NRP's Research Focus
The following is a list of the projects our researchers are currently working on:
STREAM 1 (2007-2010) BASIC SCIENCE GRANTS
Prof Alan Harvey, Prof Donald Robertson, Dr Kathryn Heel (2007-2010)
Grant Title: Gene therapy and the treatment of CNS injury.
Trauma to the adult central nervous system (brain and spinal cord) results in disruption of nerve pathways, death of neurons and long-lasting behavioural dysfunction. Gene therapy is a relatively new strategy that attempts to increase the viability and regenerative capacity of injured neurons. This promising approach involves the use of modified viruses to introduce neuroprotective and/or growth-promoting genes into compromised cells. The team had already begun to analyse the effects of such genetic modifications on transduced neurons. This project further examines, in retinal neurons (in the visual system), how long-term expression of virally-introduced growth-promoting genes affects neurons and the expression of genes in the host. From a neurological perspective, while gene therapy may eventually be of benefit to injured patients, it is important to know if there are any potential pitfalls in this promising technology.
This trial is the largest of its kind ever conducted. The CIs have demonstrated that a constant delivery of gene therapy results in significant changes in the dendritic architecture of retinal ganglion cells (RGC's), depending on the genes introduced. These findings are very significant, as there are already clinical trials underway using this kind of gene therapy, where the gene can't simply be 'switched off'.
Dr Giles Plant, Prof Alan Harvey (2007-2010)
Grant Title: Are olfactory ensheathing glia a myelinating cell in the central nervous system?
Clinical trials are currently underway in three countries using olfactory ensheathing cells (OEC) to repair the injured spinal cord of humans. OEC have been reported to have a positive effect in the repair of the spinal cord including the restoration of myelin sheaths (insulation) around axons (long nerve fibres) within the spinal cord. A successful cell transplant ideally would, in conjunction with axonal growth, produce mature myelin for the injured axons to work efficiently. This project looks at the capacity of OECs to produce myelin and the mechanisms involved. The results will help develop protocols to select and grow OEC to carry out specific repair functions. The findings will have important implications for the future use of OEG, not only for spinal cord injury, which has both primary and secondary demyelination events, but also for promoting remyelination in diseases such as multiple sclerosis.
Results so far confirm that OECs can re-myelinate axons, but the presence of appropriate co-factors is essential. Embryonic cells have a better ability to form myelin than more mature cells.
Dr Plant and Professor Harvey often present their research and discuss potential clinical applications with neuro-clinicians. Aside from brain and spinal cord injury, their work has implications for other conditions, such as cervical myelopathy, a relatively common yet debilitating disorder in older adults. Working together, NRP neuroscientists and clinicians hope to find solutions for various kinds of neurological disorders.
Dr Paul Watt, Prof Adrian West, Dr Bruno Meloni, Dr Nadia Milech (2007-2010)
Grant Title: Identification of Phylomer peptides with neuro-protective activity in neurotrauma-related brain injury models.
An important aspect of reducing neurological disabilities associated with trauma is the prevention of secondary neuronal death, known as apoptosis (or 'cell suicide'). A number of protein-derived peptides (Phylomers) have been identified that disrupt a critical control point in the induction of apoptosis. A subset of these Phylomer peptides have been assessed for this form of neuro-protective potential: five have shown strong neuro-protective potential using in vitro models of apoptotic cell death (ie, nerve cells in a petri dish); two of the Phylomers are also neuro-protective in vivo (ie tested within a living animal). The goal of this project is to characterise the remainder of the peptide leads (AP-1 inhibitory Phylomer peptides) in both in vitro and in vivo models, and thus identify Phylomers that have the potential to be useful in the clinic to limit secondary brain cell death, and therefore disability, following a traumatic brain injury or stroke.
At least one pharmaceutical company is waiting on this group's in vivo evidence with a view to building partnerships and taking discoveries that arise from this work on to pre-clinical trials of promising neuroprotective peptides.
Dr Rachel Sherrard, Prof Alan Harvey (2007-2008, now completed)
Grant Title: Neurotrauma therapy and the reformation of ordered, functionally effective connections.
Long-term improvement following neurotrauma requires either re-growth of damaged connections or modifications in those that remain so that neural circuits are rebuilt and function restored. Current experimental treatments aim to promote new connectivity by transplanting growth-promoting cells or viruses that modify tissue to over-produce growth factors and facilitate connectivity. Unfortunately, molecules that aid growth also regulate the direction in which connections grow, so that more new connections may develop at the expense of accuracy. The general aim of this pilot study was to examine whether a continuous source of growth factor disrupts the ability of reinnervating axons to recognise their appropriate targets. The investigators anticipated that the knowledge obtained would clarify the usefulness of these new technologies of tissue engineering, which can induce high expression levels of a range of growth promoting agents, for functional repair.
This research demonstrated that genetic manipulation of neurons to continuously express growth factors may be no more beneficial than a single injection of growth factor peptide. The findings also suggest that viral mediated tissue engineering may not be appropriate at a lesion site where the blood-brain barrier is breached. This was an important finding, as any new therapies must never make a situation worse.
Prof Sarah Dunlop, Dr Lindy Fitzgerald (2007-2010)
Grant Title: Defining mechanisms underlying secondary damage in the CNS.
Following neurotrauma, some nerve cells adjacent to the damaged region remain intact but stop functioning due to a complex process termed secondary degeneration. Cells lose the myelin insulation from their nerve fibres (axons), relocate their terminals to inappropriate sites and may even die. Protecting function in this intact but vulnerable tissue is currently the most feasible approach to optimizing the functional outcome of neurotrauma. This project will determine if, as currently suspected, secondary degeneration is triggered by defective transport of substances along nerve fibres or 'axons' (axonal transport). The team is testing whether a new anti-glaucoma drug (lomerizine), protective of axon transport, prevents secondary degeneration. The project is novel since calcium channel blockers are emerging as a promising therapeutic for limiting secondary damage in the CNS. Although not yet examined in visual system models, calcium channel blockers are also known to improve myelination in experimental autoimmune encephalitis and following spinal cord injury. This work will contribute towards determining whether such drugs are appropriate to consider for alleviation of secondary degeneration following neurotrauma.
The investigators have now comprehensively defined the mechanisms of cell death during secondary degeneration and demonstrated multiple beneficial effects of lomerizine. The drug protects nerve cells and decreases macrophage infiltration. Treatments to use in combination with lomerizine are now being investigated, as the drug doesn't prevent demyelination and it is also necessary to combat the oxidative stress following neural injury if cells are to be fully spared and functional recovery achieved.
Dr Giles Plant, Dr Stuart Hodgetts, Dr Paul Simmons, Dr Phil Horner, Dr Drew Sellers (2007-2010)
Grant Title: Investigating the Mechanism of Improved Functional Outcome in Spinal Cord Injured (SCI) Rats after Human Stromal Cell Transplant Therapy.
Human bone-marrow-stromal-stem-cells (hBMSCs) represent an attractive source of stem cells for cellular therapies, as they are easily isolated from a patient to repair their own cord, avoiding the likelihood of immunological problems. They can be expanded in culture, have the potential to differentiate into specific cell types, and are easily transduced with retro- or lentiviral vectors. Dr Pant has found that highly purified human bone-marrow-stromal-stem-cells (hBMSCs) isolated from adult SCI patients can promote a marked improvement in functional recovery when transplanted in rats with SCI. Anatomically, tissue sparing was observed, as well as the expression of new neuronal proteins. This project investigates the mechanism(s) responsible for this enhanced functional repair. It also seeks to determine whether the donor hBMSCs induce a stem cell response in the host animal and/or are directly involved in the repair of the myelin (insulation layer) around the nerve fibres.
So far in vitro co-culture experiments fail to show any evidence for myelination arising from the hBMSCs. Experiments to examine whether stem cells in the host animal are involved, and/or if the hBMSCs are suppressing immune responses, are ongoing. Investigators are confident that the results have shown no negatives to caution against the use of these cells clinically. There is considerable potential to extend these pre-clinical studies into clinical trials in collaboration with other major SCI research laboratories in the years ahead.
STREAM 2 (2009-2010) BASIC SCIENCE GRANTS
Dr J Rodger, Dr R Sherrard (2009,2010)
Grant Title: Less inhibition with more stimulation? Promoting recovery after Neurotrauma.
Some experimental treatments for neurotrauma aim to promote new nerve cell connections by blocking growth-inhibiting molecules in the brain, however this can happen at the expense of accuracy. This project tests whether an enriched environment and activities that increase sensory feedback to damaged parts of the brain will compensate for this loss of accuracy. Anatomical and functional repair in regions of the brain controlling vision and movement are being assessed using an in vivo animal model of adult brain injury.
Specifically, the investigators are looking at whether environment enrichment:
- enables functionally beneficial axon regeneration and reinnervation following an optic nerve lesion and peripheral nerve grafting;
- increases topographically organised neuronal sprouting following a cerebellar lesion.
The study is progressing well and addresses specific mechanisms that are relevant and transferrable to the clinic.
Dr J Rodger, J Dundas, A/Prof G Thickbroom (2009,2010)
Grant Title: A comparison of non-invasive interventions to maximise plasticity in the brain.
Following neurotrauma, the brain displays some ability to reorganise itself ('plasticity'), which can sometimes partially restore function. However, such plasticity can also result in inappropriate connections being formed and poor function. This project investigates the impact of three clinically relevant methods that have been shown to increase brain plasticity: environmental enrichment, task-specific training and repetitive Transcranial Magnetic Stimulation (rTMS). A mouse model of abnormal brain connectivity is used to compare the changes in anatomy and physiology, and consequences for function. Collaboration with medical device company Global Energy Medicine has resulted in custom-built rTMS devices with a coil specifically adapted to the size of a mouse head.
So far several significant effects have been observed in the mice with abnormal brain connectivity following rTMS treatment. For example, the number of abnormal (ectopic) neural projections was significantly reduced (like a "tidying up" of the brain). There were no connectivity/anatomical changes in normal mice, suggesting that the intervention is safe and presents no ill effects for healthy brain tissue. Investigators are now studying the impact of varying stimulation parameters, in particular frequency, intensity and duration, with a view to promoting further (functional) improvements in the animals.
Prof A Harvey, Dr J Rodger (2009, a one-year pilot)
Grant Title: Can gene therapy promote regeneration after distal axonal injury in the brain?
Using combinations of gene therapy and neural transplantation, Harvey and Rodger have successfully induced repair of the optic nerve when the nerve injury was close to the retinal ganglion cells (RGCs) in the eye. However it was important to know whether this approach enhances re-growth after an injury further along the length of the nerve tract, as is commonly the case with spinal cord injury. This project therefore looked at whether genetic manipulation and peripheral nerve grafting stimulates re-growth after an optic nerve injury occurring at a long distance from the eye's RGCs.
Encouraging results were obtained with this approach and overall, the pilot study has assisted in planning future experiments to progress this work.
Dr S Hodgetts, Dr G Plant, Dr P Simmons (2009,2010)
Grant Title: Neuronal regeneration & improved functional outcome after complete transection SCI in rats using combinatorial therapies.
Many animal studies in spinal cord regeneration have used an incomplete 'bruise' injury model that leaves some pathways intact, making it difficult to determine whether functional improvements are a result of true regeneration of injured tracts. The improvement may be due to behavioural compensation, re-'insulation' of damaged (but intact) tracts, or sprouting of spared nerve fibres. This project focuses on true nerve regeneration in a model that involves complete transection of the cord (available to few laboratories internationally). Promising strategies to treat spinal cord injury are being investigated, including human and rat bone marrow cell transplantation and anti-scarring agents.
Experiments thus far show that spontaneous axonal regeneration does occur following complete SCI, but transplantation of hBMSCs appears to improve anatomical and functional recovery. Donor cells are no longer present in the cord six weeks after transplantation, but they may induce a stem cell response in the animal that leads to the improvements seen so far. Results are promising and this year CIs will test combinatorial treatments. They will also analyse behaviour beyond six weeks to assess whether functional improvements following hBMSC treatment increase further and allow better recovery of walking function.
STREAM 1 (2007-2010) CLINICAL RESEARCH GRANTS
Dr Barbara Singer, Dr John Dunne, Prof Kevin Singer (2007-2009, completed)
Grant Title: The effect of repeated passive stretching on calf muscle stiffness after acquired brain injury.
Increased calf muscle stiffness is a common consequence of acquired brain injuries, such as traumatic head injury and stroke, in adults. In conjunction with spasticity, this stiffness interferes with functional mobility around the ankle. This makes walking far more difficult and increases the risk of tripping and falling. Prolonged stretching is used to maintain muscle length, but does not address 'through range muscle stiffness' in the calf. This study has examined the effect of a novel approach to reducing calf muscle stiffness, namely cyclic passive stretching. This treatment was expected to reduce stiffness by improving lubrication between layers of soft tissue, reducing stretch reflex sensitivity (spasticity) and reducing abnormal linkages between microscopic muscle fibres. Continuous passive movement devices (CPM) have long been used to reduce soft tissue and joint stiffness following orthopaedic surgery. Studies have provided preliminary support for their use in individuals with spastic hypertonia following stroke, but there were no data available regarding the therapeutic potential of the intervention.
This study determined that cyclic stretching is at least as good as traditional static (prolonged) stretching. Patients reported enjoying it more, plus there was an unanticipated finding. Consistent subjective reports were made of an improved awareness (kinaesthetic sense) of the affected ankle and foot position, even after a single session of cyclic stretching, and a range of qualitative improvements in walking function following daily treatment over two weeks. All subjects would have liked to continue with the therapy if they were able to do so. Discussions are underway between CIs and senior physiotherapists regarding a follow-up study on the sensorimotor effects of cyclic calf muscle stretching following stroke. Functional MRI will be used to track cortical reorganization, and clinical outcomes, including balance control and gait, will also be measured.
Dr John Beca, Dr Simon Erickson, A/Prof Warwick Butt (2007-2010)
Grant Title: Hypothermia in Traumatic Brain Injury (TBI) in Children: a multi-centre prospective RCT of early prolonged hypothermia therapy in children with TBI.
Traumatic brain injury (TBI) is the leading cause of death in childhood and survivors of severe injuries commonly have multiple life-long disabilities. Hypothermia or cooling has been shown to protect the brain and reduce damage from a variety of causes. Longer periods of cooling may also be better than shorter periods. Adult TBI studies are inconclusive and the only trial in children has shown no benefit with a short period of cooling (24 hours). Prolonged cooling (72 hours) does reduce brain damage in newborn infants with birth asphyxia. To do a study capable of determining whether prolonged hypothermia is beneficial in children with TBI would require approximately 450 children. The NRP is providing this grant for Dr Beca and his team to conduct a pilot study of 50 children admitted to intensive care with severe TBI in Australia and New Zealand. Neurological outcomes in children who are cooled (with a cooling blanket) to 32-33°C for 72 hours following TBI are being compared to those who have their temperature maintained at 36-37°C (all other aspects of care managed with a standardised protocol). The purpose of this pilot study is to establish the feasibility of doing a larger study with international centres and to assess the safety of more prolonged cooling and protocol adherence.
The study is progressing well, with patients recruited across eight study sites and no significant adverse events to date. The ongoing collaboration between major children's traumatic brain injury (TBI) research groups in Australia, New Zealand, Canada and the USA is progressing towards the instigation of a 30-40 site international multi-centre study. It will be the first trial of such scale, addressing not only the current question about hypothermia, but also providing valuable epidemiological information about risk factors, management and outcome of severe TBI in children.
A/Prof Gary Thickbroom, Dr Dylan Edwards, Prof Frank Mastaglia (2007-2010)
Grant Title: Using brain stimulation to help recovery after spinal cord injury and stroke.
Brain plasticity is known to contribute to recovery of function after stroke. Professor Thickbroom and his team previously demonstrated that, following a stroke, adaptive reorganization occurs in the area of the brain's motor cortex that controls the hand. But little is known of how the brain adapts to spinal cord injury (SCI), and whether brain stimulation techniques might be able to facilitate recovery after SCI. The team aims to enhance activity dependent plasticity with interventional magnetic brain stimulation (MBS). Stimulation methods are designed to increase synaptic strength (ie communication between nerve fibres), promoting functional recovery on the basis that brain plasticity contributes to recovery regardless of where the injury occurs in the central nervous system.
So far in this project, adaptive changes that occur in the motor area of the brain and cortico-spinal pathways after SCI have been investigated. Good progress has been made, with further development and refinement of MBS techniques.
The second part of the project involves the interventional MBS. When applied over the motor cortex to increase excitability of nerve tracts extending from the brain, down the spinal cord, researchers will be able to determine whether voluntary movement and function improves in the part of the body that area controls. The intervention is painless and it is hoped that findings will lead to the development of therapies to enhance brain plasticity and recovery following SCI, stroke and other forms of neurological injury and disease.
Prof Stephan Schug, Ms Patricia Ray, Dr A Browne, Ms Tracy Redwood, Ms Nicky Fortescue, Dr Michelle Byrnes, Mr John Ker (2007-2010)
Grant Title: Holistic Multidisciplinary Approach to the Treatment of Pain for Individuals following Spinal Cord Injury Utilizing a Biopsychosocial Model.
Pain following spinal cord injury (SCI) is a significant problem with approximately 80% of patients reporting the presence of pain and 58% of patients rating their pain as severe or excruciating. The aim of this project was to (i) investigate the incidence, prevalence and classification of SCI pain retrospectively; (ii) investigate the natural history of SCI pain using a prospective longitudinal design; (iii) to identify physical and psychological predictors of treatment response following SCI at various time points; and finally (iv) group therapy for patients with chronic non-malignant pain as a primary diagnosis. There is established efficacy for multidisciplinary pain management approaches for individuals with SCI and chronic pain. This project has extended the team's research into the effectiveness of an outpatient LEAP (a holistic and multidisciplinary Lifestyle, Education and Activation Program) implemented following SCI. This project brings together clinical expertise of state leaders in SCI neuro-rehabilitation, multidisciplinary pain management, clinical psychology within neurological populations, clinical neuroscience and neuroplasticity.
In collaboration with Sir George Bedbrook Spinal Unit clinical specialists, CIs have helped to audit specific aspects of current clinical practice within the Unit. As a result, there have been improvements in the rehabilitation and support of SCI patients through:
- additional, more specific psychological assessments for anxiety, depression and post-traumatic stress disorder (improving identification of SCI patients at high risk of poor physical and psychosocial outcomes);
- the provision of two additional 4-week LEAPs (Lifestyle, Education & Activation Programs) for chronic SCI patients experiencing significant pain;
- the design and implementation of a multidisciplinary Group Pain Therapy Program for patients post-SCI.
CIs are now assessing the potential benefits of an Outreach program to assist SCI individuals make the transition from the inpatient rehabilitation setting to living in the community, and to provide ongoing support and consultation with clinicians. Focus groups with SCI survivors have been undertaken in rural areas, as part of the development of 'on-line' support programs to be implemented for these who for geographical reasons are unlikely to benefit from locally delivered Programs.
Clinical A/Prof Jonathan Foster, Clinical A/Prof Neville Knuckey, Prof Ralph Martins (2007-2010)
Grant Title: The Role of APOE as a Modulator in Recovery from Traumatic Brain Injury.
Recent evidence suggests that the possession of the Apolipoprotein E (APOE) e4 allele may adversely influence the brain's vulnerability and is associated with a poor outcome after traumatic brain injury (TBI). Moreover, both the possession of the e4 allele and TBI represents significant positive risk factors for the incidence of Alzheimer's disease. Associate Professor Foster and his team have been working to resolve some of the discrepancies in the literature in this area by a) conducting prospective comparisons of the effects of TBI on neuropsychological functioning, and b) evaluating the relevance of a range of brain-related biomarkers (including APOE status) for recovery from TBI. The aim is to determine whether a 'high risk' biological and genetic profile exists in some individuals who sustain a TBI, conferring an increased risk of neurocognitive deficits and adverse neurological outcomes and possibly impacting upon the outcome of exercise-based rehabilitation protocols.
An 'aging' component has more recently been incorporated into the project, through testing a number of 'chronically affected' older individuals with TBI history. The statistical analysis is ongoing for this aspect of the study.
Prof Sarah Dunlop, Prof Frank Mastaglia, Mr John Ker, Prof Robert Grove, Prof Peter Hamer, A/Prof John Buchanan, A/Prof Garry Allison, Dr Barbara Singer, Dr David Lloyd, A/Prof Gary Thickbroom, A/Prof Timothy Skinner, Dr Romola Bucks, Dr Brendan Lay, Dr Elizabeth Geelhoed (2007-2010)
Grant Title: Move Again Program (MAP) - Developing exercise programs for rehabilitation & recovery in individuals with spinal cord injury.
Ultimately, the MAP team aims to deliver the highest international standard of exercise rehabilitation and recovery facilities and programs to Western Australians with neurological injury, in order to significantly improve their physical and mental health and well being. To date MAP has focused just on spinal cord injury (SCI) and the establishment of a multidisciplinary network and the design of meaningful research initiatives.
Information has been gathered on 1) the current exercise levels, attitudes towards and obstacles to exercise within the Perth SCI community; 2) the currently available local, national and international SCI exercise rehabilitation programs; 3) the research underway globally into the effects of physical activity following SCI; and 4) effective methods of outcome assessment.
Since the instigation of MAP, investigators have joined forces with other leading national SCI researchers and successfully attracted a substantial grant to undertake multicentre randomised controlled trials into various protocols of physical activity in both acute and chronic SCI (the SCIPA program). SCIPA will help us better understand which types of exercise intervention are beneficial and help individuals with SCI make informed choices about the exercise and rehabilitation options they take up following discharge from hospital. Additional information is available on the Move Again Program webpage, including the MAP & SCIPA Summary of Progress document written in June 2010 by Prof Sarah Dunlop.
STREAM 2 (2008-2010) CLINICAL RESEARCH GRANTS
Dr T Corcoran, Prof M Paech, Prof S Schug, Dr T Mori, Dr S Honeybul, Dr K Ho (2009,2010)
Grant Title: Neuroprostanes reflect ongoing neurological injury.
A major limitation to improvement in outcome from traumatic brain injury is the lack of a marker of brain injury that is sensitive and specific enough to be clinically useful. 'Neuroprostanes' are a group of compounds that reflect oxidative stress - a common endpoint of many of the mechanisms that injure the brain. Recent work suggests that they may be reliable indicators of the severity and and fluctuating status of neurological injury. In patients who have suffered a severe brain injury, this team is working to determine whether neuroprostane levels in the cerebrospinal fluid (CSF) accurately reflect neurological injury and whether they are useful predictors of neuropsychological outcomes at 6 and 12 months post injury. Plasma concentrations will then be assessed to determine whether these reflect CSF changes (perhaps obviating the need to sample CSF) and can therefore guide therapies.
Two further elements were added to the study subsequent to its initiation:
- Neuroprostanes in CSF of pregnant females with pre-ecmaplsia (a condition that involves cerebral vasoconstriction and ongoing subclinical neurological injury) is also being examined, extending the spectrum of severity of neurological injury.
- The CIs are looking at whether there are genetic factors that influence neuro-behavioural outcome from TBI through altered production of reactive oxygen species. Comprehensive neuro-behavioural assessments need to be developed for this - the CIs are working on an agreed structure with a Perth Rehabilitative Physician.
Dr Andrea Loftus, Dr Barbara Singer, Prof Geoff Hammond, Mr Ian Cooper (2009,2010)
Grant Title: The impact of NMES based bilateral training program on left neglect, anosognosia & arm function after stroke.
Following a stroke, only about 10% of patients regain useful arm function, not only because of poor motor control, but because quite often the brain injury results in individuals almost 'forgetting' the affected arm is there (neglect). In some cases the patient does not fully appreciate the significance of the deficit in the affected limb (anosognosia). Many interventions to assist upper limb recovery have been investigated. Two promising strategies are the use of electrical stimulation to assist activation of muscles in the affected arm and practicing moving both arms together. The latter strategy is suggested to help balance activation of affected and unaffected sides of the brain. This study will investigate the efficacy, and duration of any benefit, of these two strategies, combined or in isolation, to promote functional recovery after stroke.
The research is progressing well, with subjects enjoying participating and expressing they would have liked to continue using the electrical stimulation device beyond the intervention phase if they were able to do so. The involvement of Sir Charles Gairdner Hospital's Physiotherapy Department in this project will ensure that positive findings lead to translation of the research into clinical applications that are beneficial and practical.
A/Prof Garry Allison, A/ Prof John Buchanan (2009,2010)
Grant Title: A randomized controlled trial of dynamic neurological rehabilitation for acquired brain injury (running program).
This trial of a dynamic rehabilitation program for individuals with brain injury is being undertaken within Royal Perth Hospital's Physiotherapy Department. Pilot work already undertaken by the investigators determined that there is some degree of clinical utility in the innovative "running" program, which is offered to some individuals attending the Neurological Outpatients clinic. This project involves undertaking a high level assessment of each individual's underlying physical impairments before and after participation to examine functional outcomes and translation of these into activities of daily living. All individuals will be followed up to examine if improvements are maintained over time.
CIs are pleased with progress. The running program appears to particularly benefit those with some degree of mobility and motor control. In some individuals, it has been observed that when speed of lower limb loading is increased, abnormal muscle tone begins to be utilised in a functional capacity. With the development of a more sensitive measure of spasticity, valuable insight might be gained into the benefits of this form of muscle loading in the presence of neurological disorders. Thus the CIs have engaged with other researchers to examine the potential of developing such a dynamic assessment of tone. Such an innovation has the potential to allow investigations into the underlying mechanisms of tone modulation under cortical control following brain injury.
Discussions are underway with therapists overseeing service delivery and rehabilitation programs regarding the potential to develop a sustainable training program to roll this intervention out into the community via a 'train the trainers' approach. This would mean a safe and effective rehabilitation protocol for TBI and stroke patients who have some residual lower limb function would be available at community based venues.
Dr Michelle Byrnes, Dr Janet Beilby, Dr David Blacker (2009,2010)
Grant Title: Mindfulness-Based Cognitive Therapy for neurotrauma patients: application of a novel intervention.
Many people who experience neurotrauma face not only devastating physical disability, but also significant psycho-social challenges. They are faced with issues affecting quality of life, mood, coping styles, social functioning and community participation. Mindfulness-Based programs, which are proliferating in clinical settings, are used in the treatment of stress, depression, anxiety and chronic pain. Mindfulness-Based Cognitive Therapy (MBCT) has the potential to improve an individual's ability to cope with the significant stressors associated with everyday life following neurotrauma. This project involves: i) applying MBCT to spinal cord injured and stroke patients; ii) evaluating the effectiveness of a MBCT group program in the chronic phase of the rehabilitation process; and iii) identifying psycho-social and behavioural predictors of the therapeutic response.
So far the feasibility and effectiveness of the MBCT group therapy is supported, with improvements observed in all psychosocial variables assessed, including anxiety, depression, coping, self-efficacy and quality of life. This multidisciplinary group program for SCI and stroke patients also has the potential to be rolled out to the broader community to assist individuals following neurotrauma.
