The three finalists for this year's inaugural Innovation Award have been chosen, and all three presenting their innovations as part of the NZRA conference where one will be chosen as the overall winner.

Tim Young and the team from Disabled Person's Assembly submitted their 'Mahi Tika—Equity in Employment', a disabled-led employment programme for the Waitako region.

Matthew Bryson from Peke Waihanga–Artificial Limb Service submitted 'Te Pou Aropā Takitoru, a nation-wide coordinated peer support service for those adapting to limb loss.

Jo Nunnerley and her team submitted a therapeutic virtual reality tool for people who've experienced a traumatic brain injury—developed in collaboration with Laura Fergusson Brain Injury Trust, CerebralFix, University of Otago and Callaghan Innovation.

Each of the finalists will be profiled over the coming weeks, in the lead-up to the conference and will have 15 minutes to present their innovation at the conference. There are no rules for what this presentation should look like.

Finalists have been encouraged to choose a presentation approach that best conveys the innovation and helps them demonstrate that the innovation meets the award criteria.

The audience will determine the final winner of the 2021 Rehabilitation Innovation Award, judging against the award criteria. The winner will receive an additional $1000 to put toward activities of their choosing.

As a finalist, they will receive financial support of up to $1500 to attend the NZRA conference, He Mahi Tahi Tātou: Achieving Equity in Rehabilitation, 17-19 September 2021 in Rotorua. 

The following is a message from “Hidden Abilities”, which we have agreed to share on our website. However, NZRA is not involved in any aspect of Hidden Abilities, or its parent organisation SIM Ethiopia. Hidden Abilities and SIM Ethiopia do not represent NZRA. If you are interested in exploring this opportunity further, you will need to do your own research into this organisation and the terms and conditions of contributing to their work. Contact details are supplied below.

If you’ve ever wanted to use your rehabilitation skills and experience to help other countries flourish, then Ethiopia is a land of opportunity (and great coffee). 

With very few physiotherapists, particularly with any experience in paediatric therapy, and no occupational therapists or speech and language therapists, they are facing an uphill battle to support those who most desperately need the help. 

Hidden Abilities is a SIM project based in Bahir Dah, Ethiopia who provide therapy to children with physical disabilities such as cerebral palsy, spina bifida, club feet and other developmental delay. 

There is an opportunity for you to visit them on a short-term trip to upskill their staff, or share your resources or simply donate to help fund the work they do. 

In Ethiopia having a disability or a disabled child is seen as a curse from God. The shame drives many parents to hide their children in their homes, or for the father to abandon his wife and children. 

Hidden Abilities works to “help children discover and develop their ‘hidden abilities’, and to feel loved and valued for who they are”. 

Nati is one of the children they are helping flourish. While in the Neonatal Unit after a difficult birth, his parents were told that they shouldn’t waste their money as he’d probably die soon. His parents insisted that as long as he was breathing, they would do all they could for him. 

He went home after a few weeks but it wasn’t until he was about one that they noticed he didn’t stand or walk like other children and always sat with one leg bent backwards. Most medical people told them “ there’s no hope; take Nati home and feed him but he will never be able to walk”. 

But someone told them about Hidden Abilities and the family travelled over 30km to the centre where after several months Nati was able to crawl, stand and then walk. His parents dream of the day when he will be able to run and go to school like all ‘normal’ children. 

Each week they are providing free therapy twice a week for 80 children up to 18 years old. They also provide nutritional support for the poorest families and educational support for those children fortunate enough to attend school. 

They are currently in discussions with the Government training hospital about starting an Early Intervention Programme. “By treating early, we can potentially undo damage within days or weeks rather than years, which would significantly improve the quality of life of the child and their family.” 

If you’d like to know more about Hidden Abilities and the possibility to visiting them you can contact Emily Ling: emily.ling@sim.org / whatsapp: +251965179122 

Researchers from the Centre for Person Centred Research at Auckland University of Technology would like to interview:

• People and whānau experiencing age-related neurological impairment such as Stroke, Parkinson's, Mild Cognitive Impairment and Dementia.
• Health professionals who work with these people

about their experiences of living or working with age-related neurological impairment and the people and environments that help them build their personal resources for living with long term neurological impairment.

"We recognise that living with long-term neurological impairment can be challenging. We believe that things – services, people and organisations that work with people living with neurological impairment can help to build their confidence and ability to manage these challenges.

Our focus for this research is to find out what positive things services and health professionals do to contribute to a person’s ability to develop skills and confidence to thrive /manage their health condition. We are also keen to understand your impressions of why these positive things work and in which circumstances.

The interviews will be based around people reflecting on one or two critical incidents (either as health care providers or patients/clients and their whānau).

Can you tell me what happened?

What was it about this event that made it a positive experience for you?

What was the context?

What was the clinician / service doing?

How did it make you feel?

Did this incident change anything about the way that you think?

Did the incident change anything about what you do?

What was the outcome for you? "

You can view the flyer for the research here

If you are interested in participating or know of someone else who is interested, then contact Christine Cummins via email: ccummins@aut.ac.nz or visit their website https://cpcr.aut.ac.nz/

When people think about who is affected by stroke, they commonly think of older people. Yet 25-30 percent of people affected by stroke are under the age of 65, according to Stroke Foundation NZ. 

Stroke Foundation Australia’s EnableMe podcast, produced a four-part series called “Young Stroke Podcast”. 

This features people sharing their stroke stories and their recovery journey, with each episode focusing on a different aspect of rehabilitation. 

Episode one is called “I’ve had a stroke, now what?” and introduces people to the reality that stroke affects younger people and looks at the early stages after a stroke. The guests share their top tips for navigating those challenging early days and living a good life. 

Episode two explores “recovery mindset” and acknowledges that recovery means different things to different people. For most people who have experienced a stroke, the recovery is a lifelong journey rather than a destination.  

Episode three “finding the new normal” explores renewal and growth after stroke. The guests share quite openly the struggles they’ve experienced along the way, as well as the silver linings. There is an element of grief and loss with stroke, and a level of acceptance that comes, as the journey progresses. 

The final episode is especially for “parents of stroke survivors” and features Kim Beesley, whose daughter had a stroke when her and her husband were commencing a holiday on the other side of the world. She talks about what it was like in those initial months and what it’s like now, with their daughter now living at home with them. 

This podcast is well worth listening to whether you work directly with stroke patients or not. Each guest speaks from their own lived experience of stroke, and this is always a powerful position to learn from. 

Ngā Whāriki Kōrero—Kaupapa Māori Speech Language Resources

By Julianne Johns

Committed to communication as a basic human right, and recognising that stroke pathways for Māori needed improvement, speech-language therapist and Kaupapa Māori researcher Dr Karen Brewer (Whakatohea, Ngaiterangi) launched Ngā Whāriki Kōrero in July 2020 at the University of Auckland.

A few years ago, Karen undertook a Health Research Council-funded Eru Pomare post-Doctoral Research Fellowship in Māori Health. Her research aimed to develop a therapy package in collaboration with Māori whānau, speech-language therapists, Māori health researchers and health advisors.

She started listening to stories of Māori and their whānau after stroke, as well as the experiences of speech-language therapists, Māori health specialists and Stroke Foundation community advisors. Karen unpacked the complexities of designing therapy for Māori living with stroke-related communication disorders in her insightful 2016 article that NZRA profiled in January.

Ngā Whāriki Kōrero—a superb kaupapa Māori speech-language therapy package for whānau with communication difficulties caused by stroke—is the culmination of her work.

You can hear Karen talk about how to use Ngā Whāriki Kōrero in the webinar of the launch.

There are three components available to view or download in PDF format.

• The website: gathers a collection of video and written resources to help Māori who have experienced stroke to understand what has happened and what to expect. Aphasia and speech-language therapy is explained, as well as ideas as to how to rehabilitate.

• The booklet: written especially for Māori and their whānau, explains stroke, aphasia and roles of speech-language therapists and communication-based groups communication. There is a strong focus on moving forward with aphasia and ideas for enhancing recovery and ways whānau can help.

• The interactive resource utilising Talking Mats: Talking Mats is a therapy package with communication symbols depicting topics with response options and a scale placed in a way that explores feelings and opinions. Karen consulted with Māori advisers to adapt Talking Mats for the needs of Māori users.

Used together, Ngā Whāriki Kōrero helps speech-language therapists and other communication partners to build successful relationships. It also allows for them to hear about what is important for a person with aphasia and their whānau, as they develop a rehabilitation plan.

Karen sees the usefulness of this resource trending to events with big impact and slow recovery. This means the resource may transfer to other situations in which communication access could be better supported for Māori, such as to traumatic brain injury, chronic illness, dementia and spinal cord injury.

While Ngā Whāriki Kōrero was designed with speech-language therapists and Māori clients in mind, we see its scope expanding to improve communication for other allied health and medical professionals working in rehabilitation. We also love its possibilities for advancing tiro rangatiratanga and mātauranga Māori in health research—building empowerment and inclusion in research design, and participation for Māori whānau experiencing communication disorders or access barriers.

Karen is the guest speaker for Burwood Academy’s March Peer Group meeting on 11 March at 12:00pm. This will be an online presentation. For more information, please email admin@burwood.org.nz. They will provide you with the link to the online meeting.

Karen has generously distributed hard copy resources across Aotearoa to each of the District Health Board speech-language therapy departments, in numbers correlating with the proportion of Māori in that area. If you would like a set for your workplace, Karen may provide copies (on receipt of an addressed courier bag). You can contact her here. Alternatively, you can download the PDFs.

Nga mihi, Dr Karen Brewer and your research team.

Intersection of the Elements of Evidence-Based Practice in Interdisciplinary Stroke Rehabilitation: A Qualitative Study 

Authors: Catherine Vingerhoets, Jean Hay-Smith, Fiona Graham 

Within the health sector evidence-based practice (EBP) is “a foundational approach to clinical decision-making that integrates scientific research; clinical expertise; and patient preferences, values and circumstances.” 

The authors of this study, published in the latest edition of the New Zealand Journal of Physiotherapy, set out to explore how these three elements of EBP intersected in care planning within an interdisciplinary stroke rehabilitation team based in a Canadian hospital. 

The principal investigator (responsible for the recruitment, data collection and analysis) observed a ‘rehabilitation round’ where the allied health team, along with the patient’s primary nurse, met with each patient in their room to discuss care plans and set goals. 

Immediately after the rehabilitation round, the principal investigator facilitated a focus group where the rehabilitation team were asked four key questions: 

1. How do you value each of the three elements of EBP? 

1. How does the team utilise EBP for decision-making? 

1. Is there one element of EBP that is most influential during care planning? 

1. What contributes to an unequal weighting of EBP elements? 

“Patient preferences were at the forefront of discussion, and clinicians continually came back to the patient as the primary influence on care planning and team-patient negotiation.” 

Each element of EBP was evident, however “the patient was the dominant influence in decision-making.” 

The study looks at the primacy of patient-centeredness, patient-directed goals, being patient-specific as well as EBP as a fluid process, and the collaborative aspects of both within the team, patient-clinician, and professional. 

Barriers to “accessing and utilising research evidence” were identified but clinicians were more concerned with “limitations to providing patient-centred care than adherence to research-informed treatment”. 

Each patient brings their own needs, circumstances and preferences to the situation and they have the greatest influence on the clinicians. In order to deliver care that fully incorporates all three elements of EBP, a wholly collaborative approach is essential. 

You can read the full article here. 

More detail about the paper can be found here: 

For more information, contact Gwyn Lewis: gwyn.lewis@aut.ac.nz

 

Author Jim Kwik says "learning is not a spectator sport". It's not too late to get in the learning game for 2021.

The University of Otago has some great study options for Semester One.

Intellectual Disability: Theory into Practice (NURS433 / PSME439) University of Otago, Christchurch

The aim of this Interprofessional paper is to develop your knowledge base, practical and clinical skills as a practitioner working in this specialist field, and in working alongside people with intellectual (learning) disability.

The content is underpinned by evidence-based practice and current philosophy grounded on changing models of disability. Links are made between physical and mental well-being, sociological, pharmacological, behavioural, Interprofessional and ethical approaches across the lifespan.

An information flyer for the course is available here.

Contact Henrietta Trip (Convenor) henrietta.trip@otago.ac.nz

Rehabilitation Principles (REHB701)                                               Rehabilitation Teaching and Research Unit, University of Otago, Wellington

This paper will provide you with a broad framework for understanding rehabilitation practice. You will finish the paper with a strong foundation in rehabilitation theory, disability classification, rehabilitation processes (including goal setting), collaborative practices, and the fundamentals of the business of rehabilitation.

You will also be provided with tools to critique your own rehabilitation practice (if appropriate) and you will be supported to develop rehabilitation service innovations ideas.

Watch: Rachelle Martin (course coordinator) talks about what you might expect from this paper.

Contact Libby McGuire (rtru@otago.ac.nz) to find out more.

Rehabilitation for the Older Adult (REHB707)                             Rehabilitation Teaching and Research Unit, University of Otago, Wellington

This paper emphasises rehabilitation and management of conditions that cause impairment and activity limitation in older adults such as falls and cognitive impairment.

The paper also deals with the broad context of rehabilitation of older adults including a range of common conditions and multiple co-morbidities; and the context of ageing in New Zealand.

More course information can be found here.

Contact Libby McGuire (rtru@otago.ac.nz) to find out more.

Personal and Psychological Factors in Rehabilitation (REHB714)    Rehabilitation Teaching and Research Unit, University of Otago, Wellington

An enquiry into personal and psychological factors that influence outcomes in rehabilitation and long-term conditions. Identification of risk and protective factors in rehabilitation.

In this paper students will examine psychological factors influencing rehabilitation by considering the "Personal Factors" component of the World Health Organization's International Classification of Functioning Scheme. The paper aims to enhance students' understanding of the broader contextual aspects of rehabilitation.

More course information can be found here.

Contact Libby McGuire (rtru@otago.ac.nz) to find out more.

IMAGE: "learn" by Mark Brannan is licensed with CC BY-NC-SA 2.0. 

Implementation of Telerehabilitation in Response to COVID-19: Lessons Learnt from Neurorehabilitation Clinical Practice and Education. 

Authors: Nada Signal, Tara Martin, Adam Leys, Rebecca Maloney, Felicity Bright. 

Telerehabilitation enables rehabilitation to be delivered across distance using information and communication technologies such as phone, text message, email, web-based resources, videoconferencing, rehabilitation devices and wearable technologies.

  

While it has been in use for some time, COVID-19 and the necessary restrictions put in place, accelerated its inclusion for many health professionals. 

The effectiveness and use of telehealth in New Zealand in response to COVID-19 has been examined and published in the latest edition of the New Zealand Journal of Physiotherapy. 

“Despite research evidence indicating that telerehabilitation is as effective as in-person rehabilitation for people with neurological conditions, there were significant challenges in delivering and sustaining telerehabilitation practice.” 

Beginning with the benefits of telerehabilitation compared to in-person rehabilitation, the authors then looked at the ways district health boards and healthcare professionals established and maintained effective telerehabilitation services, as the country moved through the various stages of lockdown. 

“Further work is required to identify what types of interventions are best delivered using telerehabilitation, when and how they are best delivered, for whom it is most appropriate, and how telerehabilitation approaches can effectively be integrated with in-person rehabilitation.” 

The consequences of the COVID-19 lockdowns for inpatient rehabilitation providers have been captured by the researchers, including the ways in which care was provided during this time. 

The lessons learnt cover organisational readiness, patient setup, translating communication and relational skills and clinical skills to the digital space, assessment, treatment, and professional development. 

Some of the benefits of telerehabilitation may challenge physiotherapists and other health professionals' expectations and current practice, while at the same time providing a greater sense of empowerment and engagement for the patient and their whānau. 

“It is now critical to build on the experiences and investments to date, and the skills that therapists have developed, and to embed telerehabilitation in everyday neurorehabilitation so that patients, therapists and services alike can fully benefit from the opportunities that telerehabilitation opens up.” 

It is not a case of either in-person or telerehabilitation are best practice for neurorehabilitation but “both/and”. 

You can read the full article online here. 

Author: Julianne Johns

“Given the effect of communication disorders on family and social life and the connection between language and culture, it is likely that stroke-related communication disorders are culturally determined."

Speech language therapist and researcher, Dr Karen Brewer (Whakatōhea, Ngaiterangi), launched Ngā Whāriki Kōrero in July 2020 at the University of Auckland.

This is a fantastic kaupapa Māori speech language therapy package for whānau with communication difficulties caused by stroke. The outcome of Karen’s HRC-funded post-doctoral research, these resources began with the many hours Karen spent hearing the stories of Māori and their whānau after stroke. She went on to listen to the experiences of speech language therapists, Māori health specialists and Stroke Foundation community advisors.

Though developed with the work of speech language therapists in mind, both Ngā Whāriki Kōrero and the learning behind, it has great potential to amplify mātauranga Māori and support the work of rehabilitation providers and researchers—anyone involved as communication partners of Māori with a range of communication disorders.

"The therapy must not sit solely with the discipline of speech-language therapy but facilitate working across disciplines to benefit whānau. “

We will profile Ngā Whāriki Kōrero in an upcoming blog, but first some background.

As she began her work, Karen quickly recognised that a Māori therapy resource without reference to the social political, historical and economic context in which it is delivered, would not meet the needs of whānau or improve therapy outcomes.

In her 2016 article, The complexities of designing therapy for Māori living with stroke-related communication disorders, Karen draws on He Korowai Oranga: Māori Health Strategy and Whānau Ora guidelines, as well as kaupapa Māori theory to shine a light on challenges and pathways for therapists in Aotearoa New Zealand when designing and providing kaupapa Māori therapy—therapy designed by Māori for Māori and undertaken in a Māori way—for stroke related communication disorders.

She reminds us, “The creation of a kaupapa Māori speech language therapy approach should bring together people with stroke, whānau members and service providers to create therapy that crosses sectors and disciplines and acknowledges the wider social and political context.”

Health related quality of life, family, relationships, return to work, depression and social participation and leisure are all vulnerable to stroke-related communication disorders. The impact of these disorders on life participation is influenced by cultural, social, economic and political factors. Māori have particular, often negative, experiences of these factors in relation to tino rangatiratanga and are likely, therefore, to have unique experiences of stroke-related communication disorders and associated therapy needs.

Considering that most therapy services are delivered in the context of the New Zealand public health system, Karen proposes an approach in which non-Māori speech language therapists develop cultural safety and clinical skills, before providing kaupapa Māori resources.

This hierarchy of skill and resource acquisition is framed as a poutama, a stepped pattern. Moving from rung-to-rung therapists learn how to master each, before moving to the next.

Poutama (ladder) How to master each rung.

1 Learn why be culturally safe

2. Learn how to be culturally safe

3. Learn how to interact

4. Develop resources to build relationships

5. Resources for Education

6. Resources for treatment

Karen went on to develop Ngā Whāriki Kōrero, a beautiful Māori speech language therapy package for whānau with communication difficulties caused by stroke. This resource package supports clinicians to step along the first three rungs via online professional development modules then employ a website collection of video and written resources, an information and support booklet and an interactive therapy resource.

Ref: Reference Brewer, K et al (2016) The complexities of designing therapy for Māori living with stroke related communication disorders; NZMJ, 129 (1435)75-82