Advances in Stroke Recovery
Save the Date: Sept. 14, 2016
This year, the HSF Canadian Partnership for Stroke Recovery will hold two Advances in Stroke Recovery meetings. The purpose of these meetings will be to profile the CPSR to the larger stroke recovery community and highlight advances in stroke recovery research by CPSR researchers. The first Advances meeting will occur in conjunction with the Canadian Stroke Congress in Quebec City this fall. The Advances meeting will be held on the evening of Wed., Sep 14 and participants will enjoy dinner with a panel of top stroke recovery researchers who will discuss the issues around timing and intensity of post-stroke rehabilitation therapy. Prior to the dinner meeting, a full-day by-invitation only CPSR investigators' workshop will take place. Further details on how to register will be provided in the upcoming newsletter and emails. The second Advances in Stroke Recovery meeting will be held in conjunction with the Stroke Program in Neurorecovery (SPiN) trainee course in Vancouver in October.
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Mochizuki wins
Mentorship Award
On May 10, CPSR research scientist Dr. George Mochizuki was awarded the 2016 University of Toronto Rehabilitation Sciences Institute Faculty Award - Early Career Excellence in Supervision and Mentorship. The award recognizes outstanding contribution to the training and experience of graduate students, as evidenced by excellence in supervision and mentorship and dedication to students. Congratulations to George for this well-deserved honour on behalf of the CPSR!
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uOttawa puts spotlight on lifesaving research funded by HSF
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CPSR Scientific Director Dr. Dale Corbett, third from right, took part in an informative and engaging panel of presentations on May 5 in Ottawa, featuring Heart and Stroke Foundation-funded research. Research advances are especially important because, according to HSF CEO David Sculthorpe, pictured at far left, nine out of 10 Canadians have at least one risk factor for heart disease and/or stroke and a half of Canadians have been impacted by these diseases. Among presenters: Dr. Duncan Stewart, who spoke about stem-cell therapy for heart disease; Dr. Marc Ruel, who highlighted major innovations at the University of Ottawa Heart Institute; Dr. Cheemun Lum, who spoke about new interventions in the treatment of acute stroke; and moderator Dr. Heidi Sveistrup, a CPSR researcher and rehabilitation sciences professor at uOttawa, who moderated the meeting and took questions from the 90-member audience.
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Lessons-learned from the AVERT Trial: Watch the video and share!
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This month, the Canadian Partnership for Stroke Recovery hosted renowned Australian stroke rehabilitation researcher Dr. Julie Bernhardt. Dr. Bernhardt is leader of the AVERT Trial that looked at when to start physical rehabilitation for people after stroke. We recorded her lecture, which was delivered to students and faculty at the University of Ottawa on May 6, and we have just posted it on our website. The lecture provides highlights and lessons-learned from this major international trial and it highlights new research questions and next steps. It's a 55-minute-long video (45-minute lecture and 10 minutes of questions) but well worth watching and sharing. View it HERE.
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Canadian Stroke Congress, Sept. 15-17 in Quebec City
Submissions for Brag-and-Steal session now open
Submissions for the Brag-and-Steal presentations at the Canadian Stroke Congress in the area of Rehabilitation are being accepted until May 20th. The Brag-and-Steal session will be held on Saturday, September 17th from 10:30 a.m. to 12:00 p.m.
Criteria and requirements for submissions have been put in place to ensure the Brag-and-Steal session is distinct from the regular Congress programming. This is not a forum for submitting scientific abstracts and topics submitted for an abstract should not also be submitted for a brag and steal.
Don’t miss out on being part of Canada’s premier Stroke Meeting!
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Stroke can happen at any age, Swartz tells CTV's Canada AM
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In the wake of Canadian Olympic Medalist Denny Morrison's stroke in April, CPSR's Dr. Rick Swartz appeared on Canada AM on April 26 to talk about how stroke can happen at any age. Watch the interview and read the guide to Stroke in Young Adults posted on our website at www.canadianstroke.ca. We worked with Dr. Swartz, a clinician scientist at Sunnybrook Research Institute, to develop the guidebook. http://www.ctvnews.ca/video?clipId=856108
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CPSR National Trainee Association
Webinar series gets off to an excellent start
CPSR National Trainee Association held its first trainee webinar (trainees presenting to other trainees) on Wednesday May 4. Dr. Lisa Engel (Baycrest) presented to 12 NTA members on her research: “I can answer but in action I am differentâ€: Assessment of financial management skills after acquired cognitive impairments related to ABI/stroke. The presentation went smoothly, and based on a feedback survey, all who responded rated that presentation as excellent, found it useful, and valued the interactive question-and-answer period that followed.
One survey comment on the overall webinar stated “I enjoyed it very much. I don't usually attend webinars because they are too long - this one was of perfect length.â€
We hope to arrange our next CPSR NTA trainee webinar during the summer months – details to follow.
If you are interested in giving a webinar, please let us know by sending an email to training@canadianstroke.ca. The talks are meant to be 20 minutes in length with 10 min for Q&As.
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Check out the many videos we have posted on the CPSR website, some of which can be used in presentations and as educational tools. We recently posted videos on STEM CELLS AND STROKE RECOVERY, the STAGES OF STROKE RECOVERY, and a personal account of one person's stroke recovery experience called CAROLE'S STORY. Please watch and share! Look for more videos by clicking on the videos button on the homepage of our website www.canadianstroke.ca
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This month, we speak with CPSR Scientific Director Dr. Dale Corbett about the significance of his recent co-publication on the need for improved international research collaboration in stroke recovery research.
Bernhardt J, Borschmann K, Boyd L, Thomas Carmichael S, Corbett D, Cramer SC, Hoffmann T, Kwakkel G, Savitz SI, Saposnik G, Walker M, Ward N.. Moving rehabilitation research forward: Developing consensus statements for rehabilitation and recovery research. Int J Stroke. 2016 Apr 12. [Epub ahead of print]
What was the purpose of this research?
In the 1990s there was great interest in developing drugs that would reduce brain damage after stroke. Dozens of these "neuroprotective" drugs were developed and quickly moved into clinical trials without thorough preclinical evaluation. Subsequently, every one of these promising drugs failed in clinical trials. This widespread failure to translate basic research into clinical success led to several international roundtable meetings involving preclinical and clinical researchers and pharmaceutical representatives. The result of these meetings was a series of specific recommendations and guidelines, the STAIR (Stroke Therapy Academic and Industry Roundtable) reports, designed to improve the quality of both basic research and clinical trials in acute stroke. Subsequently, a second stroke roundtable STEPS (Stem Cells as an Emerging Paradigm to treat Stroke) drafted similar guidelines for the use of stem cell therapy to treat stroke.
With the growing realization that stroke recovery is the new frontier in stroke research, an international group of experts, led by Dr. Julie Bernhardt a leading Australian clinician-scientist, formed the Stroke Recovery and Rehabilitation Roundtable (SRRR) to make recommendations to improve the quality of preclinical and clinical stroke recovery and rehabilitation research. These guidelines will be reached through consensus and are meant to raise the standards of stroke recovery research around the world, to identify clinical problems of high priority for collaborative research, and to establish a different type of "research pipeline" that will minimize the likelihood of translational failure.
What were the major findings from this work?
The inaugural SRRR meeting was held in Philadelphia on May 8-9th 2016. Working groups encompassing the full range of preclinical and clinical research were formed to identify research priorities and fundamental issues related to: translational research, identification of biomarkers to predict recovery after stroke, development of common and sensitive outcome measures to assess recovery in clinical trials and how new, potentially beneficial interventions to enhance recovery could best be identified.
What implications might this work have on stroke recovery?
Stroke recovery is an exceedingly complex problem because unlike a number of other diseases where the therapeutic targets are clear (e.g. Parkinson's disease- loss of dopamine in brain) there are no clearly identified "biological targets" for stroke recovery. In order to advance knowledge in this field it will require a concerted, bi-directional collaborative effort between preclinical and clinical researchers. Only through such a collaborative, multi-disciplinary research approach will it be possible to develop game-changing therapies for stroke recovery. The SRRR will greatly facilitate this process on an international scale.
What are the major outstanding questions that arise from this work?
In spite of years of rehabilitation research it is still not known how rehabilitation works. In fact, some question whether rehabilitation works at all or instead whether improvement after stroke is mostly due to spontaneous biological recovery. A pressing question is to understand the mechanistic basis for how recovery occurs after stroke - whether it is spontaneous recovery or recovery that is facilitated by rehabilitation. In the absence of such information there is no clear basis or rationale for developing new more effective therapies or for conducting clinical trials to assess promising interventions.
The question of timing was identified as a key question. When does the transition from acute stroke (brain cell death phase) to the brain repair phase occur? Are there biomarkers that could identify when this transition occurs? Such information is essential in order to know when it is safe to start rehabilitation since too early treatment may worsen outcome. Conversely, delaying therapy for too long may also result in less good outcome. Similar questions arise to the issue of intensity of therapy where there may be minimal thresholds of therapy required to activate biological recovery processes. These thresholds may vary with the individual due to many factors such as their age, the size and location of the stroke, etc.
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In our ongoing profile series on CPSR trainees, this month we meet Jessica Powers, left, who is a Master's student in Rehabilitation Sciences working with Dr. Kara Patterson at Toronto Rehabilitation Institute, and Sébastien Maillé, right, a Master's student in Neuroscience at the University of Ottawa who is working with Dr. Jean-Claude Béïque to better understand the impact of post-stroke depression.
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Jessica Powers
Q: Tell us a bit about yourself. Where are you from?
A: I was born and raised in the Greater Toronto Area and received my BSc in Kinesiology at the University of Ontario Institute of Technology. I have recently moved to the heart of the city to pursue a graduate education at University of Toronto. I am a first year MSc student in the Rehabilitation Sciences Institute and am conducting my research at Toronto Rehabilitation Institute under the supervision of Dr. Kara Patterson.
Q: What compelled you to pursue stroke research?
A: In the fourth year of my undergraduate program my neuro-pathophysiology course hosted a guest lecturer from Toronto Rehab. The talk on stroke highlighted the impressive rehabilitation efforts at Toronto Rehab and the exciting new research taking place there. It piqued my interest, so I volunteered to participate in a study there, which was very cool! I also received a tour of the unique research labs and equipment, and met a couple of the scientists. I knew I wanted to pursue stroke research while sitting in that undergrad guest lecture and the rest sealed the deal for me.
Q: What is the focus of your research?
A: My research aims to investigate motor learning principles of the lower extremity post-stroke, specifically the extent to which visual feedback can influence motor learning of a walking task, and the frequency in which it should be provided. Understanding of motor learning principles post-stroke can be implemented in clinical practice to improve gait outcomes for patients and inform design of future interventions.
Q: At what stage are you in your research, and what are your current future plans?
A: After collecting lots of pilot data and doing some technical trouble shooting, we have recently started recruiting. Very exciting! We are recruiting individuals with stroke who are inpatients at Toronto Rehab and collecting data on site. Ultimately, I hope to pursue a career in health care as a physical therapist and hope to specialize in working with neurological populations, especially stroke.
Q: How do you and others benefit from being part of the National Trainee Association?
A: Being part of the CPSR National Trainee Association offers a platform for us to interact with our peers across Canada and share our passion for stroke recovery. The NTA offers trainees a variety of opportunities for professional development, including peer mentoring, funding competitions and events. This year I had the opportunity to attend the SPiN Workshop, which was absolutely awesome! It was a great opportunity to have hands-on learning about stroke research happening in Toronto and meet other trainees from across Canada.
Q: What other interests do you have?
A: In my spare time I enjoy tutoring young students in math and science. For fun I like to read novels, watch movies, and explore nature and run at conservation areas.
Sébastien Maillé
Q: Tell us a bit about yourself. Where are you from?
A: I'm from North Bay, Ontario. I grew up and went to high school in North Bay, before moving away in 2011 to pursue a B.Sc. in Biomedical Sciences at the University of Ottawa. I'm currently doing my Master's degree in Neuroscience under the supervision of Dr. Jean-Claude Béïque.
Q: What compelled you to pursue stroke research?
A: Throughout my undergraduate studies, I became very interested in neural physiology, in particular in the synapses that mediate the transmission of signals between neurons. I was further fascinated by the processes that dynamically regulate the function of these synapses, and how the resulting alterations in network function influence behaviour. While working under the supervision of Dr. Béïque, I was given the opportunity to further explore these processes and apply them to the very important, clinically relevant problem of stroke recovery. Now, my research allows me to apply my knowledge and curiosity to solve a problem that will improve the lives of patients and provide hope for full recovery.
Q: What is the focus of your research?
A: Following stroke, survivors’ hopes for full recovery are undermined by a remarkably high incidence (up to 50%) of post-stroke depression (PSD). The depressive symptoms experienced by patients with PSD severely impact final recovery outcomes by affecting their motivation to adhere to an optimally aggressive rehabilitation protocol. The focus of my research project is to determine, at a functional level, how a cortical stroke alters information flow in key mood-related brain circuits in the weeks and months following a stroke. Our team is using an optogenetic approach along with electrophysiological recordings in a rat model of stroke to functionally dissect the long-range synaptic connections between brain regions that are important in determining mood. Any stroke-induced alterations in information flowing through these pathways could be important in producing the depressive symptoms in PSD.
Q: At what stage are you in your research, and what are your current future plans?
A: I'm currently in my first year of my Master's degree, and I'm expecting to graduate in 2017. After completing my Master's degree I would ideally like to join an MD/PhD program. My dream is to treat patients in a clinical setting while also continuing my work in research and academia. This would allow me to provide care that is informed by cutting-edge research, while performing research that is driven by the needs of my patients.
Q: How do you and others benefit from being part of the National Trainee Association?
A: So far, I've been fortunate enough to hold a CPSR Trainee Award to help fund my Master's degree. Being a part of the NTA I've had the opportunity to meet trainees from several other labs, learn about their research, and have constructive discussions about our projects and experiments.
Q: What other interests do you have?
A: I have many interests that keep me busy in my time away from the lab. First, I'm part of the Graduate Student's Association within our department, where I serve as representative for the Neuroscience program. The GSA allows me to meet other students from the department, and address student concerns while organizing events aimed at improving the student experience. Outside of academia, I enjoy playing volleyball. This year I've played with the University of Ottawa Gee-Gees Men's volleyball team in tournaments all over Ontario and Quebec. I also enjoy cycling and rollerblading during the summer and playing guitar. I believe it is important to maintain a healthy, well-rounded lifestyle in order to perform to my highest potential in the lab.
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Sign up now for two terrific PD webinars
Heart and Stroke Foundation is offering two great professional development webinars on stroke rehabilitation and recovery. More info here: http://eepurl.com/b0624L
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Bernhardt J, Borschmann K, Boyd L, et al. Moving rehabilitation research forward: Developing consensus statements for rehabilitation and recovery research. Int J Stroke. 2016 Apr 12. [Epub ahead of print]
Chen JL, Schlaug G. Increased resting state connectivity between ipsilesional motor cortex and contralesional premotor cortex after transcranial direct current stimulation with physical therapy. Sci Rep. 2016 Mar 16;6:23271.
Falcon MI, Riley JD, Jirsa V, McIntosh AR, Elinor Chen E, Solodkin A. functional mechanisms of recovery after chronic stroke: Modeling with the virtual brain. eNeuro. 2016 Apr 4;3(2). eCollection 2016 Mar-Apr.
Findlater SE, Desai JA, Semrau JA, Kenzie JM, Rorden C, Herter TM, Scott SH, Dukelow SP. Central perception of position sense involves a distributed neural network - Evidence from lesion-behavior analyses. Cortex. 2016 Mar 18;79:42-56. [Epub ahead of print]
Flowers HL, Skoretz SA, Silver FL, et al. Poststroke aphasia frequency, recovery, and outcomes: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2016 Apr 7. [Epub ahead of print] Review.
Habib Perez O, Singer JC, Mochizuki G. The effects of predictability on inter-limb postural synchronization prior to bouts of postural instability. Gait Posture. 2016 May;46:167-72. Epub 2016 Mar 11.
Hebert D, Lindsay MP, McIntyre A, et al. Canadian stroke best practice recommendations: Stroke rehabilitation practice guidelines, update 2015. Int J Stroke. 2016 Jun;11(4):459-84. Epub 2016 Apr 14.
Ingram TG, Kraeutner SN, Solomon JP, Westwood DA, Boe SG. Skill acquisition via motor imagery relies on both motor and perceptual learning. Behav Neurosci. 2016 Apr;130(2):252-60.
Inness EL, Mansfield A, Bayley M, McIlroy WE. Reactive stepping after stroke: Determinants of time to foot off in the paretic and nonparetic limb. J Neurol Phys Ther. 2016 May 5. [Epub ahead of print]
Kapral MK, Hall R, Fang J, et al. Association between hospitalization and care after transient ischemic attack or minor stroke. Neurology. 2016 Mar 25. [Epub ahead of print]
Kielar A, Deschamps T, Jokel R, Meltzer JA. Functional reorganization of language networks for semantics and syntax in chronic stroke: Evidence from MEG. Hum Brain Mapp. 2016 Apr 19. [Epub ahead of print]
Kirton A, Andersen J, Herrero M, et al. Brain stimulation and constraint for perinatal stroke hemiparesis: The PLASTIC CHAMPS Trial. Neurology. 2016 Mar 30. [Epub ahead of print]
Koller K, Woods L, Engel L, Bottari C, Dawson DR, Nalder E. loss of financial management independence after brain injury: Survivors' experiences. Am J Occup Ther. 2016 May-Jun;70(3):7003180070p1-8.
Lee KF, Soares C, Thivierge JP, Béïque JC. Correlated synaptic inputs drive dendritic calcium amplification and cooperative plasticity during clustered synapse development. Neuron. 2016 Feb 17;89(4):784-99.
Lenton-Brym A, Kurczek J, Rosenbaum RS, Sheldon S. A new method for assessing the impact of medial temporal lobe amnesia on the characteristics of generated autobiographical events. Neuropsychologia. 2016 Mar 4;85:35-43.
Mang CS, Brown KE, Neva JL, Snow NJ, Campbell KL, Boyd LA. Promoting motor cortical plasticity with acute aerobic exercise: A role for cerebellar circuits. Neural Plast. 2016;2016:6797928. Epub 2016 Apr 4.
Ng VT, Bayoumi AM, Fang J, Burton KR, Stamplecoski M, Edwards JD, Kapral MK. Temporal trends in the use of investigations after stroke or transient ischemic attack. Med Care. 2016 May;54(5):430-4.
Parsons SL, Mansfield A, Inness EL, Patterson KK. The relationship of plantar cutaneous sensation and standing balance post-stroke. Top Stroke Rehabil. 2016 Mar 31:1-7. [Epub ahead of print]
Prout EC, Mansfield A, McIlroy WE, Brooks D. Patients' perspectives on aerobic exercise early after stroke. Disabil Rehabil. 2016 Mar 26:1-7. [Epub ahead of print]
Ramirez J, Berezuk C, McNeely AA, Gao F, McLaurin J, Black SE. Imaging the perivascular space as a potential biomarker of neurovascular and neurodegenerative diseases. Cell Mol Neurobiol. 2016 Mar 18. [Epub ahead of print] Review.
Ramirez J, McNeely AA, Berezuk C, Gao F, Black SE. Dynamic progression of white matter hyperintensities in Alzheimer's Disease and normal aging: Results from the Sunnybrook Dementia Study. Front Aging Neurosci. 2016 Mar 24;8:62. eCollection 2016.
Sheehy L, Taillon-Hobson A, Sveistrup H, Bilodeau M, Fergusson D, Levac D, Finestone H. Does the addition of virtual reality training to a standard program of inpatient rehabilitation improve sitting balance ability and function after stroke? Protocol for a single-blind randomized controlled trial. BMC Neurol. 2016 Mar 31;16:42.
Sheldon S, Amaral R, Levine B. Individual differences in visual imagery determine how event information is remembered. Memory. 2016 May 5:1-10. [Epub ahead of print]
Silasi G, Xiao D, Vanni MP, Chen AC, Murphy TH. Intact skull chronic windows for mesoscopic wide-field imaging in awake mice. J Neurosci Methods. 2016 Apr 19;267:141-149. [Epub ahead of print]
Simpson LA, Eng JJ, Chan M. H-GRASP: the feasibility of an upper limb home exercise program monitored by phone for individuals post stroke. Disabil Rehabil. 2016 Mar 26:1-9. [Epub ahead of print]
Steele CM, Bayley MT, Peladeau-Pigeon M, et al. A randomized trial comparing two tongue-pressure resistance training protocols for post-stroke dysphagia. Dysphagia. 2016 Mar 2. [Epub ahead of print]
Swartz RH, Bayley M, Lanctôt KL, et al. Post-stroke depression, obstructive sleep apnea, and cognitive impairment: Rationale for, and barriers to, routine screening. Int J Stroke. 2016 Apr 12. [Epub ahead of print] Review.
Torkia C, Best KL, Miller WC, Eng JJ. Balance confidence: A predictor of perceived physical function, perceived mobility, and perceived recovery one year following inpatient stroke rehabilitation. Arch Phys Med Rehabil. 2016 Apr 5. [Epub ahead of print]
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