Future of Upper Limb Therapy

September 2018: Biasiucci et al (2018) Brain-actuated functional electrical stimulation elicits lasting arm motor recovery after stroke. Nature Communications, 2421 https://www.nature.com/articles/s41467-018-04673-z

This is most definitely an article that all those with an interest in upper limb recovery should read. Not only is this because it has been published in “Nature” (a “dream” that every scientist has, but very, very few achieve!), it is also revolutionary! Yes, that’s right. Evidence like this will revolutionise future upper limb management!! This is not an easy article to read or understand, but it will be worth persisting.

At the start of their discussion, the authors claim that: “BCI–FES therapy resulted in a statistically significant, clinically important, and lasting reduction of impairment in chronic moderate-to-severe stroke patients. In particular, the preservation of clinically relevant improvements at least 6 months after end of therapy is remarkable”. This is “watershed” evidence that closes a loop, that to date, had not been closed. I often refer to stroke as a “brain-based problem that needs a brain-based solution”, and, for the first time, we have evidence that closing the feedback loop between the brain and the upper limb is worthwhile. A remarkable finding indeed!

This article is fully available and well worth reading in my humble opinion. Select the Journal Club 2018 page if you want to view the abstract. The rest of my humble opinion is added as a comment to this post.

Are you an…

Australian Occupational Therapist working in the Residential Aged Care sector? If so,

Request: Hi! My name is Dr Isobel Hubbard. I’ve created an anonymous “Fact Finding Mission” that targets Australian Occupational Therapists working in the Residential Aged Care Sector.

If this applies to you, please use this link or go to https://www.surveymonkey.com/r/NSNPLB8 to “have your say”. It should take around 6-10 minutes of your time and it will be available until September 28th, 2019.

If you have colleagues working in this sector, please share this link with them and ask them to share it with their colleagues. The more data we collect, the stronger the “voice”.

Background: From conversations that many of us have had, it appears that in the Residential Aged Care sector, there may be a mismatch between what our profession has to offer and what Occupational Therapists are being asked to do.

If so, using data collected from this survey, we’d like to garner evidence of this potential mismatch and in turn, give “voice” to the concerns. For example, I’d present the findings of this survey at the next Australian Stroke Coalition in November, and, if there is evidence of a mismatch, the coalition could use the findings as evidence to support letters to relevant national institutions.

Thank you: For your interest in this issue, for forwarding this on to your colleagues and, if relevant, for posting your responses.

Walking After Stroke

Berg Balance Scale Predicts Walking

Louie DR & Eng JJ (2018) Berg Balance Scale score at admission can predict walking suitable for community ambulation at discharge from inpatient stroke rehabilitation. Journal of Rehabilitation Medicine, 50 (1), 37-44, DOI: https://doi.org/10.2340/16501977-2280

One of my very favourite academic researchers is Janice Eng and I’m so excited, because, guess what; she’s a keynote speaker at the Stroke 2018 conference in Sydney next week. If you-re going, let’s try and catch up! Although I do realise this is a hugely challenging thing to do at scientific conferences.

Two of my very favourite topics, as CS followers will already know, are using standardised assessments to measure recovery after stroke and predicting recovery potential on the basis of stroke assessments.

So, in my humble opinion, this article is a hit for three very good reasons!

Why don’t we do this more? Why don’t we measure function at baseline or on admission to our services, and then, when we can, use that data to predict what is most likely to occur in most patients? We do this in almost every other aspect of our personal and professional lives. For example, when we calculate a housing loan with the bank, or put in the time and effort to apply for a job on the basis of our estimates on the chances we have of success. There’s more and more reason to do this in those recovering from stroke! These researchers have demonstrated you can use admission Berg Balance Scale data to predict mobility at discharge from inpatient rehabilitation.

This article is freely available. You can find the abstract in the 2018 Journal Club, and I’ve posted “humble opinion” below.  If you’re in Sydney next week, why not attend the Stroke 2018 conference? Hopefully I’ll see some of you there!

Quality of Life & 3-Year Outcomes

July 2018: Rudberg et al (2018) Long-term health-related quality of life, survival and costs by different levels of functional outcome six-months after stroke, European Stroke Journal, 3(2), 157-164. https://doi.org/10.1177/2396987317753444

OK, so I admit, I’m on a bit of a roll! This is my second article on “quality of life” (QoL) and they’ve been in consecutive months. Therefore, I promise that I won’t do QoL again, in 2018, at least. However, I’m certainly not apologising for my selection because essentially, isn’t this is what all healthcare relating to stroke is about? Whatever we do or don’t do in the management of those diagnosed with stroke, must have something to do with the person’s quality of life. I would propose that the most important outcome after stroke must be QoL. What’s interesting about Rudberg et al’s (2018) article is that functional level at 6 months was highly predictive of QoL and long-term survival at 3 years. This longitudinal study makes for very interesting reading, and it is readily available at http://journals.sagepub.com/doi/abs/10.1177/2396987317753444

To view the Abstract, go to the Journal Club 2018 link. To find just “Humble Opinion”, please see my comment below.

Quality of Life and Disability

June 2018: Rangaraju et al (2017) Comparison of 3-month stroke disability and quality of life across modified Rankin Scale categories. Interventional Neurology, 6, 36-41. https://doi.org/10.1159/000452634

One of the issues that continues to concern me is that we fail to consistently and routinely measure outcomes across a survivor’s recovery journey after stroke. If I were to experience a stroke here in Australia, would I have my own baseline data and/or measures across time documenting my recovery or otherwise? It’s highly, highly unlikely! Why is this the case, and in turn, how can we expect health funders to support what’s happening in facilities that support those affected by stroke?

Often health professionals will argue that the reason they’re not doing it is because of time: it just takes too much time to use standardised assessments! They may also argue that its better to spend time on interventions, not assessments! Whatever the excuse, here’s an article that has investigated a standardised assessment that takes just a split-second to reliably measure disability after stroke! The modified Rankin score (mRS), a very raw score, could be your “for starters” choice! Rangaraju et al (2017) investigated its association with quality of life. To find out what an mRS of 3 means, read what they found!

The article is freely available at  https://doi.org/10.1159/000452634. Please find my “humble opinion” below, or under the Journal Club 2018 pages with the same title.

Vision and Stroke

May 2018: Rowe, F. J., the VIS writing group. (2017). Vision In Stroke cohort: Profile overview of visual impairment. Brain and Behavior7(11), e00771. http://doi.org/10.1002/brb3.771

Since attending the UK Stroke Forum in November 2016, I’ve found myself asking why therapists, particularly occupational therapists, are involved in the assessing and treating of visual impairment after stroke. My question has been around the fact that therapists are not, in fact, experts in visual impairment. I understand the logic that because vision impacts occupational performance, therapists, particularly occupational therapists, need to give it consideration, but why are they so actively involved in its assessment and management? At the UK Stroke Forum there were presentations about the involvement of orthoptic services in stroke units – what an “ah ha” moment that was! Of course, why not involve those who have the expertise?

In this month’s article, Rowe and her colleagues report findings in relation to vision after stroke. They profile “the full range of visual disorders from a large, prospective, observation cohort study of stroke survivors with suspected visual impairment, referred by stroke multidisciplinary teams to orthoptic services”.

This article is freely available and incredibly interesting to read. To find the abstract and “humble opinion”, please select the drop down option under Journal Club 2018.

Stroke and Family Grief

April 2018: Coppock et al (2018) ‘It’s nothing you could ever prepare anyone for’: the experiences of young people and their families following parental stroke, Brain Injury, 32:4, 474-486, DOI: 10.1080/02699052.2018.1426879

I’ve recently experienced the loss of a close family member and in turn, I’m experiencing a natural, but heart-wrenching, grief and loss response. My loss has brought with it unanticipated change, and has challenged my resilience and ability to adjust. So, for me, it seems appropriate that this month I consider the grief and loss associated with stroke.

Surprisingly, there’s very little, recently-published, evidence on this, which, in and of itself, seems almost to dismiss this as an issue of clinical significance. So my thanks to Coppock et al (2018), because their “research offers an insight into the processes that may contribute to patterns of interpersonal relating that could negatively impact on adjustment. Provision of adequate information, psychological and practical support during recovery may therefore be crucial elements of supporting young people and their families in adjusting to the challenges posed by stroke”.

This article is not freely available, but if you’d like a copy, you can always email the corresponding author. To find the abstract and “humble opinion”, please select the drop down option under Journal Club 2018.