Town hall promotes collaboration in stroke care and research

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On June 12, the B.C. SUPPORT Vancouver Island Regional Centre, a collaboration between Island Health and UVic, presented a forum designed to outline critical, unmet needs for patients recovering from strokes. The event, titled ‘The Stroke Research Town Hall: Perspectives, Priorities, and Possibilities’, delivered exactly what the name promised; offering a variety of viewpoints on how to deal with strokes as a researcher or as a patient.

Three UVic researchers, a patient participant, and two VIHA research coordinators were all introduced by emcee Cheryl Armstrong, UVic’s own Health Research Projects Coordinator.

Held in the Medical Science Building, the three-hour-long forum’s objective was to bring health care consumers together with researchers — the importance of which was explained by opening presenter Colleen McGavin, the Patient Engagement Lead with the BC SUPPORT Unit, which is part of Canada’s Strategy for Patient-Oriented Research (SPOR).

“SPOR is a national strategy to foster research that is done in partnership with patients, answers research questions that matter to patients, and aims to improve health care,” McGavin explained. “Our main goal [at the SUPPORT Unit] is to increase the quality and quantity of patient oriented research.”

McGavin explained that collaborations with researchers and patients were the best way to improve the medical care available, and her opinion was shared by the other presenters.

One such presenter was Dr. Gavin Arthur, whose role with the Heart and Stroke Foundation sees him work closely with recovering patients. In his presentation, Arthur reminded the 70-person audience of a quote by Gandhi — that “actions express priorities”.

For Arthur, this rings especially true in the context of the experiences of patients whose perspectives are different from doctors or researchers, and Arthur explained in his presentation that patient–doctor collaboration can result in hopeful possibilities for both parties. The importance of direct support from researchers was aptly demonstrated by the next presenter, Mark Miller, who has been living with hemiplegia ever since he suffered a stroke eight years ago.

Miller’s participation in research has led him to benefits like the recent, delightful realization that he could feel a fly land on his arm, or the more profound action of walking without a brace. His joy with his progress is evident, especially compared to the time before Miller was able to walk.

“The most exercise I got until that point was jumping to conclusions,” Miller joked.

Miller explained that participating in research provides him with a source of optimism; it becomes a source of motivation for the hard work involved in recovering from a stroke.

This hard work is not just for those recovering from strokes but also those treating them, and Kristine Votova, who also works with Island Health’s Research and Capacity Building department, was able to speak to the difficulties that strokes present for emergency room physicians and to the work her team are doing in regards to stroke detection.

Presenting on the progress of moving research and knowledge into practice, Votova discussed how a ‘transient’ ischemic attack (TIA) can be a warning of an impending stroke in approximately 10 per cent of cases. With rapid assessment and care, however, only about two per cent of TIA’s progress to a full stroke.

Yet another challenge to clinicians are symptoms that mimic strokes, and these occur in about 40 per cent of cases presenting to an ER. Thankfully, Votova explained, researchers on Vancouver Island have been ready to advance their world-leading care strategies for some time.

Partnering with technological experts at the UVic Genome B.C. Proteomics Centre, stroke neurologist Dr. Andrew Penn leads a lot of this work. With the evolution of proteomic equipment, analyses of proteins in the blood for quick diagnosis reduces error and expands health comprehension enormously. Stroke care is extremely time-sensitive, and getting proper care has to be balanced by costs that may be lost by giving expensive care to cases that are mimics. It is only a matter of time (and money) before the evidence for proteomics can justify access on a universal, regional basis. After all, Votova said, knowledge translation is another pillar under the bridge of effective care expenditures.

Following Votova, Craig Brown, an associate professor in neuroscience at UVic, presented work done by his lab at the university; work motivated by statistics that show 73 per cent of strokes lead to living with a disability. After pondering how parts of the somatosensory cortex become sluggish after a stroke, the lab began experimenting with optogenetics; a field of study based on the knowledge that brain cells featuring a certain algae protein can be controlled with light.

Brown’s team showed that surviving neurons can be coaxed to regrow old connections. By stimulating algae protein with pulses of blue light, Brown’s team promoted the growth of new and stable neural connections which improved responsiveness to sensory motor functions. This work, led by UVic post-doctorate student Kelly Tennant, demonstrates what UVic scholars are capable of with proper support.

The final presenter was author Paul Zehr, researcher at the UVic Centre for Biomedical Research and one of the people behind Mark Miller’s ongoing recovery. Zehr is determined to knock down one of the persistent myths about the brain — that recovery from stroke has an expiration date. In his presentation, Zehr explained the potential for neuroplasticity continues long after a stroke — even for as long as 23 years afterwards.

Zehr knows humans are wired in an interconnected way: the right side of the brain supports the left, the strong arm supports the weak arm, and strong arms even support the weak legs. Zehr applied this aspect of our asymmetrical, bilateral biology and found a stroke-affected side of the body gains considerable strength when the unaffected side is strengthened.

Responding to audience questions, patient pathways to access prevention and care are not always readily marked, and while social support is a huge advantage to those who have suffered a stroke, it is not always available. But the speakers involved with the town hall are hopeful that this new, collaborative approach will take off, giving patients a seat at the table and propelling health care into a new age.

This article was edited to reflect the fact that the forum was presented by BC SUPPORT Vancouver Island Regional Centre, not VIHA. We regret the error.

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