Saturdays News - Locked-In Syndrome

Definition: Locked-in syndrome From Wikipedia, the free encyclopedia.

Locked-in syndrome is a condition in which a patient is aware and awake but cannot move or communicate verbally due to complete paralysis of nearly all voluntary muscles in the body except for the eyes. Total locked-in syndrome is a version of locked-in syndrome where the eyes are paralyzed, as well. The term for this disorder was coined by Fred Plum and Jerome Posner in 1966. Locked-in syndrome is also known as cerebromedullospinal disconnection, de-efferented state, pseudocoma, and ventral pontine syndrome.

Locked-in syndrome can be caused by stroke at the level of the

basilar artery denying blood to the pons, among other causes.

Presentation

Locked-in syndrome usually results in quadriplegia and the inability to speak in otherwise cognitively intact individuals. Those with locked-in syndrome may be able to communicate with others through coded messages by blinking or moving their eyes, which are often not affected by the paralysis. The symptoms are similar to those of sleep paralysis. Patients who have locked-in syndrome are conscious and aware, with no loss of cognitive function. They can sometimes retain proprioception and sensation throughout their bodies. Some patients may have the ability to move certain facial muscles, and most often some or all of the extraocular eye muscles. Individuals with the syndrome lack coordination between breathing and voice. This restricts them from producing voluntary sounds, though the vocal cords are not paralysed.

Causes

Unlike persistent vegetative state, in which the upper portions of the brain are damaged and the lower portions are spared, locked-in syndrome is caused by damage to specific portions of the lower brain and brainstem, with no damage to the upper brain.

Possible causes of locked-in syndrome include:

• Traumatic brain injury
• Diseases of the circulatory system
• Medication overdose
• Damage to nerve cells, particularly destruction of the myelin sheath, caused by disease (e.g. central pontine myelinolysis secondary to rapid correction of hyponatremia)
• A stroke or brain hemorrhage, usually of the basilar artery

See the full article Locked-in syndrome From Wikipedia, the free encyclopedia.

Locked-In Syndrome Definition (presented by YouTube)

Locked in Syndrome Overview

Jenny's Story.

In march 2004, jenny lynn suffered a massive brainstem stroke & was left "locked-in." This is her recovery progress the following 9 months. She still is improving.

It's a Girl Who Tells Her Story About Jenny's Story.

It's about a girl who tells her story about herself & how you people should accept yourself.

Trapped In Your Own Body (Hungry Beast)

Seventeen years ago, Maree Bourke-Calliss suffered a massive stroke from a knock received during a netball game. She's now what the medicos call "Locked In", unable to move or speak. Her brain is 100% there, but it's inside a body that can only communicate by blinking. For this interview, we sent Maree a bunch of questions in advance. It took her nearly a week to blink out the answers. In the video, Maree's responses are read out by her sister, Berni.

Produced and directed by Monique Schafter and Aaron Smith for Hungry Beast. Edited by Andrew Glover.

Marty Acierno - "The Fighter" Locked-In Syndrome.

MARTY- After an amazing recovery from his first stroke in June 2008, Marty suffered a second more catastrophic and devastating Brain Stem Stroke, resulting in a condition called, "Locked-In Syndrome".  Except for eye movement and small head movements, he is completely unable to move, yet fully conscious, aware and with cognitive function. Marty is a wonderful, vibrant and funny young man of 49, trapped inside an immobile body and can only communicate via eye movements and a computerized device which he activates with small head movements. Imagine being a fully functioning human being trapped inside a motionless body ... unable to speak, eat, swallow or move! This could happen to anyone, regardless of age.

In spite of his insurance denying him at every step of this difficult journey, (including the rehabilitation he so desperately needs), Marty has begun to show some improvement. This is a result of only his family supporting him and fighting for him. If we can gather a community of friends to help round out the support he needs, his progress will be accelerated and unlimited. He needs daily, consistent therapy to make significant gains!

Marty's family seeks financial help in providing him the tools he will need on his road to recovery. These include: private pay therapy, an accessible residential environment and a van to transport Marty. Insurance won't pay for his therapy, but you can help make his recovery possible.

See Marty's Fund on Facebook.

Laxman Dusa: Fighting Locked-In Syndrome.

Laxman Dusa was a happily married, helping and humble person until he met his nemesis in "LOCKED-IN SYNDROME" that made him paralyzed in all his voluntary muscles. He suffered a major STROKE in his brain-stem due to a blood clot on Dec 9 2010.

He is an active mind trapped inside an unresponsive body constantly fighting, with his shear will-power and support from his family, friends and well-wishers.

He is currently undergoing Rehab Therapies in Mt. Sinai Rehab center.

Out of Locked-in Syndrome 2010 Neuro Film Festival

This film has been entered into the 2010 neuro film festival from the american academy of neurology foundation at www.neurofilmfestival.com. Let's put our brains together and support brain research! Out of locked-in syndrome.

A film by Andja & Vera Trifunovich, sisters & caregivers of Aleksandar Trifunovich, brain stem stroke survivor.

Utah Woman Emerges from Locked-In Syndrome

A Utah woman who suffered the nightmare of locked-in syndrome is thriving today, even though doctors recommended allowing her to die eight years ago.

Richard Marsh Talks About His Recovery from Locked-In Syndrome.

Richard Marsh talks about his recovery from locked-in syndrome. A stroke left former police officer Richard Marsh a prisoner in his own body - he had full cognitive awareness but an almost complete paralysis of all his muscles. Marsh had locked-in syndrome, a condition for which there is no treatment or cure. But four months later he had walked out of hospital. Here, he speaks about his experiences via Skype from his home in Napa Valley, California.

YouTube: Augmentative and Alternative Communications (AAC)

Eye Tracking Communication for Locked-In Syndrome

Engineering undergraduates describe a low-cost communication technology they developed for patients with "locked-in syndrome" from neurotraumas like stroke or brain injury. This project and 32 others will be displayed at the Hajim School Design Day on April 28, 2 - 4 p.m., in Goergen Hall, Rochester University.

Stephen Murray - Professional Bmx Rider, Using Tobii PCeye to Stay Strong. (from www.tobii.com/...)

It was a trick he had done thousands of times before – but this time, it went horribly wrong. He fell while attempting his signature double back flip and was paralyzed from the shoulders down. In an instant his life had changed forever. Today the world-class BMX rider Stephen Murray and the Athlete Recovery Fund (ARF) promote the life-changing benefits of eye-tracking technology for those with spinal cord impairments and further highlight the medical needs of professional athletes suffering from performance injuries.

“Using the Tobii PCEye gives me back some independence and privacy in my life. I had come to the point that I thought I would never be able to accomplish the things I can now do with Tobii’s technology,” said Murray. “It makes me excited to wake up each day and gives me new goals to work toward. The positive effects this has had on me psychologically are far better than anything that had ever been offered to me in the past.”

Murray, a multi-gold medalist and professional BMX rider, was critically injured while performing at a competition in 2007. The crash resulted in multiple fractured vertebrae and damage to his spinal cord, leaving him quadriplegic. Despite holding insurance that covered a significant portion of his immediate emergency care, Murray and his family realized that much of his long-term care needs would not be covered by his insurance. Many action sports athletes are unable to afford this long-term coverage due to the low income levels of the majority of action sports professionals.

This hurdle served as the catalyst for forming the Athlete Recovery Fund, a 501(c)3 nonprofit that assists athletes in BMX, skate and freestyle motocross (FMX) after a severe injury to provide charitable medical and education resources to aid in recovery and rehabilitation. The Athlete Recovery Fund is Stephen Murray’s legacy because of what was learned by friend Aaron Cooke, ARF executive director, while fundraising for Stephen.

“The ARF has made significant strides in assisting action sports athletes in their rehabilitation needs and continues to grow with support from numerous organizations, such as Tobii,” said Cooke. “It is our goal to continue championing these athletes as we push for more comprehensive insurance policies that will address their long-term care.”

Murray furthers his outreach to those with spinal cord and other debilitating injuries with the Stay Strong apparel line, focusing on maintaining a positive outlook despite the challenges associated with rehabilitation and traumatic injuries. Murray hopes to build a support community around Stay Strong that will allow others to communicate, motivate and encourage one another during their rehab efforts.

Utilizing the most advanced eye-tracking technology in the world, the Tobii PCEye allows for greater independence through the use of eye movement to navigate, select and scroll through desktop applications, the Web and other common computer functions. With the robust eye-tracking and eye-control capabilities of his PCEye, Murray is able to send emails to family and friends, make phone calls, chat on Skype, review personal bank accounts, log in to Facebook , communicate with his business partner on the Stay Strong brand, and browse the Internet to keep up on current happenings in BMX.

Copyright © 2011 Tobii Technology

My Tobii P10 Eye Gaze Device Used by a Man With ALS.

This is James. James has ALS (also known as Lou Gherig's disease) and is unable to speak or use his arms and hands. He is using the My Tobii P10 to compose a message. James types by looking at the keys on the on screen keyboard. The P10 is able to determine where his eyes look. You can see a dot appear on the key he is looking at. When James wants to select a key to type he blinks and that keystrole is typed into a message window. With this device James is able to contribute to a political blog. His blog is located at http://rutherfordtimesonline.com/.

Kathrin and her MyTobii P10 (from www.tobii.com/...)

Kathrine explains in her own words how her eye controlled MyTobii helps her deal with the challenges posed by Cerebral Palsy. This is her story.

My name is Kathrin Lemler. I’m 21 years old and I have Cerebral Palsy.

I’ve used many different communication systems, starting with low tech-systems like symbol or alphabet charts which were followed by different computers. For years I used three switches in the headrest of my wheelchair and one knee-switch. After longer working periods I was exhausted, my neck ached and I had a very high body tension.

In spring 2005 I got the chance to try several different eye control systems. MyTobii was the only system that would tolerate my head movement and worked from the first moment on. It was magic! My initial feeling was that I couldn’t believe it! I was writing with my eyes! It was an indescribable feeling.

I sat in front of the computer, looking at the screen, letter after letter appeared and words evolved. From the moment I got a MyTobii my communication has run much more smoothly. It starts in the morning. I’m able to chat with my cab driver who takes me to school. We talk about unimportant things like the weather.

In school I can write long texts without having sore muscles afterwards. Because of the speed I can participate in conversations with non-AAC users and keep up with my colleagues. At home I can use MyTobii for making telephone calls on my own. I can chat much more than I did before and even afford the luxury of being polite.

Since my eye controlled MyTobii is mounted on my wheelchair I can take it wherever I go. For instance am I able to go into a bank myself and talk to the clerk independently. I don´t need an interpreter anymore. Because MyTobii is on my wheelchair, I can use it at school. And at home I can use MyTobii during meals too.

For me communication is one of the most important abilities in life. It is more than expressing your needs. Getting in contact with others and talking to them makes you a member of society. MyTobii has become my voice.can participate in conversations with non-AAC users and keep up with my colleagues. At home I can use MyTobii for making telephone calls on my own. I can chat much more than I did before and even afford the luxury of being polite.

Copyright © 2011 Tobii Technology

Saturdays Comics - Oct/13/2012

For Better and For Worse Lynn Johnston / 2007-05-12 "There's nothing better than a coffee break ..."	Dilbert Scott Adams / 2012-10-07 "Unless you have hard data ... "
Garfield Jim Davis / 2012-10-09 "Forget to let go again !"	Betty Delainey & Rasmussen / 2012-10-07 "She's really putting us to shame, ..."

* For Better and For Worse" is a serious topic of stroke but with a very nice cartoons. It is all about Grandpa Jim had a stroke and 88 further cartoon "strips" that happened to Grandpa Jim. (See as well  the author Lynn Johnston).

** I tried to get low or free price at the people http://www.UniversalUclick.com/ for the images for the cartoons. It was too high for Stroke Survivors Tattler i.e. we are not a regular newspaper and our budget is very low. Fortunately, you will have to do only 1-click more to see the cartoon image, it is legit and it is free using GoComics.com and Dilbert.com.

*** Changed from "Pickles" to "Betty" -- "Betty" is a excellent cartoon and Gary Delainey & Gerry Rasmussen are authors/artists/cartoon-strips and they live in Edmonton.

Saturday - Eclectic Stuff & Articles - Oct/13/2012

Definition:Eclectic(noun) a person who derives ideas, style, or taste from a broad and diverse range of sources.

Eclectic: SSTattler - Ditch the Chain, a New Type of Bicycle Is Here

John - SSTattler

Trek Bicycle is on the cutting edge of a movement to bury the finger-pinching, pants-munching, rust-prone sprocket and chain, and usher in a new era of belt-driven bikes.


 SSTattler: Hey Monty - maybe we have to change the Tadpole to the new type of chain!

Article: Dean - A Real-Time fMRI-Based Spelling Device Immediately Enabling Robust Motor-Independent Communication

Dean's Stroke Musing

This is so cool, instead of just working on letters I bet they could mimic ASL and do words/phrases.  -- Dean's Stroke Musing. Original  article A Real-Time fMRI-Based Spelling ... 

Highlights

fMRI-based spelling device for potential communication with locked-in patients.  Each letter of the alphabet can be hemodynamically encoded by a single mental process. Evoked single-trial fMRI responses can be decoded in real time with high accuracy.  Requires almost zero pretraining; methods can be readily used at standard MRI site.

Summary

Human communication entirely depends on the functional integrity of the neuromuscular system. This is devastatingly illustrated in clinical conditions such as the so-called locked-in syndrome (LIS), in which severely motor-disabled patients become incapable to communicate naturally — while being fully conscious and awake. For the last 20 years, research on motor-independent communication has focused on developing brain-computer interfaces (BCIs) implementing neuroelectric signals for communication, and BCIs based on electroencephalography (EEG) have already been applied successfully to concerned patients. However, not all patients achieve proficiency in EEG-based BCI control. Thus, more recently, hemodynamic brain signals have also been explored for BCI purposes. Here, we introduce the first spelling device based on fMRI. By exploiting spatiotemporal characteristics of hemodynamic responses, evoked by performing differently timed mental imagery tasks, our novel letter encoding technique allows translating any freely chosen answer (letter-by-letter) into reliable and differentiable single-trial fMRI signals. Most importantly, automated letter decoding in real time enables back-and-forth communication within a single scanning session. Because the suggested spelling device requires only little effort and pretraining, it is immediately operational and possesses high potential for clinical applications, both in terms of diagnostics and establishing short-term communication with nonresponsive and severely motor-impaired patients.

Article: Dean - UK Court Rules Against Paralysed Man In ‘Right To Die’ Case

Dean's Stroke Musing

The dark side of locked-in syndrome. FYI only,  I'm not going to further comment on this. -- Dean's Stroke Musing.
Original article UK Court Rules Against ...


A British man left paralysed from the neck down by a catastrophic stroke seven years ago lost his High Court battle on Thursday to gain a  legal right to end his life when he chooses.

Tony Nicklinson's condition means it is impossible for him to take his own life and he wants the legal right to have a doctor take his life without fear of prosecution. Since he suffered the stroke in 2005, the former rugby player, now 58, has had to endure what is known as locked-in syndrome.

"This means that most of my body is paralysed but my mind is as it was before the stroke."

"All I can move is my head, and the stroke took away my power of speech. Now I talk to people with a perspex spelling board or a computer operated by my eye blinks," he told CNN in an interview in June."

But while expressing sympathy for his situation, the High Court ruled Thursday that such a significant change to the law involving overturning the ban on voluntary euthanasia would have to be decided by lawmakers.

The judges also rejected a similar challenge to the law brought by a second man suffering locked-in syndrome, named only as Martin.  "The Court recognised that the cases raise profoundly difficult ethical, social and legal issues, but it judged that any change to the law must be a matter for Parliament to decide," a statement from the court said. said. And she said she wanted the judges to understand "the injustice of it all," as they considered his case.

"You or I could go out and take our lives at any time we want, whereas Tony, being the one who really needs that right, can't do this -- and he's only asking for what everyone else has got really, his right to take his own life, he wants that given back to him," she said. Before his stroke at age 51, the couple lived a comfortable life in the United Arab Emirates and traveled extensively.

Tony Nicklinson was a senior manager with a Greek civil engineering contractor, a job he enjoyed, and was chairman of the local sports club. Although he does not necessarily want to end his life straight away, he is frustrated by the indignity and tedium of his current condition, which hasn't changed for seven years and which doctors say could continue for years.

"Some people have in the past spoken to me in the loud, slow and deliberate tones normally reserved for the deaf or daft. I am neither," he said.

Eclectic: Monty - The KFPS Royal Friesian Horse

Monty

The KFPS Friesian Horse- beautiful, versatile, athletic, kind, willing, and able to do anything! May the world see that this breed is loved and enjoyed by all. Believe it and do it! Own a Friesian Horse! For more information please visit: www.kfps.nl.

Amazing Music is by E.S. Posthumus titled "Manju".

Eclectic: Jackie - Smart Car !!

Jackie

(SSTattler: #@$!%& it - no comment ... !)

Eclectic: Monty - This May Be The Definition of a True Friend

Monty

Yes, this is the correct definition of a true friend !!

Eclectic: Diane - Voting with an X

Diane - The Pink House OTC

Pre-stroke, Bob and I were never ones to miss an election day. But since the stroke, Bob has not voted mainly because it is a) difficult to get him a polling place and b) to complete an absentee ballot, the voter needs to be able to sign his/her name.

For over a year, Bob has been practicing signing his name. He can do it now, however, sometimes he writes the whole signature in cursive, other times he writes only his first name in cursive and prints the last name, other times he prints the whole dang thing. Then, occasionally, he gets half-way through and gets "stuck" not able to to remember how the rest of it goes ...

And your signature on the ballot must match the signature on file with the Elections Supervisor or your vote will not be counted.

So, I asked Bob's occupational therapist if she could help Bob with his signature.

And she worked with him, for awhile. But still, though it is a little more consistent, he will often write certain letters backwards (especially "b" and "d"), or skip letters completely and still sometimes he prints the whole name instead of writing in cursive.

Finally, the OT called the Election Supervisor's office, who told her that Bob could sign his ballot with an "X" as long as it was submitted in this format, every time: ...

See the full article Voting with an X in The Pink House on the Corner.

Article: Mark - Modelling in Teaching of Talking

Mark - Teaching of Talking

You can learn how to really love doing speech and language stimulation with people who have mild to profound speaking difficulties, if they are stimulable. Stimulability is the ability to repeat a sound, word, phrase or sentence with a MODEL. I have shared many of the foundation stones about our work, and this is another one of them, THE MODEL. Almost every living thing in the animal kingdom has a model to learn from.

While out walking around the lake this morning we saw a mother duck and her babies. The mother was modeling various behaviors for the ducklings, and teaching them how to swim. Many of the ducklings did not want to jump in the water from the elevated bank. There were some who were very brave, and jumped right in, while some others were hesitant, and fearful. The ones who were brave jumped right in without having to analyze everything. Once in the water the little ducklings floated around and paddled forward, as if they had always known how to paddle in water.  It was interesting to watch the ones in the water "jumping" out of the water and back onto the elevated bank from the floating position. They were jumping up in the air, and then as if by magic, they landed back on the elevated bank!

These ducklings needed a model to give them the security to stretch their wings, and challenge them to take the plunge. Without a MODEL to encourage them, how would the ducklings even know to go into the water?

The Teaching of Talking Model is about speaking again. It is not about learning how to write, spell, or read. These are all possibilities for the person with the speaking difficulty. The majority will tell you they want to TALK, or TALK BETTER. Therefore I want you to think of the person who has minimal speech and language like a baby or toddler or has very limited speech. If we were to stimulate the speech of the baby or the toddler, I don't think many of us would pull out work sheets, or sentences to read or write.

The mother, who is the MODEL will gently and lovingly speak to the child and say the word or words that are appropriate to the speaking situation. Therefore although written word cues may be helpful, our approach emphasizes the spontaneity of conversation or the interchange between the Speech Model SM and the Person with the Communication Difficulty PCD during daily interactions at home in ADL's and within simple questions and answers. That is where the "fun" of the interaction or therapy really is.

There must be a good speech model SM in the approach to The Teaching of Talking. Someone who can model the words, phrases, sentences, that contain the syntax, grammar, and articulation, prosody, and intonation which make up some of the principal parts of speaking. The PCD with limited speaking, whether a child or person with a stroke or head injury, does not always have access to the principal parts of speaking. That is where the SM comes in. The critical piece here is that the speech model within a communicative interchange with the PCD can give them the information they need in order to say a sound, word, phrase or sentence just by asking them a question.

 So if I were to say to you: ...

See the full article Modelling in Teaching of Talking.

Eclectic: SSTattler - Teatro la Quindicina Presents: Pith

John - SSTattler

THURSDAY, OCT 11 – SATURDAY, OCT 27, 2012

Location        Varscona Theatre (10329 83 Ave)
City / Town     Edmonton
Event Venue     Old Strathcona
Description First presented in 1997 Pith! is 
                Stewart Lemoine’s innovative, 
                hilarious, and ultimately moving
                tribute to the power of
                imagination.
Event Category  Theatre
Cost            $15.00 to $27.00 (depending on event date, time, and
                ticket type)
Where to purchase tickets: TIX on the Square (9930 - 102 Avenue, 
                Sir Winston Churchill Square) or online at 
                www.tixonthesquare.ca
Tickets         Phone 780.420.1757
Link            www.teatroq.com …

In the spirit of looking back while also looking forward, we close the anniversary season with one of Teatro’s best loved and most enduring classics, performed by an all new cast. First presented in 1997, and revived on multiple occasions both locally and across the continent, Pith! is Stewart Lemoine’s innovative, hilarious, and ultimately moving tribute to the power of imagination. In Providence, Rhode Island in 1931 an itinerant sailor leads a grieving society widow and her stoic housekeeper on an exhilarating and treacherous journey into the heart of the South American jungle... without ever taking them out of the living room. Andrew MacDonald-Smith assumes the role of Jack Vail, with Kristi Hansen and Jenny McKillop as Virginia Tilford and Nancy Kimble.

Article: Sharon - The Value and Meaning of Life

Sharon

If you could only blink your eyes would you think your life was still worth living?  Dominique Bauby talked about exactly that dilemma in his book about brain stem stroke.

On December 9, 1995, Dominique Bauby, the editor-in-chief of French Elle magazine, suffered a stroke and lapsed into a coma. He awoke 20 days later, mentally aware of his surroundings, but physically paralyzed with locked-in syndrome.  He was left with some movement in his head and one eye.  Similarly, an Alberta mother of two, Glenda Hickey had a stroke that left her locked in. She surprised family and friends when she had a baby.

What made Dominque Bauby and Glenda Hickey want to live and love despite significant disability?  Dominque Bauby was able to tell his story. With the help of assistants, Dominique Bauby wrote a book about his experience by blinking his left eyelid, which took ten months (four hours a day).

In the film of the book, a nurse wraps Bauby in a blanket and takes him in his wheelchair to look out towards sea.  It is a turning point — the beauty, the wind, and the waves pushes him to look inward, to his memory and his inner self, the only part of his life that he can still control.

This movie recreation is probably not unlike the questions that psychiatrist Victor Frankl asked himself when he was a prisoner in a World War II extermination camp: What is the meaning of your life when you are stripped of your position and all of your possessions?  How do you make meaning of your life when you are not in control?   While you cannot compare living with impairment to the degradation that happened in those World War II prison camps, at times, if people have severe disability, health professionals and the public will question how a person with such disabilities values their life.

Victor Frankl and Dominque Bauby decided that the meaning of life is found in every moment of living; that life never ceases to have meaning, even in suffering and death. From his experience as a prisoner in the Auschwitz death camp,  Frankl makes it very clear that that however terrible the actual conditions of life, the person still has a psychological choice.  Frankl decided that even in severe suffering, “the prisoner’ who is able to move into his spiritual inner self and can rely on hope can still finding meaning in life.

How have you found meaning in your life after stroke?

More information:

• Read about the woman who stayed with Bauby after his stroke, "The Real Love Story Behind the Diving Bell and the Butterfly", 
• You can see the movie about Dominique Bauby’s life,  The Diving Bell and the Butterfly (2007),
• You can read the book "Diving-Bell And The Butterfly" by Jean-Dominique Bauby (Apr 22 2004),
• Glenda Hickey’s story: Trapped in Your Own Body.  Glenda has passed away, but I am sure the legacy of courage, humor, and hope that she leaves her to children and family will continue to inspire them, see "A Mother Who Loved Without Words",
• Victor Frankl’s – Man’s Search for Meaning.

Article: Sharon - Are Best Practice Guidelines Effective?

Sharon

The Canadian Stroke Network’s best practice guidelines and the research evidence base support the development of organized stroke rehabilitation units, especially combined acute/rehabilitation units. However, emerging evidence suggests that across Canada, the majority of stroke patients do not receive this type of service.

Despite the best practice recommendations for intensive therapy provided by rehabilitation therapists familiar with/trained in neurorehabilitation, the evidence suggests that many stroke patients spend very little time in therapy, that much of their day is spent alone or resting.

Indeed a recent study is surprised about:

1. How low the percentage of stroke patients admitted to specialized stroke rehabilitation units is,
2. How low the therapist to patient ratios are, and,
3. That treatment in specialized stroke rehabilitation units located in free-standing rehabilitation hospitals does not necessarily result in the benefits one might expect from specialized care.

They suggest that rather than focusing on rigid structural criteria and processes of care is not enough. Focusing on patient centred care and components of care that are in the patient’s best interest may be necessary.

This includes:

1. Making sure that, whenever possible, the same staff members are responsible for rehabilitating stroke patients will help them to develop stroke expertise. 
2. Making therapy intensity a focus day-to-day will ensure that rehabilitation staff spends more time directly with patients, which will further promote their stroke expertise.

You can read the full article:

• Meyer, M., et al., (2011). Organized Stroke Rehabilitation in Canada: Redefining Our Objectives. Topics in Stroke Rehabilitation.

Tell About Your Experience

• Some stroke survivors complain that the therapy is too intensive, that they need to rest. What was your experience?  
• How much time did the speech language, physiotherapist, and occupational therapist spend with you or your family member?  Was it enough? Were you too tired?

Article: Sharon - Organized Stroke Rehabilitation in Canada: Redefining Our Objectives

Sharon

Matthew Meyer, PhD (Cand), Norine Foley, MSc, Shelialah Pereira, MSc, Katherine Salter, MSc (Cand), and Robert Teasell, MD, FRCPC

Aging, Rehabilitation & Geriatric Care Research Centre, Lawson Health Research Institute, Parkwood Hospital site; Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario; Department of Physical Medicine and Rehabilitation, St. Joseph’s Health Care London; Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada

Introduction: Evidence suggests that patients who receive care in organized stroke units experience better outcomes compared to patients who receive care in general rehabilitation units. As such, the Canadian Stroke Strategy has consistently included provision of “organized” stroke rehabilitation in their best practice recommendations for stroke care. However, recent research in Ontario suggests that development of organized stroke rehabilitation units has not led to the better patient outcomes that had been expected.

Methods: In this article, we review the evidence in favour of organized stroke rehabilitation units, assess the state of organized rehabilitation in Canada (as exemplified by care in Ontario), and discuss potential solutions for better application of best evidence and guideline recommendations for organized stroke care in Canada.

Results: The most up-to-date evidence in Canada suggests that best practice recommendations around organized stroke care are currently not adhered to well. However, further exploration suggests that some of the recommendations themselves may not be attainable as currently defined.

Conclusions: It appears that organized stroke care is not available to many Canadians, and better application of recommendations is necessary. Still, re-evaluation of current recommendations may also be necessary to ensure that they fit with the reality of providing care in Canada.

See the full article Organized Stroke Rehabilitation in Canada: Redefining Our Objectives.

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