This national research centre uniquely combines two recent advances in rehabilitation, applies them to rehabilitation of acquired communication disorder (aphasia) and translates them into a clear pathway for clinical management of people with aphasia. This cell to society research program integrates a consumer's perspective into research in the relearning of lost skills after injury. The resulting Australian Aphasia Clinical Pathway will enable and ensure best practice in aphasia services.
THE NATURAL HISTORY OF COGNITIVE IMPAIRMENT AND DEMENTIA IN A STROKE COHORT
Funder
National Health and Medical Research Council
Funding Amount
$290,747.00
Summary
In a current NHMRC-funded study, we have examined 200 stroke patients (and 100 control subjects) at 3 months after a stroke and one year later, and identified those who have impairment in memory and other cognitive functions. We have also studied these subjects in detail from a psychiatric perspective and performed brain scans on them using magentic resonance imaging. We find that many stroke patients have problems with their cognitive functioning which has a major impact on their lives. A large ....In a current NHMRC-funded study, we have examined 200 stroke patients (and 100 control subjects) at 3 months after a stroke and one year later, and identified those who have impairment in memory and other cognitive functions. We have also studied these subjects in detail from a psychiatric perspective and performed brain scans on them using magentic resonance imaging. We find that many stroke patients have problems with their cognitive functioning which has a major impact on their lives. A large number also become depressed. These consequences of stroke are not given sufficient importance by clinicians. The fact that stroke is a common problem in the elderly, and our society is aging, makes this a problem of major public health significance. In the new proposal, we plan to study these subjects up to 3 years with repeat neuropsychiatric assessments and brain scans to investigate the natural history of stroke-related cognitive impairment. We will determine whether further new cases of dementia develop in the period 1-3 years, what happens to the brain lesions picked up on brain scans, and how these deficiencies affect the patients' living status and their longevity. We will be able to determine the factors that lead to a good outcome, and suggest strategies that may be applicable to improve the functioning of these individuals.Read moreRead less
Does Aerobic Or Resistance Training Improve Walking Ability In Chronic Stroke Patients?
Funder
National Health and Medical Research Council
Funding Amount
$152,036.00
Summary
The majority of stroke patients discharged from rehabilitation are often housebound. The criterion which most often limits individuals with stroke from achieving 'community ambulation' is the inability to walk long distances. Current views suggest that an exercise program aimed at improving lower limb strength and aerobic fitness will improve walking ability in those stroke patients with mild to moderate disability. However, there are no reported studies that have rigorously investigated whether ....The majority of stroke patients discharged from rehabilitation are often housebound. The criterion which most often limits individuals with stroke from achieving 'community ambulation' is the inability to walk long distances. Current views suggest that an exercise program aimed at improving lower limb strength and aerobic fitness will improve walking ability in those stroke patients with mild to moderate disability. However, there are no reported studies that have rigorously investigated whether either of these approaches, singularly or combined, is effective for augmenting walking ability in chronic stroke patients. We will use a randomised, double-blinded controlled trial to determine which of strength training, aerobic training or a combination of the two is the most effective approach for improving walking endurance, measured by the 6-minute walk test, in individuals with mild-to-moderate stroke. In addition, we will determine the benefits of each program to subjects' cardiorespiratory fitness, lower limb strength, mobility and psychological function. Subjects will be randomly allocated to one of 4 groups: 1) Aerobic exercise (and sham strength training); 2); Strength training (and sham aerobic training); 3) Combined strength and aerobic training; and 4) Control (sham strength and aerobic training. Sham treatment for strength training is stretching and calisthenics, and for aerobic exercise is passive motorised cycling. All subjects will attend small group sessions for 10 weeks, with 3 sessions per week, and each session about 1 hour duration. The findings from this study are critical in identifying the most effective and efficient approach to improving stroke patient's walking endurance. Improvement in walking endurance will enable many persons following stroke to achieve the level of 'community ambulation'. Last, it will contribute to the 'evidence-based' scientific framework for treatment of stroke patients.Read moreRead less
Improving Health Outcomes For Aboriginal Australians With Chronic Disease Thru Strategies To Reduce Systems Barriers To
Funder
National Health and Medical Research Council
Funding Amount
$2,997,256.00
Summary
The research aims to improve outcomes for Aboriginal people with chronic disease, through strategies of care that address health system barriers. The project aims to understand barriers and then to develop, implement and evaluate appropriate models of care that incorporate policy development and engagement. The project is to incorporate research partnerships and Indigenous sector capacity development.
The Adverse Effects Of Diabetes On Stroke: An Echoplanar MRI Study
Funder
National Health and Medical Research Council
Funding Amount
$278,418.00
Summary
Stroke is the most common, major brain disease in Australia. It is the third most common cause of death and the most common cause of adult disability. There is a close link between diabetes and stroke. Firstly, diabetes is an important risk factor for the development of stroke. Secondly, about one third of stroke patients have diabetes. In general, their outcome is much worse than other patients. In fact little is known about the cause of this adverse effect in stroke patients and there is uncer ....Stroke is the most common, major brain disease in Australia. It is the third most common cause of death and the most common cause of adult disability. There is a close link between diabetes and stroke. Firstly, diabetes is an important risk factor for the development of stroke. Secondly, about one third of stroke patients have diabetes. In general, their outcome is much worse than other patients. In fact little is known about the cause of this adverse effect in stroke patients and there is uncertainty whether intensive control of blood sugar in acute stroke improves outcome. Our pilot work suggests that raised brain lactate, together with larger stroke size, might together be responsible for the worse outcome in diabetic patients. We can now measure brain lactate and stroke size with new MRI techniques called echoplanar MRI, which can allow measurements of brain chemistry, blood flow, potentially viable and dead tissue. A new monitoring device allows non-invasive measurement of blood sugar every 5 minutes. Using these strategies, we are planning a comprehensive study of the causes of the worse stroke outcome with diabetes. In addition, we are incorporating a study to determine whether intensive control of blood sugar in the first 3 days after stroke, compared with standard treatment, reduces brain lactate and growth of the actual stroke. An understanding of these effects will have important implications for the acute treatment of stroke patients. If we can show that rigorous control of blood sugar reduces brain lactate and stroke growth, our study will lay the ground work for a large clinical trial. This could have important implications, both in Australia, and overseas.Read moreRead less
Evaluation Of Enhanced Models Of Primary Care In The Management Of Stroke And Other Chronic Diseases
Funder
National Health and Medical Research Council
Funding Amount
$556,184.00
Summary
Chronic diseases are the leading cause of death and disability in Australia. Since 1999, patients in Australia have been able to access a variety of comprehensive disease management programs subsidised through Medicare. We will use comprehensive linked data from survivors of stroke registered in the Australian Stroke Clinical Registry to provide the first robust evaluation of the effectiveness of these enhanced models of primary care in patients with chronic diseases using stroke as an example.
Genetic Dissection Of The Biogenesis And Function Of Type IV Fimbriae Of Pseudomonas Aeruginosa
Funder
National Health and Medical Research Council
Funding Amount
$407,545.00
Summary
Pseudomonas aeruginosa is a common bacterium which causes serious life-threatening infections of individuals with cystic fibrosis, AIDS or who have suffered severe burns or are undergoing cancer chemotherapy. This pathogen, and a number of other important infectious bacteria use surface filaments, called fimbriae, like grappling hooks to attach to the cells of the body and to move across host tissues. These fimbriae are produced in response to environmental conditions, and are assembled by a pro ....Pseudomonas aeruginosa is a common bacterium which causes serious life-threatening infections of individuals with cystic fibrosis, AIDS or who have suffered severe burns or are undergoing cancer chemotherapy. This pathogen, and a number of other important infectious bacteria use surface filaments, called fimbriae, like grappling hooks to attach to the cells of the body and to move across host tissues. These fimbriae are produced in response to environmental conditions, and are assembled by a process that is also used in the export of toxins and other pathogenic molecules. This project will characterise genes which specify and control this system, as a means to design better treatments against such bacteria, many of which are resistant to antibiotic treatment.Read moreRead less
Targeting Oxidant-dependent Pathways To Improve Stroke Outcomes In COPD
Funder
National Health and Medical Research Council
Funding Amount
$1,069,574.00
Summary
Chronic Obstructive Pulmonary Disease (COPD) is a major incurable global health burden and is the 4th largest cause of death worldwide. Patients with COPD are at increased risk for stroke and this is even higher in the weeks following a lung viral infection. The reason for this is unknown so the aim of this study is to determine why people with COPD are at increased risk for stroke and then develop novel treatments to prevent or reduce stroke in COPD patients.
The Out-and-About Trial: Improving Quality Of Life By Increasing Outdoor Journeys After Stroke
Funder
National Health and Medical Research Council
Funding Amount
$586,009.00
Summary
Many stroke patients cannot walk well when they leave hospital nor use public transport. Escorted outdoor journeys with a rehabilitation therapist can improve outcomes and quality of life after stroke. Yet not many stroke patients do not receive this type of community rehabilitation. This project aims to evaluate an implementation program to change therapists' practice and increase outdoor journeys after stroke. Benefits include improved quality of life and well being for peope with stroke.