Advances in stroke care
By Chonglu Huang
The human brain is a powerful yet delicate organ. Illnesses and conditions such as stroke, Parkinson’s and depression are not only growing in prevalence but often result in long-term disabilities that require continuous care.
Scientists and clinicians at the uOttawa Brain and Mind Research Institute (uOBMRI) are focused on harnessing the healing powers of the brain by conducting translational research that will have an immediate impact on patients.
The crux of such research begins with connecting basic scientists in laboratories with clinical researchers in care settings—two groups that have traditionally worked in silos, even when they share the same types of medical expertise.
“The Brain and Mind Research Institute aims to address this gap in health care and deliver research that will have a significant and timely impact on patients,” says Dr. David Park, uOBMRI’s scientific director.
Dr. Park has been instrumental in bringing together experts in stroke, Parkinson’s and mental health research to collaborate on the same research projects.
One such collaboration is the iRecover program, a unified approach to stroke treatment that focuses on developing early integrative rehabilitation for stroke patients in the acute care setting at The Ottawa Hospital’s Civic Campus.
“iRecover began because the uOBMRI started to connect people like me, a stroke researcher, with neurologists who treat acute stroke in hospitals,” says Dr. Dale Corbett, a uOttawa Faculty of Medicine professor and scientific director and CEO of the Canadian Partnership for Stroke Recovery.
As a scientist working in labs, Dr. Corbett has done extensive research on the neuroplasticity of the brain after a stroke — essentially the brain’s malleability and capability to heal after suffering stroke damage.
“There’s a critical period after stroke whereby the brain tries to repair itself,” explains Dr. Corbett. “Intervene at the right time and you can achieve significantly better results than if you delay treatment.”
Yet in the clinical setting, stroke patients are bedridden for weeks before space is available at a rehabilitation facility to accommodate them for speech therapy, cognitive therapy and physiotherapy—treatments for recovery so heavily required during a short window of time when the brain has the most neuroplasticity.
Thus, Dr. Corbett partnered with Dr. Dar Dowlatshahi, a stroke neurologist at The Ottawa Hospital and an assistant professor at the Faculty of Medicine, to launch iRecover — a pilot project to test the feasibility and impact of early integrative stroke rehabilitation using iPad-assisted, self-guided therapies…right at the fingertips of patients at their bedside.
"Dale [Corbett] knows rehab, I know the acute care setting,” says Dr. Dowlatshahi. “Together, we saw a gap in the current clinical infrastructure where there was an excellent opportunity to intervene and provide early rehabilitation while stroke patients were waiting for traditional rehab.”
Many stroke patients are left with language impairments; thus the iPads-assisted therapies were first focused on providing self-guided speech language pathology. The results were well received and highly effective.
“Our first patient didn’t want to give her iPad back because she liked it so much,” says Dr. Dowlatshahi. After that, 30 patients were recruited over three months for the iRecover study, which has expanded to incorporate depression therapy for stroke survivors.
Even as stroke treatments have made considerable advancements in modern medicine — from clot-busting drugs such as tPA (tissue plasminogen activator) to endovascular clot removal, there are nevertheless limitations, often depending on how quickly the patient is admitted at a hospital.
“Stroke is a race against time,” says Dr. Cheemun Lum, a neuroradiologist at The Ottawa Hospital who often administers the endovascular clot removal treatment to eligible stroke patients. “For the best chance of full or partial stroke recovery, the endovascular clot removal treatment requires a team of six to seven health care professionals descending on the patient as fast as possible.”
Statistically, only 10% of overall stroke patients are eligible for the tPA clot busting drug, which is estimated to work 30% of the time. Meanwhile, the endovascular clot removal treatment is available only to patients who’ve suffered from severe strokes resulting in big blood clots; it has a 90% success rate for opening arteries.
According to a 2015 study published in the medical journal Stroke, at least 405,000 Canadians were living with long-term stroke disability in Canada in 2013, a number projected to increase by 80% over the next two decades.
Currently, there are over 60,000 stroke patients a year in Canada — 30% of them with long-term disabilities, evidence of the immense clinical need for earlier stroke rehabilitation in acute care.
“iRecover is really about getting rehabilitation of some kind started as early as possible after stroke so that patients in recovery can maximize the end result for a better quality of life,” says Dr. Corbett.
Dr. Corbett, Dr. Dowlatshahi and Dr. Lum will give a presentation on their unified approach to stroke treatment on Tuesday, September 15 during the uOBMRI’s Brain Health Awareness Week. The week’s activities will also include a debate on the use of stem cells for regenerative therapy as well as presentations on Parkinson’s research and suicide prevention.
Dr. Dale Corbett (left) and Dr. Dar Dowlatshahi show stroke patient Martial Dagenais how to use a self-guided therapy on a smart tablet at The Ottawa Hospital. Photo: Robert Lacombe.