WA News Feature Articles Communicating after Stroke
Communicating after Stroke
Written by Jan Hallam
Wednesday, 06 December 2017

When Medical Forum spoke to speech pathologist and clinical director of the Very Early aphasia Rehabilitation after StrokE (VERSE) trial, ECU’s A/Prof Erin Godecke, there were only 26 participants left in the three-year study.
VERSE is seeking to establish if speech rehabilitation begun within 15 days of a stroke occurring and continued over four weeks improves communication outcomes for those diagnosed with moderate to severe aphasia.
201712-Godecke-Erin-AProf Aug17A/Prof Erin Godecke“We wanted to test if rehabilitation started this early makes use of the high levels of proteins which occur in the brain as part of its natural recovery after stroke. In rat models and human motor models we have seen benefit starting treatment within that timeframe but there is nothing in aphasia that mimics that.”
“In that early recovery stage, we are focusing on harnessing successful communications via a hierarchy of strategies without practising errors. There is a strong principle in neuroplasticity that if you want something done the right way on the right pathway, that pathway needs to be strengthened – and that’s true for motor, speech or action.”

Difference detected

“The data has not been analysed yet but our VERSE therapists and usual care therapists are anecdotally reporting a strong belief that early intervention works.”
“The jury is still out on that but their response is that those people on VERSE trial are different. We just can’t work out how they are different yet. I hope we will start to see that difference manifested in people’s everyday communication.”
The research is funded by the NHMRC and the Tavistock Trust for Aphasia in the UK and is a collaboration of clinicians from ECU, UTS, St Vincent’s Health Australia, Curtin University, La Trobe University, University of Arizona, the Florey Institute, UWA and Monash University at 16 acute care sites in Australia and New Zealand.
The VERSE project aims to determine:
•    The optimal amount and type of aphasia intervention
•    The relationship between early aphasia therapy and depression
•    The effect of early, intensive aphasia therapy and quality of life at six months after recovery
•    The cost-effectiveness of aphasia therapy in the long term.
The research could lead to the development of the first prescribed therapy package for people with aphasia following stroke.
“VERSE is exploring the relationship between aphasia and stroke brain recovery patterns by using a novel ‘brain mapping’ technique to help identify people who will respond well to early, intensive treatment,” Erin said.
In the November issue we examine the role of telehealth in the delivery of stroke care in rural and remote areas where it is starting to bridge some gaps, not only in acute care but also rehabilitation. But there is still a lot of work to be done before there’s treatment equity in the regions.
Erin said telehealth was extremely useful for some therapeutic interventions and didn’t require very hi-tech solutions.

Tech beats distance

“Rehab therapy can be delivered over Skype or Zoom using the person’s own device. It’s more approachable for the person in recovery and less expensive in terms of what it needs to drive it but satisfactory for outcomes.”
“Speech and language therapy lends itself beautifully to telehealth and is proving to be a boon for people who might otherwise struggle to access interventions.”
Research in the UK was showing how virtual reality technology was helping to break down the isolation people with aphasia often felt. With impaired mobility, communication difficulties and in some cases geographical remoteness, a physical support group may not be easy to access. EVA Park is a virtual meeting space that gives participants a chance to meet each other and practise speaking with support staff input.
“People-to-people contact is a vital element in rehabilitation and sometimes that’s overlooked by clinicians but often it’s what people who are in trouble want. Communication with partners, family and friends is frequently the No.1 priority of people whose speech has been affected by stroke,” she said.
“Programs like this are really motivating for people with aphasia. It shows them that they can communicate successfully and use skills developed in recovery and rehab in their lives … that’s the stuff I’m really passionate about.”

 

While communication is one thing, investigation of notifications is another. We believe good doctors want the bad ones weeded out but they don’t want to be part of a witch hunt or get buried in lawyers, politics or paperwork.

The national Medical Board can respond to a complaint or act on the advice of the WA Medical Board to establish an assessment panel to either examine the health or performance and professional standards of a doctor. Health consumers are represented on panels along with medical practitioners.

The Medical Board and AHPRA have undisclosed lists of doctors who are approved by them as panellists and probably as expert witnesses. Many of these people, we believe, were ‘grandfathered’ across when National Law first came in (2010). Their impartiality is as unknown as they are. Then we have expected biases of the legal assessors, chosen by AHPRA, possibly thrown into the mix.

Is there a problem, Houston?

It is important this is sorted to everyone’s satisfaction as 42% of doctors in our survey thought panellists could lack impartiality to a serious extent.

In fact, only one quarter of doctors we surveyed (n=195) were happy with the impartiality shown by AHPRA or the Medical Board in processing a complaint (with 36% unhappy and 39% undecided). Nearly all of those who were unhappy said they were concerned that unfairness will be seriously damaging to someone. Investigation is a very confronting experience.

If someone is being investigated by a panel, either the panel or the person being investigated can opt for a more out-in-the-open State Administrative Tribunal (SAT) judicial hearing – the panel usually refers because it feels the evidence before it constitutes more serious professional misconduct.

What Fair Doctors Want

Talking to doctors, they appear to want an apolitical system of investigation that is fair and timely. They want to be treated reasonably. Unlike the legal profession, their work is mostly built around trust and honesty. They do not want a return to the ‘good old days’ where those with a political bent in the medical profession could influence what the Medical Board did.

While this is a very difficult area for us to investigate, with arguments and counter-arguments at every step, we cannot understand why the Medical Board would turn to arguably the most political organisation, the AMA, for its counsel (the national Board Chair met earlier this year with “senior leaders from AHPRA and representatives of the AMA” to workshop doctor complaints).

Why? Our e-Poll responses raise a question mark over the AMA’s involvement (and we don’t think AMA members have been polled on this issue.)

Normal 0 false false false EN-AU X-NONE X-NONE