Current Research

Exercise intervention to prevent falls

Improving walking in community-dwellers

Getting out and about

The efficacy of treadmill training

The effectiveness of EMG triggered electrical stimulation

Exercise intervention to prevent falls, enhance mobility and increase physical activity in community dwellers after stroke
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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.

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.

Improving walking in community-dwellers after stroke
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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.

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:

(1) improving walking capacity, community participation and health status
(2) maintaining the gains in walking capacity, community participation and health status at six months and/or twelve months

Getting out and about after a stroke

Stroke affects over 345,000 Australians, is a leading cause of disability, and the second highest cause of death in adults. Over 48,000 strokes occur each year in Australia.

Around one-third of stroke survivors experience an ongoing disability that limits their participation in home and community life. People who have experienced a stroke often do not get out as often they would like.

Reasons for fewer outdoor journeys include reduced community ambulation (particularly speed and endurance), lack of confidence and a fear of falling, environmental barriers (for example, uneven pavements), the inability to resume car driving, and insufficient information about transport options.

There is evidence that the number of outdoor journeys can be increased with specific interventions. This evidence has been incorporated into the Australian national clinical guidelines for stroke recovery and rehabilitation.

However, rehabilitation therapists report that they are either not aware of this research, or have not yet begun to provide the intervention routinely to people with stroke.

The current study targets this ‘evidence-practice gap’, with two different teams in Sydney South West.

The aims of this project are
1. To increase the uptake of evidence from a randomised controlled trial by two community stroke rehabilitation teams as recommended in the national stroke guidelines, and help people with stroke get out and about into the community

2. To increase the number of outdoor journeys by community dwelling people with stroke who receive the evidence-base intervention

The efficacy of treadmill training in establishing walking in acute non-ambulatory patients after stroke

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 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 patients walking, and get them walking earlier and better.

The experimental hypotheses 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

(i) establishing independent walking
(ii) reducing the time taken to achieve independent walking,
(iii) improving the quality of initial walking and
(iv) improving the quality of walking at 6 months after stroke.

The effectiveness of EMG triggered electrical stimulation in increasing strength and activity in acute, very weak stroke patients

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. 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.

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.

Project title: Expansion of OTseeker: An occupational therapy evidence database, 2007-2008

Chief Investigator Dr Sally Bennett, University of Queensland
Co- Investigators: Associate Professor Kryss McKenna, University of Queensland
Dr Annie McCluskey, The University of Sydney
Dr Tammy Hoffman, University of Queensland
Dr Leigh Tooth, University of Queensland

Project title: Rehabilitation of adult handwriting

Lead Investigator Dr Annie McCluskey,
Co-Investigator Dr Natasha Lannin, Rehabilitation Studies Unit, The University of Sydney