Revolutionary Scottish trial aims to improve outcomes for stroke survivors through exercise
A trailblazing rehabilitation hub using exercise and other therapies to help boost stroke survivors’ recovery has opened its doors at one of Scotland’s largest hospitals – with evidence already pointing towards its life-changing impact on patients.
The hub is part of a trial being conducted by the University of Strathclyde in partnership with NHS Lanarkshire, to meet the overwhelming demand for intensive stroke rehabilitation.
It’s already known that the sooner a patient can begin stroke rehabilitation, the more likely they are to regain lost abilities, such as speech and movement. It’s a common practice for therapy to start as soon as 24 to 48 hours after a stroke, while a patient is still in hospital.
New National Institute for Health and Care Excellence (NICE) guidelines in the UK suggest stroke patients receive three hours of rehabilitation a day, five days a week.
This is a significant increase from the previous NICE advice of 45 minutes per day.
However, due to the overwhelming demand for rehabilitation, the NHS has struggled to meet the minimum recommended level, with current data suggesting that on average patients receive just 14 minutes of physiotherapy, 13 minutes of occupational therapy, and seven minutes of speech therapy a day.
But the new technology-enriched stroke rehabilitation hub (TERHS) at the University Hospital in Wishaw, which lies 11 miles south east of Glasgow, allows patients to access therapy more quickly at the required frequency.
Just weeks after its launch, proof is already emerging that the hub, which has been designed to holistically address the physical and cognitive harm caused by a stroke, has the potential to positively transform the recovery process for survivors.
Now it’s hoped if further evaluation backs up the preliminary findings the concept could be rolled out not just across Scotland, but all four UK nations within the next two years, putting the NHS at the forefront of treating patients in the chronic stage of stroke recovery.
Dr Gillian Sweeney
Dr Gillian Sweeney, an occupational therapist with NHS Lanarkshire and advanced practitioner for stroke survivors, who has led on the development of the trial and set up the hub, told Agetech World the model could receive a wider launch if health trusts are presented with concrete evidence of its physical and financial benefits.
Referring to the hospital trial currently underway and research being done by the University of Strathclyde’s Department of Biomechanical Engineering into the use of such hubs, Dr Sweeney said: “This is groundbreaking, a life-changing trial for those who have had a stroke. I’m a therapist myself and I’ve worked in the NHS for around 20 years, and what I would say is, we have never been able to deliver enough rehabilitation within the current model and resources, and things are getting more pressurised.
“I think every therapist that works in stroke would probably say ‘We know we are not delivering the level of intensity that we should be.’ We know from evidence that the greater the intensity the better the outcomes.
“But we have been on a hamster wheel for a number of years, and I think we are now at the point where this model, with modest investment – and I don’t want to say within current resources because we need the investment in the equipment and staff to run the groups – but with a realistic, modest investment, could actually achieve those levels of rehab activity that we never foresaw we could do without making a huge investment in staffing for one-to-one treatment.
“For me, the feedback from participants, both within the university and even in the early stages on the hospital ward, is that the difference that makes is massive.
“I think for me, as well, what it does, is that it brings back the person’s control of their own rehabilitation. They have the opportunity to attend this hub and with the minimum amount of support, they are back in control of their own rehab.
“They can choose how often they come for and how long they stay. That, in itself, has been huge.”
Even more remarkable is that participants from the community that have taken part in the university-based study – some of whom suffered a stroke up to a decade ago – have seen functional improvements.
“It wasn’t what we expected to see, but we did,” Dr Sweeney said.
“The study initially was just to look at, ‘is it safe, and do people like it?’ Ten years after a stroke there wasn’t a huge amount of expectation that things like arm function or walking speed would improve.
Dr Andy Kerr working with a stroke survivor at the University of Strathclyde. Credit: University of Strathclyde
“But with the outcome measures we have taken, pretty much everybody has improved in one or more areas.
“If you look at that and think ‘we can make those improvements 10 years down the line,’ what could you do in the very early phases after a stroke when your brain is more likely to make the changes to see improvement?
“For me, it is groundbreaking. If you use this model and put some of this equipment in so people can do the things they need to, it is a total no-brainer.
“Yet it (the resource) is not there. There are reasons for it not being there, and part of that has to do with people within healthcare systems often working so hard and under such pressure they don’t get the space to think about new ways of working or to test them.
“There are traditional ways of working and it takes a long time within the NHS to adopt new ways and to embed that.”
The impact of stroke can be profound and the months immediately after suffering one are key to recovery.
Located within the University Hospital’s stroke unit, the TERHS hub has a virtual reality treadmill with a specialist harness, a balance trainer, and power-assisted equipment from UK-based wellness and wellbeing supplier Innerva, which supports users to exercise allowing them to work passively or actively, depending on where they are in their recovery stage.
The technology also incorporates ‘gamification’, such as virtual reality, puzzles and problem-solving activities, which helps to improve the engagement with and response to therapy.
In addition, the hub houses specialist cognitive and VR equipment, helping to enrich the environment and improve users engagement with and response to rehabilitation therapy.
The hub builds on the research being carried out by the University of Strathclyde which has seen a team led by Dr Andy Kerr and Professor Philip Rowe in the Department of Biomechanical Engineering, set up a gym-like space offering an eight-week programme to survivors under the supervision of Dr Sweeney and research physiotherapist, Mel Slachetka, in the Sir Jules Thorn Centre for Co-Creation of Rehabilitation Technology.
The hospital hub has attracted 15 patient recruits so far, all of whom have been “extremely positive” about the programme, Dr Sweeney said, with some managing three hours of rehabilitation a day.
“People are getting much more activity time than would have been the case. Patients like the Innerva equipment as all they have to do is press a button, and they feel they are in control.
The University of Strathclyde’s technology-enriched rehabilitation hub. Credit: University of Strathclyde
“The setting seems to be popular, and what we are finding is that patients are coming up in a group. Having a stroke can be isolating, but the feedback we are getting is that users value the opportunity to meet people who are going through the same experience as them.
“We know that on stroke wards across the country there isn’t enough staff. Often what happens is that the nursing staff will help patients get out of bed and then they will sit in a chair for hours.
“But with the hub they are using their brain, they are being active, they are off the ward, and they are having the opportunity to socialise.”
The hub can support five patients at a time alongside two support staff.
Given the evidence already accrued through the University of Strathclyde’s rehabilitation programme in which every person using the Sir Jules Thorn Centre facility has seen an improvement, mostly in walking speed but also in some cases speech, it seems difficult to understand why the hub idea isn’t being rolled out as a priority.
Especially as Dr Sweeney admits her ambition is to see technology-driven rehabilitation hubs established in community settings across the UK to provide stroke survivors with easily accessible therapy for optimal recovery.
But whilst the idea may indeed, to quote Dr Sweeney, be a ‘no-brainer,’ even the most obvious concepts need to be proved on a number of levels.
With funding from the Engineering and Physical Science Research Council’s Impact Acceleration Account, a research assistant will assess the impact of the hub on inpatients in the early phase of their recovery with the aim of enabling them to achieve, or even exceed, the recommended levels of rehabilitation.
“We need to look at the costs and the harsh economics,” Dr Sweeney said. “From a research point of view, we must prove that. We are often not very good at proving that something is cost-effective.
“Rehabilitation in general has been run in the same way for a long time and it can be difficult to change traditional practices. And rehabilitation therapists as well as the public can be frightened of technology.
“There is often a feeling that if somebody who has had a stroke is elderly, they won’t be able to cope with technology. But one of our patients is 94, and we are finding that age isn’t as much of a barrier as people may think it is.
“But we need to prove all these things as well as the positive impact this approach can have on stroke survivors. At the minute we have tried it with people who are in the very early stages of stroke rehab, we have tried it in an acute inpatient ward, and we know it is safe and that it is acceptable.
“But we need to prove that people like the hub idea, that they get great intensity of rehabilitation, and that it improves people’s outcomes. Once we do that that will hopefully allow us to make a case that these facilities should be in place.
“Obviously, there are initial costs in terms of buying equipment, and there needs to be a discussion around how do we change the pathways and how do we change the ways the services work to allow this to become part of the normal treatment.
“But at the end of the day, what we want is to keep people out of hospital so they can go home and lead as normal a life as possible in the community.”
