Dr Penelope McNulty

TEAM LEADER PROFILE

Research Fellow & Group Leader OSMR Career Development Fellow
Conjoint Lecturer, School of Medical Sciences, UNSW

+612 9399 1074

p.mcnulty@neura.edu.au

Nerve and spinal cord injury Stroke

Penelope McNulty (PhD) graduated from UNSW in 2001. After working at the University of Rochester, NY, USA on a Schmitt Fellowship she moved to the Sydney University during the first years of a NHMRC post-doctoral fellowship, before returning to NeuRA in 2007.
She studies human neurophysiology of the sensory and motor systems in healthy subjects and those with stroke and spinal cord injury including recording from single sensory receptors and stimulating single motor units. Current studies include investigations of a novel rehabilitation tool after stroke using Wii therapy, and how this changes the way the brain controls force during voluntary movement after stroke and with healthy ageing.

Projects Dr Penelope McNulty is currently involved with

CURRENT PROJECTS

The physiology of improved functional movement with Wii therapy


DR PENELOPE MCNULTY

Successful rehabilitation after stroke is limited by many factors including trained personnel, equipment, time and money.

One of the biggest impediments in rehabilitation is patient compliance and motivation. We have developed a novel rehabilitation strategy using the Nintendo Wii that is fun, cheap, and can be used in patients’ homes. This intense but flexible program can be adapted to individual patient’s needs and can be use for patients with good upper limb function and those with poor function.
Now that we know Wii therapy works, we need to understand how and why it works. This will allow us to further refine and develop Wii therapy so that more patients can benefit from post-stroke rehabilitation.

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The physiology of improved functional movement with Wii therapy

Improving rehabilitation after stroke


DR PENELOPE MCNULTY

Every year more than 60,000 Australians suffer a stroke and this number will only increase with the aging population the growing epidemics of obesity, physical inactivity and diabetes.

Because there is no cure for stroke, the only method to improve functional movement is through rehabilitation. But we need to understand how rehabilitation works, and which patients will benefit most.
We are studying patients who have weakness on one side of their body 3-12 months after a single stroke. We are comparing a new and promising strategy, Wii therapy, against the current best practice – constraint induced movement therapy in a randomised control trial.
Both therapies have been shown to improve upper limb functional movement after an intense 2 week program of rehabilitation.

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Improving rehabilitation after stroke

Changes in the properties of single receptors in the skin of the hand with healthy ageing


DR PENELOPE MCNULTY

We know that the ability to detect contact with the skin changes with age. These changes might occur in the sensory receptors that lie in the skin, in the nerves that transmit sensory signals from the receptors to the brain, in the processing of sensory signals in the brain, or in the properties of the skin itself.

We have recorded signals from the sensory receptors before they reach the spinal cord in response to stimuli of different intensities in both young and old people. This will help determine why and where sensation deteriorates with age.

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Changes in the properties of single receptors in the skin of the hand with healthy ageing

Changes in muscle drive as a function of age


DR PENELOPE MCNULTY

Measuring how well people can drive their muscle to produce maximum forces tells us a lot about the voluntary control of movement. We know that muscle strength decreases as people get older, particularly after the age of 70. Despite the loss of strength, the ability to drive muscles in maximum efforts does not deteriorate with age.

This study investigated why this might be so. It also provides normative values in healthy older people that can be used when deciding rehabilitation goals after stroke.

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Changes in muscle drive as a function of age

Changes in motor control after stroke


DR PENELOPE MCNULTY

Very little is known about the way in which the body controls voluntary movement changes after stroke, or which neurophysiological structures cause such changes.

Our series of studies will investigate how stroke patients control low-level voluntary force; how well they can drive their muscles to produce force; and how the command signal from the brain to move the body is altered in the spinal cord.
We will also study muscle and nerve function in the upper limb. we will repeat these studies after rehabilitation so that we can determine how the body works to recover functional movement and if we can identify which patients will benefit most from rehabilitation.

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Changes in motor control after stroke

Changes in motor control after spinal cord injury


DR PENELOPE MCNULTY

There are 350-400 new cases of spinal cord injury in Australia every year. These injuries cause sudden and devastating changes in patients’ ability to live independently. Surveys have shown that people living with a spinal cord injury list improved hand control second only to bladder and bowel control.

We are undertaking studies to understand how muscles change after spinal cord injury and how the voluntary control of these muscles can be improved with rehabilitation. Our goal is to increase the ability of people with a spinal cord injury to look after themselves.

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Changes in motor control after spinal cord injury

Age related sensorimotor changes in the hand


DR PENELOPE MCNULTY

Skin sensation, or the ability to detect contact on the skin, declines with age. Manual dexterity and fine motor control of the hand also decline with age.

In this study we have made an extensive survey of the sensation in the hand using multiple tools and up to 10 testing sites in people aged from 20-90. We also looked at the properties of the skin, manual dexterity and strength, all in the same group of subjects.
Although sensation has been studied before, the detailed approach of this study has shown the pattern of changes is much more complex than previously thought.

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Age related sensorimotor changes in the hand

RESEARCH TEAM

TERRY TRINH Masters student

Negin Hesam Shariati

NEGIN HESAM SHARIATI PhD student

Further information about Dr Penelope McNulty

RELATED INFORMATION

Fine motor control of the body results from a subtle yet complex integration of the motor and sensory systems. My work in human neurophysiology encompasses the control of movement and sensation, and how that control changes in able-bodied people and with healthy aging, stroke and spinal cord injury.

The major focus of my group is the neurophysiology of rehabilitation: why does rehabilitation work? where does rehabilitation work, at which specific sites in the body? how can we make rehabilitation work better for all patients regardless of the severity of their disability?

Our studies in older people investigate not only how physiology changes as we age, but it will also establish age-appropriate targets for movement rehabilitation after stroke, where few currently exist. My detailed approach employs a combination of techniques that will enable us to identify the potential for recovery in pathological conditions and suggest how we might further modify the novel rehabilitation strategies being developed in my group.

Such new approaches will provide individually tailored rehabilitation programs to maximise the restoration of functional movement after stroke and spinal cord injury.

PUBLICATIONS

Two common tests of dexterity can stratify upper limb motor function after stroke.

Thompson-Butel AG, Lin GG, Shiner CT, McNulty PA
Neurorehabil Neural Repair. 2014 Oct;28(8):788-96. doi: 24627336. Epub 2014 Mar.

This post hoc analysis examined a suite of upper limb functional assessment tools to test the hypothesis that motor function of survivors of stroke can be stratified using 2 simple tests of manual dexterity despite the heterogeneity of the population. Two simple unambiguous and objective tests of gross (BBT) and fine (grooved pegboard test) manual dexterity discriminated 3 groups of motor function ability for a heterogeneous group of patients after stroke.

Bilateral priming before wii-based movement therapy enhances upper limb rehabilitation and its retention after stroke: a case-controlled study.

Shiner CT, Byblow WD, McNulty PA
Neurorehabil Neural Repair. ;28(9):828-38. doi: 24627333. Epub 2014 Mar.

This study investigated the effect of bilateral priming before Wii-based Movement Therapy to improve rehabilitation after stroke. Bilateral priming before Wii-based Movement Therapy led to a greater magnitude and retention of improvement compared to control, especially measured with the FMA. These data suggest that bilateral priming can enhance the efficacy of Wii-based Movement Therapy, particularly for patients with low motor function after a stroke.

The efficacy of Wii-based Movement Therapy for upper limb rehabilitation in the chronic poststroke period: a randomized controlled trial.

McNulty PA, Thompson-Butel AG, Faux SG, Lin G, Katrak PH, Harris LR, Shiner CT
Int J Stroke. 2015 Dec;10(8):1253-60. doi: 26332338. Epub 2014 Sep.

This study demonstrates that Wii-based Movement Therapy is an effective upper limb rehabilitation poststroke with high patient compliance. It is as effective as modified Constraint-induced Movement Therapy for improving more affected upper limb movement and increased independence in activities of daily living.

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