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
We are studying human amnion epithelial cells (AECs) as a new therapy for stroke. Here if we find the protective effects of AECs are unaffected by a 'clot-buster' drug,we will broaden our planned Phase II trial of AECs to include patients that have received clot lysis therapy. Further, as we suspect that AECs exert their effects via release of nanoparticles called 'exosomes', we will test whether exosomes given intravenously or intranasally are similarly protective.
Targeted Delivery Of CD39 To Ischaemic Brain Improves Outcomes In Stroke
Funder
National Health and Medical Research Council
Funding Amount
$895,780.00
Summary
Stroke is most likely caused by a clot in one of the large blood vessels supplying the brain. The approach is to save the 'at-risk' area of brain with drugs that break-down clots and by manual removal of clots. These treatments are limited by timely access within 4.5 hours to larger hospitals. We are trialing a new drug that protects the brain better on its own and may add to the benefit of current treatments. Moreover, it can be given in any rural setting.
Many new therapies are being developed to treat stroke and prevent its recurrence. While a number of these have been successfully introduced, there is a puzzling gap between evidence of efficacy in animal models and humans. One of the main reasons may be lack of an integrated approach between the basic sciences and clinical researchers. By assembling a team with skills in both areas and a structure to maximise communication between groups this team plan to incrementally introduce new therapies i ....Many new therapies are being developed to treat stroke and prevent its recurrence. While a number of these have been successfully introduced, there is a puzzling gap between evidence of efficacy in animal models and humans. One of the main reasons may be lack of an integrated approach between the basic sciences and clinical researchers. By assembling a team with skills in both areas and a structure to maximise communication between groups this team plan to incrementally introduce new therapies into clinical practice.Read moreRead less
The outcomes to be assessed are recurrent ischaemic stroke, intracranial haemorrhage, myocardial infarction, parenchymal embolism and vascular death. Should these outcomes be significantly reduced, the public health and economic issues which will be addressed in this study are considerable. Approximately 40,000 new and recurrent cases of stroke occur in Australia each year, and about 80% of these are ischaemic. There is an average prevalence of about 20% of large or complex aortic plaque among p ....The outcomes to be assessed are recurrent ischaemic stroke, intracranial haemorrhage, myocardial infarction, parenchymal embolism and vascular death. Should these outcomes be significantly reduced, the public health and economic issues which will be addressed in this study are considerable. Approximately 40,000 new and recurrent cases of stroke occur in Australia each year, and about 80% of these are ischaemic. There is an average prevalence of about 20% of large or complex aortic plaque among patients with ischaemic stroke. About the same proportion of cases of ischaemic stroke yearly are associated with the presence of complex aortic plaque alone, and as many again with simple plaque (40% in total). Using the NHMRC estimated cost of $40,000 per stroke (and assuming that recurrent stroke costs are similar to initial stroke costs) and the estimated recurrent stroke rates of 11.9-100 person-years for plaque > 4 mm, the national cost of recurrent ischaemic stroke attributable to complex aortic plaque alone is about $3 million in the first year. This estimate does not include patients with incident TIA and atherosclerotic plaque or the resources spent on evaluating recurrent stroke and TIA attributable to aortic plaque, the cost of lost wages, or the negative impact on the quality of life of the victims. The economic and public health burden to our society could be greatly reduced by successful efforts at secondary stroke prevention in individuals with aortic plaque and TIA or ischaemic stroke. If just 25% of recurrent ischaemic strokes associated with aortic arch debris could be prevented by treatment interventions, the annual savings to society for recurrent ischaemic stroke alone would be considerable.Read moreRead less
STOP-AUST: The Spot Sign And Tranexamic Acid On Preventing Intracerebral Haemorrhage Growth – AUStralasia Trial
Funder
National Health and Medical Research Council
Funding Amount
$764,621.00
Summary
The STOP-AUST study is a randomized controlled trial with the aim of testing whether the medication tranexamic acid when given early within 4.5 hours of symptom onset is superior to standard care alone in stopping intracerebral haemorrhage (ICH, a bleeding into the brain) growth. Total 100 to 150 patients will be enrolled into the study.
This project will test whether activators of a novel estrogen receptor (GPER) can limit brain injury and functional deficits after stroke in mice. Part of the work will evaluate two drugs currently in clinical use for chronic conditions – tamoxifen and estradiol – as potential therapies for use in acute stroke. We will study the therapeutic time window of several drugs over up to a week after stroke, and identify key mechanisms underlying the protection by these GPER drugs.
NADPH Oxidase And Brain Repair After Ischaemic Stroke
Funder
National Health and Medical Research Council
Funding Amount
$641,877.00
Summary
Stroke is the third most common cause of death, results in considerable suffering and presents an enormous cost to health budgets. New research suggests that the injured brain can be stimulated to improve function. Generation of free radicals in the brain in the weeks after stroke may be important in long term recovery by promoting new blood vessel formation to suport brain repair. In this project we seek to identify how, when and where new blood vessels assist stem cell mediated repair.
Effectiveness Of Occupational Therapy Homevisits To Improve Participation After Stroke
Funder
National Health and Medical Research Council
Funding Amount
$1,774,083.00
Summary
This randomized controlled trial will determine the effectiveness of occupational therapy pre-discharge homevisits for people after stroke, with health economic evaluation conducted alongside to determine the cost-benefits. Recruiting adults from Australian rehabilitation hospitals, this study is designed to provide guidance for hospitals, policy-makers and clinical practice guideline developers on whether occupational therapy homevisits improve the level of community participation after stroke.
A Network Of Sites And ‘up-skilled’ Therapists To Deliver Best Practice Stroke Rehabilitation Of The Upper Limb.
Funder
National Health and Medical Research Council
Funding Amount
$955,910.00
Summary
We aim, through our partnership, to bring better therapy to more stroke survivors. Effective therapies are available to improve hand function but survivors are not currently receiving these. We will systematically address this evidence-practice gap using knowledge-transfer methods to up-skill therapists and change practice behaviours. A network of sites and up-skilled therapists will deliver this therapy and sustain change. A template will guide future translational activities.