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 email@example.com
The most recent edition of the NZ Rehabilitation Review can be viewed HERE.
This issue focuses on six of the presentations from the recent ASSBI/NZRA Inaugural Trans-Tasman conference.
We encourage you to check it out, get in the know and join the conversations.
In May, we celebrated some excellent outcomes for rehabilitation-related research funding in NZ. Dr Fiona Graham was one of the successful researchers, receiving support from HRC’s Emerging Researcher First Grant fund.
Fiona is an occupational therapist, currently working as a Senior Lecturer in the Rehabilitation Teaching & Research Unit (RTRU) in the Department of Medicine, Wellington. She was granted $233,618 to trial an Occupational Performance Coaching (OPC) intervention. As part of her PhD, Fiona developed the family-centred OPC approach - empowering caregivers to support their children's goal achievement in the participation domain of the ICF. This research will evaluate the effectiveness of this intervention in clinical settings.
The research aims to determine if children with neurodisability and their caregivers experience improved health and wellbeing following OPC compared to usual care when delivered in existing service delivery contexts.
The innovatively-designed study will be conducted using a single-blind, 2-arm parallel group, cluster RCT - with clustering happening at the level of the therapist. Post-intervention interviews will also examine caregivers’ experience of OPC in relation to cultural values and expectations.
Fiona states that it is often difficult for rehabilitation interventions to secure research funding, as rehabilitation deals in the “messy reality of people’s daily life where there is lots of variation in how people live”. This means that it is challenging to meet the rigorous design requirements of research funders like the HRC. “This time we pulled it off and HRC have recognised that research of rehabilitation interventions can’t follow a sample design formula,” Dr Graham says.
Participants will be child-caregiver dyads (cases), with the inclusion criteria that children are aged 2 to 18 years and have a primary diagnosis of neurodisability for which caregivers have sought rehabilitation. Enlisted therapists will be randomised to OPC training (intervention) or usual care (control) groups. The primary outcome, children’s social participation (Canadian Occupational Performance Measure; COPM) will determine intervention effectiveness and inform the economic analysis.
Fiona’s research has the potential to improve access and equity in rehabilitation for children experiencing neurodisability in NZ. There has also been considerable international interest in OPC, with Fiona being invited to present two international and one national keynote presentations, and 20 invited workshops.
“I’m also pretty stoked for the families of children with disabilities. They are a small health consumer group and there are no magic answers for the challenges they face. The fact the HRC has awarded this grant to explore ways to improve the quality of their lives and to help them live well despite disability is very exciting.”
Contact Fiona on firstname.lastname@example.org if you have any questions about this research.
Contributed by Kristin Gozdzikowska, Ph.D., CCC-SLP, Laura Fergusson Trust (Canterbury)
From 2014 to 2019, the number of people who own a smartphone worldwide more than doubled, nearing 3 billion individuals. Now, more than ever, people of all ages and backgrounds are connected, controlling an increasingly customised environment for on-demand access to media, music, banking, fitness tracking, calendars, social media, maps – the list goes on and on. Why then, does clinical practice at times feel so far removed from this rapidly advancing technological sector?
It has been said that it takes an average of 17 years for new evidence-based findings to reach clinical practice (Balas & Boren, 2000). However, with dropping prices and increasing access, technology is becoming an integral part of clinical care. Rather than expensive equipment, a biofeedback device can be downloaded on a free app. A wearable sensor patch can monitor blood sugar levels, needle-free. A heart-rate rhythm monitor can help improve awareness of emotional state. Simple alarms and wearable prompts can serve as reminders everyday tasks from medications to grocery lists. What’s more, the use of a smart phone can be increasingly socially acceptable for individuals trying to incorporate and generalise strategies in a community setting without drawing unwanted attention to themselves.
By harnessing available, low-cost technologies, unexpected changes can be made as well. For example, Jo Fox, a physiotherapist at Laura Fergusson Trust, is investigating use of a Fit Bit wearable to increase a client’s number of steps. Not only has the client increased physical activity, but early observations revealed unexpected improvements in response to phone calls and texts due to the tactile vibratory feedback when receiving a message. Now, this client has newfound capacity of self-management – no small feat in the world of traumatic brain injury recovery.
It is important to be mindful, however, that much of technology is designed far from the clinical realm, which may exacerbate the divide between research, technology and clinical practice. This reiterates the importance of including end-users in co-design throughout development, which impacts the robustness of experimental solutions and end-user involvement in emerging technologies. This partly inspired the Laura Fergusson Trust, in collaboration with Marcus King (Callaghan Innovation), Jo Nunnerley (University of Otago/BAIL) and Riley Stockwell & Nadia Thorne (Cerebral Fix), to co-design and test a virtual reality (VR) rehabilitation solution for individuals following TBI. VR has potential advantages as real-world stressors can be simulated and systematically introduced. Focus groups were held with people with lived experience of brain injury and clinicians to introduce the concept of VR and discussing possible applications. These groups fed back that a café setting would be most beneficial. In the newly developed game, users complete functional tasks in an increasingly loud and distracting café environment to increase their awareness of effects of cognitive fatigue after brain injury. Not only was VR well tolerated, after trying the co-designed prototype, one individual with lived experience of TBI stated,
“You put us in the exact right environment, this is exactly what happens when we’re out.”
Future research is currently underway to trial clinical implementation of this VR rehabilitation tool. In the meantime, it is clear this study provides important insights on the value of patient perspectives when developing technology for research and clinical practice. By partnering with individuals with lived experience and interdisciplinary teams, we can further harness the rapidly growing benefits of technology into health.
For more information contact Kristin via: email@example.com
Fiona Kumfor (The University of Sydney) won the NZRA Best Poster Presentation award for her poster presentation entitled: ‘Prevalence and neurocognitive basis of delusions in dementia’
Fiona aimed to examine the prevalence, clinical and cognitive profile of delusions in a large, diverse cohort of dementia patients. Delusions and abnormal belief formation have been reported in some people with dementia, however, the mechanisms causing their emergence are poorly understood.
In the cohort, 48/487 patients (9.9%) had delusions, with the highest prevalence observed in behavioural variant frontotemporal dementia (18.4%) and Alzheimer’s disease (11.8%). A diagnosis of behavioural variant frontotemporal dementia was strongly associated with the presence of delusions (odds ratio = 3.3; p<.001). Comparisons between 30 patients with delusions and 30 matched patients without delusions revealed worse performance on the Addenbrooke’s Cognitive Examination (p=.035), Rey Complex Figure Recall (p=.006), and word repetition (p=.001) in patients with delusions. Notably, the delusions group also had greater impairments in everyday skills (p=.004), stereotypical behaviours (p=.031), sleep disturbances (p=.003), memory problems (p=.012) and mood (p=.017).
Results from the study reveal that delusions are most common in behavioural variant frontotemporal dementia and Alzheimer’s disease, and relatively rare in other syndromes. Both the cognitive and clinical profile of patients with delusions differs, and suggest possible mechanisms for the emergence of delusions in these syndromes. Analyses are underway to examine the neural correlates underpinning delusions in dementia.
Click on the image of the poster to see a full-size version.
Correspondence: Fiona Kumfor; firstname.lastname@example.org
Jesse Shapiro won the NZRA Best Student Presentation award for his oral presentation entitled: ‘No diffusion imaging correlate of paediatric post-concussion syndrome: a TBSS study’
Jesse works with the Murdoch Children’s Research Institute and School of Psychological Sciences, University of Melbourne, Melbourne, Australia.
The analysis formed part of the Take CARe study. Forty-three children were recruited from the emergency department of the Royal Children’s Hospital and underwent magnetic resonance imaging and cognitive screening two weeks post-concussion. The Parent PCSI was used to dichotomise participants into “normal” and “delayed” recovery groups. Analysis of TBSS diffusion metrics: fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) was completed using nonparametric permutation-based analysis with threshold free cluster enhancement.
No significant difference was found between the normal recovery and delayed recovery groups across all diffusion metrics (p < .05). No significant difference was found on tests of cognition between the normal recovery and delayed recovery groups (p < .05). Two possible explanations for the findings are put forward: that any changes to white matter are too small to be seen by this study, or, the cause of PCS is not structural in nature.
Jesse did a great job of presenting this work in a way that was understandable and engaging. He also addressed issues within the current evidence-base, and specific study design strategies he used to overcome the limitations.
Correspondence: Jesse Shapiro; email@example.com
Felicity Bright was one of two recipients of the inaugural NZRA Emerging Rehabilitation Research Leader award offered in 2017. This award is offered on a biennial basis with a focus on growing rehabilitation research capability in New Zealand. It recognises NZRA objectives to provide leadership, advocate for excellence, and promote interest in and support opportunities for research in rehabilitation in New Zealand. The award makes it possible for an early career researcher to appoint a summer student to undertake seeding work which helps them to advance their rehabilitation research programme.
Felicity used her award to appoint a summer student to undertake a literature review using qualitative meta-synthesis methodology. The review explored how therapeutic relationships and interpersonal communication are perceived and experienced by people experiencing communication disability in stroke rehabilitation.
When people enter rehabilitation with a communication disability after stroke, they often come from a place of vulnerability. Their life and the way they communicate and relate with others has changed significantly. Their sense of self can be altered, partly because rehabilitation providers may not communicate and relate with them in a way which recognises their sense of personhood – who they were and who they are. This can see the patient isolated, feeling invalidated. Our review indicated that the relationships between the person with stroke and their rehabilitation providers were foundational for rehabilitation and developed through the communication between the two parties. Communication did not always need to be successful: what seemed critical was that providers were seen to try to communicate and connect with the patient. People with stroke described a process of reading their provider, evaluating whether they are interested in them as an individual, whether they value the person’s perspective, recognising them as a person who has a contribution to make. When patients had a sense of being validated and respected, it impacted on many things including their confidence and sense of trust in the provider, their engagement in rehabilitation and their hope for the future.
This metasynthesis will inform Felicity's on-going research programme, which centres on relationships and communication in rehabilitation, in particular, projects working with rehabilitation providers, supporting them to embed relational practices in rehabilitation.
Earlier this month, we held a hugely successful national rehabilitation conference with our partners from the Australasian Society for the Study of Brain Impairment. We used this conference as an opportunity to run a kanohi ki te kanohi AGM for 2019, plus to host a breakfast discussion session on the future and direction of the NZRA. The minutes to the AGM are now up on our website. Of note, Nicola Kayes stepped down as president of the NZRA as she had reach the end of her term. A huge thank you to A/Prof Kayes for her enormous contribution to the NZRA, including the coordination of several conferences and for her networking with key stakeholders in Aotearoa. Also standing down, having reached the end of their terms as executive members, were Kath McPerson, Will Taylor, and Max Cavit. Thank you to Kath, Will, and Max, for this long term contribution to the NZRA.
We have several new members joining the NZRA: Dr Leanne Parker (a rehabilitation physician from Southern Cross Health), Annie Jones (Clinical Partner at ACC), and Felicity Bright (a speech language therapist from AUT University). I will be returning to the NZRA Executive after a four year departure, and have accepted the role of President for the next term. Felicity has accepted the role of Secretary for the organisation as well. Staying on the NZRA Executive are: Debbie Snell (as Treasurer), Rachelle Martin, and Peter Larmer.
You can also now check out the profiles of all of the NZRA Exec members on our website.
The NZRA Exec is now meeting once a month. This year, we aim to complete some strategic development work to provide our organisation with a clearer sense of purpose and direction. We are interested in our opportunities to grow and contribute more to the NZ rehabilitation community. We are also interested in increasing diversity within our organisation and its leadership. If you would like to get more involved yourself, please get in touch!
William Levack is an Associate Professor of Rehabilitation at the Rehabilitation Teaching & Research Unit, University of Otago, Wellington, New Zealand. Twitter: @DrLevack
This month we can celebrate some excellent outcomes for rehabilitation-related research funding in NZ!
HRC Emerging Researcher Grant:
HRC Feasibility Grant:
Congratulations to all of these funding recipients, and we look forward to hearing more about your projects in due course.
The NZRA is now calling for applications for the NZRA Emerging Rehabilitation Research Leader studentship.
This award is offered on a biennial basis with a focus on growing rehabilitation research capability in New Zealand. It recognises NZRA objectives to provide leadership, advocate for excellence, and promote interest in and support opportunities for research in rehabilitation in New Zealand.
The award makes it possible for an early career researcher to undertake seeding work which helps them to advance their rehabilitation research programme. The $6,000 stipend can be used to appoint a student to work with you to advance your research programme. See more HERE.
The submission deadline is 08 July 2019. Complete the application form and return to firstname.lastname@example.org
Applicants need to be a NZRA financial member by the submission deadline – if you are not a member, you can join HERE ($25 annual fee).
This month, a handful of kiwis attended the 12th World Congress of Physical & Rehabilitation Medicine in Paris. Quelle chance! For me, this was in part about my work with Cochrane Rehabilitation. Prior to the World Congress, I hosted a two-day meeting in Paris with 18 rehabilitation experts from 12 different countries to workshop a series of projects examining methodological issues in the development of a scientific evidence base for rehabilitation. Specifically, we were discussing the challenges associated with systematic reviews and meta-analysis of clinical trials about rehabilitation interventions. This two-day meeting was funded in part by a Catalyst Seeding grant from the Royal Society Te Apārangi. We had a strong contingent from New Zealand attending this workshop including: A/Prof Jean Hay-Smith, A/Prof Will Taylor, A/Prof Nic Kayes, Dr Rachelle Martin, and myself. One outcome from this meeting will be a series of papers for a Special Issue of the European Journal of Physical & Rehabilitation Medicine to be published early next year. Keep an eye out for it. :-)
[A/Prof William Levack, A/Prof Nic Kayes, and Dr Rachelle Martin embrace the spirit of gonzo journalism at the trade display stands in the`12th World Congress of the International Society of Physical and Rehabilitation Medicine]
One thing that is always fascinating at these large international conferences are the trade displays on offer (see our YouTube video above). Increasingly these trade displays feature the very latest products on the market for robotics, virtual reality, computer games, and other technological devices to aid rehabilitation. There appears to be four main arguments that the developers behind these products propose as reasons to purchase their goods. Firstly, they argue that these technological aids help increase the amount of therapy time for patients. (However, they often still require supervision to implement.)
Secondly, it is proposed that 'gamification' of therapy, i.e. making therapy into a computer game, makes rehabilitation more interesting and engaging for patients, so sustains their attention longer. (This is an assumption worth testing: Is interest in these games really easier to sustain over the long term in comparison to standard exercise regimes?)
Thirdly, these technologies often offer increased precision. So, a robotic exoskeleton on a treadmill with overhead sling suspension might be able to alter the amount of weight that a patient takes through their legs by half of one percent, while providing data, to the minutest of degrees, on how much work a patient is actually investing in the activity. (Again it is worth questioning assumptions: Is this level of control over movement actually beneficial for recovery in the long run, or is it simply important to just be doing something of anything to make gains in rehabilitation.)
Fourthly, some of these technologies are designed to aid movement when patients are too impaired to even initiate any muscle activity - the example of the robotic exoskeleton and sling suspension once again. While "more" is almost always better in rehabilitation, we are yet to see really compelling evidence to indicate the patients using these fancy technologies actually achieve better health outcome in comparison to good ol' fashioned therapy with trained rehabilitation providers. For instance, the Cochrane reviews on both a) treadmill training with body weight support and b) virtual reality based therapy for people with stroke are equivocal in their findings. Treadmill training does not seem any better outcomes overall in comparison to tradition physical rehabilitation after stroke when it comes to regaining the ability to walk independently. Although treadmill training may result in improvements walking speed and walking endurance after stroke (for people are already able to walk a bit), these benefits are really quite small, and not sustained in the long term. Therapy based on virtual reality interventions are also not more beneficial that conventional therapy if offered in the same amount and intensity. If virtual reality activities are used to provide MORE therapy for individual patients (i.e. on top of conventional therapy) - surprise, surprise - this results in better health outcomes. The same however could be reasonably expected of MORE conventional therapy on top of conventional therapy. As noted above, in the case of rehabilitation, more is often better.
Nevertheless, there are some really interesting and innovative ideas being proposed by technology for rehabilitation. Anything that extends therapy opportunities is surely good. The question to ask is what extra benefit is being gain from the money being spent and are their other things, (more therapist hours? community gym membership? peer mentoring?) that might be equally worth spending money on.
© 2015 New Zealand Rehabilitation Association, Inc.