Stroke

Each year nearly 800,000 Americans have a stroke, and about 600,000 are first strokes. Once a person suffers a first stroke, the risk of another stroke increases. The risk of a recurrent stroke is greatest right after a stroke and decreases with time. In fact, about 25 percent of people who recover from their first stroke will have another stroke within five years, and approximately 3 percent of individuals with stroke will have another stroke within 30 days of their first stroke. Overall, one-third of recurrent strokes take place within two years of the first stroke.

Stroke occurs in all age groups, in both sexes, and in all races in every country. Stroke can even occur before birth, when the developing infant is still in the womb (a common cause of cerebral palsy).

Some risk factors for stroke apply only to females. These include pregnancy, childbirth and menopause. These factors are tied to hormonal changes that affect females at different stages of life. In females of childbearing age, stroke risk is relatively low (with an annual incidence of one in 10,000). However, studies have shown that pregnancy increases that risk three times.

Several factors contribute to the increased risk of stroke during pregnancy:

• The activity of blood-clotting proteins is naturally greater during pregnancy, increasing the chances of stroke for the mother. In some cases, clots form in the brain’s large draining veins, leading to headache or seizure.
• Pregnancy-related stroke is more likely to occur in females who experience certain complications, such as infections or preeclampsia (high blood pressure with fluid retention), or who have other risk factors for stroke, such as high blood pressure or diabetes.
• Most strokes occur during the postpartum period—the first few weeks after delivery. These strokes may be caused by a drop in blood volume or by the rapid hormonal changes that follow childbirth.

In the same way that hormonal changes during pregnancy and childbirth are associated with increased stroke risk, hormonal changes at the end of childbearing years—during menopause—can also increase the risk of stroke. Although hormone replacement therapy (HRT) may help some symptoms of menopause, studies have shown that HRT increases the risk of stroke.

Children have several unique stroke risk factors. The risk of stroke for children is actually highest during the perinatal period—which begins just before birth and ends a few weeks after. Males and Black children are at a higher risk for stroke than other groups.

Infants and children who have a stroke will experience symptoms that are similar to those in adults such as headache, hemiplegia (paralysis on one side of the body) and hemiparesis (weakness on one side of the body). However, children are more likely than adults to have other symptoms, including seizures, breathing problems or loss of consciousness.

Risk factors for childhood stroke include congenital (present at birth) heart problems, head trauma and blood-clotting disorders. An important risk factor for Black children is sickle cell anemia (a genetic blood disorder characterized by red blood cells that take on a sickle or crescent shape and block arteries). In addition to anemia, the disorder can cause joint pain, swollen spleen, frequent and severe infections, and narrowing of brain arteries.

The outcome of stroke in children is difficult to predict. A stroke during fetal development may lead to cerebral palsy. A stroke that occurs during infancy or childhood can also cause permanent disability. Generally, outcomes are worse in children under age one and in those who experience decreased consciousness or seizures.

Children who have a stroke generally recover better than adults after treatment and rehabilitation. This is due in part to the brain’s plasticity, or its ability to reorganize, change, and adapt to deficits and injury, and to rewire itself to carry on necessary functions.

Some people are at a higher risk for stroke than others. Understanding the risk factors and working on them may help prevent a stroke. Generally, stroke risk factors fall into two categories: unmodifiable or modifiable.

1. Unmodifiable risk factors—those that can’t be changed or controlled—include age, gender, race or ethnicity, and family history.
2. Modifiable risk factors and medical conditions, including high blood pressure, high cholesterol and smoking, can be controlled with medical care or changed by the person at risk.

• Age: Stroke affects people of all ages (including young adults, children, infants and fetuses in the womb). However, stroke risk increases with age; the older you are, the more likely you are to have a stroke.
• Biological sex: Sex also plays a role in risk for stroke. Stroke is more common in males than females. Males have a higher risk of stroke in young and middle age, but rates even out at older ages, and more females die from stroke. Even though females have fewer strokes than males, females are generally older when they have their strokes and are more likely to die from them.
• Family history: Having a parent, grandparent or sibling who has had a stroke puts a person at greater risk of stroke. The risk of stroke may be linked to certain genetic traits in some families. Some genetic mutations bring a strong risk of stroke, but weaker genetic contributions often come from members of a family who might have a genetic or inherited tendency for stroke risk factors, such as high blood pressure, diabetes or heart disease. It is also possible that an increased risk for stroke within a family is due to modifiable behavioral factors.
• Race: The risk for stroke varies among different ethnic and racial groups. The incidence of stroke among Black and Hispanic Americans is almost double that of White people. Black and Hispanic Americans tend to have strokes at a younger age. The death rate from stroke is higher in Black people than in other groups.
• The "Stroke Belt": Eleven states, 10 of which are in a cluster in the southeastern United States, have stroke death rates that are unusually high. The states include Alabama, Arkansas, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee and Virginia, along with Indiana. Several of these states also happen to have the highest age-adjusted death rates for cerebrovascular disease. This increased risk may be caused by geographic or environmental factors or by regional lifestyle differences, such as higher rates of cigarette smoking or a preference for salty, high-fat foods.
• Prior stroke or heart attack: Someone who has had a stroke or heart attack has a higher risk of having another one. Individuals who have had a heart attack also have a higher stroke risk.

Modifiable risk factors are those that can be changed or controlled to prevent or reduce the risk of stroke. The most important modifiable risk factors for stroke are high blood pressure, heart disease, diabetes and smoking. Others include heavy alcohol use and high cholesterol. Stroke is preventable and treatable. A better understanding of the causes of stroke has helped people make lifestyle changes that have cut the stroke death rate nearly in half in the past two decades.

Simple steps can help people reduce their risk of stroke, cognitive impairment, dementia and heart disease later in life:

• Talk with a healthcare provider about the risk of stroke
• Work with a provider to develop a plan to control blood pressure and other risk factors
• Stick to the plan

Making lifestyle changes can reduce a person’s risk of stroke. It is important for individuals to not stop taking their medications without first speaking with and getting approval from their healthcare provider. Stroke can be caused by people stopping their medications without medical guidance. The following are considered modifiable risk factors in preventing stroke:

• High blood pressure: Hypertension or high blood pressure is the number-one risk factor for stroke. For people with high blood pressure, the risk for stroke before age 80 is two to four times higher than the risk for those without high blood pressure. Hypertension promotes atherosclerosis and causes damage to blood vessels. Atherosclerosis is the major cause of blood vessel narrowing, leading to both heart attack and stroke. Early treatment is essential. Blood pressure should be checked regularly. Controlling blood pressure can decrease a person’s risk for stroke and may prevent stroke and heart attack. Maintaining healthy blood pressure may also reduce the risk of other disorders later in life, including dementia and cognitive decline. Medications to treat high blood pressure (antihypertensives) work by either relaxing the blood vessels or decreasing blood volume.
• Atrial fibrillation: The atria are the chambers that receive blood entering the heart. In atrial fibrillation the two upper chambers of the heart no longer beat; instead, the muscular walls show a fine wiggling movement called fibrillation. As a result, the atria don’t push blood out to the two lower chambers of the heart. This leads to blood stagnation in the atria, and the formation of blood clots that can loosen and leave the heart and travel to the brain, causing an ischemic stroke. Atrial fibrillation is the most common heart arrhythmia, affecting over 9 percent of people over age 65. Medications called blood thinners (e.g., warfarin or direct thrombin inhibitors) have been shown to substantially reduce stroke risk in people with atrial fibrillation. Surgical and endovascular procedures can sometimes stop atrial fibrillation from recurring or can be used to fill the part of the atria most likely to produce clots. People under age 60 with atrial fibrillation and no other risk factors may be prescribed aspirin.
• Cholesterol levels: Many people do not realize that high cholesterol contributes to stroke risk. Cholesterol, a waxy, fatty substance produced by the liver, is a vital body product. It contributes to the production of hormones such as vitamin D and is an essential part of the membranes that surround cells. There are two kinds of cholesterol: high-density lipoprotein (HDL), which is commonly called “good” cholesterol, and low-density lipoprotein (LDL), which is usually referred to as “bad” cholesterol. Most cholesterol in the body is LDL. Excessive LDL can cause cholesterol to build up in blood vessels, leading to stenosis and atherosclerosis. This excess plaque blocks blood vessels and helps to form blood clots. A person’s LDL level ideally should be less than 130 mg/dL. (Cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood.) LDL levels between 130 and 159 indicate that a person may be at a slightly higher risk for atherosclerosis, heart disease and stroke. A score over 160 puts a person at the greatest risk for a heart attack or stroke. Certain levels of HDL cholesterol are beneficial and help to prevent stroke. Currently, an HDL score higher than 35 is considered good. Low HDL levels (less than 35 mg/dL) lead to an increased risk for heart disease and stroke. Genetics also may play a role in high cholesterol levels. Hyperlipidemia (abnormally high levels of fatty materials called lipids) and hypercholesterolemia (too much cholesterol in the bloodstream) are inherited conditions that can cause high cholesterol. A healthy diet and regular exercise are the best ways to lower total cholesterol levels. In some cases, doctors may prescribe cholesterol-lowering medication like statin drugs. Statins significantly reduce stroke risk in most people with high cholesterol.
• Diabetes: Diabetes can damage the blood vessels in the brain and increase a person’s risk for stroke. In diabetes, glucose (blood sugar) is not efficiently moved from the blood to the body’s cells. Instead, it builds up in the blood, where it can damage the blood vessels and tissue that carry fluids (including blood) through the body. High blood pressure is common among people with diabetes and accounts for much of their increased stroke risk. The greatest modifiable risk factor for diabetes is obesity. The increase of obesity and diabetes in the U.S. is thought to be responsible for the recent erosion of the decades-long progress in reducing stroke and heart attack. Medications to control blood pressure and diabetes, dietary changes, and weight loss can lower a person’s stroke risk. If blood glucose levels are high at the time of a stroke, then brain damage is usually more severe and extensive than when blood glucose is closer to normal. However, a recent clinical trial did not find benefit from aggressive use of insulin to control blood pressure in acute ischemic stroke. Controlling blood sugar does appear to reduce the risk of recurrent stroke.
• Smoking: Smoking by itself (without the presence of other risk factors) almost doubles a person’s risk for ischemic stroke. Smoking promotes atherosclerosis and aneurysm formation and stimulates blood clotting factors. The risk for stroke decreases significantly two years after a person quits smoking; by five years, the risk decreases even further, to the level of nonsmokers. Smoking also increases the risk of rupture and subarachnoid hemorrhage in people with cerebral aneurysms.
• Obesity: A medical condition in which a person has too much body fat—is associated with three other stroke risk factors: high blood pressure, diabetes and heart disease. It clearly is a risk factor for stroke. While no studies have tested the effects of moderate exercise or weight loss on stroke risk, both tend to reduce high blood pressure and boost heart health. Always check with a physician before starting any exercise program.
• Head and neck injuries: Head injury or traumatic brain injury (TBI) may cause bleeding in the brain which can lead to damage similar to that caused by a hemorrhagic stroke. Neck injury, when associated with spontaneous tearing of the arteries caused by sudden and severe neck extension, neck rotation or pressure on the artery, also is a contributing cause of stroke, especially in young adults. Neck calisthenics, "bottoms-up" drinking, extending the neck backwards over a sink for hair-washing in hair salons, and improperly performed chiropractic manipulation of the neck can also strain the arteries, possibly leading to stroke.
• Drug abuse: Drug abuse greatly increases the risk of stroke. Short- and long-term use of addictive drugs such as cocaine and amphetamines can damage blood vessel walls, causing them to rupture and bleed into the brain (hemorrhagic stroke). These and other drugs can also narrow the brain’s blood vessels and stop blood flow, causing an ischemic stroke. Intravenous injection of drugs like heroin carries high risk of heart valve infection which can cause stroke. The risk of drug-related stroke increases each time the drug is used, especially if other risk factors are present.

A stroke can cause permanent damage within minutes to hours. Calling 911 immediately and arriving at the hospital in an ambulance can aid in stroke treatment and recovery.

Treatment following a stroke generally falls into three therapeutic approaches:

1. Emergency medical or surgical care given immediately after a stroke to minimize the extent of injury
2. Treatment to prevent a second or recurrent stroke
3. Rehabilitation to improve disabilities that result from stroke

Treatment for ischemic stroke or a transient ischemic attack may include medicines and medical procedures. Treatment for hemorrhagic stroke involves finding and controlling the cause of bleeding. Remarkable progress has been made in acute stroke therapy, especially with stenting and devices for clot removal to restore blood flow in brain arteries.

Medication or drug therapy is the most common treatment for ischemic stroke. The most effective kinds of drugs to prevent or treat acute (occurring in the past few hours) ischemic stroke are antithrombotics (blood-thinning medicines which include antiplatelet agents and anticoagulants) and thrombolytics (drugs that break up and dissolve existing clots). Another group of medications—called neuroprotectants—protect the brain from secondary injury caused by stroke. Although there are no approved neuroprotectants for use in stroke, many medicines have been and are being tested in clinical trials.

Ischemic strokes can be treated by returning blood flow to the brain before the damage is complete—either by using intravenous thrombolytic drugs, which dissolve the blood clot that is blocking blood flow to the brain, or by placing a catheter into the blocked brain artery and removing the blockage. In all cases, a person needs medical attention immediately after stroke symptoms start in order to be evaluated and receive treatment as fast as possible to preserve as much brain tissue as possible.

The body produces thrombolytic proteins, and some of these have been engineered into drugs. Decades ago, NINDS-funded research found that a thrombolytic drug known as t-PA (tissue plasminogen activator) can be effective if a person receives it intravenously (through a vein) within three hours after stroke symptoms have started. Study results showed that individuals who were given intravenous t-PA were 30 percent more likely to have minimal or no disability three months after treatment. This led to the first treatment approved by the U.S. Food and Drug Administration (FDA) for acute ischemic stroke. Since thrombolytic drugs can increase bleeding, t-PA should be used only after the doctor is certain that the person has suffered an ischemic, and not a hemorrhagic, stroke. In more recent studies, scientists have identified conditions in which individuals may benefit from t-PA beyond the three-hour window after stroke symptoms begin. Most clinicians now treat within a five-hour window.

Researchers have long been trying to determine if there is any benefit in giving antiplatelet drugs or anticoagulants during an ischemic stroke in addition to t-PA, or instead of t-PA (for people who are not eligible to receive t-PA). The purpose of one NINDS-sponsored trial—Trial of Org 10172 in Acute Stroke Treatment or TOAST—was to determine if stroke could be treated with a form of the anticoagulant drug heparin called Org 10172, which was less likely to cause bleeding. The study found that the drug produced no significant benefit. However, scientists were able to develop a set of guidelines—called the TOAST criteria—for defining different kinds of ischemic stroke. These guidelines now are widely used in other studies.

For many years, aspirin and warfarin were used to prevent stroke in people with atrial fibrillation, the most common heart condition that causes stroke. Researchers attempted to definitively determine if a daily regimen of aspirin or warfarin could benefit people at risk for ischemic stroke. Two NINDS studies showed that daily warfarin is best for people with atrial fibrillation who are over age 65 or who have additional risk factors. Results also showed that daily aspirin provides adequate protection against stroke among young people (under age 60) with atrial fibrillation.

Two other NINDS-sponsored trials compared the effectiveness of daily warfarin and aspirin in people who did not have atrial fibrillation but who had experienced a prior stroke, and thus were at risk for another stroke. Both trials concluded that aspirin is equal to warfarin for reducing stroke risk in people without atrial fibrillation. A trial is now in progress to determine if anticoagulation with a direct thrombin inhibitor is more effective than antiplatelet therapy to prevent recurrent stroke in persons suspected of having atrial dysfunction.

Brain blood vessels can be accessed by inserting catheters into large arteries in the leg and threaded into the brain blood vessels. This is the basis of catheter angiography, but it is also used to treat vascular abnormalities that cause stroke. Surgery can also be used to prevent or treat some types of stroke, or repair damage to the blood vessels, as well as to treat malformations in and around the brain.

Carotid endarterectomy involves surgical removal of obstructing plaque from the inside of a carotid artery, which widens the artery. The carotid arteries, located in the neck, are the main suppliers of blood to the brain.

NINDS sponsored large clinical trials to test the effectiveness of carotid endarterectomy, which showed that carotid endarterectomy is safe and very effective in preventing stroke in people with carotid-associated TIAs and also somewhat effective for preventing stroke in most people without symptoms but who have more than 50 percent stenosis (narrowing of the carotid arteries). A NINDS-funded trial is now underway to examine the effectiveness of carotid endarterectomy in patients without symptoms of TIA or stroke who are taking aggressive stroke prevention medications.

Stenting involves inserting a catheter with a wire inside of it into the diseased artery and then passing a tube-shaped device made of a mesh-like material over the wire. The stent is compressed until it is threaded into position, where it is then expanded to widen the artery and flatten the obstructing atherosclerotic plaque.

In the Carotid Revascularization vs. Stenting Trial (CREST)—a trial funded by NINDS—scientists compared endarterectomy with stenting. The findings showed that the overall safety and effectiveness of the two procedures was largely the same, with equal benefits for both females and males and for people who had previously had a stroke and for those who had not. However, the study showed that older people generally had a better outcome with surgery, and younger people fared better with stenting.

In another NINDS study involving stenting, scientists compared the effectiveness of medical treatment plus stenting to medical treatment alone for the prevention of recurrent stroke in people who have severe stenosis of an intracranial artery. Results showed that aggressive medical treatment alone is better for preventing a second or recurrent stroke, and that stenting the intracranial artery increased a person’s post-operative risk of developing a stroke or major bleeding from complications of the procedure.

Although the use of t-PA is the only medically proven treatment to dissolve a clot in patients with large arteries blocked by large clots, the drug does not open the vessel in time. To obtain reperfusion (normal blood flow) in such patients, specially trained neurointerventionalists thread a catheter (a thin, flexible tube) through the artery to the site of the blockage and use a variety of devices to open the artery. These include applying suction to vacuum out the clot. A corkscrew-like device can be extended from the tip of a catheter and used to grab the clot and pull it out. Several large, recent clinical studies have shown the benefit of stent-like devices to retrieve clots and return blood flow in people with large vessel occlusions (large clots in blood vessels) resulting in severe strokes. Severe strokes are those that can cause lifelong loss of independent functions and are often caused by blood clots that suddenly enter and block one of the main arteries that supply blood flow to the brain. A NINDS-funded trial showed that perfusion brain imaging using MRI or CT can identify some patients with large artery occlusion who benefit from clot retrieval up to 24 hours after stroke.

Recent advances in endovascular thrombectomy offer new opportunities to consider neuroprotective agents to extend the time window to restore blood flow to the brain, protect surrounding tissue and improve long-term functional outcome. Studies planned through the NIH Stroke Preclinical Assessment Network will determine if an add-on intervention can improve outcome compared to restoring blood flow alone and lead to clinical trials using the most promising neuroprotective therapies.

Treatment for hemorrhagic stroke involves finding the source of the blood leak and controlling it. Hemorrhagic strokes get worse with thrombolytic medications, making it important to determine the major stroke type before starting emergency treatment.

The brain is nourished by one of the body’s richest networks of blood vessels. A blockage or rupture in one of these blood vessels may occur in any area of the brain. Since each area is responsible for different functions, the effects of stroke may range from mild to severe disabilities depending on the type, severity and location of the stroke. The symptoms may be temporary or permanent.

For example, the brainstem controls vital functions such as breathing, blood pressure and heartbeat, and it connects the brain with the rest of the body. A stroke in the brain stem can be fatal or can leave someone in a “locked-in” state in which the person is paralyzed, cannot speak and can only move the eyes up and down.

• Problems with muscle movement (motor sensory impairment): A common aftereffect of stroke is weakness (paresis) or paralysis (plegia). The paralysis or weakness may affect only the face, an arm or a leg, or it may affect one entire side of the body and face. Movement problems can result from damage to the part of the brain that controls balance and coordination. A person who has had a stroke may have problems with the simplest of daily activities, such as walking, dressing, eating and using the bathroom. Some people with stroke also have trouble swallowing, called dysphagia.
• Problems with cognition, thinking or memory: Stroke may cause problems with thinking, awareness, attention, learning, judgment and memory. Some people with stroke have a “neglect” syndrome, which means that they have no knowledge of one side of their body (usually the left side), or one side of the visual field, and are unaware of the problem. A person with a stroke may be unaware of their surroundings, or may be unaware of the cognitive, emotional and/or behavioral problems that resulted from the stroke. Some people will experience a permanent decline in cognitive function known as vascular cognitive impairment (VCI). In its extreme, it includes vascular dementia, but it also refers to a gradual decline in mental function caused by multiple strokes, some silent (without noticeable symptoms), over time. VCI appears to primarily affect the brain’s executive function—the ability to plan activities from getting dressed in the morning to managing medications and finances or negotiating a business deal. Controlling risk factors can reduce the risk of vascular cognitive impairment and dementia.
• Problems with speaking or understanding speech: People who have had a stroke often have problems speaking or understanding language. It is often accompanied by similar problems in reading and writing. In most people, language problems result from damage to the left hemisphere of the brain and severe damage can result in a complete inability to speak or understand (aphasia). Slurred speech due to weakness or incoordination of the muscles involved in speaking is called dysarthria and is a physical, not a language, problem. Dysarthria can result from any weakness or lack of coordination of the speech muscles and can arise from damage to either side of the brain. It is often associated with trouble swallowing (dysphagia).
• Problems with emotion: People with stroke may have difficulty controlling their emotions or may express inappropriate emotions in certain situations. Post-stroke depression, which commonly occurs in people with stroke, is a serious medical problem that can hamper recovery and rehabilitation and may even lead to suicide. Post-stroke depression can be treated with antidepressant medications and psychotherapy.
• Problems with pain and sensation: People may experience pain, uncomfortable numbness or strange sensations after a stroke. These sensations may be due to many factors, including damage to the sensory regions of the brain, stiff joints, spastic muscles or a disabled limb. An uncommon type of pain resulting from stroke is called central stroke pain or central pain syndrome (CPS). CPS results from damage to an area of the brain called the thalamus, which is involved with sensory perception and movement. The pain is a mixture of sensations, including heat and cold, burning, tingling, numbness, and sharp stabbing and underlying aching pain. It is intense in the area affected by the stroke, such as the face, extremities or trunk on one side, and is made worse by movement and temperature changes, especially cold temperatures. Unfortunately, since most pain medications provide little relief from these sensations, there are very few treatments or therapies to combat CPS.

Rehabilitation is vital to stroke recovery. Stroke is the number-one cause of serious adult disability in the U.S. and worldwide, but most people with stroke have some recovery of function. Ongoing research in this area has developed several potential approaches and therapies to help rehabilitate people after stroke.

• Physical therapy is the main form of rehabilitation for most people with stroke. The aim of physical therapy is to help people relearn simple motor activities such as walking, sitting, standing, lying down and the process of switching from one type of movement to another. To achieve this, physical therapists use training and exercises to restore movement, balance and coordination. In one NINDS-supported stroke rehabilitation study, researchers compared at-home physical therapy to a locomotor training program using treadmill walking with body weight support followed by walking practice. The Locomotor Experience Applied Post-Stroke (LEAPS) trial found that people who had a stroke and had physical therapy at home improved their ability to walk just as well as those who were treated with the locomotor training program. Study investigators also found that patients continued to improve up to one year after stroke, defying conventional wisdom that recovery occurs early and largely ends at six months.
• Occupational therapy helps people relearn the skills needed to perform everyday activities such as eating, drinking and swallowing, dressing, bathing, cooking, reading and writing, and toileting. This type also involves exercise and training. Occupational therapists can recommend home or workplace modifications to better help the person resume living an independent or semi-independent lifestyle.
• Speech therapy helps people with stroke relearn language and speaking skills or learn other forms of communication. Speech therapy is appropriate for people who have no problems with cognition or thinking but have problems understanding speech or written words, or problems forming speech. Speech therapy also helps people develop coping skills to deal with the frustration of not being able to communicate fully. With time and patience, speech therapy can help a stroke survivor regain some, and sometimes all, language and speaking abilities.
• Vocational therapy helps people return to the workforce. Approximately one-fourth of all strokes occur in people between the ages of 45 and 65. For most people in this age group, returning to work is a major concern. It may involve relearning the more complex skills that were performed on the job or learning new skills for a different job. Vocational therapists can help people with lasting disabilities identify job skills and strengths and look for new work opportunities if necessary.
• Psychological or psychiatric therapy can assist many people as they recuperate from stroke. Depression, anxiety, frustration and anger are common disabilities in people with stroke. Therapy, along with medication, can help ease some of the mental and emotional problems that result from stroke. Sometimes it is useful for family members to seek psychological help for themselves, as well.
• The U.S. Food and Drug Administration (FDA) approved the Neurolutions Upper Extremity Rehabilitation System for individuals aged 18 and older with upper arm disability who are undergoing stroke rehabilitation to increase range of motion and grasping. The brain-computer interface uses non-invasive electroencephalography electrodes to record brain activity, which is then wirelessly conveyed to a tablet for the analysis of the intended muscle movement, and a signal is sent to a wireless electronic hand brace, which in turn moves the person’s hand.
• The FDA approved the MicroTransponder Vivistim Paired VNS (vagus nerve stimulation) System, which is to be used along with stroke rehabilitation to help individuals who have moderate to severe impaired upper limb and extremity motor defects caused by a chronic ischemic stroke. The system electrically stimulates the vagus nerve, which runs from the brain down to the abdomen, to improve upper limb and extremity motor function and to improve an individual’s ability to move the arms and hands.

Consider participating in a clinical trial so clinicians and scientists can learn more about stroke and related disorders. Clinical research uses human volunteers to help researchers learn more about a disorder and perhaps find better ways to safely detect, treat or prevent disease.

All types of volunteers are needed—those who are healthy or may have an illness or disease—of all different ages, sexes, races and ethnicities to ensure that study results apply to as many people as possible, and that treatments will be safe and effective for everyone who will use them.

For information about participating in clinical research, visit NIH Clinical Research Trials and You. Learn about clinical trials currently looking for people with stroke at Clinicaltrials.gov.