Session Chairs: Julie Bernhardt, Australia and Christina Jern, Switzerland
Report by Prof. Dr. Zdravka Poljaković, Croatia
This session was chaired by professor Julie Bernhard from Australia and professor Christina Jern from Sweden and introduced by prof Bernhardt. There were five lectures on the program, covering some new insights in the field of recovery and rehabilitation. The session had various topics, which opened some new doors and inspired the audience to join this developing field.
The New International Stroke Recovery and Rehabilitation Alliance: Goals And 5-Year Plan to Advance Recovery Science
First lecture by prof Bernhard explained to the audience The New International Stroke Recovery and Rehabilitation Alliance (ISRRA) and its goals. The main aim of this Alliance is to support and encourage high-quality clinical trials in biology of recovery, to encourage structured process of care (rehabilitation), shift it more to the acute phase of stroke as well as to take care about cost benefit of rehabilitation and recovery processes. One of the goals would also be to organize centers of Clinical Excellences in order to provide higher level of structured rehabilitation.
Targets for The Next Generation of Clinical Recovery Trials
In the next lecture, Anna-Sophia Wahl a Branco Weiss Fellow (ETH Zurich) and Junior Group Leader at the Brain Research Institute, presented her point of view considering targets for next clinical trials. In her talk she concentrated on several points for clinical trials: intrinsic repair, plasticity and behavioral modifications. Of special interest in the on-going trials is the investigation of the possibilities of enhancing spontaneous recovery with a specific therapy (forming of meaningful spreading) as well as to study the connection between the hind and fore limb (which might share the same neuronal network).
Recovery Clinical Trials at A Crossroads: Rethinking Trial Designs
Kate Hayward from Melbourne presented some pitfalls in the clinical trial designs, as well as some typical mistakes which can mislead the outcomes of the trial. She presented also some usual models of clinical trials with its possible advantages and disadvantages especially talking about rehabilitation trials.
Cognition: Recovery Epochs, Therapeutic Windows, Biomarkers and Candidate Therapies
Especially interesting topic was covered in the next lecture from dr Clarkson a behavioural neuropharmacologist and lecturer of neuroanatomy from New Zealand, whose main interest are cognition and cognitive impairment. In his comprehensive overview of anatomy and physiology of cognition, as well as cognitive impairment after stroke he showed also results of recent investigations considering the importance of white matter lesions and reactive astrogliosis in cognitive impairment, importance of prefrontal cortex stroke in delayed onset stroke dementia and small vessel disease and silent strokes in impairments of some special functions, like odor preference.
The Promise of Recovery Genetics: Hope Or Hype
The session ended with a highly „up to date“ topic, namely recovery genetics, a lecture given by professor Jern from Sweden. In this new field in stroke, a lot of research has been done in the past 20 years. Therefore, in 2007., the International Stroke Genetics Consortium (ISGC) was formed, in order to conduct and encourage clinical studies for genetic in stroke. One of the largest studies, MEGASTROKE, brought news to this field by discovering 35 novel loci associated with stroke alone, and some even associated with specific types of stroke. However, „recovery genes“ are still to be discovered. As stroke outcome vary widely, which can not be explained by known factors, the question about existance of genes which might influence the outcome remains open. Several studies showed conflicting results although at least one showed that some alleles were associated with worse stroke outcome. Furthermore, as injury and recovery operate in different time windows and through different pathways, it is highly possible that different gene variants may be at play at different time points. This hot topic so remains open, which is one of the most important reason why the Global Alliance for ISGC is formed in order to facilitate data sharing and collaboration of international groups and researchers dealing with stroke genetics.
In conclusion to this session – in the stroke world, recovery is the primary goal. However, as even advanced methods of acute therapy are not always sufficient to achieve good results advancing the science of recovery and rehabilitations remains crucial for a large percent of the stroke patients.