Seven minutes in stroke - Erin Godecke

1. What inspired you towards neuroscience?

In 1992, I was a 2^nd year undergraduate student in Speech Pathology and a friend gave me the book “The man who mistook his wife for a hat” by the famous neurologist Oliver Sacks. The stories in the book and the way the human brain functions, fascinated me. In particular, the way the language and cognition could allow such an insight into how the human brain works. I’m still intrigued by language and the capacity of the brain to recover after stroke.

2. Why stroke?

Two reasons! The first: Is working with the patients I see who inspire me in their strength during recovery and being able to facilitate improved outcomes for people with communication difficulties. The second is the ability to work within a team of likeminded professionals. There is something unique about people who work in stroke and the way in which they pull together for the people they are treating. I’ve worked in many different healthcare areas and stroke care is by far the most inspiring and rewarding group to be part of.

3. What have been the highs so far?

Watching people with aphasia achieve a goal they didn’t think was possible. I get a real buzz from guiding people with aphasia to independent communication.

A second high is being awarded national funding to determine the efficacy of a therapy regimen (VERSE) that has taken our team 15 years to build.

4. What have been the lows?

The ongoing battle to access stroke research funding and not having stroke in Australia recognized as a priority area of health funding at Commonwealth and state levels. This means that I watch people with aphasia and other communication disorders receive less than optimal therapy.

5. How do you balance work life with the needs of home life?

Wow! This is a tough question! Sometimes I don’t do this as well as I’d like to. I take days off, I have a ‘therapy daschshund!’, I prioritise exercise (5 sessions/week) and I have a team of special people at home who are very supportive and understanding of the work I do. They support me to help make the stroke recovery road easier for people with communication disorders.

6. Who are your most important mentors and how did you find them?

I have two mentors – both strong females and well established researchers who I have sought out for different reasons and all who offer me something unique.

I found Prof Julie Bernhardt at regular stroke meetings and I made sure I got to know her. She inspires me with her drive, passion and approach to life as a researcher and person. She continues to guide me through complex situations in stroke research and regularly links me in with people I don’t know I need to be in touch with!

I spoke with my second mentor, Professor Beth Armstrong when she visited my work place in 2008. I told her I wanted to come and work with her and asked how I could make it happen. We worked towards getting a post doc position at the university she was working at and six years later we are doing great stroke research together. Beth helps me to develop my approach to aphasia and recovery. She challenges me to think more broadly and to apply this thinking in our research and clinical practice.

7. What are your most important collaborations and how have you built them?

My collaborative network is large and varied. I tend to seek out likeminded people and develop long term working collaborations built on mutual interest. I believe that to strengthen speech pathology services in stroke, as a profession we need to broaden our collaborations and work less in discipline specific areas and more in interdisciplinary teams.

Above all, my most important collaboration is working with clinical speech pathologists to help to bring together their research and clinical worlds. I do this through ongoing education sessions, publishing research and staying grounded by making sure I maintain a clinically active position while doing research.

I use international collaborations e.g Collaboration of Aphasia Trialists  (Prof Marian Brady, Dr Myzoon Ali and many many others) to make sure Australian aphasia and stroke services are on the world research map.

Seven minutes in stroke - Andrew Bivard

1. What inspired you towards neuroscience?
When I left high school, it was obvious to me that I wanted to be involved in science and I enrolled in an Information Technology degree at the Australian National University in Canberra. For some reason I went to one of Australia’s best science universities to study technology. Early in the degree I knew that IT was not for me and decided to change to psychology. In psychology the neuroscience components around the visual system which are taught to all first years really struck a chord with me and I decided to change degrees again to pure neuroscience and never looked back. My parents where concerned that I kept changing degrees but I was very determined to do something I enjoyed, which was the end result.

2. Why stroke?
For me it was purely that I had the opportunity. After a neuroscience degree, I was looking for a research honours project to do and really wanted to focus on a human population rather than a lab based project. I did not have a high distinction average and some of my options were limited. Through sheer good fortune an opportunity emerged in the small town of Newcastle which I immediately took up. It turned out that the group that I had started with were world leaders in clinical stroke research and were very enabling of new researchers. This generosity allowed me to start a science career in clinical stroke research. So to answer why neuroscience and stroke, these are fields that I have a great instinctive interest in and never get bored reading about or working on.

3. What have been the highs so far?
Some of the normal science highs, getting your first paper, your first small project grant, your first fellowship, your first major grant, the first international presentation or the first high impact paper. I was also fortunate enough to win young investigator of the year at the International Stroke Conference in Heidelberg Germany in 2013. Then there are other highs, such as proving a point, for me that was for a recently published paper in Brain showing that imaging selection of acute ischemic stroke patients helps identify that only about 1/3 of patients arriving in the time window have a treatable penumbra, salvage of which results in improved clinical outcomes. I had been working with the Newcastle team on promoting this concept for many years and this paper sealed our efforts in many ways. Lastly, a high is actually what the future holds, we are working on several very exciting projects such as the phase 3 TASTE trial and our recently completed phase 2 fatigue trial MIDAS.

4. What have been the lows?
All of the rejection letters from journals, grant funding bodies and fellowship applications. There are just so many!

5. How do you balance work life with the needs of home life?
This is very tough, there is really no limit to how much you can put in at work. I treat weekends as sacred time and nothing can take them away anymore. During my whole PhD I never had a weekend off, so that I could get the work done and earn some extra money because the scholarship is set at the poverty line in Australia.

6. Who are your most important mentors and how did you find them?
By chance I found my PhD supervisor, and the rest is history really.

7. What are your most important collaborations and how have you built them?
Common interests have built my current collaborations. We work with the Glasgow hospital stroke group on tenecteplase trial data, 3 hospitals in China on a large multi-centre database of perfusion imaging, hospitals in Canada on the use of non-contrast perfusion imaging and groups in the United States for genetics projects. At the end of the day, these collaborators are people who I would gladly socialise with or wouldn’t mind being stuck on a long flight with because we can communicate freely and honestly.

Craig Anderson speaks about ENCHANTED results

Download the link to the ENCHANTED protocol here

Seven minutes in Stroke - Heidi Janssen

1. What inspired you towards neuroscience? After my first child (William, now 9 years) I was looking for work 1 day a week and came into a project manger role with Hunter Stroke Service. Part of this role was to work towards translating the use of an Enriched Environment from a concept developed in animal models of stroke into the clinical setting.

2. Why stroke? Again, I sort of fell into physiotherapy rehabilitation after stroke about 1 year after graduating from physiotherapy. I was the physiotherapist within the team at a new stroke unit at Belmont Hospital in Newcastle. I thoroughly enjoy working with people after stroke. I am passionate about helping people work towards their very meaningful and important goals of regaining independence once more. 

3. What have been the highs so far? Working with some amazing clinical researchers who have pushed me to think so much more than I ever did prior to having research in my world. I have been extremely lucky to have them as my mentors- A/Prof Neil Spratt, Prof Julie Bernhardt and Prof Louise Ada. They and many other stroke researchers have had a big impact on where I am today. Getting through your PhD and staying in the research game is very much dependent on the support and guidance of your mentors. 

4. What have been the lows? 1. Having a research question to be answered and struggling to recruit quick enough before money and time runs out. 2. Late nights writing grants last minute.

5. How do you balance work life with the needs of home life? Little sleep; that's about it really. You have to be there for your family first and foremost. I have two very busy little boys, William 9 and Hamish 5. A lot of work gets done in the early morning and late nights.

6. Who are your most important mentors and how did you find them? My PhD supervisors, A/Prof Neil Spratt, Prof Julie Bernhardt and Prof Louise Ada. I didn't really know any of my mentors before I started my research journey. I knew of them of course. I was linked up with Neil, a basic scientist and neurologist, through my project manager role with Hunter Stroke Service, crossed paths with Julie a bit prior to my PhD and knew Louise from a Masters degree I had done. Another recent addition to my mentor team is A/Prof Coralie English who again nurtures my inquisitive mind and keeps me motivated. I am very lucky to have her showing me the ropes in the next phase of my research journey.

7. What are your most important collaborations and how have you built them? I have collaborations with researchers and clinicians from all disciplines throughout Australia and I consider them all to be equally as important. I have built them over time through chats at conferences, email correspondence and in some cases, simply saying, 'this is what I want to know or do, I think you're the expert, are you keen to come on board?' I don't consider myself an expert in all aspects of research by any means. I am only interested in answering my research questions, and doing so with well designed research studies. If that means bringing people on who know how to do it, I am all for that. With my collaborations I learn constantly- research methodology, how to build and maintain relationships and simply how to survive in this highly competitive game. Every relationship and collaboration will teach you something. I've made some great friends and had many laughs in the process as well.

Seven minutes in stroke - Stella Bouziana

What inspired you towards neuroscience?

Neuroscience is a fascinating field and is included among the top scientific areas of research. Νeurodegenerative diseases are increasing and the latest scientific advances are a source of thrill and inspiration. I found neuroscience really attractive from the very early years in the Medical School and I wanted to serve this evolving groundbreaking field.

 Why stroke?

A truly exciting combination of medical fields are involved in stroke pathophysiology and dealing with stroke patients: Neurology, Internal Medicine, Endocrinology, which are all in my interests. I believe that this combination boosts stroke science to an unprecedented amazing scientific area. In addition, stroke combines emergent incidents with a long palliative care, which both aspects of clinical care are really interesting to me. Taking also into consideration that the brain and cognition are the features that distinguish man from the animal kingdom, exploring brain function through stroke cannot leave anyone who loves neuroscience unmoved.

What have been the highs so far?

Starting my PhD studies in stroke science, publishing my work in prestigious journals, participating as a speaker in European Congresses, teaching of medical students, namely becoming a young member of the large community of stroke scientists fills me with a lot of gratification. Moreover, offering physical and mental comfort in chronic debilitating patients, such as stroke patients, is a priceless daily reward; definitely a source of happiness.

What have been the lows?

Too many hours of extra work has limited my leisure time for both myself and my beloved ones. Moreover, compassion is not always enough for your patient. Cure is demanded and you cannot always provide it.

How do you balance work life with the needs of home life?

With a huge amount of patience and understanding of my family! I try to spend quality time with those who I care. I also try every once in a while to do some sports as I was a former 100 metres sprinter. It really helps me to relax from work and devote myself to my family.

Who are your most important mentors and how did you find them?

Assistant Professor Dr Konstantinos Tzionalos, MD, PhD (AHEPA University Hospital, Thessaloniki, Greece) is the most important mentor in my short scientific career. Dr Tziomalos with a specialty in cardiovascular diseases and stroke was one of my professors in Internal Medicine during my studies in the Medical School. His hard work and passion for Medicine truly inspired me towards his medical field. Despite his young age he has a meritorious work to present and I am glad that I am part of his team since shortly after my graduation from the Medical School. Dr Tziomalos, a really talented clinician, is one of the three-member committee of my PhD studies and our excellent collaboration has grown me as a researcher. He is the first who believed and recognized my potentials as a clinician and a researcher and gave me the opportunity to develop my skills. I am really lucky and grateful for this collaboration!

What are your most important collaborations and how have you built them?It is quite difficult to answer this question as I am in the very start of my scientific career. However, I am tremendously privileged to have met in person the 2012 Nobel Laureate in Medicine Sir John Gurdon for his contribution to the field of cell reprogramming. Through my involvement with stroke research I was selected to participate in the Biology and Medicine Seminar Lectures for young scientists held by the Bodossakis Foundation in 2012 where Sir John Gurdon was an invited speaker. I had the opportunity to discuss with him about my scientific work and interests and get his valuable advice. Definitely not a collaboration but the best is yet to come!

Seven minutes in stroke - Nadine Andrew

1. What inspired you towards neuroscience?
I was drawn to the complexity of neuroscience as complex problems require complex whole of system solutions. Maximising the use of routinely collected stroke data has great potential to change health systems, improve the quality of care received by those with stroke and improve patient outcomes. As a clinician and epidemiologist I felt that this was an area that I could contribute to in a positive way.

2. Why stroke?
From a personal perspective both of my grandmothers died from stroke. My paternal grandmother died at a young age and although I did not have an opportunity to know her the loss was greatly felt by my father and his siblings. I also spent many years working as a physiotherapist in community health. My experience working in this sector and later as a researcher coordinating a large National needs survey, highlighted that it is very difficult for survivors of stroke to access the services that they need. This is something that I hope to be able to address through my research.

3. What have been the highs so far?
Achieving national data linkage between the Australian Stroke Clinical Registry and hospital and death data between 10 different datasets from 5 different jurisdictions. This was a logistical and administrative challenge but means that we now have the largest and most comprehensive stroke dataset in Australia. We will be able to use these data to obtain a detailed view of the patient journey following stroke, identify important care gaps and investigate how the type of care received by patients impacts on long-term outcomes.

4. What have been the lows?
Working in research is incredibly competitive. It is becoming increasingly difficult to obtain funding to progress research. As a consequence many great ideas go unrealised.

5. How do you balance work life with the needs of home life?
I have a magnificent family who are supportive of my career and see value in what I do. I get great enjoyment from my work which makes the integration between work and home easy.

6. Who are your most important mentors and how did you find them?
I started working with A/Prof Dominique Cadilhac four years ago. She has incredible vision and an ability to translate this vision into reality. Her ability to network across health services, research institutions and engage with governments is inspirational.

7. What are your most important collaborations and how have you built them?
The stroke research community in Australia is very collaborative. My work with the Australian Stroke Clinical Registry has enabled me to develop valuable collaborations with researchers, academics and clinicians involved in the registry, staff from the National Stroke Foundation and data linkage experts from across Australia.

Moving rehabilitation research forward: Developing consensus statements for rehabilitation and recovery research

Moving rehabilitation research forward: Developing consensus statements for rehabilitation and recovery research: The International Journal of Stroke podcast offers interviews with key figures in the field and highlights of current topics and issues....

Seven minutes in stroke - Dipes Mandel, Founder President Stroke Foundation of Bengal

We would like to congratulate Dipes Mandal for winning an individual achievement award for his work with the Stroke Association of Bengal.

What inspires you to advocate for stroke education? 

The helpless and hapless condition  of millions of stroke afflicted  people, most of whom could have been prevented is the most important factor which ignited me to work  in  the most easy way to save them from physical and economic devastation.  As India,  with a population of about  1.3billion with an annual stroke  incidence being about  2 million, the most important way to save them is stroke prevention through Stroke Awareness and Stroke Education, which was not properly  looked into till few years back. This is more important where the infrastructure for stroke care service is very insufficient, more so in rural areas, where two thirds of Indians  reside.

What does stroke care look like in your country?

Stroke care service is most neglected among the leading devastating disorders in India and needs immediate attention of all  stake holders. India  is a vast country with people of many faiths and cultural divides. The divide between the urban and rural is also big. Health care facilities are not equally available to all. Ideal stroke care is available only in a few big cities – in few  tertiary centres and only shows the the tip of the ice berg in stroke care service for those who can afford care in private hospitals.  In India   about 2million people are afflicted annually of which over 6 lakh die and many more are disabled after immediate crisis. Stroke is on the rise in developing countries where lifestyle diseases are becoming an epidemic  due rapid urbanization and fast life. However stroke occurs equally in  the rural areas where food types,  salt intake, tobacco addictions  (smoking and chewing) add to the undiagnosed hypertension and diabetes.  >85% strokes occur in developing countries like India which lack infrastructure and finances to tackle the malady. In India the alarming fact is that stroke strikes people about 15  years earlier than  those in the Western world. This means it affects the people in the most productive years of life. If the main bread winner, usually  the male here, is affected the family suffers enormously. In eastern India, there is high incidence  of hemorrhagic stroke in contrast to the western world. In our place, it has been observed that  people in the 40s and 50s have high incidence of hemorrhagic strokes. Uncontrolled/undiagnosed high blood pressure ( hypertension) is the commonest cause of all strokes especially hemorrhagic strokes. Proper data is lacking in India. What is a fact is that >70% people live in rural India and lack uniformity and accessibility to even basic health care facilities. The cost of stroke management is quite high in terms of acute management and also in subsequent  post stroke follow-up. there is no dedicated Stroke Institute existing in West Bengal which may  cater all aspects of management to a large number of stroke patients and stroke-prone individuals – Rural &  Urban, the  Rich and the Poor irrespective of age, gender, race, religion and region.

  

What element of stroke care are you most proud of?

That stroke is by and large preventable in > 85% cases has  to be ingrained in all stroke care facilities and programs. In India most people stop their blood pressure medications and chew tobacco or smoke.  With  our continuous campaign we have been able to make people realize ill effects of these addiction on the high incidence of stroke and heart attack. The importance of  proper rehabilitation and  required medication have been established among most of the cases and the caregivers. Moreover, there has been rapid awareness about recognition of stroke and  its early hospital management.

What have been the highs so far?

Very rapid spread of Awareness among the general public   about the  term “Stroke” which means Brain Attack , and not Heart Attack through intensive  uninterrupted stroke awareness  is  a very important development in Stroke  Awareness  and its management. People now realize the  importance of acute stroke management in a stroke centre. Importance of rehabilitation is also gaining grounds, even in rural areas.

             Stroke Foundation of Bengal (SFB), the only non-profit registered organization in India and a member of World Stroke Organization (WSO) is committed to fight stroke malady in our country with minimal resources and aids, in the guidelines adopted by World Stroke Organization. As stroke is very much a preventable disease and is better prevented (esp. By controlling high blood pressure and stopping tobacco addiction) than treated,  our Stroke Foundation started its stroke prevention campaign since its inception in 2006. Before  the inception of stroke Foundation, the different programs on stroke awareness was started  in the Mdedical College, Kolkata since 2000. Along with awareness,  a study was  conducted in 2003, to assess the level of awareness of stroke among the general people, which revealed about 65% of participant considered Stroke as  Heart attack. Following awareness programs, there are significant rise in stroke information   in all section of the society.

The standard conventional modalities of stroke education  include  seminars, meetings, leaflets distribution, articles in papers, magazines,  Bulletins, Stroke Documentary (with English subtitles) souvenir, etc., and also the  publication of quarterly stroke bulletin in both Bengali and English. The more recent modalities include regularly updated website (www.strokefoundationbengal.org),  Facebook etc.  We have received enough helps from print and electronic media in stroke awareness campaign .Stroke Foundation is also taking  care of rehabilitation program of the post-stroke disabled patients and also has formed Stroke Support Group (the second in India) for overall benefits of the stroke victims and their family members. The introduction of Stroke  awareness  about its risk factors and  future predictability  through smartphone  by installing Stroke Riskometer app  is the latest and most innovative tool  in  stroke care.  All these  works are moving slowly but steadily, and that is really very high  in  a vast country with so much population with significant lack of awareness.

The activities of the Stroke Foundation are appreciated by the leaders of the World Stroke Organization (which was also established in 2006) and as a recognition of its stroke campaign activities,  the Stroke Foundation of Bengal has won First Honorable Mention  in the WSO World Stroke Day 2010 & 2012 awards. SFB has included people from all walks of life in its campaign – a very positive aspect.

What have been the lows?

It is the apathy of the many people, due to lack of stroke awareness - both general and professional- which has hampered development of stroke care in India. The priority of Stroke care is much less than Tuberculosis, AIDS and Malaria, although stroke kills more people than all the other three do together, not to talk of post stroke devastating disability.   Even among  the NCDs , stroke gets minimum attention in public health program. There is no government grants forthcoming smoothly. There is no nationalized health insurance, there is no government initiated rehabilitation facilities. prevention clinics which are of utmost importance in developing countries.  Government  institutions offering comprehensive stroke care are few in number and unavailable to the vast expanse of population. Of concern is the apathy of the professional bodies and medical fraternity itself towards prevention and rehabilitation of stroke care. SFB for that matter has taken the leadership in the  single handed campaign with  minimal help whatsoever, and the results are promising.

What is your greatest hope for stroke survivors?

There is always a ray of hope for stroke survivors. SFB has so far successfully spread stroke education to most areas of eastern India and will continue its crusade.  It has received great support from the international stroke leaders and WSO. I am sure with such encouragement and appropriate support , it is possible  to achieve  the targeted goal of  holistic  affordable stroke care in approachable places. By the influence of media and other modalities in  program,  a  section of people, mostly young educated and rich have  taken much interests in this stroke devastation and extending all possible help to the stroke survivors.  The government   has  also shown some interests in stroke care centres, although it will take some time to implement because of huge stroke burden and paucity of funds.

What were the major elements of your stroke campaign?

Stroke Foundation started its stroke prevention campaign since its inception in 2006. The modalities adopted for the campaign are seminars, meetings, leaflets distribution, articles in papers, magazines, Stroke Documentary (with English subtitles) souvenir, etc., publication of quarterly stroke bulletin in both Bengali and English and also regularly updated website (www.strokefoundationbengal.org) and facebook.  The activities of Stroke Support Group (the second in India) for overall benefits of the stroke victims and their family members are quite encouraging.  Recently the Stroke Foundation has been able to convince the  persons  in the Government and administration  to set  up a  stroke care service centre  in a remote underdeveloped district with necessary financial help.  The supports of the public, media and the government are the major elements of the present stroke campaign

Seven minutes in stroke with Dr. Nneka Ifejika

1. What inspired you towards neuroscience?

The concept of cortical reorganization. I likened it to learning the world is round after centuries of believing the world is flat.

2. Why stroke?
Family history. My maternal grandfather died of a likely ICH during my mother's first year of medical school.
My mother had a right PCOMM aneurysm coiling during my fourth year of medical school, and a clipping during my second year as an attending physician.
My family isn't alone, there's a critical need to stop the cycle of stroke.

3. What have been the highs so far?
Being included as a part of the family by stroke survivors.
It is an honor that has enriched my life and given me an intimate perspective on cultural dynamics, food preferences and customs among different ethnic groups.

4. What have been the lows?
Having a research idea that is a little premature.
Sometimes you have a concept that is cutting edge, but the technology hasn't caught up to accomplish the protocol.

5. What do you believe is unique about your work?
The combination of social, cultural and behavioral aspects of healthcare with mobile information technology.
We use apps for everything, from banking to social networking. Why not use it for healthcare?

6. Who are your most important mentors and how did you find them?
Dr. James C Grotta - as a resident, I cared for the rehabilitation unit patients on weekends to earn supplemental income.
Dr. Grotta, at that time the newly appointed Chairman of Neurology, noticed that I worked a disproportionate amount of weekends compared to my colleagues (medical licenses can be quite expensive)!

Within a few months, he hired me as the junior Neurorehabilitation faculty member. When I took an interest in stroke outcomes, he encouraged me to complete the 2 year UTHealth Clinical Research Curriculum, providing the foundation for my first NIH award.

I meet with Dr. Grotta every two to three weeks.  We talk about a variety of topics - he has worked in the Native American Health Service, volunteered during the American Civil Rights Movement and held NIH funding for decades.  He has taught me to have breadth and depth to my life experience.
To expect the unexpected.
To face adversity with grace and dignity.
And sometimes, to ask for forgiveness, not for permission, when going after something you believe in.


Dr. Jon E Tyson - He is the Director of the Center for Clinical Research & Evidence-Based Medicine at UTHealth.
I conceived the idea for Swipe out Stroke as a student in his Advanced Clinical Trial Design class.
 He is my mentor for the Masters' of Science in Clinical Research program and my institutional career development award.
Dr. Tyson is tough, yet kind and immensely supportive.
He inspires me to work smarter, utilize creative interventions and to take time to give back and mentor others.

Dr. Sean I Savitz - Dr. Savitz is an elegant example of an academician.
He's evenly keeled, brilliant and perceptive. Dr. Savitz's mind works in a stream of consciousness - he can see the structure of a manuscript from a single PowerPoint presentation.
We speak several times a week - I grab either my "Sean" notepad or my Smartphone to rigorously scribble ideas.
He's a mentor that is a wonderful example of where I want to be.

7. What are your most important collaborations and how have you built
them?
Dr. Elizabeth Noser has been my clinical partner since recruiting me to join the UTHealth Stroke Team. She is the Director of  Community Outreach, which is a key component of my work serving minority populations.  We sponsor the annual UTHealth Stomp out Stroke event, which provides free health screenings, stroke education and entertainment to thousands of Houstonians.

Dr. David E Rivers at the Medical University of South Carolina chairs the National Conference on Health Disparities.  The annual symposium has provided a platform for my work, and I joined the Advisory Board in 2015.  This year I'll give the Keynote Speech to the undergraduate and graduate students on "Successes (and failures) in Conducting Clinical Research".

As a member of the inaugural class of the American Academy of Physical Medicine and Rehabilitation (AAPM&R) Leadership Program, I received two years of training in health advocacy, strategic planning and  media skills, which has helped me spread the message of caring for underserved populations using mobile applications.
I presently serve on the AAPM&R's Health Policy and Legislation Committee, taking our message of health equity to members of the United States Congress.
As a Washingtonian, it's an honor to come home, and hopefully effect change.