Health literacy is a critical component of high-quality stroke care. Across the continuum from prevention through recovery, health literacy is strongly associated with functional outcomes and stroke-related morbidity. Despite its importance, it is often overlooked, leaving patients and caregivers overwhelmed by communication demands that exceed their capacity. These mismatches are especially pronounced among individuals with stroke-related cognitive or language impairments, limited English proficiency, socioeconomic disadvantage, or limited digital literacy. This scientific statement synthesizes current evidence on the role of health literacy and communication within stroke systems of care and identifies nurse-led opportunities to advance equity and patient-centered outcomes while recognizing this as a shared interprofessional responsibility. Nurse-led interventions, including teach-back-based education, dyadic psychoeducational programs, and tailored digital support, have demonstrated improvements in stroke knowledge, self-efficacy, quality of life, and caregiver preparedness. However, the literature is marked by methodological heterogeneity. Many studies are underpowered and infrequently use validated health literacy or communication measures. Future directions include standardized assessment of health literacy; literacy-sensitive, nurse-led, and interprofessional care models; workforce training in plain-language and culturally responsive communication; and organizational health literacy principles. Emerging technologies, including telehealth and artificial intelligence, offer promise for improving communication and personalization but require rigorous evaluation to minimize bias and ensure equity and usability.

Despite decades of clinical trial activity in stroke prevention, critical gaps remain in the evidence base guiding management of symptomatic carotid and intracranial stenosis and the quality of anticoagulation care delivered to patients with atrial fibrillation (AF). This article synthesizes recent evidence and ongoing research efforts addressing 2 enduring challenges: demonstrating the value of intensive medical therapy relative to interventional approaches and improving the quality of stroke prevention care in AF. Previous trials focused on intracranial stenosis established that aggressive, protocol-driven medical management substantially reduces recurrent vascular events. In the realm of carotid stenosis, landmark trials conducted >3 decades ago no longer reflect modern pharmacological capabilities. Emerging evidence from plaque imaging, particularly intraplaque hemorrhage on magnetic resonance imaging, suggests that stenosis severity alone is an insufficient determinant of treatment strategy. Simultaneously, strokes related to AF continue to rise in the United States, driven by demographic aging, and large vessel occlusion strokes attributable to undertreated AF represent a preventable burden on the health system. Patient-centered, precision stroke prevention requires contemporary prospective data, integration of advanced vascular imaging biomarkers, and systematic improvements in preventative therapies for patients with AF. Targeting these areas holds promise for improving stroke prevention in the coming decades.

Stroke remains a leading cause of human disability worldwide. Additional approaches beyond acute stroke therapies are needed to improve patient outcomes. Neural repair therapies focus on promoting neural plasticity in surviving tissue rather than modifying the acute injury; examples include behavioral training, drugs, biological therapies, and neural stimulation. This review discusses principles related to patient selection, control group design, intervention timing, choice of outcome measures, experience-dependent plasticity, use of biomarkers, and statistical considerations, each of which emerges from a review of key stroke recovery trials. Patient selection strategies may benefit from incorporating neuroimaging and neurophysiology biomarkers to ensure viability of treatment targets. Modality-specific outcome measures offer advantages over global disability scales for repair-based trials. The timing of intervention is critical given evolving poststroke biology and the existence of critical periods for plasticity. Repair-based therapies benefit from pairing with concomitant experience of sufficient intensity and appropriate type to shape and reinforce brain circuits. Consideration of these key principles is expected to improve the design of trials that aim to promote neural repair and improve function after stroke. Researchers and clinicians should attend to these factors when designing and interpreting clinical trials to maximize the likelihood that neural repair therapies will improve disability after stroke.

Stroke is a leading cause of disability worldwide. Neural repair therapies, distinct from acute stroke therapies, target surviving neural elements to promote plasticity after the acute injury has occurred. Repair therapies encompass a broad and rapidly evolving therapeutic landscape, ranging from behavioral training, drugs, and biological agents to neural stimulation. In this review, we highlight major advances across these therapeutic categories, focusing on the evidence base and readiness for clinical adoption. Intensive behavioral interventions, including constraint-induced movement therapy and telerehabilitation, result in meaningful gains even in chronic stroke. Biological therapies-growth factors, monoclonal antibodies, and stem cell approaches-show promise but face translational challenges. Pharmacological strategies targeting serotonergic and dopaminergic systems have yielded mixed results. Neural stimulation approaches span a spectrum of invasiveness, with vagus nerve stimulation now Food and Drug Administration-approved and emerging candidates including cerebellar deep brain stimulation and spinal cord epidural stimulation showing early promise. These studies have provided important lessons for neural repair trial design. Synthesizing evidence across modalities, we highlight how therapeutic advances are reshaping the landscape of poststroke recovery and identify the most promising opportunities for clinical translation. Emerging neural repair strategies stand to substantially improve function after stroke.