Statement from Asia-Ocenian Association of Neurology (AOAN) for the 12th World Congress of Neuro-rehabilitation (WCNR)

16th Dec 2022 (Online)

Firstly, we congratulate and thank the World Federation for Neurorehabilitation (WFNR) for the organising of WCNR. We Acknowledge that the purpose of WFNR is to advance the development of neurological rehabilitation worldwide and to inspire, encourage and develop collaboration between clinicians with an interest in the field.

Regional updates in Asia (published literature in PubMed from 2020 onwards on “neurorehabilitation” AND “country”) include:

• China
  - Acupuncture for post-stroke cognitive impairment (RCT), Exergaming in falls risk reduction and improvement of mobility post-stroke, Music therapy on stroke rehabilitation, rehabilitation nursing program non-inferiority trial comparing nurse vs therapist-led treatment.
• Afghanistan
  - Combat injury is the main research area – traumatic brain and sciatica nerve injury. More research and funding needed to examine the long-term neurorehabilitation approach in this area.
• Hong Kong
  - Wearable ankle robotics role in facilitating intensive repetitive task-specific gait training on stair environment for stroke rehabilitation. Baduanjin Qigong improves balance, strength and mobility in chronic post-stroke patients.
• India
  - Published literature on education, Training and Practices of neurorehab in India during covid-19 pandemic showed up to 2/3 of participants (n=872 neurorehab professionals) practised multidisciplinary neurorehab, with a third or less of the patients who needed rehab either exercise independently, supervised by caregivers or therapists. Tele-neurorehab was adopted in about half of the centres and continuing medical education was taught mainly online during the pandemic
• Japan
  - Japan Neurosurgical Database (JND) a prospective observational study registry established in 2017 by the Japan Neurosurgical Society (JNS) to visualize real-world clinical practice, promote science, and improve the quality of care and neurosurgery board certification in Japan. Cerebrovascular diseases comprised the largest proportion overall and in the neurosurgical subgroup (53.1%, 41.0%, respectively)
• South Korea
  - Korean Stroke Cohort for Functioning and Rehabilitation included 7459 patients, showed education and occupation can buffer an individual against cognitive impairment caused by stroke and promote rapid cognitive recovery early after stroke. Furthermore, higher education minimizes long-term cognitive decline after stroke, especially in older patients.
• Pakistan
  - A mixed method study on ethical issues and dilemmas in spinal cord injury rehabilitation in the developing world listed revealed issues in understanding patient autonomy in decision making, lack of insurance for SCI rehabilitation, financial challenges, challenges of providing emerging technology in SCI rehabilitation and SCI rehabilitation during disasters.
• Iran
  - A small RCT showed that advanced weight-bearing mat exercises combined with functional electrical stimulation improved the ability of wheelchair-dependent people with spinal cord injury to transfer and attain independence in activities of daily living
• Southeast Asia (SEA)
  - Advanced and simple technologies such as robotics, virtual reality, telerehabilitation, motion capture, assistive devices, and mobility training were carried out in Singapore, Thailand, Malaysia, and Indonesia. Published research on rehabilitation for falls and associated risks after stroke in Southeast Asia only involved a few countries namely Singapore, Malaysia, Thailand, the Philippines, and Indonesia. Recurrent falls between 6month to 1 year post stroke ranges from 12.5% to 16%. In Thailand, Village Health Volunteers’ training (8 weeks, 1hr/week) improved walking speed among stroke survivors.
• Malaysia
  - MSC (Malaysia Stroke Council) guide on acute stroke care service during COVID-19 pandemic comprises of prehospital stroke awareness, hyperacute stroke care, stroke care unit and intensive care unit admission, post-stroke rehabilitation and secondary prevention practice

Conclusion

Research on neurorehabilitation in Asia post-COVID19 pandemic mainly focused on cerebrovascular disease in adults, followed by neurodegenerative diseases such as Parkinson’s Disease and Alzheimer’s Disease. There was paucity of research on other neurological conditions such as multiple sclerosis, spinal cord injury and epilepsy, to name a few. Patients with neurological disease are usually complex with increased medical and functional needs to maintain independence.

More involvement in the community setting by healthy volunteers would be a cost-effective way in low to middle-income countries. In order to carry this out, we need to invest on education. Carer education on rehabilitation is as crucial as education of the healthcare professionals. Furthermore, rehabilitation should be included in the training curriculum of young neurologists. AOAN is committed to this mission which will be carried out by the AOAN Educational Task Force. Understanding the importance of rehabilitation and actively involved in the rehabilitation process will be beneficial managing the condition holistically. This remains true when the disease is progressively deteriorating and maintaining basic daily function is what we focus on. Alzheimer’s disease and related dementias affect over 50 million persons globally and is expected to rise with population ageing. Alzheimer’s Disease International (ADI) estimated the prevalence of people with dementia in Asia Pacific to triple from 23 million in 2015 to 71 million by 2050. More than half of people with dementia worldwide (135 million) will reside in this region. Hence, research on neurorehabilitation in this area should be accelerated and diversified, as rehabilitation is one of the strategies to slow the disease progression and maintain independence.

In conclusion, investment in education in neurorehabilitation to carers, volunteers and healthcare professionals is as important as having technologies infused in the rehabilitation process. Asia as a region is ageing rapidly; thus, more research in neurorehabilitation should include neurodegenerative diseases. National registries on neurorehabilitation should share a common minimal dataset that can be shared among other Asian nations, to guide policy, research and funding.

Hakimah Mohammad Sallehuddin
Hamidon Basri
On behalf of AOAN