The (small) secretariat of the Swedish Stroke Register is governmentally supported and part of the country’s social medicine principle. For the registration at the hospitals, each unit covers its own cost as part of the healthcare system.

The post-stroke checklist is only a tool and what counts is which actions the post-stroke checklist leads to in the next step. Just ticking off the items in the post-stroke checklist is not enough

This has not been analysed in detail so far, but at this stage, we have not found any differences

In Sweden we recommend three to six months for the follow up, recognising that a structured systematic follow up is not yet in place and that it is difficult to be very strict on the exact timing. Still receiving therapy eg speech therapy or physiotherapy would not hinder a systematic follow-up visit in my view, since there are so many domains to follow up.

Yes. The Stroke Association’s Stroke Recoveries at Risk report stroke.org.uk/sites/default/files/campaigning/jn_2021-121.1_-_covid_report_final.pdf, published September 2020, shows that 7 in 10 stroke survivors report feeling more anxious or depressed recently, 45% of all stroke survivors now feel less able to cope with the impacts of their stroke, and over a third (37%) report feeling abandoned. We know that access to rehabilitation and support - already very patchy across the UK - was hampered by the pandemic. For example, our SRAR report shows that 57% of stroke survivors had appointments related to their stroke cancelled or postponed, and 55% had therapy cancelled or postponed. 39% of stroke survivors who had their stroke last year said they had not received enough rehabilitation therapies. We are committed to understanding the longer-term impact of the pandemic on stroke survivors as Covid-19 cases fall, and the backlog of rehabilitation and support needs there may be as a result. The Stroke Association has also committed to maintaining its two new Covid services into the long term: Stroke Connect - a phone support and signposting service for those newly discharged from hospital stroke.org.uk/professionals/stroke-association-connect, and Here for You - a volunteer phone support service to help reduce isolation and feelings of abandonment - stroke.org.uk/finding-support/here-for-you

I agree that there is a skill in handling conversations and therapy provision remotely. You need both the service user to be confident with the digital medium so that the technology is not creating a barrier, and then you need a skilled therapist who is able to adapt their approach to the digital medium as well. So, it will be a case going forward of ensuring that both are enabled/upskilled - the service user to access the technology and the therapist to adapt provision to the technology.

Although there have been government and academic-led reports on the experiences of ethnic communities related specifically to Covid-19, unfortunately there is limited information regarding the experience of BAME communities in accessing stroke services during this time. Our Stroke Recoveries at Risk report did include responses from people from BAME communities, however the number of responses was not significant enough to draw any specific conclusion. This lack of data is something we are acutely aware of at the Stroke Association and over the next six to 12 months we will be developing our strategy related to tackling health inequalities across the whole stroke pathway. An important part of this will be co-creating our strategy with people from these communities to understand the barriers and challenges they face, so that we can start addressing these and influencing for action.

We need to carefully evaluate all the innovations adopted during the coronavirus pandemic. However, I think it is likely that therapy provision will become a hybrid model in future, with face-to-face provision at the beginning, then ongoing remote rehabilitation for those who prefer or can benefit from this channel. However, we must not under-estimate the power of face-to-face therapy provision, particularly for those with aphasia and cognitive impairment who currently experience digital exclusion.

The Stroke Association’s My Stroke Guide tool has accessible articles and videos with information about sex and relationships:

https://mystrokeguide.com/advice-and-information/physical/sex/advice

Different Strokes (a UK charity for younger stroke survivors) has a booklet and series of videos:

https://differentstrokes.co.uk/stroke-information/sex-and-relationships/

To manage limited mobility and spasticity, it is generally suggested that stroke survivors lie on the affected side. There are specific suggestions for positions in articles like this one:

https://pubmed.ncbi.nlm.nih.gov/27611652/

We can encourage people to experiment and find out what works for them, which can be fun way to bond with each other.

We can connect with our loved ones in lots of different ways, sometimes without words or with simple actions. Try to be creative and experiment to find new things that help you feel like a couple. This may take persistence and you may feel grief for things you have lost, so speak to your doctor or stroke team about emotional support that is available. It may help to think about things that brought you together. For example, if you both have a love of music, is there a way you can still enjoy that together?

Talk to your doctor for reassurance that you are doing everything possible to control your risk of stroke. The Royal College of Physicians (UK) guidelines state that stroke survivors can be reassured that sex is not contraindicated after a stroke and is extremely unlikely to cause another stroke. Consider making a decision not to have sex at first. You can build up to this with other forms of intimacy at a pace you feel comfortable with. Some stroke survivors have spoken about the need to balance carefulness with persistence, so do keep trying.

I think there is no perfect timing... The most important thing is that there is desire on both sides and that the limits (if any!) of each one be respected. In my case, making love to my husband again contributed to increase my confidence in rehabilitation and, without a doubt, it made me feel like a woman, sexually attractive, despite the sequels of stroke.

After suffering a stroke my mobility was very compromised, my sensitivity too and the fear of suffering a new stroke was always latent. I think it would have been important to be accompanied by a sex therapist, just as I was by a psychologist or a nutritionist. Sexual health is often underestimated! And, in my opinion, this should not happen, not least because the healthy balance of our mental health is closely linked to the degree of satisfaction we derive from our sex life. That is my personal opinion!

In the acute phase of stroke, talking about intimacy or sex might be unreasonable. But during the long months that I was hospitalised in the rehabilitation clinic, with intensive sessions of physiotherapy, occupational therapy, psychology and activities of daily living, it would have been very positive to speak with a sex therapist about my fears... When the doubts are many and the embarrassment does not let us talk sincerely, Google can be the only source of answers. Perhaps not always the most suitable ones.

Intimacy does not necessarily involve another person ... And if it is true that exchanging caresses with those we like is very pleasant, masturbation can also be very satisfying. There is no better feeling than to feel good about ourselves, with all our faults and virtues. If we do not like ourselves, we are unlikely to empathise with each other ... Alone or with a partner, the most important thing is to feel happy with the choice you make.