Over 60,000 Australians suffer a stroke every year, making it the second most common cause of disability in Australia. More than half of those who survive a stroke require help with normal daily activities.
There is no cure for stroke, nor any forthcoming. Rehabilitation is the only method to recover movement of stroke-affected limbs.
Our research focuses on the recovery of movement after stroke. We are currently setting up a project to test the delivery of rehabilitation therapy via high speed broadband to people in regional and remote parts of Australia. We are also making detailed assessments of stroke patients before and after rehabilitation that will allow us to predict which patients will benefit most from therapy.
There are several risk factors for stroke, including high blood pressure, high cholesterol levels, obesity, having diabetes, having an irregular pulse, and having had ‘mini-strokes’ (transient ischaemic attacks) in the past. If you smoke, eat a diet high in salt and fat, or drink excessive amounts of alcohol you are considered to be at higher risk of having a stroke. Age is also a risk factor; however, about one third of stroke patients are under age 65.
A stroke occurs when the blood supply to the brain is disrupted. This can occur because the arteries supplying blood to the brain are blocked by a blood clot or by fatty deposits (plaques) that have built up on the artery walls. The blood supply can also be disrupted by a bleed in the brain.
The signs of a stroke include*:
If you or someone else is experiencing these signs, seek medical attention immediately.
*Thanks to the National Stroke Foundation for this information.
A stroke can affect movement in part or all of the arm or leg on either side of the body. Because movement, including range and dexterity, may be considerably affected, a person who has had a stroke may feel discouraged about using their stroke-affected limb. However, the only way to regain movement and function is to use the limb.
In constraint-induced movement therapy (CI), the therapist constrains the patient’s unaffected arm in a sling, forcing them to use their affected side repetitively and intensively for two weeks.
Virtual reality therapy, including the use of video gaming consoles, is increasingly being used because patients find it more fun and satisfying, which means they are better able to keep up with their treatment regime.
The McNulty Group studies changes in the motor pathway after stroke, including in the brain as well as the spinal cord, peripheral nerves, muscles and single motor units – the smallest functional units of muscle.
We not only study changes in how well people can perform activities of daily living, but how the brain and nervous system control both simple and complex movements.
We use a variety of methods, from everyday tasks to detailed neurophysiological techniques, to understand the consequences of stroke and how patients recover functional movement.
We have shown how different levels of the motor pathway are affected after stroke. The brain cannot drive the muscles on the more affected side as well as those in healthy controls and the resulting force is not as steady. This lack of control makes holding objects or carrying items difficult, particularly when patients do not have vision to help control movement.
We have also shown that when patients are distracted, their control of movement on the more affected side becomes worse. This lack of movement control is compounded by the muscle weakness that characterises movement control after stroke.
We have developed a new type of therapy using the Nintendo Wii as a rehabilitation tool after stroke. Because patients have to learn a new skill when playing these games, this results in greater improvements in brain function than strength or endurance training or the repetition of simple movements alone. The Nintendo Wii doesn’t need to be modified and we can tailor the program to each patient.
Our patients significantly improved their movement ability and the range of tasks they could perform in everyday life using their stroke-affected hand and arm after only 2 weeks of therapy. More importantly they were highly satisfied with this form of therapy.
We are making detailed neurophysiological and functional assessments of people who have had a stroke before and after therapy and then again 12 months later. In this project, we are also assessing the impact of stroke in everyday life, including evidence of fatigue and depression. These comprehensive studies are the first of their kind and will allow us to predict which patients will benefit most from rehabilitation.
We are also implementing a program of intense rehabilitation using the Nintendo Wii as a therapy tool to improve hand function after stroke. Early data have shown significant improvements in multiple facets of motor control and greater independence in activities of daily living.
Based on the success of this program, we will be testing the delivery of this type of therapy using high speed broadband to people living in regional and remote Australia.