Neuroscience IPU | Pushing back the starting line with frontline

The chronic illness frontline team at CLSC Benny Farm
The chronic illness frontline team at CLSC Benny Farm raise awareness about stroke risk factors among clients. Stroke prevention pamphlets distributed by the Heart and Stroke Foundation are a helpful resource. Several members of the multi-disciplinary team are pictured, from left: Kinesthesiologist Nathalie Léveillé, Dietitian-Nutritionist Helen Xanthakos, and Clinical Nurses Claudia Corbu and Lys Razanakarivelo.

An IPU whose different phases of care run smoothly comes out ahead in the race to deliver timely medical treatment, with better outcomes for patients who have had a stroke. A full range of rehabilitation services then carries that user through to the finish line—a return, to the degree possible, to an autonomous life played out at home and within the community.

But what if our CIUSSS could reach a stroke patient even sooner?  Ideally, before they have even become a patient?

“In the initial stages of creating our stroke IPU, we examined the needs of our users, and agreed that they would benefit from the earliest intervention possible,” says Frontline Coordinator Paula Yiannopoulos, who oversees the training of nurses for the different frontline teams. “We considered, ‘What services are needed to educate our clientele about prevention?’, and, ‘Who is best placed to transmit that information?’ A family physician cannot always offer their patient an in-depth teaching about the management of their illness.”

That’s where a nurse steps in, to help guide people diagnosed with chronic conditions such as diabetes, hypertension, or cardiac problems who have been referred by their doctors. A CLSC nurse will spend up to a year and a half following these more vulnerable individuals. Through individual or group teaching sessions, they inform them about the nature of their illness and related risk factors, such as stroke. “Once that person is more familiar with the tell-tale symptoms, they are more likely to consult sooner,” notes Ms. Yiannopoulos. “Receiving timely care—be it before, during or after a stroke—will prevent more severe deterioration and complications.”

These higher-risk clients are also followed by other CLSC health professionals as needed, such as nutritionists and kinesthesiologists. “The frontline team is here to help people better manage their disease by educating them about lifestyle choices,” points out Ms. Yiannopoulos. “They take the time with the client to have a closer look at their nutritional and exercise habits, their medication practices, and make sure they follow up with their physician.”

An e-learning tool about stroke prevention and risk factors will also soon be available for CIUSSS nurses. Developed by nursing clinical coordinators, the training will help 811 nurses, for instance, to detect callers exhibiting the symptoms of a stroke.

To further raise public awareness, CIUSSS West-Central Montreal is strengthening its collaboration with partners such as the Heart and Stroke Foundation, who provide informative visual material relating to stroke prevention that is displayed in the network’s CLSCs and Family Medicine Groups (FMGs).

On the move: On-site research facilities engage stroke survivors to help improve mobility

Robot-assisted arm training led by Dr. Alexander Thiel and Dr. David Ostry (McGill University) to improve motor function in patients recovering from stroke.

The critical role stroke patients play in their own recovery is not overlooked by CIUSSS stroke teams, who routinely involve survivors and their families when developing a care plan. The network’s researchers also understand the important part recovering clients can play in improving the efficacy of their own—and others’—rehabilitation. Studies that enlist participants following a stroke can incorporate their results into decision-making, ultimately directing the research toward the most useful and individualized forms of therapy. 

This model, integrating clinical and research practices, was adopted by neuroscientists under Dr. Alexander Thiel at the Lady Davis Institute, who have long worked in parallel with the JGH stroke unit. The neuroplasticity research program, under Dr. Thiel’s directorship, was the first in Canada to place a research facility carrying out non-invasive brain stimulation and imaging right at the patient’s bedside. These techniques enabled the teams to examine patients from the early stages of the disease through the recovery process. That in turn helped researchers to better understand how strokes affect the brain and—coupled with conventional speech and language therapy—find better ways to treat them.

More recently, in 2016, Dr. Thiel took translational research one step further, establishing a clinical trial program on K10 to facilitate language and motor recovery after stroke.

Similarly, moving from an acute care to a rehabilitation context, a joint Constance-Lethbridge Rehabilitation Centre–Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal (CRIR) research laboratory adjacent to the Constance-Lethbridge rehabilitation room was recently upgraded with a state-of-the-art technological infrastructure to study real-time data that measures and monitors the mobility of clients recovering from brain injury.

The Biomedical Research and Informatics Living Laboratory for Innovative Advances of New Technologies (BRILLANT) research project, led by Site Director Dr. Sarah Ahmed, is carried out in partnership with research institutions throughout the CIUSSS and even outside the network. Their goal is to provide rehab teams with the most effective personalized treatment options.

“We hope to help our clients achieve greater endurance and autonomy, so that they can participate in society in a way that is meaningful for them,” says Dr. Ahmed.