Just because we don’t want to talk about it doesn’t mean it will go away! Incontinence can be a problem for people at different times in their life, for different reasons and it can certainly be an issue after stroke.

Here we’ve taken some information and tips from one of the National Stroke Foundation’s fact sheets: ‘Incontinence after stroke’. This resource is one of 10 available from our website and can be downloaded from: www.strokefoundation.com.au

Stroke can affect bladder and bowel control in many ways but there are steps you can take to make this less of an inconvenience or embarrassment in your daily life. The most common incontinence problems include:

• Frequency. Needing to go to the toilet very often.
• Functional incontinence.

Trouble getting to the toilet on time or at all. Physical or communication difficulties after a stroke can make it harder to get to the toilet on time.

Sometimes clothing can be hard to get undone or toilets may not be close by.

• Urge incontinence. A sudden and uncontrollable need to pass urine.
• Urinary retention. Not being able to fully empty the bladder or holding an increasing amount of urine in the bladder.
• Faecal incontinence.

Incontinence can be prevented, treated, better managed or cured and the first step is a full assessment by health professionals. For some people it might be hard to talk about incontinence but it is important you get the best help you can. There are a number of health professionals who can help you improve your continence.

These include a doctor, urologist, occupational therapist, physiotherapist and dietitian. Starting with your doctor is always a good first step.

GENERAL practice staff are being urged to encourage their nonclinical employees to take part in free training to promptly identify patients with suspected signs of impending heart attack or stroke.

Reception staff are usually the first to see patients presenting with symptoms of severe chest pain, and an online training tool has been developed to help non-clinical staff identify such patients.

The triage strategy, called BeAWARE of warning signs of heart attack and stroke, is a tool put together by the Heart Foundation and National Stroke Foundation.

Heart Foundation CEO Dr Lyn Roberts said reception staff are the eyes and ears of general practice. “For this reason it is vital reception staff are trained to appropriately identify and deal with patients presenting with the warning signs of heart attack and stroke, so they can make potentially life-saving decisions,” she said.

A Heart Foundation study found 15% of patients who experience severe chest pain attend their GP surgery or call a health professional, rather than call 000.

Research has shown nine out of 10 practice nurses have had patients present with heart attack warning signs rather than calling an ambulance.

On completion of the module, the practice receives a resource kit. To register, visit Heart Foundation online learning

Article originally published in Medical Observer, National 22 Jun 2012

Using technology to aid in stroke recovery

StrokeConnections spoke to Southern Health speech pathologists Gabrielle Writer and Jaime Cosham share with us their thoughts on iPads as rehabilitation tools. Please note though, Gabrielle and Jaime say this is not the most suitable communication device for everyone. They recommend a speech pathology assessment before making an investment as iPads are not a “onesize- fits-all” piece of equipment.

How can iPads be used as a device for communication for stroke survivors?

iPads can be a fantastic option as a communication device. They are light weight and portable, affordable and very ‘in’ right now, making them socially acceptable. They allow non-verbal communication via email or messenger applications (‘apps’) for people who can write and spell. An app is a computer program that is downloaded onto your iPad or smart phone.

There are a large number of alternative and augmentative communication (AAC) apps available, ranging in cost from completely free to several hundreds of dollars. There is a variety of types of AAC apps, for example picture or symbol-based, where a word or phrase is spoken when a picture is selected; text to talk where the person writes or types in a word or phrase to be spoken, and combinations of both.

What role can they play in therapy?

Specific therapy apps can be used in individual and group therapy, and used for extensive home practice. Suitable apps can be used to provide the person with auditory and/or visual feedback, enable self-monitoring and measure progress.

There are a variety of great apps therapists can use: for rating/measurement improvements, as a fluency rater, sound level meter for measuring volume of voice, etc.

How have you found stroke survivors respond to using an iPad?

Many love it and have found the technology of the iPad itself quite easy to pick up, even if they have not had a lot of ‘technology’ experience. Feedback from clients has included that the iPad is ‘motivating’ and ‘enjoyable to use’. We have had reports of increased family involvement in a client’s home therapy practice, as all the grandchildren wanted to be involved with the iPad!

On the other hand, there are some people who have had difficulty using the touch screen aspect of the iPad due to problems with manual dexterity/ dyspraxia.

Kingston CRC client Margaret using the iPad with Southern Health Speech Pathologist Jaime Cosham.

Will they be accessible enough? Is the price restrictive?

The price is reasonable compared with other communication technology. There can be issues with the process of using iTunes for accessing and downloading the apps. The user definitely needs to have some degree of computer know-how and access to WiFi or another computer for this, or a support person who can assist them.

There is such a huge array of apps and this can be overwhelming and confusing. Again there needs to be someone with knowledge and experience involved to find suitable apps.

What are the benefits of this technology?

It can be modified to continue to meet each person’s needs if their condition changes It may enable increased social “connectedness” with email, video calling and access to the internet.

Other features are available to assist in activities of daily living include a calendar, alarm clock, daily reminder lists, calculator, and it can provide portable entertainment (music, videos, games, photos etc).

Image Via printerinkcartridgesblog.printcountry.com

The link between osteoporosis (where the bones become fragile and brittle and more prone to breaking) and stroke is still not entirely clear but we know that people affected by stroke have a higher risk of developing osteoporosis than people of similar age without stroke. Bone loss after stroke is often rapid and more pronounced in the side of the body that was affected by the stroke. Although the cause of bone loss is unclear, the amount of bone loss experienced by people with stroke appears related to the length of time they are immobile, the extent of muscle weakness and atrophy (shrinking muscles) and reduced weight bearing activities (like walking) and fitness.

Associate Professor Julie Bernhardt, who is a member of the NSF Clinical Council and a specialist in stroke rehabilitation, says research is continuing into the best way of preventing osteoporosis after stroke but stroke survivors should be careful to reduce their risk of falling.

She recommends that you:
1. Reduce risks of falls by having an assessment of your home environment completed; this may include checking lighting, floor coverings and bathrooms.
2. Hand rails in some rooms may be useful
3. Make sure that your medications are monitored regularly (drug interactions and sleeping pills can increase your risk of falls)
4. Take part in regular exercise to help maintain your mobility, strength and balance.

Falls are common both in hospital and out. Therapy and nursing staff are particularly concerned about people affected by stroke having a fall and they may require that someone is with the person at all times when they walk, particularly in the early phase of rehabilitation. Not all falls lead to injury however, so it is always the case that the rehabilitation team weigh up the need for the stroke survivor to have independence (and practice being independent), with the possible risk of falling. Something that should be covered in a rehabilitation plan is teaching the person how to get up again if they fall but are not injured. This can be a really helpful thing to learn!

There is still a lot we need to learn about the link between stroke and bone loss and the most effective ways to prevent or slow it. There are a number of researchers around Australia interested in this issue and they hope to answer some of these questions in the coming years. In the mean time, be active and exercise as much as you can. It seems to be a promising intervention to help general well being and health as well as your bones.

There are many adjustments that need to be made to life after stroke and not all of them by the person who has had the stroke. Stroke happens in an instant – and so too, does becoming a stroke carer. Taking on the role of carer can bring with it a great many emotional, time and financial pressures. Sometimes the end of the year – with holidays, parties and family visiting – can add to carer stress. We’d like to remind carers to take some time out for themselves and to ask for support when things are feeling too difficult.

Vivienne Harkness understands the jolt to reality that comes with a new life as a carer. When her husband, Peter Harkness, suffered a severe stroke at 7.01pm on May 30 this year Peter, Vivienne and their family began a journey that continues today.

“The stroke was hard on Peter and continues to be very difficult,” Vivienne says.

“But as carer I have experienced some changes to my life that I could never have anticipated.”

As her own means of coping as well as handling the dozens of phone calls she would have to make at this stressful time, Vivienne wrote an email to all friends and family letting them know what had happened. For the next few months Vivienne kept up her correspondence as Peter went through rehabilitation and finally came home. It was a very practical form of therapy, she says.

Vivienne’s first-hand experience of life as a carer gave her a close-up glimpse of the day-to-day challenges of life after stroke.

“Carers need a great deal of support,” Vivienne says. “It is a taxing job and one that you are not prepared for as you can never prepare for stroke.”

“You can’t understand the life of a stroke carer until you become one,” she says.

Here are some general tips for looking after yourself so you have enough energy to care for someone else:

No one plans on becoming a carer. If you are a carer it is important that you don’t feel alone – especially if you don’t have family members to give help and support.
Although there will be changes in your life it is important to remember your own needs. You should continue to do the things that you did before your life was affected by stroke, making sure to keep the person who has had the stroke involved in, or at least aware of what is happening.
Carers often manage the health care and medications of the person they care for. You may also have a lot to do with health care professionals as part of your caring role. Think of yourself as being part of the team working with the stroke survivor to make the best recovery possible.
Do not be afraid to ask your general practitioner or your stroke team for guidance and support. There is also a list of carer support agencies at Strokefoundation.com.au

Image Via: Clker.com

Callers to StrokeLine 1800 STROKE (1800 787 653) often call after having trouble getting travel insurance after a stroke or TIA. With holidays upon us, it is a good time to see what travel insurance policies and avenues are best for you.

Travel Insurers assess all applications for pre-existing medical conditions on an individual case by case basis. There is no book with set responses that they will give. In reaching a decision whether to provide cover for someone with pre existing medical condition, insurance agencies take into account; age of the traveler, where they are going, the amount of time away and the stage of the condition.

John Berrill from Maurice Blackburn Reviews, has written a great article about buying travel insurance if you have a pre-existing chronic illness, Travel Insurance & Chronic Illness .

For a list of government and community suggestions, please see the links below.

Council of the Aging (COTA) has recommended these travel insurance companies, especially for the over 60’s:

Australian Seniors Insurance Ph: 1800 024 848 Web: Seniors.com.au

COTA Insurance Ph: 1300 1300 50 Web: Cota.com.au

Australian Pensioners Insurance Agency Ph: 13 50 50 Web: Apia.com.au

Stroke survivors have reported positive outcomes using:

Covermore Ph: 1300 72 88 22 Web: Covermore.com.au

Note: the National Stroke Foundation has no relationship with Maurice Blackburn Lawyers.