stroke nursing news spring summer 2011

8/6/2019 Stroke Nursing News Spring Summer 2011

1/13

Spring/Summer 2011

Volume 4, Issue 2 Stroke Nursing News

Featured in this

Issue:

Whats happening in

Stroke Rehabilitation

Fewer Strokes Better

Outcomes The work ofOSN

Highlights of the

2008/2009 Ontario

Stroke Audit

Hamilton Health

Sciences Centre: Stroke

Unit Care

Provincial Updates

Musics potential in

stroke rehabilitation

How robotics may

optimize stroke

rehabilitation

Best Practice Guideline

Recommendation 5.4

Conferences and other

news

How OneHealth Region

Adapted their ExistingResources to Meet their

Patients Rehab Needs

Major National Study on

Stroke Care in Canada

Contact the NSNC

Stroke Rehabilitation in the NewsSCORE Announcement:Canadian Best Practicesfor Stroke Care fullyIntegrates SCORErecommendations in 2010update

The Canadian StrokeNetwork SCORE project

(Stroke CanadaOptimization ofRehabilitation throughEvidence)recommendations for upperand lower limb have beenthe leadingrecommendations for strokerehabilitation since theywere first published in 2005and revised in 2007. TheSCORE recommendationshave been partially included

in previous releases of theCanadian Best PracticeRecommendations forStroke Care, however weare pleased to note thatthey have now beencompletely updated andintegrated into theCanadian Best PracticeRecommendations for2010. This providesrehabilitation providers witha comprehensive set ofguidelines that cover the

continuum of care. TheCanadian Best PracticeRecommendations forStroke Care strives to helppeople move through thestrokecontinuum, fromsymptom onset todiagnosis, treatment,management, and recoveryand recognizes that properrehabilitation after a stroke

is a criticalaspect of thiscare.

Music as Stroke Therapy

The use of music in therapyfor the brain has evolvedrapidly as brain-imagingtechniques have revealedthe brains plasticityitsability to changeand haveidentified networks thatmusic activates. Armed withthis growing knowledge,

doctors and researchers areemploying music to retrainthe injured brain. Studieshave revealed that becausemusic and motor controlshare circuits, music canimprove movement inpatients who have suffereda stroke or who haveParkinsons disease.Research has shown thatneurologic music therapycan also help patients with

language or cognitivedifficulties, and researcherssuggest that thesetechniques should becomepart of rehabilitative care.Future findings may wellindicate that music shouldbe included on the list oftherapies for a host of otherdisorders as well.

Revolutionizing StrokeRehab

Getting a jump start on hcareer, Dr. Sean DukelowHSF Investigatorship isallowing him to do the kinof things that may at firstglance appear to be the s

of science fiction. Throughis revolutionary work witrobotics using the KINARa large robotic chair DrDukelow is developing famore advanced methodsassessing stroke, enablinbetter methods to treatstroke, and reduce itsdevastating impact. One only a handful of specialiin the world currently worwith robotics, Dr. Dukelowamassing the resources aqualified personnel for afuturistic state-of-the artrobotics lab.

Were playing with a timewindow we need to takemaximum advantage of tbrains ability to heal in thfirst few months post-stroOur innovative tool isallowing us to better monand understand theimprovements in the patie

receiving therapy. As aresult, were now beginnito uncover things we didneven know were wrong wthe brain.


2/13

Page 2 ofStroke Nursing News

elpful links within the

ntario Stroke System

ntario Stroke Networkp://www.ontariostrokenetwor

ca/

eart and Stroke FoundationOntarioww.heartandstroke.ca

Ontario Stroke System

Regions

entral East Stroke Networkp://cesnstroke.ca/

entral South Regional Strokeogram

p://www.hamiltonhealthsciees.ca/body.cfm?id=364

hamplain Regional Strokeogramp://www.champlainstrokece

re.org/

orth and East GTAp://sunnybrook.ca/content/?ge=BSP_Stroke_home

ortheastern Stroke Networkp://www.neostrokenetwork.c

m/newportal/

orthwestern Ontario Regionalroke Networkp://www.nwostroke.ca

outheast Torontop://www.stmichaelshospital.m/roke Network of

outheastern Ontariop://strokenetworkseo.ca/

outhwestern Regional Strokerategyp://www.swostroke.ca/

ronto West Stroke Networkp://www.tostroke.com/

est GTA Stroke Networkp://www.trilliumhealthcentre.g/west_GTA_stroke_network

The Ontario Stroke Network

Fewer Strokes, Better Outcomes

In 2000, Ontario

implemented the OntarioStroke System (OSS), aprovide-wide strategy ofcoordinated stroke care,with the goal of providinghigh quality stroke careacross the continuum ofcare from primaryprevention to pre-hospital/emergency care,hospital-based acutecare, rehabilitation,

secondary preventionand communityreengagement.

This province-widesystem of coordinatedstroke care was pilottested by the Heart andStroke Foundation ofOntario in 1998 inconjunction with fourregions in Ontario. TheOSS was funded andsupported by the Ontario

Ministry of Health and

Long Term Care in 2000following the successfulpilot. The OSS was fullyimplemented in 2005.

The Ontario StrokeNetwork (OSN) wasincorporated in 2008 toprovide provincialleadership andcoordination for theOntario Stroke System

(OSS). The OSNrecommends,implements andevaluates province-widegoals and standards forthe continuum of strokecare, including healthpromotion and strokeprevention, acute care,recovery andreintegration processes.It also supports theevaluation of and reportson the progress of the

OSS, administers the

OSS research prograand leads provincialprojects and initiatives

The OSN and OSSshare a common visioFewer Strokes BetterOutcomes. Since theinception of the OSS 2000, significantimprovements haveoccurred in strokeprevention, diagnosisand treatment across continuum of care (sethe article on the2008/08 Ontario StrokAudit). There have bepositive impacts onaccess to stroke relatservices, the integratiand coordination ofstroke care, treatmenstroke and client andprovider satisfaction.

The OSS includes 11regions, 10 RegionalStroke Centres, 1Enhanced Stroke Cen17 District StrokeCentres, 23 SecondaPrevention Clinics,community hospitals amany regional partneThe map on the leftshows the OSS regio

The sidebar on the lefhas links to the OSN, Heart and StrokeFoundation of Ontarioand the 11 strokeregions in Ontario.

- submitted by Cindy Bolton, LKelloway and Elaine Edwards


3/13

Stroke Nursing News Page 3 of 12 SAVE THE DATE!October 17

th, 201

2011 StrokeCollaborative at th

Metro TorontoConvention Centr

Some Ontario Fact Ontarios population

more than 13 millio

It is home to about in three Canadians

More than 85 per celive in urban centrelargely in cities on tshores of the GreatLakes

Ontario is Canada'ssecond largestprovince, covering mthan one million squkilometres - an arelarger than France aSpain combined.

English is the officialanguage, howeverthere are entirecommunities whereFrench is the primalanguage

~240,000 of Ontariopeople identifiedthemselves asAboriginal (NorthAmerican Indian, Mor Inuit) in the 2006Census.

Did you know that t

OSS began with a

Pilot Study?

In 1998, four geographicareas served asdemonstration sites withthe three-year pilot proje"The Coordinated StrokeStrategy," which waschampioned by the HearStroke Foundation of On

London Health SciencesCentre (South West),Hamilton Health ScienceCorporation (Central WeQueen's University CareDelivery Network (SouthEast) and the West GTAThese pilot sites are nowregional networks within OSS.

Registry of the Canadian Stroke Network (RCSN) Report on the 2008/09 Ontario Stroke Audit.The findings from a new strokeaudit conducted by theInstitute for Clinical EvaluativeSciences (ICES) and the

Canadian Stroke network(CSN) were released in April2011. This audit looked atprovincial trends in stroke carebetween 2002 and 2009. Itfound that there have beenmarked improvements sincethe Ontario Stroke Systemwas initiated by the MOHLTCa decade ago.

Since the initial investment bythe provincial government in2000 to develop an integratedstroke system, there have

been significant improvementsn almost all aspects of strokecare delivery. In particular,rates of use of thrombolysis(clot busting therapy) for acutestroke match or exceed thosen most jurisdictionsworldwide, says principalnvestigator and ICES ScientistDr. Moira Kapral.

The study of close to 4000stroke patients arriving atOntarios acute hospitals in2008/09 found:

- Thrombolysis wasadministered to 27 per cent ofpatients presenting within 2.5hours of stroke onset, asignificant increase comparedto 9.5 per cent in 2002/03.- Thrombolysis rates were 42per cent at regional strokecentres rates that match orexceed those seen in mosturisdictions worldwide.- Neuroimaging is required toconfirm a diagnosis. In2008/09, 93 per cent ofpatients received

neuroimaging duringhospitalization a markedimprovement from 82 per centin 2004/05 and 77 per cent in2002/03.- 24 per cent of patients withstroke or TIA were admitted toa stroke unit a significantincrease compared to 3 percent in 2002/03 but still belowthe recommended standards.- Rates of discharge toinpatient rehabilitation werehigher in 2008/09 compared to2004/05 but similar to 2002/03,

but remain lower thanprojected.

(More detailed study findingsare available on the ICESwebsite: www.ices.on.ca)

These excellent results maybe attributed to Ontariosorganized system of strokecare. However, there is more

work to be done. The resultsvary across Ontarios LocalHealth Integration networksand there is still a gapbetween the number of strokepatients who need stroke unitcare and stroke rehabilitationand those who receive it. Thegood news is that the OntarioStroke Network, with a focuson continuous improvementand knowledge translation, iswell positioned to addressthese gaps, says ChrisOCallaghan, Executive

Director, Ontario StrokeNetwork.

Citation: Kapral MK, Hall R,Stamplecoski M, Meyer S., Asllani E,Fang J, Richards J, OCallaghan C,Silver, FL. Registry of the CanadianStroke Network (RCSN) Report on

the 2008/09 Ontario Stroke Audit.Toronto: Institute for Clinical EvaluativeSciences; 2011.

Dr.MoiraKapral

(leadinvesti-gator)

The Ontario Stroke Evaluation Program (source: www.ontariostrokenetwork.ca)

There is growing national/international interest in evaluating quality of stroke care. A number of qualityndicators have been selected but challenges exist in confirmation of feasible indicators, establishment ofbenchmarks, and merging performance indicator data with administrative data to enhance evaluation. TheOntario Stroke Evaluation Program has been successful in addressing many of these challenges.

The Primary Purpose of the Ontario Stroke Evaluation Program is to monitor and evaluate the impact ofhe Ontario Stroke System (OSS) in improving the delivery of optimal stroke care (e.g., adoption of

Canadian Stroke System (CSS) best practice recommendations) through the identification and assessmentof specific performance metrics. This also includes assessment of specific performance metrics to beconsidered in the HospitalServices Accountability Agreements (HSAAs) with designated stroke centres onbehalf of districts and regions. The parameters of the evaluation program are based on the followingunderlying principles of the OSS:

mprove stroke services across the continuum of care from prevention to care in a long-term care orcommunity setting.

Ontario Stroke System Evaluation Specialist: Dr. Ruth Hall at the Institute for Clinical Evaluative Sciences2075 Bayview Ave, Toronto, Ontario, M4N 3M5Phone: (416) 480-4055, x2975 Fax: (416) 480-6048 E-mail: [email protected]

ChrisOCallaghan,OSNExecutiveDirector


4/13

Stroke Nursing News

Hamilton's role as one of the world'sleading centres in cardiac, vascularand stroke research was amplified onMarch 11, 2010, with the grandopening of the David Braley Cardiac,Vascular and Stroke ResearchInstitute at the Hamilton GeneralHospital site.

The Research Institute is a six-storeybuilding comprised of 200,000 squarefeet of research space, laboratories,meeting rooms, offices and breakoutspaces. It also houses Canada'slargest biobank, which stores morethan 1.8 million tissue and geneticresearch samples from approximately250,000 participants globally.

The Research Institute brings togethertwo world-renowned research teams -the Population Health ResearchInstitute (PHRI) led by ExecutiveDirector Dr. Salim Yusuf, and theThrombosis and AtherosclerosisResearch Institute (TaARI) led byDirector Dr. Jeffrey Weitz. Workingside-by-side for the first time, thesetwo teams will be able to share ideasand knowledge that will improve thehealth of millions of people around theworld.

PHRI and TaARI have internationalreputations for innovation andexcellence. PHRI conducts clinicaltrials in 83 countries, focusing oncardiovascular disease, diabetes,obesity and the societal influences on

health such as ethnicity andgeography. TaARI (formerly theHenderson Research Centre) madehistory almost 30 years ago with theworld's first clinical trial demonstratingthe effectiveness of using aspirin toprevent stroke. Since then, TaARI hasbecome an international leader inresearch on vascular disease,specifically blood clots.

Page 4 of 12

Stroke Unit care has beenrecognized as a leading bestpractice initiative. Care on astroke unit has been shown to

increase the odds ofindividuals being alive,independent and living athome one year post stroke.The critical components ofStroke Unit care are aspecialized geographicallydefined unit dedicated to themanagement of stroke patientsstaffed by an interprofessionalteam (nursing, medicine andallied health professionals)with expertise in stroke care

1.

Stroke unit care at HamiltonHealth Sciences (HHS)underwent a significant shift inJanuary of 2011 when theconcept of acute, rehabilitationand community care wascompletely redesigned. Thenew model provides acomprehensive system ofstroke care ensuring that thepatient receives the right careat the right time in the rightplace to meet his or herindividual needs. This modelprovides a cross continuumapproach to best practice

stroke care for the strokepatient population at HamiltonHealth Sciences. Furthermore,the model leverages thestrength of its teams bylocating them together asmuch as possible so thatpatients have easy access tothe expertise and servicesthey require.Until 2009, stroke care wasprovided at 4 of the 6 HHSsites. Acute care was providedat 3 sites and rehabilitationcare was provided at 1 acute

care site and 1 stand alonerehabilitation site. As of April2011, all stroke patients areadmitted to a 24 bed strokeunit at one acute care site tobegin their stroke recovery andthen are transferred either to a28 bed specialized strokerehabilitation unit or 10 bedrestorative care unit. Thischange aligns with theCanadian Best PracticeRecommendations for Stroke

Care (Update 2010) thatidentified that stroke patientsshould receive care on acuteand rehabilitation strokeunits. This IntegratedSystem of Stroke Care isunique and ensures that allpatients will be assessed andtriaged into the strokerecovery band of care thatwill optimize their recovery.This model provides anopportunity to furtherenhance the clustering ofstroke resources, providing amore comprehensiveapproach to stroke care.The model involves allhealth care team memberscompleting a comprehensiveassessment of the strokepatient utilizing standardizedassssment tools to determinethe patient's stroke recoveryneeds. Based on thisassessment, the patientmoves seamlessly to thenext level of care to begintheir ongoing recovery. TheStroke Care Navigator workswith the teams, ensuringearly discharge planning andcare coordination throughoutthe continuum of care toallow seamless patient flowwithin the system. Alldisciplines work to enablecommunity transitions andcommunity re-integration.Nursing plays a significantrole in supporting patientadjustment along thecontinuum.This new and innovativemodel crosses the boundriesof acute, rehabilitative andcomplex continuing care,breaking down the siloapproach to stroke care.The inpatient care teams,nurses included, have beenreconfigured from the 3previously separate teams tocreate 1 large expertinterdisciplinary stroke teamwho faciliate patient tranfersthrough all phases of care tominimize patient handoffs

and maintain continuity ofcare for patients andfamilies. The model has

been developed to ensurethat some disciplinesfollowpatients along the continuuof care and others rotatedbetween the units to ensurthe consistency in practiceand a focus on strokerecovery, not silos of strokcare. The system buildsupon the assessmentscompleted in one area toinform the treatment plannin the next level of care.Furthermore, the philosphy

within the model is thatstroke recovery is a procesnot a place. This hasresulted in theimplementation ofrehabilitation approaches othe acute stroke unit with tnursing team promotingindependence and enablinpatient and family memberto be partners in care. Thmodel enables patients totransition from a focus onillness to recovery earlier

the continuum. The nursinskill mix on the specializedrehabiltation unit waschanged to support theincreased acuity of thepatients. Furthermore, strobest practice educationacross the continuum hasbeen a focus for all clinicalareas to support themanagement of the changneeds of the patients as thtransition to the next level care.

1. Lindsay, M.P., Gubitz, GBayley, M., Hill, M.D.,Davies-Schinkel, C., SinghS., Phillips, S. Canadian BPractice Recommendationfor Stroke Care (Update2010).On behalf of theCanadian Stroke StrategyBest Practices andStandards Writing Group.2010; Ottawa, OttawaCanada: Canadian StrokeNetwork.

Implementation of an Integrated Model of Stroke RecoverPrepared By Louise MacRae, Charmaine Martin, Rhonda Whiteman


5/13

rairie North Regionalealth Authority (PNRHA)entified Stroke preventionnd rehabilitation as ariority in their 2010 -11trategic Framework. Theealth regions communityased directors andanagers compared

xisting services with theanadian Best Practice

ecommendations fortroke Careto identify waysoimprove strokeoordination, education andehabilitation for healthegion clients.

ompared to bestractices, gaps wereentified in stroke careuch as inconsistentrocesses, and limitedoordination and integrationf care. Patientsarticipating in strokeducation reported difficultynavigating the system to

eceive services followingospital discharge. Theecision to adjust servicesas based on these gaps.

working group ofanagers, clinical leads

nd front line professionalsas established to developplan to improve

oordination of referrals,llow up and outpatient

ehabilitation services. Theroup looked at organizingeir time and resourcesfferently to improveervices with no additionaluman or financialesources.

The Changes to Improve Referrals and Follow Up Care

All outpatient referrals for stroke and Transient Ischemic Attack (TIA) community based care arechanneled through Chronic Disease Management Services.

The Chronic Disease Management Nurse contacts the patient to determine their needs. Clients (and their support person(s)) are offered educational opportunities:

o Individual session oro Living With Stroke Classes

If outpatient rehabilitation is required, the CDM nurse initiates the initial assessment and arrangesthe patient to attend the Stroke Rehabilitation Clinics.

Development of Outpatient Stroke Rehabilitation Clinics

An outpatient Stroke Rehabilitation Clinic has been established in each of the regions three cities: MeadowLake, North Battleford and Lloydminster. The working group planned the realignment of workloads anddeveloped an interdisciplinary team approach.

The Components of the PNRHA Stroke Rehabilitation Clinic: An interdisciplinary Stroke Rehabilitation Team One point for referral to Stroke Rehabilitation Clinic Weekly coordinated one stop outpatient services for persons

recovering from stroke

An interdisciplinary and client focused action plan for all services Stroke Education Programs Regular communication to patients physician and family.

Each Stroke Rehabilitation Team currently consists of the followingcore members:

Speech and Language Therapist

Occupational Therapist

Physical Therapist

Chronic Disease Management Nurse.There is ongoing planning to expand the team to meet client needs.

The North Battleford Outpatient Stroke Clinic started January 27, 2011and Lloydminster launched their first clinic February 22, 2011. The Meadow Lake StrokeClinic started February 9, 2011 and meets every two weeks.

Feedback from team members include comments such as

I see the person more as a whole when working in a multidisciplinary team

The family member I called was so happy to be invited.

Patients are pleased to be able to see all the therapists in one visit rather than having tcome back on different days.

I was surprised how much they needed the counselor support. All of our clients and evsupport persons have asked to see the counselor.

I have noticed that when a client is given the right information and knowledge, we see tclient use that knowledge to improve their life, or become more effective in caring forthemselves in activities of daily living or being able to better manage their disease, it isinspiring and rewarding.

One Caregiver stated I know he is going to be busy for the next few hours so I can get my errandoneAnother caregiver noticed that since going to the Living with Stroke classes Mother is happier anable to do more.One of the patients is from out of region. The daughter plans to relocate her father so he canaccess this service.

rairie North Health Initiates Outpatient Stroke Rehabilitation Clinics:How Oneealth Region Adapted their Existing Resources to Meet their Patients Rehab Needs SubmittedBy Brenda Kwiatkowski

Page 11 of 13 Stroke Nursing News

Tricia Harvey, Audrey Harder, PatMcMartin (back row, L to R), Cliffordand Sandra Carter, Wilfred and RuthSunderland (front row, L to R)

Tricia Harvey andWilfred Sunderland

Sandra Carter and Pat McMa


6/13

Stroke Nursing News Page 6 of 12

Stroke Rehabilitation through Music

usic shows potential in

roke Rehabilitation

usic therapy provided byined music therapists maylp to improve movement inoke patients, according to aw Cochrane Systematicview. A few small trials alsoggest a wider role for music

recovery from brain injury.

lions of people suffer strokesch year. Many patientsquire brain injuries that affecteir movement and languagelities, resulting in significants of quality of life. Music

erapists are trained inchniques that stimulate brainnctions and aim to improvetcomes for patients. Onemmon technique is rhythmicditory stimulation (RAS),ich relies on the connectionstween rhythm and movement.

usic of a particular tempo ised to stimulate movement ine patient.

ven small studies, whichether involved 184 people, wereluded in the review. Fourused specifically on stroketients, with three of these using

AS as the treatment technique.AS therapy improved walkingeed by an average of 14 metersr minute compared tostandardvement therapy, and helpedtients take longer steps. In onel, RAS also improved armvements, as measured by

ow extension angle.

his review shows encouragingults for the effects of musicrapy in stroke patients," saidd researcher Joke Bradt of thes and Quality of Life Researchnter at Temple University inladelphia, US. "As most of thedies we looked at used rhythm-sed methods, we suggest thatthm may be a primary factor insic therapy approaches toating stroke."

her music therapy techniques,

luding listening to live andorded music, were employed toto improve speech, behaviord pain in patients with brainuries, and although outcomes inme cases were positive,dence was limited. "Severalls that we identified had lessn 20participants," saidBradt. "It

expected that larger sampleses will be used in future studiesenable sound recommendationsclinical practice."

ed with permission. July 7, 2010,://www.sciencedaily.com/releases/2010/07/706081547.htm

Rhythm for Rehabilitation:Music Therapy as a Part of the

Stroke Rehabilitation Team

Music therapy is an evidence-based practice and is largelydependent on research. Theresearch results have beenshown to affect areas in motorskills, communication skills,cognitive skills, and socio-emotional skills.

Music therapists can co-treat withother professionals, using musictherapy in conjunction withphysical, occupational, and speechtherapists to maximize treatment.In the interdisciplinary model,music therapists work on a teamwith other professionals, typicallyincluding the patient and family, tocreate a treatment plan for thepatient. Music therapists also workin a trans-disciplinary model,seeing patients separate from otherprofessionals, but consulting withother professionals on treatmenttechniques so the patient cancontinue progress in othermodalities.

Music can be used to treat strokecognition, Music can be used as amnemonic device to orient strokesurvivors to their surroundings orhelp them recall a sequence ofevents. Rhythm is the mainingredient for music therapytechniques in treating motordeficits. In working on motorcontrol, music therapists useinstruments as a target for reachingand weight-bearing exercises.Music can be especially helpful ingait-training exercises. Speech hasa natural rhythm and certainphrases carry a natural intonation

and melody, thus music canenhance therapy for speechrecovery.

Listening to music with which thepatient identifies, songs written by thepatient, andcreating music throughimprovisation allow the patient toexpress and address emotionalneeds and music is a natural socialoutlet,helpingpeople to identify witheach other while at the same timeexpressing theirindividuality.

Chrissy Watson, MT-BC, The Carolina Center forMusic Therapy, LLC

How Music Helps to Heal the

Injured Brain

The role of music in therapy has

gone through some dramaticshifts in the past 15 years,driven by new insights fromresearch into music and brainfunction. These shifts have notbeen reflected in publicawareness, though, or evenamong some professionals.

Biomedical researchers have foundthat music is a highly structuredauditory language involvingcomplex perception, cognition, andmotor control in the brain, and thusit can effectively be used to retrainand reeducate the injured brain.Therapists and physicians use

music now in rehabilitation in waysthat are not only backed up byclinical research findings but alsosupported by an understanding ofsome of the mechanisms of musicand brain function. Neurologicmusic therapy does meet thestandards of evidence-basedmedicine, and it should be includedin standard rehabilitation care.

During the past two decades, newbrain imaging and electricalrecording techniques havecombined to reshape our view ofmusic in therapy and education.These techniques (functionalmagnetic resonance imaging,positron-emission tomography,electroencephalography, andmagnetoencephalography) allowedus to watch the living human brainwhile people were performingcomplex cognitive and motor tasks.Now it was possible to conductbrain studies of perception andcognition in the arts.

After years of research, twofindings stand out as particularlyimportant for using music inrehabilitation. First, the brain areasactivated by music are not unique

to music; the networks that processmusic also process other functions.The brain areas involved in musicare also active in processinglanguage, auditory perception,attention, memory, executivecontrol, and motor control. Second,music learning changes the brain.A key example of this secondfinding, that music learningchanges the brain, is researchclearly showing that through suchlearning,auditory and motor areasin the brain grow larger and interactmore efficiently.

Read the full article online athttp://dana.org/news/cerebrum/detail.aspx?id=26122

Music enhances cognitive recove

and mood after middle cerebral

artery stroke

We know from animal studies that astimulating and enriched environmecan enhance recovery after stroke, blittle is known about the effects of anenriched sound environment onrecovery from neural damage inhumans.

In humans, music listening activates awide-spread bilateral network of brainregions related to attention, semanticprocessing, memory, motor functions, aemotional processing. Music exposure enhances emotional and cognitivefunctioning in healthy subjects and invarious clinical patient groups. Thepotential role of music in neurologicalrehabilitation, however, has not beensystematically investigated. This singleblind, randomized, and controlled trial wdesigned to determine whether everydamusic listening can facilitate the recoveof cognitive functions and mood afterstroke.

In the acute recovery phase, 60 patientwith a left or right hemisphere middlecerebral artery (MCA) stroke wererandomly assigned to a music group, alanguage group, or a control group. Duthe following two months, the music anlanguage groups listened daily to self-

selected music or audio books,respectively, while the control groupreceived no listening material. In additioall patients received standard medical cand rehabilitation. All patients underwean extensive neuropsychologicalassessment, which included a wide ranof cognitive tests as well as mood andquality of life questionnaires, one week(baseline), 3 months, and 6 months aftethe stroke. Fifty-four patients completedthe study. Results showed that recoverthe domains of verbal memory andfocused attention improved significantlymore in the music group than in thelanguage and control groups. The musgroup also experienced less depressed

and confused mood than the control grThese findings demonstrate for the firsttime that music listening during the earpost-stroke stage can enhance cognitivrecovery and prevent negative mood.The neural mechanisms potentiallyunderlying these effects are discussed this study published in Brain (2008), 13866-876.

Cognitive Brain Research Unit, Department ofPsychology, University of Helsinki, and Helsinki BraResearch Centre, Helsinki, Department of Music,University of Jyvaskyla, Jyvaskyla, DepartmentNeurology and Department of Radiology, HelsinkiUniversity Central Hospital, Helsinki,Department ofPsychology, bo Akademi University, Turku, Finlanand Department ofPsychology, University of MontreMontreal, Canada


7/13

Working with Robots for Optimal Stroke RehabilitationStroke Nursing NewsPage 7 of 12

Nearly all individuals who survive a

stroke are left with physical andcognitive disabilities ranging frommild to severe. But based on theidea that the brain can heal itself,stroke survivors can regain some oftheir physical and cognitive skillsthrough a wide range of therapeutictreatments.

Patients will undergophysiotherapy, speech therapy andoccupational therapy, forinstance, with each therapist

working on a particular set of skills,explains Dr. Sean Dukelow, aclinical scientist at the FoothillsMedical Centre in Calgary andholder of grant funding from theCanadian Institutes of HealthResearch and the Heart and StrokeFoundation of Alberta, NWT andNunavut Investigatorship in StrokeRehabilitation Research.

Often, our challenge is measuringpatients exact deficits and how well

they respond to the treatment wedeliver, since current assessment toolsare often subjective and thereforenot completely reliable, says Dr.Dukelow. Thats why Ive beendeveloping a robotic model that will notonly help in accurately measuring thepatients improvements over time, butalso help in delivering therapy.

Dr. Dukelow is referring to theKINARM, (Kinesiological Instrumentfor Normal and Altered Reaching

Movements), which is a large roboticchair that allows stroke patients tocomfortably sit in a supportiveenvironment with both of their armsresting in flexible arm braces thatare parallel to the ground. TheKINARM is linked to a computer thatruns a variety of tests andconcurrently stores the datacollected from the patients outcome.

Given that the brain is most open trelearning skills within the first thremonths following a stroke, itsimportant that stroke patients have

access to a wide range of qualitytherapy.

With the support of the Heart andStroke Foundation and CanadianInstitutes of Health Research, Dr.Dukelow will be enrolling strokepatients at the Foothills MedicalCentre to help improve patientoutcome and post-stroke treatmenHe says, robotics not only bringprecision to the process of measurproblems following stroke, but alsoprovide unique and exciting methoof therapy delivery.

Reprinted with permission: Heart and StrokFoundation of Alberta, NWT and Nunavut,2011

Go to: www.bkintechnologies.com for moreinformation about the KINARM

Go to:http://www.ncbi.nlm.nih.gov/pubmed?term=Duk

ow%20SP[Author]&cmd=DetailsSearch for minformation on Dr. Dukelows areas ofresearch interest or contact Dr. Dukelow [email protected]

The KINARM is set up to test where

patients are at before treatment andthen measure their progress whilethey do a variety of assessments ofvision, arm movement and sensation,says Dr. Dukelow. Like standardtests, we are measuring strength,reflex responses and vision. Duringtesting, the chair is strategically placedat a computerized glass table so thatthe arms are floating below thecomputerized platform.

One of the tests that stroke patients

will undergo, for instance, is to movetheir arm and point their index finger ata red dot when it has stopped moving;a few seconds later, it reappears in adifferent spot. The robot measureseach trajectory taken by the patientsarm (direct, zigzagging or missing it alltogether), as well as the responsetime.

Following a stroke, patientsdisabilities are most often on one sideonly, affecting coordination, reflex, and

strength of the left arm and leg, orright arm and leg. Vision on theaffected side can also be impairedthrough reduced peripheral vision, orblind spots.

Patients are often delighted to feel andsee their affected arm moving, especiallythe first time after their stroke, says Dr.Dukelow. The KINARM provides theopportunity for patients to receive novelrepetitive therapy to improve affectedarm and vision.


8/13

Best PracticeRecommendation 5.4.1Management of the Armand Hand

Therapeutic Goal: Improvedarm and hand skill forindependence

i. Exercise and functionaltraining should be directedtowards enhancing motorcontrol for restoringsensorimotor and functional

abilities. [Evidence Levels:Early Level A; Late LevelA].ii. Engage in repetitive andintense use of novel tasksthat challenge the patient toacquire necessary motorskills to use the involved limbduring functional tasks andactivities [Evidence Levels:Early Level A; Late LevelA].iii. The Upper extremityprogram should includestrength training to improve

impairment and function afterstroke for upper extremity.Spasticity is not a contra-indication to strengthtraining

374[Evidence Levels:

Early - Level A; Late - LevelA].iv. Therapists should providea graded repetitive armsupplementary program forpatients to increase activityon ward and at home. Thisprogram should includestrengthening of the arm andhand (small wrist weight,

putty, hand gripper), range ofmotion (stretching, activeexercises), and gross, finemotor skills (e.g., blocks,Lego, pegs), repetitivegoaland task-oriented activitiesdesigned to simulate partialor whole skill required inactivities of daily living(e.g. folding, buttoning,pouring, and lifting). TheGRASPprotocol suggestsone hour per day, six daysper week

375[Evidence

Best Practice Guidelines - Recommendations 5.4: SCO

Recommendations for upper limb management followi

stroke

Levels: Early-Level A; Late-LevelC].v. Following appropriate cognitiveand physical assessment, mentalimagery should be used toenhance sensory-motor recoveryin the upper limb [EvidenceLevels: Early-Level A; Late- LevelB].vi. Functional ElectricalStimulation (FES) should be usedfor the wrist and forearm toreduce motor impairment andimprove functional motorrecovery [Evidence Levels: Early-

Level A; Late-Level A].vii. Intensive Constraint InducedMovement Therapy (CIMT)should not be used for individualsin the first month post stroke untilfurther research is completed[Evidence Levels: Early-Level A;Late-N/A].viii. Consider the use of intensiveCIMT for a select group ofpatients who demonstrate at least20 degrees of wrist extension and10 degrees of finger extension,with minimal sensory or cognitivedeficits. Intensive training shouldinvolve restraint of the unaffectedarm for at least 90 percent ofwaking hours, and at least sixhours a day of intense upperextremity training of the affectedarm for two weeks [EvidenceLevel: Between 3 and 6 months-Level A; Late- Level A].ix. Consider the use of modifiedCIMT for a select group ofpatients who demonstrate at least20 degrees of wrist extensionand10 degrees of finger extension,with minimal sensory or cognitive

deficits. Modified CIMT consistsof constraint of the unaffectedarm with a padded mitt or armsling for a minimum of six hours aday with two hours of therapy forfourteen days [Evidence Levels:Early- Level A; Late- Level A].x. EMG biofeedback systemsshould not be used on a routinebasis. (adapted from RCP)[Evidence Levels: Early- Level A;Late- Level A].

xi. For patients whose arm and

hand are predicted to be lesthan stage three as measurethe Chedoke-McMaster StroAssessment,

376enhance

sensory-motor recovery of tupper limb by using sensorymotor stimulation [EvidenceLevels: Early- Level B; LateLevel B]. This consists of paand active-assisted range omovement that also includeplacement of the upper limbvariety of positions within thpatients visual field (Adaptefrom HSFAH 1.2a) [Evidenc

Levels: Early-Level C; Late C].xii. There is insufficient evidto recommend for or againsneuro-developmental treatmcomparison to other treatmeapproaches for motor retrainfollowing an acute stroke[Evidence Levels: Early-LevLate Level B].xiii. Use adaptive devices fosafety and function if othermethods of performing spectasks are not available or cabe learned [Evidence LevelsEarly- Level C; Late Level Cxiv. Assess the need for speequipment on an individual Once provided, equipment sbe re-evaluated on a regulabasis. [Evidence Levels: EaLevel C; Late-Level C].

Rationale:

Stroke frequently affects thefunction of the arm and a larnumber of stroke survivors warm weakness at stroke ons

not regain normal function.

Bilateral arm function is critialmost every daily activity. Anumber of techniques have developed for those individuwho have some minimal armmovement.

The rehabilitation techniquecan be used are expanding speak to the need for increaaccess to therapy time to caout these techniques.

Stroke Nursing News Page 8of 12he Canadian Journal ofeuroscience Nursing/Le

ournal canadien des infirmierst infirmires en scienceseurologiques

olume 33, Issue 1, 2011

etecting cognitive impairmentn clients with mild stroke oransient ischemic attackttending a stroke preventionlinic

y Gail MacKenzie, RN, MScN,nda Gould, RPN, Sandra Ireland,N, PhD, Kathryn LeBlanc, BsC,hD, and Demetrios Sahlas, MSc,

MD, FRCP(C)

bstract

wenty clients diagnosed withrobable transient ischemic attackTIA) or stroke attending a strokerevention clinic (SPC) werecreened for cognitive function, asne inclusion criteria for a pilottudy examining medicationdherence and hypertension

management. The Mini Mentaltate Examination (MMSE) wasdministered at study admissionollowed by a second screeningithin two weeks using the

Montreal Cognitive Assessment

MoCA) tool. Individual scores forhe MMSE and MoCA wereompared. Results demonstratedhat the majority (90%) ofarticipants scored in the normalange ( 26) on the MMSE (M =7.9 SD 2.15). However, morehan half (55%) of participants hadome degree of cognitivempairment based on MoCAcores of < 26 (M = 23.65 SD =.082). MoCA scoresemonstrated a wider rangeRange = 16) compared to theange of MMSE scores (Range =

). MoCA scores were significantlyp =


9/13

Stroke Nursing NewsPage 9 of 12

Best Practice Recommendation5.4.2 SCORERange of Motion and Spasticity inhe Shoulder, Arm and Hand

Therapeutic Goal: Maintain Range ofMotion and Reduce Spasticity in the

Shoulder, Arm and Hand

Spasticity and contractures should bereated or prevented by antispastic pattern

positioning, range-of-motion exercises,tretching and/or splinting [Evidence

Levels: Early- Level C; Late-Level C].. For patients with focal and/orymptomatically distressing spasticity,onsider use ofhemodenervation using Botulinum toxino increase range of motion and decrease

pain [Evidence Levels: Early-Level C;Late-Level A].i. Consider use of tizanidine for spasticity

n patients with generalized, disablingpasticity resulting in poor skin hygiene,

poor positioning, increased caregiverburden or decreased function [EvidenceLevels: Early-Level C; Late-Level B].v. Recommend against prescription ofbenzodiazepines during stroke recoveryperiod due to possible deleterious effectson recovery, in addition to deleteriousedation side effects[Evidence Levels:

Early-Level B; Late-Level B].

Rationale:Spasticity is an important problem aftertroke that results increased tone or

esistance to movement in muscles aftertroke. If spasticity is not managed

appropriately there may be loss of rangeof motion at involved joints of the armsalled contractures. These contractures

may interfere with functional use of thembs.

Best Practice Recommendation5.4.3 SCOREManagement ofShoulder Pain following Stroke

Therapeutic Goal: Maintain Pain Free

Shoulder and Arm

5.4.3.1 Assessment and Preventionof Shoulder Pain

The presence of pain and anyexacerbating factors should be identifiedearly and treated appropriately [EvidenceLevel C].. Joint protection strategies include:

a. Positioning and supporting the limb tominimize pain [Evidence Level B].b. Protection and support for the limb to

minimize pain during functional mobilitytasks using slings, pocket, or by therapistand during wheelchair use by using hemitray or arm troughs) [Evidence Level C].c. Teaching patient to respect the pain.[Evidence Level C].iii. Overhead pulleys should not be used[Evidence Level A].

iv. The shoulder should not be passivelymoved beyond 90 degrees of flexion andabductionunless the scapula is upwardly rotated andthe humerus is laterally rotated [EvidenceLevel A].v. Educate staff and caregivers aboutcorrect handling of the hemiplegic arm[Evidence Level A].

5.4.3.2 Management of ShoulderPain

i. Treat Shoulder pain and limitations in

range of motion through gentle stretchingand mobilization techniques focusingespecially on external rotation andabduction [Evidence Level B].ii. Reduce hand edema by:a. Active self-range of motion exercises inconjunction with elevation [Evidence LevelC] to gain full range of movement of thefingers, thumb and wrist.b. Retrograde massage [Evidence Level C].c. Gentle grade 1-2 mobilizations for

accessory movements of the hand andfingers [Evidence Level C].d. Cold water immersion (Level B) orcontrast baths [Evidence Level C].iii. Consider using FES to increasepain free range of motion of lateralrotation of the shoulder [EvidenceLevel A].iv. Consider use of acetaminophen orother analgesics for pain relief[Evidence Level C].v. Consider the use of botulinum toxininjections into subscapularis andpectoralis muscles for individual withhemiplegic shoulder pain [EvidenceLevel C].

5.4.3.3. Assessment andManagement of Complex regionalpain syndrome

(Also known as shoulder-hand syndrome,Reflex sympathetic Dystrophy, Sudecksatrophy)i. A bone scan may be used to assistdiagnosis of this condition [Evidence LevelC].ii. Oral corticosteroids in tapering dosesmay be used to reduce swelling and paindue to this condition. {Evidence Level B].

Rationale:

The incidence of shoulder pain followingstroke is high, with as many as 72 perceof adult stroke patients reporting at leastone episode of shoulder pain within the year after stroke. Shoulder pain can delarehabilitation and recovery of function; th

pain may mask improvement of movemeand function or may inhibit patientparticipation in rehabilitation activities suas therapy or activities of daily living.

Hemiplegic shoulder pain may contributepoor functional recovery of the arm andhand, depression and sleeplessness.Preventing shoulder pain may affect quaof life.

For the full recommendations, theSCORE recommendations for lowerlimb management and other resourcgo to www.strokebestpractices.ca

Patient undergoing Constraint InducedMovement Therapy (CIMT)


10/13

Stroke Nursing News Page 10 of 12

Preconference Nursing Workshops at CSC

A series of workshops under the title Practical Issues in Stroke Nursing will be presentedSunday, October 2, before the Canadian Stroke Congress commences on Monday. Theworkshops are open to all Congress registrants, and will focus on clinical practice andapplication. All workshops will have two timeslots (1:00-2:30 and 3:00-4:30) to allow registrantsto attend more than one workshop.

- Workshop 1 Sexuality after Stroke- Workshop 2 Depression as an Independent Predictor of Stroke- Workshop 3 Transcranial Doppler Service in the Treatment of Hemorrhagic Stroke- Workshop 4 Cognitive Assessment: Screening vs. Diagnosis

Registration information is available as of June 1, 2011. Contact [email protected] or go

to the conference website for more information (see sidebar). Additional workshops with topics related tClinical Practices in Rehabilitation, Helping Your Patients Change Behavior and Key Techniques for theBiomedical Stroke Researcher will also be offered.

To mark World SaltAwareness Week(March 21-28), the CanadianStroke Network relaunchedits popularsodium101.cawebsite. In addition toEnglish and French, theupdated site is now availablein Mandarin as well.www.sodium101chinese.ca.

The website, which was

designed and built by CSNonline communitiesmanager, Lori Barron, has acleaner design, a built-insearch function, andembedded videos. Users canalso subscribe to a newsfeed on the site, or subscribeto receive email notificationsevery time news has beenadded to the site.

The website will continue to

grow in the coming monthsas we add delicious lowsodium recipes and cookintips, along with usefulinformation on great lowsodium products. In additioto the website, Sodium101 active on Facebook atwww.facebook.com/sodium101 and on Twitter@Sodium101.

Shaking up Sodium 101.ca

Save the Dates

ndCanadian Stroke

Congress, OttawaConvention Centre,October 2-4 , 2011

he purpose of a Canadiantroke Congress is to provide a

niquely Canadian forum inhich participants reflectingbench-to-bedside-to-communityerspectives of stroke canxchange ideas, collaborate, andarn about innovation in strokerevention, treatment, andecovery.ww.strokecongress.ca

Where the Brain and

pine Meet At the

Beach

Canadian Association ofeuroscience Nurses 42

nd

Annual Meeting andcientific Sessions, June4-17, 2011, Vancouverann.ca/cann_conf.php

011 Canadianypertension Congress,

October 2-5, 2011,Alliston, ON.

ww.hypertension.ca/chs/meengs/annual-meeting-2011/

Simulated salt shaker to count salt added to food. Recipe converter that allows you to track the saltadded to food while cooking, and calculates thesodium content based on serving size. Track your daily progress at a glance with the handysodium thermometer. Share your daily sodium totals on Facebook andTwitter.

Features include: Track your sodium intake based on your age group. Compare and track sodium content in takeout food. Enter and track sodium in packaged foods. A comprehensive listing of over 2000 food itemsfrom Canadas most popular takeout chains. Build a list of your favourite food items for quick andeasy tracking. A handy converter that allows you to calculate theamount of sodium in any amount of salt.


11/13

Best PracticeRecommendation 5.4.1Management of the Armand Hand

Therapeutic Goal: Improvedarm and hand skill forindependence

i. Exercise and functionaltraining should be directedtowards enhancing motorcontrol for restoringsensorimotor and functional

abilities. [Evidence Levels:Early Level A; Late LevelA].ii. Engage in repetitive andintense use of novel tasksthat challenge the patient toacquire necessary motorskills to use the involved limbduring functional tasks andactivities [Evidence Levels:Early Level A; Late LevelA].iii. The Upper extremityprogram should includestrength training to improve

impairment and function afterstroke for upper extremity.Spasticity is not a contra-indication to strengthtraining

374[Evidence Levels:

Early - Level A; Late - LevelA].iv. Therapists should providea graded repetitive armsupplementary program forpatients to increase activityon ward and at home. Thisprogram should includestrengthening of the arm andhand (small wrist weight,

putty, hand gripper), range ofmotion (stretching, activeexercises), and gross, finemotor skills (e.g., blocks,Lego, pegs), repetitivegoaland task-oriented activitiesdesigned to simulate partialor whole skill required inactivities of daily living(e.g. folding, buttoning,pouring, and lifting). TheGRASPprotocol suggestsone hour per day, six daysper week

375[Evidence

Best Practice Guidelines - Recommendations 5.4: SCO

Recommendations for upper limb management followi

stroke

Levels: Early-Level A; Late-LevelC].v. Following appropriate cognitiveand physical assessment, mentalimagery should be used toenhance sensory-motor recoveryin the upper limb [EvidenceLevels: Early-Level A; Late- LevelB].vi. Functional ElectricalStimulation (FES) should be usedfor the wrist and forearm toreduce motor impairment andimprove functional motorrecovery [Evidence Levels: Early-

Level A; Late-Level A].vii. Intensive Constraint InducedMovement Therapy (CIMT)should not be used for individualsin the first month post stroke untilfurther research is completed[Evidence Levels: Early-Level A;Late-N/A].viii. Consider the use of intensiveCIMT for a select group ofpatients who demonstrate at least20 degrees of wrist extension and10 degrees of finger extension,with minimal sensory or cognitivedeficits. Intensive training shouldinvolve restraint of the unaffectedarm for at least 90 percent ofwaking hours, and at least sixhours a day of intense upperextremity training of the affectedarm for two weeks [EvidenceLevel: Between 3 and 6 months-Level A; Late- Level A].ix. Consider the use of modifiedCIMT for a select group ofpatients who demonstrate at least20 degrees of wrist extensionand10 degrees of finger extension,with minimal sensory or cognitive

deficits. Modified CIMT consistsof constraint of the unaffectedarm with a padded mitt or armsling for a minimum of six hours aday with two hours of therapy forfourteen days [Evidence Levels:Early- Level A; Late- Level A].x. EMG biofeedback systemsshould not be used on a routinebasis. (adapted from RCP)[Evidence Levels: Early- Level A;Late- Level A].

xi. For patients whose arm and

hand are predicted to be lesthan stage three as measurethe Chedoke-McMaster StroAssessment,

376enhance

sensory-motor recovery of tupper limb by using sensorymotor stimulation [EvidenceLevels: Early- Level B; LateLevel B]. This consists of paand active-assisted range omovement that also includeplacement of the upper limbvariety of positions within thpatients visual field (Adaptefrom HSFAH 1.2a) [Evidenc

Levels: Early-Level C; Late C].xii. There is insufficient evidto recommend for or againsneuro-developmental treatmcomparison to other treatmeapproaches for motor retrainfollowing an acute stroke[Evidence Levels: Early-LevLate Level B].xiii. Use adaptive devices fosafety and function if othermethods of performing spectasks are not available or cabe learned [Evidence LevelsEarly- Level C; Late Level Cxiv. Assess the need for speequipment on an individual Once provided, equipment sbe re-evaluated on a regulabasis. [Evidence Levels: EaLevel C; Late-Level C].

Rationale:

Stroke frequently affects thefunction of the arm and a larnumber of stroke survivors warm weakness at stroke ons

not regain normal function.

Bilateral arm function is critialmost every daily activity. Anumber of techniques have developed for those individuwho have some minimal armmovement.

The rehabilitation techniquecan be used are expanding speak to the need for increaaccess to therapy time to caout these techniques.

Stroke Nursing News Page 8of 12he Canadian Journal ofeuroscience Nursing/Le

ournal canadien des infirmierst infirmires en scienceseurologiques

olume 33, Issue 1, 2011

etecting cognitive impairmentn clients with mild stroke oransient ischemic attackttending a stroke preventionlinic

y Gail MacKenzie, RN, MScN,nda Gould, RPN, Sandra Ireland,N, PhD, Kathryn LeBlanc, BsC,hD, and Demetrios Sahlas, MSc,

MD, FRCP(C)

bstract

wenty clients diagnosed withrobable transient ischemic attackTIA) or stroke attending a strokerevention clinic (SPC) werecreened for cognitive function, asne inclusion criteria for a pilottudy examining medicationdherence and hypertension

management. The Mini Mentaltate Examination (MMSE) wasdministered at study admissionollowed by a second screeningithin two weeks using the

Montreal Cognitive Assessment

MoCA) tool. Individual scores forhe MMSE and MoCA wereompared. Results demonstratedhat the majority (90%) ofarticipants scored in the normalange ( 26) on the MMSE (M =7.9 SD 2.15). However, morehan half (55%) of participants hadome degree of cognitivempairment based on MoCAcores of < 26 (M = 23.65 SD =.082). MoCA scoresemonstrated a wider rangeRange = 16) compared to theange of MMSE scores (Range =

). MoCA scores were significantlyp =


12/13

Stroke Nursing NewsPage 12 of 12

Released June 16: Major National Study finds there is significant work

to be done to improve the quality of stroke care This major nationalCanadian study on thequality of stroke care,released on June 16 by t

Canadian Stroke Networ(CSN), finds that there issignificant work to be doto improve prevention,treatment and recoveryfrom stroke.

The studys key findingsinclude: Two thirds of stroke patientsadmitted to hospital do not arrivtime to receive the best possible

stroke care. Stroke patients need greateraccess to stroke units;> 77% of stroke patients do notreceive treatment in a stroke un When patients arrive at hospitthey are not treated fast enough> Only 40% of patients who arriwithin 3.5 hours of symptom onsreceived a CT (computedtomography) or MRI (Magneticresonance imaging) scan withinhour of arrival. Patients receive good care inhospital but several aspects ofstroke care need to be significaimproved;> Only 12% of ischemic strokepatients admitted to a hospital wthe capability to administer theimportant clot dissolving drug tPwere treated with the drug. Bason tPA rates at some of Canadatop stroke centres, the targetnumber could be triple the currerate for those ischemic strokes tarrive within the 3.5-hour windo

> Only 22% of the hospitalsstudied were affiliated with asecondary stroke prevention clin Access to rehabilitation is vital> Only 37% of moderate to sevestrokes cases are discharged torehabilitation facility.

Read and download the reporonline at:www.canadianstrokenetworkPrinted copies are availableby emailing

info@canadianstrokenetwork

The Quality of Stroke Care in Canadacould not be timelier, says Dr.Robert Ct, Chair of the studys National Steering Committee and aProfessor at McGill University. The results of this study should be usedto prioritize investments in stroke care and improve and monitor thequality of stroke care for all Canadians. Stroke is one of the leadingcauses of death and the main cause of neurological disability in Canada.

The study will be of great value to our health system.

Canadians are not recognizing the symptoms ofstroke

The studys findings and recommendations are a call to action to theCanadian stroke care community, says Dr. Moira Kapral, a national steeringcommittee member and Associate Professor, Faculty of Medicine andDepartment of Health, Policy Management and Evaluation at the University ofToronto. There needs to be a greater emphasis on improving the publicsawareness about the early signs and symptoms of stroke and the importance of

calling 9-1-1 and having an ambulance bring them to hospital immediately. Thestudy looked at the quality of stroke care provided in emergency response, in-hospital care and in rehabilitation and recovery. Anonymous information frompatients records was used and included: time of stroke symptom onset,timeliness of emergency medical system access, treatment received in theemergency department, acute inpatient care and information related to patientdischarge from the acute care hospital. We are extremely pleased with theresults of the study because it illustrates what can be achieved in stroke care inCanada. If Canada invests now in innovative and sustainable stroke caresystems and programswe will achieve real benefits such as saving more livesand reducing the impact of stroke, says Dr. Antoine Hakim, CEO and ScientificDirector of the Canadian Stroke Network. The study included data from allhealth jurisdictions in Canada including government and health systems.


13/13

Stroke Nursing NewsPage 7 of 8 Page 6 o

About the National Stroke Nursing CouncilThe National Stroke Nursing Council was established in late 2005 with the support of theCanadian Stroke Network to promote leadership, communication, advocacy, education anursing research in the field of stroke.

The Council works to build understanding of the critical role of Canadian stroke nurses, ta voice to experiences on the frontline and to support the vision of the Canadian StrokeStrategy.

Statement of PurposeTo promote leadership,communication,advocacy, education and nursingresearch in the field of stroke.

Goals1. To build an understanding of the

critical role of stroke nurses inCanada.

2. To give voice to experiences ofstroke nurses on the front line.

3. To support the vision of the

Canadian Stroke Strategy.

Objectives

1. Build a nationally recognizedaccessible stroke nursing networ

2. Disseminate information and bestpractice standards to stroke nurse

3. Facilitate implementation of strokebest practices across the continuof care

4. Promote the value andunderstanding of the various nurs

roles in stroke care

National Stroke

Nursing Council

The contents ofStroke NursingNewsmay be reprinted withoutpermission. However, a credit is

requested. If reprinted,please send a copy to the National

Stroke Nursing Council c/o

P.O. Box 1594,Kingston, ON K7L 5C8

[email protected]

We want your Stroke Nursing

News!

Send stories, photos and ideas forcontent to

Colleen Taralson, Editor at

[email protected]

The NSNC is on the Web!

See us at:

www.canadianstrokestrategy.caand

www.canadianstrokenetwork.ca

Teri Green, co-chair of theNSNC and Alberta

Representative, is also the neweditor of the Canadian Journal of

Neuroscience Nursing. Send

your research articles forpublication to

[email protected]

May 17 was World

Hypertension Day

(www.hypertension.ca)

National Stroke Nursing Council Reps from Coast to Coast

British Columbia

Jaymi Chernoff, TIA Project

Coordinator, Royal Inland

Hospital, Kamloops

[email protected]

Alberta

Colleen Taralson, Stroke

Service Coordinator,

Edmonton Area Stroke

Program, Alberta Health

Services, Edmonton

Colleen.Taralson@albertahealth

services.ca

Teri Green, Council Co-Chair,

Foothills Medical Centre,

Calgary Health Region,

Calgary

[email protected]

Saskatchewan

Brenda Kwiatkowski, Stroke

Clinic Coordinator, Royal

University Hospital, Saskatoon

Brenda.kwiatkowski@saskatoon

healthregion.ca

Manitoba

Audrey Gousseau,

Cerebrovascular Nurse

Clinician, Health Sciences Centre,

Winnipeg

[email protected]

Fran Desjarlais, Regional Diabetes

Coordinator, Nutrition and Diabetes

Wellness Unit, Manitoba Region

First Nations and Inuit Health,Winnipeg

[email protected]

Ontario

Cindy Bolton, Council Co-Chair,

Project Manager Kingston General

Hospital, Kingston

[email protected]

Linda Kelloway, Best Practice

Leader, Ontario Stroke Network,

Hamilton

[email protected]

Elaine Edwards, Regional Stroke

Educator, Northwestern Regional

Stroke Network, Thunder Bay

[email protected]

Quebec

Rosa Sourial, Clinical Nurse

Specialist, McGill University Health

Centre, Montreal

Roxanne CournoyerCase Manager Neurology,Centre hospitalier de l`univedeMontral

[email protected]

New Brunswick

Patti Gallagher, Clinical NurSpecialist, Saint John Regio

Hospital, Saint John

[email protected]

Nova Scotia

Michelle MacKay, Specialty

Nurse Practitioner Neurolog

QEII Health Sciences Centr

Halifax

[email protected]

Prince Edward IslandMaridee Garnhum, Medical

Nurse Manager, Queen Eliz

Hospital, Charlottetown

[email protected]

Newfoundland and Labrad

Jenny Slade, Staff Nurse,

Neurology/Medicine, Easter

Health, St. Johns

[email protected]

stroke nursing news spring summer 2011

Documents