nurses

Poster Session for Nurses/AHP's

Date: Tuesday 26 May 2009
Time: 12:00 - 13:30
1.
Early prediction of gait after stroke: The EPOS study. What is the optimal moment for early assessment of sitting balance?
Background: 70-80% of stroke survivors regain independent gait. Sitting balance in the sub acute phase seems to be predictive for recovery of gait abilities. EPOS is an acronym that stands for Early Prediction of Outcome after Stroke and is aimed at investigating the accuracy of early clinical determinants assessed at 2, 6, 9 and 12 days in hospital stroke units for final outcome at 6 months. In the present study, the predictive value of sitting balance is investigated for outcome of walking ability at 6 months. Methods: Prospective longitudinal cohort study concerning first-ever ischemic stroke patients without pre-existent functional limitations. Trunk Control Test sitting (TCT-s) score was obtained. A TCT-s score of 25 points indicated unsupported sitting balance was present. Functional Ambulation Categories (FAC) score ≥4 at 6 months post stroke was considered as independent gait. Logistic regression was applied. Results: 89 patients, aged 67.7 (+/- 15.2) years, were included. 82.4% of the patients walked independent at 6 months post stroke. At 2 days post stroke the positive predictive value for TCT-s was 0.96. The negative predicted value increased from 0.53 (2 days post stroke) to 0.83 12 days post stroke). Sensitivity ranged from 0.84 at day 2 to 0.97at day 12 post stroke whereas specificity varied from 0.63 at day 12 to 0.83 at day 2. Conclusion: Early unsupported sitting (within 3 days post stroke), allows setting of clear rehabilitation goals to achieve independent gait. However, absence of early return of sitting balance within 3 days is less predictive for walking ability. Those patients in which sitting balance is still absent at 12 days post stroke the accuracy in predicting absence of independent gait is increased, suggesting that early monitoring of improvement in sitting balance contributes to predict walking ability at 6 months post stroke.
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J.M.Veerbeek, VU University Medical Center, Amsterdam, THE NETHERLANDS
E.van Wegen   VU University Medical Center Amsterdam THE NETHERLANDS
B.C.Harmeling - van der Wel Erasmus MC Rotterdam THE NETHERLANDS
M.Koolstra VU University Medical Center Amsterdam THE NETHERLANDS
G.Kwakkel VU University Medical Center Amsterdam THE NETHERLANDS

Poster Session for Nurses/AHP's

Date: Tuesday 26 May 2009
Time: 12:00 - 13:30
2.
A quality improvement project to maintain quality stroke care using a stroke champion approach.
The Royal College of Physicians Sentinel Audit is a measure of the quality and process of stroke care outcomes in the UK. Salford Royal Foundation Trust sentinel audit score has improved from 63% in 2004 to 81% in 2006 and further still to 88% in 2008. A successful pilot project was completed in 2008 to test a stroke champion method of achieving unprecedented improvements in quality care and maintaining them throughout the year as well as within the time of audit. The stroke champion approach is a method of motivating the clinical team to evaluate the quality of care provided and level of performance on a monthly basis. Each member of the team is allocated a process indicator to champion. Champions work to improve services by process mapping the current system and identifying weaknesses. The team, led by the champion, worked to improve or re-design the system where required. The pilot project took place between March and September 2008. The average composite sentinel audit score June 2007 -February 2008 was 73%. This increased to 91% between March and September 2008 showing a vast improvement in the quality of care given. The trust average length of stay for stroke patients April 2007 - July 2008 was 25 days. This reduced to 17 days by November 2008 showing an 8 day reduction in the average length of stay. Based on the reduced average length of stay we calculate a saving of £1,000 per patient using an average bed cost per day of £125. Total saving over a 3 month period (August to October 08) approximates to £113,000. With this additional capacity an additional 53 strokes can be treated. The initial pilot showed that the stroke champion methodology has worked within our institution to improve quality. The clinical team will maintain this work in 2009 and also champion provision of bundles of care (Nolan, 2006) to improve standards further.
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S.K.Marshall, Salford Royal Foundation Trust, Salford, UNITED KINGDOM
L.Spencer   Salford Royal Foundation Trust Salford UNITED KINGDOM
L.Swindells Salford Royal Foundation Trust Salford UNITED KINGDOM
J.Wainwright Salford Royal Foundation Trust Salford UNITED KINGDOM
M.Power Salford Royal Foundation Trust Salford UNITED KINGDOM
P.J.Tyrrell University of Manchester Manchester UNITED KINGDOM

Poster Session for Nurses/AHP's

Date: Tuesday 26 May 2009
Time: 12:00 - 13:30
3.
Early Supported Discharge following stroke: evaluation of a new service in North Staffordshire
Background A Stroke Early Supported Discharge (SESD) service has the potential to reduce long-term mortality, institutionalisation rates, hospital stays and overall costs of service provision in hospitals, whilst promoting long-term independence for a substantial proportion of people with stroke. A new SESD service was piloted for 6 months in the stroke service in North Staffordshire (UK) and subsequently evaluated. Methods A range of outcome measures was used to evaluate the service at various stages: NIHSS, Rankin Scale (RS), Barthel Index (BI), Nottingham Extended Activities of Daily Living (NEADL), Caregiver Strain Index, HADS, EuroQOL. Number of readmissions and GP contacts 1 month after discharge were recorded. Patient/carer satisfaction was surveyed post-discharge and staff views were noted. Results The pilot supported 71 people with stroke (age range 31-93 years). Average length of hospital stay decreased by 6.1 days, an estimated 433 saved bed days. Between first and last visits by the team: average BI scores increased significantly by 2 points (p<.05) but decreased on withdrawal of support; average RS scores decreased significantly (p<.05) by 1 point but increased again on withdrawal of support; average NEADL scores increased significantly (p<.05) by 14 points and were maintained after withdrawal of support. Carer strain was not significantly increased on withdrawal of support. Re-admission rates (7%) and GP contacts (n=6) were low. Patient/carer/staff satisfaction was high. Conclusion/discussion This SESD scheme was effective in reducing overall hospital stay and improving independence in ADL and participation in extended ADL whilst retaining low readmission rates and GP consultations. Patients, carers and staff were highly satisfied with the service. A SESD scheme is an effective service development for stroke. Further plans include an expansion of current team numbers as well as additional new roles such as a nurse practitioner and then further evaluation.
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S.M.Hunter, Keele University, Keele, Staffordshire, UNITED KINGDOM
R.Beech   Keele University Keele, Staffordshire UNITED KINGDOM
P.Crome Keele University / North Staffordshire Combined Healthcare NHS Trust Stoke-on-Trent, Staffordshire UNITED KINGDOM
E.Hall North Staffordshire Combined Healthcare NHS Trust Stoke-on-Trent, Staffordshire UNITED KINGDOM
M.O'Mara North Staffordshire Combined Healthcare NHS Trust Stoke-on-Trent, Staffordshire UNITED KINGDOM
C.Roffe Keele University / North Staffordshire Combined Healthcare NHS Trust Stoke-on-Trent, Staffordshire UNITED KINGDOM
J.Rushton North Staffordshire Combined Healthcare NHS Trust Stoke-on-Trent, Staffordshire UNITED KINGDOM
J.Statham North Staffordshire Combined Healthcare NHS Trust Stoke-on-Trent, Staffordshire UNITED KINGDOM

Poster Session for Nurses/AHP's

Date: Tuesday 26 May 2009
Time: 12:00 - 13:30
4.
Post-stroke depression in the acute phase and nursing implications. A systematic literature review.
Background Depression in association with stroke is a well known condition, and considered to be one of the most prevalent emotional symptoms, occurring in at least 30 % of post-stroke patients within the first year after onset. Post-stroke depression (PSD) tends to be at its highest level within the first month after stroke. Early depression is associated with continued depression in later post-stroke stages. In the case of the depressed stroke survivor, the knowledge and skill of the nurse can be of great importance. Methods A computer-aided search in Medline, CINAHL and PsychInfo, was performed. “Depression” was combined with “stroke” (MEDLINE and CINAHL), and “Cerebrovascular Accident” (PsychInfo). The search was limited to acute phase, defined as; within the first month post-stroke, and in articles published between January 1993 and June 2008. Results and discussion PSD has created a degree of controversy in the available literature. Despite this; PSD is considered a pronounced problem that influences life after stroke, both for patients and their relatives. PSD is often neither diagnosed nor treated. An emotional symptom often appears to happen by mere chance. Nurses spend much time with the stroke patient during the acute phase and have an opportunity to observe and identify symptoms of PSD. Nurses can learn how to manage observer-rated scales or assist the stroke survivor in completing the self-assessment questionnaires. Studies indicate that nurse-led intervention in regard to stroke patients - when started at an early stage - may have an impact on the development of PSD. This demands time, opportunity, knowledge and skills. It is of importance that nurses demonstrate responsibility and highlight the fact that depression after stroke is a considerable problem for many survivors.
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S.E.Kouwenhoven, Department of Health Science, Buskerud University College , Drammen, NORWAY
M.Kirkevold   Institute of Nursing and Health Science, University of Oslo Oslo NORWAY
H.S.Kim Department of Health Science, Buskerud University College Drammen NORWAY

Poster Session for Nurses/AHP's

Date: Tuesday 26 May 2009
Time: 12:00 - 13:30
5.
Survey of “Stroke understanding” amo the Nursing Staff of a busy District General Hospital
Introduction: Stroke is the 3rd largest cause of death and is the largest cause of adult disability in the UK. 2008 Stroke sentinel audit showed 98% of the district general hospital in the UK has stroke unit. Most of the patients admitted in these hospitals are managed in A&E/ MAU and other acute medical wards during first 24-48 hrs before being transferred to the Stroke unit. Early admission to hospital is critical for the effective implementation of early treatment strategies for stroke which have been shown to reduce morbidity, mortality and cost associated with the condition. Appropriate management of stroke patient including nursing and therapy input is vital for the long term morbidity and mortality in stroke. Aim & Method: Total of 250 Questionnaires distributed to all the nursing staff members in A district general hospital to assess understanding and approach towards stroke. Only the medical wards and A&E were included. Results: Of 188 responders, 184 (95%) staff agreed stroke affects the Brain, although 83 (44%) staff also believed stroke affects the Muscle, 47 (25%) Heart, and 40 (21%) Other organs. A total of 185 (98%) Hypertension as an important risk factor, 177 (94%)High Cholesterol, only 126 (67%) identified Diabetes as an important risk factor for Stroke. 188 (100%) agreed CT Scan of Brain is a must, only 141 (75%) included ECG and 98 (52%) wanted to check blood glucose levels. 178 (71%) of staff suggested Aspirin for ischemic stroke, 59 (31%) suggested Aspirin use in Intra cerebral Bleed. Only 141 (75%) believed all stroke patient must be treated in a Stroke Unit, 76 (40%) staff thought all stroke should be discharged to nursing home. Conclusion: Understanding of stroke among the nursing staffs in wards was variable. More training and information is required to keep our staffs updated and well informed. Nursing staff education and information about stroke is a vital aspect for stroke care in our hospital.
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A.NASIM, ASHFORD AND ST PETERS NHS TRUST, ASHFORD MIDDLESEX, UNITED KINGDOM
B.MANDAL   ASHFORD AND ST PETERS NHS TRUST ASHFORD MIDDLESEX UNITED KINGDOM
P.ENWERE ASHFORD AND ST PETERS NHS TRUST ASHFORD MIDDLESEX UNITED KINGDOM
Z.DHAKAM ASHFORD AND ST PETERS NHS TRUST ASHFORD MIDDLESEX UNITED KINGDOM

Poster Session for Nurses/AHP's

Date: Tuesday 26 May 2009
Time: 12:00 - 13:30
6.
Nursing of acute stroke patients admitted for iv thrombolysis to the stroke unit of a Greek tertiary care hospital
Background: In Greece, acute stroke remains a medical emergency with poor prognosis, as one-year mortality reaches 37%. The General Hospital “Papageorgiou” in Thessaloniki, is one of the few tertiary care facilities in Greece with a fully equipped stroke unit. Since 2003, the unit offers intravenous thrombolysis for acute ischaemic stroke. Methods: We report the results of specialised medical treatment and nursing to patients admitted to the hospital’s stroke (6 beds, all with non-invasive monitoring facilities) unit for i.v. Thrombolysis. Results: Main characteristics of nursing care in the department’s stroke unit are: immediate and repeat monitoring of vital signs and the clinical course of the patient, close control of therapeutic interventions, prevention and treatment of stroke complications (deterioration of the patient’s neurological state, cardiac complications, systemic complications, e.g. infections, thromboses, pressure sores). Since 2003, a total of 37 patients (24 male, 13 female mean age 56 yrs., median NIHSS score 9) has been treated with rt-PA within a 3 hours time window from symptom onset, following a protocol that strictly adhered to the guidelines of the European Stroke Organisation. 28 of the 37 patients experienced a rapid and sustained amelioration of their neurological symptoms, 4 patients remained with moderate to severe functional deficits, and 5 patients died within 3 months from treatment (3 from space-occupying infarction, one from cardiac arrest, and one from symptomatic intracranial haemorrhage due to uncontrolled hypertension). Conclusion: Dedicated nursing care for acute stroke patients is the prerequisite for specific treatment options. However, Thrombolysis remains an option for a minority of Greek stroke patients. Today, the Greek National Health System is lacking both stroke units as well as adequately trained stroke nurses, in order to ameliorate the prognosis of acute stroke patients.
Graphic: http://www.esc-archive.eu/stockholm09/graphics_stockholm/nurses/g_naid11.htm
Table: http://www.esc-archive.eu/stockholm09/graphics_stockholm/nurses/t_naid11.htm

T.Papadopoulos, Department of Neurology, General Hospital "Papageorgiou", Thessaloniki, GREECE
V.Papadopoulos   Department of Neurology, General Hospital "Papageorgiou" Thessaloniki GREECE
J.Rudolf Department of Neurology, General Hospital "Papageorgiou" Thessaloniki GREECE
I.Tsiptsios Department of Neurology, General Hospital "Papageorgiou" Thessaloniki GREECE

Poster Session for Nurses/AHP's

Date: Tuesday 26 May 2009
Time: 12:00 - 13:30
7.
The role of blood pressure monitoring in rTPA treated patients and haemorrhagic transformation.
Background and Purpose— The monitoring of physiological parameters in the acute phase of ischemic stroke can be considered an important management tool that can improve significantly the quality of care provided, allowing easier detection and correction of complications and consequently having a favourable effect on outcome. We focused our attention on blood pressure monitoring in the acute phase of ischemic stroke patients treated with rTPA and we investigated the possible relationship between blood pressure levels and hemorrhagic transformation of cerebral infarction (HTI). Methods— We retrospectively evaluated the possible role of blood pressure levels in patients with ischemic stroke treated with recombinant tissue plasminogen activator (rTPA) within 3 hours after symptoms onset. We treated, accordingly to the international recognised criteria for the management of acute ischemic stroke, 73 consecutive patients admitted to our stroke unit between 2001-2007. Patients’ age ranged between 32 and 82 years (mean age 67 years). Hemorrhagic complications by reviewing neuroimaging findings were evaluated. Blood pressure was recorded before rTPA and at 6, 12, 18, 32 hours. Results—Total cerebral haemorrhage occurred in 8 (10.9%) patients. Symptomatic intracerebral haemorrhages were 6 (8.3%). Systolic blood pressure was significantly higher in patients with HTI in comparison with rTPA treated patients without haemorrhagic complications (p<0.03) at all time point except sBP at the 32nd hour. Conclusions—This study indicate that rTPA induced haemorrhage depends on sBP. BP monitoring is very important to detect variation over the indicated limits, especially for systolic pressure levels. More aggressive pharmacological reduction of hypertension during fibrinolysis may reduce this complication. Further studies in larger populations are needed. The role of nurses in this settings is discussed.
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M.Bortoluzzi, Neurology S. Bortolo Hospital, Vicenza, ITALY
J.Bagnara   Neurology S. Bortolo Hospital Vicenza ITALY
A.Barbieri Neurology S. Bortolo Hospital Vicenza ITALY
E.De Cao Neurology S. Bortolo Hospital Vicenza ITALY
G.Carli Neurology S. Bortolo Hospital Vicenza ITALY
A.Casarotto Neurology S. Bortolo Hospital Vicenza ITALY
E.Ceron Neurology S. Bortolo Hospital Vicenza ITALY
C.Fongaro Neurology S. Bortolo Hospital Vicenza ITALY
S.Pampanin Neurology S. Bortolo Hospital Vicenza
S.Molon Neurology S. Bortolo Hospital Vicenza ITALY
M.Sensati Neurology S. Bortolo Hospital Vicenza ITALY
F.Sorgato Neurology S. Bortolo Hospital Vicenza ITALY
M.Zaffanello Neurology S. Bortolo Hospital Vicenza ITALY
A.De Boni Neurology S. Bortolo Hospital Vicenza ITALY
F.Perini Neurology S. Bortolo Hospital Vicenza ITALY

Poster Session for Nurses/AHP's

Date: Tuesday 26 May 2009
Time: 12:00 - 13:30
8.
Evaluation of an Intervention Program Targeted at Improving Balance and Functional Skills After Stroke
Background: Falls after stroke affect the person in more than one way. A fall can result in a fracture which is a very concrete effect of the fall. Another effect is the fear of falling that often follows and can reduce activity and thereby increase the need of assistance. The purpose of this study was to reduce the incidence of fall risk factors. Methods: A randomized controlled trial evaluated the effect of an intervention program. Consecutive in-hospital patients at the Umea Stroke Unit were screened for inclusion criteria. At 3-6 months after stroke onset, the patients were randomized with minimisation. Both groups received a 5-week program, the intervention group (IG) met 3 days a week for 2-3h/time and the control group (CG) met 1 day for 1h/time. All patients underwent baseline, post-test assessments as well as follow-up assessments at 3 and 6 months. Primary outcome measure Bergs Balance Scale (BBS) and secondary outcome measures were Falls Efficacy Scale (FES-I), walking ability, Functional Independence Measure (FIM) and Barthel’s Index and number of falls. Fall diaries were administered for 6 months. The study is registered at www.clinicaltrials.gov, NCT00377689. Results: 34 patients (15 IG and 19 CG) were recruited and randomized. Baseline characteristics were without significant differences. A tendency, but not significant, was seen with the IG in improvement in BBS by using repeated measure statistics. Improvement was also seen with the IG in ADL between baseline and post-test assessments (p<0.05) and at 3 and 6 month follow-up (p≤0.05). Conclusion: The IG showed a non-significant improvement in balance as measured by BBS. Significant improvements in the IG were proven in ADL. Focus on functional rehabilitation is likely a reason for the improvements in this study. This study supports the concept that risk of falls after stroke can be ameliorated by a structured intervention program.
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E. S.Holmgren, Umeå University nstitution of Community Medicine & rehabilitation, Umeå, SWEDEN
P.Wester   Umeå University Institution of Public Health & Clinical Medicine Umeå SWEDEN

Poster Session for Nurses/AHP's

Date: Tuesday 26 May 2009
Time: 12:00 - 13:30
9.
The role of family visiting in the hospital during stroke rehabilitation
Background: The hospital stroke rehabilitation is a complex team-work; in this special process the stroke care team often collaborates with the patient’s relatives facilitating the learned exercises after hospital rehabilitation. In our study we examined the effect of the patient’s relatives on the patient’s cognitive and functional state improvement in the first hospital rehabilitation phase. Methods: We studied 70 patients with acute ischemic stroke, admitted to our centre for rehabilitation. The patients’ Functional Independence Measure (FIM) and Barthel Index were recorded at admission and discharge and they were interviewed to assess the frequency and other characteristics of family visits. All patients were rehabilitated with same intensity and methods by same nurses and physiotherapists. Results: The patients were assigned to two groups according to frequency of family visiting. Between the visited (V) group (n=42) and non-visited (NV) group (n=28) we have not found significant differences in gender, age (mean: 58.0 +/- 5.9 vs. 58.1 +/- 4.8 years), localization of stroke and hospital stay (68.6 +/- 27.4 vs. 55.6 +/- 37.7 days). Also there were no differences between FIM and Barthel indexes on admission. There were significant improvement in V group in the self care (p=0.006), (especially in bathing, dressing, toileting) and use of mobility items (p=0.002), locomotion (p=0.001), and psychosocial adjustment (p=0.002) compared to NV group. We have not found changes between the levels of improvement in communication and sphincter control. Certainly, in both groups significant correlation were observed between hospital stay and grade of improvement. Conclusion: The results of present study underline the important role of health care workers in the stroke rehabilitation. The patient’s family and their relatives also help the patient’s physical and psychosocial development in the hospital rehabilitation period.
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J.Betlehem, Faculty of Health Science, University of Pecs, Pecs, HUNGARY
B.Panovics   Rehabilitation Centre of Szigetvar Hospital Szigetvar HUNGARY
J.Marton-Simora Faculty of Health Science, University of Pecs Pecs HUNGARY
G.Nagy Faculty of Health Science, University of Pecs Pecs HUNGARY

Poster Session for Nurses/AHP's

Date: Tuesday 26 May 2009
Time: 12:00 - 13:30
10.
Effects of task-oriented circuit class training on walking competency after stroke: A systematic review
Background There is increasing interest in the potential benefits of circuit class training after stroke, but its effectiveness is uncertain. Our aim was to systematically review randomized controlled trials of task-oriented circuit class training on gait and gait-related activities in patients with stroke. Methods A computer-aided literature search was performed to identify randomized controlled trials (RCTs) in which the experimental group received task-oriented circuit class training focusing on the lower limb. Studies published up to March 2008 were included. The methodological quality of each study was assessed and studies with the same outcome variable were pooled by calculating the summary effect sizes (SES) using fixed or random effects models. Results Six of the 445 studies screened, comprising 307 participants, were included. PEDro scores ranged from 4 to 8 points, with a median of 7.5 points. The meta-analysis demonstrated significant homogeneous summary effect sizes in favor of task-oriented circuit class training for walking distance (0.43; 95%CI: 0.17-0.68; p<0.001), gait speed (0.35; 95%CI: 0.08-0.62; p=0.012) and timed up-and-go test (0.26; 95%CI: 0.00-0.51; p=0.047. Non-significant summary effect sizes in favor of task-oriented circuit class training were found for the step test and balance control. Conclusions: This meta-analysis supports the use of task-oriented circuit class training to improve gait and gait-related activities in patients with chronic stroke. Further research is needed to investigate the cost effectiveness and its effects in the subacute phase after stroke, taking co-morbidity into account, and to investigate how to help people maintain and improve their physical abilities after their rehabilitation program ends. This review is in press in Stroke, a journal on cerebrovascular diseases published by American Hearth Association.
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L.E.G.Wevers, Center of Excellence for Rehabilitation Medicine Utrecht, Rehabilitation Center De Hoogstraat, Utrecht, THE NETHERLANDS
I.G.L.van de Port   Center of Excellence for Rehabilitation Medicine Utrecht, Rehabilitation Center De Hoogstraat. Rudolf Magnus Insititute of Neuroscience, Department of Neurology and Neurosurgery, University Medical Center, Utrecht, The Netherlands. Utrecht THE NETHERLANDS
M.Vermue Rudolf Magnus Insititute of Neuroscience, Department of Neurology and Neurosurgery, University Medical Center, Utrecht, The Netherlands. Utrecht THE NETHERLANDS
G.Mead University of Edinburgh, Royal Infirmary, Little France Crescent, Edinburgh, UK Edinburgh UNITED KINGDOM
G.Kwakkel Vrije Universiteit Medical Center, Department of Rehabilitation, Amsterdam, The Netherlands. Center of Excellence for Rehabilitation Medicine Utrecht, Rehabilitation Center De Hoogstraat Amsterdam THE NETHERLANDS

Poster Session for Nurses/AHP's

Date: Tuesday 26 May 2009
Time: 12:00 - 13:30
11.
Electrical stimulation to enhance the effectiveness of physiotherapy following stroke
Background The adult brain is capable of reorganisation throughout life, and this probably contributes to much of the functional improvement seen following stroke. Reorganisation can be manifest as an increase in excitability of the corticospinal projection to weakened muscles. Corticospinal excitability can be increased by exercise, physiotherapy, and recent evidence suggests that specific patterns of muscle and nerve afferent stimulation (“associative stimulation”) can also increase excitability and improve function. We hypothesised that applying associative stimulation immediately prior to physiotherapy to improve upper limb function in sub-acute stroke patients would be more effective than physiotherapy alone. Methods A standardised training protocol was developed to provide upper limb rehabilitation to all patients based on the principles of task-specific physiotherapy. Patients randomly received either one-hour of stimulation (n = 10) or sham-stimulation (n = 10), immediately prior to the physiotherapy three times per week for three weeks. Function was assessed using the Fugl-Meyer (FM) assessment and Action Research Arm Test (ARAT) at baseline and following the three week intervention. Cortical excitability was investigated using transcranial magnetic stimulation (TMS). Dexterity was also assessed using a grip-lift manipulandum. Results All patients demonstrated improved function on either the ARAT or the FM resulting in a significant effect of time as revealed by analysis of variance (both p < 0.001). There were no significant group or group by time interactions to indicate that the groups behaved differently over time. However, dexterity improved only in the stimulation group (group by time interaction, p < 0.05). There were no significant changes in corticospinal excitability between groups or over time. Conclusion These findings support the use of novel stimulation techniques prior to physiotherapy to improve functional outcome following stroke.
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M.N.McDonnell, University of South Australia, Adelaide, AUSTRALIA
S.L.Hillier   University of South Australia Adelaide AUSTRALIA

Poster Session for Nurses/AHP's

Date: Tuesday 26 May 2009
Time: 12:00 - 13:30
12.
Lower Limb Constraint Induced Movement Therapy: Electromyographic Pilot Study
BACKGROUND Constraint induced movement therapy (CIMT) is a rehabilitative therapy, used for the recovery of upper-limb in post-stroke subjects, based on the restraint of the healthy limb. The aim of this study is to analyse the possibility to apply the CIMT to the lower limb. METHODS Five post-stroke subjects (median 2 [1-4] months after stroke; mean age 49±12) were recruited. Subjects were able to walk without assistance. The study was approved by Internal Ethical Committee. The study compared the effect of one day of CIMT with one day of control (randomly assigned). During CIMT day the subjects performed some exercises wearing a knee orthesis blocked in extension and an in-line skate on the healthy limb, and a wedge heel shoe on the affected limb. In the control day subjects performed the same exercises without restraint. The exercises were: walking, standing posture, mini squat and sitting up and down performed for 7 hours. Before and after the treatment a surface electromyographic (EMG) gait analysis was performed (EMG of Tibialis Anterior, Gastrocnemius Lat, Rectus Femoris, Vastus Med, Gluteus Medius and Biceps Femoris). EMG data were compared with the correct pattern of muscles activation during walk. The gait cycle was divided in 6 periods and the presence or absence of muscular activation was recorded. The percentage of wrong activation was computed by referring to the normative data. RESULTS The percentage of wrong activation during the six periods in the five subjects for the six muscles under study resulted respectively of 37,3% pre and 33,3% post in the control day and 46% pre and 22,7% post in the CIMT day. A reduction of error is evident in both the post-control and the post-CIMT, but mostly in the post-CIMT. No statistical analysis was done due to the little sample. CONCLUSION These data encourage to go on to study the efficacy of the proposed method of CIMT for the recovery of the lower limb in subjects with stroke.
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A.Tettamanti, School of Physiotherapy - Vita Salute San Raffaele University, Milan, ITALY
V.Sirtori   San Raffaele Hospital Milan ITALY
R.Gatti School of Physiotherapy - Vita Salute San Raffaele University Milan ITALY

Poster Session for Nurses/AHP's

Date: Tuesday 26 May 2009
Time: 12:00 - 13:30
13.
Clinical effectiveness and patient perceptions of an ILC mediated by ES system using a robotic workstation
Background An inability to perform tasks involving reaching is a common problem following stroke. Evidence supports the use of robotic therapy and electrical stimulation (ES) to reduce upper limb impairments, but current systems may not encourage maximal voluntary contribution from the patient. Iterative Learning Control (ILC) is a technique developed for robotic processes which repeatedly perform a task in order to sequentially improving accuracy. The aim of this study was to test the feasibility of applying ILC mediated by ES to stroke rehabilitation using a robotic workstation, and to measure patients’ perceptions of the system. Methods 5 hemiplegic stroke patients used the workstation (see Figure 1) to track 2 dimensional trajectories, over 18 1 hour sessions within a 3 month period. Outcome measures taken prior to and after the intervention consisted of the Fugl-Meyer Assessment (FMA) and the Action Research Arm Test (ARAT), isometric force and unassisted tracking error. During the intervention patients performed a range of tracking tasks in which their remaining voluntary activity was augmented by ES. Patients were asked questions in each session and undertook a semi structured interview (including Likert style and open questions) subsequent to the study. Results Compliance was excellent. Statistically significant improvements were measured (p≤0.05) in: FMA motor score (see Table 1), accuracy of unassisted tracking, and in isometric force. The Likert responses showed that all patients found the intervention enjoyable and would have liked further sessions (see Table 2). Patients’ responses to the open questions on the system effectiveness were classified as physical or functional (see Table 3). Conclusion This study demonstrated the acceptability and feasibility of using ILC mediated by ES for upper limb stroke rehabilitation. Future work will address issues raised in the interview as well as investigating using ES for the wrist and hand.
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A.M.Hughes, School of Health Sciences, University of Southampton, Southampton, UNITED KINGDOM
C.T. Freeman   School of Electronics and Computer Science, University of Southampton Southampton UNITED KINGDOM
J.H.Burridge School of Health Sciences, University of Southampton Southampton UNITED KINGDOM
P.H.Chappell School of Electronics and Computer Science, University of Southampton Southampton UNITED KINGDOM
P.L.Lewin School of Electronics and Computer Science, University of Southampton Southampton UNITED KINGDOM
ERogers School of Electronics and Computer Science, University of Southampton Southampton UNITED KINGDOM

Poster Session for Nurses/AHP's

Date: Tuesday 26 May 2009
Time: 12:00 - 13:30
14.
ELDERLY WOMEN’S EXPERIENCES AS STROKE CAREGIVERS - A FOCUS GROUP STUDY
Withdrawn!
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G.Gosman-Hedström, Institution of Neurosciences and Physiology. Section of Clinical Neuroscience and Rehabilitation, Göteborg, SWEDEN
S.Dahlin-Ivanoff   Institution of Neurosciences and Physiology. Section of Clinical Neuroscience and Rehabilitation Göteborg SWEDEN

Poster Session for Nurses/AHP's

Date: Tuesday 26 May 2009
Time: 12:00 - 13:30
15.
The course of events for elderly stroke patients, and health care utilisation
Background Studies of the course of events for elderly stroke patients, and the total panorama of health care utilisation before and after a stroke event are needed to obtain a better understanding of elderly stroke patients’ situation. Methods In central Sweden, 390 stroke subjects, 65+, living in their own homes and having no dementia diagnosis prior to hospital admission, were studied. One week after discharge interviews with the stroke survivors were obtained. Health care records were studied for one year before and one year after the admission, and local and national registers were scrutinised for five years before and five years after the admission. Results The risk of death and of recurrence was highest in the very early post-morbid phase and then decreased rapidly. High age and functional disability predicted mortality, whereas number of previous strokes, hypertension diagnosis, and sex predicted recurrence. Hospital inpatient care was more frequent the years after index than preceding years. Outpatient care, in hospitals and primary health care centres, increased slowly during the year preceding index, and fell slowly during the following year, but to a somewhat higher level. The municipal social service support was considerably higher than the total health care utilisation. During the year before index the municipal support increased slowly, with a marked increase the following year. Women received more municipal social service support then men. Conclusion The risk of mortality or stroke recurrence decreased sharply during the early post-morbid phase. The care utilisation, both in hospital and primary health care, and municipal social service support was substantially higher the year following the index admission, but with an increasing trend the year preceding index. Of the health care provided, nursing aspects dominated. With an increasing number of elderly stroke survivors, this will be a challenge for the municipality and for the relatives.
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L.Olai, Uppsala University, Department of Public Health and Caring Sciences, Family Medicine, and Clinical E, Uppsala, SWEDEN
M.Omne-Pontén   Uppsala University, Department of Public Health and Caring Sciences, Family Medicine, and Clinical Epidemiology Section Uppsala SWEDEN
L.Borgquist Linköping University, Department of Health and Community, Family Medicine Section Linköping SWEDEN
K.Svärdsudd Uppsala University, Department of Public Health and Caring Sciences, Family Medicine, and Clinical Epidemiology Section Uppsala SWEDEN

Poster Session for Nurses/AHP's

Date: Tuesday 26 May 2009
Time: 12:00 - 13:30
16.
Validation of the extended ICF Core Set for stroke: A comparison between the perspectives of physiotherapists and occupational therapists
Withdrawn!
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A.Glaessel, Swiss Paraplegic Research, Nottwil, SWITZERLAND
I.Kirchberger   Institute for Health and Rehabilitation Sciences Ludwig Maximilian University Munich GERMANY
E. Linseisen Institute for Health and Rehabilitation Sciences Ludwig Maximilian University Munich GERMANY
E.Amann Institute for Health and Rehabilitation Sciences Ludwig Maximilian University Munich GERMANY
B.Kollerits Institute for Health and Rehabilitation Sciences Ludwig Maximilian University Munich GERMANY
G.Stucki Department of Physical Medicine and Rehabilitation, Ludwig Maximilian University Munich GERMANY
A.Cieza Institute for Health and Rehabilitation Sciences Ludwig Maximilian University Munich GERMANY

Poster Session for Nurses/AHP's

Date: Tuesday 26 May 2009
Time: 12:00 - 13:30
17.
Stroke Rehabilitation Education Program for Residential Facilities.
Background: In 2007,a third of patients(17/51) from the Osborne Park Hospital Stroke Rehabilitation Unit(OPH SRU) were discharged to residential care facilities ie(Nursing Homes,Slow Stream Rehab. Units, Care Awaiting Placement Units. Through the discharge process of these patients, the multidisciplinary Stroke Rehabilitation Team identified deficits in Stroke Education and Stroke Management in the aforementioned residential care facilities. Methods: 25 Questionnaires were sent to residential care facility staff at five sites, revealing 57% were unaware of current stroke management strategies and 47% reported attending less than 5 hours stroke education at their respective facilities. The OPH SRU developed and facilitated a One Day Stroke Education Course. Results: Sixteen staff(Allied Health Professionals and Nurses)attended the inaugural course. Pre -course knowledge test results were 47%. Post- course knowledge test results improved to 92%. Previously, Stroke Survivors were discharged from OPH Stroke Rehabilitation Unit after months of intensive therapy to residential facilities that were not sufficiently equipped with the necessary training to continue the stroke management strategies implemented at OPH SRU. This resulted in stagnation and even regression in some patients recovery and outcomes. Conclusion: The OPH SRU has developed and provided an evidence based Resource File to each facility, whilst continuing the Annual One Day Stroke Course. Furthermore the Stroke Rehabilitation Unit is currently acting as a Resource Centre to educate internal and external staff. This program is innovative and sustainable as it does not rely heavily on resources and enjoys strong managerial and executive support, lending itself to replication by other hospitals. The OPH SRU received recognition in August 2008 at the Australasia Stroke Conference in Sydney ,Australia by receiving the 'New Investigator of the Year Award' for the above program.
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M.T.Slater, Osborne Park Hospital Stroke Rehab. Unit, Perth, AUSTRALIA
S.TBurke   Osborne Park Hospital Stroke Rehab. Unit Perth AUSTRALIA
          AUSTRALIA

Poster Session for Nurses/AHP's

Date: Tuesday 26 May 2009
Time: 12:00 - 13:30
18.
AVERT Scotland: Introducing A Very Early Rehabilitation Trial (AVERT) to Scotland
Background: AVERT is an international, multi-centre randomised controlled trial evaluating whether mobilisation commenced within 24 hrs of stroke improves outcome. Our team have recently become the coordinating centre for AVERT in Scotland, UK. In addition to contributing to the main trial results, we aim to specifically test the feasibility and cost effectiveness of the very early mobilisation (VEM) protocol in Scotland. Methods: We plan to recruit 130 patients from 5 Scottish hospitals. Patients must be within 24 hrs of stroke and medically stable to be included. Those with severe pre-morbid disability, severe co-morbidities or requiring palliative care are excluded. Randomisation is stratified by site and stroke severity. Intervention group patients receive VEM delivered by a nurse/physiotherapist team within 24 hours of stroke and for a maximum of 14 days. Control group patients receive standard care. A blinded assessor evaluates 3 and 12 month outcomes. The main outcome is the feasibility of VEM measured by adherence to protocol. Data on healthcare resource use will be collected alongside the trial. Cost effectiveness will be determined from the perspective of the NHS in Scotland. Results: On completion of training in Australia the AVERT-Scotland trial manager has subsequently trained multidisciplinary AVERT teams in trial protocols at 4 Scottish hospitals. Professional support for the trial has been obtained and trial support staff have been appointed. To date 77 stroke patients have been screened and 6 (7.8%) of these recruited. Conclusion: There are many challenges in setting up a trial of a complex intervention such as AVERT. Local staff support and involvement has been crucial in the set-up of AVERT-Scotland. To account for differences in healthcare systems some flexibility in staffing models and funding structure has been required. Ensuring internal validity of trial processes and continued collaboration are important aspects for AVERT-Scotland.
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L.E.Craig, Faculty of Medicine - University of Glasgow, Glasgow, UNITED KINGDOM
P.Langhorne   Faculty of Medicine - University of Glasgow Glasgow UNITED KINGDOM
O.Wu Faculty of Medicine - University of Glasgow Glasgow UNITED KINGDOM
M.R.Walters Faculty of Medicine - University of Glasgow Glasgow UNITED KINGDOM
C.K.Ritchie NHS Greater Glasgow & Clyde Health Board Glasgow UNITED KINGDOM
L.N.Smith Faculty of Medicine - University of Glasgow Glasgow UNITED KINGDOM

Poster Session for Nurses/AHP's

Date: Tuesday 26 May 2009
Time: 12:00 - 13:30
19.
The content of gait re-education for acute stroke within a randomised controlled trial of Bobath therapy
Introduction: Walking disability is a major focus of rehabilitation post stroke, yet physiotherapists still do not know what type of exercises work best to improve people’s ability to walk post stroke. Aim: A secondary aim within a recent RCT comparing gait specific training within Bobath therapy to conventional Bobath therapy was to compare the actual treatment content in each group. Methods: A treatment checklist based on Lennon et al (2001) which included activities focused on weight transference, reaching, stepping and various walking activities was completed for each session for patients within 21 days post stroke randomized to a Bobath group (BG) or a gait specific group (GSG) for 20 sessions of daily physiotherapy lasting for 40 minutes over a 4 week period. The frequency of use of all treatment activities for the duration of physiotherapy was recorded. Results: Comparison between groups, with 30 allocated to the BG and 31 to the GSG, showed no significant difference for any outcome measure at any time point except for the Barthel Index in favour of the BG at 3 months (p< 0.047). Regarding the intervention, there were no significant differences between groups in the duration of each session (p=0.175) or mean number of sessions (p=0.997). Although there were clear differences in strategies selected (see figure 1), contrary to expectation, therapists in the BG actually practiced the task of walking more frequently than the research therapists. Conclusions: Manipulating the nature of conventional Bobath therapy to be more gait specific did not improve gait outcome unlike within other task specific trials (French et al, 2007). Future trials should no longer compare treatment approaches, the emphasis should be on combining evidence based components into the experimental programme then comparing this to carefully documented components within conventional practice.
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S.M. Lennon, University of Ulster, Newtownabbey, UNITED KINGDOM
L.Wheatley-Smith   Regional Acquired Brain Injury Unit Belfast UNITED KINGDOM

Poster Session for Nurses/AHP's

Date: Tuesday 26 May 2009
Time: 12:00 - 13:30
20.
Gait-specific training within Bobath therapy in acute stroke: a randomised controlled trial
Introduction: Walking is one of the most desired goals of stroke patients, and inability to walk contributes significantly to long term disability and burden of care post stroke (Moseley et al, 2006), yet physiotherapists still do not know what type of exercises work best to improve people’s ability to walk post stroke. Recent research has suggested that more emphasis needs to be placed on practicing the task of walking in therapy sessions rather than on carrying out exercises aimed at preparing people for walking (French et al, 2007). Aim: This randomised controlled trial aimed to find out whether introducing more walking practice into Bobath therapy (spending 50 % of the daily physiotherapy session working on walking practice) would improve the patients’ ability to walk more effectively than usual Bobath therapy. Methods: All consecutive stroke admissions within 21 days post stroke were randomized into a Bobath group (BG) or a gait specific group (GSG) for 20 sessions of daily physiotherapy lasting for 40 minutes over a 4 week period. The primary outcome measure was the Motor Assessment Scale, and a range of secondary measures based on the ICF. All measures were performed by a blinded assessor at baseline, post intervention, at 3 and 6 months post stroke. Results: Sixty one patients in total were recruited with 30 allocated to the BG and 31 to the GSG. The primary outcome, the MAS did not demonstrate significant differences at 4 post intervention (p=0.612; CI: -4.984-2.960). Comparison between groups showed no significant difference for any other outcome measure at any time points except for the Barthel Index in favour of the BG at 3 months (p< 0.047). Conclusions: Physiotherapists may choose to continue to apply their conventional Bobath therapy in their usual way as attempting to increase the amount of task specific walking practice within conventional therapy did not improve walking outcome
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S.M.Lennon, University of Ulster, Newtownabbey, UNITED KINGDOM
L.Wheatley-Smith   Regional Acquired Brain Injury Unit Belfast UNITED KINGDOM
W.M.Harpur University of Ulster Newtownabbey UNITED KINGDOM
K.Fullerton Belfast City Hospital Belfast UNITED KINGDOM
M.Power Ulster Hospital Dundonald UNITED KINGDOM
I. Wiggam Belfast City Hospital Belfast UNITED KINGDOM

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