Advances in stroke recovery are squandered by shortage of therapy in the British NHS
Orlando Swayne, consultant neurologist and co-leader of a pioneering neurorehabilitation unit at the National Hospital for Neurology and Neurosurgery in London, warns that society could be facing a future disability crisis.
The doctor, who is also the author of the book “How to Use a Fork: Stories of Mending the Broken Brain”, argues that recent therapeutic advances have made treatment more effective than ever. However, access to these interventions is decreasing, posing an increasing risk.
Claire, a mother of three in her late 30s, suffered a ruptured artery at the base of her brain during an outing with friends. Taken to hospital, she underwent surgery to relieve pressure on her brain and spent months in intensive care. When she arrived at Swayne’s unit, months later, she was seriously compromised: she could not speak, had limited mobility and responded little to stimuli.
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Challenges in treatment and life with brain injury
Experts question whether a patient with such profound impairment could improve significantly so long after the event. Swayne, however, has seen improvements in similar cases over the years, especially in those receiving intensive therapy with specialized professionals.
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He says that, initially, medical training suggested that damaged brains did not recover. Over time, as he followed patients long-term, he realized that those who made progress were those who worked with therapists. This led him to study neuroplasticity, the brain’s ability to form new connections and reorganize itself.
Stroke is one of the leading causes of disability in adults in the UK. The condition occurs when a blood vessel becomes blocked or ruptures, depriving the brain of oxygen. Brain cells die quickly, which can cause paralysis, loss of speech, vision problems, cognitive and personality changes, among other effects.
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Many patients show small improvements in the first few weeks as the swelling subsides. Old views limited expectations to this early period. Today, it is understood that brain damage activates neuronal growth processes similar to those in the developing brain. Surviving neurons create new connections to bypass the damaged tissue.
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Neuroplasticity is most intense in the first months after the event, but does not disappear completely. Studies indicate that intensive therapy can bring gains even 18 months after a stroke. In Claire’s case, positioning sessions, stretching, mouth, tongue and voice exercises, followed by music therapy, were fundamental.
Over time, she began to respond more, express herself verbally and use her right arm with greater skill. He was able to interact with his children, play games, cook with help and use a motorized wheelchair, transforming his quality of life despite persistent limitations on his left side.
Other patients in Swayne’s book illustrate the process. A vicar who lost his speech after a stroke has reconstructed tongue movements and swallowing. A mixologist relearned basic tasks like brushing his teeth. A roofer who fell from a height worked attentively and multitasked in the kitchen.
Mechanisms of neuroplasticity involve neurons in the motor cortex that, after injury, relax inhibitions and recruit neighbors for new functions, with intense training. Not everything is reversible, especially when connections are lost entirely, but distributed networks allow for some flexibility.
Swayne emphasizes that not everyone recovers fully, but early, targeted and intense therapy can bring about significant changes. He argues that there is a moral and economic obligation to provide this care, preventing a “time bomb” of social and medical deficiencies.
