End-of-life care after stroke and how current practice can be improved is being investigated in a new landmark study.
Hospital stroke units across the UK will be assessed to establish their current end-of-life care approach, and the views of health professionals, alongside patients and families will be sought in formulating the recommendations for best practice.
It explore current challenges around receiving and providing end-of-life care after stroke and will investigate what medical professionals, patients and carers consider both helps and hinders current levels of care.
The 18-month study is being supported by a grant of £142,626 and involves universities and NHS Trusts across the country.
It is being led by the UK’s largest nurse-led stroke research team at the University of Central Lancashire, whose School of Nursing is home to the only two nursing professors of stroke care in the UK.
“Despite medical advances, 21 per cent of stroke patients die within 30 days of having their stroke. High quality end-of-life care and support after stroke is therefore crucial,” says Dr Clare Thetford, senior research fellow from ULCan’s School of Nursing.
“However, stroke is different to other conditions, and can make end-of-life care complex.
“There is a lack of education and guidance for healthcare professionals responsible for providing this care. This may cause inadequate, inappropriate or delayed care and support.
“We will explore what specific challenges stroke may create, and how the many recent changes to general end-of-life care might work with stroke patients.”
The National Institute for Health Research Programme Development Grant will see UCLan and Lancashire Teaching Hospitals NHS Foundation Trust (LTHTR), based in Preston, collaborate with partners including Oxford University Hospitals NHS Foundation Trust, Canterbury Christ Church University, University of Nottingham, Poole Hospital NHS Foundation Trust, University of Exeter, alongside a dedicated patient and public involvement group.
Professor Liz Lightbody, who is leading a National Stroke Workforce group for end of life care, on behalf of Health Education England, says: “There is a view that providing end of life care is the role of specialist palliative care teams, but this is not the case.
“Good quality end-of-life care is everyone’s business, all staff involved in caring for patients following a stroke should have the knowledge and skills to provide compassionate and sensitive end of life care.
“LTHTR is committed to providing mechanisms to translate research evidence into practice and thereby influencing improvements in the quality of care. It is providing a pivotal role in the transformational development of stroke services across South Cumbria and Lancashire and will ensure the results from this research are implemented into practice.
“Together we are at the forefront of new innovations in healthcare, so I am delighted that we are involved with this research and that local patients can benefit from access to emerging new treatment for strokes.”
Calvert Reconnections strengthens senior team ahead of opening
A groundbreaking neurorehabilitation centre is helping to plan for its future even before its opening through strengthening its management team.
Calvert Reconnections is set to open on June 21 and is set to deliver new possibilities in brain injury rehabilitation through its UK-first residential programme which combines traditional clinical therapies with physical outdoor activities.
The centre, based on the outskirts of Keswick in the Lake District, is now making new additions to its senior team as is prepares for its long-awaited opening, which has previously been delayed due to COVID-19.
Claire Appleton has become head of service at Calvert Reconnections with Lorna Mulholland appointed as registered manager.
Claire, an occupational therapist, has 23 years’ experience working in the NHS and has held various community roles including in acquired brain injury, long-term neurological conditions, neurological splinting and stroke rehab.
Five years ago, Claire moved into a management post in the NHS leading the Eden Community Rehab Team, developing strategic specialist leadership and management skills, and gaining valuable experience delivering high quality health services.
Lorna has 12 years’ specialist experience within the social care sector, principally in acquired brain injury, learning disabilities, mental health and autism.
She has an extensive knowledge base in delivering care within a residential and supported living setting with experience in complex challenging behaviour.
Sean Day, centre director at Calvert Reconnections, says: “As part of our senior management team, Claire and Lorna have a key role to play in the delivery of our service.
“Everyone at Calvert Reconnections take great pride in what we do and the difference we can make to people’s lives.”
Adventures in VR for care home residents
Having fun in the snow and touching the clouds are some of the ways that residents at Exemplar Health Care’s Ribble View care home are using virtual reality technology to relax during lockdown.
This is part of Exemplar Health Care‘s commitment to investing in the latest life-enriching technology to make every day better for their people.
Over the past few months, the therapy team at the home has been working with individuals to explore their likes and interests, and tailoring the VR experience to their personal choices.
Individuals can choose from a range of pre-loaded films that are shot in 360 degrees, so that once the headsets are placed over their eyes, they can be fully immersed into a ‘virtual world’.
Lindsay Abraham, home manager at Ribble View, says: “Before we begin a session we talk to the individual to find out what they like.
“If someone’s a keen traveller, we can load videos of famous landmarks onto the VR headset, so they can travel around the world from the comfort of their home.
“The technology allows people to see a 360-degree picture and be fully immersed into the virtual experience.”
Since the introduction of VR technology at Ribble View, the team has already seen lots of benefits.
Pamela Hicken, therapist at the home, said: “VR has been well received at Ribble View. Some of our residents get very excited when they see me walking down the hallway with the headset.
“Everyone that’s used it has given positive feedback, and for many of our residents, it’s helped to reduce anxiety and pain.
“We used the VR headset with one of our residents who was experiencing anxiety. Before the session, they rated themselves as 7/10 for anxiety and 4/10 for pain.
“During the session, we used a calming snow scene on the headset, and incorporated massage and breathing exercises into the session, and we could see the individual become more relaxed throughout.
“At the end of the session, they’re anxiety score decreased to 3/10 and pain score to 3/10, and they commented that they found the session very ‘relaxing’.”
VR can also be incorporated into physiotherapy sessions to support rehabilitation and mobility.
Pamela continues: “For residents with athetosis, we’ve seen that their movements have become more purposeful, and residents with limited arm movements have been reaching out to touch things.
“We used the headset with one resident who has limited mobility, and they were moving their neck to look in different directions, and reaching out with their hands.
“Throughout the session, they made comments such as ‘I want to do it every day’ and ‘this is heaven’. By the end of the session, their anxiety score had reduced by two points.”
The benefits of virtual reality technology in care homes
DR.VR is a virtual reality distraction therapy that can support pain management and reduce stress and anxiety.
It uses a headset, which, when worn, transports people to a 3D computer generated environment and immerses them into a virtual ‘world’.
The technology can provide a safe and therapeutic experience for adults living with a range of neuro-disabilities and mental health needs.
Adding these meaningful experiences into people’s everyday lives can bring huge health and wellbeing benefits.
Research also shows that DR.VR can be effective in managing pain, anxiety and stress – the technology transports people to another environment, place or time, which can distract them from their current pain or stresses.
Clinical nurse manager, Shannon O’Dea, says: “For our service users when they are struggling, DR.VR will help to deescalate and redirect when the environment is too stimulating. DR.VR allows them to get to their safe space through guided meditation, relaxation or distraction.”
About Exemplar Health Care
Exemplar Health Care is a leading provider of specialist nursing care for adults living with a range of complex and high acuity needs.
They have over 32 community-based, specialist nursing homes and OneCare services which provide person-centred care and rehabilitation that focuses on maximising independence, building everyday living skills and empowering people to live as fulfilled lives as possible.
They support people on their journey from being in hospital or living in a secure setting to community-based living, as well as offering longer term support for people living with degenerative or life-limiting illnesses.
‘I’ll be forever grateful’
After 88-year-old Philip Haines had a stroke and lost mobility in his left side, his bespoke rehabilitation enabled him to regain his independence. Here, to mark Stroke Awareness Month, he shares his story of recovery
“I’ll be forever grateful.”
For 88-year-old Philip Haines, who lost mobility in his left side following a stroke, his thanks to those who helped him regain it are limitless.
Philip, former secretary to the Anglican Diocese of Peterborough, admits being “hit for six” after his stroke, which was caused by a blood clot in his brain.
His cerebral infarct left him with dense left hemiplegia, meaning he was unable to move his left arm and leg. While the blood clot was successfully removed, the stroke left Philip with cognitive challenges and difficulty in swallowing.
Philip was admitted to Askham Rehab from Peterborough City Hospital in November, where he was assessed by the multidisciplinary team and set clear goals, before being put on a specialist four-month programme specific to his needs.
And now, to mark Stroke Awareness Month, Philip is sharing his gratitude for the team at the specialist neurorehab community near Doddington, as well as to help show the life-changing effects such rehab can offer.
“The stroke knocked me for six and changed my life dramatically, but every day I was met with a group of very enthusiastic physiotherapists who were trying to bring some life back into my left side,” says Philip, who returned home last month.
“This whole journey has been a completely new experience, it’s almost like a rebirth. You always try to be positive, but it’s inevitable that you go through periods of feeling low.
“The team’s enthusiasm helped pick me up during those low points. We got on fine, they were very helpful, and it was a real group effort in trying to bring life back into my muscles.”
When asked if he had any final words for the team that looked after him throughout his rehabilitation, Philip says simply: “Keep up the good work. I’ll be forever grateful.”
During his time at Askham Rehab, Philip was able to make use of the family-run community’s robotics and sensor assisted technology, with it being one of a small number of providers in the UK to offer a specialist robotic-led rehabilitation service.
He used the MYRO table, a sensor-based surface with interactive applications, to aid upper limb movement and focus on balance, coordination, and cognitive training.
With strokes being a specialist area at Askham Rehab, Philip also performed mirror therapy, hands-on therapy and functional tasks as part of his tailored programme, which soon led to a significant improvement in his mobility.
“Philip had access to all four of our disciplines; clinical psychology, physiotherapy, occupational therapy, and speech and language therapy,” says Sara Neaves, clinical lead and outpatients service manager at Askham Rehab.
“It was clear from day one that Philip knew exactly what he wanted to achieve. This enabled us to set patient-centred goals with him, ensuring he was part of the process throughout his journey with us.
“Philip was fully independent before his stroke and enjoyed walking into Peterborough city centre every day for his lunch, so he was determined to get back on his feet.
“He swiftly improved the mobility of his left upper limb through the use of our robotics and mirror therapy, and was soon able to transfer using a Molift with the assistance of two.
“He also improved his swallowing through oral motor techniques and no longer needed thickening in his fluids.
“It has been extremely rewarding to see Philip come this far. He had a positive outlook on his rehabilitation journey with us from the offset.
“His sister has also been an excellent support to him and due to our patient-centred care, his individualised programme has worked to his goals.
“We’re delighted he’s now able to get back out and head into town again for his lunch outings with friends.”
Aliyyah-Begum Nasser, director at Askham, adds: “Philip’s journey at Askham encompasses what Stroke Awareness Month is all about; highlighting the strategies to improve the quality of life for persons recovering from the condition.
“Our family-run community, which has more than 30 years’ experience, including 10 years of neurological rehabilitation expertise, prides itself on having comprehensive and specialist programmes in place to ensure those undergoing rehabilitation with us receive structured, high-quality care with a holistic approach.”
For more information on Askham Rehab, visit https://askhamrehab.com/.
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