Kathryn S Hayward

Kathryn S Hayward
University of Melbourne | MSD

PhD, GC Res Comm, B Phty Hons1

About

90
Publications
12,988
Reads
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2,149
Citations
Citations since 2016
72 Research Items
2070 Citations
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20162017201820192020202120220100200300400500600
20162017201820192020202120220100200300400500600
Introduction
I am a physiotherapist with an interest in stroke rehabilitation and recovery. I am a Senior Research Fellow at the University of Melbourne and currently undertaking my NHMRC Early Career Research Fellowship. I also hold a fractional appointment at the Florey Institute of Neuroscience and Mental Health. Returning to Australia in 2018, I spent three years (2015-2017) in the Brain Behaviour Laboratory at the University of British Columbia, Vancouver, Canada. Through my clinical and research experiences I have seen that people after stroke undertake an individualized recovery pathway. My research seeks to explore the pathway for people with upper limb impairment and develop novel training approaches that exploit their biological and therapy-induced recovery potential.
Additional affiliations
April 2019 - present
University of Melbourne
Position
  • Senior Researcher
January 2015 - December 2017
University of British Columbia - Vancouver
Position
  • PostDoc Position
January 2015 - present
The Florey Institute of Neuroscience and Mental Health
Position
  • Research Associate
Education
June 2010 - June 2012
The University of Queensland
Field of study
  • Graduate Certificate in Research Commercialisation
February 2009 - July 2013
The University of Queensland
Field of study
  • PhD (Physiotherapy)
February 2005 - December 2008
James Cook University
Field of study
  • Bachelor of Physiotherapy (Honours)

Publications

Publications (90)
Article
Rationale The evidence base for acute post-stroke rehabilitation is inadequate and global guideline recommendations vary. Aim To define optimal early mobility intervention regimens for ischaemic stroke patients of mild and moderate severity. Hypotheses Compared to a pre-specified reference arm, the optimal dose regimen(s) will result in: more parti...
Article
Objective: To examine the trajectory of the Rating of Everyday Arm-use in the Community and Home (REACH) scores over the first-year post-stroke, determine if REACH scores are modified by baseline impairment level and explore the responsiveness of the REACH scale through hypothesis testing. Design: Consecutive sample longitudinal study. Setting:...
Article
Introduction: Broadening eligibility criteria has been a focus to increase the generalisability of trial findings. Using upper limb motor trials conducted early post-stroke as the illustrative domain, we sought to (a) investigate whether the published aim and conclusion statements adequately reflect the generalisability of findings and, (b) explore...
Article
Objective To use a systems paradigm to examine upper limb (UL) motor intervention elements driving biomarker and clinical measure improvement after stroke. Methods Databases were searched up to March 2022. Eligibility screening was completed by 2 authors. Studies using biomarkers and clinical measures pre- and post-upper limb intervention were inc...
Article
Full-text available
Background Persistent sensorimotor impairments after stroke can negatively impact quality of life. The hippocampus is vulnerable to poststroke secondary degeneration and is involved in sensorimotor behavior but has not been widely studied within the context of poststroke upper‐limb sensorimotor impairment. We investigated associations between non‐l...
Article
Full-text available
Introduction This study aimed to explore the perspective of nurses, therapists and stroke survivors on the performance of upper limb self-exercise and use outside therapy during early inpatient stroke rehabilitation. Methods A descriptive qualitative approach was used in focus groups with nurses (n = 21) and therapists (n = 8), as well as in-depth...
Article
Introduction: Acute exercise can modulate the excitability of the non-exercised upper-limb representation in the primary motor cortex (M1). Measures of M1 excitability using transcranial magnetic stimulation (TMS) are modulated following various forms of acute exercise in young adults, including high intensity interval training (HIIT). However, th...
Preprint
Full-text available
Persistent sensorimotor impairments after stroke can negatively impact quality of life. The hippocampus is involved in sensorimotor behavior but has not been widely studied within the context of post-stroke upper limb sensorimotor impairment. The hippocampus is vulnerable to secondary degeneration after stroke, and damage to this region could furth...
Article
Full-text available
Up to two-thirds of stroke survivors experience persistent sensorimotor impairments. Recovery relies on the integrity of spared brain areas to compensate for damaged tissue. Deep grey matter structures play a critical role in the control and regulation of sensorimotor circuits. The goal of this work is to identify associations between volumes of sp...
Article
This systematic review aimed to investigate timing, dose, and efficacy of upper limb intervention during the first 6 months poststroke. Three online databases were searched up to July 2020. Titles/abstracts/full-text were reviewed independently by 2 authors. Randomized and nonrandomized studies that enrolled people within the first 6 months poststr...
Article
The coronavirus disease 2019 (COVID-19) pandemic has presented unique challenges to stroke care and research internationally. In particular, clinical trials in stroke are vulnerable to the impacts of the pandemic at multiple stages, including design, recruitment, intervention, follow-up, and interpretation of outcomes. A carefully considered approa...
Article
Full-text available
Background. Recent studies have reported lower statistics of upper limb (UL) weakness (48-57%) compared to widely cited values collected over 2 decades ago (70-80%). Objective. To explore potential factors contributing to the accuracy of prevalence values of UL weakness using a case study from a single regional centre. Methods. All patients admitte...
Article
Background. Time outside therapy provides an opportunity to increase upper limb (UL) use during post-stroke hospitalization. Objective. To determine if a self-directed UL program outside therapy (Self-Empowered UL Repetitive Engagement, SURE) was feasible and to explore the potential effect of the SURE program on UL use and recovery. Methods. Twent...
Article
Despite an increase in the amount of published stroke recovery research, interventions have failed to markedly affect the trajectory of recovery poststroke. We argue that early-phase research to systematically investigate dose is an important contributor to advance the science underpinning stroke recovery. In this article, we aim to ( a) define the...
Article
Full-text available
Magnetic resonance spectroscopy (MRS) measures cerebral metabolite concentrations , which can inform our understanding of the neurobiological processes associated with stroke recovery. Here, we investigated whether metabolite concentrations in primary motor and somatosensory cortices (sensorimotor cortex) are impacted by stroke and relate to upper-...
Article
Background Past studies have inconsistently identified factors associated with independent walking post-stroke. We investigated the relationship between pre-stroke factors and factors collected acutely after stroke and number of days to walking 50 m unassisted using data from A Very Early Rehabilitation Trial (AVERT). Methods The outcome was recov...
Article
Full-text available
Background Technology is being increasingly investigated as an option to allow stroke survivors to exploit their full potential for recovery by facilitating home-based upper limb practice. This review seeks to explore the factors that influence perseverance with technology-facilitated home-based upper limb practice after stroke. Methods A systemat...
Article
Full-text available
Importance: Early mobilization, out-of-bed activity, is a component of acute stroke unit care; however, stroke patient heterogeneity requires complex decision-making. Clinically credible and applicable CPGs are needed to support and optimize the delivery of care. In this study, we are specifically exploring the role of clinical practice guidelines...
Article
Dose articulation is a universal issue of intervention development and testing. In stroke recovery, dose of a nonpharmaceutical intervention appears to influence outcome but is often poorly reported. The challenges of articulating dose in nonpharmacological stroke recovery research include: (1) the absence of specific internationally agreed dose re...
Article
Background: To enable development of effective interventions, there is a need to complete systematic early-phase dose articulation research. This scoping review aimed to synthesize dose articulation research of behavioral motor interventions for stroke recovery. Methods: MEDLINE and EMBASE were systematically searched for dose articulation studi...
Article
This chapter focuses on the applications of transcranial magnetic stimulation (TMS) to index and modulate the neurophysiology of the motor system after a brain injury, specifically stroke. It provides an overview of TMS, applications in healthy and neurologically injured populations to index cortical excitability and connectivity, along with the po...
Preprint
Full-text available
Objective To identify associations between atrophy of spared subcortical nuclei and sensorimotor behavior at different timepoints after stroke. Methods We pooled high-resolution T1-weighted MRI brain scans and behavioral data in 828 individuals with unilateral stroke from 28 cohorts worldwide. Cross-sectional analyses using linear mixed-effects mo...
Article
Purpose: In search of Kipling's six honest serving men in upper limb rehabilitation after stroke, we sought to investigate clinicians' perspective of when and where to begin therapy, how much and what therapy to provide, and who and why (or not) to provide therapy. Materials & methods: Within-participant case cross-over experiments were nested wit...
Article
Background The utility-weighted modified Rankin Scale, representing patient perspectives of quality of life, is a newly proposed measure to improve the interpretability of the modified Rankin Scale. Despite obvious advantages, such weighting imperfectly reflects the multidimensional patterns of post-stroke burden. Aims To investigate multidimensio...
Article
Objective: This study aims to investigate factors related to paretic upper limb use within first 4-weeks post-stroke. Design: Sixty inpatients within 4-weeks of first-time stroke were stratified by severity defined by Fugl Meyer upper limb score: severe=0-22, moderate=23-50, mild=51-66. All wore a wrist accelerometer on the paretic upper limb (2...
Article
Purpose To investigate the safety and efficacy of early mobilisation (EM) compared to usual care by meta-analysing individual participant data (IPD). Materials and methods IPD were sought from randomised controlled trials comparing out-of-bed mobilisation starting within 48 h from stroke onset to usual care for acute stroke patients. Six trials we...
Article
Full-text available
The goal of the Enhancing Neuroimaging Genetics through Meta‐Analysis (ENIGMA) Stroke Recovery working group is to understand brain and behavior relationships using well‐powered meta‐ and mega‐analytic approaches. ENIGMA Stroke Recovery has data from over 2,100 stroke patients collected across 39 research studies and 10 countries around the world,...
Preprint
Full-text available
The goal of the Enhancing Neuroimaging Genetics through Meta-Analysis (ENIGMA) Stroke Recovery working group is to understand brain and behavior relationships using well-powered meta- and mega-analytic approaches. ENIGMA Stroke Recovery has data from over 1,800 stroke patients collected across 32 research sites and 10 countries around the world, co...
Article
Background: There is limited knowledge on the upper limb (UL) use early post-stroke by impairment levels. Objectives: To 1) To characterize paretic UL use in people with different UL impairment levels early post-stroke during and outside therapy; 2) compare UL use in people early post-stroke to age-matched controls. Methods: A prospective cross-sec...
Article
Full-text available
Introduction: Despite an increase in the quality of clinical trials in stroke recovery, interventions have failed to markedly impact the trajectory of recovery after stroke. Failure may be due to the lack of consideration for the complexity of dose and its articulation within research trials. Prior to commencing the scoping review, we identified tw...
Article
A major goal of the Stroke Recovery and Rehabilitation Roundtable (SRRR) is to accelerate development of effective treatments to enhance stroke recovery beyond that expected to occur spontaneously or with current approaches. In this paper, we describe key issues for the next generation of stroke recovery treatment trials and present the Stroke Reco...
Article
Full-text available
Objectives: Investigate upper limb (UL) capacity and performance from <14-days to 24-months post stroke. Design: Longitudinal study of participants with acute stroke, assessed ≤14-days, 6-weeks, 3-, 6-, 12-, 18-, and 24-months post stroke. Setting: Two acute stroke units. Main outcome measures: Examination of UL capacity using Chedoke McMast...
Article
A major goal of the Stroke Recovery and Rehabilitation Roundtable (SRRR) is to accelerate development of effective treatments to enhance stroke recovery beyond that expected to occur spontaneously or with current approaches. In this paper, we describe key issues for the next generation of stroke recovery treatment trials and present the Stroke Reco...
Article
Full-text available
Background: Improving upper limb (UL) motor recovery after stroke represents a major clinical and scientific goal. We aim to complete three systematic reviews to estimate the (1) association between time to start of UL therapy and motor recovery, (2) relative efficacy of different UL therapy approaches post-stroke and (3) cost-effectiveness of UL...
Article
Objectives The objectives of the study are to characterize paretic upper limb (UL) use in people with different levels of impairment 4 weeks poststroke and to compare accelerometry and direct observational approaches. Methods Twelve stroke inpatients (five mild, three moderate, and four severe UL impairment) were recruited from a rehabilitation ho...
Article
Purpose: To demonstrate the validity and reliability of a smartphone app to measure ROM after stroke. Materials and methods: Twenty-one stroke survivors with a diagnosis of stroke that affected the motor cortex or subcortical motor pathways and were hospital inpatients at one of two metropolitan hospitals were recruited. A within-session test-retes...
Article
Full-text available
Question: In adults undergoing rehabilitation after stroke, does 1 hour of additional active repetitive reaching per day prevent or reduce upper limb contracture? Design: Multi-centre, randomised controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis. Participants: Fifty adults undergoing rehabilitation...
Article
Full-text available
Objective: To investigate the efficacy and safety of drug interventions to promote motor recovery post-stroke. Data sources: CENTRAL, CINAHL, Embase, MEDLINE, SCOPUS and Web of Science. Study selection: Published human randomized controlled trials in which the primary intervention was a drug administered to promote motor recovery post-stroke, vs...
Article
Full-text available
The Stroke Recovery and Rehabilitation Roundtable (SRRR) meetings bring together an international group of preclinical and clinical researchers along with statisticians, methodologists, funders and consumers, working to accelerate the development of effective treatments for stroke recovery and to support best-evidence uptake in rehabilitation pract...
Article
Full-text available
Continuous theta burst stimulation (cTBS) is a form of noninvasive repetitive brain stimulation that, when delivered over the contralesional hemisphere, can influence the excitability of the ipsilesional hemisphere in individuals with stroke. cTBS applied prior to skilled motor practice interventions may augment motor learning; however, there is a...
Article
Objectives:: To explore the effect of environmental enrichment within an acute stroke unit on how and when patients undertake activities, and the amount of staff assistance provided, compared with a control environment (no enrichment). Design:: This is a substudy of a controlled before-after observational study. Setting:: The study was conduct...
Article
Full-text available
Introduction In individuals with early (indexed ≤7 days poststroke) and severe upper limb paresis (shoulder abduction and finger extension score of <5 out of 10), our objectives are to: (1) determine if biomarkers of brain structure and function collected at <1 month poststroke explain who will experience clinically important recovery over the firs...
Article
Full-text available
Background: The ineffectiveness of most complex stroke recovery trials may be explained by inadequate intervention design. The primary aim of this review was to explore the rationales given for interventions and dose in stroke rehabilitation randomised controlled trials (RCTs). Methods: We searched the Cochrane Stroke Group library for RCTs that...
Article
Full-text available
Environmental enrichment (EE) has been widely used as a means to enhance brain plasticity mechanisms (e.g., increased dendritic branching, synaptogenesis, etc.) and improve behavioral function in both normal and brain-damaged animals. In spite of the demonstrated efficacy of EE for enhancing brain plasticity, it has largely remained a laboratory ph...
Article
Full-text available
Context: Pediatric mild traumatic brain injury (mTBI) is a common and poorly understood injury. Neuroimaging may index brain injury and outcome after pediatric mTBI, but remains largely unexplored. Objective: To investigate the differences in neuroimaging findings in children/youth with mTBI. Measures of behavior, symptoms, time since injury, an...
Article
Background: Information about the structural integrity of the corticospinal tract (CST) from diffusion-weighted imaging can improve our ability to understand motor outcomes in people with upper limb impairment after stroke, especially those with severe impairment. Yet, there is no consensus on which method of CST generation most accurately represe...
Article
Background: Stroke survivors with severe upper limb disability need opportunities to engage in task-oriented practice to achieve meaningful recovery. Objective: To compare the effect of SMART Arm training, with or without outcome-triggered electrical stimulation to usual therapy, on arm function for stroke survivors with severe upper limb disabi...
Article
Full-text available
Objective An enriched environment embedded in an acute stroke unit can increase activity levels of patients who had stroke, with changes sustained 6 months post-implementation. The objective of this study was to understand perceptions and experiences of nursing and allied health professionals involved in implementing an enriched environment in an a...
Article
Full-text available
Background: Severity of arm impairment alone does not explain motor outcomes in people with severe impairment post stroke. Objective: Define the contribution of brain biomarkers to upper limb motor outcomes in people with severe arm impairment post stroke. Methods: Paretic arm impairment (Fugl-Meyer upper limb, FM-UL) and function (Wolf Motor...
Article
Full-text available
The most difficult clinical questions in stroke rehabilitation are “What is this patient’s potential for recovery?” and “What is the best rehabilitation strategy for this person, given her/his clinical profile?” Without answers to these questions, clinicians struggle to make decisions regarding the content and focus of therapy, and researchers desi...
Article
The first Stroke Recovery and Rehabilitation Roundtable established a game changing set of new standards for stroke recovery research. Common language and definitions were required to develop an agreed framework spanning the four working groups: translation of basic science, biomarkers of stroke recovery, measurement in clinical trials and interven...
Article
Combining structural and functional magnetic resonance imaging may provide insight into how residual motor networks contribute to motor outcomes post-stroke. The purpose of this study was to examine whether a structural motor network (SMN), generated with fMRI guided diffusion-based tractography, relates to motor function post-stroke. Twenty-seven...
Article
The first Stroke Recovery and Rehabilitation Roundtable established a game changing set of new standards for stroke recovery research. Common language and definitions were required to develop an agreed framework spanning the four working groups: translation of basic science, biomarkers of stroke recovery, measurement in clinical trials and interven...
Article
Full-text available
The most difficult clinical questions in stroke rehabilitation are ‘‘What is this patient’s potential for recovery?’’ and ‘‘What is the best rehabilitation strategy for this person, given her/his clinical profile?’’ Without answers to these questions, clinicians struggle to make decisions regarding the content and focus of therapy, and researchers...
Article
Full-text available
Background Therapy that combines repetitive training with non-invasive brain stimulation is a potential avenue to enhance upper limb recovery after stroke. This study aimed to investigate the feasibility of transcranial Random Noise Stimulation (tRNS), timed to coincide with the generation of voluntary motor commands, during reaching training. Meth...
Article
Objectives: To determine whether an enriched environment embedded in an acute stroke unit could increase activity levels in acute stroke patients and reduce adverse events. Design: Controlled before-after pilot study. Setting: An acute stroke unit in a regional Australian hospital. Participants: Acute stroke patients admitted during (a) init...
Article
Full-text available
The relationships between impairment, function, arm use and underlying brain structure following stroke remain unclear. Although diffusion weighted imaging is useful in broadly assessing white matter structure, it has limited utility in identifying specific underlying neurobiological components, such as myelin. The purpose of the present study was...