A blinding headache like nothing Robert Vander Kraats APAM had ever known was the first sign that something was seriously wrong. 

The headache stopped Robert in his tracks, prompting him to quickly excuse himself from a consultation with a patient in his Greenwood practice, Next Generation Physiotherapy, in Perth, Western Australia. 

In the next room lying on a treatment plinth while simultaneously trying to attach a blood pressure monitor to his arm, Robert lost consciousness. 

He woke up in hospital two weeks later.

As Robert looked around the intensive care unit at Sir Charles Gardiner Hospital in a state of confusion, it would be weeks before he could piece together all that happened to him on that fateful afternoon in 2015. 

He would later discover that he had had a haemorrhagic stroke, had been rushed into emergency surgery,
had undergone two neurosurgeries initially and four in total and had been in an induced coma. 

He would also discover that the body he knew before had vastly changed.

‘Just a few weeks prior to the stroke, I had my annual complete blood test performed and my blood pressure taken. 

'All the blood markers were normal, as was the blood pressure; the GP was happy with everything,’ Robert says.

‘But when I got that severe headache that day, I knew it was highly unusual because I don’t suffer from headaches.’

It was six months before Robert left the hospital after his stroke. 

In that time on the ward, Robert’s perspectives on a myriad of things—life, career, achievements, limitations and aspirations—shifted and adapted as he adjusted to his new situation. 

The stroke had claimed his ability to walk, restricted his movement and thrown his physiotherapy career into doubt. 

And he was only 30 years old, with what felt like so much more to do and give.

‘The stroke has had a profound impact on my mobility. 

Using specialised equipment, Robert still enjoys getting out to the golf driving range when he can.

'Before this I ran regularly, often completed triathlons and had signed up to the Busselton Ironman. Afterwards
I needed a wheelchair for all mobility,’ Robert says. 

‘It was a considerable change. 

'What I focused on was my attitude, viewing every situation from the perspective of “Is the glass half empty or half full?” 

'Granted, at times it is challenging, but I attempt to maintain a positive attitude in every situation. 

'I acknowledge my physical limitations but I frequently consider how I can positively influence others from a wheelchair.’

During his rehabilitation journey, Robert was told more than once by hospital staff members from different departments that he would not be able to return to practising physiotherapy. 

All those athletic pursuits he once enjoyed would be beyond his reach now too, he was told. 

Robert took this as a challenge to find a way to remain engaged with his passions, albeit in a new and different form.

Practitioner becomes the patient

As a stroke patient, Robert had all the knowledge of what he needed for his own rehabilitation and his cognitive function was intact. 

Frustratingly, however, the stroke had rendered him unable to speak. 

Robert initially used a communication board to express himself until he was able to begin using single words a few weeks in. 

It was a humbling experience, he says, knowing what needed to be done but not being able to communicate any of it.

Fatigue played a big part in Robert’s rehabilitation. 

Tiring easily—one of the symptoms of the stroke—made the next six months of daily physiotherapy sessions a challenge. 

With his physiotherapist, Robert began to build up his physical capabilities such as movement and balance, his core strength and the ability to take those crucial first steps towards his goals of completing simple activities such as sitting up in bed. 

The work was exhausting but it also revealed to Robert an inner resolve and positive outlook that he nurtured to get him through the tough challenges ahead.

‘My rehabilitation journey was exactly that, a journey. 

'In hospital, an initial goal was simply to achieve basic independence with bed mobility and sitting. 

'Now, just over eight years later, the journey continues but the focus is on body weight-supported treadmill training, along with strength and conditioning work. 

'While time has gone on and my goals have changed, the rehabilitation journey continues—and will indefinitely,’ Robert says.

As part of his initial rehabilitation, Robert attended regular horse riding sessions with the Riding for the Disabled Association of Australia, which he also credits for helping to improve his balance, coordination and stamina—and his confidence.

‘Regular strength and conditioning training is of importance, not just to “practise what you preach” but for the numerous health benefits. 

Thanks to his brother, Robert competes in the Busselton Ironman competition in 2021.

'Twice a week, for an hour each time, I train using the body-weight-supported treadmill. 

'Three times a week, for 45 minutes each, I have a one-on-one personal training session,’ Robert says.

Back to the practice

As an inpatient, and with several people telling him that he would never return to physiotherapy, Robert felt spurred on to consider how he could get back to the profession, albeit in a different way. 

His dilemma, he says, was having the knowledge of a physiotherapist and the clinical reasoning but being limited physically in what he could do at the practice. 

The Greenwood clinic of Next Generation Physiotherapy had been closed down for five years during Robert’s convalescence and rehabilitation. 

So Robert began formulating a plan to get the Greenwood clinic reopened and to return to the profession he loved by using some lateral thinking.

Robert acknowledged that his physical limitations posed a significant challenge to returning to practice; his reliance on a wheelchair for mobility as well as limited use of his hands would rule out key elements of treatment most patients would require.

‘Even though I was away from patient contact for approximately five years due to considerable fatigue levels, I frequently read current research and attended local PD events. 

'This ensured that my skills and knowledge would be up to date,’ Robert says. 

‘That is where Jeff comes in; essentially, he is my “hands”. So even though I am physically restricted, Jeff fills that void.’

Jeff Wong APAM joined Robert’s practice in 2020, one year after graduating as a physiotherapist from Curtin University. 

Prior to that, Jeff had known Robert for about 15 years. He was a patient of Robert’s while working as a procurement officer in the mining industry. 

Jeff says he had been unhappy in his career and, inspired by the work Robert was doing, he decided to change careers and study to become a physiotherapist (see article below).

Robert Vander Kraats with Jeff Wong, who is Robert’s ‘hands’ at Next Generation Physiotherapy.

Between them, Robert and Jeff came up with a way to treat patients at both practice locations three days a week. 

Jeff would deliver the ‘hands on’ part of patient treatment while also collaborating with Robert and learning from him in all other aspects of patient care. 

As a team, Robert and Jeff offer patients the benefit of both of their expertise.

‘Clinical reasoning is heightened as everything that is said and carried out is critiqued, in a nice way, based on the current research,’ Robert says. 

‘In the vast majority of cases, we both agree on the diagnosis and the treatment plan. 

'When Jeff is away from the practice, a friend usually assists me to carry out the assessment and to implement the treatment.’

Life before stroke

Almost a decade before he had his stroke, Robert was in the first cohort of physiotherapy students to graduate from the University of Notre Dame Australia in Fremantle in 2006. 

Like many, Robert had chosen the profession because he wanted to help people. 

He soon discovered the rich rewards of being able to contribute to patients’ progress and help them achieve their goals.

‘As a new graduate, I wanted to start my journey towards a well-rounded career by working in a hospital to become exposed to various different presentations on the wards, including ICU,’ Robert says. 

‘My first job after graduation was two years at Joondalup Health Campus.

'I gained a great deal of practical knowledge as I rotated around all the wards, expanding my skill set.

‘Working in a busy hospital exposed me to many different presentations and further highlighted how a physiotherapist can make a difference in someone’s life. 

'This realisation motivated me to engage in postgraduate studies and to regularly attend professional development education.’

Robert wanted to open his own practice and this dream was achieved in 2008 when he opened Next Generation Physiotherapy in Greenwood as a sole trader. 

Robert enjoyed working with patients across a broad spectrum of ages and with a wide variety of conditions requiring his expertise.

‘I was ready to become a first contact practitioner.

'It allowed me to hear about various personal sporting accomplishments and to implement physiotherapy with all age groups,’ he says. 

‘I credit my solid foundation to my years spent at university and also working in a large hospital. 

'This strong footing fuelled my desire to open up my own practice.’

Once in private practice, Robert came to the realisation that to be able to better help his patients and to have them return to participation in sport, he needed to complete his master’s and become a titled physiotherapist.

In 2013, Robert achieved that goal, becoming an APA Sports and Exercise Physiotherapist.

‘The titling process was very valuable because it made me ask myself why I do things. 

'For instance, why do I choose a particular assessment or treatment technique? 

'It also refined my clinical reasoning, along with keeping up to date with the current evidence,’ Robert says.

‘Titling has assisted me to critique every assessment and treatment technique and to ensure that the technique is backed by current research.’

A sporting chance

Throughout his career, Robert had always been a keen sportsperson who enjoyed being fit and healthy. 

He pursued many sporting passions including competing in several triathlons in and around Perth. 

Treating patients with sports-related injuries was also a passion and Robert thrived on helping his patients return to engaging with their chosen sport post-injury. 

When he experienced his stroke, Robert was in the process of training to compete in the Busselton Ironman.

‘Being in a wheelchair is not an excuse for not exercising,’ Robert says. 

‘Case in point, I recently competed in the Ironman at Busselton. 

'Yes, it was a different way to compete—someone pulled me along in an inflatable boat and on the bike and pushed me for the run—but the point is that I completed it.’

Living with disability

Prior to his stroke, Robert saw a handful of stroke survivors each year in the practice. 

Much of his experience of stroke rehabilitation had come from university, through professional development and through working directly with patients in his private practice clinics. 

There was no history of stroke in Robert’s family.

‘Stroke and other neurological conditions were covered in my undergraduate degree and I attended various PD events on the topic. 

'However, lived experience and going through the process firsthand doesn’t compare with academic knowledge,’ Robert adds.

Having become a stroke patient himself, Robert says the experience has given him a new perspective on patient treatment. 

Next Generation Physiotherapy is now registered with the National Disability Insurance Scheme and Robert counts several stroke survivors among his patients. 

He also regularly attends a stroke survivors’ peer support group.

‘The irony of the situation is that before my stroke I assisted with stroke recovery and after my own stroke I was in need of stroke recovery,’ Robert says. 

‘This experience has broadened the client make-up to be more inclusive of someone with a disability. 

'Being registered with the National Disability Insurance Scheme reassures people that Next Generation Physiotherapy meets all the standards that the scheme sets.

‘Having a practitioner with a disability helps to create an atmosphere of empathy rather than only sympathy.

'The individual patient is often more at ease, knowing that their situation may have been experienced [by the physiotherapist].’

Advice to practitioners

When Robert’s own ability to communicate was affected by his stroke, he found that the people who treated him, across many professions, often assumed what they thought he would say to questions rather than taking the time to understand what his response might actually have been. 

This revelation has led Robert to urge practitioners to take the time to listen to their patients more.

‘For example, if someone presents with knee pain, it is important to consider the big picture. 

'Yes, the person has knee pain but what other contributing factors are involved?’ Robert says.

‘It seems to me that if we just focus on the knee and gloss over the possible contributing factors, we are failing to consider the whole person.

‘And it is important to view the stroke survivor as a valuable person and not just put that person into a box titled “stroke”. 

'This process may take some more time—for example, the person may have a speech impediment—but you might be the only health professional who has taken the time to listen.

‘My story is more than just me. I consider how such adversity can possibly help others. Not just someone who has had a stroke, but anyone with a disability or a severe injury.’

Jeff has handy way to help

It was in September 2020 that Jeff Wong first started working with Robert Vander Kraats as Robert’s ‘hands’. 

The pair had worked out a way to reopen Robert’s clinic in Perth with both of them working collaboratively on each patient.

‘I was still working full-time in another clinic and so we opened up a couple of mornings just to see what would happen,’ Jeff says. 

‘And we’ve been doing that ever since. 

'Rob can move and he can stand but he doesn’t quite have the coordination. So we work in tandem. 

'With an initial appointment, I’ll bring the patient into the room and we’ll both ask questions. 

'Rob will also ask more questions if he thinks that there’s some deeper digging that needs to occur.

‘Together we’ll go through a physical assessment. We’ll talk about what we both want to have a look at and then agree on a path forward.’

More complex cases, Jeff says, require more in-depth discussions between them. 

Patients requiring manual therapy are handled by Jeff, in consultation with Robert, giving the patient the benefit of treatment by two physiotherapists.

Jeff says he reaps the benefit of Robert’s extensive experience and also learns from treating many of the National Disability Insurance Scheme clients who come into the clinics. 

‘We have some very interesting cases come through the door. 

'I think it’s really good because if they [patients with disabilities] see that Rob has a lived experience with disability, then they may feel more confident that he can empathise with them.

‘Rob wants to continue to develop his skills, which I think is something that a lot of people can get inspiration from.’

Innovation leads the way

The role of innovation in creating a more accessible and equitable world is the theme of this month’s International Day of People with Disability, also known as the International Day of Persons with Disabilities.

Transformative solutions for inclusive development underpin the theme, which recognises the role that technological advances and creative thinking are playing in improving accessibility for people with disability.

The annual observance of the International Day of Disabled Persons was proclaimed in 1992 by the United Nations General Assembly. 

Observance of the day aims to promote an understanding of disability issues and to mobilise support for the dignity, rights and wellbeing of people with disabilities.

The event also seeks to increase awareness of the benefits to be derived from the integration of people with disabilities into every aspect of political, social, economic and cultural life.

There are many ways you can get involved, including:
•    donating to disability charities
•    strengthening anti-discrimination policies in the workplace
•    improving accessibility through the installation of wheelchair ramps
•    assessing diversity in the workplace
•    making a public statement of support.

Click here to find out more about Australia’s actions on International Day of People with Disability.