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Being unfit and inactive are risk factors for stroke. And after stroke (depending on your pre-stroke status), you will be far less physically active and cardiovascularly fit. If you are in either category, if appropriate, this post might be helpful… 

In the UK, stroke services are developing/referring in to stroke-specific community exercise programmes. The system is reasonably analogous to the very well-established rehabilitation services for cardiac disease patients which usually start after usual rehabilitation has ended.

Standard community pathways for exercise and physical activity vary across counties and regions in the UK, but collaborations between health boards and council-run leisure centres have resulted in the establishment of exercise referral schemes which provide a range of exercise programmes delivered in usually in small group sessions. These often utilise community leisure resources.

You can enquire yourself about local services or be referred through local identification mechanisms (GPs, health professionals).

Additionally, some UK Charities, including Stroke Association, Headway, Different Strokes and Strokeability offer free or minimal cost group exercise classes in multiple venues around the country, however these are generally low in frequency (once a week for approximately one hour in duration).

ARNI offers group classes rarely, preferring to concentrate charitable efforts on getting instructors into people’s homes in order to provide that vital one to one rehabilitation support that can be achieved at lowest cost.

Weekly exercise classes for stroke survivors (who also have resulting physical limitations requiring rehab) should be considered supplementary to what you are already doing at home and elsewhere to attempt to recover. Cost does come into this of course.

Apart from ramping up physical activity and cardio activity, by far the most important part of recovery from many stroke survivors’ points of view is rehabilitation. Hence ARNI’s concentration on teaching you techniques to tackle hundreds of improvement activities including weight-bearing, balance and gait-control (including how to cope with drop-foot and reducing the required supporting power of the AFO over time, etc), coping strategies (such as getting down and up from the floor unaided and emergency action avoidance techniques, turning etc), upper limb training (tackling spasticity. flaccidty etc) one to one, with the help of a physio or trainer, as well as how to train for cardio effect independently at home.

Wow, there’s so much to do after stroke, right?

Well, yes maybe it seems like it, but segmented into mini-efforts, it can definitely be done. You have potential to do better. PLEASE don’t get disillusioned and not make a start.

This is going to be a long term effort, with sometimes little discernible result, but believe me, absolutely everything you do matters.

Let’s define things, so you can take action.

Exercise is a physical activity that is planned, structured, repetitive, and purposeful.  Physical activity includes any body movement that contracts your muscles to burn more calories than your body would normally do so just to exist at rest. Although learning to enjoy and plan structured exercise into your routine would definitely improve fitness, it is not the only way to improve fitness. Activities of daily life keep your body moving and still count toward the recommended amount of weekly physical activity. Most importantly, no matter what your current fitness level, you are able to improve your physical fitness and therefore, your heart health, by increasing physical activity and/or exercise as you are able.

What you should be doing in terms of exercise is regarding it as comparable to a prescription of medication.

Ie, it’s probably best taken every day. You should only start exercising once you have recovered enough and only do as much as you can manage. Talk to your doctor or therapist about what is right for you.

Here’s how you can optimise everything  from now on (ie, minimise time on training and maximise time on LIVING LIFE!!).

These three priorities should be the ‘spend’ and the ‘reward’ is knowing you are doing everything optimally to recover and vastly diminish possibilities of further complications. 

1. Try and secure rehabilitation at home one to four times per week with a physio or trainer. There are lots of options. Physiotherapy clinics are all over the place with some first-class physios ready to provide excellent rehabilitation. This website, of course, shows you how to get a physio or trainer in your area who will come to your house and help you optimally, for around £45 to £50 per full hour. This can be even be supplemented by telerehabilitation (focused on upper limb training) with your instructor for around £20, during the week. 
2. Do cardio on a machine (stationary bicycle, recumbent bicycle, treadmill) at home every day, for 10 to 30 minutes, depending on status.
3. Be as physically active throughout the day as you can.

Knowledge is power – let’s look at the meanings of cardiovascular exercise, sedentary behaviour and physical activity  – so that you can quickly figure out the optimal choices for you – and how best to save time and money.

Cardiovascular exercise covers everything from walking, jogging or running over-ground or on a treadmill (with or without bodyweight support such as the Alter-G anti-gravity treadmill), to cycling, recumbent stepping or swimming. Many people call it ‘cardio’ exercise.

Cardio is a therapeutic intervention that, despite the known benefits, is under-utilised by clinicians during rehabilitation. So, do not feel guilty if you have not done any since your stroke. But let’s start putting that to right.

Sedentary behaviours are basically any waking behaviours characterised by an energy expenditure of ≤1.5 metabolic equivalents (METs), while in a sitting, reclining or lying posture.

The chart shows you the different levels of physical activity.

Most stroke survivors are stuck firmly in sedentary behaviour levels.

Over the last 10 years, evidence has emerged that too much sedentary time (e.g. time spent sitting down) is related to a multitude of physiological consequences that result in reduced fitness, increased cardiovascular risk and increased risk of further sickness and even death.

It is important to note the distinction in definition between sedentary behaviours and physically inactivity (defined as: an insufficient physical activity level to meet present physical activity recommendations – e.g. not achieving 150 minutes/week of moderate intensity activity).

Note: an individual may be physically inactive but have low levels of sedentary time across their day, or vice versa. So, a person could meet physical activity recommendations but also spend considerable time in sedentary behaviours. 

But do daily METs really ‘tell the whole story’ of the health effects from physical activity? Maybe not.

A number of crucial physical attributes beyond daily METs for health are either unexplored or have received very little attention. For example, improvements in cardio fitness requires physical activity levels of relatively high intensity (>60% of maximal cardiorespiratory fitness). Thus, large volumes of daily METs at a lower intensity may improve metabolic fitness, but not cardiorespiratory fitness (due to insufficient stimulus on the cardiorespiratory system to adapt for higher physical activity demands).

Amazingly, workers in manual jobs (eg, cleaners) measured to walk about 20,000 steps per day still have poor cardiorespiratory fitness. On the contrary, high-intensity interval training for very short time improves cardiorespiratory fitness despite low total METs spent.

Given this, it is clear that you need to adjust some variables here.

The main principle used when defining and prescribing physical activity is called The FITT principle. 

The great news is that exercise training is a really potent stimulus for improving fitness and cardiovascular risk after stroke – and it doesn’t have to be at all onerous.

The dose of physical activity is different from person to person taking into consideration your capacity and limitations while also making sure you can adhere to the activity and safely complete it. And the best physical activities  provide progressive challenge over time.

It is recommended you should try and complete frequent but shorter sessions. This still may sound like a lot to do, but it does need to be contemplated. Look below at the chart ‘Interval Training Set’ for exactly how to do it.

Cardiovascular exercise has many health benefits to strengthen the heart’s efficiency.

The heart is one of the powerhouses of the body. When you strengthen your heart, you strengthen your whole system, including the arteries. With every heartbeat it puts pressure on your arteries, which transports a constant flow of blood throughout the body.

Exercise improves the heart’s efficiency by increasing the number of your smallest arteries called capillaries (this is called an increase in capillary density); which allows greater exchange of those nutrients your body requires. Cardiovascular exercise also increases the amount of blood that leaves the heart with every beat (stroke volume) meaning the heart doesn’t have to beat as many times per minute; the heart essentially doesn’t have to work as hard, increasing its efficiency.

In terms of your arteries, aerobic exercise decreases what is called arterial stiffness, this allows for the blood to be pushed along the arteries through proper dilation and contractibility, with an adequate amount of pressure.

A recent systematic review has shown that exercise interventions can result in clinically meaningful blood pressure reductions. Particularly if initiated early and alongside education about healthy lifestyle. In a haemorrhagic stroke, long-term arterial stiffness weakens the arteries. And with a rise in pressure, arteries can burst. Cardiovascular exercise is the first step to keeping or creating a healthy heart and arteries while a second intervention is diet. I will reveal more on healthy diet for stroke survivors in a next post. Your blood contains important factors that can keep you functioning properly, such as oxygen and many nutrients transported through the arteries.

Intensity of exercise is dependent on your heart rate or the amount of effort you feel you are exerting. To determine how ‘hard’ your heart is working and the intensity during exercise is also depended on your age. The more intense the activity the higher your heart rate will be. You might hear the phrase Rate of Perceived Exertion or RPE for short.

This is a scale that generally runs from either 6-20 (6 being resting while 20 is a maximal exertion during exercise) or a scale of 0-10 (0 being resting and 10 being maximal exertion during exercise). This scale is used to see how hard you perceive the activity to be.

It is advised to complete 3-6 days per week for 10-60 minutes per session depending on your status and the intensity of the exercise being completed. To get this done most efficiently, use the HITT principle, with permission from your GP.

HIIT training is high intensity interval training: a type of cardio workout where you will perform a set of exercises, alternating between high intensity periods and active or full recovery. These are short sessions of of intense work. The intense periods can vary from 10 seconds to 1 minute long and should be performed at 80 to 95% of maximum heart rate.

It should feel like you are working hard to very hard and be short of breath. If you use the talk test you would struggle to carry on a conversation. The recovery periods are performed at 40 to 50% of maximum heart rate. This is the period where you would feel comfortable and allow the body to recover and prepare for next work interval. You can also use the RPE chart where work intervals are between 8 to 10 and rest periods are from 4 to 6. The relationship between the work and rest periods is very important. The length of work and rest can be equal in length or the rest period can be shorter than the work period. This depends on your fitness levels as well as what you are actually doing in your work period.

Cardio exercise. It’s a good idea to plan from the start, how you are going to get cardio exercise done by yourself at home. In the beginning you may be nervous about doing some exercise training at home without supervision, but if you’re smart about it you can do it safely and successfully.

What to buy? It depends on your wallet, space in your house and other personal factors of course, but some general advice below.

Stationary exercise machines such as bikes are great, as you can use them without worrying about your balance.

A rowing machine is probably a no-no – it’s a sure-fire way to mess with your shoulder if you have subluxation in your more-affected upper limb.

Treadmills are risky unless you have two hands that work (you do need to be able to hold on!)

Ellipticals are often hopeless for those with upper-limb weakness (the more-affected hand cannot hold onto the handle), but some survivors make them work, no problem.

A much better bet for stroke survivors are stationary bikes that are more horizontal in nature rather than vertical.

These are known as recumbent or semi-recumbent bikes (depending how reclined it is). These types of gym bikes can be picked up relatively affordably from a variety of places. These are, for many, much better solutions. And they hold an excellent re-sale value.

I strongly advise the recumbent bicycle for stroke survivors with upper limb limitations – this solution is the best I’ve found. Here is my own one. See pic too. It sits in my office and is absolutely great. If you get one, you can prop an Ipad on the small tray where the display is and watch box sets or TED talks on youtube as you pedal!

I also have a commercial treadmill (fold-up one) in my office and do fast walking, covering around two miles per day on it using inclines varying from 0% to 15%. I also wear a 20kg weighted back pack. I try and do two sessions of 23 minutes each to complete the 2 miles. Sometimes it’s just one mile I manage to get done on top of weight training. This is actually just to ramp up physical activity (and a bit more power) in my more-affected leg.

But obviously I’ve worked up to this. I’m also holding on tightly throughout, to both handles! So this advice is only for those stroke survivors who have been spared upper limb limitations, or have rehabilitated  to such a good functional level that they feel able to use the treadmill safely. You will find that the treadmill has a fail-safe cord on it too which cuts the motor if you move too far from the control bar.

You can get amazing deals on these. I got mine for around £430. New, they are around £1100. This was because it was an ex-demo model. I just ensured that it was refurbished before buying. Have a look at Fitness Superstore. In this link I’ve found you the page for reduced price treadmills.

Mainly, it’s about doing what you can do, within exercise after stroke guidelines which are clearly available just by googling.

A final point: it’s a good idea to monitor yourself while exercising, so you can follow your own progress and also know when you need to push yourself a little further. There are several ways you can do this. Heart rate monitors are a great way to keep track of the intensity you are working at. Speak with your GP to find out what heart rate you should be working at for your age.

Pedometers are probably a more readily available and simple way to monitor how much you do in the sense of how many steps. However, ideally you want to be doing these steps fast if you want to improve your health and fitness. Physical activity watches such as a FitBit can track all sorts of things throughout your day such as activity, sleep and heart rate. If you want a way to begin tracking your activity levels to continue with your recovery one of these gadgets could be very useful in tracking your improvements over time.

In terms of physical activity, I encourage you to incorporate a variety of exercises in to your lifestyle. Particularly things like getting out of your residence and walking as well as you can (accompanied as appropriate), swimming (swimming classes for stroke survivors are often available and run by some ARNI INSTRUCTORS) and are a great way to socialise while achieving something.

Physical activity, rehab activity and cardio activity – each one followed by kettle and mug activity!

All is possible!

Are you looking for something to send a stroke survivor friend or to advise someone to get for you for Xmas? If so, these 2 low-cost gifts could be what you need. Both are available in limited supply for under £100!

I. If you want to give someone the ultimate home DIY exercises to help them recover, try this.

A login/password for anytime online streaming access (straight to ipad, phone etc) to the full DVD series of the well-known ‘Successful Stroke Survivor’!

This is a great gift. You can also send a gift of the actual DVD set for their DVD player too.

Exercises are for people of all levels – wheelchair-bound to those with ‘fine-tuning’ requirements. It’s all there.

Click here for more and find a Xmas saving of £40 on combined cost of all the DVDs.

2. If you want to help your friend recover use of their hand after a stroke, this brand new item is hugely popular at the moment!

It’s called the Stroke Task-Training Board and allows for standardised repetitive hand training. This can be used at any point to help retrain the upper limb – particularly the grasp and release.

Comes with 11 customised items that have been found by ARNI to work best for variety in terms of texture and shape.

Comes with a special 10 page colour Guide. Ultra-helpful for the stroke survivor!

Click here for more and find a Xmas saving of £10 on each Board.

Extra!

You might also want to buy some cards to support ARNI! 

Get your set (or sets) of 10 ARNI Stroke Charity Christmas cards!

These are A5 and very thick card.

We hope you love the design done by a young stroke survivor with his affected hand!

All therapists know what a challenge it is to try and help patients gain further action control of the more-affected upper limb. For ultra-effective upper limb training, get your task-specific training board shown here in conjunction with stretching before and after each grasp and release sequence.

If you or your loved one has upper limb limitations, this can be an excellent way to ‘increase the dosage’ of repetitions.

As Professor Nick Ward at the Institute of Neurology points out continually, in his and his team’s efforts to get stroke survivors to do more to engage the upper limb, ramping up the amount of grasp and release efforts performed daily may be most likely to increase neuroplasticity and accelerate recovery.

At last, available to you is the Upper Limb Task-Training board, as described in Successful Stroke Survivor and accompanying DVDs.

An innovative and simple idea created by Dr Tom Balchin which has helped thousands of survivors around the world since 2011, is now standardised here for you with his ideas of optimal content.

Red, Pink or Silver: choose your colour for a Christmas gift to yourself or another!

Comes with a full colour, fully illustrated 10-page A4 GUIDE for use.

The laptop tray, which can be opened and locked at any angle, is covered with strategically placed Velcro hook and comb strips and squares. 11 different tactile items, each with different manual challenge, have been sourced and purchased for stroke survivors to practice grasp, place and release. 

These are really great for people to try, if there is spasticity or flaccidity present – and this is the stepping stone that we have found for countless ARNI patients over the years that works to progress their hand from one phase to another. Best advice is always start off with the wooden pegs in slots. Physiotherapists have, among their many upper limb measures, a test called the ‘9 hole peg test’. This is an idea borrowed and scaled up from that test, with slots to enable practice. Advice is (all present in the Guide), is to start off with these, working on ‘getting the gap’.

Dr Tom shows you in the Guide how to try create the temporary ability via a particular stretching sequence how to maintain a gap between thumb, index and middle finger to enable a grasp upon command. The idea is to work up to being able to go up and down the line, lifting and replacing.

When you can do this, it’s time to move on to more challenging items on the board. The longest, smoothest and widest items are the most challenging. The Velcro always keep the paretic hand from knocking over items as the survivor attempts to grasp items until more fluidity/accuracy is gained. All is explained in the Guide and DVDs. You are going to like this approach; it gives SERIOUS RESULTS in terms of action control.

This is a must-have for all stroke survivors with upper limb limitations. 

Sourcing the varying of thickness and adhesiveness of very high-strength Velcro, the cost of the lockable laptop board itself, combined with the cost of the items adds up surprisingly. We have done all this and put the time in to create and offer you this at the very best possible price to cover outlay.

Get yours here to help yourself or your loved one with ARNI style upper-limb training… and get a fully-illustrated colour 10 page accompanying Guide with it! 

Go to the Products page to get the Task-Board.

IMPORTANT – Instructors and survivors will also be using this board together for forthcoming upper-limb telerehab sessions.

Forgive us mentioning Christmas cards in November! But if you do send cards this year,  do think about getting some of these?

100% of your money will go back to ARNI Charity to help support survivors and families to deal with the aftermath of stroke and other acquired brain injuries.

The card itself was created by one of our survivors, Alex, who came to us aged 8. He is now 13. He used the training he had done over these many years to conquer/manage the effects of spasticity in his hand – and created this superb and meaningful image on the card!

He was able to fully open his more-affected hand, keep it open without assistance, paint on it and lay it flat without assistance, on a piece of paper – then sprinkle glitter and so on. It sounds easy to those without upper limb spasticity (one of his limitations), but it was the result of years of training, goals, micro-achievements etc.

There is a few lines of explanation on the back of the card for your recipients…

Card is SUPERB quality thickness and A5 size.

Limited stock available… do have a look!

Press here GET MY CARD SET!

Did you know that Atrial Fibrillation (AF) is a contributing factor in up to 1 in 5 strokes in the UK?

Given that around 1 in 5 women, and around 1 in 6 men will have a stroke in their life, you really need to be aware and checking up on this.

If you have an irregular pulse it could be a sign that you have an abnormal heart rhythm. AF is one of the most common forms of abnormal heart rhythm and a major cause of stroke.

AF might not be bad on its own, but it keeps bad company. Many people tend not to realise that AF is one of the largest risk factors for major strokes, and it can cause congestive heart failure and other cardiac diseases.

AF increases stroke risk by around four to five times because it increases the risk of a blood clot forming inside the heart. If the clot travels to the brain, it can lead to a stroke.

The good news is that with appropriate treatment the risk of stroke can be substantially reduced.

Understanding, recognising and taking proactive measures against AF can potentially save your life.

Part of what makes atrial fibrillation so dangerous is that many people with the disease may experience mild, negligible symptoms, or even none at all.

Your heart’s pumping action is controlled by tiny electrical messages produced by a part of the heart called the sinus node (sino-atrial node). The sinus node is sometimes called your heart’s ‘natural pacemaker’. Normally, the electrical messages are sent out regularly, with each message telling your heart to contract and pump blood around your body.

This is felt as a normal, regular heartbeat, or pulse felt at the wrist.

In the case of a very fast or irregular fast-beat, go and see a Doctor ASAP!

IMPORTANT: Diagnosing AF is usually a fairly simple process that includes a Doctor’s exam and an electrocardiogram (EKG). If AF is detected, your doctor may want to do follow-up tests and blood work to ensure there are no other underlying diseases such as high blood pressure.

Atrial fibrillation happens because, as well as the sinus node sending out regular electrical impulses, different places in and around the atria (the upper chambers of the heart) also produce electrical messages, in an uncoordinated way. These multiple, irregular messages make the atria quiver or twitch, which is known as fibrillation. This is felt as an irregular and sometimes fast heartbeat, or pulse.

By the way, if you’re wondering, genetics, other cardiac diseases, diabetes, obesity, smoking, sleep apnea, lung disorders, hormonal disorders and excessive alcohol consumption are all potential risk factors as well.

There is currently no cure for AF and the way it is treated is individualised to the patient’s needs. It may involve medication (both to prevent a stroke and to control the heart rate or rhythm) such as anticoagulant (blood thinning) drugs like warfarin or a newer type of drugs called NOACs., cardioversion (when the heart is given a controlled electric shock with the aim of restoring a normal rhythm) and catheter ablation (this works by scarring or destroying tissue in the heart that triggers the AF). Having a pacemaker fitted to help the heart beat regularly may also be an option for some people.

With grateful thanks to the Heart Rhythm Alliance, in partnership with MyTherapy.

Stroke Survivors, as well as the professionals who treat them, need to be armed with the latest in stroke research in order to apply the evidence-base to their practice. For survivors, the definition of ‘practice’ I refer to means simply the way in which stroke survivors HAVE to know more about how to practise the kinds of action control that they would look like to do. This is about ramping up the ‘doses’ (input/repetitions) of training/treatment that are applied/guided and or autonomously-completed, with the idea of compiling multiple dosage over time to try and cause beneficial functional change.

The 13th UK Stroke Forum Conference takes place at The International Centre, Telford, from 4 – 6 December 2018 and it welcomes stroke survivors who want to find out more about how to tackle their residual limitations.

The conference will feature over 20 main conference sessions, each focused on a different aspect of stroke care, over 110 expert speakers and researchers giving talks on the latest research updates and service improvements, over 60 exhibition stands to showcase new innovations and industry developments and over 300 research posters including ongoing trials.

There will be practical workshops (ARNI Instructor Pete Rumbold will be giving a group class demo for stroke survivors who attend), stroke survivors sharing their experiences and debate sessions.

Come and see us at the ARNI table at the Charities section! We have been running a table for 10 years at this outstanding Conference.

It is without doubt the most major Conference for Stroke in the annual calendar.

You can view the preliminary programme and ‘at a glance programme’ here.

See the delegate rates for the UKSF Conference 2018.

For stroke survivors, the 2 day complete rate is just £182 (early bird) or £214. Compare this to standard 2 day rate of £436 (early bird) or £514!

I’ve never worked out how they do it at this price… please book RIGHT NOW to come along, if your circumstances allow you to, and take everything in. A large part of all this is networking too…

You can also get discounted accommodation

You need to be there! See you there!!

If you need to know a little more  about Conference before registering interest/calling the Stroke Association, please email tom@arni.uk.com and I’ll do my best to help with questions/steer to the right person at Stroke Association who can answer your question(s) asap…

For ARNI therapists/instructors and others who would like to come, the UKSF conference gives you the opportunity to gain relevant accredited professional training, find out the latest research and service developments, learn about new innovations and services in the exhibition and network with colleagues/meet professionals from across the entire care pathway.

Please hurry to book – these tickets are at a premium.

Kieron, a former Commando based in Poole, is climbing 4 Peaks around the UK, leading a group of stroke survivors, spporters and helpers across them all, in order to raise funds for our Stroke Charity.

THE ARNI CHARITY PUTS A GENERAL CALL OUT TO KIND PEOPLE WHO WANT TO HELP, JUST ONCE PER YEAR, AND THIS TIME, THIS IS IT!

His goal is to raise £8,000 for ARNI and he needs YOUR help… (click JustGiving logo OR/AND read on)

These are funds that we very much need in order that we can continue to carry on real-life rehabilitation across the U.K. Because the Charity has no employees, all kind donations go 100% to helping stroke survivors rehabilitate.

Kieron says:

Like so many people, I didn’t really know much about strokes. I didn’t understand what they were and what effects they have. I thought it was something that only affects the old and unhealthy. I was very very wrong. Strokes can happen to anybody, any age, any fitness, any race. It does not distinguish between how much money you have, how good of a person you are or what your religion is. When it strikes, it strikes without warning, without prejudice and without mercy.

Since helping at ARNI I have seen that when a stroke happens right from its first attack the odds are stacked against you, even by a small miracle you survive, life as you know it will be permanently changed, learning how to speak, sit, walk and understand. I wanted to try and do what I could to balance the odds for people around me.

This lead me onto putting together a Fundraiser. We talked over some great ideas, and then my life as a former soldier came into the equation. Mountember was then born. The idea: take something simple, and make it hard. So, walking is simple for most people, how about people with stroke. NOT so simple. How about walking up a mountain? Impossible? Perhaps… could it be done?

With preparation, preparation and preparation, it can be, 

We will be walking up Pen–Y–Fan in Wales, Mt Snowdon in North Wales, Scafell Pike in The Lake District and Ben Nevis in Scotland. Each Sunday in September we will tackle one of these peaks, working our way up the country.

Stroke survivors will be accompanied by their coaches, trainers, helpers and friends and medics.

Training has been tough, outside hill training, using step machines inside and lots of other work.

We have spent weeks planning the routes, logistics, setting up the social media and just giving pages along with insurances, T-shirts, organising venues etc.

Our goal is to raise £8,000 for A.R.N.I and with that they will be able to train more physios and instructors to carry on real-life rehabilitation across the U.K. 

Help us to help those that have beaten the odds, already – help them live and thrive rather than just survive.

PLEASE SPONSOR US!!!

Please help right now by going to THE JUST GIVING MOUNTEMBER PAGE!!

THANK YOU SO MUCH…

If you are able to transfer from bed to chair independently or with assistance, you may be offered an Early Supported Discharge (ESD) as long as a safe and secure environment can be provided. The team is responsible for making sure your home is suitable, that your family is supported through this change, and you must all be in agreement that this ESD is the best course of action for you.

Your family and/or carers must be involved in every part of the planning for your transfer of care. Your family/carers might need – and should take up – training in caring for you – for instance, in moving, handling, helping with dressing and so on. You should expect to receive the same intensity of therapy and range of multidisciplinary skills available in hospital.

A key point: your family/carers really should plan, whilst you’re still in hospital, for when the community therapy team finishes.

They need to do the Googling and makes some calls. They need to engage an independent physiotherapist (who can literally be gold dust if they are not traditional therapists and instead, do task-training and strength training with you and advise appropriate adjuncts to training) who can come in to your house after community therapy finishes. Be careful that you are offered a reasonable rate.

Or they/you can call ARNI, and get linked with one of my own group of 130 active stroke specialist physios and trainers, who deliver the above at usually a lower cost as they are tasked to offer a reasonably charitable rate including petrol. Cost is only half of the reason that you should think about engaging an ARNI trainer however as there are some literally vital techniques for the stroke survivor’s armoury that they can teach you.

Early discharges from hospitals are a good idea to free up hospital beds and to get you back to familiar surroundings once again. But only if the support mechanism of your further ‘re-training’ is in place. Often the support can finish too quickly, leaving survivors (and usually their families/carers too) worried about what to do next, and who to go to for further help. Outpatient therapy and community care, or the lack of it, is often quite wrongly, blamed for not solving all problems.

Being at home is good. It really is all just much better at home. IF there is support for you there, and you are not just returning back to somewhere where you cannot cope with being, for whatever reason. This needs careful management and forethought.

There is evidence that you can recover physically just as well with a therapist’s or trainer’s help and ‘retraining’ yourself at your home rather than at hospital. It’s good for you psychologically: you will see all your familiar things again – which allows you to feel more ‘normal’ and in control. You might feel that your rehab will not be as intensive now, and you may be right.

But relatively little therapy time (actually a homeopathic dose as far stimulating plasticity was concerned) was actually going on in hospital anyway due to time and resources. The therapists would have loved to have helped you for many, many hours per day but large workloads get in the way, so after community therapy is finished, you just need to ensure that you’re doing something everyday. This is where engaging help and self-rehab comes in – it’s the mix of both of these that will allow the successful creation of a progressive programme for you, which will be the rock around which every intervention from method (eg. CIMT) to technology (eg. upper limb robotics combined with VR) revolves.

So now it’s discharge time? Well, this is good! Don’t fear it.

All your information will be given to the relevant health and social care professionals, and you should have the same comprehensive copy as well. Your family members/carers, and to an extent you too, should try and become as informed as possible. They need to become the ‘expert patient’ on your behalf. They need to know your current and future needs, possibilities for improvement and how and where to get further assistance.

This information will include a summary of your rehabilitation progress and your current goals, your diagnosis and your current health status. Functional abilities, which include communication needs are included as well as your care needs – washing, dressing, going to the toilet, eating and so on.

It is vital also that information regarding your psychological needs are fully explored and understood by the community team as you may have cognitive problems and emotional needs at this stage in your recovery. The information about your medications, including your ability to manage them, your social circumstances, which include your carer’s needs, and your mental capacity with regard to your transfer decision are up there on the list for your health care in the community.

Included also is a risk management assessment which must include the needs of vulnerable adults.

Your family member/carers must make sure you are aware of the plans for follow-up rehabilitation and access to health and social care and how voluntary sector services such as Stroke Association, Different Strokes, ARNI etc can help.

What is Aphasia?

Aphasia is more common than you might think.

• every five minutes someone in the UK has a stroke.
• there are approximately 152,000 strokes in the UK every year.

About a third of these people will have Aphasia. Aphasia is a communication disorder that can affect a person’s ability to speak, to understand speech, and to read and write. It can occur after a neurological injury, such as stroke. Aphasia is mainly treated by speech and language therapy.

Aphasia research is ongoing; studies include revealing underlying problems of brain tissue damage, the links between comprehension and expression, rehabilitation methods, drug therapy, speech therapy, and other ways to understand and treat aspects of aphasia.

But currently very little information can be given to people with aphasia about whether their language will get better, and how long this might take.

The PLORAS research study aims to improve our understanding of how language works in the brain. Their goal for the future is to be able to give people with aphasia, their families and healthcare professionals a prediction about:

• How much language the person is likely to re-gain.
• How long this is likely to take.

So, the two ways to help stroke patients with aphasia?

1. STROKE SURVIVORS WITH APHASIA – come for an MRI brain scan

The PLORAS study is carried out by conducting structural and functional MRI scans with people who have had a stroke, and by carrying out a language test. Both people with and without communication problems are included. This information is analysed together with information about time post-stroke, to look for patterns in recovery.

Updates on the progress of their research can be found on their website,

or by downloading their latest newsletter.

Please get involved!!

Opportunity for non-stroke survivors to get involved!

2. EVEN IF YOU HAVEN’T HAD A STROKE, please come for an MRI Brain Scan.

Currently the PLORAS team is ALSO inviting people who have NOT had a stroke to have an MRI brain scan at their centre. Please help the team…

This is because they need some participants to act as ‘healthy controls’ to help them adjust their lesion identification software.

If you think that you might be interested, please get in touch by emailing ploras@ucl.ac.uk, or by calling 020 7813 1538. The team will need to ask some questions about your medical history in order to meet the strict safety criteria at their Centre.

The PLORAS research study is based at the Wellcome Centre for Human Neuroimaging and is led by Professor Cathy Price.

Below is a talk given by Professor Cathy Price – click and play!

PLORAS would like to thank ARNI for the support for stroke survivors

Other Support for Aphasia and Stroke:

PLORAS useful links – a list of organisations that provide information or support

Just a quick note on GDPR – Changes and Privacy Rights.

Welcome to the new Data Laws coming in to effect tomorrow: May 25th.

ARNI keeps no data about you at all except your email address. 

These are used once a month or so only by one person (Dr Balchin) to send emails concerning stroke rehabilitation. 

Just to let you know that we have your data safe.

Your privacy is important to ARNI and we take our responsibility regarding the security of your personal information very seriously.

To reflect the newest changes in data protection law (the General Data Protection Regulations – GDPR), and our commitment to transparency, we have updated our Privacy Policy.

Nothing is changing about how your information is processed, rather, we’ve updated the privacy policy on our website to improve transparency and describe our data protection practices. This updated version of the Privacy Policy is available on our website: Data Policy

If you would like to find out more about any of this, or have any GDPR related queries please reply to this email or contact support@arni.uk.com