Focusing on what matters
The past year has been one of transition for the Heart & Stroke Foundation Canadian Partnership for Stroke Recovery (CPSR). After years of infrastructure investments, capacity building and solid research results, we asked ourselves: How can we fill gaps and fast-track science? How can we have the greatest impact on stroke recovery in the shortest amount of time? What changes do we need to make as an organization to better meet the needs of Canadians?
We surveyed our scientists. We consulted research leaders. And, we brainstormed. In August 2018, we presented our plan to a panel of international experts from Europe, the United States and Australia – and, after a rigorous review, they validated our ideas and encouraged us to innovate and to move in new directions.
Under the direction of CEO Katie Lafferty and Scientific Director Dr. Dale Corbett, the CPSR finalized a new three-year strategic and operational plan that aims to:
- improve access to rehabilitation therapy through systems change;
- inject critical funding into targeted, game-changing research;
- leverage the CPSR’s infrastructure to be wheels-down on new clinical trials;
- enhance our training and mentorship program by adding engineers, tech experts and social scientists; and,
- streamline our organizational structure with hand-picked leaders overseeing each strategic priority as part of a new Leadership Council.
Coincidentally, with the transition to a new plan comes personnel change for our organization. After almost a decade at the scientific helm of CPSR and a research career spanning 40 years, Dr. Dale Corbett retires in September. At the same time, Barry Cracower moves to the position of past-chair of the Board after six years in the Chair’s seat. We are indebted to them for their leadership.
Scientific direction of the CPSR will be transferred to two proven and respected clinician-researchers who are well-known in Canada’s stroke community. Stroke neurologist and Director of the Calgary Stroke Program Dr. Andrew Demchuk and physiatrist and neuroscientist Dr. Sean Dukelow of the University of Calgary/Hotchkiss Brain Institute will co-chair our newly formed Leadership Council. In addition to the top stroke recovery experts, council membership will include people with lived experience and our partners, who have reaffirmed their commitment to and investment in CPSR for the next three years. At the Board level, Barry Cracower will be succeeded as CPSR Chair by vice-chair Rod McKay, a former Chair of the Board of Heart & Stroke.
Stay tuned for updates on the work of the Leadership Council in in our monthly newsletters and visit our website regularly for news and developments. In the meantime, we encourage you to continue reading our Annual Report in order to learn about the accomplishments of the CPSR research community over the past year and their tireless efforts to improve the lives of people living with stroke.You'llsee: They are focusing on what really matters.
We are funding targeted, life-enhancing research.
Enhancing life. Improving recovery. Reducing disability for the more than 412,000 Canadians who live with the long-term after-effects of stroke.
At universities and hospitals across the country, our research is targeted to areas where it will have the greatest impact, spanning the gamut of scientific inquiry from cells to brain stimulation to exercise to robotics. We provide support to seed innovative ideas and, in 2018, our investments resulted in $3M in leveraged funding from catalyst grants and generated dozens of scientific papers.
Among 2018-19 highlights:
- A seven-site clinical trial called DOSE (Determining Optimal post-Stroke Exercise) found that patients in the early stages after stroke recover better after higher intensity walking doses. The trial protocol was published in the International Journal of Stroke; two other publications resulted from this project, and two more are in preparation. Preliminary findings from the study were presented at the International Stroke Conference in February. The trial was an important contributor to a $2.5M CIHR Foundation grant for Dr. Janice Eng at the University of British Columbia.
- A randomized study of 68 stroke patients found that strength training is the most neglected exercise component following stroke and should be combined with aerobic training to maximize metabolic, cardiorespiratory and strength recovery following stroke. Despite getting 40% less aerobic training, the group who received combined aerobic and resistance training had similar improvements in mobility and either the same or superior improvements in cardiorespiratory fitness.
- The first clinical trial testing a novel pairing of aerobic exercise and cognitive training showed that chronic stroke patients who received the combination approach made large gains in cognitive recovery. Ninety-seven people were screened and 60 participated in the study, which involved rehabilitation treatments three times a week for 10 weeks. The research, led by Dr. Michelle Ploughman at Memorial University, showed that, with the right intervention (sufficiently targeted and intense), continued recovery is possible in chronic stroke patients. The CPSR-funded study, which took two-and-a-half years to complete, was published in the March 2019 issue of Neurorehabilitation & Neural Repair.
- CPSR's Dr. Diane Lagace, Dr. Jean-Claude Béïque and their team from the Department of Cellular and Molecular Medicine and the uOttawa Brain and Mind Research Institute, including first author and postdoctoral fellow Dr. Timal Kannangara, published important research in Stem Cell Reports in November 2018 that shows stem cells in the adult brain can migrate to the site of stroke damage and become neurons. These findings ignite excitement about the capacity of stem cells to improve stroke recovery and outline new and compelling directions for stroke research—namely, how to increase the number of these immature neurons and maximize their incorporation into brain networks. Achieving these goals could make stem cells big players in stroke recovery. Read more HERE.
We are investing in new technologies to fill gaps and deliver therapies.
CPSR is committed to addressing gaps, advocating for increased access to therapy, and helping to find new and innovative ways to deliver rehabilitation. A five-year $1.3M study of six CPSR tele-rehabilitation projects involving more than 300 Canadians in 10 cities found that technology is effective in delivering post-stroke therapy to people living in rural and remote parts of Canada. Results were published in the Journal of Telemedicine and E-Health.
“Tele-rehabilitation interventions have great potential to increase efficiency and access to post-stroke therapy,” says senior author Dr. Robert Teasell of Western University in London, ON. “Our research highlights that many studies have reported tele-rehabilitation to be comparable or more beneficial over traditional rehab programs.”
Robotics and Brain Stimulation
At the University of Calgary/Hotchkiss Brian Institute, CPSR funding this year supported leading-edge research involving robotics and brain stimulation to enhance learning and recovery after stroke.
- Dr. Cherie Kuo, a post-doctoral fellow in Dr. Adam Kirton’s lab, studied robotic motor mapping and TMS measures of interventional plasticity in children with perinatal stroke and authored five papers on the topic.
- Dr. Jennifer Semrau, a post-doctoral fellow in Dr. Sean Dukelow’s lab, studied robotic assessment of sensorimotor function, including learning, and published five papers. She recently joined the faculty at the University of Delaware.
- Adrianna Giuffre, PhD candidate with Dr. Kirton, worked on projects focused on tDCS/HD-tDCS enhancement of motor learning with motor mapping and imaging to explore mechanisms for applications in children with stroke. She authored three papers and was recently awarded a prestigious Vanier scholarship.
- Alexa Keeling, MSc candidate, worked on a project with Dr. Dukelow to better understand progression in stroke rehabilitation using robotics.
“This is terrific. It is clearly the most comprehensive and evidence-based guideline that has been developed for the 10-metre walk and 6-minute walk,”
says Professor Pamela Duncan, a leading stroke rehabilitation expert at Wake Forest School of Medicine (North Carolina, USA) who reviewed the guide. “The team could not have produced a more outstanding guide.”
CPSR also funds ViaTherapy, a popular app that delivers best practice and evidence-based recovery interventions for upper extremity stroke rehabilitation at your fingertips. This year, more than 20 videos were added to the app. Since its launch in April 2017, ViaTherapy had been downloaded 13,250 times.
CPSR-funded Stroke Engine is the go-to site for information about stroke recovery -- from assessments to interventions to e-learning and more. The site gets about 12,000 visitors a week. In 2018-19, Stroke Engine, which is under the direction of Dr. Annie Rochette at the Universite de Montreal, enhanced its social media outreach and conducted an online user survey to improve content. Dr. Rochette's team worked on an module on post-stroke fatigue and on updates to the aphasia intervention module, both major issues facing people recovering from stroke. The 2019 CPSR-funded update to the AEROBICS guidelines for stroke recovery was posted on the Stroke Engine website in March. Read them here: https://www.strokengine.ca/wp-content/uploads/2019/03/AEROBICS-2019-last-revised-March.pdf
The CPSR-funded Evidence-Based Review of Stroke Rehabilitation (EBRSR) is an annually updated large-scale systematic review of the entire field of stroke rehabilitation that helps frontline clinicians, policymakers, researchers and educators to manage and take advantage of this growing wealth of evidence. The 19thedition of the EBRSR is underway and nearing completion. It will summarize 2,244 randomized controlled trials up to July 1, 2018. It is the most comprehensive research synthesis of stroke rehabilitation in the world. The EBRSR supports the Canadian Best Practice Guidelines and provides valuable support to the ViaTherapy app. In 2018-19, EBRSR produced 4 peer-reviewed articles, 7 published abstracts, 9 presentations and 15 posters.
We are providing tools to support the adoption of evidence-based exercise programs to improve long-term recovery.
CPSR-Brain Canada "Stroke Recovery in Motion", a national initiative to promote the development of community-based stroke exercise programs, drafted an implementation planning resourcethis year . Feedback from stakeholders, including regional stroke network coordinators, physiotherapists, recreation centre managers, and fitness instructors, has been very positive. Further revision is underway with a field-test ready version planned for release in September 2019. Project co-investigators and developers of the FAME, Fit for Function and TIME evidence-based exercise programs are also updating their exercise program training and support materials. Researchers anticipate including 9-12 field test sites representing both urban and rural communities across Canada, including indigenous populations where possible. The evaluation protocols are currently in development; the aim is to learn how a community uses the ‘Stroke Recovery in Motion Planner’ and to understand their planning approach from initial assessment of the need for a local program to engagement of community partners, preparation of a business case, resource allocation, launch readiness and program delivery, assessment of program and participant outcomes, and plans for sustainability.
We are building a strong and cohesive research network.
A highly successful Annual Scientific Meeting was held in Gatineau, Quebec in 2018 where more than 100 researchers and trainees presented their latest findings and engaged in important networking activities. Highlights of the meeting included keynote lectures by two leading American stroke recovery experts, Dr. Teresa Jones of the University of Texas Austin and Dr. Catherine Lang of the University of Washington, St. Louis.
At the 2018 World Stroke Congress meeting in Montreal, CPSR helped to organize a satellite meeting between stroke neurologists and recovery researchers to discuss how to bring the acute stroke and stroke recovery communities together as emerging therapies (drugs, stem cells) are delivered at times that overlap both acute and recovery time windows.
CPSR research was a major highlight of the Ottawa Stroke Summit,as well as at the American Congress of Rehabilitation Medicine meeting in Dallas. CPSR researcher Dr. Robert Teasell's trainees won numerous awards and Dr. Teasell was awarded the American Congress of Rehabilitation Medicine and National Stroke Association Award in Post Acute Stroke.
We are training, funding and mentoring the next generation of research stars.
There is no question that through our popular SPiN (Stroke Program in Neurorecovery), workshops, mentorship programs, monthly webinars and lab exchanges, we are identifying, training and retaining the next generation of Canadian research stars in stroke recovery who, in 2018 alone, published 35 papers in leading scientific journals and delivered 52 poster and oral presentations on their stroke recovery research. Each month, we profile our trainees and theirresearchin Canadian Stroke Recovery News, our monthly newsletter.
Success stories include people like former CPSR trainee Dr. Gergely Silasi, who is now a CPSR researcher and Assistant Professor at the University of Ottawa. Dr. Silasi established a mouse model of perinatal stroke and he used optogenetic motor brain mapping to reveal differences in the brain. His research served as crucial pilot data for a three-year $250K Heart & Stroke grant and a four-year $283K Canadian Foundation for Innovation infrastructure grant.
Postdoctoral fellow Dr. Matthew McDonald's pilot experiments showed that rats treated with daily doses of an exercise mimetic drug had significantly reduced hindlimb deficits post-stroke. His presentation at the American Society of Neurorehabilitation (ASNR) meeting in San Diego in November 2018 won the Presidential Award for innovative basic science research.
Former CPSR-funded postdoctoral fellow Dr. Walter Swardfager, who is now a CPSR scientist at Sunnybrook and an Assistant Professor at University of Toronto, oversaw a retrospective longitudinal cohort study of 28,406 first-ever acute stroke patients from the Ontario Stroke Registry over a ten-year period (2003-2013). Preliminary analyses revealed stroke patients with pre-stroke depression are 37% more likely to be discharged to long-term and/or complex continuing care following stroke, compared to stroke patients without depression. These patients are also 11% more likely to die in the period following stroke. He leveraged CPSR catalyst funding into a CIHR grant looking at the neurocognition and type 2 diabetes in small vessel disease ($933,300) and an Alzheimer’s Association research grant looking at neuroinflammation in vascular disease ($149,985 USD).
We are working with colleagues around the world to improve research and to forge novel collaborations.
Forty experts in stroke recovery research from eight countries convened in Saint-Sauveur, Quebec for the 2nd Stroke Rehabilitation and Recovery Research Roundtable on October 20-21. These international researchers, composed of a mixture of clinical and preclinical scientists from varied disciplines along with two stroke patient advocates, discussed the latest evidence on the following four topics: 1) interventions ready for international stroke recovery trials, 2) cognitive rehabilitation, 3) stroke recovery assessments using kinetics and kinematics, and 4) existing knowledge that can be implemented now to improve best practices. Following intense discussions, these groups laid the groundwork for a series of guideline recommendation papers. And, the efforts of the SRRR are expected to help define future research priorities and approaches worldwide.
We are building community.
We are continuing to grow the stroke recovery research community through our website, as well as online tools and resources like Facebook, Twitter and our monthly e-newsletter. To learn more or subscribe, email firstname.lastname@example.org.
Our researchers are sharing their discoveries at national and international conferences, public meetings and through webinars and lab tours, many of which are highlighted in our newsletters.
We also work closely with our partner Heart & Stroke to educate the public about the issue of stroke recovery. For example, we worked closely on the 2019 Stroke Month report that highlighted the links between heart, stroke and cognitive impairment, and members of CPSR's Stroke Community Advisory Committee shared their personal stories in the news media.
Building community, training the next generation, collaborating with the best and brightest and supporting game-changing research. These are at the core of everything we do. We are focusing on what matters to people living with stroke and their families.