Poststroke Virtual Movement Therapy No Better Than Standard Care

 Survivors don't care about 'care'; they want RECOVERY! Are you that blitheringly stupid? Yes, I guess you are! The mentors and senior researchers need to be fired for approving such crapola!

Poststroke Virtual Movement Therapy No Better Than Standard Care

TOPLINE:

High-dose, high-intensity virtual exploratory movement therapy initiated within 2 weeks of a stroke showed no advantage over conventional therapy for improvements in hand and arm recovery at 3 months in a new phase 2a trial.

METHODOLOGY:

• The ESPRESSO phase 2a biomarker-guided stroke rehabilitation trial was conducted in New Zealand between 2021 and 2024 and included 64 adults with weakness in the upper limbs and a positive motor evoked potential status indicating a functionally intact corticospinal tract — a key biomarker linked to the potential for hand and arm recovery.
• Within 2 weeks of an ischemic or hemorrhagic stroke, patients were randomly assigned to receive virtual exploratory movement therapy using an immersive video game-based platform (median age, 74 years; 61% men) or time-matched conventional therapy based on upper-extremity task-specific training principles (median age, 66 years; 54.5% men). Both groups also received 90 minutes per weekday for 3 weeks of therapist time for intensive upper limb therapy in addition to their usual care.
• The primary endpoint was the change in score on the Action Research Arm Test (ARAT) between baseline and 3 months post-stroke. Secondary outcomes included changes in ARAT scores at 1 and 6 months; changes in Fugl-Meyer Upper Extremity (FM-UE) scores at 1, 3, and 6 months; and recovery of manual dexterity.
• Intention-to-treat (ITT) analysis included all 64 patients; a per-protocol (PP) analysis included 54 patients who met the weekly target of active therapy minutes.

TAKEAWAY:

• In the ITT analysis, ARAT scores were higher immediately post-intervention for all participants (P < .0001), increasing further between 1 and 3 months (P < .0001) and again from 3 to 6 months (P = .01), with similar findings for the PP analysis. However, the primary endpoint did not differ significantly between the treatment groups, with recovery over time observed in both.
• The PP analysis showed an increase of 18.1 points in estimated FM-UE scores immediately post-intervention (P < .0001) for all participants, with a further increase of 3.1 points between 1 and 3 months (P < .001), but there were no significant differences between the treatment groups.
• Other secondary outcomes at 6 months were similar between groups for both the ITT and PP analyses.
• When both treatment groups were compared with a matched historical cohort that received usual care only, there were no differences in ARAT or FM-UE scores, despite the former groups completing more than three times the amount of upper limb therapy (mean, 901.6 minutes vs 249.3 minutes; P < .0001).

IN PRACTICE:

“Our findings suggest that early recovery after stroke is dominated by powerful biological repair processes, and increasing therapy dose over and above standard care very early after stroke may not enhance those processes,” lead study investigator Winston D. Byblow, PhD, School of Exercise, Sport, and Rehabilitation Sciences, University of Auckland, Auckland, New Zealand, said in a press release.

SOURCE:

The study was published online on March 28 in Brain Communications.

The impact of inpatient and community stroke rehabilitation on health-related quality of life in New Zealand

 So, obviously a complete failure! NO measurement of 100% recovery, the only goal in stroke!

Here is your business101 requirements.

“What's measured, improves.” So said management legend and author Peter F. Drucker  

The impact of inpatient and community stroke rehabilitation on health-related quality of life in New Zealand

Stephanie G Thompson 1, Dhairya Thakkar 2, Harry McNaughton 3, William Levack 2, Anna Ranta 2

Affiliations 

• PMID: 41159514
 
• DOI: 10.23736/S1973-9087.25.08903-8

Abstract

Background: Stroke rehabilitation - both inpatient and community - is an important part of current post-stroke care, aimed at improving outcomes. However, there is a lack of recent New Zealand research exploring associations between rehabilitation and health-related quality of life (HRQoL) post stroke.

Aim: To explore associations between stroke rehabilitation and HRQoL.

Design: Secondary analysis of data from a prospective, observational study.

Setting: Twenty-eight New Zealand hospitals.

Population: Overall, 2379 patients with stroke.

Methods: Data was collected from consecutive patients with stroke who were admitted to New Zealand hospitals between 1st May and 31st July 2018. Further data collection occurred until the target sample size was reached, or until 31st October 2018, whichever occurred first. Patients were contacted for routine follow-up at three months and were invited to consent to follow-up at six and 12 months. We used the EQ-5D-3L and calculated the health utility score using weightings for the New Zealand population. We used linear regression to explore correlations between rehabilitation and HRQOL, adjusting for known confounders including stroke severity.

Results: There were 750/2379 (31.5%) patients who received inpatient rehabilitation and 838/2379 (35.2%) who received community rehabilitation. In a multivariate analysis, patients who received inpatient rehabilitation, compared to people who did not, had lower HRQoL scores at both three months (-0.07, 95% CI -0.10 to -0.04) and 12 months (-0.08, 95% CI -0.12 to -0.04). Patients who received community rehabilitation had higher HRQoL scores at 12 months (0.04, 95% CI 0.002 to 0.08)). Stratifying scores by stroke severity, we found results in favor of inpatient rehabilitation for only the most severely impaired patients and for community rehabilitation for all but the least impaired.

Conclusions: We found a negative correlation between HRQoL and inpatient rehabilitation, and a positive association between HRQoL and community rehabilitation. A combination of personal, environmental and service factors may explain this result. Future research directly comparing outcomes for patients receiving comprehensive community-based and inpatient rehabilitation, would be useful to support stroke rehabilitation service development.

Clinical rehabilitation impact: Individualized rehabilitation planning should consider social supports, the home environment, functional level and patient preference to support decision-making around rehabilitation location and optimize outcomes.

Game that helps stroke patients recover being trialled in New Zealand

 I still prefer the cockroach stomping game, it would vastly improve your balance.

I like the cockroach stomping game

Or this interactive carpet: Interactive carpet for stroke rehab

Game that helps stroke patients recover being trialled in New Zealand 

Nearly 10,000 strokes are experienced in New Zealand every year, but now a game that helps patients recover is being trialled.

It involves the patient directing a dolphin across a floor-to-ceiling screen to catch a fish while motion-sensitive cameras track all the movements. The game gives patients a jolt which stimulates more effective brain repair.

Newshub spoke to an 81-year-old stroke patient taking part in the trial.

Related News

New Zealand research offers hope to stroke victims

New stroke rehab gets patients back in their homes

Laurie Mathews looks like he could conduct an orchestra. It's hard to believe that just three weeks ago, his left arm was basically paralysed.

"There was a tendency for me to fall over, now I can balance myself with this arm," he said.

The 81-year-old Aucklander had a stroke last month. He'd just had an angiogram and noticed his left arm going numb.

"Virtually turned into a piece of meat that I couldn't move," he said. "It was very weird, I was putting a lot of energy into my arm, and nothing was happening."

The toll has been physical and mental. It was his first - and what he hopes is his last stroke.

But before we go any further, what is a stroke? Well, a stroke normally happens when a blockage - like a clot - blocks the blood flow to the brain or when a burst blood vessel bleeds into the brain. It's essentially a brain attack.

People can be left with a drooping face weakness in the arms or legs or speaking difficulties. Then there's loss of balance, vision changes, memory loss and confusion.

Nearly 10,000 strokes are experienced each year in New Zealand - that's one every 55 minutes. And stroke is our second single-biggest killer and the leading cause of serious adult disability.

"It can be completely debilitating," said Auckland University neuroscience expert Professor Winston Byblow.

That's where this $1.5 million four-year trial can really help. Patients, like Mathews, play a specialized virtual reality game that helps rewire their brains and regain control of their nervous system.

"How it works is the camera, which is mounted just below the projector, can track Mathews's movements," Prof Byblow said.

The ones made by his affected left arm direct the dolphin to catch the fish.

"So it can build a model of his whole body. So, it uses that information to determine how well Mathews is moving, his weak side, and how to create the game so that he makes the best highest highest-quality movements possible," Prof Byblow said.

It's simple but effective. Mathews now has to do 90 minutes of upper limb therapy each weekday at Auckland University for three weeks. It's intense but, he said, worth it.

When he first arrived his arm was a dead weight which he could barely move. Today the pictures speak for themselves.

"I want to get back to what I normally do, what I could do," he said.

"As their function improves, it is really heartening to see just their confidence and forward planning that they can have a meaningful life after this life-changing event," said therapist Maxine Shanks.

Sixty patients have now taken part in the trial and it's hoped another 20 will complete it before next year. Patients can start as early as one week after their stroke. And finish, like Mathews, rehabilitated and with hope.

"He is a star," Prof Byblow exclaimed.

Stroke survivor: 'Terrifying' to rely on husband's income to live

Well you can completely blame your doctor for not initiating 100% recovery research from the first stroke patient s/he had that didn't get 100% recovered. I'd say that was malpractice. 

Stroke survivor: 'Terrifying' to rely on husband's income to live

Susan Edmunds05:00, Aug 28 2023

Sungmi Kim/Stuff

A stroke survivor is considering moving back to Australia due to insufficient support in New Zealand.

Andrew Stopps says he’s in a “terrifying” position.

In 2021, when he was 47, he suffered two strokes. His right arm was paralysed, which meant he could no longer work as a music teacher and musician.

“I always thought strokes were for people who were elderly. I didn’t know anything about young stroke survivors.”

He now has movement back in his hand and arm but not the fine motor skills he would need to play again.

More from Stuff:

* After a tenant refused to agree to a flatmate, her landlord served her notice

* Kiwis are 'one diagnosis away from moving to Australia', cancer survivor warns

* 'Aggressive' circumcisions ruined the lives of these men

“The thing that I was really surprised at is that my husband earns over the threshold so I’m ineligible for financial support. It was surprising enough I had to fill out his details on forms but to find that out was terrifying, actually.”

Once a couple jointly earns $160 as week, it affects the amount of benefit they can get. A couple with no children receives no Jobseeker Support once they earn $981 a week jointly, before tax.

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Other support can be available, such as special needs grants which can be paid when weekly income is up to $1308.60. Stopps gets some assistance with transport.

“I’ve been able to draw down my KiwiSaver to help pay for rehab and living expenses but that money is now almost out and once that goes, I don’t know what we’re going to do.”

ACC reform report delivered to MPs

Current Time 0:32

/

Duration 1:59

 

ROBERT KITCHIN/STUFF

ACC needs changes, according to researcher/writer Warren Forster, who delivered a reform report to MPs. (Video first published August 10, 2022.)

The couple migrated from Australia 14 years ago and Stopps said, had the strokes happened there, he might have been able to access disability support.

“All of his salary pays our mortgage, rates and utilities. My salary used to cover car, food and amenities. Now I cannot work we are in serious trouble.”

He said it seemed old-fashioned to disqualify from a benefit someone based on their partner’s income. “I can imagine this law being effective 50 or 60 years ago when there was one breadwinner who could afford to pay for the family but in 2023 it doesn’t work.”

Their mortgage repayments and rates had increased and making ends meet was hard.

If Stopps had suffered an accident, he could qualify for income support via ACC. But ACC does not extend to medical conditions such as strokes.

ROBERT KITCHIN/Stuff

Jan Logie says the current situation means the same disability can be dealt with in very different ways.

Green Party disability spokesperson Jan Logie said it was something the party wanted to address, and have the scheme pay out when someone was disabled, regardless of cause.

She said, as it was, Stopps was in a situation where he qualified for minimal support, whereas someone who was paralysed through an accident could receive 80% of their pre-accident income via ACC.

“There are inequities that disabled people have been calling to be resolved for years,” she said.

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“There are three systems of income support and additional support, between Work and Income, ACC and the health system.

“The levels of support are so different. You might have somebody with, in effect, the same physical experiences but one gets access to decent income and transport support and home help but the other gets nothing and is forced to be entirely reliant on a partner or live in deep poverty. It just can't be justified.”

She said the Greens would fund the change by creating a flat rate for employers, which would increase what some paid, such as professional services.

They party would also increase employee levies to remove the maximum threshold and use some of the money that ACC had invested.

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Katrina Shanks, of Financial Advice NZ, which represents financial advisers, said people could insure themselves to avoid Stopps’ situation.

“Trauma or critical illness insurance pays a lump sum on the diagnosis or occurrence of one of a list of specific illnesses such as heart attack, cancer or stroke. Each policy is different so it is important you understand what you are covered for.

“This payment gives you choice and flexibility at a time when you need it most. It will allow you to reduce your working hours, spend time with your family, get treatment or rehabilitation and pay for a carer and any number of unexpected things.”

Stopps said, because I had a benign brain tumour in 2005, he was only eligible for life insurance not trauma or critical illness. “Everywhere I went only offered life insurance, so I'm more valuable dead than alive it seems.”

Shanks said about 20,000 people had to stop each work every year due to a health condition, injury or disability but a larger number would work reduced hours.

”By comparison in 2022, ACC provided 137,939 people with weekly compensation because they couldn't work due to their injuries. ACC only covers accidents and excludes things like illness, sickness, or contagious diseases, arthritis, most hernias, and injuries that happen over time, unless an activity at work is causing it.

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“Compared to other developed countries New Zealanders are very under-insured and put their financial health, wealth and wellbeing at risk by not having the correct personal insurances. It is not until something goes wrong that you realise the true value of insurance.”

Stopps said they might have to move back to Australia.

“We don't want to do that. We moved here 14 years ago and we love it but if I can't get taken care of when I need it – I paid tax for 14 years before the stroke – I don’t see any other option. I don't have family who can help, both my parents are dead. I’m stuck between a rock and a hard place.”

Accolades for Blue Mountains stroke rehabilitation team

 Really? Since you don't tell us how many 100% recovered I can only assume you're incompetently not measuring that because it's not important to you! But vastly important to stroke survivors, they would like to know how good you are with factual statistics. 'Care' is not a valid statistic even though is it referred to 10 times.

Survivors want to know 100% recovery results. Not reporting on that is criminal.

“What's measured, improves.” So said management legend and author Peter F. Drucker 

They don't care enough to even measure it?

Accolades for Blue Mountains stroke rehabilitation team

Blue Mountains residents can be assured that should they experience a stroke, their recovery is in the best of hands with high quality care provided by the rehabilitation team at Blue Mountains District ANZAC Memorial Hospital.

Staff from Blue Mountains Hospital's Rehabilitation team

Stroke can leave a person with significantly impaired functional movement which greatly impacts health outcomes and quality of life, and the Blue Mountains Hospital team have been recognised for driving recovery after stroke for the benefit of their patients.

The hospital's rehabilitation team have been awarded by the Australasian Rehabilitation Outcomes Centre (AROC) for achieving excellent outcomes in stroke, in recognition of their exceptional care to help restore patients' functioning and wellbeing.

The team recorded outstanding results in data collected by AROC which compared patients' length of hospital stay and stroke rehabilitation outcomes, using a measure called Functional Independence Measure (FIM), across rehabilitation centres in Australia and New Zealand.

The results revealed that stroke patients at Blue Mountains Hospital are consistently recording improved FIMs from initial hospital admission to discharge and beyond.

Head of Rehabilitation at Blue Mountains Hospital, Dr Saba Asif says the accolades from AROC are well deserved by the whole team who have worked hard to deliver exceptional care for patients.

"We are an intensive rehabilitation unit. The team is very coordinated and we work closely together and respect each other," Dr Asif says.

"I am very proud of the whole team for this achievement. Everyone has put in a lot of work and this is well deserved recognition for the team effort."

Dr Saba Asif

Dr Asif says she is particularly proud that this is the second time the team has achieved this honour in recent years.

The Blue Mountains Hospital rehabilitation team employ a model of care that focuses on early intervention, family and carer involvement and personalised care, which Dr Asif says is contributing to the team's great work with patients.

"We know that to achieve a better prognosis, it is better for patients to come to us as soon as possible following their stroke and so we begin our work with them immediately."

"We also determine very clear, patient-focussed and achievable goals based on each individual's needs. Our weekly team meetings ensure we're collaborating effectively and that the focus remains on working towards each patient's personalised plan," says Dr Asif.

"We know that the journey for patients does not end when they leave hospital and so we begin discharge planning in anticipation of their needs after hospital very early on. This means we involve family and carers early and we work closely with them throughout the patient's rehabilitation."

Dr Asif says the recent recognition of the Blue Mountains team's work by a peak body should assure community members that their journey with the rehabilitation team will give them the best possible experience of care.

"We want our community to know that we're very patient-focussed and will work closely with you and your family to help you achieve positive outcomes, improving your functional abilities and independence following a stroke," says Dr Asif.

/Public Release. This material from the originating organization/author(s) might be of the point-in-time nature, and edited for clarity, style and length. Mirage.News does not take institutional positions or sides, and all views, positions, and conclusions expressed herein are solely those of the author(s).View in full here.

Why?

Tags: Australia , New Zealand , NSW , ANZAC , hospital , Blue Mountains , New South Wales , community , Government , family , quality , stroke , carer , outcomes , early intervention , peak body , quality of life , stroke rehabilitation , rehabilitation

Stroke patients failed by 'postcode lottery rehabilitation' - New Zealand

Actually the vast majority of stroke patients are failed since only 10% get fully recovered. So write the headlines correctly.

Stroke patients failed by 'postcode lottery rehabilitation' - New Zealand

Andrea Vance05:00, Dec 19 2022

• 
  

The Conductor

Iain McGregor/Stuff 

Hamish McKeich was in the prime of his career when he suddenly collapsed and lost feeling in the right half of his body.

The video above tells the full story of Hamish McKeich, the conductor who can only use one arm. 

Stroke patients are failing to recover properly because of patchy provision of rehabilitation on discharge from hospitals, advocates have warned.

To add insult to injury, sufferers are not covered by the no-fault state insurance scheme because it is judged a “non-injury disability” – despite the devastating effects.

Stuff recently featured the story of Hamish McKeich who has returned to conducting after months of intensive therapy.

READ MORE:
* 'Amazing people' - stroke victim pays tribute to staff after months spent in Waikato Hospital
* Treatment injuries for misdiagnosed strokes costing $1.5 million per year

Despite partial paralysis on his right, dominant side, the principal conductor in residence is able to guide New Zealand Symphony Orchestra musicians with one hand.

But Stroke Foundation chief executive Jo Lambert says not every patient is so lucky.

This story is featured on Stuff’s The Long Read podcast. Check it out by hitting the play button below, or find it on podcast apps like Apple Podcasts, Spotify or Google Podcasts.

“We have people falling off the edge of a cliff when they come home,” Lambert said. “That’s how they describe it to us. They leave hospital and there is nothing.

“And because the clinical environment is stretched at the moment, the chances of getting an early consult from a physio, occupational therapist in their home or a speech language therapist, they are very hard to get hold of.”

Iain McGregor/Stuff

Stuff recently featured the story of Hamish McKeich, who suffered a devastating stroke but has returned to conducting.

The Stroke Foundation is able to plug the gap and connect people with those services – but Lambert says there is also no nation-wide electronic system in place to transition patients into their care.

Post-clinical care varies from hospital to hospital in a ‘post code lottery’ of services, she said.

“If you're deemed worthy enough, you'll get social services. But for everybody else, it's effectively fend for yourself.”

Lambert spoke of one heartbreaking case in which an elderly man was discharged into the care of his wife, who had Alzheimer's. “Three weeks later, his neighbour rang us up and said, I think you need to come and do something because he's still in the same clothes he was in three weeks ago, and he's wasting away.”

Experts say early intervention is crucial as patients experience a heightened state of neuroplasticity immediately after a stroke, giving a better chance for the brain to rewire itself.

Iain McGregor/Stuff

Over 9,500 strokes occur each year.

Lambert says it is also inequitable that those who have experience a stroke are not able to access Accident Corporation Compensation services, like rehabilitation and income cover. It was always intended that the scheme be extended to non-accident disability, but the second stage of that implementation was never completed.

Stroke is the country’s leading cause of adult disability, with one occurring every 55 minutes. New Zealand’s population is ageing, and those in Maori, Pacific and Asian communities are also having strokes at a younger ages. The Stroke Foundation is also predicting a 40% increase in stroke rates over the next decade, increasing the economic cost from $1.1 to 1.7 billion a year.

“We would advocate for the opening up of ACC,” she said. “It’s not someone’s fault if they have had a stroke, and it is unfair. One in four of us will be affected in our lifetime and 64,000 people have been impacted by stroke.

“These are big statistics – but people don’t see it, and they associate strokes with old age when in fact people live really good lives after a stroke when they get the right support.”

Ultra-Long Transfers for Endovascular Thrombectomy—Mission Impossible?: The Australia-New Zealand Experience

It makes zero difference in the requirements of the patient, it is still 100% RECOVERY. Don't you dare use distance or time as an excuse not to get there. 

Ultra-Long Transfers for Endovascular Thrombectomy—Mission Impossible?: The Australia-New Zealand Experience

Carlos Garcia-Esperon,

Teddy Y. Wu,

Vinicius Carraro do Nascimento,

Bernard Yan,

Craig Kurunawai,

Tim Kleinig,

Gregory Selkirk,

David Blacker,

P. Alan Barber,

Annemarei Ranta,

… See all authors

and on behalf of the ANZ Ultra-Long EVT Transfer Group

Originally published23 Nov 2022https://doi.org/10.1161/STROKEAHA.122.040480Stroke. 2022;0

Abstract

BACKGROUND:

Endovascular thrombectomy (EVT) access in remote areas is limited. Preliminary data suggest that long distance transfers for EVT may be beneficial; however, the magnitude and best imaging strategy at the referring center remains uncertain. We hypothesized that patients transferred >300 miles would benefit from EVT, achieving rates of functional independence (modified Rankin Scale [mRS] score of 0–2) at 3 months similar to those patients treated at the comprehensive stroke center in the randomized EVT extended window trials and that the selection of patients with computed tomography perfusion (CTP) at the referring site would be associated with ordinal shift toward better outcomes on the mRS.

METHODS:

This is a retrospective analysis of patients transferred from 31 referring hospitals >300 miles (measured by the most direct road distance) to 9 comprehensive stroke centers in Australia and New Zealand for EVT consideration (April 2016 through May 2021).

RESULTS:

There were 131 patients; the median age was 64 [53–74] years and the median baseline National Institutes of Health Stroke Scale score was 16 [12–22]. At baseline, 79 patients (60.3%) had noncontrast CT+CT angiography, 52 (39.7%) also had CTP. At the comprehensive stroke center, 114 (87%) patients underwent cerebral angiography, and 96 (73.3%) proceeded to EVT. At 3 months, 62 patients (48.4%) had an mRS score of 0 to 2 and 81 (63.3%) mRS score of 0 to 3. CTP selection at the referring site was not associated with better ordinal scores on the mRS at 3 months (mRS median of 2 [1–3] versus 3 [1–6] in the patients selected with noncontrast CT+CT angiography, P=0.1). Nevertheless, patients selected with CTP were less likely to have an mRS score of 5 to 6 (odds ratio 0.03 [0.01–0.19]; P<0.01).

CONCLUSIONS:

In selected patients transferred >300 miles, there was a benefit for EVT, with outcomes similar to those treated in the comprehensive stroke center in the EVT extended window trials. Remote hospital CTP selection was not associated with ordinal mRS improvement, but was associated with fewer very poor 3-month outcomes.

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Auckland DHB opens New Zealand’s first integrated stroke and rehabilitation unit

Better outcomes is NOT GOOD ENOUGH! Since you don't tell us actual results I'm assuming they are pitiful. You don't want to go here if they don't tell you EXACTLY how good they are.

Auckland DHB opens New Zealand’s first integrated stroke and rehabilitation unit

Today Auckland DHB launched Taiao Ora, or Ward 51, at Auckland City Hospital, the first integrated stroke and rehabilitation unit in the country.

The project was initiated in 2019, when former Health Minister David Clark announced the investment of $30 million for the unit.

Taiao Ora, which was built in what was previously an administration suite on Level 5 of Auckland City Hospital, adds a much-needed 41 new beds to the hospital. It enables stroke patients to have all their care delivered in a single, specially designed facility, from hyper-acute (including clot retrieval) and acute care to rehabilitation.

The ward will also accommodate acute neurology patients and people under 65 years of age who require intensive rehabilitation and will benefit from the rehabilitation environment and specialist expertise of the clinical team.

Auckland DHB Neurologist Professor Alan Barber says: “We’re delighted to be opening Taiao Ora which will care for people from Auckland and around New Zealand.

“We know from research that stroke patients treated in an integrated unit have much better outcomes. Recovering from a stroke can be a daunting experience for patients and their whānau, but the journey will be that much easier in our world-class unit(NO proof of this claim), which is one of a kind in New Zealand.”

Anna McRae, Allied Health Director for Adult Community and Long-Term Conditions at Auckland DHB, says: “Stroke is the third largest killer in New Zealand. Every year in our country around 9,000 people have a stroke and about 2,500 people die of a stroke. Stroke is also a leading cause of long-term disability. It’s vital for us as clinicians to optimise rehabilitation opportunities for our stroke patients to give them the best chance of recovery.

“We’ve created Taiao Ora, meaning a wellness environment, as a safe, healing space to support patients on their rehabilitation journey to improved health and well being; as well as a number of shared spaces to encourage whānau involvement. We’ve brought in natural elements – including harakeke, kawakawa, tui, pōhatu and awa through the use of large murals, colours, textures, lighting and flooring.”

Barry Snow, Director of Adult Medical for Auckland DHB, says: “I’m proud of our team who have led and contributed to Taiao Ora, which puts patients and whānau at the centre and enables our patients to have the very best recovery journey. Every part of the design has been clinically led with input from patients and whānau and draws on international best practice.”

Taiao Ora is the first project in Building for the Future, Auckland DHB’s programme of work to create sufficient hospital capacity to continue to provide safe, high quality care for Auckland’s rapidly growing and aging population.

The Auckland Health Foundation, which fundraises for Auckland DHB’s adult health services, has contributed more than $188,000 to Taiao Ora for additional state-of-the-art equipment to accelerate patient recovery, and help create spaces to improve the physical and mental health of patients.

 

'Stroke research that is saving lives'

 Great, but what the fuck are you doing to get survivors to 100% recovery?

'Stroke research that is saving lives' 

For the last twelve years, the Chair of Clinical Neurology has been revolutionising the way New Zealand treats strokes that come into the Emergency Department.Year after year the number of Kiwis affected by stroke has been on the rise. It is estimated that in 2020 11,000 Kiwis will be affected by a stroke. This staggering number proves how desperately we need more research into the treatment and rehabilitation of stroke patients.In 2008 a group of people who believed in what research could accomplish helped establish the Neurological Foundation Chair of Clinical Neurology. This position’s aim was to bridge the gap between neuroscience and neurology, with the theory that this strategy would improve patient outcomes if researchers could work alongside clinicians.In 2011, this theory was proven correct when Professor Alan Barber, Chair of Clinical Neurology and the team of clinicians, nurses, researchers and rehabilitation specialist introduced New Zealand to the revolutionary clot retrieval procedure. This procedure, better known in the medical world as a thrombectomy was known as ‘science fiction’ when Professor Barber first started out. "Thrombectomy used to be science fiction. Now we are routinely going in and pulling out clots. One in every five people who receive the treatment will return home as healthy as they were before the stroke occurred."Since 2011, the work the Chair of Clinical Neurology has conducted has treated over 1,000 Kiwis across Auckland, Wellington and Christchurch, saving more than 200 lives that normally wouldn’t have survived."Currently we’re thrombolysing around 10% percent of stroke cases in New Zealand. In some centres they’re managing to thrombolyse up to 20% of stroke patients. About a third of people are going to do better than if they hadn’t had the drug. A few times a year, I see a miraculous response. "When the Chair was first introduced, Professor Barber only had one stroke nurse specialist. As a team, the nurse and him would visit all newly admitted stroke patients. From there the next step was to establish a stroke unit within the neurology ward. It was only four beds at first, but it was a beginning of something no one could imagine. Now, they not only have an entire stroke ward and research centre dedicated to treating incoming strokes with either the clot busting drug alteplase, (also led by the Chair of Clinical Neurology programme) and the clot retrieval procedure, they also have a rehabilitation specialist and her team working with patients after their stroke.Professor Cathy Stinear and her team developed the PREP2 algorithm for predicting hand and arm function after stroke. This algorithm is used to develop personalised rehabilitation programmes for each patient to optimise their recovery after stroke. PREP2 is now routine clinical care at Auckland Hospital and several other DHBs around the country. Cathy and her team also developed the TWIST algorithm, which predicts whether and when a patient will be able to walk unaided following stroke. The algorithm is being tested at Auckland, North Shore and Waitakere hospitals currently, and hopefully will be used in rehabilitation regimes in the future.Professor Barber says that none of these achievements would have been possible without the ongoing support of the Neurological Foundation, which last year committed $2.2 million to not only fund the Chair of Clinical Neurology role for another five years, but also to take on a new research fellow. This both provides support to the Chair, as well as begins the training of the next generation of neurologists and neuroscientists."Thanks to the Neurological Foundation and their loyal supporters, we have created an environment where neurological researchers can gather data from real-life clinical situations every day."Professor Barber will be speaking via webinar on 14 October, to provide an update on stroke clot retrieval in New Zealand. Free for anyone to attend, registrations can be made at https://ccn-2020.eventbrite.co.nz 

 

Treatment injuries for misdiagnosed strokes costing $1.5 million per year

What is your hospitals percentage of misdiagnosed strokes? If they don't know they aren't a stroke hospital at all. Run run run away.  There should be no subjective diagnosis of stroke at all. 

Just maybe you want extremely fast diagnosis, getting the neurologist out of the picture.

Hats off to Helmet of Hope - stroke diagnosis in 30 seconds   February 2017

 

Microwave Imaging for Brain Stroke Detection and Monitoring using High Performance Computing in 94 seconds March 2017

 

New Device Quickly Assesses Brain Bleeding in Head Injuries - 5-10 minutes April 2017

The latest here:

Treatment injuries for misdiagnosed strokes costing $1.5 million per year

Brittany Keogh05:00, Jul 31 2020

STUFF

Vicky Keen's stroke was misdiagnosed as an anxiety attack by staff at Middlemore Hospital.

ACC is paying out more than $1.5 million in compensation per year for treatment injuries relating to misdiagnosed strokes.

In 2010, ACC spent $540,251 on such claims. A decade later, the yearly bill has soared to $1,593,468.

During this period, the number of active claims for misdiagnosed strokes rose from 10 to 18, meaning the cost per patient nearly doubled.

Ryan Anderson/Stuff-co-nz

Pukekohe resident Vicky Keen's stroke was misdiagnosed as an anxiety attack at Middlemore Hospital

Most of the claims were paid out over multiple years. In total, there were 33 active claims in the past decade, totalling $10,524,557.

READ MORE:
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Auckland stroke victim Vicky Keen, who was misdiagnosed with anxiety at Middlemore Hospital in July 2011, said the figures were disappointing.

“There’s a problem. That’s really, really scary that there’s that much going on and that people like me are complaining, but we’re not being heard. It’s still happening,” Keen said.

The mum-of-three was sent home from hospital after doctors misinterpreted her brain scan, only to be rushed back to the emergency department hours later after having a second stroke.

The strokes left her with slurred speech and little coordination in her right hand. Her recovery involved months of physio and speech therapy.

ACC accepted her treatment injury claim for loss of income.

Keen’s husband, John Keen, said while Kiwis were lucky to have a compensation scheme like ACC, when it came to misdiagnosed strokes it seemed like “the ambulance at the bottom of the cliff”.

Ryan Anderson/Stuff-co-nz

Vicky and John Keen at home.

He wanted to see more investment into preventing strokes in the first place.

Keen was horrified to discover another Middlemore stroke patient, Edwin Donald Amundsen, was misdiagnosed with a migraine and discharged from hospital.

He was also rushed back to hospital, but died.

In a report into Amundsen’s death, coroner Katharine Greig identified several “missed opportunities” for diagnosis and treatment by multiple medical staff at the Counties Manukau and Auckland DHBs.

She concluded it was possible Amundsen may have survived if he had the right treatment earlier.

A 33-year-old woman who had two strokes was sent home from Christchurch Hospital's emergency department three times in four days, despite vomiting, experiencing vertigo and worsening head and neck pain and struggling to walk.

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Doctors had misdiagnosed her with an ear infection and migraine.

The woman complained to Health and Disability Commissioner Anthony Hill, who found Canterbury District Health Board’s care of the woman was substandard.

ACC chief clinical officer Dr John Robson said although it was rare for strokes to be misdiagnosed, because they could be serious and life-threatening, survivors sometimes needed support for the rest of their lives.

While advances in technology had improved treatment options, they were also more expensive.

Rehabilitation for stroke patients funded through ACC could include home care, transport costs, and physical therapy, depending on their specific needs.

Some people also received weekly compensation for lost earnings.