Research participant's arm in a machine designed for motor impairment study

Motor Impairment

RESEARCH CENTRE

About

Motor impairment is evident in a range of diseases and health conditions, including:

  • stroke;
  • spinal cord injury;
  • multiple sclerosis;
  • brain injury;
  • Parkinson’s disease;
  • neuromuscular diseases;
  • major orthopaedic injury;
  • cerebral palsy; and
  • frailty associated with old age.

Motor impairment can also result from major cardiac, respiratory, and endocrine disease.

Different impairments feature in different conditions. For example, weakness is a feature of spinal cord injury, fatigue is prominent in multiple sclerosis, impaired sensation and movement commonly occurs after stroke, impaired balance develops in Parkinson’s disease, and cerebral palsy is often accompanied by contracture. Often several impairments co-exist in a single person and the prevalence of all these impairments increases with advancing age.

Motor impairment is extremely prevalent in the Australian population and is a major health problem. The reasons are threefold: it is a feature of prevalent health conditions such as stroke (in 2003, approximately 350,000 Australians experienced a stroke); the incidence within these conditions is high (half of the patients admitted to hospital with stroke develop at least one contracture within six months [1]); and these impairments often persist, typically resolving slowly or not at all.

What do we know about the mechanisms?
Motor impairment is broadly caused by:

  • peripheral problems affecting muscles;
  • problems in the central nervous system affecting output to muscles; and
  • sensory problems affecting muscles, movement and balance.

While much is known about the mechanisms of some motor impairments, such as muscle weakness in frail elderly people, little is known about others, such as the contractures in people who have had a stroke.

Similarly, while interventions for some impairments (such as exercise for impaired balance in the frail elderly) are supported by high-quality randomised controlled trials [2], interventions for other motor impairments (such as strength training for incompletely paralysed muscles) lack even a basic understanding of neurophysiological mechanisms.

Because motor impairment features in diverse health conditions as well as ageing, and because it is not a discrete diagnosis, it has not been the focus of targeted research programs. We believe that greater recognition and understanding of motor impairment can lead to better health outcomes.

References
1: Kwah LK, Harvey LA, Diong JLH & Herbert RD. (2012). Half of those who present to hospital with stroke develop at least one contracture within six months: a prospective cohort study. J Physiother 58, 41-47.
http://www.ncbi.nlm.nih.gov/pubmed/22341381

2: Sherrington C, Whitney JC, Lord SR, Herbert RD, Cumming RG & Close JCT. (2008). Effective approaches to exercise in the prevention of falls – a systematic review and meta-analysis. J Am Geriatr Soc 58, 2234-2243.
http://www.ncbi.nlm.nih.gov/pubmed/19093923

Chief Investigators

Professor Simon GANDEVIA FAA FRACP DSc MD PhD MB BS
Deputy Director, Neuroscience Research Australia (NeuRA)
NHMRC Senior Principal Research Fellow

Professor Stephen LORD DSc PhD MA
NHMRC Senior Principal Research Fellow, Neuroscience Research Australia (NeuRA)

Professor Rob HERBERT PhD MAppSc
NHMRC Principal Research Fellow, Neuroscience Research Australia (NeuRA)

Associate Professor Janet TAYLOR MD MBiomed E MB BS
NHMRC Senior Research Fellow, Neuroscience Research Australia (NeuRA)

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Abdominal muscle stimulation to improve bowel function in spinal cord injury

Bowel complications, resulting from impaired bowel function, are common for people living with a spinal cord injury (SCI). As a result, people with a SCI have high rates of bowel related illness, even compared with those with other neurological disorders. This includes high rates of abdominal pain, constipation, faecal incontinence and bloating. These problems lower the quality of life of people with a SCI and place a financial burden on the health system. A treatment that improves bowel function for people with a SCI should reduce illness, improve quality of life and lead to a large cost saving for health care providers. Bowel problems have traditionally been managed with manual and pharmacological interventions, such as digital rectal stimulation, enemas, and suppositories. These solutions are usually only partially effective, highlighting the need for improved interventions. The abdominal muscles are one of the major muscle groups used during defecation. Training the abdominal muscles should improve bowel function by increasing abdominal pressure. During our previous Abdominal FES research with people with a SCI, we observed that Abdominal FES appeared to lead to more consistent and effective bowel motion. However, this evidence remains anecdotal. As such, we are going to undertake a large randomised controlled trial to investigate the effectiveness of Abdominal FES to improve the bowel function of people with a SCI. This study will make use of a novel measurement system (SmartPill, Medtronic) that can be swallowed to measure whole gut and colonic transit time. We will also assess whether Abdominal FES can change constipation-related quality of life and the use of laxatives and manual procedures, as well as the frequency of defecation and the time taken. A positive outcome from this study is likely to lead to the rapid clinical translation of this technology for people living with a SCI.
PROJECT