2023 Sylvia Docker lecture: Ignite your passion, and connect, to make a difference

Together, we grow our profession of occupational therapy as we engage in understanding and addressing the issues that challenge the people we work with. In this Sylvia Docker Lecture, I will share the collective journeys of myself and other occupational therapists and health professionals who have undertaken (or are currently undertaking) their PhDs and are actively involved in research, to address these challenges. Together, we will explore three themes: understanding the WHY that ignites one's passion; living the journey-the EXPERIENCE; and making a difference-the IMPACT. Stories will be told through the lived experience of those engaged in research as currently enrolled PhD students, emerging researchers, and experienced researchers. These stories will capture the lived experience across individuals, and at different times in the research journey. Stories are summarised and captured using natural language processing. Topics are identified, concept maps visualised, and outputs interpreted in context of related theoretical models. Key topics identified include: the clinical and personal motivators that have ignited the passion in individuals; the value of connecting with others and growing networks; and how one's research has made a difference. The impact of discoveries and outcomes are highlighted, together with the importance of people and networks. Analysis of connections and synthesis over time revealed frequent and strong connections across themes, concepts and topics; with synthesising concepts of passion, networks, knowledge translation, opportunities, supervision and communication emerging and being shaped over time. These collective journeys provide inspiration and pathways to creative careers that have future potential in the growth of the profession of occupational therapy. It is recommended that each occupational therapist take the time to reflect on the 'why' that ignites your passion, your journey and how you can make a difference!

The Effects of Four Weeks of Chiropractic Spinal Adjustments on Blood Biomarkers in Adults with Chronic Stroke: Secondary Outcomes of a Randomized Controlled Trial

Certain blood biomarkers are associated with neural protection and neural plasticity in healthy people and individuals with prior brain injury. To date, no studies have evaluated the effects chiropractic care on serum brain-derived neurotrophic factor (BDNF), insulin-like growth factor-II (IGF-II) and glial cell-derived neurotrophic factor (GDNF) in people with stroke. This manuscript reports pre-specified, exploratory, secondary outcomes from a previously completed parallel group randomized controlled trial. We evaluated differences between four weeks of chiropractic spinal adjustments combined with the usual physical therapy (chiro + PT) and sham chiropractic with physical therapy (sham + PT) on resting serum BDNF, IGF-II and GDNF in 63 adults with chronic stroke. Blood samples were assessed at baseline, four weeks (post-intervention), and eight weeks (follow-up). Data were analyzed using a linear multivariate mixed effects model. Within both groups there was a significant decrease in the mean log-concentration of BDNF and IGF-II at each follow-up, and significant increase log-concentration of GDNF at eight-weeks' follow-up. However, no significant between-group differences in any of the blood biomarkers at each time-point were found. Further research is required to explore which factors influence changes in serum BDNF, IGF-II and GDNF following chiropractic spinal adjustments and physical therapy.

Motor Learning, Neuroplasticity, and Strength and Skill Training: Moving From Compensation to Retraining in Behavioral Management of Dysphagia

Purpose Learning a motor skill and regaining a motor skill after it is lost are key tenets to the field of speech-language pathology. Motor learning and relearning have many theoretical underpinnings that serve as a foundation for our clinical practice. This review article applies selective motor learning theories and principles to feeding and swallowing across the life span. Conclusion In reviewing these theoretical fundamentals, clinical exemplars surrounding the roles of strength, skill, experience, compensation, and retraining, and their influence on motor learning and plasticity in regard to swallowing/feeding skills throughout the life span are discussed.

Finding the Intersection of Neuroplasticity, Stroke Recovery, and Learning: Scope and Contributions to Stroke Rehabilitation

Aim

Neural plastic changes are experience and learning dependent, yet exploiting this knowledge to enhance clinical outcomes after stroke is in its infancy. Our aim was to search the available evidence for the core concepts of neuroplasticity, stroke recovery, and learning; identify links between these concepts; and identify and review the themes that best characterise the intersection of these three concepts.

Methods

We developed a novel approach to identify the common research topics among the three areas: neuroplasticity, stroke recovery, and learning. A concept map was created a priori, and separate searches were conducted for each concept. The methodology involved three main phases: data collection and filtering, development of a clinical vocabulary, and the development of an automatic clinical text processing engine to aid the process and identify the unique and common topics. The common themes from the intersection of the three concepts were identified. These were then reviewed, with particular reference to the top 30 articles identified as intersecting these concepts.

Results

The search of the three concepts separately yielded 405,636 publications. Publications were filtered to include only human studies, generating 263,751 publications related to the concepts of neuroplasticity (n = 6,498), stroke recovery (n = 79,060), and learning (n = 178,193). A cluster concept map (network graph) was generated from the results; indicating the concept nodes, strength of link between nodes, and the intersection between all three concepts. We identified 23 common themes (topics) and the top 30 articles that best represent the intersecting themes. A time-linked pattern emerged.

Discussion and Conclusions

Our novel approach developed for this review allowed the identification of the common themes/topics that intersect the concepts of neuroplasticity, stroke recovery, and learning. These may be synthesised to advance a neuroscience-informed approach to stroke rehabilitation. We also identified gaps in available literature using this approach. These may help guide future targeted research.

Functional Neuroimaging in Stroke Recovery and Neurorehabilitation: Conceptual Issues and Perspectives

Background

In stroke, functional neuroimaging has become a potent diagnostic tool; opened new insights into the pathophysiology of ischaemic damage in the human brain; and made possible the assessment of functional–structural relationships in postlesion recovery.

Summary of review

Here, we give a critical account on the potential and limitation of functional neuroimaging and discuss concepts related to the use of neuroimaging for exploring the neurobiological and neuroanatomical mechanisms of poststroke recovery and neurorehabilitation. We identify and provide evidence for five hypotheses that functional neuroimaging can provide new insights into: adaptation occurs at the level of functional brain systems; the brain–behaviour relationship varies with recovery and over time; functional neuroimaging can improve our ability to predict recovery and select individuals for rehabilitation; mechanisms of recovery reflect different pathophysiological phases; and brain adaptation may be modulated by experience and specific rehabilitation. The significance and application of this new evidence is discussed, and recommendations made for investigations in the field.

Conclusion

Functional neuroimaging is an important tool to explore the mechanisms underlying brain plasticity and, thereby, to guide clinical research in neurorehabilitation.

Beyond the lesion: neuroimaging foundations for post-stroke recovery

A shift is emerging in the way in which we view post-stroke recovery. This shift, supported by evidence from neuroimaging studies, encourages us to look beyond the lesion and to identify viable brain networks with capacity for plasticity. In this article, the authors review current advances in neuroimaging techniques and the new insights that they have contributed. The ability to quantify salvageable tissue, evidence of changes in remote networks, changes of functional and structural connectivity, and alterations in cortical thickness are reviewed in the context of their impact on post-stroke recovery. The value of monitoring spared structural connections and functional connectivity of brain networks within and across hemispheres is highlighted.

SENSe: Study of the Effectiveness of Neurorehabilitation on Sensation: a randomized controlled trial

BACKGROUND

Sensory loss is common after stroke, with negative impact on exploration of the immediate environment, hand function, and return to daily activities.

OBJECTIVE

To compare the effectiveness of a perceptual-learning based sensory discrimination program versus non-specific exposure to sensory stimuli via passive movements and grasping of common objects.

METHODS

The authors conducted a randomized parallel-group controlled trial, with blinding of subjects, clinical assessors, and data analysts. Fifty subjects with impaired texture discrimination, limb position sense, and/or tactile object recognition (>6 weeks, median 48 weeks poststroke) were randomized to receive somatosensory discrimination training (n = 25) or repeated exposure to sensory stimuli (n = 25) in 60-minute sessions for a total of 10 hours. The primary outcome was change in a composite standardized somatosensory deficit (SSD) index following intervention. Follow-up was at 6 weeks and 6 months posttraining.

RESULTS

Between-group comparisons revealed a significantly greater improvement in sensory capacity following sensory discrimination training, t(47) = 2.75, P = .004, 1-tailed; mean between-group change = 11.1 SSD; confidence interval 3.0 to 19.2. Improvements were maintained at 6 weeks and 6 months.

CONCLUSION

Sensory discrimination training can achieve significant improvements in functional sensory discrimination capacity after stroke. The clinically oriented training achieved transfer of training effects to novel stimuli. Our findings provide support for introducing SENSe discrimination training in rehabilitation of sensory deficits after stroke.