Three members of the heads up! specialist neurological physiotherapy team attended the recent ACPIN (Association of Chartered Physiotherapists in Neurology) two-day conference in London, in association with INPA (International Neurological Physical Therapy Association).
The event brought together experts from across the globe, in neurological physiotherapy, rehabilitation and research. We have pulled together the key points, from a selection of the programme speakers:
Dr. Emma Stokes, Dublin, introduced day one by talking about the World Congress of Physical Therapists and the three priority areas they had identified:
Prof Derek Wade, Oxford presented “How to use evidence, follow guidelines, and be patient centred”. He discussed what we could do is not necessarily what we should do and how rehabilitation is all about behavioural change:
- Guidelines – the evidence is always incomplete. They are not binding and not enforced. They are focused on treatment and not the problem
- Evidence – has enormous limitations, often not well described on what they did and RCTs patients are allocated and not randomised
- Theories – should be developed which are based on evidence, but developed over time.
Prof Louise Ada, Sydney presented: “One size does not fit all” concept in mobility intervention for stroke:
- The speed of walking post stroke is a key determinant in whether a person walks outside the home. There is a need to look at groups of people with different walking speeds differently
- Current trials are not good at describing participants or interventions
- Cueing of cadence using a metronome is cheap and effective in improving walking speed and distance in people who have had strokes.
Prof Gert Kwakkel, Amsterdam (visiting Prof Chicago) presented: “Understanding upper limb recovery early post stroke: some lessons of the EXPLICIT – stroke programme”
- The quality of trials is improving, up one Piedro point over the last 10 years and how.
- In the future, there will be 4D analysis of movement – 3D+EEG
- Stroke rehab app http://www.viatherapy.org
Prof Sarah Tyson, Manchester presented “Patient-led therapy during in-patient stroke rehabilitation”
- In hospitals all policies focus on patients NOT doing something in order to prevent damage
- Good rehabilitation is about good organisation
- Out of 28 days, when patients were supposed to exercise daily, only 7% exercised every day. The average was 11 days and 1/3 people exercised less than 7 days.
Prof Steve Wolf, Emory University USA presented: “Collaborative decision making and the development of best evidence apps”
- PASS Physical Therapy and Society Summit – recommendations advocate for leadership role in prevention, health & wellness
- He discussed genetics, robotics, telehealth and regenerative medicine
- Frontiers in Rehabilitation Sciences and Technology (FIRST Initiative) www.viatherapy.org; www.neurorehabdirectory.com
Prof Fiona Jones, London presented: “It’s all about the small steps” sharing and creating solutions for successful self-management after traumatic brain injury:
- Lots of stories of people who had had traumatic brain injury not being heard
- Often people denied that they had had a brain injury
- Need change agents, people who really get it and want to make it work
- People needed to support their partner/family member to take some risks. Risks are an essential part of neurological rehabilitation
- Pilot carried out at King’s College Hospital, now looking at training people in all four major trauma centres in London and making a training film.
Prof Valerie Pomeroy, University of East Anglia presented: “Generating the evidence base for personalised stroke rehabilitation”
- One third of people with stroke will decline to participate in research trails
- Evidence Based Practice = “Using the best evidence available considering the person you actually have in front of you”.
Prof Lisa Harvey, Sydney presented: “Spinal cord injuries: recent trails and their relevance to other areas of neurology”.
- 90% physio research has equivocal results – can’t rule in or out a treatment effect
- Prof Harvey has worked on the development of elearnSCI.org; www.SCIMOOC.org; www.physiotherapyexercises.com
Prof Robert van Deursen, Cardiff presented: “Exploration of clinical-academic collaboration to achieve evidence based practice”:
- Developing research evidence is about developing theory
- In neurological physiotherapy we are dealing with behavioural change
- Emphasised the importance of researchers and academics with a clinical background.
Prof Karen Middleton, Chair Chartered Society of Physiotherapy gave a punchy address talking about “knowing the customers and what their local needs are”
- Prevention is the only way we are going to deliver sustainable health care
- We are exemplary problem-solvers. We really do work in partnership with patients, their hopes and what they want to achieve
- To focus on supported self-management and self-referral. Self management is about education for people to understand their disability and know when they need to seek help
- We are in danger of being obsessed with evidence
- We need to pull together as a profession and make the most of our professional body.
Prof Helen Dawes, Oxford Brookes University presented: “Walking and simulated walking control”
- Used imaging and treadmill training
- After stroke, people used a lot more metabolic and brain activity to move and walk
- Pre-frontal cortex more active soon after stroke, but the activity decreases over time
- Internal planning seems to affect walking more than external distractions i.e. thinking about what you are going to buy at the shops, is more distracting than confronting something in the environment.
To find out more about the conference – Evidence into Practice – visit www.acpin.net