ESOC 2026 | Under-recognized challenges in stroke recovery and approaches to improving patient care

I think that some of the most under-recognized challenges in stroke recovery are often those that are kind of invisible. They have a delayed response or they have a kind of psychosocial aspect rather than physical. And that really changes how we need to think about care. So traditionally stroke services have focused very successfully on acute stroke care and physical recovery but many of the problems that matter most to people who actually suffer a stroke emerge later and they’re much less obvious. So for example mood problems like depression and anxiety, they’re incredibly common, but they’re often missed, especially early on when people seem to be coping. So in the COMMITS study, we actually saw that mood worsened in the early weeks after a stroke across all the groups. And this was in a population with relatively mild stroke. There’s also things like fatigue, which patients often say is one of the most debilitating symptoms that they suffer. And at the moment, we still don’t really truly understand the mechanisms and we don’t know how best to manage it. And then there’s other subtle cognitive and communication difficulties like attention, social communication, processing, which don’t always show up in routine assessments that we do, but have a huge impact in terms of confidence, relationships, returning to normal life after a stroke. And on top of that, there’s complications. So things like incontinence aren’t really very well covered in terms of rehabilitation, but are strongly linked to poorer outcomes, lower quality of life and mortality and can really impact people’s dignity, their ability to go out and socially interact with other people and their independence. And actually at ESOC, I co-chaired a session called Beyond the Obvious, which focused exactly on these kind of hidden challenges. So we touched on issues like neglect, cognitive complexity, communication challenges, facial palsy. And one of the key themes running through all of them is that it didn’t just affect people’s function, it affected how people saw themselves. So things like changes in speech or facial movement impact body image, self-esteem, identity. And that’s often what patients tell us matters most, but we don’t always measure it. We don’t always address it well. So I think in terms of meeting these challenges, we need to do things differently. We need to look beyond assessing people at a single time point. We need to build in ongoing identification and screening for these issues because many of them develop over time. I also think we need to normalise and embed early psychological support for people, even those who seem well, because some of this is about prevention rather than just treatment. And I also think that we need to have a truly holistic multidisciplinary approach where things like psychological health, communication, cognition are seen as core parts of recovery and not just the optional extras. And finally, and perhaps the most important, I think we need to focus much more on what matters to the person, their confidence, their identity, their ability to participate in life. And that’s not just about physical function. So I think really the message for me is that recovery after stroke isn’t just about getting people moving again. It’s about helping them to rebuild their lives. And that means paying much more attention to those challenges I’ve just mentioned that are often really easy to miss.

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