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 skills in children and adolescents with traumatic brain injury
    Kissane, AL ; Eldridge, BJ ; Kelly, S ; Vidmar, S ; Galea, MP ; Williams, GP (TAYLOR & FRANCIS INC, 2015-12-06)
    AIM: To evaluate the reliability, validity and responsiveness of the High-level Mobility Assessment Tool (HiMAT) in children and adolescents with traumatic brain injury (TBI) and to compare the mobility skills of children with TBI to those of healthy peers. METHOD: The mobility skills of 52 children with moderate and severe TBI (36 males; mean age = 12 years, range = 6-17) were assessed using the HiMAT and the Pediatric Evaluation of Disability Inventory (PEDI). Inter-rater reliability, re-test reliability and responsiveness of the HiMAT were evaluated in sub-groups by comparing results scored at several time-points. The HiMAT scores of children with TBI were compared with those of a healthy comparative cohort. RESULTS: The HiMAT demonstrated excellent inter-rater reliability (ICC = 0.93), re-test reliability (ICC = 0.98) and responsiveness to change (p = 0.002). The PEDI demonstrated a ceiling effect in mobility assessment of ambulant children with TBI. The HiMAT scores of children with TBI were lower than those of their healthy peers (p < 0.001). INTERPRETATION: The HiMAT is a reliable, valid and sensitive measure of high-level mobility skills following childhood TBI. The high-level mobility skills of children with TBI are less proficient than their peers.
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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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    Evaluating Access and Mobility within a New Model of Supported Housing for People with Neurotrauma: A Pilot Study
    Callaway, L ; Tregloan, K ; Williams, G ; Clark, R (CAMBRIDGE UNIV PRESS, 2016-03)
    Objectives: (1) Evaluate the features of purpose-built apartment living on access, environmental control, and home and community mobility of people living with neurotrauma and (2) Examine tenant perceptions of those features. Research design: Observational case series pilot study.Setting:Three apartments within a residential development in Melbourne, Australia.Participants:Three males (aged 30–55 years) with traumatic brain and/or spinal cord injury living in the three separate apartments. Method and procedures:Measures:Two-published measures of user experience of built and technology environments, coupled with customised interdisciplinary post-occupancy evaluation (POE) methods and GPS-enabled mobility tracking.Analysis:Measures completed per manual guidelines and data reported descriptively. Customised measured drawings produced to represent tenants’ physical access and mobility. GPS community mobility data plotted on Google Earth. Results: Built design features which enabled access and mobility included linear paths of travel, well-located furnishings, and joinery design that allowed approach from either side using a wheelchair. Personal home furnishing choices posed barriers to physical access. Home automation technologies positively influenced participants’ sense of control and independence, but posed learning challenges. Close proximity of housing to accessible public transport and services enabled community travel options. Conclusion: Findings from this pilot study indicate the combination of housing location, design and technologies used, together with availability of local community services, provides an acceptable level of environmental control, access, mobility and tenant experience. Further research is required to determine validity of the novel measures used, and deliver rigorous research design to evaluate those features most important in achieving optimal outcomes.
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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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    A qualitative study of active participation in sport and exercise for individuals with multiple sclerosis
    Smith, M ; Neibling, B ; Williams, G ; Birks, M ; Barker, R (WILEY, 2019-07)
    OBJECTIVE: The aim of this study was to explore the experience of participation in sport and exercise for individuals with multiple sclerosis (MS) with minimal disability. The objectives were to gain an understanding of key factors that influence participation in sport and exercise and to determine support required by individuals with MS to participate in their choice of sport and exercise for as long as possible. METHODS: A qualitative, descriptive study utilizing three focus groups was conducted. Data were analysed thematically aided by NVivo software. Participants were individuals with MS who had an Expanded Disability Status Scale score of 0-4, indicating full ambulation. All participants were living in northern Queensland, Australia. RESULTS: Sixteen individuals participated; 63% of whom regularly participated in sport or exercise. All participants viewed sport and exercise positively and identified inherent benefits of exercise. Five key themes emerged to describe the experience of participating in sport and exercise: "personally engaging with exercise," "influencing barriers and enablers of exercise," "sustaining independence," "integrating exercise into lifestyle," and "getting the balance right." Most participants felt that advice and guidance from health professionals about the optimum mode and dose (how much and how often) of exercise was lacking. CONCLUSIONS: Participation in sport and exercise was valued by individuals with MS with minimal disability for sustaining independence and an active lifestyle. Personalized exercise advice from health professionals was the key support identified by participants to assist them to maintain an active lifestyle for as long as possible.
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    Low-cost evaluation and real-time feedback of static and dynamic weight bearing asymmetry in patients undergoing in-patient physiotherapy rehabilitation for neurological conditions
    Foo, J ; Paterson, K ; Williams, G ; Clark, R (BMC, 2013-07-12)
    BACKGROUND: Weight bearing asymmetry is common in patients with neurological conditions, and recent advances in gaming technology have produced force platforms that are suitable for use in a clinical setting. The aim of this research is to determine whether commercially-available Wii Balance Boards with customized software providing real-time feedback could be used in a clinical setting to evaluate and improve weight-bearing asymmetry in people with various neurological conditions. METHODS: Twenty participants (age = 43.25 ± 19.37 years) receiving physiotherapy as a result of a neurological condition performed three trials each of two tasks (static standing and sit-to-stand) with and without visual feedback. Vertical forces were measured using available Wii Balance Boards coupled with customized software that displayed visual feedback in real-time. Primary outcome measures included weight-bearing asymmetry as a percentage of body mass, peak force symmetry index, and a visual analogue scale score rating self-perceived level of asymmetry. RESULTS: Weight-bearing asymmetry during the static balance task was significantly reduced (Z = -2.912, p = 0.004, ES = 0.65) with visual feedback. There was no significant difference (Z = -0.336, p = 0.737) with visual feedback for the dynamic task, however subgroup analysis indicated that those with higher weight-bearing asymmetry responded the most to feedback. Correlation analysis revealed little or no relationship between participant perception of weight-bearing asymmetry and the results for the static or dynamic balance task (Spearman's rho: ρ = 0.138, p = 0.561 and ρ = 0.018, ρ =0.940 respectively). CONCLUSIONS: These findings suggest that weight-bearing asymmetry can be reduced during static tasks in patients with neurological conditions using inexpensive commercially-available Wii Balance Boards coupled with customized visual feedback software. Further research is needed to determine whether real-time visual feedback is appropriate for reducing dynamic weight-bearing asymmetry, whether improvements result in improved physical function, and how cognitive and physical impairments influence the patient's ability to respond to treatment.