reaching out to reduce the of...

ANNUAL REPORT 2006–2007

T O R E D U C E T H E

R E A C H I N G O U T

O F S T R O K E

To reduce the impact of stroke on

Canadians through collaborations

that create valuable new know-

ledge in stroke; to ensure the best

knowledge is applied; and to build

Canadian capacity in stroke.

CSN MISSION:

The Canadian Stroke Network is anindependent, not-for-profit corporation.It was established in 1999 to reduce theburden of stroke through leadership inresearch innovation. It is made up ofmore than 100 of the country’s best andbrightest scientists, clinicians, rehabili-tation specialists and knowledge-trans-lation experts from universities acrossthe country.

Headquartered at the University ofOttawa, the Canadian Stroke Networkbrings together partners from govern-ment, industry and the non-profit sector,including the Heart and Stroke Founda-tion, one of the country’s largest healthcharities.

www.canadianstrokenetwork.ca

WHO WE ARE:

The Canadian Stroke Network has been instrumentalin bringing top researchers together to develop newways to fight stroke. – Dr. Kevin Willis, Director, Canadian Stroke Network

CSN Vision:

By 2010, Canadian individuals, familiesand society will benefit from measurableimprovements in stroke prevention, treat-ment and rehabilitation.

The CSN has defined three strategic objec-tives that will ensure it achieves this Vision:

• To ensure that Canadian researchers collaborate and stay focused on creating valuable new knowledge in stroke.

• To ensure that the best stroke knowledge is applied in Canada and leads to valuablehealth and economic benefits.

• To build Canadian capacity in stroke by increasing the number of researchers and health professionals focused on stroke.

NCE Program:

The Canadian Stroke Network is part ofthe federal government’s flagship scienceand technology initiative, called the Net-works of Centres of Excellence, or NCEprogram. The Networks of Centres ofExcellence of Canada are unique partner-ships among universities, industry, govern-ment and non-governmental organizationsaimed at turning Canadian research andentrepreneurial talent into economic andsocial benefits for all Canadians. Thesenationwide, multidisciplinary and multi-sectoral research partnerships connectexcellent research with industrial know-how and strategic investment.

CSN Mission: To reduce the impact of stroke onCanadians through collaborations that create valuablenew knowledge in stroke; to ensure the best knowledgeis applied; and to build Canadian capacity in stroke.

Stephanie Spooner, a provincial level athlete with no history of illness,suffered a stroke on her 21st birthday on July 19, 2005. It began with what feltlike a migraine headache, until the pain increased and Stephanie went numb on oneside. Stephanie, who had a hemorrhagic stroke, wasn’t expected to survive. Butafter two surgeries and intensive rehabilitation therapy, Stephanie beat the oddsand returned to school at the University of Waterloo in September 2006 to pursuea degree in kinesiology. “Clearly the greatest impact to Stephanie has been on hermobility and freedom,” her mother says. “She continues to endure the loss ofpersonal dignity, given her reliance on an ever-revolving door of personal careattendants who assist with her daily routine. She takes anti-seizure medicationdaily and fatigue is a persistent part of her life, though she continues to getstronger… Steph has demonstrated her fighting spirit and her personal missionto not let the stroke prevent her from achieving her life goals. Steph will graduatewith an honours kinesiology degree, likely in 2008, and is currently evaluatingwhether she pursues research, teaching, physiotherapy or medical school.”

Table of Contents:

Message from CSN Management ........................................................1

Research.............................................................................................4

Outreach & Training ..........................................................................12

Partnerships .....................................................................................16

International Collaborations..............................................................18

Member Lists....................................................................................19

Partners ...........................................................................................20

Financial Statements ........................................................................22

Stroke is a growing problem – especially with the aging population – and

countries around the world are struggling to figure out what to do and how

to organize themselves. Other countries see the Canadian Stroke Network

as a model because we cover the complete translational spectrum from

research to application, which is hard to find elsewhere.

Dr. Antoine Hakim, CEO and Scientific Director, Canadian Stroke Network

“

”

{REDUCING THE IMPACT of stroke

Through research, training, outreach and knowledgetranslation, the Canadian Stroke Network is reducingthe impact of stroke. We are working to fund leading-edge science, to promote collaboration, to ensure thatprofessionals and patients are armed with the bestnew knowledge, and to transform the delivery of strokeprevention, care and rehabilitation.

This past year, progress was particularly significant.

We helped develop the first set of Canadian BestPractice Recommendations for Stroke Care, and we

worked with provincial champions to promote theCanadian Stroke Strategy. Funding commitments insupport of provincial strategies were realized in manyparts of the country.

We welcomed respected stroke neurologist and epi-demiologist Dr. Mike Sharma as the CSN’s DeputyDirector, Clinical Affairs and Health Policy. Dr.Sharma provides clinical support to the CanadianStroke Strategy for CSN-led initiatives, engageshealth policymakers, brings important research ques-tions to the attention of the CSN, and leads researchprojects related to health outcomes. In 2006, Dr. Sharmadeveloped the national economic model on stroke care,

We saw the Network’s profile increaseon the national and international stage

1

“”

CSN{which garnered considerable attention, and his work isnow helping to make the case for province-wideorganization of stroke care.

In 2006-07, CSN leaders visited many parts ofCanada to talk with politicians and policymakersabout the need for action on stroke. And, we confirmedwith representatives in places such as Nunavut thatdifferent approaches are required in different regionsof the country.

We saw the Network’s profile increase on the nationaland international stage – from the keynote address atthe International Stroke Conference in California tokey presentations at stroke meetings in the U.K.,Europe and Korea. The international community islooking to the Canadian Stroke Network to provideleadership and guidance.

We learned that our award-winning training programcontinues to draw and retain the best young researchersto stroke, and we delivered educational workshops andactivities to health-care professionals across the countrythrough the CSN-supported National Stroke NursingCouncil, the National Stroke Conference, and throughpresentations to numerous professional associationsand conferences.

We saw the expansion of the Registry of the CanadianStroke Network – one of the world’s most powerfuldatabases of stroke information – to the Web-basedSPIRIT system and we continued to monitor, evaluateand assess stroke care in parts of the country. Wealso saw an impressive increase in publications basedon data from the Registry, and from funded researchprojects.

And, finally, the Network took a strong stand on apopulation-level approach to stroke prevention by

pushing for increased awareness about the dangers ofexcessive sodium consumption and the related impacton blood pressure. CSN efforts helped draw mediaattention to this important issue and to push forchanges to Canada’s food guide.

While the impact of the CSN is clear and measurable,much work remains. Stroke is a leading cause of deathand disability in Canada, and emerging research showsthat for every evident stroke there are many more‘silent’ strokes that lead to impairment of cognitionup to and including dementia. The CSN is workingwith the U.S. National Institutes of Health and othersto fully understand the magnitude of this problem.

The CSN takes pride in advancements in the interna-tional recognition that Canada is receiving for its researchknowledge, improvements in prevention and care, andstrides in training and networking. As we look ahead,there is much more to be accomplished but we areimpassioned, energized, optimistic and ready to takeon the challenge of stroke.

Eric ElvidgeChair, Board of Directors

Dr. Antoine HakimCEO and Scientific Director

Katie LaffertyExecutive Director

MESSAGE FROM MANAGEMENT

2

REDUCING THE OF STROKE THROUGHIMPACT

3

{The Canadian Stroke Network is producing

results, identifying research gaps, and changing

approaches to stroke disease in Canada.

“”

2006-2007 research highlights:

· The Registry of the Canadian Stroke Network isreshaping care, evaluating the system of stroke careand providing valuable research data. Since its incep-tion in 2001, the Registry has delivered more vital in-formation to Canadian researchers, policymakers andhealth-care providers than anyone could have pre-dicted. Data has been collected on more than 50,000strokes in Canada, creating a treasury of informa-tion that is the envy of the world. Quarterly reportsare prepared on the state of stroke care and resultsare shared with provincial governments and regionalhealth authorities. This year, the Registry entered an-other phase with the development of a Web-basedsystem called SPIRIT that can be used by health-care centres across the country to collect informa-tion and confidentially compare their performanceto others. In addition to monitoring and evaluatinghealth systems, the Registry is also a magnet for strokeresearch. Undergraduate, graduate and post-doctoralstudents are using the data to further their studiesand, as a result, more people have been attracted tothe field.

· CSN researchers developed a bedside test that willenable health professionals to quickly determinewhether a stroke patient is having trouble swallowingand may be at risk of choking, pneumonia, malnutri-tion or death. The CSN-funded Toronto BedsideSwallowing Screening Test (Tor-BSST) was pre-sented at the 2007 International Stroke Conference.A training CD, developed with the support of theCSN, was produced in February and disseminatedacross Canada and around the world.

· In partnership with the Heart and Stroke Founda-tion, the Canadian Stroke Network produced Cana-dian Best Practice Recommendations for StrokeCare 2006, a guide for stroke prevention, treatmentand recovery. Six thousand copies of the publicationhave been distributed, and the document has beenposted on the Canadian Stroke Strategy (www.cana-dianstrokestrategy.ca) and Canadian Stroke Network(www.canadianstrokenetwork.ca) websites.

· As part of a CSN-funded project called Getting onwith the Rest of Your Life after Stroke, researchersare studying programs for stroke recoverers in six

4

{ RESEARCH

Unlike many other diseases, stroke is preventable.More than half of the 50,000 strokes that occur inCanada every year could be eliminated by controllingrisk factors.

cities – Vancouver, Montreal, Toronto, London, Sher-brooke and Halifax – to determine which ones areeffective and why. It is a precursor to what will be thelargest community stroke engagement project everlaunched. The goal of CSN research is to create guide-lines for effective community re-integration, to createa mechanism for organizations to secure funding fortheir programs and to determine how the availabilityand benefit of community programs can be shared withthe people who need them.

· A Canadian Stroke Network-funded initiative calledCHAP – Cardiovascular Health Awareness Program –screened more than 10,000 seniors for hypertension in20 communities across Ontario in fall 2006. In Alberta,through the CSN-funded A-CHAMP (Airdrie CommunityHypertension Awareness and Measurement Program),more than 75 per cent of the 408 seniors who tookpart in the 2006 program saw improvements in bloodpressure, diet and exercise levels. The goal is to eventu-ally expand the program, which is designed to improvestroke prevention and reduce cardiovascular risk factorsamong seniors, across the country.

· A promising new stroke drug developed by CSN re-searchers entered Phase 1 clinical trials. The drug,called NA-1, was one of only a limited number of new

pharmaceuticals to enter human trials in Canada in2006. Effective in animal models, the drug protectsbrain cells from damage in the event of ischemic stroke– the most common kind of stroke. Seed funding fromthe Canadian Stroke Network led in January 2005 to the formation of NoNO Inc., which went on to raise$8.5 million to commercialize the neuroprotective drug.

· Canadian Stroke Network researchers establishedscreening tests and other tools to measure reductionsin memory, perception and problem-solving ability –all indicators of ‘silent’ strokes that wreak havoc on thebrain. Conditions normally associated with aging –confusion or the inability to perform certain mentaltasks – are indicators of the progressive cognitive im-pairment that is caused by silent strokes. A CSN-U.S.National Institutes of Health workshop on silent strokeswas conducted in collaboration with researchers fromaround the world. New tools will allow clinicians fromdifferent disciplines to come together to tackle thishuge problem.

· CSN funded the first randomized controlled trial toassess the efficacy of an internet-based program thatprovides behavioural counselling for lifestyle change.Subjects include hypertensive individuals who are athigh risk for cardiovascular disease. Called I-START,

Men are affected by stroke at a younger age

(average of 70 years of age) than women, whose

average age of stroke is 73.6 years – CSN research

5

“The evidence is overwhelming that controlling

blood pressure is the way to dramatically lower

stroke and cardiac disease.”– Dr. Larry Chambers, Cardiovascular Health Awareness Program (CHAP) study

6

it is an interdisciplinary collaboration between behaviouralcardiology, neurology, and public health. I-START willprovide critical information about the effect of lifestylechange on brain-based mechanisms that mediate bloodpressure regulation during behavioural interventions.

· A Viral Vector Core Facility is supported by the CSNto provide high quality recombinant viral vector toolsto CSN researchers; to test and develop new generationvectors and assess their potential for gene therapyin stroke; to provide a vector registry to facilitatecollaboration among CSN researchers through theexchange of reagents; and to provide training for CSNstudents and fellows on the construction, the safe andeffective use of these viral vectors. These reagents areavailable to CSN researchers at just 10% of the com-mercial cost. All vectors generated are registered andposted on a web site where they are made available toall CSN researchers.

· A team of CSN researchers is studying how to preventthe death of neurons during stroke and the disruptionin the connections between neurons that occurs whenblood flow is reduced. The team is studying the rolesfor novel cation channels in stroke-induced neuronalcell death. In addition, the links of NMDA-type gluta-mate receptors to cell death pathways are being manip-ulated to determine the protection afforded to strokedamage. As well, the team is investigating the abilityto mobilize the brain’s own protective strategies asanti-stroke therapies.

· The CSN is funding a project called RECOVERY, whichis looking at novel approaches to stimulating recoveryfrom stroke. The purpose is to provide clear directionsfor designing better treatments for stroke based uponknowledge of how the brain is altered by experience. Itinvolves determining whether treatments for motorsymptoms will be effective for cognitive symptoms;identifying novel treatments; examining whethercofactors will interact with stroke outcome and treat-ments (e.g., age, stress and nicotine); and exploringnovel in vivo imaging techniques to analyze stroke andstroke therapy outcomes. The research is one of themost comprehensive preclinical programs ever proposedfor the problem of stroke.

· CSN researchers are probing the potential of stem cellsas a therapy for stroke. They are exploring the ability ofa number of adult human stem cell populations, includ-ing accessible stem cells from the skin, to become func-tional brain cells. They are also studying the potential to“turn on” stem cells that are resident in the mammalianbrain. This work builds on previous studies in whichresearchers have shown that stem cells in the adult braincan be activated by specific growth factors to help theinjured brain repair itself following stroke. Researchers willdevelop new strategies to enhance this regenerativeprocess and combine current rehabilitation strategieswith these novel approaches to promote brain repair. Thismultidisciplinary project is conducted in partnershipwith the Stem Cell Network and a commercial partner– Stem Cell Therapeutics Corp. in Calgary.

The earlier a patient gets inpatient rehabilitation, the greater the improvementin functional status. – CSN research

7

Betty Hayes keeps a journal to record her feelings since having astroke at age 42. Small but mighty, Betty worked hard through intensiverehabilitation therapy to relearn to walk and to care for herself. She alsohad to relearn to write – and now, when she’s sad or angry, she pushes apen and gets her feelings out. “Journaling helps me keep my sanity. ThenI can go back later and analyze my feelings and deal with it.”

8

· In 2002, the Stroke Canada Optimization of Rehabili-tation by Evidence (SCORE) Project team begandeveloping a national network of stroke rehabilitationresearch centres with support from the CSN. TheSCORE team also set out to produce evidence-informedpractice recommendations in three identified priorityareas of arm rehabilitation, leg rehabilitation andassessment for those at risk of problems with swallow-ing, falls, skin breakdown, depression, and cognitionpost stroke. Recommendations are being pilot tested insix sites. This study represents the largest knowledgetranslation study involving rehabilitation professionalsever conducted.

· The Stroke Rehabilitation Evidence-based Review(SREBR) provides the most comprehensive and currentreview of the stroke rehabilitation research literatureavailable anywhere in the world. In addition, it formsthe foundation for numerous Canadian and interna-tional stroke rehabilitation research initiatives alignedwith the CSN and the Canadian Stroke Strategy. CSNresearchers are continuing to update and expand this

remarkable resource, develop new knowledge transla-tion tools as well as guidelines and standards, informthe research agenda to help determine priorities, helpto continue the integration of clinical and basic scienceresearch and to inform policy development in strokerehabilitation.

· StrokEngine, a Web-based educational tool providingevidence-based systematic reviews of stroke rehabili-tation, continues to be enhanced by CSN researchers.This website (www.strokengine.org) offers an “A to Z”listing of every rehabilitation intervention currentlyavailable in Canada. The website is targeted at healthprofessionals, students, patients and families.

· CSN researchers are developing an Educational Inter-vention to Enhance Evidence-Based Practice for Walk-ing Rehabilitation (WALKING). Walking limitation iscommon post-stroke and one of the most importantissues addressed by physiotherapists. Strategies are beingincorporated into a pilot randomized controlled trial.

Treating atrial fibrillation (AF) is an important way to help prevent stroke.

Anticoagulant drugs (Warfarin) and antiplatelet drugs (Aspirin) are used to

“thin” the blood and make it less prone to clotting. For every nine people treated

with Warfarin, one stroke is prevented. Long-term use of Warfarin in patients

with AF can reduce their incidence of stroke by 68 per cent.

9

“We have the leading registry in stroke research.

We have the richest and biggest sample size of any

stroke registry in the world.”– Dr. Jiming Fang, biostatistician, Registry of the Canadian Stroke Network

10


11

{The Focus on Stroke award was

instrumental in attracting me to

come to Canada from EnglandTom Claydon, University of British Columbia

“”

· The Canadian Stroke Network has been a nationalleader in raising awareness about the health risks ofexcessive sodium consumption. The Network publi-cized findings from recent studies involving CSNresearchers and, with its partners, successfully urgedHealth Canada to include information about salt inCanada’s Food Guide. The CSN has been a key playerin a national task force on salt, a national steeringcommittee and it has worked with consumers, gov-ernment and industry to draw attention to the issue.

· The Canadian Stroke Network coordinated productionof a six-page special supplement in the Globe andMail newspaper on the Canadian Stroke Strategy, inpartnership with the Heart and Stroke Foundation ofCanada. It also developed a special supplement inCanadian Health magazine, featuring the efforts ofthe Canadian Stroke Strategy.

· The CSN sponsored the First National StrokeRehabilitation Conference, the World Stroke Con-gress, stroke recovery meetings, targeted workshops

and an annual public lecture on stroke to raise publicawareness about research in the field. This publiclecture is named in memory of former Governor Gen-eral Ramon J. Hnatyshyn, who was a founding boardmember of the CSN.

· The CSN developed an improved website for theCanadian Stroke Strategy (www.canadianstroke-strategy.ca), with advocacy information and toolsfor health professionals.

· The CSN works in partnership with the CanadianStroke Consortium to host two annual clinical train-ing events. The Annual Review Course for Neurol-ogy Residents is a two-day series of lectures andworkshops that provides residents with an overviewof the mechanisms of cerebrovascular disease, andits prevention and management. The National StrokeConference, also held annually, brings together morethan 150 emergency doctors, internists and neurol-ogists to coordinate stroke care. The response to bothinitiatives has been overwhelmingly positive.

12

{ OUTREACH & TRAINING

An economic analysis by the Canadian Stroke Network showswidespread access to organized stroke care could prevent160,000 strokes, prevent disability in 60,000Canadians and save $8 billion net in healthcare costs over 20 years.

· The CSN has invested $300,000 over six years to support60 undergraduate and graduate students working inlabs across Canada through its summer studentshipprogram. As well, its has awarded a $25,000 mentor-ship prize every year for the past four years to aninvestigator who has made a significant contribution tothe development of young researchers.

· The award-winning Focus on Stroke training program,funded in partnership with the Heart and Stroke Foun-dation, AstraZeneca Canada and CIHR/Rx&D, has sup-ported 99 doctoral, post-doctoral and new-investigatorawards with a total investment of $8.7 million. A recentreview of the program shows that most researchersfunded through Focus on Stroke remain in the field, anda survey of participants found that 100 per cent felt thatthe Focus on Stroke award was an important step inestablishing their research career.

· The CSN was instrumental in the creation of the NationalStroke Nursing Council in 2005, which brings togetherstroke nurses across Canada to enhance education,training and professional development. The Networkdisseminates and funds its monthly publication, calledStroke Nursing News, and funds an annual workshopfor stroke nurses.

· The Network’s Dr. Jill Cameron organized a workshopfor about 40 trainees on “Opening the Door to Oppor-tunity,” which involved providing trainees with expertadvice on writing CVs and cover letters, and the insidetrack on career opportunities in academia and industry.

The cost of stroke is huge. Stroke is a leading cause of disabilityand death. Canadians spend some three million days a yearbedridden because of stroke; it costs the health-care system $3billion a year in direct costs alone; and the impact on families andsociety is immeasurable.

13

After enjoying a morning coffee and watching the news, Hubertd’Entremont headed out to run errands when suddenly he couldn’tmove his feet. It was if they were nailed to the floor. He fell to the groundand his speech was slurred. After the stroke, Hubert spent months in arehab centre, before returning home. Hubert and Marie have learned a lotsince the stroke. “First, don’t make the assumption that stroke survivorshave something wrong with their brain. Too often people say to Hubert,‘Do you remember me?’ or ‘Do you know who I am?’ This is rather insulting.”

14


15

{In terms of the economics of

organized stroke care, a comprehensive

program does something very unique in

health care…it actually saves money.

Dr. Mike Sharma, Deputy Director, Canadian Stroke Network

“”

16

{ PARTNERSHIPS

The Canadian Stroke Network works closely with itspartners in all aspects of network life, and a number ofnew relationships were formed in 2006-2007.

For example, the Network collaborated with research,advocacy and education groups in its push to raiseawareness about the health impact of excessive sodiumconsumption and the link to hypertension. It joinedforces with these partners – including Blood PressureCanada, Dietitians of Canada, Canadian Society ofNephrology, Heart and Stroke Foundation of Canadaand Public Health Agency of Canada – to take an ac-tive role in a national steering committee and taskforce on the issue.

Partners from industry, academia, and health charitiesalso stepped forward to help the Canadian Stroke Net-work finance ‘special reports’ on the Canadian StrokeStrategy, which appeared in the Globe and Mail news-paper and Canadian Health magazine. These partnersinclude Merck Frosst, AstraZeneca, Boehringer Ingel-heim, Canadian Stroke Consortium, TrialStat, Heartand Stroke Foundation Centre for Stroke Recovery,University of Ottawa, Heart and Stroke Foundation ofCanada, Roche, Blakes and Novo Nordisk.

Partners are also working with the CSN to establishtwo new stroke prevention clinics in Manitoba, whichwill study the impact of secondary prevention meas-ures on patients who have experienced a stroke ortransient ischemic attack. These partners includeHeart and Stroke Foundation of Manitoba, MerckFrosst and Canadian Stroke Consortium.

The Canadian Stroke Network has also welcomed awide range of new partnerships through the continueddevelopment of the Canadian Stroke Strategy. Thefocus on best practices, knowledge translation andtransformative systems change has led to a number of

innovative collaborations with a broad range of part-ners including: the Public Health Agency of Canada,the Chronic Disease Prevention Alliance of Canada,the Canadian Council on Health Services Accredita-tion, Aboriginal groups, Ministries of Health, StrokeRecovery Groups, and a diverse group of professionalassociations.

Partners, including stroke survivors and caregivers,industry, professional associations, government policy-makers and health charities, work with the CSN tohelp define research priorities. As well, partners areinvolved formally through positions on the Board ofDirectors, the Planning and Priorities Committee andthe External Scientific Review Committee and throughinformal participation in CSN-sponsored workshops inCanada and around the world.

Why do we need the Canadian Stroke Strategy?

• the cost of stroke is huge• most strokes are preventable and treatable• we have a plan to improve the

health-care system• governments at all levels need to invest

in and commit to this plan• all Canadians should have access to

organized stroke care


17

{The Canadian Stroke Strategy will lead to huge improvements if everyone

steps up to the plate and does their part. The reality is that we can prevent

stroke. We can help people walk away from stroke. What we can’t do is sit

back and fail to take action.Sally Brown, CEO, Heart and Stroke Foundation of Canada and member, CSN Board of Directors.

“”

18

{INTERNATIONAL COLLABORATIONS

Canadian Stroke Network Scientific Director Antoine Hakim received

the American Stroke Association’s highest honour at the 2007 Inter-

national Stroke Conference. Dr. Hakim was awarded the 2007 Willis

Award in recognition of his significant contribution to stroke research,

his leadership of the Canadian Stroke Network and his efforts to advance

the Canadian Stroke Strategy. Dr. Hakim was also honoured in 2007

by being named an Officer of the Order of Canada, and winning the

2007 MEDEC Award for Medical Achievement.

From the U.K. to Germany to Russia to Korea to theU.S., stroke research communities around the worldhave been knocking at the door of the Canadian StrokeNetwork this year for leadership and guidance. Not onlyhave CSN researchers been invited to present scientificpapers at prestigious international gatherings, but Net-work leaders have been called on to describe the secretof Canada’s success in developing a collaborative anddynamic community.

The CSN recently provided insight to stroke researchleaders in the U.K. who are establishing a research network.The Network also visited Korea to meet with neurolo-gists and other stroke experts who want to learn moreabout how the CSN was organized and its involvementin the Canadian Stroke Strategy.

This fall, the Canadian Stroke Network will be featuredat Russia’s major stroke meeting. As well, CEO andScientific Director Dr. Antoine Hakim has been asked tolead the external scientific review committee for a Euro-pean stroke research network, which is in development.

At the 2007 International Stroke Conference in SanFrancisco, the Canadian Stroke Network had a highprofile. Dr. Hakim was presented with the 2007 WillisAward, the American Stroke Association’s highesthonour, and he used the opportunity to provide severalthousand stroke researchers from around the worldwith an overview of the work of the Canadian StrokeNetwork and its efforts to promote the CanadianStroke Strategy. The event also received considerablemedia attention in Canada and the U.S.

19

MEMBER LISTS

Investigators:Dalhousie UniversityMarilyn Mackay-LyonsGeorge Robertson

Hospital for Sick ChildrenFreda MillerMichael Salter

London Health Sciences CentreRobert Teasell

McGill UniversityNicol Korner-BitenskyNancy Mayo Sharon Wood-Dauphinee

McMaster UniversityJanusz Kaczorowski

Memorial UniversityDale Corbett

Mount Sinai HospitalJohn Roder

Ottawa Health Research InstituteDavid Park Luc SabourinPeter Stys Charlie Thompson

Sunnybrook and Women’s College Health Sciences Centre Moira Kapral Patrice LindsayFrank Silver

Toronto Rehabilitation InstituteMark Bayley

University Health NetworkRobert Nolan Michael Tymianski

University of AlbertaFred Colbourne

University of British ColumbiaMax CynaderJanice Eng Brian MacVicar Tim Murphy Steve Vincent Yu-Tian Wang

University of CalgaryCam Teskey Sam Weiss

University of LethbridgeAlbert Cross Bryan KolbOlga Kovalchuk Gerlinde Metz Rob McDonald Glen PruskyRobert Sutherland Ian Whishaw

University of OttawaLarry Chambers Ruth Slack

University of SherbrookeJohanne Desrosiers

University of TorontoMichelle Aarts Mark BayleySusan JaglalJohn MacDonald Cindi Morshead Nancy Salbach

University of Western OntarioKevin Shoemaker

University of P.E.I.Andrew Tasker

Board of DirectorsEric Elvidge, (Chair) Blake, Cassels & Graydon LLP Howard Alper, University of OttawaPierre Boyle, University of MontrealSally Brown, Heart and StrokeFoundation of CanadaJoy Calkin, formerly of Extendicare Inc.Michael Cloutier, AstraZenecaDale Corbett, Memorial University of NewfoundlandGregory Del Zoppo, Scripps Clinic and ResearchFoundation (California)Antoine Hakim, Canadian Stroke NetworkKatherine Lafferty, Canadian

Stroke NetworkSamuel Liang, Johnson & JohnsonEnikö Megyeri-Lawless, Networks of Centres of Excellence Carol Richards, Université LavalDavid W. Scott, Borden LadnerGervais LLP (Emeritus)Robert Smith, University ofBritish ColumbiaAubrey Tingle, Michael SmithFoundation for Health ResearchKevin Willis, Canadian StrokeNetworkFred Wing, Rice Financial Group Inc.Joan Wing, Stroke Survivor

Planning and Priorities CommitteeAntoine Hakim (Chair), Canadian Stroke NetworkNorman Campbell, University of CalgaryBryan Kolb, University of Lethbridge, (Theme IV co-leader)Nicol Korner-Bitensky, McGillUniversity, (Theme IV co-leader)Mary Lewis, Heart and StrokeFoundation of OntarioBrian MacVicar, University ofCalgary, (Theme III leader)Enikö Megyeri-Lawless, Networks of Centres of Excellence Ashfaq Shuaib, University of Alberta, (Theme I leader)Frank Silver, University ofToronto, (Theme II leader)Samuel Weiss, University of CalgaryKevin Willis, Canadian Stroke Network

External Scientific Review CommitteeAntoine Hakim (Chair), Canadian Stroke NetworkPak Chan, Stanford UniversityRebecca Craik, Arcadia UniversityHans Christophe Diener, University Duisburg-EssenPamela Duncan, Duke UniversityGiora Feuerstein,Wyeth Pharmaceuticals

20

Larry Goldstein, Duke University Lynn McQueen, Department ofVeterans Affairs (United States)Lee Schwamm, MassachusettsGeneral HospitalSteven Wolf, Emory UniversitySchool of Medicine

Business Development Advisory CommitteeKevin Willis (Chair), Canadian Stroke NetworkJohn Dickey, Capital Insights IncorporatedEric Elvidge, Blake, Cassels & Graydon LLPGeorge Jackowski, Phoenix Biopharm Inc.Marc LePage, Consul General of Canada in San FranciscoSamuel Liang, Johnson & JohnsonPaul Morley, Zelos TherapeuticsBrian Radburn, PriceWater-houseCoopers LLP

Ethics Advisory CommitteeBernard Dickens (Chair) Facultyof Law, University of TorontoOther Members (ad hoc)

Partners:Academic and clinical:

• Baycrest Centre for Geriatric Care

• Canadian Association of Emergency Physicians

• Canadian Association of Neuroscience Nurses

• Canadian Medical Association• Canadian Stroke Consortium • Hamilton Health Sciences• Hospital for Sick Children • Institute de recherches

cliniques de Montréal• Institute for Clinical

Evaluative Sciences • Montreal General Hospital• Mount Sinai Hospital • Ottawa Health Research

Institute • Robarts Research Institute• Sunnybrook & Women’s

College Health Sciences Centre

• Toronto Rehabilitation Institute

• Dalhousie University• London Health Sciences Centre• McGill University• McMaster University• Memorial University of

Newfoundland• University Health Network• University of Alberta• University of British Columbia• University of Calgary• University of Lethbridge• University of Ottawa• University of Sherbrooke• University of Toronto• University of Western Ontario• University of Prince

Edward Island

Private Sector:• AstraZeneca Canada • Blake, Cassels &

Graydon LLP • Boehringer Ingelheim

(Canada) • Bristol-Myers Squibb Canada• Eli Lilly • Johnson & Johnson • Merck • Merck Frosst • NeuroInvestigations • NoNO Inc. (spin-off company) • Northstar Neuroscience • Novo Nordisk Canada• Pfizer Canada• Phoenix Biopharm Inc.

(spin-off company) • Hoffman La Roche • Stem Cell Therapeutics

(spin-off company) • TrialStat

Non-profit:• Blood Pressure Canada• Canadian Society of Nephrology• Chronic Disease Prevention

Alliance of Canada • Dieticians of Canada• Heart and Stroke

Foundation Canada • Heart and Stroke Foundation

Alberta, NWT, and Nunavut • Heart and Stroke Foundation

Saskatchewan

• Heart and Stroke Foundation Manitoba

• Heart and Stroke Foundation New Brunswick

• Heart and Stroke Foundation Newfoundland and Labrador

• Heart and Stroke Foundation Nova Scotia

• Heart and Stroke Foundation Prince Edward Island

• Heart and Stroke Foundation British Columbia and Yukon

• Heart and Stroke Foundation Quebec

• Heart and Stroke Foundation Ontario

• National Stroke Nursing Council

• Northern Ontario Remote Telecommunications Health Network

• Stem Cell Network • Stroke Recovery

Association of Alberta • World Stroke Federation

Government:• Canadian Institutes of

Health Research • Health Canada • National Institute of

Mental Health, United States • National Institute of

Neurological Disorders and Stroke, United States

• Ontario Ministry of Health and Long-Term Care

• Réseau provincial de recherche en adaptation-réadaptation (REPAR)

• Public Health Agency of Canada

Richard Pothier was in a state of disbelief after a stroke in 2003left him paralysed on his left side. Determined for his life to return tonormal, Richard was hit hard by the reality that he could not sit up, go tothe bathroom or take a single step. He felt imprisoned in his own body.After several months of inpatient rehabilitation, Richard returned homein a wheelchair. With the support of his wife, he slowly began to walk –and persevered until he could resume his ‘daily constitutional’ alongbeloved Cape Wharf Road in Nova Scotia. Although his gait is a little jerkyand his left arm swings to the side once in awhile, Richard feels like his oldself when he is walking the road.

21

22

To the Directors and Members of theCanadian Stroke Network

We have audited the statement of financial position of the Canadian Stroke Network as at March 31, 2007 and the statements of operations, changes in net assets and cash flows for the year then ended. These financial statementsare the responsibility of the Network’s management. Our responsibility is to express an opinion on these financial statements based on our audit.

We conducted our audit in accordance with Canadian generally accepted auditing standards. Those standards require that we plan and perform an auditto obtain reasonable assurance whether the financial statements are free of material misstatement. An audit includes examining, on a test basis, evidencesupporting the amounts and disclosures in the financial statements. An auditalso includes assessing the accounting principles used and significant estimates made by management, as well as evaluating the overall financialstatement presentation.

In our opinion, these financial statements present fairly, in all material respects,the financial position of the Network as at March 31, 2007 and the results of its operations and its cash flows for the year then ended in accordance with Canadian generally accepted accounting principles. As required by the Canada Corporations Act, we report that these principles have been applied on a consistent basis with that of the preceding year.

Ottawa, Canada, Chartered AccountantsJune 15, 2007. Licensed Public Accountants

{ }AUDITORS’ REPORT

23

2007 2006$ $

ASSETS

Current Cash and cash equivalents 2,572,460 3,689,374Contributions receivable 1,166,942 608,150Other receivables (note 7) 94,420 53,094Prepaid expenses 125,526 163,576

Total current assets 3,959,348 4,514,194Capital assets (note 3) 12,480 10,338

3,971,828 4,524,532

LIABILITIES AND NET ASSETS

Current Accounts payable and accrued liabilities 338,804 609,997Contributions received in advance (note 4) 2,329,704 2,627,534

Total current liabilities 2,668,508 3,237,531

Commitments (note 6)

Net assetsInvested in capital assets 12,480 10,338Unrestricted 1,290,840 1,276,663

Total net assets 1,303,320 1,287,001

3,971,828 4,524,532

See accompanying notes

On behalf of the Board:

Director Director

{ }STATEMENT OF FINANCIAL POSITIONAS AT MARCH 31

24

{ }STATEMENT OF OPERATIONSYEAR ENDED MARCH 31

2007 2006$ $

REVENUE

Network Centres of Excellence grant 6,688,679 5,699,361Other grants 2,255,530 1,576,799Contributions 115,000 90,000Services in-kind (note 7) 42,204 42,213Deferred capital contribution recognized — 15,793Interest 85,446 68,664

9,186,859 7,492,830

EXPENSES

Research grants (note 5) 6,715,595 5,645,545Canadian Stroke Strategy 898,970 507,611Salaries and benefits 883,845 723,650Conferences, seminars and meetings 384,439 358,213General and administration 229,730 207,715Professional and consulting fees 51,572 31,757Amortization of capital assets 6,389 23,111

9,170,540 7,497,602

Excess (deficiency) of revenues over expenses for the year 16,319 (4,772)


25

Invested in 2007 2006Capital Assets Unrestricted Total Total

$ $ $ $

Net assets, beginning of year 10,338 1,276,663 1,287,001 1,291,773

Excess (deficiency) of revenuesover expenses (6,389) 22,708 16,319 (4,772)

Investment in capital assets 8,531 (8,531) — —

Net assets, end of year 12,480 1,290,840 1,303,320 1,287,001


{ }STATEMENT OF CHANGES IN NET ASSETSYEAR ENDED MARCH 31

26

2007 2006$ $

OPERATING ACTIVITIES

Excess (deficiency) of revenues over expenses 16,319 (4,772)Amortization of capital assets 6,389 23,111Deferred capital contribution recognized — (15,793)Decrease (increase) in contributions receivable (558,792) 147,001Decrease (increase) in other receivables (41,326) 179,848Decrease (increase) in prepaid expenses 38,050 (67,002)Increase (decrease) in research advances — 25,000Increase (decrease) in accounts payable and accrued liabilities (271,193) 503,779Increase (decrease) in contributions received in advance (297,830) (707,585)

Cash provided by (used in) operating activities (1,108,383) 83,587

INVESTING ACTIVITIES

Net capital asset acquisitions (8,531) (7,361)

Cash used in investing activities (8,531) (7,361)

Increase (decrease) in cash and cash equivalents for the year (1,116,914) 76,226Cash and cash equivalents, beginning of year 3,689,374 3,613,148

Cash and cash equivalents, end of year 2,572,460 3,689,374


{ }STATEMENT OF CASH FLOWSYEAR ENDED MARCH 31

27

1. GENERAL

The Canadian Stroke Network [“CSN”] was incorporated on May 23, 2001, as an independent not-for-profit corporation in accordance with the provisions of the Canada Corporations Act.

The CSN is part of the Canadian Network Centres of Excellence [“NCE”] program. The CSN’s mission is to reduce the effects of stroke on the lives of Canadians and Canadian society. The Networkwill place Canada at the forefront of stroke research through its multidisciplinary research program,high-quality training for Canadian scientists, and national as well as global partnerships. The newknowledge generated by the Network’s research activities will help launch a competitive Canadiancommercial presence.

The CSN consists of research experts across Canada in basic sciences, clinical sciences, social sciences, epidemiology, health economics and policy, and rehabilitation. The CSN aims to break the barriers of treatment of stroke by developing innovative prevention and recovery strategies throughmultidisciplinary and multi-sectorial research. Specifically, the CSN focuses on five research themes:preventing stroke, treating stroke, reducing cell death and minimizing stroke damage, brain repair andfunctional recovery post-stroke, and knowledge translation.

The CSN has been approved for NCE funding of $6.4 million per year for the years ending March 2007 to March 2010.

2. SIGNIFICANT ACCOUNTING POLICIES

These financial statements have been prepared by the CSN in accordance with Canadian generally accepted accounting principles. The preparation of financial statements in conformity with generallyaccepted accounting principles requires management to make estimates and assumptions that affectthe reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at thedate of the financial statements and the reported amounts of revenue and expenses during the year.Actual results could differ from those estimates.

{ }NOTES TO FINANCIAL STATEMENTSMARCH 31, 2007

28

REVENUE RECOGNITION

The CSN follows the deferral method of accounting for contributions, which includes governmentgrants. Funds are received from the Canadian federal government as well as other private and publicsector partners.

Grants and other contributions which have external restrictive covenants governing the types of activities that they can be used to fund are deferred until such time as the actual spending is incurred.Consequently, unspent grants having restrictions will be recognized as revenue in future periods whenthe spending occurs. Grants approved but not received at the end of the accounting period are accrued.

Investment revenue and unrestricted contributions are recognized as revenue when received or receivable if the amount to be received can be reasonably estimated and collection is reasonably assured.

CONTRIBUTION AND SERVICES IN-KIND

Many organizations and individuals contribute a significant amount of volunteer effort in each year. The fair value of these services is often difficult to determine. Contributed services are not recognizedin the financial statements unless a fair value can be reasonably estimated, such services are used inthe normal course of operations and the provider of the services has explicitly defined the value of theservices to the CSN. The CSN is dependent on such contributors to appropriately report the value of allcontributions and services in-kind to its administrative centre.

CASH AND CASH EQUIVALENTS

All highly liquid investments with original maturities of three months or less are classified as cash andcash equivalents. The fair value of cash equivalents approximates the amounts shown in the financialstatements. Cash and cash equivalents were held with one institution.


29

CAPITAL ASSETS

Purchased capital assets are recorded at cost. Donated capital assets are recorded on the balancesheet at their estimated fair value, and recognized in the statement of operations based on their related amortization policy.

Capital assets are amortized on a straight-line basis using the following annual rates:

Software 100%Computer equipment 33%Furniture and fixtures 20%Leasehold improvements 20%

RESEARCH GRANT EXPENSES

Research grant expenses are recorded as expenses when they become payable. Research grants thatwill be payable in future periods are summarized and disclosed as commitments in the notes to the financial statements. If, at the end of the funding period, unspent research grants are returned, they are accounted for in the year returned.

FINANCIAL INSTRUMENTS

The Network’s financial instruments consist of cash and cash equivalents, contributions receivable,other receivables, accounts payable and accrued liabilities. Unless otherwise noted, it is management’sopinion that the Network is not exposed to significant interest, currency or credit risks arising fromthese financial instruments and that their carrying value approximates fair value.

INCOME TAXES

The Network is not subject to income taxes.


30

3. CAPITAL ASSETS

2007 2006

Accumulated AccumulatedCost Amortization Cost Amortization

$ $ $ $

Software 150,280 150,280 150,280 150,280Computer equipment 147,006 139,378 143,454 133,905Furniture and fixtures 13,648 8,796 8,669 7,880Tradeshow booth 10,542 10,542 10,542 10,542Leasehold improvements 79,000 79,000 79,000 79,000

400,476 387,996 391,945 381,607

Less: Accumulated amortization 387,996 — 381,607 —

Net book value 12,480 — 10,338 —

4. CONTRIBUTIONS RECEIVED IN ADVANCE

Contributions received in advance represent grants and other restricted contributions for which the relatedspending has yet to occur.

Contributions received in advance are comprised of the following:

2007 2006$ $

Network Centres of Excellence Grants 1,445,081 1,800,219Heart and Stroke Foundation Funding 371,661 360,675Other 512,962 466,640

2,329,704 2,627,534


31


5. RESEARCH GRANTS

Research grant expenses are allocated as follows:2007 2006

$ $

Theme I - Preventing Stroke 1,319,240 656,800Theme II - Optimizing Acute Stroke Care 1,774,620 1,340,497Theme III - Reducing Cell Death and Minimizing Stroke Damage 1,116,083 852,200Theme IV - Brain Repair and Functional Recovery Post-stroke 1,911,470 1,611,882Theme V - Knowledge Translation — 262,753Research training (studentships, fellowships, frontiers, libraries) 345,486 356,738Discretionary initiatives 666,151 666,160Recovery of unused research funds (417,455) (101,485)

6,715,595 5,645,545

6. COMMITMENTS

The CSN commits annually to funding a number of research projects. It reserves a portion of its annual research budget to additionally fund promising projects that are presented during the fiscal year and also commits to funding several training programs.

The CSN is committed to the following future expenses:2010 and

2008 2009 thereafter$ $ $

Heart and Stroke fundsFocus on Stroke MOU 211,481 317,707 96,125Summer studentships 50,000 — —

261,481 317,707 96,125

NCE fundsResearch grants 4,460,040 — —

4,460,040 — —

Ministry of Health funds CSN Registry Project 797,500 — —

797,500 — —

Total committed to date 5,519,021 317,707 96,125

In addition, CSN has committed up to $50,000 to the Canadian Stroke Consortium in fiscal 2008 for the National Stroke Conference.

32


7. RELATED PARTY TRANSACTIONS AND BALANCES

Under an agreement with the University of Ottawa [the “University”], the University provides accounting and administrative support services as well as office space without charge to the CSN.The value of the in-kind contribution received in fiscal 2007 was $42,204 [2006 $42,213].

The CSN has expensed $602,800 during fiscal 2007 [2006 $421,000] in research grants to its host institution, the University.

Included in accounts payable and accounts receivable is a net payable of $5,669 [2006 – ($86)] due to (from) the University of Ottawa.

8. COMPARATIVE FIGURES

Certain of the prior year’s figures have been reclassified in order to conform with the presentationadopted in the current year.

33

{ }NOTES

reaching out to reduce the of...

Documents