It’s probably true to say that a lack of motivation is one of the more serious factors involved in unsuccessful rehabilitations. A gradual diminishing of motivation is also a really normal reaction to setbacks, and stroke is one SERIOUS set-back. 

You can bet that I’ve met quite a few stroke survivors over the years who’ve become prone to anxiety, depression and/or anger because of the condition they have found themselves in.

I hope that I’ve been able to facilitate at least some of these people towards the benefits of maintaining a ‘growth mindset’ concerning their recovery, despite their difficulties.

For example, there is a question that is often asked after a while if successes become imperceptible or grind to a halt. It is: ‘why bother to try retraining when nothing more seems to be happening, despite everything I’m doing so far?’

There are a number of instant answers that a neurologist would give you to this. Primary among them would be the point that even though changes may not be visibly occurring as a result of your efforts, your rehab training will still be as essential for warding off decline as well for driving positive functional change. This is why getting an ARNI trainer to tackle this with you is even more important.

So a good battle-plan is to find out more and more about your presentation (as it stands RIGHT NOW) and available treatments (AS THEY STAND RIGHT NOW), via as many knowledge-sources, is key.

For example, most people don’t understand (forget, aren’t told, or don’t read about the) need to continually promote an increase in active range of movement (AROM) in as many planes and pivots as possible.

Increase in non-functional AROM increases strength and muscle bulk, encourages muscular activity which promotes vascular return, decreases the potential for soft-tissue shortening and damage with resultant pain and stiffness and increases osteoblastic activity on your more-affected (and also possibly osteoporotic) side. Also, by doing this, you’ll render yourself more eligible for new technologies and/or medical options and emerging treatments to augment your retraining.

So, by steering you toward the potential inherent in effective retraining, I hope to promote a ‘growth mindset’ in you, if you’re not already ‘on-board’. You are a learner. And so am I, as a stroke survivor of what is now a full 25 years. You and I have to keep learning and keep retraining as stroke survivors, keep exploring and keep innovating over the long term. Easy to say, harder to do. But you MUST please, please write down a few things and start doing them. Then make a pattern of them day by day, which you don’t want to break, because it’s what you ‘do. And trust me, people will respect you for that.

Do MORE than able bodied people training-wise. Show them up!! Make them wish they WERE YOU!!

It’s possible.

Ultimately you may want to pass the things you’ve learned and constructed onto other survivors so that they can make of them what they will. I will show you how you can get motivated by getting successful; on what I call the ‘big fixes and the small steps’. This is, of course, only done by getting busy and starting to retrain with sensible staging posts. You’ll find your way through.

(fyi, the video of Successful Stroke Survivor manual above has no sound on: it’s not your laptop or iphone at fault!)

Have you thought about becoming an ARNI Stroke Rehab Instructor or nominating a colleague of yours to enter on the Course in order to Accredit/Qualify in Functional Rehabilitation After Stroke?

If not, please read on….  or please help if appropriate, by forwarding to a suitable colleague or two as a suggestion for consideration.

We have a couple of places left on forthcoming ARNI Stroke Rehabilitation Standard 6-Day Qualification Course… which is for the moment (due to Covid) available largely ONLINE.

Accredited by ARNI Institute, Middlesex University and very kindly assisted by the Institute of Neurology, UCL, and other experts in neurorehabilitation including from Oxford University. The Course has run 3 times per year for 15 years.

ARNI is well-known around the UK as a ‘go-to’ for stroke survivors and families when considering requesting an excellent instructor or therapist who will help survivors to rehabilitate in the community.

A Course synopsis is here for you: https://arni.uk.com/instructors/5-day-accreditation-for-instructors/

1. COURSE DATES FOR COHORT 1, 2022 https://arni.uk.com/cohort-1/

All dates are 10.15am – 5pm on Saturdays, for easiest access.

Day 1: January 22nd

Day 2: Feb 12th

Day 3: Feb 22nd

Day 4: March 12th

Day 5: March 26th

Day 6: April 9th

(Also practice training/shadowing days: March 22nd, April 1st, April 8th)

2. ADVANTAGES OF COMPLETION:

• Learn how to really train stroke survivors: what they actually need from you in the community to recover as much function as possible.
• Learn evidence-based skills, knowledge, retraining know-how and ‘tricks of the trade’ that you can offer and over again to stroke survivors (and families) to help them with ongoing rehab and self-management.
• Be sent repeated referrals over time from ARNI Charity for rehab training.
• Use the ARNI tele-rehabilitation system.
• We may have people already on our lists who need your help, because we often have no other Instructor in specific areas to refer to or because existing Instructors sometimes find themselves unable to accept any more survivors to retrain.
• Join our group of over 140 active trainers after Accreditation via www.strokesolutions.co.uk

3. COURSE PRICE:

Please enquire. 

Please take advantage as we will go back to having all contact days (back to usual price) at ARNI Central for Cohort 2 of 2022.

4. WHAT DO I DO NOW?

Don’t Delay! Email Dr Tom Balchin to register or ask to speak on the phone about the Course.

HAPPY CHRISTMAS FROM ARNI!

Buy yourself or someone you care about some ARNI goodies TODAY:  claim a huge 50% RIGHT NOW off any of the items featured below!

Get a bundle of ARNI gear at half-price – any published ARNI Book or manual (Successful Stroke Survivor or Had a Stroke, Now What?), physical DVD or DVD set, online anytime video subscription, limited edition blue 4-logo ARNI Training t-shirt, training diary, ARNI badged USB stick or cool gold-effect logo coaster! 

3 DAYS ONLY! HURRY PLEASE! No orders in after 5pm on Friday 17th December please!

See Product page 1 and Product page 2 to see usual item prices and see below the illustration pictures for HOW TO GET THE ITEMS FEATURED BELOW at 50% off! 

PLEASE NOTE:

We have no coupon facilities set up for this Christmas offer, so just go to Product page here and choose everything you like that is featured on this page, note them down and then call us at ARNI on:

 Call Us : 0203 053 0111

With your order! 

We’ll then apply your 50% discount and you can pay via card over the phone or via paypal! Hurry please!   

HAPPY CHRISTMAS!!!

‘I’m pretty elderly now. If I have a stroke, I’m sure I won’t recover function’.

Good news though. This isn’t automatically so. The evidence reveals that overall, age is NOT considered to be a strong predictor of a better or worse functional recovery after stroke.

And elderly patients with stroke are still absolutely considered candidates for rehabilitation regardless of stroke severity, and each case needs to be considered on the basis of individual characteristics and potential. Factors such as fitness, cognitive functioning, family/community support and comorbidities (other health problems you may have had pre-stroke and may still have) are considered important in these cases.

Here is a wonderful photo of two people who are currently being retrained by ARNI Rehabilitation instructors: Harry Baker and his Grandfather! Harry, when he came to see us was just 15. His Grandfather is 95!

You probably know that stroke is most likely to occur after 55 years of age, with 38% of strokes occurring between 40-69 years and 59% of strokes occurring in people aged over 69 years. You’re most probably also aware that advancing age is considered a risk factor for stroke, with the incidence of stroke approximately doubling each year above 60 years of age. The average age of stroke is 72 years for men and 78 years for woman in the UK.

Although many people choose to ignore it, it’s very important for an older person to identify (or this being done for them by their GP) the things which increase their risk of having a stroke so that they can modify the way they live to reduce the risks.

The aging process is known to cause specific cardiovascular changes that impair heart and blood vessel function. These changes lead not only to reduced physical and mental ability, but aging is also a risk factor for cardiovascular disease (CVD). CVD is a classification term for diseases that involve the heart or blood vessels. For example: heart attack, stroke, heart failure, angina, hypertensive heart disease, rheumatic heart disease, cardiomyopathy, abnormal heart rhythms, congenital heart disease, valvular heart disease, carditis, aortic aneurysm, peripheral artery disease, thromboembolic disease and venous thrombosis.

A few lifestyle changes could reduce your risk.

Stopping smoking, reducing your alcohol intake, maintaining a healthy weight, eating healthier (high fibre, less fatty/surgery) foods and taking regular exercise can make a massive difference.

Existing medical conditions, like high blood pressure, high cholesterol, heart disease, diabetes, irregular heartbeat (atrial fibrillation), and having a transient ischaemic attack (TIA) can increase your risk of suffering a stroke. If you’ve not yet done so, you should probably ensure to consult your GP or a healthcare expert to summarise your risk factors for stroke as well as conduct a medication review for you.

Recovery after stroke

As noted above, older people are more likely to have pre-existing health conditions which can affect their ability to adjust to change and/or be the cause of functional limitations which in turn make ADLs more difficult to.

However, the brain has a life-long capacity to learn and adapt. Through processes called neuroplasticity and neurogenesis, the brain remodels itself in response to learning and experience. This allows the brain to change it’s structure and organisation; strengthening, adding or removing neural connections or creating new cells (neurons).

Neuroplasticity does decline as we age, but it doesn’t stop. It’s never to late to learn a new skill and many people use retirement as an opportunity to learn something new. This is only possible due the still present ‘plasticity’.

Does that mean that elderly stroke survivors can regain function after a stroke? Yes, and they do!

There is hope for recovery, even for elderly and previously ill stroke survivors. Specialist post-stroke care and early rehabilitation are key to gaining the best outcomes. Most improvements occur in the first 3 months after a stroke, after which they do slow down, but the brain will keep creating new neural pathways after this time: well after 6 months and in numerous cases, after many years. See how this is done in Had a Stroke? Now What? So it’s very important to begin and to continue with a tailored rehabilitation programme once no community (state given) help is available.

In order to bring about functional change, neural pathways for desired activities need to strengthened. At a very basic level, this can be optimally achieved through repetitions (facilitated by ‘smart’ use of use of some augmentations and principles which one can ‘add’ to movements to optimise their performance over time, always trying to work ‘on the edge of your current ability. How do do this is explained in my ‘stroke rehab possibilities wheel diagram’ in Had a Stroke? Now What?. The more repetitions you can achieve in a shorter time, the better the brain can re-structure. The skill you are trying to ‘re-learn’ should be something that is relevant and meaning for you.

You’re more likely to succeed if you deem the task or tasks important and worth-while. For this reason, I’ll show you how you can set mini-plans (or goals) and identify what you want to achieve, so that you can prioritise your time. This is particularly important if you suffer from fatigue and low energy levels. Goal-setting (although to many people it sounds like a very woolly term) will help you to stay motivated and on-task if you match it with record-keeping. Actually, record keeping is the valuable one. Goals can quite vague but recording what you achieve each time you retrain is the massive biggie. So few people really do it, and it’s a shame. They really should – success lies in knowledge – knowledge is power!

So, young or old – let’s go! There’s ALWAYS a way. If you can’t locate what that way is at the moment, ask us and we’ll give you some pointers ok?

To get involved with rehab talk with other stroke survivors, please visit ARNI Facebook

The majority of stroke survivors whom I’ve met, when describing their prior physiotherapy and any other rehabilitative efforts, will report that the focus of therapy was usually on seated stabilisation, seat to stand, weightbearing and walking practice. All vital stuff. But only a small minority remembered being introduced to/practising upper limb exercises.

This happens for a number of reasons, but as time and resources are most usually limited, therapists often do not have time to devote to extensive hand-function efforts. Many receive no upper limb therapy at all. And by the time further treatment is sought, the task is all the more harder. At the height of the pandemic, many patients were told that it was safer to go home and receive no therapy or no further therapy.

This is why it’s critical that the leading edge Upper Limb Clinic developed at the Institute of Neurology at UCL by Professor Nick Ward builds up more and more a body of evidence of efficacy so that it becomes clear that a ‘3 week intensive blast’ of multi-therapies that such a Clinic can offer, with the learning for survivors and families that can accompany it, can become an effective bolt-on or plug-in funded for each hospital in the UK with a stroke unit in order to push/promote/kick-start recoveries. Maybe this will happen in due course. I hope so!sive

In the meantime, it’s vital that stroke survivors are shown what to do as far as upper limb is concerned in the community, as soon as possible after discharge, in order to continue the work of the therapists or initiate it if none has yet been done.

The reason is that all evidence points to the fact that high dosages of repetitions, over time, stand best chance of assisting upper limb recovery. This has to be done by the survivor, at their own residence. Survivors need to know what to try to do themselves and what they need to seek help with/for.

The evidence (see yearly-updated in-depth reviews of well over 4,500 studies including over 2,170 randomized controlled trials at www.ebrsr.com) reveals that:

• Task-specific training, alone or in combination with other therapy approaches, may be beneficial for upper limb function.
• Higher and lower intensity task-specific training may have similar effects on upper limb function.
• Trunk restraint with reaching training may improve upper limb function.

Let’s discuss how you as a stroke survivor can use this evidence. Remember, high dosages of repetitions (of reach, grasp and release) are needed. Remember that all attempts at repetitions (including mental practice) drive neuroplasticity. You NEED to get it done, over and over again, even if nothing is happening: there are ‘tricks of the trade’ as it were’ that you can use.

I’m going to show you all of this in a series of Youtube clips.

You can go ahead and get access to the full series of videos on physical DVD or anytime online streaming access, if you like, by going clicking to here The Successful Stroke Survivor Full Video Series 300 minutes.

Have a look at this small video I put together: this is clip 1 of 20 or so about upper limb training. Then take part with me by subscribing to the new ARNI Stroke Rehab Tips on Youtube. Upper limb rehab will come first and Video 1 is already up on there: watch and subscribe for further Youtube videos! Many other stroke rehab topics will be loaded up on there as time moves on.

If you do want to take part, you need only a minimum amount of kit. A short stick (cut a broomstick and chamfer the edges), a tray or book, some items with blue tack stuck to the bottom (or MUCH better a laptop board with heavy duty Velcro strips attached and some specific items with Velcro squares attached to them – click the link to get, or make your own board).

Being in a seated position is fine when doing upper limb task-specific training. But completing the reaching task by moving your trunk forward to complete a reaching activity is ‘cheating’. This is where trunk constraint works well. This is often done via a chest seatbelt/harness.

How to start retraining your upper limb after stroke? Your starter programme consists both of stretches and tasks. You may or may not have been taught how to safely self-stretch but the idea is that more is better and safety is paramount. You have to stretch your upper limb (gently), knowing at the same time simply stretching won’t bring recovery. You have to be task-focused. So, when you do a stretch, you then do something challenging and specific functionally with the stretch.

For example, stretch, then try to pick a hairbrush up and put it into a cupboard. In your retraining sessions, stretches must be considered as promoting the chances of the successful performance of the task.

Remember my upper limb catch-phrase: stretching enables the task and extends ‘time on task’.

These are very important for improving your potential ability to reach for, grasp and release items with your hand: activities that are denied to so many stroke survivors. You can use stretches daily in order keep muscles long and prevent further complications. The best results are often seen in people who have consistently stretched their wrist, fingers and thumb on their more-affected side from a very early period in the hospital.

Upper limb task-specific practice concerns reaching (which you perform mainly with your shoulder, elbow and wrist joints) and grasping/releasing (which you do mainly with your fingers and thumb joints). Stroke survivors often find it very hard to make purposeful movements requiring precise control of either; rendering movement slow, inaccurate, and usually not well directed or coordinated. Isolated recovery efforts for the upper limb, often in terms of grasping and releasing an item during a task, correspondingly demand effort and accuracy.

Unlike (to an extent), lower body, training coping strategies for and during rehabilitation of the upper limb should be largely avoided.

If you have spasticity and find it hard to reach away from your torso,  you may tend to ‘throw’ your more-affected arm at a task mainly by activating your shoulder joint. This stands in contrast to a more controlled movement sequence, where your arm can move away from your torso using your shoulder, elbow and wrist joints to help position your hand to complete a task. The latter situation is better than the former.

Success at reaching therefore needs to be trained for. Building up strength and working for incremental spasticity decline can be worked on at the same time. So, trunk constraint whilst performing task-practice has strong evidence for improving outcomes, because it makes ‘cheating’ nearly impossible to do.

Also, limb de-weighting via wrist holding or using de-weighting technology is a therefore a good way of facilitating this from the start. See picture, below and left. This is because ‘heavy arm’ can render tasks very difficult to perform.

I’ll show you all this in one of the videos, and how a therapist, trainer or any family member can do this precisely to help the survivor ‘get the ‘gap’  between thumb, first finger and middle finger, in order to pick up an object.

So, arm de-weighting, often in terms of assisting in reaching for an item during a task can be used to initiate and/or extend your time practising a task.

One thing you need to know is that although there is evidence that functional control of your hand will only improve once you gain more control over joints which are closer in towards the body (proximal) rather than further away (distal), recent evidence suggests that you should be also be trying to work with your fingers and thumb right from the start rather than waiting for your arm to get stronger in order to position your hand accurately.

This might sound strange if you can’t even ‘get a gap’ between your first finger and your thumb, or that your fingers and thumb are ‘floppy’. Both states would seem to make ‘useful’ hand function non-existent.

However, it’s suggested that, via specific retraining, distal control can and should be trained for immediately after stroke, This is also because if you waited for control to return from proximal to distal, you might achieve some strength in the shoulder, elbow and wrist over time but may not have done any task-specific grasp and release attempts at all, let alone put in the very large amount of intensive retraining time that might stand a chance of helping you regain control of the main reason why you have an arm in the first place.

The UCL World Stroke Day Forum is back!

Being physically active is a great way to improve and maintain health and wellbeing… and reduce the chance of a stroke. And of course, rehab is required if you’ve had one.

If you have had a stroke, you will hopefully have been shown how to implement your own programme of consistent repetitive movement at home during your recovery.

To help you with this and many other features of tackling limitations from stroke, you are invited to take part in a week-long programme of online sessions.

Each has been designed to encourage open dialogue and activity between researchers, clinicians, charities and stroke survivors.

We’ll also be joined by the team behind the campaign We Are Undefeatable, which aims to inspire and support people with long-term conditions to build physical activity into their lives in a way that works for them. They will talk about their campaign, the kind of movements that can be done from the comfort of your own home, and give some tips about how to make being more active fun.

The programme is available by clicking: Register Here.

Looking forward to seeing you: do book to enter the various workshops taking place during this amazing week-long event NOW!

On Tuesday, September 28, from 6pm to 7pm, on the NR Times website, a webinar will be held to discuss what the Rehabilitation Prescription is achieving for patients, and what more could/should be done.

The impact so far of the Prescription, and its potential, will be assessed by four leading names from across neurorehab. The webinar, held by NR Times working alongside NRC Medical Experts, is the first in a series to analyse key issues in neurorehabilitation. The panel taking part in the webinar are:

• Professor Mike Barnes, one of the UK’s most experienced neurorehabilitation experts
• Dr Tom Balchin, founder of The ARNI Institute.
• Sara Grimshaw, clinical specialist occupational therapist at Rehabilitate Therapy.
• Hokman Wong, senior solicitor and brain injury specialist at Bolt Burdon Kemp.

The Rehabilitation Prescription is designed to give patients, GPs, case managers and everyone involved in an individual’s care a comprehensive overview of their immediate and longer-term neurorehabilitation requirements in one summary document, which acts as a guide to navigate the complexity of neurological disability.

The event will look at whether the Rehabilitation Prescription really is improving patients’ lives or whether, when the patient reaches the community, outside of the realm of NHS help, a rehabilitation prescription that can be used to guide ongoing rehabilitation, is part of standard current practice or not.

Certainly, rehabilitation prescriptions for stroke survivors which are updated as a patient advances in their don’t seem to happen at all. But it it would be invaluable for a patient to know that any therapist they work with can access a ‘passport’ containing up to date information on their rehabilitation needs, which can perhaps also be updated over time…

* The webinar is free to attend but registration is needed. There is also the opportunity to submit questions in advance. To register, visit here.

LOOKING FORWARD TO SEEING YOU THERE!!

Your exclusive invitation for professionals who help those with brain injury, and for survivors and their families, only by application RIGHT NOW!

For 2.5 hours, this Thursday (23rd September 2021, 10.30am to 1pm), listen to and talk directly with the UK’s Leading Experts in Stroke Recovery.

Listen to and ask Professor Val Pomeroy (University of East Anglia) about getting to grips with/analysing action control and Professor Avril Drummond (University of Nottingham) about managing fatigue.

Co-chairs: Hokman Wong (Bolt Burdon Kemp) and Tom Balchin (ARNI).

This is a rare chance for you to ask these two engaging experts about their fields and any other query you have. They will present for 45 mins each and the rest of the time will be concerned with taking your questions. So do come prepared with a few questions to ask: go for it!

There is NO CHARGE and we can also also apply on your behalf for a Certificate for 2.5 hours National CPD Service CPD points for attending.

These people are experts who I myself try and engage with when I need help in order to help a patient with a certain issue. So whoever you are, be it professional, survivor, family member or carer, do book up for this event (see flyer below). 

Reservations for Thursday’s awesome event are going quickly, so please do read the flyer below and reserve yours NOW by emailing tom@arni.uk.com 

Please note: if you already registered (for example, you attended last Thursday’s Conference with Professors Cathy Price and Heidi Johansen-Berg), then there’s nothing more to do except login at 10.15 or so, ready for 10.30 start!

Professor Valerie Pomeroy is Professor of Neurorehabilitation and Director of Research at the School of Health Sciences, University of East Anglia with expertise in translational research into neuroscience-based rehabilitation interventions (proof-of-concept and early phase trials). Emphasis is placed on care closer to home and development of sensitive physiological measures for timely identification of response to therapy, prediction of response and the neural correlates of response. A particular expertise is in MedTech development especially after securing team mentorship on the Design Council Leadership Programme in 2014.

Professor Avril Drummond is Professor of Healthcare Research in the School of Health Sciences in the University of Nottingham. She is Non-Executive Director at University Hospitals of Derby and Burton NHS Foundation Trust. She is particularly interested in patient care and NHS research. She is an expert in rehabilitation research and evaluation of service delivery. An occupational therapist by background, her research includes rehabilitation research in stroke, traumatic brain injury, low back pain, total hip replacement, Multiple Sclerosis, specific studies of GP fit notes, hemianopia, early supported discharge, fatigue, falls prevention and home visit assessments, the work of the stroke units and community re-enablement.

Open this Email for Your Invitation to listen to, and talk directly with via Zoom, the UK’s Leading Experts in Stroke Recovery!

Listen to and question Professor Cathy Price (UCL) about language recovery, Professor Heidi Johansen-Berg (Oxford University) about neuroplasticity & imaging, Professor Val Pomeroy (University of East Anglia) about movement analysis and Professor Avril Drummond (University of Nottingham) about the management of fatigue.

On 16th and 23rd September, ARNI and BBK are holding two COMPLETELY FREE 2.5 hour stroke rehabilitation event/discussions for survivors and their families, and for professionals who help those with brain injury.

The reason for holding these events is that these topics have ranked as the top four that survivors and professionals we’ve asked would like to ‘get the latest information about’ as they recover (or help others recover).

This is a rare chance for you to ask the experts about their presentation and any other query within their field of expertise. They will present for 45 mins each and the rest of the time will be concerned with taking your questions, so do come prepared with a few questions to ask: go for it!

These four people are experts who I myself try and engage with when I need help in order to help a patient with a certain issue. So whoever you are, be it professional, survivor, family member or carer, I urge you to book up for these events as soon as you can.

Reservations for these events are going quickly, so please do read the 2 flyers below and reserve yours NOW by emailing the email address on the flyer (webinar@boltburdonkemp.co.uk) or by just emailing me back. Do attend one or both days.

Professor Cathy Price is Professor of Cognitive Neuroscience and Director of the Wellcome Centre for Human Neuroimaging at Queen Square, whose early work in human neuroimaging helped to produce new approaches for investigating the brain bases of cognitive functions. She also provided theoretical frameworks for understanding cognitive impairments in neurological patients. Her research has helped to transform our understanding of how the brain supports language processing – including speech perception, speech production, semantic memory and reading. Cathy has shown how specialisation for all types of language processing emerges through cross-talk among unique combinations of areas that are each involved in many other non-linguistic functions. Her current work is in the development of neuroimaging tools that predict and explain how stroke survivors recover from speech and language impairments (aphasia).

Professor Heidi Johansen-Berg is Professor of Cognitive Neuroscience and Director of the Wellcome Centre for Integrative Neuroimaging (WIN) in the Nuffield Department of Clinical Neurosciences. WIN is a multi-disciplinary neuroimaging research facility. WIN aims to bridge the gap between laboratory neuroscience and human health, by performing multi-scale studies spanning from animal models through to human populations. Within WIN, Heidi heads the Plasticity research group. Her group is interested in how the brain changes with learning and recovery from damage, such as stroke. Her group use cutting edge brain scanning techniques to monitor brain change and develop new technologies to enhance rehabilitation effects following stroke.

Professor Valerie Pomeroy is Professor of Neurorehabilitation and Director of Research at the School of Health Sciences, University of East Anglia with expertise in translational research into neuroscience-based rehabilitation interventions (proof-of-concept and early phase trials). Emphasis is placed on care closer to home and development of sensitive physiological measures for timely identification of response to therapy, prediction of response and the neural correlates of response. A particular expertise is in MedTech development especially after securing team mentorship on the Design Council Leadership Programme in 2014.

Professor Avril Drummond is Professor of Healthcare Research in the School of Health Sciences in the University of Nottingham. She is Non-Executive Director at University Hospitals of Derby and Burton NHS Foundation Trust. She is particularly interested in patient care and NHS research. She is an expert in rehabilitation research and evaluation of service delivery. An occupational therapist by background, her research includes rehabilitation research in stroke, traumatic brain injury, low back pain, total hip replacement, Multiple Sclerosis, specific studies of GP fit notes, hemianopia, early supported discharge, fatigue, falls prevention and home visit assessments, the work of the stroke units and community re-enablement.

With the emergence of the COVID-19 pandemic and the subsequent mandatory lockdowns that followed, performing rehab exercises prescribed by physiotherapists, at home without help (save some telerehab options) was and still continues to be the most usual mode of rehab available for some stroke survivors.

Evidence suggests, however, that non-adherence represents a significant challenge for many when it comes to exercising at home. Even when exercises are delivered by a physiotherapist in a face to face setting, research shows that approximately 50% of patients are not adherent.

Unsurprisingly, non-adherence becomes significantly more prevalent when rehabilitation is administered at home without any physiotherapist supervision.

There are many factors that contribute to non-adherence such as self-image, attitude towards health and exercise, depression, anxiety and most importantly self-efficacy.

In simple terms, self-efficacy can be described as the beliefs an individual has towards their ability to successfully perform a task or achieve a certain outcome, in this case completing home exercise.

In theory, if a person has low levels of self-efficacy relating to a particular task, they would not only have an aversion to that task but the effort applied would be of a less intense and less persistent quality when they are forced to engage.

Although there are many ways in which a physiotherapist can help improve self-efficacy in patients that are not confident in themselves to perform exercise at home, self-efficacy for home exercise is not routinely appraised in stroke survivors.

This is because no tool has been developed thus far to reliably and accurately measure self-efficacy towards home exercise in the stroke population.

Brunel University London is aiming to determine if an adapted version of the Self-Efficacy Home Exercise Program Scale (SEHEPS) can reliably and accurately measure self-efficacy for home exercise in the outpatient stroke population.

This is a pilot study to test the validity of the SEHEPS on the outpatient stroke population.

I’ve personally been helping with this, as I think it’s a facet that’s rather missing from ‘what’s available’ after stroke to help people at home.

What’s your view? Let’s see what we can do to help the Brunel Team get this right for us stroke survivors – thanks everyone for your support, in advance!

If you think you fit the (current) participant criteria below – ie, you:

1. are aged 18 or above
2. have been diagnosed with a stroke
3. can provide consent
4. understand written/spoken English sufficiently enough to complete the study 
5. are community-dwelling (not currently in hospital or residing in a care home)

and would be able to give a few minutes of your time to improving after-stroke rehab considerations by helping to test the validity of the scale, to ensure it reflects your own needs/considerations/ideas, do please email the Team today…

Dr. Cherry Kilbride, Dr. Elmar Kal, and Gary Sahota on 1909128@brunel.ac.uk

Thank you