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A Canadian research group has found evidence not only that doing more exercise is associated with greater gains in function and motor recovery but that cardiorespiratory exercise aids stroke recovery by promoting neuroplasticity.

Despite the benefits of cardio exercise early post-stroke, physiotherapists perceive that people who have had a stroke have rehabilitation goals related to improving physical function rather than addressing physiological impairments underlying function such as low cardiorespiratory fitness, which leads them to de-prioritize cardio exercise during limited therapy time.

Few clinical trials investigating the benefits of doing cardio exercise during stroke rehabilitation on functional recovery have been conducted to date but systematic reviews have reported that people with stroke who complete cardio exercise experience improved certain aspects of cognitive function, such as attention and processing speed, but not memory, problem-solving, executive function, or working memory.

Providing further evidence for a link between cardio exercise and improved outcomes, the group found that higher total time spent in cardio exercise correlated with greater improvement in total FIM (Functional Independence Measure), FIM motor and cognitive sub-scores, FAC, and CMSA arm, leg, and foot scores. These results indicate that a higher dose (ie, increased duration) of cardio exercise could lead to greater gains in functional independence.

Sarah Thompson, Augustine J. Devasahayam, Cynthia J. Danells, David Jagroop, Elizabeth L. Inness, Avril Mansfield,
Cardiorespiratory exercise during rehabilitation is associated with improved functional recovery early post-stroke: A cohort study,
Annals of Physical and Rehabilitation Medicine, Volume 68, Issue 8, 2025.

Read more at https://www.sciencedirect.com/science/article/pii/S1877065725000715

A new “orange” ambulance category will be introduced in Wales this winter to improve emergency care for stroke patients currently grouped within broader amber calls. Under the new system, specialist nurses and paramedics will screen 999 calls to identify patients with stroke or STEMI heart attacks—where blood flow to the heart is completely blocked—who need a faster response and specialist care before arriving at hospital.

The aim is to better direct time-critical cases to specialist pre-hospital treatment. Stroke patients are currently within the amber category, which covers about 70 per cent of all 999 calls in Wales. The new orange category will not have a specific response time target, but average and longest response times will be recorded, along with the type and quality of care provided before hospital arrival.

Alongside orange, two additional categories will replace the current amber group: yellow, for cases requiring further clinical assessment to determine the best response, and green, for issues such as blocked catheters that may need community care or planned transport. The changes follow updates earlier this month to how the most urgent 999 calls are categorised. A purple category was introduced for patients in cardiac or respiratory arrest, and a red emergency category for cases such as major trauma. These categories carry a target average response time of six to eight minutes. A “video triage” pilot scheme is also underway in five areas, allowing paramedics to consult hospital stroke specialists in real time before the patient arrives.

Balance and gait are essential components of functional movement, yet balance and mobility problems are among the most frequent and disabling effects of stroke, with 7 in 8 strokes affecting those over 44 years of age. Balance (both standing and walking) training is the only effective treatment for balance disorders, as recommended by both ARNI and the National Institute for Health and Care Excellence (NICE) UK.
The evidence shows that training balance and gait during stroke rehabilitation is crucial for improving a patient’s mobility, reducing the risk of falls, enhancing their quality of life, promoting brain plasticity, and preventing secondary complications.
By incorporating these activities into a rehabilitation programme, stroke survivors can improve their overall recovery, regain their independence reducing feelings of depression, while increasing participating in daily and social activities, and improving their quality of life.
Join in to current UCL Research to Improve Rehabilitation of Stroke Survivors and complete a home-based balance rehabilitation programme using augmented reality, with body motion tracking for real-time feedback.
Email study co-ordinator Brooke Nairn now: you will be required to attend the clinic for pre and post study assessments, at 33 Queen Square, National Hospital for Neurology and Neurosurgery (NHNN), WC1N 3BG. The 9-week intervention will then take place in the comfort of your own home with remote monitoring by a trained physiotherapist.

A new study finds that people who have this type of stroke may also have prolonged fatigue lasting up to one year.
Dr Modrau at the Aalborg University Hospital and his team’s study (published in Neurology®) shows that a TIA, also known as a mini-stroke (typically defined as a temporary blockage of blood flow to the brain that causes symptoms that go away within a day), shows an association with lasting fatigue.
People with a transient ischemic attack can have symptoms such as face drooping, arm weakness or slurred speech and these resolve within a day. However, a significant number report continued challenges including reduced quality of life, thinking problems, depression, anxiety and fatigue.
The study, involving 354 people with an average age of 70 who had a mini-stroke, were followed for a year. Researchers looked at how many participants experienced fatigue as defined as a score of 12 or higher. Of the participants, 61% experienced fatigue two weeks after the mini-stroke and 54% experienced fatigue at each of the three other testing time periods at three, six and 12.
It was found that for some people, fatigue was a common symptom that lasted up to one year after the transient ischemic attack.
ARNI Rehab says: for future studies, people diagnosed with a transient ischemic attack should be followed in the weeks and months that follow to be assessed for lingering fatigue. This could help researchers better understand who might struggle with fatigue long-term and require further care.

A just-published systematic review and meta-analysis confirms the reason why, since 2001, one of the 3 parts of ARNI rehab has ALWAYS been (stroke-specific) strength training. Just published in the BMJ’s British Journal of Sports Medicine the review, entitled ‘Prescribing strength training for stroke recovery’ concludes that:

‘Training alone or combined with usual care improves stroke recovery outcomes and more frequent strength training, power-focused intensities and traditional programme designs may best support stroke recovery’.

More frequent strength training, traditional strength training programmes and power-focused intensities (ie, emphasis on movement velocity) were also positively associated with walking capacity, health-related quality of life and fast-paced walking speed.

(Eight electronic databases (MEDLINE, EMBASE, EMCARE, AMED, PsycINFO, CINAHL, SPORTDiscus, and Web of Science) and two clinical trial registries (ClinicalTrials.gov and WHO International Clinical Trials Registry Platform) were searched from inception to 19 June 2024. )

Noguchi KS, Moncion K, Wiley E, et al. Prescribing strength training for stroke recovery: a systematic review and meta-analysis of randomised controlled trials. British Journal of Sports Medicine 2025;59:185-197.
https://bjsm.bmj.com/content/59/3/185

Incorporating higher-intensity walking into early stroke rehabilitation significantly improves patient outcomes, including mobility and quality of life; new research suggests that higher-intensity exercise, including walking, during the initial phase of stroke rehabilitation leads to better recovery outcomes.

A specific protocol called “Walk ‘n Watch” has been developed to increase the intensity of walking exercises in stroke rehabilitation.

This protocol has been successfully implemented in real-world rehabilitation settings, demonstrating its feasibility and effectiveness in improving patient mobility and quality of life. Patients who participate in this higher-intensity walking program show improvements in walking distance, speed, and overall quality.

The study also found that stroke patients in inpatient rehabilitation following the implementation of high-intensity stepping training took significantly more steps per day compared to those receiving usual care.

These improvements are not only statistically significant but also clinically meaningful, indicating a tangible difference in patients’ ability to walk and perform daily activities. Click to Walk n Watch for more.

These can all be achieved by you to a certain degree, however old you are, if you want them badly enough and are prepared to sacrifice some time and effort.

Can a generic programme be created? For example, is there one ‘programme’ that will fit everyone? It would be much easier that way, right? The simple answer is ‘no’. But there are many things that all stroke survivors must do, and many things that most will need to do.

The ARNI Approach preaches the superiority of simplicity and slow and steady mini-successes over the fast talk, fast supply, fast gains and fast losses that seem to characterise modern life and by extension, how you view stroke recovery. It needs no special preparation to understand, and can be accessed regardless of present activity level. Each exercise has enough variety and progressions attached to keep you challenged and incrementally recovering.

Remember, this ‘retraining’ can phase into an enjoyable and social physical activity wherein you are actively rehabilitating. So encouragingly, it seems that ‘formal training’   is finite… but it must be done right. And try to grow to enjoy your rehabilitation now, strange though this may seem. For you will be harnessing the tension and release of your own creative force during the process. To be aware of this is an amazing thing.

Stroke, however, can rob you of the ability to enjoy life much and may leave you with a host of emotions, none of which are likely to help you feel like being creative. Equally you may think that ‘enjoying rehabilitating’ is a silly notion, what with everything you’ve been through. We hope that starting ARNI retraining with a trainer or just by yourself with the help of Successful Stroke Survivor, Had a Stroke? Now What and/or the 7 ARNI anytime-view streaming videos playable from dashboard (see the Product section  to inspire you to examine your limitations and get to grips with them yourself by being proactive. Everything you do will rewire your brain: by doing more, you WILL incrementally develop more motor control and gain strength. You will ‘get nothing by doing nothing’. 

Loss of arm function is a very common problem after stroke. A well-known feature that can creep in is called ‘learned non-use’, where the stroke survivor quickly gets very good at doing most reaching, grasping and releasing tasks with their less-affected, functional arm… ultimately him or her to forego efforts to improve the more-affected arm. Which is not good at all.
Stroke survivors really want to know therefore whether intensive rehabilitation really does improve their upper limb motor control processes and reduce their impairments. And if it does, how should they go about getting this/doing it?
There is converging evidence that more therapy might result in better outcomes: current evidence suggests that intensive rehabilitation therapy helps people regain movement in their affected arm in the first few months after stroke. However, stroke survivors get to believe that little (if any) improvement can be made later on, which is sad, because we know this is not true.
Regaining lost movement may be possible many years after suffering a stroke, thanks to intensive rehabilitation therapy methods and inclusion of some principles, concepts and augments into rehab programmes. With the right therapy/retraining combinations (note the available ARNI intervention), people can see improvements in movement, everyday function, and quality of life.

This is quite an alarming finding; for the first time, the cognitive decline rate after a mini stroke has been found to be the same as a full stroke.

Mini strokes, as you know, are events during which a brain region is temporarily deprived of oxygen, most often for only few minutes, and are without a lesion on brain MRI scans.

Researchers at the University of Alabama at Birmingham evaluated TIAs’ effect on cognitive function and found a correlation between TIAs and future cognitive decline. While TIA participants were less impaired than stroke participants, results showed the two groups have the same rate of cognitive decline after their cerebrovascular event. Results have just been published in JAMA Neurology.
Mini strokes are often viewed as relatively benign cognitive events that have minimal impact on long-term health besides an increased risk of a full stroke, This study suggests that TIAs are important medical events that affect long-term cognitive outcomes.
Previous research showed reduced cognitive function following a TIA. However, the studies did not have measurements of cognition before the TIA, and additional vascular risk factors were not adjusted or excluded. In the absence of the pre-TIA cognitive baseline, this created uncertainty about whether cognitive decline after the TIA was related to the actual TIA event.
“Clinically, TIA patients should be carefully evaluated for physical and cognitive changes at the time of the event and evaluated over time for potential cognitive decline,” Del Bene said. “Future research should also focus on the mechanisms by which a TIA and causes cognitive decline. Ultimately, it could broaden how we define stroke, which would change established clinical and research guidelines.”
Hence the real importance of knowing the signs of strokes and TIA, such as FAST. As soon as symptoms appear, even if temporary, call the emergency service. A TIA is often associated with a larger stroke within 30 days, especially the first 72 hours. Earlier intervention improves the likelihood of preserving brain function and reducing long-term disability.

Del Bene VA, Howard G, Gropen TI, et al. Cognitive Decline After First-Time Transient Ischemic Attack. JAMA Neurol. 2025;82(4):323–332. doi:10.1001/jamaneurol.2024.5082

https://jamanetwork.com/…/jama…/article-abstract/2830012

A pioneering health tracker being developed for stroke survivors will use the body to transmit data and accurately monitor progress, particularly to encourage spasticity & flaccidity decline.
A team of researchers in the United States are developing a revolutionary way of tracking body movements using Body Channel Identification sensing technology.
There are three components to this – small tags, or ‘smart stickers’, which are placed on everyday objects around the home; these are activated by a wearable wrist device; these are connected by the wearer’s body to create a closed-loop circuit.
This system can help give a comprehensive picture of a survivor’s movement post-stroke, and is currently being trialled in the world-leading Shirley Ryan AbilityLab.
“Human skin is made out of conductive material, so you can think of it as a wire,” Dr Lee explains.
“We were the first group that has demonstrated that humans can be actually used as the power transfer medium. And if the power can be transmitted, that means data can be also transmitted because the wire is the same wire.”
Through accurately monitoring mobility, it can support patient progress, he adds, especially when the survivor returns back to the community again.


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