Reducing your stroke risk

Episode 28, 19 December 2022

Improving your stroke risk factors can reduce your chance of having another stroke. Some factors you can talk to your doctor about, like high blood pressure, type 2 diabetes, cholesterol and atrial fibrillation, or irregular heartbeat. Then there are things that are part of a healthy life, like quitting smoking, avoiding alcohol, and eating well and staying physically active.

In this podcast, we talk about these risk factors, and we'll look at a new website to help stroke survivors to eat well and move more, i-Rebound.

We speak to stroke lived-experience advocate Meredith Burke, researcher and physiotherapist Dina Pogrebnoy, and registered nurse Fi Camino from StrokeLine.

 

Podcast transcript

Announcer: Welcome to the EnableMe podcast series, where we bring together stroke survivors, health professionals and researchers, providing you with practical advice to enable you on your journey to reclaim your life after stroke. The advice given in this podcast is general in nature, and you should discuss your own personal needs and circumstances with your healthcare professionals. You can join the conversation at enableme.org.au. This series is presented by Australia's Stroke Foundation, working to prevent, treat, and beat stroke.

Chris: [00:37]: One of the first podcasts we did on EnableMe was about the serious issue of the fear of having another stroke, and how to deal with that anxiety. Now we know that one thing you can do is try to improve your stroke risk factors, which are the things that make having a stroke more likely.

Now some of the common risk factors are things you can talk to your doctor about, like high blood pressure, type 2 diabetes, cholesterol and atrial fibrillation, or irregular heartbeat. But then there are other things that are part of a healthy life, like quitting smoking, avoiding alcohol, and eating well and staying physically active.

In this podcast, we'll talk about these risk factors and we'll look at a new website to help stroke survivors to eat well and move more. The website is called i-Rebound, and it's part of the EnableMe family.

Now as usual, we will get some advice from one of the fabulous health professionals on StrokeLine, registered nurse Fi Camino, and we'll also be speaking to a couple of the people behind the new i-Rebound website. Shortly, we'll talk to researcher and physiotherapist Dina Pogrebnoy to share her perspective.

But first, we have with us Meredith Burke, who is passionate about stroke survivors living their best lives, and who also belongs to the club. She has worked with researchers the last four years to translate and educate them about the stroke experience, so that projects like i-Rebound are accessible and get to the core of the issues. Meredith, thanks so much for joining us.

Meredith: [02:02] Hi, how are you?

Chris: [02:03] Really good, thank you. Now, I do want to talk to you about the i-Rebound website, but first I kind of want to understand the need for it. How important is it to stroke survivors to have help like this in preventing another stroke?

Meredith: [02:17] I think it's really important, because when you come out of the first part of your stroke and then you're let loose in the community, it's like, "What do I do now?" It's a really hard time, because you're trying to navigate what's going on with your body and how that affects your life. It's just another gentle tool in the background that you can use to help you start your post-stroke life.

Chris: [02:50] Like you said, you're released into the community without, I guess knowing what's going on. So, do you think that people aren't really given much information generally, or haven't been given much information previously on preventing another stroke?

Meredith: [03:03] No, I don't think so. It's one of those things that, say for example in the public system, provided you can walk and you have some level of speech, you are left to go back into the community. Of course, there are resources that you are given now, from the Stroke Foundation, but there's nothing to literally guide you gently in different areas of your life. So I think that's where the i-Rebound website can fit in quite comfortably, in that space.

Chris: [03:46] Okay, now this is where I might bring in one of Meredith's colleagues, Dina Pogrebnoy, who I know has some thoughts on this issue as well. Now, as I said earlier, Dina is a physiotherapist, a neurological physiotherapist, I believe. Is that correct?

Dina: That is. Thanks, Chris.

Chris: [04:01] Now, Dina is currently doing her PhD at the University of Newcastle, and preventing further strokes is part of her research. Dina, how serious is this lack of support for preventing stroke?

Dina: [04:14] Yeah, Chris, I think it really is a problem for survivors of stroke who find themselves in hospital with a life changing event, and they do get some of their independence back. As Meredith spoke, often there's a focus on getting people walking again, and a focus on getting them living independently or as best as possible, and then they're sent home. What we were hoping to achieve with i-Rebound is to create resources that feature stroke survivors so other stroke survivors can relate to them. That's been the real focus, on making sure that this resource is fit for purpose, it really does talk to the end user in the best possible way.

Chris: [04:56] Great. Just clarifying that, by secondary prevention, that is a term meaning preventing a second stroke really, isn't it?

Dina: [05:03] Essentially. What we know from research in the past is that stroke is... For people that have had a stroke, they are at a greater risk of having another stroke. What we also know is that there is an opportunity to influence that. So people who have had a stroke do have an opportunity to reduce some of the risk factors, which are what we call modifiable, so you can change those. And the two highest modifiable risk factors are inactivity and a poor diet, which is why we're focused on those two areas with the i-Rebound website, in that hoping to help survivors of stroke, give them as much chance, I suppose as possible, to have access to resources that will allow them to make positive lifestyle choices and changes to help reduce the risk of another stroke.

Chris: [05:55] Great. Now, just before we get into the detail of the website, I just want to check with our third guest, because I'm sure that these are issues that come up when people call into StrokeLine as well. I mentioned in the introduction, we have with us today Fi Camino, who is a registered nurse of 12 years standing, specialising in neurology, and she is now one of the health professionals that you can talk to on StrokeLine. Fi, what are the needs... I guess, the questions and concerns that you hear from people who call into StrokeLine?

Fi: [06:24] Yeah. Hi, Chris. As Meredith mentioned earlier, we do very often hear on StrokeLine about concerns relating to how people can prevent having another stroke, and how they can work best with their families and with their health professionals as to mitigating those risk factors. We also often hear questions like, "Do you think my stress levels may have contributed towards my stroke?" Or, "I'm going through a stressful time and I'm worried this will increase my stroke risk." We often do tell them that while stress hasn't been proven to be directly related to stroke, we do know that it can affect other things that are considered risk factors for strokes, such as it can raise blood pressure. As what Dina mentioned earlier, having high levels of stress can lead to unhealthy eating or inactivity or a lack of exercise. So it's also paramount to manage stress in a way that works for them.

Chris: [07:36] And I guess the anxiety about another stroke is part of that thing causing them the stress as well.

Fi: [07:42] Yes. During those conversations that we have with them, we talk about managing that anxiety and focusing on what they can do to mitigate and manage their risk factors to prevent another stroke, but also enhance and enrich their life, yeah.

Chris: [07:59] Okay. Well, that's a beautiful way to lead into talking about what people can do to manage those risk factors, which is I guess the thing we want to focus on is eating well and moving more with the help of something like the i-Rebound website. Meredith and Dina, I don't know who wants to go first. Can you tell us a bit about i-Rebound, and what it does, first of all?

Dina: [08:20] Meredith, do you want to take this one first?

Meredith: Okay. i-Rebound, what is it? It's a website. What it does is empower stroke survivors to make decisions in their power for their health for the rest of their life. It's a website that's easy to get around, and we talk about how to move our bodies more, and types of things that we can eat to help our health as well. I suppose Dina will talk about what we call the Mediterranean diet, which for stroke is, I'll explain in a different kind of way, that it's around the Mediterranean Sea and there's places like Greece and Italy and Spain. It helps you reduce your risk factors for stroke, but it's better for your quality of life post-stroke, because it's important our quality of life, and to do lots of things in post-stroke, we need to eat well and move more. That's a springboard into other things you're wanting to do in your life.

Chris: [09:39] When you talk about how the website has information about eating well and moving more, it's not just talking about the diet and what you need to do, is it? It's actually giving you actual practical information, like recipes and instructions, isn't it?

Meredith: [09:56] Yes, totally. There's videos of stroke survivors moving their bodies. There's videos of stroke survivors talking about the kinds of foods. Basically, the content has come from researchers, but then us as stroke survivors, we have put it on the website in a way that we can relate to easier.

Chris: [10:27] Fantastic. I might go across to Dina now and ask her some information on, I guess, the research side of this. So, Meredith has talked about the Mediterranean diet there and how there is evidence that it is beneficial for your risk factors. What is the Mediterranean diet, apart from just a geographical location?

Dina: [10:50] Thanks, Chris. I'll add to what Meredith has said. The Mediterranean diet that's recommended after stroke is really not a diet where you follow one day and then you're done. It's actually a way of eating, and it's an eating pattern rather than a diet as such. So there's certain things that, within the Mediterranean diet pattern, that you should be eating on a daily basis and there are certain things that you should be eating on a weekly basis, and that's all very clearly outlined on the website. The reason for that is we're trying... The Mediterranean diet is really not about removing things out of your diet, it's just about getting the right nutrients into your body to live your best life. For instance, things like fruits and vegetables and healthy things like that, are recommended to be eaten daily. Then, there's things like maybe meats, more white meat than red meat, are recommended to be eaten less frequently.

So there's no real hard and fast rules about what you can't eat, but there are things you should eat. Things like olive oil, is really important in the Mediterranean diet pattern, and there's some wonderful suggestions on the website about how you can increase the amounts of olive oil that you are able to put into your meals. What this website will do, is it will help people who go on there to try and stick to the Mediterranean diet pattern easier. There's things like checklists, so you can tick off things as you've consumed them throughout the week, and then you can try and plan your meals around what you have and haven't been able to consume throughout the week. There's also meal planners, there's shopping lists, so there's all sorts of examples on the website that will help the user to try and stick to this diet pattern as best as possible.

Chris: [12:36] Great. Does the same apply to the exercise section? Is that, again, based on research and evidence-based recommendations?

Dina: [12:45] Absolutely. The exercise, or the 'moving more' section, so we know that people after stroke are recommended to exercise roughly for 30 minutes at moderate intensity on most days of the week. What we are hoping that people will find useful on the website is there's actual full exercise routines that you can follow along to, so you don't have to create an exercise routine yourself. You can find somebody who has a similar level of function to you and you can just follow along. You can chop and change bits of the exercise routines if you want. If you're wanting to combine different shorter routines together, you can do that as well.

What we've done is we've been really conscious of making sure that the exercise routines are performed by stroke survivors, so there's no physio standing in front of the camera showing you what to do. You have the opportunity to have a look at another stroke survivor during the exercise that we're asking them to do.

Chris: [13:43] Okay. I guess, that's a question then for Meredith really, how important do you think that is that, I guess everything is checked and validated by stroke survivors? Because I understand it's fairly easy to say everyone should get 30 minutes exercise per day, but people, even if they haven't had a stroke, will find all kinds of obstacles to doing that. Yeah, do you think this website addresses the challenges that people face and gives them the tools to get around it?

Meredith: [14:15] Absolutely. As Dina said, the people who are doing the exercises on the website are at different levels post-stroke, so we're trying to design it so they're relatable to different kinds of stroke survivors out there in the community, to try and empower someone to go, "Oh, I can do that. They're a bit like me, or I should be able to do that." It's just that motivating thing that go, "Oh, I can do things that are good for me." It's that kind of motivation that I think is really important.

Dina: If I can add to that, Meredith, as well, I think one of the things that you'll find on the website is not only the exercise videos, but there are also in the hints and hacks section, which is probably my favourite section. In there, there's various videos on other stroke survivors sharing their tips about how to incorporate exercise into daily life as well, so exercise doesn't need to be necessarily your squats or whatever you might be doing. It can be vacuuming, or it can be doing some stuff around the kitchen. Really, what we're trying to achieve is for survivors of stroke to have access to some sort of movement. And if that movement adds up across the day to 30 minutes, then they would be meeting their recommended physical activity targets for the day. So there's all sorts of different tips on there to help survivors of stroke engage in activity that's meaningful to them and therefore hopefully sustainable.

Chris: [15:59] Yeah. I did want to ask you about the hint and hacks section because I've had a look at the website and when you first glance, there's a recipe section. There's the exercise videos section, and then there is this, I guess very comprehensive hints and hacks and so what else is in there? What can people find in that?

Dina: [16:20] Oh, I love this section. I think it's been a combination of lots of stroke survivors, who've been involved in this project, sharing what works for them to do with physical activity, but also things like fatigue and energy conservation and how do you get back to activity when you're now in a wheelchair, and what sort of things can you do when you're in the wheelchair? As an example, there's a video there about going hot air ballooning when you're in the wheelchair. You'll find all sorts of amazing things on there that you probably will never have thought of yourself, but if somebody else has shared it with you, makes it so much more inspiring to try something that perhaps you haven't thought of trying yourself. Have you got any thoughts on that, Meredith?

Meredith: Yeah. It's a great little section, and there's lots of different bits and pieces in there. For stroke survivors out there, I would just suggest to just click around on the videos. It mightn't be what you think and it might ignite some sort of, "Oh, I can do that too." Even there's tips and tricks for one-handed cooks, as well, and of course fatigue. We cover that quite a lot. Yes, it's just an Aladdin's Cave of information in there.

Dina: A Pandora's box. You just made me think, Meredith, some of the things to do with fatigue. We don't only talk about fatigue, but there's some practical tips around when you're feeling tired, what are some of the things you might have in your pantry, as an example, that you can whip together a fairly simple meal that's still in keeping with the Mediterranean diet pattern. So it's things like that. They're not just suggestions, they're actually practical tips to help someone at every stage and every potential complication relating to their stroke.

Chris: [18:24] Fantastic. Now, I do want to change tack a little bit now slightly, because obviously i-Rebound is really covering some of these major modifiable, like you said, lifestyle risk factors. I think I'm getting the terminology right there. But obviously there are a lot of other important risk factors as well. I know that for instance, high blood pressure is one that the Stroke Foundation often focuses on. I guess I wanted to just check with Fi, what are the other important risk factors that people need to be aware of and address?

Fi: [18:59] Yes, Chris. As you mentioned, high blood pressure is one of those very common culprits for strokes. It's important to know what normal blood pressure is. Ideally, around 120 over 80, but that can be individualised. It's important to speak to your doctor GP about what your normal blood pressure would be. I often tell patients and/or stroke survivors who call on StrokeLine that they can help control their blood pressure by adhering to the medications that are prescribed to them, and even monitoring it at home, to help their doctor work out the best regimen for them, because it can be quite tricky controlling it.

Another one that you've touched on briefly earlier was atrial fibrillation, so keeping that rhythm in control through taking medications as prescribed. Another big one is type 2 diabetes, which ties in nicely with having a healthy balanced diet, but also making sure to see the GP regularly or a diabetes educator to ensure that their blood glucose is well managed and well controlled.

Another one that ties very closely to diet as well is high cholesterol and it's important that people know their cholesterol numbers. The stroke Clinical Guidelines, I think recommends keeping the bad cholesterol to less than 1.8 to be precise. For some people, diet alone isn't enough to lower cholesterol, so they may need to take medication and monitor their cholesterol levels quite regularly.

Chris: [20:48] Okay. Fantastic, thanks, Fi. Yeah, some good messages there and absolutely there's often for many of these risk factors, you do need to take additional medication. Yeah, as you said, we know that particularly with things like cholesterol and type 2 diabetes are very much influenced by diet, I guess. Dina, how about the big one? High blood pressure? Is that something that the resources and recommendations on a website like i-Rebound can help with as well?

Dina: [21:19] Absolutely, Chris. The exciting news is within our research group, we've conducted a telehealth trial, both the diet and the physical activity aspect. The early results indicate that, in fact, if you are engaging in the right level of activity and eating or sticking to a Mediterranean diet pattern, that is something that can help lower blood pressure, improve levels of cholesterol, and generally improve the other risk factors. So we do have some preliminary evidence that suggests that adhering to recommendations on the i-Rebound website will in fact help reduce those risk factors.

Chris: [21:56] Great. Which is not, again, not to say that you shouldn't stop taking your medication, but yeah.

Dina: [22:00] Yeah. No, absolutely. We would never replace medical advice. I think the important thing to note is, using the i-Rebound website to help you move more and eat well is an additional part to receiving appropriate medical care from your health professional. Certainly if medication is recommended, by all means the user of the website should be doing that, but they could challenge the norm and see what happens when they exercise and eat well and see whether they get natural improvement, which is an added bonus.

Chris: [22:30] Great. It's also good to hear how this is all fitting in with the other research you've been doing, which I guess something that I wanted to ask about as well, something that... i-Rebound has come out of a research project, and it's come out a particular, I guess approach to a research project. You've talked about the input from stroke survivors, people with lived experience to it, as sort of a co-design, I believe it's called.

Dina: [22:54] Yes.

Chris: [22:55] I do want to talk to both you and Meredith about what that process is like and what it's been like to be part of that? Meredith, you've already talked about it a bit. But could you expand a bit more of what you think the co-design process and having the different kinds of voices involved? What does that actually mean, and what does it bring to a project like this?

Meredith: [23:15] Well, the co-design process is basically... All it means is that there's researchers and stroke survivors. In this research, we are involved from the very start, which is really exciting because we actually get to put our stamp on it from the start. In traditional research, they potentially only ask us questions and things near the end, and then we don't actually get some meaningful input into it. But with this one, we had a team of us, there was six of us on a committee. And we worked with Dina from day one. What is important is there was a real mutual respect between the researchers and us, and that we're on the same level as them, so there was no hierarchy that the researchers are telling us what to do. It was all just smooth sailing, Dina, really.

Dina: You're very kind, Meredith.

Meredith: Because of that mutual respect.

Chris: [24:33] How did you find the process, Dina?

Dina: [24:35] Yeah look, it's been a really rewarding part of the process for me. I think... I came onto the project when there was already wheels in motion in some ways. I think what's been a really interesting and rewarding part for me is making sure that this website, or this resource bank, is really fit for purpose. I think if we hadn't involved stroke survivors from the beginning, there's no guarantees that it would've been a resource that's meaningful to the intended user. Having Meredith and the team behind this project from the beginning, I think has been the secret sauce to making sure that we deliver a product that really means something to survivors of stroke, and that's who we want to tap into.

We want people going home after hospital feeling like they've got something to turn to and they've got support available to them, which hasn't been around. There really isn't anything like i-Rebound out there, to the best of our knowledge. So we're pretty proud of what it is and hopefully what it will do.

Chris: [25:36] Do you think that this is something that you'd like to see, I guess every project, having some sort of... Using co-design in this way, using lived experience in this fashion?

Dina: [25:47] Yeah, absolutely. Look, what we probably haven't touched on is the i-Rebound website not only had a co-design element of the content, but also in the early phases of the project, we went through quite a comprehensive phase of the design of the website, and making sure that it's accessible to survivors of stroke with different levels of abilities. So we actually involved quite a lot of stroke survivors in making sure that the navigation, the usability of the website was appropriate for somebody after stroke, because there's no point creating something that looks pretty and maybe even the content is really relevant in evidence-based, but if it's not something that's accessible to stroke survivors, then we probably haven't hit the brief.

So this project has been very well considered in terms of making sure that every survivor of stroke, hopefully every survivor of stroke who finds their way to the website will feel like it's easy to use. It reflects something that's interesting and appropriate for them, and they'd like to come back to it.

Chris: [26:48] Great. Meredith, certainly, you talked about how you're passionate about making sure that projects like these are accessible and that they do meet the needs of stroke survivors. What else do you get out of it as, I guess a personal benefit? Do you find it rewarding to be involved in these kind of things?

Meredith: [27:05] Yes. I do find it really, really rewarding, just because moving more and eating well are two of my passions. To combine that with researchers and to help educate them about what we are like after stroke, and then seeing that morph into 18 months of work to come out to this website, it is really rewarding.

Chris: [27:40] So how do people get involved in research like this, if they are someone with lived experience?

Meredith: [27:46] It just depends on where you live, to be honest, and how passionate and interested you are. But I suppose you could ask potentially the hospital where you are, and maybe they'd be able to put you into... well, contact with some other researchers.

Chris: [28:08] Okay. I guess people can also talk to the Stroke Foundation, can they, Fi?

Fi: [28:16] Absolutely. We often do speak to survivors of stroke on StrokeLine who are interested in trying out different avenues, and being involved in research as well. In that conversation, we try and see what they want out of it, what specific kind of aspect of stroke do they want to try and achieve, whether that's rehab, or fatigue management, or exercise. We try and help point them in the right direction and link them up to research organisations that they can get in touch with and see if they'd be eligible to participate or contribute to, yeah.

Chris: [29:00] Great. Now, this is a fantastic resource that you all have developed and we have talked about a lot, but what is on it and what it does? Yeah. We do have to acknowledge it is part of a research project, it will maintain into the future. It's not going to end at some point, I understand. Is that right, Dina?

Dina: [29:21] No, that's right. That's really the benefit of having a really strong partnership between our research team and the Stroke Foundation. They've been super supportive of this work from the get go. It was always intended that i-Rebound would live on the Stroke Foundation website under the EnableMe umbrella and it will continue to live there well beyond the research as a resource that can be used by anybody within Australia, no matter where they live at a time that's convenient to them, at a place that's convenient to them. We suspect our friendly neighbours from other countries may well tap into it as well, but the intention has always been to provide survivors of stroke living in Australia with a resource that's fit for purpose.

Chris: [30:05] Great. But it is also part of your PhD project, as we discussed. From the research point of view, what are you hoping to get out of it? What are you hoping to learn from it?

Dina: [30:17] Yeah, it is part of my PhD project and it's been the big project of the program, but I guess for me, what I'm hoping is to be able to evaluate over time whether people are using the resource, and which parts of the website are being used by survivors of stroke, but also what we're hoping to do over time, is to grow the number of resources that are available on the website. We're also hoping to encourage a more diverse representation within the website, and that's a bit of a pipeline dream, but to touch on the point you touched on before in terms of being involved in research, it's really important for us to have stroke survivors from different cultural backgrounds, different ages, different levels of abilities come forward and want to be involved in these projects, because ultimately the aim is to try and represent as diverse a group as possible. We can only do that if we have access to lived experience from a diverse group of stroke survivors.

Chris: [31:22] Great. Meredith, we're nearly at the end of this podcast. Do you have any final advice that you would want to give to people?

Meredith: [31:30] A lot of times after stroke, there's so many different rules placed on us about our body and our movement and what we can achieve in life. I think this website can help you open up opportunities and potentially reopen things that you've enjoyed pre-stroke, like cooking to show that you can do it after stroke and you can move your body. It's just potentially in a different way. So I think for people, just to get on the website, have a look, have some fun, and enjoy it.

Chris: [32:18] Great. Dina, any other last words from yourself?

Dina: [32:22] I just love when Meredith talks about the website and what it means to her, because it's like the honey on top of a cake for me. For me, it's always been about creating something that's fit for purpose, and what's been really rewarding is the more people I talk to, the message is consistent. People love that it's positive. The website is about what you can do, not what you can't do. It features stroke survivors, stroke survivors sharing their experience, as Meredith said, whether it's about one-hand cooking, or whether it's about how they've incorporated activity into daily life. For me, it's been a really rewarding project to be part of, and I'm hoping that once people come across the website, they will see something on there that is relevant, and they enjoy using it, and hopefully it increases value to their lives because that's ultimately why we did it.

Chris: [33:16] Great. Now, we do like to wrap up with, I guess some words from StrokeLine. Fi, can you give us, just a quick summary, some top tips for preventing another stroke?

Fi: [33:31] I think the fear and anxiety about having another stroke is real, but so is the fact that 80% of strokes can be prevented, and it is never too late to start thinking about stroke prevention. And part of recovery and rehabilitation, it's good to surround yourself with a team of people who can support you in your stroke journey, and stroke prevention as well, and focusing on what you can control as well. It's a really good one. And there are ways to get help. So do reach out to StrokeLine and speak with one of health professionals like me to get advice and support that is right for you.

Chris: [34:21] Fantastic. Thank you, thank you Fi, thank you all of you. Now, if you do want this information on eating well and moving more that is on the new i-Rebound website, it is part of the EnableMe family. You can find it by going to irebound.enableme.org.au, or if you just go to the EnableMe homepage, there is a link on there. It is on the left-hand side. You can probably Google "i-Rebound" as well. I'm not sure whether it's showing up on Google yet. It is a very new website as we speak in recording this.

If you do want to speak to a health professional like Fi for some additional advice, you can of course call StrokeLine on 1800 787 653. That is 1800 STROKE if you want to use the letters on your phone keypad. Or you can just ask a question through EnableMe and get a response from health professionals and other stroke survivors.

Now, if you do like what you've heard today on this podcast, please, I would appreciate giving us a good rating and review on your podcast app, because that helps lift us up in the search rankings and other people can find the podcast.

But look, I would like once again to thank all our guests, Meredith Burke, Dina Pogrebnoy and Fi Camino.

Announcer: [35:37] That's all for today's EnableMe podcast. You can find out more on this topic and continue the conversation or listen to other podcasts in the series at enableme.org.au. It's free to sign up, and you can talk with thousands of other stroke survivors, carers, and supporters. You can also suggest a topic or provide feedback on this podcast.

EnableMe has qualified health professionals from StrokeLine who can answer your questions and give evidence-based advice. The advice given here is general in nature, and you should discuss your own personal needs and circumstances with your healthcare professionals.

The music in this podcast is "Signs" by stroke survivor Antonio Iannella and his band The Lion Tamers. It's recorded at Antonio's studio, which you can find out more about at facebook.com/studiofour99. This EnableMe podcast series is produced by the Stroke Foundation in Australia, working to prevent, treat and beat stroke. See strokefoundation.org.au.

This podcast was produced in collaboration with JOY, Australia's Rainbow Community Media organisation. For more information on JOY and our services, visit joy.org.au.