Active Brain | Active Body

Here’s wishing you all the very best for 2017! As I’ve done in previous years, I’m going to start this year off with a Changing Stroke project. Journal Club and “humble opinion” will kick off in February.

Are you looking for an interesting Quality Improvement project for 2017? If so, what about joining others in the Active Brain | Active Body project? It’s something I developed for an acute stroke unit in New South Wales Australia, and, considering it’s applicability, I’m thinking, “why not share it” so others can do the same.

To find out more, select the Active Brain | Active Body tab under the CS Project tab. Here’s hoping the attachment on the project’s page gives you a useful starting point, but of course you’ll need to modify the project to your own clinical context.

Let me know what you think about the project and let me know if you have other ideas that could bridge the practice-evidence gap in people recovering from stroke.

Thanks again to the faithful followers of my blog. I look forward to another interesting year as we journey together.

 

Impairments after Stroke

December 2016: Lawrence et al (2001) Estimates of the prevalence of acute stroke impairments and disability in a multiethnic population. Stroke, 32, 1279-1284 http://dx.doi.org/10.1161/01.STR.32.6.1279

OK, so this is a bit weird! I’m reviewing an article that was published 6 years ago!! What are you doing Isobel? Isn’t one of your aims to make sure you only ever review recently-published evidence?

True, but this time I’m going to make an exception. I’m currently in the process of writing a book!! It’s titled “Stroke and the Upper Limb: A practical guide for therapists”. I’m aiming to launch it mid-way through next year. Whilst researching the evidence about predicting upper limb recovery, I wanted to find out how prevalent upper limb dysfunction was and where it ranked on the prevalence “hierarchy”. I probably shouldn’t have been surprised, but Lawrence et al (2001) report that upper limb motor dysfunction has the highest prevalence in patients 3 months post-stroke. At 77% of all patients, it comes in just in front of lower limb motor dysfunction. No wonder we see so many patients with motor dysfunction!

This article is a really interesting “read” if you’d like to know more about the prevalence hierarchy of impairments early after stroke. I also thought this was a good place to conclude this year’s Journal Club. Our aim is to reduce the impact of stroke and this article is a useful summary of the oh-so-many impairments that patients experience after stroke. The article is publicly available at: http://stroke.ahajournals.org/content/32/6/1279.short

To find the full reference, abstract and “humble opinion”, go to Journal Club 2016 and Impairments After Stroke.

Physical Fitness Training

November 2016: Saunders et al. (2016) Physical fitness training for stroke patients. Cochrane Database Systematic Review March 24;3: CD003316. doi: 10.1002/14651858.CD003316.pub6

It’s been quite some time since I’ve reviewed a Cochrane Database Systematic Review. This research was led by Professor Gillian Mead. If you’ve not heard of her before, I would recommend her to you. She is a stroke champion, who, as her website states: “aims to find out how to improve recovery and quality of life in people who survive a stroke”.

Stroke is a cardiovascular disease, so perhaps it’s somewhat surprising that for so many years we’ve ignored the importance of physical fitness and cardiovascular health in survivors of stroke. In the past, stroke rehabilitation has focused on the restoration of independence in everyday activities, but increasingly, the focus is shifting towards physical fitness, which is a positive move in my humble opinion, as both go hand-in-hand.

These authors found that: “Cardiorespiratory training and, to a lesser extent, mixed training reduce disability during or after usual stroke care; this could be mediated by improved mobility and balance. There is sufficient evidence to incorporate cardiorespiratory and mixed training, involving walking, within post-stroke rehabilitation programmes to improve the speed and tolerance of walking… Cognitive function is under-investigated despite being a key outcome of interest for patients.”

As a Cochrane Review, it is publicly available at http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003316.pub6/full

To find the full reference, abstract and “humble opinion”, go to Journal Club 2016 and Physical Fitness Training.

Altered Sexual Function

October 2016: Brandstater & Kim (2016) The challenge of altered sexual function in stroke survivors undergoing rehabilitation. Topics in Geriatric Rehabilitation, 32 (3), 199-203

This is a topic which I’ve not posted about before and yet, it is so integral to enjoying life, particularly within our intimate relationships. As the authors state: “..poststroke changes have a profound effect on the way a stroke survivor shares intimacy with the spouse of significant other and participates in sexual activity”. I can’t imagine how challenging it must be to participate in sexual activities when one half of your body isn’t working that well and when you’re potentially prone to fatigue and depression! As the authors point out in their concluding statement: “Attention should be given to sexual counselling at an appropriate stage during the individual’s recovery”.

The full article is not publicly available, so don’t forget, if you’d like a copy, you can always request it from the corresponding author. To find “humble opinion”, go to Journal Club 2016 and Altered Sexual Function and scroll down to the comment section at the base of the page.

Shaping Early Reorganization

September 2016: Volz et al (2016) Shaping early reorganization of neural networks promotes motor function after stroke. Cerebral Cortex, 26(6), 2882-2894 10.1093/cercor/bhw034

This is such impressive research because it’s so “cutting edge”! These researchers are amoung some of the most influential in this field. The intervention they’ve investigated is intermittent theta-burst stimulation applied just before physiotherapy that’s targeting upper limb recovery. The outcomes they’ve assessed are hand function and cortical excitability. This is a multi-modal intervention which aligns with the recovery approach of the future.  To find out more, go to the abstract under Journal Club 2016. The full article is feely available at: http://cercor.oxfordjournals.org/content/26/6/2882.full

To find “humble opinion”, scroll down to the comment section at the base of this Journal Club page. I know that neuroplasticity literature can sometimes be hard to understand, but my advice is to read it anyway – an understanding of neuroplasticity and the brain’s response after stroke is just far, far to important to not be reading this literature!

Time spent Sitting

August 2016: English et al (2016) Sitting time and physical activity after stroke: physical ability is only part of the story. Topics in Stroke Rehabilitation, 23(1), 36-42 10.1179/1945511915Y.0000000009

OK, so what seemed like a good idea at the time, may not have been such a good idea! How oft’ is that the case? I was going to work through a series of consequences after stroke, but, when I did the maths, (which is probably what I should have done at the start,) I realise that, using my proposed plan, I would only get through four consequences a year. Considering how many there are after stroke, this was looking more and more like a 5-year plan!! I have to confess that my concentration span doesn’t reach that far!

So, back to one of my “soap-box” topics and an article first-authored by a friend and colleague, who, incidentally, is offering the Evidence Research Demystified in November 2016, Dr Coralie English. This month’s journal is all about what might, or might not contribute to the amount of hours people with stroke, spend sitting. As the authors hypothesized, you would think that level of disability, particularly physical disability, may be the main contributing factor. But what was interesting was that despite the various analyses they undertook, it only ever contributed to up to 30% of the variance. So, that leaves us with an really interesting question: what contributes to the other 2/3rds of variance?

As usual, you’ll find the abstract and “humble opinion” under Journal Club 2016. Only the abstract is freely available at http://www.tandfonline.com/doi/abs/10.1179/1945511915Y.0000000009

The Stroke TOTE Bag Project

It’s been a while since we’ve had a Changing Stroke Project; so here one for 2016! To find out more, go to the link under CS Projects.

Is this a slightly crazy idea? I don’t think so. My thanks to those who told me about this – here’s hoping you don’t mind that I’ve added my own twist! If you decide to give this project a go, please let us all know how it goes.