Stroke of genius

Stroke patients who live outside larger centres in northwestern Ontario can now receive follow-up care in their own communities, thanks to a research project funded by the Ministry of Health and Long Term Care.

November 12, 2009: Volume 36 #23, Page A1

The Northwestern Ontario Regional Stroke Network at Thunder Bay Health Sciences Centre was awarded more than $100,000 to implement the project “Tele-Rehab: Improving Access to Quality Stroke Rehabilitation in Rural and Remote Communities.” Through partnerships with KO Telemedicine, KO Home and Community Care, Ontario Telemedicine Network and St. Joseph’s Care Group, stroke patients can have access to occupational therapists, physiotherapists, speech language pathologists and social workers six weeks and three months after being discharged from hospital.

According to research affiliate Kirsti Reinikka of the Thunder Bay Regional Health Sciences Centre, the project came in response to an identified need from First Nations communities.

“For patients living in Thunder Bay, there is outpatient rehabilitation in town.

Project eliminates huge wait times

“For people outside the area, there is little or no follow-up. Community reintegration is a huge issue for people post-stroke. It’s when patients get home that those issues confront them.”

Research partner and NWO Regional Stroke Rehabilitation Specialist Esme French said: “People don’t know how they’ll manage returning to their usual roles in the community or at home.

“The thing with stroke recovery is that it goes on for years. This project is trying to help people continue to improve and recover from the effects of stroke.”

“We’re piloting four in-home cameras supported by KO Telemedicine and the grant,” explains Reinikka. “This allows us to do the visits right in the patients’ homes. The clients don’t have to leave their communities or in some cases their homes where there are safety and mobility issues at home.”

The project relies on partners KO Home and Community Care and KO Telemedicine to arrange local support to operate the cameras, set up visits and deliver the care identified by the rehab professionals.

As an example of how the project is benefiting people, French cites one man from a remote community who had poor seating in his home.

“The rehab professional called the nursing station and the home care program to find out if there was a SWAP program or funds to purchase better seating.”

“His stroke had been ages ago and the assumption had been that he had no problem,” says Reinikka. “This program provides the opportunity to identify ongoing issues as they arise. There is a two-pronged approach, for both new stroke survivors and long-term ones.”

French describes KO Telemedicine’s part in the project as “huge.”

“They enabled the whole community engagement piece. None of this would have happened without them.”

Heather Coulson, project development co-ordinator for KO Telemedicine, said the project “eliminates a huge amount of waiting. At Meno-Ya-Win Hospital in Sioux Lookout the Physiotherapy Department at one time had 350 people on the waiting list, and couldn’t offer an outpatient service.”

Through the Stroke Tele-Rehab project “the appointment time is preset for weeks ahead. It might be only six weeks waiting.

Potentially, if this project becomes sustainable we could deliver quality of service in a timely fashion and help people get back to their lives.”

In addition, she notes that it eliminates the high cost of patients traveling from their communities to hospital, with the accompanying problems of bad weather.

“It’s also less stressful for the patient not to travel. We think that it’s a win-win situation.

“I can say that we have seen change within 10 days after a visit . That’s exciting. We know that we have been able to provide an excellent service.”

One of the aspects of the partnership has been to provide additional training for home and community care within the communities. “We did two sets of training in 15 communities on Tele-Rehab. The Ontario Stroke Network wanted to make sure that certified Personal Support Workers could sustain the support. Additional training was done by Esme and her team, and was paid for by LHIN and Stroke Network, although Esme and her team donated their time. That was beautiful.

It was very heartwarming and enlightening. They are such a dedicated team. It was a very interactive training, and all the participants loved it.

“It’s the biggest project that I’m working on presently. We started with four base communities. If we set it up so that the four cameras can be sent to any one of the other 26 communities serviced by KO Telemedicine, we can potentially reach all 26 eventually.”

However, she notes “there is a time frame on this pilot project. We’re asking for an extension. Sustainable funding is always the issue in health care.”

This is the fourth research project Reinikka and French have collaborated on.

“The larger issue is that this is a jumping off point,” Reinikka said. “There are a myriad of other populations in the north that can benefit from Telehealth medicine.

“We’re using this project as a springboard for wider applications to benefit other populations: post-surgical, arthritis, and others.”