The toolkit was uniquely co-designed by an interprofessional group of researchers, allied health professionals, stroke organizations and people with lived stroke experience, to create a person-centred, inclusive experience for users to learn about and access aquatic therapy.

“STARRT is the first aquatic therapy toolkit developed at Sunnybrook,” explains Dr. Marinho Buzelli, STARRT project lead. “This unique toolkit will help deliver a more specialized aquatic therapy experience to persons with stroke experience across Canada.”

The need for a stroke toolkit for aquatic rehabilitation

Stroke is a medical emergency resulting in a sudden loss of brain function and is often caused by an interference with blood flow to the brain. In Canada, stroke is the leading cause of adult disability as it can result in restricted movement, paralysis and impaired speech even after medical intervention. For many persons with stroke experience, the road to recovery is long and filled with many challenges. Aquatic therapy, which involves exercise in water, has been shown to have several benefits for people recovering from a stroke.

“I’ve had the chance to observe how aquatic therapy has changed the lives of so many with stroke experience,” says Shaylene Leibl-Smith, a recreation therapist at Saskatchewan Health Authority and a member of the STARRT advisory team. “From stress and pain management, freedom of movement, confidence building and connecting with others, it’s rewarding to see the progress individuals can make participating in aquatic therapy.”

Sharing lived experience to empower survivors

Danny Foran is the patient partner that is sharing his own stroke journey to help and empower other survivors. As a member of the STARRT co-design team, Danny’s experience using aquatic therapy informed some of the benefits, exercises and caregiver supports identified in the toolkit.

Dr. Marinho Buzelli, STARRT project lead, and Danny Foran, transferring his experience with stroke to help design the toolkit.

In 2012, Danny suffered a serious stroke that left him paralyzed on the left side of his body. In addition to different on-land rehabilitation exercises like physiotherapy, Danny joined an aquatic therapy club for stroke survivors. Since pursuing aquatic therapy, Danny has felt an improvement in his balance, strength and endurance, and has even learned how to swim using his right arm.

“Not only has swimming helped me physically, but it’s also supported my mental health since suffering my stroke,” explains Danny. “Swim clubs like the Oakville Strokers allow survivors to meet with each other in and outside the pool, which is a very empowering and motivating experience.”

Rehabilitation can be a frustrating experience for persons with stroke experience, who struggle with movements and activities that they could do before having a stroke. Danny hopes that sharing his experience to design resources like STARRT, will help survivors on their rehabilitation journey, and provide them with both physical and mental benefits and comfort.

“It’s been rewarding to participate in the design process of STARRT,” adds Danny, “I’ve been able to transfer my knowledge of aquatic therapy into an accessible tool for others.”

Danny participating in aquatic rehabilitation after suffering a stroke that left him paralyzed in one side of his body.

Optimizing recovery through aquatic therapy

STARRT is designed to teach persons with stroke experience, caregivers and health care professionals about the benefits of aquatic therapy, answer questions about what to expect from an aquatic therapy class and showcase aquatic therapy pool locations across Canada via an interactive map.

There are currently over 700 pools in Canada that patients and caregivers can explore in the STARRT toolkit. From swimsuits to medications to snacks, STARRT also provides a list of what you might need at an aquatic therapy session, as well as different strengthening, balance, aerobic exercises and games you can try in the pool.

“When designing STARRT we wanted persons with stroke experience to inform the foundation of the toolkit,” adds Dr. Marinho Buzelli. “The goal of this project is to help persons with stroke experience reap the physical benefits from aquatic therapy, and feel more confident and independent in their functional ability by providing them with all the information they might need in one location.”

If you or someone you care for is interested in learning about the rehabilitation benefits of aquatic therapy post-stroke, or would like to learn about aquatic therapy facilities near you, visit STARRT.ca.

The post Let’s get STARRT-ed: Empowering stroke survivors with access to aquatic therapy appeared first on Your Health Matters.

Dr. Amanda Mayo is a physiatrist who specializes in amputee care at St. John’s Rehab. Todd Domingo is an active amputee and a certified peer visitor who offers support to other amputees. Both share insights to help you along your journey.

A life-changing event

Says Dr. Mayo, “It is important to recognize limb loss is a life-changing event. Limb loss affects how you move and many aspects of your life. It is common to go through a period of grieving after loss of a limb, and you may have a period of developing a new self image. Having a good support network of friends, family, and/or healthcare providers can help with these transitions.”

Says Todd, “When it comes to body image, keep reminding yourself that value is about who you are and what you can do – and less about physical appearance. Though it takes a lot emotionally the goal is to try to get to a point where you can say, let me make something better of this. People will always stare: it is human nature. Use it as a positive teachable moment.”

Last year Todd had to have a left below knee amputation. “Losing a limb is similar to losing loved one – believe it or not,” he says. “Everyone experiences the process of dealing with limb loss differently.”

Recovery takes time

Dr. Mayo: It is a long process to recover from amputation. Be patient with yourself. It takes time to regain your strength, emotional recovery and for the residual limb to heal.

Patients have to wait at least 4-6 weeks after amputation before being measured for their first prosthetic device by a prosthetist.

Be open to new experiences

Todd: Over time it is then good to get to know the things you can do and to remain open to new experiences. I found it helped to accept that my prosthesis was not replacing my limb. It’s a ‘tool’ to help me do things.

Don’t be discouraged

Todd:  During fittings and adjustments, try to stay positive and get to know the differences between pain, soreness, discomfort and pressure. Acknowledge and address the discomfort and find a way to trust that your device will support you.

Seek support about the financial aspects of a potential device

Dr. Mayo: Patients also often face financial stressors at this time. Talking with members of your medical team – the social worker, the physiotherapist, the occupational therapist – can help you learn more about potential device options and how to navigate assistive devices funding.

Todd: Find out what your options are, and aim for a device that can help match the activities you want to do.

Become adaptive and active

Todd: Learn what being adaptive means. Ask yourself, how am I going to do this? in a strategic way to safely do it.  For example, instead of asking, how am I going to get in my car with my leg prosthesis on since it is low to the ground? Start by thinking how you can physically get into your car. Whether that is by holding on to the car as you sit down and swinging your legs over, it is all about taking that first step. You’ll soon figure out that adapting simply means doing things in a different way, but still getting to the end goal. 

Todd: Be active and involved. Be aware of the community of amputees around you. Advocate for yourself and have good, regular exchanges with your medical team.

The post Going forward after limb loss appeared first on Your Health Matters.

Fangshu Yu, left, and Shintaro Tsukamoto were both seriously injured in fires in their off-campus rental homes.

Each year, the health care team at Sunnybrook’s Ross Tilley Burn Centre sees far too many students injured by fires in unsafe off-campus housing.

“Windows that are too small or don’t open, not enough exits, smoke detectors that don’t work – these things may not seem like a big deal, but they can mean the difference between life and death if there’s a fire,” says Dr. Marc Jeschke, the medical director of Sunnybrook’s Burn Centre.

Here, two university students share their stories of how they survived and thrived after devastating fires in their off-campus rental homes.

Shintaro Tsukamoto says that even though his injuries “caused huge setbacks in my life, I’m motivated to keep moving forward. I’ve kept a positive outlook throughout my recovery, and that’s helped me a lot.”

Shintaro’s story

Shintaro Tsukamoto, 21, was excited about moving into his new place last July. He had just completed his first year of university in Ottawa, and with only a few weeks until classes started up again, he’d found a basement bedroom in an off-campus rental house.

He had only been living there for three weeks when, one night, he heard a loud noise and glass shattering upstairs. Concerned that someone was breaking into the house, he called 911.

“That’s when the operator told me they had already gotten a call about my house, and that it was actually on fire,” Shintaro says. “I had no idea, because there were no working smoke detectors.”

The 911 operator told him to get out of the basement immediately, but he quickly realized there was no way to escape through the tiny windows.

“I left my room, walked upstairs to the main floor, and saw the entire front half of the house was on fire. I made it to the back door, but it was so smoky that I couldn’t find the lock,” Shintaro says. Overcome by the intensity of the smoke, he passed out.

He eventually regained consciousness and managed to get the door open, escaping into the backyard.

“I have no idea how I got out of there,” he says. “I think it was just pure adrenaline.”

—

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“For a long time, it was difficult and painful to speak, to make my voice heard.”

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The extreme heat generated by the fire caused thermal burns to Shintaro’s hands, arms, neck and face.

He was stabilized at a hospital in Ottawa before being airlifted to Sunnybrook Health Sciences Centre’s Ross Tilley Burn Centre in Toronto, the provincial centre of excellence for burn treatment and Shintaro’s hometown. He received treatment there for three weeks, led by Dr. Alan Rogers, a plastic and reconstructive surgeon in the Burn Centre. A month of inpatient rehabilitation at Sunnybrook’s St. John’s Rehab followed.

There were concerns he wouldn’t regain full use of his arms and hands, a distressing possibility for a talented athlete who had won several national championships with his ultimate frisbee team.

The smoke Shintaro inhaled during the fire also damaged his lungs, meaning he was intubated and unable to speak for weeks.

“For a long time, it was difficult and painful to speak, to make my voice heard,” he says.

Now, Shintaro wants to use his experience to tell other students how they can avoid ending up in a similar situation.

“Basements are not an ideal place to live, because many of them don’t have direct exits. Make sure there’s a way for you to safely escape in the event of a fire. Working smoke detectors are so important – if they had been working in my house, maybe I would’ve had more time to get out,” he says.

Shintaro was living in the house with people he didn’t know, which meant it was unclear to first responders how many people were actually home when the fire started. Having your housemates’ cellphone numbers, or even having a group chat set up, would be helpful in the event of an emergency.

He also advises taking your time when choosing somewhere to live.

“I was rushing, so I overlooked things about the house,” he says. “Survey all of your housing options, and make sure you feel comfortable. Your safety is the most important thing.”

—

Shintaro describes his recovery as a long, slow road. Still, he counts himself as one of the lucky ones.

“Even though these injuries caused huge setbacks in my life, I’m motivated to keep moving forward. I’ve kept a positive outlook throughout my recovery, and that’s helped me a lot,” he says.

Shintaro has spent the last year recovering, working and even traveling to Japan to visit family.

This month, he is finally set to return to Carleton University for his second year of studies in the human rights program. With help from his friends, he’s found a new rental house that he feels comfortable living in. He’s also looking forward to returning to the field with his ultimate frisbee teammates.

“My hands and arms have healed really well and I pretty much have full function, thankfully,” he says. “My voice is better too. It’s definitely gotten deeper, although maybe that’s not such a bad thing!”

Dr. Marc Jeschke examines Fangshu Yu’s arms and hands during a follow-up appointment at Sunnybrook’s Ross Tilley Burn Centre.

Fangshu’s story

Fangshu Yu, 20, gently takes off the pressure garments she wears for 23 hours a day, covering the skin from her shoulders all the way to her fingertips. Dr. Marc Jeschke nods approvingly as he examines her arms and hands. “Your skin is healing really nicely,” he says.

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“If the window opened further, maybe things would have turned out differently.”

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Fangshu, a second-year statistics student at the University of Toronto’s Scarborough campus, was injured three months ago when a fire started in the basement of the off-campus rental house she shared with three other students.

“The house had smoke detectors, but by the time I heard them going off, the smoke was so black and thick that I couldn’t see anything. When I opened my bedroom door, smoke just came pouring in,” she says.

While Fangshu’s bedroom was on the main floor of the house, the window didn’t open up far enough in order for to her jump out.

“If the window opened further, maybe things would have turned out differently,” she says.

Instead, she dropped to the ground and started crawling toward the front door. Covering her mouth with one hand, she held her cellphone in the other, using its flashlight function to navigate the pitch black, smoke-filled hallway.

Though it was only a short distance to the front door, she could feel herself losing consciousness.

“I got so tired, I had to stop and take a break,” she says.

The floor, heated by the intensity of the fire directly below, caused extensive burns to her arms and hands as she crawled. She managed to make it out to the front yard, where neighbours helped her until first responders arrived.

—

Fangshu was immediately taken to the Ross Tilley Burn Centre at Sunnybrook. There, Dr. Jeschke performed surgery to graft skin from one of her thighs onto her arms and hands. After two weeks in the hospital, she began a five-month course of outpatient rehabilitation at Sunnybrook’s St. John’s Rehab.

“I’m at St. John’s four days a week, working on getting the range of motion back in my elbows, wrists and fingers,” she says. “If I’m lucky, I may be able to stop wearing the compression garments after nine months, but I’ll probably need to wear them for two years.”

Fangshu credits the fact that she wasn’t asleep as the main reason she was able to get out of the house quickly.

“The fire happened at 2 o’clock in the morning, and I was up late, sending out resumes to try and find a co-op job for the next semester,” she says.

Sadly, while four people were in the house at the time, only three of them were able to escape the fast-moving fire.

“It was probably a minute from the time I heard the smoke detector until I got out of the house,” she says. “Another minute after that, I could see the whole main floor in flames.”

—

Fangshu hasn’t yet been able to return to school, but she’s hoping to recover enough to start classes again in January. Her mom came from China to stay with her, and has been helping her with daily tasks, from getting to medical appointments to putting her hair in a ponytail.

There are some things she still insists on doing herself, though.

“I usually eat using my chopsticks, but for now, I’m stuck using a fork,” she says with a laugh.

Despite her busy rehabilitation schedule, Fangshu is slowly getting back to a routine. She’s determined to find a co-op placement for next year, and to finish her degree. She recently moved into a new condo with her friends, and smiles when recalling the biggest selling point of the unit: the fire-safety features.

“There are smoke detectors everywhere,” she says. “There’s one in every room, out in the hallway, even in the elevator. I feel safe there.”

Fangshu Yu currently goes to appointments at Sunnybrook’s St. John’s Rehab four days a week, where she’s “working on getting the range of motion back in my elbows, wrists and fingers.”

Are you a student looking for off-campus housing? Ontario’s Office of the Fire Marshal has tips on finding fire-safe student accommodation.

Important things renters should know about the provincial Fire Code can be downloaded here.

If you have concerns about fire safety in your current rental accommodations, in Toronto you can contact the Fire Prevention Office by dialing 3-1-1.

The post Is your off-campus rental fire-safe? Two students survive, thrive after devastating fires appeared first on Your Health Matters.