Redefining Stroke Recovery Beyond Physical Function: Alison Holman, PhD, FNP

Stroke recovery is often measured by physical milestones, but growing evidence suggests that what survivors feel—and whether they feel heard—may be just as important. In this video from the International Stroke Conference 2026, Alison Holman, PhD, FNP, professor and associate dean for academic personnel at the University of California, Irvine School of Nursing, discusses findings from the multicenter STRONG study examining how early post-stroke “social constraints” shape long-term outcomes.

Drawing on data from more than 760 patients, the study shows that when survivors feel uncomfortable sharing their fears, worries, or emotions with family and friends, they are more likely to experience loneliness one year later—and those social constraints are as strong a predictor of poorer functional outcomes as initial stroke severity, while also being linked to worse cognitive performance. Holman frames stroke as a traumatic life event that reshapes how people experience their bodies and the world, arguing that recovery models focused only on speed and physical function miss a critical piece of the lived experience. The conversation highlights why emotional safety, open dialogue, and supportive social environments should be considered core components of high-value, holistic stroke care.

Transcript

How does the "loneliness" mentioned in your results differ from physical isolation, especially in the context of a survivor living with family?

Loneliness is a felt experience. Physical isolation is a physical experience. You can be physically isolated and lonely. You can be physically isolated and not lonely because you have connections to other people, even though you may not be physically around them. You can be lonely and not physically isolated, and you can be lonely and physically surrounded by people. Really the 2 are different animals. They're very different animals. The loneliness is really the perceived experience of the individual, feeling like they are alone and they don't have the connections to other people in the world that they wish they would have.

In what ways do you think current rehabilitation models fail to account for the survivor’s "emotional safety" during recovery?

What my work shows is that it's very, very important to address the social needs of the patients, and that if you address those social needs, you are actually better able to address the emotional needs of the patients. Those go hand-in-hand, and the work that I presented today clearly shows that when a person is experiencing constraints on their ability to talk to other people about what they're feeling and what their worries are, their fears about the stroke, and when they can't do that, they end up more likely to be lonely later on.

Loneliness and depression are 2 birds that go together. People who experience those constraints—that inability to engage in conversation where you feel like somebody is actually, truly listening to you and engaging with you—if your social environment is constraining that, then people are more likely to be lonely and most likely more likely to be depressed. And so, it's really important to think about the social interactions and how they might impact the mental interactions and the emotional response of the patient.

Given the shift toward value-based care, how do these results argue for a more holistic definition of "successful recovery"?

Well, because we're talking about the whole person here, we are talking—we’re not talking about what's the quickest way to get rid of a clot or what's the quickest way to improve arm movement. We're talking about how we can help the patient address the concerns that come up for them when they have a stroke. It's really important for me to back up here for a moment and just say that I define [having a stroke] as a traumatic life event. It is a major trauma for people because it redefines how you experience your body in the world. And so it's very important to consider that broader, holistic approach to understanding the whole person as they are trying to cope with having the experience of a stroke.

In a model that really values value, you're more likely to have what has been shown in other long-term or life-threatening diseases: that when you are able to address the social concerns of a patient and effectively do that, you can actually improve their care, not just mentally, but also physically. And if you are able to do either of those, it's going to bring better value for the care.

As you look at the future of stroke care, what makes you most optimistic about our ability to improve the "lived experience" of survivors beyond just survival?

I have to say, I have been very impressed as I walked around this convention center to see these large poster boards of images of people talking, and the quotes right next to them are all about the experience of the stroke patient, how it's scary, and how they don't know how they're going to live in their body. It's good that that stuff, that human side of the experience of a stroke, is starting to be addressed here.

I think what gives me the most hope is when I see people addressing that. Because I think we can be really good at doing the details of the care. Do we give them the right medication? Did we do the right thing at the right time and at the speed that we need to do it? But if you aren't taking into account how that whole person is experiencing the stroke and what it means to them, you're missing a whole lot of what the recovery potential is in that patient, and you're better able to tap the recovery potential in a patient when you truly connect with them. And by seeing all this, these advertisements out here, they aren't really advertisements, but they're basically statements about the experience of stroke patients. I think the fact that that's being acknowledged now is really good.

Reference

Holman A, Cramer SC. When social interactions undermine stroke recovery: findings from the STRONG study. Presented at: International Stroke Conference 2026. February 3-6, 2025; New Orleans, LA. Abstract DP099.