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.
August 2019: Carey et al (2019) Finding the intersection of neuroplasticity, stroke recovery, and learning: Scope and contributions to stroke rehabilitation. Neural Plasticity, Article ID 5232374, https://doi.org/10.1155/2019/5232374
My congratulations to Leeanne and her colleagues on this incredible piece of research. The fact that an initial search identified just over 400,000 publications gives you some idea of just how much work was involved in this investigation. The temptation to stop right there must have been very strong indeed. Not only is this research innovative in its research question and methods, it is intriguing in its findings. As the title indicates, the investigators set out to find the intersection between neuroplasticity, stroke recovery and learning, and what they found is portrayed in Figure 3. Interestingly, the findings don’t quite intersect, which may say more about where research is up to, in the evolution of this evidence; because, the connectivity between these three issues is in no doubt at all. That “cognition was the major theme identified”, does not come as any surprise. Other identified themes like “task-based….and activity-based learning” and “experience-dependent learning” provides the therapeutic perspective. This watershed evidence is a “must read” for all those involved in recovery after stroke, I’d suggest. This article is freely available. As always, this is just my “humble opinion”.
PS: To make my blog less complicated, as of this month, I’m only going to post. I’ll leave it to others to comments if they want to.
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.
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.
June 2019: Rejnö et al (In Press) Changes in functional outcome over five years after stroke. Brain and Behaviour https://doi.org/10.1002/brb3.1300
As the authors rightly claim, there is little evidence about the long-term, functional outcomes in survivors of stroke; which, when you think about it, is surprising! Stroke is a chronic disease, one that survivors will live with for the rest of their lives, yet we know very little about its long-term, functional impact. What I also find very surprising, is the lack of ongoing support that those with stroke, receive in the long-term. Australian researcher, Dr Jeni White, found that, once discharged, many feel “abandoned” by the healthcare system. So, its timely that we review an article about the long-term needs of people living with stroke. This article is freely available. Please find the abstract under Journal Club 2019, and my “humble opinion” attached as a comment to this post.
May 2019: Large et al (In Press) A changed reality: Experience of an acceptance and commitment therapy group after stroke. Neurophsychological Rehabilitation, DOI: 10.1080/09602011.2019.1589531
The honesty and frankness of Stephen Jenkinson, a “grief monger”, is refreshing. He’s currently touring Australia, but please assume this is not a promotion of his tour and that I’m not a beneficiary. I refer to him because his ideas interest me. In an interview with the ABC in 2016, he stated: “Every solution to dying that we come up with preserves the fear of it while claiming to absolve us of it.” Hmmm… is it time to talk about this?
Of course, I’m not suggesting that stroke is synonymous with dying, but up to one third die within the first year. However, stroke is synonymous with the experience of prolonged grief. In my search for studies investigating post-stroke grief in the past 2 years, I found only one! Large et al (In Press) investigated the efficacy of Acceptance and Commitment Therapy (ACT) after stroke, and found the main difficulty survivors face is “accepting the changed reality”. Do the clinical practices associated with stroke recovery include time and interventions targeting prolonged grief and the “accepting the changed reality”; or, is most of what we do as professionals, an avoidance of this?
To find Large et al’s abstract, please go to the Journal Club 2019 page. This article is not publicly available, so you may need to purchase it or ask your facility’s librarian. Please find my “humble opinion” as a posted comment.
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.
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.
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!
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.