AUT study: Stroke survivors deteriorate when they get home

The gains stroke victims can make in hospital can be lost when they get home. Photo / Thinkstock

Many stroke survivors who regain the ability to walk in hospital struggle to maintain the same level of mobility once they return home, according to a new study.

While stroke can affect virtually every aspect of human function, walking is one area that matters enormously to people, says AUT University PhD student Caroline Stretton, whose study outlines the difficulty in getting out and about following a stroke.

Stretton, a registered physiotherapist with an interest in developing innovative methods of rehabilitation for people with physical difficulties says, "Traditionally physiotherapists can tend to view the body much like a machine when it comes to rehabilitation and try to use exercise in the clinic to fix the bits that aren't working well. While this is effective at the time, there is often deterioration when people return to the home environment."

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Study co-supervisor Professor Kathryn McPherson says around 9000 people suffer from strokes yearly - and improving the quality of life of survivors should be as much a priority as saving lives.

"We invest a lot in saving people's lives so we surely have an ethical or moral responsibility to help people live well after this."

She says that without set routines and support in place, stroke survivors can languish in inactivity.

"Exercise habits are hard to instill even for the able-bodied" says Stretton. "But when people have a disability such as a stroke, it becomes even harder."

Stretton's study aims to uncover the most effective achievement of ongoing recovery of walking skills in stroke survivors. She will look at social and environmental factors around what she calls "real world walking" and analyse how family and community support can help enhance long-term recovery.

Stretton hopes her study will help improve the outcomes for people with stroke: "Real world walking is a very tangible thing," she says. "It's a metaphor for the general recovery of the person as a whole. If we can work out ways in which to encourage people to keep moving, we can hopefully see improvements in many other areas of their lives."

She says it can be hard to find the most effective paths to long-term mobility as there are multiple strands of any recovery process.

"Rehabilitation is like a black box," she says. "There are a whole lot of different factors that go into it but it's hard to identify which makes the biggest difference. This study is trying to unpack the black box; to work out the most effective interventions and help put them into place."

Stretton says the development and continuation of real world walking skills is vital for post-stroke physical and psychological recovery. "They need help to get out and about to regain their confidence," she says. "Regular practice is the best way to achieve this."

Family members were vital to the ongoing mobility of the stroke survivor: "There are practical suggestions I would offer family members of those who have had a stroke.

Firstly, be pro-active about asking rehabilitation professionals or GPs to help you and your family member develop a plan to practise walking more often in the real world," she says, also suggesting a family meeting to discuss ways to help the patient walk more and to develop a plan to achieve it.

She says support from friends, family and the general public can have either an enabling or restrictive effect on how much walking the stroke survivor engages in. By walking with the person, noticing their progress and providing encouraging feedback, support people can better help recovery.

The study was done through AUT's Person-Centred Rehabilitation Centre which has a holistic ethos in placing the patient experience at the centre of the work. Stretton is one of 12 PhD students linked to the centre - many of whom who are exploring the intersection of neuroscience, behavioural science - and indeed social science to help find the best approaches to support those living with disability.

Professor McPherson, who is the centre director, says it uses both hard science and social science to help find the best interventions for those living with disabilities and focuses on developing and testing new strategies to help reduce that effort and improve outcome.

"We try and find new ways of working and supporting people that build on what we learn from those who have experience of health conditions because we think that is the most likely way to find strategies that fit - that work in their everyday lives."

"Our centre works on the principle that new knowledge at the intersection of these disciplines has potential to inform significant changes in healthcare delivery and reduce the burden of stroke and other conditions" says Professor McPherson.

* This story is part of a content partnership with AUT