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Dr. Avril Mansfield

Fast-tracking research to improve care

The Heart and Stroke Foundation Canadian Partnership for Stroke Recovery (CPSR) is about transforming stroke care.

It’s about doing research, testing it, evaluating it and then implementing it.

Take what’s happening at the Toronto Rehabilitation Institute (TRI), for example.

Researchers collaborated with clinicians to develop a novel clinic designed to study stroke patients with balance, mobility and falls issues.

  • They set up a safety harness and attached it to what looks like an aluminum gazebo frame. They put stroke patients in the harness, and then observed how they avoided falling when they lost their balance.
  • Force plates were installed on the floor to measure how patients used each leg to control balance while standing.
  • A long floor mat tracked strides, walking speed and footfalls.

Information from assessments was fed to therapists to develop training programs for their patients.

The whole program worked so effectively that these assessments are now used for patients recovering from stroke at TRI.

“Putting best practices into use often takes time,” says Dr. Avril Mansfield, a CPSR Investigator based at TRI. “But having the researchers and clinicians working together eliminates the barriers. If we find something useful we can translate it into practice right away.”

There are more examples. CPSR researchers did two clinical trials at TRI that provided convincing evidence that aerobic exercise helps people recovering from stroke. Again, their findings were so useful a permanent aerobic training unit has been set up at TRI using the best technologies. Ongoing research is investigating better aerobic exercise programs, and ways to keep people with stroke active after discharge.

“We supported it from the research side, implemented it clinically and we build research on top of it,” says Dr. Mansfield, who has a PhD in Medical Science from the University of Toronto. “What this aerobic work demonstrates is the constant connection between research and clinical practice. We do a study. We implement it into practice. We evaluate it to see what’s working. We come back to do another study.”

One study with particularly impressive results involved including stroke patients in cardiac rehab programs to improve recovery. Patients made tremendous gains in walking speed, use of weakened limbs, and mobility – even years after stroke. The results were so powerful that TRI now integrates stroke patients in their cardiac rehab programs.

“We should re-label cardiac rehab as ‘vascular health training,’ ” says Dr. Bill McIlroy, a professor at the University of Waterloo and research leader at TRI and CPSR. “The clinical-research partnership has transformed what is done clinically. For me, that is the exciting part.”

The other exciting part? The people who deliver the care are part of the research studies.

Dr. McIlroy is the brainpower behind an important CPSR research platform called Rehab Affiliates, a partnership between clinicians and researchers. Basically, it is a network of rehab centres that support CPSR research and then put the best evidence into practice.

Dr. McIlroy’s goal is to develop what is essentially a handbook of the Rehab Affiliates evidence for use everywhere ¬- to train clinicians, provide guidance about infrastructure and offer initial support.

“I think where we can make the biggest difference is taking what we have already learned and putting it to use,” he says.

In addition to changing practice, CPSR is also about innovation, he says.
Here’s just one example: To improve fitness and cognition after stroke, CPSR researchers connected an exercise bike with Google Earth. They sent stroke patients through the virtual streets of Paris to find the Eiffel Tower, and then had them navigate their way back to the hotel. The concept provides exercise that’s fun, stimulating and benefits the body and mind.

“We are taking advantage of things that are free and inexpensive when at home,” Dr. McIlroy says. “We want to know how we can get people to exercise when they leave us, how we can get them to keep it up when they land back home. We want to recovery to continue.”