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Rehabilitation across the continuum and beyond our current vision

Rehabilitation across the continuum and beyond our current vision. Nicol Korner-Bitensky, PhD. Each team member contributes a unique piece.

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Rehabilitation across the continuum and beyond our current vision

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  1. Rehabilitation across the continuum and beyond our current vision Nicol Korner-Bitensky, PhD

  2. Each team member contributes a unique piece Dumoulin C, Korner-Bitensky N,Tannenbaum C. The Cross Canada Study of Stroke Rehabilitation: Finding on the identification, assessment and management of urinary incontinence after stroke. Stroke 2007 38:2745-2751

  3. 1st JOB Enlarging our post-stroke focus from ….. illness care to health care

  4. 2nd JOB Finding out what health focused care is available post-stroke … • Strong bones • Strong hearts • Strong limbs • Strong minds • Strong hope – when we have told them no further improvement is expected

  5. 3rd JOB – to get the answer to “does health focused care work specifically in the chronic phase”? Mirror therapy Functional electrical stimulation Task-specific training Constraint-induced therapy Aerobic exercise for cardiac health Virtual reality Visual imagery

  6. So, that when this lady has a question for us… I had a stroke last year – my hand and leg are partially paralyzed –are there effective therapies for me?

  7. Mirror therapy – what is it? Unaffected hand Garry, Loftus & Summers (2004)

  8. Mirror therapy – similarly used for lower limb? Unaffected leg

  9. Mirror therapy – does it work for the upper limb in chronic stroke? Limited but positive evidence in upper limb…. For grip strength For wrist function For speed of movement No published studies yet for chronic lower limb - but effective for sub-acute

  10. Aerobic therapy– does it work in “chronic” stroke? need at least 8 weeks, 3 x per week, permission of Dr. P. McKinley For peak VO2 max For BP (sub-maximal systolic) For bone density of the femoral neck of the affected limb For walking endurance, distance and speed

  11. Functional electrical stimulation –– what is it? Use of electric current to stimulate muscle contraction in paralyzed muscles

  12. Functional electrical stimulation – in chronic stroke – does it work? walking speed knee coordination ankle dorsiflexion walking efficiency

  13. Constraint induced therapy –does it work in chronic stroke?? unaffected limb

  14. New evidence just yesterday……. Citation 10.October 6, 2008 Status MEDLINE Authors Lin KC. Wu CY. Liu JS. . Title A randomized controlled trial of constraint-induced movement therapy after stroke. Source Acta Neurochirurgica - Supplement. 101:61-4, 2008. Abstract OBJECTIVES: To evaluate the benefits of constraint-induced movement therapy (CIMT) relative to traditional intervention equal in treatment intensity and use of restraint mitt outside rehabilitation on motor performance and daily functions in “chronic” stroke patients.

  15. Body weight support and treadmill training post-stroke – what is it? For who? – those with severe? or mild? Or moderate? impairments in gait, strength? Valuable for chronic stroke? On what outcomes? speed? function? endurance? Visit www.strokengine.ca to find out

  16. 4th JOB Find out whether health focused care is being provided post-stroke …. here in Quebec?

  17. The Canadian National Survey on Rehabilitation Practices for Stroke

  18. University of Ottawa University of Western Ontario Nicol Korner-Bitensky, Sharon Wood-Dauphinee, Robert Teasell, Francine Malouin, Johanne Desrosiers, Aliki Thomas, Eva Kehayia, Margaret Harrison, James Hanley, Francine Kaizer, Rosemary Martino Project coordinator: Anita Menon Post-doctoral fellows: Annie Rochette, Chantal Dumoulin FUNDED BY: The Canadian Stroke Network, FRSQ/REPAR, CRIR, Heart and Stroke Foundation of Ontario

  19. Methods • We traced > 5500 randomly sampled clinicians • Identified >1600 stroke clinicians (OT, PT, SLP) in 10 provinces, • Across:acute in-patientin-patient rehabilitation and, community practice

  20. Our findings 1. we rarely use any of the new effective interventions; 2. we often use ineffective treatments or untested treatments; 3. we want to provide the best possible treatments but are not Often we are: not aware of what the best treatments are; nor have the training on how to provide them.

  21. So, when this lady asks her question of us… I had a stroke last year – my hand and leg are partially paralyzed –are there effective therapies for me? • when we say • “no further improvement is expected” – • WE ARE WRONG!

  22. So in the name of the 300,000 Canadians living with chronic stroke My name is Josh. I had a severe stroke 8 years ago. I am now 94. I am back at work full time and improving all the time!

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