Every step counts… even following a stroke

It is estimated that more than 80 percent of strokes can be prevented simply by managing risk factors and living a healthy lifestyle.

As the slogan for this year’s National Stroke Week implies, “Every step counts towards a healthy life”. Accordingly, The Stroke Foundation is encouraging Australians to discover how easy it is to fit healthy habits into their day and do their part to prevent stroke.

There are, however, still some risk factors for stroke that can’t be prevented, such as age, family history and prior stroke. If you’re male, your risk is also higher. For those people who unfortunately have experienced stroke, MICCN has science-driven programs in place to assist with their recovery and to give them the best life possible. Because, even after stroke, it is still easy – and beneficial – to fit healthy habits into your day.

Dr Rene Stolwyk is a clinical and research neuropsychologist and an expert in management of psychological difficulties following stroke. His focus lies on two key areas that are crucial to effective recovery: memory rehabilitation, and improving rural access to psychological services using Telehealth.

Memory difficulties are experienced by approximately half of stroke survivors and can impact a person’s ability to carry out everyday tasks. Through the Monash Psychology Centre, MICCN neuropsychologist Dr Adam McKay is delivering impactful recovery programs such as the Monash Memory Skills Program. This program provides stroke survivors with a range of evidence-based tools and techniques to enhance their memory function in a supportive group environment. Furthermore, recent MICCN research has demonstrated that the program is effective in helping people to rebuild memory skills and knock down the most common barriers to recovery.

Dr Stolwyk is also leading MICCN’s Telehealth clinical research, and was key to developing a new teleneuropsychology service for Victorian rural hospitals. “Access to psychological services in rural areas is typically very poor. Telehealth is helping to reform assessment and treatment services for those who experience stroke-related cognitive, behavioural and mood impairments, and is enabling rural stroke-survivors who cannot travel to cities access to these much-needed services,” Dr Stolwyk said. Based on the initial success of the program, Safer Care Victoria is supporting Dr Stolwyk’s team to implement the Telehealth program across three more rural hospitals. MICCN is also in the process of establishing a specialised service in teleneuropsychology to support this initiative.

As well as in-person treatment, Professor Jennie Ponsford is also using Telehealth in her trial of psychological therapy to address sleep and fatigue in stroke. She understands that finding the right balance in activity levels and developing healthy lifestyle and sleep habits is key to overcoming these common problems following stroke.

“Fatigue is very common in people with stroke, but there aren’t any established treatments,” Professor Ponsford said. “We’ll be addressing fatigue by examining a person’s lifestyle and activity schedules to work out what makes them tired, so that we can work towards maximising their energy levels. The individual’s sleep hygiene will also be reviewed – including napping, caffeine and alcohol intake and timing of their sleep/wake schedule. We can then make the necessary adjustments and offer recommendations to enable better sleep, which will reduce fatigue and deliver improved health as well as improved mood. In summary, we’re developing an individually tailored multifaceted intervention so that people with stroke can overcome these debilitating problems and improve their quality of life.”

In his approach to stroke management, MICCN Research Director, Professor Mark Bellgrove, focuses on the fascinating condition of unilateral spatial neglect. Unilateral spatial neglect arises most commonly from a stroke to the right side of the brain and results in poor awareness for the left side of space (i.e., opposite to the side of the stroke). Classically, patients with unilateral spatial neglect experience a range of spatial deficits, from omitting the left-hand features of a picture when drawing, to only eating the food from the right side of a plate, and even failing to shave the left-hand side of the face. Unilateral spatial neglect is important to understand because patients with this condition vary markedly from one another and this syndrome is associated with a poorer recovery from stroke.

In collaboration with The University of Queensland and Trinity College Dublin, Ireland, Professor Bellgrove and team are working to isolate discrete subgroups of unilateral spatial neglect by combining brain imaging data of the location of the stroke, measures of brain activity recorded by the scalp using EEG, and behavioural measures of attention, as well information on everyday functioning and quality of life. It is hoped that this integrated approach will help to understand why patients with unilateral spatial neglect vary from each other so much, and will help the development of personalised therapies rather than taking a one-size fits all approach.

MICCN’s ultimate aim in the management of stroke is to make life more comfortable and enjoyable for people who have experienced it, and to work with them to actively achieve healthy brains and healthy bodies. In this journey, it is indeed true that every step counts.