Post-stroke REhabilitation Start Evaluation for Reducing Vascular Events

What this study is about

The purpose of this research study is to better understand when to start rehabilitation therapies after acute ischemic stroke to prevent further harm to the brain and to improve outcomes for stroke survivors. Stroke is the second leading cause of death and reduced quality of life worldwide, with one Canadian diagnosed with stroke every five minutes. The most common subtype, ischemic stroke, occurs when a blood vessel in the brain is blocked. Hyperacute treatments aim to remove these blockages to restore blood flow and improve deficits, but in some cases, this is not achieved and leads to persistent large or medium intracranial vessel occlusion. After stroke, early medical and physical care can reduce physical and cognitive impairment and improve long-term functional outcomes. Prolonged immobilization can cause secondary complications and make recovery more difficult. Other research studies have demonstrated varying results with both benefit and no difference in the long-term level of functional independence when starting physical activity between 24 to 48 hours after acute ischemic stroke. The optimal timing for mobilization is unclear especially for patients with persistent vessel occlusion large stroke size, or intracranial hemorrhage, where starting active therapy too soon can cause additional harm by damaging the brain further. In this research study, the investigators aim to evaluate the feasibility and effect of delayed mobilization (DeM), defined as physical therapy starting on or after day 3 from stroke symptom onset, on stroke volume growth and functional outcomes in patients with persistent vessel occlusion. The investigators think that individuals who still have evidence of persistent blockage in their arteries may benefit from waiting until day 3 after stroke to begin rehabilitation. Improving care strategies for stroke survivors will ultimately benefit individuals, their families, and healthcare systems. This study may guide the optimal timing of initiating stroke rehabilitation in patients with persistent vessel occlusion and ischemia to improve recovery times and reduce long-term disabilities.

Who can join (things the study team will check)

✅ You may be able to join if…

• Participants with acute ischemic stroke presenting to Foothills Medical Centre meeting eligibility for intravenous thrombolysis (Tenecteplase, TNK) - ≥18 years of age presenting within 4.5 hours of symptom onset with a diagnosis of suspected acute ischemic stroke causing significant neurological disability - and/or endovascular thrombectomy (EVT).
• Age ≥18 years.
• Persistent vessel occlusion will be defined as any of the following:
  • EVT treatment of medium or large intracranial vessel occlusion with a thrombolysis in cerebral infarction (TICI) score of ≤2b.
  • A moderate infarct core (ASPECTS ≤5) despite TICI 3.
  • 24-hour CT with evidence of hyperdense sign appropriate to clinical deficits.

🚫 You may not be able to join if…

• Comorbid conditions limiting recovery or life expectancy (e.g., significant cognitive impairment, stage IV cancer, end-stage renal disease).
• Low pre-stroke baseline functional status (mRS ≥4).
• Symptoms due to another acute neurological condition (e.g., migraine with aura, seizure) or neurological deficits secondary to metabolic/toxic derangements (e.g., hyponatremia, hypoglycemia).

Where this trial is running

• Foothills Medical Centre, Calgary, Alberta, Canada