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From Here Forward shares stories and ideas about amazing things UBC and its alumni are doing around the world. It covers people and places, truths, science, art, and accomplishments with the view that sharing better inspires better. Join hosts Carol Eugene Park and Jeevan Sangha, both UBC grads, in exploring solutions for the negative stuff out there — focussing on the good for a change, from here forward.
[00:00:00] Carol Eugene Park: Hello, friendly alumni. Welcome back to From Here Forward, an award-winning UBC Podcast Network podcast. I'm Carol
[00:00:07] Jeevan Sangha: And I'm Jeevan
[00:00:08] Carol Eugene Park: Now, if we go down memory lane, COVID-19 pandemic opened up many doors for telehealth, virtual doctor appointments, tele-rehab, virtual physiotherapy, and more. And prior to the pandemic, myself included many of us were probably skeptical of virtual healthcare services
[00:00:28] And I think even now there are a lot of us who aren't even aware of the different kinds of care you can receive through telehealth services. for a lot of people, having access to that is really convenient and helpful for folks who aren't able to leave the home or don't have practitioners nearby in their community. And as our guest for today illuminated, one impactful way that telehealth is meeting people where they're at is by supporting folks through stroke recovery and rehabilitation Across British Columbia, many stroke survivors, particularly those in rural and remote communities, face an uphill battle when it comes to recovery and rehab. So, we sat down with one of the folks in the UBC research ecosystem who are changing that
[00:01:07] Jeevan Sangha: We chatted with Dr. Brodie Sakakibara, an associate professor with the Department of Occupational Science and Occupational Therapy and an investigator at the Centre for Chronic Disease Prevention and Management at UBCO
[00:01:18] Carol Eugene Park: Brodie leads the Okanagan Stroke Research Lab, where his team is leading innovative patient-centered clinical trials aimed at making stroke recovery more accessible
[00:01:26] Jeevan Sangha: There was lots for us to learn about stroke rehab and prevention. And without further ado, we hope you learn something too.
[00:01:33] Carol Eugene Park: Great. Okay, so why don't we start off with introducing yourself? Who are you, and what is your occupation/title?
[00:01:40] Brodie Sakakibara: Yeah, sure. So, hi everyone. My name is Brodie Sakakibara. I'm an associate professor at UBC in the Department of Occupational Science and Occupational Therapy. I'm also an investigator at the Center for Chronic Disease Prevention and Management, which is located at UBC Okanagan Campus, which is where I'm physically located.
[00:01:58] Jeevan Sangha: can you tell us a bit about your work around stroke recovery research? What initially inspired you to pursue that route, and what kinds of work are you doing around it now?
[00:02:06] Brodie Sakakibara: So generally, my overarching research mission is really to improve the recovery of people who have experienced a stroke and empower them to really better manage their long-term health and well-being. And so, my work is really, with people who have had a stroke, with physical, functional, cognitive, communicative challenges, and working with them to improve their longer-term health and well-being.
[00:02:29] And in doing so, I have a couple of research pillars. So, my first research pillar is clinical research, and this focuses on chronic disease self-management or self-care and how people who have had a stroke manage their health and wellness over time. And the second research pillar that I have is on health services, which focuses on tele-rehabilitation or the delivery of and rehabilitation services using technology
[00:02:56] Carol Eugene Park: Maybe take us back to how you got to this point in your life. You're an undergrad student, you're a graduate student, you're thinking about things. How'd you get here?
[00:03:04] Brodie Sakakibara: Well, if we go back way back, in the early 2000s, interestingly, I started my undergraduate at what was called Okanagan University College, which is now the UBC Okanagan campus. But then eventually I moved to, to Vancouver and attended the UBC Vancouver campus.
[00:03:21] In 2008, I guess it was, I started my graduate training at UBC, where I worked with Dr. Bill Miller, who is now a professor in the Department of Occupational Science and Occupational Therapy. And during this time, I focused on some of the psychological and behavioral aspects of mobility and specifically self-efficacy or confidence among adults who use wheelchairs for their mobility.
[00:03:45] After completing my PhD, I pursued postdoctoral training, where I worked with Dr. Janice Eng, who's now a professor in the UBC Department of Physical Therapy, and also, with Dr. Scott Lear, who's a professor in the Faculty of Health Sciences at Simon Fraser University. And in this work, I was exposed to stroke rehabilitation, chronic disease self-management and also cardiac rehabilitation and telehealth. And following my postdoctoral training, I landed a faculty position, at UBC in the Center for Chronic Disease Prevention and Management, at the Southern Medical Program, and also affiliated with the Department of Occupational Science and Occupational Therapy.
[00:04:21] Interestingly, before my graduate training, I thought I was gonna pursue a clinical degree.
[00:04:26] I thought I was gonna be a physical therapist or an occupational therapist. And I got an interview to be part of those programs. Unfortunately, fortunately, actually, I wasn't accepted and then I thought, "Okay, well, to give myself a better chance of being accepted into the clinical program," I thought I would do a Master of Science in Rehabilitation Sciences, and that's what led me to my graduate training with Bill Miller.
[00:04:48] And then I got exposed to research and developing the evidence that informs clinical practice, and then had the opportunity to do a PhD, and I chose that opportunity and pursued the academic career path rather than the clinical career path
[00:05:02] Jeevan Sangha: Super interesting just how things unfold in your career journey. I'm curious about your work with the Okanagan Stroke Research Lab. So, can you tell us a bit about what that lab focuses on and what is unique about the work you're doing there?
[00:05:16] Brodie Sakakibara: Yeah. So, the Okanagan Stroke Research Lab is actually my lab. Within the lab, I have a couple of postdoctoral fellows, couple of PhD students, master students, undergraduate trainees, volunteers and whatnot. And we really work in the two research pillars, that I talked about previously. So clinical research focusing on chronic disease self-management, as well as we have various projects, focusing on virtual rehabilitation and tele-rehabilitation.
[00:05:42] We started in 2018, And we've been growing slowly but steadily. What I think is unique about our research is that we really focus on secondary prevention after stroke. Part of the issue or concerns about our existing health system is that it's very acute focused.
[00:06:02] And so if we have stroke symptoms, we go to the emergency where we are, transferred to an acute stroke unit. And then many people receive inpatient rehabilitation and then outpatient rehabilitation. After our care within the health system is over, then many people are discharged back home into the community.
[00:06:21] And as part of our research, you know, we hear time and time again that once people are finished with, their services as part of the health system, that they're often forgotten or they feel lost once they're out in the community and, and they have to sort of fend for themselves. The issue here is that many people will live a long time with the effects of stroke.
[00:06:41] And so what we see is many of these individuals having secondary events. Around 16% of people will have a secondary stroke within one year of their initial event. One-third of people who have had a stroke will have another stroke within five years. And so, it's really, I think, in the chronic setting, once people have returned home and are living back in the communities, that they require substantial amounts of support, but there are few resources for them to access.
[00:07:05] And so, my research really focuses on working with individuals once they're back home and in the community to extend the recovery continuum and also to work with them on providing them with support and strategies for them to be a key player in their health and for them to manage their health and wellness on their own, which hopefully could prevent secondary events down the road.
[00:07:24] Carol Eugene Park: I've only been exposed to tele- health and virtual physical therapy, but that's something that I always had skepticism about. Like, is this a thing that will actually help me? I guess my question is, in this point in time, having had this research career, did you ever think that we would be at this point where you would be able to help people through virtual tools like telehealth and tele-rehab?
[00:07:45] Brodie Sakakibara: Yep, absolutely. I think, you know, technology now is changing everything that we do in ways that, you know, that we probably never really thought about previously, right? And the same is true for health and rehabilitation. Technology is allowing us to connect in ways like through Zoom and through Teams and whatnot, like we've never done before.
[00:08:07] Especially since COVID-19 when there were, restrictions and requirements for social and physical distancing. I think this is when really the clinical community, really saw the benefits of using technology to connect with their clients and patients. In research, telehealth, telerehabilitation has been around for, for many years, and we're developing the evidence that it, does work and clients and patients are happy with virtual services.
[00:08:35] As I mentioned, really it was COVID-19 that was sort of was the catalyst, that forced, I guess, the health system to use alternative means of delivering health and rehabilitation, and that was through technology. Post-COVID the use of technology for delivery of health and rehabilitation has declined, but it's at levels that are still higher than it was pre-COVID.
[00:08:56] As well if you take a look at general trends in the research the amounts of virtual health, telehealth research is, increasing as, as well.
[00:09:06] can you talk to us a bit about, the difference in access to care, in cities, in smaller cities, versus more rural locations? What are the discrepancies in care, and is that a point of interest for your research?
[00:09:18] The access to care is, I would say, different, in larger urban centers relative to smaller communities and, remote, settings. A large part of it has to do with health equity. In larger urban centers, there are more resources, for recovery and, and health services that, that people can access.
[00:09:36] Also, the thing about larger urban centers is that's where typically research-intensive universities are located. And it's at these research-intensive universities where new research, therapies are being developed and conducting their, their research. And, you know, they're recruiting individuals in larger urban centers to participate in, in these studies because that's where they're physically located, right?
[00:09:58] And so not only are there more general resources available in larger centers than in smaller communities, but there's also the research-intensive universities that are developing these new therapies that people have access to. In smaller communities, in rural areas, yeah, the, the number and amount of resources is, is a fraction, I would say.
[00:10:17] The other thing is, if you look at our health authorities in BC, the Interior Health Authority, where I'm located with its head office in Kelowna, it serves a, a vast geographic range in British Columbia. And so, while the main hospital, Kelowna General Hospital, is in Kelowna, it serves people from, you know, Revelstoke, Cranbrook, right?
[00:10:37] Two, three hours away. And Kelowna, you know, is increasing in size, and so the number of resources is expanding here that people can access. But if we're providing service to people in Revelstoke, for example, and they're being discharged home to Revelstoke, which is a very small, community, you know, the resources that they have there that they might require is less.
[00:10:59] Carol Eugene Park: But if people are in, say like in a rural location such as Revelstoke, like I would imagine that the recovery would look different from someone, as you said, you know, is in an urban setting. Are there any kind of gaps that your research focuses on to minimize that through telehealth or virtual rehab?
[00:11:16] Like does that actually, address that challenge for people who are in rural locations?
[00:11:21] Brodie Sakakibara: The telerehabilitation, the virtual rehabilitation, very important for areas like the interior of BC and, and Interior Health Authority specifically because we serve such a vast region, people in, in Revelstoke, as an example. And so, I think the use of technology, virtual rehab, to connect individuals, clients who are discharged who have stroke symptoms and require ongoing rehabilitation with expertise in, physical occupational therapists in Kelowna, I think that's one solution to increase the accessibility of the health and rehab services and to make more for an equitable system.
[00:11:56] The more common challenge that we see in some of our, our research participants anyway is, access to devices, so computers, and whatnot, and even having, an internet plan.
[00:12:06] Brodie Sakakibara: They probably have mobile devices like a tablet or a phone, but delivering and receiving, rehab services using a small phone or smaller tablet is not as ideal as using a larger, screen. this is probably research specific, but for individuals that don't have a, a computer or internet access, we typically would send them a, a computer and set them up with internet for the duration of the programs that, that we offer.
[00:12:32] And like I said, that's probably research specific. You're probably not gonna see that in like a health authority
[00:12:36] Jeevan Sangha: we've talked about, you know, management and prevention and recovery, but what are some of, like, generally the challenges, major challenges that you're seeing from stroke survivors in the face of their recovery? Like, what are the common things that come up?
[00:12:48] Of course, I'm sure there's a range of things that are, are patient-specific but just for folks who maybe are less in the know.
[00:12:54] Brodie Sakakibara: Yeah. So, you know, when you talk stroke and secondary prevention of, of stroke, we have to think about what some of the risk factors are. And, you know, when we think about risk factors, you could categorize them into non-modifiable versus modifiable risk factors. So, some of the non-modifiable risk factors are things like age, stroke is an aging condition family history, genetics, things like that.
[00:13:17] You could further categorize the modifiable risk factors into things like health behaviors, so physical activity, diet, nutrition, stress management. And the other category, broader category would be metabolic risk factors. So, things blood pressure, cholesterol, glucose intolerance, so on and so forth.
[00:13:33] And if you put these risk factors on a continuum, it's really the health behaviors, I would say, that we have the most control over. But what's interesting is that the health behaviors also have a large implication on those metabolic risk factors. So, if we are more physically active, if we eat healthier, our cholesterol will probably be lower, our blood pressure will probably be lower, which all contribute to downstream prevention of stroke or/or stroke onset.
[00:13:57] Part of the issue with, with our health system now is that it's like, as I mentioned before, it's very acute focus, right? We have symptoms, we go to the hospital they keep us alive, we receive rehabilitation, and we recover to a level of independence, and then we're discharged home.
[00:14:10] Part of the issue is that it's all responsive and not proactive for prevention. And what I mean by that is, as I mentioned, 33%, one-third of individuals will have a stroke in five years for the similar risk factors that contributed to their stroke in the first place. So many individuals will continue living and have health behaviors that contributed to their stroke in the first place because they're not receiving or they don't have ongoing support into the community.
Carol Eugene Park: In the last, like, few months, I've been reading a lot about how, the different health diseases, illnesses are affecting younger people more than it has before. I'm curious if that's showing up in your stroke research and, if that's true in that part of your world
[00:14:53] Brodie Sakakibara: I don't know the details or the numbers or the literature, But the incidence of younger stroke is, is increasing. And I think a lot of it has to do with uh, health behaviors. You know, I think younger people might have not as, positive activity levels or nutrition habits as, our parents or our, our grandparents.
[00:15:14] And I think that might be contributing to some of the younger strokes that we're seeing for sure.
[00:15:19] Carol Eugene Park: And just to confirm, the stat of one-third in five years and 16% in a year of people having a second, stroke, is that, like, a high number, or is that, like, an okay number? Like, yeah, what is that stat, like, emotionally?
[00:15:34] Brodie Sakakibara: I, I think it's pretty scary. I think, you know, if individuals have had one stroke, you know, you would think that we would provide them and support them as much as we could to prevent them from having another stroke.
[00:15:45] Secondary events are associated with higher levels of, you know, rehospitalizations, mortality, and morbidity, and at the end of the day, overall larger cost to our health system and, and our economy.
[00:15:58] And so, yeah, anything that we can do, I think, to prevent secondary events in particular, and even primary events, stroke events are, are very important
[00:16:06] Jeevan Sangha: And, you know, along that line, a bigger picture question. What, in addition to some of the things you've shared, what impact do you hope your research can continue to have on stroke survivors and their families and caregivers as it continues to develop?
[00:16:19] So two things. One is to extend the continuum of stroke care into the community. So once people have been discharged home, to continue providing them with recovery services, so that they can, improve their physical and, and functional abilities. That's through the virtual rehabilitation aspect.
[00:16:37] Brodie Sakakibara: The other hope is really to empower individuals themselves to be key players in their longer-term health and wellness and empowering them with the self-management abilities for them to do more things for themselves to maintain longer-term a- and wellness.
[00:16:58] Carol Eugene Park: Do you have any surprising stats that you wish people knew about strokes and recovery?
[00:17:04] Brodie Sakakibara: So generally, stroke is a leading cause of disability and mortality in Canada and, and around the world. After 55 years of age, one in five people or 20% of people, will experience a stroke. And in the next 10 to 15 years, it's estimated that nearly three quarters of a million of Canadians will be living with the effects of stroke. And so, the numbers of stroke and people who survive those initial stroke events are, are increasing.
[00:17:32] What is good, a good thing is 83% of individuals who have a stroke will survive, and around 90% of people who have had a stroke and receive rehabilitation will return to community living.
[00:17:46] And so really the acute numbers, of people who will survive, that's due to like, medical interventions and doctors and whatnot. It's a great thing. The rehabilitation is great. 90% of people will return home to-- will get to some level of independence that will allow them to get home. But as, as we've been talking, it's really the chronic phase, I think once people are at home and living in the community, where they do receive less support, the numbers are not as, as great as, as we talked about, you know, 33% of people will have a secondary event over the, over five years
[00:18:17] Jeevan Sangha: For any alumni who are listening who are curious about how to get involved or things that they can do in their day-to-day lives, what, what words would you have for them?
[00:18:26] Brodie Sakakibara: Okay. So generally, I would say, have awareness, about stroke, its signs and symptoms, and recovery. stroke awareness is, is really important because it can save lives, minimize long-term disability. And so, recognizing some of the stroke symptoms early and responding quickly, either for ourselves or friends or family members, can really improve a person's chances of recovery and reducing the severity of lasting effects.
[00:18:53] And when I say recognizing the symptoms, the Heart and Stroke Foundation of Canada actually has done a really good job of improving awareness about stroke onset. And they have an acronym called FAST, which is face. So, is it drooping? Your arms, can you raise both arms? And speech, is it slurred or jumbled?
[00:19:13] And T is for time. If you-- if your face is drooping, if you cannot raise both hands, if you have slurred speech, then call nine one one and, and go to the hospital as soon possible
[00:19:22] Carol Eugene Park: What do you do, in your day-to-day life, the environmental stuff that you can control as a stroke researcher to ensure that you are minimizing the stats that we've talked about today?
[00:19:33] Brodie Sakakibara: It's tough. I, I, I have to follow more of what I preach. And really what I preach is, you know, the behavioral risk factors, sort of the root foundation of, stroke onset and, and stroke prevention. Because, you know, behaviors are very individual, and we have a lot of control over our behaviors and what we do and what we don't do.
[00:19:56] but, you know, being more active, eating healthier. I think an important one is stress management as well. You know, getting, good sleep. Sleep quality and sleep quantity I think are very important. If we don't have proper sleep, then it's really difficult to be more active, right?
[00:20:12] Carol Eugene Park: Awesome. Well, thank you so much for this insightful conversation. and I will be aware of stroke from now on, and I'll try to keep walking my 10,000 steps is what I'm... That's what I took from this conversation.
[00:20:23] Jeevan Sangha: Get those eight hours
[00:20:24] Brodie Sakakibara: Yeah, totally
[00:20:25] Carol Eugene Park: but is it really eight hours?
[00:20:27] Brodie Sakakibara: Of sleep?
[00:20:27] Carol Eugene Park: just... Yeah, isn't that, like,
[00:20:28] Brodie Sakakibara: I don't know. I think it’s; I think it's individual. I think there are recommendations of eight hours, but it's not only quantity, right? It's quality of, of sleep. So yeah, I try to get eight hours, and I try to have a good quality sleep.
[00:20:42] Jeevan Sangha: So, Carol, any takeaways from our conversation with Brody?
[00:20:46] Carol Eugene Park: So, I guess I really want to say is I know last month was Stroke Awareness Month here in Canada. And you're like, "Why are you doing this in July?" Don't ask us. It's better late than never, as the theme of today's Convos go.
[00:21:00] The main takeaway was the stat that he talked about the one-third of people who have had a stroke will have another year, and 16% will have a secondary stroke within a year. I mean, I know in the conversation I was like, "Is that a lot?
[00:21:16] I don't know." Looking back now, that's a lot. That's crazy
[00:21:21] Well, firstly, yeah, I think that stat is really crazy, and it is, it's just interesting how there are so many things that could happen to you in your life and so many things that you could be doing to kind of help support yourself and, like, make yourself as healthy as possible, in the process. And I realized a lot of things that I could be taking a little bit more seriously in my life to help support myself for stroke prevention. and I think it's really cool that there are folks out here doing the work to help make sure that those who have experienced strokes get the support that they need.
[00:21:55] I feel like because we're in the era of technology and AI, there's a constant criticism of like, "I hate technology. This is bad." But I always forget that technology is still a great tool, not everyone has access to healthcare services the same way that people like me who lives downtown in a big does. So that was really cool Well, stay healthy, folks everyone for listening. Make sure you catch our next episode by subscribing or following our show on Spotify, Apple, or wherever you get your podcasts. if you're feeling your feels, please drop us a review. Find me on Bluesky @caroleugenepark
[00:22:30] Jeevan Sangha: And me on Twitter @JeevanKSangha. From Here Forward is an alumni UBC podcast produced by Kylie McPhedran for Podium Podcast Company.