Prof Simon Gandevia

TEAM LEADER PROFILE

Deputy Director and Foundation Scientist, NeuRA Senior Principal Research Fellow, NHMRC
Conjoint Prof, UNSW
Honorary Prof, USyd and UQld

+612 9399 1617


Simon Gandevia (MD PhD DSc FAA FRACP) trained at the University of New South Wales and the Prince Henry Hospital. He has broad research interests in human movement control and he has used a wide range of techniques to examine fundamental aspects of pathophysiology in human neuroscience and clinical medicine. His work often sits at the interface between medicine and basic human neurophysiology.

Professor Gandevia is one of the four Founding Scientists of the Prince of Wales Medical Research Institute (in 1992), which was later renamed NeuRA. He was also a founder of the 3T Clinical Research Imaging Centre and is a Clinical Neurophysiologist at the Prince of Wales Hospital. He has served on many editorial boards, including the Journal of Physiology (1993-2000; 2011-) and is currently a Senior Editor. He is currently Associate Editor for the Journal of Applied Physiology (since 2005). His clinical work includes patients with neuromuscular disorders and those with spinal cord injury.

Projects Prof Simon Gandevia is currently involved with

CURRENT PROJECTS

Emotional breathing

Not only are the breathing muscles controlled automatically from the brainstem and motor cortex, but they can be activated in response to emotion, e.g. during laughing and crying. We plan to investigate the neural pathways involved in emotional breathing in healthy volunteers.

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Emotional breathing

Investigations into the firing behaviour of human motoneurones in health and after neurological inju

This basic science project aims to examine the behaviour of human motoneurones during sustained activation to reveal their mechanisms of recovery after activation. We will take the fundamental findings from this study and compare the behaviour of motoneurones innervating muscles affected by neurological injury such as spinal cord injury and stroke.

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Investigations into the firing behaviour of human motoneurones in health and after neurological injury

Control of coughing and expiratory muscles in spinal cord injury

Respiratory complications are the major cause of death for people with spinal cord injuries. People with a high level spinal cord injury are 150 times more likely to die from pneumonia than the general population. This is because after high level spinal cord injury, people have a reduced ability to cough and to clear secretions from the lungs. The major group of muscles that produce a cough are the abdominal muscles. If the abdominal muscles are paralysed after spinal cord injury then the strength of the cough will be severely reduced. In our lab, we are looking at ways to improve cough in people with spinal cord injury by using surface functional electrical stimulation of the abdominal muscles. We have shown that this type of stimulation can improve cough significantly. We are now looking for ways to further improve cough through muscle training as well as ways to develop a portable stimulator that would allow independent activation of a cough.

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Control of coughing and expiratory muscles in spinal cord injury

Studies of voluntary and involuntary control of human breathing

Breathing is a complex motor task that needs to be coordinated at all times while we eat, speak, exercise and even during sleep. The breathing muscles are controlled automatically from the brainstem during normal breathing but can also be controlled voluntarily from the motor cortex. The way these two drives to the breathing muscles interact is still not well understood. While there is some evidence that there are at least two independent pathways, and that integration of the pathways occurs at the spinal cord, there is some uncertainty about whether these pathways may have some interaction in the brainstem. Our current experiments are looking at voluntary and involuntary drive to the breathing muscles to try to answer this fundamental question about the neural control of breathing. In addition we are looking at the potential cortical contributions to retsing breathing in respiratory disorders.

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Studies of voluntary and involuntary control of human breathing

Control of the neural drive to human breathing muscles in health and disease

Our recent studies of the control of breathing muscles have shown a strong link between neural drive and mechanical action of the muscle. We showed that for a number of breathing muscles, the neural drive is directed to the muscles with the best mechanical effect for breathing. We termed this link between mechanics and neural drive ‘neuromechanical matching’. It is a new principle of muscle activation that allows for metabolically efficient activation of the muscles. This basic research finding is now leading to further studies in patients with respiratory disorders where muscle mechanics have changed. Chronic obstructive pulmonary disease is one such disease, where muscle mechanics are known to change. Our new studies will look at whether these patients have “adapted” to the changed muscle mechanics or whether their muscles may be activated inefficiently.

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Control of the neural drive to human breathing muscles in health and disease

The effect of respiratory muscle training on respiratory health after spinal cord injury

After cervical spinal cord injury (SCI), the respiratory muscles are partly or completely paralysed. This has two major clinical consequences: a decreased ability to get air into the lungs and a decreased ability to cough and remove secretions. This results in a lifetime of recurrent respiratory tract infections (2/year/person) that often progress to pneumonia with frequent and extended hospital admissions. People with cervical SCI are 150 times more likely to die from respiratory complications than the general population, as many as 28% die within the first year after injury. For those that survive the first year, a cervical SCI has a lifetime cost of $9.5million, a large proportion of which is attributed to respiratory-related complications. A recent longitudinal study of people with cervical SCI showed that respiratory muscle weakness is associated with incidental pneumonia. Respiratory muscle weakness also causes dyspnoea (breathlessness) and sleep-disordered breathing, which is 4-10 times more prevalent in people with SCI than the able-bodied population. Therefore, there is an urgent need to identify a simple and cost-effective treatment for respiratory muscles weakness to prevent respiratory complications after SCI, improve quality of life and reduce the burden on the healthcare system.

Our primary aim is to determine definitively the effectiveness of training on respiratory muscle strength, respiratory physiology and health outcomes. To do this we will conduct a randomised controlled trial 2 times bigger than the largest previous study, of respiratory muscle resistive load training in individuals with acute and chronic cervical SCI. The project will provide critical new knowledge about the efficacy of a simple and inexpensive respiratory muscle training regime, which can be applied immediately in the hospital and community, to minimise respiratory morbidity in people with SCI. This project also provides a unique opportunity to investigate other consequential effects of long-term respiratory muscle training that have never been studied in people with SCI. These include effects on cough efficacy, sleep-disordered breathing, breathlessness, respiratory morbidity, respiratory health and neural drive to the diaphragm, as well as quality of life.

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The effect of respiratory muscle training on respiratory health after spinal cord injury

Obstructive Sleep Apnoea Imaging

We have developed novel imaging methods to measure the stiffness and movement of the upper airway muscles, and are using these together with measures of pharyngeal sensation, and electromyography to determine the patient-specific causes of obstructive sleep apnoea. We aim to use this information to tailor treatments for patients. One such treatment is a mandibular advancement splint, but currently it’s not possible to predict who will benefit from use a splint. We have a major project that aims to predict splint treatment outcome, based on our novel imaging methods.• Honours and PhD projects are available to study the neural, biomechanical and physiological aspects of obstructive sleep apnoea, including computational modelling

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Obstructive Sleep Apnoea Imaging

NeuroSleep: A NHMRC Centre for Research Excellence

This project aims to understand the bidirectional relationship between sleep and the brain to test and develop new approaches to treatment for sleep disruption across a range of medical disorders.  

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NeuroSleep: A NHMRC Centre for Research Excellence

Defining the Causes and Developing New Treatments for People with Spinal Cord Injury and Sleep Apnoe

The prevalence of sleep apnoea in people with chronic quadriplegia is two to seven times higher than the general population. Optimal treatment approaches may also differ.

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Defining the Causes and Developing New Treatments for People with Spinal Cord Injury and Sleep Apnoea

Upper-Airway Reflexes and Muscle Control

We are conducting research to understand how important reflexes in the upper airway function to gain insight into the causes of obstructive sleep apnoea.

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Upper-Airway Reflexes and Muscle Control

Effect of Morphine on Obstructive Sleep Apnoea

The goal of this project is to investigate the effects of opioids on upper airway muscle activity, respiratory control, and breathing during sleep in patients with obstructive sleep apnoea.

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Effect of Morphine on Obstructive Sleep Apnoea

Control of the neural drive to human breathing muscles in disorders such as obstructive sleep apnoea

We are looking at how changes in muscle architecture and mechanics relate to the neural drive to the muscle and whether that relationship is maintained in people with sleep apnoea.

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Control of the neural drive to human breathing muscles in disorders such as obstructive sleep apnoea

Changing sensory input alters how cells behave in some areas of the brain

We are studying how this affects the perception of body parts and the control of movement in humans.

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Changing sensory input alters how cells behave in some areas of the brain

Control of the neural drive to human breathing muscles

Our new studies will look at whether patients with chronic obstructive pulmonary disease have “adapted” to the changed muscle mechanics or whether their muscles may be activated inefficiently.

READ MORE

Control of the neural drive to human breathing muscles

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RESEARCH TEAM

Martin Heroux

DR MARTIN HéROUX Research officer

Lewis Ingram

LEWIS INGRAM PhD student

Peter Nickolls

DR PETER NICKOLLS Honorary Senior Research Officer : +612 9399 1013

Annie Butler

DR ANNE BUTLER Research Officer

Annalese Bolton

ANNALESE BOLTON Research Assistant

Chaminda Lewis

DR CHAMINDA LEWIS PhD student

PUBLICATIONS

Comparison of measurements of medial gastrocnemius architectural parameters from ultrasound and diffusion tensor images.

Bolsterlee B, Veeger HE, van der Helm FC, Gandevia SC, Herbert RD

In vivo measurements of muscle architecture provide insight into inter-individual differences in muscle function and could be used to personalise musculoskeletal models. When muscle architecture is measured from ultrasound images, as is frequently done, it is assumed that fascicles are oriented in the image plane and, for some measurements, that the image plane is perpendicular to the aponeurosis at the intersection of fascicle and aponeurosis. This study presents an in vivo validation of these assumptions by comparing ultrasound image plane orientation to three-dimensional reconstructions of muscle fascicles and aponeuroses obtained with diffusion tensor imaging (DTI) and high-resolution anatomical MRI scans. It was found that muscle fascicles were oriented on average at 5.5±4.1° to the ultrasound image plane. On average, ultrasound yielded similar measurements of fascicle lengths to DTI (difference <3mm), suggesting that the measurements were unbiased. The absolute difference in length between any pair of measurements made with ultrasound and DTI was substantial (10mm or 20% of the mean), indicating that the measurements were imprecise. Pennation angles measured with ultrasound were significantly smaller than those measured with DTI (mean difference 6°). This difference was apparent only at the superficial insertion of the muscle fascicles so it was probably due to pressure on the skin applied by the ultrasound probes. It is concluded that ultrasound measurements of deep pennation angles and fascicle lengths in the medial gastrocnemius are unbiased but have a low precision and that superficial pennation angles are underestimated by approximately 10°. The low precision limits the use of ultrasound to personalise fascicle length in musculoskeletal models.

Neurogenic changes in the upper airway of obstructive sleep apnoea.

Saboisky JP, Butler JE, Luu BL, Gandevia SC

Obstructive sleep apnoea (OSA) is linked to local neural injury that evokes airway muscle remodelling. The upper airway muscles of patients with OSA are exposed to intermittent hypoxia as well as vibration induced by snoring. A range of electrophysiological and other studies have established altered motor and sensory function of the airway in OSA. The extent to which these changes impair upper airway muscle function and their relationship to the progression of OSA remains undefined. This review will collate the evidence for upper airway remodelling in OSA, particularly the electromyographic changes in upper airway muscles of patients with OSA.

Use of a physiological profile to document motor impairment in ageing and in clinical groups.

Lord SR, Delbaere K, Gandevia SC
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