World Stroke Academy

World Stoke Academy

The World Stroke Academy is an online educational resource that can contribute to CPD/CME points and the sharing of information and knowledge. The current focus is Paediatric Stroke authored by Professor Nabil Kitchener, Dr. Gabrielle deVeber and Dr Vijeya Ganesan.

You can upload podcasts, and a well of various information, at your fingertips. We know these tools are looking great, and getting better all the time, we know the content is excellent for the best authors in stroke, but what we don't know is how you feel about it, and we'd love to hear your responses to the new look WSA.

  

IJS rehabilitation edition OUT NOW

At IJS we are often asked the question, 'why don't you have a rehabilitation section in your journal?' and we always answer that as stroke rehabilitation is such an essential part of stroke as a whole that it cannot be regulated to one simple section. With that in mind we have acquiessed to some extent and put together for our readers immediate accessibility a special themed rehabilitation edition. This is really to emphasise stroke rehabilitation in the field and not to make rehab a separate section.

When we approached the wonderful Associate Professor Julie Bernhardt and Professor Steve Cramer they were both brimming with ideas of how to pull together an edition that would bring together the most important aspects of stroke rehabilitation. They have of course done a splendid job. 

Access to IJS directly, Rehab edition is free access

Editorial

We have focused an entire edition of the International Journal of Stroke with guest editors Associate Professor Julie Bernhardt and Professor Steven Cramer on rehabilitation for a very good reason. For those of us who manage stroke patients on a regular basis, there are a number of obvious issues, which often arise. The first is that the acute stroke process is often only the beginning of what becomes a lifelong disability, the consequences which are entirely born by the individual and their families; second, while we are accumulating significant amounts of evidence-based knowledge about stroke prevention and acute therapy, there is still a paucity of evidence-based knowledge about recovery and rehabilitation.

Assembling this volume, Professors Bernhardt and Cramer have drawn together strands of information from the basic sciences, right through to the global World Health Organization perspective about rehabilitation generally. The burden of stroke during the rehabilitation phase and beyond in terms of life-years is enormous. The prolonged phase of disability for the patient and limited evidence pool to guide practitioners and families remain a sleeping giant of stroke medicine. We hope that this edition may fuel the great awakening.

Professor Geoffrey A. Donnan

Read Stroke disability and rehabilitation of stroke: World Health Organization

Festive season

The festive season specifically for those following the Gregorian calendar, has just wrapped up and we at IJS office are having a well deserved (if we may say it) break from the lovely job of putting together this wonderful journal and all its accoutrements for you the readers, the authors and the reviewers. So, if you have been watching us, and noticing our voice is a little quieter at this time of year, never fear because as this year rolls over we will be doing more, offering more, working even closer with the World Stroke Academy, which is now online; and bringing you the voices of the SSOs globally. As many of you will find tech commentators are excitedly predicating a wonderful year for eLearning. The potential for people to explore actively, on so many platforms information, debate and knowledge from experts is full of all kinds of potential.

Keep your eye on the blog, and sign up to receive our posts.

Stroke Telemedicine

http://www.youtube.com/watch?v=iQdkBKF8p5g&feature=youtu.be
Dominique Cadilhac and Chris Bladin speak about telemedicine - paper is coming soon to IJS.

IJS is experimenting with coding - have you seen this ground breaking work on fatigue with Gillian Mead and martin Dennis? Keep an eye out for more stroke and fatigue papers as this topic garners more and more attention.

Sri Lanka World Stroke Day

 Launching the Stroke Solidarity String on World Stroke Day 2012 at Temple Trees in Sri Lanka by presenting the string to His Excellency the President Mahinda Rajapaksha by the President of the National Stroke Association of Sri Lanka, Dr. Padma Gunaratne. Hon Maithripala Sirisena, Minister of Health and Dr. Harsha Gunasekara, Secretary of the stroke Association are also present.

Changes in spleen size

International Journal of Stroke Managing Editor spoke to Drs. Sean Savitz and Farhaan Vahidy on the eve of the online publication of this very novel study. You can download this interview here. 

https://itunes.apple.com/gb/podcast/changes-in-spleen-size-in/id580359468

The spleen in stroke patients undergoes dynamic changes of contractions and re-expansion in the days following the onset of stroke symptoms, releasing inflammatory cells and contributing to further brain injury, according to researchers at The University of Texas Health Science Center at Houston (UTHealth) Medical School.

“We’ve known from animal studies that the spleen contracts after stroke, followed by the release of inflammatory white blood cells leading to secondary brain injury, so we wanted to observe what happens to the spleen in patients after a stroke,” said Sean I. Savitz, principal investigator and professor of neurology at the UTHealth Medical School. 

Photo credit: NIH

“This is a completely understudied area. The spleen is not normally an organ that neurologists or neuroscientists pay attention to. This was our initial attempt to look at the size of the spleen in stroke patients.”

The spleen is part of the lymphatic system, which fights infection by releasing white blood cells. It also helps control the amount of blood in the body and destroys old and damaged cells.

The study included 29 stroke patients and 20 healthy volunteers. The research team performed daily abdominal ultrasounds to measure the size of the spleens. In the stroke patients, spleens initially reduced in size and then re-expanded. The spleens of the healthy volunteers showed minimal variation in daily spleen size compared with the stroke patients.

Savitz said the study demonstrated a good correlation between the contraction of the spleen and the amount of white blood cells in the body. The results also suggested that some patients whose spleens contracted for a longer period of time, releasing more inflammatory white blood cells, had poorer clinical outcomes. Further studies will be needed to confirm and explain these early findings, Savitz said.

Savitz and fellow researchers became interested in studying the spleen after animal studies at UT-Health and elsewhere showed that stem cells administered intravenously after a stroke travelled to the spleen, as well as to the brain.

“The big question was why,” said Savitz, who is director of the Stroke Program at UTHealth and an attending physician at Memorial Hermann-Texas Medical Center. “Emerging work by our group and other researchers suggest that some types of stem cells have a dampening effect on the inflammatory response emanating from the spleen. The spleen is a possible target in the future for treating stroke.”

Savitz’s research team at UTHealth included first authors Preeti Sahota, M.D., and Farhaan Vahidy, M.D. 

A little bit of art...

IJS are preparing to interview Swedish Neurologist Barbro B Johansson and I was touched by this image and historical note on her web page.
Her website 'banner' held this picture of a beautiful sculpture and I have left in tact the historical note she made about it as seen below.

Historical note: I took the picture of the sculpture on the top left when I visited the Institute of Neurosurgery and Brain Research in Santiago, Chile 1961. It is made by Marta Covin, a famous Chilean Sculptress (1905-1993), using the hands of Alfonso Asenjo as a model. Asenjo was a pioneer in neurosurgery that founded the Institute of Neurosurgery and Brain Research in Chile already in 1939. Because he was a friend of Salvador Allende the sculpture was removed and disappeared in connection with the military coop in Chile 1973. I think that the sculpture is a too beautiful illustration of what makes us human to be forgotten.

This re-empahsises for me as Managing Editor for the journal, the important work people do in neurology and how globally this work in undertaken in all conditions; how each individual treatment and care impacts on each human being which resonates globally. This gift of quality of life is why we at this journal, the flagship of the World Stroke Organization must always remember that we are a global platform for a global voice, so no matter the conditions that people work in, or the resources available to them, we are there to share knowledge and support these amazing practitioners to reduce the burden of stroke.

Trade-offs between effectiveness and efficiency in stroke rehabilitation

Trade-offs between effectiveness and efficiency in stroke rehabilitation

Keywords:

• activities of daily living;
• effectiveness;
• efficiency;
• rehabilitation;
• stroke;
• trade-off

Background Most stroke research has studied rehabilitation effectiveness and rehabilitation efficiency separately and not investigated the potential trade-offs between these two indices of rehabilitation.

Aims To determine whether there is a trade-off between independent factors of rehabilitation effectiveness and rehabilitation efficiency.

Methods Using a retrospective cohort study design, we studied all stroke patients (n=2810) from two sub-acute rehabilitation hospitals from 1996 to 2005, representing 87·5% of national bed-years during the same period.

Results Independent predictors of poorer rehabilitation effectiveness and log rehabilitation efficiency were • older age • race-ethnicity • caregiver availability • ischemic stroke • longer time to admission • dementia • admission Barthel Index score, and • length of stay.

Rehabilitation effectiveness was lower in females, and the gender differences were significantly lower in those aged ≤70 years (β −4·7 (95% confidence interval −7·4 to −2·0)). There were trade-offs between effectiveness and efficiency with respect to admission Barthel Index score and length of stay. An increase of 10 in admission Barthel Index score predicted an increase of 3·6% (95% confidence interval 3·2–4·0) in effectiveness but a decrease of 0·04 (95% confidence interval −0·05 to −0·02) in log efficiency (a reduction of efficiency by 1·0 per 30 days). An increase in log length of stay by 1 (length of stay of 2·7 days) predicted an increase of 8·0% (95% confidence interval 5·7–10·3) in effectiveness but a decrease of 0·82 (95% confidence interval −0·90 to −0·74) in log efficiency (equivalent to a reduction in efficiency by 2·3 per 30 days). For optimal rehabilitation effectiveness and rehabilitation efficiency, the admission Barthel Index score was 30–62 and length of stay was 37–41 days.

Conclusions

There are trade-offs between effectiveness and efficiency during inpatient sub-acute stroke rehabilitation with respect to admission functional status and length of stay.

WSC in pictures

Marc Fisher and Geoffrey Donnan talk about journals STROKE and IJS

INCOMING WSO PRESIDENT STEPHEN DAVIS

GEOFFREY DONNAN AT THE IJS BOARD MEETING

Dominique Cadhilaic, Marion Walker, Geoffrey Donnan and Julie Bernhardt

The Canadian Stroke Network

http://www.canadianstrokenetwork.ca/index.php/about/our-partners-links-page/provincialterritorial-strategies/

The Canadian Stroke Network have a great blog. This blog is an excellent example of where content can be published, free and easily accessible for the public. The International Journal of Stroke are planning on working with SSOs to build a public stroke network here on our blog, which has as of this month had over 31,000 views! Blogs are a great way of disseminating important information at low, or no cost!