Via: Neurology Update 29 Nov 2011 written by Michael Woodhead.

An “in the field” stroke screening tool used by ambulance staff may boost thrombolysis rates from the typical 3% to around 50% of patients with ischaemic stroke, an NSW program has shown.

The pre-hospital stroke triage protocol developed by the John Hunter Hospital in Newcastle has been successfully adopted for use in other hospitals to help alert and prepare a stroke team and improve “door to needle” times, a study (link) in Journal of Clinical Neuroscience shows.

The protocol known as FASTER (Face, Arm, Speech, Time, Emergency Response) is based on pre-hospital checks of arm function and speech in patients who have had onset of stroke symptoms within the last two hours.

This allows an on-call stroke team to be alerted, and the patient is fast tracked through the ED for stroke evaluation.

In the first six months following the introduction of the protocol, 42 patients were referred via the FASTER pathway, and 50% of them received tpA.

The study authors say the protocol not only resulted in significantly faster ED door-to-needle times, but also patients were admitted to the Stroke Unit over an hour faster than those receiving tPA prior to use of the protocol, due to rapid clinical and radiological assessments.

The stroke screening protocol also had a high accuracy of stroke diagnosis with only two of 42 referrals (<5%) found to be stroke mimics.

Response to article from Kelvin Hill Manager of the Clinical Guidelines Program “Improved ambulance and acute hospital processes lead to stroke patients getting best practice care recommended in the National Stroke Guidelines.”

Two workshops were delivered on Motivational Techniques for Health Professionals in Brisbane in November. The workshops were facilitated by the National Stroke Foundation and delivered by Dr Stan Steindl.

76 health professionals attended. The workshops were highly interactive and the participants were very engaged.

MI (motivational interviewing) is a patient-centred technique used for cooperative goal setting and can strengthen patient self management of their risk factors; known to improve patient satisfaction with the Health Professional. MI involves the use of open questions, affirmations, reflective listening and summarising key points/decisions.

Dr Stan Steindl taught the spirit and methodology of motivational interviewing and how to use this powerful technique to elicit behaviour change and improve your patient’s health outcomes.

The workshop included a demonstration of timed interventions to help Health Professionals understand how motivational interviewing can be used in time-limited settings.

These workshops were developed as part of a package aimed at increasing the delivery of advice on lifestyle changes that decrease the risk of secondary stroke. MI is recommended in the Clinical Guidelines for Stroke Management as a way to deliver individualised lifestyle modification advice for secondary prevention of stroke.

To find out more about these workshops please email Kevin Pyle

Maintaining a healthy lifestyle following a stroke is as important as it is prior to a stroke event. To this end the Heart Foundation has partnered with the National Stroke Foundation to make the Heartmoves exercise program more attractive and appropriate for stroke survivors.

“This partnership has developed a new nationally accredited training course, providing Heartmoves leaders with additional skills and knowledge on how the health teams are currently managing stroke survivors,” said Tony Thirlwell, Heart Foundation NSW – CEO.

“Participation in physical activity after stroke is important and can help survivors lead a healthy and happier life as well as reducing their chances of having another stroke. Many survivors are left with complex physical and cognitive problems after stroke which makes participation in regular exercise programs difficult, but now the Heartmoves program will help make exercise accessible” says Dr Erin Lalor, National Stroke Foundation CEO.

Building on the Heart Foundation’s successful Heartmoves exercise program, and using the National Stroke Foundations’ expertise in stroke, this new initiative equips Heartmoves leaders with strategies specifically designed to benefit stroke survivors.

“The new program will give Heartmoves instructors the opportunity to work with stroke survivors through movement and exercise that can be tailored so that individuals can work at their own pace,” said Mr Thirlwell.
Heartmoves exercise providers can continue their learning and professional development with this new nationally accredited course. It will also be available online, providing rural and remote leaders with easy access.

“Heartmoves for Stroke will provide health professionals managing stroke survivors with a safe and evidence based referral destination for their clients, following rehabilitation,” said Mr Thirlwell.

Heartmoves programs focus on delivering safe, low-to-moderate intensity exercise incorporating aerobic activity, weight-bearing or resistance exercise, stretching and balance components – all of which help to build strength and fitness as well as improve balance.

The Heart Foundation would welcome expressions of interest from existing Heartmoves trainers to take part in this nationally accredited training module. To find out more about Heartmoves for Stroke visit Heart Moves or call 1300 362 787.

Anita Mitchell describes herself as a “novice runner” even though she took up the sport as part of a new fitness regime several years ago.

Since then the 30-year-old mother of two has built up her strength and stamina to a point where she has already completed a half-marathon (21kms).

“I didn’t think I could run a long distance until a trainer told me that if I could run 10kms then I could run 21,” Anita says.

And she was thrilled to find that she could.

Anita, who lives in Melbourne’s northern suburbs, has recently committed to running a full marathon – the renowned Paris Marathon in April 2012 – for the National Stroke Foundation.

She aims to raise $12,000 which will go towards funding stroke research, prevention and awareness programs.

Stroke is Australia’s second biggest killer and a leading cause of disability. 1 in 6 people will have a stroke in their lifetime and the National Stroke Foundation works to raise awareness of stroke, advocate for better treatment and more stroke units in hospitals, fund research and provide services and programs to support stroke survivors, families and carers.

She enjoys the challenge of running because, she says, it draws on reserves of patience she did not previously think she had.

“I don’t naturally have a lot of patience – I generally want to get in, get it done and go,” Anita says.

“Marathons take a lot of patience, a lot of concentration on getting through the next kilometre and the next.”

Anita, who is Business Operations Manager at NSF, had no hesitation in raising this money for her new favourite charity.

“And Paris is my favourite city, I can’t imagine running through more beautiful streets.”

For more information on running the Paris Marathon and other NSF challenges, go to Doit4Stroke or call Kim Vernon on (03) 9670 1000.

Image Via: Sunshine Coast Daily.

BY a stroke of much more than luck, I find myself staring at my computer screen instead of at a hospital ceiling.

I had been rushed to the Nambour General Hospital, and my release in good shape after only three nights could suggest I had suffered only a mini-stroke. In fact, it was a full on ischaemic stroke … a blocked blood vessel in the brain.

Why am I telling you all this? Because it is a cautionary tale, and a timely one at that.

Why timely? Because my narrow escape has coincided with media publicity for the F.A.S.T. program telling how to recognise the signs of stroke and stressing that there is only a small window of time for treatment After this has elapsed, the affected brain cells die.

F.A.S.T. stands for Facial weakness; Arm weakness; Speech difficulty and Time .… time to act fast and dial 000.

On that Tuesday morning, after my usual brisk walk, I sat down to breakfast, reached across the table for the Daily, and found to my astonishment that it seemed to keep slipping away from my outstretched hand. Actually, it was the hand that wasn’t doing its job.

I then decided to eat my breakfast, but the first spoonful went nowhere near my mouth, so I knew I was in trouble. Reaching with my left hand for my mobile phone, I speed-dialled my son Ross, who lives nearby.not far away.Although what I said was unintelligible – or maybe because it was – he was here in minutes and called for an ambuilance via 000.

After a rapid but careful diagnosis by the stroke team at NGH,, Dr Tony Tampiyappa CORRECT had to decide whether to risk an aggressive treatment that might diffuse the clot causing the blockage, but could also cause a brain bleed, which would be disastrously damaging.

After explaining this, and with my agreement, he went ahead and all went well, so much so that I am back where I was before I noticed the first symptoms. I will always remember the smile on his face when he told me the procedure had been totally successful, and I’m told mine was pretty wide, too.

After three days, I ticked all the boxes for discharge.

I find it hard to adequately express my gratitude for the expertise and care of the stroke team, and also to the ward staff who greatly helped me through an anxious time until my treatment was shown to have been successful.

Thanks, too, to my daughter Laurel for programming a speed dial facility into my phone only a few days before the incident, and to my son Ross for getting here so fast, dialling 000.and giving clear directions to the ambulance.

I doubt that I would have even been able to dial 000 …just the one number was hard enough, but as things turned out, mine was not up.

Peter Richardson is a columnist for the Sunshine Coast Daily, in which this article first appeared on October 16 2011.

The symptoms and triggers of fatigue, and how to manage it.

Fatigue is one of the most invisible effects of a brain injury, with family members, employers or friends often mistaking this lack of energy as simple laziness. This excerpt from BrainLink’s publication For Those Who Care, provides some handy coping strategies.

Contingency plans

Fatigue may occur at the least convenient times – on public transport or during a meeting. You need to negotiate ways of coping when this happens. You can use specific strategies or call for extra support.

Work out contingency plans with your family member. Your neurologist, occupational therapist or physiotherapist can help you with suggestions.

Assess your environment

Provide an environment that is easy to move around and work in. Think about how and where things should be stored, bench heights, entrances, types of furnishings, lighting. For example, some people may find florescent lights or dim lighting more tiring.

Schedule rest periods

Make a daily or weekly schedule and include regular rest periods. “Rest” means do nothing at all.

Use aids

Use medical aids to conserve energy for when it really counts. One man spared his legs extra by using his wheelchair to get form the house to the car, then from the car to the church, before walking his daughter, his bride down the aisle.

Break it down

Break down activities into a series of smaller tasks. This provides opportunities to rest while allowing the person to complete the task. Encourage sensible shortcuts.

Set Priorities

Focus on things that must be done and let others go.

Medication highs and lows

Be aware of changes throughout the day that relate to medication. Is the person better or worse immediately after their tablets. Plan their activities around these times.

Sleep

Encourage a regular sleeping pattern. Some people may also need a regular nap – or two – during the day.

Fitness

Your family member should maintain fitness within their individual ability, that is, enough exercise to stay fit, but never to the point of causing tension, overtiredness or cramps.

Weight

Maintaining a healthy weight helps. Of your family member’s condition affects their ability to eat, consult a dietician and speech pathologist to ensure they have a nutritious diet that is easy to manage.

Weather

Hot weather can also increase fatigue. Plan around this.

Seek support

Ask for advice. In particular, an occupational therapist can visit your home and advise on energy-conserving plan of action.

Acknowledgement

This article is copied with the permission of Synapse – The Brain Injury Association of Qld. Original article reproduced from BrainLink.

This article by Adam Cresswelt (health editor) was published in The Australian today.