I have had a look at the contents of the journal over the last 2 years or so. My eye was caught by the review paper by Yang et al, (Journal of Stroke 2023;25(3):327-337 https://www.j-stroke.org/upload/pdf/jos-2023-01011.pdf) which is perhaps the clearest so far. It is a fairly comprehensive review of the causes of stroke, and therefore of some interest. This includes gender and ethnicity as non-modifiable factors, but also over-work, high BP, high temperatures, high ambient pollutant levels, diabetes mellitus, dyslipidemia, atrial fibrillation, and smoking as possible modifiable factors. For example, work-stress is broken down into alcohol-use, inactivity, an inadequate sleep profile. The writing is less ‘academic’ than most and uses much more everyday language and fewer medical terms.
Much of this paper is interesting and it reflects the causes of stroke and, by implication, the possible causes of the reoccurrence of a stroke should these factors not be addressed in our behaviour. Well, that is what I have drawn from this.
The lens with which I view things is primarily to do with how I improve my lot, regain lost but desirable functions, and avoid the reoccurrence of strokes. So the paper is practically useful for the last of these, and underscores the importance of performing a retrospective on why what happened happened. My view is that this is useful to do in the first instance, and then the appropriate things are put in place and done. It happened, the stroke that is, and how we react to that in our lifestyles is now of supreme practical importance. In my case, I certainly avoid obesity, work stress and high BP. I have fixed these factors, and I would be really stupid not to.
The more important and practical things are the therapies I now need to devise to counteract what the stroke did to me. I have found that the therapists are very good in the earlier stages, especially when they knew a lot more than I did. Later, I have had to be more specific around my own loss of function, and hence the need to go off-piste, apparently, to make up my own therapies to address the very specific deficiencies that will be outside of the therapist’s experience.
As I have mentioned elsewhere, neuroplasticity is our friend, is not magical for it happens all the time, and in other contexts may be equated with learning, crudely that is. We can all learn, and learning involves the brain remodelling itself, but it also requires a huge amount of focused repetition. The paper doesn’t really help with this aspect much at all except as a general review of what possibly might have happened and what should be avoided in the future. And, of course, it didn’t set out to help with the ongoing therapies. We need to bring all of our intellect to bear on our own individual issues, and to use the many ideas of others from our respective groups. But I am now straying well away from the content of the paper!