My reason for preventing stroke? I want to be there for my children and my family

Foday Johnson, lives in Liberia and the UK. Here he tells us how his brother's stroke has spurred him on to do whatever he can to prevent stroke.

Before your brother’s stroke did you have any idea that he was at any risk? 

Not at all, in hindsight the signs were there though – he smoked, did not do exercise and had a poor diet. 

When and how did you realise he had a stroke? 

I was in London at the time, but his family around him suspected he was having a stroke. After his initial treatment he went to Monrovia for rehabilitation and was making some progress and returned home. After his return home he had a second stroke. 

Building Clinical Stroke Research Capacity in China

The World Stroke Organization Stroke Research Methodology Training Workshop, Chengdu, China

This WSO Training Workshop took place on 26th May 2017 the day before the Tianfu Stroke Conference and was organised by Professors Ming Liu and Shihong Zhang and their team from the West China Hospital Chengdu. The workshop was attended by 56 clinicians, all in the early stage of their research careers and with an interest in clinical stroke research.

Happy Teachers Will Change the World

Learning about Healthy Lifestyles, Stroke Prevention and Brain Impairment at the WSO Summer School

The Dubrovnik Summer School has become a regular feature on the World Stroke Organization educational calendar. The school, which takes place from June 5-9,  is a demonstration of the shared commitment of School Directors and WSO to the education of young stroke professionals thorugh the dissemination of knowledge and its application in their communities. 

The World Stroke Organization strongly endorses the efforts of the World Health Organisation to reduce tobacco-related illness and death

Stephen Davis and Valery Feigin, on behalf of the World Stroke Organization 

Stroke is a leading cause of death and disability, particularly in low and middle-income regions. Smoking is a major modifiable risk factor for stroke, with similar risk in women and men. Smoking (both active and passive) has been known as one of the most important risk factors for stroke for many years. In the most recent Global Burden of Disease 2015 Study, smoking was ranked the 5th most important risk factor for stroke accounting globally for almost 26 million disability-adjusted life years (DALYs) (23%) due to stroke, with the bulk of the burden (almost 22 million DALYs or 85% of stroke-related DALYs due to smoking) born in low- to middle-income countries. Smoking accelerates atherosclerosis in the cerebral arteries, an important cause of stroke.

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) 

Ron Smith - 'stroke is to be avoided'.

Ron Smith returns with a second blog about his recent speaking tour in Canada and the steps he now takes to prevent a stroke.

What has inspired you to give talks in hospitals and libraries?

Initially I decided to go on tour to promote my book, The Defiant Mind: Living Inside a Stroke, which I wrote because I felt that most people did not understand what a stroke was or what it entailed. Not only does the general public have a limited understanding of a ‘brain attack’, so does the medical profession. I felt I received excellent ‘physical’ therapy but little or no ‘brain’ therapy. And it was my brain that had been damaged. My feeling is that knowledge of stroke stories would go a long way to solving many of the weaknesses in treatment and stroke recovery. The more anecdotal information we have the better. Stroke survivors are reluctant to talk about their strokes for fear of being thought ‘crazy’ and yet stroke stories may be the basis for some very important information about how the brain functions. What is often happening in the brain of someone who has suffered a stroke is ‘different’, not abnormal or aberrant.

Celebrating the 20th Iberoamerican Stroke Organisation in La Paz

The World Stroke Organization were pleased to contribute to the Iberoamerican Stroke Organization's 20th Annual Congress in La Paz, Bolivia between June 7^th and 9^th.

On June the 7^th we delivered our traditional Stroke Teaching Course, dedicated to general doctors and non-neurologists, with more that 300 participants and lecturers from Argentina, Bolivia, Brazil, Chile, Colombia, Mexico, Panama, Peru and the special participation of WSO representative Prof David Spence, from Canada. Simultaneously, there were workshops on Neurosonology, Vascular Cognitive Impairment and a NIHSS training session.

We all have good reasons for preventing stroke

The World Stroke Organisation has officially launched the World Stroke Day Campaign for 2017. The focus of World Stroke Day on 29th October is stroke prevention.

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.

Mrs Neodesha Liyanage from Sri Lanka benefited from regular and coordinated rehabilitation following her stroke

I am Mrs Neodesha Liyanage from Sri Lanka, a 36 year old house wife and mother of a 10 year old son and a 5 year old daughter. My husband is a school teacher. Last year, on September 11th, I got up early in the morning as I had to send my children to Sunday Dhamma school. At 11 am while I was cooking, I felt my mouth was deviating to the left side and I had weakness on the right side of my face. I realized that something abnormal was happening and I called my husband. He took me to the National Hospital with the help of my mother. I was admitted to a medical ward and underwent a CT scan of my brain. It was normal and I was on follow-up observation.

The following morning I noticed weakness of my right arm and right leg. I could not move the right side of my body. Then I tried to tell this to the ward staff but I was speechless. When I tried to drink some water I developed a vigorous cough, which indicated that my swallowing was also affected. Fortunately, I was continent. A second CT scan of my brain was done and it showed a massive left middle cerebral artery infarction (the artery which supplies blood to the middle part of the brain on the left side was blocked by a clot). Hence, a large part of the brain cells were dying, including the area for speech. All my disabilities could be explained by this second CT scan.

I was admitted just with right facial weakness but it ended up a full blown picture of a stroke, which I did not expect at all. I thought I would be going back home soon with medication. I expected a quick recovery from my disabilities. But it was not that quick, as I was not aware of the course of the stroke on human beings. After one week in the medical ward, I was transferred to the stroke unit for long term rehabilitation.

In the stroke unit, I felt comfortable, because the stroke team is more caring. Treatment and rehabilitation were made to run in parallel. The rehabilitation program consisted of three major components. They were physiotherapy, occupational therapy and speech therapy. All three therapies were arranged according to a daily schedule. The outcome of all these therapies and treatments was reviewed every Thursday during the stroke meeting, which was led by the senior consultant neurologist. As I was a young stroke patient, I was investigated extensively.

My main worry was my affected speech which made me so embarrassed. Because I couldn’t follow what others said (affected reception) and at the same time others couldn’t understand what I said (affected expression).

Day by day, my speech, swallowing and other physical disabilities improved. The caregiver was my dearest mother who was with me throughout the hospital stay. She was a courageous woman so I didn’t have any fear after being touched by the stroke. My husband, my two children, my brother and sister were with me giving me the maximum moral support. All my friends and neighbours visited me at hospital.

I left the stroke unit after one month with good swallowing, normal speech and ability to walk without support. Still my right arm is weaker than the right leg. But I am independent in day-to-day activities. Now I attend the stroke clinic and stroke support group meetings monthly, retaining my hope of cooking in the future, which I am so good at. I would like to thank everybody who helped me in my fast recovery. The biggest thanks should go to the senior consultant neurologist, who leads the stroke team successfully

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