Behavioural Domains

April 2017: Ramsey et al (2017) Behavioural clusters and predictors of performance during recovery from stroke. Nature Human Behaviour, Early Online, DOI: 10.1038/s41562-016-0038

Although this may be a difficult “read”, its this month’s journal article because it challenges the way we think about stroke recovery and particular impairments or areas of dysfunction. To date, our understanding of the impact of stroke is usually in terms of differentiating between impairments. Different therapists see patients with different impairments based on their professional expertise . For example, speech pathologists manage patients with language impairments. However, what Ramsey et al found challenges this approach. In relation to recovery in the first 12 months after first-ever stroke, they have found a clustering of impairments and two behavioural domains: 1) motor and attention; and 2) language and memory. This means we may need to re-think our differentiation and management of impairments after stroke.

This article is freely available and is well worth reading. To find the abstract and “humble opinion”, go to Journal Club 2017 and select: Behavioural Domains.

Self-Assessment After Stroke

March 2017: Törnbom et al  (2017) Self-Assessed Physical, Cognitive, and Emotional Impact of Stroke at 1 Month: The Importance of Stroke Severity and Participation. Journal of stroke and Cerebrovascular Diseases, 26(1), 57-63,

The last journal article I posted about on CS in December 2016, reported the prevalence of impairments after stroke; so this article seemed like a useful “other side of the coin” article to review for February 2017. In contrast to Lawrence et al, Törnbom et al give voice to the people directly affected by stroke. In the words of the authors, the “aims of this study were to describe the self-assessed physical, emotional, and cognitive impact of stroke. and to investigate associations with participation and stroke severity at 1 month poststroke”.

What is the actual experience of those who are recovering from stroke, and more particularly, those with a stroke-affected upper limb? Good question! Also, do the early self-assessments of their own experiences, have any association with what actually occurs one month down the track? If you want to know more, this article is well worth reading!

The PdF is freely available at: To find the full reference, abstract and “humble opinion”, go to Journal Club 2017 and Self-Assessment After Stroke.

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

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:

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

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:

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!