Predicting Upper Limb Recovery

van der Vliet et al (Accepted manuscript) Predicting upper limb motor impairment recovery after stroke: a mixture model. Annals of Neurology, https://onlinelibrary.wiley.com/doi/abs/10.1002/ana.25679

This is the first time I’ve referenced an article that’s still being edited! Be assured it’s been accepted by the journal, but it’s sooo.. recent, that it’s not even “in press” yet!

Acknowledging that this article comes out of Gert Kwakkel’s research team, it’s yet more confirmation that upper limb recovery after stroke can be predicted in most affected people, most of the time. And that’s what evidence is all about – it’s about predicting patterns across populations. Sure, there’ll always be the exceptions, but it’s still important to understand what’s most likely to occur in most patients, most of the time; even if they indicate no improvement in some.

When I read this article, I thought “phew”! As a health professional who’s been presenting evidence on this for some years now, I’ve copped my share of criticism and disbelief. And that’s OK. Essentially, as scientific communities, it’s very important that we’re always prepared to question, challenge and discuss current clinical practice. However, there’s now ample evidence that, most of the time, it’s possible to accurately predict upper limb recovery after stroke in most people, based on data collected in the first week post-event.

As I argue in my Changing Stroke book, accepting this evidence means presenting it to those directly affected, and in turn, offering them interventions influenced by the early data. What I refer to as a stratified approach. Not accepting this evidence means leaving those directly affected, ill-informed, and, by applying a one-size-fits-all approach, potentially spending time engaged in interventions that are highly unlikely to be effective. Were I to have recently experienced a stroke-affected upper limb, I’d want to know what is most likely to occur, and, as with most events in my life, prepare for the worst and hope for the best.

As always, this is just my humble opinion, and you’ll find the full reference and abstract under Journal Club 2020. It’s important to read this article for yourself. Although challenging to read, it’s worth it; particularly the figures which at present, are on the final page of the PdF. Once published, these will be embedded in the article’s results.

All the best in 2020

To all my loyal followers. Here’s wishing you a very rewarding, engaging and interesting 2020. I also hope you can find balance between your professional and personal journeys in a way that will bring you some joy in both.

As I grow older, I spend more time with my seven grandchildren, and in turn, more time doing joyous activities for no reason at all, except to spend precious hours together. For example, splashing around at the beach or playing monopoly! Time with grandies has re-affirmed to me the importance of experiencing some joy. Hence the reason I’m wishing you a 2020 that includes some joy!

I originally established this blog as a “record” of my own continuing professional development. It has pressed me to spend time each month searching out, and reviewing a recently published article about recovery after stroke. As my blog testifies, it’s worked a treat!  However, 2020 year will be my last. If any of you would like to take this blog over, please contact me. It’s not hard to do, and if needs be, I’d be more than happy to walk you through it. But if that doesn’t occur, it will cease with no regrets, as it’s achieved what I intended, and more, thanks to my followers.

Aged Care: Neglect!

A couple of weeks back, I attended the community forum in Newcastle, for Australia’s Royal Commission into Aged Care Quality and Safety. I was close to tears as I listened to people’s harrowing stories of their experiences in relation to the aged care sector. So, this month, I can’t go past this particular publication. Sure, it’s not a journal article, but it’s of equal importance, in my humble opinion, particularly to Australians.

The Foreword of the Commission’s Interim Report (2019), titled: Neglect, opens with: “It’s not easy growing old. We avoid thinking and talking about it….The Australian community generally accepts that older people have earned the chance to enjoy their later years…Yet the language of public discourse is not respectful towards older people. Rather, it is about burden, encumbrance, obligation and whether taxpayers can afford to pay for the dependence of older people.” As many of the forum’s speakers stated, once a person is being cared for by the aged care sector, it’s often “out of sight, and out of mind”.

I attended because I’m concerned about my own ageing; because I’ve been troubled about the care given to elderly members of my family; and because of the stories I’ve heard and investigated in the pre-prescribed care many therapists are trained to provide to residents of Aged Care facilities. Understandably, commission may raise more questions than it answers, but, at this celebratory time of the year for many, I leave you with the question the attending Commissioner, Ms Lynelle Briggs AO, asked asked us, in her closing comments: “Where’s the joy?”

Out of interest, I’ve just searched publications in the last 2 years, for evidence relating to older people and joy. Although findings are limited, one study sheds some light on this. Rinnan et al (2019) set out to find “new approaches to increase positive health and well-being” in residents aged care facilities in Norway. The researchers found “joy of living” was associated with “positive relations, a sense of belonging, sources of meaning, moments of feeling well, and acceptance”. I look forward to a day when quality aged care is the norm, and not the exception. I look forward to a day when the concept of Old People’s Home For 4 Year Olds is just one of many examples of quality aged care; again, the norm and not the exception.

It’s not easy growing old. As Commissioner Briggs asked us to do, I ask you to read the Interim Report, tell people about the report, and talk with family and friends about our aged care. Let’s make sure older Australians are not “out of sight, and out of mind”.

Reference: Rinnan E, André B, Drageset J, Garåsen H, Arild Espnes G, Haugan G (2018) Scandinavian Journal of Caring Sciences, 32(4), 1468-1476, https://doi.org/10.1111/scs.12598

Know’vember!

In celebration of five years of successes, CPDLife® is celebrating with its “Know’vember” promotion. During all of November 2019, all Self Directed courses offered through CPDLife® website are at half price! This means that our “flag-ship”, 8 hour courses are only $110! But this promotion only applies during this months, so get in quick as there’s only a couple more weeks to go.

Stroke Recovery & Rehab

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October 2019: Bernhardt, Borshmann, Kwakkel et al (2019) Setting the scene for the second stroke recovery and rehabilitation roundtable. International Journal of Stroke, 4(5), 450-456, DOI ttps://doi.org/10.1177/1747493019851287

It’s hugely, hugely encouraging to hear about the work of international collaboratives like this one. I’ve been involved in one of the sub-groups and again, this is also hugely encouraging and energising. After all, why not approach stroke recovery from an international perspective; taking what is done best in one country and applying it in another, and learning lessons from the less effective practices and models of care? When it comes to improving outcomes for those directly affected by stroke, an international “team” approach should be underpinning the clinical practices of every local team. To stay up-to-date on what is happening at an international level, this is the team to follow.

As the authors rightly state, this team includes those who are working with people recovering from stroke right through to researchers like Andrew Clarkson, who are investigating animal models of stroke. This broader perspective and collective provides a richer source of what is, and is not, the very best practice that we can deliver to those directly affected. It also provides the broadest platform on which future research and change can occur. If you have a professional and/or personal interest in stroke recovery and rehabilitation, I commend the work and output of this group to you. If we liken stroke recovery to a ship sailing international waters, this group acts as the rudder mechanisms directing and plotting its course.

This article is freely available. Although it is not reporting original research, it is nevertheless an important publication for those with an interest in stroke recovery.

Exciting News!

Today is the first day of my new CPDLife® website. It’s not only full of beautiful, Australian landscape photography, it now proudly boasts the following:

  • New suite of Self Directed course options, which, for the 8-hour courses, are priced at only AUD$220
  • Completely updated Neuroplasticity course, with a new, Self Directed option
  • Completely updated Educating Online (3hr), Stroke in 30 and Evidence in 30 courses, which are still complimentary!
  • My new, Self Directed, 3-hour Understanding Evidence course, priced at only AUD$88
  • My new Blog, with posts Health Care, Professional Development and Online Learning, which I’ll add to regularly. (I’ll still keep doing Journal Club on this website, I promise!)

If you’d like to receive CPDLife® updates, go to the Courses page, scroll down and submit your name and email address.

PS. I’m still updating my Stroke Recovery course, and, if all goes according to plan, an Educator Led and Self Directed option will be available in October 2019.

Carers’ Unmet Needs

July 2019: Denham et al (2019) “This is our life now. Our new normal”: A qualitative study of the unmet needs of carers of stroke survivors. PLoS ONE 14(5): e0216682. https://doi.org/10.1371/journal.pone.0216682

Its always special to reference an article published by authors I have some connection with. This article, which incidentally, is open access, provides unique insight into the care needs of those who care for people recovering from and/or living with stroke. The authors introduce their research reflecting on the fact that stroke is a “family disease”. They’re right, aren’t they? It’s not just the survivor who is directly affected, but those who they share their lives with – hence the “family” description. What’s unique to this study, is its investigation of the unmet needs of carers across diverse settings. Previous research has mainly focussed on the rehabilitation phase of care. Although this study used qualitative methods and the majority of responders were female, it nevertheless provides unique insights into these members of our communities. You’ll find the abstract under Journal Club 2019 and “humble opinion” as a comment to this post.