Going strong

During her formative years of medical training, Dr. Jamie Fleet started learning about osteoporosis (loss of bone strength) and a seed was planted in her head.

After a stroke, someone’s bone health and bone strength weakens rapidly. But she noticed there weren’t any guidelines for Canadian care providers on how and when to screen, diagnose and treat osteoporosis in stroke survivors before it leads to a catastrophic problem like a hip fracture.

That’s a troubling gap.

Dr. Fleet decided to make a difference by focusing her medical interest onto stroke rehabilitation and fall prevention.

And there’s another big reason why bone health resonates so deeply with her. “I've had my own health issues before, I’ve had trouble walking and I've had surgeries,” shares Dr. Fleet. “I fall all the time. That’s why osteoporosis and falls and fracture prevention are always in the forefront of my mind.”

Guiding stroke rehabilitation research

In 2021, Dr. Fleet was named the inaugural holder of the Dr. Robert Teasell Fellowship in Stroke Rehabilitation Care & Research to answer some of these questions. Dr. Teasell is internationally renowned for his contributions to stroke rehabilitation research through his career. The fellowship in his name was created through a partnership between St. Joseph’s and St. Joseph’s Health Care Foundation to fund the work of a promising young researcher. Generous donors have made this possible.

With that support on her side, Dr. Fleet is already making waves in stroke rehabilitation research in Canada. She’s hoping to develop best practice guidelines for long-term recovery and bone health to help stroke survivors maintain their quality of life, prevent secondary strokes and stay healthy and strong as they grow old.

“Osteoporosis is a silent disease until it isn’t,” says Dr. Fleet. In her clinical work with stroke rehabilitation patients, she meets people every week who are struggling with the effects of weak bones. “A lot of patients say that they wish they would have known sooner about their bone density. I want to stop people from reaching the point of needing surgery and facing high care needs, requiring mobility aids and having chronic pain.”

This work involves assessing how many people experience fractures post-stroke, how many are being treated for osteoporosis and how many are screened for bone health. Current data shows that bone health screening is extremely low in the general population, but even lower for people who’ve had a stroke – even though their risk is much higher.

“There's no real guidance compared to the general population of what to do to help these people,” says Dr. Fleet.

Developing clear guidelines on how and when to assess bone health in stroke survivors will help physicians detect changes as early as possible and prevent complications for their patients. Dr. Fleet recently surveyed rehabilitation physicians across Canada and found there is a very high clinical demand for best practice guidelines in bone health for patients who’ve had a stroke.

A prescription for physical activity

The clinician researcher is also collaborating with St. Joseph’s Gray Centre for Mobility and Activity to study the benefit of different forms of physical exercise for stroke rehabilitation patients. Aerobic exercise improves heart function, blood flow and reduces fatigue – but exercise is not one-size-fits-all. Some patients struggle with mobility after a stroke, which can impact their ability to participate. Dr. Fleet is tracking the effect of aerobic exercise on brain activation and fatigue levels in order to determine the optimal “dose” of activity for each person.

Part of the family

Working at St. Joseph’s has allowed Dr. Fleet’s career to flourish, and she thanks the organization’s culture for that – along with all of the donors who helped bring this Fellowship to life. “Everybody at St. Joseph’s has been really helpful,” she says. “I’m always connecting with patients and colleagues on this work. I just feel like part of a family here.”

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