We are keen to regularly profile rehabilitation-related research conducted within NZ. Please contact us if you would like us to profile a published paper, poster or conference presentation firstname.lastname@example.org
When people think about who is affected by stroke, they commonly think of older people. Yet 25-30 percent of people affected by stroke are under the age of 65, according to Stroke Foundation NZ.
Stroke Foundation Australia’s EnableMe podcast, produced a four-part series called “Young Stroke Podcast”.
This features people sharing their stroke stories and their recovery journey, with each episode focusing on a different aspect of rehabilitation.
Episode one is called “I’ve had a stroke, now what?” and introduces people to the reality that stroke affects younger people and looks at the early stages after a stroke. The guests share their top tips for navigating those challenging early days and living a good life.
Episode two explores “recovery mindset” and acknowledges that recovery means different things to different people. For most people who have experienced a stroke, the recovery is a lifelong journey rather than a destination.
Episode three “finding the new normal” explores renewal and growth after stroke. The guests share quite openly the struggles they’ve experienced along the way, as well as the silver linings. There is an element of grief and loss with stroke, and a level of acceptance that comes, as the journey progresses.
The final episode is especially for “parents of stroke survivors” and features Kim Beesley, whose daughter had a stroke when her and her husband were commencing a holiday on the other side of the world. She talks about what it was like in those initial months and what it’s like now, with their daughter now living at home with them.
This podcast is well worth listening to whether you work directly with stroke patients or not. Each guest speaks from their own lived experience of stroke, and this is always a powerful position to learn from.
Ngā Whāriki Kōrero—Kaupapa Māori Speech Language Resources
By Julianne Johns
Committed to communication as a basic human right, and recognising that stroke pathways for Māori needed improvement, speech-language therapist and Kaupapa Māori researcher Dr Karen Brewer (Whakatohea, Ngaiterangi) launched Ngā Whāriki Kōrero in July 2020 at the University of Auckland.
A few years ago, Karen undertook a Health Research Council-funded Eru Pomare post-Doctoral Research Fellowship in Māori Health. Her research aimed to develop a therapy package in collaboration with Māori whānau, speech-language therapists, Māori health researchers and health advisors.
She started listening to stories of Māori and their whānau after stroke, as well as the experiences of speech-language therapists, Māori health specialists and Stroke Foundation community advisors. Karen unpacked the complexities of designing therapy for Māori living with stroke-related communication disorders in her insightful 2016 article that NZRA profiled in January.
Ngā Whāriki Kōrero—a superb kaupapa Māori speech-language therapy package for whānau with communication difficulties caused by stroke—is the culmination of her work.
You can hear Karen talk about how to use Ngā Whāriki Kōrero in the webinar of the launch.
There are three components available to view or download in PDF format.
Used together, Ngā Whāriki Kōrero helps speech-language therapists and other communication partners to build successful relationships. It also allows for them to hear about what is important for a person with aphasia and their whānau, as they develop a rehabilitation plan.
Karen sees the usefulness of this resource trending to events with big impact and slow recovery. This means the resource may transfer to other situations in which communication access could be better supported for Māori, such as to traumatic brain injury, chronic illness, dementia and spinal cord injury.
While Ngā Whāriki Kōrero was designed with speech-language therapists and Māori clients in mind, we see its scope expanding to improve communication for other allied health and medical professionals working in rehabilitation. We also love its possibilities for advancing tiro rangatiratanga and mātauranga Māori in health research—building empowerment and inclusion in research design, and participation for Māori whānau experiencing communication disorders or access barriers.
Karen is the guest speaker for Burwood Academy’s March Peer Group meeting on 11 March at 12:00pm. This will be an online presentation. For more information, please email email@example.com. They will provide you with the link to the online meeting.
Karen has generously distributed hard copy resources across Aotearoa to each of the District Health Board speech-language therapy departments, in numbers correlating with the proportion of Māori in that area. If you would like a set for your workplace, Karen may provide copies (on receipt of an addressed courier bag). You can contact her here. Alternatively, you can download the PDFs.
Nga mihi, Dr Karen Brewer and your research team.
Intersection of the Elements of Evidence-Based Practice in Interdisciplinary Stroke Rehabilitation: A Qualitative Study
Authors: Catherine Vingerhoets, Jean Hay-Smith, Fiona Graham
Within the health sector evidence-based practice (EBP) is “a foundational approach to clinical decision-making that integrates scientific research; clinical expertise; and patient preferences, values and circumstances.”
The authors of this study, published in the latest edition of the New Zealand Journal of Physiotherapy, set out to explore how these three elements of EBP intersected in care planning within an interdisciplinary stroke rehabilitation team based in a Canadian hospital.
The principal investigator (responsible for the recruitment, data collection and analysis) observed a ‘rehabilitation round’ where the allied health team, along with the patient’s primary nurse, met with each patient in their room to discuss care plans and set goals.
Immediately after the rehabilitation round, the principal investigator facilitated a focus group where the rehabilitation team were asked four key questions:
How do you value each of the three elements of EBP?
How does the team utilise EBP for decision-making?
Is there one element of EBP that is most influential during care planning?
What contributes to an unequal weighting of EBP elements?
“Patient preferences were at the forefront of discussion, and clinicians continually came back to the patient as the primary influence on care planning and team-patient negotiation.”
Each element of EBP was evident, however “the patient was the dominant influence in decision-making.”
The study looks at the primacy of patient-centeredness, patient-directed goals, being patient-specific as well as EBP as a fluid process, and the collaborative aspects of both within the team, patient-clinician, and professional.
Barriers to “accessing and utilising research evidence” were identified but clinicians were more concerned with “limitations to providing patient-centred care than adherence to research-informed treatment”.
Each patient brings their own needs, circumstances and preferences to the situation and they have the greatest influence on the clinicians. In order to deliver care that fully incorporates all three elements of EBP, a wholly collaborative approach is essential.
You can read the full article here.
Auckland University of Technology has a range of postgraduate programmes – Postgraduate Certificate and Diplomas and Masters of Health Science and Health Practice. Information about our Postgraduate pathways and papers within the pathways can be found here and on our website
Core Semester One papers are:
1. Concepts of Rehabilitation
Concepts of Rehabilitation focuses on the concepts which underpin rehabilitation practice (by 'concepts', we mean the big ideas that provide us with tools to think about ways of working, processes, beliefs). Such concepts are commonly transdisciplinary, not specific to any one discipline.
Within the paper, we will support students from various rehabilitation contexts and disciplinary locations to explore what is taken-for-granted in rehabilitation, and to critically reflect on the ways their own practice is shaped by these elements for better or worse. There are many things we do because we should, we think they're worth doing, or our professional guidelines, KPIs, and other systems pressures say that we must.
This paper provides an opportunity for people to stop and explore the assumptions they might hold, to think about these in light of the diversity of theory and evidence and consider what this means for rehabilitation practice, education, and research in the future. In particular, we are keen to locate these ideas within the specific Aotearoa/New Zealand context, including the implications of Te Tiriti O Waitangi for the production of mana-enhancing care and practice.
More detail about the paper can be found here.
For more information, contact Gareth Terry: Gareth.firstname.lastname@example.org
2. Neurological Rehabilitation
Neurological Rehabilitation bridges the gap between practice and theory within neuro-rehabilitation. The paper is geared towards understanding and applying both the science that underpins practice and the evidence base for practice. Students are inter-disciplinary and engage throughout the paper in collaborative learning. For more detail go to:
More detail about the paper can be found here
For more information, contact Sue Lord: email@example.com
3. Occupational Ergonomics
Ergonomics is a multidisciplinary science that applies a broad systems approach to the prevention and management of work-related accidents and ill-health. This paper, Occupational Ergonomics, is designed to provide health and safety practitioners with a broader perspective on their role in influencing prevention and management strategies for improved worker health and safety. Practitioners will be encouraged to critically reflect on the evidence supporting an ergonomics approach and explore how they might apply this knowledge to their area of practice.
For more information, contact Mark Boocock: firstname.lastname@example.org
4. Pain: Mechanisms and Management
This paper will give you a greater understanding of the mechanisms involved in the sensation of pain and the development of chronic pain syndromes, expand your knowledge of clinical diagnostic techniques, and broaden your approach to the management of patients in pain. The on-campus version of the paper includes structured lectures, class discussions, and group presentations on neurophysiologic concepts related to pain mechanisms and pain management. Expert clinicians from a range of clinical backgrounds also present and discuss pain management strategies.
More detail about the paper can be found here:
For more information, contact Gwyn Lewis: email@example.com
Author Jim Kwik says "learning is not a spectator sport". It's not too late to get in the learning game for 2021.
The University of Otago has some great study options for Semester One.
Intellectual Disability: Theory into Practice (NURS433 / PSME439) University of Otago, Christchurch
The aim of this Interprofessional paper is to develop your knowledge base, practical and clinical skills as a practitioner working in this specialist field, and in working alongside people with intellectual (learning) disability.
The content is underpinned by evidence-based practice and current philosophy grounded on changing models of disability. Links are made between physical and mental well-being, sociological, pharmacological, behavioural, Interprofessional and ethical approaches across the lifespan.
An information flyer for the course is available here.
Contact Henrietta Trip (Convenor) firstname.lastname@example.org
Rehabilitation Principles (REHB701) Rehabilitation Teaching and Research Unit, University of Otago, Wellington
This paper will provide you with a broad framework for understanding rehabilitation practice. You will finish the paper with a strong foundation in rehabilitation theory, disability classification, rehabilitation processes (including goal setting), collaborative practices, and the fundamentals of the business of rehabilitation.
You will also be provided with tools to critique your own rehabilitation practice (if appropriate) and you will be supported to develop rehabilitation service innovations ideas.
Watch: Rachelle Martin (course coordinator) talks about what you might expect from this paper.
Contact Libby McGuire (email@example.com) to find out more.
Rehabilitation for the Older Adult (REHB707) Rehabilitation Teaching and Research Unit, University of Otago, Wellington
This paper emphasises rehabilitation and management of conditions that cause impairment and activity limitation in older adults such as falls and cognitive impairment.
The paper also deals with the broad context of rehabilitation of older adults including a range of common conditions and multiple co-morbidities; and the context of ageing in New Zealand.
More course information can be found here.
Personal and Psychological Factors in Rehabilitation (REHB714) Rehabilitation Teaching and Research Unit, University of Otago, Wellington
An enquiry into personal and psychological factors that influence outcomes in rehabilitation and long-term conditions. Identification of risk and protective factors in rehabilitation.
In this paper students will examine psychological factors influencing rehabilitation by considering the "Personal Factors" component of the World Health Organization's International Classification of Functioning Scheme. The paper aims to enhance students' understanding of the broader contextual aspects of rehabilitation.
IMAGE: "learn" by Mark Brannan is licensed with CC BY-NC-SA 2.0.
Implementation of Telerehabilitation in Response to COVID-19: Lessons Learnt from Neurorehabilitation Clinical Practice and Education.
Authors: Nada Signal, Tara Martin, Adam Leys, Rebecca Maloney, Felicity Bright.
Telerehabilitation enables rehabilitation to be delivered across distance using information and communication technologies such as phone, text message, email, web-based resources, videoconferencing, rehabilitation devices and wearable technologies.
While it has been in use for some time, COVID-19 and the necessary restrictions put in place, accelerated its inclusion for many health professionals.
The effectiveness and use of telehealth in New Zealand in response to COVID-19 has been examined and published in the latest edition of the New Zealand Journal of Physiotherapy.
“Despite research evidence indicating that telerehabilitation is as effective as in-person rehabilitation for people with neurological conditions, there were significant challenges in delivering and sustaining telerehabilitation practice.”
Beginning with the benefits of telerehabilitation compared to in-person rehabilitation, the authors then looked at the ways district health boards and healthcare professionals established and maintained effective telerehabilitation services, as the country moved through the various stages of lockdown.
“Further work is required to identify what types of interventions are best delivered using telerehabilitation, when and how they are best delivered, for whom it is most appropriate, and how telerehabilitation approaches can effectively be integrated with in-person rehabilitation.”
The consequences of the COVID-19 lockdowns for inpatient rehabilitation providers have been captured by the researchers, including the ways in which care was provided during this time.
The lessons learnt cover organisational readiness, patient setup, translating communication and relational skills and clinical skills to the digital space, assessment, treatment, and professional development.
Some of the benefits of telerehabilitation may challenge physiotherapists and other health professionals' expectations and current practice, while at the same time providing a greater sense of empowerment and engagement for the patient and their whānau.
“It is now critical to build on the experiences and investments to date, and the skills that therapists have developed, and to embed telerehabilitation in everyday neurorehabilitation so that patients, therapists and services alike can fully benefit from the opportunities that telerehabilitation opens up.”
It is not a case of either in-person or telerehabilitation are best practice for neurorehabilitation but “both/and”.
You can read the full article online here.
Author: Julianne Johns
“Given the effect of communication disorders on family and social life and the connection between language and culture, it is likely that stroke-related communication disorders are culturally determined."
Speech language therapist and researcher, Dr Karen Brewer (Whakatōhea, Ngaiterangi), launched Ngā Whāriki Kōrero in July 2020 at the University of Auckland.
This is a fantastic kaupapa Māori speech language therapy package for whānau with communication difficulties caused by stroke. The outcome of Karen’s HRC-funded post-doctoral research, these resources began with the many hours Karen spent hearing the stories of Māori and their whānau after stroke. She went on to listen to the experiences of speech language therapists, Māori health specialists and Stroke Foundation community advisors.
Though developed with the work of speech language therapists in mind, both Ngā Whāriki Kōrero and the learning behind, it has great potential to amplify mātauranga Māori and support the work of rehabilitation providers and researchers—anyone involved as communication partners of Māori with a range of communication disorders.
"The therapy must not sit solely with the discipline of speech-language therapy but facilitate working across disciplines to benefit whānau. “
We will profile Ngā Whāriki Kōrero in an upcoming blog, but first some background.
As she began her work, Karen quickly recognised that a Māori therapy resource without reference to the social political, historical and economic context in which it is delivered, would not meet the needs of whānau or improve therapy outcomes.
In her 2016 article, The complexities of designing therapy for Māori living with stroke-related communication disorders, Karen draws on He Korowai Oranga: Māori Health Strategy and Whānau Ora guidelines, as well as kaupapa Māori theory to shine a light on challenges and pathways for therapists in Aotearoa New Zealand when designing and providing kaupapa Māori therapy—therapy designed by Māori for Māori and undertaken in a Māori way—for stroke related communication disorders.
She reminds us, “The creation of a kaupapa Māori speech language therapy approach should bring together people with stroke, whānau members and service providers to create therapy that crosses sectors and disciplines and acknowledges the wider social and political context.”
Health related quality of life, family, relationships, return to work, depression and social participation and leisure are all vulnerable to stroke-related communication disorders. The impact of these disorders on life participation is influenced by cultural, social, economic and political factors. Māori have particular, often negative, experiences of these factors in relation to tino rangatiratanga and are likely, therefore, to have unique experiences of stroke-related communication disorders and associated therapy needs.
Considering that most therapy services are delivered in the context of the New Zealand public health system, Karen proposes an approach in which non-Māori speech language therapists develop cultural safety and clinical skills, before providing kaupapa Māori resources.
This hierarchy of skill and resource acquisition is framed as a poutama, a stepped pattern. Moving from rung-to-rung therapists learn how to master each, before moving to the next.
Poutama (ladder) How to master each rung.
1 Learn why be culturally safe
2. Learn how to be culturally safe
3. Learn how to interact
4. Develop resources to build relationships
5. Resources for Education
6. Resources for treatment
Karen went on to develop Ngā Whāriki Kōrero, a beautiful Māori speech language therapy package for whānau with communication difficulties caused by stroke. This resource package supports clinicians to step along the first three rungs via online professional development modules then employ a website collection of video and written resources, an information and support booklet and an interactive therapy resource.
Ref: Reference Brewer, K et al (2016) The complexities of designing therapy for Māori living with stroke related communication disorders; NZMJ, 129 (1435)75-82
As part of understanding what has been going on across the country to develop telehealth services, The New Zealand Telehealth Leadership Group (NZTLG) has launched a National Telehealth Register to collate and disseminate information on current or completed work undertaken on telehealth.
A letter from NZTLG Chair, Dr Ruth Large and NZ Telehealth Forum: Research, Audit and Evaluation Working Group Chair, Associate Professor Inga Hunter outlines more about the Register.
The NZTLG would like to ask for your assistance by registering any telehealth work by filling out the attached form and sending to firstname.lastname@example.org. They will categorise to a searchable database and publish on the Telehealth Resource Centre: www.telehealth.org.nz for the benefit of all.
Please contact either NZTLG Programme Manager Dr Charis Frethey (email@example.com) or A/Prof Inga Hunter (firstname.lastname@example.org) if you have any queries.
Reflections on Inequalities and the Impact of COVID-19 on Disabled People
Authors: Meredith A. Perry, Tristram Ingham, Bernadette Jones and Brigit Mirfin-Veitch
The latest edition of the New Zealand Journal of Physiotherapy contains a paper: “At Risk” and “Vulnerable”! Reflections on Inequities and the Impact of COVID-19 on Disabled People.
This paper, authored by a group of respected NZ disability researchers, includes both international and national reflections on disability outcomes in the wake of COVID-19. While the article is focused on a physiotherapy audience, its key messages are relevant for all health care professionals.
According to the authors, COVID-19 has “provided an opportunity to consciously consider how physiotherapists as health professionals and the systems we operate within should respond to health inequities including and especially those affecting disabled people.”
Despite the significant number of disabled people within our health system, they are not recognised by health professionals as a “distinct population in the same manner as they view older persons, children, racial minorities, and older groups.”
This paper provides an overview of disability and disability identity, social determinants of health, COVID-19 and disability. It also explores ethical dilemmas related to COVID-19—professional responsibility, allocating scarce resources, and asks what is the impact of COVID-19 on disabled people to date?
Several strategies are suggested for how physiotherapists, and health care professionals more generally, can help address inequalities for disabled people within the health sector, including the recognition and collection of disability identity. The authors note that it is only since health services in Aotearoa New Zealand routinely collected ethnicity data that the extent of Māori health inequalities have been revealed. You can access this article via the online version of the New Zealand Journal of Physiotherapy here.
Rehabilitation Innovation Award
Share your mahi with the rehabilitation community!
The New Zealand Rehabilitation Association (NZRA) invites applications for the 2021 Rehabilitation Innovation Award. This Award is being offered on a biennial basis and seeks to recognise innovation and excellence in rehabilitation in Aotearoa/New Zealand. The award will be presented at our “Me Mahi Tahi Tātou—Achieving Equity in Rehabilitation” conference to be held in Rotorua, 17-19 September 2021.
Applications will be accepted by individuals or teams (if the lead applicant is a member of the NZRA). A panel will shortlist the applicants, and the three finalists will be supported to attend the NZRA conference to present their innovation, where the audience will determine the winner.
We are particularly keen to see applications relating to innovations which work toward achieving equity in health and enhancing experiences and outcomes for those who commonly receive inequitable services and outcomes. The application must relate to an initiative implemented within the previous three years. We particularly welcome applications which have sought to address unmet needs and reduce inequity for Māori.
Please check the conference website for further details about this exciting opportunity to profile your mahi, and that of your team and the application form.
If you have any question about this award, please email email@example.com
© 2015 New Zealand Rehabilitation Association, Inc.