Speaker 1 00:04
With information on the latest developments in assistive technology and initiatives, from the studios of 2RPH in Sydney, RPH Australia brings you AbleQuest. Hello, I'm Barbara Sullivan. Stroke is a common and serious health issue in Australia.
Speaker 1 00:28
It affects approximately 2% of the population and is a leading cause of disability. Loss of arm and leg mobility is a common problem. But one in two people also experience a loss of touch sensation after a stroke, and this can often be a hidden problem.
Speaker 1 00:47
The ability to know when they are touching objects, recognising textures and knowing where the hand is in space may be affected. Our guest today, Professor Leanne Carey and her team have developed a world -first therapy called SENSE.
Speaker 1 01:02
Based on the acronym, Study of the Effectiveness of Neurorehabilitation on Sensation. SENSE therapy, which is S -E -N -S, and a small e, therapy, is designed to help stroke survivors regain a sense of touch and use this information in everyday activities.
Speaker 1 01:21
Marni Ropers spoke to Professor Carey at La Trobe University in Victoria.
Speaker 2 01:27
Welcome to AbleQuest. We are going to discuss a special treatment for stroke patients today, but before we do, can you give us an overview of what causes a stroke and what effect it can have on a patient?
Speaker 3 01:41
Thank you. Strokes caused by a loss of blood supply to the brain, and this can happen due to a blockage or to a bleed to the brain. In relation to what effect it can have, every stroke's different. So when the blood supply to a particular part of the brain is interrupted, there can be damage to that part of the brain and to the function that are controlled, such as movement of the arm and leg or sensation in the hand.
Speaker 3 02:09
So as you can imagine, our brain controls a lot of different functions, such as how we think, receive sensory messages, use language, and move your body. So the effects of the stroke can vary a lot.
Speaker 2 02:23
You're the Professor of Occupational Therapy at La Trobe University in Victoria and the Head of Neurorehabilitation and Recovery at the Flory Institute of Neuroscience and Mental Health. And how did you first get interested in looking into century loss in stroke patients?
Speaker 3 02:41
Well it actually happened quite early in my career when I was working as an occupational therapist in a rehab hospital in the late 80s in fact. And I remember working with a young dental nurse who was essentially my age and she had a stroke and sensory loss.
Speaker 3 02:57
And that loss impacted her ability to hold objects without dropping them and which as you might imagine was particularly problematic for her work as a dental nurse. And so at that time it was thought that there was little that could be done other than compensate for sensory loss and that the person would have a poorer outcome and essentially that didn't seem good enough.
Speaker 3 03:21
So the interesting thing was that around that time evidence was emerging that the adult brain could change with learning and following brain injury. So I decided to investigate the potential for sensory recovery and rehabilitation further.
Speaker 3 03:36
I enrolled in a PhD and I at the very beginning organised a six month study tour around America. And at this time I was able to meet with pioneers in the field of neuroplasticity which is we refer to that changes in the brain and how it might relate to recovery, went to motor learning centres and was able to build the development refine my ideas of how I could use neuroscience and learning to help survivors of stroke regain a sense of touch.
Speaker 2 04:10
Because I noticed my time as a physio treating stroke patients, the main aim was to restore mobility and get people, you know, up and about. But from your experience with the dental nurse, people do have a loss of touch sensation and it can be a hidden problem.
Speaker 2 04:27
I mean, you noticed it or she noticed it. So what do they actually experience?
Speaker 3 04:33
That's a really good question, a good observation. So the person may be able to move their arm and leg but they have trouble with tasks such as holding objects without dropping them and knowing where their arm is in space especially when it's out of view.
Speaker 3 04:48
The problem is that they'll often learn not to use the limb and as one survivor stroke actually described it's like the hand's blind. Everyday tasks are clumsy and require a whole lot of concentration, things like picking up and using a fork, laboured and as she says where my hand was out of sight like doing that bra or putting on jewellery and tying up my hair was virtually beyond her.
Speaker 3 05:18
Others actually report the loss of confidence when you can't feel things and others the impact of it. So for example saying it's very difficult for people to understand the experience that you're having when you can move your hand but you can't feel and no one around you will accept that it's real and that you're kind of fighting on both fronts.
Speaker 2 05:41
And there's things that people don't even think about like shaking hands with someone. It's a natural thing that we do and they have difficulty, don't they? Or dangerous things like could get a burn because they can't feel.
Speaker 3 05:55
Yeah, I think there's three key ways we can think about how it causes problems in everyday tasks. So if you think about sensation, that it's just important that in its own right, it's for those things that you mentioned, the safety, cutting or burning yourself, feeling connected with people through a handshake, just being able to interact with the world.
Speaker 3 06:15
But the other thing that's also important for actions and using the hands. So what we find is that survivors of stroke often crush or drop objects. And when they're using their hands, they have difficulty combining movements smoothly or adapting their movements because they can't feel the changes that are going on.
Speaker 3 06:35
And so you can imagine when they've got life roles and want to participate in everyday tasks as a worker or a father or a grandmother, they have trouble performing tasks such as just even using cutlery, doing up fasteners, handwriting, typing, turning pages of a book.
Speaker 3 06:54
So there's a huge number of difficulties that we hear people share with us.
Speaker 2 06:59
And so after a lot of research, as you said, in America and here, you've designed the SENSE Program, which is S -E -N -S and little e, which stands for Study of Effectiveness of Neurorehabilitation on Sensation.
Speaker 2 07:15
So just how does this work?
Speaker 3 07:17
So the aim of sense therapy is to help the person regain a sense of touch and then to be able to use it in everyday activities. So as I mentioned, it's a science -based approach that's based on evidence of these neuroplastic changes in the brain and on learning.
Speaker 3 07:35
So what we do is we use training modules to train specific skills such as texture discrimination, sense in the position of the limb in space, recognising objects through the sense of touch, as well as we help the person to learn how to apply these skills in daily tasks that have been identified by them.
Speaker 3 07:58
And in fact we use seven core principles to help drive this change. So we select the specially designed training tasks that are tailored to the person to make sure they're motivating and goal -directed.
Speaker 3 08:13
We then guide the person to actively explore the sensation in the best way using the tension and the most optimal exploratory movements. We give feedback on accuracy using vision on the other hand. And what happens is the person learns to calibrate or match what the sensation is supposed to feel like.
Speaker 3 08:36
And in this way what they do is they actually rebuild like a new internal scale for example of what rough feels like or where their limbs are in space. And then in the next trial the person's guided to anticipate the correct sensation using reduced choices.
Speaker 3 08:54
The training tasks are then repeated and there's progression from large differences to medium and finer differences. And then of course it's really critical that the person learns how to transfer the skill of discriminating the different body sensations to the chosen task and to other tasks that they encounter in everyday life.
Speaker 2 09:15
And then you can test and measure these, is that right? Yes.
Speaker 3 09:18
So we've developed a number of measures for these, so we've been able to quantify a person's texture discrimination ability. We've got the tactile discrimination test, their limb position sense is in the wrist position sense test, recognition of everyday objects through touch with the functional tactile object recognition test.
Speaker 3 09:38
And all these tests have been standardised, got age -matched standards and can reliably pick up improvements. And who conducts the therapy? Well occupational therapists and physiotherapists who have been specially trained in sense can conduct the therapy.
Speaker 3 09:54
And to date we've trained approximately 100 therapists in different hospital settings and in specialist sense therapy centres as part of our implementation studies and these therapists are credentialed by us.
Speaker 3 10:08
But also therapists have been trained at sense workshops and we've recently developed a sense online training work course.
Speaker 2 10:16
And where are your sense -therapist centers?
Speaker 3 10:19
We've got four specialists since therapy centres, so one is located at the Flory Institute Austin campus in Heidelberg, Victoria at the Alfred Hospital in Victoria, Hunter New England Health in Newcastle, New South Wales and Uni SA Health in South Australia.
Speaker 3 10:39
And we've also got eight other healthcare networks that have been involved in our studies.
Speaker 2 10:44
And are you hoping that this will be expanded Australia -wide?
Speaker 3 10:48
Yeah, we're keen to upskill more therapists so that more survivors of stroke can receive this therapy because they've really identified quite a big gap in this area. So we've been conducting workshops in most states in Australia, developed the online training program and have also been doing some training internationally in Canada, Sweden, England etc.
Speaker 2 11:10
Oh, terrific. And how long is the program? Thanks.
Speaker 3 11:14
Basically, when a person is involved with therapy, it's delivered in 10 sessions over approximately 6 weeks, but people are also encouraged to practice at home as well.
Speaker 2 11:27
And do they need a refresher course?
Speaker 3 11:28
Oh, no, usually one time's enough, but we have had people who, as they've improved, have got to another level of goals that they want to do. So there's a couple of people where we've done two bursts of therapy of the sense therapy with different goals because they've improved and then they've wanted to improve more and have particular activities to focus on.
Speaker 2 11:51
And do patients need a referral?
Speaker 3 11:55
Right. In our research studies they can self -reper and that's particularly to the specialist sense therapy centres but at the other sites they would need to follow the usual referral system.
Speaker 2 12:07
And I suppose you want to sort of get doctors to be aware of this so that they are referring people to you.
Speaker 3 12:12
Good point. Part of this is supported by a partnership grant that we have, so we have a number of rehabilitation physicians and doctors involved with that as well, but I think we do need to get that message out more.
Speaker 3 12:24
And often we find that that's by word of mouth of people who've been involved in the sense therapy. More people need this. And the stroke foundation as such has been particularly strong advocate as well.
Speaker 2 12:37
Absolutely. And finally, what's the best way for patients or interested therapists to contact you?
Speaker 3 12:44
Yeah, well we've actually now developed up a website, it's called Sense Therapy, all in one word, S -E -N -S -E -T -H -E -R -A -P -Y dot net dot AU, that's got a lot of information that people might be interested in and if you wanted to contact us, there's an email linked with that website, the Sense Resources email.
Speaker 3 13:06
Alternatively, you could contact me directly l .cary, c -a -r -e -y, at Latrobe dot edu dot AU.
Speaker 2 13:15
Yeah, and that is so interesting and wonderful work. Thank you for joining us on AbleQuest. Thank you.
Speaker 3 13:20
Thank you very much for having me.
Speaker 2 13:22
I've just been speaking with Professor Leigh Ann Carey about her specialist treatment for stroke patients.
Speaker 1 13:35
You have just been listening to AbleQuest, a program that looks at developments in assistive technology and initiatives. From Barbara Sullivan and Marni Roper, thank you for listening, and goodbye till next program.
