HCTM in clinical trial to determine optimal early rehab for stroke

Our hospital’s involvement in this large-scale international scientific study is an incredible opportunity for us to contribute to research that has a huge impact on stroke recovery during the acute stage. Dr Katijjahbe Mohd Ali

This article is in conjunction with World Stroke Day 2020 that falls tomorrow

KUALA LUMPUR: Senior citizen Yee Yoke Har was ge ing ready to go to the market one morning in August when she suffered a stroke. She was rushed to Hospital Canselor Tunku Muhriz (HCTM) in Cheras where she received immediate medical a ention.

Yee, 78, has since recovered completely from the stroke and is now back to her routine life.

Mohd Razif Ab Mallek, 54, who is chief security officer at Maxis Centre at Technology Park in Bukit Jalil here, suffered a stroke in early August while at his workplace. Today, he can speak and walk normally having a ained nearly 96 per cent recovery.

A stroke happens when blood carrying oxygen is unable to get to part of the brain and if le without oxygen, brain cells can get damaged and die. Stroke, depending on its severity, can leave a patient paralysed or with limited mobility, thus severely impacting their quality of life.

Medical experts say that medical intervention within the first one hour up to 4.5 hours – also known as the ‘golden hour’ – can reduce damage caused by a stroke and this is probably why Yee and Mohd Razif recovered rather quickly.

Both underwent immediate treatment at HCTM’s Stroke Care Unit where they received a clot-dissolving drug first.

Yee’s daughter Ivy Lee, 57, told Bernama that if not for the early intervention, her mother’s condition may have worsened or she could have ended up in a coma.

Mohd Razif said when the stroke happened, his le hand became numb and he felt his facial muscles drooping and was not able to move either.

A er undergoing the initial treatment, he was sent to a specialised ward where for five days, he was made to do rehabilitation exercises to improve his mobility and strengthen his hand muscles, as well as learn to walk and speak.

“I’m grateful I can now speak normally and my face looks normal too. I also can walk on my own without any help from others,” he said.

AVERT DOSE in Malaysia

Incidentally, Yee and Mohd Razif are among six patients who are participating in HCTM’s AVERT DOSE clinical research project, which is aimed at identifying the best early mobility training programme for people with ischemic stroke (caused by a blood clot in the brain) of mild and moderate severity.

AVERT is the acronym for ‘A Very Early Rehabilitation Trial’ while DOSE stands for ‘Determining Optimal early rehabilitation a er StrokE’.

According to HCTM clinical physiotherapy specialist and AVERT DOSE trial national lead investigator Dr Katijjahbe Mohd Ali, the clinical research project, which is Malaysia’s first, is being carried out in collaboration with

Florey Institute of Neuroscience and Mental Health in Melbourne, Australia.

About 50 hospitals in Australia, New Zealand, United Kingdom, India, Taiwan, Singapore and Malaysia are involved in the project which started in 2019 and is expected to end in 2023.

In the Florey Institute’s official website (florey.edu.au), AVERT DOSE research director Professor Julie Bernhardt is quoted as saying that the study aims to identify best practices in reducing disability a er stroke.

She said during the clinical trial, four evidence-based mobility therapies will be delivered by physiotherapists and nurses to patients within the first few days following a stroke.

“The trial has a novel, adaptive design where patient outcomes help to direct new patients into treatment arms showing the most promise as the study continues,” she said, adding that more than 2,500 patients from over 50 hospitals worldwide, including HCTM, will ultimately take part in the study.

Katijjahbe told Bernama HCTM hopes to recruit a minimum of 100 patients for the AVERT DOSE trial.

“Our hospital’s involvement in this large-scale international scientific study is an incredible opportunity for us to contribute to research that has a huge impact on stroke recovery during the acute stage,” she said.

She said their research would hopefully provide the answers with regard to the optimal dose for rehabilitation in terms of frequency, intensity and duration of the exercises upon completion of the stroke patient’s acute treatment process.

High-risk group

HCTM neurologist and AVERT DOSE trial national colead Dr Wan Asyraf Wan Zaidi, meanwhile, said among those in the high-risk group for stroke are individuals with high blood pressure whose systolic readings exceed 140 and diastolic above 90, as well as heart patients and diabetics.

“While a heart a ack is preceded by signs such as chest pain and numbness in the hand, stoke can occur without any sign and can happen to anyone at any time,” he said.

Another risk factor for stroke is atrial fibrillation (irregular heartbeat) which, among others, can lead to the formation of blood clots in the brain, he added.

There are two main types of stroke – ischemic stroke, caused by interruption of blood flow and decrease in oxygen to the brain; and haemorrhagic stroke, which occurs when a blood vessel in the brain ruptures, spilling blood into adjacent brain tissue.

Dr Wan Asyraf said most of the stroke cases reported in Asia involve ischemic stroke while the percentage of haemorrhagic stroke is also growing higher. Like any other noncommunicable disease, stroke is best prevented, he said.

He said the delay in ge ing treatment can potentially lead to permanent paralysis of the limbs due to the disruption of blood supply going to the brain or ruptured blood vessels that can prevent the proper flow of blood and oxygen to the brain. Without oxygen, the affected brain cells are damaged or they die, resulting in physical, cognitive and mental disabilities.

“However, it is not impossible for a stroke patient to make a full recovery if they are treated within 4.5 hours a er the stroke, which we refer to as the ‘golden hour’. In such a case, the chances of preventing paralysis are high,” said Dr Wan Asyraf, who is Malaysia Stroke Council deputy president.

Treatment

The neurologist said stroke patients are subjected to acute treatment and rehabilitation to prevent the recurrence of an a ack. HCTM has since 2013 opened a ward for acute stroke patients where they are a ended to by various specialists from the emergency, radiology and anaesthetic departments, as well as nurses, paramedics and physiotherapists.

Dr Wan Asyraf said stroke patients are also given the latest endovascular treatment in HCTM whereby any blood clot in the brain can be removed with the help of a stent that is inserted into the blood vessel where the blood clot is present.

“This process has to be carried out as soon as possible in a hospital that is equipped with a team of stroke experts,” he said, adding that as many as two million brain cells can die every minute as soon as blood flow to the brain is interrupted.

Dr Wan Asyraf also said that the latest data on stroke patients in this country has revealed an increase in cases among young people, especially men, who were in their mid-30s to 40s.

“Stroke is no longer a disease that only affects older people. In fact, one in four adults in the world can get a stroke,” he said.

He said those who have suffered a mild stroke are at risk of facing a second a ack because they already have a history of having a clogged or ruptured blood vessel.

“If they don’t take care of their diet or observe a healthy lifestyle, there’s a great possibility of a second a ack which is more severe. It’s important for stroke patients to continue to go for followup health checks even a er they have recovered to prevent stroke recurrence,” he added. - —Bernama