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Stroke: evidence, experience and resources

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On this page, you can find our blogs about different aspects of stroke. Many of them include research evidence and also reflections from people affected by stroke themselves, health professionals involved in the care of people with stroke and stroke researchers. There are also links to helpful resources.

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Information after stroke – what’s helpful?

In their blog Giving information after stroke: what’s helpful? (December 2022) James Garrard (Specialist Registrar in Stroke and Geriatric Medicine) and Annette Dancer (stroke survivor and research advisor) give their reflections on giving information to people after stroke, and look at the evidence on what might be helpful for stroke survivors and their carers.

Stroke is a varied condition which affects each person differently There is a lot of available information, but it is difficult to ensure patients and families get the right information, and understand what is told to them For Annette Dancer, a stroke survivor and research advisor, the needed level of information and the way information was provided changed through her journey of stroke survival and recovery There is Cochrane evidence that giving information actively, including planned follow-up for clarification or reinforcement, may improve stroke-survivor knowledge and quality of life and may reduce anxiety and depression, although uncertainties remain. The evidence for passive information giving (for example leaflets) is unclear

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New treatments

In this blog Stroke: advances in treatment offer hope for patients (April 2022), for people interested in stroke treatment, James Garrard, Specialist Registrar in Stroke and Geriatric Medicine, reflects on his experience as a doctor working in a stroke centre and looks at the latest evidence and some game-changing developments in treatments for some stroke patients.

Take-home points: Stroke is a medical emergency and the quicker the person can be treated, the higher the chance of a better outcome. For people with a stroke caused by a clot in a major blood vessel, Cochrane evidence shows that thrombectomy (the removal of the blood clot using a mechanical device) is an effective treatment. It improves the likelihood of independence and survival compared to standard treatment with thrombolysis (a clot-busting medication). For people who wake up with a stroke, it used to be thought that treatment with thrombolysis or thrombectomy was unsafe, because the time of their stroke starting was not known. But new evidence suggests that the benefits may outweigh the risks.

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Dysarthria (unclear speech) after stroke

Stephen Taylor, Joe Bugler, and Annette Dancer are three stroke survivors affected by dysarthria (unclear speech). They are also members of HEARD (Healing, Empowered And Recovering from Dysarthria), a patient involvement group which has helped to shape research to identify the things that matter most in speech recovery after stroke. In this blog, Stroke survivors: measuring what is important in speech recovery, they tell us more.

Dysarthria, where people have difficulty speaking (and being understood), affects about half of stroke survivors to some extent and can be devastating. HEARD (Healing, Empowered And Recovering from Dysarthria) is a patient involvement group made up of stroke survivors affected by dysarthria. Working alongside others interested in dysarthria, they have helped to identify a list of things that matter most in speech recovery after stroke. Historically, the things that speech therapists have used to measure speech recovery have been mechanical (such as tongue strength, or words spoken per minute). The new list identified in this research project is more meaningful. For example, it focuses on effective conversations, how intelligible someone’s speech is, and living well with the condition. The hope is that this new list can be used to measure the effectiveness of therapies, inform new research and, ultimately, improve the lives and recovery of people with dysarthria.

Annette Dancer first wrote about her experiences of dysarthria here, in a blogs with Claire Mitchell, speech and language therapist and researcher –  Sorry, what did you say? Living with dysarthria (unclear speech) after stroke (August 2017).

Annette also wrote a blog about Confidence after stroke: dating with dysarthria (March 2018). Annette had a stroke in 2014 and avoided social interactions because of her dysarthria. She believes that involvement in research has helped her to conquer fears of new relationships by putting dysarthria into perspective. This blog shows how her research experience helped her to see a potentially deflating experience turned into a step forward. Annette has also shared her experiences of The surreal side of life after stroke (March 2018).

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The impact of stroke – Caroline’s story

In her blog, I miss me (March 2018) Caroline Carus reflects on some of the impacts of her stroke, one year on. “I miss me, the old me, the gone me”…

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Physiotherapy-based dance to improve strength and balance

Breathe Dance for Strength & Balance is a 10-week dance-based physiotherapy programme for adults prescribed strength and balance physiotherapy. These include, but aren’t limited to, people who have had a stroke. In the blog Breathe Dance for Strength & Balance: offering choice, delivering benefits (April 2023) Hannah Dye from Breathe Arts Health Research explains how their innovative dance programme provides an alternative to exercise classes for older adults prescribed strength and balance physiotherapy at Guy’s Hospital, London. Created with patients, the programme is offering people choice in their healthcare pathway and bringing multiple benefits.

Breathe Dance for Strength and Balance is a 10-week programme for older adults referred to the Older Person’s Assessment Unit at Guy’s Hospital, London. Patients are prescribed strength and balance physiotherapy, and they can choose this programme as an alternative to exercise classes Co-design is key to embedding a successful, sustainable arts and health service. Developed by social enterprise Breathe Arts Health Research, in collaboration with patients, physiotherapists and a dance artist, people taking part are reporting multiple benefits and showing improvements in clinical outcomes. For example, improvements in physical functioning, confidence levels and independence Work is continuing to evaluate the impacts of the programme and how it compares with the strength and balance exercise programme

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Static splinting

In the blog Static splinting after stroke: evidence and practice Danny Minkow, studying for an MSc in Occupational Therapy, invites other students and therapists to consider the problem of continuing use of therapies which lack evidence to support them or have been shown to be ineffective, and explores this in relation to splinting and stretching as stroke rehabilitation interventions. In December 2022, Sarah Chapman from Cochrane UK revised and republished this 2014 blog with recent evidence and guidance. 

Take-home points: Writing in 2014, occupational therapist Danny Minkow reflected on the use of static splints for people after stroke as an example of a treatment in use but not supported by evidence The most recent (living) guideline, from the Stroke Foundation in Australia, which includes Cochrane evidence, says the use of splints or muscle stretch for stroke survivors at risk of developing contractures is not recommended. Updated guidance on stroke rehabilitation is in development from NICE and from SIGN The Royal College of Occupational Therapists and James Lind Alliance Priority Setting Partnerships identified the Top 10 Priorities for occupational therapy research in the UK in 2021, setting the research agenda to address the the unanswered questions that matter most to people accessing and delivering occupational therapy services

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Living and dying well after stroke

The blog Living and dying well after stroke (March 2018) continues to draw a large number of readers and many comments and we are glad that many people are finding something helpful here. In the blog, Scott Murray and Marilyn Kendall talk about the rich evidence from their in-depth interviews, which could guide provision of person-centred care after major stroke and support people in living and dying well. 

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Research participation

In their blog Research is better together: a stroke survivor and a researcher tell us why (March 2018) Annette Dancer and Claire Mitchell give us their perspectives on why research is better when researchers and people affected by stroke work together, and what they gained from their collaboration. 

Both Claire and Annette, along with two other stroke survivors affected by dysarthria, Stephen Taylor and Joe Bugler, were involved in recent research to identify the things that matter most in speech recovery after stroke. You can read about that in the blog Stroke survivors: measuring what is important in speech recovery. 

If you’re interested to know more about the research or might be interested in opportunities to take part, Dr Claire Mitchell Claire.mitchell@manchester.ac.uk always wants to hear from stroke survivors living with dysarthria.

In the blog Stroke rehabilitation trials: let’s measure what matters (March 2018, updated August 2022) researcher and physiotherapist Julie Duncan Millar reflects on the difficulties of comparing and sharing upper limb rehabilitation trial data and proposes a condensed toolkit of measures recommended for researchers to use in future trials. The toolkit was developed by considering the stroke survivor, family and friend, clinician and researcher perspectives on life after stroke with upper limb dysfunction.

Other opportunities to take part in research: 

The National Institute of Health Research page Be Part of Research has opportunities that you can search for by location and keyword (such as the name of a condition or treatment). They also have information about the stroke research projects they fund on their page Stroke.

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Resources

NHS

UK guidance 

UK Charities

 

Join in the conversation on Twitter with @CochraneUK or leave a comment on the blog.

Please note, we will not publish comments that link to commercial sites or appear to endorse commercial products. Please note, we cannot give specific medical advice and do not publish comments that link to individual pages requesting donations or to commercial sites, or appear to endorse commercial products. We welcome diverse views and encourage discussion but we ask that comments are respectful and reserve the right to not publish any we consider offensive. Cochrane UK does not fact-check – or endorse – readers’ comments, including any treatments mentioned.

References (pdf)

Sarah Chapman and Selena Ryan-Vig have nothing to disclose.


Sarah Chapman and Selena Ryan-Vig

About Sarah Chapman and Selena Ryan-Vig

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Sarah and Selena are Cochrane UK’s Knowledge Brokers. Their role involves sharing evidence in accessible ways with those who could find it helpful for their health decision-making, and encouraging engagement with it through social media. Sarah trained and worked as a nurse, has degrees in History from the Universities of Oxford and Reading, and worked in health services research before joining Cochrane UK in 2007. She is a recent cochlear implant recipient (2021) and is a Patient Ambassador for the COACH Trial, a randomised controlled trial of cochlear implantation versus hearing aids in adults with severe hearing loss. Sarah tweets @SarahChapman30. Selena has a psychology degree from the University of Bath and has previously worked for a national charity that provides support for young women. With a colleague, Selena delivers interactive sessions to students from Years 10 to 13 to teach about evidence-based practice and to encourage critical thinking, particularly around healthcare claims made in the media.

Stroke: evidence, experience and resources by Sarah Chapman and Selena Ryan-Vig

is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International

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