By: Allison Currie
In Canada, a stroke strikes roughly every five minutes, or roughly 108,000 cases a year, according to Heart and Stroke. What is a concerning rise in stroke rates highlights not only the urgent need for increased prevention but also for comprehensive stroke care, from acute treatment to long-term recovery.
For Dr. Gail Eskes, this is not just a statistic, it’s a lifelong mission. Since early in her career, she has been devoted to understanding the inner workings of the brain and helping stroke survivors reclaim their lives.
Dr. Eskes, affiliate scientist with Nova Scotia Health, is currently a professor at Dalhousie University, jointly appointed between psychiatry and psychology and neuroscience, with cross appointments in medicine for rehab and neurology. While she has worn many hats during this time, she has been at Dalhousie since 1978.
Dr. Eskes’s journey began with a passion for cognitive neuroscience, sparked during her PhD studies at Berkeley. Influenced by inspiring professors and later by her postdoctoral work at the Rotman Research Institute and Dalhousie University, she became fascinated by how the brain orchestrates critical functions like memory and attention.
“Attention and memory provide the scaffold for who we are,” she explains. “They shape our adaptive behaviour and our sense of identity, both who we are now and who we believe we were.”
This fascination fueled her desire to better understand how stroke disrupts these core abilities, and how to strengthen the brain again once it happened.
Her clinical career began at what was then the Victoria General Hospital in Halifax, where she worked alongside an acute stroke team dedicated to delivering optimal care and a rehab team that focused on after stroke rehabilitation. There, she witnessed firsthand the full spectrum of stroke recovery. The complexity of stroke outcomes intrigued her. Every patient’s brain and stroke were unique, each presenting a new puzzle.
As a neuropsychologist, Dr. Eskes spent countless hours mapping the cognitive effects of stroke for patients. But knowing what was wrong was just the first step in a patient’s recovery, and there were few available effective treatments. This limitation inspired her to pivot back to Dalhousie to focus more on the research side of things.
Her research focused on healing the very functions most vulnerable to stroke. Attention, memory and executive function were the area’s most clearly affected. Drawing on her scientific and clinical expertise, she aimed to discover ways to help patients regain their independence and rebuild their lives.
Her vision and passion for research led to the creation of the Cognitive Health and Recovery Research Lab, located at Dalhousie’s Life Sciences Research Institute (a joint initiative of Dalhousie University, Nova Scotia Health and IWK Health, serving as a hub for life sciences research).
Her lab, originally made possible through a grant from the Atlantic Innovation Fund, focuses on understanding how attention and working memory are regulated, how these cognitive functions change with aging and diseases like stroke or Parkinson’s and developing clinical interventions to improve them.
One major area of study is spatial neglect, a condition that commonly follows a stroke in the brain’s right hemisphere. Unlike left-side strokes, which often cause more recognizable symptoms like communication difficulties, right-side strokes can lead to a person losing awareness of the left world entirely. This means losing awareness of the left side of their body, their environment, items in a closet, or the food on a plate. Often, they don’t realize it’s happening. It can be subtle or severe, but either way, it impacts independence and quality of life.
“Recovering from spatial neglect is different for each person,’ says Dr. Eskes, “so our focus is on helping patients understand it so they can engage in treatments, ideally regaining as much awareness and function as possible.”
To do that, her lab has been studying an approach called prism adaptation. Patients wear goggles fitted with wedge prisms that shift their visual field to the right. As they adapt to the new environment by pointing at targets on a screen, their brain begins to adjust. When the goggles are removed, the adaptation causes a leftward shift of working space, helping patients pay more attention to the neglected side.
After years of refining the process, Dr. Eskes and her team developed a digital version of the training: a home-use app that allows stroke survivors to practice prism adaptation for ten minutes a day using their goggles and an iPad. A current study, funded by the Nova Scotia Health Research Fund, and led by Dr. Anne-Sophie Champod, a former postdoctoral student and now a professor at Acadia University, is testing how much improvement can be seen over two weeks of home-based training.
Another study, also supported by the fund, takes a different digital therapeutic approach.
This fully online program is designed for stroke patients recovering at home. Using a gamified platform, patients practice leftward scanning on the computer and learn strategies to continue improving their leftward scanning in their own environments by setting individualized goals to improve daily activities that are affected by the stroke. Progress is measured continuously to assess effectiveness.
“The reason we created digital approaches, in addition to the fact that they’re gamified and more fun, is that when retraining the brain, it requires constant practice, over and over again,” says Dr. Eskes. “These types of apps really allow you to focus and get the intensity that you need to create the change you want to see. To retrain old brain cell networks or develop new ones, you need to challenge yourself on an ongoing basis.”
Dr. Ashely Hilchie, Senior Director of Research at Nova Scotia Health, agrees that gamified and digital care such as this is transformative when working with patients across all fields of healthcare.
Dr. Eskes hopes her work not only helps those recovering from stroke but also helps continue to reshape how we think about brain health in general.
“We’re becoming more aware of how vulnerable the brain is, and how it’s connected to the health of our entire body,” says Dr. Eskes. “All of the healthy habits we’re encouraged to follow like eating well, getting enough sleep, and exercising matter just as much for the brain as they do the rest of the body and mind. We shouldn’t wait until after a stroke to care for it.”
That shift in thinking, she believes, is starting to drive more multidisciplinary research and care, helping to bring together clinicians, researchers, technologists and patients. Ultimately, this will mean better outcomes for all Nova Scotians.
Dr. Eskes shares that the success of her work has been made possible through the contributions of many talented academic collaborators, students and staff she has had the privilege of working with over the years. She is also grateful for the funding support she has received from the QEII Foundation and Nova Scotia Health on multiple occasions, dating back to 1998.
Dr. Eskes has also applied her stroke expertise as a co-chair and member of various Heart & Stroke Foundation working groups to develop stroke best practices.
If you would like to get involved in the work being done you can find more information at the Cognitive Health and Recovery Research Lab.
Research is care. Clinical studies translate research into potentially life-changing therapies that can help you, your loved ones, and your community. To learn more about how to get involved, visit Nova Studies Connect.
