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ACPIN-INPA INTERNATIONAL NEUROPHYSIOTHERAPY CONFERENCE

17th-18th March 2016 • QE2 Centre London UK

Lecture abstractsSpeaker details

Programme

Delegate list

ACPIN–INPA INTERNATIONAL CONFERENCE 2016

Our thanks to our main sponsors of the

ACPIN–INPA International conference 2016

Evidence into practice

EVIDENCE INTO PRACTICE


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Day 1 programme

TIME FLEMING ROOM WESTMINSTER ROOM

JAMES ROOM WHITTLE ROOMPLATFORM PRESENTATIONS

BRITTEN ROOMEXHIBITION SPACE

8.00am Registration and exhibition opens

9.00am – 9.50am

ACPIN AGM 2016

10.00am – 10.20am

Dr Emma StokesThe importance of international neuro physiotherapy collaboration – a view point from WCPT

10.30am – 11.20am

KEYNOTE ADDRESSProf Derick WadeHow to use evidence, follow guidelines, and be patient-centred all at the same time

11.30am – 12.20pm

Prof Sheila LennonGroup circuit training for balance, mobility and falls prevention in MS: implications for practice

Prof Louise Ada“One size does not fit all” concept in mobility intervention for stroke

P14 Gary MorrisP17 Stephen AshfordP60 Benjamin EllisP62 Anna DanielssonP32 Kate Lee

12.30pm – 1.20pm

Prof Gert KwakkelUnderstanding upper limb recovery early post stroke: Some lessons of the EXPLICIT-stroke programme

Dr Rhoda AllisonConsultant and advanced practice roles in neurology: including bed based responsibilities, injection therapy and prescribing

P61 Doncha LaneFP8 Pawel Kiper

Khymeia VRRS Virtual Reality Rehabilitation System Remote rehabilitation effectiveness and clinical evidence” Dr Andrea Turolla

1.30pm – 2.15pm

Lunch Ekso GT Implementing robotic neurorehabilitation into modern practice Barry Richards Ekso Bionics Clinical Director Europe

2.15pm – 2.25pm

Baroness Finlay of LlandaffLunchtime address

2.30pm – 3.20pm

Prof Sarah TysonPatient-led therapy during in-patient stroke rehabilitation

Prof Monica BusseShould we be exercising for brain health? With a specific focus on Huntington’s disease

P3 Corali SearyP68 Matthew Dale

Odstock FES – from research to clinical practice Professor Ian Swain

3.30pm – 3.50pm

Coffee Later Life (Evidence based) Exercise and fitness after stroke; STARTER, a longer term solution for your stroke patients? Bex Townley

4.10pm – 4.50pm

Prof Steve WolfCollaborative decision making and development of best evidence apps

Dr Stephen AshfordEvidence for goal setting, attainment and integration of physical and pharmacological intervention for spasticity management’

P30 Isa Usman LawalFP10 Martine Nadler

Bioness FES – trials and tribulations Matthew Dale and Alex Cheyne

5.10pm – 5.50pm

Prof Fiona JonesIt’s all about the small steps: sharing and creating solutions for successful self-management after traumatic brain injury

Dr Elisa PelosinFalls, gait and balance in Parkinson’s disease: New prospective for rehabilitation

P27 Rose GalvinFP3 Praveen Kumar

Saeboflex Why do so few stroke survivors recover upper limb function?’ Prof Sarah Tyson

6.00pm Close for the day and next day information

6.15pm onwards

Drinks reception and awards presentation


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Day 2 programme

FLEMING ROOM WESTMINSTER ROOM

JAMES ROOM WHITTLE ROOMPLATFORM PRESENTATIONS

BRITTEN ROOMEXHIBITION SPACE

TIME

Registration and exhibition opens 8.00am

Prof Dario FarinaClosing the loop in neurorehabilitation – how to induce plasticity by closed-loop interaction

Dr Olumide DadaNeurophysiotherapy in Nigeria: an overview of neurophysiotherapy service models, how current evidence is used in supporting treatment models and the challenges therein

Prof Valerie PomeroyGenerating the evidence base for personalised stroke rehabilitation

Odstock FES – from research to clinical practice Professor Ian Swain

Later Life (Evidence based) Exercise and fitness after stroke; STARTER, a longer term solution for your stroke patients? Bex Townley

9.00am – 9.40am

Coffee break 10.00am – 10.20am

Prof Jan MehrholzElectromechanical-assisted training for upper and lower limbs after stroke

Prof Lisa HarveySpinal cord injuries: recent trials and their relevance to other areas of neurology

Mr Peter SkeltonHandicap International training programme for physiotherapists on humanitarian missions

P29 Carlo BertoncelliP13 Rhiannon StokesP70 Katherine JacksonFP15 Gita RamdharryP23 Rachel Young

10.30am – 11.20am

Prof Robert van DeursenExploration of clinical-academic collaboration to achieve evidence based practice

Prof Janice EngWearable sensors to challenge arm and hand use after stroke

P31 Antoine ZaczykP58 Tine KovacicP11 Marielle Graziano

11.30am – 12.20pm

Prof Birgitta LanghammerExercise and training after stroke: maintaining capacity and ability

Prof Mindy LevinVirtual reality technologies for upper limb motor learning and recovery in rehabilitation

P66 Gemma MoselyP43 Adine Adonis

Ekso GT Implementing robotic neurorehabilitation into modern practice Barry Richards Ekso Bionics Clinical Director Europe

12.30pm – 1.20pm

Prof Karen MiddletonLunchtime address

1.15pm – 1.30pm

Lunch Bioness FES – trials and tribulations Matthew Dale and Alex Cheyne

Khymeia VRRS Virtual Reality Rehabilitation System Remote rehabilitation effectiveness and clinical evidence” Dr Andrea Turolla

1.30pm – 2.20pm

Prof Helen DawesWalking and simulated walking control

Prof Jonathan MarsdenHereditary spastic paraparesis: pathophysiology and rehabilitation

FP7 Louise HawkinsP33 Cheryl Anderson

Saeboflex Why do so few stroke survivors recover upper limb function?’ Prof Sarah Tyson

2.30pm – 3.20pm

Coffee 3.30pm – 3.50pm

Mr Alex MasseyService users review

4.00pm – 4.20pm

Prof Derick WadeRound up and closing of conference

4.30pm – 5.00pm


Delegates and conference speakersSPEAKERS

Prof Louise AdaDr Rhoda AllisonDr Stephen AsfordProf Monica BusseDr Olumide DadaProf Helen DawesProf Robert van DeursenProf Janice EngProf Dario FarinaBaroness Finlay of LlandaffProf Lisa HarveyProf Fiona JonesProf Gert KwakkelProf Birgitta LanghammerProf Shiela LennonProf Mindy LevinProf Jonathan MarsdenProf Jan MehrholzProf Karen MiddletonDr Elisa PelosinProf Valerie PomeroyMr Peter SkeltonDr Emma StokesProf Sarah TysonProf Derick WadeProf Steve Wolf

ACPIN EXECUTIVE COMMITTEE

President Dr Fiona Jones

Honorary Chair Jakko Brouwers

Vice Chair Adine Adonis

Honorary Treasurer Chris Manning

Honorary Secretary Dr Gita Ramdharry

Honorary Research Officer Jane Petty

Honorary Membership Secretary Lorraine Azam

Honorary Minutes Secretary Fran Brander

Synapse Coordinator Joe Buttell

iCSP Link & Move for Health Champion Chris Manning

INPA link Ralph Hammond

Committee members Nikki GuckLisa BunnMelanie Falk

DELEGATES

AMary AbbottAlice AbedCarl AdamsNicola AdamsNicola AlexanderJoanna AllenMargit Alt MurphyCheryl AndersonJuliet AndersonSofi AnderssonGudbjorg Thora AndresdottirCaroline AppelNadia ApplegateVictoria Atherton

BSheila BaconPamela BaileyBrigitt BaileyHelen BallKaren BakerMary BanksJennifer BarrassStephen BassVicky BassettRachel BaynesHannah BedfordAmy BelisarioJane BellisarioMelissa BenyonNorah BessantSarah BillingsBelinda BilneySimone BirnbaumKaren BlagojevicLois BloomfieldLaura BochkoltzMojca BoläinaDebbie BostelmannAudrey BramfordSarah BrogdenRenee BrouwersPenny BrownKerian BuckKate BullPenny BulleyAndrea BurnsKate BusbyEva-Lena BustrãnEleanor ButlerLisa ButlerClaire Butterworth

CAnita CahalinKate CaldwellMegan CampbellLorna CampbellSarah CandyPhilip CassonJane CastHema ChhimaGeorgie ChiversTeresa ClarkKatherine ClarkeKim ClarkeHelen ClarkeEleanor ClarkeKirsty CochraneAnna ColbearLouise ConnellJudith ConstantVictoria ConwayClaire CookEmma CookGemma CookRebecca CookeSophie CookeSusan CooteSusannah CorbettEmma CorkRosie CoshStephen CoxSarah CraisterMary CrampJames CreakJacqueline CrosbieHelen CuttingKen Cutting

DGry Cecilie DalbyIrina DaleAnna DanielssonSally DavenportElizabeth DaviesAnna DavisHayley DavisKatherine DaySally de la FontaineGill Dean LofthouseLuschka DearleAnthea DendyAmy Dennis-JonesAmanda DentonSarah DixonEleanor DohertyIan DolbyColin DomailleNicola DoranCharlie Dorer

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Elizabeth DorwardMichael DouglasLaura DouglasMary DowningClaire DownsAisling DoyleVicky DraperDiana DrawbridgeBethan DrinkallSamantha DuncanBecky DuncanAlexandra DunthorneRebecca Dytor

EEmma EasonSusan EdwardsBen EllisNicola EllisPenny EscreetKaren EvansSarah Eversfield

FAnnys FairweatherShauna FalknerSalu FellowsRhiannon Ferguson-ThomasJudith FewingsRadoslaw FilipczukJill FisherElizabeth FixterRhodora FontillasMadeleine FormoyHanne Ludt FossmoSuzanne Fulner

GRose GalvinÃris Rut GarãarsdãttirEmma GarrattHelen GaskellGary GeorgeAngela GibbonSarah GibsonAndrew GillespieLiz GilliganJan GloverKate GoddardGail GoldingAlison Gomes da SilvaBethanie GoodfellowSam GoodwinTerry GorstSusanna GradyPippa GrahamMaria Elena Graziano

Natasha GreenHayley Grice Adele GriffithsRenee GroeneveltRamakrishna GundapudiHilary Gunn

HEiriksina HafsteinsdottirAnnegret HagenbergVictoria HallClare HallAnna HamerLinda HammettShirley HandelzaltsSteinunn Ylfa HarãardãttirRebecca HargreavesHeather HarleyGerry HarlowKirsten HartJames HartLouisa HaswellLouise HawkinsRachel HaydenRachel HaydenMiriam HayesDavid HegartyLaura HendersonSarah HerringBernita HexterDebbie HillClaire Hill-CcottinghamHelen HillelSophie HiltonHelen HobbsSam HollidayEirinn HoplandJanet HornbyGeorgina HughesKaren HullLynn HurstFiona HurstHelen Hutton

INoit InbarJude Isaac

JClare JacksonBeverley JacksonJo JacksonClaire JenkinsLouise JohnsonSue JonesRebecca JonesDiana JonesVicky Joshi

KAllison KandiahJayne KennieLouise KenworthyAnbreen KhanCherry KilbrideNicola KingHayley KingLeanne KinderPawel KiperDawn KnibbsTine KovacicAgnieszka KubalicaDr Praveen KumarSuneel Kumar

LIsabelle LabonteIsabelle LabonteKate LancasterDonncha LaneKaren LeciJosie LedbetterCatherine LeeRachel LeighLin LeongJulia LewisCameron LindsayLiz LivingstoneNicola LorenaHannah LouissaintNathalie LucasZoe LundieCamilla LundquistAllison LuscombeMichael Luther

MSusie MacAllisterMichelle MacdonaldKaty MacswineyMargret MagnysdottirManuela MaieronSophie MakowerErica MalcolmKenth MalmstromSophie MasCharlotte MasseyTabitha MathersCaroline MatthewNicola MaultHelen MayAnne McAuliffeRebecca McCrackenKaren McGillicuddyJudith McLainPhil MeakinSarah Meharg

Dara MeldrumBethany MellorLuciana MeredithSusanna MezzarobbaLeah MigdalSamantha MigginsLesley MillAilsa MillerSarah MindhamPriti MistryAidan MitchellStephanie MockJoanna MooreDanielle MorbyDavina MorganKelly MorrisErica MorrisonGemma MoseleyKate MossRocio Muina LopezJo MulvinAnna Maria Muntz TorresCathrine Klykken Mwanyolo

NMartine NadlerSharon NewmanAnna van NiekerkClare NicolLouise NicholsGlenn NielsenSinead Noonan

OElizabeth O’ SullivanShirley Jean OakeyDeborah O’ConnorHadas OfekMaria O’HaraIda Braga OmarsdottirArve OpheimFiona O’ReillyVicky OscroftTanya Owen

PSue PaddisonAndy PageKirsty PageAnushka PalKristian PallesenSalil ParkarAmanda ParsellZoe PascucciSarah PatersonJoanna PattersonRichard Pawsey


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Lucille PayetNikki PennyClaire PeplowKellie PikeAnn PimmVenkat GR PotamsettiLindsay PotterEmma ProcterMirja PutkonenEmily Putt

RKim RadfordBhanu RamaswamySandy RamsayRebecca RaynerCarmen ReedClaire ReidLuke RendellEmma RichardsDavina RichardsonEdward RimmerLavinia Rizzacasa Christine RobbinsLouise RobsonAnne RodgerLorraine RomanDenise RossStephan RostagnoNirit Rotem LehrerHelle Rovsing JãŗgensenBen RubyDarja RugeljPetra RussellTina Ryan

SElie SakrHelle SampsonAhmad SarrajRichard SealyAlice SearleCoralie SearyAmelia ShawJamie SheehyAmber SheridanAndrea ShipleyAmrik Singh SidhuThora SiguthorsdottirDaniella SilverSteffi SkallaJudy SkinnerGemma SmithKathryn SmithLindsay SmithAnna SmithKelly SmithKathryn Smith

Chris SmithMrs SophieSarah SparkesChristine SparkesAndrew SpeightJanez SpoljarNicola StaffordAideen SteedHayley SteeleAndrea StennettKaren StevensLucie StevensonKirsten StillmanKatharine StoneFiona StorkeyTamsyn StreetRebecca StuckSandeep SubramanianRachel SuttonGillian SzetaNatalie Sutton

TPeggoty TalbotGillian TaylorHeather TaylorStojanka TodorcicCaroline ToughJoanne TuckeyRowan TurnerEmma TurtleAndrea TurollaAilie Turton

UObiagel UfodiamaVictor Utti

VClare Vardy

WJan WaddingtonClaire WardAlan WardEmma WarnerHannah WatkinsGill WeadenRebecca WedemanJane WestonRebecca WheelerSusanna WilkinsonAnna WilkinsonKaren WilliamsCathy WilliamsAlice WilsonAmy WilsonAlex Wilson

Will WinterbothamKathryn WintersteinPortia WoodmanNatalie WoodmanArzu WoodruffAlison WoottonRowena WrightJennifer Wright

YWeeranan YaemrattanakulAnna YarkerTammuz YaronRebecca YeomanRachel Young

ZAntoine Zaczyk

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9.00am – 9.50am | FLEMING ROOM

ACPIN Annual General Meeting 2016

AGENDA1 Welcome and introduction to the committee members

2 Apologies

3 Minutes of the 2015 AGM

4 President’s address

5 Chair’s address

6 Treasurer’s report

7 Election of Executive Committee members

8 Any other business


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The importance of international neurophysiotherapy collaboration a viewpoint from the WCPTDr Emma Stokes

Dr Emma K Stokes is president of the World Confederation of Physical Therapists (WCPT). She qualified as a physiotherapist in 1990 and worked in the clinical field until 1996. She completed her PhD in 2005 and an MSc in Management Science in 2008. She is an associate professor and fellow of Trinity College Dublin, where she is also the deputy head of the physiotherapy programme. She teaches on programmes in Dublin and Singapore and her teaching and research focus is professional issues in physiotherapy.


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How to use evidence, follow guidelines, and be patient-centred all at the same timeProf Derick Wade

Professor Derick Wade MA, MB, BChir, FRCP, MD, Consultant in Neurological Rehabilitation at the Oxford Centre for Enablement is perhaps best known as the editor of the specialist journal Clinical Rehabilitation, a role he has taken on in 1994 and still continues to the present day. In addition to general medical training, Professor Wade trained in several specialties including neurology, neurosurgery, psychiatry and neurophysiology. He also spent six years undertaking research into stroke and rehabilitation. Professor Wade has extensive experience and expertise in several other clinical areas, including head injury rehabilitation, management of multiple sclerosis and motor neurone disease, assessment of patients in the permanent vegetative state

and the management of patients who have disability without any underlying disease. His research activities cover a wide area – he has published over 170 papers in peer reviewed journals on many different studies including twelve randomised controlled trials, studies on many measures of outcome, investigation of specific phenomena such as hysteria, and studies on the natural history of illness in disabling neurological conditions. Professor Wade is involved in other academic activities – he supervises and examines higher degrees. He also writes books and chapters on many aspects of disabling neurological disease and is regularly invited to give lectures worldwide. Professor Wade is involved in health service management at a local and national level. In June 2002 he was made an honorary fellow of the College of Occupational Therapists.

KEYNOTE ADDRESS


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11.30am – 12.20pm | FLEMING ROOM

Group circuit training for balance, mobility and falls prevention in multiple sclerosis: implications for practiceProf Sheila Lennon

Professor Sheila Lennon qualified as a physiotherapist at McGill University in Canada in 1979. She has worked in neurorehabilitation in Canada, Switzerland, and the United Kingdom. Sheila is the inaugural Professor of Physiotherapy and coordinator of the graduate entry Master of Physiotherapy programme at Flinders University in Adelaide, Australia. She is the author/editor of over 45 peer-reviewed publications including a Pocketbook of Neurological Physiotherapy with Professor Maria Stokes. Sheila’s main research interest is the evaluation of physiotherapy practice in the area of exercise therapy and physical activity for health and well-being for people with neurological disability in particular in relation to stroke and multiple sclerosis.

Sheila uses mixed methods designs to study the effectiveness of specific exercise or activity based interventions with an emphasis on self-efficacy and self-management. Sheila was awarded Fellowship of the Chartered Society of Physiotherapy in 2010 in recognition of her research in neurorehabilitation.

ABSTRACTMS is the most common cause of disability in young adults. People with Multiple Sclerosis have a life -long need for physiotherapy and exercise interventions due to the progressive nature of the disease and their greater risk of the complications of inactivity (Coote et al 2009). Current evidence suggests there is strong evidence in favour of exercise therapy compared to no exercise therapy in terms of mobility-related activities (Rietberg et al 2006). Most of this evidence comes from inpatient rehabilitation, however, delivering the service in an outpatient setting may be more cost effective, but to date there is little evidence for this provision. People with MS (35%-60%) frequently report balance and mobility as problems (MacAuley 2010). Poor balance and limited mobility lead to falls (Cattaneo et al 2007, Finlayson et al 2006). People with MS fall frequently (Gunn et al 2014). Preventing falls in people with Multiple Sclerosis (PwMS) is important with falls prevalence estimated to be between 50% to 63%. This presentation will focus on a series of studies aimed at understanding falls in people with MS and preventing falls in people with MS.

METHODSStudy 1: Does group circuit training improve balance and mobility, self-efficacy and quality of life in people with MS? Following baseline assessment, people with MS were stratified according to the primary outcome, the Rivermead Mobility Index (mild=13-14; moderate to severe=12 or below), then randomised to either a control or an exercise group.

Study 2: The primary objective of this study was to explore the views and experiences of health care professionals in relation to falls prevention in people with MS. A quantitative survey was distributed online via Survey Monkey to 490 health professionals from relevant professional databases.


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Study 3: This study examined the feasibility of delivering a falls prevention programme using a group exercise and education format with self-management specific to PwMS, who fall. PwMS participated in a group program for two hours per week over six weeks. The impact on balance (Berg Balance Scale-BBS) and a range of secondary measures related to mobility, number of falls, self-efficacy, fatigue and quality of life was measured. Exercises targeted strength, balance, walking practice through obstacle courses, getting on and off the floor and dual tasking. Education focused on falls risk factors, action planning, balance and mobility, and fatigue management.

RESULTSStudy 1: 89 participants were randomised into the exercise group and 88 to the control group.Following intervention significant differences were observed between groups for the Berg Balance scale, MS impact scale physical, MS impact scale psychological, MS walking scale, self-efficacy scale and walking speed. For most of these outcome measures this difference between groups was continued at the three month follow-up. No differences were observed between groups on the River Mead, Barthel index or number of falls. There was a significant difference between groups post intervention for near falls with significantly fewer near falls in the exercise group. Analysis of the outcome measures showed that participants with a low risk of falls showed significant improvements following exercise on most of the outcome measures; however those with a high risk of falls showed no differences from the control group.

Study 2: The response rate was 24% with 120 surveys completed out of 139 responses. Common falls risk factors included impaired balance (96.7%, n=117), weakness (90.1%, n=109), and decreased proprioception (82.6%, n=100). Falls predictors identified were impaired balance (89.3%, n=108), a history of falls (79.3%, n=96) and fatigue (71.1%, n=86). The top strategies to be included in a FPP were balance exercises (91.7%, n=111), education about falls prevention (90.9%, n=110), home visit (86.8%, n=105), fatigue management (82.6%, n=100) and exercises embedded in daily tasks (68.6%, n=83).

Study 3: Twenty one participants were recruited to three groups in the community. Feedback was positive with high attendance. Changes in self-reported confidence levels in balance (p=0.007) and mobility (p=0.001) were significant. There was a marked reduction in the number of falls (Mean falls pre= 8.81 ± SD 10.79; Mean falls post = 0.90 falls ±SD 1.58). There was no significant difference on the BBS (Wilcoxon test; p=0.420). Thirteen participants reported a reduction in fatigue on the Modified Fatigue Impact Scale (mean difference= 11.67; p=0.000). The MS Impact Scale (MSIS-29) improved by 9.29 points (p=0.003).

CONCLUSIONSThe findings of these studies provide promising results to add to the limited evidence base for falls prevention in people with MS. Delivering group education and circuit training for people with MS in the community may be a resource efficient way to improve accessibility to therapy to improve balance and mobility in order to reduce falls.

FUNDINGThese studies were partially funded by the Public Health Agency in Northern Ireland and a seeding grant from Flinders University and the Flinders Medical Foundation.

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REFERENCESCoote S, Hogan N, Franklin S (2013) Falls in people with multiple sclerosis who use a walking aid: prevalence, factors, and effect of strength and balance interventions. Archives of Physical Medicine and Rehabilitation 94 (4) pp616-621.

Giannì C, Prosperini L, Jonsdottir J, Cattaneo D (2014) A systematic review of factors associated with accidental falls in people with multiple sclerosis: a meta-analytic approach Clinical Rehabilitation 28 (7) pp704-716.

Gunn H, Creanor S, Haas B, Marsden J, Freeman J (2014) Frequency, characteristics, and consequences of falls in multiple sclerosis: Findings from a cohort study Archives of Physical Medicine and Rehabilitation 95 (3) pp538-545.

Gunn HJ, Newell P, Haas B, Marsden JF, Freeman JA (2013) Identification of risk factors for falls in multiple sclerosis: a systematic review and meta-analysis Physical Therapy 93 (4) pp504-513.

Matsuda PN, Shumway-Cook A, Ciol MA, Bombardier CH, Kartin DA (2012) Understanding falls in multiple sclerosis: association of mobility status, concerns about falling, and accumulated impairments Physical Therapy 92 (3) pp407-415.

Plow MA, Finlayson M, Rezac M (2011) A scoping review of self-management interventions for adults with multiple sclerosis PM&R 3 (3) pp251-262.

Zackowski KM, Cameron M, Wagner JM (2013) 2nd International symposium on gait and balance in multiple sclerosis: interventions for gait and balance in MS Disability & Rehabilitation 36 (13) pp1128-1132.


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11.30am – 12.20pm | WESTMINSTER ROOM

“One size does not fit all” concept in mobility intervention for strokeProf Louise Ada

Louise Ada is a physiotherapist who is a Professor of Neurological Physiotherapy at The University of Sydney with an interest in stroke rehabilitation. She is particularly interested in the relative contribution of impairments to disability as well as the efficacy of physiotherapy interventions and the design of environments to promote the active participation of people

ABSTRACTNeurological conditions are extremely heterogeneous. For example, after stroke, survivors range from being unable to walk at all right through to being able to walk at a normal speed. Research over the last two decades is providing clearer evidence that intervention needs to be targeted. For example for the non-ambulatory person, mechanically assisted walking with partial weight support via an overhead harness provides the opportunity to complete large amounts of walking practice. More evidence has become available that this form of intervention is effective at establishing more walking without detriment to the quality of walking. For those who can already walk, there is evidence from systematic reviews that treadmill walking and cueing of cadence are effective in improving walking speed and distance. However, there is emerging evidence that interventions are not equally effective across the range of stroke survivors, ie one size does not fit all. This has implications for both the clinic and for future research. Interventions need to be tailored to the individual, perhaps using walking speed to do the tailoring. Systematic reviews and clinical trials should take into account the inclusion criteria of the participants investigated.

REFERENCESAda L, Dean CM, Vargas J, Ennis S (2010) Mechanically assisted walking with body weight support results in more independent walking than assisted overground walking in non ambulatory patients early after stroke: a systematic review Journal of Physiotherapy 56 pp153-161.

Dean CM, Ada L, Lindley R (2014) Treadmill training provides greater benefit to the subgroup of community dwelling people after stroke who walk faster than 0.4 m/s: a randomised trial Journal of Physiotherapy 60 pp97-101.

Nascimento LR, Ada L, Teixeira-Salmela LF (in press) The provision of a cane provided greater benefit to the group of community-dwelling people with chronic stroke with speed between 0.4 and 0.8 m/s Physiotherapy.

Nascimento LR, de Oliviera CQ, Ada L, Michaelsen SM, Teixeira-Salmela LF (2015) Walking training with cueing of cadence improves walking speed and stride length after stroke more than walking training alone: a systematic review Journal of Physiotherapy 61 pp10-15. doi: 10.1016/j.jphys.2014.11.015.

Polese JC, Ada L, Dean CM, Nascimento L, Teixeira-Salmela L (2013) Treadmill training is effective for ambulatory adults with stroke: a systematic review Journal of Physiotherapy 59 pp73-80. doi: 10.1016/S1836-9553(13)70159-0.


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12.30pm – 1.20pm | FLEMING ROOM

Understanding upper limb recovery early post stroke: some lessons of the EXPLICIT-stroke programmeProf Gert Kwakkel

Professor Gert Kwakkel started his career as a physical therapist and movement scientist at the VU University Medical Centre in Amsterdam. In 1998, he received his PhD on his thesis: Dynamics in functional recovery after stroke. Professor Kwakkel received a chair in ‘neurorehabilitation’ at the VU University Medical Centre in Amsterdam in March 2008 and was head of research in the department of neurorehabilitation at the Reade Rehabilitation Centre in Amsterdam. Since June 2015 he is the visiting professor at the Rehabilitation Institute of Chicago in the USA. His chair is dedicated to translational research in the field of neurorehabilitation with special focus on the longitudinal relationship between neuroplasticity and motor recovery. His

interest is mainly on patients with stroke, but also in Parkinsons’s Disease and multiple sclerosis. Professor Kwakkel has published more than 184 papers in leading scientific journals such as The Lancet, The Lancet Neurology, BMJ and Stroke. With a prestigious advanced grant from the European Research Council, Professor Kwakkel is in collaboration with Prof Dr Frans van der Helm at the Technical University of Delft investigating the longitudinal relationship between stroke recovery and brain plasticity. Professor Kwakkel is also the European managing editor of the journal Neurorehabilitation and Neural Repair. In addition, he is also a member of the editorial boards of Stroke, International Journal of Stroke, Journal of Rehabilitation Medicine and Physiotherapy Research International. Finally, professor Kwakkel is president of the Dutch Society of Neurorehabilitation.

ABSTRACTThe time course of stroke recovery as well as the impact of exercise therapy on the pattern of (motor) recovery is poorly understood. This lecture presents the current knowledge about the predictability of the time course of body functions and activities following a stroke. There is growing evidence that the natural logarithmic pattern of functional recovery can be modified by early started, intensive task-oriented practice. However, the impact of practice on learning-dependent and intrinsic, spontaneous mechanisms of neurological recovery is not well understood. Several, probably interrelated mechanisms, have been identified that affect recovery after stroke. These mechanisms underlying recovery are highly interactive and operate within different, sometimes limited, time-windows after stroke. In this invited lecture, a hypothetical phenomenological model for understanding skill reacquisition after stroke will be presented. Subsequently, the need for elucidating the longitudinal association between neurological recovery and regaining meaningful activities will be discussed in order to understand what and how patients learn when they show functional improvement post stroke. This statement will be discussed in light of measuring serial outcomes defined at different levels of ICF post stroke. There is growing evidence that the effects of neurorehabilitation are rather adaptive (substitution) rather than based on mechanisms of ‘true neurological repair’ (restitution). Restitution seems to be restricted to a time window of the first eight weeks post stroke within which spontaneous neurological recovery occurs. After this critical time window, upper limb recovery is mainly the result of the most efficient optimization of the intact end-effectors to accomplish meaningful tasks.


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Recent studies also showed that about two-third of all stroke patients show proportionally, the same amount of spontaneous neurological recovery in the first six months post stroke. Roughly, this spontaneous amount of improvement accounts about 70 to 80% of the maximal available improvement on a motor impairment scale such as Fugl-Meyer-Arm score. Recent prospective studies further show that this 70% recovery rule is also applicable for other modalities such as speech in patients with left hemispheric strokes and visuospatial neglect in right hemispheric strokes. More important, patients who fail to show the expected amount of spontaneous motor recovery also fail for the other affected modalities in the same hemisphere, suggesting a common underlying biological mechanism for spontaneous neurological recovery.

Identifying and subsequently, stratifying fitters and non-fitters of this 70% recovery rule, will have an important impact on designing trials early post stroke. In addition, these studies should focus on understanding stroke recovery by studying the distinction of restitution of neurological impairments from adaptive mechanisms of motor recovery. To do that, designs are needed based on intensive serial measurements applied at fixed moments post stroke in time in which the longitudinal relationship between kinematics and neuroplasticity is investigated early post stroke.

REFERENCESBuma F, Kwakkel G, Ramsey N (2013) Understanding upper limb recovery after stroke Restorative Neurology and Neuroscience 31 (6) pp707-722. doi: 10.3233/RNN-130332. Review. PubMed PMID: 23963341.

van Kordelaar J, van Wegen EE, Nijland RH, Daffertshofer A, Kwakkel G (2013) Understanding adaptive motor control of the paretic upper limb early poststroke: the EXPLICIT-stroke program. Neurorehabilitation and Neural Repair 27 (9) pp854-863. doi: 10.1177/1545968313496327. Epub 2013 Jul 24. PubMed PMID: 23884015.

Kwakkel G, Veerbeek JM, van Wegen EE, Wolf SL (2016) Constraint-induced movement therapy after stroke. Lancet Neurology 14 (2) pp224-234. doi: 10.1016/S1474-4422(14)70160-7. Review. PubMed PMID: 25772900; PubMed Central PMCID: PMC4361809.

Kwakkel G, Winters C, van Wegen EE, Nijland RH, van Kuijk AA, Visser-Meily A, de Groot J, de Vlugt E, Arendzen JH, Geurts AC, Meskers CG, EXPLICIT-Stroke Consortium (2016) Effects of unilateral upper limb training in two distinct prognostic groups early after stroke: the EXPLICIT-stroke randomized clinical trial Neurorehabilitation and Neural Repair pii: 1545968315624784. [Epub ahead of print] PubMed PMID: 26747128.

Veerbeek JM, van Wegen E, van Peppen R, van der Wees PJ, Hendriks E, Rietberg M, Kwakkel G (2014) What is the evidence for physical therapy poststroke? A systematic review and meta-analysis PLoS One 9 (2) e87987. doi: 10.1371/journal.pone.0087987. eCollection 2014. Review. PubMed PMID: 24505342; PubMed Central PMCID: PMC3913786.


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12.30pm – 1.20pm | WESTMINSTER ROOM

Consultant and advanced practice roles in neurology including bed based responsibilities, injection therapy and prescribingDr Rhoda Allison

Rhoda Allison has been a consultant physiotherapist in stroke in Torbay and South Devon NHS Foundation Trust since 2004. She is the clinical lead for the Stroke Rehabilitation Unit with responsibility for fifteen beds, provides clinical leadership to the community stroke and neurology service and leads the spasticity clinic as a trained injector and independent prescriber. She developed and continues to teach on the Injection therapy module of the masters programme at Plymouth University. She has been a member of the NICE Guideline Development Group for Acute Stroke Guidelines, and is a member of the Royal College of Physicians Stroke Service Peer review team.

ABSTRACTThe scope of physiotherapy has developed significantly over the past twenty years with increasing opportunities to improve the patient experience through the development of both advanced and consultant level practice in the UK. This presentation will review developments to date and discuss practical examples of how these roles have improved services. Opportunities for the further development of roles and a possible road map for personal development towards advancing and consultant practice will be suggested.

REFERENCESAmerican Physical Therapy Association (2013) Vision Statement for the Physical Therapy Profession and Guiding Principles to Achieve the Vision Downloaded at: http://www.apta.org/Vision/ 25 Feb 2016.

American Physical Therapy Association (2014) Scope of practice Downloaded at: http://www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/Practice/ScopePractice.pdf 25 Feb 2016

Chartered Society of Physiotherapy (2013) Scope of practice Downloaded at: http://www.csp.org.uk/professional-union/professionalism/scope-of-practice/background-governance/scope on 25 Feb 2016.


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2.15pm – 2.25pm | BRITTEN ROOM

Lunchtime addressBaroness Finlay of Llandaff

The Baroness Finlay of Llandaff is president of the Chartered Society of Physiotherapy. She has been a member of the House of Lords from 2001. Medically trained in palliative medicine, she is consultant physician and palliative care lead clinician for Wales, Velindre NHS Trust, Cardiff. She is also vice-president of Marie Curie Cancer Care, a governor at Cardiff Metropolitan University, past president of the British Medical Association (interest ceased 17 July 2015), chair of the National Mental Capacity Act Forum, president of Multiple Sclerosis Cymru, president of ASH Wales, associate of the Girls’ Day School Trust, fellow of the NSPCC and chair of the National Council for Palliative Care.


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Patient-led therapy during in-patient stroke rehabilitationProf Sarah Tyson

Sarah Tyson is Professor of Rehabilitation and leads the Long-Term Conditions Research Group at the University of Manchester. Her work focuses on stroke rehabilitation particularly balance and mobility problems, rehabilitation/assistive technologies, the organisation of rehabilitation services and the challenges of implementing evidence based practice. She has over 100 publications and £5million of research funding from the Department of Health, NIHR, research councils, medical charities, professional bodies and the Knowledge Transfer Partnership/Technology Strategy Board. Her research has impacted on stroke and physiotherapy services nationally and internationally with inclusion in national clinical guidelines and production of

assessment tools that are used throughout the UK and globally.

ABSTRACTIt is well-established that the amount of therapy patients’ undertake is key to the effectiveness of stroke rehabilitation; the more the better. Despite this, it is equally well-established that stroke patients spend only a small proportion of their day in therapy and, even during inpatient rehabilitation, most of their day is spent inactive and alone. As exercise and the intensive practice of functional tasks are the most effective interventions to promote motor recovery after stroke, there is an imperative to find ways to maximise patients’ opportunities to be active and exercise during rehabilitation.

In this presentation I will introduce the results of recent work to evaluate the feasibility and acceptability of interventions to increase the amount of therapy received and patients’ activity during in-patient rehabilitation, consider some of the barriers and enablers to their adoption in practice and ways these can be addressed.

REFERENCESAda L, Dean CM, Mackey F et al (2006) Increasing the amount of physical activity undertaken after stroke. Physical Therapy Reviews 11pp91–100.

Bernhardt J, Dewey HM, Thrift AG et al (2004) Inactive and alone: Physical activity in the first 14 days of acute stroke unit care Stroke 35 pp1005–1009.

Horne M, Thomas N, McCabe C, Selles R, Vail A, Tyrrell P, Tyson SF (2015) Patient-directed therapy during in-patient stroke rehabilitation: stroke survivors’ views of feasibility and acceptability Disability and Rehabilitation 37 (25) pp2344-2349.

Horne M, Thomas N, Vail A, Selles R, McCabe C, Tyson S (2015) Staff’s views of delivering patient-led therapy during in-patient stroke rehabilitation: A focus group study with lessons for trial fidelity Trials16 p137 DOI: 10.1186/s13063-015-0646-9.

Huijben-Schoenmakers M, Rademaker A, Scherder E (2013) Can practice undertaken by patients be increased simply through implementing agreed national guidelines?’ An observational study Clinical Rehabilitation 27 (6) pp513–520.

Kwakkel G, van Peppen R, Wagenaar RC et al (2004) Effects of augmented exercise therapy time after stroke: A meta-analysis Stroke 35 pp2529–2539.

Mackey F, Ada L, Heard R et al (1996) Stroke rehabilitation: are highly structured units more conducive to physical activity than less structured than less structured units? Archives of Physical Medicine and Rehabilitation 77 pp1066–1070.


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National Institute for Health and Clinical Excellence (2007) How to change practice; Understand, Identify and Overcome Barriers to Change http://www.nice.org.uk/Media/ Default/About/what-we-do/Into-practice/Support-forservice-improvement-and-audit/How-to-change-practicebarriers- to-change.pdf

Tyson SF, McGovern A, Burton LJ (2015) The impact of patient timetables, therapeutic group work, patient-led therapy and structured social activity during in-patient stroke rehabilitation: A Phase I modelling study Clinical Rehabilitation e-pub 11th March DOI 10.1177/0269215515575335

Tyson SF, Wilkinson J, Thomas N, Selles R, McCabe C, Tyrrell P, Vail A (2015) Phase II randomized controlled trial of patient-led mirror therapy and lower limb exercises in acute stroke Neurorehabilitation and Neural Repair 29 (9) pp818-826 DOI 1545968314565513.

De Wit L, Putman K, Dejaeger E et al (2005) Use of time by stroke patients a comparison of four European rehabilitation centers. Stroke 36 (9) pp1977–1983.

De Wit L, Putman K, Schuback B et al (2007) Motor and functional recovery after stroke a comparison of four European rehabilitation centers Stroke 38 (7) pp2101–2107.


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Should we be exercising for brain health? With a specific focus on Huntington’s diseaseProf Monica Busse

As a physiotherapist, I have an established interest in exercise and physical activity for people with chronic health conditions with a particular focus on the development of targeted physical interventions in neurodegenerative diseases. My specific expertise is in the assessment and management of mobility problems and falls, defining contents of physiotherapy interventions, methodologies for appropriate assessment of outcomes in complex health conditions and promotion of physical activity for health (along with behaviour change applications and development of interventions). I lead the Cardiff Huntington’s disease (HD) Physiotherapy Group (www.activehd.co.uk) and am Deputy Head of School: Research and Innovation in the School of

Healthcare Sciences, Cardiff University. In much of my work, I interact closely in a clinical and research capacity with the Cardiff HD Centre and the Cardiff University Brain Repair Group, Cardiff University as well as the South East Wales Trials Unit (SEWTU) where I am an associate director. Over the past eight years, I have been and continue to be principal investigator in a series of multi-centre observational and interventional studies related to physiotherapy, physical activity and mobility in HD. Within a wider neurology remit, I have conducted studies of mobility and falls in muscular dystrophy, mobility assessments in multiple sclerosis and focussed on documentation of rehabilitation interventions. I have been involved in collaborative studies with researchers investigating the role of neural feedback in people with Parkinson’s disease where my expertise in outcome measures and physical training is informing both intervention delivery and assessment of mobility.

ABSTRACTAerobic and multi-modal exercise programmes (incorporating muscle strengthening and aerobic components) are well known for their effect on cardiorespiratory fitness, muscle strength, cognition and depression in the general population. There is now growing interest in the use of exercise as a therapeutic approach in the management of neurodegenerative diseases such as Parkinson’s, Huntington’s (HD) and Alzheimer’s diseases, with clear suggestions that these interventions can result in improvements in both motor and cognitive deficits.

Despite many promising advances, widespread uptake of exercise interventions in neurodegeneration is however limited and there are clear knowledge gaps that prevent the intelligent application of exercise as a therapeutic. It is clear that mechanistic understanding of the biology of exercise is a crucial step towards developing and optimising novel and existing exercise protocols.

With a specific focus on HD as a powerful model disease, this presentation will review the current state of knowledge from both animal and human studies. It will highlight evidence in support of the role of exercise in HD and will pose unanswered questions in the quest to understanding how exercise can be influential in optimising brain health in neurodegeneration. Practical and clinical implications will be discussed.


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REFERENCESBusse M et al (2013) A randomized feasibility study of a 12-week community-based exercise program for people with Huntington’s disease Journal of Neurologic Physical Therapy 37 pp149–58.

Busse M et al (2014) Supporting physical activity engagement in people with Huntington’s disease (ENGAGE-HD): study protocol for a randomized controlled feasibility trial Trials 15 p487.

Cruickshank TM et al (2015) The effect of multidisciplinary rehabilitation on brain structure and cognition in Huntington’s disease: an exploratory study Brain and Behaviour 5 (2) e00312.

Dawes H et al (2015) Exercise testing and training in people with Huntington’s disease Clinical rehabilitation 29 pp196–206.

Fontes EB et al (2015) Brain activity and perceived exertion during cycling exercise: an fMRI study. British Journal of Sports Medicine 49 pp556–560.

Harrison DJ et al (2013) Exercise attenuates neuropathology and has greater benefit on cognitive than motor deficits in the R6/1 Huntington’s disease mouse model Experimental Neurology 248 pp457–469.

Hayes SM, Hayes JP, Cadden M, Verfaellie M (2013) A review of cardiorespiratory fitness-related neuroplasticity in the aging brain Frontiers in Aging Neuroscience 5 pp1–16.

Quinn L et al (2014) Task-specific training in Huntington disease: a randomized controlled feasibility trial Physical Therapy 94 pp1555–1568.

Quinn L et al (under review) Physical exercise improves fitness and motor function in Huntington’s disease: a randomized trial” Movement Disorders.

Quinn L et al (in press) Development and delivery of a physical activity intervention for people with huntington’s disease: facilitating translation to clinical practice Journal of Neurologic Physical Therapy.

Steves CJ, Mehta MM, Jackson SHD, Spector TD (2015) Kicking back cognitive ageing: leg power predicts cognitive ageing after ten years in older female twins Gerontology 62 (2) pp138-49. doi:10.1159/000441029

Voss MW, Vivar C, Kramer AF, van Praag H (2013) Bridging animal and human models of exercise-induced brain plasticity Trends in Cognitive Sciences 17 pp525–44.


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Collaborative decision making and development of best evidence appsProf Steve Wolf

Steve Wolf received his PT training at Columbia University and then got MS degrees in Physical Therapy (Boston University) and Anatomy (Emory University) followed by his Ph.D. in neurophysiology (Emory University) and post-doctoral work as a Muscular Dystrophy Association of America Fellow (Karolinska Institute, Stockholm). He has been on the faculty at Emory University for almost 40 years since that time where he now is Professor, Departments of Rehabilitation Medicine and Medicine and Associate Professor, Department of Cell Biology. He explore novel interventions to improve extremity use in patients with stroke as well as mechanisms of cortical reorganization and inter-joint coordination associated with such

changes. Within the past 23 years he has led several NIH funded clinical trials governing this concept. More recently, his lab has been emphasizing clinical measures of neural plasticity for interventions designed to improve posture in older adults or stroke survivors as well as to improve limb function in the latter group through the addition of electrophysiological (including TMS) and imaging studies. Our newest studies involve use of robotics and mixed reality, both of which have telerehabilitation capabilities and are directed toward home-based treatment post-stroke. Our recently completed NINDS ICARE Trial explored a novel intervention for upper extremity recovery in acute stroke survivors. Recently our stroke studies have also included obtaining buccal swaps to identify a polymorphism for brain derived nerve growth factor so that we can determine if a relationship exists between the presence of the polymorphism and limitations in reacquisition of motor function. We also study changes in upper extremity movement following stroke using home base robotic and telerehabilitation interfaces that complement our mixed reality studies. While our studies with stroke survivors have addressed primarily efforts to improve motoric function within the upper extremity, we have also done extensive work in monitoring lower extremity muscle activity to determine the extent to which selective feedback can enhance ambulation amongst stroke survivors. In January 2014 he was asked to serve as co-chairman of the Recovery/Rehabilitation Working Group of the newly NINDS funded Stroke Network in which we are one of 25 sites. This honor provides further opportunity to facilitate recruitment and retention strategies for clinical trials. Most recently we have been funded to participate in a multisite trial (NIH U01 NS091951) on use of telerehabilitation to facilitate upper extremity functional return within 90 days after stroke. This study, led by Steven Cramer, MD, is the first rehabilitation and recovery project funded through the Stroke Network. This work is compatible with our experiences in a successful, home-based robotics study (RC3 NS070646-01) recently completed in collaboration with colleagues at the Cleveland Clinic that targeted chronic stroke survivors. We have recently completed a 4 year project in which 24 clinicians and scientists volunteered their time to create an evidence based algorithm to instruct clinicians regarding best practice for treatment of upper extremities following stroke


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ABSTRACTThe growth of technology and science has profound implications for the practicing physiotherapist specializing in the treatment of patients with neurological deficits. This presentation highlights some of the advances made in fostering these advances within the United States and how they are entering our educational and clinical arenas. Among the discussion points are the creation of the Physical Therapy and Society Summit (PASS) and one of its outcomes, Frontiers in Rehabilitation Sciences and Technology (FiRST Initiative) and how the latter made its way into a curriculum. We present the history and genesis of an app for upper extremity stroke rehabilitation as a forerunner of instantaneous information assimilation, a concept that will be demanded of tomorrow’s therapist, consumers and insurers.

REFERENCESAmbrosio F, Wolf SL, Delitto A, Fitzgerald GK, Badylak SF, Boninger ML, Russell A (2010) The emerging relationship between regenerative medicine and physical therapy: a perspective Physical Therapy Journal 90 pp1807-1814.

Kigin C, Rodgers, Wolf SL for the PASS Committee Members (2010) The physical therapy and society summit (PASS): observations and opportunities. Physical Therapy 90 pp1555-1567.

Winstein CJ, Wolf SL, Dromerick AW, Lane CJ, Nelsen MA, Lewthwaite R, Cen SY, Azen SP (2016 )Impact of dose and content on arm rehabilitation after stroke: The ICARE Trial JAMA 315 (6) pp571-581.

Wolf SL (2013) FiRST and Foremost: Advances in Science and Technology Impacting Neurologic Physical Therapy Journal of Neurological Physical Therapy 37 (4) pp147-148. doi: 10.1097/NPT.

Wolf SL, Kwakkel G, Bayley M, McDonnell MN (2016) Best practice for arm recovery post stroke: An international application Physiotherapy 102 pp1-4. DOI: http://dx.doi.org/10.1016/j.physio.2015.08.007.

Wolf SL, Sahu K, Bay RC, Buchanan S, Reiss A, Linder S, Rosenfeldt A, Alberts J (2015) The HAPPI (Home Arm Assistance Progression Initiative) Trial: A novel robotics delivery approach in stroke rehabilitation Neurorehabilitation and Neural Repair 29 (10) pp958-968.


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Evidence for goal setting, attainment and integration of physical and pharmacological intervention for spasticity managementDr Stephen Ashford

Stephen completed a PhD at King’s College London investigating the measurement of arm function following focal interventions for spasticity. This work resulted in the development of the Arm Activity measure (ArmA). In 2012 he became consultant physiotherapist and in 2013 NIHR clinical lecturer and is undertaking further investigations into focal spasticity and measurement of outcome. A component of this work has resulted in the development of the Leg Activity measure (LegA). Stephen completed a Post Graduate Certificate in non-medical independent prescribing in 2014 at London Southbank University. Stephen’s ongoing work includes the use of Goal Attainment Scaling (GAS). His research has considered the use of GAS alongside

standardised outcome measures, considering the need for standardisation of measurement alongside measures responsive to very specific and individual changes in many patients undergoing rehabilitation. He has published peer-reviewed papers in the rehabilitation literature, as well as book chapters and clinical guideline contributions.

ABSTRACTNeurological damage to the brain, as a result of brain injury (traumatic/anoxic brain injury or stroke), typically leads to paralysis (primarily muscle weakness) of one or both sides of the body (partial or complete). In the early stages after brain injury, the affected limbs are often flaccid (low-toned paresis), but after a few weeks muscle tone may start to return and can lead to the development of muscle over activity or ‘spasticity’. Spasticity will often have unwanted effects, such as pain and could result in secondary problems such as muscle stiffness, contracture and pressure sores.

Goal attainment scaling (GAS) is increasingly used as an outcome measure for evaluation of focal interventions for upper limb spasticity(Ashford and Turner-Stokes 2006, Ashford and Turner-Stokes 2009, Turner-Stokes et al 2010). Goals for treatment of upper limb spasticity are widely diverse, depending on the individual aspirations and priorities of the patient and/or their family. They may be directed at reducing impairment (eg preventing contractures and deformity), improving activities (such as personal care) or use of the limb for participatory activities (such as work, hobbies, recreation etc). In other words, goals may be directed at achieving change at any level of the World Health Organisation (WHO) International Classification of Function, Disability and Health (ICF) (Wade 1992, WHO 2002) – body systems (impairment), activities or participation.

A total of 696 individualised primary and secondary goals for treatment of upper limb spasticity using BoNT injection were analysed from four of our studies. Goal classification is summarised as follows, overall 322 (46%) of goals were set in the domain of symptoms/impairment, whilst 374 (54%) goals were related to activities and participation (Ashford et al 2015). Goal analysis has now also been expanded to evaluate goals set for lower limb spasticity with the same categories identified (Ashford


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et al In press). This work has resulted in a goal setting and classification system for upper and lower limb spasticity where focal physical and pharmacological interventions are considered.

Alongside the systematic setting of patient focused goals and the evaluation of their outcome, exploration in this area has identified an ongoing requirement to carefully record the interventions patients receive from a physical perspective. Systems in the form of patient reported experience measures (PREMs) for recording this information have been developed and tested in three cohort studies to date.

These approaches to recording both outcome and what constitutes intervention in this patient group, have supported practice development in this area and are leading to improvement patient outcomes. Nevertheless there is a need to apply these findings to evidence based practice for clinicians in the field.

REFERENCESAshford S, Jacinto J, Fheodoroff K, Turner-Stokes L (2015) Common goal areas in the treatment of upper limb spasticity: a multicentre analysis Clinical Rehabilitation DOI: 10.1177/0269215515593391.

Ashford S, Jackson D, Mahaffey P, Vanderstay R, Turner-Stokes L (In press) Conceptualisation and development of the Leg Activity Measure (LegA) for patient and carer reported assessment of activity (function) in the paretic leg in people with acquired brain injury Physiotherapy Reasearch International.

Ashford S, Turner-Stokes L (2006) Goal attainment for spasticity management using botulinum toxin Physiotherapy Research International 11 (1) pp24-34.

Ashford S, Turner-Stokes L (2009) Management of shoulder and proximal upper limb spasticity using botulinum toxin and concurrent therapy interventions: A preliminary analysis of goals and outcomes Disability and Rehabilitation 31 pp220-226.

Turner-Stokes L, Baguley I, De Graaff S, Katrak P, Davies L, McCrory P, Hughes A (2010) Goal attainment scaling in the evaluation of treatment of upper limb spasticity with botulinum toxin: A secondary analysis from a double-blind placebo-controlled randomised clinical trial Journal of Rehabilitation Medicine 42 pp81-89.

Wade DT (1992) Measurement in neurological rehabilitation Oxford, Oxford University Press.

WHO (2002) International classification of functioning, disability and health Geneva, World Health Organisation.


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‘Its all about the small steps’: sharing and creating solutions for successful self-management after traumatic brain injuryProf Fiona Jones

Fiona is Professor of Rehabilitation Research at St George’s University of London and Kingston University. She is the founder of ‘Bridges self-management’ an individualised approach to self-management used by rehabilitation and healthcare teams across the UK. Since developing the Bridges programme she has carried out research exploring professional attitudes to self-management programmes and factors influencing sustainability of using programmes within health and social care. Fiona was the Chief Investigator for ‘SESAME’ an NIHR funded study to test Bridges within stroke teams in London which was completed in 2014. Fiona has published articles on stroke, self-management and self-efficacy and currently

supervises six doctoral students who are carrying out research related to self-management and life after stroke. Fiona is also the chief investigator for a new NIHR funded study, ‘CREATE’ which started in January 2016 and uses Experience-Based Co-Design to explore ways to increase therapeutic activity in stroke units. In 2009 Fiona received the Life after Stroke award for excellence from the UK Stroke Association and in 2011 she was made a fellow of the Chartered Society of Physiotherapists. Fiona is the current President of the UK Association of Physiotherapists in Neurology.

ABSTRACTSupporting an individual who has experienced a life changing condition such as traumatic brain injury to have knowledge, skills and confidence to self-manage is an aim for most healthcare professionals. But this process requires creativity and a willingness to not hold all the answers. Often our practices and priorities within rehabilitation and other parts of the healthcare system do not encourage professionals to think creatively and explore strategies and ideas together with individuals and their families.

‘Building Bridges after Brain Injury’ was a unique project to adapt Bridges stroke self-management programme to meet the needs of people with TBI and their families, starting first in an acute neurotrauma setting. We co-created new self-management tools and co-designed training for multi-disciplinary staff working in one London neurotrauma pathway. The project was funded by The Health Foundation UK and completed in November 2015. Seventy patients with TBI received Bridges, most within the first seven days post brain injury. More than 140 staff received training in Bridges self-management adapted for the acute neurotrauma context. Post implementation staff had changed their attitudes and beliefs about supporting people with TBI to self-manage, and gained knowledge, skills and confidence to integrate the approach into their everyday practice. Additional funding has now been secured to spread Bridges/TBI across other major trauma centres in London. Learning from this from project in TBI and previous work in stroke and other long term neurological conditions has shown that successful self-management support requires a whole systems approach. Professionals require confidence and knowledge about how to tailor support to the needs of different individuals and their families, and an awareness of organisational processes which can inadvertently foster dependency on rehabilitation. This presentation will end with a summary of the small steps which have helped us to get there.


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A full report of the Health Foundation project can be found here: www.health.org.uk/programmes/shine-2014/projects/self-management-support-following-traumatic-brain-injury

More information about Bridges self-management can be found here: www.bridgesselfmanagement.org.uk

REFERENCESBoger E, Ellis J, Latter S, Foster C, Kennedy A, Jones F, Fenerty V, Kellar I, Demain S (2015) Self-management and self-management support outcomes: a systematic review and mixed research synthesis of stakeholder views PLoS ONE 10 (7) e0130990. ISSN (online) 1932-6203

Jones et al (2016 ) Feasibility study of an integrated stroke self-management programme: a cluster-randomised controlled trial BMJ Open http://bmjopen.bmj.com/content/6/1/e008900.full.pdf+html

Jones F (2013) Self-management: is it time for a new direction in rehabilitation and post stroke care? Pan Minerva Medica 55 (1) pp79-86.

Jones F, Bailey N (2013) How can we train stroke practitioners about self-management? Description and evaluation of a pathway wide training programme European Journal of Person Centered Healthcare 1 (1) pp246-254.

Jones F, Benson L, Jones C, Waters C, Hammond J, Bailey N (2012) Evaluation of a shared approach to interprofessional learning about stroke self-management. Journal of Interprofessional Care 26 (6) pp514-516. doi: 10.3109/13561820.2012.702147.

Lennon S, McKenna S, Jones F (2013) Self-management programmes for people post stroke: a systematic review Clinical Rehabilitation 27 (10) pp867-878. ISSN (print) 0269-2155.

Makela P, Gawned S, Jones F (2014) Starting early: integration of self-management support into an acute stroke service BMJ Quality Improvement Reports http://qir.bmj.com/content/3/1/u202037.w1759.short?rss=1 (accessed October 2015)

de Silva D (2011 0 Helping people help themselves: A review of the evidence considering whether it is worthwhile to support self-management The Health Foundation, London http://www.health.org.uk/media_manager/public/75/publications_pdfs/Helping%20people%20help%20themselves.pdf


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Falls, gait and balance in Parkinson’s disease: new prospective for rehabilitationDr Elisa Pelosin

Dr Elisa Pelosin completed her PhD in experimental neuroscience at the University of Genoa, where she is now a lecturer with the department of neuroscience. She is also a reviewer for international journals (including: Neurorehabilitation and Neural Repair, Archive Physical Medicine and Rehabilitation, Parkinsonism and Related Disorders). Dr Pelosin has been a key member of the writing group of European Guidelines for Physical Therapists in Rehabilitation of Parkinson’s Disease. In her research, Dr Pelosin’s work has been primarily focused in verifying the feasibility and the efficacy of innovative rehabilitative treatments in in elderly population and in movement disorder patients, based on motor learning processes. Specifically, the thrust of Dr Pelosin’s research projects, has been to develop new rehabilitative protocol to improve gait, balance and freezing of gait. In addition, in the last years, she was actively involved in studying compensatory mechanisms and brain plasticity in patients with movement disorders.

ABSTRACTFalls in the elderly are a major health problem. Approximately 30% of community-dwelling elderly over the age of 65 fall at least once a year and 6% of these falls result in fractures. These figures become even worst in populations with neurological disease such as Parkinson’s disease (PD). This patient population has an even higher risk of falls, with annual incidence of 60–80%, at least twice that of the general elderly population. The consequences of falls in the elderly are severe: Falls often lead to disability, fear of falling, depression and social isolation, and loss of confidence in the ability to walk safely.

Most falls occur during walking and not surprisingly, gait impairment has been associated with an increased risk of falls. With ageing, elderly individuals generally walk more slowly, with shorter strides, decreased arm swing and longer double limb support times. Many of these age-associated changes in gait are exaggerated further among elderly fallers and even more in patients with PD.

Until recently, gait and balance were essentially perceived as automated, biomechanical processes and falls were largely viewed as a failure of these motor mechanisms. Work over the past decade or so has, however, underscored the strong connection between balance, gait and falls, on the one hand, and cognitive function, on the other hand.

A large number of scientific studies investigating the effectiveness of physical therapy protocols to improve gait and balance problems in patients with PD have been published so far, and to date, data are consistent in supporting the overall efficacy of rehabilitation intervention. On the other hand, the effect on fall risk seems to be small and the reported changes are focused on motor aspect with limited long-term retention.

Thus, recent evidences suggest that in order to obtain long term retention of the results obtained, and thus promoting motor learning processes, physical therapy interventions should move toward task specific motor cognitive combined approaches. In this view, physiotherapy intervention might represent a gateway to promote a more functional recovery, focusing on both the physical and cognitive domains to decrease the risk of falls and empower safe community ambulation and function.


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REFERENCESAbbruzzese G, Marchese R, Avanzino L, Pelosin E (2016) Rehabilitation for Parkinson’s disease: Current outlook and future challenges Parkinsonism and Related Disorders 22 Suppl 1:S60-4. doi: 10.1016/j.parkreldis.2015.09.005.

Canning CG, Paul SS, Nieuwboer A (2014) Prevention of falls in Parkinson’s disease: a review of fall risk factors and the role of physical interventions. Neurodegenerative Disease Management 4 (3) pp203-221. doi: 10.2217/nmt.14.22. Review.

Deandrea S, Lucenteforte E, Bravi F, Foschi R, La Vecchia C, Negri E (2010) Risk factors for falls in community-dwelling older people: a systematic review and meta-analysis Epidemiology 21 (5) pp658-668.

Giladi N, Horak FB, Hausdorff JM (2013) Classification of gait disturbances: distinguishing between continuous and episodic changes Movement Disorders 28 (11) pp1469-1473. doi: 10.1002/mds.25672. Review.

Iansek R, Danoudis M, Bradfield N (2013) Gait and cognition in Parkinson’s disease: implications for rehabilitation Reviews in the Neurosciences 24 (3) pp293-300. doi: 10.1515/revneuro-2013-0006. Review.

Mirelman A, Maidan I, Deutsch JE (2013) Virtual reality and motor imagery: promising tools for assessment and therapy in Parkinson’s disease. Movement Disorders 28 (11) pp1597-1608. doi: 10.1002/mds.25670. Review.

Rochester L, Yarnall AJ, Baker MR, David RV, Lord S, Galna B, Burn DJ (2012) Cholinergic dysfunction contributes to gait disturbance in early Parkinson’s disease Brain 135 (Pt 9) pp2779-2788. doi: 10.1093/brain/aws207.

Tomlinson CL, Patel S, Meek C, Clarke CE, Stowe R, Shah L, Sackley CM, Deane KH, Herd CP, Wheatley K, Ives N (2012) Physiotherapy versus placebo or no intervention in Parkinson’s disease The Cochrane Database of Systematic Reviews.

van der Kolk NM, King LA (2013) Effects of exercise on mobility in people with Parkinson’s disease Movement Disorders 28 (11) pp1587-1596. doi: 10.1002/mds.25658. Review.


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11.30am – 5.50pm | WHITTLE ROOM

Platform presentations

11.30am – 12.20pmP14 Gary Morris

P17 Stephen Ashford

P60 Benjamin Ellis

P62 Anna Danielsson

P32 Kate Lee

12.30pm – 1.20pmP61 Doncha Lane

FP8 Pawel Kiper

Khymeia VRRS Virtual Reality Rehabilitation System: Remote rehabilitation effectiveness and clinical evidence” Dr Andrea Turolla

1.30pm – 2.15pm

Ekso GT – Implementing robotic neurorehabilitation into modern practice” Barry Richards Ekso Bionics Clinical Director Europe

2.30pm – 3.20pmP3 Corali Seary

P68 Matthew Dale

FES – from research to clinical practice Professor Ian Swain Odstock

3.30pm – 3.50pm

(Evidence based) Exercise and fitness after stroke; STARTER, a longer term solution for your stroke patients? Bex Townley Later Life

4.10pm – 4.50pmP30 Isa Usman Lawal

FP10 Martine Nadler

FES – trials and tribulations Matthew Dale and Alex Cheyne Bioness

5.10pm – 5.50pmP27 Rose Galvin

FP3 Praveen Kumar

Why do so few stroke survivors recover upper limb function? Prof Sarah Tyson Saeboflex

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Closing the loop in neurorehabilitation – how to induce plasticity by closed-loop interactionProf Dr Dario Farina

Dario Farina received PhD degrees in automatic control and computer science and in electronics and communications engineering from the Ecole Centrale de Nantes, Nantes, France (2001) and Politecnico di Torino (2002), respectively. After being a research scientist at the Laboratory for Neuromuscular System Engineering (LISiN) of Politecnico di Torino, he was an associate professor in biomedical engineering at Aalborg University, Aalborg, Denmark (2004-2008). At the same university, in 2008 he became full professor in motor control and biomedical signal processing and the head of the research group on neural engineering and neurophysiology of movement. In 2010 he was appointed full professor and founding chair of the Department

of Neurorehabilitation Engineering at the University Medical Center Göttingen, Georg-August University, Germany, within the Bernstein Focus Neurotechnology (BFNT) Göttingen. In this position, he is also the chair for neuroInformatics of the BFNT Göttingen since 2010. Prof Farina has been the president of the International Society of Electrophysiology and Kinesiology (ISEK) in 2012-2014 and he is currently past president of ISEK. Among other awards, he has been the recipient of the 2010 IEEE Engineering in Medicine and Biology Society Early Career Achievement Award. His research focuses on neurorehabilitation technology, neural control of movement, and biomedical signal processing and modelling. Within these areas, Prof Farina has co-authored more than 350 papers in peer-reviewed journals and over 400 among conference papers/abstracts, book chapters, and encyclopedia contributions. He has been the co-editor of the IEEE/Wiley books Introduction to Neural Engineering for Motor Rehabilitation (2013) and Surface Electromyography: Physiology, Engineering and Applications (2015). He is currently the editor-in-chief of the Journal of Electromyography and Kinesiology and an associate editor of The Journal of Physiology and of IEEE Transactions on Biomedical Engineering.


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9.00am – 9.40am | JAMES ROOM

Generating the evidence base for personalised stroke rehabilitationProf Valerie Pomeroy

Following qualification as a physiotherapist at the Cambridge School of Physiotherapy and after holding a variety of clinical posts, Professor Pomeroy obtained a PhD from the School of Medicine, University of Southampton. Between 1996 and 2002 she was senior lecturer in stroke therapy research at the University of Manchester and was also director of The Stroke Association’s Therapy Research Unit. She subsequently took up the post of Professor of Rehabilitation for Older People at St George’s London until 2007 when she was appointed to her current post as Professor of Neurorehabilitation at UEA. Prof Pomeroy is also co-chair of the Acquired Brain Injury Rehabilitation Alliance (ABIRA). Prof Pomeroy’s research

programme is focused on enhancing recovery of movement control and functional activity after stroke through: identifying underlying mechanisms of impairment and disability, identifying underlying mechanisms of ‘natural’ and therapy-enhanced recovery, using resultant knowledge to inform the content of rehabilitation interventions and then evaluating these interventions in randomised clinical trials. This programme of work is enabled by undertaking biomechanical and neurophysiological studies in the UEA’s movement analysis laboratory and also through established bioengineering and neuroscience collaborations with researchers in other universities. Prof Pomeroy is currently leading the development of a UK-wide (UKSRN) translational rehabilitation research programme (neuroscientists and clinical scientists) in the FAST INdICATE Trial and is co-chair of the Acquired Brain Injury Rehabilitation Alliance (ABIRA) which combines the UEA with Cambridge University (eg Brain Recovery Centre, Clinical neurosciences and the MRC Brain and Cognition Centre).

ABSTRACTThe evidence base for stroke rehabilitation has increased pleasingly and continues to do so. Growing with this evidence base is a scientific appreciation of the clinical need for prescription of specific therapy most likely to enhance recovery in well-characterised groups, or even individual, stroke survivors. Using the model of motor recovery this presentation will explore current knowledge about the tailoring of physical therapy for people with different clinical presentations. Special reference will be made to therapy dose, predictive markers for response to specific physical therapies and a new evidenced-based algorithm to support therapists in clinical decision-making. Further development of the clinical science of personalised stroke rehabilitation will require integrated investigations of clinical efficacy, predictive markers and mechanisms of recovery. The recently completed SWIFT Cast Trial and ongoing FAST INdICATE Trial are examples of such investigations. Learning from conducting these trials will be shared.


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REFERENCESBradnam L, Stinear C, Barber P et al (2012) Contralesional hemisphere control of the proximal paretic upper limb following stroke Cerebral Cortex 22 pp2662-2671.

Jones PS, Pomeroy VM, Wang J et al (2016) Does stroke location predict walk speed response to gait rehabilitation? Human Brain Mapping37 pp689-703.

Morone G, Iosa M, Bragnoni M et al (2012) Who may have durable benefit from robotic gait training? Stroke 43 pp1140-1142.

Pomeroy VM, Ward NS, Johansen-Berg H et al (2014) FAST INdICATE Trial protocol. Clinical efficacy of functional strength training for upper limb motor recovery early after stroke: neural correlates and prognostic indicators International Journal of Stroke9 pp240-245.

Wolf S, Kwakkel G, Bayley M for the Upper Extremity Stroke Algorithm Working Group (2016) Best practice for arm recovery post stroke: an international application Physiotherapy pre-print.


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9.00am – 9.40am | WESTMINSTER ROOM

Neurophysiotherapy in Nigeria: an overview of neurophysiotherapy service models, how current evidence is used in supporting treatment models and the challenges thereinDr Olumide Dada

Olumide Olasunkanmi Dada, MNSP PhD PT, is a licensed physiotherapist with core competence in stroke rehabilitation and the rehabilitation of general neurological conditions. He had his undergraduate education in physiotherapy from the premier physiotherapy training institution in Nigeria, University of Ibadan, Ibadan, Nigeria where he graduated top of his class with numerous distinctions and prizes including prizes for the overall best student in physiotherapy and best student in exercise therapy. He proceeded to obtain his postgraduate qualifications from the same institution, obtaining a master’s degree with honours and a doctor of philosophy degree in neurological physiotherapy. Dr Dada was awarded the African Doctoral Dissertation

Fellowship grant in 2009 towards his PhD dissertation. He has also won several other awards and prizes for excellence in research including the Travelling Grant for the International Brain Research Organization of the African Neuroscience School in 2005, the African Doctoral Dissertation Research Fellowship Grant in 2009, the award for the Embodiment of the African Doctoral Dissertation Research Fellowship (ADDRF) for collaborative work with other fellows in 2013 by the African Population and Health Research Center (APHRC). Dr Dada has authored several peer review articles in the areas of disability and wheelchair accessibility, genealogical patterns of stroke survivors, constraint induced movement therapy (CIMT), and post stroke fatigue with a goal mantra of ‘returning the clients to as near as possible to premorbid state’. He is currently a clinician and instructor in the University of Ibadan Health Service where he is involved in teaching undergraduate and postgraduate students in his current position as the head of physiotherapy. He is also an associate teaching faculty in the department of physiotherapy at the same university, where has been a co-examiner in clinical examinations for some years. He was formerly an assistant lecturer in the School of Health Technology in Federal University of Owerri, Nigeria. Dr Dada is the pioneer chair of the Neurophysiotherapy Specialty Group of the Nigeria Society of Physiotherapy (NSP) and currently serves as the National Public Relations Officer of the NSP. He is a reviewer with the Bayero Journal of Evidenced-Based Physiotherapy and the editor-in-chief of the National Magazine of the NSP. He is married to Oluchi with whom he has two sons (Ore and Mayo) and a daughter (Dara).

ABSTRACTStroke rehabilitation is a combined and coordinated use of medical, social, educational and vocational measures to retrain a person who has suffered a stroke to his/her maximal physical, psychological, social and. vocational potential, consistent with physiologic and environmental limitations. Stroke rehabilitation services in Nigeria are usually delivered under two major models – hospital-based and community-based (home) rehabilitation services. At the acute phases, majority of the survivors are managed as inpatients on the wards (commonly in the


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secondary and tertiary hospitals) by Physicians and Physiotherapists in what can best be described as multi-disciplinary approach. After the stroke survivors are discharged from the ward, they either receive physiotherapy (stroke rehabilitation) services on outpatient basis or at home, based on factors such as finance, proximity, accessibility and comfort.

The frequently adopted rehabilitation models in the Nigerian practice are Bobath, Proprioceptive Neuromuscular Facilitation and Constraint-induced Movement Therapy (CIMT). The rehabilitation preference is determined by experience/exposure of the physiotherapist, weight of evidence in support of the model and availability of skills/equipment.

The challenges in stroke rehabilitation services are mainly personnel and resources; specifically few number of trained Neurophysiotherapists, fewer number with knowledge of specialized models, lack of training platforms to hone skills and dearth of facilities.

REFERENCESOlaleye OA, Hamzat TK (2013) Relevance of location to outcome of stroke rehabilitation Nigerian Journal of Medical Rehabilitation 16 (1).

Ogunlana MO, Dada OO, Oyewo OS, Odole AC and Ogunsan MO (2013) Quality of life and burden of informal caregivers of stroke survivors Hong Kong Physiotherapy Journal 32 (1) pp6-12.

Dada OO, Sanya AO (2011) Constraint-Induced Movement Therapy: Determinants and Correlates of Duration of Adherence to Restraint Use among Stroke Survivors with Hemiparesis Disability, CBR and Inclusive Development 22 (3).

Mbada CE, Nonvignon J, Ajayi O, Dada OO, Awotidebe TO, Johnson OE, Olarinde A (2012) Impact of missed appointments for outpatient physiotherapy on cost, efficiency and patients recovery Hong Kong Journal of Physiotherapy 31 (1) pp30-35.

Brubo-Petrina A (2014) Motor recovery in stroke assessed on 29 January, 2016 via emedicine.medscape.com/article/324386-overview.

Hamzat TK, Dada OO (2005) Wheelchair accessibility of public buildings in Ibadan, Nigeria Asia Pacific Disability Rehabilitation Journal 16 (2) pp115-124.


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Electromechanical-assisted training for upper and lower limbs after strokeProf Dr Jan Mehrholz

Prof Dr Jan Mehrholz, has been the Professor in Physiotherapy (FH Gera) at the Scientific Institut Klinik Bavaria Kreischa since 2008. He is also associate professor (privatdozent) and supervisor of MD and PhD students at the Faculty of Medicine and Department of Public Health Technical University in Dresden. Prof Mehrholz lectures in neurosciences, assessments, neurorehabilitation/therapies, evidence based practice and statistics, public health and has an international track-record in presentation and publication. He is an associate editor of the Cochrane Stroke Review Group, Edinburgh UK and an editor of the journal Neuroreha, published by Thieme in Germany. His main research interests are in neurological rehabilitation and physiotherapy

including motor training after stroke, Parkinson’s disease, critical illness polyneuropathy and myopathy and other neurological diseases.

ABSTRACTUsing machines to assist training might improve upper and lower limb function after stroke. Scientific evidence for the benefits of electromechanical-assisted training, however, is required to justify the large equipment and human resource costs needed to implement electromechanical-assisted gait devices, as well as to confirm the safety and acceptance of this type of training. Therefore, this talk provides an update of the best available evidence from Cochrane reviews about electromechanical and robotic-assisted gait and arm training devices for improving motor function and activities after stroke.

In three updated Cochrane reviews we included 67 randomised trials involving 3657 participants for electromechanical-assisted gait and 34 randomised trials involving 3657 participants for electromechanical-assisted arm training.

Electromechanical-and robotic assisted gait training in combination with physiotherapy increases the odds of non-ambulatory patients becoming independent in walking. Although currently direct comparisons between different devices are lacking, indirect comparisons suggests higher walking speed and walking endurance in favor of end-effector devices compared with exoskeletons. Non-ambulatory patients benefit mostly from an electromechanical-assisted gait approach. We did not found any evidence for wearable exoskeletons or bionic suits.

In already ambulatory patients after stroke a treadmill training approach might increase walking speed and walking endurance, but therapists should apply higher intensities of treadmill training. Treadmill training should therefore be used when people after stroke can walk independently and when improvement of walking speed and endurance is the aim of therapy.

Electromechanical and robot-assisted arm and hand training after stroke might improve activities of daily living, arm and hand function, and arm and hand muscle strength. These devices can be applied as a rehabilitation tool, however, we still do not know when or how often they should be used.


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REFERENCESMehrholz J, Pohl M, Platz T, Kugler J, Elsner B (2015) Electromechanical and robot-assisted arm training for improving activities of daily living, arm function, and arm muscle strength after stroke Cochrane Database of Systematic Reviews (11) CD006876. DOI: 10.1002/14651858.CD006876.pub4.

Mehrholz J, Elsner B, Pohl M (2014) Treadmill training and body weight support for walking after stroke Cochrane Database Systematic Reviews (1) CD002840. doi: 10.1002/14651858.CD002840.pub3.

Mehrholz J, Elsner B, Werner C, Kugler J, Pohl M (2013) Electromechanical-assisted training for walking after stroke Cochrane Database of Systematic Reviews (7) CD006185.


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10.30am – 11.20am | JAMES ROOM

Handicap International training programme for physiotherapists on humanitarian missionsMr Peter Skelton

Pete Skelton is a London based physiotherapist and rehabilitation project manager with Handicap International. He has worked as part of emergency responses in Nepal, Gaza, Iraq, the Philippines, Libya, Jordan and Haiti. Prior to this, he spent ten years combining physiotherapy with his first degree in medical anthropology, balancing work in the National Health Service in London with development projects in Africa and Asia. Pete’s current role involves integrating rehabilitation professionals into the UK International Emergency Trauma Register, and creating within the register the first ever dedicated Spinal Cord Injury disaster response team. The multi-disciplinary trauma register draws staff from the health service in the UK and aims to

rapidly deploy them in response to sudden onset disasters, with the support of a field hospital. Pete is co-author of two forthcoming publications – WHO Minimum Standards for Rehabilitation in Emergency Medical Teams, and a WCPT briefing paper on the Role of Physical Therapists in Disaster Management.

ABSTRACTDisasters are a growing global problem with increasing numbers of people affected around the world. There is increasing guidance that supports the inclusion of rehabilitation professionals in responding emergency medical teams, but they are rarely included at the forefront of emergency responses. For the first time, rehabilitation professionals have been fully integrated into an international emergency medical team – the UK Emergency Medical Team (UKEMT). This study aims to describe the process of integrating rehabilitation professionals into the UKEMT, including collaboration with ACPIN and other professional networks. This has included the development of professional standards, recruitment, training, equipping, and deploying teams.

Over 100 rehabilitation professionals have been recruited to the UK Emergency Medical Team Community of Practice. Clinical humanitarian training was developed to UK best practice standards in partnership with Professional Networks, and was supported by a system of self rated confidence assessments designed to evaluate humanitarian clinical competencies and guide future training development. Humanitarian training and leadership of the UK team was provided by the organisations UKMed, Save the Children and Handicap International.

As an integral part of the UK team, 22 rehabilitation professionals have since deployed to emergencies in the Philippines, Gaza and Nepal. Post deployment evaluation has revealed that the training offered met the needs of those deployed.

REFERENCESWHO (2013) Classification and minimum standards for foreign medical teams in sudden onset disasters http://www.who.int/hac/global_health_cluster/fmt_guidelines_september2013.pdf

Sphere Project (2011) Humanitarian charter and minimum standards in humanitarian response http://www.spherehandbook.org/


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10.30am – 11.20am | WESTMINSTER ROOM

Spinal cord injuries: recent trials and their relevance to other areas of neurologyProf Lisa Harvey

Professor Lisa Harvey has twenty years clinical experience in spinal cord injuries. She currently holds an academic position at Sydney Medical School, University of Sydney where she teaches, runs her own research program and supervisors PhD students. She has over 130 publications which include clinical trials and systematic reviews. Most of her research has focused on putting an evidence base to widely administered physiotherapy interventions. She is currently principal investigator on some large multi-centered clinical trials being run in Australia and Asia. In addition, Lisa is an associate editor of Spinal Cord and on the editorial board of the Journal of Physiotherapy. She teaches widely both nationally and internationally, and played a lead role in the

development of www.physiotherapyexercises.com and www.elearnSCI.org

ABSTRACTPhysiotherapy is a relatively young profession. Consequently, it is yet to build a strong evidence base for the many different physiotherapy interventions commonly administered to people with spinal cord injuries (SCI). Randomised controlled trials provide the most robust estimates of treatment effectiveness because they minimize bias arising from the expectations of clinicians, patients and researchers. We recently conducted a systematic review and identified 53 randomised controlled trials investigating the effectiveness of different physiotherapy interventions for people with SCI. This is a relatively small number of clinical trials given the scope of physiotherapy practice. This is problematic because clinicians and patients need good quality evidence to guide decisions about the most effective interventions. To address this problem, my colleagues and I have devoted the last 15 years to conducting simple randomised controlled trials aimed at systematically examining the effectiveness of physiotherapy interventions. To date we have completed 20 randomised controlled trials looking at a range of interventions such as those used to manage contractures, improve motor control, reduce respiratory complications, aid gait, enhance hand function and increase strength.

Most of these trials are simple in design but with a focus on methodology to reduce bias. This includes the use of blinded assessors, concealed allocation, intention-to-treat analyses and pre-defined primary outcomes. These trials have been possible because research is embedded within clinical practice thereby minimising costs. The trials are largely done within the three Sydney SCI units by the physiotherapy clinicians. The interventions to experimental participants are administered as part of routine clinical care. A professional development program runs in parallel providing opportunities for SCI physiotherapy clinicians to attain post-graduate qualifications through their participation in the trials. The findings of the trials have sometimes challenged long-held beliefs about the effectiveness of widely administered interventions. For example six of our clinical trials have contributed to a recent Cochrane Systematic Review which provided clear evidence for the first time that stretches administered through the hands of physiotherapists are not an effective form of contracture management in people with SCI. Some of our trials have pointed to the importance of functional training while others have reconfirmed long-held assumptions about the effectiveness


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of interventions which have been administered to date without a good evidence base. While the primary purpose of our research program has been to progress the physiotherapy care of people with SCI, a by-product of our research program has been the development of a SCI physiotherapy work-force which is highly educated in evidence based practice. This not only helps ensure that patients receive high quality evidence-based physiotherapy but it also fosters a workplace that is intellectually stimulating for therapists. This in turn increases job satisfaction, retains staff and builds clinical expertise. This model of conducting simple trials as part of clinical practice is of relevance to physiotherapists working across all areas of neurology.

REFERENCESArora M, Harvey LA et al (2015) Effectiveness and cost effectiveness of telephone-based support versus usual care for treatment of pressure ulcers in people with spinal cord injury in low- and middle-income countries: study protocol for a 12-week randomised controlled trial. BMJ Open 5 e008369 doi:10.1136/bmjopen-2015-008369.

Calhoun C, Harvey L (2014) Mobility for children with spinal cord injury In: Vogel LC, Zebracki K, Betz RR and Mulcahey MJ (ed). Spinal cord injury in the child and young adult Mac Keith Press 2nd Edition.

Chhabra HS, Harvey LA, Muldoon S (2015) www.elearnSCI.org: A Global Educational Initiative of ISCoS. In Chhabra HS (ed) Comprehensive Management of Spinal Cord Injuries.

Harvey LA (2008) Management of spinal cord injuries: a guide for physiotherapists Elsevier London ISBN-13: 978 0 443 06858 4 (published in English, Korean and Spanish).

Harvey LA (2013) GRADE the evidence (invited editorial) Journal of Physiotherapy 59 p5.

Harvey LA (2013) Improving the quality of systematic reviews in Spinal Cord (invited editorial) Spinal cord 51 pp174-175.

Harvey LA (2014) Statistical power calculations reflect our love affair with p values and hypothesis testing: time for a fundamental change (invited editorial) Spinal Cord 52 p2.

Harvey LA (2015) Spin kills science (invited editorial) Spinal Cord 53 p417.

Harvey LA (2015) Randomised controlled trials do not always give the results we want but that doesn’t mean we should abandon randomised controlled trials (invited editorial) Spinal Cord 53 p251.

Harvey LA (2016) Physiotherapy rehabilitation of people with spinal cord injuries Topical Review (invited) Journal of Physiotherapy 62 pp4-11.

Harvey LA, Somers M, Glinsky JV (2015) Physiotherapy management of people with spinal cord injury In Chhabra HS (ed) Comprehensive Management of Spinal Cord Injuries.

Hossain MS, Harvey LA et al (2016) Community-based InterVentions to prevent serIous Complications (CIVIC) following spinal cord injury in Bangladesh. Protocol of a randomised controlled trial BMJ Open 6 (1).

Hossain MS, Islam MS, Glinsky J, Lowe R, Lowe T, Harvey LA (2015) A massive open online course (MOOC) can be used to teach physiotherapy students about spinal cord injuries: a randomised trial Journal of Physiotherapy 61 pp21-27.

Hossain MS, Rahman MA, Herbert RD, Quadir MM, Bowden JL, Harvey LA (2015) Two-year survival following discharge from hospital after spinal cord injury in Bangladesh Spinal Cord doi: 10.1038/sc.2015.92.

Kwok S, Harvey LA, Glinsky J, Coggrave M, Tussler D (2015) Does regular standing improve bowel function in people with spinal cord injury? A randomised controlled cross-over trial Spinal Cord 53 pp36-41.

Mudge A, Harvey LA, Lancaster A, Lowe K (2015) Electrical stimulation following Botulinum Toxin A in children with Spastic Diplegia: a within-participant randomized pilot study Physical and Occupational Therapy in Pediatrics 35 pp342-53.

Ross L, Lannin N, Harvey LA (2015) Strategies for increasing the intensity of upper limb task-specific practice after acquired brain injury: a secondary analysis from a randomised controlled trial British Journal of Occupational Therapy doi:10.1177/0308022615615590.


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11.30am – 12.20pm | FLEMING ROOM

Exploration of clinical-academic collaboration to achieve evidence based practiceProf Robert van Deursen

Prof van Deursen was born in the Netherlands where he obtained a BSc in Physiotherapy (1981); between 1982-1992 he worked in various rehabilitation settings; he obtained an MSc (cum laude) in Movement Science (1994) at the Free University, Amsterdam; and a PhD in Biomechanics and Locomotion Studies (1997) at The Pennsylvania State University. He joined the School of Healthcare Studies, Cardiff (1998); established the Research Centre for Clinical Kinaesiology (1999); became Director of Physiotherapy (2004); and is now Professor of Rehabilitation Science (2013). His expertise is in the area of movement analysis and biomechanics applied to clinical problems in rehabilitation. His research interests include the rehabilitation of joint instability

in relation to the development of osteoarthritis; the prevention and rehabilitation of lower limb complications due to diabetic neuropathy; and mobility problems in neurological conditions. Defining functional recovery and determining the effect of exercise on patients in the presence of movement disorders is a common thread in this research. He has recently established a new Gait Real-time Analysis Interactive Lab (GRAIL); a system to provide real-time movement feedback to patients whilst they are moving.

ABSTRACTProfessor Archie Cochrane (1972) argued that healthcare interventions should only be provided unless effectiveness has been demonstrated using scientific methods. Since his recommendation, scientific evidence has become an important ingredient of clinical decision making and a lot has happened to develop evidence-based practice (EBP) in the UK as well as world-wide. Within rehabilitation it has been a bit of a wake-up call that for EBP one needs evidence; and for evidence one needs research on questions relevant to rehabilitation. Fortunately, it was realised that ‘no evidence of effect’ is not the same as ‘evidence of no effect’. However, that does mean that research evidence needs to emerge at some point. It is helpful that a reasonable number of countries have decided to incorporate healthcare education into the university-level. For instance in the UK, physiotherapy has become a university degree in the early 90s. Being part of a university has facilitated the addition of post-graduate education and research programmes becoming available for continued professional development. These will certainly have contributed to the development and adoption of EBP in clinical practice but the process of producing research evidence in rehabilitation still requires substantial effort.

Stroke rehabilitation is a good example where a lot of progress with EBP has been made. An online literature search for [‘clinical guidelines’ AND stroke AND rehabilitation] reveals that 55 documents were published between 1995 and 2015. In this same period around 120 systematic reviews related to stroke rehabilitation were published. Starting with one systematic review in the year 1997 the annual number has increased gradually to twelve in 2015. The UK published its latest version of clinical guidelines for stroke rehabilitation in 2013 based on just under 300 studies comprising of systematic reviews and randomised controlled trials (RCTs). However, these guidelines are not yet comprehensive since some aspects of the rehabilitation care pathway were not covered because of


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a lack of RCTs in these areas. For other neurological conditions the lack of evidence is much more apparent and therefore a continued effort to fill the existing gaps is necessary.

The need to build academic and clinical research capability and capacity in physiotherapy and neurorehabilitation is clear but this objective has not yet been sufficiently accomplished. The traditional relationship between clinical and academic physiotherapy has predominantly revolved around undergraduate and clinical placement learning. However, research has become part of both career pathways. If we focussed our collaborative efforts more on ensuring there will be enough active researchers in both environments this would speed up the rate of evidence production in rehabilitation. In academia, research excellence is not only defined by publications but also by research impact. For instance, patient benefit is an important impact category. Also, the current emphasis on translational and on clinical research means that there seems to be a fertile ground for such collaborations to flourish. In this presentation I will explore ideas how we can capture opportunities for collaboration in both the clinical and academic environment to progress rehabilitation research in support of EBP.

REFERENCESCochrane AL (1972) Effectiveness and Efficiency: Random Reflections on Health Services London: Nuffield Provincial Hospitals Trust.

National Institute for Health and Care Excellence (2013) Stroke rehabilitation: long-term rehabilitation after stroke (clinical guideline CG162).


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11.30am – 12.20pm | WESTMINSTER ROOM

Wearable sensors to challenge arm and hand use after strokeProf Dr Janice Eng

Dr Janice Eng is a professor in the department of physical therapy at the University of British Columbia, Vancouver, Canada, and is also director of the Rehabilitation Research Program, Vancouver Coastal Health Research Institute. She holds a prestigious Canada Research Chair Award and has a background in physical therapy, occupational therapy and biomedical engineering. She focuses on the development and knowledge translation of innovative neurological rehabilitation treatments and has published over 200 peer-reviewed publications in this field. Two of her stroke exercise programs, GRASP for improving arm and hand function and FAME for improving fitness and mobility, are implemented in over 1,500 sites in 40 countries.

ABSTRACTDespite the ability to move the upper extremity, many individuals with stroke do not go on to use their stroke-affected arm and hand for daily activities. Motor or functional ability does not necessarily provide an estimate of how much the affected upper extremity is used in daily life. Recently wearable devices such as wrist accelerometers have been used to measure the extent and intensity of upper extremity movements in the home and community setting. This session will provide an overview of the use of wrist accelerometers to provide a reliable and objective way to assess real-world upper extremity use in individuals with stroke. In addition, the development and validation of a new wearable sensor based on force myography will be presented. This new device detects force myographic signals at the wrist using an innovative wrist band consisting of smart materials to capture arm movements, as well as hand grasp and release. We anticipate that this wearable device will enable clinicians to monitor the upper limb activity of their patients during their therapy sessions in the clinic or during daily activity in the home setting, and motivate them to reach prescribed daily activity targets after stroke. Lastly, the integration of wearable sensors into a program to improve upper extremity recovery using a self-management framework will be described. Wearable sensors provide one solution to motivating and monitoring patients in rehabilitation without additional supervision.

REFERENCESBillinger SA, Arena R, Bernhardt J, Eng JJ, Franklin BA, Johnson CM, MacKay-Lyons M, Macko RF, Mead GE, Roth EJ, Shaughnessy M, Tang A (2014) Physical activity and exercise recommendations for stroke survivors: a statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke 45 pp2532-2553.

Connell LA, McMahon NE, Redfern J, Watkins CL, Eng JJ (2015) Development of a behaviour change intervention to increase upper limb exercise in stroke rehabilitation Implementation Science 10 p34.

Connell LA, McMahon NE, Watkins CL, Eng JJ (2014) Therapists’ Use of the Graded Repetitive Arm Supplementary Program (GRASP) Intervention: A Practice Implementation Survey Study Physical Therapy 94 pp632-643.

Hayward KS, Eng JJ, Boyd LA, Lakhani B, Bernhardt J, Lang CE (in press) Exploring the role of accelerometers in the measurement of real world upper limb use after stroke Brain Impairment.

Klassen TD, Eng JJ, Lim SB, Louie DR, Parappilly B, Sakakibara BM, Simpson LA, Zbogar D (in press) “Stepping Up” activity post-stroke: ankle positioned accelerometer can accurately record steps during slow walking Physical Therapy.


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Mayo N, Anderson S, Barclay R, Cameron J, Desrosiers J, Eng JJ, Huijbregts M, Mackay-Lyons M, Richards CL, Salbach NM, Scott SC, Teasell R, Bayley M (2015) Getting on with the rest of your life after stroke: Evaluation of a complex intervention aimed at enhanced life participation post-stroke Clinical Rehabilitation 29 pp1198-1211.

Noble JW, Eng JJ, Boyd LA (2014) Bilateral motor tasks involve more brain regions and higher neural activation than unilateral tasks: An fMRI study Experimental Brain Research 232 pp2785-2795.

Simpson LA, Eng JJ, Backman CL, Miller WC (2013) Rating of Everyday Arm-Use in the Community and Home (REACH) Scale for capturing affected arm-use after stroke: development, reliability, and validity PLoS ONE 8 e83405

Simpson LA, Eng JJ (2013) Functional recovery following stroke: Capturing changes in upper extremity function Neurorehabilitation and Neural Repair 27 pp240-250.

Tang A, Eng JJ, Krassioukov AV, Madden KM, Mohammadi A, Tsang MYC, Tsang TSM (2014) Exercise-induced changes in cardiovascular function after stroke: A randomized controlled trial International Journal of Stroke 9 pp883-889.


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Exercise and training after stroke: maintaining capacity and abilityProf Dr Birgitta Langhammer

Dr Birgitta Langhammer is Professor at Oslo University College, Faculty of Health, and at Sunnaas Rehabilitation hospital, Research department. Dr Langhammer teaches at undergraduate and graduate level in geriatrics, neurology, rehabilitation and methodology. Her current research involves the Sunnaas International Network Stroke study, a specialized collaboration in rehabilitation between nine institutions in seven countries Norway, China, USA, Russia, Israel, Palestine and Sweden. Also two studies with the Oslo and Akershus University College/Norwegian University of Science and Technology: Life Early After Stroke (LEAST) early mobilization after stroke, an observational study of acute stroke care in ten hospitals and Life After Stroke (LAST) a

randomized controlled trial on longitudinal intervention after stroke to maintain capacity and function, following persons with stroke from three months till 18 months post stroke; follow-up of 300 sub-acute and chronic patients in the Trondheim, Asker and Baerum communities.

ABSTRACTLong-term rehabilitation and follow up after early rehabilitation in the stroke unit is scarce. Studies have shown that in order to maintain physical functioning and physical capacities, persons suffering a stroke need to do as much physical activity as the general population. However, the opportunities for such activity are limited for persons with stroke with moderate to severe disabilities. The inactivity that often follows can be devastating for a person with borderline physical capacity after a stroke. The main aim with this talk is to focus on maintenance of physical function and capacities post stroke.

Questions to be discussed:n When should therapy / exercise / training start and when should it end?n Physiotherapy is part of the rehabilitation team in acute and specialized rehabilitation, but there

are questions regarding the optimal models of rehabilitation. n Furthermore, there are questions regarding content, time, frequency and intensity of therapies /

exercises. n Where are we and where are we going?

REFERENCESKleffelgaard I, Soberg HL, Bruusgaard KA, Tamber AL, Langhammer B (in press 2015) Vestibular rehabilitation after mild traumatic brain injury – a case series Physical Therapy.

Langhammer B, Becker F, Stibrant-Sunnerhagen K, Zhang T, Du X, Bushnik T, Panchenko M, Keren O, Banura S, Elessi K, Luzon F, Lundgren-Nilsson Å, Li X, Sällström S, Stanghelle JK (2015) Specialized stroke rehabilitation services in seven countries. Preliminary results from nine rehabilitation centers International Journal Of Stroke 10 pp1236-1246.

Langhammer B, Lindmark B (2014) General Motor Function assessment – reliability of a Norwegian version Disability and Rehabilitation 36 (20) pp1704-1712.

Langhammer B, Lindmark B (2015) The Norwegian General Motor Function assessment scale – an outcome measure for the frail elderly. A validity study Geriatrics & Gerontology International Early online DOI: 10.1111/ggi.12491.


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Langhammer B, Lindmark B, Stanghelle JK (2014) Physiotherapy and physical function post stroke: exercise habits and function four years after? Long term follow up after a one year long term intervention period, a randomized controlled trial Brain Injury 28 (11) pp1396-405. doi:10.3109/02699052.2014.919534.

Langhammer B, Stanghelle JK (2015) The Senior Fitness Test. Australian Journal of Physiotherpy 61 p163.

Langhammer B, Stanghelle JK, Sällström S, Becker F, Zhang T, Du X, Bushnik T, Panchenko M, Keren O, Banura S, Khamis E, Lundgren-Nilsson Å, Stibrant-Sunnerhagen K, Xie L, Jachniuk F (2015) An international multicenter study of specialized rehabilitation for stroke patients . Protocol of the Sunnaas InterNational (SIN) stroke project Journal of Clinical Trials 5 (2) pp1-4.

Langhammer B, Veerheyden G (2013) Stroke rehabilitation: issues for physiotherapy and physiotherapy research to improve life after stroke Editorial Physiotherapy Research International 18 (2) pp65-69.

Loureiro Cunha AP, Guarita-Souza LC, Lerdal A, Langhammer B (2014) A systematic review of the relationship between post-stroke fatigue and physical activity Topics in Geriatric Rehabilitation 30 (4) pp296-306.

Sandhaug M, Andelic N, Langhammer B, Mygland A (2015) Community integration two years after moderate and severe traumatic brain injury Brain Injury 29 (7–8) pp915–920.

Sandhaug M, Andelic N, Langhammer B, Mygland A (2015) Functional level during the first two years after moderate and severe traumatic brain injury Brain Injury 11 pp1-8.


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Virtual reality technologies for upper limb motor learning and recovery in rehabilitationProf Mindy Levin

Dr Levin trained as a physiotherapist at McGill University and practiced for several years at the Rehabilitation Institute of Montreal where she specialized in neurological rehabilitation. She then obtained a MSc. degree in Clinical Sciences from the University of Montreal followed by a PhD. in Physiology from McGill University under the directorship of Dr Christina Hui-Chan. She completed an additional two years of post-doctoral training in neurophysiology at the University of Montreal under the co-directorship of Drs Yves Lamarre and Anatol G Feldman. From 1992 to 2004, Dr Levin held positions as researcher and professor in the School of Rehabilitation at the Université de Montréal. She taught courses at the undergraduate and graduate level mainly

in the areas of electrotherapy and neurology. Dr Levin was Scientific Director of the Research Centre of the Rehabilitation Institute of Montreal from 1997 until November 2001. She was a research scholar of the Fonds de la Recherche en Santé du Québec from 1992 until 2004 and was director of the Physical Therapy Program in the School of Physical and Occupational Therapy at McGill University from July 2004 to July 2008. She served as president of the International Society of Motor Control and is currently president of the International Society of Virtual Rehabilitation and an executive member of the International Neurological Physiotherapy Association of the World Physical Therapy Association. Dr Levin’s research focuses on understanding the motor control of upper limb reaching and grasping of one and/or both arms as well as the coordination of arm and trunk movements. She is interested in the measurement of sensorimotor impairments, as well as the effectiveness of new interventions for arm and hand sensorimotor recovery following neurological injury or disease, such as stroke. New interventions of interest include task-oriented therapy and virtual reality technology. Dr Levin has investigated the validity of upper limb movements made in different types of virtual environments by healthy subjects and people with neurological impairments. She has also done several studies on the effectiveness of feedback delivered through virtual training environments. Dr Levin also holds a Tier 1 Canada Research Chair in Motor Recovery and Rehabilitation (2005-2012, 2012-2019).


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Lunchtime addressProf Karen Middleton

Before her appointment as CSP CEO, Karen was chief health professions officer, leading more than 80,000 physiotherapists and other allied health professionals in the NHS and other sectors. Among other achievements in her former role, Karen led and completed a number of self-referral pilots for musculoskeletal (MSK) physiotherapy. This work helped to pave the way for patient self-referral to become the optimum route into allied health profession services. She also led the work to enable physiotherapist and podiatrists to independently prescribe. Karen is, of course, no stranger to the Society. She graduated in physiotherapy in London in the mid-1980s and has been a CSP member for almost 30 years. Indeed, she was a CSP steward for six years

earlier in her career, actively representing the interests of physiotherapy staff in the NHS while working as a physiotherapist herself. Since graduating, Karen has worked in a wide variety of clinical and managerial roles. She initially specialised in MSK before moving into rehabilitation and then becoming associate director of primary care in Tower Hamlets, east London in 1999, when she managed the community nursing workforce. From there she moved to the London Directorate for Health and Social Care as a primary care development manager. In 2003 she joined the Department of Health as allied health professions advisor before being appointed as chief health professions officer four years later. Karen has raised the profile of physiotherapists and other allied health professionals by speaking at a range of national and international events. She led a range of programmes that modernised the careers of allied health professionals, using a competency-based approach to workforce development. In 2013, Karen was made a CSP Fellow for advancing the physiotherapy profession, developing leadership capacity and promoting professionalism, through her role as chief allied health professions officer at NHS England. Karen is also a Fellow of the Society of Orthopaedic Medicine, and, in that capacity, has taught physiotherapists and GPs on a national and international basis. She gained an MA in consultation and the organisation: a psychoanalytical approach in 2006. Driven by a desire to improve patient care, Karen is convinced that physio staff are the ‘rehabilitationists’ of healthcare – skilled and influential practitioners who have a mission both to add ‘life to years’ and ‘years to life’.


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Walking and simulated walking controlProf Helen Dawes

Helen Dawes, Elizabeth Casson Trust chair, leads the Movement Science Group based in the Faculty of Health and Life Sciences at Oxford Brookes University. Helen initially trained and practiced as a physiotherapist specializing in sport physiotherapy and working in the UK and New Zealand, prior to undertaking postgraduate training in exercise science and neuroscience. Helen then embarked on a PhD exploring exercise for people with neurological conditions. She has since then focused on optimizing performance of everyday activities through rehabilitation and on enabling physically active lifestyles in adults and children with disorders affecting movement such as: stroke, Parkinson’s, cerebral palsy and multiple sclerosis.

Her research requires cross-disciplinary collaborations. Her activities include research, teaching and the provision of clinical exercise and rehabilitation in the community. Her research spans from exploring underlying mechanisms affecting performance through to service delivery of subsequently developed interventions and tools.


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Hereditary spastic paraparesis: pathophysiology and rehabilitationProf Jonathan Marsden

Prof Jonathan Marsden is professor and chair of Plymouth University’s Rehabilitation School of Health Professions (Faculty of Health & Human Sciences). Prof Marsden’s role at Plymouth University is to lead and develop research capacity in the field of rehabilitation. His research interests and experience are in the field of neurorehabilitation and human motor physiology. Prof Marsden is currently investigating the pathophysiology and rehabilitation of balance and gait disorders after central and peripheral neurological lesions in adult and paediatric populations. The primary aim of this current research is to identify the cause of balance and gait impairments after neurological dysfunction and to evaluate the efficacy of therapeutic interventions that aim

to ameliorate these impairments. He currently supervises six postgradute students, two PhD students as first supervsior, three PhD students as second and an one Mphil student as first supervisor.


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Service users reviewMr Alex Massey

Alex is Senior Policy and Campaigns Adviser at the Neurological Alliance. Previously he has worked as a policy adviser at ACEVO, the charity leaders’ network, and as a research fellow for education at the think-tank Policy Exchange.

ABSTRACTThis presentation will discuss the work of the Neurological Alliance and its members to improve understanding of the needs of people with neurological conditions and the issues currently affecting neurology services in the UK. It will include discussion of the results of the latest Neurological Alliance patient experience survey with a focus on access to diagnosis and to specialist treatment, care and support, including multi-disciplinary working. It will also examine the pathway from primary care services to specialist neurology provision, which is characterised by long delays. It will also look at the available data and evidence gathered by the Neurology Intelligence Network on service availability and outcomes. The presentation will also discuss some of the key initiatives and ambitions for NHS neurology services going forward.

REFERENCESNeurological Alliance (2015) The Invisible Patients: Revealing the state of neurology services.

ABN (2014) Acute Neurology Survey.

Neurology Intelligence Network (2015) Outpatient data briefing.

Neurological Alliance (2014) Going the Distance.


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9.00am – 3.20pm | WHITTLE ROOM

Platform presentations

9.00am – 9.40am

FES – from research to clinical practice Professor Ian Swain Odstock

(Evidence based) Exercise and fitness after stroke; STARTER, a longer term solution for your stroke patients? Bex Townley Later Life

10.30pm – 11.20amP29 Carlo Bertoncelli

P13 Rhiannon Stokes

P70 Katherine Jackson

FP15 Gita Ramdharry

P23 Rachel Young

11.30am – 12.20pmP31 Antoine Zaczyk

P58 Tine Kovacic

P11 Marielle Graziano

12.30pm – 1.10pmP66 Gemma Mosely

P43 Adine Adonis

Ekso GT – Implementing robotic neurorehabilitation into modern practice” Barry Richards Ekso Bionics Clinical Director Europe

1.30pm – 2.20pm

FES – trials and tribulations Matthew Dale and Alex Cheyne Bioness

Khymeia VRRS Virtual Reality Rehabilitation System: Remote rehabilitation effectiveness and clinical evidence” Dr Andrea Turolla

2.30pm – 3.20pmFP7 Louise Hawkins

P33 Cheryl Anderson

Why do so few stroke survivors recover upper limb function? Prof Sarah Tyson Saeboflex


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Round up and closingProf Derick Wade


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