7th NORTHERN IRELAND - Stroke Association · Welcome to the 7th Northern Ireland Stroke Conference organised in ... Insert exhibition stand list (subject to change) – to follow

7th NORTHERN IRELAND

Tuesday 12th June 2018Crowne Plaza, Shaws Bridge, Belfast

Delegate Programme & Exhibition Guide#NISC18

Stroke Conference

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Welcome to the 7th Northern Ireland Stroke Conference organised in partnership between the Northern Ireland Multidisciplinary Association for Stroke Teams (NIMAST) and the UK Stroke Forum (UKSF).

We hope you enjoy the day and the variety of sessions planned for our multidisciplinary audience by the Conference Planning Committee.

Thanks to our sponsors:

Gold:

Silver:

Bronze:

Lanyards sponsored by:

Farbe/colour:PANTONE 288 CV

Breathe. Eat. Smile. Talk.

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Useful Information 4

Programme 10

Exhibition Guide 16

Abstracts for Oral Presentation 26

Posters 33

Northern Ireland Conference Planning Committee 2017/18

Dr Patricia Gordon, Chair of NISC Committee / Stroke Consultant at BHSCTNicola Moran, Belfast Trust / NIMAST ChairAlison Beattie, Western TrustPaula Ford-Hutchinson, Northern TrustFiona Greene, Northern Ireland Chest Heart and StrokeDr Liz Laird, University of UlsterBarry Macaulay, Stroke AssociationAlison McGlone, Belfast TrustDr Michael Power, South Eastern HSCTDr Robert Rauch, Northern TrustProfessor Philip Reilly, Stroke AssociationKaren Ross, Belfast TrustElizabeth Scullion, Belfast Trust

UK Stroke Forum Event Management and Sponsorship Team:

Sammy Connell, UK Stroke Forum Relationship & Business ManagerTracy Johnson, UK Stroke Forum Conference ManagerCarly Razzell, Sponsorship & Exhibition ManagerJenna Bennett, UK Stroke Forum Event AdministratorJenny Cherry, UK Stroke Forum Event Administrator

CONTENTS

ACKNOWLEDGEMENTS

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Venue • The majority of conference sessions will take place on the first floor in the Grand Ballroom with the

exception of Parallels 1C and 2C which will take place on the second floor in the Birch room

• A wide variety of Exhibition stands are located in the Grand Ballroom Pre-function Lounge and Poster Room – do take time to explore

• The high-scoring research posters, including ongoing trials, are in the Grand Ballroom sub-section 2 for you to review

WIFI Internet access is available free of charge throughout the venue.

EnquiriesThe Enquiries Desk is located outside the Grand Ballroom on the first floor.

First AidDelegates requiring first aid are asked to report to venue or conference staff for assistance.

RefreshmentsTea, coffee and lunch are included for all delegates and will be served in the Exhibition areas in the Grand Ballroom Pre-function Lounge. Delegates are welcome to use seating in session rooms (except Grand Ballroom Section 1) during refreshment breaks (rooms will be cleared 30 minutes before the next session starts).

Speaker Presentation slidesPresentation slides, where permitted, will be available on www.ukstrokeforum.org after the event.

CPD and EvaluationAccreditation has been awarded from the Federation of the Royal Colleges of Physicians of the United Kingdom for 6 category 1 (external) CPD credits.

CPD certificates will be issued upon completion of the on-line conference evaluation form.

Your feedback is extremely valuable to ensure the event continues to improve and meet your needs each year and we welcome any feedback you have.

The online evaluation form will be sent to you by email after the event.

This service is kindly provided by DCC Ltd

PhotographyOur team will be taking photographs throughout the conference and we may use some of the images taken for promotional purposes (including our website and social media). Please let us know if you have any concerns about this.

USEFUL INFORMATION

Presentation slides, where permitted, will be available on www.ukstrokeforum.org after the event. CPD and Evaluation Accreditation has been awarded from the Federation of the Royal Colleges of Physicians of the United Kingdom for 6 category 1 (external) CPD credits. CPD certificates will be issued upon completion of the on-line conference evaluation form Your feedback is extremely valuable to ensure the event continues to improve and meet your needs each year and we welcome any feedback you have. The online evaluation form will be sent to you by email after the event. This service is kindly provided by DCC Ltd Photography Our team will be taking photographs throughout the conference and we may use some of the images taken for promotional purposes (including our website and social media). Please let us know if you have any concerns about this. (page 5 - 6) Floorplan (see word docs attached of floorplans) Exhibition Stands Insert exhibition stand list (subject to change) – to follow This statement needs to be displayed under the exhibitor list either here or where the exhibitor profiles are: Exhibitors/Sponsors have had no involvement in the educational content of this meeting unless specified (pages ? - ?) Programme (insert attached programme – subject to change at proof stage) (pages ? - ?) Posters (insert abstract posters in order of document supplied – to follow after 20th April)

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CONFERENCE FLOORPLAN

THE GREEN ROOMRESTAURANT

Organisers Office

Speaker Preparation

RoomCLOAKROOM

FEMALE

MALE BAR

TERRACE

Exhibition Stands

Catering

Grand Ballroom pre-function Lounge

LIFT

LIFT

CRUSH LOBBY

LIFT

LIFT

LIFTLOBBY Registration

and Enquiries

Poster Room

Includes exhibition stands

and catering

Plenary Room(Plenary 1 and 2)

(Parallel 1A and 2A)

Grand Ballroom section 3

Parallel Room(Parallel 1B and 2B)

Grand Ballroom section 1

GRANDBALLROOM

Entrance

LIfts to 2nd FloorBirch Room for

Parallel 3A & 3B

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FLOORPLAN

Exhibition stands

Stand 1 – Merz Pharma

Stand 2 – MYoroface

Stand 3 – Halyard Health

Stand 4 – Bayer

Stand 5 – Lifetec

Stand 6 – Turun UK

Stand 7 – Daiichi Sankyo UK

Stand 8 – TalarMade

Stand 9 – Medtronic

Stand 11 – CaptureStroke

Stand 12 – Direct Medics Healthcare Recruitment

Stand 13 – Amgen

Stand 14 – Allergan

Stand 15 – Boehringer Ingelheim

Stand 16 – Stryker

Stand 17 – Ipsen

Stand 18 – Bristol-Myers Squibb

Stand 19 – Novacor

Bar

Bar

t e a / coffee

po i n t t e a / coffee

Refreshments

Pillar Pillar PillarRefreshmentsRefreshments Refreshments

Pillar Pillar Pillar

1 2 3 4 5

6

7

8

9

16

17

1819

Through to Plenary, Parallel rooms, posters

and more exhibitors

Entrance from and exit to first floor lobby and registration

1112131415

Exhibitors/sponsors have had no involvement in the educational content of this meeting unless expressly specified.

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FLOORPLAN

Exhibition stands

Stand A – Northern Ireland Chest Heart & Stroke

Stand B – Royal College of Speech and Language Therapists

Stand C – The Magic Project

Stand D – Stroke Association

Stand E – NIMAST

Plenary Room

Parallel Room

A B C

E

D

Poster Boards

Poster Boards

Refreshments

Poster Room and exhibitors

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AT A GLANCE PROGRAMME

Tuesday 12 June 2018

08:00 - 09:00

09:00 - 10:30

10:30 - 11:15

11:15 - 12:30

12:30 - 13:30

13:30 - 15:00

15.00 - 15.30

15:30 - 17:00

17:00

17:00 - 18:00

Registration, Exhibition and Refreshments

Exhibition / Posters and Refreshments

Exhibition / Posters and Lunch

Exhibition / Posters and Refreshments

Welcome & Plenary 1: Advancing the stroke care pathway

Parallel 1A: Food for thought

Parallel 2A: High scoring abstracts

Plenary 2: FAST, SSNAP and recruit

NIMAST AGM

Conference Ends

Times Grand Ballroom Section 3

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Tuesday 12 June 2018

Parallel 1B: Understanding & managing functional stroke, stroke mimics and migraines

Parallel 1C: Recovery and participation in life after stroke

12:40 - 13:20: Lunchtime robust research workshop

Parallel 2B: Upper limb rehab / spacity management and re-thinking falls

Parallel 2C: Delivering hyperacute and effective stroke care

Conference Ends

Grand Ballroom Section 1 Second Floor Birch

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PRELIMINARY PROGRAMME

08:00 – 09:00 Grand Ballroom Lobby and Pre-Function Lounge

Registration, Exhibition and Refreshments

Conference Chairs: Dr Patricia Gordon (Consultant Physician, Belfast Health and Social

Care Trust) and Nicola Moran (NIMAST Chair & Clinical Physiotherapy Specialist in Stroke, Belfast Health and Social Care Trust)

09:00 – 10:30 Plenary 1 Grand Ballroom Advancing the stroke care pathway Section 3

Chairs: Dr Patricia Gordon (Consultant Physician, Belfast Health and Social Care Trust) and Nicola Moran (NIMAST Chair & Clinical Physiotherapy Specialist in Stroke, Belfast Health and Social Care Trust)

09:00 – 09:10 Welcome and Introductions

09:10 – 09:25 The future of stroke services in NI Richard Pengelly (Permanent Secretary of the Department of Health and

Chair of the Transformation Implementation Group)

09:25 – 09:45 Reshaping stroke services Emer Hopkins (Co-ordinator Northern Ireland Stroke Network)

09:45 – 10:15 Journey Times: the stroke survivor experience Stroke survivors Paul McClean and Kim Calhoon will share their experiences

of stroke and their recovery. This includes them travelling a longer distance beyond their local area for acute treatment and their transition from one hospital to another.

10:15 – 10:30 Question and answers

10:30 – 11:15 Exhibition, Posters and Refreshments

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11:15 – 12:30 Parallel 1A Grand Ballroom Food for thought Section 3

Chair: Carolee McLoughlin (Clinical lead SLT, Belfast Health and Social Care Trust)


11:20 – 11:40 Yes or no? Assessing decision making and mental capacity in adults with communication difficulties Anna Volkmer (Speech and Language Therapist / NIHR Doctoral Research Fellow)

11:40 – 12:00 Dysphagia, nutrition and hydration bundle – supporting decision making Amy Holehouse (Dietitian, University of Chester)

12:00 – 12:20 Stroke Associated Pneumonia and Dysphagia Dr Lucy Bolger (Medical Intern)

12:20 – 12:30 Questions and Answers

11:15 – 12:30 Parallel 1B Grand Ballroom Understanding and managing functionalSection 1 stroke, stroke mimics and migraines

Chair: Dr Chris Price (Clinical Reader in Stroke Medicine, Newcastle University)


11:20 – 11:40 Vestibular symptoms - differentiating central versus peripheral causes

Dr Douglas Duffy (Physiotherapist Royal Victoria Eye and Ear Hospital and The Balance Centre)

11:40 – 12:00 Functional neurological disorders mimicking stroke Dr Ingrid Hoeritzauer (ABN/Patrick Berthoud Charitable Trust CRTF)

Bayer have sponsored the following parallel session but has not had any involvement in

the content of this presentation

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12:00 – 12:20 The clinical features of migraine Dr Raeburn Forbes (Consultant Neurologist, Craigavon Area Hospital, Southern Health and Social Care Trust)


11:15 – 12:30 Parallel 1C Second Floor Recovery and participation in life after strokeBirch

Chair: Alison Beattie (Stroke Services Co-ordinator, Western Health and Social Trust)

11:15 – 11:35 Fatigue: is there anything clinicians can do? Professor Avril Drummond (Occupational Therapist and Professor of

Healthcare Research, University of Nottingham)

11:35 – 11:55 Driving after stroke Professor Nadina Lincoln (Professor of Clinical Psychology,

University of Nottingham)

11:55 – 12:15 Long-term neuropsychological and psychological sequelae of subarachnoid haemorrhage (SAH)

Dr Colin Wilson (Consultant Clinical Neuropsychologist RABIU, Belfast HSC Trust)

12:15 – 12:25 Closing the gap on meeting the emotional wellbeing needs of stroke survivors & carers - Liverpool service model

Kate Charles (Head of Stroke Support, North West, Life After Stroke Services, Stroke Association)


12:30 – 13:30 Lunch, Exhibition and Poster Viewing

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12:40 – 13:20 Lunchtime robust research workshopGrand Ballroom Chair: Dr Liz Laird (Lecturer of Nursing, Ulster University) Section 1 It is important that research projects are designed to be as robust as possible

within timeframe and funding restraints. Hallmarks of robust research include PPI (public and professional involvement in planning the research), the fitness of methods to address the research question, attention to sample size, attention to elimination/reduction of bias, adherence to research ethics governance, diligence in data analysis, cautious interpretation, and transparent reporting. We will learn practical tips on planning and undertaking robust stroke research from a range of researchers.

12:40 – 12:57 Working up a research proposal re: mirror therapy for stroke Dr Alison Porter-Armstrong (Senior Lecturer in Rehabilitation Sciences in

School of Health Sciences at Ulster University)

12:57 – 13:12 Challenges of technology research in stroke rehabilitation Professor Suzanne McDonough (Professor of Health and Rehabilitation in

School of Health Sciences at Ulster University) and Dr Darryl Charles (Senior Lecturer in School of Computing at Ulster University)

13:12 – 13:27 The CONVINCE Trial Professor Peter Kelly (Consultant Stroke Neurologist and Director of the

Stroke Service at the Mater University Hospital, Dublin)


13:30 – 15:00 Parallel 2A Grand Ballroom High scoring abstractsSection 3

Chair: Professor Peter Kelly (Consultant Stroke Neurologist and Director of the Stroke Service at the Mater University Hospital)

13:30 – 13:48 Outcomes of cognitive impairment post-stroke: A five-year follow-up of the ASPIRE-S cohort

Daniela Rohde (PhD student, Royal College of Surgeons in Ireland)

13:48 – 14:06 A streamlined approach to atrial fibrillation screening –partnership between the cardiac rhythm management team and department of stroke medicine

John Dowds (Chief Cardiac Physiologist, Belfast Health & Social Care Trust) and John Britton (Senior Cardiac Physiologist, Belfast Health & Social Care Trust)

Kindly Sponsored by

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14:06 – 14:24 An adapted home-based cardiac rehabilitation programme for TIA and ‘minor’ stroke patients? SPRITE - A pilot study

Dr Neil Heron (NIHR PhD Clinical Fellow in GP and Sport and Exercise Medicine)

14:24 – 14:42 Evaluating a stroke prevention review in 12,392 patients with atrial fibrillation across GP surgeries in Northern Ireland

Anne O’Brien (Clinical Pharmacist)

14:42 – 15:00 Enhanced Stroke Early Supported Discharge Team improves patient experience, reduces length of stay in Acute Hospital Trust and reduces dependence on social care packages

Alice Podmore (Stroke Therapy Manager / Advanced Occupational Therapist)

13:30 – 15:00 Parallel 2B Grand Ballroom Upper limb rehab / spasticity management and re-thinkingSection 1 falls

Chair: Cameron Lindsay (Physiotherapist, South Eastern HSC Trust)


13:35 – 14:00 Re-thinking falls-risk after stroke Dr Mary Walsh (Postdoctoral Research Fellow and Honorary Lecturer in

Physiotherapy, Royal College of Surgeons in Ireland)

14:00 – 14:25 Spasticity management Dr Sheena Caldwell (Consultant in Rehabilitation Medicine, Regional

Acquired Brain Injury Unit, Belfast Health & Social Care Trust)

14:25 – 14:45 An integrated therapeutic approach to intensive upper limb rehabilitation

Fran Brander (Consultant Physiotherapist, National Hospital for Neurology & Neurosurgery) and Kate Kelly (Consultant Occupational Therapist, National Hospital for Neurology and Neurosurgery)


13:30 – 15:00 Parallel 2C Second Floor Delivering hyperacute and effective stroke careBirch

Chair: Dr Liz Laird (Lecturer of Nursing, Ulster University)

Kindly Sponsored by

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13:40 – 13:55 Stroke Response – upping the game Dr Nigel Ruddell (Interim Medical Director, Northern Ireland Ambulance

Service)

13:55 – 14:25 Implementing and sustaining centralised hyperacute stroke systems

Dr Angus Ramsay (Senior Research Associate, UCL)

14:20 – 14:40 Practicalities and overcoming challenges in delivering hyperacute stroke care

Maria Kinnaird (Department of Stroke Medicine, Belfast Health & Social Care Trust)


15:00 – 15:30 Exhibition, Posters and Refreshments

15:30 – 17:00 Plenary 2 Grand Ballroom FAST, SSNAP and recruit Section 3

Chairs: Dr Patricia Gordon (Consultant Physician, Belfast Health and Social Care Trust) and Nicola Moran (NIMAST Chair, Clinical Physiotherapy Specialist in Stroke, Belfast Health and Social Care Trust)


15:40 – 16:10 SSNAP data Gillian Cluckie (Stroke Nurse Consultant Neurology, St George’s University

Hospitals NHS Foundation Trust)

16:10 – 16:30 Pre-hospital assessment: faster than FAST? Dr Chris Price (Clinical Reader in Stroke Medicine, Newcastle University)

16:30 – 16:50 NI stroke clinical research / incorporating research into everyday practice Dr Michael Power (Ulster hospital, Southern Eastern Health and Social Care Trust)

16:50 – 17:00 Prize Giving, Close and Final Remarks

17:00 Conference Ends

17:00 - 18:00 NIMAST AGM

Kindly Sponsored by

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Stand 14 – Allergan

Email: [email protected] Website: www.allergan.co.uk

Founded in 1950, Allergan, Inc., with headquarters in Irvine, California, is a multi-specialty health care company that discovers, develops and commercializes innovative pharmaceuticals, biologics and medical devices that enable people to live life to its greatest potential – to see more clearly, move more freely, express themselves more fully. The Company employs approximately 8,000 people worldwide and operates state-of-the-art R&D facilities and world-class manufacturing plants. In addition to its discovery-to-development research organization, Allergan has global marketing and sales capabilities with a presence in more than 100 countries.

Stand 13 – Amgen

Email: [email protected] Website: Amgen.co.uk

At Amgen, our mission is to serve patients. As a science based, patient focused organisation, we develop innovative therapies to treat serious illnesses.

Stand 4 – Bayer

Email: [email protected] Website: www.bayer.com

Bayer aims to improve people’s quality of life with our products. To achieve this, we concentrate on the research and development of innovative drugs and novel therapeutic approaches. At the same time, we are constantly improving established products. In this context, Bayer HealthCare Pharmaceuticals uses the experience it has gained from over a century in the business.

EXHIBITORS

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Stand 15 – Boehringer Ingelheim

Email: [email protected] Website: www.boehringer-ingelheim.co.uk

Innovative medicines for people and animals have for more than 130 years been what the research-driven pharmaceutical company Boehringer Ingelheim stands for. Boehringer Ingelheim is one of the pharmaceutical industry’s top 20 companies and to this day remains family-owned. 50,000 employees create value through innovation for the three business areas human pharmaceuticals, animal health and biopharmaceutical contract manufacturing. In 2016, Boehringer Ingelheim achieved net sales of around 15.9 billion euros.

Social responsibility comes naturally to Boehringer Ingelheim. That is why the company is involved in social projects such as the “Making More Health” initiative. Boehringer Ingelheim also actively promotes workforce diversity and benefits from its employees’ different experiences and skills. Furthermore, the focus is on environmental protection and sustainability in everything the company does.

Stand 18 – Bristol-Myers Sqibb

Email: [email protected] Website: www.eliquis.co.uk

Stand 11 – CaptureStroke

Email: [email protected] Website: www.capturestroke.com

CaptureStroke is the UK’s marketing leading Stroke clinical pathway software, enabling clinicians to deliver best evidence-based Stroke care and giving NHS Trust complete ownership of their data while providing real-time insights to better understand and measure performance throughout the Stroke care pathway. CaptureStroke goes beyond the basic SSNAP reporting promoting a culture of safety and quality with real-time analytics and care alerts, and an at-a-glance understanding of all stroke patients status across the Trust.

Complementing and integrating with a wide range of Trust EPR & PAS systems, CaptureStroke has imbedded clinical protocols enabling clinicians to easily adhere to the NHS RightCare Stroke pathway.

CaptureStroke allows clinicians to interact with their data to enable service improvement and monitor key performance indicators with ease, leading to an increase in tariff performance and improved patient outcomes.

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Stand 7 – Daiichi Sankyo UK

Website: www.daiichi-sankyo.co.uk

Daiichi Sankyo is dedicated to the creation and supply of innovative pharmaceutical products to address diversified, unmet medical needs of patients in both mature and emerging markets.

With over 100 years of scientific expertise and a strong portfolio of medicines for hypertension, thrombotic disorders and oncology. For more information, please visit: www.daiichi-sankyo.co.uk

Stand 12 – Direct Medics Healthcare Recruitment

Website: www.directmedics.com

Direct Medics is a leading healthcare recruitment company working in the sector since 2000.

We place a range of high calibre Doctors, Nurses, HCAs and Allied Health Professionals in short-term shift work, long-term locums and fixed -term placement positions across the UK and Ireland.

Stand 3 – Halyard Health

Website: www.halyardhealth.co.uk

Halyard Health is a medical technology company focused on eliminating pain, speeding recovery and preventing infection for healthcare providers and their patients. Halyard is committed to addressing some of today’s most important healthcare needs.

Halyard delivers recognised brands (MIC*, MIC-KEY*, CORFLO*, ENTRAL*) and reliable Digestive Health solutions that help improve patient outcomes and quality of life, particularly for patients in need of supplemental nutrition delivery through enteral feeding.

Come and get a hands-on session at our booth.

For more information, visit www.halyardhealth.co.uk

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Stand 9 – Medtronic

Email: [email protected] Website: www.medtronic.com

As a global leader in medical technology, services and solutions, Medtronic improves the lives and health of millions of people each year. We use our deep clinical, therapeutic, and economic expertise to address the complex challenges faced by healthcare systems today. That’s why we’re committed to partnering in new ways and developing powerful solutions that deliver better patient outcomes. Medtronic is committed to providing evidence-based technology for Stroke patients. Medtronic is working in collaboration with health care professionals to increase patient access to Mechanical Thrombectomy and remote patient monitoring for patients with Atrial Fibrillation. Learn more at Medtronic.com

Stand 5 – Lifetec

Email: [email protected] Website: www.lifetec.ie

LifeTec brings the latest innovative technologies in Neuro & Ortho Rehabilitation and Advanced Pain Management to the everyday lives of patients, their carers and clinicians across UK & Ireland. Our technologies provide clinicians with new ways to treat patients with neurological & physical impairments and, through our Homecare Service Programme, embed these treatments in the daily lives of patients at home.

Stand 17 – Ipsen

Website: www.ipsen.com

Ipsen is a global specialty-driven biopharmaceutical group focused on innovation and specialty care. The group develops and commercializes innovative medicines in three key therapeutic areas - Oncology, Neurosciences and Rare Diseases. Ipsen sells more than 20 drugs in over 115 countries, with a direct commercial presence in more than 30 countries. Ipsen’s R&D is focused on its innovative and differentiated technological platforms located in the heart of the leading biotechnological and life sciences hubs (Paris-Saclay, France; Oxford, UK; Cambridge, US). For more information on Ipsen, visit www.ipsen.com

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Stand 1 – Merz Pharma

Email: [email protected]

Merz Pharma focuses on therapeutic use of Xeomin (Botulinum neurotoxin type A) for the treatment of upper limb spasticity in adults.

Stand 2 – MYoroface

Email: www.iqoro.com Website: [email protected]

IQoro® is a neuro-muscular trainer that addresses many of the conditions that can be left as a legacy of stroke. It is a simple, hand-held CE marked Class 1 Medical Device that trains the musculature in the face and swallowing chain that can be slack and ineffective in patients with dribbling, drooling, speech formation difficulties and dysphagia. It strengthens the muscles and promotes the brain’s ability to regain control of these functions. Training takes just 1½ minutes per day and in clinical trials 97% of stroke survivors with dysphagia improve their swallow and 63% recover normal swallowing ability.

Breathe. Eat. Smile. Talk.

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Stand E – NIMAST

Email: www.nimast.org.uk/contact Website: www.nimast.org.uk

NIMAST is the only multidisciplinary association for stroke in Northern Ireland and provides a forum for sharing best practice, disseminating service improvements and research findings. NIMAST also has significant influence on stroke service development, guidelines and stroke strategies, through direct co-operation with government, HSC and the Public Health Agency. NIMAST has strong links with stroke groups both in the UK and Ireland, including the Stroke Association and the UK Stroke Forum.

NIMAST can give you the opportunity to engage more fully with stroke service change and implementation, and help implement the things that you, as a front line stroke service provider, see as important.

Our annual conference is the only dedicated multidisciplinary conference in the UK or Ireland.

VISIT OUR NEW WEBSITE & JOIN NIMAST BY REGISTERING ONLINE www.nimast.org.uk

For a small annual subscription of £20, (reduced rate of £10 for students) you can gain full access to online discussion forums, links to other relevant sites, service improvement bulletins and conference presentations/slides.

You will also benefit from reduced NIMAST/UKSF conference rates.

• Please note that all current NIMAST members will soon be receiving further notification regarding updating their membership online

Stand A – Northern Ireland Chest Heart & Stroke

Email: [email protected] Website: www.nichs.org.uk

NICHS is the local charity for the care and prevention of chest, heart and stroke illnesses. We work with people who have these conditions and their families, offering practical and emotional support at what can be a difficult time in their lives. Our support groups provide an opportunity to share experiences while benefiting from a structured programme of activities including rehabilitation, exercise and information. We do health promotion in schools, with the homeless and in workplaces. We fund research relating to prevention, treatment and care. We campaign at Assembly level for people and families who are affected by these conditions.

Stand 19 – Novacor

Email: [email protected] Website: www.novacor.co.uk

A dedicated and highly focussed company, specialising in the sale and support of the most innovative and cost effective Ambulatory Patient Monitoring Systems.

CaptureStrokewww.capturestroke.com

Supporting Stroke Clinicians to Save Lives

Enabling Best Practice Stroke Pathways

Demonstrating Optimum Evidence Based Care

FOR MORE INFORMATION0191 280 4654

[email protected] Information. Better Outcomes.

PATIENT MANAGEMENT

REAL-TIMEDATA & ALERTS

DASHBOARDS& REPORTS

SSNAP AUDITCOMPLIANCE

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Stand B – Royal College of Speech and Language Therapists

Email: [email protected] Website: www.rcslt.org

About the Royal College of Speech and Language Therapists

The Royal College of Speech and Language Therapists (RCSLT) is the professional body for speech and language therapists in the UK, representing more than 17,000 members (around 500 in Northern Ireland). It facilitates and promotes research into the field of speech and language therapy – the care for individuals with communication, swallowing, eating and drinking difficulties. It promotes better education and training of speech and language therapists and is responsible for setting and maintaining high standards in education, clinical practice and ethical conduct. The RCSLT’S Giving Voice campaign is highlighting the importance of speech and language therapy by sharing the life-changing stories of those who have benefited from treatment and by demonstrating evidence of speech and language therapists’ efficiency and value for money. For more information on RCSLT and Giving Voice visit www.rcslt.org and www.givingvoiceuk.org

Stand 16 – Stryker

Email: [email protected] Website: www.stryker.com

Stryker is focused on advancing the practice of less invasive stroke therapies through its Complete Stroke Care solutions. Stryker is dedicated to providing innovative stroke products and services for ischemic and haemorrhagic stroke, and committed to providing clinical education and support to help physicians deliver better patient outcomes. Products include: stent retriever, detachable coils, stents, balloons, guidewires and microcatheters.

Stand D – Stroke Association

Email: [email protected] Website: www.stroke.org.uk

Stroke Association is a charity. We believe in life after stroke together we can conquer stroke. We work directly with stroke survivors and their families and carers, with health and social care professionals and with scientists and researchers. We campaign to improve stroke care and support people to make the best recovery they can. We fund research to develop new treatments and ways of preventing stroke. The Stroke Helpline (0303 303 3100) provides information and support on stroke. More information can be found at www.stroke.org.uk

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Stand C – The Magic project

Email: [email protected] Website: www.magic-pcp.eu

Business Services Organisation (BSO) provides a broad range of regional businesses support functions and specialist professional services to the Health and Social Care sector in Northern Ireland. MAGIC is a European Commission Co-Funded Pre-Commercial Procurement Project focused on the development of ICT based solutions to improve the well-being of patients and optimise the opportunity for recovery post-stroke. BSO leads and co-ordinates the MAGIC consortium. Other NI participants are the Health and Social Care Board, the Public Health Agency, Invest NI and the University of Ulster. Other member states involved in the consortium are Ireland, Italy, Finland, Spain, Luxembourg and Denmark.

Stand 6 – Turun UK

Email: [email protected] Website: turun.co.uk

Turun UK is the leading patient safety provider of falls and elopement solutions, with over 20 year’s experience. We are pioneers in helping to reduce the risk of falls from a bed, chair and toilet, and would welcome the opportunity to showcase our latest innovation to you at our stand.

Stand 8 – TalarMade

Website: www.talarmade.com

TalarMade is owned and managed by professionals from the fields of Orthotics, Podiatry physical therapy and rehabilitation.

With over 30 years market experience and using their extensive knowledge the team have worked diligently to create a leading clinical product portfolio.

TalarMade are committed to product research and development whilst having a focused approach to design a range of devices based around the latest validated clinical evidence.

TalarMade will be showcasing their leading neurological range of products including HeadUp, Neurotec and Turbomed.

www.nimast.org.uk/join-us

Reduced rates for NIMAST & UK Stroke Forum

Conferences

Access to NIMAST website with up to date news feed,

relevant documents & guidelines

NIMAST hosted / organised study days

Networking with colleagues regionally

Lobbying to influence decision makers, inform

policy, protocols and strategy

Involvement in stroke-related projects regional, national

& international

Contribute to guideline consultations

Opportunity to share good ideas and practice

Research bursary (coming soon)

NIMAST (Northern Ireland Multidisciplinary Association of Stroke Teams) is a charitable organisation bringing together a wide group of professionals from health and social care, the voluntary sector, education and research who have an interest in providing,

delivering and improving stroke care.

What can you gain from being an active member of NIMAST?

MEMBERSHIP BENEFITS

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ABSTRACTS FOR ORAL PRESENTATION

Cognitive, emotional and psychological

Outcomes of cognitive impairment post-stroke: A five-year follow-up of the ASPIRE-S cohort

Rohde D1, Gaynor E2, Large M3, Mellon L1, Hall P3, Brewer L4, Conway O1, Bennett K5, Williams D4, Callaly E7, Dolan E6, Hickey A1.

1Royal College of Surgeons in Ireland, Psychology, Dublin, Ireland. 2Royal College of Surgeons in Ireland, Medicine, Dublin, Ireland. 3Royal College of Surgeons in Ireland, Clinical Research Centre- Beaumont Hospital, Dublin, Ireland. 4Royal College of Surgeons in Ireland, Geriatric and Stroke Medicine- Beaumont Hospital, Dublin, Ireland. 5Royal College of Surgeons in Ireland, Population Health Sciences, Dublin, Ireland. 6Connolly Hospital Blanchardstown, Geriatric Medicine, Dublin, Ireland. 7Mater Misericordiae University Hospital, Geriatric Medicine, Dublin, Ireland.

IntroductionCognitive impairment is common post-stroke, and can increase disability and levels of dependency. This study explored the impact of cognitive impairment six-months post-stroke on outcomes at five years.

MethodThis was a five-year follow-up of the Action on Secondary Prevention Interventions and Rehabilitation in Stroke cohort. Cognitive impairment was assessed using the Montreal Cognitive Assessment at six months post-stroke. Outcomes at five years included mortality, quality of life, activities of daily living, and anxious and depressive symptoms. Mortality was ascertained from medical records and death notifications. Quality of life was assessed using the Stroke Specific Quality of Life Scale. Independence in activities of daily living were assessed using the Nottingham Extended Activities of Daily Living scale. Depressive and anxious symptoms were assessed using the Centre for Epidemiologic Studies Depression Scale and Hospital Anxiety and Depression Scale – Anxiety subscale, respectively. Data were analysed using regression models.

ResultsOf 256 patients assessed at six months post-stroke, 63 (24.6%) had died within five years. Cognitive impairment at six months was significantly associated with increased risk of mortality within five years, controlling for age, sex and stroke severity [HR (95% CI): 2.19 (1.42, 3.39)]. Cognitive impairment at six months was also associated with poorer quality of life, lower levels of independence in activities of daily living, and increased likelihood of depressive symptoms five years post-stroke.

ConclusionCognitive impairment post-stroke continues to be associated with poorer outcomes. There is a need for more effective interventions to improve outcomes for this patient group.

27

Service development (research)

A Streamlined Approach to Atrial Fibrillation Screening – Partnership between the Cardiac Rhythm Management Team & Department of Stroke Medicine

Britton J1, Dowds J1, McNair W1, Turkington L1, Curry L1, Williamson R1, Kinnaird M2, Scullion E2, Wiggam MI2

1Cardiac Rhythm Management Team, Special Investigations Unit, Royal Victoria Hospital, Belfast 2Department of Stroke Medicine, Royal Victoria Hospital, Belfast

IntroductionThe National Clinical Guideline for Stroke recommends at least 12 hours’ cardiac monitoring to screen for atrial fibrillation (AF) after ischaemic stroke or TIA. Each year, the Royal Victoria Hospital admits 1500 suspected stroke patients and assesses 800 out-patients with possible TIA. Screening for AF previously utilised Holter ECG monitoring. However long outpatient waiting lists and limited availability of in-patient monitoring meant that timely investigation was not always possible. In July 2017 we established a new AF screening service using Novacor monitors (18 devices). Stroke unit nurses were trained to fit monitors at presentation. This report evaluates the impact of the new service.

MethodWe compared the performance of AF screening during the old service (4 months from November 16) with that during the new service (4 months from November 17). Primary outcome measures were the number of patients screened during the two 4-month periods, percentage accessing same-day screening and waiting time in the remainder who did not access same-day screening.

ResultsThe total number of patients accessing AF screening more than doubled after introduction of the new service (402 v 153). The proportion screened on the day of referral increased from 78/153 (51%) to 318/402 (79%), p<0.001). The average wait for those not accessing same day investigation fell from 144 days to 30 days, p<0.001.

ConclusionA new ECG monitoring system, empowerment of stroke unit staff to initiate monitor hook-up and a close partnership with the Cardiac Rhythm Management team has led to significant improvements in AF screening after stoke.

28

Rehabilitation

An adapted home-based cardiac rehabilitation programme for TIA and ‘minor’ stroke patients? SPRITE - A Pilot Study

Dr Neil Heron1,2, 3 Prof Frank Kee1,2, 3 (MD), Prof Jonathan Mant4 (MD), Prof Margaret Cupples1,2, 3 (MD), Prof Michael Donnelly1,2, 3 (PhD).

1Dept of General Practice and Primary Care, Queen’s University, Belfast; 2Centre for Public Health Research, Queen’s University, Belfast; 3UKCRC Centre of Excellence for Public Health Research (NI); 4Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge, UK.

IntroductionThe value of cardiac rehabilitation (CR) after a transient ischaemic attack (TIA) or ‘minor’ stroke is untested despite these conditions sharing similar pathology and risk factors to coronary heart disease. The aim of this study was to pilot an adapted home-based cardiac rehabilitation programme, ‘The Healthy Brain Rehabilitation Manual’, with an added pedometer intervention and telephone follow-up from either a GP or stroke nurse, in the acute period (within 4 weeks) following a first TIA or ‘minor’ stroke of atherosclerotic origin. The aim was also to obtain an initial estimate of the effectiveness of the intervention in improving cardiovascular risk factors in the TIA and ‘minor’ stroke population.

MethodThis intervention has been developed following the Medical Research Council (MRC) guidelines for developing complex health service interventions. This body of work describes the pilot study which lasted 12 weeks. There were 3 different treatment groups: (1) standard care; (2) manual and a pedometer with telephone follow-up by a General Practitioner (GP); (3) manual and a pedometer with telephone follow-up by a stroke nurse. The telephone follow-up was undertaken at 1, 4 and 9 weeks. Focus groups were undertaken to explore participants’ views on the intervention.

ResultsDuring 32 weeks of recruitment, of 125 eligible patients, 44 (35.2%) consented to initial study contact, with 40 (90.9%) participating and 39 (97.5%) completing the study. Twelve were randomised to Group 1(control) and 14 each to Groups 2 and 3. From baseline to follow-up, there was a general improvement in cardiovascular risk factors in the intervention arms. End of study qualitative work with participants and the stroke nurses doing the telephone follow-up and recruitment, confirmed the acceptability of the research study and intervention although some amendments were suggested.

ConclusionRecruitment and retention rates as well as qualitative feedback and improvements in cardiovascular risk factors suggest that a trial to evaluate the effectiveness of a novel home-based CR programme, ‘The Healthy Brain Rehabilitation Manual’, implemented within 4 weeks of a first TIA/minor stroke of atherosclerotic origin is feasible. This intervention has been developed following appropriate guidelines, with clear patient and public involvement. The findings from the pilot work will be used to further refine the next stage of the intervention’s development, a randomised controlled trial.

29

Primary Prevention

Evaluating a stroke prevention review in 12,392 patients with atrial fibrillation across GP surgeries in Northern Ireland

O’Brien A¹, Devlin S²

¹Interface Clinical Services, Leeds, UK ²Donard Family Practice, County Down, UK

IntroductionAtrial fibrillation (AF) is the most common cardiac arrhythmia, affecting more than one million people in the UK. Patients with AF are five times more likely to have a stroke, and when a stroke is AF-related there are increased levels of mortality, disability, and longer hospital stays. Around 7,000 strokes and 2,000 deaths could be prevented every year through effective detection of AF and treatment with appropriate anticoagulant drugs.

MethodThis project involved a clinical assessment of 12,392 AF patients in 123 audits in Northern Ireland between 2013 and 2017. The review aimed to identify high-risk AF patients and to improve outcomes in stroke and VTE. Clinical pharmacists, GPs, and other practice staff worked in partnership to achieve the aims of this review.

ResultsClinical pharmacists working within GP practices identified patients diagnosed with AF, and patients with the clinical markers of AF, and assessed them using the CHA2DS2-VASc scoring system. The percentage of patients identified as at high-risk of stroke has remained steady over the four-year review (mean=88.71%); however, the percentage of those high-risk patients not on appropriate oral anticoagulant treatment has decreased, from 32% to 18%, since the review began. Despite the increase in patients on appropriate AF treatment, the review has continued to prevent large numbers of strokes, with 80 prevented in 2017.

ConclusionWhile these results show an overall improvement in the levels of AF treatment, it is also clear that further work and similar reviews are needed to continue to prevent strokes in AF patients.

30

Enhanced Stroke Early Supported Discharge Team improves patient experience, reduces length of stay in Acute Hospital Trust and reduces dependence on social care packages

Podmore AL , Stergiou P

Department of Stroke Medicine, Royal Stoke Hospital, UK

IntroductionThis has been a service development to structure an enhanced early supported discharge team that can provide care support at home but delivered by therapists so every intervention is delivered by therapy trained staff. This provides an intense programme of therapy with a functional task approach in the patient’s own home with up to 4 interventions per day being delivered covering activities of daily living. The intervention is provided for up to 2 weeks post discharge from the Acute Stroke Unit.

MethodData collected alongside normal service delivery. Data looking at level of intensity given at home and the duration of time in days post discharge that the team provides support. Also recorded level of social care dependency and requirements at the end of the enhanced ESD team input.

ResultsOver a period of 11 months, 94 patients have been discharged on the enhanced ESD pathway. Of those 94 patients only 4 had social care requirements at the end of the 2 week period of support. All of the 94 patients would have been referred to social care and would have had to wait for care package provision prior to discharge, therefore saving a considerable number of bed days and improving flow through the Acute Stroke Unit. There has been an overall reduction in length of stay from 6.8 days to 4.8 days since the start of the service.

ConclusionThe Enhanced Early Supported Discharge Team has demonstrated a reduction in length of stay, an improved patient flow through the Acute Stroke Unit and a decreased dependence on the local social care team. Patient experience has also been positively impacted as patient’s are not left waiting in hospital once medically fit for discharge and confidence is increased due to discharge being supported by the same team that has been providing therapy as an inpatient, rather than a new social care team. Also, suggestive that intensity of therapy being delivered leads to a faster recovery time.

31

Swallowing

Stroke Associated Pneumonia and Dysphagia

Bolger L, Meagher MK, Noone I, Cassidy TP

St Vincent’s University Hospital. Elm Park. Dublin 4

IntroductionStroke associated pneumonia (SAP) has been reported to be a common complication post stroke and is associated with dysphagia.

MethodIn a cohort of acute stroke patients admitted to our acute service we reviewed the use of antibiotics given in the first week post stroke and the indication for this treatment.

Results40 consecutive acute stroke patients with a median age 79 (Range 67 – 92) years and median Glasgow Coma Score 15 (Range 4 – 15) were assessed. There were 17 (42.5%) left hemisphere, 13 (32.5%) right hemisphere and 9 (22.5%) posterior circulation strokes. The majority of strokes (77.5%) were ischaemic in aetiology.

Antibiotic therapy was required in 14 (35%) patients. Abnormal swallow occurred in 17 (42.5%) patients; there was no significant difference in neurology between those with a normal swallow and those without.

A SAP occurred in 53% of patients with dysphagia compared with 26% of patients with a normal swallow (p<0.01).

Patients with a dysphagia had a poorer outcome, Nursing home / death (p<0.001) compared with those with a normal swallow. Median times to swallow screen was similar in both groups.

ConclusionSAP is a common problem and is associated with poorer outcomes in this cohort. The reason for this higher incidence of SAP in our cohort is unknown and requires further review.

Northern Ireland Stroke ConferenceTuesday 11 June 2019 Crowne Plaza, Shaws Bridge, Belfast

• Be part of the debate with key players to shape theNorthern Ireland stroke agenda

• Gain an MDT perspective and network with colleaguesfrom across the whole stroke care pathway

• Find out about the latest industry developmentsand innovations

• Showcase your work by submitting an abstractfor poster or oral presentation

Delegate fees starting at just £70, to find out more visit www.ukstrokeforum.org.uk

[email protected] #NISC19

Join us to learn the latest research and service developments in stroke care

The conference is a must for anyone interested in increasing their knowledge, professional expertise and learning.

“” (delegate)

JN 1718.199_UKSF_NI_A5 Flyer_.indd 1 26/10/2017 16:38:23

33

POSTERS

Acute Care

1. Acute Stroke in a Patient Receiving Adalimumab for Chrohn’s Disease

Anketell J1 , Wiggam MI1, Benson G2, Turner G3

1Department of Stroke Medicine, 2Haematology and 3Gastroenterology, Belfast Health and Social Care Trust

IntroductionIt has previously been reported that patients treated with Adalimumab (Humira) who develop anti-adalimumab antibodies may be at increased risk of arterial and venous thromboembolic events. We present the case of a 45 year old lady who developed and acute ischemic stroke whilst receiving Adalimumab. Anti-adalimumab antibodies were positive.

MethodClinical notes and electronic records were accessed and reviewed. The literature investigating venous and arterial thromboembolic events in association with anti-adalimumab antibodies was also reviewed.

ResultsA 45 year old lady with a long history of Crohn’s disease who had been treated with Adalimumab for three years was admitted with gastroenteritis and dehydration. During admission she developed infra-renal aortic thrombus and subsequently became aphasic. MRI brain showed an acute left parieto-occipital infarction. Contrast-enhanced MRA, echocardiogram and 24-hour ECG monitoring were normal. Other routine screening investigations did not reveal a clear cause for the stroke. It was felt that the prothrombotic state of inflammatory bowel disease, together with dehydration and use of the combined oral contraceptive pill may have contributed. Anti-adalimumab antibodies were also positive at 80 ng/ml (n 1-10 ng/ml). Adalimumab was discontinued and anticoagulation initiated.

ConclusionIt was concluded that anti-Adalimumab antibodies were a likely contributing factor to this patient’s stroke and extensive aortic thrombus. Extraordinary thromboembolic events have been described in the presence of these antibodies and the limited literature suggests a causative link. Patients receiving Adalimumab who present with acute ischaemic stroke should be tested for anti-Adalimumab antibodies as this may have implications for future anti-inflammatory therapy.

Northern Ireland Stroke ConferenceTuesday 11 June 2019 Crowne Plaza, Shaws Bridge, Belfast

• Be part of the debate with key players to shape theNorthern Ireland stroke agenda

• Gain an MDT perspective and network with colleaguesfrom across the whole stroke care pathway

• Find out about the latest industry developmentsand innovations

• Showcase your work by submitting an abstractfor poster or oral presentation

Delegate fees starting at just £70, to find out more visit www.ukstrokeforum.org.uk

[email protected] #NISC19

Join us to learn the latest research and service developments in stroke care

The conference is a must for anyone interested in increasing their knowledge, professional expertise and learning.

“” (delegate)

JN 1718.199_UKSF_NI_A5 Flyer_.indd 1 26/10/2017 16:38:23

34

2. Developing Transport MAPS for Conveyance of Emergency Stroke Patients in Northern Ireland

Emer Hopkins, (Health and Social Care Board NI). Noreen Kamal (University of Calgary) Dr Ivan Wiggam (Belfast Health and Social Care Trust). Dr Brid Farrell (Public Health Agency)

IntroductionIschemic stroke is a treatable disease with alteplase, a clot-busting medical treatment, or endovascular therapy (EVT), mechanical removal of the clot through minimally invasive surgery. Alteplase is widely available at eight sites in Northern Ireland (NI). EVT is only available at the Royal Victoria Hospital in Belfast. Maps were sought to identify in which areas there is advantage or disadvantage to patients in attending their local stroke thrombolysis services, and how this varies in respect of the performance of the local service?

MethodWe developed a number of maps based on conditional probability and brain decay curves, generated from pooled clinical trials. These sought to determine the best transportation for patients. Two populations were modelled 1) those with a LAMS greater than 3; and 2) all potential stroke patients recognised by paramedics using a series of assumptions. Three scenarios were mapped for two populations producing six maps. These maps are informed by both real audit data and a number of theoretical performance scenarios.

ResultsThere is a green band to the north of Belfast where patients with LAMS > 3 are more likely to benefit if transported directly to the Royal Victoria Hospital (RVH). The maps show that there is a large area to the north and south of Belfast where all patients, regardless of LAMS score, should be transported directly to the RVH. However, in some of the western area patients should always be transported directly to the two local stroke units.

ConclusionThese maps have been used to inform commissioners of the minimum number of sites needed to service the population of NI, without reducing the effectiveness of thrombolysis and at the same time improving the effectiveness of intra-arterial interventions. Final options for a reconfigured stroke service will require further modelling and must also consider; workforce constraints, infrastructure, financial constraints and the effect of stroke mimics. The next phase of this research is to develop an interactive and modifiable map to evaluate a broader range of scenarios.

35

Audit

3. A retrospective audit of atrial fibrillation related ischaemic stroke in Great Western hospital: evidence of substantial under treatment in primary prevention and inadequate post stroke screening

Joanna S Gumley1 Benedict J Andrew,2 Jessica Close,1 Gabriel SC Yiin1

1Stroke Unit, Great Western Hospital, Swindon2Queen Elizabeth Hospital, Woolwich

IntroductionUndertreatment of AF in the community is widespread despite the advent of new oral anticoagulants, and the extent of AF monitoring post stroke is also uncertain. Therefore, we determine the prevalence of premorbid anticoagulation in patients with ischaemic stroke and known prior AF and the use of prolonged cardiac monitoring in non-AF patients.

MethodWe studied consecutive ischaemic stroke patients admitted to the stroke unit between January and April 2015 and determine the rate of premorbid anticoagulation and risk scores in those with known prior AF, reasons for premorbid non-anticoagulation, and the proportion of non-AF related stroke receiving prolonged cardiac monitoring.

ResultsOf the 119 patients (mean age/SD - 75 years/12.9), 35 (29.4%) were AF-related, 21 (18%) were known prior AF, of whom 11 (52.4%) were anticoagulated. Of the 10 patients not anticoagulated, the mean CHA2DS2VASC score was 3.8 and the HAS-BLED score was 2. 13 (10.9%) additional patients had AF detected with routine ECG but of the remaining 85 without AF, only 58 (68%) had 3-5 days of prolonged cardiac monitoring, of whom 1 (1.7%) had new AF. Compared to the non-AF group, AF-related stroke tended to be significantly older (p<0.05) and have a higher prevalence of previous myocardial infarction and peripheral vascular disease (p<0.05).watershed areas between two vascular areas. Interestingly with chronic hypo-perfusion collaterals form and the tissue is adapted to ischaemic conditions resulting in smaller ischaemic lesions.

ConclusionIn keeping with recent population-based studies, 1-in-3 ischaemic strokes are related to AF, with evidence of considerable underuse of anticoagulation for those with known prior AF. Utilisation of prolonged cardiac monitoring remains suboptimal, which might undermine long term stroke prevention.

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Case reports and interesting cases

4. The Equality Delivery System

Hitchman LH1 MBBSAbdul Hamid A1

1Hull Royal Infirmary, Anlaby Road, Hull and East Yorkshire Hospitals NHS Trust, HU3 2JZ

IntroductionBilateral anterior circulation infarction is most commonly associated with cardio-embolic events secondary to arrhythmias, therefore patients do not undergo carotid artery imaging. This case illustrates the importance of considering carotid artery disease in those with bilateral stroke and sinus rhythm.

CaseA 57 year old gentleman presented with sudden onset left sided weakness. Initial imaging demonstrated bilateral ischaemic stroke. The patient was anti-coagulated and discharged. He was re-admitted with dysphasia and further investigations revealed an occluded right carotid artery and high grade left carotid artery stenosis. He underwent carotid endarterectomy and remained symptom free at follow up.

Discussion Micro-emboli and hypo-perfusion are both implicated in the pathophysiology of this patient’s presentation. Micro-embolic is the most common documented cause of bilateral stroke. Micro-emboli pass through collateral circulation resulting in artery-to-artery embolisation through the circle of Willis and any anatomical anomalies. Hypo-perfusion occurs at watershed areas between two vascular areas. Interestingly with chronic hypo-perfusion collaterals form and the tissue is adapted to ischaemic conditions resulting in smaller ischaemic lesions.

ConclusionBilateral strokes in patients with sinus rhythm should undergo further imaging to allow for timely medical and surgical interventions to prevent further stroke.

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5. Is this a case of antiphospholipid syndrome?

Nowak K.1, Loughrey C.2, Battacharya, D.3, Patterson C.1

1Department of Stroke Medicine RVH Belfast 2Department of Clinical Biochemistry RVH Belfast 3Department of Neuroradiology RVH Belfast

IntroductionA right-handed 33-year old female moved back to Northern Ireland and presented to the neurovascular clinic for follow-up of a left parietal lobe infarct which occurred peri-partum 18 months previously, with a history of anti-phospholipid syndrome. She described ongoing sensory symptoms in her right arm and leg, extreme fatigue and poor short-term memory.

MethodPast medical history included previous DVT, stillborn pregnancy and miscarriage diagnosed while living in England.

ResultsCarotid Dopplers revealed bilateral narrowing of internal carotid arteries. CT brain and angiography confirmed abnormality of both internal carotid arteries and previous left MCA territory infarction. There was no evidence to suggest dissection. Further investigations revealed no evidence of vasculitis. However, plasma homocysteine levels were markedly elevated. Plasma amino acids confirmed classical homocystinuria with high methionine levels.

DiscussionClassical homocystinuria is an autosomal recessive disorder caused by mutations in the cystathionine β-synthase gene. This condition is characterised by very high levels of plasma total homocysteine and methionine.

Thromboembolism is a major cause of early death and morbidity. It is not unusual for previously asymptomatic individuals to present in adult years with only a thromboembolic event that is often cerebrovascular.

According to data collected from countries that have screened >200,000 new-borns, the current cumulative detection rate of CBS deficiency is 1 in 344,000. In Northern Ireland the incidence is much higher - 1 in 73,000. Hypermethioninaemia, used as a screening criterion in all new-borns, unfortunately does not pick up all cases.

Screening for homocystinuria should be considered in young patients with ischaemic stroke.

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Cognitive, emotional and psychological

6. Survivors not Victims. The making of a documentary exploring the ongoing journey of recovery following a stroke

Reeks A, Findlay YM, Findlay PF

Strokeness, Creative Visions Moray, Dept. Stroke Medicine, Raigmore Hospital, Inverness NHS Highland Scotland.

IntroductionA stroke is a life changing experience. Strokeness a self-help group of stroke survivors based in Inverness wanted to produce a film highlighting the challenges and adaptations in the aftermath of a stroke. The resulting film explores the journey of recovery following stroke and is a record of hope and achievement.

The process of producing the film highlighted the benefits of the creative arts to stroke recovery.

Method In 2017 over a period of nine months the group made a film in collaboration with Creative Visions Moray and the Stroke Unit Raigmore Hospital. Members discovered talents they did not know they had by attending the film production sessions and creative arts sessions. The commitment and discipline of producing the film had unexpected benefits and facilitated a strong group cohesion. They also collaborated in a series of music sessions that resulted in a song cycle. The concert performance was also recorded on film. The première screening of the documentary sold out at Eden Court Theatre Inverness and both the documentary and concert are available on DVD with proceeds going to Strokeness.

ResultsThe DVDs and have been used in health care education and to raise awareness of stroke. The DVD is now included in an information pack for patients on discharge from the stroke unit Raigmore Hospital.

ConclusionThe process of involvement in producing the documentary and concert was beneficial to those who took part. The creative arts and social involvement were considered by participants to have enhanced their wellbeing and confidence.

39

Rehabilitation

7. Prevalence of trunk impairment in stroke subjects using trunk IMPAI

Kanchan Koul, Mr Nandkumar, Assistant Professor M.S Ramaiah department of physiotherapy, Bangalore.

M.S Ramaiah Memorial Hospital, M.S Ramaiah Teaching Hospital, M.S Ramaiah Department of Neurology, Neuro-Rehabilitation center of M.S Ramaiah Department of Physiotherapy and M.S Ramaiah AYUSH hospital.

IntroductionStroke is among one of the major causes that induce impaired trunk control, including equilibrium reaction and weight shifting leading to functional disability. Approximately half of all post stroke survivors will experience some long-term disability.

Reduced trunk control has been found to be early indicator of long-term functional disability in several studies. Knowledge gained from this prevalence study will help researchers to better understand the contribution of trunk impairment to functional performance of trunk with stroke, and may lead to the development of new treatment techniques aimed at improving trunk control.

MethodOne fifty two subjects with trunk impairment post stroke fulfilling the inclusion and exclusion criteria were taken up for the study. Trunk impairments was measured using trunk impairment scale in all the subjects. Descriptive statistical analysis has been carried out for this study. Results on continuous measurements were presented on Mean. Results on categorical measurement were presented in Number (% age). Level of Significance was set at (0.05). The association between the categorical measurements has been analysed using chi-square test

ResultsIt was noted that (85.5%) of subjects post stroke who underwent trunk impairment assessment scored lowest on trunk impairment scale. Mean age determined was (58.28yrs.) among 152 subjects and prevalence of trunk impairment was found to be (85.5%) of the total sample with the p value <0.05 the scores were found to be statistically significant. Furthermore, within the age group (>60yrs.) trunk impairment was found to be highest among MCA territory involvement, right sided hemiparesis and ischemic type of stroke. Male subjects predominantly scored higher (86.6%) than female on trunk impairment score.

ConclusionPrevalence of Trunk impairment among ambulatory stroke subjects was found to be high in post stroke subjects. Furthermore prevalence was found to be higher among ischemic type of stoke with the age (>60 yrs.) with predominantly right sided hemiparesis.

40

8. Effect of oral training in post-stroke four-quadrant facial dysfunction, and dysphagia: a comparison study.

Hägg M1, 2, Tibbling L3

1Department of Otorhinolaryngology, Speech & Swallowing Centre Hudiksvall Hospital, Hudiksvall, Sweden, 2Centre of Research & Development, Uppsala University/Region of Gävleborg, Sweden and 3Department of Otorhinolaryngology, Linköping University, Sweden.

IntroductionFacial Activity Testing (FAT) in patients with dysphagia after stroke has previously identified pathology in the upper quadrants in 74% of patients, and some pathology in all 4-facial quadrants in 52%.

Dysphagia after stroke can be treated with a palatal plate (PP), or by IQoro® neuromuscular trainer (IQNT). This study compares the efficacy of the two methods in treating facial dysfunction, and checks for:different outcomes on 4-quadrant facial dysfunction,different outcomes on dysphagiaenduring improved outcomes at late follow-up.

MethodThe study is a prospective clinical intervention study in patients after a first-ever stroke. At baseline, all patients exhibited pathological values in FAT.IQNT patients recruited 2009–2012 (n = 18), trained totally 1½ mins per day. PP patients recruited 2005–2008 (n = 13), trained 1½ hours per day. Training period was 3 months.

IQoro devices are uniformly manufactured, PP require a patient dental cast before PP production for each individual.

Assessment methods were:4-quadrant facial dysfunction by FATswallowing dysfunction by Swallowing Capacity Test (SCT)conducted at baseline, end of training, and 18 months after end of training.

ResultsFAT and SCT showed significant improvement (p < 0.001) in both groups at end of training, and at late follow-up, and did not differ significantly between the groups.

Improvements remained at late follow-up in both groups.

ConclusionIQNT or PP training can significantly improve 4-facial quadrant activity and swallowing in patients with longstanding dysfunction after stroke.

IQNT has training time and complexity; and economic, advantages over PP training.

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9. Increasing engagement, reaching rehabilitation goals and reducing depression: a Neurologic Music Therapy service evaluation in a NHS acute stroke ward

Ruddock, E.

Chiltern Music Therapy with Bucks Healthcare NHS Trust

IntroductionIn July 2017 Chiltern Music Therapy recommenced a Neurologic Music Therapy (NMT) service at Wycombe Stroke Unit. This presentation highlights the findings of a service audit with the aims to identify the benefits of NMT for the patients, team and healthcare trust, look at how the service is enhancing the ward’s standard therapies and how the service might be developed further.

MethodPatient statistics, reasons for referrals, session aims, outcomes and patient feedback was collected over a 5-month period by the Music Therapist and MDT. 100% of patients referred to and receiving NMT were used for data collection with a sample size of 34 with 24 reasons for referral. The data was quantitatively and qualitatively analysed by each category which is presented visually and discussed in the context of national stroke standards.

ResultsThe 3 key findings were:

1. NMT increases patient engagement in therapy

2. NMT meets rehabilitation goals quicker than expected

3. NMT reduces depression and increases emotional wellbeing

The audit also found that the NMT service is meeting many of the national stroke standards.

ConclusionBased on the results it is concluded that the NMT service is providing significant benefit to the patients, team and healthcare trust by meeting the majority of the national stroke standards. It is proposed that NMT increases patient engagement in therapy and provides the therapy team with additional resources for the needs of patients. It is recommended that the NMT service is increased from 1 day per week to at least 2 days per week and to incorporate a home programme provision for each patient.

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10. A Case Study investigating the efficacy of combining the use of Botulinum Toxin Type A and Dynamic Hand Splints, in chronic reduced hand function due to flexor spasticity following a stroke.

Benson, J.A

Background and purposeDynamic hand splints are a promising intervention for aiding functional use of a person’s hand following a stroke. If spasticity is present it can be major limiting factor in using a Dynamic Hand Splint. The purpose of this case study is to report the use of a combination of Botulinum Toxin Type A (BtxA) to reduce spasticity, prior to initiating a repetitive training rehabilitation programme with a Dynamic Hand Splint.

Case DescriptionThe 31 year old male who had a stroke 6 years ago. Whilst progressing in other areas of his rehabilitation such as mobility and speech. He had made limited progress in restoring function in his hand.

Prior to the intervention he was unable to extend his fingers to grasp objects due to moderate spasticity and fasciculations in his Flexor Digitourm Superficialis, Flexor Digitorum Profundus and Flexor Pollicis Longus. On examination he presented with a prominent catch on high velocity stretch using the Modified Ashworth Scale.

OutcomesThe patient exhibited improvement in his muscle tone, with no catch present after the BtxA injections. The Dynamic Hand Splint was reported as easier to Don and Doff by his carers and family members, and there was vast improvement in the main outcome measure of placing 5 balls in a container. This dropped from 60 seconds to 17 seconds, a 71.67% improvement in a 3 month period.

It is notable that his overall hand function is improved beyond grasping 5 balls, he is able to feed himself, clean his face and shake hands with friends. In addition to this, activities such as mobility and using the stairs improved. This is a result of using both hands to grip and balance more effectively.

His upper limb function is now to a point whereby other evidence-based modalities can implemented. He is starting a new programme of Constraint Induced Movement Therapy, and he is able to tolerate Functional Electronic Stimulation, which he couldn’t tolerate prior to the combined treatment of BtxA and Dynamic Hand Splint.

ConclusionThere is currently minimal available evidence concerning the use of BoNT-A and dynamic hand splints in combination.

In a patient with ‘chronic’ reduced hand function due to flexor spasticity following a stroke, a combined treatment of BoNT-A and Dynamic Hand Splints has shown a marked improvement in function. This combination of modalities may be appropriate for other stroke survivors with a similar presentation.

Further use of mixed modalities may be of benefit such as CIMT and FES, to enhance function further. Both of these modalities were not tolerated prior to the intervention with BoNT-A and dynamic hand splints. As such appropriate and targeted spasticity management should be at the forefront of clinical reasoning.

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Secondary Prevention

11. Comparative review of prescription of statins in patient discharged from Cardiology and Stroke unit following ACS and AIS respectively

Dr L Ajayi1, Dr M Siddiqui1

1Department of stroke medicine, Salford Royal Hospital, Stott lane, Salford M6 8HD

IntroductionACS (Acute Coronary syndrome) and AIS (Acute Ischaemic stroke) share common pathophysiology in many aspects including atherosclerotic causes. Extensive evidence, including recommendations from all major AIS guidelines, support use of high dose, high intensity statins (Atorvastatin 40mg or 80mg OD and Rosuvastatin 10mg or more OD) following AIS due to survival advantage they offer. MINAP collects data regarding use of high intensity statins at discharge following MI, however no such data is collected following AIS.

MethodWe did a comparative study of statin prescription on discharge in 100 consecutive patients admitted with ACS and AIS respectively, in a tertiary centre.

ResultsPrescription rate of high dose high intensity statins was considerably higher in patients discharged with diagnosis of ACS compared to patients discharged with diagnosis of AIS. 65% patients discharged after ACS received high dose, high intensity statins. 9 out of 10 ACS patients receiving high dose high intensity statins were prescribed Atorvastatin 80mg or Rosuvastatin 10mg or more. Only 35% patients discharged after AIS received high dose, high intensity statins. Only 3 out of 10 AIS patients receiving high dose high intensity statins were prescribed Atorvastatin 80mg or Rosuvastatin 10mg or more.

ConclusionWe believe, increasing high dose high intensity statin prescription in patients with AIS will offer long term benefits. SSNAP should start collecting data similar to MINAP regarding secondary prevention however; care must also be exercised to identify patients at high risk of haemorrhagic stroke, using available evidence. We plan to review our practice again in 6 months.

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Service development (research)

12. A Six Month Physiotherapy Service Review of a Dublin Inpatient Stroke Rehab Unit

Eimear Noonan, Elaine McCabe

Royal Hospital Donnybrook, Dublin 4

IntroductionThe inpatient stroke service in the Royal Hospital Donnybrook (RHD) expanded and developed its service in 2016. Bed capacity increased from twelve to eighteen beds. Younger stroke survivors (<65’s) were amalgamated onto a previous >65’s stroke service. A six month physiotherapy service review was conducted to identify physiotherapy practice and to identify potential service delivery improvements to reflect the change in service needs.

MethodData was retrospectively collected and analysed for patients admitted onto the stroke service from November 2016 to April 2017.

ResultsThirty-one referrals were analysed over the six month review period. Of these referrals, 48% were <65 years and 52% were >65 years with an average age of 65 years. The Motor Assessment Scale, Timed Up and Go, Berg Balance Scale, Hand Dynamometer and 9 Hole Peg Test were the physiotherapy assessments used. Improvements were made in each measure; 75%( MAS), 81% (TUG), 94% (BBS) 62% (Hand Grip) and 55% (9HPT). Thirty patients went home (96%), and one went to live with a family member (4%). No-one required long term care. Seventy eight per cent of inpatients received onward physiotherapy referral to either Primary Care, Day Hospital, Baggot Street Stroke Rehab or the National Rehabilitation Hospital.

ConclusionA significant proportion of inpatients were <65’s (48%), which is a stark contrast to pre 2016. Data collected in this review identified a gap in physiotherapy provision as it did not reflect and accommodate for the change in service needs. As a result of this review, significant developments were established. A stroke exercise circuit class was piloted, tested and implemented. An inter-disciplinary (PT/OT) GRASP programme was introduced. The senior stroke physiotherapist made close links with Irish Heart and assisted with the development of a Working Age Stroke Support Group.

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13. The feasibility of an inter-disciplinary upper limb, group exercise programme (GRASP) in a stroke inpatient rehabilitation unit

Eimear Noonan, Ailish McCaffrey


IntroductionThere is an increasing evidence base recommending that stroke survivors receive intensive, task-specific training to maximise upper limb recovery. However, providing optimal levels of intensity and dosage of upper limb rehabilitation is often difficult to achieve. The purpose of this service development project was to assess the feasibility of running an inter-disciplinary (PT and OT) Graded Repetitive Arm Supplementary Programme (GRASP) for people admitted onto the Stroke Rehabilitation Unit in the Royal Hospital Donnybrook, in order to augment upper limb intensity and dosage.

MethodParticipants were screened and assessed by their therapist (PT/OT) for suitability. This was a rolling programme which ran twice a week with a maximum of 6 participants. Eligibility criteria included the presence of active scapular elevation against gravity, a palpable wrist extension and ability to give informed consent. Assessments (Box and Block, Grip Strength, 9HPT and NeuroQOL) were conducted by the participants OT both at baseline and post intervention. Intervention consisted of a 60 minute group class of the GRASP Home Programme under the supervision of a therapist. A bedside programme of one hour was recommended.

ResultsResults to date indicate a statistically significant improvement in upper limb function using various standardised outcome measures and analysis using matched sample t - tests. The box and block test showed an average improvement from 32 to 42 (p value 0.00005). The NeuroQOL showed an average improvement from 26 points to 32 (p value 0.027). Grip strength using the Dynamometer showed and average increase in scores from 18 to 20 pre and post treatment.

ConclusionA rolling inter-disciplinary group exercise GRASP programme deemed feasible and provided increased upper limb intensity. Further evaluation is required regarding the choice of outcome measures. The GRASP group is now an established group on the unit and is accepting referrals from the Day Hospital.

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14. The feasibility of running a structured stroke exercise circuit class in an inpatient stroke unit

Eimear Noonan


IntroductionStroke survivors experience marked reduction in physical activity and fitness. Regular physical fitness and strength training, could help recovery in the long term. This pilot project aimed to assess the feasibility of running a stroke exercise circuit class (x3/7) for people admitted onto a stroke inpatient rehabilitation unit, in order to augment physical activity and increase compliance with clinical guidelines and exercise recommendations (Billinger et al, 2014).

MethodParticipants were screened, assessed and recruited over a period of six weeks. Eligibility criteria included patients who were medically fit to participate in an exercise class, demonstrated good cognition (MMSE >24/30) and could navigate the circuit independently or with supervision. Assessments (10MWT, BBS, Grip, HADS, FFS) were conducted by the participant’s physiotherapist both at baseline and post intervention. Feasibility measures included safety (documentation of a near-miss or a fall), adherence to the class (attendance rates) and satisfaction (measured by a satisfaction feedback questionnaire). Intervention consisted of a 60 minute circuit class of pre and post warm-up, cardiovascular training, strengthening and balance stations. Participants were instructed to train to a moderate intensity as measured by the BORG scale.

ResultsEight participants completed the six week stroke exercise circuit class. There were no incidents of a near-miss or fall. There was a 90% attendance rate. Feedback was excellent. Exercising in a group setting proved both very enjoyable and motivational. Initial analysis from the pre and post outcome measures were also favourable in terms of balance and mobility.

ConclusionA six week pilot stroke exercise class was deemed feasible and safe to be carried out in this setting and demonstrated high levels of enjoyment and satisfaction from participants. Further evaluation of exercise intensity, evaluation of pre and post outcome measures was addressed after completion of this pilot project.

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TIA

15. The Diagnosis of Transient Ischaemic Attack (TIA) Score (DOT Score) is a potential tool to improve neurovascular clinic triage

Alexander AL1, Gillen S2, Longwell A2, Murphy N2, Fulton A3, Fearon P1

1Belfast Health and Social Care Trust2Queen’s University Belfast3South Eastern Health and Social Care Trust

IntroductionEnsuring rapid neurovascular clinic access is persistently challenging for stroke services, in particular due to the high proportion of stroke mimics referred via non-specialists. The diagnosis of TIA (DOT) score is a diagnostic tool designed to help non-specialists diagnose TIA/minor stroke with greater accuracy. We assessed the efficacy of the DOT score in neurovascular clinic triage.

MethodIn September 2016, we telephoned 60 consecutive patients referred to a neurovascular clinic to arrange appointment and complete a standardised DOT score template. Diagnosis of TIA/minor stroke was at the discretion of the neurovascular clinic consultant, blinded to pre-determined DOT score. Dichotomised DOT scores were used to calculate measures of diagnostic test accuracy.

ResultsOf the 60 new referrals: 56% male; mean age 62 years (SD 13); 83% referred from general practice. DOT scores were: probable TIA, 39 (65%); possible TIA, 6 (10%); unlikely TIA, 15 (25%). Four patients did not attend and were excluded from further analysis. Clinical outcomes were: definite stroke/TIA, 11 (18%); possible TIA, 6 (10%); non-stroke, 34 (57%). There was no statistical correlation between DOT score and clinical outcome. Tests of diagnostic test accuracy were: sensitivity, 82%; specificity, 40%; positive predictive value (PPV), 25% (95%CI:18.8-32.5); negative predictive value (NPV), 90% (95%CI:71.0-97.1).

ConclusionThe DOT score was not useful as a diagnostic tool for TIA/minor stroke in this small dataset. However, the high NPV suggests it could potentially be useful in triaging patients more likely to have a stroke mimic to a less urgent stream for assessment.

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ONGOING TRAILS

Ongoing

OG1. Development of a novel rapid assessment TIA service

Kinnaird M1, Gordon P1, Wiggam I1, Kerr E1, Patterson C1, Fearon P1, Roberts G1, Adams K1, Cuddy S2, Tauro S2

1Department of Stroke Medicine, Belfast Health and Social Care Trust2 Northern Ireland Clinical Research Network.

IntroductionPatients with suspected TIA should have a full diagnostic assessment urgently. (National clinical guideline for stroke fifth edition 2016).In 2017 the RVH had a 5 day TIA service, however failed to meet the 2016 guidelines recommendations of assessment within 24 hours. In May 2017 a Stroke Day Assessment Service (SDAS) was set up on the RVH stroke unit to assess and investigate patients within 24 hours.

MethodSDAS is ward based, it runs full days Monday to Friday. It is coordinated by a specialist nurse, consultant and registrar/specialty doctor. Patients undergo a comprehensive clinical assessment and can have a range of investigations including bloods, ECG, Carotid Dopplers, ambulatory AF monitoring and neuroimaging. Diagnosis is provided to the patient and secondary prevention medication is prescribed and issued.

ResultsMay 2017 – March 2018 444 patients assessed. 19 (4.2%) required direct admission to the stroke unit following clinical assessment 143 (32.4%) referred from GP 47 10.5%) from ED 19 (4.3%) from other sources (Regional Eye Casualty, Vascular surgery and medical specialities)235 (52.9%) of patients are follow up from ward discharges and SDAS reviews for results.

ConclusionThe service has proven to be invaluable, allowing for prompt assessment and management of TIA referrals and avoiding unnecessary admissions. A patient satisfaction survey has demonstrated a very positive patient experience. This has been a multidisciplinary novel approach to meet TIA guidelines and reduce our time to first assess these patients.

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OG2. Reflections on the Creation of Virtual Reality based Mirror Therapy for Stroke Rehabilitation

Charles DK1, Pedlow K2, Holmes DE1, McKinney J1, McDonough SM1

1Computer Science Research Institute, School of Computing, Ulster University2Centre for Health and Rehabilitation Technologies, School of Health Sciences, Ulster University

IntroductionMirror Therapy is a form of motor imagery where stimuli via the ‘mirror trick’ generates sensory feedback (through vision and proprioception) to the side of the brain where the stroke has occurred.

A novel virtual reality (VR) mirror therapy system has been created, requiring only a head mounted VR display (HMD) for user motion tracking, enabling free body movement in sitting/standing positions. We reflected on its design and feedback from initial user testing.

MethodA state-of-the-art VR HMD (Oculus) is used to immerse users within a 360-degree VR environment, with a HMD-mounted Leap Motion sensor to track user hand and finger movement; and facilitating realistic movement of a virtual 3D body. Prototypes were iteratively developed and tested by healthy adults through User Centred Design. Verbal feedback and detailed writing observations informed prototype evolution.

ResultsDifferent forms of mirror therapy were developed; these variations are not possible with conventional mirror therapy. Initial tests in five healthy adults highlighted specific forms of mirror therapy were cognitively less challenging than others; for example, with ‘true mirror mode’ locating the object required greater orientation and instruction. Some motor strategies were found to be more challenging to realise within a VR environment.

ConclusionThe feedback from the first round of testing has shaped the development of the second version of the prototype which now includes instruction and observation at the beginning, and greater use of visual and proprioceptive cues from the unaffected/dominant arm to aid the user. Future work will aim to test with service users.

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OG3. An Interesting Case of Stroke in a Young Patient

Fowler-Williams CL, Affley B

IntroductionThe incidence of strokes in patients under the age of 55 has increased over the years. This is most likely to be due to both better detection of strokes and the presence of risk factors at an ever younger age. Although young patients still only represent a fairly small proportion of stroke patients, research is increasingly being focused on this area.

MethodOur poster includes an interesting case of a young female presenting with an ischaemic infarct. She was hoping to get pregnant, however this put a halt to her plans. After a full work up we identified a patent foramen ovale (PFO). We will discuss the issues brought up by this case, including the research surrounding the closure of PFO for secondary prevention of strokes and how a PFO can affect the physiology of a pregnant patient.

ResultsAn estimated 20% of the population have a PFO, therefore the relevance of a PFO in a stroke patient is often debated. The closure of a PFO is not currently funded on the NHS. Three large multicentre trials published in 2017 showed promising results for the closure of PFOs in select patients for secondary prevention of further strokes.

ConclusionResearch surrounding PFO closure in stroke patients is a dynamic and fascinating area. Recent results predict that PFO closure may be used for secondary prevention in the near future. We don’t fully understand the risk of a PFO in pregnancy, so research is required to guide us in delivering antenatal care for these patients.

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Rehabilitation

OG4. Sex after stroke

Stevens J

Bury Community Stroke Team, Pennine Care NHS Foundation Trust, UK

IntroductionRCP guidelines state that we should be asking our patients at regular intervals if they have concerns about sex; however, research tells us that many healthcare professionals believe they have neither the knowledge nor skills to do this adequately (Mellor 2013).

MethodThe paucity of evidence from stroke rehabilitation research highlights the need to examine this area further, with the research evidence that is available describing only the barriers that healthcare professionals feel limit their ability to discuss sex and intimacy, rather than the approaches favoured by stroke survivors. I argue that engaging with patients about sex requires us to apply the same functional approach as in other aspects of stroke rehabilitation.

ResultsI explore ways to approach the subject borrowed from the field of sexual health, and give some practical tips to take away to help immediately focus practice.

ConclusionOverall the development of further guidance is needed and research into the best approaches to use would enable a more balanced MDT strategy to assist in facilitating a return to an active intimate life post stroke.

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Late Breaking

LB1. The long-term effects of Stroke in Northern Ireland; the voices of stroke survivors, carers and clinicians

Kennedy Niamh¹, Macaulay Barry²

¹School of Psychology, Ulster University, ² Stroke Association

IntroductionStroke is a leading cause of disability in the UK with almost two thirds of stroke survivors leaving hospital with moderate to severe disability. Stroke has a number of long-term effects and can impair mobility, speech and communication, vision and memory. However, there is currently little research on the long-term effects of stroke in Northern Ireland, with the majority of outcomes and performance data concentrated on the acute phase. As the reshaping stroke services consultation process moves forward, it is essential that we better understand this important aspect of the stroke pathway. In order to do this, it was felt that asking the experts; stoke survivors, stroke carers and stroke clinicians, was essential.

MethodThree targeted questionnaires were developed for stroke survivors (aphasia friendly), carers and professions working across the whole stroke pathway. The questionnaires are being distributed via professional networks, the Stroke Association and NICHS support groups, social media and newspaper advertisement.

ResultsThe research is currently in a period of ongoing data collection. Once all data is collected, appropriate statistical tests and a thematic analysis will be undertaken to identify emerging trends and themes.

ConclusionIn order to deliver first-class, high quality stroke care in Northern Ireland it is vital to first understand the needs of stroke survivors and their carers, as well as views of professionals working across the stroke pathway. The results of this project will help to inform what long-term stroke care in the region should look like, in order to best meet the needs of the 36’000 stroke survivors in Northern Ireland.

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Join us for the 13th

Telford | 4 - 6 December 2018

Early bird until 31 August

Join us for the UK’s largest multidisiplinaryconference for stroke care professionals

• The conference is unique in the UK, showcasing the latest in stroke research from a wide range of inspiring and world-class speakers each covering a different aspect of stroke care

• Engage with over 1,500 professionals from across the whole stroke care pathway

• Join the debate with key players shaping the stroke agenda

• Five accredited training streams and fourteen interactive educational workshops to choose from – giving you practical ideas to improve your own practice

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