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Dr Phu Hoang

Step training for people with MS

RESEARCH STUDY

Exercise to improve balance, stepping and thinking speed to reduce falls in MS

What is the purpose of this study?

To investigate whether a 6-month period of training using a stepping device can improve your balance, thinking skills and reduce your risk of falling.

What does the study involve?

If you are interested in this study you will be invited to one of our study sites: NeuRA in Randwick, the MS Limited Centres in Lidcombe (NSW), Canberra, Hobart or Melbourne to undertake a falls risk assessment and step performance test. This involves measuring the strength in your legs, and ability to stand still on different surfaces and walking ability. You are free to use mobility aids that you use in daily activities.

After the assessments you will be randomly allocated to one of two groups: exercise booklet or stepping exercise.

  • If you are allocated to the exercise booklet group you, will be given a series of exercises to practice for 6 months.
  • If you are allocated to the stepping exercise group, you will be provided with the smartstep computerised step training system.
  • The smartstep training system has been designed to enable you to undertake training in your own home, by playing engaging and enjoyable computer games. The system connects to a TV or computer monitor and are played with a step mat.
    Smartstep - step mat

    Smartstep – step mat

  • These games have been designed to train important balance and cognitive functions, while also being fun. You may recognise some of the games, such as Space Invaders and Tetris.
    Smartstep - computer games

    Smartstep – computer games

  • During the 6 months of the study we ask that you try play the stepping games for 120 minutes per week. You will be able to contact us at any time throughout the study if you have any questions about the system.While participating in the study, whether you are in the normal or stepping exercise group, you can continue your routine exercises such as hydrotherapy, riding bicycle, yoga, tai chi, gym, etc. You will be asked to keep a diary of falls during the 6 months of the study and 6 months after completion of the study. Following the 6-month exercise period, you will be invited to return to the study site for follow-up assessments. These assessments are identical to the assessments that you would have completed at the beginning.

Participants can also take part in 2 optional sub-studies related to the main study with the aims to a) investigate whether exercises using a stepping training system would improve sensation in the joint and muscles and muscular performance in lower limbs of people with multiple sclerosis and b) determine the relationship between sleep disruption and its consequences on balance and fall risks in people with multiple sclerosis. The study is currently recruiting people in Metropolitan Sydney, Canberra, Hobart and Melbourne.
Who can enrol?
People who have confirmed diagnosis of MS, aged 18 years and over, living in the community. To be included in the study, MS participants need to be:
• Mobile and able to walk at least 50 meters with or without mobility aid
• Able to understand and follow instructions
• Having stable MS (with or without disease modifying drugs) with no exacerbation in the past 30 days
• And currently not involved in any falls prevention programs.
Will I be reimbursed?
Your participation in the study is totally voluntary. You will be reimbursed for expenses associated with participation in the study such as travel to the study site.
Contact Information
If you have any questions, or if you are interested in participating, please feel free to contact a member of the research team:

Chief Investigators: Professor Stephen Lord, Dr Phu HoangDr Jasmine Menant, Dr Daina Sturnieks and other members of the Motor Impairment program.
UNSW HREC Approval number: 14211

Prince of Wales Hospital HREC Approval number: 14/312

See what’s going on at NeuRA

FEEL THE BUZZ IN THE AIR? US TOO.

The RESTORE Trial: Immersive Virtual Reality Treatment for Restoring Touch Perception in People with Discomplete Paraplegia

Chief Investigators: Associate Professor Sylvia Gustin, Prof James Middleton, A/Prof Zina Trost, Prof Ashley Craig, Prof Jim Elliott, Dr Negin Hesam-Shariati, Corey Shum and James Stanley While recognition of surviving pathways in complete injuries has tremendous implications for SCI rehabilitation, currently no effective treatments exist to promote or restore touch perception among those with discomplete SCI. The proposed study will address this need by developing and testing a novel intervention that can provide touch restoration via the primary source of sensory perception: the brain.Complete spinal cord injury (SCI) is associated with a complete loss of function such as mobility or sensation. In a recent discovery we revealed that 50% of people with complete SCI still have surviving somatosensory nerve fibres at the level of the spine. For those with complete SCI this is hopeful news as it means -- contrary to previous belief that communication to the brain had been severed by injury -- that the brain is still receiving messages. This new SCI type is labelled “discomplete SCI” -- a SCI person who cannot feel touch, but touch information is still forwarded from the foot to the brain. The project will use virtual reality (VR) in a way it has never been used before. We will develop the first immersive VR interface that simultaneously enhances surviving spinal somatosensory nerve fibres and touch signals in the brain in an effort to restore touch perception in people with discomplete SCI. In other words, immersive VR is being used to re-train the brain to identify the distorted signals from toe to head as sensation (touch). For example, participants will receive touch simulation in the real world (e.g., their toe) while at the same time receiving corresponding multisensory touch stimuli in the virtual world (e.g., experiencing walking up to kick a ball). This project is the first effort worldwide to restore touch sensation in 50% of individuals with complete injuries. The outcomes to be achieved from the current study will represent a cultural and scientific paradigmatic shift in terms of what can be expected from life with a spinal cord injury. In addition, the project allows potential identification of brain mechanisms that may ultimately represent direct targets for acute discomplete SCI rehabilitation, including efforts to preserve rather than restore touch perception following SCI. RESTORE consolidates the expertise of scientists, clinicians, VR developers and stakeholders from NeuRA and UNSW School of Psychology (A/Prof Sylvia Gustin, Dr Negin Hesam-Shariati), John Walsh Centre for Rehabilitation Research, Kolling Institute and University of Sydney (Prof James Middleton, Prof Ashley Craig and Prof Jim Elliott), Virginia Commonwealth University (A/Prof Zina Trost), Immersive Experience Laboratories LLC (Director Corey Shum) and James Stanley. If you are interested in being contacted about the RESTORE trial, please email A/Prof Sylvia Gustin (s.gustin@unsw.edu.au) and include your name, phone number, address, type of SCI (e.g., complete or incomplete), level of injury (e.g., T12) and duration of SCI (e.g., 5 years).
PROJECT