successful transitions - Heart and Stroke Foundation of Ontario

Transcription

SUCCESSFUL
TRANSITIONS
the key to recovery
2012
October 15, 2012
Hilton Downtown Toronto Hotel
FACULTY & PLANNING COMMITTEE
FACULTY
Andrea Andrade, MD
Pediatric Stroke Fellow at Hospital for Sick Children
Gail Avinoam, BSc (Nutritional Science) M Ed
Regional Education Coordinator, Toronto West
Stroke Network
Patricia Hill Bailey, RN, BScN, MHSc, PhD
Professor, School of Nursing, Laurentian University
John Barry, BA, BEd
President, Pursuit Health Management
Pauline Bodnar, MHSA, HBSW, RSW
Community & Long-Term Care Specialist
Northwestern Ontario Regional Stroke Network
Rebecca Bowes, HBA, OACCPP
Vladimir Hachinski, CM, MD, FRCPC, DSc
Distinguished University Professor
University of Western Ontario
Robert Hart, MD
Professor of Medicine (Neurology), McMaster
University, Population Health Research Institute
Shannon Howson, BScOT, OT Reg. (Ont.)
Occupational Therapist, Parkwood Hospital
Stephen Holzapfel, MD, CCFP FCFP
Director, Sexual Medicine Counselling Unit,
Women’s College Hospital; Associate Professor,
Dept. Family & Community Medicine, University
of Toronto
Darren Jermyn, BScPT, MBA
Regional Director, NEO Stroke Network
Alda Tee, Reg. PT
Regional Community and LTC Coordinator,
Central East Stroke Network
Sheldon Tobe, MD, MscCH (HPTE) FRCPC,
FACP, FASH
Chair, Canadian Hypertension Education
Program; Co-Chair, C-CHANGE, Nephrologist;
Sunnybrook Health Sciences Centre; Associate
Professor of Medicine, University of Toronto
Sue Verrilli, BA, RT (R/TRO)
Northeastern Ontario Stroke Network
Jacquie Willems, MN, BScN
Regional Director, South East Toronto
Network
Stroke
PLANNING COMMITTEE
Stroke Community Navigator, ICAN
Independence Centre and Network
Linda Kelloway, RN, MN, CNN (c)
Best Practices Leader, Ontario Stroke Network
Gwen Brown, RN, BA, Bed
Gwen Brown, RN, BA, BEd
Theo Lancee, RN BScN, MHSc
Regional Community & LTC Coordinator, SEO
Stroke Network
Regional Community & LTC Coordinator, SEO
Stroke Network
Director of Care, Carefree Lodge
Leona Bryan, RN
Director of Performance, Canadian Stroke Network
Nurse Manager, Seven Oaks, Long-Term Care,
Homes and Services, City of Toronto
Patty Lindsay, RN, PhD
Administrator, Seven Oaks
Beth Linkewich, MPA, BScOT, OT Reg. (Ont.)
Regional Director, North & East GTA Stroke
Network; Assistant Professor, Northern Ontario
School of Medicine
Leanne K. Casaubon, MD, MSc, FRCPC
Matthew Meyer, PhD Candidate,
Gayle Campbell, RN, BSN, MBA, PhD
Assistant Professor of Medicine, University of
Toronto, Division of Neurology – Stroke Program
Director, TIA and Minor Stroke (TAMS) Unit,
Toronto Western Hospital / University Health
Network
Donna Cheung, OT Reg. (Ont.)
Rehab and Community Re-engagment
Coordinator, South East Toronto Stroke Network
Department of Epidemiology and Biostatistics,
Schulich School of Medicine and Dentistry;
Western University; Vanier Canada Graduate
Scholar
Jocelyne McKellar, MSW, RSW
Rehabilitation and Community Re-engagement
Coordinator, Toronto West Stroke Network
Robert Fenton, BA Sociology, BA Indigenous
Morgan Moe, BSc Kin, EMT
Co-Founder, StrokeLink
Learning; Chair, Aboriginal Advisory Committee
Colleen Murphy, RN, BNSc
Best Practices Leader
Ontario Stroke Network
Christanne A. Lewis, BA, RN
Coordinator – District Stroke Centre
QHC Quinte Health Care
Beth Linkewich, MPA, BScOT, OT Reg. (Ont.)
Regional Director, North & East GTA Stroke
Network; Assistant Professor, Northern Ontario
School of Medicine
Louise MacRae, BSc N RN, MBA
Regional Program Director, Central South
Regional Stroke Network
Amy Maebrae-Waller, BScPT, BA (Hons) KIN
District Stroke Coordinator, Lakeridge Health
Judy Murray, MSc, PT
District Stroke Centre at Mackenzie Health
Regional Stroke Best Practice Coordinator
Lily Poon, MBA
Regional Education Coordinator, North&East
GTA Stroke Network
Brian Murray, MD, FRCPC
Manager, Health Professional Education, Ontario
Heart and Stroke Foundation
Paula Gilmore, MSc, BScOT, OT Reg. (Ont.)
Shelley Sharp, BSc, PT, MSc
Joanne Fortin, MSc, BHScOT, OT Reg. (Ont.)
Interim Director, Southwestern Ontario Stroke
Network
Associate Professor, Sunnybrook
Regional Director, Toronto West Stroke Network
Beverley Powell-Vinden, BNSc, MEd
Manager, Mission Information, Ontario
Sherry Grace, PhD
Elyse Shumway, MA
Education Consultant, The Aphasia Institute
Scientist, TGRI Behavioural Sciences
Associate Professor, YorkU Faculty of Health
Adam Steacie, MSc, MD, FCFP
Rehab & Community Re-engagement
Coordinator
North & East GTA Stroke Network
Family Physician, Upper Canada Family Health
Team, Brockville, Ontario
Krystyna Skrabka, RN, MA
Richard Swartz, HBSc, MD, PhD, FRCPC
Regional Stroke Education Coordinator, South
East Toronto Stroke Network
Millie Graham
Stroke Survivor
Clinician – Scientist
1
Sylvia Quant, BScPT, MSc, PhD
SUCCESSFUL
TRANSITIONS
the key to recovery
DEAR COLLEAGUE,
On behalf of the Heart and Stroke Foundation and the Ontario Stroke Network, welcome to the
15th annual Stroke Collaborative.
There are an estimated 25,500 new stroke events in Ontario every year and at least every 20 minutes
there is one new stroke victim in Ontario. One in five residents living in long term care has had a stroke.
But thanks to your efforts and dedication, the recovery journey for stroke survivors is not as daunting as
it once was. Today, there is hope.
Bringing together the skills and experiences of 600 healthcare professionals, each with new ideas and
approaches to better support survivors and their families through their care transitions, will undoubtedly
make their recovery journey home easier.
An impressive collection of speakers and researchers, paired with the opportunity to learn, discuss,
share, and engage in knowledge exchange will ultimately improve stroke care across the continuum.
Each of you already possesses unique knowledge and perspectives critical to stroke care and with
such a gathering of expertise, we urge you to learn and teach amid this wealth of talent, passion and
commitment at Stroke Collaborative 2012.
Sincerely,
Tom McAllister Malcolm Moffat
Chief Operating Officer, Ontario Chair, OSN Board of Directors
Chris O’Callaghan
Executive Director, Ontario Stroke Network
STROKE COLLABORATIVE 2012
2
Conference Agenda
7:00
REGISTRATION OPENS
7:30 – 8:30
BREAKFAST SYMPOSIUM
9:00 – 10:15
15TH ANNIVERSARY CELEBRATION & WELCOME
WELCOME
Tom McAllister, Chief Operating Officer, Ontario, Heart and Stroke Foundation
Malcolm Moffat, Chair, OSN Board of Directors
CEREBROVASCULAR DISEASE:
EMERGING REALITIES
Vladimir Hachinski, OC, CM, MD, FRCPC, DSc
10:15 – 10:35
SURVIVOR STORY – MILLIE GRAHAM
10:35 – 11:05
POSTERS / EXHIBITS / BREAK
11:05 – 11:50
PLENARY 1
Distinguished University Professor
STROKE AND SLEEP MEDICINE
11:50 – 12:35
CONCURRENT SESSION 1
[C1a]
[C1b]
[C1c]
[C1d]
Canadian Best Practice
Recommendations
Update: 2012
Atrial Fibrillation
Stroke Flow:
Collaborative
Transformational System
Changes to Support
Access to Best Practices
Across the Continuum
Stroke Outpatient
Flow to Vascular
Rehabilitation
Director of Performance, Canadian
Stroke Network
Robert Hart, MD
Professor of Medicine (Neurology),
McMaster University, Population
Health Research Institute
Beth Linkewich, MPA, BScOT, OT
Best Practices Leader, Ontario
Stroke Network
Reg. (Ont)
Regional Director, North & East
GTA Stroke Network, Assistant
Professor, Northern Ontario School
of Medicine
Regional Director, South East Toronto
Stroke Network
Shelley Sharp, MSc, BScPT
Regional Director, Toronto West
Stroke Network
[C1e]
[C1f]
[C1g]
Patients and their
Caregivers Experiences
of Community
Reintegration Post-stroke
Stroke in Young/
Pregnancy
Mobile Technology and
its Impact Across the
Continuum
Patricia Hill Bailey, RN, BScN,
MHSc, PhD
Professor, School of Nursing,
Laurentian University
Rebecca Bowes, HBA, OACCPP
Stroke Community Navigator, ICAN
Independence Centre and Network
Darren Jermyn, BSc PT, MBA
Regional Director, NEO Stroke
Network
Northeastern Ontario Stroke
Network
3
Richard Swartz, HBSc, MD, PhD,
FRCPC
Sherry Grace, PhD
Scientist, TGRI Behavioural
Sciences; Associate Professor,
YorkU Faculty of Health
12:35 – 13:35
LUNCH
13:35 – 14:20
[C2a]
[C2b] [C2c]
[C2d]
C-Change
Malignant MCA Infarct,
the Neurovascular Time
Bomb
The Integration of Stroke
Best Practices into LTC
Resident Care Planning
Andrea Andrade, MD
Pediatric Stroke Fellow at Hospital for
Sick Children
Regional Community & LTC
Coordinator, SEO Stroke Network
Flying Pizzas to Fort
Severn: Learning How to
Do Stroke Research with
First Nations Youth
Sheldon Tobe, MD, MScCH (HPTE)
FRCPC, FACP, FASH
Chair, Canadian Hypertension
Education Program
Co-Chair, C-CHANGE, Nephrologist
Sunnybrook Health Sciences Centre
Associate Professor of Medicine,
University of Toronto
Community & Long-Term Care
Specialist; Northwestern Ontario
Robert Fenton, BA Sociology, BA
Indigenous Learning
Chair, Aboriginal Advisory
Committee; Northwestern Ontario
Gayle Campbell, RN, BSN, MBA,
PhD; Administrator Seven Oaks
Leona Bryan, RN
Nurse Manager, Seven Oaks, LongTerm Care Homes and Services City
of Toronto
[C2e]
[C2f]
Toolkit for Returning to
Work after Stroke
An Innovative Approach
The Impact of Moving to
for Improving Continuity Stroke Rehabilitation Best
of Care in Stroke Recovery Practices in Ontario
Paula Gilmore, MSc, BScOT, OT
[C2g]
Reg. (Ont.); Southwestern Ontario
Stroke Network Community and Long
Term Care Coordinator, LHSC
Shelley Sharp, MSc, PT, BSc
Matthew Meyer, PhD Candidate
Director, Regional Stroke Program,
UHN/Toronto West Stroke Network
Shannon Howson, BScOT, OT
Department of Epidemiology and
Biostatistics, Schulich School of
Medicine and Dentistry; Western
University; Vanier Canada Graduate
Scholar
Reg. (Ont.); Occupational Therapist,
Parkwood Hospital
John Barry, BA, BEd
Rehabilitation and Community Reengagement Coordinator, Toronto
West Stroke Network
Gail Avinoam, BSc (Nutritional
Science) M Ed
Regional Education Coordinator,
Toronto West Stroke Network
14:20 – 14:50 POSTERS / EXHIBITS / BREAK
14:50 – 15:35
[C3a]
[C3b]
[C3c]
[C3d]
TIA Evaluation and
Management – A Window
of Opportunity for Stroke
Prevention
Using the ‘Teach-Back’
Method to Improve
Communication of Health
Information
Stroke and Sexuality
Using Social Media to
Enhance Knowledge
Exchange and
Interprofessional
Collaboration across the
Care Continuum
Leanne K. Casaubon, MD, MSc,
Elyse Shumway, MA
FRCPC, Assistant Professor of
Education Consultant, The Aphasia
Medicine, University of Toronto,
Institute
Division of Neurology – Stroke Program
Director, TIA and Minor Stroke (TAMS)
Unit, Toronto Western Hospital /
University Health Network
[C3e]
[C3f]
A Guide for Working
with and Understanding
Aboriginal Peoples:
The Perspective of One
Individual
Planning Collaboratively to
Improve Vascular Health
within Primary Care in
Southeastern Ontario
Robert Fenton, BA Sociology, BA
Stephen Holzapfel, MD, CCFP, FCFP
Director, Sexual Medicine Counselling
Unit, Women’s College Hospital
Associate Professor, Dept. Family &
Community Medicine, University of
Toronto
Joanne Fortin, MSc, BHScOT, OT
Reg. (Ont.)
Regional Education Coordinator,
North&East GTA Stroke Network
Indigenous Learning, Chair, Aboriginal
Advisory Committee, Northwestern
Ontario Regional Stroke Network
Donna Cheung, OT Reg. (Ont.)
Rehab and Community Re-engagment
Coordinator, South East Toronto Stroke Network
Community & Long Term Care Specialist,
Northwestern Ontario Regional Stroke
Network
Alda Tee, reg. PT
Regional Community and LTC
Coordinator, Central East Stroke Network
4
floor plan
3rd Floor
Guest Elevators
Osgoode
West
Executive
Offices
East
Hilton Meeting
Reception
Richmond
Opus Boardroom
West
Adelaide
East
University
2nd Floor
Guest Elevators
Governor
General
Parlor
Governor General
Main
Fitness Centre
To second floor bridge
Convention Level
Exit
Guest Elevator
Ruth’s
Chris
Carmichael
F&B
Office
Tom Thomson
Coat
Check
Exit
14
13
12
17
18
11
10
9
8
Jackson
7
Fitzgerald
Registration
15
Foyer
16
Varley
Casson
6
Exit
Johnston
Exit
5
5
4
3
2
1
Toronto
Ballroom
Toronto
Ballroom
Toronto
Ballroom
3
2
1
keynote address
CEREBROVASCULAR DISEASE:
EMERGING REALITIES
Vladimir Hachinski, CM, MD, FRCPC, DSc
Distinguished University Professor University of Western Ontario
Dr. Hachinski received his MD from the University of Toronto. After completing his residency
training at the same university, Dr. Hachinski undertook a Cerebrovascular Laboratory
fellowship at the National Hospital for Nervous Diseases at Queen Square in London,
England and a research fellowship at Bispebjerg Hospital in Copenhagen, Denmark.
Dr. Hachinski is Professor of Neurology and Distinguished University Professor at Western
University, Founding Chairman of the International Society for Vascular Behavioural and
Cognitive Disorders, and President of the World Federation of Neurology comprising of
114 national neurological societies, since 2010.
With John W. Norris he established the world’s first successful acute stroke unit. He
discovered with colleagues, the key role of the brain’s insula in sudden death and an
ischemia/amyloid/inflammation link between Alzheimer disease and stroke, paving the way
for new treatments.
He was Editor-in-Chief of STROKE Journal, the leading publication in the field for an
unprecedented 10 year term from 2000-2010. He has contributed to over 600 book
chapters, scientific papers, editorials and other scholarly publications. He is the author
of 16 books including Stroke: A Comprehensive Guide to Brain Attack, co-authored with
his daughter Larissa Hachinski, which was written to increase public awareness of “brain
attacks,” a term coined by Dr. Hachinski to help drive home the urgency of strokes.
He has received 4 honorary degrees. He has also been awarded the Mihara International
Award, Order of Canada, World Stroke Organization Leadership in Stroke Medicine Award,
the Premier’s Discovery Award in the Life Sciences and Medicine for “ground breaking
research on relationship between stroke and Alzheimer disease” and most recently, the
International BIAL Merit Award in Medical Sciences for his monograph on “The Long Fuse:
Silent Strokes and Insidious Alzheimer Disease.
COLLABORATIVE
2012
STROKESTROKE
COLLABORATIVE
2012
6
SURVIVOR STORY
10:15 – 10:35
TORONTO BALLROOM
MILLIE GRAHAM
Stroke Survivor, Author
This presentation will be a first hand description of the impact of stroke on an individual,
and the journey back to a full and fulfilling life. For Millie Graham, this year marks the 20th
anniversary of her stroke. She will share her retrospective view of the challenges she has faced
and her recovery over the last 20 years. She is grateful for the progress she has made since
the quality of life she has now is much better than the dismal prognosis she was initially given.
She will share what she has learned and the implications for healthcare providers.
7
Plenary 1
11:05 – 11:50
TORONTO BALLROOM
STROKE AND SLEEP MEDICINE
Sleep disorders are common and increasing in prevalence. Treatment of sleep disorders
can improve primary prevention, secondary prevention, and recovery from stroke. Simple
interventions can often have significant impact for patients and their families. This session
will review some basic sleep physiology, and some common sleep disorders that are seen in
patients with stroke. Particular attention will be paid to sleep deprivation, sleep apnea, and
restless legs syndrome. I hope this session will raise awareness of the significance of sleep
to stroke care, and highlight the significant and emerging findings from this field.
STROKE
COLLABORATIVE
2012
STROKE
COLLABORATIVE
2012
8
concurrent sessions
C1a
CANADIAN BEST PRACTICE RECOMMENDATIONS UPDATE: 2012
Director of Performance, Canadian Stroke Network
11:50 – 12:35
GOVERNOR GENERAL
Best Practices Leader, Ontario Stroke Network
The Canadian Best Practice Recommendations for Stroke Care were first released in 2006, by the Canadian
Stroke Strategy with a commitment to update every two years. The Recommendations are intended to
help reduce practice variations and close gaps between evidence and practice. The Canadian Best Practice
Recommendations reflect the latest stroke research evidence and expert opinion. Each update undergoes a
critical review of the literature to inform decisions for changes to recommendations and performance measures.
This presentation will review the changes to the Secondary Prevention recommendations update for 2012
and includes introduction of supporting knowledge transfer tools.
C1b
ATRIAL FIBRILLATION
Robert Hart, MD
Professor of Medicine (Neurology), McMaster University,
Population Health Research Institute
Atrial fibrillation is a common cardiac arrhythmia whose most serious clinical consequence is stroke.
Uncoordinated atrial contractions result in sluggish blood flow and the formation of thrombus in the atrial
appendage. The stasis-precipitated thrombi lead to emboli that are distributed according to cardiac output,
but emboli to the brain account for about 80 percent of symptomatic emboli. Because they are larger on
average than emboli of valvular origin, emboli to the brain cause disabling and often lethal strokes. Most
strokes associated with atrial fibrillation cause substantial neurologic disability, and therefore primary
prevention, rather than belated prophylaxis among survivors of an initial stroke, is the only sensible approach.
An estimated 2.6 million Americans have atrial fibrillation, and this number is expected to double during
the next two decades. The prevalence of atrial fibrillation increases with age and affects about 5% of those
70 years of age or older. The average age of patients with atrial fibrillation is about 75 years. Among the
very elderly (and particularly in elderly women), atrial fibrillation is the single most important cause of
ischemic stroke. Anticoagulation with warfarin reduces the risk of stroke by about 85% by on-treatment
analysis of randomized clinical trials – when properly administered, adjusted-dose warfarin therapy virtually
eliminates the excess risk of stroke associated with atrial fibrillation. Recently, a new generation of oral
anticoagulants (dabigatran, rivaroxaban, apixaban) have been shown to be at least as efficacious as warfarin
for stroke prevention with less risk of intracranial bleeding and greater ease of use.
During the ongoing epidemic of atrial fibrillation, all clinicians should be aware of this common cause of
preventable stroke.
9
11:50 – 12:35
OSGOODE
C1c
STROKE FLOW: COLLABORATIVE TRANSFORMATIONAL
SYSTEM CHANGES TO SUPPORT ACCESS TO BEST PRACTICES
ACROSS THE CONTINUUM
Beth Linkewich, MPA, BScOT, OT Reg. (Ont)
Shelley Sharp, MSc, BScPT
Regional Director, North & East GTA Stroke Network,
Assistant Professor, Northern Ontario School of Medicine
Regional Director, Toronto West Stroke Network
11:50 – 12:35
TOM THOMSON
Regional Director, South East Toronto Stroke Network
Evidence supports that organized acute stroke care and early access to appropriate and intense
rehabilitation improves patient outcomes. Stroke Flow is a collaboration of The Toronto Stroke Networks
(TSNs) and the GTA Rehab Network with the Toronto Central Local Health Integration Network (TC LHIN)
and organization leaders to transform the system to ensure access to these best practices, no matter where
the patient journey begins. This session will: provide a context for Stroke Flow and the recommended
system changes, outline the process and outcomes within the TSNs to date, and describe emerging
opportunities, key enablers, and future directions of the work.
C1d
STROKE OUTPATIENT FLOW TO VASCULAR REHABILITATION
11:50 – 12:35
CASSON
Sherry Grace, PhD
Scientist, TGRI Behavioural Sciences
Associate Professor, YorkU Faculty of Health
Outpatient cardiovascular rehabilitation (CVR) is proven to reduce mortality in cardiac patients, and
emerging evidence demonstrates safety and benefit for patients with transient ischemic attack (TIA)
or mild non-disabling stroke (MNDS). In this session, the findings of two applied studies we are
undertaking in this area will be described. First, we are observing and coding TIA/MNDS outpatientprovider communication regarding CVR, and what elements of this communication are related to
patient referral and enrollment in CVR. Referral communication is key to promoting patient transition to
outpatient rehabilitation, and providers will learn what key elements of their communication are related
to patient intention to enroll.
Second, we have been undertaking an evaluation of integrated CVR for patients with multiple chronic
vascular diseases, including TIA/MNDS. Participants are assessed pre and post-program with regard
to risk factors, activity status, health behaviours and psychological well-being. The outcomes of
CVR participation will be presented, and compared by vascular indication. We also assess patient’s
perceptions of their care, so we can understand how well we are doing in supporting patients through
their care transitions.
10
concurrent sessions
C1e
PATIENTS’ AND THEIR CAREGIVERS’ EXPERIENCES OF
COMMUNITY REINTEGRATION POST-STROKE
Patricia Hill Bailey, RN, BScN, MHSc, PhD
Professor, School of Nursing, Laurentian University
Darren Jermyn, BSc PT, MBA
Regional Director, NEO Stroke Network
Rebecca Bowes, H.B.A., O.A.C.C.P.P.
Sue Verrilli, B.A., R.T. (R/TRO)
Stroke Community Navigator, ICAN Independence Centre and
Network
11:50 – 12:35
CARMICHAEL/JACKSON
Northeast Community Reintegration Stroke Research Team
Every year, approximately 50,000 Canadians suffer a stroke, making it the fourth leading cause of mortality
and disability. In 2011, approximately 1,000 individuals were discharged home following an acute stroke
hospitalization in northeastern Ontario. Many of these individuals relied on their family members, a situation
that may increase the health vulnerabilities of both stroke survivors and their care partners. Stressors
associated with living in their northern community may include isolation, travel distance, unavailable or few
speciality resources, and limited local community support services. Lack of access to speciality or primary
health care services is concerning given the positive empirical relationship between supportive, coordinated
community services in the first year post-hospitalization and positive survivor health outcomes. The aims
of this plenary are threefold. First, the needs of stroke survivors and their care partners will be described.
Second, in response to these northern needs, strategic approach of navigation services for the community
reintegration of stroke survivors will be outlined. Finally, preliminary quantitative and qualitative results
about navigation services will be presented. This plenary concludes with a discussion of plans for refinement
of navigation services and presentation of an Ontario Stroke Network funded two-year mixed methods
study involving stroke survivors, care partners, clinicians and decision-makers in northeastern Ontario.
11
11:50 – 12:35
C1f
STROKE IN YOUNG/PREGNANCY
VARLEY
Richard Swartz, HBSc, MD, PhD, FRCPC
Stroke is the leading cause of adult neurological disability in Canada and a leading cause of death and,
perhaps because of this, it is often thought to be a disease of older patients. However, stroke affects
roughly one in 10,000 people aged 18-45, and is more common (~1 in 4,000) in pregnancy. It is a leading
cause of death and disability in young adults. Stroke in the young and in pregnancy can have a diverse
range of causes – some common and some exceedingly rare. This session will review the diverse causes
and consequences of stroke in the young and of stroke in pregnancy and provide an approach to the
assessment and management of these complex cases.
C1g
MOBILE TECHNOLOGY AND ITS IMPACT ACROSS THE CONTINUUM
11:50 – 12:35
RICHMOND
Join Morgan Moe, Founder and CIO of StrokeLink as she discusses mobile technology, the app world, and
the development of StrokeLink, a new tablet application for stroke survivors!
Technology is transforming the way we conduct our lives. It provides us with access to unlimited information
right at out fingertips and introduces simple tools capable of enriching our everyday experiences. Patients
everywhere are benefiting from numerous eHealth and mHealth initiatives. These projects are improving
patient access to information, navigation of care options and best of all providing a wealth of tools and
resources for self management, ultimately reducing the strain on an over burdened healthcare system. With
these objectives in mind Morgan and her multidisciplinary team have developed StrokeLink to transform
rehabilitative care delivery.
StrokeLink empowers stroke survivors and their caregivers throughout their recovery by providing
knowledge and self-care tools to bridge the gaps in care delivery. StrokeLink provides a comprehensive
toolkit of resources designed to guide and actively engage patients as they recover and regain
independence. On a daily basis, the mobile application plays a large role in therapy delivery by providing
patients with customized therapy programs through which they are guided in an interactive and engaging
manner. Listen in to learn about how StrokeLink is being deployed in various care settings across the
continuum and the impact it is having.
12
concurrent sessions
C2a
C-CHANGE
Sheldon Tobe, MD, MScCH (HPTE), FRCPC, FACP, FASH
Chair, Canadian Hypertension Education Program
Co-Chair, C-CHANGE, Nephrologist, Sunnybrook Health Sciences Centre
Associate Professor of Medicine, University of Toronto
Cardiovascular disease (CVD) is the most prevalent chronic medical condition in Canada, and evidencebased management of risk factors for cardiovascular disease can reduce morbidity and mortality.
However, there are more than 400 practice recommendations for risk management of cardiovascular
disease from various guidelines authored or sponsored by many different organizations in Canada.
Given that the guidelines were developed through multiple processes, use different evidence grading
systems, wording and emphasis it is a challenge for health providers to manage patients with an
increased risk of atherosclerotic diseases or with multiple co-morbidities. This challenge inhibits
implementation, understanding and adherence, and hinders the delivery of clinically effective,
guideline-based care.
The C-CHANGE (Canadian Cardiovascular Harmonization of National Guidelines Endeavour) Initiative
was developed as a joint community project in partnership with eight guidelines groups focused on
cardiovascular risk reduction and has created and published the first Canadian set of harmonized
guidelines to prevent and manage CVD in primary care practice. The C-CHANGE Initiative evolved
from a group of developers of clinical practice guidelines who shared a vision to harmonize their
guidelines to meet the needs of primary care practitioners and their patients. The mission of the
Initiative is twofold: to establish through a common vision and action plan for the prevention and
treatment of chronic atherosclerotic disease in Canada one authoritative set of harmonized guidelines;
and, to develop, disseminate, implement and evaluate a nationally coordinated, harmonized
and integrated strategy for the prevention and treatment of vascular disease (cardiovascular,
cerebrovascular, peripheral vascular) to help understand vascular risk, treatment targets and treatments
to achieve these targets.
13
13:35 – 14:20
CARMICHAEL/JACKSON
C2b
MALIGNANT MCA INFARCT, THE NEUROVASCULAR TIME BOMB
13:35 – 14:20
VARLEY
Andrea Andrade, MD
Pediatric Stroke Fellow at Hospital for Sick Children
Malignant MCA syndrome is a devastating complication commonly seen in adults presenting with arterial
ischemic infarct. It accounts for up to 10% of all supratentorial infarcts. During the first 72 hours, there is
around 80% mortality in patients managed with conservative measures. Early hemicraniectomy has shown
to have improved the mortality rate, and the neurological outcome.
Its incidence in children is not well known.
Our objective is to identify risk factors in pediatric patients that could predict the development of malignant
MCA syndrome.
PATIENTS AND METHODS We did a retrospective review, of children who developed malignant MCA
infarcts during the last five years. We reviewed their clinical course, and their radiological findings.
RESULTS We identified seven patients who developed malignant MCA infarctions from 2007 to 2012.
There were five boys, and two girls. The age range when the stroke happened was from three to 15 years
(mean 11 years). The risk factors were variable 4/7 cardioembolic, 2/7 vasculopathy, 1/7 mixed (cardiac, and
hematologic). 4/7 had seizures. Their NHISS ranged from eight to 18 (retrospectively applied). On the initial
CTH, all of the patients had a “hyperdense” MCA sign. 5/7 undergone hemicraniectomy. 2/7 died before
the surgery.
CONCLUSIONS Malignant MCA syndrome is a very severe complication from stroke. Its mortality is high
if it is not treated surgically. The presence of seizures, high scores on the initial NHISS, “hyperdense MCA
signs”, can be indicators for the development of malignant MCA in the pediatric population, and early
recognition would allow for an earlier surgical intervention and the improvement of outcomes.
14
concurrent sessions
C2c
THE INTEGRATION OF STROKE BEST PRACTICES INTO LTC
RESIDENT CARE PLANNING
Gayle Campbell, RN, BSN, MBA, PhD
Regional Community & LTC Coordinator, SEO Stroke Network
Administrator, Seven Oaks
Leona Bryan, RN
Nurse Manager, Seven Oaks, Long-Term Care
Homes Services, City of Toronto
22% of residents in Long Term Care (LTC) age 65 or older have had a stroke and stroke is the third most
common diagnosis in LTC.
The Stroke Care Plans were created by professionals from the Ontario Stroke Network and LTC sector
to increase awareness and facilitate the uptake of best practice stroke care. The care plans were drafted
using a generic format familiar to LTC Homes and reviewed by a MOHLTC Compliance Director to ensure
contiguity with accreditation and other standards. Developed from the Heart and Stroke Foundations’ Tips
and Tools for Everyday Living©, the care plans integrated RAI-MDS scores/scales into the goal statements
linking a best practice resource with an embedded assessment tool. The care plans were piloted in five
Ontario LTC Homes and the pilot evaluated using the three domains of awareness, accessibility and
effectiveness. Two LTC Homes will share their experiences during the pilot and the results of the pre- and
post-surveys will also be presented.
15
13:35 – 14:20
TOM THOMSON
C2d
FLYING PIZZAS TO FORT SEVERN: LEARNING HOW TO
DO STROKE RESEARCH WITH FIRST NATIONS YOUTH
13:35 – 14:20
RICHMOND
Community & Long-Term Care Specialist
Robert Fenton, BA Sociology, BA Indigenous Learning
Chair, Aboriginal Advisory Committee
In 2009, the Ontario Stroke Network supported a project to explore stroke education needs of Aboriginal
youth age 10-13 in Northwestern Ontario. The goal was to develop age and culturally-appropriate tools.
This research was done in response to a previous stroke education project, in which First Nations Elders
requested that future stroke awareness initiatives “teach First Nations youth” about stroke. Community
members suggested that stroke education would help youth recognise the signs and symptoms and
know the need to respond promptly. Elders felt very strongly that the youth could serve as messengers,
bringing stroke awareness information home to their parents and grandparents. They also emphasized
the importance of culturally appropriate health teachings. Fifteen communities and organizations were
interested in the study and ten First Nations and four organizations participated in the research component,
which included discussion groups with youth and interviews with health and education professionals. Six
First Nations and one Aboriginal organization assisted with the filming of the educational tool, a DVD
featuring First Nations youth teaching youth about stroke. This presentation describes the lessons learned,
about the uniqueness of First Nations, the generous support offered by the communities and organizations
and their strong commitment to improving youth awareness of stroke. It offers concrete examples of the
strategies that were effective, the practical supports that were needed, and how barriers were overcome.
The enthusiasm of the youth who took part in the project, their interest in learning more about stroke,
and their creativity in finding ways to teach about stroke are illustrative of the positive results that can be
achieved when researchers work with First Nations to develop culturally-appropriate health education tools.
(And the pizzas did make it to Fort Severn!)
16
concurrent sessions
C2e
TOOLKIT FOR RETURNING TO WORK AFTER STROKE
Paula Gilmore, MSc, BScOT, OT Reg. (Ont.)
Interim Director, Southwestern Ontario Stroke Network
Shannon Howson, BScOT, OT Reg. (Ont.)
Occupational Therapist, Parkwood Hospital
John Barry, BA, BEd
Presently, 26% of stroke survivors are between the ages of 45-65 and in the prime of their working life when
they experience stroke. Return to work (RTW) rates after stroke have been documented to be as low as 7%
even though employment is one of the most important social roles that a person fulfills. The presentation
will focus on an innovative project where a web-based toolkit of resources has been developed based
on best practice to assist stroke survivors and health care professionals navigate the process of RTW. The
web-based toolkit has been designed as a self management tool navigating users to various resources
based on their individual work situation. The presentation will highlight the literature for return to work after
stroke as well as provide a guided tour of the web-based toolkit and how to use the resources with stroke
survivors who wish to return to work after stroke. Web-based resources that will be reviewed include a self
assessment guide designed to help focus an individual’s recovery efforts and inform him/her about his/her
current ability to return to work, questions to ask employers and insurers, government financial supports,
organizations providing return to work services and volunteering after stroke.
LEARNING OUTCOMES
• Enhance participant’s knowledge of return to work after stroke.
• Learn about a web-based resource available to assist clients with return to work.
• Learn about how and where to access resources for return to work after stroke.
17
13:35 – 14:20
GOVERNOR GENERAL
C2f
AN INNOVATIVE APPROACH FOR IMPROVING CONTINUITY
OF CARE IN STROKE RECOVERY
Shelley Sharp, MSc, BSc PT
Gail Avinoam, BSc (Nutritional Science), MEd
Director, Regional Stroke Program, UHN/Toronto West
Stroke Network
Regional Education Coordinator, Toronto West Stroke Network
13:35 – 14:20
TORONTO BALLROOM
1&2
Rehabilitation and Community Re-engagement
Coordinator, Toronto West Stroke Network
In Ontario, people with stroke often experience fragmented and unsatisfying care because they encounter
multiple healthcare providers in various settings. Overlaid on this is the burden of managing the system
at a time when they are most vulnerable and overwhelmed, thereby potentially limiting their recovery
and outcomes. Recent publications as well as provincial and local priorities in healthcare highlight the
need for improvement in health care transitions as a key driver to improve health outcomes and system
efficiencies. This presentation will provide an overview of a system wide approach undertaken to create a
standardized, but adaptable means to support a person-centred model of cross continuum care in Toronto.
The model was designed to enhance communication, strengthen cross-system relationships/collaboration,
care coordination, and promote patient self-management, system navigation and greater satisfaction with
the transition and recovery experience for everyone in the system. Specifically, participants in this session
will learn what is important about transitions of care from the healthcare provider and patient/caregiver
perspectives and gain insight into an approach undertaken to promote seamless care in a complex system.
18
concurrent sessions
C2g
THE IMPACT OF MOVING TO STROKE REHABILITATION
BEST PRACTICES IN ONTARIO
Matthew Meyer, PhD Candidate, Department of Epidemiology and Biostatistics,
Schulich School of Medicine and Dentistry; Western University
Vanier Canada Graduate Scholar
Post-stroke rehabilitation has received a lot of attention in Canada, and internationally, as a way to help
patients make meaningful functional recoveries and to improve their overall quality of life post stroke.
Recently, post-stroke rehabilitation is also being examined as a means for reducing hospital length of stay
and decreasing healthcare costs. This session is designed to discuss some of the challenges currently faced
by Ontario’s stroke system and the potential economic impact that better application of best-practice
principles might have.
Discussion will begin with an outline of Ontario-based research assessing the challenges faced by Ontario’s
stroke system. This will be followed by a brief outline of the best-practice recommendations for stroke
rehabilitation developed by the Ontario Stroke Network’s Stroke Reference Group and summary of an economic
evaluation of their potential impact. Finally, results of several studies will be presented that demonstrate
evidence of potential for improvement in patient care through better application of best-practice.
19
13:35 – 14:20
CASSON
C3a
TIA EVALUATION AND MANAGEMENT – A WINDOW OF
OPPORTUNITY FOR STROKE PREVENTION
14:50 – 15:35
GOVERNOR GENERAL
Leanne K. Casaubon, MD, MSc, FRCPC
Assistant Professor of Medicine, University of Toronto,
Division of Neurology – Stroke Program
Director, TIA and Minor Stroke (TAMS) Unit,
Toronto Western Hospital / University Health Network
Stroke is the most common cause of adult disability in Canada and a leading cause of death, dementia,
long hospital stays, and nursing home placement. To reduce the incidence of stroke and related disability,
identification of patients at high-risk of stroke is needed. A transient ischemic attack (TIA) is a stroke
warning event. About one in four ischemic strokes are preceded by a TIA; with 43% of those TIAs occurring
within one week of the stroke.
Given the potential risk of stroke after any TIA is up to 10% or higher within the first 30 days following a
TIA, and half of that risk is within 48 hours of the TIA, patients with a TIA require urgent assessment, risk
stratification, and initiation of preventative treatment. However, for various reasons, many patients are not
accessing the recommended urgent care strategies that would optimally assist them in preventing a stroke.
In this session, attendees will be provided with information about TIAs, the risk of stroke in patients with
a TIA, and the evidence that supports the recent paradigm shift in the evaluation and management of
patients with TIA, highlighting novel care models such as rapid-assessment TIA units/clinics. Attendees
of this session will develop an appreciation of the care strategies that are available and necessary for TIA
patients to be able to optimally prevent a subsequent stroke and attendees will learn various ways to assist
their patients in accessing these resources.
20
concurrent sessions
C3b
USING THE ‘TEACH-BACK’ METHOD TO IMPROVE COMMUNICATION
OF HEALTH INFORMATION
14:50 – 15:35
TOM THOMSON
Elyse Shumway, MA
Education Consultant, The Aphasia Institute
The Teach-Back Method is a health literacy initiative designed to ensure that health information given
to patients is understood correctly. Studies have shown that too much health information is forgotten
immediately and much of the information that is retained is incorrect. The Teach-Back Method is an
evidence-based strategy that can improve knowledge transfer between health-care practitioners and
patients. Furthermore, for individuals who have communication disorders the challenge of understanding
health information is magnified. The Teach-Back Method will be explored and adaptations to increase
communicative access to health information will be discussed.
C3c
STROKE AND SEXUALITY
Stephen Holzapfel, MD, CCFP, FCFP
Director, Sexual Medicine Counselling Unit, Women’s College Hospital
Associate Professor, Dept. Family & Community Medicine, University of Toronto
More than half of stroke victims and their partners have sexual concerns following a cerebrovascular
accident. Most wish that counselling were provided for the patient and their partners as a part of the
rehabilitation process. Fear of causing another stroke is the commonest factor contributing to decreased
sexual frequency post-stroke. Stroke can affect sexuality through physical, psychological, and relationship
impairments. Most health-care providers feel unprepared in dealing with sexuality questions. This session
hopes to increase comfort in professionally dealing directly with your clients’ common sexual concerns
through an interactive discussion with the audience. Please bring questions, and brief case examples for the
group to discuss.
21
14:50 – 15:35
OSGOODE
C3d
USING SOCIAL MEDIA TO ENHANCE KNOWLEDGE
EXCHANGE AND INTERPROFESSIONAL COLLABORATION
ACROSS THE CARE CONTINUUM
14:50 – 15:35
CARMICHAEL/JACKSON
Joanne Fortin, MSc, BHScOT, OT Reg. (Ont.)
Regional Education Coordinator, North&East GTA Stroke Network
A Community of Practice (CoP) is a newer vehicle for knowledge exchange in health care delivery (Barwick,
Peters & Boydell, 2009). A CoP is defined as “a group of people who share a concern, a set of problems,
or a passion about a topic and who deepen their knowledge and expertise in this area by interacting on an
on-going basis” (Wengar et al., 2002, p. 4). The Toronto Stroke Networks (TSNs) have developed a Virtual
Community of Practice (VCoP) as a strategy for knowledge sharing and to realize the benefits of a CoP
across three stroke regions.
This session will serve to introduce its participants to the newly launched TSNs VCoP with a focus on utilizing
the membership and groups directories, resource repository and discussion forums to enhance cross-system
interprofessional collaboration and knowledge exchange. Three stroke healthcare professional practice problems
will be discussed to demonstrate the versatility of the social media technology within the TSNs VCoP.
While there has been controversy over whether face-to-face communication is more effective than virtual
communication (Dickenson, Burgoyne & Pedler, 2010), this session will also discuss cross-system activity
to enhance virtual competency ((Wang & Haggerty, 2009) for a better appreciation of the benefits of this
virtual knowledge translation method. The session will conclude with a live demonstration and invitation to
join the site.
22
concurrent sessions
C3e
A GUIDE FOR WORKING WITH AND UNDERSTANDING
ABORIGINAL PEOPLES: THE PERSPECTIVE OF ONE INDIVIDUAL
Robert Fenton, BA Sociology, BA Indigenous
Learning
Chair, Aboriginal Advisory Committee
Donna Cheung, OTReg(Ont)
Alda Tee, reg. PT
Regional Community and LTC Coordinator, Central East
Stroke Network
Rehab and Community Re-engagment Coordinator, South
East Toronto Stroke Network
Community & Long Term Care Specialist,
2006 Census data indicates that there are over one-million Canadians who self identify themselves as Aboriginal.
In Ontario, Aboriginal Peoples experience the lowest health status of any identifiable population as
evidenced by shorter life expectancy, higher infant mortality, elevated rates of obesity, and greater
prevalence of chronic disease. Research shows that Aboriginal People are twice as likely to die from stroke
when compared with the general Canadian population.
Recently, Health Canada acknowledged that the current health status of Aboriginal Peoples is inextricably
linked to the history of colonization and oppression. Often Aboriginal individuals do not receive health care
in a manner that reflects understanding and respect for their history, culture and beliefs; resulting in noncompliance, mistrust and feelings of fear, disrespect and alienation. In order for decision makers and health
service providers to effectively engage Aboriginal individuals and communities to address these disparities;
an awareness of Aboriginal Culture and History and its impact on health is imperative.
The Stroke Aboriginal Resource Guide provides clinical and educational tools which can assist health service
providers to engage and offer culturally safe and effective stroke-related education and care to Aboriginal
individuals, families and communities. It was developed collaboratively by Aboriginal community partners
and four Ontario Stroke Regions.
This presentation will provide participants with an overview of the Resource Guide, and the perspective of
an Aboriginal partner on why culturally safe education is important to assist health service providers to gain
knowledge, empathy and awareness in offering culturally safe and effective stroke care to Aboriginal individuals.
23
14:50 – 15:35
CASSON
C3f
PLANNING COLLABORATIVELY TO IMPROVE VASCULAR HEALTH
WITHIN PRIMARY CARE IN SOUTHEASTERN ONTARIO
14:50 – 15:35
VARLEY
Adam Steacie, MSc, MD, FCFP
Family Physician
Upper Canada Family Health Team
Brockville, Ontario
Health organizations in Southeastern Ontario decided to integrate their efforts and determine how best to
work in collaboration with primary care to support vascular health locally and regionally. The Southeastern
Health Collaborative includes representation from all regional chronic disease programs, public health
and primary care. Ultimately primary care plays a critical role in ensuring the success of an integrated and
collaborative vascular health strategy. The many different resources, services and programs within primary
care in relation to vascular disease prevention may not be fully understood. An environmental scan and
Think Tanks were led by the Stroke Network of Southeastern Ontario to better understand the nuances
within primary care, to help identify needs from a primary care perspective and to begin to determine
how best to work with primary care to support their efforts. The objectives for this session will be to: 1)
provide an overview of the methods; 2) report on the combined findings from the environmental scan and
the Think Tanks involving many different health care professionals and administrators from different rural
and urban locations; and 3) highlight some opportunities for collaborative action. Despite the variation in
resources, services or programs and the diversity of the community primary care serves, there were some
commonalities identified including needs and opportunities that will facilitate regional planning. Examples
included: 1) enhanced information sharing between primary care organizations; 2) effective utilization of
electronic medical record; 3) integrated vascular health programs within primary care; and 4) strengthening
community partnerships.
24
POSTER ABSTRACTS PREVENTION
THE ASSOCIATION BETWEEN PHYSICAL
ACTIVITY LEVELS AND BLOOD PRESSURE
STROKE SECONDARY PREVENTION
EDUCATION SESSION
AUTHORS Dilani Wijesena and Jian Liu, Brock University, Canada
AUTHOR Tracey Sanford, R/TRO, Community Health Navigator,
Providence Healthcare
BACKGROUND AND PURPOSE Existing research shows the use
of physical activity to reduce high blood pressure, but a few studies
have examined the effects of different levels of physical activity on
blood pressure. Previous research suggested demonstrating a dose
response relationship. The purpose of this study is to estimate the
proportion of adults who have met the current recommendations
of physical activity guidelines and to examine the association
between physical activity levels and blood pressure.
METHODS A total of 3389 (1687 men and 1702 women) adults
aged 18 to 65 years from the National Health and Nutrition
Examination Survey 2007-08 were included. The physical activity
levels (inactive, less, moderate and highly active) were derived
from guidelines by Center for Disease Control and Prevention 2008
using the minutes of moderate and vigorous intensity recreational
activity per day. Multiple and logistic regression models are used.
RESULTS 56.4% of men and 50.4% of women met the
recommended amount of physical activity. In men, compared to
the inactive group, on average the less active group had systolic
blood pressure reduced by 4.40 mmHg (p<0.05) when controlled
for age, ethnic group, smoking and total cholesterol. The odds of
having high blood pressure was 0.224 (CI= 0.068-0.719) in the less
active group compared to inactive group. In women, only systolic
blood pressure showed an inverse relationship in less active group
compared to inactive.
CONCLUSIONS The less active group showed a significant
reduction in high blood pressure in men compared to inactive
group though there were no significant results seen in women.
BACKGROUND A Community Health Navigator at Providence
Healthcare identified that outpatient stroke survivors and their
families have a desire for more education around stroke prevention
and self-management for their recovery. With the help of the
Interprofessional Stroke Clinic team an interactive education
session, was developed in collaboration with our community
partners: South East Toronto Stroke Network (SETSN) and Diabetes
Education Community Network of East Toronto (DECNET)
OBJECTIVES
1. To review information related to TIA/Stroke
2. To create an action plan related to their recovery
3. To learn about physical activity and energy conservation
4. To improve self-management of medications
5. To manage blood glucose (BGs) and make healthy food choices
6. To monitor blood pressure (BP) and manage stress
7. To connect with the community
ACTIVITIES
• Former Stroke Clinic patients share their stories
• SETSN: powerpoint presentation
• DECNET: action planning exercise on goal setting, managing
BGs and healthy eating
• The Interprofessional Team: stations on physical activity,
fatigue, medications, BP, community resources and stress
OUTCOMES
• Over 70 people have completed the program. Evaluations
suggest that participants are pleased with the content and
the program reinforced their learning.
• Participants have signed up for 1:1 education sessions with
DECNET
• Participants are now engaged with community programs: for
example Variety Village
CONCLUSIONS This initiative has been successful in facilitating
community reintegration, enhancing self-management, and
participation in programs such as the Living with Stroke all of which
impact quality of life. There is an interest in adopting this model for
other outpatient clinics at Providence Healthcare.
25
25
ACUTE CARE
CAN WE IMPROVE INTIMACY EDUCATION
IN STROKE PREVENTION CLINICS?
AUTHORS Cathy Bouthillier, RN, BN, MED, MN, Clinical Nurse
Specialist for the North and East GTA Stroke Network; Armi
Armesto, RN, BN, MHS, Clinical Nurse Specialist for the North
and East GTA Stroke Network; Ashley Blackington, OTD, OTR/L,
Occupational Therapist who is currently working at Northeast
Rehabilitation Hospital in Portsmouth New Hampshire; Dr. Marc
Boulos, MD FRCP (c), CSCN (EEG), Clinical Associate in the
Division of Neurology at Sunnybrook Health Sciences Centre.
BACKGROUND In order to ensure comprehensive care is
provided to stroke patients, the topic of intimacy must be
appropriately discussed with patients and their family members in
Canadian stroke prevention clinics. Katz (2005) indicated the need
for nurses to address the topic of sexual health with patients as
this is an opportunity to educate patients in comprehensive holistic
preventative care model.
OBJECTIVE To identify current educational practices in discussing
intimacy with stroke patients and their family members in Canadian
stroke prevention clinics.
METHODS An online survey was developed and sent to nurses
working in stroke prevention clinics across Canada. Questions on the
topic of intimacy included the respondent’s definition of intimacy,
level of comfort with discussing the topic and which practitioner
initiated the topic, and if these questions were asked by nurses in
stroke prevention clinics. Finally, available resources and various
methods of receiving intimacy information were identified.
RESULTS Various meanings of intimacy were provided such as
“an emotional and personal connection with a significant partner”
or “a sexual relationship”. Seventy-two percent of respondents
were either clinical nurse specialists or nurses. When asked if the
topic of intimacy was included in the patient assessment, the
responses were “not directly” or “indirectly implied.” None of the
respondents reported that they were either uncomfortable or very
uncomfortable in discussing intimacy with the stroke patient or
their family member; however, respondents indicated reluctance
in approaching the subject by nurses in stroke prevention clinics.
Resources to support the topic of intimacy were identified. For
example, an educational session on weekends or availability of
online resources for health care professionals.
CONCLUSIONS Responses from this preliminary survey indicate
that the topic of intimacy is rarely explored in the stroke prevention
clinic. Intimacy is an important aspect of health to all stroke
patients regardless of their age. This timely topic requires further
support through education and resources to assist nurses with
discussing this topic with the patient.
IMPLEMENTATION OF THE ORAL HEALTH
ASSESSMENT TOOL (OHAT) IN AN ACUTE
CARE SETTING
AUTHORS Dalia Abromaitis, Jennifer Beal, Kelly Dadurka, Penney
Letsos, Courtney McCallum, Lynda Ryall-Henke, Gina Tomaszewski
BACKGROUND & PURPOSE Poor oral health of hospitalized
patients is associated with an increased risk of hospital-acquired
infections and reduced quality of life.¹ An appropriate oral care
protocol should be used for every patient with stroke.² The
purpose of this study is to implement best practice in oral care for
patients admitted to the Clinical Neurosciences (CNS) program at
University Hospital, London Health Sciences Centre, a Regional
Stroke Centre.
METHODS An interprofessional task team was formed and five
key components of the oral care project were identified:
1. Baseline data obtained through chart and bedside audits,
and distribution of an online survey.
2. Identification of a validated oral care assessment tool. The
Oral Health Assessment Tool (OHAT) was selected.
3. Development of an oral care guideline.
4. Design of staff education.
5. Identification of supports to facilitate implementation into
practice.
RESULTS There was a 30% response rate to the survey. Three
knowledge gaps were identified:
• Uncertainty regarding frequency of oral care provision.
• Incorrect product usage
• Uncertainty regarding frequency of oral health assessment.
The interdisciplinary, oral care guideline was completed which
described equipment, procedure, documentation, and quality
monitoring. Staff education was delivered in June 2012.
CONCLUSIONS Frequency and quality of oral care has improved
on CNS. Staff found the OHAT tool useful for assessing patients’
oral health. Impromptu observations revealed presence of
appropriate oral care tools at the patient’s bedside. Next steps:
incorporate oral care into unit orientation; continue to evaluate the
project; and assess the need for any additional bedside supports
and follow-up education.
¹ Terezakis E, Needleman I, Kumar N, Moles D, Agudo E: The impact of hospitalization
on oral health: a systematic review. Journal of Clinical Periodontology, 2011 Jul; 38(
7): 628-36
STROKE
COLLABORATIVE
2012
STROKE
COLLABORATIVE
2012
2626
POSTER ABSTRACTS
CROSS-CONTINUUM
SUPPORTING SYSTEM CHANGE:
ESTABLISHING A COMMON STANDARD
OF CARE FOR STROKE PATIENTS IN
ACUTE CARE AND REHABILITATION
BEST PRACTICE RECOMMENDATIONS
GUIDES: ENHANCING SYSTEM-WIDE
PERFORMANCE AND OUTCOMES FOR
PERSONS WITH STROKE
AUTHORS Sylvia Quant, PhD, MSc, BScPT Rehab & Community
Re-engagement Coordinator, North & East GTA Stroke
Network, Jocelyne McKellar, MSW, RSW Rehab & Community
Re-engagement Coordinator, Toronto West Stroke Network,
Donna Cheung, BScOT, OT Reg. (Ont.), Rehab & Community
Re-engagement Coordinator, South East Toronto Stroke Network,
Beth Linkewich, MPA, BScOT, OT Reg. (Ont.)Title: Regional
Director, North & East GTA Stroke Network
AUTHORS Nicola Tahair, Donna Cheung, Jocelyne McKellar,
Sylvia Quant, Shelley Sharp, Jacqueline Willems, Krystyna Skrabka,
Gail Avinoam, Joanne Fortin, Beth Linkewich
BACKGROUND AND PURPOSE The Stroke Flow initiative is
a system-wide alignment of stroke services to improve access
to stroke unit care and timely and appropriate rehabilitation. To
support this initiative, the Toronto Stroke Networks met with stroke
nursing leaders (SNLs) to create a standard of stroke care within
the Greater Toronto Area (GTA). The purpose of this study is to
develop common core elements (CCEs) for stroke care that reflect
stroke best practices and emerging system changes; and 2) to
identify priorities for implementation.
METHODS Monthly meetings were held with 43 SNLs from
16 acute and rehabilitation hospitals within the GTA. These
meetings used an appreciative inquiry approach and focused
on: 1) identifying CCEs that could be integrated into existing
care processes (e.g., stroke protocols); 2) validating these CCEs
through consultation with interprofessional stroke teams; 3)
forming consensus on these CCEs; and 4) identifying priorities for
implementation.
RESULTS In collaboration and consultation with SNLs and
interprofessional teams, CCEs were developed for acute care and
rehabilitation. These CCEs reflect best practice recommendations
for stroke care and emerging system changes. Common priorities
related to transitions of care included: team communication,
patient/family education, and the integration of outcome measures
into care processes.
CONCLUSIONS Through collaborative planning, this work
promotes a standardization of stroke care and the integration of
stroke best practices. This work also highlights the importance of
seamless transitions of care across the continuum. Future work will
include thematic analysis to further identify common priorities for
organizational improvement. A committee will also be established
to further the integration and sustainability of this work.
¹ Common core elements for stroke care reflect the Canadian Stroke Strategy’s
Canadian Best Practice Recommendations for Stroke Care (2010) and the Rehab/CCC
Expert Panel Recommendations
27
27
BACKGROUND AND PURPOSE The Toronto Stroke Flow
initiative involves the redesign of patient flow and access to acute
stroke services and timely appropriate rehabilitation. Grounded
in best practice this initiative serves to improve patient outcomes
and system efficiencies. The purpose of this study is to support
this initiative. The Toronto Stroke Networks (TSNs) developed
three best practice recommendations guides (BPRGs) to assist
organizations with prioritizing, implementing, and evaluating
stroke best practices. These guides summarize key best practice
recommendations, outline administrative and clinical processes
required to meet the recommendations, and list evaluative/
monitoring indicators.
METHODS As part of a broader knowledge translation
strategy, the BPRGs were developed based on an extensive
literature review integrating content from: Canadian Best
Practice Recommendations for Stroke Care (2010), Ontario
Stroke Evaluation Report (2012), Consensus Panel on the
Stroke Rehabilitation System (2007) and Stroke Flow initiative
recommendations.
RESULTS BPRGs were developed for acute, inpatient, and
outpatient rehabilitation , and were disseminated to 17 hospitals
in the Toronto area. These guides are being used by healthcare
providers, educators, and administrators to review existing
organizational flow and processes of care, and to support
education and implementation initiatives. Based on stakeholder
feedback, organizations have expressed the utility of the guides
and applicability to current system changes.
CONCLUSIONS The BPRGs are educational and administrative
tools that have been instrumental in building awareness and
supporting the integration of stroke best practices. Through the
use of established monitoring indicators, future opportunities exist
to evaluate and track stepwise implementation of best practices
and organization performance for overall system improvement.
BRIDGING THE GAP: THE TORONTO
STROKE FLOW KNOWLEDGE
TRANSLATION STRATEGY
AUTHORS Joanne Fortin, Regional Program Coordinator;
Krystyna Skrabka, Regional Education Coordinator; Gail Avinoam,
Regional Education Coordinator, Beth Linkewich, Regional
Program Director; Jacqueline Willems, Regional Program Director;
Shelley Sharp, Regional Program Director; Donna Cheung, Rehab
& Community Re-engagement Coordinator, Sylvia Quant, Rehab
& Community Re-engagement Coordinator, Jocelyne McKellar,
Rehab & Community Re-engagement Coordinator
BACKGROUND AND PURPOSE The Toronto Stroke Flow
initiative is a systems transformation facilitating patient flow and
timely access to designated stroke services and rehabilitation.
Grounded in best practices, Stroke Flow serves to improve patient
outcomes and system efficiencies. Using Graham’s Knowledge to
Action Cycle, a plan was developed to identify knowledge gaps
and education needs among stroke healthcare providers within
the Toronto Stroke Networks (TSNs). The purpose of this study is
to develop an Education and Knowledge Translation (KT) plan to
support stroke best practice and interprofessional collaborative
(IPC) competencies for cross system consistency, efficiencies and
improved patient outcomes.
METHODS The process involved a two-part consultation (a
process self-assessment survey followed by a face-to-face meeting)
to identify each organization’s strengths, needs, and priorities.
RESULTS Process assessment surveys indicated that pathways
and policies were in place to support Stroke Flow best practice
recommendations including IPC competencies. Face-to-face
collaborative sessions revealed a gap in consistency of application
of foundational knowledge, processes and IPC competencies that
support Stroke Flow. These results led to the development of a
cross system Education and KT plan. Additionally, a cross-system
KT and implementation committee was developed to serve as a
catalyst for system wide collaboration.
CONCLUSIONS Foundational knowledge, skills training and IPC
competencies required a strategic KT approach for consistency,
sustainability and cross system implementation of best practices.
The Toronto Stroke Flow Education and KT Initiative is iterative in
nature and sustained through collaborative partnerships and team
based processes following evidence based KT interventions and
educational strategies.
ESSENTIAL PROFESSIONAL
CONVERSATIONS FOR SEAMLESS STROKE
CARE: AN INNOVATIVE APPROACH TO
SUCCESSFUL TRANSITIONS (PART OF
THE TRANSITION IMPROVEMENT FOR
CONTINUITY OF CARE INITIATIVE)
AUTHORS Gail Avinoam, MEd, Regional Stroke Education
Coordinator, Toronto West Stroke Network; Sherry Darling, MSc,
SLP, Stroke Outreach, Toronto West Stroke Network; Shelley Sharp,
MSc, BSc PT, Director, Regional Stroke Program, Toronto West
Stroke Network
BACKGROUND AND PURPOSE People with stroke (PWS)
experience fragmented care since multiple health care providers
(HCPs) are needed to support care. Toronto Stroke Networks’
stakeholders identified the time of patient/client transition as
an opportunity to have a significant impact on quality of care
for PWS. This is consistent with Canadian Stroke Best Practice
Recommendations (2010).
Verbal exchange is key to successful patient/client transition,
enabling: exchange of unique information about the PWS;
clarification of written information; HCPs familiarity with each other’s
practice environments; and relationship development between
HCPs, fostering collaboration. This study investigates the use of
EPCs to enable and enhance conversations between HCPs at times
of transition. Essential Professional Conversations (EPCs) is a learning
initiative for HCPs, designed to foster learning and meaningful
collaboration across the system to know each other’s work in ways
that enable delivery of seamless, optimistic care for PWS.
METHODS A multi-organization project team representing HCPs
from across the continuum, with expert consultation, used an
appreciative inquiry approach to gain insight into HCPs needs
and hopes regarding conversations between HCPs at times of
transition. Information gathered was used to design an education
program and implementation guide.
EXPECTED IMPACT Short term evaluation: increased number
of conversations between HCPs and enhanced relational strength.
Long term: greater efficiency/effectiveness of care, increased
interorganizational collaboration, ability to provide more
individualized, hopeful care, and increased comfort at the next
stage of the care journey for the PWS.
CONCLUSIONS HCPs see a need for conversations. Support to
adapt EPCs at the local level will ensure success.
References:
Tregunno, D. (2009) Transferring Clients Safely: Know Your Client and Know Your
Team. College of Nurses of Ontario Transfer of Accountability Knowledge Translation
Project Report in partnership with the Ontario College of Pharmacists and College of
Physicians and Surgeons
STROKE
COLLABORATIVE
2012
STROKE
COLLABORATIVE
2012
2828
POSTER ABSTRACTS
CROSS-CONTINUUM
THE STROKE PASSPORT: A PATIENT
ENGAGEMENT AND NAVIGATION TOOL
AUTHORS Shelley Sharp, MSc, BSc PT, Sylvia Chan,
BSc PT; Jennifer Elliott, BSc PT; Denyse Richardson, MD;
Catherine Creede, PhD
BACKGROUND AND PURPOSE Transition experiences
following stroke are fragmented, inadequately informed and
stressful. Persons with stroke and caregivers’ desire meaningful
care, system navigation support, and improved relations with
healthcare providers. Healthcare providers desire a timely and
complete portrait of the patient’s experience. Research identifies
that timely and accurate written communication and verbal
interactions are required for successful collaboration and safe,
quality care. Patient-mediated interventions are useful in engaging
patients to implement effective informed self-care. The purpose
of this study is to create a patient-mediated communication and
navigation tool to enable the experience of seamlessness, facilitate
meaningful care and encourage enhanced collaboration and selfmanagement for the person with stroke/caregivers.
METHODS A project team representing 12 organizations (acute,
rehabilitation, community) was created. A broad consultative,
iterative development process over seven months was undertaken,
including two focus groups with people with stroke and caregivers.
Appreciative Inquiry (AI) methodology and design constructs of
relational strength, hopeful care, self–management and navigation
anchored the content and layout development.
RESULTS Over 50 contributors designed an innovative Stroke
Passport containing two user-friendly core sections: a transferable/
adaptable communication component to characterize the person,
track goals and map their healthcare experience; a removable
self-contained resource guide to support knowledge development
and system navigation in 15 areas of community re-engagement.
Twelve pilot sites are evaluating the Stroke Passport to assess its
reach and impact.
CONCLUSIONS Eagerness to embrace the concept of the
Passport reinforces the need for resources to enable greater
collaboration and engagement in care. The generative (AI)
approach anchored in a person-centered care conceptual
framework during development makes the Passport unique.
AN INNOVATIVE APPROACH TO
OBJECTIVELY MAPPING THE STROKE
PATIENTS JOURNEY FROM HOSPITAL TO
HOME USING THE INTEGRATED DECISION
SUPPORT TOOL
AUTHORS Young K, Gould L, Wisniewski E, Banko T,
Gdyczynski A, Ansley B, MacRae L
BACKGROUND AND PURPOSE Stroke clinicians work to ensure
optimal transitions from hospital to home; however it is difficult
to identify the patient’s journey cross continuum. Health Care
organizations measure care but do not capture subsequent patient
transitions. With the Integrated Decision Support Tool (IDS) in the
Hamilton Niagara Haldimand Brant (HNHB) LHIN, de -identified
information from participating institutions are linked enabling
facilities to examine patient flow. The purpose of this study is to
create a visual representation of the current state of a patient’s
journey using objective information in the IDS to identify key
transition point and gaps.
METHODS Starting with a first encounter for Stroke, subsequent
interactions are mapped to visualize care. Key transitions and
interactions include: Emergency room visits, Medical and Surgical
Day care, Acute and Rehab admissions and length of stay,
Community Care Access Centre admissions and length of service,
and hospital readmissions.
RESULTS A series of case studies completed to create a visual
representation of the current state of a patient’s journey using the IDS.
IMPLICATIONS
1. Inform IDS participants and advocate for the inclusion of
community support systems.
2. Explore models of care coordination, i.e. Community Stroke
Navigator, to assist with health care transitions.
3. Identify and engage organizations that deliver stroke care.
4. Utilize information to apply Provincial cost analysis methods.
5. Develop future state care map incorporating Best Practices
and Provincial cost analysis methods.
6. Map the patient’s journey with readmissions to inform
systems change.
7. Support and develop cost effective programs and systems
to support community transitions during the stroke survivor’s
recovery journey.
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COMMUNITY AND LONG-TERM CARE
ENSURING SEAMLESS STROKE PATIENT
FLOW TO RECOVERY
AUTHOR Stefan Pagliuso, MPT, BAKin (Hon), Stroke Navigator
INTRODUCTION/BACKGROUND Stroke best practices
indicate that stroke patients achieve their optimal outcomes
when they access acute stroke units and early rehabilitation. The
new Integrated Stroke Model was developed to ensure all stroke
patients have access to stroke unit care and seamless access
to early rehabilitation. In order to achieve this, communication
within and between each team must be exceptional. To this
end, Hamilton Health Sciences (HHS) has introduced the Stroke
Navigator position. The Navigator facilitates expedient and
efficient assessment of acute stroke patients, recommends the
level of care required for each patient to achieve their maximal
outcome and facilitate communication across transition points of
care. By maximizing these points of communication the model
has achieved a seamless flow of information from acute to rehab
therefore eliminating the need for a formal rehabilitation referral.
Conversely, the Navigator facilitates re-entry to acute care should
complications arise.
OBJECTIVES
• Demonstrate a model of stroke care that emphasizes
communication within and between teams
• Explain the role of the Stroke Navigator and demonstrate its
effectiveness
• Demonstrate improvements in key indicators
METHODS The Navigator facilitates communication by:
• Leading daily bullet rounds
• Liaising with Physicians on acute and rehabilitation wards
• Facilitating admissions from external facilities
RESULTS/CONCLUSION/IMPLICATIONS Communication is
an essential aspect of the new Integrated Stroke Model of Care
at Hamilton Health Sciences. This flow of information is facilitated
by the role of the Stroke Navigator and has created a model of
care that allows for patients to safely, appropriately an seamlessly
transition in their stroke recovery journey.
REHABILITATION AND COMMUNITY
INTEGRATION FOR STROKE SURVIVORS:
THE ROLE OF PERSONAL SUPPORT
WORKERS IN PROVIDING BEST PRACTICES
AUTHORS Justine Toscan, Research Associate; Paul Holyoke,
Director, Research and Program Development, Wendy Gifford,
Assistant Professor, University of Ottawa, Associate Researcher
Saint Elizabeth; Danielle Bender, Research Associate, Sandra
Tudge, Research Associate, Vivienne Epstein, Professor Practice
Leader, Speech-Language Pathology; Judy Provencher,
Physiotherapy Professional Practice Leader; Bonnie Jean
Stegemann, Personal Support Worker; Melissa Aldoroty,
Occupational Therapy; Susan Donison, Personal Support
Supervisor; Jody Hales, Manager, Client Safety & Clinical Support
BACKGROUND & PURPOSE The 2010 Canadian Stroke Strategy
Best Practice Recommendations (CSS-BPRs) include a new section
on transitions of care with recommendations for community
integration. In Ontario, the majority of homecare provided to
stroke survivors after hospital discharge is from unregulated
Personal Support Workers (PSWs). However, little is known on the
provision of best practices by PSWs, or the extent PSWs contribute
to rehabilitation and community reintegration. The purpose of
this research is to describe how PSW practice could support best
practices in rehabilitation and community reintegration for stroke
survivors as described in CSS-BPRs.
METHODS Focus groups (n=4) were held with an interprofessional
team consisting of PSW, PSW supervisor, speech-language
pathologist, physiotherapist, occupational therapist and researchers.
PSW practices and opportunities for PSWs to apply CSS-BPRs
were identified and mapped onto relevant CSS-BPRs. A matrix was
developed for 13 areas of PSW stroke care related to rehabilitation
and reintegration and is now out for stakeholder consultation.
RESULTS PSW practices are broad, ranging from identifying client
difficulties with swallowing, monitoring risk for falls, to identifying
the need for increased involvement of rehabilitation professionals.
While many opportunities exist for PSWs to provide best practices,
system and organizational challenges exist that include: ambiguity
with PSWs’ scope of practice and accountability, health system
rules and regulations, and lack of health professionals’ knowledge
of PSW roles.
CONCLUSIONS Potential opportunities exist for PSWs to support
CSS-BPRs and integrate more with multidisciplinary health care
teams to ensure stroke survivors receive evidence-informed care in
the community.
STROKE
COLLABORATIVE
2012
STROKE
COLLABORATIVE
2012
3030
POSTER ABSTRACTS
CARDIORESPIRATORY RESPONSES
DURING THE SIX-MINUTE WALK
AND RAMP CYCLE ERGOMETRY TESTS
AND THEIR RELATIONSHIP TO PHYSICAL
ACTIVITY IN STROKE
AUTHORS Nancy M. Salbach (PhD), Assistant Professor,
Department of Physical Therapy, University of Toronto, Dina Brooks
(PhD), Professor, Department of Physical Therapy, University of
Toronto, Julia Romano (MSc), Research Coordinator, Department
of Respiratory Medicine, West Park Healthcare Centre, Toronto,
Lynda Woon (BSc), Physiotherapist, West Park Healthcare
Centre, Toronto,Thomas E. Dolmage (MSc), Special Procedures
Technologist/Scientist , Departments of Respiratory Diagnostic
& Evaluation Services and Respiratory Medicine, West Park
Healthcare Centre, Toronto.
BACKGROUND & PURPOSE The six-minute walk test (6MWT)
is used to measure exercise capacity after stroke. We sought to
compare cardiorespiratory responses to the 6MWT with responses
to a ramp cycle ergometry test (CET) in community-dwelling
individuals with stroke. A secondary objective was to determine
the relationship between cardiorespiratory responses to each test
and daily physical activity.
SYSTEMIC CAUSES OF FALLS IN STROKE
SURVIVORS THROUGH THE CONTINUUM
OF CARE
AUTHORS Mona Madady , Western University, London, Ontario,
Aleksandra Zecevic, Western University, London, Ontario, Alan
Salmoni, Western University, London, Ontario, Bryan Young,
Western University, London, Ontario and London Health Sciences
Centre, London, Ontario, Eileen Britt , St. Joseph’s Health Care,
London, Ontario
BACKGROUND & PURPOSE According to WHO, 15 million
people worldwide and almost a million North Americans suffer a
stroke every year. While information about the incidence and risk
factors of falling among stroke survivors is available, considerably
less is known about the actual causes of falls and the circumstances
surrounding these adverse events. The purpose of this project
was to identify systemic causes of falls in stroke survivors as
they transition from acute care to rehabilitation hospital, and to
community or long-term care.
METHODS Nineteen participants (17 male), a mean±standard
deviation of 2.1±1.0 years after stroke, aged 70.2±10.3 years,
completed three evaluation sessions. One CET and two 6MWTs
were completed in sessions separated by ≥72 hours. Participants
wore a portable gas analysis unit (Cosmed™ K4b2) which also
measured heart rate during the 6MWT. A uniaxial accelerometer
(activPAL), attached to the participant’s thigh, was used to estimate
daily physical activity over five days.
METHODS A total of 30 stroke survivors were followed-up for
six months post stroke. Their first fall at each stage of the care
continuum was investigated using Systemic Falls Investigative
Method (SFIM). Comprehensive data were collected through
multiple interviews, document reviews, environmental scans,
re-creation of events and was entered into the SFIM Database.
The database produced falls reports that contained information
about the faller, the fall, a descriptive summary of the occurrence,
chronological sequence of events, a summary table of acts/decisions
and contributing factors, and conclusions. The guiding framework in
data reduction and analysis was the Swiss Cheese Model of Accident
Causation. Summary tables from all falls reports were organized
using NVIVO and coded to identify dominant themes.
RESULTS Compared with the 6MWT, the CET elicited a higher
(p=0.034), (p=0.006), heart rate (p=0.029), and self-reported
perceived breathing (p<0.0001) and leg heaviness (p<0.0001) at
test completion. Except for the first minute, during the 6MWT was
80-85% of from the CET. Average steps per day was associated
with distance walked during the 6MWT (r=0.561, p=0.019) but not
from CET (r=0.133, p=0.638).
RESULTS/CONCLUSIONS Results indicate that person-related
factors combine with behavioural, situational and broader
organizational and healthcare system influences as contributors to
falls. When considering falls prevention programs in post-stroke
rehabilitation and community re-integration, it is important to
address stroke-specific causes, but also challenge system-wide
contributors that affect stroke survivor’s safety.
CONCLUSIONS Although the 6MWT elicited a lower than a CET,
the intensity of exercise achieved during the 6MWT was sufficiently
high for aerobic training assuming CET accurately reflects
cardiopulmonary capacity. Moreover, 6MWT distance related to
physical activity. Findings have important implications for using
6MWT results to prescribe exercise post-stroke.
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31
URINARY CONTINENCE: MAXIMIZING THE
STROKE SURVIVOR’S TRANSITION HOME
CURRENT STATE OF COMMUNITY STROKE
RESOURCES IN ONTARIO
AUTHORS Kate Pettapiece RN BScN MN GNC (C), Advanced
Practice Nurse – Complex Medical Services, Ashley Martins RN
MN, Nurse Educator, Foroozan Zayani RN MN Nurse Educator,
Michelle Marki RPN, Staff Nurse, Bridgepoint Hospital, Toronto
AUTHORS Mark Bayley, MD, FRCPC, Medical Director Neuro
Rehabilitation Program Evaluation Champion and Member
Provincial Coordinating Council, Toronto Rehabilitation Institute and
University of Toronto, Aura Kagan, PhD, Executive Director, Director
of Education and Applied Research, Aphasia Institute – The Pat
Arato Aphasia Centre, Jill Cameron, PhD, Ministry of Health and
Long-term Care Career Scientist, Assistant Professor, Department
of Occupational Science and Occupational Therapy, Graduate
Department of Rehabilitation Science,University of Toronto, Nancy
Salbach, PT, PhD, Assistant Professor; Heart and Stroke Foundation
of Ontario Career Scientist Dept. of Physical Therapy, University of
Toronto, Maria Huigbregts, PT, PhD, Director, Quality, Risk, & Patient
Safety, Lecturer, Baycrest Centre for Geriatric Care; University of
Toronto, Robert Teasell, MD FRCPC, Professor & Chair-Chief; Medical
Director, Stroke Rehabilitation Program; Clinical Researcher Parkwood
Hospital, SJHC Health Care London, Lawson Health Research Institute
Aging, Rehabilitation and Geriatric Care Program, Olga Yaroslavtseva,
HBSc, Research Associate, Toronto Rehabilitation Institute, Anja
Kovacevic, HBSc, Research Assistant,Toronto Rehabilitation Institute
BACKGROUND & PURPOSE Urinary incontinence in the stroke
survivor population can have psychosocial impacts on their
transitions to recovery post stroke, which include but are not
limited to: social embarrassment, low self-esteem, depression,
and social engagement. (Pellat, G., 2012). Furthermore, urinary
incontinence is a statistically significant indicator of poor outcomes
including disability, skin breakdown, falls, and admission to
institutional care (Jordan, et al., 2010). Urinary incontinence is often
poorly identified and managed throughout the stroke continuum
with nurses relying on strategies to contain incontinence, rather
than best practices to promote continence. Nurses have a key
role in patients’ urinary continence assessment and developing an
individualized continence plan. (Pellat, G., 2012). The continence
assessment and management tool was created to promote: best
practices in urinary continence management, patient satisfaction,
knowledge for nurses, accurate reflection of patient care needs/
complexity and discharge planning.
METHODS After a comprehensive review of the literature, a
sub group of nurses including advanced practice nurses, nurse
information management specialists and staff nurses developed
an electronic urinary continence intervention in Bridgepoint’s
electronic patient care record. The intervention was reviewed,
revised and approved by the Nursing Advisory Council.
Techniques for communication and knowledge translation of this
comprehensive assessment tool included poster dissemination,
screener video, unit in-services, and corporate practice alerts/
communications.
RESULTS Outcomes included: standardized assessment and
intervention based on best practice, practice change, patient
satisfaction, use of best practice, capturing complexity of care in
MDS coding.
CONCLUSIONS The tool has implications in promoting patient’s
independence, return to home, continence and quality of life,
maximizing nursing knowledge and autonomy.
References
1. Pellat, G., (2012). Non-containment management options of urinary continence.
Nursing and Residential Care, 14(2), 68-73
2. Jordan, L., Mackey, E., Coughlan, K., Wyer, M., Allnutt, N., & Middelton, S. (2010).
Continence management in acute stroke: a survey of current practices in Australia.
Journal of Advanced Nursing, 67(1), 94-104.
BACKGROUND & PURPOSE Persons with stroke live on average
seven years after a stroke. These individuals have chronic health
issues that could be ameliorated if they participate in community
activities. Yet, community based resources for persons with stroke
are limited. The objective of this project is to evaluate the extent to
which currently available community stroke support programs follow
evidence-based practices and are accessible to the residences of
stroke survivors and identify barriers to best practice implementation.
METHODS Program visibility was evaluated by assessing
the programs marketing strategies, a survey of their outreach
efforts, the referral process and recruitment materials. Program
accessibility was evaluated by looking at the infrastructure
necessary to enable people to attend the program. A Likert
scale was used to rate the barriers to participation. Adherence to
evidence based best practices was assessed during the course
of the interview. Maps of stroke incidence and prevalence were
created using data collected by ICES.
RESULTS The project identified the neighbourhoods within
each of the municipalities that have the highest prevalence of
stroke survivors and examined the extent to which existing stroke
resources are located in areas of highest stroke survivor prevalence.
The project evaluated the visibility and accessibility of available
community stroke resources and identified factors facilitating
and impeding the implementation of best practices. The project
assessed internal and external barriers to participation as well as
successful strategies enabling stroke survivors and their caregivers
to access the available resources.
CONCLUSIONS The data suggest that many of the existing
community programs have limited resources and do not always
follow the evidence that exists for supporting individuals in the
community. The program location does not always coincide
with the areas of highest incidence and prevalence of stroke.
Recommendations were made for improving the accessibility
of the existing stroke community resources and best practice
implementations.
STROKE
COLLABORATIVE
2012
STROKE
COLLABORATIVE
2012
3232
POSTER ABSTRACTS
APHASIA COMMUNICATION GROUP:
ENABLING SUCCESSFUL TRANSITION
TO COMMUNITY. ST. PETER’S HOSPITAL,
HAMILTON HEALTH SCIENCE
WHAT’S IT GOING TO TAKE TO IMPLEMENT
CAREGIVER EDUCATION AND SUPPORT
PROGRAMS IN ONTARIO: A KEY
INFORMANT STUDY
AUTHORS Tracy Carnegie, MHSc, SLP(C); Shannon Stanners,
MClSc, SLP(C)
AUTHORS Victrine Tseung, MScOT, PhD Candidate, Susan Jaglal,
PhD, Nancy Salbach, PhD, and Jill Cameron, PhD.
BACKGROUND & PURPOSE The SLP outpatient team felt
there was a need for “bridging the gap” between clinical therapy
sessions and functional communication in a social setting. SLPs
were concerned that some patients were tending to withdraw from
social interaction. We felt that offering a communication group
comprised of individuals with aphasia would enable effective
carry-over of treatment gains, while enhancing quality of life for the
participants through social engagement with peers. The purpose of
the study was to provide patients with an opportunity to maintain
communication abilities and strategies obtained during inpatient/
outpatient individual S-LP intervention, provide patients with an
opportunity to interact with peers, utilize Supported Conversation
for Adults With Aphasia™ techniques.
BACKGROUND & PURPOSE Family caregivers play a crucial role
in the ongoing care of stroke survivors. Their unpaid labour saves
the Canadian health care system over 25 billion dollars annually.
There is evidence that caregiver education and support programs
are beneficial but these programs are not being implemented by
the health care system. Understanding the implementation of these
programs will ensure caregivers are supported in this important
role. The purpose of this study is to identify the factors that
influence the systematic implementation of caregiver education
and support programs into the Ontario Stroke System (OSS).
METHODS Bi-weekly, hour-long sessions with up to seven patients
from St. Peter’s Hospital inpatient and/or outpatient programs. The
group is facilitated by a SLP, with or without assistance from a CDA,
student, or volunteer. Supported Conversation™ techniques are an
integral part of all sessions.
Activities focus on enhancing overall, functional communication,
and are intended to enable active participation by all group
members. Some examples are: personhood profiles, discussion of
current events, modified games, and opinion polls.
RESULTS Informal observations, attendance records, and group
member feedback strongly support the benefit of the group to all
participants. Participants will be completing an Aphasia-friendly
Satisfaction Survey, with support from a neutral SLP volunteer
familiar with Supported Conversation™ techniques in August 2012
CONCLUSIONS Based on our positive results with our Aphasia
Communication Group, we strongly encourage other facilities to
adopt a similar model of therapy. Despite our limited resources, we
are proud to “bridge the gap” between the clinical smetting and
social engagement in a community setting.
33
33
METHODS This study employs a qualitative case study design
using the OSS as the research case, as it represents a preeminent model of stroke care in Canada. Qualitative interviews
were conducted with a purposive sample of 10 key informants
affiliated with the Ontario Stroke System and Network, Ontario’s
Ministry of Health, Ontario’s Local Health Integration Networks
and Community Care Access Centres. Participants were
asked to discuss the factors that influence caregiver program
implementation.
RESULTS Four themes were identified: 1) it is important to
demonstrate the need for caregiver support programs; 2) programs
considered for implementation must have a strong evidence base;
3) caregiver education and support should be incorporated into
standard practice; and 4) key stakeholders should be involved in
the implementation process.
CONCLUSIONS This study clarifies the factors that affect
caregiver program implementation. The topics identified in this
study will be explored further in the next phase of data collection
involving broader representation from the OSS.
A SYSTEMATIC REVIEW OF THE
EFFECTIVENESS OF PHARMACOLOGICAL
INTERVENTIONS IN THE TREATMENT OF
SPASTICITY OF THE HEMIPARETIC LOWER
EXTREMITY MORE THAN SIX MONTHS
POST STROKE
AUTHORS Amanda McIntyre, MSc¹, Taeweon Lee BMSc¹,
Shannon Janzen, MSc¹, Swati Mehta, MA¹, Robert Teasell, MD¹,²
BACKGROUND & PURPOSE The long-term treatment of
lower limb spasticity after stroke is an important aspect for an
individual’s physical recovery, safety, comfort and quality of life.
The objective of this study was to review the available evidence
on the effectiveness of pharmacological interventions in reducing
spasticity of the lower limb among chronic stroke survivors.
METHODS A literature search of multiple databases (Pubmed,
CINAHL, EMBASE) was conducted. Studies were included for
review if: 1) ≥50% sample size had sustained a stroke; 2) the
research design was a randomized control trial (RCT); 3) the mean
time since stroke was ≥6 months; 4) the treatment group received
a pharmacological intervention aimed at treating lower limb
spasticity; and 6) spasticity was assessed pre-treatment and posttreatment. Methodological quality was assessed using the PEDro
tool with a maximum score out of ten.
RESULTS Ten RCTs (PEDro scores 4-9) met inclusion criteria and
included a pooled sample size of 665 individuals with a mean
age of 58.2 years (range 14-86). Four RCTs provided evidence
that Botulinum toxin type A was effective in reducing spasticity
compared to those receiving placebo or phenol nerve block. Two
studies provided evidence on the effectiveness of three nerve
blocks (i.e., alcohol, phenol, thermocoagulation) in reducing
spasticity compared to placebo. Finally, four studies provided
evidence on the effectiveness of oral and intrathecal medications
(i.e., tizanidine, baclofen and tolperisone) in reducing treating
lower limb spasticity compared to those receiving placebo.
CONCLUSIONS Pharmacological treatments initiated ≥6 months
post stroke may help reduce lower limb spasticity, however,
evidence is limited.
BOTOX IN TREATMENT OF FOCAL
SPASTICITY AMONG GERIATRIC STROKE
SURVIVORS
AUTHORS Janusz A. Kaleta RN, BScN (Hons), CPTA, Nurse
Manager & Stroke Program Coordinator, Katalin Beck RPT, MCA,
Physiotherapy, Stroke & Aphasia Program Lead
BACKGROUND & PURPOSE To evaluate the effectiveness
of BOTOX (Botulinum Toxin Type A) in the treatment of focal
spasticity among geriatric stroke survivors residing in Long Term
Care Homes. Spasticity is a common challenge encountered
post stroke by survivors, families as well as therapists, nurses and
other health care professionals involved in treatment and care of
Stroke Survivors. Dependent on the severity spasticity can lead to
serious debilitating conditions such as pain, stiffness, rigidity and
inability to participate in essential activities of daily living as well
as in therapy. Spasticity as well as muscular overactivity frequently
have profound impact on lives of Stroke Survivors. Although
conventional Physical Medicine and Rehabilitation offers some
interventions for spasticity management there is a continuous
search to combat spasticity more effectively and to allow for
greater recovery and independence of Stroke Survivors. Geriatric
Stroke Survivors are often confronted with greater difficulties
post stroke including risk for severe spasticity and therefore need
proper approach geared towards this population.
METHODS Spasticity program combining evidence based practice
and use of BOTOX was developed in Long Term Care Home.
The 4-point Disability Assessment Scale (DAS; 0, no disability;
1, mild disability; 2, moderate disability; and 3, severe disability)
was used to assess four domains (hygiene, dressing, pain, and
limb position). Twelve Geriatric Stroke Survivors and one client
with Cerebral Palsy were assessed by Physiatrist. Clients, families
and interdisciplinary team were involved in active collaboration.
Based on comprehensive assessment five Stroke Survivors received
BOTOX injections in addition to conventional physiotherapy. All
clients were also encouraged to participation in offered activation
therapy that combines movement, self expression and discussions.
RESULTS The Spasticity Program combining conventional
rehabilitation practices and use of BOTOX demonstrated marked
improvements in function, ROM, decrease in pain, rigidity,
improved comfort / limb positioning, ability to participate in
Physiotherapy and basic activities of daily living.
¹Lawson Health Research Institute, St. Joseph’s Parkwood Hospital, London, ON
²Department of Physical Medicine and Rehabilitation, University of Western Ontario,
London, ON
STROKE
COLLABORATIVE
2012
STROKE
COLLABORATIVE
2012
3434
POSTER ABSTRACTS
A REVIEW OF THE EVIDENCE OF
THERAPEUTIC INTERVENTIONS FOR
COGNITIVE DISORDER INITIATED MORE
THAN SIX MONTHS POST STROKE
THERAPEUTIC INTERVENTIONS FOR
APHASIA INITIATED MORE THAN SIX
MONTHS POST STROKE: A REVIEW OF THE
EVIDENCE
AUTHORS Laura Allen, Liane Lobo, Robert Teasell,
Katherine Salter
AUTHORS Laura Allen, Liane Lobo, Robert Teasell,
Katherine Salter
BACKGROUND & PURPOSE The long-term management of
stroke has recently become an area of great interest. The purpose
of this study is to review the current evidence surrounding
therapeutic interventions for cognitive disorders that have been
initiated more than six months post stroke.
BACKGROUND & PURPOSE Aphasia affects up to 38% of
acute stroke patients. For many of these individuals, this condition
persists far beyond this acute phase. The purpose of this study
is to complete a review of the evidence of the effectiveness of
therapeutic interventions for aphasia which have been initiated
more than six months post stroke.
METHODS A literature search was conducted in which all
randomized control trials citing an intervention initiated six months
or more post stroke were included. Databases searched included
CINAHL, Scopus, EMBASE and Medline.
RESULTS A total of 28 studies, including 21 RCT’s, were
examined. It was found that there is evidence to suggest that the
use of Memantine and compensatory strategies may be beneficial
in the treatment of vascular dementia and memory deficits.
There is also evidence to support the use of electroacupuncture,
transcranial direct current stimulation, daily aspirin therapy,
Nimodipine, and Donepezil in the treatment of vascular dementia,
memory, and cognitive decline. Additionally, computerized
training programs have been found to be moderately effective
in the treatment of memory deficits. Conversely, the use of
exercise programs, repetitive transcranial magnetic stimulation
and citicoline may have no significant effect on treating post
stroke cognitive disorders. Finally, there is conflicting evidence
surrounding the use of anti-hypertensive therapies for the
prevention of vascular dementia and cognitive decline more than
six months post stroke.
CONCLUSIONS There is evidence to support the use of several
treatments for cognitive disorders post stroke; however, more
research is needed to more fully support the use of many of these
interventions.
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METHODS A literature search was conducted for articles in which
aphasia treatments were initiated more than six months post
stroke. Searches were conducted in multiple databases including
PubMed, Medline, and EMBASE.
RESULTS A total of 68 studies, including 22 RCT’s, met the
inclusion criteria. It was found that there is good evidence to
suggest that the use of computer based treatments, constraint
induced therapy, intensity of therapy, group language therapies,
training conversation/ communication partners, community based
aphasia programs, and caregiver/ patient education programs are
effective treatments for chronic aphasia. Repetitive transcranial
magnetic stimulation, transcranial direct current stimulation, and
the use of the drugs Piracetam, Donepezil, Memantime and
Galantamine have also been found to be effective treatments of
aphasia six months or more post stroke onset. Filmed language
instruction and the drug bromocriptine have both been shown to
be ineffective in treating chronic aphasia.
CONCLUSIONS There is much evidence to support the use of
a number of treatments for chronic aphasia post stroke. Further
research is required to more fully support the use of these
interventions, and to explore the potential effectiveness of other
aphasia interventions, in the chronic stage.
THE INTEGRATION OF STROKE BEST
PRACTICE INTO LTC RESIDENT CARE
PLANNING
AUTHORS Gwen Brown, Community & Long Term Care Stroke
Coordinator, Stroke Network of Southeastern Ontario, Sharon
Trottman, Community & Long Term Care Stroke Coordinator, West
GTA Stroke Network, Alda Tee, Community & Long Term Care
Stroke Coordinator, Central East Stroke Network
BACKGROUND & PURPOSE 22% of residents in Long Term
Care (LTC) age 65 or older have had a stroke and stroke is the
third most common diagnosis in LTC. The Regional Community
and Long Term Care Coordinators of the Ontario Stroke Network
(OSN) collaborate with LTC stakeholders to increase awareness and
facilitate the uptake of best practice stroke care. The objective of
this initiative is to integrate the stroke best practice resource, Tips
and Tools for Everyday Living, into resident care plan libraries by
creating Stroke Care Plans that link with RAI-MDS data elements
and Resident Assessment Protocols.
METHODS The Stroke Care Plans were created by professionals
from the OSN and LTC sector using a generic format familiar to
LTC Homes and reviewed by a MOHLTC Compliance Director
to ensure compliance with accreditation and other standards.
Developed from Tips and Tools modules, the care plans integrate
RAI-MDS scores/scales into the goal statements linking a best
practice resource with an embedded assessment tool. The care
plans are being piloted in five Ontario LTC Homes. Pilot phase will
be evaluated using the three domains of awareness, accessibility
and effectiveness through pre and post pilot surveys.
RESULTS The evaluation of pilot expected to be completed
by end of August 2012. It is anticipated that results will show an
enhanced awareness and increased uptake of best practice stroke
care in LTC. It is hoped that future measurable outcomes using
RAI-MDS data may also show augmented improvement in resident
function.
CONCLUSIONS Pre-pilot assumption: Improved resident-focused
stroke care through embedded best practice strategies.
FIT FOR FUNCTION A COLLABORATIVE
PARTNERSHIP: A PILOT STUDY TO
EVALUATE A SELF-MANAGEMENT
AND PHYSICAL ACTIVITY PROGRAM
FOR PERSONS POST STROKE IN THE
COMMUNITY
AUTHORS Fleck, R., Richardson, J., Hladysh, G., McBay, C.,
McKay, E, Thorlakson, R., Sinclair, S., LeBlanc, K.
BACKGROUND & PURPOSE Currently 300,000 people are living
with stroke in Canada. While the majority of stroke survivors return
to their homes after stroke, this period is consistently reported to
be stressful and challenging. LiveWell is an innovative partnership
between the YMCA of Hamilton/Burlington/Brantford, Hamilton
Health Sciences and McMaster University. This partnership is
founded on a framework of population health, to promote wellness
through access to community based programs. The purpose of
this study is to assess the feasibility of a community partnership
between three institutions (health (HHS), community (YMCA)
and academic (McMaster University)) to deliver a community
based wellness program for persons with stroke, (2) To evaluate
the community based wellness program for persons with stroke
to improve their physical functioning, community reintegration,
patient activation and quality of life, (3) To increase the capacity
of a community institution (YMCA) to deliver a community stroke
wellness program.
METHODS A single blinded randomized controlled trial was
used to evaluate the 12 week intervention comprised of group
and individual exercise programs and the Living with Stroke selfmanagement education program.
RESULTS 60 participants were recruited. Preliminary analysis at
12 weeks post intervention (n=40) shows significant improvement
in favour of the intervention group in: Physical Activity (RAPA1:
p=0.003); Community Re-integration (RNLI: p=0.03); Walking
(2MWT: p=0.05;SPPB Walk Subscale: p=0.03); and Right Grip
Strength (p=0.05). Full study analysis will be completed by
September 2012.
CONCLUSIONS Preliminary results indicate favorable outcomes,
demonstrating that this program can be a resource for people at
different stages of stroke recovery.
STROKE
COLLABORATIVE
2012
STROKE
COLLABORATIVE
2012
3636
POSTER ABSTRACTS
A PILOT EVALUATION OF THE FAMILY
INFORMAL CAREGIVER STROKE SELF
MANAGEMENT (FICSS) PROGRAM: IMPACT
ON THE CAREGIVER PSYCHOSOCIAL,
EMOTIONAL AND HEALTH NEEDS
AUTHORS Gail Mores, Director of National and Provincial
Programs – March of Dimes Canada, Rhonda Whiteman, Stroke
Best Practice Clinical Nurse Specialist, Hamilton Health Sciences,
Dr. Jenny Ploeg, McMaster University, Associate Professor, School
of Nursing, Faculty of Health Sciences, Patricia Knobl, March of
Dimes Canada, Miriam Cahn, Social Worker – Caregiver Services
– VON Canada, Hamilton Site, Anne Lindley, Manager Adult Day
Centre and Caregiver Services – VON Canada, Hamilton Site
BACKGROUND & PURPOSE Due to the abrupt onset of a
stroke, caregivers are often unprepared for the role, have extensive
needs and are at risk for negative outcomes. Interventions
facilitating development of coping and problem solving skills are
shown to decrease the negative effects of caregiving. The Family
Informal Caregiver Stroke Self Management (FICSS) Program
was developed to address these unmet needs. The purpose of
this study is to evaluate the impact of the FICSS Program on the
psychosocial, emotional and health needs of caregivers of stroke
survivors using pre-post mixed methods design.
METHODS FICSS is a four module series of facilitated small
group discussions. Topics include: sharing experiences, community
resources, communication, managing behaviour changes, stress
management, changing roles, dealing with emotions and caregiver
advocacy skills. Qualitative and quantitative measures at baseline,
two weeks and six months post intervention evaluated program
impacts.
RESULTS Caregivers identified increased social support, coping
strategies, resource knowledge, quality of life and decreased
isolation. Significantly (p= 0.02) improved changes in life as a
caregiver (Bakas Caregiving Outcome Scale) at two weeks
(n= 28, baseline m= 46.62; 2-week post m=52.64) and six months
(n= 25, m=53.88). Significant reduction in time taken for caregiver
activities (Oberst Caregiving Burden Scale) was found between
baseline (m=45.1) and six months (m=38.84) (n=25, p<0.01). The
program was beneficial at any point but especially three to six
months post stroke.
CONCLUSIONS The FICSS program has demonstrated positive
short and long term outcomes for caregivers of stroke survivors.
Next steps are to finalize content and develop a national facilitator
training program.
37
37
“IF YOU DON’T HAVE A PURPOSE FOR
IT, IT’S NOT WORTH DOING”: THE ROLE
OF COMMUNITY-BASED THERAPEUTIC
RECREATION IN STROKE RECOVERY
AUTHORS Lynn Curley, Recreation Therapist, Community Stroke
Rehabilitation Team, Owen Sound, Shannon Hebblethwaite,
Assistant Professor, Department of Applied Human Sciences,
Concordia University
BACKGROUND & PURPOSE The recreation therapist on the
Community Stroke Rehabilitation Team (CSRT) in Grey-Bruce
assists the stroke survivors to engage in recreation as a means of
addressing therapeutic goals and objectives (e.g., enhancing selfesteem, decreasing social isolation) using a collaborative, personcentred approach to care. Since few community-based stroke
programs employ recreation therapists, the purpose of this study
was to examine the experience of community-based therapeutic
recreation (TR) for stroke survivors in the Grey-Bruce region in
Ontario.
METHODS Employing a participatory action research framework
and using a Photovoice methodology, the CSRT recreation
therapist asked 14 stroke survivors and their families to take
pictures of what their leisure had been like since they had
experienced their stroke. These photographs were used to
facilitate discussion among the participants about the role that
leisure played in their recovery. Qualitative data analysis of these
individual interviews employed the constant comparative method
as a means to process the data.
RESULTS Purposeful involvement in community-based leisure
activities gave the stroke survivors hope, self-confidence, and
created a sense of belonging and engagement with their
community. They stayed physically and mentally active and were
able to give and receive support from each other, contributing to a
sense of belonging in their communities.
CONCLUSIONS This collaborative approach has enhanced our
understanding of the role of TR in stroke recovery. Empowered by
TR and the action research process, the participants have become
active in advocating for stroke survivors and educating other stroke
survivors about the important role of recreation therapy in recovery,
using a calendar developed from the research project.
TIMING IT RIGHT, STROKE FAMILY
SUPPORT PROGRAM: PILOT RESULTS AND
ONGOING RANDOMIZED CONTROLLED
TRIAL
AUTHORS Jill I. Cameron, PhD, Gary Naglie, MD, Grace Warner,
PhD, Theresa Green, PhD, Monique Gignac, PhD, Mark Bayley,
MD, Maria Huijbregts, PhD, Angela Cheung, MD, Frank Silver, MD,
Stephen Phillips, MD, Anna Czerwonka H BSc, on behalf of the TIR
Investigators
BACKGROUND & PURPOSE Family caregivers play a central
role in the recovery, rehabilitation, and community re-integration of
stroke survivors. We developed the Timing it Right Stroke Family
Support Program (TIRSFSP) to provide stroke families with timely
education and support as they care for stroke survivors’ across
the care continuum. The purpose of this study is to determine if
receiving the TIRSFSP results in better stroke knowledge, support,
and mental health outcomes for family caregivers.
METHODS Participants are being recruited into a mixed
methodology RCT in 11 acute care hospitals across Canada.
Caregivers are randomized to: 1) standard care, 2) Self-directed
TIRSFSP, or 3) TIRSFSP delivered by a stroke support person for
the first six months post stroke. Participants complete surveys at
baseline, 3, 6, and 12-months post-stroke. Six participants per
research site are invited to participate in qualitative interviews.
Stroke support persons are keeping journals of each session.
RESULTS From the pilot study, no significant changes were
observed in any outcome variables, as expected with the small
sample size (N=31). Stroke support persons spent an average
of 2.5 hours per participant over approximately five sessions.
Qualitative findings (n=19) suggest that the TIRSFSP benefits
family caregivers.
To date, we have recruited 289 of 300 caregivers into the full trial
and will complete follow-up data collection by September 2013.
CONCLUSIONS This research will help us determine if
the TIRSFSP may benefit family caregivers and if it can be
recommended as a model of stroke family education and support
that crosses care environments and, therefore, supports transitions.
PEERS FOSTERING HOPE
AUTHORS Jocelyne McKellar, MSW, RSW; Donna Mackay;
Joanne Mackie
BACKGROUND & PURPOSE Stroke is a life altering experience.
People with stroke and caregivers often lack the necessary skills to
cope with changes to self-identity, personal relationships and life
after stroke. It’s been demonstrated that engaging in conversations
with others who share a similar experience can profoundly affect
the course of recovery. Peers Fostering Hope focuses on emotional
support and knowledge exchange to provide hope, help in
navigating the system and improve recovery.
METHODS Dedicated interprofessional healthcare providers,
persons with stroke and caregivers have co-created the vision and
design of this innovative peer support program. Peers are persons
with stroke and caregivers, who have undergone extensive training
on: communicating and supporting persons with stroke/caregivers;
bio-psychosocial effects of stroke; roles, responsibilities and
boundaries as peers. This program will be piloted in five hospitals
within Toronto.
RESULTS
• Development of a comprehensive peer support education
program through extensive consultation with key
stakeholders, and a review and analyses of existing peer
support models.
• Development of a peer reference guide that accompanies
the training program.
• A recruitment strategy involving outreach to local hospitals,
support groups, volunteer agencies and community groups.
• Piloting the peer visiting program in five acute and
rehabilitation hospitals within Toronto.
CONCLUSIONS This unique program may result in improved
system navigation, better access to community supports/resources,
and more individualized optimistic and emotionally infused care for
persons with stroke and caregivers. Future work includes evaluating
the impact of this program on patient/caregiver experiences and of
the peers themselves.
STROKE
COLLABORATIVE
2012
STROKE
COLLABORATIVE
2012
3838
POSTER ABSTRACTS
REHABILITATION
LONG-TERM REHABILITATION
MANAGEMENT OF STROKE (LOMOS):
WHAT DOES THE EVIDENCE SHOW?
AUTHORS Robert Teasell MD¹, Swati Mehta PhD candidate²,
Amanda McIntyre MSc², Liane Lobo², Shelialah Pereira MSc², Laura
Allen MSc candidate², Norine Foley MSc², Katherine Salter PhD
candidate²
BACKGROUND & PURPOSE There is a growing realization of
the importance of the Long-term Rehabilitation Management
of Stroke Patients. However, a strong evidence-based case for
this, combining demographic and registry-type data and natural
history as well later complications of stroke information has yet to
be made. The end result is that health care systems, particularly
in Canada, are withdrawing resources for long-term management
of stroke patients even over the relatively short-term, after stroke
patients have been discharged into the community. The objective
of this study was to conduct a systematic review of the research
literature regarding the long-term management of stroke patients.
METHODS A systematic review was conducted of all stroke
rehabilitation studies, with a focus on RCTs, where the therapeutic
intervention was initiated more than six months post stroke onset.
RESULTS There were over 330 RCTs and over 200 other studies
identified. There were 230 RCTs for therapies involving mobility
or upper extremity motor interventions, 44 for cognitive and
aphasia interventions and only 15 for psychosocial and community
reintegration interventions. The majority of the studies were
significantly positive indicating efficacy of the intervention.
CONCLUSIONS Several findings stand out. There was a
substantial evidence base supporting interventions more than six
months post stroke (over 330 RCTs) with many strong levels of
evidence. However, paradoxically little resources are allocated for
rehabilitation therapies more than six months post stroke. Over
two-thirds of RCTs involved mobility or upper extremity motor
interventions as compared to less than 5% involving psychosocial
or community reintegration interventions. There is a substantial
evidence base supporting long-term rehabilitation of stroke
patients, particularly those with ongoing motor deficits.
¹Department of Physical Medicine and Rehabilitation, Schulich School of Medicine,
²Lawson Research Institute.
39
39
DETERMINING EFFECTIVENESS OF
INTERVENTION IN A SPASTICITY CLINIC
AUTHORS Ms. Debbie Hebert, Mr. Ross Baker, Dr. George
Mochizuki, Ms. Tracy Paulenko, Dr. Anne Agur, Ms. Parvin Eftekhar,
Mr. Jeremy Griffiths, Dr. Denyse Richardson
BACKGROUND & PURPOSE Spasticity is a major contributor to
changes in motor control and functional performance. Impairment
measures (i.e. Modified Ashworth Scale) often change with
management, but outcomes measuring activity level (WHO Model)
are more important to patients. The purpose of the study was
to determine the most effective outcome measures in detecting
change in treated patients.
METHODS A retrospective chart review of 13 stroke patients (6
or more months post stroke) was completed. The objective was
to determine the most effective outcome measures in detecting
change in treated patients. Tests were administered at baseline
and one or more test points six weeks apart. Clinically significant
changes were then identified for each outcome.
RESULTS The Fugel-Meyer appeared to be the most responsive
test. The Wolf MotorTest was the next responsive Less responsive
were the Chedoke Arm and Hand Inventory and the Box and Block
test(B & B) The Chedoke McMaster Stages of Recovery – Hand and
Arm and Nine Hole Peg Test(NHPT) were relatively non-responsive.
The Six Minute Walk Test demonstrated clinically significant change
as did the Berg Balance Scale. Community Balance and Mobility
Scale(CB&M) and the COVS were responsive in fewer individuals.
The Chedoke-McMaster Stage of Recovery-Leg only changed in
one patient while that measure for the Foot did not change at all.
CONCLUSIONS The Fugel-Meyer (upper extremity) and six
Minute Walk Tests (lower extremity) were most responsive to
change. Tests such as the CB&M, B & B and NHPT were responsive
for persons with higher level motor recovery. Missing from this
exploration of outcomes was measurement of patient goals. This is
now being employed in our facility.
USE OF BENZODIAZEPINES AFTER
STROKE: ARE WE ADHERING TO BEST
PRACTICES?
AUTHORS Caitlin Cassidy¹, Eric Leci², Matthew Meyer², Shannon
Janzen², Robert Teasell¹,².
BACKGROUND & PURPOSE Motor recovery is frequently listed
as patients’ most important goal of stroke rehabilitation. Evidence
shows that benzodiazepine medication impairs motor recovery in
animals and likely has a similar effect in humans who have suffered
a stroke. Canadian Best Practice Recommendations state that
benzodiazepines should be avoided in the post-stroke population,
at least during the recovery phase. The purpose of the study was to
examine adherence to Canadian Best Practice Recommendations
in a specialized inpatient Stroke Rehabilitation unit in London,
Ontario as they pertain to the use of benzodiazepines.
METHODS The charts of 120 patients admitted for stroke
rehabilitation at Parkwood Hospital were reviewed for frequency
and type of benzodiazepine prescriptions.
RESULTS 26.7% of patients admitted for stroke rehabilitation
were prescribed benzodiazepines while they were inpatients.
Most of the prescriptions were initiated prior to admission to the
rehabilitation unit and were simply continued into the rehabilitation
phase; they were for use as needed.
CONCLUSIONS These results indicate that despite current
(2010) Best Practice Recommendations, 26.7% of patients were
prescribed benzodiazepines while admitted to hospital following
their stroke. This identifies an area of potential improvement in
providing evidence-based, patient centred care following stroke
HOW DOES A BIG YELLOW POSTER ABOVE
EACH PATIENT’S BED CONTRIBUTE TO
INCREASED PATIENT SATISFACTION AND
REDUCED STRAIN INJURIES?
AUTHORS Barbara Knapton RN, CRN(C) Program Educator,
Physical Medicine and Rehabilitation, Providence Care, Leena
Altosaar BScPT Providence Care, Jennifer Hoffman, BScOT,
Providence Care, Cathy Lyle, RN, MSc, Providence Care, Ann
Murray, RN, CHPCH(C) Providence Care, Judy Tse, BScOT,
Providence Care
BACKGROUND & PURPOSE At our hospital, every patient
is seen within 24 hours of admission for a Bedside Assessment
by a Nurse, Physiotherapist and Occupational Therapist. This
team assessment, together with the Patient and/or family is a
co-operative, problem solving effort. Bed Mobility, transfers,
ambulation, wheelchair assessment, seating, bedrail and call bell
set up, room layout and the need for reconfiguration of furniture
of additional adapted equipment, ADL plans and general safety
precautions are assessed. The Bedside Assessment reflects the
Falls Prevention program as patients are assessed for risk of falls
using the FRAT (fall risk assessment tool). The purpose of this study
is to enhance interprofessional collaboration and allow the patient
and family to express their goals for rehabilitation to the team.
METHODS Relevant patient care information and safety
recommendations are documented on the laminated yellow poster
above the patient’s bed for all to see. To facilitate continuity of care
the poster moves with the patient and there is a corresponding
yellow Bedside Assessment form in the Patient health care record.
Both the poster and form are updated whenever there is a change
in patient status. The Bedside Assessment recommendations are
followed by all team members.
CONCLUSIONS The Bedside Assessment process, poster
and form have enhanced interprofessional collaboration, timely
communication and have contributed to reduced work strain
injuries. The Bedside Assessment allows the Patient and/family to
express their goals for rehabilitation to the team.
¹University of Western Ontario
²Lawson Health Research Institute
STROKE
COLLABORATIVE
2012
STROKE
COLLABORATIVE
2012
4040
POSTER ABSTRACTS
REHABILITATION
PATIENT-PROVIDER COMMUNICATION IN
THE PROMOTION OF PATIENT TRANSITION
TO CARDIOVASCULAR REHABILITATION
AFTER MILD NON-DISABLING STROKE OR
TRANSIENT ISCHEMIC ATTACK
AUTHORS Pourhabib, S¹; Murray, J²; Neabel, B²; Grace, SL¹, ², ³
BACKGROUND & PURPOSE Cardiovascular rehabilitation (CVR)
is proven to reduce mortality in cardiac patients, and preliminary
evidence demonstrates benefit for patients with transient
ischemic attack (TIA) or mild non-disabling stroke (MNDS). The
most successful strategy to promote CVR utilization is systematic
referral with a patient-provider discussion. Indeed, provider
encouragement is related to a 2-times greater CVR enrolment.
The purpose of this study is to describe (1) TIA/MNDS outpatientprovider communication regarding CVR, (2) the role of tools to
promote referral, and (3) patient intention to enroll.
METHODS TIA/MNDS outpatients and their healthcare providers
were recruited at a Stroke Prevention Clinic in this pilot study.
After informed consent, a digital audio-recorder was provided
to record the interaction. During a subsequent interventional
phase, providers were given tools (e.g., motivational letter, patient
contract, telephone script) designed to promote communication
about CVR. All recordings were anonymized and coded.
Participants were asked to complete a self-report survey assessing
perceptions of CVR and their medical interactions. CVR referral and
enrolment were ascertained (yes/no).
RESULTS Nine interactions were recorded (n=5 male; mean
age=72.0±11.0), of which five (50.0%) incorporated a CVR
tool. During eight (80.0%) encounters, the provider raised CVR
and encouraged patient participation. In six (60.0%) of these
encounters, referral was discussed. Three (30.0%) interactions were
2-way discussions, and during 1 (10.0%) encounter patient barriers
to CVR participation were raised. Patient intention to enroll in CR
was 2.78±1.39/5, and 1 (10.0%) patient enrolled.
CONCLUSIONS While there is insufficient power to undertake
inferential analyses, these pilot data suggest more should be done
to promote stroke patient enrolment in CVR.
THE IMPACT OF A SUSTAINED,
COMPREHENSIVE AND FREELY-AVAILABLE
RESEARCH SYNTHESIS IN STROKE
REHABILITATION
AUTHORS Robert Teasell MD¹, Shelialah Pereira MSc²,
Norine Foley MSc², Katherine Salter PhD candidate², Matthew
Meyer¹, Andrew McClure², Mark Speechley²
BACKGROUND & PURPOSE To review the impact of the
Stroke Rehabilitation Evidence-Based Review (www.ebrsr.com), a
comprehensive, continually updated, freely available review of the
stroke rehabilitation literature which has been actively sustained for
over a decade.
METHODS The SREBR utilizes a well-validated methodology
which includes an extensive literature search, data extraction
and analysis, study quality assessment using the PEDro scale and
development of levels of evidence, with the focus on randomized
controlled trials (RCTs).
RESULTS The SREBR (2012) now entering its 15th edition has
summarized 1200 RCTs and over 2,500 non-RCTs into over 400
levels of evidence. The SREBR has served as a source of research
evidence for provincial, national and international guidelines,
recommendations and models of care designed to improve patient
care. Through an integrated strategy of knowledge translation we
are beginning to see an acceleration of best evidence translated
into implementation of clinical best practices.
CONCLUSIONS The SREBR has played a pivotal role in attempts
to promote evidence-based best practices within Canadian stroke
rehabilitation and has become a role model for other diseasespecific rehabilitation groups outside of stroke. It points to the
importance of not just supporting new research but ensuring that
there is infrastructure in place to summarize and promote available
research findings, particularly within a health care system which is
becoming more interdisciplinary in nature. The value of funding this
type of infrastructure support, for what has been a relatively modest
investment, is compelling and it is more powerful when combined
with highly motivated provincial and federal stroke networks
determined to promote clinical implementation of best evidence.
¹Lawson, Research Institute, ²Schulich School of Medicine, University of Western
Ontario, London, Ontario, Canada
¹York University, ²Mackenzie Health, ³University Health Network
41
41
KNOWLEDGE TO ACTION IN STROKE
REHABILITATION: DETERMINING THE GAP
BETWEEN BEST-PRACTICE AND ACTUAL
PRACTICE
AUTHORS Robert Teasell MD¹, ², Shannon Janzen MSc², Matthew
Meyer PhD candidate², Shelialah Pereira MSc², Laura Allen²,
Katherine Salter MSc candidate².
BACKGROUND & PURPOSE It has been shown that clinical
care provided in accordance with evidence-based guidelines
is associated with improved outcomes and yet, the problem of
clinical care not being delivered in accordance with evidencebased guidelines is well recognized. In Ontario, evidence suggests
that failure to practice in accordance with established guidelines
may negate the benefits of specialized organized interdisciplinary
care. The purpose of this study is to determine the gap between
Canadian Best-Practice Recommendations and actual practice on a
stroke rehabilitation unit.
METHODS Evidence-based reviews (EBRs) and national
guidelines were used to identify best-evidence/best practices for
post stroke rehabilitation that were explicit and worded in such
a way that compliance could be measured. At a single tertiary
care stroke rehabilitation unit evaluation of actual practices was
performed via chart reviews and clinical observation and evidenceimplementation gaps were identified.
RESULTS An audit of over 100 charts found significant gaps
between clinical practice guidelines and actual practices for
the following areas: Failure to meet recommended intensity of
rehabilitation therapies (less than half the recommended three
hrs/day), failure to screen and assess for depression (4.9%; 9.8%),
failure to assess for cognitive disorders following a positive screen
(3.7%), failure to document a continence management program
for urinary incontinence (5%), failure to establish an oral hygiene
protocol (0%), failure to regularly monitor blood pressure (average
of 4.6 unrecorded days) and inappropriate use of Benzodiazepines
during the neurorecovery period (26.7%). Areas where gaps did
not exist included the management of dysphagia and nutritional
disorders, screening and management of diabetes and smoking
education. The unit has now developed a number of strategies
to address these gaps and align the stroke rehabilitation unit with
clinical practice guidelines and these are now being audited.
THE RELEVANCE OF CLINICAL MEASURES
TO PHYSICAL ACTIVITY AFTER STROKE
AUTHORS Dina Brooks (PhD), Professor, Department of Physical
Therapy, University of Toronto, Nancy M. Salbach (PhD), Assistant
Professor, Department of Physical Therapy, University of Toronto,
Julia Romano (MSc), Research Coordinator, Department of
Respiratory Medicine, West Park Healthcare Centre, Toronto,
Lynda Woon (BSc), Physiotherapist, West Park Healthcare Centre,
Toronto.
BACKGROUND & PURPOSE To examine the relationship
between daily physical activity and five clinical measures of motor
function, balance, balance self-efficacy, and walking speed and
distance in community-dwelling individuals with stroke.
METHODS Daily physical activity was estimated using average
steps/day measured over a five-day period with a uniaxial
accelerometer (activPAL) attached to the participant’s thigh. The
Chedoke-McMaster stroke assessment (CMSA; leg and foot scales),
Berg balance scale (BBS), Activities-specific Balance Confidence
(ABC) scale, 5-metre walk test (5mWT), and the 6-minute walk test
(6MWT) were used to measure motor function, balance, balance
self-efficacy, walking speed, and walking distance, respectively.
RESULTS Fifteen men and two women with a mean±standard
deviation age of 71.4±9.7 years, who were 2.0±1.0 years poststroke, participated. Participants walked 1905±2148 steps/
day. Average steps/day was associated with scores on the ABC
scale (rho=0.603, p=0.010), 5mWT (r=0.586, p=0.013), 6MWT
(r=0.561, p=0.019), TUG (r=-0.515, p=0.034), and CMSA leg scale
(rho=0.495, p=0.043) but not scores on the CMSA foot scale
(r=0.243, p=0.348) or BBS (r=0.320, p=0.210).
CONCLUSIONS Balance self-efficacy and walking speed and
distance were more strongly associated with daily physical activity
than voluntary leg movement and functional mobility. Findings
support the relevance of the clinical measures used and suggest
that improvement in not only walking capacity but also balance
self-efficacy in stroke rehabilitation may be necessary to promote
daily physical activity following discharge to the community setting.
CONCLUSIONS Significant gaps between best practices and
actual practices. This study offers various examples of areas in
stroke rehabilitation with testable guidelines. This form of practice
audit is an important initial step in identifying areas for knowledge
translation of best evidence.
¹Department of Physical Medicine and Rehabilitation, Schulich School of Medicine,
University of Western Ontario, ²Lawson Research Institute.
STROKE
COLLABORATIVE
2012
STROKE
COLLABORATIVE
2012
4242
POSTER ABSTRACTS
REHABILITATION
CHANGE IN COMMUNICATION FOR
STROKE PATIENTS: DOES THE FIM®
CAPTURE IT?
AUTHORS Leigh Barr, Barb Ansley, Sue Bramberger, Barb
Kubilius, Rhonda Whiteman
BACKGROUND & PURPOSE The use of measurement scales
is a common practice in stroke care to document changes in
patient status and describe patient needs at transition points
in the recovery process. In Ontario, as part of the National
Rehabilitation Reporting System (NRS), the Functional
Independence Measure (FIM)® and supplementary Canadian
Institute for Health Information (CIHI) items are mandated for
use to measure change for stroke patients on admission to and
discharge from rehabilitation. This study seeks to learn if the
FIM® and CIHI cognitive and communication items are sensitive
enough to capture the actual gains made in communication during
rehabilitation at Hamilton Health Sciences.
METHODS A retrospective analysis of 1432 patients FIM®comprehension/expression scores and CIHI Verbal/Nonverbal Expression; Written Expression; Auditory/Non-auditory
Comprehension and Reading Comprehension scores from the
hospitals NRS database is underway to determine if statistically
significant FIM® and CIHI changes exist between admission scores
when compared with discharge scores.
RESULTS Preliminary analysis of the data is underway. This
analysis will inform the need for implementation of additional
communication and cognition measures to adequately and
accurately capture the changes made in stroke survivor’s
communication ensuring that ongoing patient needs are identified
on transitions.
SYSTEMATIC REVIEW AND META-ANALYSIS
OF CONSTRAINT INDUCED MOVEMENT
THERAPY IN THE HEMIPARETIC UPPER
EXTREMITY MORE THAN SIX MONTHS
POST STROKE
AUTHORS Amanda McIntyre, MSc¹, Ricardo Viana, MD², Shannon
Janzen, MSc¹, Swati Mehta, MA¹, Shelialah Pereira, MPT¹, Robert
Teasell, MD¹,²
BACKGROUND & PURPOSE Constraint induced movement
therapy (CIMT) requires that individuals restrict their unaffected
arm using a mitt or sling with the purpose of forcing use of the
affected arm to complete activities. The purpose of this study is
to conduct a systematic review and meta-analysis of the available
evidence on the effectiveness of constraint induced movement
therapy in the hemiparetic upper extremity (UE) among individuals
who were more than six months post stroke.
METHODS A literature search of multiple databases (Pubmed,
CINAHL, EMBASE) was conducted. Studies were included for
review if: 1) ≥50% sample size had sustained a stroke; 2) the
research design was a randomized control trial (RCT); 3) the
mean time since stroke was ≥6 months; 4) the treatment group
received CIMT; 5) a control group received a form of traditional
rehabilitation; and 6) functional improvement was assessed
pre-treatment and post-treatment. Methodological quality was
assessed using the PEDro tool with a score out of ten.
RESULTS Sixteen RCTs (PEDro scores 4-8) met inclusion criteria
and included a pooled sample size of 572 individuals with a mean
age of 58.2 years (range 30-87). The meta-analysis revealed a
significant treatment effect on the amount of use and quality of
movements subscales of the Motor Activity Log (p<0.001 for
both), Fugl-Meyer Assessment (p=0.014), and Action Reach Arms
Test (p=0.001); however, there was no significant treatment effect
demonstrated by the Wolf Motor Function Test (p=0.120) or
Function Independence Measure (p=0.070).
CONCLUSIONS Constraint induced movement therapy, to improve
UE function, is an appropriate and beneficial therapy for individuals
who have sustained a stroke more than six months previously.
¹Lawson Health Research Institute, St. Joseph’s Parkwood Hospital, London, ON
²Department of Physical Medicine and Rehabilitation, University of Western Ontario,
43
43
MANAGEMENT OF HYPERTENSION DURING
POST-STROKE REHABILITATION: ARE WE
DOING ENOUGH?
USING LEAN TOOLS AND TECHNIQUES TO
MAXIMIZE OPPORTUNITIES FOR DIRECT
PATIENT THERAPY
AUTHORS Laura Allen, Matthew Meyer, Sarah Donaldson, Erik
Leci, Katherine Salter, Shannon Janzen, Robert Teasell
AUTHORS Kathleen Lawhead BScPt Registered Physiotherapist
and Interprofessional team at Windsor Regional Hospital
BACKGROUND & PURPOSE Hypertension is a significant
risk factor for recurrent stroke. The Canadian Best-Practice
Recommendations for Stroke Care suggest that treatment be
provided to consistently achieve a target blood pressure (BP) less
than 140/90 mmHg in all patients who have experienced a stroke.
BACKGROUND & PURPOSE An inpatient rehabilitation program
wanted to increase direct therapy opportunities using existing resources
with the intent of producing positive impact on patient outcomes
including length of stay, FIM scores, FIM efficiency, and patient
satisfaction. Specifically, objectives of the initiatives focused on:
METHODS A retrospective chart audit was performed for all
patients admitted to the neuro-rehabilitation unit at Parkwood
Hospital (London, Ontario) between Oct 1, 2010 and March 31,
2011. Two extractors independently retrieved data and compared
results to check for accuracy. Data was analyzed to assess the
number of days on which BP was not taken/recorded, the number
of patients who experienced hypertension, the number of times a
medication change was required to lower BP, the number of days
for which elevated BP was not treated, and the longest consecutive
period over which elevated BP was not treated. Data were
analyzed using frequencies with ranges and means with standard
deviations.
RESULTS One-hundred twenty patients were admitted to the
neuro-rehabilitation unit during the period of evaluation. During
that time, 92% of patients went at least one day without having
their BP taken/recorded, the average patient experienced 4.6
(±4.7) days where BP was not taken/recorded, and 81% of patients
experienced at least one bout of hypertension (50% of whom
required at least one change in medication to lower elevated BP).
CONCLUSIONS Management of hypertension post stroke
significantly reduces the risk of recurrent stroke. Yet, results of
this study suggest room for improvement in the management of
hypertension on a single inpatient rehabilitation unit in Ontario.
1. Increasing direct therapy from two to three hours per to four
to five hours per day with a stretch goal of six hours per day;
2. Reducing “competition” for scheduling therapy sessions
during peak times by better utilizing the beginning and
end of the day and finding opportunities to expand the day
beyond tradition therapy hours;
3. Reducing Length of Stay;
4. Reducing waste and increasing therapy time through more
efficient utilization of existing resources.
METHODS The initiative used LEAN tools and techniques
including mapping the current process, locating “waste” and
non-value added activities, and identifying opportunities for
improvement. Interdisciplinary working groups applied rapid
cycling testing to improvements and developed innovative
solutions to extend therapy opportunities beyond the traditional
work day.
RESULTS Preliminary results showed an increase in direct therapy
times overall and weekly therapy opportunities almost doubled
for stroke and deconditioned patients. Recreational therapy times
expanded to include some evening and weekend slots. A number
of group therapy sessions were developed to enhance one on one
therapy and increase educational opportunities for patients. There
was also an increase in patient self-directed activities on evenings
and weekends.
Staff are now collecting additional outcome data and now
preparing to apply both the LEAN principles and the interventions
to outpatient rehabilitation services.
STROKE
COLLABORATIVE
2012
STROKE
COLLABORATIVE
2012
4444
breakfast symposium
THE USE OF ECG SCREENING IN
THE COMMUNITY: ARE WE DOING
ENOUGH FOR PREVENTION OF
STROKE AND SUDDEN DEATH?
Anatoly Langer, MD, M.Sc., FRCP (C), FACC
Chair, Canadian Heart Research Centre
Professor of Medicine, University of Toronto
Chair, Foundation for Medical Education and Research
The majority of out-of-hospital sudden cardiac deaths (SCD) occur among either those
patients in whom cardiac arrest is the first clinical expression of an underlying disease or
those in whom cardiac disease was previously identified but classified as low risk. The
incidence of SCD is age related and may range from 1 per 1000 in 50 year old men to 8
per 1000 in 75 year old men.
Screening for higher risk features in the general population, such as through use of
electrocardiograms (ECGs) has not previously been widely adopted due to the need to
use trained personnel with access to expensive devices. Recently, relatively inexpensive
strategies have been proposed that enable accurate and diagnostically valid remote and
local arrhythmia detection. The ECG represents a particularly useful tool through which
a variety of easily obtainable measures, such as conduction abnormalities (e.g. QRS
duration, heart block), QT prolongation, early repolarization, and arrhythmias such as
atrial fibrillation, can be obtained as indicators of potentially modifiable risk.
THE HEART AND STROKE FOUNDATION WISHES TO
ACKNOWLEDGE AND THANK THE FOLLOWING:
SPONSOR
EXHIBITORS
Cardiocomm Solutions, Inc.
Bayer Healthcare Pharmaceuticals
45
7:30 – 8:30
TORONTO BALLROOM
BE A PA RT O F A GROWING P ROGRAM !
You can make a difference to stroke survivors and their families
LIVING
withSTROKE
WHAT IS IT: A community education and support program for stroke survivors
and their families
WHO RUNS IT: Volunteer champions in the community – healthcare providers
and stroke survivors in partnership
WHAT SUPPORT IS AVAILABLE:
• Free facilitator training
• Administration grants and honoraria available for each completed program
• Check out the resources available at www.heartandstroke.ca/hcp – look for
Living with Stroke in the Stroke section.
HOW CAN I GET INVOLVED: contact Linda LeDuc at [email protected]
2012
REGISTER
BY OCT. 31 &
SAVE
2012 PROGRAM HIGHLIGHTS
• Stimulating keynote address by Dr. Sandra Black on “Optimizing Brain Health and Preventing Cognitive Decline”
• Go viral! The use of social media to communicate with patients
• Latest information on C-CHANGE, antithrombotic therapies and Afib clinical trials, lipids, and managing diabetes
• Discussions on sleep apnea, managing syncope, fact and fad in alternative remedies, practical management
of heart failure and vascular dementia
To register, please visit heartandstroke.ca/clinicalupdate
December 7 – 8, 2012 [ Pre-Conference December 6, 2012 ]
Hilton Downtown Toronto Hotel

successful transitions - Heart and Stroke Foundation of Ontario

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