Welcome to our regular online bulletin bringing you news about the network and the wider world of stroke and neurorehabilitation

Network news

The network team continue to support a wide portfolio of projects which you can view on our new "Projects and impacts" webpages. The pages summarise our ongoing work whilst sharing some of the key outputs over the past 2 years since we merged. 

We continue to strengthen our clinical leadership following a review earlier in the year. We have appointed five new Clinical Associates to join the team who have specific areas of expertise. Jenny Harrison (formerly a Clinical Lead) will support our cardiorespiratory workstream, with Katherine Swinthenbank and Sarah Williams recognised for their contribution to vocational rehabilitation. Thom Luxom and Susan Bannister (pictured left and right) will continue to offer their experience in workforce development as chairs of our subgroup.

Due to ongoing uncertainty around our funding, we have asked our Community Neurorehabilitation Clinical Lead Chris Hyde to also pick up stroke, with an extra half day a week until March 2025 when we will review again.

We will be interviewing for new stroke Acute and also Inpatient Rehabilitation Clinical Leads in early October. These roles will support projects in their respective areas and will initially be appointed until March 2025 whilst we await clarity over funding.

In other staff news, our Facilitator Amanda Fish (pictured right) will be returning to Trafford General when her secondment ends at Christmas, and we are currently planning how we will redistribute her portfolio.

Multiple Sclerosis (MS) quality improvement kicks off

The first MS steering group met in late September following several meetings of key stakeholders to flesh our potential work.

The new group met at Salford Royal Hospital, with others attending virtually. The project will emulate the approach of our successful MND collaboration which has just secured further funding focusing on emotional wellbeing.

Representation at the steering group includes the Manchester Centre for Clinical Neurosciences MS team led by Dr David Rog, as well as Community Neurorehabilitation Teams and the voluntary sector (MS Society, MS Trust and MS Therapy Centre NW). Most importantly, the group includes people with lived experience with plans to engage more widely as the project develops.

The initial meeting discussed key areas such as:

• Mapping pathways and links between services
• Self management resources
• Clinician toolkit
• Patient information and communication
• Data and dashboards
• Addressing health inequalities

A project plan is being developed and we will keep you updated with progress.

Innovative approaches to therapy

Fairfield General Speech & Language Therapists have been adding some fun into the hospital's stroke wards. In September, the team brought some new visitors onto the ward including a lizard and guinea pig, with animal therapy a great way of increasing communication environments, participation and general happiness.

Over in Bolton, the therapy team harnessed excitement around the Paris Olympics by hosting their own mini event on the stroke unit. Patients were encouraged to take part in sports to help boost engagement with their rehabilitation, which also cheered everyone up on the ward.

Two new stroke care pathways launched in Stockport

Following a rather lengthy set up phase owing to the challenges of recruiting specialist staff, Stockport NHS FT successfully launched the new SQuIRe Catalyst-funded pathway on August 12th, with some of the launch speakers pictured left. 

Over the past four weeks, the orthoptic team has been actively working on the acute wards, and the new Orthoptic Stroke Service has already assessed 115 patients, with 15 being referred to the Community Stroke Team for further support.

In addition, an Eye Care Liaison Officer will soon join the ward team, providing vital guidance and acting as a key point of contact for patients requiring further assistance. Both staff and patients have greatly appreciated the orthoptic involvement, with collaborative efforts receiving positive feedback. One Occupational Therapist remarked:

“We want to thank you for your great support. You’ve been really helpful—for example, with a patient with hemianopia who was screened by OT over the weekend. The orthoptists were able to make a direct referral to the Community Stroke Team on Monday.”

Patients have also shared their gratitude, with one commenting:

“I was worried I was losing my sight or my mind, but you’ve helped reassure me and explained everything so well.”  

The stroke team have also launched a pilot to improve monitoring of Atrial Fibrillation, a key risk factor for stroke. The devices will be fitted to patients seen by the team who they think may be at risk of the condition. Early diagnosis can ensure anti coagulation treatment is started, reducing the risk of a further cardiovascular event. Fairfield General are also running a pilot and we will report the results when available in 6 months time.

MS Society Hospital Attendance Survey

The charity is launching a survey to explore the experiences of people with MS when attending the hospital. The survey asks about planned or unplanned (emergency) attendance and the reasons for it in order to gain an understanding of how and why patients are admitted to the hospital. The organisation plan to use survey responses to show where there may be opportunities to reduce unnecessary hospital visits and improve healthcare experiences for people with the condition. 

The period covered by the survey is 4th September - 18th October 2024. Please share with people with MS, over 18 years old and living in the UK. You can find the survey here.

Supporting people with aphasia

Local charity Speakeasy have welcomed a new member to its team. Alison McGrath (pictured left) has been appointed to deliver some of their online support.  She will be the first point of contact for many new referrals offering support for both people with aphasia and carers whatever stage they are at. She will support people into accessing face to face services where possible.

Alison is currently offering Communication Partner Training for carers as a four week course on line and a drop in virtual support session. There are plans for delivering themed courses, support for therapy through apps and aphasia software and a region wide group for younger people with aphasia. As ever, the menu of support changes according the needs of current members so get in touch or keep an eye on the website for current information. Speakeasy accepts referrals from all Greater Manchester areas, preferably through their online referral system. If you know anyone who might be interested in accessing services please contact: office@speakeasy-aphasia.org.uk

On another note the team want to share an inspirational story from Seth who is a member of Speakeasy and is part of our Patient & Carer Group. Seth says: He has been keen on outdoor activities since he was a bairn, including cycling. He has been riding a recumbent bike since 2015. He set himself the challenge of riding C2C (Coast to Coast) with his friends Mark and Gareth. He had been wanting to do this for 20 years, since before his brain injury - and he didn't let his disability stop him. Two volunteers from Speakeasy rode part of the way with him. He shared his adventures through a presentation for members and has inspired others to have a go. The team will be booking a trip to Wheels for All in Bury very soon.

New national SSNAP pre-hospital findings shared 

In late September, network Facilitator (and Paramedic) Chris Ashton (pictured left) attended the Northern Ireland Stroke Conference which is supported by the Stroke Association. Chris has been providing expertise to the national SSNAP team and his presentation focused on the prehospital pathway and analysis of a national population level based dataset.

The workstream is investigating the variables affecting the four elements of the ambulance pathway which includes the time from patient onset to 999 call. During his talk, Chris tied in national findings with some of our region's  prehospital stroke care protocols. The national work, when implemented within practice, should lead to further improvements in the prehospital pathway for our patients. 

Pathway updates

Increasing the intensity and frequency of therapy

Increasing intensity and frequency of rehabilitation was recently identified as a high priority project for our stroke and neurorehabilitation teams in the region. We’ve explored workstreams that require focus:

• Digital health technologies
• Workforce optimisation
• Accessing community services
• Patient self-management

The project will be overseen through our Rehabilitation Subgroup, with the workplan discussed in more depth at our next meeting on 6^th November. Please get in touch if you want to be involved.

Driving guidelines (Neuro)

The network recently facilitated a task and finish group to develop a set of guidelines for clinicians when supporting patients with neurological conditions. The guidelines were also taken through our Patient & Carer Group and amended following feedback. Following approval, they can be found on our website alongside our stroke version of the document: Driving advice for professionals.

Training and education

Once again, we have been delighted to host Stroke Ed, an Australian based company specialising in stroke rehabilitation training for therapists.

During the week commencing 23rd September, we helped facilitate two courses: balance and lower limb. Both were well attended by therapists from across inpatient and community stroke and neurorehabilitation services. Each day involved real life patients to help attendees practice their new skills and knowledge. 

In slightly less positive news, we recently scoped how easily teams are able to access funding for training. We found many are now struggling for costs over £100. Unless this changes, we have reluctantly decided not to run further courses with significant costs we have to pass on e.g. Stroke Ed.

We offer a wide programme of face to face and online events, those hyper linked are open for bookings. You can view all our previously recorded webinars on our YouTube channel, with details of how to access restricted content at the bottom in the archive section. Our training website pages are also a useful source of information and include our events, Elearning packages, online resources and course information.

Introductory level

2024

Introductory Stroke Study Day – 27th November – Trafford General

2025

Introductory Stroke Study Day – 5th February – Salford Royal ( Mayo Building)

Introductory Stroke Study Day – May (Date TBC) – Fairfield Education Centre

Introductory Stroke Study Day – 16th September – Wrightington (provisional date)

Introductory Stroke Study Day – November (Date TBC) – Trafford General

2024

Sex and Relationships Webinar – 16th October

Cardiorespiratory Training Workshop – 31st October 

Other training with dates to be confirmed:

Unconscious bias workshop, Sensory Rehabilitation, Advanced Practice and UKABIF and GMNISDN Webinar –  Improving outcomes in people with neurological conditions experiencing homelessness. 

Patient & Carer involvement

Our group met once again in September although numbers were a little depleted as some members were on holiday or unavailable. The group had a lively discussion with local academic Dr Clare Davison who spoke to the network's stroke group last year about her study on emotionalism post stroke. The project has benefited from the input of those with lived experience and Clare plans to continue to engage with the group as her research progresses.

Our Co-ordinator Abi Bisset is currently working on recruitment of new members to ensure we remain as diverse as possible. She is also developing a toolkit for clinicians that we hope to launch in a few months time.

Research news

We have developed some new webpage to help teams and clinicians better understand how to get involved in research. You can explore them here.

New trial of an anti-inflammatory antibiotic for pneumonia in people with a stroke

Pneumonia (a serious infection of the lungs) occurs frequently after a stroke and leads to worse outcomes for patients. Despite modern stroke unit care and antibiotic treatment, the chances of death are three times higher in stroke patients that develop pneumonia, compared to those that don’t. Pneumonia causes excessive, harmful inflammation in the lungs and bloodstream, which is thought to contribute to worse outcomes.

Clarithromycin is a macrolide antibiotic with anti-inflammatory properties. A team led by Professor Craig Smith, the Stroke Research Theme lead in the Geoffrey Jefferson Brain Research Centre and a consultant in stroke medicine at Salford Royal, have been awarded funding from National Institute for Healthcare Research (NIHR) to undertake a phase 3, multi-centre, randomised trial of clarithromycin treatment for stroke patients developing pneumonia. The CLArithromycin for post-Stroke Pneumonia (CLASP) trial will take part in 45 stroke units across the UK and will enrol 1166 people hospitalised with a stroke complicated by pneumonia, within 14 days of admission. The trial will determine whether addition of clarithromycin for 5 days to usual antibiotic treatment, when macrolides are not being given, will improve clinical and health economic outcomes.

HASU and non-HASU sites can participate and Dr Smith's team are really keen to have as many sites in Greater Manchester taking part as possible. CLASP is currently in the set-up phase and will start to enrol participating patients in early 2025.  For more information contact craig.smith-2@manchester.ac.uk 

TRICEPS study

The TRICEPS (TRanscutaneous lImb reCovEry Post-Stroke) trial investigates whether arm recovery after a stroke can be improved with a treatment called Transcutaneous Vagus Nerve Stimulation (TVNS).

Criteria to take part include:

• Anterior circulation ischaemic stroke between 6 months and 10 years ago and still have arm weakness (Fugyl Meyer 20-50)
• Aged 18+
• Discharged from therapy
• Willing to take part in a trial
• Do not have a pacemaker, cochlear implant or similar
• Willing to commit to a 12 week rehab programme and to travel to site

The trial is looking for new sites, with South Manchester Community Team already successfully recruiting patients. You can read about one of their participants featured in the Manchester Evening news here. Leanne from the team would be happy to speak to anyone interested about their positive experience, please email leanne.calcutt@mft.nhs.uk.

Carer research

Professor Audrey Bowen has asked us to share a summary report of a study by one of her postdoctural students Bethany Harcourt entitled: "Understanding the experience of caring for a friend or family member after their stroke – a research study". You can download the report here.

Bolton Neuro Voices update

The charity has gone through a transition period as long standing members retired. You can find out what they have been up to and plans for the future in their newsletter here.

Stroke Association news

Service to re-launch in Bury

Following the incredible support and campaigning from stroke survivors, the network and local Stroke Association teams; the charity are delighted to announce that that Stroke Recovery Service will be re-launching in Bury very soon.  This exciting development comes on the back of  SQuIRe funding received in 2023-24 which has made it possible to showcase the benefits of the service to enable longer term funding from Bury. A huge thank you to everyone involved in making this possible.  Updates to follow on the service.

Manchester services

In the June bulletin, we mentioned a workshop to hear what is important to stroke survivors and clinicians in the Manchester locality when it comes to the provision of Life After Stroke services.  This followed a request to make some changes to Manchester Stroke Recovery Services, to include stroke survivors in the southern area of the city within the existing funding for the locality. 

The organisation are pleased to announce that their Manchester Stroke Recovery Service now covers the South of the city, alongside North and Central areas. This expansion is a significant step in broadening our reach, ensuring that even more people can benefit from the support we offer.

Despite the fact that no additional funding has been received, the team have taken great care to ensure the changes are meaningful by involving the voice of lived experience in the design process and listening to their feedback helped us to understand what matters most.  They will continue to review the impact of these changes.

Updated digital health information for carers

The charity have worked with the families, friends and unpaid carers of stroke survivors to update the digital health information for carers. The new webpages mean people will be able to navigate the information more easily feel more confident and better supported. You can find them here.