Sitting, Upper Limb Impairment and Falls

April 2019: Hanna et al (2019) Participation, Fear of Falling, and Upper Limb Impairment are Associated with High Sitting Time in People with Stroke, Occupational Therapy In Health Care, DOI: 10.1080/07380577.2019.1587675

OK, so I best confess that I’ve selected this article on the basis of the fact that it’s written by some of my closest colleagues, who I most admire, and it’s about topics that I’m very interested in! So, put that all together, and you have, in my humble opinion, a most engaging article. The investigators and their research questions exemplify the type of new knowledge that can be generated when the line between researcher, scientist and therapist, is so blurred, as to be indistinguishable.

This article is not publicly available, but you can always contact the corresponding author and request a copy. This study is an exploratory study only, but raises important questions and provides provisional answers. As always, you’ll find the abstract under Journal Club 2019 and “humble opinion” as a comment to this post.

Falls and Acute Stroke

March 2019: Westerlind et al (In Press) Drug treatment, postural control and falls: An observational cohort study of 504 patients with acute stroke, the fall study of Gothenburg. Archives of Physical Medicine and Rehabilitation.

As some of you might know, I have fairly strong opinions about our approaches to reducing the risk of falls, generally, and more specifically, reducing risk in those recovering from stroke. I challenge the applying of a zero tolerance to falls, because it assumes that risk-reduction is a unilateral approach; however, in those recovering from stroke, there is the competing demand of the benefits of getting up and about! Rarely are the two issues discussed in tandem. In those recovering from stroke, we already have a cohort known to have a higher-than-average risk of falls. So, does this mean we go all out to reduce the risk of falls? Yes, but only if consideration is given to the physical, cognitive and emotional benefits of getting up-and-out and about! So, to assist us in this, let’s better understand who is most at risk and why.

In this month’s Journal Club, Westerlind et al (In press) report on their investigation of the risk of falls in acute stroke, with a particular focus on its association with postural control, and in turn, the impact of drug treatment. In my humble opinion, their findings make for very interesting reading.

This article is not publicly available; but you can always contact the corresponding author for a copy if your library doesn’t have access to the APHR journal. To find the abstract, go to Journal Club 2019 tab and select Falls and Acute Stroke from the drop-down menu. “Humble Opinion” is added as comment to this post.

Music & Anxiety After Stroke

February 2019: Le Danseur et al (2019) Music as a therapy to alleviate anxiety during inpatient rehabilitation for stroke. Rehabilitation Nursing, 44(1), 29-34

Before you read my first 2019 post, turn on your favourite music, take a few minutes to simply listen, draw a few deep breaths and enjoy the sense of pleasure it generates. Funny really; if we were all to hear the music of one another, I reckon the differences would be very noticeable; and yet, “each to their own”, as the saying goes. The music that I’d select, could, and probably would, be very different to the music that select; yet, both of us would be experiencing a similar sense of pleasure. That pleasure could be relaxing, enervating or anywhere in between! Music; what an amazing thing it is!

So, could listening to music reduce anxiety of people recovering from a recent stroke? Because anxiety affects around one third of stroke survivors, this article is well worth reading! It’s not publicly available; but don’t forget, you can usually contact the corresponding author to request a copy.

For the abstract, go to the new Journal Club 2019 page and select the only drop-down option for now! For “Humble Opinion”, go to the comment attached to this post! All the very best in wherever your professional journeying takes you in 2019!

Stroke & Horse Riding

Pohl et al (2018) A qualitative exploration of post-acute stroke participants’ experiences of a multimodal intervention incorporating horse riding. PLOS One, https://doi.org/10.1371/journal.pone.0203933

This is the final Journal Club entry for 2018. When it comes to stroke recovery, a collective “light bulb” moment has been the realisation that the average stroke recovery environment is bereft of stimuli, interest, reasons to participate and requirements to be involved in…well, almost anything and everything. So, here’s a stroke intervention that’s completely “out of the box”! It’s yet to be proven to be clinically effective, but for the 18 participants in the horse-riding group, the experience was transformative! I’m not sure we’d have ever considered rehabilitation could be transformative. They’re powerful words indeed. To find the abstract, go to the Journal Club page and to find “Humble Opinion”, go to the attached comment.

I hope 2018 has been a transformative year for you, in the smaller and/or greater experiences of life. For me, 2018 started with great sadness, but it’s finishing with gladness as I look towards a 2019 that’s heralding change. I wish you a hugely rewarding 2019 and here’s hoping you can enjoy some relaxing time over the Christmas/New Year break, with those precious to you.

A huge thank you to all my Changing Stroke followers and to those who have participated as learners and/or educators in my CPDLife® courses. I look forward to more Journal Clubs postings in 2019, but please note that these won’t re-start until February.

Sexuality After Stroke

McGrath et al (In press) How is sexuality after stroke experienced by stroke survivors and partners of stroke survivors? A systematic review of qualitative studies. Clinical Rehabilitation, https://doi.org/10.1177/0269215518793483

I don’t suppose these findings will come as any surprise, but it’s always good to have evidence that supports what we think is, or is not happening. Here in Australia, the results of the national audits support the authors’ conclusion in the abstract, that, after stroke, “sexuality is rarely discussed openly”. In Journal Club 2016, you’ll find an explanation based on a review of the literature, about how stroke impacts sexual function. The page is titled: Altered Sexual Function. So, as a follow-up, this month’s JC directs you to McGrath et al’s (In press) systematic review which investigated and systematically reviewed the “real world” experiences of those who are directly affected.

Please find “Humble Opinion” as a comment to this post, and the Abstract under the Journal 218 page.

Thank you!

A huge thank you to the 63 Occupational Therapists who completed the SurveyMonkey questionnaire about the work that you do in Australian Residential Aged Care facilities. What an amazing response! Your data are providing a strong, collective “voice” that expresses your concerns and experiences. Two colleagues and I are now analysing the data and writing up the findings. Please be assured that when it’s ready, I’ll provide you with the link.

Shoulder Pain

October 2018 Journal Club: Lindgren et al (In Press) Pain management strategies amount persons with long-term shoulder pain after stroke – a quantitative study. Clinical Rehabilitation, Online early

How do survivors manage persistent shoulder pain after stroke? In 2007 [1], this same research group published findings indicating that 22% of all patients with stroke experienced shoulder pain and of these, at least three-quarters classified it as moderate to severe. One year later, some experienced no pain, but others, who started experiencing shoulder pain further down the track, were added to this cohort. What a complicated issue this is for those experiencing it and for health professionals managing it!

Since 2007, this research group has continued to investigate shoulder pain after stroke and their findings include a 2018 publication [2], which is also worth reading, if this is a topic of interest to you.

The October 2018 Journal Club publication reports the strategies the “experts” use to manage their shoulder pain in the long-term. This article is not freely available; but as I always say, if you contact the “corresponding author”, they’re usually only too happy to send it to you.

To find “humble opinion” see my posted comment and to read the abstract, use the Journal Club 2018 link.

[1] Lindgren et al (2007) Shoulder pain after stroke: A prospective population-based study. Stroke, 38, 343-348. https://www.ahajournals.org/doi/pdf/10.1161/01.STR.0000254598.16739.4e

[2] Lindgren et al (2018) Shoulder pain after stroke: Experiences, consequences in daily life and effects of interventions: a qualitative study. Disability and Rehabilitation, 40(10), 1176-1182. https://www.ncbi.nlm.nih.gov/pubmed/28637154