The WCNR attracted neurorehabilitation clinicians and therapists from 55 countries. More than 1800 health professionals attended the meeting in Melbourne’s award-winning Congress Centre, where there were 650 submitted abstracts, and over 300 posters.
The Congress was held in conjunction with the 35th Annual Brain Impairment Congress for the Australian Society for the Study of Brain Impairment (ASSBI) and the 20th Annual Scientific Meeting of the Australasian Faculty of Rehabilitation Medicine, The Royal College of Australasian Physicians (RACP). The Congress included 12 half-day workshops, ‘Meet the Professor’, breakfast sessions and a scientific programme covering international research, discovery and innovation in all the major areas of neurorehabilitation including traumatic brain injury,multiple sclerosis,stroke,spasticity management and neuro-oncology. In addition there were 17 World Federation for NeuroRehabilitation (WFNR) Special Interest Group Meetings taking place concurrently.
In the Opening ceremony, Professor John Olver, Convenor and Chairman of the Organising Committee and WFNR Regional Vice-President for Australia, New Zealand and Oceania welcomed delegates. The meeting officially opened with The 2nd Michael Barnes Lecture, established in recognition of the visionary leadership and dedication of the founding President and delivered by Professor Randolph Nudo, Director of the Landon Centre on Aging and Professor in the Department of Molecular and Integrative Physiology at the Kansas University Medical Centre, USA. Neuroplasticity occurs on a variety of levels, ranging from cellular changes due to learning, to large-scale changes involved in cortical remapping in response to injury. It provides the scientific basis for the treatment of acquired brain injury with goal-directed therapeutic programmes in the context of rehabilitation. The adult brain is not ‘hard-wired’ with fixed neuronal circuits. Cortical and subcortical rewiring of neuronal circuits occurs in response to training and injury; this active, experience- dependent re-organisation of the synaptic networks of the brain involves multiple inter- related structures including the cerebral cortex. Individual connections within the brain are constantly being removed or recreated, largely dependent upon how they are used. If there are two nearby neurons that often produce an impulse simultaneously, their cortical maps may become one. Professor Nudo encapsulated this concept by saying “Neurons that fire together, wire together”. He outlined animal studies showing that if a tiny stroke is produced by blocking the blood flow to a small part of a monkey’s motor cortex, the part of the body that used to move in response to electrical stimulation of that area of cortex moves when nearby areas of the brain are stimulated. Understanding this interaction between the damaged and undamaged areas provides a basis for better treatment plans in stroke patients. Functional imaging studies have shown that the brain can change its responses in human stroke patients in ways similar to that found in monkeys.This has also been shown by experiments using transcranial magnetic stimulation of the human cortex. “The challenge is to translate these results to the clinic” concluded Professor Nudo.
Current neuroprosthetic applications include Deep Brain Stimulation in Parkinson’s Disease, the Cochlear Implant, Bionic Eye and epidural stimulation post-stroke. Professor Nudo is currently collaborating with engineers to develop micro-implantable devices for repairing neural circuits after stroke and traumatic brain injury.
Against the exciting developments in neuroplasticity and neuroprosthetic tools, there are frustrations due to the limits imposed by the biology of the brain, and the difficulty in doing human experiments that demonstrate the benefits of therapy. It has proved difficult for researchers carrying out rehabilitation trials to determine how much an improvement is due to a particular therapy, how much is placebo and how much is the ‘normal’ spontaneous partial recovery that follows stroke or brain injury. Professor Bruce Dobkin, Professor of Neurology and Director of the Neurologic Rehabilitation Program at the University of California, Los Angeles, USA highlighted the shortcomings of neurorehabilitation clinical trials. He illustrated his talk by looking at randomised control trials of body weight-supported treadmill training and robotic-assisted step training which did not produce better outcomes than a comparable dose of progressive over-ground training or exercise in disabled persons with stroke, spinal cord injury, multiple sclerosis, Parkinson’s disease and cerebral palsy. Professor Dobkin suggested that the shortcomings require better strategies to assess the conceptual basis, design and outcome measurements for future trials of pharmacological, cortical stimulation, neural repair and other experimental neurorehabilitation interventions.
Professor Robert Teasell, Chair-Chief of the Department of Physical Medicine and Rehabilitation, University of Western Ontario, Canada pointed out that despite all the evidence available, clinical care for stroke patients is not generally delivered in accordance with established guidelines and this may negate the benefits of specialised, organised, interdisciplinary care. Stroke is increasing – it’s a disease of older people – this was the recurring message throughout the Congress and Professor Teasell emphasised “the demographic crunch that is coming”. The three key principles for stroke rehabilitation are a) organised stroke care, b) the earlier the better and c) intensity of therapy. Evidence is growing that rehabilitation has a significant impact on functional outcomes following stroke with improvements in discharge disposition and community reintegration. If the rehabilitation team adhere to guidelines the outcomes are better. “You can discover all you want but if you don’t transfer it to the patient then it doesn’t matter” said Professor Teasell, “the simple existence of research evidence doesn’t automatically result in alterations in policy or clinical decisions”.
Professor Michael Barnes presented the Early Career Development Awards in recognition of the most outstanding oral and poster presentations by a delegate. The Awards, totalling AU$6000, were donated by the Melbourne Convention and Visitors Bureau. The recipients of the Poster Awards were Louisa Ng (Australia) and Corina Schuster (Switzerland). The recipients of the Oral Presentation Awards were Camila Fiore (Australia) and Mayowa Owolabi (Nigeria).
The meeting closed with a presentation by Professor Anthony Burkitt on the development of the Retinal Implant for the Sight Impaired. The ‘Bionic Eye’ works by using electrical currents to stimulate nerves at the back of the eye. This Australian technology is targeted at two forms of vision loss; retinosa pigmentosa and age-related macular degeneration.
Commenting at the closing ceremony Professors Barnes and Clarke said: “The WFNR needs to position itself to address the challenges of acute to community rehabilitation so we can do the best possible rehabilitation for our patients.We should strengthen our teaching initiatives and awareness raising is key amongst politicians and the public”. “In 15 years we have come a long way and we need to keep moving forwards. The WFNR’s 32 National Societies cover half the world’s population but there’s 400 million people who are not getting any rehabilitation at all and we need to address this through education and training.There is reasonable evidence to suggest that low tech aids can provide some rehabilitation to the masses and we should work on the concept that something is better than nothing”.