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List of Stroke Care Units in Australia

In 2005, at just 40 years of age, Alison Bakker had a stroke. Had she not received a fast and accurate diagnosis at a stroke unit, Alison may not have made it back home living with her husband and two sons today.

Hers was not a straightforward diagnosis but stroke was confirmed after Alison was taken to the stroke unit at Melbourne’s Austin Hospital.

“Everything was on hand at the stroke unit,” Alison says.

“There were scans and MRIs when I needed them. Everything was directly geared to caring for a stroke - from the ambulance getting us there to nurses and the neurology registrar on the stroke unit. I had 24-hour, seven-days-aweek, specialised care.”

Did you know stroke units save lives every day? At the National Stroke Foundation we work hard to ensure every eligible hospital in Australia has a stroke unit so people like Alison have the best possible chance of returning home to their families without – or with as little as possible – permanent disability. A stroke unit in a hospital allows a patient to be seen consistently by a team of doctors, nurses, speech and occupational therapists and physiotherapists who can monitor progress and intervene when necessary.

Alison was in a stroke unit for four days and was then transferred to a neurology ward where she stayed for 10 weeks.

She says that if she hadn’t received this specialised care she knows she would not be living the life she is today. “Being in a stroke unit was critical to my recovery,” Alison says. “My husband still shudders when he thinks about how things could have turned out with the appropriate treatment and care.”

The National Stroke Foundation has been working hard to ensure that the best stroke care is available to every Australian individual. This hasn’t always been the case but we are passionate about this goal because we know prompt, expert treatment makes the difference between death, a severe disability and returning home to an independent life.

In 2007 the Foundation started a series of audits of clinical treatment of stroke so we could understand the type of stroke care available in Australian hospitals and where the greatest needs may be. We also work on providing a snapshot of the current state of stroke care in Australia so we can chart changes and areas that need improvement.

This unique program has helped many people recover from stroke but we have more to do. The Foundation will continue to audit and encourage best clinical care for stroke patients around the country.

See a list of Stroke Care Units in Australia

Please note this is a response to a question from @calebferg on twitter @strokefdn

Question: Do stroke case managers in Aust need to have an ^ focus on the use of anticoags in AF post stroke? @strokefdn #stroke www.sciencedirect.com

In the 2011 Clinical audit of acute stroke services the following information was reported.

70% of all patients with atrial fibrillation were not medicated for this condition prior to their stroke. This information does not reflect hospital care in Australia. Rather care before people came to hospital. See table 6 page 17 of the 2011 Clinical audit of acute stroke services Report which reports care on people who received care in 2010.

Table 6 Patients with previous stroke or TIA receiving secondary prevention treatment (prior to admission)

Medication Medication history documented (N=1,178)* Medicated n (%)
Antithrombotic# 1,130 890 (79)
Anticoagulant (if atrial fibrillation) # 427 145 (34)
Antihypertensive 1,127 864 (77)
Lipid-lowering# 1,108 615 (56)

In regards to Hospital care in Australia.

We asked the question: On discharge was the patient prescribed:

a Antithrombotics Yes/No

If yes, mark all that apply below.
i Aspirin
ii Clopidogrel
iii Dipyridamole MR
iv Warfarin/other anticoagulant
v Other
iv None (select reason):

– Contraindicated
– Patient refused
– Under review
– No reason given

In 2011 the NSF acute clinical audit reported 96% of patients deemed suitable for an antithrombotic received this medicaton.

However at the 2011 Heart Foundation National Conference the following was presented on data from 2009 Clinical audit of acute stroke services.

Title: Outcomes for people with atrial fibrillation in an Australian nationwide audit of stroke care

Objective: Few data are available about patients with stroke and atrial fibrillation (AF) in Australia. We sought to describe outcomes for people with AF admitted to hospital with acute stroke.

Methods: Data were collected by retrospective clinical audit on consecutive patients with acute stroke admitted to public hospitals in 2008. Patients with known AF status (pre-stroke/new onset) were included. Patient characteristics, stroke subtype, modified Rankin Score (mRS), living arrangements and antithrombotic medication (pre- and post-stroke) were documented. Multivariable logistic regression adjusting for age, co-morbidity, stroke type, stroke severity variables and patient clustering for health outcome assessments were undertaken.

Results: AF status was known for 2,707 (92%) cases; 974 had pre-stroke/new onset AF. More patients with AF (36%) had a history of stroke/TIA when compared to those without AF (29%) (p <0.001). The median age at stroke onset was greater in those with AF (81 years [IQR 75-86] v no AF 74 years [IQR 62-82]). Few (30%) AF cases with ischaemic stroke were on warfarin prior to stroke onset and 42% of AF cases with ischaemic stroke were discharged on warfarin. Stroke survivors with AF had a 1.56 greater odds (95% CI 1.14 to 2.12) of being discharged to aged care and 1.48 greater odds of dying in hospital (95%CI 1.08 to 2.03) than patients without AF.

Conclusion: People with stroke that have AF experience worse health outcomes. Considering the cost of AF to the health system (about $1.25 billion), more research and use of evidence-based treatment is needed.

1 Ms Dawn Harris, Australia
2 Dr Dominique A Cadilhac, Australia

If you have any further questions or require clarification please email admin@strokefoundation.com.au

What is blood pressure?

Blood pressure (BP) is a measurement of the force your blood puts on blood vessel walls as it travels through your body.

Blood pressure varies throughout the day to meet your body’s needs and most people cannot feel when it is high. High blood pressure is sometimes called the “silent killer” because sufferers can have high blood pressure and show no warning signs.

Therefore the only way to know your numbers is to have your blood pressure checked regularly. If your reading is high, your doctor may measure your blood pressure on a number of occasions or you may be asked to monitor your blood pressure at home.

Consequences of high blood pressure

• Chronic high blood pressure leads to a number of complications including stroke and heart attack.

• High blood pressure puts unnecessary stress on blood vessel walls which may weaken them leading to a bleed in the brain.

• High blood pressure can cause blood clots or cholesterol plaques to break off artery walls and block a brain artery causing a stroke.

Tips for lowering your blood pressure

Find a free blood pressure check near you

The lower your blood pressure, the lower your risk of stroke.

Mechanics of Learning – lessons from neurorehabilitation

“Use it or lose it” – is a particularly apt description of brain function. Continuously (until death) new connections are formed between the 100 billion nerve cells which we have been born, and the 100 to 10 000 connections per neuron with others forming extensive networks makes the brain an enormously complex organ.

Probably some neuro-neogenesis (perhaps 6000 cells a day) occurs even in adulthood. Only those synapses, however, which are actively used, remain functional.

This is the basis of learning – the interaction and exchange between organism (us) and environment in problem solving tasks of daily living. Investigations on neuroplasticity in recent years have become a central topic in neuroscience, and have changed the attitude towards patients with lesions of the central nervous system.

They have also led to a better understanding of the adaptations of structures and functions of the brain according to requirements from the environment (environment being understood as the physical, psychological and social surroundings with their potentials and constraints).

In neurorehabilitation, such understanding of the interactions between organism and environment and that of learning is used and adapted in the treatment of patients with acute or chronic diseases or trauma. In reverse the observation of the changes attained during rehabilitation of such patients provides new insights into the mechanism of learning and of adaptations of brain structures and functions.

By Prof. Jurg Kesselring, Department of Neurology & Neurorehabilitation, Switzerland.

This article was first published in the Brain Association of Queensland Synapse magazine. www.synapse.org.au

Neuroplasticity

Researchers used to believe the brain pathways (for sending messages between the brain and the body) were fixed or unchangeable. This meant if a function was performed by a certain area of the brain, it could only be performed by that area. Therefore, after stroke they believed any damage that wasn’t repaired within a few months would be permanent.

Research now indicates the brain has the ability to change. This means brain pathways can change. This ability is called neuroplasticity. As a result, some stroke survivors may be able to retrain the brain by learning to use different parts of their brains to regain function during rehabilitation.

For a video about Neuroplasticity from Dr Norman Doige

There are a number of great puzzle games that can help you to exercise your brain IQ Puzzler are some great ones

Stroke survivor Andrew Iselin is set to run the Gold Coast Marathon on Sunday 1 July and in doing so will break a world record. Here he shares with us his journey to Do it 4 Stroke.

My name is Andrew Iselin and I suffered a stroke in early 2009 when I was 17 years of age. My left vertebral artery was dissected and this caused the complete loss of movement to the right side of my body. I spent about two weeks in hospital where I tried to regain basic functions. After this I went into a rehabilitation unit where I spent about 6 weeks partaking in intensive rehab where I spent about an hour a day with the physios and occupational therapists, as well as constantly doing the exercises they gave me until I went to bed. I worked with them in learning to gain the function back in the right hand side of my body, where I learnt to crawl, walk, write, etc. Once I had exited the rehabilitation unit I was still visiting about twice a week until I started university midway through that year.

Since then I have been classified into athletes with a disability where I have competed three times at nationals with the hope of eventually making an Australian team for the 800m or 1500m events on the track. I did have my sights set on London 2012 but I came to the realisation that in order to make it I will have to train for longer and get more used to my disability. After my disappointment of not performing how I would have liked during the track season I was again looking over the world records for my classification which one-day I hope to be able to achieve. I decided out of interest to look at the marathon world record and when I did I realised that there had been no record set for my classification. This motivated me to set a world record for my classification. My training schedule has not changed greatly from what I would have been doing at this time of year in order to prepare for the next track season. I train 6 days a week, twice a day whilst completing three university subjects. The only difference now is I have picked up the kilometres so I will now do an average of 60km a week.

My main challenges facing me now when it comes to preparing for the marathon is making sure I listen to my body and don’t train to hard when I feel a small injury occurring. My aim is to run the marathon under four hours and hopefully the right side of my body will handle the distance. I know that I have the determination to finish the marathon; it all comes down to how fast I complete it. In running this marathon I want to raise as much money as I can for the National Stroke Foundation and I also hope my running of the marathon can help raise awareness of stroke and encourage people to seek out the warning signs of a stroke because as you can see a stroke can happen to anyone of any age, of any athletic ability. If I knew the warning signs my stroke could have been prevented.

To donate money and support Andrew in his amazing effort to break a world record visit his fundraising page: Andrew Islin

The National Stroke Foundation recommends that you seek the advice of a healthcare professional before embarking on any strenuous exercise.

image via health-and-hygiene.com

An injury can disrupt the complex subsystems in our brain that provide our eyesight.

A brain injury can lead to focusing problems, eye muscle coordination deficits, changes in eyeglass perception, and peripheral vision changes. The type and extent of any visual problem depends on the severity and location of the injury. Even when visual problems are diagnosed there is often little vision rehabilitation offered. This is unfortunate as treatment often provides relief from visual symptoms. Some symptoms to look for are:

Headaches from visual tasks
Blurred or double vision
Sensitivity to light
Inability to concentrate or focus
Reading or comprehension difficulties
Trouble judging distances
Sore eyes
Loss of visual field

If you find it difficult to process visual information you may be straining without realising it. A general sense of fatigue can arise from visual problems.

Common visual problems

Dry eye

This can result when nerves or muscles of the eyelids are affected. Symptoms are often relieved with the use of the correct eye drops. In bad cases plugs placed in the tear ducts can solve the problem.

Double vision

This condition may cause confusion and disorientation. People experiencing this condition are often given an eye-patch to cover one eye, although it reduces the field of vision and interferes with daily function. Double vision can often be prevented without an eye patch, through the use of prisms and vision therapy. Prisms are used to shift objects in the field of vision. They can correct problems between body image and perception of space.

Loss of visual field

This loss is a common visual effect of a brain injury. There are many kinds but the most common is loss of half the field of vision in each eye. People frequently bump into objects, and easily trip or fall over objects. They may be afraid of leaving home and have difficulty reading. Therapy can help to detect objects on their ‘blind-side’ and use constant scanning to compensate. Compensatory strategies are useful, such as always aligning oneself to objects or people so they are centred in the remaining visual field.

Prisms and mirror devices are often helpful in cases of visual field loss. Tiny mirrors attached to glasses can expend visual field awareness. If there is some remaining vision, stimulatory exercises can be used to increase light sensitivity and regain some lost function.

Reading difficulties

These may arise from blurred or double vision, jerky eye movements, or visual field loss. Treatment can involve aids such as prisms or using a typoscope to focus on individual sentences. After injury, it can be hard to focus on a page due to nerve damage that effects the eye refocussing. Bifocal glasses can compensate.

Impaired eye movements may prevent smooth reading along a page. Therapists may be able to rebuild reading skills to reduce problems such as this.

Low vision

Following a brain injury some people have normal field of view but can’t read print or watch television with conventional glasses because of low vision. Low vision aids include telescopic lenses for distance vision and other fine tasks.

Photosensitivity

Light sensitivity varies from person to person. Some have no trouble, but others find bright light painful. Solutions may include tinted eyewear or amber filters. Sometimes treatment for other problems will reduce photosensitivity.

Hallucinations

Visual hallucinations may be formed objects such as a person or figure or may be unformed such as flashes of lights, stars or flickering distortions.

Impaired visual memory

Memory is often impaired after stroke or head injury. In rare cases very specific types of memory processing are impaired. A person may no longer be able to recognise faces, objects or letters.

Vision rehabilitation

After a brain injury, some people experience a natural recovery in the following months. Recovery can be assisted with the use of any prescription lenses. Some people will not recover naturally, but may do so with vision therapy. Vision therapy hastens natural recovery as well.

A clinician skilled in both low vision and brain injury will understand the interaction of these problems, and be able to make a plan to rehabilitate the visual system. After evaluation examination and consultation, a clinician will determine how a person processes information after an injury, and where that person’s strengths and weaknesses lie. They provide treatment designed for each person, and frequently incorporate combinations of lenses, prisms, low vision aids and vision therapy activities. The road to recovery needs teamwork of many doctors and therapists with time and patience throughout the rehabilitation process.

Ring the Optometrists Association on your state for a list of optometrists and opthamologists, or visit the national website at www.optometrists.asn.au

This article was first published in the Brain Association of Queensland Synapse magazine. www.synapse.org.au