Effectiveness Of Training Somatosensation In The Hand After Stroke: A Randomized Controlled Trial.
Funder
National Health and Medical Research Council
Funding Amount
$180,660.00
Summary
Stroke is a leading cause of death and disability, requiring provision of rehabilitation services to help minimize impairment and its impact on the ability to resume daily activities. The ability to feel textures and objects through touch and to know where one s limbs are in space are impaired in up to 85% of people who have suffered a stroke. People with this loss are handicapped by difficulties in exploring objects through touch and in performing everyday tasks that require grasp and manipulat ....Stroke is a leading cause of death and disability, requiring provision of rehabilitation services to help minimize impairment and its impact on the ability to resume daily activities. The ability to feel textures and objects through touch and to know where one s limbs are in space are impaired in up to 85% of people who have suffered a stroke. People with this loss are handicapped by difficulties in exploring objects through touch and in performing everyday tasks that require grasp and manipulation of objects. Yet clinicians are either not treating the problem or are using methods without a sound theoretical basis and controlled evidence to support their application. We have systematically investigated optimal methods of sensory training across different sensory abilities using a series of single-subject experiments. Marked improvement in the ability to discriminate trained and related untrained texture stimuli and limb positions was achieved and maintained in most participants. These findings have provided the foundation for development a scientifically based and clinically focused sensory retraining program that has apparently excellent therapeutic potential. The purpose of the proposed study is to test the effectiveness of this scientifically based, clinical sensory retraining program in a broad group of stroke clients using the internationally recommended randomized controlled group design. The program will train a range of functionally important sensory discrimination tasks, i.e. texture discrimination, limb position sense and tactual object recognition, in clinical and home environments. Demonstration of clinically important and statistically significant training effects will provide the evidence necessary to recommend the introduction of the program into routine health service delivery. Investigation of patient characteristics that may impact on the ability to benefit from training will assist in the targeting of services to appropriate individuals.Read moreRead less
Neuromuscular Exercise : A Novel Treatment To Reduce Symptoms And Joint Load In Medial Knee Osteoarthritis
Funder
National Health and Medical Research Council
Funding Amount
$719,199.00
Summary
There is currently no cure for knee osteoarthritis (OA). Thus treatments are needed that not only reduce symptoms but also slow disease progression. Exercise is recommended for knee OA but traditional thigh muscle strengthening exercises do not appear to be effective in all cases and may not slow the disease. This project will compare novel 'neuromuscular exercise' and compare it to traditional strengthening exercise. The results have the potential to alter current exercise prescription
Neurophysiological Basis For Sensorimotor Interventions In Rehabilitation After Stroke
Funder
National Health and Medical Research Council
Funding Amount
$332,036.00
Summary
Stroke is estimated to cost the Australian government almost $2 billion annually, and is the most common cause of death after heart disease and cancer and one of the largest single causes of long-term disability. Of people who survive a stroke, a large number have some degree of residual motor dysfunction on one side of the body. Motor rehabilitation programmes are generally considered to enhance the recovery of motor function and to reduce the degree of long-term disability. However the rationa ....Stroke is estimated to cost the Australian government almost $2 billion annually, and is the most common cause of death after heart disease and cancer and one of the largest single causes of long-term disability. Of people who survive a stroke, a large number have some degree of residual motor dysfunction on one side of the body. Motor rehabilitation programmes are generally considered to enhance the recovery of motor function and to reduce the degree of long-term disability. However the rationale for the design of effective rehabilitation programmes is largely empirical, and there is uncertainty regarding the efficacy and cost-effectiveness of currently used therapies. The empirical nature of stroke rehabilitation has resulted in a diversity of techniques, many of which were pioneered 30-40 years ago, and which are generally aimed at enhancing brain plasticity as a means to facilitate motor recovery. However, despite the belief that brain plasticity is a key to recovery, it is still not known how best to develop this potential for reorganisation into practical interventions that could be introduced in stroke rehabilitation. The aim of the present study is to investigate the physiological bases for the action of commonly used sensorimotor rehabilitation strategies and identify those strategies which are most effective in bringing about corticomotor reorganisation, in the belief that such reorganisation is fundamental to motor recovery. Specifically we will investigate the changes in the organisation of the cortical projection to muscles of the upper limb as a result of passive movement, resisted and non-resisted movement, increased functional motor use and visuomotor training programmes. It is anticipated that the study will lead to a better understanding of the physiological basis for therapeutic interventions after stroke and will allow a more rational approach to the design of effective rehabilitation programmes for stroke patients.Read moreRead less
The Efficacy Of Novel, Non-robotic Devices To Train Reaching Post Stroke
Funder
National Health and Medical Research Council
Funding Amount
$491,605.00
Summary
Up to 50% of stroke survivors are left with upper limb disability that limits their daily activities and their paralysis is so severe that it excludes them from training with the most effective methods. This study is a clinical trial of innovative new techniques to assist people with severe upper limb paralysis to reach following stroke. Positive results are likely to reduce disability in a large number of stroke survivors and has the potential to be used by other patients with paralysis.
Many older people who fracture their hip do not recover to their previous level of function. This study will test whether it is possible to help recovery of function, particularly walking, after hip fracture by using different and more intensive physiotherapy treatment. The treatment will concentrate on exercise when standing, will be provided twice daily and will continue after the person with hip fracture has returned home. Four months after the hip fracture it is expected that walking ability ....Many older people who fracture their hip do not recover to their previous level of function. This study will test whether it is possible to help recovery of function, particularly walking, after hip fracture by using different and more intensive physiotherapy treatment. The treatment will concentrate on exercise when standing, will be provided twice daily and will continue after the person with hip fracture has returned home. Four months after the hip fracture it is expected that walking ability, strength and balance will be improved by the new treatment methods.Read moreRead less
Determinants Of Successfully Living With Aphasia After Stroke: A Prospective Cohort Mixed Methods Study
Funder
National Health and Medical Research Council
Funding Amount
$469,003.00
Summary
People with the communication disability of aphasia following stroke are critical of rehabilitation services. This project seeks to determine what it takes to live successfully with aphasia so that aphasia rehabilitation can be improved. Participants will be interviewed over the first 12 months following the stroke. The most important factors contributing to success will be identified and barriers and facilitators described. The most important factors can then be targeted in rehabilitation.
Effects Of Prism Adaptation On Space Perception Following Chronic And Reversible Cortical Lesions
Funder
National Health and Medical Research Council
Funding Amount
$319,336.00
Summary
Damage to one side of the brain following a stroke often produces a debilitating disorder called spatial neglect. Affected patients persistently ignore objects, sounds or touches on the side of space opposite their brain injury. This disorder occurs despite normal sensory function, and reflects damage to the brain's internal representations of one side of space, causing patients to behave as if that side of space no longer exists. Spatial neglect is difficult to rehabilitate and is a major predi ....Damage to one side of the brain following a stroke often produces a debilitating disorder called spatial neglect. Affected patients persistently ignore objects, sounds or touches on the side of space opposite their brain injury. This disorder occurs despite normal sensory function, and reflects damage to the brain's internal representations of one side of space, causing patients to behave as if that side of space no longer exists. Spatial neglect is difficult to rehabilitate and is a major predictor of poor functional recovery after stroke, but there are no effective treatments for it. A promising new treatment for spatial neglect has been recently discovered, which involves patients practicing pointing to a visual target while wearing spectacle-mounted prism lenses that systematically correct for their altered view of the world. Following a brief period of this training, patients' show increased ability to perceive visual objects presented to the previously neglected side of space. Studies have shown that the prism treatment can have long-term benefits for many neglect sufferers. However, it is not known what the brain mechanisms underlying the treatment effects are, and to what degree the effects generalize to all affected senses. The proposed project aims to investigate whether prism treatment ameliorates spatial neglect of sounds as well as visual objects in a group of stroke patients. The project will also systematically examine which part of the brain is critical for the beneficial effects of prism treatment by using focal magnetic stimulation to create reversible, virtual lesions in the brains of healthy participants. Addressing these issues has clear implications for identifying suitable candidates for the treatment, and for understanding how the sensory world is represented in the human brain.Read moreRead less
Evaluating The Active Communication Education Program For Older People With Hearing Impairment
Funder
National Health and Medical Research Council
Funding Amount
$240,550.00
Summary
Hearing loss is one of the most prevalent disabilities in older people and as the Australian population ages, the number of people with hearing loss will also increase. Hearing loss can lead to social isolation and depression and has a profound effect on quality of life. Hearing aids are often seen as the panacea for hearing loss in older people but approximately 35% of people who have obtained a hearing aid use it infrequently or not at all. Even those who do use the hearing aid frequently may ....Hearing loss is one of the most prevalent disabilities in older people and as the Australian population ages, the number of people with hearing loss will also increase. Hearing loss can lead to social isolation and depression and has a profound effect on quality of life. Hearing aids are often seen as the panacea for hearing loss in older people but approximately 35% of people who have obtained a hearing aid use it infrequently or not at all. Even those who do use the hearing aid frequently may still have difficulty hearing in everyday situations. In addition, there are many older people with a hearing impairment who do not want a hearing aid. Cost is often cited as a factor but reasons such as cosmetic appearance and attitude towards hearing loss are also major reasons for not using hearing aids. Hearing is just one element of successful communication. The ability to communicate despite the presence of a hearing impairment is the focus of a new intervention, the Active Communication Education (ACE) program. Participants develop problem-solving strategies to help with communication in everyday life. The program uses a positive approach aimed at enabling older people themselves to try new solutions to old problems. The aim of this project is to evaluate the effectiveness of ACE for a range of older people with hearing impairment: those who are already using hearing aids, and those who have not sought a hearing aid. Some of the questions answered in this study are: Does the ACE program improve communication and quality of life for older people with hearing impairment? Do some people respond better to ACE , and if so, why? Are there long term effects of ACE? A simple low cost and effective program such as ACEwill have a major impact on the social and psychological health of older people.Read moreRead less