An Australasian, Multi-centre, Randomized, Double-blind, Placebo-controlled Trial Of The Efficacy Of Fluoxetine In Improving Functional Recovery After Acute Stroke
Funder
National Health and Medical Research Council
Funding Amount
$2,306,367.00
Summary
Stroke is one of the top three causes of disability. Treatments that improve recovery after stroke are lacking. We reviewed the world literature and found a number of very small studies which, together, suggest that the antidepressant drug, fluoxetine, may improve the recovery in stroke patients. AFFINITY is a large trial in 1600 Australians and New Zealanders with stroke which aims to find out whether taking fluoxetine for 6 months after a stroke improves recovery compared to a placebo.
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
Promoting Upper Limb Recovery After Stroke In People With Severe Paresis.
Funder
National Health and Medical Research Council
Funding Amount
$348,948.00
Summary
Stroke survivors with severe arm disability have poor potential for functional recovery. Yet, an incomplete understanding of indicators of good potential currently dictate clinical decisions concerning referral to rehabilitation and therapy provision. The proposed research aims to characterise the dynamic capacity of the severely damaged brain to recover. This research will provide the foundations for more personalized health care options and extend our understanding of this growing cohort.
Changes In Motoneurone And Motor Axon Properties Distal To The Lesion In Stroke
Funder
National Health and Medical Research Council
Funding Amount
$367,530.00
Summary
Following a stroke, adaptive changes occur in spinal cord motoneurones below the level of the stroke, but these are poorly understood. Apart from the exaggeration of spinal reflexes, distal changes have largely been neglected by clinicians. Even the mechanisms responsible for the exaggeration of spinal reflexes are still debated, in part because no single process can account for it. Using novel experimental techniques originally developed to study biophysical properties of human peripheral nerve ....Following a stroke, adaptive changes occur in spinal cord motoneurones below the level of the stroke, but these are poorly understood. Apart from the exaggeration of spinal reflexes, distal changes have largely been neglected by clinicians. Even the mechanisms responsible for the exaggeration of spinal reflexes are still debated, in part because no single process can account for it. Using novel experimental techniques originally developed to study biophysical properties of human peripheral nerves, this project will quantify the changes in excitability that occur in motoneurones and their peripheral extension, the motor axon, and compare these with the findings on the non-paralysed side of the same patients and with healthy matched control subjects. The changes that occur over time will be documented in longitudinal studies. The findings will be correlated with the patient's clinical status, providing insight into the extent to which changes in motoneurone properties drive clinical manifestations such as spasticity. In addition, control studies will provide further insight into whether disturbed transmission in some specific spinal reflex pathways contributes significantly to spasticity. The project is important for understanding the nature of adaptive changes (plasticity) in neural structures following lesions in the central nervous system and will shed light on the remote changes that occur in stroke. The studies are relevant not only for understanding current deficits but also for understanding and perhaps altering outcomes using rehabilitation procedures.Read moreRead less
Circuit Class Therapy For Rehabilitation Clients. A Pragmatic Randomized Controlled Trial Of Therapy Intensity (CIRCIT).
Funder
National Health and Medical Research Council
Funding Amount
$526,361.00
Summary
Loss of independence is common after stroke, and may lead to reduced quality of life and admission to nursing home care. We will investigate if an increased amount of rehabilitation following stroke leads to improved mobility. Two ways of delivering more intense rehabilitation will be compared with usual care to find out which leads to improved physical mobility, and how they compare economically. This will allow health service providers to optimise services and will benefit people with stroke.
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.
Neural Mechanisms Associated With Recovery Of Function Following Motor Cortical Lesions
Funder
National Health and Medical Research Council
Funding Amount
$196,415.00
Summary
Damage to movement control areas in the brain early in life (e.g. cerebral palsy) or in adulthood (e.g. stroke, tumours) results in motor weakness and loss of skill; over a period of many months there is gradual recovery of function. The neural mechanisms that are associated with functional reorganization of the brain and motor recovery are not well understood. This project plans to use animal experiments to identify the location of regions in the brain that undergo neural reorganization and com ....Damage to movement control areas in the brain early in life (e.g. cerebral palsy) or in adulthood (e.g. stroke, tumours) results in motor weakness and loss of skill; over a period of many months there is gradual recovery of function. The neural mechanisms that are associated with functional reorganization of the brain and motor recovery are not well understood. This project plans to use animal experiments to identify the location of regions in the brain that undergo neural reorganization and compensate for lost function. Following brain lesions detailed mapping of the motor areas of the brain and a careful study of movement disabilities will be performed. The study will attempt to identify changes in motor maps that indicate neural reorganization and relate these changes to motor recovery. The results of this study will be used in future projects to test training programs, drugs and neural prosthesis on neural reorganization and recovery of function. Eventually the information may be used to direct pharmacological and physiotherapeutic interventions, and motor rehabilitation programs for optimal recovery of function.Read moreRead less