Current projects
- Exercise to prevent falls in Parkinson’s disease: the PD-FIT trial
- Exercise to prevent falls, enhance mobility and increase physical activity after stroke: the STROKE CLUB trial
- Treadmill training to improve walking after stroke: the AMBULATE trial
- Treadmill training with body weight support to establish more walking in acute stroke the MOBILISE trial
- EMG-triggered electrical stimulation to increase strength and upper limb activity after stroke: the ACTIVATE trial
Exercise to prevent falls in Parkinson’s disease: the PD-FIT trial
Aim
This project will test the efficacy and cost-effectiveness of an exercise program in reducing falls in people with Parkinson’s disease.
Summary
100,000 Australians have Parkinson’s disease at any one time and up to 68% of these people will fall each year. Reduced balance, poor leg muscle strength and freezing while walking have been identified as risk factors for falls in people with Parkinson’s disease.
Participants will be randomly allocated to an exercise group or a control group. Both groups will receive standardized falls prevention advice and will keep a falls diary.
The exercise group will also participate in a home-based exercise program for 6 months, with the option of attending a once a month support-group based exercise class.
This NHMRC funded study (2008-2010) is conducted in collaboration with Parkinson’s NSW – a not for profit, community based organisation providing information, counselling and support to people living with Parkinson’s disease.
The protocol for this study is published in Biomed Central Neurology.
Exercise to prevent falls, enhance mobility and increase physical activity after stroke: the STROKE CLUB trial
Aim
This project aims to work with the Stroke Recovery Association’s Stroke Club network to establish and evaluate community-based sustainable exercise programs for stroke survivors.
We hypothesise that these exercise programs will prevent falls, enhance mobility and increase habitual physical activity levels among people following stroke.
Summary
Stroke is the most common disabling neurological condition in adults and is estimated to cost $1.3 billion per year in Australia. The major burden of stroke is chronic disability.
Falls and poor mobility are major contributors to stroke-related disability. Falls among stroke survivors are more frequent and more likely to result in injury than among the general older population.
There is now good evidence that exercise can enhance mobility after stroke, yet ongoing exercise opportunities are practically non-existent for stroke survivors and general community-based exercise programs often specifically exclude individuals with neurological conditions such as stroke.
Although well-designed exercise programs have been found to prevent falls in other populations, the role of exercise in prevention of falls among stroke survivors has not yet been investigated.
The Stroke Recovery Association of NSW runs community support groups for stroke survivors through local Stroke Clubs. Members of these groups have identified the urgent need for increased access to exercise opportunities and falls prevention programs.
Treadmill training to improve walking after stroke: the AMBULATE trial
Aim
We will determine, in individuals after stroke who reside in the community and are able to walk independently but slowly, whether a 4 month treadmill and overground walking program be more effective than a 2 month program compared to control in:
- improving walking capacity, community participation and health status
- maintaining the gains in walking capacity, community participation and health status at six months and/or twelve months
Summary
Despite the rehabilitation process, only 7% of those who leave rehabilitation can walk effectively in the community. This presents problems for the quality of life of these Australians.
Being able to walk normally is a major determinant of whether someone after stroke can participate fully in their community.
For the person themselves, being able to walk well after stroke will stave off the likelihood of becoming housebound.
For the family, an independently functioning stroke sufferer will mean a significant reduction in the burden of care that they face.
Previous research by the present group indicates that an innovative method is available to achieve this outcome: treadmill training combined with overground walking.
The present proposal is to extend this research to find the optimum treatment duration of training to bring about a permanent (long-term) improvement in walking ability.
Treadmill training with body weight support to establish more walking in acute stroke: the MOBILISE trial
Aim
The purpose of this study is to investigate whether an innovative physiotherapy intervention, treadmill walking with partial weight support via an overhead harness, can get more stroke patients walking, and get them walking earlier and better.
Summary
It has been reported that approximately 70% of stroke patients admitted to inpatient rehabilitation in Australia cannot walk independently.
Although the majority of patients leave rehabilitation with some level of independent walking, many have had a lengthy hospital stay.
In addition, many have residual walking disabilities, such as decreased speed, which result in significant handicap. For example, many individuals after stroke cannot walk fast enough to cross the road safely.
The experimental hypotheses of this study are:
In patients early after stroke who are unable to walk, training of walking using a treadmill with partial weight support via an overhead harness will be more effective than assisted overground walking in:
- establishing independent walking
- reducing the time taken to achieve independent walking,
- improving the quality of initial walking and
- improving the quality of walking at 6 months after stroke.
EMG-triggered electrical stimulation to increase strength and upper limb activity after stroke: the ACTIVATE trial
Aim
Seventy very weak, acute stroke patients will be allocated to receive usual therapy and EMG triggered electrical stimulation to four major muscles of their arm or usual therapy only.
Summary
People who have had a severe stroke generally remain very disabled. An EMG triggered electrical stimulation machine measures electrical activity in muscles and provides an electrical stimulation when a threshold level of muscle activity is reached.
Hence it can provide feedback to people with very weak muscles and strengthen these muscles.
Measures of muscle strength and activity will be taken before and after the intervention. This intervention has the potential to improve the strength and function of the arm after a stroke and hence increase the likelihood of returning to independence.