BIOS Stroke and Neuro rehab clinical advisory group study session 4th February 2021
The first virtual stroke and neuro rehab CAG study sessions took place on the morning of 4th February 2021. The session was introduced by Alex Green, clinical lead for the CAG, who explained the workings of this new way for members to attend study sessions. He introduced Dr Lauren Hepworth, CAG academic lead, who was to be in the background organising the session and collecting questions as the presentations went on.
The morning consisted of 4 presentations and then a Q+A session. The questions were requested from members prior to the session, and delegates were also able to submit extra as the session went on.
Impact of COVID-19 on stroke care
Chris Ashton. Greater Manchester Integrated Stroke Delivery Network (GMISDN) Stroke Network Coordinator and former Paramedic. Chris presented data collected throughout the first lockdown of COVID-19. The data highlighted that stroke activity was reduced and there was a fall in TIA numbers. There was also an increase of people ringing 111 instead of 999 with stroke like symptoms, many resulting in emergency ambulance. Stroke is a time critical disease and data was shown that the number of stroke patients being identified in the 4-hour critical period had reduced during this time. Treatment options for stroke, thrombolysis/thrombectomy, is time sensitive and obviously a concern many patients have been missed following this data collection. He concluded by saying small ideas along with passion and support it is possible to make a difference to patient care.
Driving and visual impairment after stroke
Dr Claire Howard. Specialist Orthoptist, Salford Orthoptic Department.
Claire covered driving and vision regulations following stroke for group 1 and group 2 driving licenses. She also described the specific issues that orthoptists can deal with for those patients following a stroke. For example, monocular vision needing adaptation and diplopia being declared to the DVLA.
Exceptional cases – Claire took the group through her experience of helping patients with visual field loss following stroke, reobtain their license through the exceptional cases panel.
Life after Stroke
Stroke survivor, Janet Rockliffe, gave the group a personal account of how she dealt with the benefit system following her stroke. She highlighted a leaflet which she has developed and explained how we can help our stroke patients through this system. The leaflet is available at www.vision-research.co.uk.
Vision screening and assessment post stroke
Dr Fiona Rowe. Lecturer, University of Liverpool.
VISA – Visual Impairment Screening Assessment is a vision screening tool for MDT professionals within stroke service.
Fiona discussed how a gold standard stroke vision screening service would be an orthoptic delivered system, for each stroke patient to be given a full visual assessment. However, if this service is not available, the VISA tool can be obtained, for other service providers to use. It is available as a manual paper copy (available through University of Liverpool VISION Research Unit website) and iPad app and the assessment takes 10-30 minutes to complete, dependant on the extent of visual problems. Fiona also discussed the BIOS stroke care pathway and the orthoptic screening checklist – for stroke team to refer to orthoptist. Both of which are available on BIOS website.
Claire and Fiona also discussed the current research studies they are involved in during their presentations. Watch this space!
Q+A session
The remaining time in the session was hosted by Alex, who asked the speakers any questions that the delegates had posted into the Q+A section. Many were directed to Claire due to the nature of her talk. Driving is obviously one of the biggest issue’s that orthoptists find with their patients post stroke. The DVLA have an information booklet on their website, which can be found with this link – https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/866655/assessing-fitness-to-drive-a-guide-for-medical-professionals.pdf
This gives the most up to date information regarding medical conditions and their impact on driving and is a useful resource for orthoptists in stroke care. Claire also highlighted the new driving pathway and exceptional cases sample letters available on the BIOS Stroke and Neuro Rehab webpage.
COVID-19 has had an impact for all, in so many different ways. This new virtual study session was a part of that. As an orthoptist in Scotland, the online session was welcomed and done well. I personally enjoyed the lack of travel and no overnight stay, allowing more time in my clinics. As with everything COVID-19 lately though, the networking with colleague’s element was greatly missed. We look forward to being able to enjoy an in person study session in the future. However, these virtual study sessions are an excellent way to allow CAG delegates to be a part of stroke study. I wonder if a mixture of online and virtual sessions going forward may be something we consider, dare I say ‘a new normal’.
