New Zealand Rehabilitation Association Untitled page

DR HARRY McNAUGHTON: Intrinsic motivation - the key to improving rehabilitation outcomes

Rachelle Martin — Fri, 01 Sep 2023 09:16:42 GMT

We were privileged to have Dr Harry McNaughton speak at the NZRA AGM this week.

This is what he talked about:

Most publicly-funded rehabilitation services in New Zealand and other 'western' countries adopt a professional-dominant approach, focusing on biomedical concerns, particularly trying to reduce impairments and improve simple activities. A broader context acknowledging the ideas of rehabilitation pioneers, the wishes of people living with the consequences of inherited or acquired disabling conditions, educational psychology and recent randomised trials for people after stroke suggest that the key to optimising outcomes of importance to the people themselves requires a focus on psychological concerns, particularly intrinsic motivation. Major questions remain. Timing, dose and duration of interventions? How to start changing practice? What about conditions with dominant cognitive and behavioral concerns like TBI and mental health conditions? This short talk provided the briefest of overviews of what we know so far and explore some of the ideas of where we may be heading.

You can watch a recording of the session here: https://youtu.be/ICgebhT5pK0

You can also download a copy of the PPT slides in PDF version

Harry's email: harrymcn100@gmail.com

Take Charge website for all materials and articles: https://bit.ly/3ysp1KM

Rehab Conversation: Quality Improvement in Clinical Practice

Rachelle Martin — Sun, 13 Aug 2023 08:31:16 GMT

Rehab Conversation held on Monday, 31 July 2023

Session Recording & PPT slides

Steph's PPT slides in PDF format here

Maree's PPT slides in PDF format here

Video recording of session: https://youtu.be/sY0oFtCn4cc

ACC updates: April 2023

Rachelle Martin — Mon, 17 Apr 2023 19:43:38 GMT

Kia ora koutou

Caroline Juinot, who is doing a great job liaising with NZRA on behalf of ACC, has forwarded the following information that may be of interest to you.

CONSULTATION: Cost of Treatment Regulations

ACC has opened a targeted consultation for the next round of changes to the Cost of Treatment Regulations (CoTR). The consultation is open from 3 April – 1 May.

The Minister has requested that ACC run a targeted consultation on behalf of the Minister for ACC, with the Ministry of Business, Innovation & Employment (MBIE). Previously this has been an MBIE led process. The Minister's desire is to return to a bi-annual review and implementation cycle.

That means that this year ACC is focused on delivering changes that can be applied quickly while collecting feedback on wider sector issues so that they can address these in future reviews. Their hope is that this will allow providers to realise the benefits from the proposed changes sooner.

The consultation document: CoTR 2022 review - consult document.pdf

ACC would really appreciate your feedback on the proposal. They would also like to take the opportunity to encourage NZRA members to make submissions.

ACC will also be sharing the consultation document with providers who have billed us under CoTR in the last year and through our Provider Update.

ACC like to acknowledge that the new changes for the previous review cycle came into effect on Saturday 1 April. The new pricing sheets are available on ACC's website

As always if you have any questions, don’t hesitate to get in touch with ACC directly. Otherwise, you can email cotr@acc.co.nz directly with submissions or pātai.

ACC are pleased to announce the Innovation Fund is returning for a second round!

Next month ACC be calling for proposals for innovative health service initiatives. This round ACC are offering contestable, one-off grants of up to $100,000 (incl. GST) to successful applicants.

This year ACC want to hear about your ideas on how whānau can be supported to stay connected, engaged and return to their workplace after an injury. Your proposal could focus on service design, systems, technology, equity, or improvements to a current process.

For this fund ACC are not looking for research or injury prevention initiatives – they have other grants or project funding in place for these.

Your idea should be ready for implementation early 2024, without the need for ongoing support from ACC. It may need funding support to get it off the ground, or it could already be implemented but needs more funding support to get across the line.

More details on what ACC are looking for and how to apply will come out in the May Provider Update [head to the link to subscribe to these emailed updates].

mailto:cotr@acc.co.nz

ACC Communication: Introducing the Choosing Wisely Campaign

Rachelle Martin — Wed, 08 Feb 2023 06:46:53 GMT

This statement has been provided by ACC, asking that we share the following, particularly with members with an interest in musculoskeletal and/or orthopaedics.These statements include the use of Xray and ultrasound imaging, as well as injections and knee arthroscopy treatments for ACC clients.

Tēnā koe,

As part of our commitment to delivering good outcomes for our clients, NZOA and ACC have collaborated on the Choosing Wisely campaign, which seeks to reduce unnecessary low-value treatments and tests for orthopaedic patients within New Zealand.

We have created five statements for the Choosing Wisely campaign to promote a culture where clinicians avoid low-value and inappropriate interventions, as well as support patients and health professionals to have well-informed conversations about their treatment options, leading to better decisions and outcomes.

These five statements reflect current research, evidence, and clinical best practice in orthopaedics. The intent is that clients will only receive clinically appropriate procedures which are meaningful for a diagnosis and to inform their treatment plans.

These statements are now available on the Health Quality & Safety Commission website: https://www.hqsc.govt.nz/resources/choosing-wisely/recommendations-and-resources/for-clinicians/new-zealand-orthopaedic-association. I encourage you to take a moment to read it and consider what it means for your practice and how you work with our clients.

We acknowledge there will be some differences in delivery based on several factors including geographic location, local expertise, and available equipment.

Acknowledgements

We’d like to thank NZOA and the genuine partnership we have created through this work. This collaboration is an example of our commitment for the benefit of providers and our clients. We would also like to thank RANZCR and others who worked with us on these statements for their valuable contributions.

If you have any immediate queries, please contact Emma.O’loughlin@acc.co.nz.

Ngā mihi nui,

Dr John Robson

Head of Health Partnerships and Chief Clinical Officer for ACC

ACC Communication: Contract variations related to MECA settlement

Rachelle Martin — Mon, 31 Oct 2022 02:00:53 GMT

Last week ACC communicated with organisations who held contracts with them, advising them of rate increases ACC is applying following the Allied Health MECA settlement earlier this year. A copy of the communication is below.

If you have any questions please contact your ACC Portfolio Advisor, or Engagement and Performance Manager.

Kia ora koutou,

As you’ll be aware, in June a Multi-Employer Collective Agreement (MECA) was settled for Allied Health professionals. Next week we’ll issue you with contract variations including rate increases to reflect this.

We’ve applied the MECA increase to the Allied Health worker pay band component of the relevant service codes in your contract. This is in addition to any increases provided within the last year, prior to the signing of the MECA.

Each service code is made up of several components (e.g., pay bands, public holidays, administration, and overheads). The increase has been applied to the Allied Health worker wage components only.

Some contracts will also receive increases related to other changes, including staff sick leave allowances and the Matariki public holiday, other relevant MECA settlements, and to allow for general inflation, where these changes have not been allowed for in previous variations. This means you’ll see different increases depending on which contract(s) you hold with us.

Variations will be provided for the following contracts:

Allied Health Services – Hand Therapy

Allied Health Services – Physiotherapy services

Allied Health Services – Podiatry

Artificial Limb Services

Burn & Scar Management

Concussion Services

Concussion – Secondary Proof of Concept

Functional Capacity Evaluation

Home and Community Support Services – Integrated (IHCS)

Initial Occupational Assessment

ISSC – Integrated Services for Sensitive Claims

Living My Service

Non-Acute Rehabilitation

Non-Acute Rehabilitation Pathways

Orthotist Services

Pain Management Services

Residential Support Services

Services for the Blind/Visual Rehab Service

Soc Rehab Asses - Social Rehabilitation Needs Assessment

Soc Rehab Asses - Specialised Assistive Technology

Soc Rehab Asses - Specialised Education (Support)

Soc Rehab Asses - Specialised Housing (Modifications)

Soc Rehab Asses - Specialised Wheelchair and Seating

Soc Rehab Asses – Support Needs Assessment

Spinal Cord Injury Rehabilitation Service

Spinal Injury Vocational Services

TBI Residential Rehabilitation Service

Training for Independence - Adult with other injuries

Training for Independence - Adults with sensitive claims

Training for Independence - TBI

Training for Independence - Children and Young People

Training for Independence Advisory Services

Vocational Independence Occupational Assessment

Vocational Rehabilitation Services.

We’re doing our best to get these contract variations to you as soon as possible. Please note that you will need to have received, signed, and returned your contract variation by 20 November 2022 to allow you to bill for any services delivered on or after 1 December 2022 at the new rates.

You'll also need to update your invoicing systems to reflect the new rates. If you continue to bill at the old rates for services on or after 1 December 2022, we won’t be able to backpay the difference.

If you have any questions about the changes to your contract, please contact your Portfolio Advisor or Engagement and Performance Manager (EPM).

Ngā mihi

ACC Recovery Services

Early bird registration for NZRA conference extended to 31 December 2021

Rachelle Martin — Mon, 13 Dec 2021 04:07:23 GMT

Thanks for your patience while we work on transferring this year’s NZRA Conference to 2022. We are excited to announce the new conference dates as:

FRIDAY 1ST – SUNDAY 3RD APRIL 2022

The conference will still be held at the Novotel Hotel in Rotorua with the same conference format. All the information about the conference can be found on the conference website.

If you had registered for the conference, it will automatically be transferred over to the new dates. If these dates do not suit, please contact Brooke Miller brooke@conference.nz to cancel, and a refund will be organised. As advised in our earlier communication, we cancelled any accommodation booked through the registration process for the September dates. We have now secured some rooms at the Novotel for the new conference dates. Therefore, if you would like to rebook your accommodation please contact Rosanna Carleton rosanna@conference.nz.

If you are yet to register for the conference, we invite you to join us to participate in a national hui to discuss, debate, and share knowledge about rehabilitation in Aotearoa. We have extended the early bird registration fees to 31 December 2021 so don't delay and register today.

We look forward to you joining us in April 2022!

Dr Rachelle Martin
Conference Convenor

Professor William Levack
NZRA President

Postponement of NZRA ‘Achieving Equity’ Conference, 17-19 th September 2021

Tue, 24 Aug 2021 21:46:22 GMT

Given the recent changes in COVID Alert Levels, the NZRA Executive and the Conference Planning Committee has made the difficult decision to postpone the NZRA 2021 Conference, ‘Achieving Equity’, to be held in Rotorua, 17-19 September 2021.

In making this decision, we have considered: the low likelihood of New Zealand being in Alert Level 1 before 17 September; the challenges of hosting an in-person conference at other alert levels; the cost and impact of not postponing but moving to a fully online conference; the currently high workloads of health professionals in New Zealand; the core objectives of NZRA; and, most importantly, what option would give us the best chance to deliver a high value conference to attendees.

We are currently exploring options for when the conference can be held and will be in touch with you with more details by Friday 3 rd September.

We would also like to advise that anybody who booked accommodation via the registration process, Conference Innovators will cancel this and no cancellation fees will apply. If you booked your own accommodation, we would recommend that you make contact with the provider to cancel.

We are disappointed by the need to postpone what was shaping to be a very thought-provoking and inspiring conference. We are so very grateful for everyone’s willingness to share their insights and kōrero about achieving equity in rehabilitation within Aotearoa NZ.

We look forward to you joining us when we get the chance to gather again!

If you have any questions that require immediate attention, please email emma@conference.nz .

Otherwise, we will email you again soon with more details.

Thanks for your understanding.

Me mahi tahi tātou.

Rachelle Martin

Conference Convener

William Levack

NZRA President

Innovation Award Finalist–Mahi Tika

Wed, 18 Aug 2021 02:37:52 GMT

Mahi Tika–Equity in Employment is a disabled-led employment programme developed by Disabled Persons Assembly (DPA) New Zealand.

The programme is delivered across the Waikato region in a project funded by Trust Waikato and Te Ara Mahi (TAM), a portion of the Provincial Growth Fund allocated to focus on regional skills and employment development with the aim of getting local people into sustained local employment.

Disabled people experience marginalisation and discrimination. However, they are resilient problem solvers with a wealth of skills and knowledge on offer.

Mahi Tika–Equity in Employment is designed and led by disabled people and includes large elements of pastoral care to empower participants and enable them to achieve sustainable employment

Prudence Walker, Chief Executive of DPA spoke about what it means to be chosen as a finalist.

This innovation will be presented at the conference and you will have an opportunity to vote for which innovation you think is most deserving of this year's award.

Speaker Spotlight—NZRA Conference 2021

Fri, 13 Aug 2021 22:39:09 GMT

We have a fantastic line up of speakers at this year's conference. Here's a brief bio on each of them, so you can get a glimpse into the diverse group of contributors this year.

CATE GRACE [Kai Tahu, Kāti Mamoe, Waitaha]

Cate works as Person with Lived Experience Engagement Lead with the Burwood Academy Trust. She is the founder and kaiwhakahaere of Whānau Whanake, a community-based social enterprise supporting Māori and whānau health and wellbeing.

Cate also lives with the experience of disability and is involved in the governance of several disability advocacy and Māori organisations.

Cate’s passion is to increase accessibility and participation for those facing barriers, creating diverse and thriving places within our local communities and wider society.

JACQUIE KIDD

Jacquie is of Ngāpuhi, Irish and French descent and is an Associate Professor at the Auckland University of Technology. Her academic practice is focused on social justice, anti-racism and equity in health for Māori.

Generally, she takes a kaupapa Māori approach to her research, meaning that her projects are based on whānau strengths, community needs and local solutions to complex issues.

She has a particular interest in the use of creative methodologies of research dissemination and has had her poetry published in several academic journals and books.

JOSH CALDWELL [Pirirākau, Ngāti Ranginui]

When Josh is not providing peer support to people with newly acquired spinal cord injury, he works as a research assistant and as the Person with Lived Experience (PLEx) Network Coordinator for the Burwood Academy Trust.

Josh acquired his SCI in 2016 as a result of an autoimmune disease. Josh’s involvement with peer support research has allowed him to develop his research skills further while also ensuring that the resulting research findings are applicable to people who are learning to live well with a SCI and useable by peer support providers.

MARTIN CHADWICK

Martin is the Chief Allied Health Professions Officer within the Ministry of Health, working in partnership with the Chief Medical Officer and Chief Nursing Office in providing transdisciplinary clinical leadership and advice.

The role works at a systems level as well as providing support to clinicians, programmes, and projects across the Ministry. He is aligning a work programme around what he describes as the five challenges facing allied health. This includes the challenges of demonstrating the value add of the allied health professions to population health outcomes; and working towards the concept of transdisciplinary working in the provision of healthcare services. Martin was the 2019-20 New Zealand Harkness Fellow in Health Care Policy and Practice.

RUKINGI HAUPAPA

I am a Māori, have a big whānau (family), and belong to many. I was a teacher and an educator for many years but that disappereared when I suffered stroke in 2005. I could not talk or do anything for myself. Though people were all around me, I was terrified and felt alone.

My brain was damaged, but I knew enough to know that education could give me purpose, direction, and hope. There were educational achievements and successes, but the greatest was knowing who I am and who I belong to.

I am Rukingi, a stroke survivor.

DR SARAH GORDON

Sarah’s personal experience of mental illness shaped her university study with the areas of psychology, medical law, bioethics, and psychological medicine being the focus through to PhD level.

Combining this theoretical education and personal experience, Sarah has spent the last 20 years working and advocating for an improved mental health sector and societal perceptions of mental health from the perspective of a person who personally experiences mental illness.

Since 2011 Sarah has worked as a service user academic with the Department of Psychological Medicine, University of Otago. Through this role, she has promoted and progressed service user-led and co-produced education and research.

This work has resulted in the establishment of "World of Difference" – a service user academia education and research team, which Sarah currently leads. The education and research programs being led or co-produced by the World of Difference team are focused on ending discrimination, and promoting recovery, inclusion, and respect for the human rights of people who experience mental distress.

TIM YOUNG

Tim has a background in educational psychology, research, and app development. Tim works as a research assistant with the Burwood Academy, and is also a consultant to central and local governments on accessibility issues.

Tim focuses on using technology to solve accessibility issues after facing many accessibility issues in his own experiences as a tetraplegic.

Tim has a business, Smart Access, which collects and sells data on 35 accessibility variables to local governments to help better prioritise infrastructure spending. In his spare time, Tim is embarking on PhD studies!

Innovation Award Finalist—Te Pou Aropā Takitoru

Mon, 02 Aug 2021 04:02:28 GMT

Te Pou Aropā Takitoru has been announced as one of the finalists for this year's innovation award.

Te Pou Aropā Takitoru is a nation-wide coordinated peer support service providing informal support to those adapting to limb loss. It was officially launched in New Zealand in August 2019 in collaboration with Peke Waihanga, Limbs 4 Life and Amputees Federation of New Zealand reflected in its Māori name – Te Pou Aropā Takitoru.

The Pou symbolises the three organisations, Peke Waihanga, Amputee’s Federation of New Zealand (Inc) and Limbs 4 Life representing the three Pou supporting the wharenui.

The service offers pre/post-amputation, living with amputation and partner support from trained volunteers who have experienced limb loss themselves. The service Coordinator matches recipients to a peer support volunteer, conducts follow-up phone calls to evaluate the support provided and facilitates access to other support services as and when needed.

Matthew Bryson spoke to NZRA about being chosen as a finalist.

This innovation will be presented at the conference and you will have an opportunity to vote for which innovation you think is most deserving of this year's award.

Earlybird Registration closing soon...

Thu, 22 Jul 2021 08:15:31 GMT

Just a reminder that the NZRA Conference 2021 early bird registration closes on 31 July.

Current rego prices for full conference are: NZRA member $550 / Non-member $600 / student/person with lived experience* $350.

From 1 August the prices for full conference are: NZRA member $750 / Non-member $800 / student/person with lived experience* $400

One day conference rego til 31 July: NZRA member $350 / Non-member $400 / student/person with lived experience* $200

One day conference rego from 1 August: NZRA member $400 / Non-member $450 / student/person with lived experience* $250

It's definitely worth your while to register now! Save yourself (or your organisation) up to $200.

Go to www.nzrehabconference.co.nz/register to secure your spot!

#rehabilitation #conference #earlybird #NZRAconference2021

Anne Hawker—Recognised for her Contribution

Tue, 29 Jun 2021 18:45:54 GMT

Congratulations to NZRA life member and current board member Anne Hawker on becoming an Officer of the New Zealand Order of Merit for her services to disabled people.

We caught up with Anne and asked her about her Queen’s Honour. Anne says she was humbled but proud to be acknowledged for her work.

Anne became the first woman president of Rehabilitation International and used that to “assist disabled women to have a different life,” says Anne. She’s also proud to have been President of the Disabled Persons Assembly and get the Human Rights Act passed as well as the Disability Survey.

Despite having achieved so much, Anne still sees potential for more change and development within the disability space. “[I’d like to see a] continued move from special into mainstream and clearer when specialised services are required,” says Anne. She’d also like to see more community development in rehabilitation, and for rehabilitation to be available to everyone.

Anne also wants disability to be part of the diversity conversation, for the stigma towards disabled people removed, for people’s strengths not their deficits to be seen, and for a move away from the medical model to the social model.

“Disabled people are proud of who we are, and we are proud to use the term disabled people without having others define us,” She adds.

Anne says that her career path chose her, as she had to give up teaching after being diagnosed with disseminated sclerosis.

We asked Anne why people should come to the NZRA conference this year. “Be part of the conversation to drive change in the rehabilitation sector to ensure you contribute to a revitalised and relevant rehabilitation sector.”

The full impact of Anne’s work cannot be measured as her work has been life-changing for so many, but milestones in her career were curated for the Queen’s Honours announcement, and we’ve added some others that need acknowledging.

• President of Otago DPA & Otago MS Society

• Setting up Total Mobility in Otago

• The first non-DHB to establish a home support service for ACC

• Established the first stroke club and carers group in New Zealand

• Set up the attendant care scheme in Otago

• Member of the Taieri Social Service & Dunedin Social Service Committee

• Ran the Dunedin women’s school girl cricket competition

• Managed the Otago women’s school girl cricket and school girl hockey teams

• President of Rehabilitation International from 2008 to 2012 and chaired their Social Commission from 2000 to 2008.

• Played a leading role in Rehabilitation International’s work towards the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD).

• President of the Disabled Persons Assembly New Zealand from 1993 to 1997, where she led and partnered a range of policy initiatives and championed all issues facing disabled people from employment, data, human rights; education, health and accessibility.

• Advocated for the New Zealand Disability Strategy, which then became New Zealand’s negotiating mandate for the UNCRPD.

• Treasurer of the New Zealand Rehabilitation Association and the Federation of Disability Information Service in the late 1980s and 1990s.

• New Zealand’s representative to the International Federation of Multiple Sclerosis Society from 1988 to 1993.

• CEO of the Head Injury Society in 1995/1996.

• Principal Disability Advisory for MSD since 2007. With the Ministry for Social Development, she singlehandedly implemented the ‘Lead Toolkit: A guide for employing disabled people’, published in 2018.

• Instrumental in establishing the ‘We Enable Us’ network, providing leadership on effective and inclusive employment of disabled people in the public sector.

• Been a driving force behind ‘The Accessibility Charter’.

Well done Anne, we are so proud of you and your achievements so far! And we are grateful for your ongoing involvement in the NZRA.

Innovation Award Finalist—Jo Nunnerley

Sun, 20 Jun 2021 01:11:56 GMT

Jo Nunnerley (and team) were announced as one of our three finalists for the NZRA Innovation Award 2021, for their use of virtual reality to help with brain injury rehabilitation.

In collaboration with Laura Fergusson Brain Injury Trust (LFBIT), CerebralFix, University of Otago and Callaghan Innovation they used a co-design process with clinicians and people with traumatic brain injury to develop a therapeutic virtual reality tool aimed at increasing the awareness of and teaching self-management strategies for cognitive fatigue after brain injury.

This tool can simulate real-world situations without having to bring the client to those locations. This could include a supermarket, a cafe/restaurant or a place of work—activities the client would need to interact with as part of their normal daily lives post-injury.

Cognitive fatigue is the most troubling and longest lasting symptom in 73% of individuals recovering from a traumatic or acquired brain injury. The long-term effects of fatigue can considerably impair an individual's ability to work and lead a normal life, including participating in social activities with whānau and friends.

The team used a three-phase co-design approach to develop the virtual reality system, to ensure that input and opinions of people with lived experience of brain injury and experienced clinicians were integrated throughout the entire process.

Jo spoke to NZRA about what it means to be chosen as a finalist for this year's award.

This innovation will be presented at the conference and you will have an opportunity to vote for which innovation you think is most deserving of this year's award.

Innovation Award Finalists Announced

Thu, 10 Jun 2021 23:10:58 GMT

The three finalists for this year's inaugural Innovation Award have been chosen, and all three presenting their innovations as part of the NZRA conference where one will be chosen as the overall winner.

Tim Young and the team from Disabled Person's Assembly submitted their 'Mahi Tika—Equity in Employment', a disabled-led employment programme for the Waitako region.

Matthew Bryson from Peke Waihanga–Artificial Limb Service submitted 'Te Pou Aropā Takitoru, a nation-wide coordinated peer support service for those adapting to limb loss.

Jo Nunnerley and her team submitted a therapeutic virtual reality tool for people who've experienced a traumatic brain injury—developed in collaboration with Laura Fergusson Brain Injury Trust, CerebralFix, University of Otago and Callaghan Innovation.

Each of the finalists will be profiled over the coming weeks, in the lead-up to the conference and will have 15 minutes to present their innovation at the conference. There are no rules for what this presentation should look like.

Finalists have been encouraged to choose a presentation approach that best conveys the innovation and helps them demonstrate that the innovation meets the award criteria.

The audience will determine the final winner of the 2021 Rehabilitation Innovation Award, judging against the award criteria. The winner will receive an additional $1000 to put toward activities of their choosing.

As a finalist, they will receive financial support of up to $1500 to attend the NZRA conference, He Mahi Tahi Tātou: Achieving Equity in Rehabilitation, 17-19 September 2021 in Rotorua.

Opportunity to strengthen rehabilitation in Ethiopia

Wed, 21 Apr 2021 18:38:49 GMT

The following is a message from “Hidden Abilities”, which we have agreed to share on our website. However, NZRA is not involved in any aspect of Hidden Abilities, or its parent organisation SIM Ethiopia. Hidden Abilities and SIM Ethiopia do not represent NZRA. If you are interested in exploring this opportunity further, you will need to do your own research into this organisation and the terms and conditions of contributing to their work. Contact details are supplied below.

If you’ve ever wanted to use your rehabilitation skills and experience to help other countries flourish, then Ethiopia is a land of opportunity (and great coffee).

With very few physiotherapists, particularly with any experience in paediatric therapy, and no occupational therapists or speech and language therapists, they are facing an uphill battle to support those who most desperately need the help.

Hidden Abilities is a SIM project based in Bahir Dah, Ethiopia who provide therapy to children with physical disabilities such as cerebral palsy, spina bifida, club feet and other developmental delay.

There is an opportunity for you to visit them on a short-term trip to upskill their staff, or share your resources or simply donate to help fund the work they do.

In Ethiopia having a disability or a disabled child is seen as a curse from God. The shame drives many parents to hide their children in their homes, or for the father to abandon his wife and children.

Hidden Abilities works to “help children discover and develop their ‘hidden abilities’, and to feel loved and valued for who they are”.

Nati is one of the children they are helping flourish. While in the Neonatal Unit after a difficult birth, his parents were told that they shouldn’t waste their money as he’d probably die soon. His parents insisted that as long as he was breathing, they would do all they could for him.

He went home after a few weeks but it wasn’t until he was about one that they noticed he didn’t stand or walk like other children and always sat with one leg bent backwards. Most medical people told them “ there’s no hope; take Nati home and feed him but he will never be able to walk”.

But someone told them about Hidden Abilities and the family travelled over 30km to the centre where after several months Nati was able to crawl, stand and then walk. His parents dream of the day when he will be able to run and go to school like all ‘normal’ children.

Each week they are providing free therapy twice a week for 80 children up to 18 years old. They also provide nutritional support for the poorest families and educational support for those children fortunate enough to attend school.

They are currently in discussions with the Government training hospital about starting an Early Intervention Programme. “By treating early, we can potentially undo damage within days or weeks rather than years, which would significantly improve the quality of life of the child and their family.”

If you’d like to know more about Hidden Abilities and the possibility to visiting them you can contact Emily Ling: emily.ling@sim.org / whatsapp: +251965179122

BRNZ Research Recruitment: Building Psychosocial Capability

Wed, 07 Apr 2021 08:01:21 GMT

Researchers from the Centre for Person Centred Research at Auckland University of Technology would like to interview:

People and whānau experiencing age-related neurological impairment such as Stroke, Parkinson's, Mild Cognitive Impairment and Dementia.
Health professionals who work with these people

about their experiences of living or working with age-related neurological impairment and the people and environments that help them build their personal resources for living with long term neurological impairment.

"We recognise that living with long-term neurological impairment can be challenging. We believe that things – services, people and organisations that work with people living with neurological impairment can help to build their confidence and ability to manage these challenges.

Our focus for this research is to find out what positive things services and health professionals do to contribute to a person’s ability to develop skills and confidence to thrive /manage their health condition. We are also keen to understand your impressions of why these positive things work and in which circumstances.

The interviews will be based around people reflecting on one or two critical incidents (either as health care providers or patients/clients and their whānau).

Can you tell me what happened?

What was it about this event that made it a positive experience for you?

What was the context?

What was the clinician / service doing?

How did it make you feel?

Did this incident change anything about the way that you think?

Did the incident change anything about what you do?

What was the outcome for you? "

You can view the flyer for the research here

If you are interested in participating or know of someone else who is interested, then contact Christine Cummins via email: ccummins@aut.ac.nz or visit their website https://cpcr.aut.ac.nz/

"It happened to me" Young Stroke Podcast

Sun, 28 Mar 2021 23:00:09 GMT

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

Thu, 04 Mar 2021 02:05:07 GMT

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.

The website: gathers a collection of video and written resources to help Māori who have experienced stroke to understand what has happened and what to expect. Aphasia and speech-language therapy is explained, as well as ideas as to how to rehabilitate.

The booklet: written especially for Māori and their whānau, explains stroke, aphasia and roles of speech-language therapists and communication-based groups communication. There is a strong focus on moving forward with aphasia and ideas for enhancing recovery and ways whānau can help.

The interactive resource utilising Talking Mats: Talking Mats is a therapy package with communication symbols depicting topics with response options and a scale placed in a way that explores feelings and opinions. Karen consulted with Māori advisers to adapt Talking Mats for the needs of Māori users.

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 admin@burwood.org.nz. 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.

Evidence-Based Practice in Interdisciplinary Stroke Rehab

Mon, 15 Feb 2021 00:51:43 GMT

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 (AUT) study options—semester one

Thu, 11 Feb 2021 01:25:50 GMT

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.terry@aut.ac.nz

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: sue.lord@aut.ac.nz

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.

More detail about the paper can be found here

For more information, contact Mark Boocock: mark.boocock@aut.ac.nz

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: gwyn.lewis@aut.ac.nz

Study options for Semester One 2021—University of Otago

Wed, 03 Feb 2021 20:30:49 GMT

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.

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

IMAGE: "learn" by Mark Brannan is licensed with CC BY-NC-SA 2.0.

Implementation of Telerehabilitation in Response to COVID-19

Wed, 27 Jan 2021 23:15:52 GMT

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.

Kaupapa Māori Speech Therapy—Dr Karen Brewer

Sun, 17 Jan 2021 23:34:38 GMT

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

National Telehealth Register launches

Sun, 17 Jan 2021 23:23:12 GMT

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

Sun, 10 Jan 2021 22:12:57 GMT

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 Announced

Wed, 16 Dec 2020 21:05:01 GMT

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

The wow factor: Strengthening the Wellbeing of Women—Jean Hay-Smith's Inaugural Professorial Lecture

Sun, 06 Dec 2020 21:42:31 GMT

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 and Rehabilitation—Cochrane Rehabilitation resource

Sun, 22 Nov 2020 18:47:23 GMT

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:

an evidence-based living mapping of all the current evidence
a living rapid systematic review of all the current evidence updated every month
a list of research priorities produced in collaboration with the WHO rehabilitation programme
a Special Collection of Cochrane Systematic Reviews in the Cochrane Library
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

"Meaningful Research—Meaningful Lives" William Levack's Inaugural Professorial Lecture

Tue, 17 Nov 2020 20:19:55 GMT

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

Study opportunity - Intellectual Disability: Theory into Practice

Rachelle Martin — Fri, 06 Nov 2020 00:51:23 GMT

NURS433/PSME439 Intellectual Disability: Theory into Practice

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 evidenced-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.

You could be eligible to undertake this Level 8 paper if you hold a professional health/education qualification and/or undergraduate degree and are a professional working in the health and/or disability sector.

Nurses must hold registration from a three-year programme or course, congruent with the Health Practitioners Competence Assurance (HPCA) Act (2003). The paper is able to be included in the suite of papers for a number of PGDiplomas and it can also be taken as a standalone paper – COP, Certificate of Proficiency and brought into a PG qualification at a later date.
For enquiries about this paper contact: Henrietta Trip henrietta.trip@otago.ac.nz, (03) 364 3857

Research participation opportunity - interprofessional team communication

Rachelle Martin — Fri, 25 Sep 2020 04:25:21 GMT

Would you like to share your thoughts on interprofessional team communication in inpatient rehabilitation?

Julia Paxino is PhD student in Melbourne. She is keen to talk to clinicians in NZ and Australia from a whole range of professions and clinical contexts (i.e. not linked to specific patient/diagnostic groups) about this topic. If you’re interested in taking part, please feel free to contact Julia directly. Her details are on the attached invitation...

Interprofessional communication study recruitment information.pdf

NZRA Treasurer Vacancy

Tue, 21 Jul 2020 03:27:48 GMT

NZRA is looking for a financially minded person with good communication and interpersonal skills to join our national executive as treasurer.

The NZRA executive is a dynamic group of rehabilitation enthusiasts working together to provide leadership and to advocate for excellence in rehabilitation in NZ. The executive meets on a monthly basis and the treasurer’s role would be to provide financial oversight and report to the committee at meetings, taking the lead in financial matters.

The role is voluntary and the usual term is two years up to a maximum of four years. If you are interested get in touch with Debbie Snell deborah.snell@cdhb.health.nz.

Guidance for Rehabilitation of people recovering from COVID-19 in NZ

Tue, 14 Jul 2020 23:10:15 GMT

Developed by Martin Chadwick – MoH Chief Allied Health Professions Officer - with input from Allied Health Aotearoa

Come and mahi tahi with us ...

Mon, 29 Jun 2020 22:44:47 GMT

The NZRA is currently seeking keen beans to join us as we work to ....

...raise the awareness and voice of rehabilitation in New Zealand, creating opportunities that connect organisations and advocating for excellence in rehabilitation to achieve best outcomes.

We are looking for people to contribute in a number of ways.

We are seeking greater diversity in both the NZRA Executive and the NZRA Conference Planning Committee. We particularly welcome people who are Māori, who have the lived experience of disability, clinicians, organisational and/or provider representatives. That said, we would love to hear from anyone who is interested in joining us as we would value the time, skills and enthusiasm of all.

1. Join the NZRA Executive team.

Keen to help us explore ways to promote rehabilitation in NZ? We need a few more people to help out. It's a great way to network and keep up with what's happening.

We are also particularly interested in hearing from people who could help us in a treasurer role. Do you know someone who would be willing to do this work pro bono - e.g. an accountant looking for some NGO organisational experience?

Get in touch with William Levack (NZRA President) via william.levack@otago.ac.nz for more information or to indicate your interest.

2. Join the 2021 Conference Organising Committee

Would you like to assist dream, scheme and pull-together an innovative NZ Rehabilitation Conference? The plans are underway and we exploring options for September 2021. We are keen to make this a really interactive, practice-based event with a particular focus on improving equity of access and outcomes in the NZ context. Do you think you would like to join the team and contribute? Get in touch with Rachelle Martin (Conference Convener) via rachelle.martin@otago.ac.nz for more information or to indicate your interest.

How a Lego-loving kid got into rehabilitation technology

Tue, 23 Jun 2020 02:09:43 GMT

Contributed by Agnetha Korevaar, Callaghan Innovation.

I was one of those kids who was always playing with Lego, adventuring on the farm or helping Dad fix broken equipment; curious to know how things work, eager to explore, and keen to make new and improved inventions. So when I heard about mechatronics engineering (mechanical engineering + electronics + software smarts = robots), I thought it seemed like the perfect way to use science to create things which are helpful in day to day life.

It was in the final year of university that I got my first taste of rehab tech. Alongside standard engineering courses, I had the opportunity to learn about human physiology and how diseases such as stroke can affect it. For the final year project, our student team came up with a device to help people who have had a stroke with arm rehabilitation exercises. Guided by an expert mentor, we developed the idea for an affordable device for in-home use, so that people would have more opportunities to do their rehabilitation exercises and (hopefully!) be able to regain more of the function they’d lost.

Fast-forward a few years and I was working to develop new technologies at a Christchurch company who design the electronics on powered wheelchairs and mobility scooters (Dynamic Controls). While there I gained valuable technical skills from fellow engineers, user experience designers, and product managers. I was also encouraged to think outside the box and develop new technology that could improve the quality of life for people using wheelchairs and mobility scooters. We had the opportunity to spend time using these mobility aids, and feel firsthand some of the frustrations. Another key way we got user insights was interviewing people who are dependent on these devices every day and hearing of their joys and difficulties. Putting these experiences together, we could figure out where crazy ideas and new technology could help the most.

Now I’m a research engineer at Callaghan Innovation, helping innovative businesses across New Zealand to turn their ideas into real-life prototypes. I’ve joined the MedTech CoRE - a network of researchers from both clinical and engineering backgrounds, who are developing new medical technologies. The theme of stroke rehab has continued, and I’ve been helping to develop a new version of the arm rehabilitation device. Over the past year, I’ve been working together with speech and language therapists and people who use speech generating devices (SGDs), to figure out how we can give Māori SGD users a te reo voice and the ability to express themselves using their first language. These are the kinds of projects that excite me - opportunities where tech could make a very real difference for those living with disability.

So what’s next? I’d love more opportunities to chat with clinicians and people with lived experience of injury or disability, to hear about areas where technology could make a huge difference, and then, to turn those ideas into reality.

Agnetha can be contacted via: Agnetha.Korevaar@callaghaninnovation.govt.nz

Study Rehabilitation with Children (REHB716)

Thu, 04 Jun 2020 00:36:35 GMT

This 30-point distance-taught paper is intended for those working with or interested in supporting children and their families in their management of child-related health and disability issues. Core content includes interprofessional frameworks for health and disability, family-centred practices, lifespan trajectories and models of service delivery. Interprofessional and evidence-based practices are emphasized while all assignments are individual and applied to student-led areas of enquiry. The course is ideal for health professionals, consumers, advocates, managers and policy makers from health, education or community settings. Teaching methods are remote but highly interactive. Skills developed include finding relevant research evidence quickly; evidence-informed project management; advanced written and oral communication to diverse audiences; networking with current and future sector leaders.

Tutor: Dr Fiona (Fi) Graham

https://www.otago.ac.nz/wellington/departments/medicine/postgraduate/rehabilitation/staff/otago019968.html

Fi is an occupational therapist committed to improving opportunities for participation for children and families. She has worked clinically in health and education settings with children specialising in neurodisability and its life-impacts. Her research centres on effective ways of working with caregivers of children with disabilities to create more enabling contexts for children.

Course commences week of July 6th. Enrol by June 25 to avoid late enrolment.

https://www.otago.ac.nz/study/enrolment/index.html

Course Fees:

Domestic Tuition Fees (NZD) $2,857.50
International Tuition Fees (NZD) $10,363.00

The benefits, challenges and learnings of telehealth in practice (Presentations from NZRA AGM)

Tue, 02 Jun 2020 01:23:54 GMT

These presentations preceded the NZRA AGM, Thursday 14th May 2020.

1. Lessons from lockdown – Dr Suzie Mudge

Suzie is a Physiotherapist and Director of Neuro Rehab Results, a private neurorehabilitation clinic in Auckland. Like other rehab providers, Neuro Rehab Results has had to make a quick shift to telerehabilitation.

2. Building telehealth capability for community based allied health – Jonathan Armstrong

Jonathan is Clinical Director for Allied Health in the Community Health Services at Counties Manukau Health. Since Level 4 restrictions, Jonathan has been working with the Allied Health team to build their capability for delivering intervention via telehealth. This has included: Ensuring the availability of equipment and technology, establishing guidelines, trialling a variety of tools, developing training, and utilising outcome measures to collect patient feedback.

3. The use of telehealth for wheelchair and seating solutions – Rachel Brown

Rachel is an Occupational Therapist. She has been working for Enable New Zealand as an Equipment and Modification Services (EMS) Advisor since 2010. Her role involves coordinating outreach clinics for wheelchair, seating and lying supports in the lower South Island as well as completing requests for advice.

4. Zooming in to improve lung health and general wellbeing – Anne Fitzpatrick

Anne Fitzpatrick works part time as a researcher in the Department of Medicine at University of Otago’s Wellington campus and is a Board member of Polio NZ. Anne had polio as a child which left her with paralysis in her right leg and a foot drop. In recent years she has experienced a significant deterioration in her ability to walk, and onset of COPD. She has always actively managed her health to optimise her functionality and live life as fully as possible. She is an active member of a weekly exercise group and SYLO choir for people with chronic lung conditions (SYLO= Sing Your Lungs Out).

Engaging with people with the lived experience of disability

Thu, 28 May 2020 00:38:58 GMT

Ko Aoraki te maunga

Ko Wataki te awa

Ko Kāi Tahu te iwi

Ko Hakiri Price tōku tipuna,

Ko Moeraki me Ngāi Tūāhuriri te hapu

Ko Cate Grace tōku ingoa.

Tēnā koutou, tēnā koutou, tēnā koutou katoa

Since I was young, my whānau on both sides has worked in our community to support others to find and share their own voice. It came as no surprise to my parents that in my teenage years I became interested about other viewpoints and making connections with diverse groups. My own journey with acquired disability in my 20’s broadened my world view even more and exploring unexpected pathways and new opportunities became my new normal.

So, six months ago when I sat down over tea with Dr Jo Nunnerley and discussed an opportunity to continue Dr Johnny Bourke’s vision at Burwood Academy of Independent Living (BAIL), it was an easy decision!

Dr Bourke established a person with lived experience (PLEx) group around New Zealand and Australia. The group known as the Burwood Academy Consultation (BAC) Network, was set up to review research projects, particularly around disability and all that world encompasses.

My role as BAIL’s PLEx Engagement Lead has a focus on creating meaningful connections and ensuring those who have a disability or lived experience contribute and participate at all phases of research. This is a fabulous diverse and active group. My role is to facilitate and match the group to the various work we are asked to take part in. Over the six months since I began, the group has been involved with co-designing research proposals, evaluating scoping documents, being research participants, matching advisors to research projects, co-designing and delivery of education course material and creating pathways for students to undertake further study at a Masters and PhD level.

The lens of disability has changed dramatically over the last decade. I am proud to work for such a forward thinking organisation that works to ensure that not only does research reflect societal changes, but that those with lived experience have a voice and acknowledged contribution. It is exciting to be involved in societal and social change as BAIL collectively introduces new ways of thinking across not only the disability sector but also the wider wellbeing and health sectors. My role allows diverse groups to contribute to the conversations that BAIL are already having in the research and health sectors.

Recently I was appointed to act as an Advisory Committee Chair with the PEC - PLEx Engagement Committee. The committee meets regularly to give advice and support, and direction to other organisations. As a facilitator, this group is an important part of re-framing disability, as it ensures there is a collective and diverse voice representing those with lived experience. Our voice can contribute to the strategy of organisations who are forward thinking about connecting research that is produced within the sector.

Taking on this role at BAIL, and all it includes, means I can combine many of my passions with a team and with different organisation’s who share similar values, experiences and goals. I believe it is important to remember that this research comes from a person and their everyday life; sometimes their story needs to be told outside of percentages and figures. We produce research that matters, and we do it because we care.

Where to from here? I look forward to building our BAC Network and PEC and continuing to support BAIL to have a positive impact to those with lived experience of disability. So, if you have lived experience of disability or know someone who does and is interested in contributing to meaningful research please drop me a line cate.grace@burwood.org.nz. I would love to connect with you!

Comprehensive Telehealth resource

Wed, 27 May 2020 00:48:44 GMT

The comprehensive resource Telehealth (Digital Practice) Handbook – a practical guide for physiotherapy has been provided to NZRA by Miranda Buhler. Contents include:

Professional practice guidelines and ACC contracts
Telephone triage
Video Consult
Practice points
Tips for an effective consult
Working from home
Professional resources
APA Telehealth Webinar Q & A
Digital supplementary resources

Rehabilitation in the wake of Covid-19

Tue, 05 May 2020 00:03:07 GMT

The British Society of Rehabilitation Medicine have just published a working document outlining what specialist rehabilitation services could and should look in the wake of the Covid-19 pandemic.

Taken from the Executive Summary:

Rehabilitation forms a critical component of the acute care pathway, helping to relieve pressure on the acute and frontline services. It is shown to be both effective and cost-effective, whether through improving independence and societal reintegration; or managing the impacts of long-term disability including neuro-palliative care.

An as yet unquantifiable additional case-load of patients with post-Covid disability presenting with a wide range of problems due to cardio-pulmonary, musculoskeletal, neurological and psychological/psychiatric complications of the disease, compounded in many cases by de- conditioning from prolonged stays in ITU. As NHS services re-boot in the wake of the pandemic, there is an important opportunity to work collaboratively to rebuild services on a better, more co-operative model – a phoenix from the ashes. This document sets out the BSRM’s recommendations for rehabilitation services for adults aged 16 years and over in the wake of the Covid-19 pandemic - in particular, the role of specialist rehabilitation to support patients with more complex rehabilitation needs.

A guide to using telehealth when assessing for mobility and seating

Sun, 19 Apr 2020 22:22:42 GMT

Rachel Brown (Enable) has kindly shared this resource with the rehabilitation community. Please feel free to forward it on to anyone you think would find it useful.

Thanks Rachel!

A Guide to Using Telehealth - Enable New Zealand 2020.pdf

Telehealth in Rehabilitation with Dr Fiona (Fi) Graham

Thu, 16 Apr 2020 01:42:57 GMT

Dr Fiona (Fi) Graham is providing rapid response tele-teaching during the COVID-19 lockdown. These resources relate to Telehealth in Rehabilitation - the use of technology in delivering healthcare.

The following recordings of presentations on this topic are now available:

Session 1. Introduction to Telehealth

Session 2. Effective communication for tele-delivery

Session 3. Rethinking 'hands-on' rehabilitation in telehealth delivery

More demonstrations will be added in coming weeks, including:

Session 4. Group work by tele-delivery

Session 5. Measuring outcomes by tele-delivery

Also available is a Demonstration of Telehealth coaching for caregiver

and session playlist. This is the best place to find everything in one location.

5 small steps to help support others

Thu, 16 Apr 2020 01:42:04 GMT

Some encouragement for those who are supporting others during COVID-19 in this 2-minute video from the Bridges Self-Management team.

Useful for the current time - but actually relevant for all times and spaces!

Stroke rehabilitation - Telehealth resources in response to COVID-19

Thu, 16 Apr 2020 01:41:03 GMT

The resources on this page have been collected for use by stroke care and rehabilitation professionals to provide telehealth services due to COVID-19 isolation or social distancing.

https://informme.org.au/telehealth

Resource categories include:

Medicare item numbers
Communication tools for people with aphasia
General telehealth guides and tips
Assessment tools
Therapy tools and resources
Fitness training
Relevant research papers

WFNR Franz Gerstenbrand Award

Thu, 16 Apr 2020 01:39:30 GMT

This £3000 prize award that is open to anyone worldwide who has contributed in a substantive way to neurorehabilitation. Not even limited to research, this is a great opportunity for younger clinicians or academics.

Further information and apply here

Survey invitation: Concussion Guidelines – do NZ clinicians use them?

Wed, 15 Apr 2020 21:39:25 GMT

What is the survey about? Do NZ concussion clinicians use clinical practice guidelines? What do they like or dislike about currently available guidelines? Are there gaps? What makes a guideline useful? These are some of the things we are seeking more information about in our new study.

Concussion is a very common injury and while most people do well and recover uneventfully, for some recovery can last a long time and can be very distressing and disruptive. In New Zealand we have services funded by ACC for assisting people recover from concussion. However there is a lot of information floating around about concussion management and the body of research is growing exponentially. That means there is a lot of evidence out there for clinicians to integrate into their practice, not all of it necessarily of the best quality.

What are clinical practice guidelines? Clinical practice guidelines are one way research evidence is ‘packaged’ so it is easy to use by healthcare providers. However there are a range of different concussion guidelines available and not all clinicians find it easy to choose between them or find them helpful and we want to know more about why this might be.

Take the survey: In our survey (see link below) we ask questions about barriers and facilitators to guideline use by concussion clinicians. Based on pilot feedback, the survey will take five-10 minutes of your time and your responses will be anonymous. Please send the link to others you know who work with concussion – the more responses we get the more confident we will feel about the findings. Thank you in advance for your thoughts. We will circulate the findings once these have been analysed – here’s the link to the survey:

https://is.gd/concussionguidelines

Thank you!

Latest NZ Rehabilitation Review (Issue 50)

Wed, 08 Apr 2020 22:43:42 GMT

The latest issue of NZ Rehabilitation Review (Issue 50) is now available.

Reflections of Prof. Jacinta Douglas symposium (Feb. 2020)

Wed, 04 Mar 2020 20:35:32 GMT

Last month NZRA was delighted to host Professor Jacinta Douglas presenting on:

"Community reintegration and social connection for people with brain injury”

Professor Douglas discussed the social isolation and loneliness frequently experienced by people with acquired brain injury. Around 70 people – mainly clinicians working with people following brain within inpatient and community-based rehabilitation settings - attended the two symposia in Christchurch and Auckland

Social connection refers to forming and maintaining various interpersonal relationships which are significant and satisfying and that extend beyond the family. People who experience disability frequently report wanting to be actively integrated and connected within their social relationships. Their sense of self is often maintained in terms of their experiences in social and activity contexts – whether they were feeling ‘part of things’ or not. Importantly, people often prioritise being able to contribute to relationships, rather than just being in receipt of care and support.

It was wonderful to spend the morning thinking about these issues and having time to reflect on the ways that the services support (or don’t do so well at supporting) the development or maintenance of social connections.

School of Physiotherapy Neurorehabilitation course - Semester 2, 2020!

Rachelle Martin — Fri, 28 Feb 2020 00:29:37 GMT

Submitted by Ally Calder

The School of Physiotherapy, University of Otago PHTY 535 Neurorehabilitation for Physiotherapists paper is offered by distance or on campus. It aims to provide practising physiotherapists with a more advanced level of knowledge, competence and skill in the neurorehabilitation field through integrating theory, practice, and reflection. The student will develop an ability to critically appraise and evaluate current neurorehabilitation practice trends beyond that of the entry–level practitioner, and apply this information to the evaluation and management of the patient. One of the most valuable aspects of this paper is being able to “put your own spin on it” within the context of the broad topics covered. Topics include exploring physical activity and health, management of secondary conditions, fatigue management, neuropathophysiology, and philosophies of healthcare and service delivery. Within these areas, the student can individualise their learning to their particular interests within a neurorehabilitation context (e.g., TBI, Concussion, Stroke, MS, Parkinson’s Disease, Spinal Cord Injury, Paediatrics). To illustrate such diversity, previous students have explored the effects of cycling on gait parameters in paediatric rehabilitation, the management of central post-stroke pain, passive standing in the long term management of people with spinal cord injury, and strength training in people with chronic stroke. The paper is assessed via three written assignments, one reflective piece, and an oral presentation.

Leanne Robinson provided feedback about her experiences of this paper. “I would like to express my gratitude for the fantastic friendly and open way that this paper was facilitated. As an older adult learner I valued the way you were able to facilitate so everyone had the ability to share and learn from each other no matter where they were on the spectrum of experience or area of practice. It has provided me with a framework for taking limited research in some areas of my area of work, synthesizing and then being able to articulate what that means to my practice. I have already been able to further support a 4th year student, my new grad physio and my other colleagues to look at research in a slightly different and more robust way. I have renewed my enthusiasm for research and the implementation of physiotherapy in my very slow rehabilitation area is of huge benefit to those families and children I have known for a very long time.”

The PHTY 535 paper is primarily facilitated by Dr Ally Calder along with her colleagues at the School of Physiotherapy whose expertise and interests span a wide range of areas within the field of neurorehabilitation. For further information about this paper, please don’t hesitate to contact Ally at ally.calder@otago.ac.nz or to discuss your postgraduate programme of study at the School of Physiotherapy contact the Associate Dean of Postgraduate studies Dr Meredith Perry (meredith.perry@otago.ac.nz)

AUT Rehabilitation courses in 2020!

Tue, 18 Feb 2020 02:48:16 GMT

Postgraduate Study – Rehabilitation pathway at AUT

Many practitioners find the skills and knowledge they develop through their undergraduate qualification are necessary, but not sufficient, to manage the complexities of rehabilitation practice. In the postgraduate rehabilitation pathway in the School of Clinical Sciences at AUT, they help you explore some of these complexities and then apply your new knowledge in your practice. The pathway is intended for rehabilitation practitioners or other professionals working in a range of patient populations, across a range of practice settings.

AUT offer the benefits of connecting on campus with lecturers and peers at block courses, alongside the flexibility of online and self-directed learning.
Papers are delivered by lecturers from a range of disciplines who are leaders in rehabilitation research.
Course content is continually updated in response to current research and engagement with industry.
Focus is on up-to-date evidence-based learning with immediate application to practice.

Enrol yourself in the following programmes:

Rehabilitation papers on offer in 2020 semester 1 (Feb to June)

RHAB801 Occupational Ergonomics: Concepts of Moving and Handling: provides a foundation in the academic and contextual setting for the moving and handling professional. Click on link to view paper flyer.
RHAB802 Vocational Management and Rehabilitation: Fosters critical synthesis and application of current evidence and theory to practice in vocational management and rehabilitation. Examines the relationship between work and health at individual and societal levels. Click on link to view paper flyer.
RHAB805 Concepts of Rehabilitation (also offered in semester 2): Examines core concepts which underpin rehabilitation. Enables students to explore and challenge their own rehabilitation practice through critical review of theory, evidence, and practice. Click on link to view paper flyer.
RHAB814 Clinical Anatomy: Provides detailed advanced applied and theoretical anatomy that links the anatomical evidence with advanced clinical practice. Click on link to view paper flyer.
RHAB817 Biomechanics: Fosters the advanced study of mechanical principles and their association with the musculoskeletal system. Click on link to view paper flyer.
RHAB818 Pain: Mechanisms and Management (also offered in semester 2): Provides neurophysiologic mechanisms of acute and chronic pain and the relation to clinical practice. Click on link to view paper flyer.
RHAB819 Therapeutic Exercise Science: Explores and debates the scientific basis of exercise testing and prescription for special populations. Click on link to view paper flyer.

Rehabilitation papers on offer in 2020 semester 2 (July to November)

HEAL801 Disability and Health: Develops a critical understanding of theories, policies and practices that influence the provision of health services to disabled people in New Zealand and Internationally. Click on link to view paper flyer.
RHAB807 Motor Control in Rehabilitation: Develops a scientific approach to the therapeutic management of people with movement disorders. Click on link to view paper flyer.
RHAB809 Stroke Management: Critiques and advances the knowledge of principles and practice of stroke care, prevention, management and rehabilitation in hospital and community settings. Click on link to view paper flyer.
RHAB811 Health Ergonomics: Provides a broad based introduction to ergonomic principles and their application in the design of work, equipment and the workplace. Click on link to view paper flyer.
RHAB812 Innovative Strategies: Engaging in Rehabilitation : Provides an overview of concepts, theories and research related to behaviour, beliefs and cognition and investigates how nursing, allied health professionals and others can apply them to practice in rehabilitation. Click on link to view paper flyer.
RHAB813 Breathing, Performance and Rehabilitation: Explores the role of breathing retraining in performance and rehabilitation for a wide range of professional practitioners who wish to optimise physical performance or rehabilitate disordered breathing patterns. Click on link to view paper flyer.

Full Year rehabilitation paper (Feb to November )

RHAB806 Hand and Upper Limb Therapy: Encompasses advanced study in the practical and applied assessment of hand and upper limb dysfunction and the understanding and integration of the scientific and clinical research foundation of current medical, surgical and therapeutic management strategies for such dysfunction. Click on link to view paper flyer.

View landscape graphic of postgraduate study progression in the rehabilitation pathway.

For further information, contact Nicola Kayes (Professor of Rehabilitation and Director, Centre for Person Centred Research, School of Clinical Sciences):

Phone: 09 921 9999 ext 7309 Email: nicola.kayes@aut.ac.nz

RTRU Rehabilitation courses in 2020!

Wed, 12 Feb 2020 20:26:38 GMT

The Rehabilitation Teaching and Research Unit (RTRU) of the University of Otago welcomes students from anywhere in the country. They are a distance learning unit to the following programmes:

PGCertRehab
PGDipRehab
Masters in Health Sciences by thesis or dissertation
PhD

They are also very happy for students enrolled in other New Zealand tertiary institutions to take just one of their papers and include that in an award they are doing elsewhere (with the approval of their ‘home’ institution). RTRU is also happy to consider crediting postgraduate study done elsewhere to their programmes.

Papers on offer In 2020 Semester 1 (March to June)

REHB701 Rehabilitation principles - addresses the core themes of rehabilitation and provides students with the tools to critique their own rehabilitation practices and develop innovations to local rehabilitation services. View paper information

REHB703 Musculoskeletal rehabilitation - develop a more in-depth understanding of rehabilitation of a range of musculoskeletal disorders. View paper information

REHB714 Personal and psychological factors in rehabilitation - examine psychological factors influencing rehabilitation by considering the "Personal Factors" component of the World Health Organization's International Classification of Functioning Scheme. View paper information

Papers on offer in 2020 Semester 2 (July to October)

REHB712 Rethinking rehabilitation - Integration of the student’s reflections on their experience as clinician, consumer, funder/manager with research findings to evaluate contemporary and challenging rehabilitation process/outcome questions arising from their rehabilitation setting. View paper information

REHB704 Neurological rehabilitation - A rehabilitation perspective on the assessment and management of a range of neurological conditions. View paper information

REHB716 Rehabilitation with children - An investigation of theory, research and practice of inter-professional rehabilitation with children who have congenital or acquired health conditions in the context of family-centred practice. View paper information

REHB706 Work rehabilitation - Understanding the workplace, workers and employers and using modern management techniques to reduce worksite injury and promote early return to work. View paper information

And to help prospective students with planning ahead:

Papers repeated in 2021: REHB701, REHB714, REHB712, REHB706
Also offered in 2021: HASC701 Working in interprofessional teams, REHB707 – Rehabilitation for older adults
Next offered in 2022: REHB703, REHB704, REHB716

The TBI Network – become part of a group striving for change

Tue, 04 Feb 2020 01:44:45 GMT

Contributed by Alice Theadom, Director of the TBI Network

I’ve been working the field of brain injury and concussion for the last 10 years now. It’s been a fantastic journey and I’ve been lucky enough to be involved in some great projects, work with some fabulous people and learn an incredible amount along the way. Recently however, I have realised that I’ve been so focused on writing papers, chasing research funding and supporting students that I haven’t been giving enough time and attention to why I actually entered academia in the first place… to make a real difference to people’s lives!

It’s also a personal thing. In 2011, I experienced a concussion myself - not that I knew about it at the time. I fell off a bolting horse and had multiple complex fractures to my arm and shoulder. My orthopaedic surgeon and rehab professionals were amazing and my shoulder was patched up in no time… however, that wasn’t the end of my journey.

It was only after I stopped the painkillers and started to go back to work that my OT noticed something wasn’t quite right. I was struggling to concentrate, my emails were confused, I was still so fatigued… you know the signs.

Once my concussion was picked up, I got the help and advice I needed. Even though I worked in the field and should’ve known just what to do, I still needed someone to talk through how it was affecting me specifically. The individual experience is so different to others and what the generic research says. I was one of the lucky ones, but I often reflect on why nobody asked me about my head at the emergency department or how things might have played out if my OT hadn’t picked it up.

So after taking time to reflect, I decided to change my approach! With the help of a Rutherford Discovery Fellowship, my faculty, the wider university and some amazing like-minded colleagues, last year we launched the TBI Network.

The idea of the TBI Network is to help researchers undertake the research that matters, rather than the research that’s ‘nice to have’ or ‘what’s easy to do and publish’. To successfully focus on research that is going to make a real difference to the lives of individuals and their whānau suffering from TBI, we need the input from clinicians, policymakers and people with experience of TBI (both their own and from those who have supported those suffering from TBI), the power of the network.

After talking to members of the TBI Network last year about where to prioritise our efforts initially, we’re currently working on:

How we can identify brain injuries more consistently across primary and emergency care and the different health care professions.
Different care pathways and how referrals might be processed more efficiently.
Undertaking more research into TBIs in vulnerable populations such as those in the youth justice systems, our prisons or those who suffer interpersonal violence.
Evaluating new treatments such as the treatment of visual disturbances and sharing the most up-to-date knowledge from across the globe.

These are all complex and difficult issues, but we hope that they are areas that will make the biggest impact. To do this though we need to work together…

So we invite anyone with an interest in TBI to join the Network. Its free (we’re a not-for -profit entity reliant on donations) and you can be as involved as little or as much as you like! You can see some of the things we’ve been up to already on our website:

https://www.aut.ac.nz/traumatic-brain-injury-tbi-network

To join up and receive our regular newsletters, simply enter your name and email into the contact us box and we’ll be in touch!

Latest NZ Rehabilitation Review (issue 49)

Wed, 22 Jan 2020 23:37:52 GMT

The latest issue of NZ Rehabilitation Review (Issue 49) is now available.

Why I think Jacinta is pretty amazing.... & why you need to come to hear her speak!

Wed, 04 Dec 2019 23:34:13 GMT

Contributed by Rachelle Martin, PhD, Burwood Academy of Independent Living

I first met Jacinta when attending an ASSBI conference in Perth in 2015 as a nervous Masters student with a strong dose of the infamous imposter syndrome. I met her again in 2019 at the ASSBI/NZRA conference in Wellington. Amazingly, she remembered what I had studied and what I was planning to do for my PhD. This is one of the many things I appreciate about her and something that comes through in her research - Jacinta is interested in people. She listens well. She is passionate about supporting others to live well. She also has great hair!

Jacinta has been involved in the production of a huge number of publications, chapters and reports. What stands out in her publication list is the diversity of projects, students and colleagues, all caring about making a difference to how people communicate who they are and what their needs and desires are.

Let me share one recent paper, authored with Kate D'Kruz and Tanya Serry, with you...

Personal narrative approaches in rehabilitation following traumatic brain injury: A synthesis of qualitative research

Head to ResearchGate to request a full copy of this publication if you would like one.

Sharing stories with others is an everyday human experience. Research evidence suggests that through narrative storytelling, we process and make sense of ourselves, creating a coherent life-narrative.

The review aimed to identify and synthesise published evidence on the use of personal narrative approaches in rehabilitation following TBI.

Findings from 12 qualitative research articles were synthesised. Written methods of narrative approaches were most evident, with only three articles utilising spoken methods, and visual methods used in two articles.

One overall theme of building a strengths-based identity was developed, with four sub-themes:

expressing and communicating to others
feeling validated by the act of someone listening
reflecting and learning about oneself
being productive.

The paper cites a poem from case study participant “Ned” (Pinhasi-Vittorio, 2007) alluding to his experience of growth from participation in writing.

When I write, I feel
When I feel I cry
Others may pass me by
but still I write to try
to figure out the past, the present + analyse the future,
of what may be to come
because I …
am not done
but am just starting
this rhyme
This flow
This dose do
with word these verbs just won’t slow
+will be with me while I grow (p. 121)

To quote a section from the discussion:

Successful reintegration into the community is a complex process of adjustment, coping and adaptation for both the survivors of TBI and their support network. Developing a positive identity focussed on strengths rather than impairments is increasingly understood as central to this process and reflected in holistic and multi-disciplinary approaches to TBI rehabilitation. Consistent with this strengths based approach, narrative, when understood from a constructivist perspective, presents a view on life after TBI that offers hope and a belief in the potential for change. Through story sharing, survivors of TBI are afforded a space to express and communicate their experiences and feelings, thus constructing their own personal story.

A takeaway message: seek opportunities for survivors of TBI to share their stories.

Another takeaway message: come and hear Jacinta speak for yourself!

NZRA emerging rehabilitation researcher 2019/20 grant

Wed, 13 Nov 2019 21:33:22 GMT

The NZRA is pleased to announce that Dr Rachelle Martin has been awarded the NZRA Emerging Rehabilitation Researcher 2019/20 grant. This grant is for $6,000.

Rachelle aims to use to funding to explore the perceived health optimisation priorities of people living with the long-term experience of disability. She is keen to understand if there are differences for those with child- versus adult-onset impairments, or those with predominantly neurological versus musculoskeletal impairments.

Rehabilitation funding and provision tends to be primarily focused on impairment onset (e.g., when a person is first diagnosed, or first acquire their health condition). However, since health can be defined as an emergent set of capacities that develop over a lifetime thereby enabling people to interact successfully with their physical psychological, and social environments, support may be required at different times in a persons life, as their environmental context changes, or within the trajectory of their health condition.

Currently, there is little information available exploring the peoples own perceptions of their needs and priorities in terms of life-long health optimisation and rehabilitation. This exploratory research therefore aims to gain a ‘snapshot’ of the sorts of concerns that people who experience long term disability prioritise. Results will be use to inform the design of future research.

Learning and education modules on understanding bias in health care

Wed, 06 Nov 2019 20:35:13 GMT

Who me – biased? He ngākau haukume tōku?

Wiki Haumaru Tūroro | Patient Safety Week 2019 is about understanding bias in health care. Having biases toward particular groups or individuals can affect their health as they may not get the proactive care they need. To start to address this issue, the Health Quality & Safety Commission have developed three video learning modules on bias for people working in the health care sector who engage directly with consumers or who influence the way health organisations are managed.

Module one: Understanding and addressing implicit bias
Module two: Te Tiriti o Waitangi, colonisation and racism (featuring the amazing Dr Matire Harwood)
Module three: Experiences of bias

The modules are an introduction to bias in health care. They encourage health professionals to examine their biases and how they affect the health care they provide, their interactions with consumers, and therefore their health outcomes.

Have a look, reflect on your own practice and be informed!

Māori lived experience of osteoarthritis: a qualitative study guided by Kaupapa Māori principles

Mon, 21 Oct 2019 21:44:19 GMT

Nikita McGruer, BHSC (Physio); Jennifer N. Baldwin PhD; Brian T. Ruakere, DHSc and Peter J. Larmer, DHSc

School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology

A recent paper published in the Journal of Primary Health Care investigates the lived experience of Māori women with osteoarthritis. Their experiences suggest that osteoarthritis adversely affects the spiritual and family wellbeing of Māori women in addition to their physical and mental health.

Seven Māori females aged 44–71 years participated. Physical manifestations of osteoarthritis, namely pain and limited daily activities, affected mental, spiritual and family wellbeing. Participants experienced whakamā (a term to describe being ashamed or embarrassed) and frustration. Cultural duties such as attending the marae were impeded, affecting spiritual wellbeing and cultural identity. Participants described drawing on the strength of their ancestors to cope with their impairments. Western medicine was commonly used, although side-effects were prominent, and few participants had received information about the condition from health professionals.

The authors recommend that culturally sensitive osteoarthritis education for Māori and their whānau is needed in primary care settings.

The centrality of spiritual wellbeing within the Māori outlook on life emerged clearly […] through the themes of āhuatanga Māori and whakapapa. These themes are unique in that they address cultural identity, a significant aspect of being Māori. Critically, women in this study described how their osteoarthritis affected their ability to participate in activities at the marae, having serious implications for their spiritual wellbeing. Provision of information about the causes and management of osteoarthritis to marae and iwi would enable Māori to implement strategies to better support their own people while also maintaining the customs and protocols of their marae.

Access to a copy of this paper is available via: https://www.publish.csiro.au/hc/pdf/HC18079

ASSBI/NZRA Conference 2019 Report

Tue, 03 Sep 2019 03:35:26 GMT

The 42nd Annual ASSBI Conference was held this year collaboration with the New Zealand Rehabilitation Association (NZRA) at the TSB Arena in Wellington, New Zealand. Wellington is known for its somewhat unpredictable and occasionally unforgiving weather, but put on a phenomenal three days of sunshine and clear skies for us.

The conference theme this year was: “A Call to Action”, drawing on the primary objectives of the World Health Organisation’s Rehabilitation Strategy to 2030. The conference was attended by 261 registrants from all corners of the world: Australia, New Zealand, UK, USA, Estonia, Hong Kong and The Russian Federation. The programme involved plenary sessions from international and national speakers, plus four highly successful preconference workshops, 56 platform papers, 26 datablitz papers, 46 posters, and 5 ‘How to’ sessions.

The conference was opened on the evening of Day 1, with a welcome from Mark Orbsby and Leigh Andrews – mana whenua representatives from Te Whanganui-a-Tara (the Wellington region). Prior in the day, our keynote speakers (Prof. Fiona Jones, Prof. Fary Kahn, Prof. Jonathan Evans, and Dr Matire Harwood) had provided a series of workshops on topics including: self-management after brain injury, practical aspects of research methods, rehabilitation of memory and executive function and strategies to better meet the needs of indigenous people.

On Day 2, Fiona Jones provided an inspiring talk on her CREATE project, which has involved co-production principles to improve patient, carer and staff experiences in inpatient stroke units in the UK. A key message from this presentation was how much could be achieved through robust partnerships between patients, families and health professionals.

Following this plenary, a panel discussion on the topic of “Upscaling Rehabilitation: Policy, Practice, and Politics” was led by Dr Kathie Irwin (Head of Māori and Cultural Capability at the Accident Compensation Corporation, NZ), Anne Hawker (Principle Disability Advisor for the Ministry of Social Development, NZ), and Prof Kath McPherson (Chief Executive of the Health Research Council, NZ). These three fabulous speakers gently challenged our ideas about how to develop rehabilitation in the future, including how to break out of status quo thinking on service delivery and community engagement.

Annual General Meetings for both ASSBI and NZRA were held on Day 2, which saw the election of Prof Robyn Tate and myself to the roles of President for these two organisations, respectively. Our conference dinner was held that evening at the Harbourside Function Venue on the Wellington harbour. Many moves were busted out on the dance floor. No hips were dislocated to anyone’s knowledge. Word has it that the night did not end when the Harbourside Function Venue closed at midnight, but continued – at least for some – in a karaoke bar down the street into the wee hours of the morning.

Day 3 began with an insightful, thought-provoking and wide-ranging presentation from Jon Evans on the topic of music, mindfulness and positive psychotherapy after brain injury. This was followed by many more platform, data blitz, and ‘how to’ presentations throughout the day, covering topics from: paediatric rehabilitation, to information technology in rehabilitation, to research into collaborative approaches and diverse perspectives in rehabilitation. The day, and conference, ended with our award ceremony and prizes. The following is a list of prizes and awarded given out on the day:

Douglas Tate Award 2018 - Alice Theadom for her publication in Brain Impairment. 2018 Volume 19, Special Issue 2 (Mild Traumatic Brain Injury) – Brain Impairment Theadom, A; Barker-Collo, S; Greenwood, A; Parmar, P; Jones, K; Starkey, N; McPherson, K and Feigin VL on behalf of the BIONIC Research Group Do Mild Traumatic Brain Injury Severity Sub-Classification Systems Help to Identify People Who Go on to Experience Long-Term Symptoms?
ASSBI Student Awards -

o Kevin Walsh Award – Jai Carmichael for his presentation entitled: Readiness of Community ABI Therapists to Learn and Implement Positive Behaviour Support: A Mixed-Methods Study

o Luria Award – Kellie Stagg for her presentation entitled: Communication impairment and the working alliance in stroke rehabilitation

o Travel Award – Owen Lloyd for his presentation entitled: Impaired Self-Awareness after Paediatric Traumatic Brain Injury: Liability or Protective Factor

NZRA Awards

o Best Poster Presentation award - Fiona Kumfor for her poster entitled: Prevalence and neurocognitive basis of delusions in dementia

o Best Student Presentation award - Jesse Shapiro for her presentation entitled: No diffusion imaging correlate of paediatric post-concussion syndrome: a TBSS study

Mindlink Brightwater award was won by Vanessa Rausa - Delivering concussion evidence to the community: A digital solution

One last highlight of the conference which needs to be mentioned is the amazing artwork of Paul Telling from Visual StoryTeller. Paul worked harder than perhaps anybody else at the conference, continuously designing storyboard posters about each presentation as they were being presented. The art from this work was on display in the venue foyer for reading and enjoying between sessions. A great many of these storyboards went home with presenters and audience members alike and are now no doubt in offices and rehabilitation centres throughout NZ and Australia.

All of the artwork by Paul Telling for the conference presentations can be downloaded here.

A big thank you to everyone who made this conference a success. Thank you to all our conference partners: ACC, Laura Fergusson New Zealand, Drake Medox, ABI Rehabillitation, AUT University’s Centre for Person Centred Research, University of Otago’s Rehabilitation Teaching and Research Centre, Cambridge University Press, AUT University, Brain Research New Zealand, the University of New South Wales. Thank you also to the 2019 Conference Organising Committee: Nicola Kayes, Jacinta Douglas, Leanne Togher, Debbie Snell, Felicity Bright, Jonathan Armstrong and Andrew Clarkson as well as the Scientific Committee. Finally, none of this could have been achieved without, of course, the fabulous direction and support of Margaret Eagers. Thank you all for making the ASSBI/NZRA conference 2019 such a fantastic success.

A/Prof William Levack

Conference Convenor

William Levack is an Associate Professor of Rehabilitation at the Rehabilitation Teaching & Research Unit, University of Otago, Wellington, New Zealand. Twitter: @DrLevack

Upscaling rehabilitation: policy, practice & politics - thoughts from Anne Hawker

Wed, 21 Aug 2019 00:43:27 GMT

Anne Hawker, Principal Disability Adviser at Ministry of Social Development spoke as part of a panel discussion at the ASSBI/NZRA Conference in May 2019. Anne was asked to reflect on the future of rehabilitation within New Zealand, with an emphasis on policy, practice and politics. A number of people have indicated that they were keen to access her notes ... so Anne has very kindly allowed us to publish them.

A couple of definitions:

The World Health Organisation (WHO) Rehabilitation Strategy defines rehabilitation as...

a set of interventions designed to optimise functioning and reduce disability in individuals with health conditions in interaction with their environment.

In Article 26, the United Nations Convention of the Rights of Persons with Disabilities (UNCRPD) definition of habilitation and rehabilitation states,

parties shall take effective and appropriate measures including through peer support, to enable persons with disabilities to attain and maintain maximum independence, full physical, mental, social and vocational ability, and full inclusion and participation in all aspects of life.

Why the difference?

One of the reasons is the significant role played by disabled people and their organisations within the development of the Convention. As article 4.3 of the UNCRPD says

In the development and implementation of legislation and policies to implement the present Convention, and in other decision- making processes concerning issues relating to persons with disabilities, States parties shall closely consult with and actively involve person with disabilities, including children with disabilities through their representative organisations.

For disabled people the aim is participation in the community in which they live.

The need to genuinely dialogue with disabled people

When the debate was first raised around functional capacity, disabled people pushed against the efforts to make functional gains where they were not adequately involved in the decision-making process. This is why the schema of the WHO International Classification Functioning, Disability and Health (ICF) is so important to me - it adds that important dimension of participation. It is why I celebrate the call from Dr Alarcos Cieza, who oversees WHO’s work on vision, hearing, rehabilitation and disability, states on page 25 of the WHO strategy,

rehabilitation, above all, is a person-centred strategy to address an individual needs which are beyond specific organisations, beyond specialisations and beyond specific groups. The spirit of collaboration that we hear in the statements from different stakeholders needs to be maintained in our Call for Action.

I was interested in the call for action that they talk about and health having the stewardship role in strengthening rehabilitation services.

Stewardship is now generally recognised as the acceptance or assignment of responsibility to shepherd and safeguard the valuables of others.

I believe that stewardship is an interesting term, specifically due to:

A failure to deliver up to now
A paternalistic stance being suggested by this term
The term does not engender collaboration and partnership (as Treaty of Waitangi and Reform of the Public Service Act)

The need to ensure that rehabilitation is included in NZ health strategy & delivery

It was interesting the 'New Zealand Health Strategy 2016-2026 – Future Direction' does not mention rehabilitation and yet WHO has called for the

full spectrum of essential, quality health services from health promotion, prevention, treatment, rehabilitation and palliative care.

When I raised questions [about rehabilitation being missed from the NZ Health Strategy,] I’m looked at blankly. As Jan Monsbakken, Past President of Rehabilitation International, said,

very few people really know about rehabilitation and it is our obligation to make sure that everyone is aware of the importance.”

The UN's Sustainable Development Goals (SDG) emphasise the importance of ensuring the needs of disabled people are met.

Rehabilitation is crucial. It’s a life changer, and it needs to be beefed up all over the world… Habilitation and Rehabilitation is crucial if we really want to make sure that no one is left behind.

How do we know that no one will be left behind – what information do we capture? How do we measure success - is it when people are able to do their activities of daily living, or when they are able to participate in the community in activities of their choosing?

Suggestions for the future....

I agree with the statement 'efficient rehabilitation requires proper planning.' To do this we need health information systems to collect, process and manage relevant information. We need a broader and integrated information approach.

Change requires more than collaboration. It involves genuine dialogue with disabled people and their organisations. Habilitation and rehabilitation have lost respect in the disability sector, which I think is sad. Why? People still remember it being about “fixing people, making them normal.”

People need to be involved in the decisions that impact on their lives. This must include thinking about how services address:

Choice and control
Health literacy - getting the information that is needed, understanding the information and deciding if it is accurate and enough, and then acting on the information
Ageing with a disability

As NZRA's only life-time member, we are grateful to Anne for these reflections and for the challenges that they present. We want to thank Anne for her ongoing commitment to ensuring that genuine dialogue occurs, and that disabled people are offered services that promote their ability to meaningfully and fully participate in the communities in which they live.

Burwood Academy of Independent Living (BAIL) hosts A/Prof William Levack

Mon, 19 Aug 2019 20:52:30 GMT

In July 2019, Burwood Academy of Independent Living (BAIL) was delighted to host A/Prof William Levack for the day.

William provided a workshop for researchers about 'Theory building in qualitative research' and then presented to the wider peer group on 'Making use of Cochrane evidence'.

The rehabilitation community is a major stakeholder in the work of Cochrane (formerly the Cochrane Collaboration). One in every 11 reviews and protocols published by Cochrane are on interventions provided by rehabilitation professionals. In 2016, Cochrane Rehabilitation was founded as a Field to act as a bridge between Cochrane and the health-related rehabilitation community worldwide. In part, this work has involved creating resources for rehabilitation providers, policy makers, and service users - ensuring that evidence within the Cochrane Library is relevant and useful to the work and lives of a range of rehabilitation stakeholders.

William's presentation was designed for health professionals to learn more about how to read and interpret knowledge from systematic reviews, with a particular focus on how to read Cochrane reviews on rehabilitation topics. It was particularly relevant for doctors, nurses, and allied health professionals.

Cochrane systematic reviews can be accessed freely from the Ministry of Health website.

Both sessions were well received. Your can view the peer group presentation and see the presentation slides HERE.

Making research findings REAL

Tue, 06 Aug 2019 21:37:57 GMT

Contributed by Rachelle Martin, PhD, Burwood Academy of Independent Living

I sometimes think, just like the Velveteen Rabbit who didn’t become REAL until it was loved and used, research findings don’t become REAL until they are used and ‘loved’ into meaning:

To take creative license ….

REAL … is a thing that happens. It doesn’t happen all at once. It takes a long time.

That’s why it doesn’t happen for [every bit of research] – it might not happen for knowledge that might break easily, or have sharp edges or have to be carefully kept.

Generally by the time [research] is REAL, most of its shine has been rubbed off, its pontificating has dropped out, and it might even look a bit shabby.

But these things don’t matter at all, because once it is REAL, it can be used and useful and loved by people who actually have to put it into practice.

For my PhD, I evaluated whether therapeutic horse riding (as delivered by the NZ Riding for the Disabled Association; NZRDA) optimised health outcomes for children and adolescents experiencing disability.

What did I do to share the results of the research?

I made sure findings were reported in published papers within peer-reviewed journals
I worked within the NZRDA – liaising with both the Board and national training team
I conducted workshops for therapists and coaches who coordinate riding sessions - to help them to integrate findings into their existing understandings, role experience and clinical expertise.
I ensured that volunteers (upon whom the NZRDA depend) heard about the study findings and recommendations by presenting at the yearly NZRDA national training days. In this forum, I particularly focused on ensuring that the messages they heard were based on agreed-upon concepts – e.g. what is health, what is being aimed for when we provide health-optimising interventions, what do we mean by child- and family-centred practices etc.

All of these different avenues for dissemination were directed at making sure that the PhD research findings related to what is already happening within the 50-odd NZRDA groups across NZ, while also extending and challenging the way things are done.

But, in my opinion, the most helpful to make the findings REAL were the workshops that turned into a giant discussion. In this forum, coaches and volunteers had the opportunity to talk together about how the findings related to specific riders they were working with, how they could start to think about the policy implications, or how they could provide training so that services could be delivered consistently with the research recommendations.

And this is true for all organisations that I have been involved with. It is only when the new knowledge gets applied to a specific context that it becomes relevant. And it is only when it is applied and used again and again that it becomes REAL.

To help with this process of ‘research being used’ within the NZRDA, I have worked with a graphic designer to develop some simplified (i.e., more simple than a thesis or a journal article) resources. The infographic and the comic (for riders) were created make it easier for people to share ideas, to talk to riders and their families about the benefits of riding, and to feel more comfortable using the research results in funding applications and training materials. They can be put on websites and Facebook pages, they can be handed out to riders, they can be hung on arena walls, and they can be included in training materials.

I am committed to not leaving the results of research in the journal, or even in a blog. I am committed to playing my part in helping clinicians to make research REAL.

Let’s all find ways to ensure new knowledge is used and useful and loved.

If you want to ask more about therapeutic riding and how it optimises health outcomes for young people experiencing disability, feel free to email Rachelle at rachelle.martin@otago.ac.nz
If you would like a copy of the infographic or comic, they can be accessed at: http://hdl.handle.net/10523/9019

Matt, the graphic designer, can be contacted via: http://mattthewlaw.com/

Latest NZ Rehabilitation Review (issue 48)

Tue, 06 Aug 2019 21:36:46 GMT

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.

Dr Fiona Graham - HRC Emerging Researcher First Grant

Rachelle Martin — Thu, 04 Jul 2019 03:40:16 GMT

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.”

Congratulations Fiona!

Contact Fiona on fi.graham@otago.ac.nz if you have any questions about this research.

Technology in Rehabilitation

Tue, 25 Jun 2019 21:48:41 GMT

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: kristin@lftcant.co.nz

NZRA poster and oral presentation winners at the ASSBI/NZRA19 conference

Sun, 09 Jun 2019 22:37:12 GMT

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; fiona.kumfor@sydney.edu.au

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.

His study examined white matter microstructure in a paediatric sample to explore possible associations between white matter integrity and recovery time post-concussion. Post-concussion syndrome (PCS) is a continuation of concussive symptoms beyond the typical recovery period, which is 4 weeks for children and adolescents. The factors that contribute to ongoing symptoms post-concussion are unknown, but the integrity of white matter microstructure has been associated with the development of PCS in adults.

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; jesse.shapiro@unimelb.edu.au

NZRA 2017 Emerging Rehabilitation Research Leader award recipient, Felicity Bright

Tue, 04 Jun 2019 00:02:49 GMT

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.

A new NZRA Exec Committee for 2019!

Fri, 24 May 2019 22:32:19 GMT

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

Latest NZ Rehabilitation Review (issue 47)

Mon, 20 May 2019 23:07:43 GMT

The most recent edition of the NZ Rehabilitation Review can be viewed HERE.

We encourage you to check it out, get in the know and join the conversations.

New Rehabilitation Funding

Mon, 20 May 2019 22:50:02 GMT

This month we can celebrate some excellent outcomes for rehabilitation-related research funding in NZ!

HRC Emerging Researcher Grant:

Dr Nada Signal, AUT University: Measuring perceived task difficulty during rehabilitation
Dr Fiona Graham, University of Otago, Wellington: Coaching caregivers of children with developmental disability: A cluster RCT

HRC Feasibility Grant:

Prof Denise Taylor, AUT University: Feasibility of noisy galvanic vestibular stimulation for improving postural stability in older adults

Congratulations to all of these funding recipients, and we look forward to hearing more about your projects in due course.

NZRA Emerging Leaders - calling for applications!

Mon, 20 May 2019 21:15:22 GMT

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 president@rehabilitation.org.nz

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).

Postcard from Paris - Trade displays at the 12th World Congress of the International Society of Physical & Rehabilitation Medicine 2018

Wed, 25 Jul 2018 01:32:18 GMT

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.

William Levack is an Associate Professor of Rehabilitation at the Rehabilitation Teaching & Research Unit, University of Otago, Wellington, New Zealand. Twitter: @DrLevack

The place of the Treaty of Waitangi in health science (and other) research

Mon, 26 Mar 2018 09:10:59 GMT

Today, I responded to an article in Stuff that was critical of the concept of cultural consultation in research. The article, which you can read here, stated that the Treaty of Waitangi has 'no place in scientific endeavour'. The article was also critical of the University of Otago's requirement for all researchers to incorporate consultation with Ngāi Tahu when planning and implementing research activities. (In fact, researchers at the University of Otago will also consult with local iwi in any region where they conduct research, not just Ngāi Tahu). The author, Bob Brockie, stated that: "I am astonished that a Māori iwi has the audacity to impose these heavy-arm rules on scientists, and more astonished that Otago University has acquiesced in these proscriptive, inquisitorial demands. The only researchers to speak out about these issues seem to be retirees. Young researchers dare not question these moves for fear of being labelled racist and putting their careers at stake."

It's not fear, Bob; it's education. So, in response to this article, I wrote a four-line comment, in Stuff, as follows: "Science is knowledge. Knowledge is power. Power is political. If you think science is not political you are naive. OR you are in power and it suits you to maintain this myth. Retired researchers who complain about positive social change lack education in contemporary perspectives on colonialism. Younger researchers don't want to perpetuate the oppression and arrogance of the older generation."

There were a number of misinformed and misleading responses to this article in general, but in response to my comment, I received the following from Richard Treadgold: "Your comments raise more questions than they answer. What has changed about scientific principles that requires input from Maoris? What scientific heritage justifies an invitation to Maoris to join the discussion? Why are Maoris invited above the Dutch, Korean, Chinese, Irish or any other of our national groups? Why do you call this racist invitation to Maoris based solely on their claimed race as "positive social change" and how can it improve science? Why are younger researchers concerned with the older generation (their elders) more than with the science they study? Why are scientific qualifications insufficient to judge the worthiness of research projects?"

It is impossible to answer all these questions, even superficially, in the 200 word limit of a Stuff.co.nz comments box. And so, here is my 1000+ word response, which I will send a link to via Stuff:

What has changed about scientific principles that requires input from Māori?

Nothing has changed about the physical laws that govern the universe. Of course! But science doesn’t occur in a social vacuum. Nothing is stopping you from building your own fusion engine in your basement, using your own money. But if you are using society’s money to undertake this research (as Universities do) then it is reasonable for that society to set some processes and policies about how that money is spent. Our last National government for instance introduced the ‘National Science Challenges’ and tied this to research funding, which is an example of an explicit political effort to change the direction of research in the country from ‘researcher-led’ to ‘mission-led’ research. Governments have always influenced the direction of research by saying what they choose or do not choose to fund: HRC and MBIE both do this. This is not new.

Here, in New Zealand, we have this founding document called the Treaty of Waitangi, which establishes a partnership between two groups of peoples: the indigenous population and a colonial group. The Treaty of Waitangi remains an important legal, social and political contract, despite there being extended periods of history when the colonial group (incidentally, my ancestors – albeit very indirectly) did not honour it. It is outside the scope of this blog to provide an in-depth discussion of the Treaty or its implications. Suffice to say that when dishing out research funding it is reasonable to have robust process to consider the conduct of that research from the perspective of the Treaty: partnership, participation, and protection. This consultation is not about how to do your statistical calculations, how to run to your DNA sequencer, or how to analyse your histology slides. Instead, this consultation is about asking who benefits from the research, how it will be used, by who, and to what end effect. This is the bit of science that has changed – not the nuts and bolt of ‘doing science’, but the social accountability of the actions and activities of scientists.

What scientific heritage justifies an invitation to Māori to join the discussion?

This question implies that you, Richard Treadgold, believe that you have gained your ‘right’ to engage in science on the basis of what science your ancestors conducted – and perhaps not your direct ancestors even, but people with similar skin colour to you, who were very, very vaguely related to some of your ancestors. This is sounding a teeeeeny bit racist. What social heritage justifies an invitation to Māori to join discussion of the use and application of science in New Zealand? Easy. The Treaty of Waitangi, which established the governance of New Zealand as a partnership between two peoples: see above.

Why are Māori invited above the Dutch, Korean, Chinese, Irish or any other of our national groups?

One: The Treaty of Waitangi. See above. Two: In my area of research, which is in the health sciences, Māori have MUCH worse health outcome than non-Māori. Lower life expectancy. Higher hospitalisation rates. Higher levels of morbidity for pretty much any major health condition. Healthcare is about so much more than popping pills and doing surgery: it is about health systems, health literacy, community engagement, interpersonal relationships and so on. It is perfectly reasonable for Māori to expect to be involved in discussions about health science research intended to improve Māori lives.

Why do you call this racist invitation to Māori based solely on their claimed race as ‘positive social change’?

One: It’s not racist, it’s moral thing to do. Two: In my area of research at least (health care), it produces better research, with more meaningful, translatable results for a group who is less well served, in terms of health outcomes, by New Zealand society. Three: It’s a positive social change because it is about confronting and addressing 170+ years of injustice. I look at race issues in the US and see a dominant colonial group who are too afraid, too arrogant, or perhaps too naïve to openly acknowledge and address the consequences of slavery in their nation. I strongly suspect this has significantly contributed to the failure in the US to address race-based conflict. They suffer as a nation as a result. The situation for the indigenous population in the US is even worse! I am proud of the Treaty we (non-Māori New Zealanders) have with our indigenous population in New Zealand, and when I look to countries like Australia and the US, I am proud of the efforts (however incomplete) being made to confront and rectify problems with it. New Zealander benefits enormously from Māori people and Māori culture. Let's not shit on them.

How can it improve science?

In my area of science – health science – consultation with Māori can and has helped people live longer, healthier lives. It helps by ensuring that interventions designed by non-Māori people can be implemented in the real world of Māori communities. It helps by ensuring that research findings relevant to Māori lives are disseminated to Māori communities. It helps by empowering Māori to lead their own research. It helps through the development of new methodologies to conduct better, more impactful research. How much more ‘improvement’ do you want??

Why are younger researchers concerned with the older generation (their elders) more than with the science they study?

Younger researchers are not concerned with the older generation more than with the science they study. This question can’t be answered because it contains false assumptions, so doesn’t make any sense to begin with.

Why are scientific qualification insufficient to judge the worthiness of research projects?

The ‘worth’ of a research project can be judged on the basis of: a) the quality of the science, b) its ethical implications, c) the potential cost-benefit of its possible outcomes, d) the meaningfulness of the research question being asked. Ethics committees and research funders consider all these things when judging the 'worth' of a research proposal. It is a REALLY bad idea to judge the worth of a research project just on the basis of whether or not the scientist has a qualification. Do I really need to give example of where this went horrendously wrong in history?

In summary, the practice of science changes over time because society changes. Science should not be above the laws and mores of a society. New Zealand society is structured, in part, around the Treaty of Waitangi. This Treaty established a formal agreement between two groups of people to work in partnership, and to protect the indigenous population, and agreements ought to be honoured. Besides, even if we did not have a Treaty, New Zealand (and New Zealand research) is enriched, not diminished, by engagement with our indigenous communities.

William Levack is an Associate Professor of Rehabilitation at the Rehabilitation Teaching & Research Unit, University of Otago, Wellington, New Zealand. Twitter: @DrLevack

The problem of goal attainment scaling as an outcome measure

Fri, 04 Aug 2017 09:05:00 GMT

Goal setting in rehabilitation is a topic that I have written a lot about of the past ten plus years – both in term of research publications and textbooks. It’s a topic that has a lot of currency with health professionals, and is something that I’m frequently asked to talk about at conferences and workshops. (In fact, I developed a distance-taught postgraduate paper for people wanting to develop their knowledge and skills in this area of clinical practice.)

One aspect of goal setting that I’m often asked to comment on is the use of goal attainment scaling (GAS) as an outcome measure in rehabilitation. In fact, I have a number reservations about goal attainment in general as an outcome measure. My opinion is that goal setting is an extremely important part of the rehabilitation process, but is probably more important for communication of expectations, shared decision making, and motivation of patients and health professionals than it is for demonstrating the effectiveness of rehabilitation services. We have other tools for evaluating health outcomes – namely psychometricallyvalid, standardised outcome measures.

So, recently when I was asked to contribute a chapter on goal setting for the 4^th edition of Physical Management for Neurological Conditions (due to be published in 2018), I took the opportunity to explore the topic of using goal achievement as an outcome measure in more detail. Below is a video that I put together to summarise the key points that I raise on this topic in the book chapter. For a more detailed discussion of these issues and for my other latest content on goal setting in neurorehabilitation, I encourage you to get hold of a copy of this textbook when it come out later next year.

(Footnote: The sound in this video is a little sketchy because I filmed it in my home, in a room with a lot of echo, and on an old family camera. There's only so much fixing of sound and image quality one can do after filming it turns out. I'm still learning how to be a rehab YouTuber!)

William Levack is an Associate Professor of Rehabilitation at the Rehabilitation Teaching & Research Unit, University of Otago, Wellington, New Zealand. Twitter: @DrLevack

Computer-brain prosthetics – the very latest research from University of Pittsburgh

Fri, 04 Aug 2017 07:10:54 GMT

Earlier this year I attended the 11^th World Congress of the International Society of Physical & Rehabilitation Medicine (ISPRM), held in Buenos Aires, Argentina. My primary reason for attending this conference was to contribute to a symposium on the work of Cochrane Rehabilitation and the inaugural meeting of its Advisory Board. I will be reporting back on my work with Cochrane Rehabilitation at our upcoming New Zealand Rehabilitation Conference, in Christchurch next month. However attending international conferences like this one provides an amazing opportunity to find out about some of the cutting-edge research and technological developments in rehabilitation going on around the world.

One of the most fascinating presentations at this ISPRM conference was by Professor Michael Boninger, Medical Director of Human Engineering Research at the University of Pittsburgh. Professor Boninger presented his team’s very latest research into brain-computer interfaces. His research unit has been working extensively over many years to develop brain implants that allow people with complete high-level spinal cord injury to operate robotic arms with their thoughts alone. These implants are neuro-surgically attached to a person’s cerebral cortex and connect to a computer via a large plug on the top of the person’s head. Five years ago, the University of Pittsburgh released a video of a woman with tetraplegia using this technology to feed herself chocolate. Currently, Dr Boninger’s team is able to give a person in excess of 12 degrees of movement with a robot arm using this approach.

Most astounding, they have now added sensory feedback to this brain-computer interface, meaning that not only can a person with tetraplegia control a robotic arm to perform functional tasks – they also can receive the sensation of movement in their brain when the arm is moved in particular ways. In the video below, a man with tetraplegia uses this neuro-prosthetic to detect, while blind folded and with 100% accuracy, which finger of a robotic arm is being moved by the researcher.

Of course, this type of technology is extraordinarily expensive. This is million dollar technology that requires a team of people to re-calibrate it every day - so it is only ever offered to one or two people at a time. In other words, this is research for the sake of knowledge creation – not research that is going to available to all people with tetraplegia any time soon. Indeed, one thing I appreciated about Professor Boninger’s presentation was that fact he went out of his way to address this limitation in his talk, and to highlight other research he is involved in, which is more immediately important to people with spinal cord injury – but which draws smaller crowds at conferences. One example of this other work was research into training strategies to help people with spinal cord injury learn to use wheelchairs for the first time. Professor Boninger promoted an organisation that had focused on this other type of work – the International Society of Wheelchair Professionals. Practical, low cost solutions for everyday challenges are going do a lot more for improving the quality of life of people with spinal cord injury worldwide than the fancy-pants, Star Trek-level technological ones.

Nonetheless – using a million dollar brain implant plus robotic arm to feed yourself chocolate is still pretty cool.

William Levack is an Associate Professor of Rehabilitation at the Rehabilitation Teaching & Research Unit, University of Otago, Wellington, New Zealand. Twitter: @DrLevack

Dr Lance O'Sullivan - Champion of evidence-based healthcare

Wed, 24 May 2017 01:00:09 GMT

I read today about Dr Lance O'Sullivan's proactive steps to interrupt a screening of anti-vaccine documentary Vaxxed in Kaitaia this week in order to tell organisers that they are contributing to the deaths of children. Dr O'Sullivan (2014 New Zealander of the Year) has invested considerable time, effort, and creativity into addressing health disparities in the rural north. The video of his plea for reason around vaccination is well worth watching. While vaccination is not directly related to rehabilitation (other than in terms of preventing long term chronic health conditions and disability), I want to highlight Dr O'Sullivan's actions, which I fully support. This is a terribly important issue for New Zealand, as it is around the world. To be clear: vaccines prevent deaths and do not cause autism. Vaxxed is a dangerous, misleading, and potentially harmful movie.

To take just one vaccine: Prior 1980, BEFORE a vaccine for measles was first introduced, measles was killing an estimated 2.6 million people every year - mostly babies and small children. Today, worldwide, measles results in 130,000 deaths each year. According to the World Health Organization:"During 2000-2015, measles vaccination prevented an estimated 20.3 million deaths." However, due to some misinformed (and maybe unscrupulous) individuals, there has been a rise in the incorrect belief that measles wasn't all that bad, that vaccines are not needed, and that vaccines do more harm than good. All these beliefs are incorrect.

Movies like Vaxxed, and advocates for them, do incredible amounts of harm. One example of this has been the recent, and highly predictable, outbreak of measles among Somali immigrants in Minnesota - the biggest outbreak in the USA in decades. This group of immigrants was specifically targeted by anti-vaccination proponents, who directly contributed to a plunge in vaccinations rates in this population from 92% in 2004 to 42% in 2015. As of this month, at least 50 individuals had been affected in this latest outbreak, many of whom were hospitalised. It is not inconceivable, if we were to let our guard down, that this kind of outbreak could happen in New Zealand. The people who would suffer most would be the most vulnerable - children and babies; people with poorest access to healthcare services.

As such, Dr O'Sullivan is absolutely correct to take such strong action against the spread of misinformation about vaccines. We should all do more to follow his lead in fighting for a health-literate public and for evidenced-based healthcare services in our country.

William Levack is an Associate Professor of Rehabilitation at the Rehabilitation Teaching & Research Unit, University of Otago, Wellington, New Zealand. Twitter: @DrLevack

Rehabilitation 2030: A Call to Action

Tue, 23 May 2017 00:58:52 GMT

On 6 February this year, the World Health Organization (WHO) launched a new initiative: Rehabilitation 2030 – A Call for Action. This initiative begins with a recognition of the "substantial and ever-increasing unmet need for rehabilitation worldwide". While the WHO has highlighted the particularly pressing need for development of rehabilitation services in low and middle income countries, this call for action is intended for all countries. Even within relatively well-resourced countries, such as New Zealand, access to rehabilitation is often insufficient or restricted by cost. Thus the emphasis of WHO is on accessible and affordable rehabilitation for all people worldwide. This call for action links closely with other WHO objectives around a global strategy for managing our aging populations, the WHO's Mental Health Action Plan, and the push for Integrated People-centered Health Services. The WHO website includes a number of associated resources, including background papers on the need to scale up rehabilitation, the cost of failing to provide rehabilitation, and examples of efforts to implement the WHO recommendations for rehabilitation in Germany, Pakistan, and Philippines.

The WHO writes that “barriers to scaling up rehabilitation indicate a need for greater awareness and advocacy, increased investment into rehabilitation workforce and infrastructure, and improved leadership and governance structures”. They highlight that addressing these barriers to necessary rehabilitation services will required investment of people, finances, and technical tools. They also highlight the need for the political will to make such investments. In New Zealand, actions related to the Rehabilitation 2030 initiative could usefully include:

Increased advocacy for investment into rehabilitation services nationally
Better integration of rehabilitation services across primary, secondary, and tertiary care
Identification and implementation of strategies to address inequities in terms of access to rehabilitation services and outcomes from rehabilitation throughout New Zealand, with a particular focus on the needs of Māori and Pacific peoples.
Ensuring that specialised rehabilitation services for people with complex needs are available in all District Health Board regions
Ensuring that rehabilitation services are appropriately financed for the work that is expected and the number of people who need those services.
Ensuring that all New Zealanders have access to assistive technology and mobility equipment who need them, and that appropriate training and support is provided in the use of this equipment
Development of more family/whānau centred rehabilitation services
Provision of advanced clinical training and education to health professionals working in the rehabilitation sector.

So, I encourage you to raise awareness of the Rehabilitation 2030 initiative in your local regions. Get active, get political, and get involved.

William Levack is an Associate Professor of Rehabilitation at the Rehabilitation Teaching & Research Unit, University of Otago, Wellington, New Zealand. Twitter: @DrLevack

More information on the World Health Organization's guidelines on rehabilitation in health systems is available in this video below:

Fight for your right to paaarty!

Tue, 17 Jan 2017 03:08:50 GMT

I first wrote a column about the Stay Up Late campaign for the NZRA back in 2007 (when our newsletter was just a word doc sent out by email). Recently I've been writing a review of the literature on working aged adults with neurological impairments who end up in geriatric residential facilities for one reason or another, and the challenges that emerge from this around creating individualised, flexible, person-centred care for people who need 24 hour support. All this made me think of the Stay Up Late movement once again. In a nutshell, Stay Up Late is a grassroots UK charity originally initiated by Heavy Load – a UK punk band consisting of musicians with intellectual disability or mental health issues and their support staff. The movement boils down to putting a halt to people with support care needs having to leave clubs and music gigs early because their staff finish their shifts at 10pm.

I have to say, I love everything about this movement. I love the punk aesthetics. I love the music. I love the challenging of the status quo; the drive to have fun and maybe be a little bit badly behaved sometimes. I love the enthusiasm and momentum of the people behind it all. Since I last looked at this group in 2007, they have just grown in strength and numbers. The website is intensely active, there is such clear pride in the work, and the charity has pushed into other areas of independent living that need a bit of cage rattling. This is what we need more of in rehabilitation and disability sector.

Check out the website, or if you just want to enjoy the wall of sound that is Heavy Load, checkout the video from back in 2007 below. Rock on, dudes.

William Levack is an Associate Professor of Rehabilitation at the Rehabilitation Teaching & Research Unit, University of Otago, Wellington, New Zealand. Twitter: @DrLevack

Redefining 'rehabilitation' - beyond maximising independence

Wed, 21 Dec 2016 23:04:52 GMT

Coming up with a definition of rehabilitation that everyone agrees on is super difficult! A good definition should clearly and comprehensively describe what is and what is not within scope of rehabilitation. Does rehabilitation include the management of cerebral pressure in the acute stages of management of traumatic brain injury? Is ice for an ankle sprain rehabilitation? Is cognitive behaviour therapy a form of rehabilitation in all or just some contexts, or it is never actually rehabilitation? Does rehabilitation extend beyond the formal health services to include things like getting back to one's bridge club meetings, going to the beach or pub for the first (or tenth?) time after spinal cord injury, or starting up with wheelchair rugby? At what point is 'rehabilitation' just people getting on with their lives again?

Some might say that rehabilitation is defined by the process involved. If it is goal directed, does that make it rehabilitation? (Football is goal directed: Is that rehabilitation?) Does rehabilitation require the involvement of formally trained health professionals? It is rehabilitation because it is provided by a rehabilitation service (a tautological definition)?

In the business case to establish Cochrane Rehabilitation, we referred to the World Health Organization's (WHO) current definition of rehabilitation which is: ‘a process aimed at enabling [people with disabilities] to reach and maintain their optimal physical, sensory, intellectual, psychological and social functional levels. Rehabilitation provides disabled people with the tools they need to attain independence and self-determination’. In 2001, WHO also included the view that: ‘The rehabilitation process does not, however, involve initial medical care’ (p.290). I suspect some people disagree with this extra criteria to define rehabilitation however, which might exclude initial management of spasticity after brain or spinal cord injury for instance. It also raises the question about when 'initial medical care' ends. Nonetheless, this is the definition my colleagues and I used in our review of goal setting in rehabilitation (Levack, 2015) to help make decisions about papers that were and were not ‘in scope’ for the review. Of note, we used this definition to include papers from the mental health sector as well.

One additional thought I have on this topic however is that I’m increasingly questioning the idea that the primary focus of rehabilitation should be on maximizing independence. For people with complex disabilities, I’m wondering whether rehabilitation should be more about maximizing people’s opportunities to fulfill their personal preferences, which may or may not include maximizing independence. It may also include maximizing interdependence. It could also include making decisions to pass control of some aspects of one’s life over to other people.

This is not actually an incredibly radical idea. Being someone with very little hair, I am 'independent' in getting my two weekly haircut. (I just shave my own head.) Others however choose to get help with their hair. They pass control of their hairstyle over to trained professionals. When the hairdresser says 'what would you like me do for you today', the individual in question could in fact say 'I don't know. You decide. Surprise me.' Interestingly, this is not considered 'being dependent on others' (considered a poor outcome in rehabilitation), but rather this is considered to be people exercising their right to choose.

From this perspective, rehabilitation for people with complex conditions should be primarily about reinvention of oneself rather than primarily about regaining independence. Restoration of one's prior skills and abilities is still part of this perspective on rehabilitation, but simply not the sole focus. This position in fact aligns nicely with Amartya Sen and Martha Nussbaum 'capabilities theory', which focuses on 'the moral significance of individuals' capability to achieve the kind of lives they have reason to value'. It also fits nicely with a focus on strength of positive self-identity as primary outcome from rehabilitation rather than using measures of functional independence as the main way to judge the 'success' or otherwise of rehabilitation programmes.

In 1624, John Dunne wrote: "No man is an island/Entire of itself/Every man is a piece of the continent/A part of the main." In doing so, Dunne reminds us that none of us are independent; none are separate from the thoughts and actions of others. Maybe it is time to re-define rehabilitation to incorporate a more holistic, interdependent view of functional lives.

William Levack is an Associate Professor of Rehabilitation at the Rehabilitation Teaching & Research Unit, University of Otago, Wellington, New Zealand. Twitter: @DrLevack

References

Levack, W. M. M., Siegert, R. J., Dean, S. G., McPherson, K., Hay-Smith, E. J. C., & Weatherall, M. (2015). Goal setting and activities to enhance goal pursuit for adults with acquired disabilities participating in rehabilitation. Cochrane Database of Systematic Reviews, Issue 7, Art. CD009727.

World Health Organization. (2001) The UN Standard Rules on the Equalization of Opportunities for Persons with Disabilities. II. Main Report. Geneva: World Health Organization.

Cochrane Rehabilitation – Establishing a new global evidence group

Wed, 21 Sep 2016 12:52:33 GMT

This week I have been in the beautiful city of Brescia, Italy, attending a Formal Exploratory Meeting to help finalise a proposal for a new Field in Cochrane – one focussing on clinical rehabilitation. This meeting has been the culmination of two years of work, and is the last step required before the submission of an Action Business Plan to Cochrane. The Cochrane Steering group will formally consider our proposal at the 24^th Cochrane Colloquium in Seoul next month, after which – if the proposal is accepted – Cochrane Rehabilitation will be launched. So what is this all this about?

What is Cochrane?

Cochrane (previously known as ‘The Cochrane Collaboration’) is a global, independent, not-for-profit organisation, which is set up to gather and summarise the current best evidence to guide healthcare decision making. Cochrane has been running for 20 years and is comprised of Review Groups, Centres, Method Group, and Fields and Networks. The Review Groups are typically organised around diseases or health disorders and are in charge of the work required to prepare and maintain systematic reviews. Cochrane Centres are the regional branches of Cochrane, and are primarily responsible for providing local support for Cochrane contributors. Cochrane New Zealand is one example of a Cochrane Centre. Method Groups focus on specific issues to do with development and synthesis of evidence in healthcare. The job of a Cochrane Field is to cross boundaries between the various Cochrane groups – so often Fields focus on broader dimensions of healthcare, such are primary care, ageing, children’s health, or, in the case of our proposal, rehabilitation. More recently, Cochrane has indicated a key part of the work of fields will be knowledge translation – making the information about evidence based practice generated in Cochrane more accessible to health funders, providers, and consumers worldwide.

In New Zealand, everyone can freely access all resources within Cochrane if you enter the Cochrane website via the Ministry of Health. To do this, go to the part of the Ministry’s website on Cochrane; then click on the link on the right-hand side to ‘Access the library’.

What is Cochrane Rehabilitation?

Development of a group within Cochrane dedicated to rehabilitation was an idea initially proposed by the Evidence Based Medicine Committee of the European Society of Physical and Rehabilitation Medicine. Since then the idea has garnered support from a number of national and international organisations, include the International Society of Physical and Rehabilitation Medicine. Funding to help establish the new Field has come from the Don Gnocchi Foundation and University of Brescia, so the headquarters of Cochrane Rehabilitation will begin in Rovato - a province in Brescia, Italy.

The aim of the Field is to act as a bridge between Cochrane and rehabilitation stakeholders (in the broadest sense of the word). The concept of a ‘bridge’ includes the notion of traffic going both ways. In one direction, Cochrane Rehabilitation intends to act as a conduit for making evidence generated by Cochrane on best practice in rehabilitation more understandable, more meaningful, and more accessible for health professionals, patients, and their families. The sort of ideas already discussed here include the possible development of an online eBook summarising information on different aspects of rehabilitation from Cochrane reviews, the use of newsletters and social media to keep people updated on evidence in rehabilitation medicine, and the provision of training on how to make best use of the resources about rehabilitation available through Cochrane. In the other direction, Cochrane Rehabilitation intends to provide a means by which rehabilitation researchers, professionals, and consumers can actively contribute to the work and thinking of Cochrane as an organisation. This could involve, for instance, active involvement of the Field in discussions within Cochrane regarding new ways to generate, interpret, and synthesise research evidence to better address the challenges of research in rehabilitation contexts. These challenges include issues such as the complexity of rehabilitation intervention that frequently involve multiple components, individualisation of treatment, require behaviour changes from both patients and health professionals, and which may influence a range of different types of health outcomes.

What is a Formal Exploratory Meeting?

The Formal Exploratory Meeting held this week in Brescia was a necessary step in the establishment of a new Cochrane Field. Cochrane requires these meetings to be held in a certain way – for instance it could not be a meeting that is simply added on to an existing international professional conference. A degree of commitment to discussing and developing a proposal for a new Field is required. Prior to the meeting a draft Action Business Plan was written and circulated to people attending, including Mark Wilson, the CEO of Cochrane. The meeting served as a way to confirm support from the rehabilitation community worldwide regarding the goals, direction, and organisation of the proposed Field. In this regard, the meeting was a huge success. More than 190 people from 48 countries worldwide have so far expressed interest in becoming members in one capacity or another with this new Field, should it be established. Over 40 of these people, representing 19 countries, were able to attend the meeting in Brescia.

Of note, there was considerable commitment at this meeting to making Cochrane Rehabilitation an interprofessional organisation. There was also strong support for consumer representation within the Field and to ensure that the work of the organisation is responsive to the needs of lower income as well as middle and high income countries. This commitment is evident in the name of the organisation, the proposed governance structure, and through its initial aims and objectives.

There will be a lot more to come out about this new initiative over the coming months and years. However, if you would like to learn more, you can read our editorial on the establishment of this group in the Archives of Physical Medicine and Rehabilitation (also published in Physical Therapy, Manual Therapy and the European Journal of Physical and Rehabilitation Medicine). If you wish to sign up to the mailing list for the new Field, you can do so by complete this brief SurveyMonkey questionnaire. You can share the link to this question with others by sending them this URL: http://surveymonkey.com/r/CochranePRM. All are welcome!

William Levack is an Associate Professor of Rehabilitation at the Rehabilitation Teaching & Research Unit, University of Otago, Wellington, New Zealand. Twitter: @DrLevack

Driverless cars – a new road to accessibility in Aotearoa?

Tue, 16 Aug 2016 23:15:08 GMT

I confess to being fascinated by the sudden advance in technology over the last few years in driverless (aka. autonomous) cars. Unlike personal jetpacks (which frankly I’ve been waiting for since 1984 when some dude flew into the opening ceremony of Los Angeles Olympics) driverless cars are a real thing that is highly likely to available for sale within five years. One of the reasons to expect driverless cars on our roads in the near future is that we have not one but multiple major car companies saying they will have autonomous cars on the market by 2020, if not sooner. Yes, there was a tragic fatal accident recently involving a test driver of a Tesla autonomus car, but already there is significant evidence to suggest that driverless car are very likely to be more safe on the road than human driven ones – after all, most accidents on roads are caused by human error.

So what advantages would driverless cars offer people with impairments? Several benefits immediately spring to mind. Firstly, driverless cars provide a personal transport option for people who cannot drive. If you are unable to drive due to visual impairments, cognitive impairments, or physical impairments you could still have all the benefits of personal car use from a driverless car.

Secondly, driverless car do not need to wait where you leave them. It would be possible with a driverless car to take a trip to the supermarket, stop right outside the front door, exit your vehicle, and then send your car off to park somewhere convenient around the corner (or several blocks away) while you do you shopping. When you’re ready to return home, shopping in hand, all you would need to do is just call your car by phone (or by speaking into your watch if you want to do it Michael Knight style) to have it come and pick you up again. Shopping centers would still probably need to have drop-off points reserved for people with disabilities, but driverless cars would increase the number of vehicles that could make use of such parks at any one time.

Thirdly, driverless cars do not need to be owned by a single individual. Driverless cars create options for community ownership of vehicles, which can be used by multiple people at the same time. Your car could drop you off at work, then go and help someone else get to their doctor's appointment rather than sit unused in a carpark, waiting for you to finish your work day.

A fourth advantage of driverless cars is likely to be how space inside the car can be used. Currently, cars have to be set up to accommodate a driver, with a steering wheel, gear shift and so on. A fully functional driverless car wouldn’t even need front-facing seats. The entire interior of a car could be one large space to accommodate a wheelchair or other adaptive equipment, making getting into and out of car much easier.

The cost of driverless car will be an initial barrier to their uptake by people with disabilities, but as use of driverless cars increases, the cost will be driven down. In fact Travis Kalanick, CEO of Uber, has said that his taxi fleet will be completely driverless by 2030, by which time he expects Uber services to be so ubiquitous and cheap as to make car ownership obsolete.

William Levack is an Associate Professor of Rehabilitation at the Rehabilitation Teaching & Research Unit, Univerity of Otago, Wellington, New Zealand. Twitter: @DrLevack

Highlights of the upcoming AFRM/NZRA meeting 2015

Tue, 04 Aug 2015 19:46:06 GMT

Two outstanding international pioneers in their respective fields of rehabilitation medicine will deliver the keynote addresses at the forthcoming AFRM/NZRA Combined Rehabilitation Meeting.

Norington Lecture by Associate Professor Barbara Gibson

Associate Professor Barbara Gibson from the University of Toronto will deliver the Norington Lecture on 14 October at the AFRM/NZRA Combined Rehabilitation Meeting.

Associate Professor Gibson is a physical therapist with a PhD in bioethics. She is also a Senior Scientist at the Bloorview Research Institute at the Holland Bloorview Kids Rehabilitation Hospital where she directs the Critical Disability and Rehabilitation Studies (CDARS) unit.

The Norington Lecture is named in memory of the late Bradney Norington, CBE, the first President of the Australian College of Rehabilitation Medicine (ACRM). During his medical studies at Sydney University, Dr Norington developed acute poliomyelitis and was severely affected by extensive severe residual paralysis, restricting him to life in a wheelchair. However, he graduated and went on to work and study in rehabilitation around the world.

Associate Professor Gibson said she was honoured to be invited to deliver the Norington Lecture and will speak on the debate over the fundamental purposes of rehabilitation.

“Rehabilitation has been experiencing a philosophical shift as there is less of a focus on normalising people’s bodies and impairments and an increasing emphasis on the facilitation of functional activities and community participation. There remains, however, considerable debate regarding what constitutes ‘good’ outcomes for people with disability. These debates come down to questions of the norms and values we hold within the rehabilitation community. For example, many of our outcome measures assume a direct link between functional abilities and quality of life, yet this link has been shown to be deeply flawed.”

She also said that she has an interest in both physiotherapy and philosophy and the two disciplines come together in her work.

“When I began my career as a physiotherapist, I suppose I was naturally drawn to the ethical and philosophical issues that arose in practice. In particular, my experience working in a paediatric intensive care unit, where life and death decisions were made based on judgments of future quality of life with a disability, served as a catalyst for me to pursue a research career that could focus on exploring the ethics of such practices.”

In her presentation, Associate Professor Gibson will address the issue of professionals’ and clients’ expectations of ‘rehabilitation’.

“The gradual shift in rehabilitation philosophies from a focus on impairment to participation is not always transparent to the recipients of care and may conflict with their own values and goals. In an era of ‘client and family centred care’ interventions are ostensibly meant to focus on client values, and yet there is a paucity of research investigating how these values align with rehabilitation norms and priorities.”

Associate Professor Gibson says there’s still a great deal of emphasis on achieving ‘normal’ movement and mobility which may not always be the answer.

“Enabling mobility is a primary focus of rehabilitation, and yet larger questions about hierarchical valuing of some forms of mobility over others, and the effects on the recipients of care, are largely absent. For example, walking is considered a better outcome than wheeling in almost all rehabilitation practices and measures. Perhaps more provocatively, an alternative mobility like crawling would be viewed as a ‘failure’ of rehabilitation and/or a personal ‘tragedy’. Nevertheless there are adults who will tell you that their preferred mode of mobility is crawling. I [in the lecture] will explore the opportunities for creative practices that arise when assumptions regarding ‘good’ or ‘bad’ mobility outcomes are reconsidered.”

George Burniston Oration by Professor Derick Wade

Professor Derick Wade, a consultant in Neurological Rehabilitation at the Oxford Centre for Enablement in the UK, will deliver the George Burniston Oration on Wednesday, 14 October at the AFRM/NZRA Combined Rehabilitation Meeting.

The George Burniston Oration is given every year to honour the late George Burniston, OBE, CMG. Dr Burniston was born in 1914 and graduated in medicine from the University of Sydney in 1939. He served with the RAAF and the RAF during the Second World War. Dr Burniston established and commanded the No 2 RAAF Medical Rehabilitation Unit at Jervis Bay in 1944. He was one of the great pioneers of rehabilitation medicine in Australia and was awarded an OBE in 1969 and a CMG in 1972 for his services in the field of rehabilitation of the handicapped. He died in 1992 at the age of 77.

Professor Wade is also considered a pioneer in the rehabilitation field. He trained in general medicine as well as several specialties including neurology, neurosurgery, psychiatry and neurophysiology. He has been researching stroke and rehabilitation for the past 35 years.

Professor Wade said there have been many achievements since he began his research.

“Since 1980, we’ve achieved the recognition that measured outcomes and randomised controlled trials are possible in rehabilitation, even though at the time, they were considered impossible.

“During my career there has been a surge of rehabilitation research, led by stroke research, and the recognition that stroke rehabilitation (in stroke units) is cost-effective. This has been combined with the development of meta-analysis, systematic reviews and multi-centre trials.”

He also said there are several challenges in the area of stroke rehabilitation.

“The major challenge is to overcome the dominance of the biomedical model of illness, and to reduce the focus on disease and technology towards disability and the patient. We need to explain what rehabilitation is (and is not) and can achieve (and cannot achieve) and gain recognition that rehabilitation is a very complex matter, not just ‘therapy’.”

Professor Wade’s research activities cover a wide area. He has published over 170 papers in peer-reviewed journals on many different studies, including 12 randomised controlled trials and studies on the natural history of illness in disabling neurological conditions. He is currently working on four trials and hopes to set up several trials in China, which may include Chinese massage and feedback to encourage movement.

He says his approach to rehabilitation is holistic.

“I believe in focusing on the patient’s perspective; considering the illness at different, equally relevant levels; weighing up all the contextual factors and accepting that relationships between factors are complex.”

Professor Wade says he is looking forward to sharing his knowledge at the AFRM/NZRA Meeting in October.

“I hope to persuade delegates that we must alter the environment in hospitals so that it does not further disable people. I will warn that not using the biopsychosocial, holistic model will lead to a failure of rehabilitation both as a specialty, and for individual patients.

“I will also stress that understanding the patient’s perspective is essential so that relevant motivating goals are set and that patient practice and engagement in the process is central.

“I will outline my belief that healthcare should have a rehabilitation service that runs in parallel with healthcare from the outset,” Professor Wade concluded.

The latest, best evidence for rehabilitation of hemiplegic arms and hands after stroke

Mon, 09 Feb 2015 21:31:45 GMT

Systematic reviews, which once upon a time were new and unfamiliar, have now proliferated and are commonplace. Where once it was difficult to read all the clinical trials published on a given topic, it is now a challenge to just get through all the systematic reviews that have been written! In response to this, the Cochrane Collaboration (which all New Zealanders can access for free via the Ministry of Health website) has begun publishing Cochrane Overviews. These are, in essence, systematic reviews of systematic reviews.

One excellent example of a Cochrane Overview is a recent publication by Pollock and colleagues (2014) entitled “Interventions for improving upper limb function after stroke.” For this overview, Pollock et al. collected, critically appraised, and combined the findings from 40 complete systematic reviews on various interventions for hemiplegic arms and hands after stroke. This includes 19 Cochrane reviews and 21 published non-Cochrane reviews. The review covers 18 individual interventions, including investigation of dosages (e.g. frequency and intensity of exercise) and the setting for intervention.

So how useful are these new types of reviews? What can a Cochrane Overview actually tell us about therapies for people with upper limb hemiplegia after stroke? In fact it would appear quiet a bit! Here is summary of some of the key findings from Pollack et al.'s (2014) review:

We can say there is moderate quality evidence that the following interventions for hemiplegic upper limbs after stroke may be effective: constraint-induced movement therapy (CIMT), mental practice, mirror therapy, interventions for sensory impairment, virtual reality, and a relatively high dose of repetitive task practice.
There is now moderate quality evidence that unilateral arm training (exercise of the weak arm) is probably more effective that bilateral arm training (exercise involving both arms at the same time). This has been a bit of an on-going debate for the last couple of decades, so it is interesting to see the weight of evidence slowly coming out in favour of one side of the debate over the other.
While there is still need for further research to determine the right dose of rehabilitation for hemiplegic arms, there is growing evidence that more is indeed better - more intensive exercise increases the opportunities for people to regain arm and hand function after stroke.
The highest quality evidence was in relation to transcranial direct current stimulation, which (interesting, given that this seems to be all the rage at the moment) showed that this type of therapy is NOT effective for improving people's upper limb functional ability after stroke.

The review concluded that there was still considerable room for improving the quality of research trials into upper limb therapies, and in particular into determining the optimal intervention dose for arm rehabilitation.

William Levack is an Associate Professor of Rehabilitation at the Rehabilitation Teaching & Research Unit, University of Otago, Wellington, New Zealand. Twitter: @DrLevack

Reference:

Pollock et al. (2014) Interventions for improving upper limb function after stroke. Cochrane Database of Systematic Reviews. Issue 11. Art. No.: CD010820. DOI:10.1002/14651858.CD010820.pub2.

Villains with disabilities are people too

Mon, 09 Feb 2015 19:44:47 GMT

Popular culture plays a significant role in how the general public views disability. Representations in the media influence how people think about impairments, and therefore how they act towards people with differences in body structure and function. If impairments are presented in movies as something to be feared or despised, then people will learnt to fear and despise them, with these attitudes (and subsequent behaviour) contributing to everyday disabling experiences for others.

Recently, I was playing a free online game, Facility Z, in which the ‘twist’ at the end involved discovering some guy in a wheelchair as the villain of the story (i.e. the evil scientist in a wheelchair cliché). This got me thinking about all the times that people with disabilities have been villains in movies, books, and games. (Of course, people with impairments are frequently the heroes in these stories too, raising other questions about the role of the ‘super crip’ in popular media, but I’ll save that discussion for another day.)

Disability is often presented in these stories as representing ‘otherness’, with authors of these games, books, and movies using disability in an attempt to make their hero’s nemesis more scary. This presents people with impairments as being ‘not like us’ and therefore objects of uncertainly and a potential threat. Negative stereotypes, discriminatory views of disability, and able-bodied people’s fear of the unknown are used as tools of convenience by the author to drive the story’s narrative. Examples of this include Dr Strangelove (in a wheelchair) and Dr No (with mechanical hands) from the James Bond franchise, and Davros, creator of the Daleks, from Doctor Who.

Other times authors use disability as a justification for why the villain in a story turned bad. The disability becomes a plot point. Perhaps the villain has been seeking a cure for their impairment and as a result of an experiment going ‘horribly wrong’ the otherwise well-intentioned antagonist turns ‘bad’. Inevitably the usually able-bodied hero has to rescue the villain from themselves, or save other people from them, perhaps unwillingly destroying the villain in the process. Here, disability is presented as the origin of evil; an explanation why people with good intentions might go bad. An example of this type of villain is Spiderman’s nemesis, the Lizard, who turned into a superhuman monster after daring to dabble with reptilian DNA in an attempt to grow back his amputated arm. Another example is the character Blizzard in the 1920's silent film classic, The Penalty, the plot of which, according to Wikipedia, is as follows: "Driven insane by the social pressures of being forced to walk on crutches, (bilateral amputee) Blizzard becomes a crime lord. He tracks down the doctor who performed his operation, and plots a twisted revenge: kidnap the doctor's daughter's fiance, and graft his legs onto Blizzard's stumps."

But in an inclusive world, people with disabilities should have every chance of being the villain as they do of being the hero in these stories. Is it possible then for a person with impairments to be the villain of a story, but where their impairment is incidental to the plot? I've wondered whether one movie character has recently achieved this – Bolivar Trask from “X-men: Days of Future Past”. Played by Peter Dinklage (fresh from massive popular acclaim as the anti-hero, Tyrion Lannister, in Game of Thrones) Trask is the evil scientist who takes it upon himself to defend humanity by creating giant robots designed to hunt down and kill the growing mutant superhuman population (the X-men and their community; i.e. the heroes of the story). Interestingly, Bolivar Trask in the original X-men comic book on which the movie is based, did not have a height restricted disorder. But because Dinklage (the actor) has achondroplasia, Trask (the character) is also restricted in height. Sure, the introduction of a Trask with dwarfism in the movies adds an interesting element to his character, but this is utterly incidental to Dinklage’s massive onscreen presence, which is what brings Trask to life for the audience. With a recent resurgence of criticism of able-bodied actors playing disabled characters, it is very refreshing for the movie casting to head in the other direction for a change.

William Levack is an Associate Professor of Rehabilitation at the Rehabilitation Teaching & Research Unit, University of Otago, Wellington, New Zealand. Twitter: @DrLevack

New Zealand Rehabilitation Association Untitled page

DR HARRY McNAUGHTON: Intrinsic motivation - the key to improving rehabilitation outcomes

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Rehab Conversation: Quality Improvement in Clinical Practice

Session Recording & PPT slides

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CONSULTATION: Cost of Treatment Regulations

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FRIDAY 1ST – SUNDAY 3RD APRIL 2022

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Earlybird Registration closing soon...

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Opportunity to strengthen rehabilitation in Ethiopia

BRNZ Research Recruitment: Building Psychosocial Capability

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Implementation of Telerehabilitation in Response to COVID-19

Kaupapa Māori Speech Therapy—Dr Karen Brewer

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Reflections on Inequalities and the Impact of COVID-19 on Disabled People

Rehabilitation Innovation Award Announced

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Study opportunity - Intellectual Disability: Theory into Practice

NURS433/PSME439 Intellectual Disability: Theory into Practice

Research participation opportunity - interprofessional team communication

Would you like to share your thoughts on interprofessional team communication in inpatient rehabilitation?

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Guidance for Rehabilitation of people recovering from COVID-19 in NZ

Come and mahi tahi with us ...

1. Join the NZRA Executive team.

2. Join the 2021 Conference Organising Committee

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Reflections of Prof. Jacinta Douglas symposium (Feb. 2020)

School of Physiotherapy Neurorehabilitation course - Semester 2, 2020!

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Rehabilitation papers on offer in 2020 semester 2 (July to November)

Full Year rehabilitation paper (Feb to November )

RTRU Rehabilitation courses in 2020!

The TBI Network – become part of a group striving for change

Latest NZ Rehabilitation Review (issue 49)

Why I think Jacinta is pretty amazing.... & why you need to come to hear her speak!

Personal narrative approaches in rehabilitation following traumatic brain injury: A synthesis of qualitative research

NZRA emerging rehabilitation researcher 2019/20 grant

Learning and education modules on understanding bias in health care

Who me – biased? He ngākau haukume tōku?

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ASSBI/NZRA Conference 2019 Report

Upscaling rehabilitation: policy, practice & politics - thoughts from Anne Hawker

For disabled people the aim is participation in the community in which they live.

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Latest NZ Rehabilitation Review (issue 48)

Dr Fiona Graham - HRC Emerging Researcher First Grant