The Wellbeing Podcast by Wolper Jewish Hospital
Presented by Wolper Jewish Hospital, the Wellbeing Podcast series delivers high‑quality, up‑to‑date health information from leading experts across a range of disciplines.
Moderated by passionate health advocate and award‑winning freelance journalist Julie McCrossin AM, the series is designed to be informative and engaging—offering listeners practical insights to support their health and wellbeing.
The Wellbeing Podcast series by Wolper Jewish Hospital is proudly supported by the Shell Family.
The Wellbeing Podcast by Wolper Jewish Hospital
STROKE AWARENESS: Prevention, management and rehabilitation
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Every 11 minutes, someone in Australia experiences a stroke. In this important episode of The Wellbeing Podcast by Wolper Jewish Hospital, host Julie McCrossin AM brings together a panel of leading experts to discuss what everyone needs to know about stroke—from recognising the warning signs and reducing your risk, to emergency treatment, rehabilitation, and recovery.
Our expert panel includes Professor Coralie English (Stroke Foundation), Dr Tal Corin, Dr Hamza Jubran from Hadassah Medical Centre in Jerusalem, and Dr Lauren Christie, who share the latest evidence on stroke prevention, acute treatment, rehabilitation, and life after stroke. The discussion also explores the critical role of rapid intervention, the FAST (and BE FAST) warning signs, risk factors such as high blood pressure and cholesterol, stroke treatment advances, fatigue, swallowing difficulties, mental health, and the importance of ongoing rehabilitation and support.
Whether you are concerned about your own risk, caring for a loved one, or simply want to better understand one of Australia's leading causes of disability, this episode provides practical advice, expert insights, and hope for recovery.
In this episode:
- How to recognise the signs of stroke using the FAST and BE FAST acronyms
- Why every minute matters in stroke treatment
- Major stroke risk factors and how many strokes can be prevented
- The difference between a stroke and a TIA ("mini-stroke")
- Current treatments, including clot-busting medication and clot retrieval
- Rehabilitation, recovery, and life after stroke
- Managing fatigue, swallowing difficulties, mobility challenges, and emotional wellbeing
- The role of exercise, diet, and ongoing medical care in preventing future strokes
A valuable conversation for stroke survivors, carers, health professionals, and anyone interested in protecting their brain health.
Recorded: July 2026
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This WALPA podcast is brought to you by Walpa Jewish Hospital, providing truly personalized care to people from all cultural and religious backgrounds.
SPEAKER_01Welcome to the WALPA Wellbeing Forum, hosted by WALPA Jewish Hospital and Friends of WALPA. My name's Julie McCross, and it's my pleasure to be your host this evening, and our topic is stroke awareness, prevention, management, and rehabilitation. We're effectively going to try to share with you everything that you need to know about stroke. But let me begin by acknowledging that we're broadcasting to you on the land of the Gadigal people, predominantly based in Sydney, and to pay our respects to elders, past, present, and emerging. And if this is your first time with us, WALPA Jewish Hospital is a private hospital, a medical rehabilitation and palliative care hospital in the eastern suburbs of Sydney. WALPA welcomes people from all cultural and religious backgrounds while offering care within a framework of Jewish cultural, religious values and dietary requirements. We also want to acknowledge uh the generous donation of the Shell family in member of their husband and father, Dr. Alan Schell, OAM. Dr. Schell was a longtime supporter of Walpa Jewish Hospital, a passionate advocate of health education, and in keeping with his vision, WALPA will dedicate the family donation to ongoing community health initiatives, including uh these WALPA well-being forums. Our question moderator this evening is General Practitioner Dr. Carmela Milke, and uh she will join me and bring your questions uh to our panel. And our community partner for this webinar is the Stroke Foundation, and it gives me great pleasure to welcome Professor Coralie English, who's a professor of physiotherapy at the University of Newcastle, and she's also on the board of the Stroke Foundation and the uh chair of the subcommittee for research. And uh, she's going to tell us about the information and resources offered by the Stroke Foundation. Welcome, uh Professor English, welcome.
SPEAKER_02Excellent. Thank you very much for that warm welcome, Julie. Um, so I have got my Stroke Foundation hat on. I'll switch to my researcher hat later, and I just want to tell you a little bit about the Stroke Foundation and the support services they can provide. So, Stroke Foundation is the largest NGO or the trusted voice of Stroke in Australia and the and the lead NGO for stroke. A couple of facts here, and we'll return to them around the frequency of stroke in Australia. There's about 50,000 new strokes every year, and about half a million people living with the effects of stroke in Australia. But the good news is that we'll come back to is more than 80% of strokes can be prevented. Broadly speaking, strokes to there's two main types of stroke. The most common one by far is a blood clot in the blood vessels to the brain, but that could also be caused by a bleed in the brain. The most important thing is that time is brain, and if you suspect that someone's having a stroke, it's a medical emergency, and the quicker you can get to hospital, the quicker you can get the life-saving treatments. And the acronym to remember is FAST to any changes in face drooping, arm weakness, changes in speech, and remembering that T stands for Time. So our Stroke Foundation strategy is around being stronger together, and we have three pillars around prevention of stroke, trying to reduce risk factors for stroke across Australians, saving lives through access to evidence-based care, and enhancing recovery and helping people live well with stroke in the community. Two main resources I wanted to point you to, and we'll mention others through the evening. The main one is Stroke Line, which is manned by health professionals that provide information, advice, support, and referrals. So that's 9 to 5 Monday to Friday, and that's an excellent service for anyone who people with a stroke, people with loved ones, support crew, and so on. We have a website that has as well professional staff face or professional health healthcare professional facing materials, but the one I wanted to highlight is focused on people living with stroke in the community and their support crew, and that's known as Enable Me. So that's a good one to have a look at. Loads and loads of resources for people living with stroke on that website.
SPEAKER_01It gives me great pleasure now to welcome our panelists. Welcome to Professor Coralie English, Professor of Physiotherapy and Associate Dean of Research in the College of Health Medicine and Wellbeing at the University of Newcastle. Welcome to Coralie. Dr. Lauren Christie, an occupational therapist, a working clinician and researcher in stroke rehabilitation, and senior research fellow, Allied Health at St. Vincent's Health Network, Sydney. Welcome also to Dr. Tal Corinne, a neurologist practicing in East Sydney and Northern Sydney, and also at Walpa Jewish Hospital. And Tal has also clinical experience managing stroke in rural and regional New South Wales in Tamworth, Shell Harbour, and Port Macquarie. Welcome also to our special guest this evening, another neurologist and stroke specialist, Dr. Hamza Jubran, MD, from the Hadassah Medical Centre in Jerusalem. And we thank you immensely, Hamza, for overcoming time difficulties and differences. And Hamza has uh key interests, including stroke prevention and treatment and neurological rehabilitation. He also teaches and trains uh medical students and junior physicians, and he's published internationally um in relation to stroke. Oh, now we're going to cover many issues, but if I could come to you first, uh Dr. Zhubron in uh Jerusalem, but tell us what is a stroke, and and tell us just a little bit more about the different kinds of stroke.
SPEAKER_00Hello everybody, as uh thank you for inviting me. And um, what is stroke? Stroke is the one of the leading causes for uh death and uh long-term morbidity and disability, and there are uh two types of stroke. This is one of the types that the occlusion of the blood flow to the tissue because of occlusion blocks of the blood uh visal, and the other uh issue, the other type, which is less common if there is a uh bleeding in the brain. These are the two types of uh the stroke.
SPEAKER_01And what are the most common causes?
SPEAKER_00The most common cause for post-type stroke are the hypertension. The hypertension was uh the uncontrolled hypertension, and many people thought that there is they they don't have any hypertension because they didn't check. This is what the important thing that the hypertension is the silent killer. Nobody will feel that he has a hypertension, but if if they will uh check and will um uh monitor, they will find and there there is a need to be treated and to change the lifestyle accordingly.
SPEAKER_01And hypertension uh is high blood pressure.
SPEAKER_00High blood pressure. Okay, this is very important. The time is brain. We know that all the body, and including the brain, there is many cells that cells that working together, uh one helping the other and working the function, moving the hand, uh, speak, uh, vision, all the cells that need the oxygen and the nutritions from the blood. And if there is an inclusion of the blood, the blood is not coming to these cells, they will die, and they will die one after the other and within minutes. So, because of that, the time is spraying. Every minute, every second, we are losing, not making the blood again to these cells, they will die. And unfortunately, if that cells die, it will not it will be irreversible, that will not uh working again. And that's the important thing of the timing. How the people will find the the and the neighbor, the anybody beside them that have a stroke, what are the symptoms of stroke? So we'll do the the fast, but I will add it on it, and this is the another uh important the P fast. What is the P? It is the balance, the person has unsteady gait, dizziness, falling to one side. This is very important thing. And the E, if there is any eye problem, that there is a loss of vision, there is a double of vision, this is another sign that it works needs to take an action. And the F, it is the face. If there is a dropping of the face, as this is the the third, if there is the first A, the arm, arm or leg, any limb, that there is a weakness of the arm, that if the things falling down from uh the hand, this is uh the another important thing. Uh S, if there is any abnormality in speech, slurred speech, or that the difficulty to take the to say this the word. Uh, and t the the end that if the any of the symptoms uh happen, there is it is the time to call for uh help, to call the ambulance and to go to the uh hospital.
SPEAKER_01I wonder if I could begin with you, uh Dr. Dr. Corinne and cut then come to Dr. Jubran. That critical issue of ringing triple O. Could you just emphasize again the importance of ringing the ambulance? Because I have heard of people hesitating, maybe getting someone to drive them to the hospital. Why is it critical to ring triple O and get an ambulance?
SPEAKER_05Yeah, absolutely. Um, so as Dr. Jubran was saying, the critical point to get across is that um every second of a minute that passes, your neurons are likely dying in the context of an occlusion of a vessel within the brain. So we really want to try to get patients to the hospital as soon as possible so we can offer them therapies. Um, within what we call the hyperacute stroke setting, so it's really within the first um few hours of an acute stroke, that particular therapies which we can offer patients. Um we speak about thrombolysis, which is a clock busting medication. And the idea is we can try and give people who had a stroke a medication to break open the blocked artery to try and release the damage and um allow oxygen in blood to go back to those um neurons, which are not getting sufficient oxygen. Um but those medications are only really available and within the first four and a half to six hours of an acute stroke. So the faster you get to the hospital, um, the faster um you possibly can be candidate for those therapies. We unfortunately, like, and I often get called on for strokes in the middle of the night. And when we see patients who come to the hospital after 24 hours, they've missed the boat to be able to get those therapies. So if you're worried about someone having a stroke, it's it's best to call an ambulance to get them to the hospital as soon as possible.
SPEAKER_01And Dr. Jubran, could you explain those treatments a little bit more? What actually happens for the patient when they arrive in the ambulance?
SPEAKER_00Okay, when the patient arrives for the ambulance, uh there is a need to the ambulance talk with the hospital, the nearest hospital, to tell them that there is a patient that has the symptoms of strokes, highly suspected first stroke. So the team, the neurological team, the stroke specialist that needs to be in the hospital in the emergency room, waiting for the patient to come and to take to make the things make more faster, to do the brain CT brain imaging, to check if there is a homorage, if there is a collusion, and after that, there is a need to decide if there is any option to treatment or not. And uh, as uh we said before, the timing is very important or very important. That there is a treatment that there is a no way to give it uh after uh four and a half hours, after six hours, and um if the patient presented as soon as early after the symptoms uh haven't received the treatment, and also the to open the visel that is occluded and the blood comes to the cells and the brain will gain uh the function. That the occlusion of the visel, why it happens, because of the um the risk that the causes for the stroke. One of the causes that also we have to mention the hyperlipidemia, the cholesterol, the high cholesterol. The high cholesterol will build up in the uh the wall of the visels, and one year after the another, it will occlude the visel, and also there will be a plague that there is cholesterol, uh like a bump on the visel that could move from the uh visel from the neck to the brain and also do the occlusion of the blood, uh blood visel. Another cause is also heart problem. If the patient has like atrial fibrillation, that irregularity in the heart beat also will cause a thrombosis, like the blood will be clothed, and the clots from the heart will go to the brain and also make a blockage of one of the vessels in the brain. Like this, the the the cause happens, and the all the medications, and now we could later on in the treatment to open this visal that the blood will return back as soon as possible uh to the uh to the brain and to the cells.
SPEAKER_01And Dr. Karen, I I still just like a definition of occlusion. I know we talk about clot busting treatments and retrieval of the clot. So is occlusion another word for thick blood clot? I'm sorry, I just want a definition.
SPEAKER_05Um, well, essentially it is. So if we think about um a vestosol specifically in artery in that context, so if it gets blocked off the same way as a water pipe may get blocked off by anything really, um, then no water is going to fly through the pipe. So the same as the arteries, if anything blocks them off, no blood is gonna flow through them. So in our context, um in the context of stroke, the majority of strokes are thinking about occlusion or blockage based on lots of blood that basically got blocked off into um a clump. So similar way that whenever you bleed, your blood eventually clots off. Um, the blood itself, um especially in the context of cholesterol plots, it can build up over time, can have a full occlusion of that artery.
SPEAKER_01What do you do if you're in a regional area and it's hard to get that speed? Uh, or we may not have people with the expertise in the hospital setting. Can you just tell us your experience in Australia? And then we might hear in Israel.
SPEAKER_05Sure. So I think in Australia we we have the difficulty of the eternity of distance, where it's well, you can build very um fancy hospitals throughout regional Australia. It's not always um possible to get um neurologists and stroke specialists in all those centers, and definitely not 24-7. So in practice, what happens is majority of tertiary hospitals will have at least a city scanner, it will have an emergency department, whether it's Shell Harbor, Dabo, Tamworth, anywhere Broken Hill. Um, but the people who staff those places don't specialize in managing stroke. So, first of all, we still emphasize to get to the nearest emergency department as soon as possible. And practically what happens then is that the local doctors would then call some of us stroke specialists within Sydney through a process called telestroke, where basically we get to assess the patient over a Zoom, over telehealth, we get the immediate access to the scans as they come out of the scanner. And even if it's two in the morning, we guide through the local team about how to administer those clot busting thrombolysis um therapies. Um, now some patients, and we can get into it as well if you like, um, could benefit from a process called clot retrieval. We can actually try and remove the clot out entirely.
SPEAKER_01Could you explain that, yes?
SPEAKER_05Yes, so clot retrieval, again, only within the first 24 hours of a stroke. Um same way that if you may have a blocked artery, someone may come in through the vein to try and remove a blocked artery in the heart. Um for some people, if there's a very large clot which is accessible, we can get interventional neuroradiologists that will come in through your vein from your arm, travel up to the arteries in the brain, and will actually try and use a small hook to pull out that clot and release the artery. Um that's only really effective for very large blockages, and but it's very useful therapy. But of course, we don't have those people everywhere around Australia. So the practicality of what happens is if you present with a stroke to Tamworth Hospital, Port Macquarie Hospital, and we will call an air ambulance to transfer you even in the middle of the night to Sydney, to Prince of Wales, Rural North Shore, um, Rock Prince Affinning Hospital to get those um um prototybal therapies um in in a more tertiary center.
SPEAKER_01Thank you. Uh and how do you handle that urgency, Dr. Dubran, in Israel? Are you able to get people quickly to treatment? It's obviously a smaller nation.
SPEAKER_00Yes, it's smaller and uh it's uh more easy to the patients come to the hospital and uh to the hospital, it is uh shorter, and then like in Jerusalem, we have two hospitals that they are giving the treatment for uh the clot retrieval, as uh Dr. uh Corinsa uh said. Uh so they will come and then the the ambulance will talk with the the hospital to make sure that uh everything is ready, and we are coming with the patient that we thought that he has stroke. The team will uh will pick the patient from the ambulance and take him to the to take them to the city to do the ct to confirm that he has stroke and going to the treatment uh through uh the medication through the IV line for uh uh clot uh removal or to the catheterization, as uh Dr. Corin said, will go and remove the clot from the print. So it is because of the short the smaller uh country, it is more feasible to come and the shorter uh time to come to the uh these treatments.
SPEAKER_01Can I just ask you, um, Dr. Corinne, if I could start with you, other than that immediate acute need, how long do people tend to stay in hospital after a stroke and what other treatment uh before we're moving to the home-based and then other rehabilitation processes?
SPEAKER_05So in Australia, we usually keep patients in the hospital after the immediate 24 hours for at least three to five days, depending on the severity of the stroke. Um, there's a few different things that we focus on. So, first of all, we're trying to work out what was the reason for the stroke. So, as Dr. Jabrand said, if someone has got an irregular heart rhythm, such as atrial fibrillation, and we try and detect it. So we put them on a halter monitor to monitor the heart for 48 hours. Um, we also monitor their blood pressure and the um and and a few other blood tests just to make sure that um it doesn't fluctuate too much. And we really want to make sure they don't get any complications in this immediate stroke settings. Um if you can imagine someone who had um a stroke affecting the ability to swallow, they may actually develop aspirational pneumonia in that context. And we have to make sure that they're safe to eat and drink before we can even think about sending them home. Um, so spending a lot of time on preventing complications, finding out the cause of the stroke, so irregular heart rhythm, we'll check the cholesterol, we'll check them for diabetes. Um, if they're younger, we'll check for more irregular um causes of strokes as well. If it's um um someone who's a young person presenting with a stroke. Um, and then we actually start the rehabilitation process while the patient is in hospital. Um because we know the earlier we start together to mobilize to walk and to speak, the the better the outcomes they're going to have down the line.
SPEAKER_01Okay, and and Dr. Jiuban, is it essentially a multidisciplinary approach because you're moving to preventing another stroke and to begin rehabilitation even in the hospital setting?
SPEAKER_00Of course, the treatment for the stroke and the detection of the stroke is multidisciplinary. The neurologist is one of the one part of the this uh whole team. The radiologist who will uh detect the stroke in the CT, one of the team. Also, the cardiologist to work up for other uh issue in the heart that causes the stroke, they will need to uh also to help us in this. Also, the the uh the internist, the hematologist. What is the hematologist? The the specialist in uh uh doing the work up for uh the blood coagulation, that there is a problem with the blood itself that causes the stroke. And also, of course, uh the rehabilitation and also the physiotherapist that will help the patient to improve and to gain their uh previous um uh condition.
SPEAKER_01Um, what I'd like to do now is to invite Dr. Camelo Milka out. General practitioner who's been monitoring your questions to bring us some audience questions. And I may introduce uh our Allied Health team members as well as we answer the questions. Welcome to you, Dr. Milke. What sort of questions would you like to bring to us, please?
SPEAKER_03Thank you, Julie. We've had quite a few questions. Um, the one that's come up is what is the difference between a TIA and a stroke?
SPEAKER_01Okay. Uh Dr. Crane, could you begin? What is a TIA? What does it start for stand for and what is the difference?
SPEAKER_05So a TIA stands for transit ischemic attack. So um essentially it's the idea that someone develops acute neurological symptoms, whether it's difficulty speaking or loss of vision or weakness of one arm, but the symptoms themselves resolve within a few hours. And we use an arbitrary cutoff of 24 hours for that. Um the understanding of a TIA is that a patient had a blocked artery again, similar to a normal stroke, but for whatever reason, that blockage was opened up by the body itself, um, and it hasn't caused any long-lasting damage. And if we scan the patient either with a CT or an MRI, we actually can't see any evidence of an ongoing blockage. Um, but there are particular um symptoms um which would suggest to us that this is very much in keeping with a blocked artery which um opened up after a time in the TIA. So classically, it's an acute onset of symptoms. Um typical ones, people describing loss of vision over one eye, which slowly comes down as a curtain for an hour and disappears. Um, and in those contexts, we get quite concerned because it suggests to us that someone um is essentially had a small stroke which resolved, but is there an increased risk of getting further strokes down the line? Um so we still treat them in a very similar manner in terms of trying to assess their blood pressure and cholesterol, checking for diabetes, and really try and um do the best we can to avoid them having any future strokes in the future.
SPEAKER_01You can really see that having an active relationship with your general practitioner, checking all these uh causal elements that can lead to a stroke is absolutely critical for both prevention but also recovery and prevention of a second stroke.
SPEAKER_05Yeah, absolutely. And we we often communicate with the GPs on a quite a regular basis in terms of retail emissions. When you go home, you still have to go to the GP because someone needs to check your back pressure when you go home. Someone needs to uh make sure your cholesterol is actually coming down if you're giving you cholesterol medications, and even the um the lifestyle factors such as alcohol, um, reducing smoking, um, regular exercises. It's important to make sure that you have someone who is aware of um different approaches to managing those to reduce those other risk factors from the lifestyle as well.
SPEAKER_01Looks like you another question, Camilla.
SPEAKER_03Thank you. Um, which is the best hospital in Sydney to attend to if somebody is having uh a stroke?
SPEAKER_05Look, I think all the hospitals in Sydney are pretty good. I've myself worked um within the stroke service in both Prince of Wales, Ronald's show, and Rock Prince Alfred hospitals. So I could predominantly speak about those ones. Um they all have excellent stroke teams, um, and they all have dedicated stroke neurologists, stroke nurse practitioners, and an LL health team which specializes in stroke. What actually happens in the real life is that when you go into an ambulance, and again, the focus is go to the ambulance, don't go to the emergency department yourself, they will call the hospital in advance and see whether they have the space available to facilitate whatever treatments you think they need. And they may actually reroute you to a um a more appropriate hospital depending on how far the stroke water is and whether or not, if you need, for example, a procedure like plot retrieval, whether they'll actually be able to provide it to you that night. And we often send patients between different hospitals in the middle of the night depending on what is available.
SPEAKER_01We have let's have another question, Dr. Milke, before we I introduce our other panel members.
SPEAKER_03It says, what is the current evidence for intensive allied health intervention, specifically speech pathology, physiotherapy, and occupational therapy for people who've had strokes?
SPEAKER_01Coralie, how how would you respond to that?
SPEAKER_02Um, so thank you. Um, the we have got good evidence that more therapy and particularly more therapy early is better. Um, our clinical guidelines are excellent in the world, and I I say that having helped to um pull them together years ago. Um but what what we have in Australia is these living clinical guidelines, which means they're the only living clinical guideline for stroke in the world. They're accessible internationally, but it means as soon as there's new evidence from research, it gets updated. And so people like um Dr. Tau and Dr. Hamza can look up online at any time and see, oh, now actually it's safe to do the treatments for a longer period of time, or now we know that this sort of therapy is really effective. In terms of the intensity, as an example of that, there was a really large international trial that I was involved with that's just been published only a few months ago that has told us more information about the optimal timing and amount of therapy early after stroke, and particularly the physiotherapy, getting people out of bed. So we now know that we don't want to get people up before 24 hours. They do need some time for their brain to recover, but then as soon after 24 hours as possible, and we've got really detailed data now about how often and for how long people should be getting up and out of bed to get moving. But the shorter answer to your question is more is better, um, and more short bursts frequently in the earlier stage is better. And we do know that people aren't getting enough of what they need, and um and Lauren's done some fantastic work in terms of intensity of therapy, particularly for arm recovery, that I'm sure she can tell you about.
SPEAKER_01Yes, can we hear from our occupational therapist, clinician and researcher, Lauren?
SPEAKER_04Thanks so much, Julie, and thank you, Coralie. Uh, as Professor English has outlined, um, we now have some really clear information about how we should manage rehabilitation in those early stages after stroke. But once people are medically stable, we now then know people then need to be doing as much as possible, really, in terms of scheduled therapy. Um, and that's across disciplines, across physiotherapy, occupational therapy, engaging people in lots of their day-to-day activities, upper limb rehabilitation, for example, as well as in the area of speech therapy and communication and swallowing. Um, what we also know though is that in terms of how our services are currently staffed, is that we're not going to be able to provide enough practice, as Coralie says, if we focus on just seeing people one-on-one. Unfortunately, our staffing ratios just mean that that one-on-one session with each patient each day is not going to be enough practice. So, we do have recommendations within our guidelines as well to teach people how to practice on their own, either with the support of family members or using other independent practice strategies to help people to be getting in as much practice as possible.
SPEAKER_01So there's this issue of needing the right rehabilitation and the right amount frequently enough to get maximum uh recovery. And and is that capacity for recovery, does that, Lauren, differ from person to person? Is it a very personalized thing?
SPEAKER_04Yes, it is, Julie. And I think that's where it um one of the challenges is for us within stroke rehabilitation and stroke more broadly, is that the symptoms that people experience after stroke can be very varied. The severity of the stroke can be quite varied. And so then we really do need to think about how we tailor that rehabilitation to best suit the needs of that person. Um, as Coralie said, you know, for some people that's going to be frequent shorter bursts of therapy throughout the day, whereas there might be other people who can who can engage in therapy for longer blocks of time. So that importance of tailoring of therapy uh to people's individual needs is a real area where we're we're continuing to learn more.
SPEAKER_01And Lauren, could you just summarize the the key most common side effects of stroke?
SPEAKER_04Yes, so in terms of from a rehabilitation perspective, um, the key areas that we often see people presenting with are what we'd refer to as motor problems, so weakness in their leg or their arm that then impacts on areas such as walking, balance, and their ability to use their arm in day-to-day function. People might also experience changes in their what we refer to as cognition, so their thinking skills, their memory, uh attention, ability to process information and problem solve. It's very common that there might be changes in their speech, their communication, either understanding of information or their ability to communicate to others. Their swallowing can be impaired, as Dr. Corinne has already explained. So that then places them at increased risk of complications like aspiration pneumonia. People may also experience changes in their vision, uh, so visual field loss, which can then have implications for their ability to be able to get around safely or return to activities like driving, and what we also refer to as perceptual problems, so their ability to understand where their body is in space and also in relation to other objects and how to use those objects. Um, there's some of the key areas that we see within rehabilitation. Uh, in addition to that, we also see for some people there can be changes in mood, so anxiety and depression can be quite common after stroke, as well as uh changes in energy levels, so changes in fatigue, which um Professor English is an is an expert in that field. So there's some of the main areas uh where we can see changes, and obviously that has a significant impact then on people's ability to engage in roles and activities that are meaningful and important to them.
SPEAKER_01You know, um uh if I come to you, uh Coralie English, our physiotherapist and researcher, and and you've been very involved in the development of the website materials and the is it the iRebound website, which I was having a look at, and I'll I'll get you to outline the content there and and how that people can find it. But I was so impressed that there were many people who've had stroke demonstrating and and communicating uh practical tips and ways to uh regain capacity to live their lives. Can you explain what's available there on that website?
SPEAKER_02Absolutely, and before I do, in terms of your comment about hope, Julie, the important thing is that the most rapid recovery does happen early after stroke as the blood flow is going back and as the brain can remould. But recovery can continue for every for people throughout their entire life. So continuing on with rehab, continuing with practicing what you what you want to be able to do, that you can always continue to improve. And Lauren and I both do a lot of work with people who've had a stroke in our research, and those people tell us all the time about the new recovery they've made and how they can improve. So it's a lifelong journey. But coming to I Rebound, yes, that was a particular baby of mine and my team. This was something that I did in conjunction with the Stroke Foundation, um, our PhD student and a group of other researchers, but most importantly, a group of people who've had a stroke. We we refer to them as our lived experience research partners. And we had this idea that we wanted to create accessible resources for people to be able to live well after stroke with a particular focus on secondary prevention, so particular focus on helping people be active and eating well, but also, well, that was what we started with, and the whole section that's actually most popular on that website now is the hints and hacks, which our lived experience partners said we want a section on hints and hacks, we want it to have almost no health professionals on there. You'll see there's a bit of a talking heads piece from me and a couple of others, but all of the videos are our volunteer and our research partners. They want it to be strengths-based and positive. This is what you can do, not deficit-based.
SPEAKER_01And Lauren mentioned you've done work on fatigue and helping people fatigue. And I think a very large number of our audience have indicated fatigue. Could you just speak to that? What can help with that?
SPEAKER_02Yeah, look, um, it's such a I did notice that, um, absolutely. And we know that for people who've had a stroke, it's um most people after well, the stats tell us at least half, but I've not met, I've met very few, a handful, but very few people who've who are survived who have survived a stroke who don't have fatigue is a major issue. And we don't know, we don't have yet evidence-based treatments. My team is working on one that's got some promising results in early studies. There is some promising results about a particular medication that might help, but for many people, it's the most debilitating aspect of their life after stroke is this fatigue that is absolutely overwhelming and means that they can't function the way that they want to. We've also just done a piece of work around Australia in combination with the Stroke Foundation researchers, but again very much in partnership with an engaged group of people who'd had a stroke. We've set research priorities. We've looked at the evidence gaps, we've looked at um then the preferences of people living with stroke and health professionals. And what came out of that in the area of rehabilitation and life after stroke was understanding the causes and developing treatments for fatigue, is the number one research priority that we need to be focusing on.
SPEAKER_01I I just um wanted to ask about equity of access, Lauren Christie, because I know you feel strongly about that. So is equity of access to that intensity of ongoing uh allied health care an issue?
SPEAKER_04Uh yes, it is, unfortunately, Julie, uh nationwide. So, and it's felt even more uh prominently by um stroke survivors living in our regional and remote areas of Australia. Um to uh share with the audience though, we are doing some work around this. I'm part of a national rehabilitation task force, and that is one of the areas that we are investigating, is looking at ways in which we can improve equity of access to rehabilitation. As Dr. Karen mentioned, um our length of stay within after a stroke now is relatively short. People might only be in for say roughly five days, and then that's followed by rehabilitation either as an inpatient or an outpatient. With those changes, it's really um we're starting to look more specifically, both in research that I'm leading as well as research Professor English is leading, looking at how we can also be using telehealth and virtual models of care to address this issue of equity of access to rehabilitation because that has benefits not only for stroke survivors in regional and remote areas, but also for those in metro areas where it's difficult to be getting into a hospital five days a week for intensive for intensive career.
SPEAKER_01Not everybody's got someone to drive them.
SPEAKER_04That's exactly right. That's exactly right. So um there is work being done in that space to help try and address uh some of that. And I'm hoping that within you know the next decade we're going to see much greater access to that using virtual care and telehealth models to improve that equity of access to rehab.
SPEAKER_01Dr. Corinne do you want to kick off with Australia?
SPEAKER_05Um, I think that's what I reflect everything that um Dr. Lauren and and Professor Um Kali said as well. Like the the rehabilitation does happen for um a few for months or sometimes years after the initial stroke effect. Um and it's actually quite rewarding to be working in stroke clinics where we see patients as they leave the hospital and then three months after they come back, and to see that difference in terms of what they're able to do, even just three months later, is quite um it's quite a rewarding experience for myself. Um what I work what we mostly do with patients is we make sure that we all the investigations for the cause of the stroke were addressed. So sometimes, especially if the hospital is full, if people want to go home, some investigations may be missed, like an ultrasound of the heart or adequate investigations of the heart rhythm. And especially for patients that we um are quite um suspicious that they may have had an irregular heart rhythm causing clots to travel from the heart to the brain, we actually provide them with wearable, wearable devices, which they can wear for weeks on to try and assess for irregular rhythms, which may only come on every few weeks, but can still cause damage. Um we make sure that they're actually taking the medications. And unfortunately, lots of people, once they leave the hospital, they think that they may not need the medications anymore. So it's important to us to educate them the role of the medications and how they need to keep um using them, depending on the specific um settings. Um, but also we do assess quite routinely for the other complications of stroke that um Professor Kwali spoke about. So mood is a big problem. Um, and we know that stroke can cause depression to some people in terms of the actual effect on the neurobiology of the brain. And we sometimes need to treat patients even with medications together with psychotherapy to address issues like depression and fatigue and anxiety to assess them in the rehabilitation process. Um, and as of course, fatigue is a very common problem across all neurological conditions. We see it in morticosclerosis, we see it in bastinia gravis. Um and we try and make sure there's nothing else contributing to that fatigue and that um loss of brain reserve, which we can address. So we check them for anemia, we're checking for iron deficiency, we're checking for thyro problems, we're checking for sleep apnea. Um there's lots of things that we can try and assess, which may be contributing to fatigue. Um but I agree, unfortunately, the medications that we have for fatigue are quite limited at the moment. So if you can find more research in that area, it could be a very welcome um advancement.
SPEAKER_01Could I ask Dr. Juban to join us as well? And I wonder if you could share with us uh uh your observations about uh rehabilitation and systems that are effective.
SPEAKER_00Of course, that uh the rehabilitation uh team, also the doctors that we hear in Estrada, also there is a specialist with uh in rehabilitation, that neurologist specialist in rehabilitation that will check the situation from the neurological wise, why the patient has the symptoms, why the patient has the stroke, and we'll continue also the evaluation for the stroke, why the patient has the stroke to address the cause and also to work on the rehabilitation on the multidisciplinary uh issues, the mood, the diet, also the diet is very important in rehabilitation uh and also the physiotherapy and the occupation, how we can uh help the patient to go back home with nearly the same baseline situation. And uh, as Dr. Corinne said, when we are seeing like doctors, when you are seeing the patient in the emergency room in the first few days after the stroke, and see the patient after three months, um six months in the clinic, there will be a huge improvement in the situation. And also the patient has to make uh uh the steps to do the strength, to come back and to make a follow-up to prevent the other uh stroke and to control all the things that we already said, and also the primary physicians, not the neurologists and not in the hospital, in the family doctors, that needs to address these issues to follow up for the hypertension, the betin, the high cholesterol every six months, that not to miss the patient that had the stroke and still didn't control these risk factors to prevent another stroke. And one thing I want to mention that we didn't mention before, that we are talking about stroke in the thirdly, but it is not affecting just the older patients, not the elderly. It also may affect the younger patients. Many patients also during the adulthood and also in their 30s will experience a stroke, maybe because of a heart problem, and also we don't want to forget that the smoking and also the drug abuse, it is uh one of the things that may cause stroke at the young age. Yes, because of the accidentary lifestyle now, and also the diet that um uh many people now taking it will affect the visits earlier than uh elderly, and because of that we are seeing the increase in the population, the younger population will stop. About the diet we are talking, the Mediterranean diet, that uh the fruits, uh, vegetables, uh and the avoid the saturated uh saturated fat, uh the processed uh food, these things to prevent and to to make the fish, for example, one of the things that will uh give the Mediterranean uh diet and will improve the the improve the the health. And also will decrease the weight. And decreasing the weight will also prevent the stroke and also the sport and exercise. This is the home message to do sport, to exercise, not to be athletes, just to do a sport like a quick walking for 30 minutes a day every day will prevent the stroke.
SPEAKER_01And how common is a second stroke once you've had a stroke?
SPEAKER_00The duration in the first month, it will be more uh risky to have a stroke, especially if we didn't address the cause for the stroke. For example, if the patient has a heart problem and we didn't find we didn't, the patient didn't do the halter, the monitor for the heart to check if there is a regular heartbeat, it will recur. And if there is a patient with hypertension that didn't uh control it, it will recur. And the recurrence of the stroke is uh with mainly within the first few months after the first stroke or the first uh TIA, the transient ischemic attack.
SPEAKER_01Come back to Camela, Dr. Camela Milka with questions from the audience. Thank you.
SPEAKER_03Thanks, Julie. Um, another question is anti-phospholipid syndrome and factor five later, and how is that related to stroke?
SPEAKER_05Yes, sure. Um, so when we think about people presenting um to the hospital with a stroke, um, it's usually in Australian studying people um of older age, so people in their 70s or in the 80s who over the years have accumulated those other risk factors that um we spoke about before. So high blood pressure, high cholesterol, diabetes, smoking, alcohol. Um, but we do see patients who are young who present to the hospital sometimes, as Dr. Juban alluded to. So that's um people in their 20s, 30s, and 40s. And if there's no history of um drug abuse, for example, then we try and look for the more rare causes of stroke, which may predispose a young person to have a stroke at a young age. So some of them are autoimmune conditions, such as antiphospholipid syndrome. Um, that's a particular condition which is somewhat associated with lupus, whereby the um body is more likely to perform perform clots, and those may appear in your legs, like a deep vein thrombosis, a DVT in your lungs, but it can also travel to the brain and cause strokes. Um, factor five latent deficiency is a um it's a genetically inherited condition whereby the body is missing a particular factor within the coagulation process in the bloodstream, which means again you'll be more likely to form clots. Um, we often, especially in young women who have strokes, who may they may give us a history that they've had a history of significant miscarriages in the past, which again increases our suspicion for those conditions. Um, what we do these days is if someone is coming at a young age with a stroke, we actually don't only test for those conditions individually, we actually do them as part of the panel. So we test for um over 10 or 20 different um inherited conditions which may cause a stroke. We do different blood tests to check for autoimmune causes of stroke, and we also check for more structural abdominalities of the heart, as Dr. Jubran alluded to as well.
SPEAKER_03Yes. Um, are there any alternatives to taking statins to reduce cholesterol?
SPEAKER_01Uh uh Dr. Jubran, would you answer that one, please?
SPEAKER_00Yes, uh actually the the statins is the medication that uh reduces the cholesterol, the the the cholesterol, the LDL. It is one of the the cholesterol is many types like LDL, HDL, triglyceride. Ld is the major uh cause for uh uh changes in the blood uh vessels, and uh uh and other than statins, there is any new medications add-on statins, not with uh instead of statins, uh, and like is MEP one of the medications that will help the statins, and there is a new uh area of anti-PCSK9 inhibitors. These medications, uh IV injections, meanwhile, that it patients who had the allergy to statins, or there is a side effect of statins that may cause a muscle pain, muscle pain, very fatigue, and muscle pain. So there is uh an alternative of uh giving them the uh anti BCSK9, it is injections uh once every um this is changes according to which medication, but yes, there is an option to to switch to another uh treatment.
SPEAKER_05Yeah, I agree with what Dr. Juban said. I think it's important to emphasize that um while in the general population we speak about reducing cholesterol because it's good for um vast different things, it's good to with your um heart disease together with brain disease. And we often advocate for in the general population for dietary changes first, and specifically Mediterranean diet, low animal fat diet. Um, in the context of people who've had a stroke, we put them in a different risk profile. So the idea is those people are an increased risk of having further strokes in the future, which is why we think there's benefit for studying cholesterol medications such as statins. And that's it's particular for those patients. The the benefit significantly outweighs the possible complications of medication.
SPEAKER_03Another one, any tips for assisting with dysphagia, which is problems with swallowing?
SPEAKER_04Yes, so it was dysphagia with a G, Dr. Carmela, just to confirm. Yes. Okay, yes. Um, so that's that's an issue with uh swallowing function after stroke. Um, and what can happen is that, um, and again, I'm not a speech pathologist, so I I hope I don't um overstep my professional mark here, but basically the the way in which um when we swallow, we get um things that close off to prevent food from going down into our lungs, that that doesn't happen as effectively. There can also be changes in terms of um the coordination of the muscles within the face and the the throat that help assist with uh swallowing function. Um and so I think from that regard, the best thing to do is to speak to a speech pathologist. You really need to look at having specialist expertise around swallowing um rehabilitation. Uh uh Coralie English, did you want to comment on that?
SPEAKER_02Um, no, just to say, in terms of um what people can do to manage that, again, under the advice of a speech pathologist, but you can alter the texture of your diet looking for soft foods. Um we we used to do, we still do some in the hospitals use of thickened fluids. If people have lots of problems swallowing and are at risk of liquids going into their lungs, then sometimes we have to put thickener in people's drinks, which is not very pleasant at all. If you can imagine never being able to have a cool drink of water, you just have to glug down like gluey stuff. What research has shown us over the last, or Lauren might have to correct me, five, six, seven years, is that with what just water, the risk of getting pneumonia if you accidentally get some pure water in your lungs isn't too much. And so we do in hospital, it's now recommended, unless people have got very severe swallowing issues, that they can sip at least water. But I think as as Lauren said, it's it's about the advice of a speech pathologist. But if people are having difficulty swallowing and chewing, it is about softer foods slowing down, eating while you're sitting up, um, and being being careful and taking it seriously because you can, of course, choke, or if you get food and um the wrong sorts of liquid in your lung, you can end up with a pneumonia, which can be very serious.
SPEAKER_03Um, why do stroke patients experience pain in the affected areas after a stroke?
SPEAKER_00There is one area of the brain that uh calling a thalamus, the thalamus of the brain, if there is a stroke in the thalamus, that the blood not coming enough to the this area and it will die, this will cause uh uh the numbness like tingling and uh feeling uh a sharp sensation in the limbs, and after that they could may cause uh pain. Like instead of loss of function, there is an increase in the function that in the abnormal sensation.
SPEAKER_05While a lot of patients initially after stroke have weakness of the arm or the leg, if you see them a few months down the track, they actually develop spasticity, which is a rigidity of the arm or the leg. And that it um it basically the brain normally tries to um dial down the movements of the muscle when that pathway gets injured, the muscles stiffen up. So while they may have difficulty doing movements, a lot of it is actually to do with spasticity and rigidity of the arm or the leg, and it by itself can be quite a painful process as well.
SPEAKER_02There used to be a school of thought that putting splints on, spending a lot of time with a therapist doing stretching regimes would help reduce spasticity, and now evidence of what doesn't work is just as important as evidence of things that do work, and we now know for sure that intensive stretching does not change spasticity. Um, there's a the medication called Botox, which most people associate with wrinkles and crow's feet, has really good evidence for reducing spasticity in people, and it's particularly useful if it if the spasticity is painful, uh if it's limiting someone's function.
SPEAKER_01You know, I'm just thinking you uh several of you have mentioned the state-of-the-art clinical guidelines that are updated, I think, every six months and are publicly available. Where what would you Google to find them? Because highly motivated family members or people who've had stroke might like to look at the latest research so they can talk to their doctors about it.
SPEAKER_02Very easy. If you just Google stroke guidelines, you'll find them. Um, but they they are housed on the Stroke Foundation website, so you can navigate to them that way. But if you and if you add in living stroke guidelines and Australian stroke guidelines, you will find them very quickly and they're freely available.
SPEAKER_03Yes. Um, does being a migraine sufferer predispose to having a stroke?
SPEAKER_00There is a link between migraine and stroke, uh, absolutely. But the migraine with aura, what is the aura? There is uh symptoms before the headache. What is the migraine? It's a headache, one type of the headache, the primary headaches, and the aura it is a could be visual aura, the visual symptoms or sensory symptoms or weakness before the headache. And they notice in the researches and the previous researches and papers that uh women with uh migraine with aura who are smoker and also taking oral contraceptives, there will be a very increased risk of uh stroke, especially at a young age.
SPEAKER_03Is the stroke of the eye the same and is the treatment the same?
SPEAKER_05Yes, sure. So um depends what you mean by stroke of the eye. So you can have an occlusion of the ophthalmic artery, which is the artery which um branches off to give blood to the entire eye, and it's traditionally presents with a kind of loss of vision of the whole eye in one go, and those ones we do treat as per normal stroke, especially if there's a preventative therapies. You can get strokes of the very small arteries um within the eye and the retina, which can also cause loss of vision. Unfortunately, for those ones, we there isn't as good evidence to suggest that the hyper-acute therapies that Dr. Jubal and I spoke about are beneficial. Um, so we don't use them as often for those kind of forms of strokes. But we still speak about the same um long-term management, um, because the same people who developed stroke-affecting vision can still get more strokes online. So we still speak about the exact same modifiable risk factors of cholesterol, diabetes, hypertension.
SPEAKER_01There's a very strong theme coming through here about addressing risk factors, isn't there? Let's see if we can get a couple more questions out there.
SPEAKER_00Prevention is much better than the treatment here.
SPEAKER_03Absolutely. Okay, what are the early warning signs of an impeding stroke, meaning in the weeks or months before a stroke, if any?
SPEAKER_00If there is a stenosis there, there is a like um 70% stenosis, and the patient may have the symptoms of the eye, as uh we said before, that the curtain, black curtain of the eye, and it will come for a few minutes and resolve. And also, these patients may experience like a weakness on their left side for a few minutes and result. And this is the warning uh symptoms that the patient may have in the last few months. So if any patient has these symptoms, you have to go to the emergency room, to the neurologist, and to check this because it may be there is a way to prevent the major stroke.
SPEAKER_05Um, one specific significant risk factor for stroke, so to haven't addressed enough today, and I think is quite relevant to the Australian audience, is of course alcohol. I think overall um as Australians, all of us drink too much and consume too much alcohol. And the kind of they have updated the recommended guidelines in terms of alcohol these days. So we speak about not more than 10 standard drinks per week, um, not more than five alcohol days, these two um alcohol-free days per week. Um, and that is this one specific thing which I think uh a lot of us need to be conscious of.
SPEAKER_04Julie, I was just going to mention again once more that just in terms of those living guidelines for stroke that we've mentioned several times this evening, just for uh our audience listening, you can access them as a member of the general public. And they are a great resource that if you are advocating for a family member or loved one and wanted to check, well, what are the sorts of things my family member should be accessing, should be doing as part of their stroke recovery, uh, that's a great resource that you you too can access. The other thing was just to mention that we also know now as well, supporting people around taking more of a self-management approach to help support their ongoing long-term recovery after stroke. There's a fantastic program initially developed in New Zealand that's now very widely available, got great evidence to show that it helps support people to improve after stroke called taking charge after stroke that would recommend people have a further look at that.
SPEAKER_02Adding on to the advocacy piece and people being able to access the guidelines, getting to hospital fast, really very, very important, as we said, and then making sure that your loved one is being treated on a stroke unit. Ask the question is this a stroke unit? Because we have very good evidence that stroke unit care improves people's recovery and reduces their chance of dying. And all that means is that it's a group of experts, you're getting the multidisciplinary care that you need. So get to hospital and make sure you're treated on a stroke unit.
SPEAKER_00As Professor English said, the stroke unit is the main main the stroke unit, also the um the stroke clinic. So the patient came every six months to the stroke clinic because the stroke specialist will see, will know what the things that we have to control, to check, uh, to prevent the next stroke and to improve the symptoms. Yes, of course. Now with the the ministry research extending that the time of treatment, the to choose the patient that will benefit from the extension of the time, not just for with the to give the medication the IV thrombolysis within four and a half hours, to extend it for longer time uh according to very specialized uh imaging, and also for the catheterization to take the that lot of there are many uh researches when and the best time to do it, and also to include patients that in previously they were not included in these treatments.
SPEAKER_05Yeah, so I think um especially within the Australian settings, um um there is a lot of work about trying to integrate um artificial intelligence into some of our diagnostic tests. So um we are using kind of um deep learning models, and I do somebody's research at the Brennan Mind Center as well, and focusing on training um AI algorithms to recognize patterns on MRIs and CTs. And we are trying to already integrate some of those into our healthcare pathways in Australia. So um it doesn't matter if you get a stroke in um in Sydney or in Dabo or in Darwin or in Alice Springs or Mount Isa. Um the idea is that when you get the scan, um we should be able to recognize if the stroke there and treat the patients immediately, even if there's no radiologist available.
SPEAKER_01I I need to thank our panel, uh, and I really do thank you sincerely for the high quality of the information that you've provided, and Dr. Kamela Milke for your careful addressing of the questions and bringing them to us. So thank you to Professor Coralie English, our physiotherapist, to Dr. Lauren Christie, uh occupational therapist, Dr. Tal Karen, uh neurologist in Australia, and Dr. Hamza Jibran uh from Jerusalem, the Hadassah Medical Centre. Thank you again for joining us. Uh, my name's Julie McCrossen, and uh thank you and farewell to everybody. Thank you.