Meeting the Challenge
Like other research networks in Canada and around the world, CPSR has faced unprecedented challenges over the past number of months due to the coronavirus global pandemic.
Many of our research projects and training initiatives were suddenly put on hold in March 2020, clinical trials were suspended, grant submissions and reviews were delayed, and our partners faced enormous financial hardships.
CPSR offices at the University of Ottawa closed (and remain temporarily closed as we write this in early fall), our team began to work from home, meetings moved online, and our operational plan was revisited.
At the same time, we remained focused on the potential impact of this once-in-a-century health crisis. Were individuals and families getting the care and resources they needed to make the best possible recovery when nothing was normal and when many parts of the health-care system had shut down? What could we, as a research community, do to help?
CPSR worked with partners to respond. We shared online resources and tools on our website and social media platforms and we worked with the Calgary Stroke Program’s Early Supported Discharge team to develop an 11-episode self-management video series. The videos, posted on our Youtube channel and website (http://canadianstroke.ca/en/tools-resources/videos), and accompanying resource sheets, provide guidance and information on topics in stroke recovery, such as fatigue, memory, anxiety, stress, attention, and more.
On the research front, we quickly pivoted some of the trials slated to rollout on the CanStroke Recovery trials platform. For example, Arm Boot Camp (ABC) and TRAIL (TeleRehabilitation with Aims to Improve Lower Extremity Recovery Post-Stroke) moved to exclusively virtual delivery. And, we touched based with CPSR researchers all across the country to find out how the shutdown had affected their work and how we could support continued scientific pursuits.
Networking, scientific and educational events transitioned from in-person to online. Plans were hammered out for multi-site virtual lab tours and presentations as part of our hugely successful annual Stroke Program in Neurorecovery (SPiN) workshop in late July, while our program committee considered new approaches for the Annual Scientific Meeting, slated for the late fall. Ongoing virtual activities, including regular trainee-led webinars, did not miss a beat.
We also used this sudden pause in normal operations to stop, refocus and consider how CPSR could better serve the broader stroke recovery research community, both in Canada and around the world. We reached out to consult old and new partners about the future of research, find out how we could fill gaps, deliver new value-added activities, and answer the big questions in stroke recovery. We have some ideas that you will hear about very soon.
But the past year has not been all about pandemics. Before the jolt of Covid-19:
- CPSR awarded four large team grants in the fall of 2019 focused on the dose and timing of post-stroke rehabilitation;
- We delivered two excellent SPiN workshops -- one in Toronto in November and another virtually in July, which were well-attended and well-received by trainees from across the country and around the world;
- We ramped up the CanStroke Recovery platform at eight clinical research centres and identified new potential trials;
- We joined colleagues from around the world to develop a plan to build international capacity in stroke research and trials;
- We supported our partners to roll out the Canadian Stroke Congress;
- We supported multi-centre research teams in their efforts to tap into major new funding opportunities by hosting brainstorming meetings, providing writing support, and gathering input from people with lived experience;
- Our research leaders spoke at national and international conferences, sharing the latest research with clinicians as far away as Singapore, Australia and Brazil; and,
- CPSR researchers published like crazy in scientific journals on topics ranging from caregiver challenges to robotics to gender differences in rehab, and so much more.
This annual report is written with an acute awareness that what is planned can quickly become unpredictable, but also with a sense of gratitude for the resiliency and adaptability of our research community. As always, our researchers remain focused on making life better for the hundreds of thousands of individuals living with stroke disability and their families.
Andrew Demchuk, MD, Co-Scientific Leader
Sean Dukelow, MD, PhD, Co-Scientific Leader
Katie Lafferty, MSIA, Chief Executive Officer
Rod McKay, FCPA FCA, Chair of the Board
2019-20 was a year focused on advancing research through multi-site collaborative grants, expanding and formalizing the first national clinical trials platform dedicated to stroke recovery, leveraging catalytic investment to secure large-scale funding, and publishing new knowledge.
Despite a year of twists and turns created by the pandemic, CPSR researchers continued to press forward. During the past year, they have tested innovative ideas, developed new national and international collaborations, built a unique clinical trials infrastructure and published a lot of new research.
Every month, our newsletter features important publications in high-impact journals. In the last four years, more than 125 papers and 300 poster and oral presentations have described the findings of CPSR-funded research studies -- running the gamut from stem cells to robotics to caregiver burden, and more.
Among prominent publications this year was an October 2019 report, published in the Journal of Telemedicine and E-Health, on the results of a five-year CPSR-led study of six tele-rehabilitation projects. The study, involving more than 300 Canadians in 10 cities, found that technology can be as effective in delivering post-stroke therapy to people in rural and remote parts of Canada as traditional care.
These findings underscored the importance of caregiver engagement and easy-to-use technology – insights that helped inform the explosion of tele-rehabilitation during the pandemic.
Another major milestone this year was the organization and expansion of the CanStroke Recovery clinical trial platform, the first national trials network focused exclusively on stroke recovery. It brings together the leading clinicians and researchers across Canada to test new approaches, therapies, therapeutics and technologies to improve recovery from stroke. Several innovative trials are mobilizing the eight-centre network to fast-track patient recruitment -- and more trials are in the planning stages. It's anticipated that CanStroke Recovery will become the go-to trials platform for stroke researchers in Canada and around the world.
In 2019, CPSR awarded four large-scale collaborative grants to multi-centre research teams studying the dose and timing of post-stroke rehabilitation.
- A team, led by Dr. Lara Boyd at the University of British Columbia and Dr. Michelle Ploughman at Memorial University, is determining whether aerobic exercise primes the brain for recovery early after stroke and whether this priming in combination with therapy can benefit motor learning, cognition and motor function after stroke.
- Dr. Janice Eng leads a multi-site study to determine the effect of the DOSE (Determining Optimal post-Stroke Exercise) protocol in improving the primary outcome of walking in stroke patients over the hospital rehabilitation period. Secondary outcomes include motor recovery and quality of life.
- A team led by Drs Avril Mansfield and Elizabeth Inness at Toronto Rehabilitation Institute is studying the optimal dose of reactive balance training for people with stroke who are attending rehabilitation.
- Dr. Greg Silasi leads investigators in Canada (and collaborators in Australia) in a basic research study of reaching practice to determine the most effective dose early after stroke, as well as much later when recovery is perceived to slow down.
Our researchers also leveraged catalytic funding from CPSR to secure larger grants from the Canadian Institutes of Health Research (CIHR), Heart & Stroke and others. For example, Dr. Greg Silasi of the University of Ottawa leveraged both his 2017 Catalyst grant and his 2018 Trainee Award to win a CIHR grant of $827K to study the role of microinfarcts – small, microscopic lesions that potentially alter recovery. And, Dr. Paul Albert used optogenetic data generated from CPSR catalyst and trainee funding to support his successful CIHR grant of $792K focused on overcoming resistance to antidepressant treatment.
CPSR researcher receives prestigious Rhodes mentorship award
Dr. Michelle Ploughman, the CPSR site leader at Memorial University of Newfoundland, was awarded the Rhodes Inspirational Educators Award for being “the ultimate mentor” in training the next generation of researchers and clinician-scientists. Dr. Ploughman was nominated by medical student and MUN neuroscience grad Matthew Downer, a 2019 Rhodes Scholar at Oxford University. Rhodes Scholars were asked to nominate mentors who had the biggest impact on their lives and Dr. Ploughman was selected as the winner. “She saw potential in me before I had any belief I could ever succeed to become a clinician or a researcher,” he said, adding that Dr. Ploughman helped him discover a passion for rehabilitation medicine. Earlier this year, Dr. Ploughman was named one of Canada’s Top 100 Health Influencers for 2020 by OptiMYz, Canada’s leading women’s wellness magazine.
Training is one of our flagship programs, and it's an area we value and invest in. Our workshops, mentorship programs, webinars, lab exchanges, and the highly successful Stroke Program in NeuroRecovery (SPiN), grow and nurture a new generation of exceptional researchers, who will make the practice-changing discoveries needed to restore lives affected by stroke. CPSR has directly supported about 110 future research stars in labs across Canada over the past five years and there are 175 active members in the National Trainee Association.
At the 2019 SPiN course in November, for example, 40 trainees toured 19 labs at Baycrest, Sunnybrook and Toronto Rehab. The multi-day workshop included interactive activities, presentations, hands-on lab demonstrations, dedicated time with stroke survivors, and lots of time for networking.
The 2020 virtual SPiN course in July involved more than 65 trainees from Canada, the US, Australia and India and featured work in labs across Canada, as well as one in the U.S. This year’s themes featured the latest in stroke recovery research with an emphasis on physical rehabilitation and assistive technologies, brain stimulation, imaging, and analysis techniques. In addition to participating in various lectures and demonstrations, trainees had the opportunity to share their research. The event also included mentorship and career discussions.
Says stroke neurologist and research leader Dr. Sandra Black of Sunnybrook Health Sciencecs: “This is a very special event that takes a lot of work and coordination to provide a unique blend of learning and mentorship, to promote interdisciplinary understanding, scientific exchange, and social networking. This year, because it was virtual, it allowed more people at various career stages to attend more “locations” across time zones to help build a community of scholars focused on enhancing stroke recovery.”
In post-SPiN workshop evaluations, 96 per cent of participants rated it as 'excellent' or 'very good'. One hundred per cent said they learned something new and would recommend the meeting to other trainees and 96 per cent said they strengthened their networks and collaborations.
We know that our training program is making a difference. But don’t just take our word for it.
"SPiN was wonderful! Not only was it amazing to see the diversity of research, it was also incredible to get to know our fellow trainees from across Canada,” said Jennifer Ferris, a PhD candidate in Dr. Lara Boyd’s lab at the University of British Columbia (pictured at right). “One of the best things about SPiN is to build that peer network."
After another stellar year of programming, interest in leading the National Trainee Association was so high that a new approach was developed to ensure continued strong leadership. For the first time, the two co-chair roles were split into a senior-junior pairing.
Pictured below, from left:
Basic Science co-chairs: Michael Liu (5th year PhD candidate with Dr. JoAnne McLaurin at Sunnybrook) and Zanna Vanterpool (1st year PhD with Dr. Greg Silasi at University of Ottawa)
Clinical Research co-chairs: Matt Chilvers (4th year PhD candidate with Dr. Sean Dukelow at University of Calgary) and Lydia Kuhl (1st year MSc with Dr. Sean Dukelow at University of Calgary).
Former NTA chair recruited for faculty position at U Minnesota
CPSR trainee program develops 21st century research stars
Rachel Hawe, a post-doc in Dr. Sean Dukelow's lab at the University of Calgary, has joined the University of Minnesota Kinesiology faculty. She is using robotics and neuroimaging to understand and maximize recovery of the upper limb following stroke. Rachel is past-chair of the CPSR National Trainee Association. She won the Sex and Gender-Based Analysis Trainee Award at Canadian Stroke Congress in October. While at the U of Calgary, her "big thing" was a major study on proportional recovery, published in Stroke, and she participated in the proportional recovery debate at the American Society of Neurorehabilitation (ASNR) meeting in Chicago in October.
In addition to working with colleagues at universities and hospital-based research institutes across the country, researchers expanded their networks through collaborations with scientists and clinicians in other countries. In late 2019, our Scientific Directors, Drs Sean Dukelow and Andrew Demchuk, and research leader Dr. Janice Eng took part in a planning meeting in Australia to develop the framework, goals and objectives for an international consortium of researchers and thought-leaders who aim to identify the big questions in stroke recovery, mobilize researchers around the world to participate in large-scale trials, and to change practice. And, Dr. Demchuk's leadership of GAINS (Global Alliance of Independent Networks focused on Stroke trials) involved CPSR in the organization's mentorship efforts, young investigator forums and meetings at international stroke conferences.
CPSR researchers continue to be seen as international leaders in the field of stroke recovery research. For example, Dr. Robert Teasell spent the final months of 2019 sharing Canadian stroke recovery research around the world.
He was the first Canadian invited to deliver the Glen E. Gresham Visiting Professorship and Lecture in Rehabilitation Science at the University of Buffalo, SUNY, where he spoke to a large audience of rehabilitation professionals and students on “Stroke Rehabilitation at a Crossroads: Where We Have Been and Where We Are Going“ and met with a number of faculty and graduate students.
He was invited by the Singapore Ministry of Health as a 'visiting expert' in integrating stroke rehabilitation across the continuum of care – from hospital to the community. At the end, Dr. Teasell produced a report on the state of stroke rehabilitation in Singapore for the Ministry of Health.
CPSR provides the tools and resources to share the latest knowledge, research, assessments,
e-learning and more to clinicians, researchers, and people living with stroke in Canada and around the world.
The CPSR-funded Evidence-based Review of Stroke Rehabilitation (www.EBRSR.com) is the world’s leading comprehensive review of the stroke rehabilitation literature, providing a comprehensive and accessible resource to facilitate evidence-based practices. Since its original publication in April 2002, EBRSR.com has undergone 18 major revisions. The 19th edition was completed in early 2020 and included all stroke rehabilitation randomized controlled trials (RCTs) published up to July 1, 2018; 273 new RCTs were added. Cumulatively, the EBRSR includes 2,172 RCTs. The 20th edition of the review is now in development.
The EBRSR has been accessed in 182 countries and receives 4,113 weekly page views. In a year time frame, the PDFs for the evidence review chapters and the clinician handbook were downloaded a total of 83,236 and 32,275 times, respectively.
CPSR also funds the popular Stroke Engine website (www.strokengine.ca) and provided additional financial support this year for a complete redesign and revamp of the site, which delivers education, assessments, evaluations, e-learning and patient education resources. The relaunch is scheduled this fall.
And, finally, CPSR worked with the Calgary Stroke Program/Alberta Health Services, and the Universite de Montreal during the COVID-19 pandemic to develop 11 English and 6 French self-management videos and corresponding resource materials to help individuals and families navigate stroke recovery topics at home. The videos are available on our website. More French-language videos are in production.
To learn more about what we do, check out our monthly newsletters (http://canadianstroke.ca/index.php/en/news/newsletter) and follow us on Twitter @HSFCSR and Facebook www.Facebook.com/CanadianStroke
CPSR is managed by a small, efficient team, headquartered in Ottawa, Toronto and Calgary, under the direction of a very engaged Board of Directors, chaired by Calgary business leader and former national Heart & Stroke Board Chair Rod McKay. CPSR directors possess skills and expertise in research, management, marketing, academia, and health care.
Scientific leadership of CPSR, under the direction of the Calgary's Dr. Sean Dukelow and Dr. Andrew Demchuk, includes the top stroke recovery researchers in Canada. From West to East:
Dr. Lara Boyd, University of British Columbia;
Dr. Elizabeth Inness, Toronto Rehabilitation Institute;
Dr. Sandra Black, Sunnybrook Health Sciences;
Dr. Jed Meltzer, Baycrest;
Dr. Diane Lagace, University of Ottawa;
Dr. Dar Dowlatshahi, Ottawa Hospital Research Institute;
Dr. Michelle Ploughman, Memorial University of Newfoundland.
The CPSR's partnership model is unique. Heart & Stroke provides support for the organization and CPSR's institutional partners invest in large-scale collaborative projects, platforms and training initiatives. Prudent stewardship of all investments means that 100% of member partner contributions are allocated to stroke recovery research, and 86% of total expenditures are directed to stroke recovery research and programs (knowledge translation, trainee programs, and our Annual Scientific Meeting). Read our audited financial statements HERE.
Putting people first
TJ Caluducan, top left, was a work-hard, play-hard 33-year-old tech executive when, without warning, he experienced a major stroke while at the office. "Six months ago, I was in a wheelchair," he told 40 CSPR trainees at the 2019 SPiN course in Toronto. "All of this adversity is a humbling experience. My story could be a Netflix movie."
"Research," he said, "allowed me to regain my independence and my mobility. I'm not quite there yet, but I'm working on it." After participating in two trials run by CPSR researchers - one focused on mobility and the other on cognition - Caluducan was able to get out of his wheelchair and start to walk. "I'm still recovering. It's an unfinished book. I look forward to new developments and research advances and I know you are going to make an impact," he told the trainees.
Ric Williams, pictured top right, was age 74 and still working as a management consultant when he suddenly couldn't move at his desk in his home office. He called his wife, she called 9-1-1 and he was rushed to Sunnybrook Hospital. "Prior to this, I was a typical male. I thought I was invincible. Nothing could happen to me." What followed was difficulty using his arm, difficulty speaking, difficulty swallowing, a feeding tube and intensive therapy at Toronto Rehabilitation Institute. He now volunteers as a patient advocate at TRI, helping researchers look at problems from the 'client perspective'. "The biggest learning for me was I used to think heroes were the Toronto Raptors or hockey players or businessmen. Now I know that heroes are people like TJ, the doctors, nurses, other health professionals, and the people who helped me to return to a more normal life."
Read our audited 2019-2020 Financial Statements
English financial statements French financial statements