Cloud group

Stroke

Key terms

Stroke, cerebrovascular disease, vertebrobasilar, carotid, stroke recovery, stroke rehabilitation

The group


2018 Cloud group. L-R: Ms Fiona Hocking, Ms Estelle Hamson, Ms Andrea Moore, Dr Jorge Zavala, Professor Geoff Cloud, Dr Peter Hand, Dr Gary Yip, Ms Carla Borg-Caruana, Dr Anna Balabanski.

Research Goal

To develop new stroke treatments for acute stroke care and novel treatments to aid stroke recovery.

Research Overview

We conduct randomized controlled trials of new treatments for acute stroke care, secondary prevention of stroke and novel treatments to improve stroke recovery.

We also participate in the National Stroke Registry (AuSCR) which informs national stroke service quality improvement in stroke care.

Current Trials

Project

A network of sites and ‘up-skilled’ therapists to deliver best practice stroke rehabilitation of the upper limb

This NHMRC Partnership project includes clinicians, health providers, consumers, researchers and academics, who aim to increase access to best-practice stroke rehabilitation of the arm and thus achieve better outcomes for people who experience a stroke. We will employ knowledge transfer methods to change clinician behaviour and create a network of sites and ‘up-skilled’ therapists to deliver best-practice rehabilitation. Effective therapies are available to improve hand function. However, our recent national survey found that stroke survivors who experience loss of touch sensation and impaired hand function are not currently receiving recommended best-practice therapy. We developed a ‘knowledge transfer’ intervention to target this evidence-practice gap and the unmet rehabilitation needs of survivors. The intervention is guided by the Theoretical Domains Framework and Behaviour Change Wheel. It targets the delivery of science-based rehabilitation that requires specific knowledge and skill of the therapist; an application of knowledge translation that is virtually untested in our field. We will use a pragmatic before-after design to test the effectiveness of our knowledge transfer intervention to change clinician behaviour and improve outcomes. We will investigate current-generalist and specialist modes of delivery as well as cost-effectiveness. The implementation intervention will be an exemplar for translating recommended science-based rehabilitation interventions to the clinic and community. The project will deliver a knowledge translation hub, specialist delivery clinics, and a community of up-skilled therapists embedded in a range of healthcare settings. Together we will establish an allied health network across Australia for translational activities in stroke rehabilitation and establish and measure the potential benefits of a ‘new’ translational approach, which can be used to introduce other new therapeutic programs as translational activities in the future.

Current Project Funding

  • 2017-20 NHMRC Partnership Grant  APP1134495 A network of sites and ‘up-skilled’ therapists to deliver best practice stroke rehabilitation of the upper limb.

Selected Recent Publications

See most recent PubMed listed publications

  • Bray BD, Cloud GC, James MA, Hemingway H, Paley L, Stewart K, Tyrrell PJ, Wolfe CD, Rudd AG; SSNAP collaboration. Weekly variation in health-care quality by day and time of admission: a nationwide, registry-based, prospective cohort study of acute stroke care. Lancet. 2016 May 10. pii: S0140-6736(16)30443-3. doi: 10.1016/S0140-6736(16)30443-3. [Epub ahead of print]
  • Bray BD, Smith CJ, Cloud GC, Enderby P, James M, Paley L, Tyrrell PJ, Wolfe CD, Rudd AG; SSNAP Collaboration. The association between delays in screening for and assessing dysphagia after acute stroke, and the risk of stroke-associated pneumonia. JNNP. 2016 Jun 13. pii: jnnp-2016-313356. doi: 10.1136/jnnp-2016-313356. [Epub ahead of print]
  • Muir KW, Ford GA, Messow CM, Ford I, Murray A, Clifton A, Brown MM, Madigan J, Lenthall R, Robertson F, Dixit A, Cloud GC, Wardlaw J, Freeman J, White P; PISTE Investigators. Endovascular therapy for acute ischaemic stroke: the Pragmatic Ischaemic Stroke Thrombectomy Evaluation (PISTE) randomised, controlled trial. JNNP. 2016 Oct 18. pii: jnnp-2016-314117. doi: 10.1136/jnnp-2016-314117. [Epub ahead of print]
  • Campbell BC, Mitchell PJ, Churilov L, Yassi N, Kleinig TJ, Yan B, Dowling RJ, Bush SJ, Dewey HM, Thijs V, Simpson M, Brooks M, Asadi H, Wu TY, Shah DG, Wijeratne T, Ang T, Miteff F, Levi C, Krause M, Harrington TJ, Faulder KC, Steinfort BS, Bailey P, Rice H, de Villiers L, Scroop R, Collecutt W, Wong AA, Coulthard A, Barber PA, McGuinness B, Field D, Ma H, Chong W, Chandra RV, Bladin CF, Brown H, Redmond K, Leggett D, Cloud G, Madan A, Mahant N, O'Brien B, Worthington J, Parker G, Desmond PM, Parsons MW, Donnan GA, Davis SM; EXTEND-IA TNK Investigators. Tenecteplase versus alteplase before endovascular thrombectomy (EXTEND-IA TNK): A multicenter, randomized, controlled study.Int J Stroke. 2017 Jan 1:1747493017733935. doi: 10.1177/1747493017733935
  • Segan L, Permezel F, Ch'ng W, Millar I, Brooks M, Lee-Archer M, Cloud G: Cerebral arterial gas embolism from attempted mechanical thrombectomy: recovery following hyperbaric oxygen therapy. Pract Neurol. 2017 Dec 28. pii: practneurol-2017-001828. doi: 10.1136/practneurol-2017-001828. [Epub ahead of print]
  • Creamer M, Cloud G, Kossmehl P, Yochelson M, Francisco GE, Ward AB, Wissel J, Zampolini M, Abouihia A, Berthuy N, Calabrese A, Loven M, Saltuari L. Intrathecal baclofen therapy versus conventional medical management for severe poststroke spasticity: results from a multicentre, randomised, controlled, open-label trial (SISTERS). J Neurol Neurosurg Psychiatry. 2018 Jan 11. pii: jnnp-2017-317021. doi: 10.1136/jnnp-2017-317021. [Epub ahead of print]