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) henrietta.trip@otago.ac.nz

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 (rtru@otago.ac.nz) 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.

Contact Libby McGuire (rtru@otago.ac.nz) to find out more.

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.

More course information can be found here.

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 research@telehealth.org.nz. 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 (charis@telehealth.org.nz) or A/Prof Inga Hunter (i.hunter@massey.ac.nz) 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 admin@rehabilitation.org.nz 

Author: Shar Davis

Commencing her Inaugural Professorial Lecture with a quote from Katherine Mansfield, Jean Hay-Smith set the tone for not only her lecture but her academic career— “I want to be all that I am capable of becoming”.

Speaking to the gathered audience and those streaming the lecture online, Jean began by tracing the educational legacy of the previous four generations of women on her maternal side. From her great-great-grandmother who was illiterate through to her mother, a teacher, who had a huge influence on her education and “perhaps unwittingly she was the influence on my clinical career in women’s health”, said Jean.

Jean’s foray into women’s health began when she was 15 years old, after her mother got her a job as a nurse aid at the Helensville Obstetrics Hospital, where she continued to work part-time for six years until she completed her physiotherapy studies.

“The health and wellbeing of women was as much in my blood as education,” Jean reflected. Her career took her to London for 10 years where she met Professor Wendy Savage, who began referring patients experiencing painful sex after childbirth to her. “I didn’t have a clue what to do, and I suspect she didn’t either,” said Jean.

She also met Jill Mantle who Jean credits as the person who encouraged her to consider doing a higher degree and set her on the academic path. Perhaps Jill saw all that Jean was capable of becoming.

As she commenced her master’s looking at the issue of painful sex post-childbirth, Jean began to realise that lots of treatments were being used in women’s health, without much evidence to support them.

“Randomised control trials were considered the gold standard way of testing the effectiveness of healthcare interventions—finding randomised trials, critiquing randomised trials and synthesising the data—this is the methodology that became the foundation of my research career,” said Jean.

A large portion of Jean’s research and work that followed focused on pelvic floor muscle exercises as a treatment to assist in the issue of continence for women, particularly after childbirth. As part of her PhD, she undertook a randomised trial with more than 300 women screened and more than 120 taking part.

“By the end of the trial I’d heard so many stories of [women] living with a bladder problem and trying to do these exercises called pelvic floor muscle exercises that I felt compelled to put a qualitative study in my PhD”.

“What I learned from the 20 women I interviewed was how long and how hard they had worked to keep their incontinence private, how silenced they were by a whole set of circumstances.”

No one will forget the picture Jean painted when she shared one woman’s experience after her doctor suggested she could try ‘those exercises’ to help with her incontinence. “This woman had done toe raises while washing the dishes for more than 20 years,” Jean explained.

Jean is not afraid to call out the weaknesses in research or in the health care system, suggesting New Zealand’s current maternity health care is substandard, causing women to miss out on effective interventions. Midwives are being overloaded with so many different aspects of a woman’s health journey as their workload has increased but the system hasn’t adapted with those changes.

Perhaps the most powerful moment of the lecture came as Jean described how an alternative reading of women’s responses regarding seeking medical assistance, showed women as “resourceful and resilient, rather than recalcitrant—because a lot of these research paper introductions are saying ‘You naughty people, you should be seeking help for this problem and you’re not.’,” Jean explained.

“So, I want to think more broadly about the wellbeing of women, taking an anthropological, more sociological view, the misogyny of science and medicine—it’s pretty clear to see,” said Jean.

“Women have been excluded from research. Women’s anatomy, physiology and behaviour has been considered deviant and, at other times. women have been experimented on.

“What must stop is the widespread adoption of new treatments in practice which outrun the evidence of their effects for women, and for safety for women.”

Jean has moved away from middle-aged women, pelvic floor muscle exercises, systematic reviews and randomised trials and moved towards research for people with bladder and bowel problems after stroke. Working alongside Dr Rachelle Martin, Jean has completed a small study investigating “what might support stroke survivors with bladder and bowel problems to take part in their social roles inside and outside their home.”

Jean finished her lecture with a series of thanks, firstly to those who she collaborated on research projects with, “it’s their work as much as mine that has created the portfolio that means I stand here today.” She thanked her colleagues at the Rehabilitation Teaching and Research unit past and present, and her family who have supported her throughout her career.

During his introduction, Professor William Levack said, “If I had to pick one word to describe Jean’s work over the years, it would be collegial. She is the embodiment of the whakataukī, ‘me mahi tahi tatau mo te oranga o te katoa—we must all work together for the wellbeing of us all.’.”

There is more than enough evidence to confirm that Jean has embodied Katherine Mansfield’s quote. Congratulations Professor Jean Hay-Smith and may you continue to be all you are capable of becoming as you champion women’s health in New Zealand and around the world.

You can watch Jean's full lecture here.

COVID-19 has impacted our lives for much of this year and will continue to be present heading into 2021. It has no doubt impacted both your personal and professional spaces. We are fortunate in New Zealand to have had low infection numbers.

As a result we are seeing few instance of people needing rehabilitation after Covid. However, if you are faced with a client who is experience secondary impairments after Covid, what should you do?

Cochrane Rehabilitation have been working hard to identify all the evidence produced about COVID-19 and rehabilitation. This action is highly essential for clinicians located all over the world. This collection of evidence is reliable and updated each month, so clinicians can access the latest evidence being produced.

The Rehabilitation COVID-19 Evidence-based Response (REH_COVER) action plan includes:

1.  an evidence-based living mapping of all the current evidence
2.  a living rapid systematic review of all the current evidence updated every month
3. a list of research priorities produced in collaboration with the WHO rehabilitation programme
4. a Special Collection of Cochrane Systematic Reviews in the Cochrane Library
5. a series of rapid reviews on evidence about expected rehabilitation needs due to COVID-19 (in production). The REH-COVER action is led by an international multi-professional Steering Committee (13 members, seven professions, four continents, including LMIC).

Should Covid become more of a problem in New Zealand, it is reassuring that we will have access to the REH-COVER action plan, and if needed we can use this resource to keep up-to-date with the latest additions to the collection.

Authored: Shar Davis

Author: Shar Davis

NZRA President William Levack gave an insight into the depth and breadth of his academic career when he presented his Inaugural Professorial Lecture in Wellington recently.

Speaking on the topic of “Meaningful Research—Meaningful Lives” William took the audience on a journey though touchpoints in his career that helped to shape the lens through which he now operates.

William’s research focusses on patient experiences of rehabilitation, goal setting processes, and interventions to increase patient engagement in rehabilitation activities.

Using four stories as anchor points for his presentation, William highlighted distinct areas of his career that, while separate, were connected through the importance of research being meaningful (not just for the sake of it) and how it could positively impact lives. The key areas were rehabilitation after traumatic brain injury, goal setting in rehabilitation, pulmonary rehabilitation for chronic lung disease and Cochrane rehabilitation—development of methods for knowledge translation and evidence production.

One thing that stood out during the presentation was how he has consistently asked questions throughout his life, and that leads him to find answers to these questions (and any subsequent questions that arise in the process).

Professor Paul Brunton Pro-vice Chancellor of Health Sciences said, “To become a professor at the Uni of Otago is incredibly difficult. We have very high academic standards.”

A promotion to Professor is “an endorsement of people’s academic activity, both in teaching research but also in academic service, both to the university and the wider community,” said Brunton.

These words, a testament to the high degree of respect that William has within the Academic community.

William began the night with a humorous account of his early interest in research though his study of earthworms and slaters, he credits his mother as the one who introduced him to experimental design, statistical test and the importance of a good control group.

According to his research findings, “slaters like cuddling rather than being by themselves,” shared William. While perhaps an unexpected topic for an Inaugural Professorial Lecture, it highlighted his extended and extensive love of research and his ability to connect with his audience in a personable, down-to-earth, and grounded-in-research fashion.

Congratulations Professor William Levack!

You can check out his full presentation here