The 16th UK Stroke Forum conference was held virtually again in 2021. A total of 1807 delegates from across the multidisciplinary team attended to watch 135 speakers across 10 parallel sessions, 4 plenaries, 11 training workshops and 223 posters. The benefit of the virtual nature of the conference was all sessions could be watched on demand for three months after the live event.
Vision had two slots on the programme; a parallel session and as part of a training workshop. The vision parallel session was ranked as the 7th top out of all sessions during the live event and 4th top for on-demand sessions.
BIOS also held a virtual stand, featuring our patient leaflets. This gave the opportunity for four orthoptists who have supported the CAG steering committee over the previous 12 months to attend the conference for free. They have put together some of their thoughts on the sessions they attended to share with you.
The opening plenary was titled from pandemic to possibilities: challenges and opportunities for UK stroke care and research. Professor Chris Whitty introduced the session discussing the impact of COVID-19 on the NHS and the significant disruption to cardiovascular disease services including stroke. Dr Michael McCormick gave an update on the Northern Ireland stroke services, within which CT angiograms are not offered within all hospitals, leading to outsourcing. The thrombectomy rate in Northern Ireland is 5.3% (range 1.2-8.3%), which is significantly lower than mainland UK and fell between 2019 and 2020. This final plenary was closed by a stroke survivor reflecting on being involved in the James Lind Alliance priority setting partnership for stroke.
The following parallel sessions included the vision parallel titled, seen and unseen: from screening to management of perceptual and visual problems, chair by Dr Lauren Hepworth. This was a really interesting session into the background of visual perception and how we can screen for perceptual problems after stroke. There was some discussion around management options which mainly look at inattention, but some interesting resources and advise exist for hallucinations too:
Dr Dominic ffytch from King’s College London provided an interesting overview of hallucinations and this talk was particularly interesting. This presentation drew on previous evidence where hallucinations have first been described and dated back to earliest mention of hallucinations in older adults, and the stigma that was reported from these since then. Visual hallucinations are considered to be a positive perceptual problem i.e the brain is hyperactive (as opposed to visual agnosia for example which is a negative perceptual problem i.e a bit of the visual brain is now missing). The presence of hallucinations could therefore could be a sign that indicates neuroplasticity and indication of potential for recovery. It was interesting to see that despite this being a historic finding that little has yet been done to address it. Suggestions for managing hallucinations in Charles Bonnet Syndrome included changing the lighting conditions of the room as one way of trying to immediately remove a hallucination. Esme’s Umbrella (charlesbonnetsyndrome.uk) is a useful source of resources on hallucinations that can be used by staff, patients and charities.
Dr Christine Hazelton from Glasgow Caledonian University discussed interventions for visual inattention based on a Cochrane review of the evidence. Scanning training which is quite well known already and prism adaptation for neglect used by Occupational Therapists, but all interventions discussed currently have low quality evidence to support.
Dr Kathleen Vancleef for Durham University presented her research developing a screening tool for visual perception defects after stroke. She has looked at which allied health professionals are doing this screening and what methods are currently in use. Often cognition and physical ability of the patient impacts the ability to accurately screen for visual perception defects after stroke. Clinicians need to be properly trained in how to accurately conduct visual perception screens on stroke survivors. During this session, an app was used to make the session interactive for the audience, we inputted information about our own clinical background and answered questions on her proposed research. With the answers being live streamed into the presentation. Currently it seemed Occupational Therapists and Physiotherapists are mainly doing this screening but a good number of orthoptists were also noted.
Vision also features in a workshop session titled multi-sensory stimulation to promote recovery, chair by Dr Lauren Hepworth. This session saw presentations from three speakers, a physiotherapist, a music therapist and Dr Claire Howard took to the stage to represent orthoptics.
Another session which got us talking was titled, not just the elderly: perspectives on younger strokes. This session offered a fascinating discussion on the needs and experiences of young stroke survivors including a personal story from a 25-year-old who had a basilar infarct involving her vision. She recalled a very honest and frank report of her stroke journey including significant impact on her mental health. She also reported how diplopia impacted significantly on many of her activities of daily living, this comes as no surprise to Orthoptists. She requested that patients be given time and space to discuss their issues and requested that professionals don’t assume young stroke survivors understand more than an older patient might, and that we may over-estimate young stroke survivor’s understanding of their condition and treatment. There was an excellent talk on risk factors for young stroke with data to suggest an increase in young stroke (<55 years) over the past two decades. With modifiable risk factors having an even stronger association in young stroke. The risk factors are also important in predicting outcomes long term. But how is this relevant to Orthoptists? For those working either directly with stroke survivors or routinely in outpatient clinics we are often the first professional to diagnose and manage patients with acute cranial nerve palsies etc. As orthoptists, we are well placed to discuss life style changes and have that conversation about the potential impact of these on their life long health. That mild VIth nerve palsy may just be the first sign action is needed on these modifiable risk factors, whether currently diagnosed or not, that may be the precursor for stroke. Further support is available from the Stroke Association who provide more tailored support for young stroke survivors (<65 years) and Different Strokes (www.differentstrokes.co.uk) are a charity specifically aim to help younger stroke survivors, including a befriending service, peer support groups and lots of experience supporting stroke survivors returning to work.
A lot of the talks across the different sessions made reference to the digital progress that has been made during the pandemic and how this is being utilised for stroke patients, particularly in rehabilitation. This tied in nicely with the talk on treatment Burden after a stroke presented by Dr Katie Gallacher from the University of Glasgow. She made the recommendation that each patient’s plan is individualised and for clinicians to consider whether we can reduce that patients treatment burden.
The conference closed with the final plenary looking at what’s hot and what’s next. The lifetime achievement award for 2021 was presented to Mr Brin Helliwell for his patient and public involvement contribution to stroke. This contribution includes frequently and strongly shouting up for vision and orthoptics in stroke care. This was a fabulous end to a great conference.
BIOS continues to be represented on the UK Stroke Forum conference and steering committees as one of the coalition members, and have already submitted suggestions for another vision session. This 2022 conference is already being advertised and it returns as a face to face conference on Tuesday 29th November to Thursday 1st December in Liverpool. The call for abstracts is already open. Keep an eye out for registration opening, it will be great to see you in person!
Authors: Alex Green, Dr Kerry Hanna, Dr Lauren Hepworth, Tracey Shipman and Debbie Steel
