17th annual convention

SSP VISIONSSP Strategic Planning; January 12, 2013

By 2018, the Stroke Society of the Philippines will be the leading multidisciplinary stroke organization of healthcare professionals in the country, collaborating with partners working toward effective stroke reduction in the Asia Pacific Region.

SSP MISSIONSSP Strategic Planning; January 12, 2013

• To empower people to take a proactive role towards a “culture of health” through advocacy in stroke awareness and prevention

• To disseminate and promote the practice of evidence-based stroke management through continuing medical education

• To create and utilize innovative strategies for optimum comprehensive stroke care appropriate to the local setting

• To promote and attain excellence in ethical and relevant stroke research with local and international stroke care network

• To take an active role in the international stroke care network

• To organize stroke support groups and promote a “culture of help” by supporting stroke survivors, their families and caregivers.

• To institutionalize stroke prevention and intervention through legislative advocacy and collaboration with government agencies

MESSAGE

MALACAÑAN PALACE Manila

My warmest greetings to the Stroke Society of the Philippines as you hold the 17th SSP Annual Convention.

Stroke is among the most debilitating conditions afflicting our countrymen today. This ailment hinders the mobility, reduces the productivity and diminishes the wellbeing of its victims and their families. The government looks to the fields of science and medicine to provide effective detection, treatment, rehabilitation and recovery options for everyone affected by this sickness. I therefore thank the Stroke Society of the Philippines for spearheading these endeavors and for addressing the key issues of your specialty in this convention.

The journey towards real change will be challenging and difficult, and our first steps will be hard and wobbly. But guided by our convictions, no obstacle will be too insurmountable for our country and our people. I ask you to join us and become our partners in building a healthier Filipino nation and ushering in a better Philippines.

I wish you a productive convention.

President of the PhilippinesRODRIGO ROA DUTERTE

MESSAGE

Republic of the PhilippinesDepartment of Health

OFFICE OF THE SECRETARY

Warm greetings to The Stroke Society of the Philippines on the occasion of its 17th Annual Convention.

There is life after stroke. This is what your Convention seeks to advance among your participants composed of physicians, nurses, physical therapists, and other members of the allied medical profession involved in the care and rehabilitation of stroke patients. Indeed, the management of stroke calls for an organized team of competent health professionals.

Thus, by your example, the Department of Health’s rallying cry, “All for Health towards Health for All,” becomes more than a chant. It also becomes alive as our health institutions, the private hospitals included, join our government and the Department of Health to work as one for the realization of the Duterte Health Agenda. For truly, change is coming!

Mabuhay tayong lahat!

Secretary of HealthPAULYN JEAN B. ROSELL-UBIAL, MD, MPH, CESO II

MESSAGE

PHILIPPINEMEDICAL ASSOCIATION

Greetings from the Philippine Medical Association!

It is an honor and a pleasure for me to convey my heartfelt felicitations to all the officers and members of the STROKE SOCIETY of the PHILIPPINES on the holding of its 17TH SSP Annual Convention on August 4 to 6, 2016 at the Subic Bay Traveler’s Hotel with the theme: “PRIORITIES, PROGRESS and PROMISE of REHABILITATION and RECOVERY AFTER STROKE”.

Rehabilitative and Restorative Care is one of the four important fields in Medicine that is needed in the delivery of total health care to our people. Like the other fields of specialization, it will continue to evolve as the search for new and innovative approaches in managing disease conditions continue to challenge medical practitioners throughout the world. With the participation of allied health professionals in your forthcoming conference, you have just emphasized the value of “team effort or team work” in the delivery of health care. I am confident that with the way your conference is designed, fruitful discussions and sharing of experiences will not only enrich the knowledge and skills of all the participants but will be memorable to each and everyone as well.

On behalf of the 2016-2017 National Officers and Board of Governors of the Philippine Medical Association, I would like to reiterate my warmest greetings and felicitations to one and all. Mabuhay ang Stroke Society of the Philippines at Maraming Salamat sa Inyong lahat!

PMA President 2016-2017IRINEO C. BERNARDO III, MD

MESSAGE

PHILIPPINECOLLEGE OF PHYSICIANS

I bring you warm greetings from the officers and members of the Philippine College

of Physicians on the occasion of your 17th SSP Convention with the theme: “Priorities,

Progress and Promise of Rehabilitation and Recovery after Stroke”. This brings

recognition of your contribution in helping rehabilitate our patients who have had

strokes.

You have chosen relevant and significant topics related to stroke and have aptly

involved most of our other allied professionals like the nurses and physical therapists.

Only an organized team approach will truly benefit our stroke patients.

We are one with you in your advocacy on promoting the ‘Global Stroke Bill of Rights’.

Be persistent and consistent and surely you will succeed.

Mabuhay!

President, Philippine College of PhysiciansNENITA AVENA-COLLANTES, MD, MHPE, FPCP, FPSN, FACP

MESSAGE

PHILIPPINEACADEMY OF FAMILY

PHYSICIANS

My warmest felicitations to the officers and members of The Stroke Society of the

Philippines on your 17th Annual Convention.

Stroke is one of the common health problems encountered by different health

professionals like Family Medicine specialists. It is a multidisciplinary health problem

and the topics outlined in the said activity will surely benefit various health care

professionals.

Your valuable efforts are truly essential in raising the bar of excellence and having

continuing medical education of health professionals will benefit our patients and

their families. Let us work together and attain quality of life for the Filipino families.

PAFP PresidentEVA IRENE YU MAGLONZO, MD, FPAFP, FPCGM, MHPED

MESSAGE

PHILIPPINENEUROLOGICALASSOCIATION

In behalf of the PNA Board of Governors of 2016, I would like to congratulate the officers and Board of Trustees of the Stroke Society of the Philippines headed by Dr. Maria Cristina Z. San Jose for the 17th SSP Annual Convention with the theme: Priorities, Progress and Rehabilitation and Recovery after Stroke at the Subic Bay Traveler’s Hotel, Subic Bay Freeport Zone in August 4-6, 2016. The program provides an interesting mix of topics from Unlocking the Signals of Stroke to the Asia-Pacific Organization-Stroke Society of the Philippines Collaborative Symposia, Posterior Circulation Stroke, Simultaneous Sessions for Nurses and Allied Health Professionals and the joint SSP-Philippine Society of Neurorehabilitation Symposium with workshops for spasticity, swallowing assessment and rTPA treatment. As stated in the Stroke Bill of Rights, “patients have the right to the best stroke care, be informed and prepared, and be supported in their recovery. It is a tool that can be used by individuals and organizations to communicate with stroke care providers and with governments and their agencies about what people affected by stroke think are the most important things in their recovery.” As neurologists, we fully support these basic rights towards the progress and recovery of our patients. Again, congratulations to the Stroke Society of the Philippines!

President, Philippine Neurological AssociationARNOLD ANGELO M. PINEDA, MD, FPNA

MESSAGE

THE STROKESOCIETY OF THE

PHILIPPINES

Warmest greetings to all participants of the 17th SSP Annual Convention!

This year, the Stroke Society of the Philippines has decided to go on full circle, putting emphasis on topics related to long-term post stroke management. Behind the frequently cited numbers and prevalence rates are stroke survivors and carers whose lives have been affected significantly, who are forced to come into terms and deal with the aftermath and who need all the assistance on the road to recovery. This convention hopes to enlighten participants that many post stroke complications are treatable with drug therapy, appropriate specialist referral, rehabilitation and multidisciplinary care.

It shall be a packed 3-day scientific activity with lectures, interactive cases and workshops to be handled by esteemed local and international faculty. Joint symposia and separate sessions have been prepared to address common as well as varied topics of importance and interests among the members of the health care team managing stroke.

On behalf of the officers and members of the SSP Board of Trustees, I would like to express my sincere appreciation to the SSP Olongapo Chapter for co-organizing this convention in Subic. We would like to thank all our invited speakers especially the faculty of the Philippine Society of Neurorehabilitation (PSNR) and members of the organizing committee for their generous offer of time and expertise. To our pharmaceutical partners, maraming salamat for supporting and working with us to help ensure success of this convention.

Wishing everyone a fruitful convention as we continue to work together towards providing the best possible therapy along the continuum of stroke care with determination, hope and optimism.

Truly yours,

SSP PresidentMARIA CRISTINA Z. SAN JOSE, MD, FPNA

MESSAGE


PHILIPPINES

Welcome to the 17th Annual Convention of the Stroke Sociefy of the Philippines!

Through the years, the society has been coming up with various themes and programmes with the goal of helping patients afflicted with stroke and their caregivers. With the same goal in mind, the organizing committee endeavors to provide basic knowledge, updates, and practical guidelines. This year we focus on what happens after stroke - the sequelae of the disease. No matter how ‘minor’ a stroke is, it leaves a ‘mark’- may be a more rigorous secondary measure or problems that impact even on the daily existence like memory, swallowing, sleep, bladder control and others. It may concern how he perceives the world coupled with feeling of hopelessness. We also focus on the caregivers who do not only share the burden but are instrumental for the step by step recovery.

The SSP cares for those who had a stroke, for those at risk, for the healthy individual who wants to avoid having a stroke and the caregivers. All together our paramount concern is to make the lives of our stroke victims better lived.

Maraming salamat po.

Overall Convention Committee ChairSSP 17th Annual Convention

RAQUEL M. ALVAREZ, MD, FPNA

MESSAGE


PHILIPPINES

Greetings!

In behalf of the SSP Board of Trustees and the Organizing Committee, I warmly

welcome everyone to the STROKE SOCIETY OF THE PHILIPPINES 17th Annual

Convention at the Subic Bay Traveler’s Hotel. We prepared a 3-day scientific program

packed with topics focusing on the aftermath of stroke. Specific sessions on posterior

circulation stroke, improving life after stroke and thrombolysis workshop are prepared

for physicians and stroke specialists. Continuing education courses for nurses,

physiotherapists and occupational therapists are also included in the program. The

3rd day will feature a joint SSP-Philippine Society of Neurorehabilitation whole day

session focusing on the different aspects of stroke rehabilitation.

It will be a hectic 3 days of learning for all of us. With God’s grace, we hope that all our

efforts in organizing this convention will be rewarded with success.

Scientific Committee ChairSSP 17th Annual Convention

ROMULO U. ESAGUNDE, MD, FPNA

Scientific ProgramAugust 3, 2016

DAY 1: August 4, 2016

Pre-convention Symposia

Opening Ceremonies and President’s Plenary

1:00 – 3:00 pm

8:00 – 9:00

9:00 – 9:30

6:00 – 9:00 pm

Addressing Stroke Risks in the WorkplaceDietary Do’s and Don’t’s In the WorkplaceManagement of Stress in the WorkplaceShift Work: Boon and Bane

Opening Ceremonies/ExhibitMaster of Ceremonies: Dr. Maria Socorro F. Sarfati and Dr. Romulo U. Esagunde

President’s Plenary: Burden of Stroke in the Philippines:Challenges, Opportunities and Initiatives

Dr. Nicole A. Bernardo-Aliling Dr. Lea Stephanie OigaDr. Rosalina Espiritu Picar

Dr. Maria Cristina Z. San JoseDr. Johnny K. LokinDr. Rosalina Espiritu-PicarDr. Rodell Miguel M. Mayuga

Dr. Maria Cristina Z. San Jose

TIME TOPIC SPEAKERJames Gordon Memorial Hospital

Industry Supported Symposium (Pfizer)

Unlocking the Signals of StrokeBurden of Stroke In AsiaUnderstanding Stroke and Risk Factors in AsiaDylipidemia Management in Stroke PreventionHypertension Management in Stroke Prevention

Mansion Garden Hotel, Subic

Verona Function Hall 2

Scientific ProgramDAY 1: August 4, 2016

Whats New in Acute Stroke TherapyTIME TOPIC SPEAKER


9:30 – 09:50 1. Low dose vs Standard Dose of Intravenous Alteplase in Acute Ischemic Stroke: Results of ENCHANTED Trial and Implications in the ASEAN Region

Professor Craig AndersonModerators: Dr. Romeo Y. Enriquez and Dr. Sheryl Manalili

9:50 – 10:10

10:10 – 10:30

10:30 – 10:50

10:50 – 11:00

11:00 – 11:30

11:30 – 2:00

Dr. Allan A. Belen

Dr. Peter Paul P. Rivera

Professor Craig Anderson

Dr. Maria Cristina Z. San Jose

Dr. Gerardo Carmelo B. Salazar

2. Telemedicine and Thrombolytic Therapy: The SSP.Assist.ph Project3. Endovascular Therapy in Acute Ischemic Stroke: Are we there Yet?4. How to Manage BP in Acute ICH: Reconciling Results of the INTERACT and ATACH Trials

Open Forum

BREAK/BOOTH VISIT

Industry Supported Symposium 1. Boehringer-Ingelheim Stroke Prevention in Atrial Fibrillation: Principles, Practice and Shifting Paradigms

2. Natrapharm Patriot


Focus Clinical Topic : Posterior Circulation Stroke

2:00 – 2:302:30 – 3:003:00 – 3:303:30 – 4:004:00 – 5:00

5:00 – 6:00

Moderator : Dr. Maricar P. Yumul

Dr. Jose C. NavarroDr. Ma. Cristina Macrohon-ValdezDr. Johnny K. LokinDr. Romulo U. EsagundeDr. Sharimah T. Abantas-DiamlaDr. Francesca Rose. G. De Leon

Dr. Romulo U. Esagunde, Dr. Roberto de Guzman and Dr. Maria Cristina Z. San Jose

TIME TOPIC SPEAKER


Anatomy and Blood SupplyBrainstem Syndromes Diagnostic TestsMedical ManagementInteractive Case Presentation

Industry- Supported Symposium (Hi-Eisai)From Theory to Practice: Approach to Antiplatelets and PPI Combination

Nursing Continuing Education: Stroke Therapies and Nursing Care

2:00 – 2:302:30 – 3:003:00 – 3:30

3:30 – 4:004:00 – 4:304:30 – 5:00

6:00 – 8:00

Dr. Belinda Mesina-NepomucenoDr. Pedro Danilo J. LagamayoElmer J. Catangui, RN

Milanie V. Gonzales, RNStephanie Jan Arriola, RNFerdinand P. Aganon, RN

Moderators: Mikhail D. Paraiso, RN and Diana Jean F. Serondo, RN

Clinical Stroke Recognition and Stroke SyndromesImaging in the Diagnosis of Acute StrokeTargets and Timelines in Acute Ischemic Stroke: Focus on Thrombolytic TherapyDrugs in Stroke and Nursing ConsiderationsNurses Role in Acute Stroke ManagementInteractive Case Presentation

SSP Business Meeting



Focus Clinical Topic : Improving Life After Stroke

8:30 – 9:00

9:00 – 9:30

9:30 – 10:0010:00 – 10:30

10:30 – 11:00

Dr. Artemio A. Roxas Jr.

Dr. Josephine C. Gutierrez

Dr. Alejandro C. Baroque IIDr. Darwin A. Dasig

TIME TOPIC SPEAKER

Moderators : Dr. Paulita P. Pingul & Dr. Loreto Talabucon

Stroke should not Strike Twice: Practical Evidence-Based Useof the Power Trio: Antithrombotics, Antihypertensives and Statins Post Stroke Seizure: Predictors Prophylaxis and Pharmacologic TherapyPost Stroke DepressionScreening and Management of Vascular Dementia

BREAK/Visit to the Booth


11:00 – 11:3011:30 – 12:00 N

12:00 – 1:30

1:30 – 2:002:00 – 2:30

2:30 – 4:30

4:30 – 6:00

Deep venous thrombosis in Stroke Pains in Post Stroke Patients

Industry Supported Symposium (E-CHIMES)

Bladder Dysfunction Post Stroke Sleep Disturbance after Stroke

Neurosurgery Symposia 1. Complications of Surgery for Stroke 2. Neurological Improvement after Early Cranioplasty for Decompressive Hemicraniectomy

Industry Supported Symposium (MEDICHEM)

Dr. Geraldine L. MarianoDr. Maria Salome N. ViosDr. Johnny K. Lokin

Dr. Maria Epifania V. CollantesDr. Rosalina B. Espiritu- Picar

Dr. Manuel MarianoDr. Carlo Barredo

Dr. Maria Epifania V. CollantesDr. Ma. Geraldine Espiritu


TIME TOPIC SPEAKERNursing Continuing Education: Rehab for Nurses

8:30 – 9:00

9:00 – 9:30

9:30 – 10:00

10:00 – 10:30

Bed positioning for Optimal Patient Safety and Comfort

Safe Patient Handling (Lifts and Transfers)

Passive Range of Motion Exercises

Dealing with Aphasic Patients

Arlene Chiong Maya, MSPT, PTRP

Christine Rose Versales, MSPT, PTRP

Valentin C. Dones, III, PhD, PTRP

Jocel Regino, MSPT, PTRP

Moderators: Louie Paul P. Eugenio, RN and Diana Angeline P. Abella, RN

10:30 – 11:00

11:00 – 11:30

11:30 – 12:00

12:00

Kristina Devora, MSPT, PTRP


BREAK/BOOTH VISIT

Aspiration Precautions: Dealing with Patients with Swallowing Problems

Demo

Industry Supported Symposium (Astellas Pharma)Management of Increased Blood Pressure after Acute Stroke



Allied Health Care: Current Approaches to Stroke Rehabilitation

1:30 – 2:00

2:00 – 2:20

2:20 – 2:40

2:40 – 3:00

3:00 – 3:30

3:30 – 4:00

4:00 – 4:45

4:45 – 5:00

7:00 PM ONWARDS

Rehabilitation Precautions in Stroke

Mindfulness-based Strategies

Contemporary Approaches in Improving Oral Motor Function

Open Forum

Upper Extremity Re-training

Lower Extremity Re-training

Interdisciplinary Approach to Stroke Rehabilitation: Case Presentation

Open Forum

Induction of Incoming SSP Officers and Board of Trustees

Fellowship NightTheme: Let’s Get Physical

Dr. Myla C. Wahab

Patricia Medina (Psychologist)

Andrea Monique Dargantes, CSP-PASP

Kristine Ann Carandang, OTRP

Paul Christian Reyes, PTRPRensyl B. Barquia, PTRPDr. Jose Alvin Mojica

Dr. Angelita Roma P. Hebreo

TIME TOPIC SPEAKER

Moderator : Dr Alvin P. Mojica Verona Function Hall 1

Rialto Ballroom

Rialto Ballroom


Joint SSP-Philippine Society of Neurorehabilitation Symposium

8:30 – 9:00

9:00 – 9:30

9:30 – 10:00

10:00 – 10:30

10:30 – 11:00

11:00 – 11:30

11:30 – 12:00 N

12:00 – 2:00

Dr. Manolette C. Guerrero

Dr. Michelli Gose-Yusay

Dr. Arturo F. Surdilla

Prof. Ma. Georgina D. Mojica

Dr. Raymond L. Rosales

Dr. Reynaldo Rey-Matias


Dr. Annabelle Y. Lao-Reyes

TIME TOPIC SPEAKER

Moderators: Dr. Arturo F. Surdila and Dr. Maria Mercedes Barba Verona Function Hall 2

The Evolution of Neuroplasticity and its Application into Clinical Practice

Rehabilitation in Patients with Dementia

Rhythm-based Therapy in Stroke Rehabilitation

Speech Evaluation and Rehabilitation in Stroke

BREAK/Visit to the Booth

Spasticity Neurorehabilitation Care, Evidence-based

TMS, tDCS and Neuromodulation Stroke Rehabilitation

Industry Supported SymposiumDimensions of Real World Evidence of NOAC’s (Bayer)

Use of Controlled Release Cilostazol in Secondary Stroke Prevention: A New Approach (Pharma 3)


Joint SSP-Philippine Society of Neurorehabilitation SymposiumTIME TOPIC SPEAKER

Moderators: Dr. Arturo F. Surdila and Dr. Maria Mercedes Barba Verona Function Hall 2

2:00 – 2:30

2:30 – 3:00

3:00 – 5:00

5:00 – 6:00

6:00 – 8:00

Dr. Jerico De la Cruz

Dr. Marissa B. Lukban

Dr. Marc Conrad C. MolinaDr. Pedro Danilo J. Lagamayo

Dr. Jennifer F. Manzano

*Limited slots per workshop. Pre-registration is required.

Robotics in Stroke Rehabilitation

An Overview of Childhood Strokes

SIMULTANEOUS WORKSHOPS 1, 2 and 3 1. Botulinum Injection for Spasticity - Facilitators : Dr Jeanne Flordelis & Dr Jerico De la Cruz

2. Rehabilitation Techniques in Swallowing: What is the Evidence? - Facilitators: Dr Reynaldo Rey-Matias & Dr. Corazon Cabuquit

3. Thrombolysis (rTPA) Workshop Review of Inclusion and Exclusion Criteria CT scan Imaging: Use of the ASPECTS score In Determining Eligibility rTPA Preparation and Administration Interactive Case Presentations

Holy Mass

Closing Dinner

Palermo Hall 2

Opening CeremoniesAugust 4, 2016, Verona Function Hall 2, 8:00 – 9:30 am

8:00 - 8:15 Ribbon-cutting and Opening of exhibits 8:15 - 9:00 Invocation, Pambansang Awit,,SSP Hymn PresentationofSSPNationalandChapterOfficers,BoardofTrustees Awarding of Plaques to SSP Past Presidents9:00 - 9:30 President’s Plenary

Dr. Romulo Esagunde and Dr. Maria Socorro SarfatiMaster of Ceremonies

Induction of Incoming SSP Officers & Fellowship Night

August 5, 2016, Rialto Ballroom, 7:00 pm

DINNER

AwardingofCertificatesofAppreciationtoParticipatingPharmaceuticalCompanies

Valedictory Address Dr. Maria Cristina San Jose SSP PresidentInductionofNewSSPOfficers Dr. Joven R. Cuanang SSP Founding PresidentInaugural Address Incoming SSP President

Emcees: Dr. Godfrey Robeniol and Dr. Maria Annette Bautista

Fun Fun Fun Fellowship Night Theme: Let’s Get Physical

Game Masters: Dr. Jeremias Bautista and Dr. Maria Annette Bautista

Games, Music and Dancing

SPEAKERSand

ABSTRACT

DAY 1: President’s Plenary: August 4, 2016SpeakerAbstract

Evidence-based strategies considered as “standard of care” for the treatment, prevention and rehabilitation of stroke has been established. Unfortunately, gaps exist between what is known and what is being done for Stroke in the Philippines. Lack of knowledge of stroke signs and symptoms & importance of risk factor control and seeking immediate medical attention by the public account for adherence problems and delays in presentation. Many hospitals are ill – equipped or unprepared to handle hyperacute Stroke. Despite efforts for education & dissemination, key information has not reached many critical parts of the country. Specialist care is highly concentrated in the urban areas. We cannot undermine economic, political & geographical reasons as major barriers for equal access to & provision of standard of care.

The task to reduce the burden of Stroke in the Philippines is formidable. Our health care system and resources are already challenged and we expect the number of Stroke cases to rise over the next several years. While there are definite challenges, we need to focus on opportunities and workable solutions. The Stroke Society of the Philippines and the Philippine Neurological Association have spearheaded worthy advocacy projects and activities towards improving Stroke care, yet much remains to be done. Concerted efforts and strategic partnerships by individuals, organizations, both government and NGO, local and international is crucial if we aim for a stroke-free Philippines.

STROKE BURDEN IN THE PHILIPPINES: CHALLENGES, OPPORTUNITIES AND INITIATIVES

MARIA CRISTINA Z. SAN JOSE, MD, FPNA

• 1994, Doctor of Medicine, UST Faculty of Medicine and Surgery• 1999, Residency in Adult Neurology (Chief Resident), UP-PGH• 2001, Fellowship in Stroke/Cerebrovascular Disease (Chief Fellow), St. Luke’s

Medical Center• Clinical Rotations at the University of Pittsburgh Medical Center (UPMC) Stroke

Institute, 2001 and Columbia-Presbyterian Medical Center Stroke Institute & Neurovascular Laboratory, 2002

EDUCATION AND TRAINING

AFFILIATIONS, ACADEMIC AND ADMINISTRATIVE POSITIONS• President, Stroke Society of the Philippines• Head, Stroke Service, St. Luke’s Medical Center, QC• Head, Health Service Outcomes Research (HSOR) under the Research and

Biotechnology Group of St. Luke’s Medical Center• Residency Training Officer, Adult Neurology, Department of Neurosciences UP-PGH• Clinical Associate Professor, UP College of Medicine• Member: Stroke Council; Research Committee, Neurosonology Group of the

Philippine Neurological Association and Member of the Editorial Board of the Philippine Journal of Neurology (PJN)

• 2012, 2013 Research Chair Holder, St. Luke’s Medical Center QC for commitment to research excellence in the field of Neurology

• 2015 SLMC-NOVARTIS Young Researcher Award• 2015 St. Luke’s Medical Center Special Award for Excellence in Clinical

Outcomes

AWARDS AND CITATIONS

DAY 1: What’s New in Acute Stroke Therapy: August 4, 2016Speaker

Craig Anderson is Professor of Stroke Medicine and Clinical Neuroscience in the Sydney Medical School at the University of Sydney and the Institute of Neurosciences of Royal Prince Alfred Hospital. Having led several major international stroke studies, Craig is widely acknowledged as a leader in his field.

He was recently awarded the Royal Prince Alfred Research Medal for Excellence in Research. Craig is a member of several specialist societies, an Editor for the Cochrane Stroke Group, and a former President of the Stroke Society of Australasia. He has published widely on the clinical and epidemiological aspects of stroke, cardiovascular disease and aged care. He is on the Steering Committee for several large-scale research projects

LOW DOSE VS STANDARD DOSE OFINTRAVENOUS ALTEPLASE

IN ACUTE ISCHEMIC STROKE: RESULTS OF ENCHANTED TRIAL

AND IMPLICATIONS IN THE ASEAN REGION

HOW TO MANAGE BP IN ACUTE ICH: RECONCILING RESULTS OF THE

INTERACT AND ATACH TRIALS

PROF. CRAIG ANDERSON

SpeakerAbstract• 2007, Doctor of Medicine, UST Faculty of Medicine and Surgery

• 2012, Residency in Adult Neurology and Psychiatry (Chief Resident), UST Hospital

• 2014, Fellowship in Stroke and Neurovascular Ultrasound (Chief Fellow), UST Hospital


AFFILIATIONS, ACADEMIC AND ADMINISTRATIVE POSITIONS• Member, International Parkinson and Movement Disorder Society• Fellow, Philippine Neurological Association• Core Member, Stroke Council, Philippine Neurological Association• Specialty Coordinator, Neurology and Psychiatry Group, San Pablo City Medical

Society• Head, Stroke Services and Acute Stroke Unit, Community General Hospital of

San Pablo City, Inc.• Head, Hospital HIV & AIDS Core Team, Community General Hospital of San

Pablo City, Inc., Laguna

Stroke Telemedicine is a real-time audiovisual conferencing system allowing stroke specialists to remotely access patients through the healthcare provider and to review their history, physical and neurological findings, neuroimaging, and investigational results across the network. The American Heart Association and American Stroke Association gave recommendations on the technical requirements of such program but SSP came up with a conceptual framework that is feasible, innovative, and inexpensive. Thus, the project, “Stroke Society of the Philippines – Alternative Support System for Ischemic Stroke Thrombolysis Philippines” or SSP.ASSIST.PH.

SSP.ASSIST.PH program is designed to make use of available technology in order to provide 24 hours a day, 7 days a week, specialist’s assistance to any physician who is in need of real-time guidance for acute ischemic stroke thrombolysis – anywhere in the Philippines. It is intended to improve the efficacy of acute stroke management by providing an alternative real-time support to facilities located in geographically remote areas where stroke expertise is typically not available on an emergent basis. This program will serve as a channel that may empower first-line physicians to confidently institute IV tPA treatment knowing that they, at any time, can be virtually assisted by a stroke specialist or a neurologist with vast experience in thrombolytic therapy.

TELEMEDICINE AND THROMBOLYTIC THERAPY: THE SSP.ASSIST.PH PROJECT

ALLAN A. BELEN, MD, FPNA

DAY 1: What’s New in Acute Stroke Therapy: August 4, 2016

Speaker• UP College of Medicine 1994• UP PGH Neurosurgery Residency Program 1999• Cerebrovascular Neurosurgery Fellowship, University of Toronto

2000 – 2001• Diagnostic and Interventional Neuroradiology Fellowship,

University Of Western Ontario 2002-2003


AFFILIATIONS, ACADEMIC AND ADMINISTRATIVE POSITIONS• Head of Stroke and Neurosurgery, St. Luke’s Medical Center Global City• Training Officer, UP PGH Neurosurgery• Board of Directors, Philippine Board of Neurosurgery

ENDOVASCULAR THERAPY IN ACUTE ISCHEMIC STROKE; ARE WE THERE YET?

PETER PAUL P. RIVERA, MD

DAY 1: What’s New in Acute Stroke Therapy: August 4, 2016

The management of ischemic stroke has evolved at a very fast pace in recent years. The management of ischemic stroke by endovascular means began in earnest in the 1990’s with the development and improvement of neuroimaging, stroke teams and endovascular devices, technology and know how. The past ten years have shown a rapid evolution in stroke management, with most true neurovascular centers relying on endovascular techniques, particularly mechanical thrombectomy, to achieve early recanalization and therefore good outcomes in carefully selected patients. Even during the “dark ages” cast by IMS III results, a lot of neurovascular specialists continued to follow their thrombectomy protocols. At present, at least five trials, beginning with MR CLEAN, have shown good results in favor of endovascular recanalization of vessels for acute stroke. In part because of this, the number of cases done and the number of devices available for the interventionist have multiplied and many more are in development/production. Despite these, there are still multiple challenges that face the stroke specialist. There are certain problems with regards to the management of stroke that are common amongst developing countries; but there are also some problems that are specific to the Philippines.

Abstract

The prerequisite in understanding brainstem ischemic syndrome is to know the anatomy of the brainstem perfectly. Peter Gates’ The Rule of 4 is a simple method to help neurologists and non-neurologists remember the anatomy of the brainstem and the associated various brainstem vascular syndromes.

Essentially, understanding of the different vascular syndromes will guide us to the specific vascular territory involved in stroke and its corresponding mechanism. The syndromes are derived from the following sections of the brainstem: lesions of the medial upper medulla, lesions of the lateral upper medulla, lesions of the medial lower pons, lesions of the lateral lower pons, lesions of the medial midpons, lesions of the lateral midpons, lesions of the medial upper pons, lesions of the lateral upper pons, lesions of the medial midbrain, and lesions of the lateral midbrain.

The names of the syndromes are quite fascinating as these are all eponymic and named after the original describers of the syndromes. In this lecture, we will recognize all of them again with their various constellations of signs and symptoms commonly found in posterior circulation infarct.

BRAINSTEM SYNDROMES

DAY 1: Posterior Circulation Stroke: August 4, 2016

• 2001, Doctor of Medicine, Ateneo de Zamboanga University College of Medicine• 2002, Masters in Public Health, Ateneo de Zamboanga University College of Medicine• 2007, Residency in Adult Neurology, St. Luke’s Medical Center• 2009, Clinical Research Fellowship in Stroke/Cerebrovascular Disease, St. Luke’s Medical Center• Visiting Clinical Stroke Fellow – Massachusetts General Hospital, June 2009 and University of

Cincinnati, July-August 2009


AFFILIATIONS, ACADEMIC AND ADMINISTRATIVE POSITIONS• Fellow, Philippine Neurological Association• Board of Trustees, Stroke Society of the Philippines• Head, Acute Stroke Unit, St. Luke’s Medical Center, Quezon City

Speakers

BRAINSTEM SYNDROMES

MA. CRISTINA Z. MACROHON-VALDEZ, MD, FPNA

JOSE C. NAVARRO, MD, FPNA

ANATOMY AND BLOOD SUPPLY

• 1972, Doctor of Medicine, Faculty of Medicine and Surgery, University of Santo Tomas• 2002, Master of Science in Clinical Epidemiology, Department of Medicine, UP


AFFILIATIONS, ACADEMIC AND ADMINISTRATIVE POSITIONS• Fellow, Philippine Neurological Association• Fellow, Philippine Society of Critical Care Medicine• Former Chair, Department of Neurology, Jose R. Reyes Memorial Medical Center• Head, Neuro ICU and Acute Stroke Unit and Neurovascular Laboratory, Philippine Heart Center• Head, Stroke Services and Stroke Unit, Department of Neurology and Psychiatry, UST• Member, Clinical Epidemiology Unit, Faculty of Medicine and Surgery, University of Santo Tomas • Past President, Philippine Neurological Association• Honorary Fellow, Thai Stroke Society• Member, Editorial Board, ASEAN Neurological Association• Executive Member, Neurosonology Research Group of World Federation of Neurology• Past President, Asian Chapter, Neurosonology Research Group at World Federation of Neurology• Chair, Neurosonology Group of Philippine Neurological Association• Past President, Stroke Society of the Philippines• Member, Board of Directors (Asia), International Stroke Society• Executive Member, Asian Stroke Forum


Speakers

MEDICAL MANAGEMENT

ROMULO U. ESAGUNDE, MD, FPNA

JOHNNY K. LOKIN, MD, FPNA

DIAGNOSTICTESTS

AFFILIATIONS, ACADEMIC AND ADMINISTRATIVE POSITIONS• Treasurer, Stroke Society of the Philippines • Chief of Neurology Section, Delos Santos Medical Center• Past President, Philippine Neurological Association • President of the Philippine College of Psychopharmacology• Head, Neuro-Intensive Care and Stroke Unit, Chinese General Hospital & Medical Center • Member, Stroke Services, University of Santo Tomas Hospital• Vice Chair for Clinical Training, Department of Neurology and Psychiatry, University of

Santo Tomas Hospital• Member, Adult Neurology Specialty Board, Philippine Neurological Association • Honorary Fellow, Korean Neurocritical Care Society

• Doctor of Medicine, University of Santo Tomas Faculty of Medicine and Surgery • Residency Training in Neurology, Jose R. Reyes Memorial Medical Center• Fellowship in Stroke / Neurosonology, Singapore General Hospital


AFFILIATIONS, ACADEMIC AND ADMINISTRATIVE POSITIONS• Chairman, Department of Neurology, Jose R. Reyes Memorial Medical Center • Vice President, Philippine Neurological Association• Secretary, Stroke Society of the Philippines • Member, World Stroke Organization• Member, Asian Chapter Neurosonology Study Research Group• Member, American Academy of Neurology• Member, Neurosonology Study Group, Philippine Neurological Association• Member, Stroke Council, Philippine Neurological Association• Member, Dementia Society of the Philippines• Member, International Movement Disorder Society


DAY 1: Stroke Therapies and Nursing Care: August 4, 2016SpeakerAbstract• 2007, Doctor of Medicine, UERMMMC College of Medicine

• 2012, Residency in Adult Neurology, UERM Memorial Hospital• 2014, Fellowship in Stroke and Cerebovascular Disease, St.

Luke’s Medical Center


AFFILIATIONS, ACADEMIC AND ADMINISTRATIVE POSITIONS• Fellow, Philippine Neurological Association• Active Staff, Providence Hospital, Quezon City• Visiting Staff, Rizal Medical Center and Capitol Medical Center

As in any medical case, the clinician’s first task is to decide what is happening to his patient. Clinical diagnosis of stroke is often challenging, but the task becomes less trying when we follow a systematic approach when dealing with such patients. Two key questions must be answered, to be able to direct appropriate diagnostic modalities and timely treatment:

First, is my patient having a stroke? Clinicians should first ask whether the findings could alternately be caused by conditions other than a stroke, such as a brain tumor, metabolic disorder, infections, drugs, traumatic injury, and the like. Data from the patient’s history are used to answer this, including timing of events, presence of cerebrovascular risk factors and accompanying signs and symptoms. Several scoring systems are also available to aid in distinguishing a stroke from non-strokes.

Second, where is the lesion? This concerns the anatomic localization of the stroke, in the brain and in the cerebrovascular system, deduced from a thorough physical and neurologic examination. Stroke syndromes are sets of symptoms that help identify which part of the brain has been injured in a stroke. It is important that we are aware of the various stroke syndromes, particularly those with potential devastating effects, which could lead to significant disability and even death.

CLINICAL STROKE RECOGNITION AND STROKE SYNDROMES

BELINDA MESINA-NEPOMUCENO, MD, FPNA

SpeakerAbstract• 1977, Doctor of Medicine, UST Faculty of Medicine and Surgery

• 1983, Residency in Diagnostic Radiology and Ultrasound, Division of Radiological Sciences, Santo Tomas University Hospital


AFFILIATIONS, ACADEMIC AND ADMINISTRATIVE POSITIONS• Head, Section of Ultrasound, Philippine Heart Center• Board Member – The Stroke Society of the Philippines• Chair, Department of Radiological Sciences and Medical Imaging at the

MCU-FDTMF Hospital• Associate Professor 2, UST Faculty of Medicine and Surgery• Visiting Professor, MCU College of Medicine• Active Medical Staff (Rotating) in Diagnostic Radiology, Ultrasound, CT

Scan and MRI and held different administrative positions at the following: Santo Tomas University Hospital (UST), Philippine Heart Center, Manila Central University – FDTMF

The use of diagnostic imaging such as non-contrast CT is a very important tool in the management of stroke particularly in differentiating hemorrhagic from ischemic stroke.

It just be emphasized that the most important factor that will determine the outcome of management in acute stroke is time. The faster clinical diagnosis and the diagnostic tests are completed and results are relayed to the stroke team, the better is the outcome. CT provides the fastest diagnostic test for evaluating patients who are suspected to have suffered a stroke.

MRI can provide much more detailed information regarding the state of the brain in acute stroke and at the present state of development can also provide diagnosis of hemorrhage but this examination takes a longer time to perform. Since the procedure will take a longer time to complete, the chance of encountering problems with the quality of images becomes magnified. Motion is the worst enemy of MRI as this can significantly degrade the image that will be produced to the point that it can no longer of diagnostic quality.

IMAGING IN THE DIAGNOSIS OF ACUTE STROKE

PEDRO DANILO J. LAGAMAYO, MD

DAY 1: Stroke Therapies and Nursing Care: August 4, 2016

SpeakerAbstractCompleted his nursing degrees and midwifery studies and his Masters in

Business Administration major in Human Resources and Development in the Philippines. He obtained his stroke nursing expertise in the United Kingdom. He worked as a clinical nurse specialist in stroke and TIA in the UK for 12 years. He finished his Masters Degree with distinction in London South Bank University major in Nursing with background of specialist neuroscience, acute management in stroke, thrombolysis nursing and stroke prevention.

He is currently working as a Stroke Nurse Specialist at the King Abdulaziz Medical City ( Riyadh) . He developed the Specialized Stroke Nursing Program and initiated the stroke focus group at the KAMC. . He is leading on the development of competencies among CRNs and nursing staff in acute medical units.

He has published 30 articles, researches and abstracts in the international journal of nursing and practice. He is a member of the editorial board of the Public Health Open Journal.

He was nominated as the 2014-2015 Rising Star of the year in the UK’s leading Health Service Journal for his major contribution to stroke care in the UK.

Time is brain. If time is lost, brain is lost. This concept is clinically relevant in

acute management of stroke particularly in thrombolytic treatment. The use of

thrombolysis or clot busting treatment in acute ischemic stroke is effective if it is

administered within 4.5 hours of onset of stroke symptoms. It is imperative that

nurses, being health care providers, should act in a timely and proactive fashion.

The presentation will highlight the evidence–based thrombolytic treatment for

acute ischemic stroke, define the importance of timeline and targets, and explore

the role of nurses in the safe administration and post monitoring of the treatment.

TARGET AND TIMELINES IN ACUTE ISCHEMIC STROKE: FOCUS ON THROMBOLYTIC THERAPY

ELMER J. CATANGUI RN, RM, MBA, PGCERT, MSC IN NURSING (UK)


SpeakerAbstract• 2006, BS Nursing, Associate in Health Science Education, FEU


AFFILIATIONS, ACADEMIC AND ADMINISTRATIVE POSITIONS• Member, Philippine Nurses’ Association • Member, Critical Care Nurses’ Association of the Philippines• Member, Stroke Society of the Philippines• Stroke Nurse, St. Luke’s Medical Center, QC

Stroke is a devastating and complex disease that really imposes a great burden to

patients and their loved ones. A wide variety of treatment includes physiologic and

pharmacologic ones. Drug administration is a key principle in stroke management.

Being frontliners, nurses play a key role towards patients’ care and giving

medication is one of their major duties and responsibilities.

Given a wide range of medications in stroke, cautious and accurate delivery is

warranted. Nurses are responsible for the timely administration of a drug and giving

the right dose to a stroke patient. We should be knowledgeable of the commonly

used drugs in stroke to avoid committing errors. Likewise, educating patients and

their family about stroke and the medications they are taking is very essential for

secondary stroke prevention.

DRUGS IN STROKE AND NURSING CONSIDERATIONS

MILANIE V. GONZALES, RN

• HERO (Hospital Employees Reaching Out) Award, Institute for Neurosciences/ Acute Stroke Unit



DAY 1: Stroke Therapies and Nursing Care: August 4, 2016SpeakerAbstract• 2012, Bachelor of Science in Nursing, Trinity University of Asia, St.

Luke’s College of Nursing, Quezon City


AFFILIATIONS, ACADEMIC AND ADMINISTRATIVE POSITIONS• Stroke Nurse, Stroke Service and Brain Attack Team, St. Luke’s

Medical Center, Global City• Member, Neurocritical Care Society • Member, Critical Care Nurses Association of the Philippines, Inc. • Member, Stroke Society of the Philippines• Member, Philippine Nurses Association

Time is of the essence when it comes to stroke. It is important to have a good

clinical-eye for us to recognize the signs and symptoms of stroke in order to save

the patient from death or serious disability. Nurses play a vital role in the course

of hospitalization of stroke patients. From admission to discharge, we provide

continuous assessment, planning and intervention ensuring quality outcome for our

patients. Stroke is an intricate disease that requires multidisciplinary management

where nurses act as the coordinators of care throughout the patient’s admission.

This lecture will touch on 2 phases of stroke care: (1) The emergency or hyperacute

phase, which encompasses pre-hospital setting and the emergency department,

and (2) the acute care phase, which covers critical care units, intermediate care

units, stroke units, and general medical units.

NURSES ROLE IN ACUTE STROKE MANAGEMENT

STEPHANIE JAN C. ARRIOLA, RN

SpeakerAbstract• 1997, Tertiary, Bachelor of Science in Nursing, Centro Escolar University

• 2000, Specialization Training, Stroke Management Program, National Neuroscience Institute and Tan Tock Seng Hospital, SIngapore

• 2004, Master of Arts in Nursing, University of Santo Tomas• 2011, Master in Business Administration in Health, Graduate School of Business,

Ateneo de Manila University• 2011 – present, Doctor of Philosophy in Human Resource Management, Graduate

School, University of Santo Tomas


ACADEMIC AND ADMINISTRATIVE POSITIONS• Director of Nursing, The Medical City Clark• Nurse Manager, Special Projects Team, TMC Dubai and TMC Clark Projects• Member, Philippine Nurse’s Association• Member, Critical Care Nurses’ Association of the Philippines• Member, Stroke Society of the Philippines• Member, Philippine Nursing Research Society, Inc.• Member, ANSAP - Infusion Nurses Society-Philippines• Member, American Association of Critical Care Nurses (Digital membership)

The objective of the presentation is to integrate the basic principles of stroke nursing

care management to the different imaging findings. This will be an interactive

discussion with the speaker and participants.

INTERACTIVE CASE PRESENTATION

FERDINAND P. AGANON, RN, MAN, MBAH

• 2005, The Outstanding Performance Success (TOPS) as Clinical Nurse Supervisor, Medical City Annual Awards

• 2013 and 2011 Winner for Nursing Excellence in Patient Safety • Hospital Management Asia Awards



DAY 2: Improving Life After Stroke: August 5, 2016SpeakerAbstractAFFILIATIONS, ACADEMIC AND ADMINISTRATIVE POSITIONS

• Associate Professor and Section Chair : UP- College of Medi-cine, Department of Neurosciences

• Director of Acute Stroke Unit and Neuro-ICU: The Medical City Hospital

• Chairman - Stroke Council, Philippine Neurological Association• Immediate Past President : Stroke Society of the Philippines• Past President: Philippine Neurological Association• Past Editor in Chief: Philippine Journal of Neurology• Clinical Epidemiologist-Investigator for stroke related studies:

HOPE-3, ENGAGE, INTERSTROKE, RELY, RELY-Able, ON-TARGET, TRANSCEND, REACH Registry, STROKE-OP, APOLLO, PICASSO and SOCRATES

Stroke begets stroke. Although the best way to prevent stroke is not to have one, among patients with prior Stroke or TIA - the best defense is a good offense! For patients with ischemic stroke or TIA, the use of Antithrombotics, Antihypertensives and Statins have been consistently shown to be helpful in reducing stroke recurrences.

Within 5 years of a first stroke, the risk for another stroke can increase to more than 24 to 40% especially during the first year. Recurrent strokes increases with age in all stroke subtypes and often have a higher rate of death and disability. Pertinent questions we clinicians should ask to guide management for stroke recurrence are the following: Is it early stroke recurrence or worsening of incident stroke? Was the prior stroke diagnostic work-up complete or were key diagnostic studies omitted? Are we providing the appropriate stroke treatment and preventions based on the stroke mechanism? Based on the extent of the prior stroke diagnostic work-up, the patient’s overall clinical condition and severity of illness, and patient-family input, is it appropriate to obtain additional diagnostic studies?

What to prescribe among the locally available approved drugs, which dose to choose, when to start and how long, and in what clinical subtypes of ischemic stroke to use these medications will be discussed using evidence-based data and latest guideline recommendations. As always, individualized approach to patient care and lifestyle modification are emphasized.

STROKE SHOULD NOT STRIKE TWICE: PRACTICAL EVIDENCE-BASED USE OF THE POWER TRIO:

ANTITHROMBOTICS, ANTIHYPERTENSIVES AND STATINS

ARTEMIO A. ROXAS JR., MD, FPNA

SpeakerAbstract

Seizures are reported following a stroke in 2-30% of cases.

Early onset seizure incidence range from 4.3-6.5% while late onset seizures are much less frequent, reported in 2.3 -3.14% of cases in different studies. Although reliable predictors that determine recurrence of post stroke seizures or epilepsy have not yet been vefiried, some of the risk factors that have been highly associated with early onset (<2 weeks) seizures following a stroke are intracerebral and subarachnoid hemorrhage, hemorrhagic transformation, hyponatremia and alcoholism. Factors that correlate with late onset seizures (>2 weeks) are cerebral cortical involvement (regardless of whether it is from an infarction or hemorrhage), younger age of the patient and severity of neurological deficits. Late onset seizures occur 6 mos- 2 yrs after a stroke and has a high tendency for recurrence (50%). Post stroke epilepsy or seizure recurrence has been independently correlated to large volume of hemorrhage and seizure on admission.

Epileptogenetic mechanisms underlying post stroke seizures and epilepsy are still vaguely understood. The breakdown products of hemosiderin may increase hyperexcitability of cortical neurons. Animal studies on ischemic injury and seizures have demonstrated that the down regulation of IA type potassium channels in the brain tissue surrounding the infarct may contribute to the development of post stroke seizures and long term seizure susceptibility after ischemia.

Prophylactic coverage with anti-epileptic drugs in stroke is not routinely recommended. However, due to the high risk of recurrence after a first late onset seizure, maintenance antiepileptic drug treatment is strongly advised for long term use, especially in the presence of other risk factors.

The choice of treatment for epilepsy among patients with stroke entails special consideration. The use of the first generation antiepileptic drugs (phenobarbital, phenytoin and carbamazepine) which are hepatic enzyme inducers may increase clearance of certain stroke medications rendering them less effective. They also have high protein binding which can result in drug-drug interactions (with warfarin, losartan, statins,etc) esp. among those patients with multiple medical co-medications. Enzyme inducing antiepileptic drugs (EIAEDs) also interfere with cholesterol metabolism, elevating cholesterol levels and may worsen atherosclerosis.

POST STROKE SEIZURE: PREDICTORS, PROPHYLAXIS AND PHARMACOLOGIC THERAPY

JOSEPHINE CASANOVA-GUTIERREZ, MD, FPNA

• Doctor of Medicine, 1984, University of the Philippines- College of Medicine

• Neurology Residency, 1986-1989, Philippine General Hospital• Fellowship in Clinical Immunology, 1990, Kyushu University• Fellowship in Clinical Epileptology, 2006-2007, University of New South

Wales


AFFILIATIONS, ACADEMIC AND ADMINISTRATIVE POSITIONS• Associate Professor 4 and Head, Section of Neurology, Department of

Internal Medicine, De la Salle University College of Medicine• Associate Professor 3• Asst. Chairman for Postgraduate and Faculty Development and Head,

EEG Unit, Department of Neurosciences, UP- Philippine General Hospital• Past President, Philippine League Against Epilepsy 2010-2011

DAY 2: Improving Life After Stroke: August 5, 2016

SpeakerAbstract

Post-stroke depression (PSD) is one of the most important complications of medical illnesses and the most clinically significant of all the neuropsychiatric sequelae of stroke, yet often overlooked if not totally ignored. In the most recent updated systematic review and meta-analyses of observational studies, recognizing the differences in methods of ascertaining symptoms of depression and differences in enrolled populations, a pooled estimate from population-based studies of individuals who have had a stroke indicated a prevalence of depression of 31% (95% confidence interval 28% to 35%). The prevalence rate is 19.3% among hospitalized patients and 23.3% among outpatient samples.

Stroke-associated depression leads to greater disability, increased mortality and risks of recurrent vascular events. Predictors for PSD include previous stroke, degree of disability, prior history of depression and anxiety, restricted social activity, age <68 years old, female and single living. The most recent systematic review offered no support for the hypothesis that lesion of the left hemisphere was associated with an increased risk of depression after stroke.

Given that the nature of physical and psychiatric illnesses are inseparable, PSD appears not to be the result of “pure” biological nor psychological causes, but instead to be multifactorial in origin and consistent with the biopsychosocial model of illnesses.

POST-STROKE DEPRESSION

ALEJANDRO C. BAROQUE II, MD, FPNA

• 1984, Doctor of Medicine, UST College of Medicine and Surgery• 1989, Residency in Neurology and Psychiatry, Santo Tomas University Hospital,

Manila• Transcranial Doppler Training, University of Texas Medical School, Hermann

Hospital, Houston, Texas, 2002


AFFILIATIONS, ACADEMIC AND ADMINISTRATIVE POSITIONS• Fellow, Philippine Neurological Association • Fellow, Philippine Psychiatric Association • Secretary, Department of Neurology & Psychiatry, Faculty of Medicine & Surgery, UST• Past President, Philippine Neurological Association • Past Chairman, ASEAN Neurological Association • Past Secretary General, Asia-Pacific Conference Against Stroke • Convenor and Member, Stroke Services Unit, Section of Neurology, Department

of Neurology & Psychiatry, UST• Member, Neurosonology Group, Philippine Neurological Association• Past Chairman, Adult Neurology Specialty Board, Philippine Neurological Association• Past Secretary, Stroke Society of the Philippines

• University of Santo Tomas International Publication Award (2012-2014) • University of Santo Tomas Gold Series Award for Research (2012-2014)



SpeakerAbstract

Vascular Dementia (VaD) is a common cause of dementia, noted to be the second most common single cause after Alzheimer’s Disease (AD) in many epidemiological studies, and the most common cause in some Asian countries. But diagnosis has not been as straightforward as those of other common causes of dementia, for several reasons.

As in most disorders causing dementia, the diagnosis of VaD relies mainly on clinical evaluation. The medical history, supplemented by an independent informant, should establish the vascular event and the presence of dementia, with focus on the cognitive domains affected, mode of onset, pattern of progression and impact on function (Activities of Daily Living). The history should likewise document information regarding the level of education, past medical history, medication history and family history. The neurological examination, including a detailed mental status examination, should document the pertinent findings supportive of cognitive impairment in dementia and neurological deficits in cerebrovascular disease. A formal neuropsychological evaluation is ideal, and would be most helpful in cases with diagnostic dilemma. As in every patient suspected of having dementia, structural neuroimaging is recommended for evaluation. In VaD, this is used to document the presence of cerebrovascular disease and the particular etiology causing dementia. The Ischemic Score (Modified Hachinski Ischemic Scale for Vascular Dementia, 1975 and 1980) remains a useful tool for clinicians and researchers in the diagnosis of VaD.

Stroke prevention remains an important component in the management of VaD. This includes pharmacological and non-pharmacological strategies to reduce risk factors for cerebrovascular disease. Reversible conditions that mimic dementia, like hypothyroidism or vitamin B12 deficiency, if clinically suspected, should be ruled out and treated. Concomitant cognitive impairing conditions including BDSDs should also be managed. Loss of cholinergic neurons and cholinergic pathway disruption are features of VaD. Use of Cholinesterase Inhibitors (ChEI) have been shown to have symptomatic improvement on cognition, function and behaviour. In clinical practice, ChEI and Memantine are usually given empirically and continued if improvement of symptoms is noted.

SCREENING AND MANAGEMENT OF VASCULAR DEMENTIA

DARWIN A. DASIG, MD, FPNA

• Doctor of Medicine, University of the Philippines • Residency in Neurology, Makati Medical Center • Research Fellowship in Neuropathology, Royal Perth Hospital, Western

Australia • Postdoctoral Training in Diseases of Nerve and Muscle, Royal Perth

Hospital, Western Australia • Postdoctoral Training in Dementia, University of California in Los Angeles• Research Training in Chronobiology, Ludwig Maximilians University,

Munich, Germany


AFFILIATIONS, ACADEMIC AND ADMINISTRATIVE POSITIONS• Chief, Section of Neurology, Makati Medical Center • Head, Section of Neurophysiology, Department of Physiology, University of

the Philippines College of Medicine • Fellow, Philippine Neurological Association• President, Dementia Society of the Philippines• Member, Physiology Society of the Philippines


SpeakerAbstract

It has been always a challenge in preventing deep vein thrombosis among stroke patients. Patients admitted to hospital with a stroke of recent onset are at risk of developing deep vein thrombosis (DVT) which may be complicated by pulmonary emboli (PEs) and sudden death. The risk of DVT is highest in patients who are initially immobile, a previous history of DVT, dehydration, or comorbidities such as malignant diseases or clotting disorders. Patients with an increased risk of DVT should receive prophylactic treatment and to reduce the chance of DVT, patients should be mobilized as soon as possible and should be kept well hydrated. Treatment with subcutaneously administered low-dose unfractionated heparin is preferred to unfractionated heparin and may be considered in patients with ischemic stroke if the risk of DVT is estimated to be higher than the risk of hemorrhagic complications. In patients with intracerebral hemorrhage, low-dose subcutaneous low-molecular-weight heparin is probably safe after documentation of cessation of active bleeding, and may be considered on an individual cases several days from stroke onset. The goal of this lecture is to provide an evidence-based framework for the appropriate administration of thromboprophylaxis in patients with neurologic illness. This includes patients with ischemic stroke, intracranial and intraventricular hemorrhage (ICH and IVH), aneurysmal subarachnoid hemorrhage (aSAH), and patients undergoing neurosurgical and neurovascular interventions.

DEEP VENOUS THROMBOSIS IN STROKE

GERALDINE SIENA L. MARIANO, MD FPNA

• 2001, Doctor of Medicine, UERMMMC• 2005, Residency in Internal Medicine, The Medical City• 2008, Residency in Adult Neurology (Chief Resident), St. Luke’s

Medical Center• 2009, Fellowship Training in Neurocritical Care


AFFILIATIONS, ACADEMIC AND ADMINISTRATIVE POSITIONS• Fellow, Philippine Neurological Association• Chief, Neurocritical Care Unit, St. Luke’s Medical Center• Training Officer, Section of Adult Neurology, Institute for

Neurosciences, St. Luke’s Medical Center


SpeakerAbstract

Post stroke patients may develop chronic pain. In most cases, this is due to

musculoskeletal pain or pain due to the obligatory overuse of the unaffected

limbs. Pain from spasticity may also develop. However, in 8-12% of patients

with stroke, central neuropathic pain may ensue due to the insult involving the

spinothalamocortical pathway. It may begin months or even years after the insult.

This lecture shall discuss the diverse clinical features of this pain syndrome,

progress in understanding its pathophysiology, and review of the pharmacologic,

non-pharmacologic and neuromodulatory treatments of this insidious pain that

never seems to go away.

PAINS IN POSTROKE PATIENTS

MARIA SALOME N. VIOS, MD, FPNA, DPBPM

• Doctor of Medicine, College of Medicine, University of the Philippines, 1978 Field of Specialization: Neurology, Pain Medicine, Bioethics • Post Doctoral Fellowship/Studies University of Sydney, Australia (Neurophysiology), 1987 Visiting Professor: Pain Clinic, Royal Prince Alfred Hospital, Sydney, Australia Visiting Scientist: Conotoxin Lab, (Neurophysiology Dept.), University of Utah,

USA, 2002 Currently doing MS Bioethics


AFFILIATIONS, ACADEMIC AND ADMINISTRATIVE POSITIONS• Fellow Philippine Neurological Association, 1984• Fellow, Physiology Society of the Philippines, 1987• Diplomate, Phil. Board of Pain Medicine, 2010• College Secretary, UPCM, 2012 - present• Member, SubCommittee on Accreditation of Research Ethics Committee, Phil.

Research Ethics Board, PCHRD• Surveyor for FERCAP, 2011-present• Member, Board of Examiners, Phil. Board of Pain Medicine, 2009-present


SpeakerAbstract

Urinary bladder dysfunction frequently accompanies stroke and is distressing, disabling with major implication in the patient’s quality of life after stroke.

The brain is the master control of the entire urinary system. The urinary bladder stores and expels urine in a coordinated fashion. This coordinated activity is regulated by the CNS and PNS. Damage to the neuro-micturition pathways, decrease mental ability , decreased cognition, immobility and language problem are all possible factors for post stroke urinary bladder dysfunction.

The most common types of urinary dysfunction are urgency/incontinence, urinary retention and functional incontinence.

Structured assessment with planned processes and individually tailored interventions can improve continence levels in stroke patients.

BLADDER DYSFUNCTION POST STROKE

MARIA EPIFANIA V. COLLANTES, MD, FPNA

• Msc. Clinical Epidemiology, UP College of Medicine • Visiting Fellowship in Neurocritical Care, Critical Care

Neurology, Barnes Jewish Hospital, St. Louis, MO, USA • Residency Training in Neurology, Department of

Neurosciences, UP-PGH • Residency Training in Internal Medicine, Manila Doctors Hospital


AFFILIATIONS, ACADEMIC AND ADMINISTRATIVE POSITIONS• Clinical Associate Professor, UP College of Medicine • Coordinator, NeuroICU, Philippine General Hospital • Research Coordinator, Department of Neurosciences,UP-PGH • Member, Ethics Review Board, Manila Doctors Hospital • Attending Neurologist to UP-PGH and Manila Doctors Hospital • 2nd Vice-President, Stroke Society of the Philippines


SpeakerAbstract

We spend a third of our lives asleep. Sleep is a natural and integral part of an

organism’s survival and to ensure proper functioning of all it’s body systems.

Numerous studies and relationships have been postulated with regards to the role

of sleep duration, circadian rhythm changes and sleep disordered breathing in

the vascular physiology that underlies cerebrovascular disease. This lecture will

focus on the various sleep disorders, not limited to sleep disordered breathing, that

occurs after stroke. An elucidation on their role and impact on patients’ recovery

and quality of life will be discussed. Management principles ranging from the

most practical bedside principles and pharmacologic management will also be

emphasized.

SLEEP DISTURBANCE AFTER STROKE

ROSALINA B. ESPIRITU-PICAR, MD, FPNA

• 1992, Doctor of Medicine, cum laude, UST Faculty of Medicine and Surgery• 1997, Residency in Neurology, Makati Medical Center• 1998, Fellowship in Sleep Medicine, Columbia Presbyterian Medical

Center, New York, USA


AFFILIATIONS, ACADEMIC AND ADMINISTRATIVE POSITIONS• Fellow, Philippine Neurological Association• Vice Chairperson, Department of Neurosciences, Makati Medical Center• Section Chief and Associate Professor in Clinical Neurology, Dr. Jose G.

Tamayo Medical University, Binan, Laguna• Section Chief, Neurophysiology, University of Perpetual Help Medical

Center, Binan, Laguna• Co-Director, Sleep Laboratory, Makati Medical Center• Attending Neurologist at the Makati Medical Center, Mt. Sinai Medical

Center and Sta. Rosa Medical Center


SpeakersCOMPLICATIONS OF SURGERY

FOR STROKE

MANUEL M. MARIANO, MD

• 1982, Doctor of Medicine, University of the East - Ramon Magsaysay, College of Medicine

• 1983, Internship, UP-PGH


AFFILIATIONS, ACADEMIC AND ADMINISTRATIVE POSITIONS• Neurosurgeon Consultant• Member, Board of Trustees, The Stroke Society of the Philippines

DAY 2: Improving Life After Stroke: August 5, 2016NEUROSURGERY SYMPOSIA

NEUROLOGICAL IMPROVEMENT AFTER EARLY CRANIOPLASTY FOR DECOMPRESSIVE

HEMICRANIECTOMY

CARLO BARREDO, MD

DAY 2: Rehab 101 for Nurses: August 5, 2016

Abstract

Stroke is a major global disease burden that can cause lifetime

disability. Cerebral blood flow is affected among patient with

stroke. With proper bed positioning, cerebral blood flow may

be facilitated. Bed positioning is a delicate balancing act;

harms and benefits of a certain position should be weighed.

Other factors, such as secretions and other comorbidities,

should be taken in consideration as well. Stroke patients,

especially in the acute stage need to be positioned in the best

way to contribute to healing as well as improve comfort and

prevent pain and contractures. Bed position is an example of

how attention to detail improves outcomes.

BED POSITIONING FOR OPTIMAL PATIENT SAFETY AND COMFORT

Nurses, like physiotherapists, spend considerable time

monitoring and caring for patients with stroke. Deconditioning

among those afflicted with stroke is commonly reported. To

counter the deleterious effects of deconditioning, proper

bed mobilization, transfers and range of motion exercises

should be regularly provided. To deter life threatening risks of

aspirations, proper assessment and handling of patients with

dysphagia is warranted. Considering that aphasia hampers

effective communication between nurses and stroke patients,

strategies have to be used to effectively instruct, obtain

feedback and ensure delivery of appropriate treatment..

NURSING CONTINUING EDUCATION: REHAB 101 FOR NURSES

ARLENE CHIONG MAYA, MSPT, PTRP; CHRISTINE ROSE VERSALES, MSPT; VALENTIN C. DONES III, PHD, PTRP, JOCEL REGINO, MSPT,

PTRP, KRISTINE DEVORA MSPT, PTRP

Speakers

SAFE PATIENT HANDLING (LIFTS AND TRANSFERS)

A faculty member of the College of Rehabilitation Sciences and also The Graduate School of the University of Santo Tomas. She obtained her Master’s Degree in Physical Therapy in UST and graduated Bachelor of Science in Physical Therapy in UST as well. She is a certified manual therapist and was a practicing clinician for 7 years in the University of Santo Tomas Hospital. Her main interests are orthopedic and sports rehabilitation. She actively participates in research and is a member of the Ethics Review Committee of CRS. She also co-authored a publication together with Dra Consuelo Suarez, Dr Janine Dizon and Dr Karen Grimmer.

CHRISTINE ROSE VERSALES, MSPT, PTRP

ARLENE CHIONG MAYA, MSPT, PTRP

She graduated Bachelor of Science in the Universuty of Santo Tomas in 2007 and Masters of Science in Physical Therapy cum laude in the same university in 2012. Her graduate thesis is entitled Quality of Life Among Adults with Hypertension. She worked as a physical therapist and later on as a rehabilitation department supervisor in Our Lady of Lourdes Hospital for a duration of 7 years. She is currently a faculty member of the University of Santo Tomas.

BED POSITIONINGFOR OPTIMAL

PATIENT SAFETYAND COMFORT


SpeakersChair of Department of Physical Therapy of the College of Rehabilitation Sciences of the University of Santo Tomas. Val is a certified manual therapist, a Certified Dorn Teacher and Specialist; and a Mulligan Practitioner. He obtained his Doctor of Philosophy in the School of Health Sciences of the University of South Australia . He took up his Master’s Degree in Orthopedic Physical Therapy in the University of Santo Tomas in Collaboration with the University of South Australia (cum laude). He obtained his bachelor’s degree in Physical Therapy from the College of Rehabilitation Sciences of the University of Santo Tomas (cum laude). He is a manual physical therapy consultant at Blessed Margaret of Castelo Rehabilitation and Medical Center of Dominican College, HealthHub Manila, HealthHub Quezon City and Contour Rehabilitation and Wellness. He served as the vice-president internal of the PPTA (2008- August 2010). His main interest is manual therapy in orthopedics. Val is a highly experienced lecturer and clinician who trained and attended postgraduate courses abroad. He is also actively involved in various research programs.

A Faculty Member and continuing professional development coordinator of the College of Rehabilitation Sciences of the University of Santo Tomas. As a coordinator, she organizes seminars, workshop and certification courses for students and professional Physical Therapist to develop the capacity to provide an excellent and holistic education, and enhance personal and professional skills, knowledge and behavior.

She was a former Chief Physical Therapist and Patient Administrative Service Officer of the University of Santo Tomas Hospital. Jocel obtained her Master’s Degree in Physical Therapy - Orthopedic Specialist from the College of Rehabilitation Sciences. She is a certified manual therapist. She co-authored an article entitled “Evidence-based practice training from health professionals in the Philippines”. Her research focuses on Sports injury, orthopedics, outcome measure tool, and clinical audit. She has served as resource speaker and lecturer. She is also a member of the Philippine Physical Therapy Association (PPTA).

A faculty member of the Department of Physical Therapy of the College of Rehabilitation Sciences of the University of Santo Tomas. Tina, to her friends, she obtained her Master’s Degree in Orthopedic Physical Therapy at the University of Santo Tomas (cum laude) in 2015. She obtained her Bachelor’s degree in Physical Therapy from the College of Rehabilitation Sciences of the same university in 2011. Tina has been in the academe for 4 years and is actively involved in research.

VALENTIN C. DONES III, PHD, MSPT, PTRP

PASSIVE RANGE OF MOTION EXERCISES

JOCEL REGINO, MSPT, PTRP

DEALING WITH APHASIC PATIENTS

KRISTINA DEVORA, MSPT, PTRP

ASPIRATION PRECAUTIONS: DEALING WITH PATIENTS WITH SWALLOWING

PROBLEMS


DAY 2: Stroke Rehabilitation: August 5, 2016

Abstract

Currently, the use of the WHO International Classification of Functioning,Disability and Health (ICF) is recommended in the evaluation and treatment planning of patients for rehabilitation. This framework recognizes the underlying organ structure (pathology) and function (pathophysiology) and the potential for restoring/optimizing personal function or preventing further limitation of activity. It also recognises that the ability to participate depends not only on activities or personal functioning but also on a corresponding number of contextual factors affecting personal life and the individual’s environment.

PATIENT ASSESSMENT AND MANAGEMENT IN STROKE REHABILITATION

Patient Assessment and Management in Stroke Rehabilitation Jose Alvin P. Mojica MD, FPARM, FPCGM

ABSTRACT

Currently, the use of the WHO International Classification of Functioning,Disability and Health (ICF) is recommended in the evaluation and treatment planning of patients for rehabilitation. This framework recognizes the underlying organ structure (pathology) and function (pathophysiology) and the potential for restoring/optimizing personal function or preventing further limitation of activity. It also recognises that the ability to participate depends not only on activities or personal functioning but also on a corresponding number of contextual factors affecting personal life and the individual’s environment.

Health Condition

(disorder or disease) Body Functions & Structures (Abnormalities of Function) Environmental Personal Factors Factors ( Living situation) (age, gender, health

behavior, lifestyle, coping strategies)

Fig. 1. WHO International Classification of Functioning, Disability and Health (ICF)

(J Rehabil Med 2007;39:12-13) On the other hand, the stroke rehabilitation management should: 1) have well defined endpoints, 2) be participatory, 3) preventive, 4) personalized 5) interdisciplinary and 6) evidence based.

Participation (Restrictions in community life, recreation, leisure)

Activities (Difficulties inexecution of tasks)

Fig. 1. WHO International Classification of Functioning, Disability and Health (ICF)

(J Rehabil Med 2007;39:12-13)

On the other hand, the stroke rehabilitation management should: 1) have well defined endpoints, 2) be participatory, 3) preventive, 4) personalized 5) interdisciplinary and 6) evidence based.

Abstracts

The incidence of stroke has been increasing in the recent years, and patients having stroke are getting younger. Their ability to fully participate in the community and contribute to the financial stability of their family becomes limited due to the different deficits from stroke. Therefore, the importance of rehabilitation towards functional recovery cannot be overemphasized. Needless to say, rehabilitation should be started at the earliest possible time. However, it should proceed with caution, taking into consideration the type and severity of stroke as well as the other medical conditions that the patient might have. Most of the time, these are the questions that are asked during rehabilitation: 1. When should rehabilitation start? 2. What are the precautions that should be taken during therapy sessions? 3. What are the conditions that will necessitate deferral of treatment? And 4. When can we progress from a less strenuous to a more strenuous activity? The answers to these questions should be clear to ensure that we facilitate recovery and not cause further injury.

The Motor Relearning Programme (MRP) for patients with lower extremity deficits involves training of sit-to-stand, standing, and ambulation. The plan of action involves identification of missing component of these activities, followed by practice of the component movements in part before practicing the task as a whole. Transference of learning beyond the therapy session is also necessary to provide consistent practice of related activities during the patient’s day to day life.

The essential components of sit-to-stand that are usually affected post stroke include loss of forward inclination of trunk, lack of scooting and backward placement of unaffected leg, and maintaining symmetrical weight on both legs upon standing up. For balanced standing, alignment is attained with feet a few inches apart, hips in front of ankles, shoulders over hips, head balanced on level shoulders, and erect trunk. The components needed for stance phase of ambulation include hip extension, lateral horizontal pelvic shift, and flexion of the knee while the swing phase includes hip, knee, and ankle flexion.

Focus of intervention, for assumption of standing, will work on retraining strategies from the pelvis towards the legs to enable symmetrical weight bearing in standing.

Symmetrical and balanced standing can be achieved by improving base of support and balance strategies to overcome internal and external perturbations.

Paresis of the lower extremity post-stroke would decrease the ability to weight bear during stance phase, as well as foot clearance and placement during swing phase of level ambulation. Furthermore, it will be more challenging to bear one’s body weight when walking up and down ramps or stairs, and across uneven terrain. Hence, training is devoted to improving control of lower extremity during stance and swing.

REHABILITATION PRECAUTIONS IN STROKE LOWER EXTREMITY RE-TRAINING


Speakers

MYLA C. WAHAB, MD, FPARM

REHABILITATION PRECAUTIONS IN

STROKE

ANDREA MONIQUE DARGANTES, CSP-PASP

CONTEMPORARY APPROACHES IN

IMPROVING ORAL MOTOR FUNCTION

KRISTINE ANN CARANDANG, OTRP

UPPER EXTREMITY RE-TRAINING

AFFILIATIONS, ACADEMIC AND ADMINISTRATIVE POSITIONS




• Fellow Philippine Academy of Rehabilitation Medicine• Diplomate Philippine Board of Rehabilitation Medicine• Consultant, Department of Rehabilitation Medicine, UP-PGH• Associate Clinical Professor, College of Medicine, UP Manila• Assistant Professor III, College of Rehabilitation Sciences, De La Salle Health Science Institute• Volunteer Physiatrist, Physicians for Peace and St. Juliana of Cumae School• Head, Department of Rehabilitation Medicine, St. Clare Medical Hospital• Assistant Professor II, College of Physical Therapy, Pamantasan ng Lungsod ng Maynila• Lecturer, College of Physical Therapy, Delos Santos Medical Center - STI College

• Staff Occupational Therapist and Clinical Training Coordinator for Interns, Section of Occupational Therapy, Department of Rehabilitation Medicine, UP-PGH, 2012 - present

• 10th Placer, Philippine Occupational Therapy Licensure Exam, 2009

• Speech Therapist, Speech & Language Section, Philippine General Hospital, 2014- Present • Speech Therapist, Physical Medicine and Rehabilitation, Makati Medical Center, 2015- Present


Speakers

PAUL CHRISTIAN REYES, PTRP

LOWER EXTREMITY RE-TRAINING

RENSYL B. BARQUIA, PTRP

LOWER EXTREMITY RE-TRAINING

JOSE ALVIN P. MOJICA, MD, FPARM, FPCGM

INTERDISCIPLINARY APPROACH TO STROKE

REHABILITATION: CASE PRESENTATION



• Physical Therapist II and Head, Education Committee Department of Rehabilitation Medicine, Section of Physical Therapy, 2012 – present

• Consultant Pediatric Physical Therapist, Bright Beginnings Therapy Center, 2010 – present• Consultant Review Lecturer, Sultan Review Group, Physical Therapy Division, 2010-present

• Physical Therapist I, Department of Rehabilitation Medicine, Philippine General Hospital, 2015 - present

He finished his residency training in Rehabilitation Medicine at the Philippine General Hospital then subspecialized in Stroke Rehabilitation at Tohoku University School of Medicine in Miyagi, Japan and Cardiovascular Rehabilitation at the University of Sydney Cumberland College of Health Sciences and Lidcombe Hospital in New South Wales, Australia. He also has a Master’s degree in Health Professions Education (MHPEd) from the National Teacher Training Center for the Health Professions (NTTC-HP), UP Manila then became a World Health Organization (WHO) Fellow in Problem Based Learning at the Universities of Maastricht, Nijmegen and Groningen in The Netherlands. He is the former dean of the NTTC-HP and is presently Professor and Chairman of the Department of Rehabilitation Medicine, College of Medicine and Philippine General Hospital, UP Manila.


DAY 3: Neurorehabilitation: August 6, 2016SpeakerAbstract

As early as 1906 Santiago Ramon Y Cajal was talking about how the brain can change, at that time it was almost heretical. 50 years later Paul Bach y Rita talked of brain networks as a roadway system., then with the explosion of the computer technology, an avalanche of information and understanding of brain function took centerstage. The third phase in the comprehensive management of stroke deals with the recovery of deficits incurred by the stroke. Medical progress leads to more stroke survivors, however the deficits remain the same. Recovery of the stroke patient entails that the brain REORGANIZES !!!. The brain is plastic and can remodel itself to adapt to the needs of the individual. A stroke leaves permanently damaged areas, thus the brain has to compensate by re organizing. The capability of the brain to reorganize is called the plasticity of the brain. There are 3 major types of reorganization, , Synaptogenesis,neurogenesis, and angiogenesis. There is also restorative rehabilitation where other areas of the brain take over lost function.. The second is a newer field called regenerative rehabilitation , wherein new brain cells fromed by neural stem cells in the subventricular regions migrate to the peri infarct area.

There are five basic princi[ples governing neuro plasticity

NEUROPLASTICITY PRINCIPLE # 1 : BODY PARTS COMPETE FOR BRAIN REPRESENTATION: It is in this principle where the term “ USE DEPENDENT PLASTICITY “ was coined. This has been modified to “EXPERIENCE DEPENDENT PLASTICITY” There is a need for the brain to use experience to initiate a new synaptic connection between neurons. The more a part is used the bigger its area of representation in the brain that correlates with improved function. CIMT or constraint induced movement therapy has been advocated for this principle. The opposite effect if the body part is not used leads to “ LEARNED NON USE”

NEUROPLASTICITY PRINCIPLE # 2 : THE IPSILATERAL HEMISPHERE CAN CONTRIBUTE TO MOTOR CONTROL This has been shown by functional MRI studies on stroke patients

NEUROPLASTICITY PRINCIPLE # 3 : SENSORY STIMULATION ENHANCES PLASTICITY. Using electrical stimulation to enhance the sensory representation of the body part makes that area in the brain hyperexcitable to plasticity

NEUROPLASTICITY PRINCIPLE # 4: REDUCTION OF INHIBITION ENHANCES PLASTICITY:By removing factors that make the patient less motivated, sleepy , then recovery is enhanced. One important consideration here is to treat post stroke depression and not use drugs that induce drowsiness.

NEUROPLASTICITY PRINCIPLE # 5: PHARMACOLOGIC AGENTS CAN ENHANCE PLASTICITY: All of these principles have to be translated into FUNCTIONAL TASK AND CONTEXT oriented exercises.The lecture will include some practical home tasks for the stroke patient using the above principles If a stroke patient is to recover he must do all these activities by himself

THE EVOLUTION OF NEUROPLASTICITY AND ITS APPLICATION INTO CLINICAL PRACTICE

MANOLETE RENATO C. GUERRERO, MD, PTRP, FPNA



• Doctor of Medicine, Uermmmc, 1988• Neurology Residency Training, Uermmmc, 992• Chief Resident- Department Of Clinical Neurosciences, Uermmmc,1992

• Dean, Physical Therapy Department, San Pedro College, 1995- Present• Neurologist, Active Staff, 1994- Present San Pedro Hospital, R. Limso Medical Center, Cooperative Health Development

Hospital (Chdc/ Clinica Anda), Medical Mission Group Hospital, Metro Davao Medical And Research Center, Davao Medical School Foundation Hospital

• Neurologist, Visiting Staff Staff, 1994- Present Davao Doctors Hospital, Brokenshire Memorial Hospital• Lecturer, San Pedro College, 1994-Present • Head, Stroke Rehabilitation And Rehabilitation Of Other Neurologic Conditions ,

1995-Present• Chairman: Medical Audit Committee, Ricardo Limso Medical Center,

2000-Present• Chairman Admissions & Promotions , Department Of Internal Medicine), San

Pedro Hospital, 2000- Present

SpeakerAbstract

Dementia is a neurologic clinical condition characterized by progressive decline or loss of memory and other domains in cognition such as attention, language and problem solving. The most common form is Alzheimer’s disease which accounts for more than 70% of the cases. Coming in second is vascular dementia followed by mixed, Lewy Body, Parkinsonson Dementia, frontotempral dementi and dementia from secondary causes.

There is no cure for dementia. The best option is still prevention and early recognition and intervention In contrast to traditional goal of restorative therapies in rehabilitation to cure or minimize impairment to improve status, dementia rehabilitation is improving skills and functioning or hablitative and compensatory. Pharmacologic options are Cholinesterase inhibitors which has benefit in mild to moderate stages. Non pharmacologic management includes cognitive and behavioral interventions. The 3 principal goals of rehabilitation for individual with dementia are: 1. Help improve if not maintain function and engage in daily activities. 2. Restore or compensate any functional decline due to acute injury and 3. Provide family and caregiver with skills to provide a supportive home environment.

REHABILITATION IN PATIENTS WITH DEMENTIA

MICHELLI GOSE-YUSAY, MD, FPNA



• Medical School : University of the Philippines College of Medicine Manila – 1988-1992

• Internship : Philippine General Hospital, 1992-1994• Residency Training : Section of Neurology, Department of Internal Medicine

1994-1998

• Canlaon Medical Society• Pain Society of the Philippines• Philippine League against Epilepsy• Movement Disorder Society of the Philippines• Board of Governor, Philippine Neurological Association• Director, Philippine Society of Neurorehabilitation• Associate Professor, University of St La Salle College of Medicine• Fellow, Philippine Neurological Association (1999)• Doctor of Medicine, Philippine Regulation Commission (1993)• B.S. Biology – UP College of Science, Diliman Q.C. (1988)

DAY 3: Neurorehabilitation: August 6, 2016

SpeakerAbstract

This presentation will discuss the neural dynamics and explore the applications of rhythm-based techniques in post-stroke sensorimotor and gait rehabilitation.

RHYTHM-BASED THERAPY IN STROKE REHABILITATION

ARTURO F. SURDILLA, MD, FPNA



• 1989, Doctor of Medicine, Dr. Jose P. Rizal School of Medicine, Ateneo de Cagayan

• 1996, Residency in Adult Neurology, UP-PGH• 1997, Fellowship in Electromyography, UP-PGH• 2012, European Master in Stroke Medicine, Danube University, Austria

• Head of Neurological and Stroke Services in Northern Mindanao Medical Center• Director of the AKBAY Stroke Care & Neurological Rehabilitation Center• Assistant Professor at the Dr Jose P Rizal College of Medicine, Xavier University• President Stroke Society of the Philippines-Northern Mindanao Chapter• Vice-President of the Philippine Neurological Association-Northern Mindanao

Chapter• Member, Board of Directors, Philippine Society for Neurorehabilitation• Member, Local Health Board of Cagayan de Oro City• Member, Board of Directors, House of Hope Foundation• Visiting clinical consultant in Neurology & Stroke Medicine in the local hospitals

in Cagayan de Oro City


SpeakerAbstract

Cognizant of the limited number of practicing speech language pathologists in the country, the discussion shall be focused on a functional evaluation and management of the speech problems associated with post-stroke patients.

The 30-minute presentation will have the following learning objectives:

1. To describe the possible speech problems secondary to stroke;2. To outline the areas of evaluation used to diagnose speech-related

problems in stroke;3. To differentiate the speech problems from the other concomitant problems

associated with stroke;4. To provide an overview of the management of speech problems in post-

stroke patients

SPEECH EVALUATION AND REHABILITATION IN STROKE

MA. GEORGINA D. MOJICA, MHPED CSP-PASP

A speech pathologist by profession for speech, language and hearing problems servicing both the pediatric and adult population. She obtained both her bachelor and masteral degrees from the University of the Philippines. She has extensive teaching and clinical experience in the field of speech pathology. Has actively taken part in various local and international conferences both as a resource speaker and as a participant. Has engaged in collaborative research works in the fields of hearing habilitation, stroke rehabilitation and most recently in inclusive education. She is the founding chair and current Chairperson of the Department of Speech Language Pathology at the College of Rehabilitation Sciences – University of Santo Tomas. Concurrently, she is a member of the Technical Committee for Speech Language Pathology Education of the Philippines’ Commission on Higher Education. She holds the position of Trustee in the Philippine Association of Speech Pathologists.


SpeakerAbstract

Post stroke spasticity (PSS) has a 19% prevalence at 3 months, reaching up to 38% in one year for first ever strokes. PSS may become disabling, leading to significant functional impairment that ranges from loss of mobility, loss of dexterity and muscle pain, ultimately resulting to poor quality of life. Meta-analysis on various Neurorehabilitation care practices in PSS prove that certain procedures have good evidence, such as: (a) For improvement of motor arm function: constraint-induced movement therapy, robotics and electromyography-triggered neuromuscular stimulation; (b) For improvement in walking ability: electromechanical-assisted gait training, circuit class training and TENS. Furthermore, Pooled systematic studies on PSS prove that Botulinum toxin-A (BoNTA) has superior efficacy and safety and has become the first line management, in tandem with physiotherapy. Through time, not only do neural mechanisms of muscle hypertonus spasticity occur, but that biomechanical changes at affected joint movers do worsen the evolving events . Most studies use BoNTA in the chronic stage, or “established spasticity” (>6months from onset of PSS), which is perhaps why functional benefits were not achieved. Furthermore, complications of spasticity like co-contractions, dystonia and contractures may have already set-in. Early intervention with BoNTA (<3 months from onset of PSS) at the stage of “evolving spasticity,” has been shown in 3-upper limb and 1-lower limb spasticity injections.

SPASTICITY NEUROREHABILITATION CARE, EVIDENCE-BASED

RAYMOND L. ROSALES, MD, FPNA




• Doctor of Medicine, UST Faculty of Medicine and Surgery• Neuroscience PhD, Kagoshima University Graduate School of Medicine. • Neuromuscular and Movement Disorders’ Subspecialty Training, Dept. of

Neurology and Geriatrics of Kagoshima University (Japan)• Clinician Programs from the EMG laboratory of Mayo Clinic (Minnesota) and

from the Dystonia Clinic, Columbia University (New York).

• University Professor and current Chair of the Dept. of Neurology and Psychiatry of the University of Santo Tomas (UST) Hospital, Manila.

• Former President, Philippine Neurological Association, Movement Disorders Society of the Philippines

• Founding President of the Philippine Society of Neuro-Rehabilitation• Current Vice President, Asian and Oceanian Myology Center and the Secretary

of the International Parkinson and Movement Disorder Society-Asian and Oceanian Section.

• He has received various Rector’s research and international publication awards from UST (2003-2016).

• Outstanding contribution in Peer Reviewing – Journal of Neurological Sciences, 2015


SpeakerAbstract

Transcranial Magnetic Stimulation (TMS) is delivered to the brain by passing a strong brief electrical current through an insulated wire coil placed on the skull. This rapid phasic current flow generates a transient magnetic field, which propagates in space and in turn induces a secondary current in the brain that is capable of depolarising neurons if the coil is held over the subject’s head (Pascual-Leone et al., 2002).

tDCS uses homogenous DC field delivered at intensities of around 1 mA via two electrodes placed on the scalp. An active electrode is placed on the site overlying the cortical target, and a reference electrode is usually placed over the contralateral supraorbital area or in a non-cephalic region. tDCS induces long-lasting changes in the brain and it can be used to manipulate brain excitability via membrane polarisation: cathodal stimulation hyperpolarises, while anodal stimulation depolarises the resting membrane potential, whereby the induced after-effects depend on polarity, duration and intensity of the stimulation (Paulus, 2011).

Neuromodulation is the physiological process by which a given neuron uses one or more neurotransmitters to regulate diverse populations of neurons. This is in contrast to classicalsynaptic transmission, in which one presynaptic neuron directly influences a single postsynaptic partner. Neuromodulators secreted by a small group of neurons diffuse through large areas of the nervous system, affecting multiple neurons.

Both TMS and tDCS have shown evidence of neuromodulation for stroke rehabilitation.

TMS, TDCS AND NEUROMODULATION STROKE REHABILITATION

REYNALDO REY-MATIAS, MD, FPARM



• 1988, Doctor of Medicine, University of Santo Tomas• 1992, Residency in Physical Medicine and Rehabilitation, UP-PGH• 1994, Fellowship in Adult Brain Injury Rehabilitation, Rancho Los Amigos

Medical Center, California, USA • 2006, Masters in Human Movement Science, UP College of Human Kinetics• 2007, Certificate Course in Swallowing Rehabilitation, Northwestern University,

Chicago, Illinois, USA

• Chairperson, Department of Rehabilitation Medicine – St. Luke’s Medical Center • Chairperson, Philippine Board of Physical and Occupational Therapy,

Professional Regulation Commission • President, Philippine Academy of Rehabilitation Medicine • Secretary, Asia Oceania Society of Physical Medicine and Rehabilitation • Clinical Associate Professor, Department of Rehabilitation Medicine- UP College

of Medicine • Board Member, Pain Society of the Philippines • Board of Trustees, Philippine Society of Neurorehabilitation • International Member, World Federation of NeuroRehabilitation • International Member, International Society of Physical and Rehabilitation Medicine


Speaker

ROBOTICS IN STROKE REHABILITATION

JERICO DE LA CRUZ, MD, FPARM


• Fellow, Philippine Academy of Rehabilitation Medicine• Diplomate, Philippine Board of Rehabilitation Medicine• Member of the Broad of Trustees, Philippine Society of Neuro-Rehabilitation Medicine Inc.,

2014-Present• Vice President, Philippine Academy of Rehabilitation Medicine- National Capital Region Chapter,

2015 – Present• Congress Chair, 2nd Asia-Oceanian Conference of NeuroRehabilitation in 2017• National Representative to the Asia-Oceanian Conference for NeuroRehabilitation, Asia-Oceanian

Conference for NeuroRehabilitation, 2015 - Present• Clinical Associate Professor, Department of Rehabilitation Medicine, Philippine General Hospital,

College of Medicine , University of the Philippines –Manila, 2012 –Present• Co Chair, Media Relations and Publication Committee, Philippine Academy of Rehabilitation

Medicine, 2015 - Present• Clinical Associate Professor , College of Medicine, University of the Philippines-Manila, October

2011 – Present• Consultant / Medical Specialist III (Active Staff), Philippine Childrens’ Medical Center, 2012-

present• Consultant (Active Staff), Asian Hospital and Medical Center and Tagaytay Medical Center, 2013

-Present• Visiting Staff, The Medical City; Lung Center of the Philippines and Delos Santos Medical Center,

2010 - Present

EDUCATION AND TRAINING• Doctor of Medicine, University of the East Ramon Magsaysay Memorial Medical Center, 2002• Clinical Post Graduate Medical Internship, Cardinal Santos Memorial Medical Center, 2003• Residency in Rehabilitation Medicine, Department of Rehabilitation Medicine, UP-Philippine General

Hospital, 2008• Fellowship in Neuro-Rehabilitation, Department of Rehabilitation Medicine, Juntendo University Hospital,

Tokyo, Japan, 2011


SpeakerAbstract

Stroke in children is a multifactorial disease. The etiologies, risk factors and differential diagnosis in children are more varied compared to adults thus the work-up for the cause is more extensive compared to adults. Congenital and acquired heart disease, hematologic disorders, vasculopathies, metabolic disorders, infection and trauma are the more common causes in children. Randomized controlled trials of treatment in children are lacking and treatment of pediatric stroke is largely patterned from adult stroke trials. Current guidelines recommend the use antiplatelet doses of aspirin for secondary prevention.

Despite neural plasticity in children, majority have persistent disability. There is lack of literature on the use of standardized functional outcome measurements following pediatric stroke. Scales which describe neurological impairments and activity limitation are mostly used to dichotomize into good and poor outcomes. Apart from hemiparesis and impairments in sensation that compromise manual dexterity, speech/language disorders, cognitive deficits, and behavioral problems significantly affect the children’s Education and social opportunities, long term participation and quality of life. Neurorehabilitation is a learning process. In children the focus of rehabilitation is not only recovery of previously learned abilities and compensation for impairments of function but also emphasis is given to the continued acquisition of developmentally appropriate skills.

AN OVERVIEW OF CHILDHOOD STROKES

MARISSA B. LUKBAN, MD, FPNA



• Medical School and Internship : Philippine General Hospital, 1983-1984• University of the Philippines College of Medicine Manila – 1979-1983• Residency Training: Department of Pediatrics, Philippine General Hospital,

1985-1987• Fellowship training in Pediatric Neurology, Department of Pediatrics and

Department of Neuroscience, Philippine General Hospital, 1990-1992• Fellowship training in Clinical Neurology and Neurophysiology, Royal Alexandria

Hospital for Children, New South Wales, Australia 1994-1995• Observership in Neurosonology, University of Padova, Italy, 1998• Masters in Clinical Epidemiology (undergraduate)

• Fellow, Child Neurology Society Philippines (1995)• Fellow, Philippine Neurological Association (1995)• Fellow, Philippine Pediatric Society (1992)• Doctor of Medicine, Philippine Regulation Commission (1984)• Board Member, Philippine Society of Neurorehabilitation (2014-2016)• Past President, Child Neurology Society Phils, Inc. (2007-2008)• Professor 1, College of Medicine, University of the Philippines• Member and Immediate Past Chair, Specialty Board Exam in Child Neurology• Philippine Neurological Association (2014-2019)


Several studies have assessed the efficacy of old and recent rehabilitation techniques in swallowing such as thermal stimulation, electrical stimulation, acupuncture, oral strengthening, air pulses, Transcranial direct current stimulation (tDCS) and Transcranial Magnetic Stimulation (TMS).

There is strong (Level 1-2) evidence that repetitive Transcranial Magnetic Stimulation improves swallowing function post stroke. There is strong (Level 1-2) evidence that transcranial Direct Current Stimulation improves swallowing function post stroke. There is conflicting evidence that electrical stimulation can improve swallowing function post stroke but in the largest study, the use of two co-interventions (ES+therapy) improved swallowing function compared to either of the two interventions given in isolation. There is strong (Level 1) evidence that thermal stimulation does not improve swallowing function post stroke. There is limited (Level 2) evidence that acupuncture and EMG treatment can be used to improve swallowing function post stroke and there is limited evidence that the chin down position, head rotation, and lingual exercises prevent aspiration in approximately 50% of patients who are known aspirators.

REHABILITATION TECHNIQUES IN SWALLOWING:

WHAT IS THE EVIDENCE ?

CORAZON CABUQUIT, MD

REYNALDO REY-MATIAS, MD, FPARM

AbstractSWALLOWING ASSESSMENT & MANAGEMENT

WORKSHOPDAY 3: Neurorehabilitation: August 6, 2016

Boehringer Ingelheim

Ever Neuro

Hi-Eisai

LRI Therapharma

Natrapharm Inc.

Otsuka

CORPORATE SPONSORS

A. Menarini Philippines Inc.Astellas PharmaBayer Philippines

BTL Medical TechnologiesConjug8E Chimes

SPONSORS

Cathay YSS Medicomm

CitibankMetrobank

Medichem Pfizer

Pharma3Sandoz Pharma

Torrent

dabigatran etexilate

CMYCM

MY

CY

CM

YK

17th Annual SSP ConventionOrganizing Committee

August 4 - 6, 2016Subic Bay Travelers Hotel

Dr. Maria Cristina Z. San JosePresident

Scientific: Dr. Romulo U. Esagunde Dr. Ana Marie S. Nolido Dr. Arturo Martin P. Arkoncel III Dr. Manuel M. Mariano

Publicity/Flyers/Posters: Dr. Artemio A. Roxas, Jr. Dr. Sheryl Manalili Dr. Ma. Cymbeline P. Santiago

Physicals: Dr. Carlos L. Chua Dr. Winston S. Salem

Registration: Dr. Ma. Cristina M. Valdez Dr. Maricar P. Yumul

Hotel Accommodation: Dr. Cristina C. Urbi

Ways and Means: Dr. Maria Epifania V. Collantes Dr. Johnny K. Lokin

Documentation: Dr. Pedro Danilo J. Lagamayo Dr. Jose Leonard Pascual V Dr. Robert Francis G.Luzod

Socials: Dr. Ma. Annette DG. Bautista Dr. Jeremias G. Bautista Dr. Godfrey T. Robeniol Dr. Maria Socorro F. Sarfati Dr. Ovidio R. De Leon Jr.

Souvenir Program: Dr. Ruth T. Villanueva Dr. Maritoni C. Abbariao

Dr. Raquel M. AlvarezOverall Convention Chairman

Dr. Paulita P. PingulCo-Chairman

Awards and Certificates: Dr. Maria Carmencita B. Gonzales Dr. Juvy M. Asuncion

Dr. Arturo F. SurdillaDr. Jose Alvin P. MojicaLouie Paul P. Eugenio, RNDiana Jean F. Serondo, RN

1st Philippine Congress on Brain AttackTheme: Thinking Globally, Acting Locally October 1-2, 1999, Manila Midtown Hotel

2nd Philippine Congress in Brain AttackTheme: Organizing Stroke Services Year 2001

3rd Philippine Congress on Brain AttackTheme: Intracerebral Hemorrhage (ICH) and Subarachnoid Hemorrhage (SAH) August 2002

4th SSP Biennial ConventionTheme: Ugaliing Tingnan, Ating Kalusugan, Upang Brain Attack ay Maiwasan August 20-22, 2003 Bethel Guest House, Dumaguete City

5th SSP Annual ConventionTheme: Emerging Diagnostic Modalities & Therapeutic Interventions in Acute Brain Attack August 19-21, 2004 Taal Vista Hotel, Tagaytay City

6th SSP Annual ConventionTheme: SSP Goes to the Community Ausgust 18-20, 2005 Fort Ilocandia Hotel, Laoag City

7th SSP Annual ConventionTheme: SSP Goes to Mindanao: Empowering the Community for Optimal Stroke Care August 21-23, 2006 The Marco Polo Hotel, Davao City

8th SSP Annual ConventionTheme: SSP Goes to Central Luzon August 16-18, 2007 Legenda Hotel, Subic Bay Freeport Zone, Zambales

9th SSP Annual ConventionTheme: Stop Stroke before it Stops You

August 22-24, 2008 Baguio Country Club, Baguio City

10th SSP Annual ConventionTheme: The Philippine Stroke Agenda: Tackling Knowledge, Issues, Concerns and Awareness in Stroke August 20-23, 2009 Holiday Inn, Clarkfield, Pampanga

11th SSP Annual ConventionTheme: Harmonizing Strategies in Stroke: From Bench to Bedside to Backyard August 18-20,2010 Marco Polo Hotel, Davao City

12th SSP Annual ConventionTheme: Strengthening the Weaker Links in Philippine Stroke Care August 11-13, 2011 Sarabia Manor Hotel, Iloilo City

13th SSP Annual ConventionTheme: From Thinking Globally, Acting Locally to Individualized Therapy August 9-11, 2012 Malberry Suites, Cagayan De Oro City

14th SSP Annual ConventionTheme: H.I.T. Stroke: Hitting Ideal Targets Against STROKE August 8-10, 2013 Oriental Hotel, Palo, Leyte

15th SSP Annual ConventionTheme: Basics in Bicol: Best Practices in Community- Based Stroke Care July 31-August 2, 2014 Avenue Plaza Hotel, Naga City Bicol

16th SSP Annual ConventionTheme: Fight Stroke: Global Perspective Local Initiatives Collective Action August 13-15, 2015 The Manila Hotel

SSP ANNUAL CONVENTIONS

SSP ANNUAL CONVENTIONS

Global Stroke Bill of RightsAs a person who has had a stroke

I have a right to:Receive the best stroke care• A rapid diagnosis so I can be treated quickly.

• Receive treatment by a specialised team at all stages of my journey (in hospital and during rehabilitation).

• Receive care that is well coordinated.

• Access treatment regardless of financial situation, gender, culture or place that I live.

• Receive treatment that is right for me as an individual considering my age, gender, culture, goals and my changing needs over time.

Be informed and prepared• Be informed about the signs of stroke so I can recognise if

I am having one.

• Be fully informed about what has happened to me and about living with stroke for as long as I require it.

Be supported in my recovery• Be provided with hope for the best possible recovery I can

make now and into the future.

• Receive psychological and emotional support in a form that best meets my needs.

• Be included in all aspects of society regardless of any disability I may have.

• Receive support (financial or otherwise) to ensure I am cared for in the longer term.

• Be supported to return to work and/or to other activities I may choose to participate in after my stroke.

• Get access to formal and informal advocacy to assist me with access to the services I need.

• Be connected to other stroke survivors and caregivers so I may gain and provide support in my recovery from stroke.

www.world-stroke.org

Stroke is a leading cause of death in developed and developing countries and a major cause of disability. There are over 17 million strokes each year and six million lives lost to the disease. Every other second, someone has a stroke, regardless of age or gender.

Behind these numbers are real lives.

Despite these shocking statistics, many people affected by stroke are unable to access the treatments, rehabilitation and support that would provide them with the greatest chance of a good recovery and a healthier, more productive and independent life.

The Global Stroke Bill of Rights is an important priority for the World Stroke Organization. These rights identify the aspects of care that are important for ALL stroke survivors and caregivers from across the world.

It is a tool that can be used by individuals and organizations to communicate with stroke care providers and with governments and their agencies about what people affected by stroke think are the most important things in their recovery. Many aspects of care considered important by those affected by stroke, and included in this document, have been shown to reduce death and disability after stroke.

The Stroke Bill of Rights is not a legal document. It is a guide to the elements of stroke care that are important to stroke survivors and care givers to drive to the best possible outcomes and experiences associated with stroke.

The Stroke Bill of Rights was developed by a group of stroke survivors and caregivers from each region of the world. They were supported by a larger group of survivors and caregivers and by thousands more from different countries, cultures and languages who completed surveys to understand if there are any differences in different parts of the world. Their responses demonstrated what is considered to be important in stroke recovery is consistent regardless of where people affected by stroke live.

The issues identified through this process are outlined in the Global Stroke Bill of Rights, listed according to the importance survivors and caregivers placed on them.

We hope it is a useful tool to help improve access to care for people affected by stroke across the globe.

Global Stroke Bill of Rights

www.world-stroke.org

Post-stroke CheCklist (PsC): imProving life After stroke

Since your stroke or last assessment, have you received any advice on health related life style changes or medications for preventing another stroke? Observe Progress

1. seCondAry Prevention

Since your stroke or last assessment, are you finding it more difficult to take care of yourself?

Observe Progress

Do you have difficulty dressing, washing and/or bathing?Do you have difficulty preparing hot drinks and/or meals?Do you have difficulty getting outside?

2. ACtivities of dAily living (Adl)

Since your stroke or last assessment, do you have increasing stiffness in your arms, hands, and/or legs?

Observe Progress

Is this interfering with activities of daily living, sleep or causing pain?

Since your stroke or last assessment, are you finding it more difficult to walk or move safely from bed to chair?

Observe Progress

Are you continuing to receive rehabilitation therapy?

3. mobility

4. sPAstiCity

This Post-Stroke Checklist (PSC) has been developed to help healthcare professionals identify post-stroke problems amenable to treatment and/or referral. The PSC is a brief and easy-to-use tool, intended for completion with the patient and the help of a caregiver, if necessary. PSC administration provides a standardized approach for the identification of long-term problems in stroke survivors and facilitates appropriate referral for treatment.

instruCtions for use: Please ask the patient each numbered question and indicate the answer in the “response” section. In general, if the response is NO, update the patient record and review at next assessment. If the response is YES, follow-up with the appropriate action. Please note that the actions described in this version are for guidance and the ‘If Yes’ and ‘If No’ text boxes (highlighted in yellow) can and should be edited for local implementation.

If NO, refer to a Primary Care Physician or Stroke Neurologist for riskfactor assessment and treatment if appropriate

If YES to any, refer to Primary CarePhysician, Rehabilitation Physicianor an appropriate therapist (i.e. OTor PT) for further assessment

If YES, update patient record andreview at next assessment

If NO, refer to Primary Care Physician,Rehabilitation Physician or anappropriate therapist (i.e. OT or PT)for further assessment

If YES, refer to a physician with aninterest in post-stroke spasticity (i.e.Rehabilitation Physician or StrokeNeurologist) for further assessment

If NO, update patient record andreview at next assessment

Since your stroke or last assessment, are you having more of a problem controlling your bladder or bowels?

Observe Progress

Since your stroke or last assessment, are you finding it more difficult to communicate with others?

Observe Progress

Since your stroke or last assessment, do you feel more anxious or depressed?

Observe Progress

Since your stroke or last assessment, are you finding things important to you more difficult to carry out (e.g. leisure activities, hobbies, work)

Observe Progress

Since your stroke or last assessment, has your relationship with your family become more difficult or stressed?

Observe Progress

Since your stroke or last assessment, are you finding it more difficult to think, concentrate, or remember things?

Observe Progress

Does this interfere with activity or participation?

Since your stroke or last assessment, do you have any new pain?

Observe Progress

5. PAin

6. inContinenCe

7. CommuniCAtion

8. mood

9. Cognition

10. life After stroke

11. relAtionshiP with fAmily

Adapted from: Philp I, et al. Development of a Poststroke Checklist to Standardize Follow-up Care for Stroke Survivors. Journal of Stroke and Cerebrovascular Diseases. December 2012. Endorsed by the World Stroke Organization to support improved stroke survivor follow-up and care

If YES, refer to a physician with an interest in post-stroke pain forfurther assessment and diagnosis

If YES, refer to Healthcare Provider with an interest in incontinence

If YES, refer to specialist Speech and Language Pathologist forfurther assessment

If YES, refer to a Physician or Psychologist with an interest inpost-stroke mood changes for further assessment

If YES, schedule next Primary Care visit with patient and familymember. If family member is present refer to a local strokesupport group

If YES, refer to a Physician or Psychologist withan interest in post-stroke cognition for furtherassessmentIf NO, update patient record and review at nextassessment

If YES, refer to a local stroke support group or a stroke association(i.e. The American Stroke Association or National StrokeAssociation)

MALACAÑANGManila

BY THE PRESIDENT OF THE PHILIPPINES

PROCLAMATION NO. 92

DECLARING THIRD WEEK OF AUGUST OF EVERY YEAR ASBRAIN ATTACK AWARENESS WEEK

Whereas, the Stroke Society of the Philippines was organized in 1995 composed of multi-disci-plinary professionals to help address the different concerns in the prevention, treatment and rehabilita-tion of brain attack victims;

Whereas, the problem of stroke or “Brain Attack” continues to grow as one of the country’s seri-ous health problems due to the growing prevalence of certain types of lifestyle and diet, which puts the Filipino people at high risk for the disease and eventually will affect our national socio-economic development;

Whereas, the different strategies in the prevention, treatment and rehabilitation of brain attack should be vigorously pursued to reduce stroke related deaths and disability, and to reduce the risk factors for said disease;

NOW, THEREFORE I, GLORIA MACAPAGAL ARROYO, President of the Philippines, by virtue of the powers vested in me by law, do hereby declare the Third Week of every August as Brain Attack Aware-ness Week.

IN WITNESS WHEREOF, I have hereunto set my hand and caused the seal of the Republic of the Philippines to be affixed.

Done in the City of Manila, this 28th day of August, in the year of Our Lord, Two Thousand and One.

By the President:

ALBERTO ROMULOExecutive Secretary

BOARD OF TRUSTEESOfficers 2015-2016

The STROKE SOCIETY of the PHILIPPINESRoom 1403 14th Flr. North Tower

Cathedral Heights Bldg. Complex Inc.St. Luke’s Medical Center, 279 E. Rodriguez Sr.Blvd, Quezon City

Telefax (632) 722-5877 Tel. No.723-0103 loc. 5143E-mail: [email protected]

Dr. Maria Cristina Z. San Jose President

Dr. Raquel M. Alvarez P.R.O.

Dr. Alejandro C. Baroque II 1st Vice-Pres.

Dr. Pedro Danilo J. LagamayoDr. Betty D. Mancao

Dr. Manuel M. MarianoDr. Jose Alvin P. MojicaDr. Orlino A. Pacioles

Dr. Jose Leonard R. Pascual VDr. Peter P. Rivera

Dr. Maria Socorro F. SarfatiDr. Maria Cristina M. Valdez

Dr. Artemio A. Roxas, Jr.(2013-2014)

Dr. Carlos L. Chua(2011-2012)

Dr. Jose C. Navarro(2009-2010)

Dr. Ester S. Bitanga(2007-2008)

Dr. Abdias V. Aquino(2005-2006)

Dr. Joven R. Cuanang(Founding President 1995-2004)

Dr. Romulo U. Esagunde Secretary

Dr. Maria Epifania V. Collantes 2nd Vice-Pres.

Dr. Johnny K. Lokin Treasurer

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