Researchers and clinicians working together for better patient outcomes

In 2007, the Neurological Foundation decided to bridge the gap between neuroscience and neurology by deciding to establish the Neurological Foundation Chair of Clinical Neurology within the Faculty of Medical and Health Sciences at the University of Auckland.

The position was created to provide a direct link between the university’s neuroscience researchers and the clinical neurology unit at Auckland City Hospital. The theory behind this strategy was that patient outcomes would improve if researchers could work alongside clinicians.

Twelve years later, that theory has been proven correct. The process of translating neuroscience discoveries into clinical treatments for people living with neurological conditions has been simplified and accelerated as researchers and clinicians work side by side.

In 2008, following an extensive fundraising campaign, the Neurological Foundation appointed clinical neurologist Professor Alan Barber as Neurological Foundation Chair of Clinical Neurology.

“When the Chair of Clinical Neurology was set up, there was no acute treatment for stroke survivors, just a general ‘one size fits all’ rehabilitation programme with physio and language therapy,” says Professor Barber.

The professor’s first initiative was the appointment of a stroke nurse specialist. As a team, he and the nurse would visit all newly admitted stroke patients. The next step was to establish a stroke unit within the neurology ward. It was only four beds at first, but it was a beginning.

An early research focus for Professor Barber and his team was EPITHET, which captured and evaluated the effects of administering clot busting drugs shortly after stroke, an action known as ‘thrombolysis’. As a direct result of this trial, the clot busting drug alteplase became Auckland Hospital’s first-ever acute stroke treatment.

“Currently we’re thrombolying around 10% percent of stroke cases in New Zealand. In some centres they’re managing to thrombolyse up to 20[H1] % of stroke patients. About a third of people are going to do better than if they hadn’t had the drug. A few times a year, I see a miraculous response.”

Clot retrieval (thrombectomy) was the next revolutionary acute treatment introduced at Auckland Hospital. The Neurology and Radiology Departments, in conjunction with the Departments of Critical Care Medicine (DCCM) and Anaesthesia, developed a protocol for the use of clot retrieval in 2011.

“Thrombectomy used to be science fiction. Now we are routinely going in and pulling out clots. One in every five people who receive the treatment will return home as healthy as they were before the stroke occurred.”

To increase the effectiveness of rehabilitation following stroke, movement scientist Professor Cathy Stinear joined Professor Barber and they have built a team linked to the clinical team on the stroke unit.

Professor Stinear and her team developed the PREP2 algorithm for predicting hand and arm function after stroke. This algorithm is used to develop personalised rehabilitation programmes for each patient to optimise their recovery. PREP2 is now routine clinical care at Auckland Hospital and several other DHBs around the country.

Cathy and her team also developed the TWIST algorithm, which predicts whether and when a patient will be able to walk unaided following stroke. The algorithm is being tested at Auckland, North Shore and Waitakere hospitals.

In parallel with his team’s work on treatment and rehabilitation, Professor Barber led the Neurological Foundation-funded Auckland Transient Ischaemic Attack Study (TIA), one of the largest studies of its kind in the world. The study’s results are helping with New Zealand’s health policy planning and development.

Professor Barber says that none of these achievements would have been possible without the ongoing support of the Neurological Foundation, which last year committed $2.2 million to not only fund the Chair of Clinical Neurology role for another five years, but also to take on a new research fellow. This provides support to the Chair, as well as begins the training of the next generation of neurologists and neuroscientists.

“Thanks to the Neurological Foundation and their loyal supporters, we have created an environment where neurological researchers can gather data from real-life clinical situations every day.”

- Professor Alan Barber