Physiotherapy - Research Publications

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    Feldenkrais Method Balance Classes Improve Balance in Older Adults: A Controlled Trial
    Connors, KA ; Galea, MP ; Said, CM (HINDAWI LTD, 2011-01-01)
    The objective of this study was to investigate the effects of Feldenkrais Method balance classes on balance and mobility in older adults. This was a prospective non-randomized controlled study with pre/post measures. The setting for this study was the general community. A convenience sample of 26 community-dwelling older adults (median age 75 years) attending Feldenkrais Method balance classes formed the Intervention group. Thirty-seven volunteers were recruited for the Control group (median age 76.5 years). A series of Feldenkrais Method balance classes (the 33312Getting Grounded Gracefully33313 series), two classes per week for 10 weeks, were conducted. Main outcome measures were Activities-Specific Balance Confidence (ABC) questionnaire, Four Square Step Test (FSST), self-selected gait speed (using GAITRite instrumented gait mat). At re-testing, the Intervention group showed significant improvement on all of the measures (ABC, P = .016, FSST, P = .001, gait speed, P < .001). The Control group improved significantly on one measure (FSST, P < .001). Compared to the Control group, the Intervention group made a significant improvement in their ABC score (P = .005), gait speed (P = .017) and FSST time (P = .022). These findings suggest that Feldenkrais Method balance classes may improve mobility and balance in older adults.
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    Gait training with real-time augmented toe-ground clearance information decreases tripping risk in older adults and a person with chronic stroke
    Begg, RK ; Tirosh, O ; Said, CM ; Sparrow, WA ; Steinberg, N ; Levinger, P ; Galea, MP (FRONTIERS RESEARCH FOUNDATION, 2014-05-08)
    Falls risk increases with ageing but is substantially higher in people with stroke. Tripping-related balance loss is the primary cause of falls, and Minimum Toe Clearance (MTC) during walking is closely linked to tripping risk. The aim of this study was to determine whether real-time augmented information of toe-ground clearance at MTC can increase toe clearance, and reduce tripping risk. Nine healthy older adults (76 ± 9 years) and one 71 year old female stroke patient participated. Vertical toe displacement was displayed in real-time such that participants could adjust their toe clearance during treadmill walking. Participants undertook a session of unconstrained walking (no-feedback baseline) and, in a subsequent Feedback condition, were asked to modify their swing phase trajectory to match a "target" increased MTC. Tripping probability (PT) pre- and post-training was calculated by modeling MTC distributions. Older adults showed significantly higher mean MTC for the post-training retention session (27.7 ± 3.79 mm) compared to the normal walking trial (14.1 ± 8.3 mm). The PT on a 1 cm obstacle for the older adults reduced from 1 in 578 strides to 1 in 105,988 strides. With gait training the stroke patient increased MTC and reduced variability (baseline 16 ± 12 mm, post-training 24 ± 8 mm) which reduced obstacle contact probability from 1 in 3 strides in baseline to 1 in 161 strides post-training. The findings confirm that concurrent visual feedback of a lower limb kinematic gait parameter is effective in changing foot trajectory control and reducing tripping probability in older adults. There is potential for further investigation of augmented feedback training across a range of gait-impaired populations, such as stroke.
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    Real-time foot clearance biofeedback to assist gait rehabilitation following stroke: a randomized controlled trial protocol
    Begg, R ; Galea, MP ; James, L ; Sparrow, WAT ; Levinger, P ; Khan, F ; Said, CM (BMC, 2019-05-31)
    BACKGROUND: The risk of falling is significantly higher in people with chronic stroke and it is, therefore, important to design interventions to improve mobility and decrease falls risk. Minimum toe clearance (MTC) is the key gait cycle event for predicting tripping-falls because it occurs mid-swing during the walking cycle where forward velocity of the foot is maximum. High forward velocity coupled with low MTC increases the probability of unanticipated foot-ground contacts. Training procedures to increase toe-ground clearance (MTC) have potential, therefore, as a falls-prevention intervention. The aim of this project is to determine whether augmented sensory information via real-time visual biofeedback during gait training can increase MTC. METHODS: Participants will be aged > 18 years, have sustained a single stroke (ischemic or hemorrhagic) at least six months previously, able to walk 50 m independently, and capable of informed consent. Using a secure web-based application (REDCap), 150 participants will be randomly assigned to either no-feedback (Control) or feedback (Experimental) groups; all will receive 10 sessions of treadmill training for up to 10 min at a self-selected speed over 5-6 weeks. The intervention group will receive real-time, visual biofeedback of MTC during training and will be asked to modify their gait pattern to match a required "target" criterion. Biofeedback is continuous for the first six sessions then progressively reduced (faded) across the remaining four sessions. Control participants will walk on the treadmill without biofeedback. Gait assessments are conducted at baseline, immediately following the final training session and then during follow-up, at one, three, and six months. The primary outcome measure is MTC. Monthly falls calendars will also be collected for 12 months from enrolment. DISCUSSION: The project will contribute to understanding how stroke-related changes to sensory and motor processes influence gait biomechanics and associated tripping risk. The research findings will guide our work in gait rehabilitation following stroke and may reduce falls rates. Treadmill training procedures incorporating continuous real-time feedback may need to be modified to accommodate stroke patients who have greater difficulties with treadmill walking. TRIAL REGISTRATION: Australia New Zealand Clinical Trials Registry, ACTRN12617000250336 . Registered on 17 February 2017.
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    Effects Of treadmill training on hindlimb muscles of spinal cord-injured mice
    Battistuzzo, CR ; Rank, MM ; Flynn, JR ; Morgan, DL ; Callister, R ; Callister, RJ ; Galea, MP (WILEY, 2017-02-01)
    INTRODUCTION: Treadmill training is known to prevent muscle atrophy after spinal cord injury (SCI), but the training duration required to optimize recovery has not been investigated. METHODS: Hemisected mice were randomized to 3, 6, or 9 weeks of training or no training. Muscle fiber type composition and fiber cross-sectional area (CSA) of medial gastrocnemius (MG), soleus (SOL), and tibialis anterior (TA) were assessed using ATPase histochemistry. RESULTS: Muscle fiber type composition of SCI animals did not change with training. However, 9 weeks of training increased the CSA of type IIB and IIX fibers in TA and MG muscles. CONCLUSIONS: Nine weeks of training after incomplete SCI was effective in preventing atrophy of fast-twitch muscles, but there were limited effects on slow-twitch muscles and muscle fiber type composition. These data provide important evidence of the benefits of exercising paralyzed limbs after SCI. Muscle Nerve, 2016 Muscle Nerve 55: 232-242, 2017.
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    People With Stroke Who Fail an Obstacle Crossing Task Have a Higher Incidence of Falls and Utilize Different Gait Patterns Compared With People Who Pass the Task
    Said, CM ; Galea, MP ; Lythgo, N (OXFORD UNIV PRESS INC, 2013-03-01)
    BACKGROUND: Obstacle crossing is impaired in people following stroke. It is not known whether people with stroke who fail an obstacle crossing task have more falls or whether the gait adjustments used to cross an obstacle differ from those used by people who pass the task. OBJECTIVE: The purposes of this study were (1) to identify whether a group of people with stroke who failed an obstacle crossing task had a greater incidence of falling and (2) to determine whether people who fail an obstacle crossing task utilize different gait adjustments. DESIGN: This was a prospective, observational study. METHODS: Thirty-two participants with a recent stroke were recruited. Participants walked at self-selected speed and stepped over a 4-cm-high obstacle. Performance was rated as pass or fail, and spatiotemporal, center of mass (COM), and center of pressure (COP) data were collected. Prospective falls data were recorded for 20 participants over a 6-month period. RESULTS: The incidence of fallers was significantly higher (incidence rate=0.833) in the group that failed the obstacle crossing task than in the group that passed the task (incidence rate=0.143). The group that failed the task had a slower walking speed and greater normalized separation between the trail heel (unaffected support limb) and COM as the affected lead toe cleared the obstacle. This group exhibited greater normalized times from affected lead toe clearance to landing, unaffected trail toe clearance to landing, and affected trail toe-off to toe clearance. LIMITATIONS: The sample size was small, and falls data were available for only 20 participants. CONCLUSIONS: Obstacle crossing is an important task to consider in people following stroke and may be useful in identifying those at risk of falls.
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    Obstacle crossing following stroke improves over one month when the unaffected limb leads, but not when the affected limb leads
    Said, CM ; Galea, M ; Lythgo, N (ELSEVIER IRELAND LTD, 2014-01-01)
    While it is well established that obstacle crossing is impaired following stroke, it is not known whether obstacle crossing improves as gait improves following stroke. The purpose of this study was to determine whether obstacle crossing changed over a one month time period in people with a recent stroke. Twenty participants receiving rehabilitation following a recent stroke were tested on two occasions one month apart. Participants received usual care rehabilitation, including physiotherapy, between the tests. The main outcome measure was obstacle crossing speed as participants stepped over a 4-cm high obstacle. Secondary measures were spatiotemporal variables. Data were collected via a three dimensional motion analysis system. When leading with the affected limb no changes in obstacle crossing speed or spatiotemporal variables were observed over the one month period. When leading with the unaffected limb, crossing speed significantly increased (p=.002), and affected trail limb swing time (p=.03) and crossing step double support time reduced (p=.016). While not significant, the lead and trail limb pre-obstacle distance increased (p=.08), and lead swing time (p=.052) reduced. Change in obstacle crossing speed did not correlate with change in level gait speed. Obstacle crossing does not necessarily improve over a one month time period in people receiving rehabilitation following stroke. These findings suggest that there may be a need for more targeted training of obstacle crossing, particularly when leading with the affected limb.
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    People with stroke who fail an obstacle crossing task have a higher incidence of falls and utilise different gait patterns compared with people who pass the task
    Said, Catherine M. ; Galea, Mary P. ; LYTHGO, NOEL (American Physical Therapy Association, 2013)
    Background: Obstacle crossing is impaired following stroke. It is not known whether people with stroke who fail an obstacle crossing task have more falls, or whether the gait adjustments used to cross an obstacle differ from those used by people who pass the task. Objective: To identify whether a group of people with stroke who failed an obstacle crossing task had a greater incidence of falling, and to determine whether people who fail an obstacle crossing task utilise different gait adjustments. Design: This study was a prospective observational study. Methods: Thirty-two participants with a recent stroke were recruited. Participants walked at self-selected speed and stepped over a 4-cm high obstacle. Performance was rated as pass or fail, and spatiotemporal, centre of mass (COM) and centre of pressure (COP) data were collected. Prospective falls data were recorded for 20 participants over a six month period. Results: The incidence of fallers in the group that failed the obstacle crossing task was significantly higher (IR =.833) than the group that passed (IR = .143; p = .007). The group that failed had a slower walking speed and greater normalised separation between the trail heel (unaffected support limb) and COM as the affected lead toe cleared the obstacle. This group exhibited greater normalised times from affected lead toe clearance to landing, unaffected trail toe clearance to landing and affected trail toe off to toe clearance. Limitations: Sample size was small, and falls data were only available for 20 participants. Conclusions: Obstacle crossing is an important task to consider following stroke and may be useful in identifying those at risk of falls.
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    Voluntary activation of the ankle plantar flexors following whole-body vibration
    Pellegrini, MJ ; Lythgo, ND ; Morgan, DL ; Galea, MP (SPRINGER, 2010-03-01)
    This study investigated the effect of whole-body vibration (WBV) on the voluntary activation of the ankle plantar flexors. Twelve healthy young adults were randomly exposed to two treatments on separate occasions. The first (non-WBV) involved stretching of the plantar flexors at end range of dorsiflexion for five 1-min bouts. The second involved the same stretch with WBV (26 Hz) for five 1-min bouts. Attempted maximal voluntary contractions (AMVCs) of the plantar flexors were performed on an isokinetic dynamometer (30 degrees s(-1)) before and after each treatment. A twitch interpolation technique was used to investigate voluntary activation. Post-treatment data were normalised against pre-treatment data. Subjects were classified as maximally (n = 6) or sub-maximally (n = 6) activated using the pre-treatment twitch interpolation data. The effects of WBV were assessed by repeated measure (RM) MANOVA. After WBV, the group of subjects classified as sub-maximally activated increased peak voluntary torque and rate of voluntary torque production (P < 0.05), whereas angular displacement to peak torque reduced (P < 0.05); i.e. peak torque was produced at a longer muscle length. No significant non-WBV treatment effects were found for this group. No significant WBV effects were found for the group of subjects classified as maximally activated. This study found that the response to WBV was dependent on the level of voluntary activation of the ankle plantar flexors during a set of AMVCs.