What’s happening in post stroke · 2019-04-15 · What’s happening in post stroke research in...

Talk 2:

What’s happening in post stroke

research in Scotland

Megan Lloyd, Dr Andy Kerr, Prof Jo Booth, Dr Terry Quinn

Non-ambulatory exercise

after stroke

Megan Lloyd,

Glasgow Caledonian University

#strokeassembly

Acknowledgements Funding:

With thanks to:

Academic Supervisors: Prof. Frederike van Wijck, Prof. Jo

Booth & Prof. Brian Williams

#strokeassembly

What does non-ambulatory mean?

• Unable to walk at all

• Unable to walk without the help of another

person most of the time

#strokeassembly

Background • Non-ambulatory stroke survivors are

around 50% less fit than healthy, age

matched adults.

• Increased time inactive and reduced

fitness puts people at greater risk of ill

health.

#strokeassembly

Why is this important for you? • All stroke survivors should be physically active most

days of the week. • Exercise after stroke top research priority important

to stroke survivors. • Research has shown that walking is the best wat to

improve fitness after stroke.

#strokeassembly

What is the gap? Physical activity and exercise for non-ambulatory

stroke survivors:

• Evidence

• Service provision

• Guidance

#strokeassembly

What is out there?

82%

15%

3%

Exercise interventions for non-ambulatory stroke survivors

Walking

Cycling

Pilates

#strokeassembly

What do non-ambulatory stroke

survivors want?

• Exercise to be fun, enjoyable and accessible.

• Individual programmes made to meet their needs and

preferences.

• Exercise to be delivered by a trained, qualified

professional.

• Can be with others or on your own, but choice is important.

#strokeassembly

What did we do?

#strokeassembly

PHANSS-2: Endurance training

0.0

5.0

10.0

15.0

20.0

25.0

30.0

SS01 SS02 SS04 SS05 SS06 SS07 SS08 SS09

First session (min.)

Final session (min.)

#strokeassembly

What did people think changed

after the programme?

• They felt more confident

#strokeassembly

What did people think changed

after the programme?

• They met their goals

• They were more outgoing

• Carers thought that stroke survivors were more

independent

#strokeassembly

And importantly… • Stroke survivors enjoyed the exercise!

ML: “What did you find the most enjoyable parts of it?” SS04d-2: “The whole bloody thing?” ML: “All of it?” SS04d-2: “Oh, it’s been far too short!”

#strokeassembly

Summary • What is out there: few easily accessible options for

non-ambulatory stroke survivors.

• Exercise can help stroke survivors feel more

confident and independent.

• Stroke survivors can exercise and be more active in their own home.

#strokeassembly

What can you do? • Look out for community exercise groups

• Do simple exercises in your own home

• You don’t have to be able to walk to be fitter

• Think outside the box

• Being active does not have to be daunting and

boring – it should be fun!

#strokeassembly

Any questions?

Email: [email protected]

Telephone: 0141 273 1822

mailto:[email protected]

Stroke rehabilitation and

technology

Dr Andy Kerr

#strokeassembly

• Andy Kerr

• Centre for Excellence in

Rehabilitation Research

• https://www.researchgat

e.net/profile/Andy_Kerr

• 10 researchers in stroke

rehabilitation technology

https://www.researchgate.net/profile/Andy_Kerr



#strokeassembly

Rehabilitation principles after stroke

Injured brains can (re)learn movement.

• Movement repetition.

• Movement variation.

• Error detection and feedback.

• Motivation.

#strokeassembly

Not enough!

#strokeassembly

“people get a few

weeks physio when

what they often need

is a few years” – Andrew Marr, 2016

#strokeassembly

The solution?

#strokeassembly

Examples

#strokeassembly

A way forward Collaboration

Low cost portable technology

Home use

Leisure centres

Jo Booth

Professor of

Rehabilitation Nursing

Incontinence

after stroke

Bladder incontinence after stroke

• Affects more than half of all stroke survivors

• More than one third have ongoing bladder problems

• Often not seen to be caused by stroke and so may be ignored

Bowel incontinence after stroke

• Affects around 40% stroke survivors in acute stage

• 1 in 6 have ongoing bowel incontinence

• 4 times more likely to have both bladder and bowel leakage

after stroke

How does incontinence affect stroke

survivors?

• Embarrassment

• Isolation

• Fear

• Frustration

Effects on stroke survivor, carers and families

Causes of incontinence after stroke

• Problems with bladder or bowel

• Damage to brain

• Environmental challenges

• More than one of these

What do stroke survivors say?

Stroke survivors described their bladder changes after

stroke:

• urgency

• frequency

• inability to empty fully

• incontinence

What do stroke survivors do?

People said they:

• stay at home and don't go out

• keep going to the toilet ‘just in case’

• drink less

• wear pads

• carry change of clothing

Stroke survivors believe they have to ‘live with’

incontinence rather than seek treatment from the NHS

Note …

• Assessment is essential to identify the type of problem

• The type of problem determines what

the correct treatment is

Good news! • Around three quarters people with incontinence can be

helped, or even cured

• Simple approaches are effective

• Important to understand own bladder and bowel condition

and learn to self-manage

• Seek advice and treatment from NHS

Lifestyle & behavioural therapies • Lifestyle changes

• Fluid management

• Avoiding constipation

• Lose weight

• Behavioural therapies • Education & self-management

• Bladder training

• Pelvic floor muscle exercises (PFME)

• Abdominal massage

• Environment management • Use of the toilet

• Adapting the environment

Drugs

• Drugs for urgency incontinence

• Drugs for prostate problems

• Drugs to reduce waking up at night to use toilet

• Many associated with side effects: dry mouth,

constipation, blurred vision, headaches, dizziness

38

TPTNS for

Rehabilitation

and Treatment of

Urinary Incontinence

39

What is the treatment?

tptns stands for

transcutaneous

posterior

tibial

nerve

stimulation

40

TPTNS treatment gives:

• small electric pulses

• to the nerves in ankle

• painless

41

Use the

treatment

42

How do we know if this worked?

We tested before we started, at 6 weeks,

3 months and 6 months

using ….

bladder scan

bladder diary

questionnaires

43

What did we find?

This treatment is safe

Stroke survivors found it easy to use

Very few people dropped out of the research

It seems this treatment may work

It is worth doing a bigger research project

44

What did stroke survivors say?

6 of 13 stroke survivors who used TPTNS treatment (46%) said it

improved their bladder symptoms:

– fewer bladder leaks

– less need to use the toilet in the daytime

– less need to get up at night to use the toilet

– feeling that their bladder was emptying better.

Most said they were less anxious about their bladder condition and

felt more confident they could control their bladder.

45

Incontinence after stroke

• It’s very common

• It’s often ignored

• It’s embarrassing

• But for most people it’s

treatable!!

46

Incontinence after stroke is usually treatable,

if people seek help

Psychological Problems

Dr Terry Quinn

Stroke Association/CSO Senior Lecturer

@DrTerryQuinn [email protected]

#strokeassembly

1. What are the best ways to improve cognition (memory and thinking) after a stroke

1. What are the best ways to improve cognition after a stroke

2. What are the best ways to help people come to terms with stroke

3. What are the best ways to help people recover from aphasia

4. What are the best treatments for arm recovery

5. What are the best ways to treat visual problems after a stroke

6. What are the best ways to manage of prevent fatigue

7. What are the best treatments for balance, gait and mobility

8. How can stroke survivors & families cope with speech problems

9. What are the best ways of improving confidence after stroke

10. Are exercise and fitness programmes beneficial

http://www.google.co.uk/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=rmyEhFvTkijiEM&tbnid=CoE2F5WQHCO0JM:&ved=0CAUQjRw&url=http://lewybody.org/node/3584&ei=osRWUobRE6jt0gXO3IDIBQ&bvm=bv.53760139,d.d2k&psig=AFQjCNGETt8pv_JMtSCxmAhk4PHkRX0uUg&ust=1381504542503564

Patients with memory and mood issues don’t want to take part in stroke research projects

Yes we do

Don’t bother the care-givers with research, they have enough to deal with

It’s OK to ask

Patients with communication or memory issues cant contribute to research

Yes we can

#strokeassembly

PPLE Assessing Post-stroke Psychology a Longitudinal Evaluation

STROKE

No Dementia

Dementia

Memory or mood test

Mini Mental State

Examination

Addenbrookes’

Cognitive Evaluation

Cambridge Cognitive

Battery

Hachinski Battery

Alzheimer’s Disease

Cognitive Assessment

Battery

Neuropsychiatric

Inventory

Blessed Dementia Scale

Mini-COG

Clock drawing test

Verbal fluency test

Abbreviated mental

test

Stroop test

Harvard verbal learning

test

Montreal Cognitive

Assessment

Short and sweet

cognitive screener Alzheimer’s

disease

assessment –

cognitive

subscale

Animal naming test

Digit span Hodkinson

mental test

Letter digit coding test

Nine hole peg test

Picture word

learning tasks Raven’s

progressive

matrices

Ray complex

figure test

Trail making

tests

Modified mini-

mental state

examination

Abbreviated mental test

-10 point

Mini Mental State

Examination

Addenbrookes’


Cambridge Cognitive

Battery

Hachinski Battery



Battery

Neuropsychiatric

Inventory


Mini-COG

Clock drawing test

Verbal fluency test

Abbreviated mental

test

Stroop test


test

Montreal Cognitive

Assessment

Short and sweet


disease

assessment –

cognitive

subscale

Animal naming test


mental test


Nine hole peg test

Picture word


progressive

matrices

Ray complex

figure test

Trail making

tests

Modified mini-

mental state

examination


-10 point

Questionnaire of all Scottish Stroke Units

No. of “routine” cognitive/mood

screening tests - ??

Mini Mental State

Examination

Addenbrookes’


Cambridge Cognitive

Battery

Hachinski Battery



Battery

Neuropsychiatric

Inventory


Mini-COG

Clock drawing test

Verbal fluency test

Abbreviated mental

test

Stroop test


test

Montreal Cognitive

Assessment

Short and sweet


disease

assessment –

cognitive

subscale

Animal naming test


mental test


Nine hole peg test

Picture word


progressive

matrices

Ray complex

figure test

Trail making

tests

Modified mini-

mental state

examination


-10 point

Questionnaire of all Scottish Stroke Units

No. of “routine” cognitive/mood

screening tests - 45

Direct Strategy: Montreal Cognitive Assessment

STROKE

No Dementia

Dementia

Memory or mood test

STROKE

Poor Cognitive Reserve

Blood vessel disease

Severity of stroke

Brain scan abnormalities

Cognitive stimulation

Healthy lifestyle

Social networks

Poor Cognitive Reserve

Severity of stroke

Brain scan abnormalities

Cognitive stimulation

Healthy lifestyle

Social networks

Blood vessel disease

STROKE

Before the stroke

In acute stroke unit

Getting home Longer term

Care-givers

#strokeassembly

Shaping research Setting New Priorities

1.Haemorrhagic Stroke

2.Psychological Consequences of Stroke

3.Vascular Dementia

Working with: health care professionals, stroke

survivors, carers, families, other funders

Shaping the research agenda

Setting New Research Priorities

1.Haemorrhagic Stroke

2.Psychological Consequences of Stroke

3.Vascular Dementia

Priority Programme Awards funded in each area

Working with:

researchers, health care professionals, stroke survivors, carers, families, other funders

Psychological Problems

Dr Terry Quinn

Stroke Association/CSO Senior Lecturer

@DrTerryQuinn [email protected]

Closing Remarks

Stephen King

What’s happening in post stroke · 2019-04-15 · What’s happening in post stroke research in...

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