabilitation

One of the most effective ways to counteract sarcopenia after a stroke is through early mobilization and rehabilitation. Physical activity and targeted exercises help maintain and build muscle mass, improve strength, and enhance overall mobility. Rehabilitation programs tailored to the individual’s abilities and needs play a crucial role in preventing muscle atrophy. Starting these interventions as early as possible in the recovery process can have a significant impact on minimizing sarcopenia. This is why access to ongoing rehabilitation is vital once the stroke survivor is discharged home.

Healthcare professionals, including physical therapists, occupational therapists, and rehabilitation specialists, play a vital role in designing personalized exercise regimens. These programs may include a combination of resistance training, functional movements, and activities that promote balance and coordination. By incorporating these exercises into a stroke survivor’s routine, muscle wasting can be mitigated, and overall physical function can be improved. The discharge planning process should include a skilled handoff to appropriate community exercise options to reduce the chances of exercise relapse and prevent secondary complications from immobility. 

2. Adequate Nutritional Support

Malnutrition is a common concern after a stroke and can contribute to the development of sarcopenia. Adequate nutrition is essential for muscle health and recovery. Ensuring that stroke survivors receive a well-balanced diet with sufficient protein, vitamins, and minerals is crucial. Protein, in particular, plays a pivotal role in muscle synthesis and repair.

Careful monitoring of nutritional intake, possibly with the assistance of a registered dietitian, can help identify and address deficiencies. Additionally, healthcare providers may recommend protein supplements to ensure that individuals receive the necessary nutrients for muscle preservation and recovery. A comprehensive approach that combines physical rehabilitation with proper nutrition is key to reducing the risk of sarcopenia after a stroke.

3. Continuous Monitoring and Adaptation of Care

Stroke recovery is a dynamic process, and the risks of sarcopenia accelerate over time. Therefore, continuous monitoring and adaptation of care are essential components of preventing and managing sarcopenia. Regular assessments of muscle strength, functional capacity, and nutritional status allow healthcare professionals to identify changes and adjust interventions accordingly could provide better insights and potentially improve outcomes.  Part of the real problem with stroke recovery currently is despite the technologies to measure and monitor these biomarkers for stroke recovery being readily available, there is a disconnect in stroke care utilizing these tools to manage long term stroke outcomes. 

In the US, there is not currently a connected ecosystem for stroke recovery management that benefits survivors and their families.

David Dansereau- Know-Stroke.org

What should happen “after” after stroke to minimize sarcopenia

Healthcare providers should collaborate with stroke survivors and their caregivers to establish a long-term plan for maintaining muscle health and helping keep a body in balance. This plan may include periodic reassessments, adjustments to exercise routines, and modifications to nutritional strategies based on individual progress and changing needs. By staying proactive and responsive to evolving conditions, healthcare teams could optimize outcomes and minimize the impact of sarcopenia on stroke survivors.

Bottom Line

Sarcopenia after a stroke poses a significant challenge to the overall well-being of survivors. However, with a comprehensive approach that includes early mobilization, nutritional support, and continuous monitoring and adaptation of care, the risk of muscle loss can be substantially reduced. By integrating these three steps into stroke rehabilitation and long-term care plans, healthcare professionals, caregivers, and stroke survivors can work together to promote muscle health and improve quality of life but we must build a connected stroke care community ecosystem to realize best outcomes.

This should be the moonshot mission for stroke care and breaking down current care silos will take a coordinated effort.

My New Book Release in 2024

Doing My Part to Connect Stroke Care

My plan since the beginning of recording my stroke recovery and advocacy journey through this blog has always been to build a meaningful resource for others.  After 16 years of posting and updating I’ve essentially kept a chronicle online of the barriers I’ve encountered in my stroke recovery, and what the promising future can hold for stroke care if we can overcome the present obstacles to connect care at discharge into the home. 

This is why this year my plan is to release chapters from my upcoming book that will spotlight the best of and worst of care so stroke survivors and their advocates will have a blueprint to learn from my mistakes and harness the wisdom of the wins I had as well. Finally,  innovators can follow this blueprint if they read my notes and want to make change a reality in the stroke care pathway.  I’ve pulled from my unique lived experience both as a stroke survivor, practicing physical therapist, degreed nutritionist and emerging rehab technology enthusiast to offer my insights and help others know stroke. 

In the coming weeks on this blog, I’ll drip a few of the chapters out and lay the foundation for the key pillars for a successful stroke recovery game plan.  I’ll share these insights through survivor stories, beginning with my own experiences trying to find safe exercise guidelines and eventually hacking my recovery and my way back to running multiple marathons after my stroke using both high tech strategies at the time and high touch home solutions. 

But before I ever aspired to run a marathon as part of my comeback stroke goal, my stroke journey actually began on the ice playing hockey in high school. I’ll share this part of my story in the next post and why, well before knowing about my congenital heart defect (PFO),  an early stroke was missed because I did not know the stroke warning signs and as you will discover neither did my coaches. 

Stay tuned!