Optimising Upper Limb Recovery Following Stroke: A Randomised Controlled Trial Of The Effects Of Botulinum Toxin-A Combined With Intensive Rehabilitation Compared To Botulinum Toxin-A Alone
Funder
National Health and Medical Research Council
Funding Amount
$1,070,230.00
Summary
The devastating loss of movement in the hand after stroke could potentially be addressed, but we currently lack of research investigating treatment interventions. This randomised controlled trial will compare the routine interventions of botulinum toxin to botulinum toxin plus best-practice therapy for both cost and clinical outcome. Findings from this trial will provide the necessary information to make decisions about what will improve spasticity and function in the hand and arm after stroke.
An RCT To Determine The Optimum Frequency Of Botulinum Toxin Injections To The Calf In Children With Cerebral Palsy
Funder
National Health and Medical Research Council
Funding Amount
$286,358.00
Summary
Cerebral Palsy (CP) is the most common cause of disability amongst children across the developed world. There are about 1800 children with CP in Victoria alone. It is caused by damage to the brain in early childhood. Children with CP have difficulty controlling how their muscles work. Muscles are often spastic, which means that they are switched on all the time, and this makes walking and performing other tasks difficult. As the child grows the spastic muscles can become too short and this occur ....Cerebral Palsy (CP) is the most common cause of disability amongst children across the developed world. There are about 1800 children with CP in Victoria alone. It is caused by damage to the brain in early childhood. Children with CP have difficulty controlling how their muscles work. Muscles are often spastic, which means that they are switched on all the time, and this makes walking and performing other tasks difficult. As the child grows the spastic muscles can become too short and this occurs can only be corrected by orthopaedic surgery. The spasticity in particular muscles can be reduced by injecting them with Botulinum Toxin (commonly known as Botox and used cosmetically to remove wrinkles). The effects of a single injection have been closely studied and we know that the effect of the toxin wears off. Children are thus offered repeat injections but there have been no studies to investigate what is the most appropriate interval between injections. The aim of this study is to determine this. In routine clinical practice children tend to get injections approximately once a year. A consideration of what we know about how the toxin acts, however, suggests that injections every 4 months might be expected to be more effective. This study will thus randomly allocate children to receive injections either every twelve months or every four months over a two year period. During the study both groups will be monitored to see if there are differences in how easily they can walk and perform other functions and in their overall quality of life. After the study the children will also be assessed to see whether there is any difference in the length of the spastic muscles. There have been no other studies to investigate the most appropriate interval between injections. This study will thus be the first anywhere and will be the foundation for guidelines for the ongoing use of botulinum toxin in children with cerebral palsy in Australia and throughout the world.Read moreRead less
Human Muscle Stretch Reflexes: The Effects Of Stimulus Properties, Muscle State And Subject Intention
Funder
National Health and Medical Research Council
Funding Amount
$170,604.00
Summary
The best known muscle reflex is the tendon jerk, which is usually evoked by tapping the muscle tendon with a small hammer. This tap imposes a very rapid stretch on the muscle, which produces a stretch reflex. Different stretch responses, however, can be observed to slow or fast stretches, or to vibration of muscle. Normally, when the muscles of a relaxed person are stretched, no active response is observed. However, when the person is engaged in a task and contracting their muscles, then stretch ....The best known muscle reflex is the tendon jerk, which is usually evoked by tapping the muscle tendon with a small hammer. This tap imposes a very rapid stretch on the muscle, which produces a stretch reflex. Different stretch responses, however, can be observed to slow or fast stretches, or to vibration of muscle. Normally, when the muscles of a relaxed person are stretched, no active response is observed. However, when the person is engaged in a task and contracting their muscles, then stretch modulates the muscle activity such that an increase in contraction of the muscle opposes the stretch and defends the position of the joint against the external disturbance. This is the everyday situation in which stretch reflexes operate. Despite extensive investigation for over a hundred years, there is still no consensus among researchers about the behaviour of stretch reflexes nor about their role in the control of movement. Even the demarcation of reflex from voluntary muscle activity is not always certain. One of the outstanding features of stretch reflexes is the variability of their behaviour, which depends on the particular muscle involved, its level of contraction, the type of stretch and the task in which the person is engaged. This variability has made it difficult for researchers to determine the role of reflexes in the control of movement. In order to study stretch reflex behaviour in human subjects, we will measure the electrical activity of elbow muscles, the elbow position and the force generated at the joint under a variety of conditions. A series of five experiments will investigate specific unresolved issues such as the effect of subject intention on the modulation of muscle activity and how altered modulation of muscle activity may change the stiffness of our limbs. The objective of the experimental series is to fill in important gaps in the picture of the behaviour of the stretch reflex.Read moreRead less