10 Things That Work Against survivors.

1. Fault: survivors, caregivers. Most stroke survivors don't get to the hospital nearly soon enough. A lot of stroke

survivors, as they are having the stroke, feel overwhelmed with  fatigue. So they go to sleep. And this delays getting to the hospital. Many other symptoms of stroke are ignored, or passed off as completely separate issues.

2. Fault: MDs. Once in the hospital stroke is often misdiagnosed. For instance: I cannot tell you how many young survivors who have told me that, once they got to the hospital all anyone asked them about was their drug use. Over and over again. Sometime that's a germane; you want to know about potential meds interactions. But often the MD misdiagnosed the stroke as a potential affect of illegal drugs.

3. Fault: managed care. Survivors are often rushed from the hospital without the clinicians involved being able to take the time to figure out what the next best step is. How

rushed? After stroke it is not uncommon for the survivor to be discharged from the hospital within a few days (2-3)! The mean length of hospital stay for stroke survivors in the US? 5.2 days. In the Netherlands its 25 days!  

4. Fault: managed care, clinicians. Survivors are often sent from hospital to sub optimal situation. And where survivors are sent next will impact not only recovery, but also is predictive of how much longer they'll live. Ref1 ... Ref2

5. Fault: managed care, clinician. Too much therapy too soon within rehabilitation hospitals can be dangerous to the recovering brain. Survivors are often discharged from hospitals to rehab hospitals. Rehab hospitals require a minimum of 3 hours a day of rehab. Because survivors are discharged soon after their stroke (see #4., above) they are forced to do "too much, too soon" and this can hurt the recovering brain.

6. Fault: managed care, clinicians. Survivors, especially within the first week of their stroke, are often not given enough opportunity and tools to get decent sleep. Decent

sleep is absolutely necessary to post stroke recovery. Noisy environments, sleep interrupted by clinical visits, visiting family.. many things work against the survivor getting the ZZZs necessary to recovery to the fullest potential.

7. Fault: clinicians. Rehabilitation clinicians are sometimes very well trained in the best treatment for stroke recovery. But they are often not trained nearly enough. Clinicians treat many pathologies – and stroke is only one of them. Survivors would be best served by being sent to facilities designed and trained to be the best for stroke.

8. Fault: managed care, clinicians. Stroke survivors are often discharged from therapy once there is a perceived "plateau". But this plateau is often more an artifact of poor outcome measures than actual potential for progress.

9. Fault: clinicians. What survivors will do "with the rest of their life" after they are discharged from therapy is often left to happenstance. Clinicians would serve survivors well by working with the survivor immediately "from the first session" as to what the plan should be once their discharge.

10. Fault: stroke survivors. Survivors often do not work particularly hard after therapy ends. This is usually because the survivor doesn't believe that they can get any better. They don't believe that they can get any better for two reasons: a. Because they've "plateaued" the survivor does not believe they can get any better b. Clinicians often lead the survivor to believe that once they are discharged from therapy – partly because they plateaued and partly because they're no longer under the care of the therapist –  they won't get any better. How to combat that here.