Young stroke survivor Nicky Bruno reminds us of the importance of self advocacy

Two years ago Nicky Bruno had a stroke, as a young adult working and coaching in collegiate athletics in the USA, this was absolutely devastating. Here Nicky shares her story and encourages us all to take the initiative in preventing a stroke.

Where were you when you had your stroke? - I had my stroke at my home at the age of 30.

Could you access hospital? - I was in the vicinity of two hospitals (within 30 minutes) of my home. One was a Primary Stroke Center and one was a Comprehensive Stroke Center.  

What expectations did you have for your treatment, rehabilitation and recovery? -  I was diagnosed with a spontaneous vertebral artery dissection, which is a tear that formed in the artery of my neck, that produced a clot which disrupted the flow of blood to my brain. This led to my cerebellar stroke. Following my diagnosis, I expected that there would be more information known about my specific condition and that there would be a set plan for recovery already in place. 

What was your experience of treatment and rehabilitation? - Since my condition is rare, I had to research and visit a young stroke specialist to help me devise a rehabilitation plan. The stroke affected my cerebellum and left me unable to walk, balance, or read. Entering a rehabilitation and nursing facility and then finding an outpatient physical therapy clinic that could help create innovative vestibular exercises was crucial to my recovery.  

What has helped you in your recovery? - Directly following my stroke, I dedicated myself to learning as much as I possibly could about my condition and focused relentlessly on my rehabilitation. Having been an athlete all of my life and a collegiate coach at the time of my stroke, I transferred my focus to retraining my brain. Currently, I have slowly regained my balance and the ability to not only walk on my own but jog again. With time, dedication and practice, I was also able to manage my visual symptoms enough to be able to type, read, and drive. Each day I continue to work to find ways to modify my daily life to fit my new normal.  

What have been/are your fears? - I would have to say my biggest fear was/is sustaining another stroke since mine was spontaneous. 

How did your family and friends feel and respond? -  Following my stroke, I was unable to work or care for myself. Without the help and support of my family and their tireless pursuit to get me the best possible care, I would not be where I am today! 

Do you have a message for our World Stroke Campaign this year?

I firmly believe that it is equally important to be your own advocate when it comes to your health if you are able. This begins with taking the initiative to employ prevention strategies, knowing your individual risk factors, and identifying the various signs and symptoms of a stroke! 

While stroke is typically thought of as something that affects only older individuals, this experience has opened my eyes to the fact that young stroke is more common than we think. I am passionate about advocating for young stroke, and I wanted to reach out in the hope that I can help others! 

New WSO stroke support organisation member prioritises stroke prevention in New Zealand

Stroke Central Region is a not-for-profit, member-based organisation that provides support services for stroke survivors and their families in the central region of New Zealand, including a stroke community and field officers that guide those affected by stroke through the journey to recovery.

2019 has been a busy year for Stroke Central Region. With the number of stroke patients rising, our field officers have been getting more than twice as many stroke referrals than in 2016. In New Zealand, around 9,000 people suffer a stroke each year and that number is expected to increase by 40 percent by 2028. Due to this expected increase, our focus for 2020 will include primary stroke prevention. Helping us to put an infrastructure in place for this is Professor Valery Feigin.

Professor Feigin has recently been appointed Honorary Clinical Director to our Board of Governors which is a big milestone for Stroke Central. He is the director of the National Institute for Stroke and Applied Neurosciences at Auckland University of Technology (AUT). He is also an executive committee member of the World Stroke Organisation (WSO), and a World Health Organisation expert on stroke. He is currently the most cited scientist in New Zealand with more than 650 publications, including 340 scientific articles. He will be a major asset to our stroke community and we are looking forward to working with him.

Another big milestone for our organisation in 2019 will be the coordination of the World Stroke Day Campaign for New Zealand on the 29^th October. We feel very honoured to lead the campaign for WSO within our country and are currently liaising with other likeminded companies to partner with for this special day. Part of this campaign for New Zealand will be the promotion of the Stroke Riskometer App, developed by Professor Valery Feigin together with AUT. The App tells users their risk of stroke within the next 5-10 years and how they are able to lower their stroke risk.

Stroke Central staff

Looking forward to 2020, apart from focusing on stroke prevention, our Stroke Awareness Week will take place in April and is another big opportunity for us to raise the awareness of stroke, and coordinate our big fundraising campaign for the year. This is a big opportunity for all our members and volunteers to help, within their communities, to spread their knowledge on stroke, share information and help with raising funds for our charity.

October 2019 News

Stroke Central Region's #DontBeTheOneNZ Stroke Prevention Campaign was successfully launched on 29th October 2019 with the help of Auckland University of Technology (AUT) and the World Stroke Organisation. To learn more about the year long campaign, the Stroke Riskometer App and how to prevent stroke, watch the full launch video or visit the #DontBeTheOneNZ website https://www.strokecentral.org.nz/dont-be-the-one/ 

For more information visit: https://www.strokecentral.org.nz/

Up Again After Stroke

This year the focus of World Stroke Day is on life after stroke. Around 80 million people living in the world today have experienced a stroke and over 50m survivors live with some form of permanent disability as a result. 

While for many, life after stroke won’t be quite the same, our campaign aims to show that, with the right care and support, a meaningful life is still possible. As millions of stroke survivors show us every day, it is possible to get #UpAgainAfterStroke.

While the impact of stroke is different for everyone on 29th October 2018, we want to focus the world’s attention on what unites stroke survivors and caregivers; their resilience and capacity to build on the things that stroke can’t take away and their determination to keep going on the recovery journey.

Join with us

Our website has resources and key messages to help you raise awareness of life after stroke issues on World Stroke Day. Here's how you can join with us and show support and solidarity with stroke survivors on World Stroke Day:

• Download campaign social media resources from the campaign website www.worldstrokecampaign.org; If you have some design skills and software and want to adapt materials for local use contact campaign@world-stroke.org
• Change the heading pictures on your account and share social posts with your networks.
• Share your personal experience as a stroke survivor or caregiver on Facebook and twitter. Be sure to include the campaign hashtag #UpAgainAfterStroke so that your experience is seen and shared.
• If you don’t use social media, share your story of stroke recovery on the World Stroke Campaign website. 

PODCAST RELEASES Sedentary behaviour after stroke: a new target for therapeutic intervention: Sarah Morton

Over the last 10 years evidence has emerged that too much sedentary time (e.g. time spent sitting down) has adverse effects on health, including an increased risk of cardiovascular disease incidence and mortality. A considerable amount of media attention has been given to the topic. The current UK activity guidelines recommend that all adults should minimise the amount of time spent being sedentary for extended periods. How best to minimise sedentary behaviour is a focus of ongoing research. 

Carmen Lahiff-Jenkins, Managing Editor of the International Journal of Stroke spoke to Dr Sarah Morton lead author of the opinion piece Sedentary behaviour after stroke: a new target for therapeutic intervention.

The International Journal of Stroke is the flagship publication of the World Stroke Organization - please consider becoming a member.  https://www.world-stroke.org/membership/join-wso

DOWNLOAD HERE

http://journals.sagepub.com/doi/full/10.1177/1747493018784505

Kool Kats by Kevin Macleod 

Stroke has taken away so much but given me the gift of helping others

Sas Freeman uses her experience of stroke and recovery to raise awareness of key issues in prevention, treatment and support.

Prior to my stroke I was fit and healthy; I ate healthily, and exercised regularly; I am naturally slim, and did not put on weight – so not someone I believed to be a candidate of stroke. Post stroke, and now having learned all that I have, I know sadly, stroke can strike anyone at any age.

Stroke Recovery and Rehabilitation Roundtable - development, monitoring and reporting - Marion Walker

Stroke Recovery and Rehabilitation Roundtable - development, monitoring and reporting - Marion Walker

Improving the development, monitoring and reporting of stroke rehabilitation research: consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable (SRRR) 

Agreed definitions and a shared vision for new standards in stroke recovery research: The Stroke Recovery and Rehabilitation Roundtable taskforce.

Stroke Recovery and Rehabilitation Roundtable - definitions - Karen Borschmann and Kate Hayward

Common language and definitions were required to develop an agreed framework spanning the four working groups for the The Stroke Recovery and Rehabilitation Roundtable taskforce. 

: translation of basic science, biomarkers of stroke recovery, measurement in clinical trials and intervention development and reporting. 

The Stroke Recovery and Rehabilitation Roundtable (SRRR) was convened with the aim to move rehabilitation research forward. Working collectively across four initial priority areas the #SRRR team reviewed, discussed, and attempted to achieve consensus on key recommendations in each of the areas of translation of basic science, biomarkers of stroke recovery, measurement in clinical trials and intervention development and reporting. 

Stroke Rehabilitation and Recovery Roundtable - Looking at translational/preclincal research in recovery with Dr Dale Corbett PODCAST

SRRR - Translational/Preclincal with Dr Dale Corbett

Stroke recovery research involves distinct biological and clinical targets compared to the study of acute stroke. We know that moving preclinical treatments into the clinical realm has been fraught with notorious difficulties, one very well known area has been of course the incredible disappointments with neuroprotection. In comparison Stroke recovery involves distinct biological principles and a very different time window, in fact is unlike acute stroke at all! 

We spoke to Dr Dale Corbett, from the Faculty of Medicine who was the lead author on the Stroke Rehabilitation and Recovery Roundtable paper on 'Enhancing the alignment of the preclinical and clinical stroke recovery research pipeline'.

Stroke Rehabilitation and Recovery Roundtable - Looking at biomarkers with Dr Lara Boyd PODCAST

SRRR - Biomarkers with Dr Lara Boyd

A biomarker is a naturally occurring molecule, gene, or characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention.

Carmen Lahiff-Jenkins. Managing Editor of the International Journal of Stroke spoke to Dr Lara Boyd, physical therapist from the University of British Columbia and the biomarkers group from the Stroke Rehabilitation and Neurorecovery Roundtable.  

To listen to the podcast please click on the title link.

Seven minutes in stroke - Linda Worrall

1. What inspired you towards neuroscience?
I moved addresses to Brisbane, the capital of Queensland, Australia from rural North Queensland in 1977 to decide what university degree to apply for.  I observed a speech pathologist with a person with severe aphasia and have been wanting to help ever since.

2. Why stroke?
I was on a working holiday in the UK when I took up the Research Speech Therapist position at the newly opened Stroke Research Unit in Nottingham. The innovation of the multidisciplinary team led by Dr Nadina Lincoln on the stroke ward was exciting and meaningful. I completed my PhD there from 1984-1987 at an exciting time when the UK stroke and aphasia scene was rich with innovation, leading the world in the organization of stroke services and stroke rehabilitation. 

3. What have been the highs so far?
I loved leading the NHMRC funded Centre for Clinical Research Excellence in Aphasia Rehabilitation from 2009-2014. We have a very strong network of aphasia researchers now in Australia and have the online Australian Aphasia Rehabilitation Pathway. I was also immensely impressed when the Duchess of Bedford came to Brisbane during one of our massive tropical storms to award me the Tavistock Prize for my contribution to aphasia. It was the first time she had awarded it to someone outside of the UK. 

4. What have been the lows?
Stroke patients with aphasia have the worst outcomes, yet they remain marginalised in stroke research, practice and policy. It’s not rocket science to include them.  I don’t like to see the Australian Aphasia Association for people with aphasia and their families struggle for funding and support when larger stroke organizations forget they are there.  I hate that some stroke clinicians still question the value of speech pathology services for people with aphasia and their families despite two positive Cochrane Reviews.  I hate to hear stories of people with aphasia who have been treated very badly in the health system. All health professionals need to step up to the challenge of understanding how language is processed in the brain, how aphasia is not a cognitive, intellectual or memory problem to be afraid of, and how to communicate with someone with aphasia.  

5. How do you balance work life with the needs of home life?
I am finally getting the hang of it after 30 years of academia. Progressing my career, having three young girls, and an academic husband was hard work in the early years. I deliberately expanded my home life through more exercise, more family time, more travel and supporting my home rugby league team, the Broncos.  I don’t work on weekends or nights, but do work hard and strategically during work hours with a great team of aphasia pre-doc and post doc researchers. 

6. Who are your most important mentors and how did you find them?
At the University of Queensland, we had a formal mentoring scheme for women and I was allocated Professor Cindy Gallois, who I have worked with for many years.  I approached Professor Audrey Holland (University of Arizona) during some travel in the USA in 1985 and she focused my thinking on what matters in aphasia research and rehabilitation.  I now have a rich network of aphasia research colleagues from around the world and we mentor each other, usually during a writing retreat alongside an international aphasia conference. We have also turned our attention to mentoring others. 

7. What are your most important collaborations and how have you built them?
I will graduate my 26th PhD student soon and these have been very important collaborators. They form the next generation of aphasia researchers. The CCRE in Aphasia Rehabilitation brought me my “rope team”, Associate Professor Miranda Rose (Latrobe University) and Professor Leanne Togher (University of Sydney), and we are tied together to support each other through the ups and downs of academic life.  During the research capacity building years in speech pathology at The University of Queensland, I was also fortunate to have my old university friend, Professor Louise Hickson in the same department as a collaborator from audiology and this cross fertilization across the disciplines sparked many successful grants and PhD projects. 


Professor Linda Worrall is the Director, of the NHMRC CCRE in Aphasia Rehabilitation and Co-director of the Communication Disability Centre, as well as the Postgraduate Coordinator for the School of Health and Rehabilitation Sciences at the School of Health and Rehabilitation Sciences, The University of Queensland

Promoting SSOs in China

Sarah Belson, WSO International Development Manager, has just spent a week in China.

When I was first approached by Liying Xing, a neurology clinical research nurse at University College Hospital London, to participate in the Tiantan Stroke Conference in Beijing, my initial response was that I wasn't sure I was the person she was looking for. 'Yes you are' she said, 'we want someone to talk about stroke support in the community'. This was certainly a good start. I can’t say whether my 20 minute session introducing the WSO, its priority to support SSOs, and examples of SSO work around the world, had an immediate impact on my audience. This might have been because I was a bit of an anomaly in the session on Risk factors intervention and neuroprotection for cerebrovascular diseases. But the topic of SSOs was on the programme at least.

On the first evening of the Conference, the Chinese Stroke Association organised a celebration and award giving event for 300 of its 27,000 registered volunteers. These volunteers include doctors and nurses and are known as the Red Bracelet Movement, the stroke support arm of the Chinese Stroke Association. The movement is championed by Professor Wang Shaoshi and he attended the event along with the leadership of the Chinese Stroke Association. It was inspiring to see so many volunteers from across this vast country, committed to raising awareness about stroke - the risks, the signs and the emergency response. There is huge potential for some of these volunteers to develop SSOs and build on the stroke awareness work. This is certainly something that Professor Shaoshi recognises and wants to explore further.

And then on to Chongqing, a city that has grown from a population of 7 million to 37 million in the past two decades. We visited the Fourth People's Hospital of Chongqing and the attached Emergency Medical Centre. The hospital is not lacking in the latest modern equipment and some of the patients we met on the neurology ward couldn't be more enthusiastic about the care they had received. 'I'm a mathematician' one said, 'I only talk facts; they really took care of me'. One of the neurosurgeons said that 40% of the patients he sees have had a stroke. We met with staff from across the department and there was real consensus that support to stroke survivors in the community is lacking. Straight away we could see the opportunity to integrate stroke support work into the neurology department’s community medical association initiative, through which they share knowledge and good practice with community medical centres. So, what next? There is now a plan to set up an SSO in Chongqing and there is certainly a number of people who are in a position to make this happen.

In other meetings we met with the vice secretary of the Foreign and Chinese Affairs Office, and at the Health Commission we met with representatives of a number of other hospitals across Chongqing. There is great enthusiasm for learning more about what SSOs are, how they contribute to prevention awareness and how they can respond to the gap in rehabilitation and recovery support in China. In addition, many people we met are keen to join the WSO in order to access its resources and opportunities. The priority now is to build on this enthusiasm and these connections, in a country where stroke is the leading cause of death and where there are 7.7 million stroke survivors, who all have a right to be supported in their recovery. 

Stroke survivor stories - Ron Smith

Where were you when you had your stroke?  

The initial mini strokes happened at my home in Nanoose Bay, British Columbia. I had my stroke on November 19, 2012, a day, as a stroke survivor, you never forget and your family never forgets. So many people are affected

Could you access hospital?

I had what the emergency doctor referred to as a stuttering stroke. I think what he meant by this is that I had a series of smaller strokes at home before the bigger stroke hit. After the major event, which happened in the waiting room of emergency or I wouldn't be here today, I wasn’t having thoughts that registered. I inhabited a place I can only describe as ‘limbo’.

What expectations did you have for your treatment, rehabilitation, therapy and recovery?

I was in denial from the onset, an all too common response to the symptoms of stroke. My right side was paralyzed. This was frightening. Initially my speech was impaired but this righted itself fairly quickly. With a little effort, people could understand me after a few days. Perhaps the biggest problem was that I didn’t feel like I belonged to the world anymore even though I felt my cognitive powers were still intact. The combination of loss of physical and emotional control and the sense of no longer belonging to the everyday world resulted in severe depression. After a couple of weeks I decided I could either wallow in self-pity or take action. In combination with physical therapy I decided to meditate. I also decided, very deliberately, that I needed to take a positive and proactive approach to my recovery. I have never stopped therapy. I have read as much as possible by other stroke survivors and a number of books on the brain, brain plasticity and new forms of therapy. I also used memory to find my way back to myself, to the person I had been. Patience is vital to the stroke survivor’s well-being because recovery can be very slow.

What was your experience of treatment and/or rehabilitation and therapy?

I have two complaints: My formal therapy was terminated far too early; and all forms of therapy need to be tailored to the individual; that is, personalized. The patient needs to be consulted if therapy is to be effective. Too many assumptions are made about what will work. Anecdotal accounts can be every bit as reliable and as useful as clinical research if collected properly.

What has helped you in your recovery?

Before my stroke I taught English and Creative Writing at the university level; I owned a publishing company; and I wrote and published books. I was lucky, writing was my life and was a vocation to which I could return with relative ease. Eight months after my stroke I decided to write about my stroke experience. My only handicap was that I had lost the use of my right arm and hand. I typed my book, The Defiant Mind: Living Inside a Stroke, over 300 pages, with the index finger on my left hand. The Defiant Mind is a book about the wonder that is the human brain, both before it has been damaged and after. I hoped the book would be useful to other stroke survivors, care-givers and therapists. I also hoped it would help the general public understand what a stroke is, at least from my perspective. But if my book doesn’t achieve these goals at least it will have been another form of therapy for me; another way to explore my own experience. Writing also puts my brain to work, which seems essential to my recovery. I also take walks, cane assisted, amongst trees, practicing Japanese 'forest bathing' or Shin-rin Yoku. Scientific studies indicate that trees help reduce the stress hormone, cortisol, and increase the immune defence system. And at least three to four times a week I go to a local pool. I can exercise in water with abandon. I love the water’s primal feel and wish it had been a part of my therapy from the beginning.

What have been/are your fears?

Of course, always at the back of my mind is the fear of having another stroke, a risk for which I'm genetically predisposed. But I tuck this away and carry on.

How did your family and friends feel and respond?

I've been very fortunate; my family and friends have been incredibly supportive and loving.

Stroke Survivor Stories - Youko Yamaguchi

Where were you when the stroke happened?  

My wife, Youko Yamaguchi, was traveling with her friends 17 years ago. While chattering at night club after dinner she got subarachnoid hemorrhage at the age of 53. The hotel manager called ambulance car, and she was carried to an emergence hospital.

Could you access hospital?

A phone call at 11 pm asked me to come to the hospital soon. I drove about 440 km all night, and arrived there at 7 am.  After approval sign, the operation took place. 

The shrinkage of blood vessels occurred 7 days after the operation and my wife suffered aphasia and became right side hemiplegic.

What expectations did you have for treatment, rehabilitation, recovery?

We didn’t know anything about aphasia, so we couldn’t imagine anything about treatment, rehabilitation and recovery.   She murmured “I am sorry, sorry, I made a serious thing!” ”How should I manage many tasks to be done”   She couldn’t recognize that she couldn’t continue these tasks.  Without any special rehabilitation, she left the hospital one month later.

What was your experience of treatment and/or rehabilitation?

2 days later after we returned home, my wife was admitted to a rehabilitation hospital cerebrovascular center.  Here physical therapy, occupational therapy and speech therapy began.  She was positive about the physical therapy because it was carried out in a large gym and she could interact with other patients.   But, occupational and speech therapy took place in small private room, and therapists sat down side by side without noticing the appearance of my wife.   They only executed the curriculum without any guidance from their superiors.  During 3 months stay, her communication didn’t improve clearly.  But, she could stand up and walk by herself and use a spoon and knife with her right hand.

What has helped in the recovery?

3 months later she moved to another rehabilitation center in Yokohama for 2 months, which mainly focused on language rehabilitation.   The speech therapist sat face to face with my wife, greeted and talked about easy topics.  Then, the language rehabilitation curriculum started. This speech therapist advised us to make a Japanese syllabary table. Each Hiragana was combined with each Chinese character which was easier to remember than Hiragana for my wife.  Using this table, rehabilitation was carried on.  The speech therapist also advised my wife to join the calligraphy circle which was open next door to the hospital.

After my wife left the hospital, we visited once every week for language rehabilitation for two and half years.   The speech therapist advised us to install a specific software to our PC, and advised us to write and send a short mail to her about any topics.  A few days later the return mail came back without fail. Video conversation through IPad facetime with daughters and grandchildren was also a great help for her rehabilitation.

What have been/are your fears?

When my wife has to live alone, how she can manage to live daily life without my support.   This is most serious matter to us.

How did your family and friends feel and respond?  

Stroke Survivor Stories - Tom Head

The stories of stroke survivors are what drives our fight at the World Stroke Organization to achieve our goal of a world free from stroke. Welcome to our Stroke Survivor Stories series, which we'll pop up on the blog every Thursday, you may wish to contribute to this poignant narrative of stroke globally. Please contact Sarah.Belson@stroke.org.uk

Where were you when you had your stroke?

I was visiting relatives in Kent with my family. My stroke occurred at a very young age, shortly before my 3rd birthday so I don’t remember anything about what happened.

Could you access hospital?

My Mum, a nurse, realised that something was wrong and took me to the nearest GP in Kent, then to the local hospital. From there I was taken by ambulance to Guy’s Hospital in London.

What expectations did you have for your treatment, rehabilitation, recovery?

Very few. I think everyone hoped the treatment and rehabilitation would minimise the effect of the stroke on my life although as I had to grow and develop there were lots of unknowns.

What was your experience of treatment and/or rehabilitation?

The NHS treatment was excellent throughout my childhood. I was seen by paediatric doctors and had regular physiotherapy to help with the walking difficulties and dystonia I suffered. There have been many challenges as the approach was to monitor and wait and see how my body developed and react with medications and treatments along the way. When I reached adulthood and moved around the country more I did find it more difficult to access treatment and to have continuity of care, but now have an excellent orthopaedic surgeon who monitors my progress and has operated on me to alleviate arthritic pain caused by my right sided weakness, dystonia and uneven gait.

What has helped you in your recovery?

My family who have been there from the beginning and took me to so many hospital appointments when I was young. As my stroke occurred so early in life I haven’t known any different so it’s a case of working out ways to overcome challenges rather than thinking how I did things before the stroke and how to do them after.

What have been/are your fears?

When I was young I feared being different and not able to do the same things as my friends. As I’ve gotten older the worries have mainly been focused on whether I can live independently and just how the wear and tear on my body because of the after affects of my stroke impact my day-to-day life. There is a lot of uncertainty and new health issues crop up because I’ve lived with right sided muscle weakness and dystonia for so long.

How did your family and friends feel and respond?

Naturally there have been anxieties along the way but on the whole I don’t feel I’ve been treated any differently. We have all had to adapt but 35 years on from my stroke it has shaped who I am but does not define me.

Stroke Survivor Stories - Sas Freeman

Where were you when you had your stroke?

I am a survivor of two strokes, both at the age of 45. On the morning of my first stoke, I woke with a tremendously strong pain in a small area on the left side of my head. I am no stranger to migraines but it was stronger than a migraine yet in such a small area. 

Could you access hospital?

I told myself it would pass and I could go to work as usual. Time passed and by now I was tripping over, my eye weeping and I was struggling to get my words out as I phoned my doctors for help. Help was not as hoped, the response being 'there is a cancellation if you come now!' I have no idea how I managed this, where I left the car or its keys! 

What was your experience of treatment and/or rehabilitation?

On arrival help was fast and efficient, realising immediately it was a stroke, hospital staff were waiting for me to begin scans etc.

What expectations did you have for your treatment, rehabilitation, recovery?

I was left with right sided paralysis,loss of  speech, weaker hearing and sight on my right side, my right arm and leg were twisted in and my face dropped, I also was left with cognitive difficulties and huge problems with fatigue, which even now six years on is still the case.

I have fortunately always been an optimistic and determined person, so despite eventually leaving hospital in a wheelchair with the departing message, 'this is as good as it is going to get,' I was not prepared at 45 to live the rest of my life totally dependent on others,

At that stage I had no idea what if anything I could do about it but I had to and would do something. 

What has helped you in your recovery?

I worked using visualisation, trying absolutely anything as I simply had nothing to lose. Eventually little by little, I began to make very small but some improvements. I did not ever let go of my positive mental attitude even in the very low times, and there were many.

This drove me to write my book, ‘Two Strokes Not Out’ to help fellow survivors through these difficult and lonely times and also their families who have also been thrown into this devastating mess without warning. The child forced to become carer, yet at school they return to child role. The book's intention is to be a companion and personal reference guide to the survivor and a support to their families. It is a long and lonely road.

How did your family and friends feel and respond?

Stroke changed our lives as a family forever, overnight, taking away my mobility, independence and ability to work. It left me having to rely on others to eat, wash and dress simply to do everything for me for a great deal of time,

My most recent and exciting task will be revealed on World Stroke Day, Take a look on my website www.sasfreeman.com and Sign Against Stroke website www.signagainststroke.com

Wishing all survivors a good recovery, from someone who understands,

A Fellow Survivor and Mentor, Sas