Contributing authors: Karen Borschmann, Nat Fini, Dana Wong, Liz Lynch and Lin Ong, on behalf of the organising committee
It was standing room only in our Stroke Rehabilitation pre-conference workshop at Stroke 2018 in sunny Sydney. Over 100 clinicians, researchers and consumers from around Australia and New Zealand attended this exciting event, and were informed, entertained and challenged by our talented presenters. The day started with Julie Bernhardt providing a broad description about progress that is being made in stroke recovery research then Karen Borschmann provided a snapshot of stroke researcher location, topics, use of social media and collaborations across Australia. Updates were then provided from CRE streams of clinical trials, implementation science, data linkage, clinical discovery insights from neuroimaging, basic science and the establishment of a new stroke biobank (which really isn’t very basic!), and a virtual-reality guided journey for patients to understand cerebral blood flow during stroke. Presenters did well to provide detailed information and take home messages within their allocated 3 minutes – with the incentive of a chocolate reward for keeping to time.
“Fatigue, stress and anxiety after stroke” was the topic of the next session. Avril Drummond (UK) opened the session presenting about the unmet needs of fatigue and anxiety after stroke. Lin Ong then brought us back down the research pipe with a description of his pre-clinical studies in post-stroke stress and cognitive impairment, which was followed by Andrew Bivard discussing his promising research into medication use for extreme post-stroke fatigue. Dana Wong’s presentation on the application of cognitive-behavioural techniques to improve fatigue and mood post-stroke gave some valuable clinical insights. The ensuing panel produced a broad discussion of the topic from many perspectives.
The Rapidfire session showcased current rehabilitation and recovery trials. Each presenter had 3 minutes to speak and no time for questions, so the challenge was on to present an overview of the study in that short amount of time. Topics ranged from very early rehabilitation (arm and speech), combining exercise and motor training, breaking up stroke survivors’ sitting time, altering the rehabilitation environment and facilitating discharge from hospital. Presenters included established researchers (Dominique Cadilhac and Erin Godecke), emerging and early career researchers (Kate Hayward and Heidi Janssen) and PhD students (Sarah Valkenborghs and Paul Mackie).
The topic “Community service and meeting the needs of stroke survivors” rounded off the morning. We heard from Vincent Thijs from The Florey about the needs of young stroke survivors that are often different to those of older people, and are often not addressed. Vincent hopes to tackle this by starting a young stroke survivor clinic in the near future. Then it was onto Ingrid Rosbergen who talked about the BEEPRS (Building efficient and equitable pathways to and through rehabilitation in stroke) project that demonstrated the many and varied paths that stroke survivors take through Queensland Health and many different health providers, particularly when in the community. Finally we were lucky enough to have Marie-Louise Bird talk about the various programs offered to stroke survivors throughout Canada and Avril Drummond speak about establishing the “Life After Stroke” domain in the European Action Plan.
The post-lunch lull was kept at bay by the intriguing technological innovations presented in the “Using technology to enhance access to evidence based care in stroke recovery” session. Michael Nilsson kicked off the session by outlining the model and scope of his exciting new Centre for Rehab Innovations. Cathie Sherrington’s presentation on the interesting findings from the AMOUNT (Activity and MObility UsiNg Technology) rehabilitation trial increased the heart rate of all the physios in the room, while Rene Stolwyk’s ground‑breaking project using telehealth to increase access to neuropsychology services for stroke survivors in rural/regional areas was later nominated as one of the highlights of the day. Finally, Eleanor Horton provided a fascinating insight into the experience of living in a Smart Home, and the resulting implications for privacy sparked off an engaging panel discussion to finish off a fantastic session.
Erin Godecke and Lin Ong chaired the final session of the day: “Next Big Things”. We discussed what’s next for AVERT-DOSE (A Very Early Rehabilitation Trial – Determining Optimal early rehabilitation after StrokE): A multi-arm covariate-adjusted, response-adaptive randomised controlled trial), what’s hot in implementation in stroke clinical guidelines, data linkages and up-skilling therapists to deliver best practice as well as basic science advances. Julie Bernhardt introduced CARA – Covariate Adjusted Response Adaptive randomization process for the bigger and better AVERT-Dose. Liz Lynch shared her insights into the implementation of Stroke Clinical Guidelines for inpatient stroke rehabilitation. Nadine Andrew discussed her new NHMRC study on comparing differences in long-term health outcomes, linking data from the Australian Stroke Clinical Registry, Medicare and other databases. Leeanne Carey presented the framework to deliver best practice stroke rehabilitation of the upper limb. Rohan Walker gave critical fundamental insights on the role of microglia – brain immune cells and glymphatic – brain waste clearance system in brain repair after stroke. Julie Bernhardt, Michael Nilsson and the audience then provided discussion on the future of stroke rehabilitation.
Although there was a lot of information crammed into one day, the program attendees felt the day covered a broad range of topics relevant to both research and clinical settings. We have begun discussions for the 2019 CRE Stroke Rehab Day in Canberra so put the date in your diary now (Tuesday, 10 September 2019).