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The emergence of neuromodulation therapies, which aim to enhance the brain’s intrinsic capacity for recovery (neuroplasticity), offers new avenues for improving outcomes in chronic stroke. One such device is the Portable Neuromodulation Stimulator (PoNS) developed by Helius Medical Technologies. The PoNS device utilises a novel, non-invasive method of translingual neurostimulation (TLNS) to augment the effects of physical rehabilitation.

The PoNS device consists of a handheld controller and a mouthpiece with a matrix of 143 gold-plated electrodes. When placed on the tongue, these electrodes deliver gentle electrical stimulation that activates cranial nerves V (trigeminal) and VII (facial). These nerves possess rich neural connections to the brainstem and cerebellum, key regions for regulating motor control, balance and coordination. The stimulation generates a cascade of neural impulses that travel to these areas, promoting neuroplastic changes within the central nervous system. When coupled with targeted physical therapy, this amplified neural activity is believed to facilitate the formation of new neural pathways, allowing the brain to compensate for damage sustained during a stroke. This process supports the retraining of motor skills and the recovery of lost function.

For stroke survivors, the PoNS device is integrated into a structured, intensive 14-week therapy program that combines both in-clinic and at-home use. Under the guidance of a trained therapist, patients engage in exercises focused on improving gait, balance, motor control and breathing. The PoNS device is typically used during these sessions, with the intensity of the stimulation adjusted by the patient based on their tolerance. Over the course of the therapy, the device helps maximise the neuroplastic benefits of the rehabilitation program. A key aspect is its portability, which allows for consistent, high-frequency rehabilitation outside of a clinical setting, empowering patients to take an active role in their recovery.

Clinical trials have indicated that the combination of PoNS therapy and physical rehabilitation can lead to significant improvements in functional outcomes for stroke survivors, particularly in gait and balance. For instance, a recent study demonstrated clinically meaningful improvements in gait speed and function in chronic stroke patients.

The availability of the PoNS device for stroke survivors varies significantly by region, as its approval is dependent on regulatory bodies.

• UK & Europe: In the UK and throughout the EU, the PoNS device is still considered an ‘investigational medical device’; meaning it is undergoing review by regulatory bodies and is not yet approved for general sale.
• Canada: The PoNS device has been authorised for use in Canada for treating gait and balance deficits associated with stroke, traumatic brain injury (TBI) and multiple sclerosis (MS). Canadian stroke survivors who meet the eligibility criteria can access the device in authorised clinics as part of a supervised rehabilitation program.
• United States: As of late 2025, the PoNS device is not yet approved by the Food and Drug Administration (FDA) for stroke rehabilitation and remains an investigational device for this specific indication. Helius Medical Technologies submitted an application to the FDA in September 2025 for its use in chronic stroke patients, supported by data from its Stroke Registrational Programme. FDA approval for stroke is pending. It is, however, FDA-authorised for gait deficit in MS patients in the U.S.
• Other Regions: The PoNS device has also been approved for limited use in Australia for balance and gait issues related to MS and TBI when used alongside a therapeutic exercise programme.

The PoNS device represents an innovative application of non-invasive neurostimulation to enhance neuroplasticity and improve functional outcomes for stroke survivors. By delivering gentle electrical impulses to the tongue in conjunction with a targeted physical therapy programme, it offers a promising tool for addressing persistent gait and balance impairments. As research continues to build upon the evidence base for TLNS, regulatory approvals and broader accessibility for stroke recovery will be an important area to watch.

A new national campaign, ‘Every Second Counts,’ launched recently by the HSE in Ireland, is driving home a vital message: the moment you suspect a stroke is the moment you dial 999 or 112. Developed with the invaluable support of stroke survivors and community groups, this campaign aims to close the gap between symptom awareness and swift action.

In Ireland, the statistics are sobering; every year, approximately 7,500 people experience a stroke and over 90,000 people are living with the resulting disability. Stroke is a leading cause of acquired neurological disability in Ireland and the third leading cause of death. Despite these figures, a concerning number of patients (fewer than 50%) arrive at the hospital within three hours of symptom onset. This is a critical window for life-saving and disability-reducing treatments.

Professor Rónán Collins, HSE National Clinical Lead for Stroke, emphasises that ‘every second counts’. He notes that while public awareness of the F.A.S.T. symptoms has improved, hesitation before calling an ambulance remains a significant issue. The new campaign is designed to overcome this hesitation and ensure that immediate action is taken.

Siobhán McGrath, a 34-year-old stroke survivor, understands the importance of immediate action first-hand. As a former Dublin senior ladies’ football team player, she initially didn’t recognise the signs of her own stroke three years ago and waited before seeking help. She now knows that this delay impacted her recovery and is a passionate advocate for the campaign.

Beyond raising public awareness, the National Stroke Strategy is also making significant progress in early stroke rehabilitation. A new report, Early Supported Discharge (ESD) for Stroke 2022 to 2023, highlights the success of a program that allows stroke survivors to receive therapy, social work, and nursing support at home.

The ESD model enables survivors to leave the hospital sooner and begin their recovery in the comfort of their own homes. This not only promotes greater independence but also improves bed capacity in hospital stroke units. In 2023, over 800 people benefited from ESD, a substantial increase from 2019. The expansion of ESD teams across Ireland is a key component of the National Stroke Strategy’s commitment to delivering more care in people’s homes.

Fine Gael politician & Minister for Health, Jennifer Carroll MacNeill, underscores the severity of stroke as a medical emergency and highlights the importance of quick treatment. With stroke incidence projected to rise in the coming decades, the Irish government is investing significantly in both public awareness and expanded services. This investment is aimed at ensuring more people can not only live longer after a stroke but also live to their full potential.

For stroke survivors, recovery doesn’t end when they leave the hospital. Recognising the variation in post-hospital care, the NHS is currently running a number of pilot programmes across the country to develop new models of community-based rehab. These innovative approaches focus on integrated, high-intensity and personalised support right in people’s own homes. Here is a look at how three pilot sites are leading the way:

Northamptonshire: Fostering independence and vocational success

In Northamptonshire, the pilot programme is built on the principle of seamless, coordinated care. A multi-disciplinary team provides an integrated approach, delivering intensive rehab in the patient’s home. The programme includes specialist support to help stroke survivors return to work, with OTs and other specialists working with employers and patients to facilitate a successful return to the workplace or explore alternative roles if necessary. Services are delivered quickly, with therapeutic care beginning within 24 hours of hospital discharge. This pilot also addresses the patient’s wider needs, including psychological well-being, providing resources such as a patient forum, online communities and face-to-face support groups. Furthermore, a ‘self-directed rehab pathway’ trains staff to deliver conversational coaching, equipping patients with the skills for ongoing self-management.

North Central London: A dynamic, roving support network

The North Central London pilot takes a mobile and flexible approach to support stroke survivors. It uses a dynamic, roving team of rehab assistants who work under the guidance of senior staff. This model has a number of features that provide tailored, holistic care. The team works to help patients get home as quickly as possible and ensures their living environment is optimised for successful rehab. Assistants provide flexible, in-home therapy that is designed to provide an extended and intensive rehab experience. The team also provides advocacy and support, recognising the wider impact of stroke on both the patient and their loved ones.

Northumbria: Prioritising psychological well-being

The Northumbria pilot site is addressing a crucial yet often overlooked aspect of stroke recovery: psychological well-being. The programme focuses on ensuring mental health receives the same priority as physical recovery, offering a number of services to achieve this. A senior clinical psychologist has been employed to oversee the service, providing expert support for survivors’ psychological needs. The pilot offers enhanced peer support to both patients and their families and carers, which provides a crucial network for sharing experiences and offering mutual encouragement. Northumbria is also extending and expanding its Early Supported Discharge services, allowing more patients to receive intensive rehab in the comfort of their own homes.

Each of these pilot sites offers a unique and valuable perspective on how to improve community-based stroke rehab. While the approaches differ, they share a commitment to more intensive, integrated, and out-of-hospital care. The robust evaluation of these programmes will provide crucial evidence to inform the future development of national stroke services, helping to improve outcomes and quality of life for UK stroke survivors.

The integration of Neuromersiv’s ‘Ulysses’ system represents a significant advancement in the tech-for-stroke space, offering a dedicated VR solution for upper-limb. The system’s design and therapeutic approach align with core neuroscientific principles, particularly concerning task-specific training, repetition, and motivation…

The Neuromersiv ‘Ulysses’ system is designed to be used by stroke survivors in a structured, repetitive, and highly engaging manner, ideally with guidance from a trained clinician. The therapy focuses on functional tasks in a virtual environment to promote neuroplasticity.

The process begins with a therapist assessing your specific needs and upper limb impairment. This determines the appropriate rehabilitation goals and how the system will be integrated into your overall therapy plan.

You then put on a wireless VR headset, such as a Meta Quest 2. The system uses the headset’s built-in hand-tracking technology, which means you don’t need to hold bulky controllers. Then, a virtual assistant within the software guides you through every step, making the process accessible even for users with no prior VR experience.

The core of the therapy involves engaging in simulated ADLs within a realistic virtual environment. The tasks are designed to be challenging but fairly fun, like washing dishes, sorting cutlery, and organizing cupboards and engaging in personal care activities. The tasks are all gamified with reward systems that encourage you to keep going and achieve your goals, providing a motivational boost that is often lacking in traditional therapy.

The system can track your movements in real-time and some users can also incorporate haptic gloves, to provide sensory feedback and assist with muscle activation. For survivors with more severe impairment, the system can be combined with a sleeve containing FES electrodes. The FES helps activate and strengthen muscles you can’t move voluntarily. For example, if you’re trying to grasp a virtual object but can’t, the FES can assist the movement, creating a feedback loop that helps the brain form new neural pathways.

The therapist can use a web-based dashboard to track your progress over sessions, which allows them to monitor your performance and adjust the therapy plan to best suit your needs. The system also allows clinicians to livestream your virtual reality experience to a phone or tablet. This enables them to provide remote assistance and guidance during home-based therapy sessions. Sessions are typically repetitive and intensive to maximise their effect on plasticity. For example, a pilot study used 25 sessions of 45 minutes over several weeks. If you’re interested in using the Ulysses system, the best first step would be to talk to your OT or physiotherapist. They can help determine if this technology is suitable for your specific needs and rehabilitation goals.

The Ulysses system is now commercially available in both Australia and the UK, following registration as a Class 1 software medical device with the UK’s Medicines and Healthcare products Regulatory Agency (MHRA). Neuromersiv has adopted a multi-tiered commercialisation strategy, focusing primarily on institutional sales to rehabilitation clinics and hospitals. This approach facilitates broader access through established healthcare providers, leveraging clinical oversight and integration into existing therapy programs.

Neuromersiv also offers access directly to individual end-users (B2C), a development with significant implications for home-based neurorehabilitation. The company’s co-founders have indicated a commitment to affordability, offering flexible monthly leasing options alongside direct purchase to make the system more accessible. However, specific, publicly listed costs for individual purchase or leasing are not readily available online and require direct contact with the company for a quote. This pricing model requires stroke survivors and caregivers to actively engage with the company to understand the financial implications for home-based use.

Recent large-scale, longitudinal studies have reinforced the established understanding that hypertension is a critical antecedent to cerebrovascular events, including stroke. Contrary to the misconception that strokes can occur unpredictably in otherwise healthy individuals, observational data from vast populations indicate that almost all individuals who experience a stroke exhibit underlying cardiovascular risk factors, most notably elevated blood pressure, for years preceding the event. This extensive body of research, including cohorts followed for up to two decades, underscores the importance of long-term preventative strategies over reactive responses to acute crises.

The mechanisms linking chronic hypertension to stroke pathogenesis are well-documented. Persistent high blood pressure exerts mechanical stress on the arterial walls throughout the body, including those supplying the brain. Over time, this contributes to the stiffening and narrowing of arteries, a process known as atherosclerosis. These changes facilitate the build-up of fatty plaques, which can rupture and cause clots, leading to an ischemic stroke. In smaller vessels, chronic hypertension can lead to microvascular damage, increasing the risk of haemorrhagic stroke. The cumulative effect of these pathological processes highlights that stroke is often the culmination of a long-term, progressive vascular disease rather than an isolated, sudden episode.

This profound insight has significant implications for both clinical practice and public health policy. Traditional clinical approaches have often focused on short-term management and the immediate post-event phase. However, the data now clearly argue for a more sustained, proactive approach to hypertension management across the lifespan. Population-level screening and health monitoring programs are vital for identifying individuals with non-optimal blood pressure years before a potential stroke.

By leveraging routine health data, healthcare providers can intervene earlier with lifestyle modifications and pharmacological therapies to manage blood pressure effectively. Evidence from landmark clinical trials, such as the Systolic Blood Pressure Intervention Trial (SPRINT), has demonstrated that intensive blood pressure control (targeting a systolic blood pressure below 120 mmHg) can significantly reduce the risk of stroke and other major cardiovascular events in high-risk populations.

The message is clear: stroke prevention is a marathon, not a sprint. The groundwork for a stroke is often laid years in advance, with hypertension as a persistent and identifiable warning sign. Shifting the focus toward long-term risk factor management, guided by routine monitoring and evidence-based interventions, offers a powerful strategy to reduce the incidence and burden of stroke in the UK.

This requires a concerted effort from clinicians, public health officials, and individuals to recognise and address the silent threat of hypertension long before it manifests as a debilitating cerebrovascular event.

A team from the University of Zurich and the University of Southern California has just successfully demonstrated (in mice) that stem cell transplantation can reverse stroke damage, paving the way for a future where brain repair is no longer the stuff of science fiction. This pioneering work offers a powerful glimmer of hope for the millions of survivors who live with persistent limitations after stroke.

For years the medical community has held that brain damage caused by stroke is largely irreversible. The internal bleeding or lack of oxygen that occurs during a stroke kills brain cells, leading to lasting effects like paralysis, speech impairment and other neurological deficits. Current treatments are focused on damage limitation in the immediate aftermath of a stroke, and no therapies exist to fully repair the damage that has been done. This groundbreaking study fundamentally challenges that paradigm.

In the study, which was published in Nature Communications, researchers transplanted human neural stem cells into the brains of mice that had experienced a stroke. These stem cells, which have the remarkable ability to develop into various cell types of the nervous system, were successfully integrated into the damaged brain tissue. Over a five-week period the team observed extraordinary results. The grafted cells not only survived and matured into functioning neurons but also stimulated the growth of new blood vessels, reduced inflammation and strengthened the blood-brain barrier.

The most striking outcome however, was the functional recovery observed in the mice. Using an AI-assisted gait analysis to meticulously track the animals’ movements, the researchers confirmed that the treated mice regained motor abilities that were previously lost. This was particularly evident in tasks that required fine motor skills, demonstrating that the stem cell therapy had a tangible, real-world effect on recovery.

This research, while conducted only in a mouse model, holds profound implications for human stroke treatment. The investigators were able to confirm that the therapy was most effective when administered one week after a stroke… a timeline that would be practical for clinical use in humans. While further work is needed to ensure safety, including a mechanism to prevent uncontrolled cell growth, this breakthrough probably represents a leap forward in regenerative medicine. As ongoing clinical trials explore similar stem cell applications for other neurological diseases like Parkinson’s, the possibility of a human stroke trial draws ever closer. This leading-edge research from the University of Zurich offers genuine hope that one day the devastating effects of a stroke could be reversed, ushering in a new era of brain repair and recovery.

A recent £1.9 million investment by the Scottish Government is set to enhance stroke aftercare through the deployment of mobile heart-rate monitoring technology. This initiative, delivered via the Accelerated National Innovation Adoption (ANIA) pathway, aims to provide advanced diagnostic tools to approximately 8,000 stroke patients annually. The goal is to improve the detection of cardiac rhythm irregularities, particularly atrial fibrillation (AF), which is a significant risk factor for secondary stroke events.

The new technology involves ambulatory electrocardiogram (ECG) patch monitors. These compact, wireless and water-resistant patches are worn on the chest for up to 14 days and are designed to replace older, more cumbersome heart monitoring systems.

Clinical studies have indicated these patches are significantly more effective at detecting AF than previous methods, potentially reducing diagnosis and treatment times from several months to a few weeks. By facilitating a faster diagnosis of AF, clinicians can initiate preventative treatments more promptly, thereby reducing the patient’s risk of a recurrent stroke.

The projected outcomes of this investment are substantial. Over the next five years, it is estimated that the widespread use of these monitors could prevent nearly 700 secondary strokes and save more than 300 lives across Scotland. Beyond the clinical benefits, the initiative offers several operational and patient-focused advantages. By enabling at-home monitoring, it reduces the need for multiple hospital visits, improving patient convenience and reducing travel-related burdens.

The adoption of this technology is also expected to increase the efficiency of NHS Scotland by freeing up clinical capacity, including the equivalent of 15.7 full-time cardiac physiologists. Furthermore, the projected cost-savings for the NHS over the five-year period are estimated to be £14.6 million.

Overall, this investment represents a strategic application of innovative technology to improve patient care pathways for stroke survivors. It focuses on early and accurate detection to mitigate the risk of secondary events while simultaneously improving patient experience and operational efficiency within the healthcare system.

A new device called Neubond, a wearable technology for stroke rehab from a spin-off company formed at Imperial College is now in research & testing phase. Neubond is a closed-loop system built on a technology called Volition-Induced Paired Associative Stimulation (VIPAS). PAS differs from FES as FES is an open-loop system.

The lightweight, comfortable bracelet is equipped with tiny sensors that can detect the very subtle electrical signals your brain sends when you try to move your affected limb, even if you can’t see or feel the movement yet. At the precise moment your brain is sending that command, Neubond delivers a gentle electrical stimulation to the corresponding muscle. This reinforces the neural pathway and helps your brain re-learn. By repeatedly pairing your intention to move with the actual movement, the device essentially helps to rewire your brain, promoting plasticity and strengthening that vital brain-to-muscle connection over time.

Neubond is a discreet, comfortable wearable, therapy can happen anytime, anywhere. The user is no longer limited to short clinical sessions… this continuous, everyday practice is key to maximising ones recovery potential.

Linked to a mobile app, Neubond tracks your muscle activity and provides data-driven insights for both you and your clinicians. This makes progress visible and motivating, turning small gains into big milestones. Users in trials have reported regaining the ability to do small but incredibly significant things, like handwriting or even cuddling a grandchild. These personal victories ignite hope and show that meaningful recovery is possible.

Neubond is an exciting step forward in making neurorehab more accessible, effective, and human. The wearable is still in the testing and development phase and is not currently available for stroke survivors to purchase but as of recent reports, Neubond is working to turn its prototype into a production-ready device and conducting clinical testing to prepare for randomised clinical trials. The company plans to first release a version of the device that monitors movement intention and guides rehabilitation by providing visual feedback to the user. This version will require a less demanding regulatory process than the full therapeutic device.

Their website holds a waiting list for early access to pilot and beta testing, which you can join if you are interested in potentially participating in future trials.

The new 70-bed National Rehabilitation Centre (NRC) has been built near Loughborough (it’s in its ‘inside-fittings’ stage now) and is set to begin accepting its first patients in 2026.

It’s an NHS facility run by Nottingham University Hospitals Trust, which will offer a significantly more intensive model of care to patients in the East Midlands than is typically available; it’s going to be staffed and run by Nottingham University Hospitals NHS Trust and the idea is that it will serve as a template for other sites. While the standard NHS offering might be around 30 to 40 minutes of therapy a day, the NRC will provide up to three to four hours of rehabilitation daily.

The NRC will share facilities with the adjacent Stanford Hall Defence Medical Rehabilitation Centre (DMRC). This includes a Computer Assisted Rehabilitation Environment (CAREN), a high-tech virtual reality system to help patients relearn movement and a state-of-the-art gait lab.

The NRC is part of the government’s New Hospital Programme and is being built by the joint venture Integrated Health Partners (IHP), which includes VINCI Building and Sir Robert McAlpine, and will be run by the Nottingham University Hospitals NHS Trust. While taxpayer funds support the NRC through the government’s New Hospital Programme to the tune of £105 million, the construction is handled by the private sector and the centre collaborates with the University of Nottingham and Loughborough University for research, training, and education alongside clinical care.

Another aspect of the NRC will be its seamless integration of clinical care, research, innovation, and training. By partnering with leading academic institutions like Loughborough and Nottingham universities, the centre aims to accelerate the translation of new research into frontline patient care. For stroke survivors, this means they could be among the first to benefit from the latest innovations in rehabilitation therapy.

For decades, scientists viewed fibroblasts as little more than the structural scaffolding of the body. These cells, the most common in connective tissue, were thought to simply provide support. However, recent academic research is fundamentally changing this view, revealing that fibroblasts possess a hidden power to actively heal the brain after a stroke. These dynamic cells are now emerging as key players in the brain’s natural repair process, offering a beacon of hope for developing new therapies that could one day significantly improve outcomes for stroke survivors.

After a stroke, the brain’s delicate environment is compromised. This is especially true of the blood-brain barrier; a protective sheath that prevents harmful substances from entering the brain. In the event of a stroke, this barrier can become ‘leaky’, and fibroblasts rush to the scene to serve as the brain’s ‘plumbers’. This is where their true nature shines through. Instead of being passive support cells, fibroblasts spring into action, traveling from larger vessels to the damaged capillaries to patch up the breach in the blood brain barrier. A recent study found that these fibroblasts secrete a protein called TIMP2, a critical tool for repairing the damage and restoring the barrier’s integrity… and that by shoring up the blood brain barrier, fibroblasts help mitigate further damage and create a more stable environment for healing.

The fibroblast’s healing role doesn’t stop at mending the barrier. These cells create protective scars that stabilise the damaged tissue. This fibrotic scar tissue was once thought to be purely inhibitory to recovery, but studies show it serves a dual purpose. Early on, the scar is essential for providing structural integrity and containing inflammation. However, fibroblasts are also key to orchestrating a delicate balancing act; after the initial wound is contained, they transition to new roles, moderating the inflammatory response to ensure it doesn’t cause more harm.

In a fascinating sequence of events, some fibroblasts recruit immune cells needed for repair, while others regulate inflammation. Some even return to their original locations in the protective membranes surrounding the brain. This orchestrated and timed response suggests a sophistication previously not associated with these cells.

While much of this research is still in its early stages and based on animal models, it opens up exciting new avenues for treatment. Understanding the distinct stages of fibroblast activity, from early wound-healing to late-stage immune modulation, could guide the timing of new interventions. For example, therapies that enhance the early, beneficial scarring might be used immediately following a stroke, while those that modulate the later immune response could be used in the chronic phase.

Researchers are also exploring whether drugs already used for other fibrotic conditions, such as lung and liver fibrosis, could be adapted for brain injuries. In the long term, scientists are even exploring the possibility of directly injecting beneficial proteins like TIMP2 into the injured brain, bypassing the need for the body’s own fibroblasts to deliver them. This new understanding of fibroblasts is more than just a biological curiosity; it offers a compelling vision for the future of stroke treatment…