Prof. Kwakkel, who is also head of acquired brain injury research at Reade Rehabilitation Center in Amsterdam, travelled to San Diego, California to accept the prize. He is very happy and surprised to receive the ONCS Award: “This prize almost always goes to an American scientist and rarely to investigators who have a Chair outside the United States. I see it as international recognition of our work in the field of neurorehabilitation.”
Since the mid-1990s Prof. Kwakkel’s research has been primarily focused on recovery after stroke. A stroke can be due to a bleed or an infarction in the brain, infarction being far and away the most common cause. Prof. Kwakkel has demonstrated that intensive rehabilitation after stroke accelerates the return to independence. In addition, he has developed prediction models on the return of arm-hand function, walking ability and activities of daily life after a stroke. Prof. Kwakkel has been involved in the development of the current multidisciplinary guidelines post stroke, as well as in a number of international consensus agreements on stroke management.
Prof. Kwakkel began his career as a physical therapist on the department of neurology at the former Valerius Clinic in Amsterdam. “At the start of the nineties, while working as a physical therapist, I started to study human movement sciences. I found the sometimes spectacular recovery that is seen early after stroke fascinating. However, the recovery rate of different patients who had the same treatment varied greatly. Why does one patient progress so quickly and another lag behind in the recovery process? What is the influence of rehabilitation on this process of spontaneous neurological recovery? Is it possible to predict the expected progress at an early stage post stroke? Is the brain capable of restoring neurological impairments or does it learn to adapt to the underlying behavioral deficits? These were some of the questions that drove me to do more scientific research at that time.”
Professor Kwakkel: “In order to delineate between behavioral restitution and using compensation strategies after acute stroke, it is not useful to carry out a single examination of a patient at an arbitrary point in time after a stroke, nor to make comparisons between stroke subjects. It is much more useful to investigate the time course of neurological and functional recovery by applying systematically measurements taken post stroke. Intensive repeated measurement designs makes our research unique. In doing this, we do not focus solely on the changes in the quality of movement by using kinematics and combining these changes longitudinally with changing activation patterns in the first months after stroke.”
The Brain Van
The sometimes weekly examinations can be quite a burden to the patient. Kwakkel: “Thanks to an advanced ERC award from the European Commission in 2012, Amsterdam UMC together with the Technical University of Delft, were able to build a Volkswagen Brain Van containing the equipment for our serial measurements in time. This enabled us to travel to patients at prearranged times. In this way the burden on the patient was reduced and the quality of EEG data collected was better than that collected at the hospital outpatient clinic. In addition, due to the virtually weekly measuring of the patient, close contact with investigators develops and patients are able to see their progress for themselves.”
Each year, approximately 42,000 Dutch people will have a stroke for the first time, of which approximately twenty percent die within one year after stroke. As a consequence, the prevalence of stroke is about 478,000 people. However, this number also includes those patients who suffered from a so-called transient ischemic attack.
Stroke is the main cause of invalidity. Prof. Kwakkel: “Recovery following stroke is uncertain, which makes predicting the outcome important. This is not only important for the patient, but also for determining the further discharge policy (going home with or without help, rehabilitation center or nursing home). If recovery can be more accurately estimated, then the collaboration within the rehabilitation services can also be better organized and by extension, we will know who will benefit most from which type of therapy. This is what makes our prognostic research valuable.”
For more information about the ONCS AWARD: https://www.asnr.com/i4a/pages/index.cfm?pageid=3356