Physiotherapy - Research Publications

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    Upper-Limb Motor Intervention Elements That Drive Improvement in Biomarkers and Clinical Measures Post-Stroke: A Systematic Review in a Systems Paradigm
    Wingfield, M ; Fini, NA ; Brodtmann, A ; Williams, G ; Churilov, L ; Hayward, KS (SAGE PUBLICATIONS INC, 2022-11)
    OBJECTIVE: To use a systems paradigm to examine upper limb (UL) motor intervention elements driving biomarker and clinical measure improvement after stroke. METHODS: Databases were searched up to March 2022. Eligibility screening was completed by 2 authors. Studies using biomarkers and clinical measures pre- and post-upper limb intervention were included. Studies of adjunct interventions (eg, brain stimulation) were excluded. Cochrane Risk-of-Bias tools and Template for Intervention Description and Replication were used to rate studies. Studies were synthesized using a systems paradigm: intervention outcome was considered an emergent property of the systemic interactions of 4 intervention elements (demographics, type, quality, and dose) characterized by individual dimensions. RESULTS: Sixty-four studies (n = 1814 participants) containing 106 intervention groups (66 experimental; 40 control) were included. Combined biomarker and clinical outcomes defined 3 scenarios: restitution, mixed, and unchanged. The restitution scenario included more moderate-to-severely impaired participants in earlier recovery phases (<6 months). Interventions with graded difficulty were more frequently used in the restitution scenario compared with the unchanged scenario. No difference in quality or amount of therapy was identified when examining scenarios that demonstrated restitution compared to those that did not (mixed and unchanged). CONCLUSIONS: A systems paradigm may be one of many approaches to understand UL motor restitution. This review found no single element consistently delivered improvements in biomarkers and clinical measures in the examined intervention groups. Complex patterns formed by multiple interacting intervention elements were observed in participants with and without restitution.
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    Ballistic resistance training has a similar or better effect on mobility than non-ballistic exercise rehabilitation in people with a traumatic brain injury: a randomised trial
    Williams, G ; Hassett, L ; Clark, R ; Bryant, AL ; Morris, ME ; Olver, J ; Ada, L (AUSTRALIAN PHYSIOTHERAPY ASSOC, 2022-10)
    QUESTIONS: In people recovering from traumatic brain injury, is a 3-month ballistic resistance training program targeting three lower limb muscle groups more effective than non-ballistic exercise rehabilitation for improving mobility, strength and balance? Does improved mobility translate to better health-related quality of life? DESIGN: A prospective, multicentre, randomised trial with concealed allocation, intention-to-treat analysis and blinded measurement. PARTICIPANTS: A total of 144 people with a neurological movement disorder affecting mobility as a result of traumatic brain injury. INTERVENTION: For 3 months, the experimental group had three 60-minute sessions of non-ballistic exercise rehabilitation per week replaced by ballistic resistance training. The control group had non-ballistic exercise rehabilitation of equivalent time. The non-ballistic exercise rehabilitation consisted of balance exercises, lower limb stretching, conventional strengthening exercises, cardiovascular fitness training and gait training. OUTCOME MEASURES: The primary outcome was mobility measured using the High-Level Mobility Assessment Tool (HiMAT). Secondary outcomes were walking speed, strength, balance and quality of life. They were measured at baseline (0 months), after completion of the 3-month intervention (3 months) and 3 months after cessation of intervention (6 months). RESULTS: After 3 months of ballistic resistance training, the experimental group scored 3 points (95% CI 0 to 6) higher on the 54-point HiMAT than the control group and remained 3 points (95% CI -1 to 6) higher at 6 months. Although there was a transient decrement in balance at 3 months in the experimental group, the interventions had similar effects on all secondary outcomes by 6 months. Participants with a baseline HiMAT < 27 gained greater benefit from ballistic training: 6 points (1 to 10) on the HiMAT. CONCLUSION: This randomised trial shows that ballistic resistance training has a similar or better effect on mobility than non-ballistic training in people with traumatic brain injury. It may be better targeted towards those with more severe mobility limitations. TRIAL REGISTRATION: ACTRN12611001098921.
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    High-Level Mobility Assessment Tool Normative Values for Children
    Eldridge, BJ ; Galea, MP ; Kissane, AL ; Broder, JC ; Brilleman, SL ; Wolfe, R ; Williams, G (OXFORD UNIV PRESS INC, 2020-02)
    BACKGROUND: Physical therapists need to be able to evaluate high-level gross motor skills of children to determine their capacity to engage in activities such as running, jumping, hopping, and stair climbing. The High-Level Mobility Assessment Tool (HiMAT) has excellent interrater and retest reliability and is less susceptible to a ceiling effect than existing mobility scales in children who are 6 to 17 years old and have traumatic brain injury. OBJECTIVE: The purposes of this study were to develop normative HiMAT score ranges for Australian children and to investigate the relationship between children's HiMAT scores and their age, height, weight, and body mass index (BMI). DESIGN: This study used a cross-sectional design. METHODS: Children included in this study were 5 to 12 years old, had no condition affecting their mobility, could follow 2-stage instructions, and had written informed consent from their parent or guardian. A total 1091 children were assessed at their local school, where their height, weight, and HiMAT score were recorded. The relationships between children's age, height, weight, and BMI were summarized using Spearman rank correlations. Truncated regression models were used to determine the most appropriate predictor variable for developing sex-specific normative ranges. RESULTS: There was a positive correlation between children's HiMAT scores and their age, height, weight, and BMI. Age explained the most variability in HiMAT scores for both boys and girls. LIMITATIONS: The reliability, validity, and responsiveness of the HiMAT have not been tested across a broad range of children with mobility limitations. Normative data reported in this study are for Australian children only. CONCLUSIONS: HiMAT scores for children in this study increased with age, height, weight, and BMI. Age was the most appropriate variable for developing a normative dataset of HiMAT scores for children of primary school age.
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    Inertia Sensors for Measuring Spasticity of the Ankle Plantarflexors Using the Modified Tardieu Scale-A Proof of Concept Study
    Banky, M ; Williams, G ; Davey, R ; Tirosh, O (MDPI, 2022-07)
    Ankle spasticity is clinically assessed using goniometry to measure the angle of muscle reaction during the Modified Tardieu Scale (MTS). The precision of the goniometric method is questionable as the measured angle may not represent when the spastic muscle reaction occurred. This work proposes a method to accurately determine the angle of muscle reaction during the MTS assessment by measuring the maximum angular velocity and the corresponding ankle joint angle, using two affordable inertial sensors. Initially we identified the association between muscle onset and peak joint angular velocity using surface electromyography and an inertial sensor. The maximum foot angular velocity occurred 0.049 and 0.032 s following the spastic muscle reaction for Gastrocnemius and Soleus, respectively. Next, we explored the use of two affordable inertial sensors to identify the angle of muscle reaction using the peak ankle angular velocity. The angle of muscle reaction and the maximum dorsiflexion angle were significantly different for both Gastrocnemius and Soleus MTS tests (p = 0.028 and p = 0.009, respectively), indicating that the system is able to accurately detect a spastic muscle response before the end of the movement. This work successfully demonstrates how wearable technology can be used in a clinical setting to identify the onset of muscle spasticity and proposes a more accurate method that clinicians can use to measure the angle of muscle reaction during the MTS assessment. Furthermore, the proposed method may provide an opportunity to monitor the degree of spasticity where the direct help of experienced therapists is inaccessible, e.g., in rural or remote areas.
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    CLINICAL SPASTICITY ASSESSMENT USING THE MODIFIED TARDIEU SCALE DOES NOT REFLECT JOINT ANGULAR VELOCITY OR RANGE OF MOTION DURING WALKING: ASSESSMENT TOOL IMPLICATIONS
    Banky, M ; Clark, RA ; Mentiplay, BF ; Olver, JH ; Williams, G (FOUNDATION REHABILITATION INFORMATION, 2021-01)
    OBJECTIVE: Spasticity assessment is often used to guide treatment decision-making. Assessment tool limitations may influence the conflicting evidence surrounding the relationship between spasticity and walking. This study investigated whether testing speeds and joint angles during a Modified Tardieu assessment matched lower-limb angular velocity and range of motion during walking. DESIGN: Observational study. SUBJECTS: Thirty-five adults with a neurological condition and 34 assessors. METHODS: The Modified Tardieu Scale was completed. Joint angles and peak testing speed during V3 (fast) trials were compared with these variables during walking in healthy people, at 0.400.59, 0.600.79 and 1.401.60 m/s. The proportion of trials in which the testing speed, start angle, and angle of muscle reaction matched the relevant joint angles and angular velocity during walking were analysed. RESULTS: The Modified Tardieu Scale was completed faster than the angular velocities seen during walking in 88.7% (0.400.59 m/s), 78.9% (0.600.79 m/s) and 56.2% (1.401.60 m/s) of trials. When compared with the normative dataset, 4.2%, 9.5% and 13.7% of the trials met all criteria for each respective walking speed. CONCLUSION: When applied according to the standardized procedure and compared with joint angular velocity during walking, clinicians performed the Modified Tardieu Scale too quickly.
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    Can adults with cerebral palsy perform and benefit from ballistic strength training to improve walking outcomes? A mixed methods feasibility study
    Gjesdal, BE ; Maeland, S ; Williams, G ; Aaslund, MK ; Rygh, CB ; Cumming, KT (BMC, 2021-12-18)
    BACKGROUND: Power bursts of hips and ankle plantar flexors are prerequisites to walking propulsion. However, these power bursts are reduced during gait for persons with cerebral palsy (CP) and mainly in the ankle plantar flexors. Hence, task specific training, such as ballistic strength training, is suggested to increase muscle power in walking but not investigated in adults with CP. Therefore, the aim was to investigate if adults with CP could perform and benefit from ballistic strength training to improve walking, evaluated through physical measures and self-reported measures and interviews. METHODS: In this mixed methods feasibility study, eight ambulatory adults (aged 24-56) with spastic CP conducted ballistic strength training on a glideboard targeting the ankle plantarflexors two times a week for eight weeks. The feasibility of the training was assessed through objectives described by Orsmond and Cohn. Before and after the intervention, physical measures (6-Minute Walk Test and the eight-item High-level Mobility Assessment Tool) and self-reported measures (Patient Global Impression of Change, Numeric Pain Rating Scale, Fatigue Impact and Severity Self-Assessment, and Walk-12) were collected. After the intervention, semi-structured interviews explored experiences of this training. RESULTS: The participants experienced training the ankle plantar flexor as relevant but reported it took about four weeks to coordinate the exercises successfully. Although we observed no changes in the physical performance measures, most participants reported improvements; some felt steadier when standing, walking, and hopping. CONCLUSION: This study demonstrated that ballistic strength training was feasible and suitable in adults with CP. However, guidance and a long (4 weeks) familiarization time were reported necessary to master the exercises. Most participants reported self-experienced improvements, although no physical performance measures improved. Thus, prolonged intervention may be required for perceived physical improvements to emerge. Also, other outcome measures sensitive to power output remains to be investigated.
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    Kits for wearable sensor systems: exploring software and hardware system design, building guides, and opportunities for clinical rehabilitation
    Clark, RA ; Thilarajah, S ; Williams, G ; Kahn, M ; Heywood, S ; Tan, HH ; Hough, EJ ; Pua, Y ; Godfrey, A ; Stuart, S (Academic Press, 2021)
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    The effect of exercise on high-level mobility in individuals with neurodegenerative disease: a systematic literature review
    Smith, M ; Barker, R ; Williams, G ; Carr, J ; Gunnarsson, R (ELSEVIER SCI LTD, 2020-03)
    OBJECTIVE: To investigate the effect of exercise on high-level mobility (i.e. mobility more advanced than independent level walking) in individuals with neurodegenerative disease. DATA SOURCES: A systematic literature search was conducted in Medline, CINAHL, Scopus, SportDiscus and PEDro. STUDY SELECTION: Randomised controlled trials of exercise interventions for individuals with neurodegenerative disease, with an outcome measure that contained high-level mobility items were included. High-level mobility items included running, jumping, bounding, stair climbing and backward walking. Outcome measures with high-level mobility items include the High Level Mobility Assessment Tool (HiMAT); Dynamic Gait Index; Rivermead Mobility Index (RMI) or modified RMI; Functional Gait Assessment and the Functional Ambulation Category. STUDY APPRAISAL: Quality was evaluated with the Cochrane Risk of Bias Tool. RESULTS: Twenty-four studies with predominantly moderate to low risk of bias met the review criteria. High-level mobility items were included within primary outcome measures for only two studies and secondary outcome measures for 22 studies. Eight types of exercise interventions were investigated within which high-level mobility tasks were not commonly included. In the absence of outcome measures or interventions focused on high-level mobility, findings suggest some benefit from treadmill training for individuals with multiple sclerosis or Parkinson's disease. Progressive resistance training for individuals with multiple sclerosis may also be beneficial. With few studies on other neurodegenerative diseases, further inferences cannot be made. CONCLUSION: Future studies need to specifically target high-level mobility in the early stages of neurodegenerative disease and determine the impact of high-level mobility interventions on community participation and maintenance of an active lifestyle. Systematic review registration number PROSPERO register for systematic reviews (registration number: CRD42016050362).
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    Finding the right balance with participation in exercise and sport for individuals with multiple sclerosis: protocol for a pre and post intervention feasibility study
    Smith, M ; Williams, G ; Barker, R (BMJ PUBLISHING GROUP, 2020-03)
    INTRODUCTION: Individuals with minimal disability from multiple sclerosis (MS) requested advice on finding the right balance, between too much and too little exercise, when participating in their choice of sport or exercise. To optimise exercise participation during the early stages of the disease, a flexible exercise participation programme (FEPP) has been developed. The FEPP is novel because it provides guidance and support for individuals with MS to participate and progress in their preferred sport or exercise. The primary objective was to assess the feasibility of the FEPP. The secondary objective was to assess the feasibility of a larger trial to demonstrate the efficacy of the FEPP. METHODS AND ANALYSIS: A stage I feasibility study of the FEPP, using a single group preintervention/post-intervention design, will be conducted with 16 participants with minimal disability from MS (Expanded Disability Status Scale level of 0-3.5). The 12-week FEPP will guide participants to independently participate in their preferred sport or exercise at a location of their choice. Exercise progression will be guided by individual energy levels and a weekly telephone coaching session with a physiotherapist. Participation in exercise or sport will be recorded in parallel with assessment of disease biomarkers (plasma cytokines interleukin (IL)-2, IL-4, IL-6, IL-10, interferon (IFN)-γ and tumour necrosis factor (TNF)), subjective vitality and high-level mobility. Acceptability of the FEPP will be assessed using a sequential explanatory mixed methods design where the findings of a participant survey will inform the interview guide for a series of focus groups.Feasibility of a larger trial will be assessed via process, resources, management and scientific metrics. Progression to a larger trial will depend on the achievement of specified minimum success criteria. ETHICS AND DISSEMINATION: Ethical approval has been obtained for this study from the James Cook University Human Research Ethics Committee (H7956). Dissemination of findings is planned via peer-reviewed journals, conference presentations and media releases. The protocol date was 21 December 2019, V.1. TRIAL REGISTRATION NUMBER: The trial is registered with Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12620000076976.
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    Effects of Supervised Early Resistance Training versus standard care on cognitive recovery following cardiac surgery via median sternotomy (the SEcReT study): protocol for a randomised controlled pilot study
    Pengelly, JMS ; Royse, AG ; Bryant, AL ; Williams, GP ; Tivendale, LJ ; Dettmann, TJ ; Canty, DJ ; Royse, CF ; El-Ansary, DA (BMC, 2020-07-15)
    INTRODUCTION: Mild cognitive impairment is considered a precursor to dementia and significantly impacts upon quality of life. The prevalence of mild cognitive impairment is higher in the post-surgical cardiac population than in the general population, with older age and comorbidities further increasing the risk of cognitive decline. Exercise improves neurogenesis, synaptic plasticity and inflammatory and neurotrophic factor pathways, which may help to augment the effects of cognitive decline. However, the effects of resistance training on cognitive, functional and overall patient-reported recovery have not been investigated in the surgical cardiac population. This study aims to determine the effect of early moderate-intensity resistance training, compared to standard care, on cognitive recovery following cardiac surgery via a median sternotomy. The safety, feasibility and effect on functional recovery will also be examined. METHODS: This study will be a prospective, pragmatic, pilot randomised controlled trial comparing a standard care group (low-intensity aerobic exercise) and a moderate-intensity resistance training group. Participants aged 18 years and older with coronary artery and/or valve disease requiring surgical intervention will be recruited pre-operatively and randomised 1:1 to either the resistance training or standard care group post-operatively. The primary outcome, cognitive function, will be assessed using the Alzheimer's Disease Assessment Scale and cognitive subscale. Secondary measures include safety, feasibility, muscular strength, physical function, multiple-domain quality of recovery, dynamic balance and patient satisfaction. Assessments will be conducted at baseline (pre-operatively) and post-operatively at 2 weeks, 8 weeks, 14 weeks and 6 months. DISCUSSION: The results of this pilot study will be used to determine the feasibility of a future large-scale randomised controlled trial that promotes the integration of early resistance training into existing aerobic-based cardiac rehabilitation programs in Australia. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12617001430325p . Registered on 9 October 2017. Universal Trial Number (UTN): U1111-1203-2131.