Neurological Foundation of New Zealand Chair of Clinical Neurology

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One of the greatest challenges of neuroscience research is translating discoveries made in our universities into clinical treatments for people suffering neurological disorders.  

Several years ago the Neurological Foundation committed to bridging the gap between neuroscience (the scientific study of the human brain and nervous system) and neurology (the medical application of that research) with the establishment of the Neurological Foundation Chair of Neurology within the Faculty of Medical and Health Sciences at the University of Auckland.

The position was expressly designed to build a direct link between the neuroscience department at The University of Auckland and the clinical neurology unit at Auckland City Hospital, building on the strengths of each to improve patient outcomes.

Professor Alan Barber

After an extensive fundraising campaign, the Neurological Foundation was able to establish the position in 2008, appointing clinical neurologist Professor Alan Barber as Neurological Foundation Professor of Clinical Neurology.  In this role, Professor Barber combines a clinical position within the Neurology Research Unit at Auckland City Hospital and a research position at the university (where he is also Deputy Director of the Centre for Brain Research).  He and his team of talented neurologists and neuroscientists are the ‘bridge’ between the two facilities and the two fields.

The establishment of the Chair of Clinical Neurology was the first stage of a longer-term vision: the future development of a Centre of Excellence for Neurological Clinical Research at the University of Auckland.

From bench to bedside: realising advances in prevention and recovery of stroke

Since his appointment in March 2008, Professor Alan Barber and his team have already made some exciting advances in stroke and brain injury rehabilitation techniques. Current research initiatives have the potential to greatly enhance worldwide understanding of risk factors and treatment strategies for stroke and related conditions – among the leading causes of disability and death in New Zealand today.  Ongoing research includes:

The Auckland Transient Ischemic Attack (TIA) Study

A transient ischemic attack, or TIA, is often a warning sign prior to ischemic stroke in an estimated 2000 people in New Zealand each year.  Around one in five of these are fatal and a further three in five are disabling. TIAs therefore identify a group of people at very high risk of stroke and provide an ideal window of opportunity for stroke prevention.

Professor Alan Barber is leading the Auckland Transient Ischemic Attack Study.  Funded by the Neurological Foundation, it is one of the largest TIA incidence and follow-up studies to be undertaken worldwide.  Little is known about the true incidence of TIA in New Zealand, nor about patient outcomes following TIA and the risk of stroke. 

The study, conducted during 2011 and 2012, seeks to test the utility of current predictors of stroke risk across all ethnicities in New Zealand and to identify other factors which may contribute to greater risk of stroke following a TIA.  These results will be used in the planning and development of health policy and services nationally in relation to TIA and stroke to ensure optimum prevention measures and patient care plans are put in place.

Identifying a new risk factor in younger stroke patients

Each year some 2,000 people under 55 have a stroke.  Observing that the usual risk factors associated with stroke were absent among many people in this age group, Professor Barber and his team set up a study in late 2009 to determine whether recreational drug use, in particular cannabis, might be a risk factor for stroke among people under 55 years of age.  The results of this study, which will be released in 2012, will help refine international understanding of stroke risk factors and prevention measures for people under 55. 

The Dual Vent Circuit - preventing brain injury during open-heart surgery

Brain injury is a significant complication of open-heart surgery. Sadly it can result in death or stroke in five per cent of patients while 50 per cent suffer measurable cognitive decline, particularly memory loss.

A new bypass technique – the Dual Vent Circuit (DVC) – has been developed by New Zealand cardiologist Dr Paget Milson.  The DVC filters blood during surgery, removing the clots and air bubbles that could cause brain damage. If successful, the DVC has huge potential to save lives and prevent brain injury following open-heart surgery.

In 2009, Professor Barber began a clinical research trial to assess patients undergoing open heart surgery.  In 2010, working with Dr Cheryl Johnson at North Shore and Auckland City Hospitals, Professor Barber expanded the study to investigate brain injury following general surgery.  Not only will this second study provide a control group for the brain injury following cardiac surgery study, it is also the first time brain injury complications after general surgery have been examined.  Results of these studies will be available in 2012

Improving patient outcomes following stroke

Prof Barber is part of a team researching rehabilitation techniques that could help some of the 56,000 stroke survivors in New Zealand. Among the techniques being trialled are:

• Non-invasive magnetic stimulation:

A safe and painless priming therapy combined with physical therapy to promote normal movement following brain injury from stroke. Magnetic stimulation involves gently holding an insulated coil against the scalp where a very brief magnetic field is created. This stimulates the stroke-affected part of the brain and taps into the brain’s ability to rewire the damaged neural networks of the stroke survivor.  A recent clinical trial showed magnetic stimulation prior to therapy improved dexterity and fine control in the affected hand of stroke patients. This is a great result and a world-first, and suggests it could be an effective rehabilitation technique for stroke survivors. More trials are required to confirm its long-term benefits so the technique can be implemented clinically as soon as possible.

The primer:

Another innovative Kiwi invention that is proving effective in clinical trials, the Primer is a simple low-tech device designed to improve the brain’s response to rehabilitation in people with arm or hand weakness following stroke.  Developed by Professor Winston Byblow and Dr Cathy Stinear with support from the Health Research Council, the Primer allows the patient to perform hand movements with their good hand while the affected hand passively mimics the movements. This action primes the brain to better respond to rehabilitation therapy.  Professor Barber has brought his considerable expertise to the clinical trials of this device. A clinical trial with 80 stroke patients at different stages of recovery compared with patients in the earlier trial is currently underway.

Early mobilisation post stroke:

Can very early rehabilitation post-stroke improve long-term patient outcomes?  An Australian-led global study to test this hypothesis has been adopted by physiotherapists in the Auckland City Hospital stroke unit.  The results of the study will assess the benefits of early mobilisation (out of bed activity within 24 hours of a stroke) and will help refine post-stroke rehabilitation strategies for individual patients.