Promoting Optimal Physical Exercise for Life (PROPEL): aerobic exercise and self-management early after stroke to increase daily physical activity-study protocol for a stepped-wedge randomised trial.

Introduction: Physical exercise after stroke is essential for improving recovery and general health, and reducing future stroke risk. However, people with stroke are not sufficiently active on return to the community after rehabilitation. We developed the Promoting Optimal Physical Exercise for Life (PROPEL) programme, which combines exercise with self-management strategies within rehabilitation to promote ongoing physical activity in the community after rehabilitation.

Using a quality improvement process to create measurable improvement in care delivery for acute stroke.

The introduction of thrombolytic therapy has revolutionized the management of acute ischemic stroke, and it has now been conclusively established that tissue plasminogen activator (t-PA) given within 4.5 hours of stroke onset both limits irreversible ischemic neuronal damage by establishing reperfusion of the penumbra and improves outcomes for patients who have undergone stroke. As a regional stroke centre, Hamilton Health Services (HHS) seeks to ensure it meets guidelines and readiness criteria in acute stroke care.

Detecting cognitive impairment in clients with mild stroke or transient ischemic attack attending a stroke prevention clinic.

Twenty clients diagnosed with probable transient ischemic attack (TIA) or stroke attending a stroke prevention clinic (SPC) were screened for cognitive function, as one inclusion criteria for a pilot study examining medication adherence and hypertension management. The Mini Mental State Examination (MMSE) was administered at study admission followed by a second screening within two weeks using the Montreal Cognitive Assessment (MoCA) tool. Individual scores for the MMSE and MoCA were compared.

Nurse case management to improve risk reduction outcomes in a stroke prevention clinic.

Stroke prevention clinic health care professionals are mandated to provide early access to neurological consultation and treatment, diagnostic testing, and behavioural risk factor management for clients with transient ischemic attack or mild non-disabling stroke. Clinic nurses collaborate with clients and interprofessional teams to support risk factor reduction to prevent recurrent stroke events. Although hypertension is the most important modifiable risk factor for stroke, broader evidence indicates that adherence to prescribed medications may be less than 50%.

Best practices in stroke care.

In 2001, the Ontario Ministry of Health and Long-Term Care introduced the Ontario Stroke Strategy by designating regional stroke centres across the province. The primary role of these centres is to coordinate stroke care within the region and across the care continuum in keeping with best practices. Concurrently, Trillium Health Centre was identifying best practice projects to support its ongoing quest for excellence.

Bringing innovation to stroke care: development of a comprehensive stroke unit.

Much work has been done in the past 10 years to research and document best practices in stroke care along the continuum of care. The challenge now for stroke care practitioners is to turn those best practices into reality in a clinical setting. In spite of a general understanding and acceptance of the benefits to the patient, an organization's culture and limited access to resources can frustrate our best efforts to introduce best practices at the bedside.

Motivating for infrastructure change: toward a communicatively accessible, participation-based stroke care system for all those affected by aphasia.

Unlabelled: This paper provides a rationale for changing the base upon which healthcare services for individuals with stroke and aphasia can be provided. It is a nuts-and-bolts summary of the interactions between the Aphasia Institute and the West Greater Toronto Stroke Network who worked together to effect meaningful change. Further, the article provides a practical set of guidelines for others to use, should they wish to effect such change.