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How art unlocked a new future for brain injury survivor

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Artist and art therapist Carl Arroyo, from therapy provider Chroma, shares the story of brain injury survivor Ricky, whose interest in tattoo art began a path towards a life with more possibilities.

I’ve been an art therapist for more than a decade now, and it’s an incredible way of drawing people out and allowing them to express themselves.

I started working with Ricky (not his real name) in the Spring of 2020, about a year and a half after his injury. He already had a multidisciplinary team around him, and it was felt that he needed something else to support him in adjusting to his experience and his injuries.

To be honest, Ricky wasn’t particularly interested in art as a whole, but he had a specific desire to design some tattoos based on his experience of his injury.

And that’s very much one of the skills that you have to have as an art therapist; that means of making a connection at some level and seeing where it takes you.

Tattoos are culturally acceptable and accessible – most towns have got tattoo parlours – so people of a certain generation find them appealing, and that certainly was the case with Ricky.

Initially, it was all about reflection, talking about the artwork, what that might relate to and then towards the end, we were looking at where he wanted to go and what he could do with his life.

And through all this was threaded the idea was that he was going to take the design he produced to a tattoo parlour and have it made into a tattoo.

One of the fascinating things that came through the design process was how he was relating it to his life, his injuries, and also his new place in the world.

His design was a skull with a crown on it, which was significant to Ricky both physically and emotionally. For example, as part of his immediate treatment following his accident, he had to have the top of his skull removed, because the brain was so swollen.

He was telling me about having this plate and the materials that they were using, and from that we had the idea to place a crown on there. And then that segued into talking about what the crown represents, in terms of Ricky being in charge of his own kingdom, and how his injury had changed how people viewed him.

One of the aspects of his injury he found hardest to deal with was being the centre of attention, surrounded by carers all the time, because in his life, in his family, he’d never had that attention. He’d not been listened to.

While he found it frustrating at times, paradoxically he came to accept that he was a king of this world and the attention was on him. The idea of the crown allowed Ricky to focus on some of the less tangible effects of his condition.

In the end, we had about 15 sessions, but, with lockdown, we were never able to meet physically and, sadly, by the time we could, he’d somewhat disengaged from the process.

However, prior to that, he was getting to the point where he could see that, if he wanted to create this new life, he was going to have to be more assertive and actually start asking for what he wanted.

And that wasn’t going to be an easy process. That’s what art therapy does; it’s about encouraging the creative process to give the patient a voice, and helping them find ways to cope with their new way of life.

www.wearechroma.com

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New campaign to reduce stroke risk launched on Stroke Prevention Day 

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Almost nine out of ten strokes are associated with modifiable risk factors

A 12-week campaign is being launched today – Stroke Prevention Day – to help raise awareness of how the risk of stroke can be reduced. 

The campaign encourages people to make one small positive change to their lifestyle to reduce the possibility of stroke, which is the fourth highest cause of death in the UK. 

According to the Stroke Association UK, 89 per cent – almost 9 in 10 – strokes are associated with modifiable risk factors in the Western countries, including lifestyle elements that can be changed to reduce risk, such as weight, diet and blood pressure. 

New research commissioned by the charity, which is leading the campaign, has also revealed: 

  •  Only 1 in 20 (6%) UK adults think they’re at high risk of a stroke, despite the fact that the global lifetime risk of stroke from the age of 25 years onward was approximately 25% among both men and women
  • Almost half (47%) of the country don’t know that high blood pressure is a top risk factor for stroke 
  • 3 in 4 people (73%) said that they have had no information about stroke reduction recently, which rises to over 4 in 5 (85%) of over-65s, who are most at risk of having a stroke.

Blood pressure is the biggest cause of stroke, with 55 per cent of stroke patients having hypertension when they experience their stroke. Further, around 1 in 4 adults from 55 years of age will develop AFib. 

“While these numbers are concerning, they also demonstrate that with increased awareness, we can all take simple steps to reduce our risk,” says Charlie Fox, sales director of OMRON Healthcare, who are supporting the Stroke Association campaign alongside Patients Know Best. 

“As an incredibly important risk factor for stroke, having a healthy heart should be a top priority and remain front of mind.”

AFib can be asymptomatic and may not be present during a medical appointment as episodes can be occasional, which means it is often left undiagnosed. 

But given its seriousness, those who may be at risk should routinely record electrocardiogram (ECG) measurements, according to current medical guidelines. 

Through doing so at home will enable patients to become more in control of their health, with OMRON being one of the companies developing the technology to support them in doing so. 

“The public wants and needs to be more in control of its health, which is why we create products and services that are suitable for use at home as part of our Going for Zero strokes pledge,” adds Fox. 

“OMRON Complete, for example, is an upcoming, clinically validated home blood pressure monitor with a built-in ECG which can help detect AFib which we’re excited to launch in the coming months. 

“It is our hope that through this awareness programme and by equipping the public with the tools it needs, we can make having an empowered and informed lifestyle the new normal.”

People with a Patients Know Best (PKB) Personal Health Record can also log readings to get a more complete picture of their health journey. This allows them to look back with ease and share readings with clinical teams and caregivers in a safe, secure and meaningful way.

Fox concludes: “Your blood pressure provides important health insights. Monitoring it regularly alongside your ECG readings empowers you with knowledge, helps you act sooner, and can even save your life”.

More information about the campaign and how you can make your one small change can be found here: www.stroke.org.uk/PreventionDay

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What are the IDDSI Levels and why do they matter?

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Wiltshire Farm Foods takes you through the importance of the IDDSI Levels

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Dysphagia, more commonly known as swallowing difficulties, can be prevalent amongst those in neuro rehabilitation. For those in recovery, understanding how their swallowing has been affected, what solutions are available and which nutritional, delicious and above all, safe, meals they should be eating, is of paramount importance.   

When someone starts to experience dysphagia, they are most commonly seen by a speech and language therapist (SLT) and a dietitian. Together, they will create a plan for the management of dysphagia. A speech and language therapist will explain in detail the importance of texture modified food and drinks and will work with you to carefully understand the right texture modification for you. 

What is IDDSI?

This is where IDDSI can help you understand your recommended texture modified diet in more detail.  IDDSI stands for International Dysphagia Diet Standardisation Initiative. This is a committee that have developed a framework of 8 levels which provide common terminology to describe food textures and the thickness of liquids for those living with dysphagia.

The purpose of IDDSI is to create standardised terminology and descriptors for texture modified foods and liquids that can be applied and understood globally – across all cultures and age spans.

Before the introduction of IDDSI, there were national descriptors in the UK which were formed by opinion rather than international standards. Having different terminology, categories and definitions in different countries caused some instances of food being of incorrect consistency. The IDDSI framework was fully adopted by food manufacturers and healthcare settings in the UK in March 2019.

The framework consists of levels for both drinks (liquids) and foods, some of which overlap as you can see in the image above. Here is a breakdown of each category in the IDDSI FOODS framework. 

Level 3 – Liquidised/Moderately Thick

  • Can be drunk from a cup
  • Does not retain its shape
  • Can be eaten with a spoon, not a fork
  • Smooth texture with no ‘bits’

Level 4 – Pureed/Extremely Thick

  • Usually eaten with a spoon (a fork is possible)
  • Does not flow easily
  • Does not require chewing
  • Retains its shape
  • No lumps
  • Not a sticky consistency

Level 5 – Minced

  • Can be eaten with either a fork or a spoon
  • Can be scooped and shaped
  • Small lumps are visible, but are easy to squash with tongue
  • Biting is not required
  • Minimal chewing required

Level 6 – Soft & Bite-Sized

  • Can be eaten with fork or spoon
  • Can be mashed/broken down with pressure
  • Chewing is required before swallowing

How can I check my meals are made to IDDSI standards?

You can check to see whether your food is compliant with the IDDSI Framework by watching these IDDSI Food Test videos.

To discover a Softer Foods range which is IDDSI compliant and created with your patients’ needs in mind, register here for the opportunity to try some complimentary meals from Wiltshire Farm Foods.

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Link between brain injury and cancer could yield new treatment approach

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The research comes from The Hospital for Sick Children in Toronto

Brain cancer could be triggered by the healing process from a brain injury, new research has said, in findings which could yield new breakthroughs in patient therapies.

The tumours of 26 patients with glioblastoma were analysed in the Canadian research project, and found that mutations can affect the process of new cells being created, which can therefore stimulate tumour growth.

“Our data suggests that the right mutational change in particular cells in the brain could be modified by injury to give rise to a tumour,’ says report author and neurosurgeon Peter Dirks, from The Hospital for Sick Children in Toronto.

“Glioblastoma can be thought of as a wound that never stops healing.

“We’re excited about what this tells us about how cancer originates and grows and it opens up entirely new ideas about treatment by focusing on the injury and inflammation response.”

In the study, published in Nature Cancer, researchers used single-cell RNA sequencing and machine learning technologies to map out the molecular make-up of glioblastoma stem cells.

The team found new subpopulations of glioblastoma stem cells which bear the molecular hallmarks of inflammation and are comingled with other cancer stem cells inside patients’ tumours.

These findings, Dr Dirks said, suggest that some glioblastomas start to form when the normal tissue healing process — which is supposed to generate new cells to replace those lost to injury — is interrupted by mutations.

The mutant cells will then continue to multiply, spurring tumour growth, although it may be many years before a patient becomes symptomatic.

In the research, cells from the tumours of 26 patients were collected, and in total almost 70,000 were analysed using single cell RNA sequencing. 

The team found evidence of ‘extensive disease heterogeneity’ and that each tumour contained multiple subpopulations of molecularly-distinct cancer stem cells.

This will, therefore, make cancer recurrence more likely, as existing therapies are unable to wipe out all the different ‘subclones’.

However, as a result of this understanding, new therapies and bespoke approaches could be developed.

“We’re now looking for drugs that are effective on different points of this gradient,” adds co-author and cancer genomicist Trevor Pugh, from Princess Margaret Cancer Centre in Toronto.

“There’s a real opportunity here for precision medicine — to dissect patients’ tumours at the single cell level and design a drug cocktail that can take out more than one cancer stem cell subclone at the same time.”

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