London, United Kingdom 2013 Poster Session Nurses/AHP’s Cerebrovasc Dis 2013; 35 (suppl 3)1-854 201 2011 Acute stroke: treatment concepts for physiotherapists and nurses Strength training with electrical stimulation- Is this a viable method of preventing muscle at-rophy after a moderate to severe stroke? L.M. Claydon1, C. Stewart2, N. Postans3, R. Durairaj4, A.D. Pandyan5 St Mary’s University College Twickenham, Twickenham, UNITED KINGDOM1, Robert Jones and Agnes Hunt Orthopaedic NHS Foundation Trust, Oswestry, UNITED KINGDOM2, Robert Jones and Agnes Hunt Orthopaedic NHS Foundation Trust, Oswestry, UNITED KINGDOM3, Ain-tree University Hospital NHS Foundation Trust, Liverpool, UNITED KINGDOM4, Keele Universi-ty, Keele, UNITED KINGDOM5 Background: Key muscle groups show significant levels of disuse muscle atrophy after a stroke, de-spite routine therapy; preventing patients from participating in rehabilitation. It is commonly known in rehabilitation that increases in muscle pennation angle (PA) have a high correlation with increases in muscle strength. This study aimed to see if electrical stimulation (ES) could prevent muscle atro-phy after an acute stroke, improving the likelihood of walking. Methods: A phase I RCT recruited stroke patients from an acute hospital. Inclusion criteria: aged less than eighty, 2-6 weeks post-stroke, capable of supported sitting, medically stable. Exclusion criteria: ability to walk, contraindications to ES. Treatment subjects received a 6 week ES protocol on their affected quadriceps and gastrocnemius. Frequency: 50Hz, pulse duration: 450μs, current: maximal tolerated. Ton:Toff: 3econds:10seconds. Both groups received standard NHS physiothera-py. Control group received no additional treatment. Outcome measures (baseline, week-3 and week- 6): muscle strength (portable measurement device), internal muscle structure (2D ultrasonography) and walking ability. Results: 9 Stroke patients were recruited (mean time since stroke: 22.7days, SD 29.5days). Compli-ance with treatment was 100%, no adverse events reported. Four patients regained mobility at study completion (three treatment 95% CI 0.3-0.95 and one control 95% CI 0.06-0.70). Odds ratio of walking as a result of treatment is 6 (95% CI 0.2-162.5). Treatment PA increased by a mean of 5.2° SD 4.2° and 2.8° SD 5.4° in control group. Conclusion: Treatment with ES may help patients regain walking ability. PA demonstrated small increases, indicating a degree of hypertrophy. A treatment subject demonstrated no increase in strength, but increases in PA: suggesting maintenance of internal muscle structure. This could have profound clinical implications. This is a phase I study; extrapolation of results is not possible at this stage. Table 1: Summary of subjects in treatment and control groups. Subject Age Intervention Quadriceps change in number force (baseline-6weeks, Nm) Gastrocnemius change in force (baseline -6weeks, (Nm)) Increase in pennation angle (baseline – 6 weeks (degrees)) 1 64 (M) Treatment 0 0 11.3 2 49 (M) Treatment 1.5 8.2 3.64 3 75 (F) Treatment 4.2 26 4 4 79 (F) Treatment 7.1 19.7 1.9 Mean changes 3.4 (SD:3.4) 13.5 (SD: 11.6) 5.2 (SD: 4.2) 5 54 (M) Control 19 2.6 -1.1 6 69 (M) Control 0 0 6.6 7 69 (F) Control Not applicable- withdrew consent at 3 weeks 8 63 (F) Control Not applicable- withdrew consent at baseline 9 74 (F) Control Not applicable- passed away Mean Changes 9.5 (SD: 13.4) 1.3 (SD: 1.8) 2.8 (SD: 5.4) (M= male; F= female; Nm= Newton meters; SD= Standard Deviation; pennation angle measured by 2D ultrasound imaging on the lateral head of gastrocnemius) 2012 Acute stroke: treatment concepts for physiotherapists and nurses Weekend working on HASU: Occupational Therapy and Physiotherapy alternating days C. O’Neill1, K. Bull2 University College London Hosptials, London, UNITED KINGDOM1, University College Lon-don Hosptials, London, UNITED KINGDOM2 The NICE quality standards for stroke (2010) have included assessment from therapists as a mea-sure of quality on the HASU which is audited through the Stroke Improvement National Audit Pro-gramme (SINAP). ‘Patients with stroke are assessed and managed by stroke nursing staff and at least one other mem-ber of the specialist rehabilitation team within 24 hours of admission to hospital and by all relevant members of the specialist rehabilitation team within 72 hours’ This can be challenging for units with no weekend therapy cover. During March 2012, 88% of patients met this standard. A 6 month audit revealed that on average 27% of patients waited until Monday to be assessed by therapists. These patients could have gone home at the weekend if there was a therapy service. Therapists on HASU looked into the provision of a weekend therapy service comprising of OT and Physio. Core skills of both professions, plus skills that both professions share were looked at to es-tablish boundaries and identify areas of cross over. This pilot looks at whether OT’s and Phyiso’s can work individually at the weekend to complete ini-tial assessments and facilitate discharge. The OT/PT weekend working started August 2012. Preliminary data indicates 99% of patients were assessed within 24 hours (national average 61%), and weekend discharges have increased. Low numbers of patients remained in hospital waiting for the other discipline to assess demonstrating that for the purpose of weekend working, OT and PT can cover the unit alternating over the days of the weekend.
Karger_ESC London_2013
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