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After stroke, you will probably experience problems with trying to recover your balance (your ability to control your body without movement against gravity) and stability (your ability to control your body during movement).

Your stroke will have weakened the messages your ears, eyes and muscles send to your brain. These messages are essential to initiating and maintaining balance, and they work together automatically and subconsciously so you’re usually unaware of them unless something goes wrong.

As your brain begins to repair itself, and therapists help you, you will hopefully see larger-scale improvements. However, long-lasting balance problems may occur after discharge, especially if the stroke has affected your vision or hearing.

After discharge, with a therapist or trainer guiding and guarding you to extend your capabilities, rehabilitation can take many forms and should be supervised by a therapist or a specialist trainer who will provide individually-tailored activities to progressively stimulate your recovery.

You may find that this includes challenging types of weight bearing and weight-shifting. You may be starting by holding onto a fixed bar such a rail or banister (making sure to involve your more-affected upper limb in the way that your therapist or trainer will show you).

Balance perturbation and lower body strength training (again with a therapist or trainer guiding and guarding you to extend your capabilities) are identified as successful further training regimens.

Multiple guided and guarded requirements for you to cope with gentle pushes, attempts to reach for objects away from your trunk can complement your balance control attempts.

It’s completely normal to feel worried or scared about carrying out any balance exercise. They are challenging and all retraining away from a seated position carries a risk of falling.

But it’s vital to continually extend your boundaries whilst minimising the risk to your safety. And it’s equally vital that you ask your therapist or specialist trainer how to do this.

When you start to take steps and are into the primary zone of controlling your gait again, there are so many ways you may find that a simple walking stick can improve your stability and confidence.

My caution would be to try not to rely fully a stick held in your less-affected hand so that it becomes habitual to weight-bear substantially though that side, thereby ‘negating the potential’ somewhat of your more-affected side. This can happen as a matter of course and can put back your recovery without you realising it.

TIP TO CONSIDER: try to reduce the use of a stick as much as possible when starting to move around the house again, in preparation for going outside with it. Then graduate towards leaving it at home or using it only when you’re out for longer stretches of time. Available for purchase is a handy stick which folds into three for this purpose. This can be carried and used if you’re tired.

To rehabilitate balance, a very simple rule seems to emerging from the sum of the latest evidence, which supersedes some of the historical accepted therapeutic advice for community rehab efforts: the more you attempt to move, the better your movement will get, not worse.

ANOTHER POINT TO CONSIDER: there are strong indications in the research that recovery of functional control after stroke occurs through strategic behavioural compensations plus what can be termed as ‘true recovery’ efforts rather than via processes of ‘true recovery’ efforts alone. Hence, an accumulation of some coping strategies that are most essential for your needs is a very good idea and can open a doorway to further levels of functional ability.

Passive or ‘correctional’ movement as a treatment option for most community survivors is being shown to be rather  inferior to the stroke survivor being guided to make repeated, active attempts to complete tasks for themselves, ramping up the repetitions of tasks as much as is possible/is appropriate and as much as concomitant problems such as fatigue allow for.

So, some physical coping strategies (such as a quick technique for getting to your feet from seated without help or a lying position on the floor without help) are much better to have learned quickly via training to enable you to progress, rather than to be stuck without applicable techniques to perform them easily.

Other examples you can explore in Had a Stroke? Now What? can last you a lifetime. By retraining each one and making it part of your ‘repertoire’, you may also start noticing that they help you manage your (current) limitations and help you perform task specifics.

And some coping strategies are absolutely fit for purpose therefore and can be retained as useful, but many can be minimised and ideally negated as you gain more control and strength. They can be regarded as ‘facilitators’ which can help you to self-manage.

You’ll most probably ‘souvenirs’ from your stroke, but nevertheless, you need to get yourself into the ‘success zone’ fast in order to try to counteract their effects.

For optimal recovery, you need helpful interim strategies which can minimise the chances of any damage (from balance loss, for instance) that can occur whilst pushing yourself forward to deal with situations you’ll find yourself in during daily life.

You can also find lots of these in the ARNI 7 stroke rehab training video set, available in DVD or online anytime viewing.

When people have strokes, loss of strength as a result can be extensive and a major contributor to prolonged recovery times. It’s estimated that the strength loss after the stroke is around 50% on the affected side of the body. The reasons for losing strength are related to factors such as weak neural activity after a brain injury and losing muscle mass (atrophy).

The evidence suggests that stroke survivors, at an appropriate time, should be guided to take part in some sort of regular resistance training that emphasises strengthening both affected and unaffected sides to prevent strength and muscle loss.

For example, one recent study, with 370 stroke survivors, showed that progressive resistance training had a large positive effect on strength regaining compared with no activity.

Structured resistance training can increase muscle mass (hypertrophy) and also has been shown to have  positive effects on reducing anxiety, improving quality of life and cognitive function. Resistance training is often pretty simple to do, but does need guidance. It could be dynamic (moving an object such as a dumbbell for a few repetitions) or isometric (producing maximum contractions against static resistance), or a mixture of both.

Showing stroke survivors how to do simple targeted strength-training is a good thing, not only for managing the weakness caused by muscle-loss, but also for targeting spasticity (with limitations). Improving motor neuron recruitment by using gravity against limbs, weight of objects used in tasks, external support and external resistance are evidence-based parameters which can be manipulated to increase strength.

Furthermore, A recent Cochrane Review revealed that strong correlations exist in the current stroke rehabilitation research between improvements in strength and improvements in function. This is significant, as researchers previously did not have enough data not so long ago to make this evidence available for therapists and trainers to incorporate into their work with survivors.

An invitation to you:

A group of researchers from Sheffield Hallam University, the University of Sussex and ARNI partnership are interested to know your thoughts on designing feasible home exercises for strengthening and mobilising the upper limbs after a stroke at a chronic stage (at least 6 months after stroke).

The research team recently secured a grant from UK Research and Innovation (UKRI) to investigate the methods to design smart and digital environments for stroke survivors at home (click the link below to the grant page to find out more).

Creating digital, interactive, smart home exercise environments for older adults with stroke – healthylongevitychallenge.org

What is this research about… and could it be of use to you to take part?

The research team are very interested in working with you, face to face, to find out your views about how best to create a digital programme to help improve muscle strength.

They would ask you to consider whether you would prefer to use forms of equipment such as weights, dumbbells, resistance bands and combinations of such items.

The research team would very much like to invite you to participate in a small group discussion (maximum 10 people) in a large boardroom at Lingfield Racecourse in Surrey, overlooking the race-track, with three researchers from Sheffield Hallam University and the University of Sussex, as well as Dr Tom Balchin and a number of the ARNI therapists to run the proceedings.

The object, as noted above, would be to share your opinions and experience in doing resistance training at home or in gyms. The session duration will be 2 hours with refreshments.

If you had a stroke at least in the last 6 months and you are ambulant (not a wheelchair user) and with experience in using fitness equipment (after or before your stroke), the team would be so grateful to to listen to your considered opinions…

Place, date and your travel fare paid.

The session is in person at Lingfield Park Marriott Hotel & Country Club (Lingfield, RH7 6PQ).

The date of this event in January 2023 is to be confirmed, but please enquire now.

You can choose to come either for 10.30-12.30 session or for the 13.30-15.30 session

The event is free and the Research budget will pay your travel fares up to £25.

Covid-19 Safety.

A message from the research team about Covid-19 safety: they will ask the participants and researchers to use a face mask and sit in a safe distance (2m). They will provide face masks and hand sanitisers and the windows in the room are open for ventilation. They will ask you to do not attend the session if you had any flu symptoms or you were with someone who was infected by COVID-19 in the last 10 days before the session.

Who to contact

If you like the sound of taking part in this study, please contact Dr Mohsen Shafizadeh (m.shafizadeh@shu.ac.uk) to register for this event or ask further questions. We will send you the Participant’s Information Sheet and other forms via email. You will sign a hard copy of the consent form in the session.

The Research team

Dr Mohsen Shafizadeh, Dr Khalid Ali, Dr Nasrin Nasr, Dr Tom Balchin, Dr John Hart, Dr John Kelley.

Emotional responses to stroke are very varied indeed – and are influenced by a host of issues.

For example, by the severity of your difficulties and perceived losses, your individual coping style, your familial/social support network, your cultural beliefs about disability, and your previous mental-health.

Some of the emotional and personality changes you may face are caused not only by changes that have taken place in your brain, but because of the ongoing emotional burden caused by your stroke.

It’s important that your family, carers and friends understand the more common possible emotional changes, in order to appreciate the way you express your feelings and thoughts about your stroke. It can readily be seen that ideally, they should receive advice concerning how to help you cope and how to cope themselves.

The idea is to help you take as many active measures to (emotionally) manage situations as you can.

For example, it may be best to avoid crowds and stressful conditions, which may in turn make you feel overwhelmed. You can try learning relaxation techniques to help you combat any stress and fatigue you may experience after your stroke. There are lots of devices and apps to help you manage to bring emotions to an equilibrium over time.

A big tip from me, as a successful stroke survivor, is that consistent physical re-training yourself with the help of an instructor AND by yourself)can potentially bring an  increase in confidence and strength of mind, which can in time result in the feeling that you’re steadily ‘covering yourself with armour’ emotionally, with a potential result in the decline of ‘negative’ emotional changes. It certainly did for me, and I’ve seen it in many hundreds of people since.

It’s so important that you are helped to tackle emotional difficulties that you may be having – and it may take a specialist cognitive therapist to help you. This is because having difficulty coping with your emotions can impact you for years in many different aspects of your life. Linked to your emotional responses, the cascade of changes that have will have taken place in your brain during your stroke can alter your behaviour dramatically. For example, your character may have changed in some surprising ways.

You may now be experiencing new, impulsive tendencies and poor judgements of your own safety and that of others. You may also be experiencing emotional lability. This is a condition where you have rapid and emotional changes in mood.

You may cry easily or laugh uncontrollably or display feelings of hopelessness, frustration, anger, aggressiveness, impulsiveness and other symptoms.

Apathy is another possible problem (more information from ‘Stroke’, 2013). where you may experience diminished goal-directed behaviour and you may go through periods where it seems like you feel nothing or not feel like doing anything at all. Diminished motivation, lack of emotion, interest, concern or enthusiasm to take part in your own recovery may be noticed by yourself and/or others around you.

Apathy can have negative impact on your recovery of function, your ADLs, general health, and quality of life. It can stop you from enjoying your social connections and bothering to do things that you enjoy. If you develop apathy, it can also lead to a significant extra burden for your families, carers and friends… and worries them because it’s obvious how it will hold you back from potentially conquering/coping better w the situation you’re in.

Depression is also amazingly common. Around a third of stroke survivors experience it after stroke (roughly the same percentage as those who suffer aphasia). Stroke survivors with suspected depression can be referred to a clinical psychologist by their GP. It’s very important for you, your family, carers and friends to be aware of depressive symptoms so you can receive the help you need, if required. Depression is classified as more than just being sad. You may feel worthless, hopeless, have little motivation to keep living, experience intense anxiety and you may even sleep more to ‘escape’. If you experience any of these feelings, please consult your GP immediately.

The Potentially Good News

It can be easy to think that emotional changes will never improve, but research shows that you may well come to terms with the after-effects of your stroke, which may in turn help responses and mood to become more balanced.

Please see my point above about the further possible positive effects of successful functional retraining. Moreover, if appropriate medication is administered to help you self-manage, your emotional balance may well improve to the extent that you won’t need to struggle.

Mood problems can impact engagement in retraining, adjustments to difficulties, reintegration to the community and vocations, and can result in higher care needs and increased mortality, including risk of suicide. Physiological changes in the brain can lead to new and exaggerated expression of behaviour.

These are most likely to be experienced by those working with families and carers working with survivors with significant cognitive, communication and physical difficulties. Behaviours can range in severity and most usually have a function such as communicating a frustrated or unmet need. Families and carers have to come to understand these behaviours as best as they can.

Partners in particular, who are now cast in what I’ve always thought of as the terribly impersonal role of ‘carer’, must understand that now it may well be a case of ‘one stroke, two survivors’. Moreover, there is a higher depression rate recorded in studies of caregivers to those with stroke too, particularly when those whom they’re caring for are severely dependent.

So, successful surviving after stroke -and successful re-integration into a good quality of life with a return to work perhaps, and/or a good quality of life  – does require multifactorial on-going interventions – many of which need to be light-touch (and ‘get-able when required), but there nevertheless. 

Consistent and positive support, such as that offered by an excellent therapist/trainer (a qualified ARNI Instructor being just one example) is a great way to start this, as such a person will come in to the home, offering an encouraging example of health and strength for the survivor to hopefully be motivated by, and will know many innovative strategies to trial with the person to help them be creative with their own recoveries.

A survivor who starts to take ownership of their recovery as soon as they can is possibly more likely to start to take control of emotional issues which may be affecting them.

For example, a research study conducted back in 2011 to examine the effect of depression or apathy on functional recovery after stroke in 237 Japanese stroke patients found that:

‘an appropriate level of insistence on recovery may, in fact, be associated with reduced depression and apathy, resulting in enhanced recovery from stroke-related disabilities. Improvements in physical disabilities (trunk stability or activities of daily living, such as walking) also reduce depression and apathy. Therefore, the experience of post-stroke depression and apathy may be intertwined with various initial emotional responses and improvements in physical functioning. Effective treatment of post-stroke depression and apathy require a multidisciplinary approach, such that neuroanatomical/neurobiological, emotional, and physical (rehabilitation) domains are all addressed’..

Post-stroke motor recovery suggests the existence of a period of heightened plasticity in which the survivors seem to be more responsive to treatment. This is the so-called ‘critical time-window’ for recovery. In short, a systematic review in 2002 found that on average, recovery reaches a plateau at 15 weeks for patients with severe hemiparesis and at 6.5 weeks for patients with mild hemiparesis.

This is one of the reasons that you may well have already heard from a number of sources that 3 months to 6 months to recover function is your limit, and after that, improvement is probably going to range from very difficult to impossible. The field of neurorehabilitation has generally accepted this time-window in the past and the hypothesis has also justified the general cessation of physical therapy at chronic stages.

But you must also appreciate that a gradient of significant possible responsiveness to treatment (and also responsiveness to neglect of rehab/retraining) that extends after 12 months post-stroke has been uncovered, which is VERY relevant for the majority of stroke patients.

Pay attention to the way the red line shows the possibility of improvement  in body functions and activity after six months, as well as the possibility of decline.

The chart above, published in the Lancet in 2011 by experts in stroke (Professors Peter Langhorne in the UK, Julie Bernhardt in Australia and Gert Kwakkel in Holland), clearly shows this.

All research professionals in stroke want to locate optimal routes/combinations of interventions & therapies for you to improve. But as it stands right now, the optimal timing for rehabilitation and intensity of treatment remains unclear. Research scientists are currently trying to determine the best time after stroke for intensive motor training and others are investigating the effect of early and intensive therapy on upper extremity motor recovery.

The evidence is starting to show that physical therapy and self-training can have a significant impact on body structure and the function of the upper extremity at all periods post-stroke. So, if you can, please try to pay as little attention as you can to anyone making the point that your ‘time window’ has either fully closed or is about to fully close from now on and let’s crack straight on with working very hard (and with know-how of what to do/what not to do) at your recovery. Who knows what will happen? Make efforts – and locate someone to help. Even coaches need a coach. I do! I have a  strength training partner who works in the neurorehabilitation field, who acts in that way for me and has done for around 20 years now.

Even if you’re unlucky and can’t find a therapist or trainer who is able to assist you, it’s about using self-help guides (like Had a Stroke, How What, from which this article is taken) to steer your recovery through the stroke maze. This is the reality. You just need to start. Plasticity will be kicked into high gear when your brain perceives new information as particularly important and when your training is frequently repeated. After a significant period of honest effort of pure ‘rehabby’ efforts, you’ll be transformed both physically and mentally.

To help with task-training, strength training and developing physical coping (not compensation) strategies, there are also so many adjuncts to community stroke rehab retraining these days – low tech to high tech – from AFO’s that can phase you on from rigid plastic orthotics, to upper limb de-weighting devices, simple and cost-effective devices like the Neurogripper (shown right, and available from ARNI), dynamic orthoses, upper and lower limb robots, virtual reality, FES, EMG biofeedback, telerehab and apps etc and there a number of well-evidenced clinical interventions too to target limitations from stroke, from targeted intensive therapies like CIMT, to pharmacological and even to surgical.

But here’s the thing. The day will come when you’ve found a combination of external adjuncts and retraining elements that works for you. If you haven’t or can’t, PLEASE consult a physiotherapist. And ‘phone up ARNI – we can and we will help to guide you.

I make my view about stroke rehab very clear, which is that if it’s ‘by rote’ and too ‘samey’ and doesn’t challenge you to work on the edges of your ability during your days, then the best way forward, to accompany retraining efforts is to consciously accompany your active recovery efforts with a physio or trainer with an into an actual hobby that is enjoyable and very productive. Or a couple of hobbies with different emphases. If you need to work this through with a health professional or family member or friend, then that’s just great – do is as part of on-going goal-setting/accomplishing…

The best results I’ve seen are when people start to do new hobbies which creatively challenge their own functional limitations. Producing artwork, music making, swimming, cooking, indoor shooting, model railway or Airfix kit constructing and photography are all examples which can be made to be highly rehabilitative if used to directly/knowingly/progressively to tackle motor limitations.

Many more examples of these are revealed in ‘Had a Stroke? Now What?‘, including the combination of ‘hobbies’ that I used to support my very successful upper limb rehabilitation

So, it will be time to get out there and do all sorts of things that are open to you as you seek to create (and get healthy) in the 21^st century. And this will open up a whole new tranche of innovative new recovery possibilities. You’ll see. I can promise you that the ‘doing’ of a creative hobby or two which repetitively involves your more-affected limbs is the most efficient way to keep recovery and self-management efforts going over the long term. It’s the ‘no-rehab optimal rehab style’!

Permissions.

Hypothetical pattern of recovery after stroke with timing of intervention strategies (Figure 2). Reprinted from The Lancet, 377(9778):1693-1702, Langhorne P, Bernhardt J, Kwakkel G., Stroke Rehabilitation, 2011, with purchased permission from Elsevier.

You can now help stroke survivors directly with each purchase you make with Amazon! It takes just a quick step – below!

AmazonSmile is a charitable version of the normal Amazon website. It has the same products and prices but the difference is that when you shop on AmazonSmile, a donation of 0.5% of the net purchase price will be made to a charity of your choice. It’s free to set up an AmazonSmile account and very simple! You just need an Amazon account (and it doesn’t matter if it’s Prime or not).

Just click on the AmazonSmile BOX above or any of the Amazon logos on this page and get started!

If you this doesn’t work for you, try doing this:

Thank you so much!

Note: If you have already chosen to support a different charity, you can change your charity any time by logging into AmazonSmile and clicking “Accounts & Lists,” then scrolling down to “Your AmazonSmile.” From there, click “Change charity” under “Your current charity” on the top right.

Arm impairment is the most common type of disability for stroke survivors, affecting 450,000 people in the UK alone, with persisting problems for between a half and three quarters of survivors.

This can be partly explained by where the injury is in the cortex. But because regaining lost function in the upper extremities has been found to be more difficult to achieve than return of normal function in the lower extremities, only 14% will regain any useful function. Between 55% and 75% continue to experience upper extremity functional limitations after 6 months.

Research reveals that from admission to discharge, survivors receive a fractional dose of rehabilitation for this area compared to what your brain requires at this critical time in order to stimulate new connections and adapt others.

Plasticity theory tells us that neuronal structure is altered and refined by experience. Movements highly related to particular activities that are experienced and practiced intensively pre-stroke will excite and interest the brain if introduced into rehabilitation post-stroke.

Repetitive activity therefore is critical for recovery, but research also shows people struggle with knowing what or how much to do after hospital finishes and then keeping track of their progress.

Working with more than 100 therapists (occupational therapists and physiotherapists) and 200 stroke patients, ‘OnTrack’ has been developed by Imperial College London’s Helix Centre.

This combined software for smart devices with coaching support, is ultimately designed to support the patient in the manner detailed below. The idea is hopefully to improve their particular targeted outcomes.

What is OnTrack?

OnTrack is a digital rehabilitation tool which is designed to facilitate the self-management of stroke recovery.

This platform includes a smartwatch app with tailored coaching to help people own their rehabilitation journey and inform their clinicians on their progress. The smartwatch app works like a step counter, it tracks minutes of arm activity through an algorithm developed for stroke survivors.

The purpose of OnTrack Rehab is to support and motivate stroke survivors to improve their recovery through daily activities.

How you can get involved.

Imperial College London’s Helix Centre is looking for stroke survivors with an arm impairment (18+ years old, living in London and more than 6 months post-stroke) to help them develop a new digital rehabilitation tool.

This will involve wearing wrist-based sensors and motion trackers during a 2 hour session at Imperial’s White City Campus to carry out tasks of daily activities such as using a knife and fork, reading a book and more.

They will then record this data to improve the technology behind OnTrack which will be anonymous. They will also provide a Participant Information Sheet for you, so you know what to expect.

What support will there be?

They will make sure to consider any accessibility needs you may have and work with you to best support you to attend, including providing interpreter services. They have wheelchair access on site as well as space for a carer to be in the session if you need to bring someone with you. They will also provide a break for you during the session.

Will there be a reimbursement?

This involvement is paid at £25 per hour as per INVOLVE guidelines, meaning that it is £50 per session paid to you. They will contribute £10 towards your travel also.

I am interested. When are the sessions?

The in-person sessions between April 2022 and May 2022, and you only need to attend one slot for 2 hours.

Where are the sessions?

They are at the White City Lab, Imperial College London, White City Campus, London, W12 0BZ.

How do I express interest?

Please fill in this expression of interest form: https://bit.ly/OnTrack_lab.

You can also email OnTrack@helixcentre.com for more information.

How confident are you in doing your home exercises provided by your therapist or ARNI instructor?

Rehabilitation after stroke is a partnership between you and your ARNI instructor or therapist. You’ll know that regular practice of techniques and exercises is necessary to optimise progress after stroke, but during the times that your Instructor isn’t present, these may or may not be difficult to perform.

So, have you ever been given exercises to do at home after your stroke? How confident did you feel to do those exercises without guidance? Or how confident would you feel doing them?

It’s well known that confidence is something many people may struggle with when exercising, especially when starting a new exercise programme. For instance, you may worry that you are doing the exercises incorrectly, or find it hard to make yourself practice as often as you know you should. Researchers use the term self-efficacy to describe how confident we feel to successfully carry out a particular action; in this case retraining home by ourselves.

Research has found that people with a high level of self efficacy are more likely to regularly practice their home exercises, especially without motivation or supervision from others. Research also shows that many stroke survivors find it difficult to access home retraining, for many reasons.

Theoretically therefore, it may be possible, by attaching measures to a number of stroke survivors’ levels of self efficacy (for carrying out home retraining independently), it may be possible to identify those survivors who are not so confident… and therefore highlight the requirement for additional help (and in what ways) for these people.

Currently there is no stroke specific measurement tool available to do this. This study aims to address this gap in stroke rehabilitation.

Can you help the researchers by giving approximately 30 minutes of your time and completing an online questionnaire?

Working under the supervision of Dr Cherry Kilbride and Dr Elmar Kal and with ethical approval from Brunel University London, Dylan Kerr and Kevin Murray are carrying out research to help develop a stroke-specific self efficacy measure for doing home exercises.

CALLING ALL STROKE SURVIVORS – PLEASE HELP BY GETTING INVOLVED IN THIS STUDY IF IT IS APPROPRIATE TO YOUR SITUATION!

What will I need to do if I would like to help, and take part in the study?

1. Click here to access the study
2. Read the Participation Information Sheet for more information and give your consent
3. Complete the background questionnaire (questions about living with stroke, mentally and physically) followed by 2 quick self-efficacy scales
4. One week later, we will send you a short version of the questionnaire (10 minutes) to complete. This is to see if anything has changed in your self-efficacy scores

A tip: For the best display of the questionnaire graphics, use a laptop/desktop computer or tablet.

Thank you!

Your responses will be anonymised prior to the analysis. The results of the study will be reported in the form of a written MSc dissertation, and may be published in international scientific journals. Please note that your information will kept confidential at all times, and no identifying information will be reported.

If you have any questions, please contact Dylan Kerr (2028493@brunel.ac.uk) or Kevin Murray (1908047@brunel.ac.uk), or call our designated research phone (07342 793564). Additionally, you can contact project supervisors Dr. Elmar Kal (Elmar.Kal@brunel.ac.uk) or Dr. Cherry Kilbride (Cherry.Kilbride@brunel.ac.uk) for any inquiries if you wish.

Tiredness is something we all experience in our everyday lives. But how about the sort of tiredness which seems to be unrelated to physical or mental exertion, and does not seem to be alleviated by rest? This is a real problem for many stroke survivors on top of the many other problems they may face – and is called ‘fatigue’.

Fatigue is one of the most commonly reported symptoms after Stroke with a prevalence of up to 80%, characterised by overwhelming physical and/or mental tiredness or exhaustion.

For many the symptoms dissipate and lessen over time. Others continue to experience these symptoms at a high level many years after their stroke. This is called chronic fatigue.

Chronic Fatigue has a major impact on Quality of an individual’s life, making everyday tasks feel overwhelming and unachievable, or just plain exhausting. Despite the high prevalence, what causes fatigue to persist for months or years after a stroke remains an open question.

Researchers continue to try and get a better understanding of the mechanisms that underlie fatigue in order to answer this question. Understanding more about it may in turn can maybe lead to the development of effective interventions which may significantly alleviate the condition.

The Effort Lab, led by Dr Anna Kuppuswamy, based at the Institute of Neurology, UCL, in London, has been studying fatigue over the last 10 years to better understand the brain mechanisms that underlie this highly debilitating symptom, not only after Stroke but across other neurological conditions such as Multiple Sclerosis and Parkinson’s Disease.

Their work suggests that altered perception of various sensations can explain the onset and persistence of fatigue.

When performing day to day tasks for example, altered perception will make the tasks feel more effortful. And when in a busy environment with background noise, altered perception results in being overwhelmed and brings on fatigue.

What remains unclear is the relationship between fatigue and visual perception.

They have designed a way that stroke survivors can feedback their experiences to the research team in order to gather important information from various neurological conditions so that they can better understand the possible links.

CALLING ALL STROKE SURVIVORS – PLEASE HELP BY GETTING INVOLVED IN THIS IMPORTANT STUDY IF IT IS APPROPRIATE TO YOUR SITUATION!

It takes no more than 45 minutes on an online combined quiz and questionnaire: 

online quiz: completing a couple of questionnaires

online task: identifying shapes and responding by pressing the appropriate buttons on your keyboard.

A tip: For best display of the questionnaire graphics, use a laptop/desktop computer or tablet…

For more information, please read the participant information sheet and if you are interested in taking part please go to the study website.

If you have any questions please contact Dr William De Doncker (William.doncker.11@ucl.ac.uk) or have a look at the Effort Lab’s website:  The Effort Lab | Ensnared

Strong evidence exists that physiotherapy improves the ability of people to move and be independent after suffering a stroke. But at six months after stroke, we know that many people remain unable to produce the movement needed for every-day activities such as answering a telephone. So, what can be done?

1. First, it’s important to be able to recognise if a physiotherapy intervention is really aiding a survivors’ abilities to undertake everyday activities or whether the intervention is doing less than it than it purports to/would ideally do.

This requires a deeper knowledge of the biological underpinnings of neuromuscular function. Neuromuscular function includes the ability to use weak muscles in the right order and at the right time during movement and performing everyday tasks in the same way as you did before the stroke.

2. Second, to optimise a physiotherapist’s chances to advise/work on an optimal combination of rehab interventions for each individual after stroke, it would be ideal to find out what kinds of sleep patterns are most beneficial for them.

Physiotherapists need to be able to have the same opportunity to diagnose how to help each stroke survivor gain the kind of very accurate movement measures at any point in their rehabilitations that currently, only specialist University facilities can routinely produce. This equipment is obviously expensive and can only be used in large specialised laboratories.

Ideally, more portable equipment should also be able to be accessed by therapists, which would cost less and is designed for use in small spaces. But such equipment would have to also be sensitive enough to provide meaningful feedback for therapists in a similar way to those used by the specialist labs. Such feedback could then be very useful for therapists and survivors to create optimal rehab plans together which would really enable the survivor to work on his/her edges of current ability.

A School of Health Sciences research team at the University of East Anglia (UEA) headed up by Professor Valerie Pomeroy have been attempting to find out if this can be done and have also been examining how sleep patterns affect rehabilitations.

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Following on from a request last year, the UEA would like to invite YOU to come TWICE to their Movement and Exercise Laboratory (MoveExLab) to get involved with this Project if you can/if it’s appropriate for your circumstances.

Dr Balchin says: you never know how such involvement can directly or indirectly push your own rehab forward, at whatever time away from stroke you are. Knowledge is power, Anything that can give you clues and cues about the state of your rehab and current/future interventions can be useful.

Go for it if you can/if it’s appropriate for you!

Inclusion criteria: you need to be 18 or above, have had a stroke at any point in the past, be discharged from NHS stroke services and be without an allergy to latex.

What you’ll be doing:

Upon application, if no contra-indications are revealed, you’ll be invited to undertake 2 assessments at the MoveExLab.

These assessments (around 90 mins to complete each) will be between 2 and 4 months apart. In each, you’ll have EMG electrodes placed on your skin using hypoallergenic sticky tape. These will measure your muscle activity as you move and don’t hurt at all, but just record your natural muscle activity during movement.

They’ll then place reflective markers on your skin. These markers are tracked by infra-red cameras placed at the top of the walls of the MoveExLab.

You’ll then be asked to pick up a telephone several times, which is placed a number of different positions, whilst your performance on the tasks is recorded (and reconstructed on the computer).

Then you’ll complete some questionnaires about how you sleep.

Then you’ll wear a motion watch on each wrist for 7 days to measure your everyday activity, which you’ll then send back in an SAE.

No sort of ‘therapy’ is implemented to project participants.

The Team will be in contact with you throughout the period of your involvement.

Travel expenses can be reimbursed for return journeys of up to 50 miles (ie, 25 miles each way).

If you are travelling in from further away, you can claim travel expenses for your journey up to 50 miles in total as well.

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Apply now by speaking with the principal investigator: Professor Valerie Pomeroy..

Email: v.pomeroy@uea.ac.uk  Phone: 01603 59 1923

Or get in touch with her personal assistant: Pel Fordham.

Email: p.fordham@uea.ac.uk   Phone: 01603 59 1923

Both will be very happy to answer any questions you might have.

Location: School of Health Sciences, Queen’s Building, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ

It’s probably true to say that a lack of motivation is one of the more serious factors involved in unsuccessful rehabilitations. A gradual diminishing of motivation is also a really normal reaction to setbacks, and stroke is one SERIOUS set-back. 

You can bet that I’ve met quite a few stroke survivors over the years who’ve become prone to anxiety, depression and/or anger because of the condition they have found themselves in.

I hope that I’ve been able to facilitate at least some of these people towards the benefits of maintaining a ‘growth mindset’ concerning their recovery, despite their difficulties.

For example, there is a question that is often asked after a while if successes become imperceptible or grind to a halt. It is: ‘why bother to try retraining when nothing more seems to be happening, despite everything I’m doing so far?’

There are a number of instant answers that a neurologist would give you to this. Primary among them would be the point that even though changes may not be visibly occurring as a result of your efforts, your rehab training will still be as essential for warding off decline as well for driving positive functional change. This is why getting an ARNI trainer to tackle this with you is even more important.

So a good battle-plan is to find out more and more about your presentation (as it stands RIGHT NOW) and available treatments (AS THEY STAND RIGHT NOW), via as many knowledge-sources, is key.

For example, most people don’t understand (forget, aren’t told, or don’t read about the) need to continually promote an increase in active range of movement (AROM) in as many planes and pivots as possible.

Increase in non-functional AROM increases strength and muscle bulk, encourages muscular activity which promotes vascular return, decreases the potential for soft-tissue shortening and damage with resultant pain and stiffness and increases osteoblastic activity on your more-affected (and also possibly osteoporotic) side. Also, by doing this, you’ll render yourself more eligible for new technologies and/or medical options and emerging treatments to augment your retraining.

So, by steering you toward the potential inherent in effective retraining, I hope to promote a ‘growth mindset’ in you, if you’re not already ‘on-board’. You are a learner. And so am I, as a stroke survivor of what is now a full 25 years. You and I have to keep learning and keep retraining as stroke survivors, keep exploring and keep innovating over the long term. Easy to say, harder to do. But you MUST please, please write down a few things and start doing them. Then make a pattern of them day by day, which you don’t want to break, because it’s what you ‘do. And trust me, people will respect you for that.

Do MORE than able bodied people training-wise. Show them up!! Make them wish they WERE YOU!!

It’s possible.

Ultimately you may want to pass the things you’ve learned and constructed onto other survivors so that they can make of them what they will. I will show you how you can get motivated by getting successful; on what I call the ‘big fixes and the small steps’. This is, of course, only done by getting busy and starting to retrain with sensible staging posts. You’ll find your way through.

(fyi, the video of Successful Stroke Survivor manual above has no sound on: it’s not your laptop or iphone at fault!)