The Accelerating Stroke Improvement programme is a Department of Health initiative to build on existing stroke care, improving and speeding up access to high-quality treatment. It includes the encouragement of early supported discharge, which allows many stroke patients to return home without delay.
Studies suggest that those who do so are more likely to remain at home in the long term and to regain independence in daily activities. Good in theory, but how do patients cope in practice?
Surprisingly well, it seems. It all comes down to making new connections, not just in the brain, but also in the wider physical world. From telemedicine schemes, which can allow doctors to keep a check on patients, to online forums where carers and patients can discuss morale and share frustrations, and apps which can help communication, patients just need to log in.
Dr Madina Kara, a neuroscientist at the Stroke Association, says: “Advances in technology are helping stroke survivors in the whole journey of rehabilitation, and consumer technology is increasingly being used to help people with both physical and emotional needs.
“Motion-controlled computer games, for example, can help people regain movement, and computer tablet applications can help with both cognitive recovery and speech. The onset of social media and online forums, such as the Stroke Association’s own TalkStroke platform, can also create online communities that allow stroke survivors to share useful stories and practical advice.”
Advances in technology are helping stroke survivors in the whole journey of rehabilitation, and consumer technology is increasingly being used to help people with both physical and emotional needs
And the web also connects less traditional patients, such as younger stroke survivors, who can chat in the forums. The charity Different Strokes has forums on its website http://www.differentstrokes.co.uk/ where conversations range from dating to how to get back to work.
The charity also collates a list of blogs worth following, including that of 21-year-old Becki Cobb, a recent graduate (http://lifestrokeadventures.tumblr.com/ ) and of Sue Sanders, who had an unexpected stroke at the age of 48 (http://youngerstrokesurvivor-suesupdate.blogspot.co.uk).
But it is not all about communication. Some online tools are helping with rehabilitation too. For the one in five stroke survivors left with partial or total loss of vision to one side following a stroke, known as hemianopia, new online therapies developed by University College London, and funded by the Stroke Association, could help with tasks like reading the newspaper and identifying individual objects.
The websites, Read-Right and Eye-Search, are the first web-based rehabilitation techniques to be introduced in the UK. Read-Right, which has been trialled by more than 190 stroke survivors to date, helps patients improve their reading by encouraging them to read text as it scrolls across a screen. It is thought that this retrains the brain to perform more efficient scanning eye movements, which can then be transferred to the reading of normal, static text.
Meanwhile, Eye-Search helps stroke survivors to find objects through a series of online games that retrain eye movements. Lead researcher Dr Alex Leff says: “We have shown that proven behavioural therapies for visual disorders can be translated to the internet where patients can run them for themselves.”
There is a wide range of apps which can help stroke patients stay connected too. Voice4u consists of numerous fun and memorable images that can help to improve language. You can create a visual schedule, tell stories, explain an event or occasion, and even make and share recipes.
Proloquo2Go provides natural sounding text-to-speech voices, a high-resolution library of more than 14,000 symbols and powerful automatic conjugations. It also has two research-based vocabulary organisations, advanced word prediction, multi-user support, and the ability to fully customise vocabularies for users of all abilities.
MyTalkTools Mobile is for use with the iPhone, iPod touch and iPad, and enables people with communication difficulties to express needs and desires to those around them. The system makes it easy to customise how you communicate through a variety of images, pictures, symbols, video and audio files, including human voice. In five minutes, you can create your own content and communicate in a way that you choose. All the information is fully backed up on MyTalk Workspace.
“Apps for both smartphones and tablets not only connect stroke survivors to others through social media, they may also help with parts of rehabilitation. Apps, such as those that can ‘speak’ for the person, could help stroke survivors with communication difficulties as well those with cognitive problems,” adds Dr Kara.
ONLINE TREATMENT BY VIDEO
Webcams are being used to diagnose stroke patients out-of-hours at Nottingham University Hospitals NHS Trust (NUH). Medical experts are using video technology on remote laptops to examine patients and decide whether thrombolysis or clot-busting medication is needed.
Doctors are called when the patient is on the way to the hyper-acute stroke ward at the City Hospital Campus, usually by ambulance. Through telemedicine, the consultant can speak to the patient via the web-cam, watch the stroke specialist nurse examine the patient’s nervous system and see the brain scan on screen. The webcam is powerful enough so that the consultant can even zoom in at the pupils in the patient’s eyes to see whether they are reacting appropriately or not.
Dr Ganesh Subramanian, stroke consultant at NUH, explains: “This technology is making a real difference to the way we provide cover out-of-hours. In the past, the consultant on call would have to drive in to the hospital and that would waste precious time. It also wasn’t practical if there were several calls throughout the night. Now we can log on, see the patient and even speak to them, their carers and the stroke specialist nurse,” he says.
“More importantly, patients can see us too. We can access their X-rays and see special stroke tests being carried out by the nurse; we can also review their previous medical records if they have been treated at Nottingham University Hospitals. We can make a life or death clinical decision over a video screen.”