The University of Newcastle, Australia

A biomedical engineer, a physiotherapist, an exercise scientist, a neuroscientist yogi, and a biochemical engineer work into the night in their lab. They are experimenting with novel ways to integrate body, mind, and machine. They have come from across the globe to form a master team and start a revolution.

It may sound like the stuff of science fiction, but these superheroes are real, and they are working on their PhDs right here, at the Hunter Medical Research Institute, and the University of Newcastle under the tutelage of stroke rehabilitation research leader, Professor Paulette Van Vliet.

The team members are focusing on the rehabilitation of the arm and hand following stroke, implementing interdisciplinary studies involving aerobic exercise, cognitive neuroscience, and biomechanical engineering to build on a strong foundation in physiotherapy.

In Australia, there are 50,000 acute strokes each year, making it the leading cause of long-term adult disability. Limitations on resources, geography, cost, and the complexities of studying the brain have all impacted on the scope and success of the rehabilitation of stroke sufferers.

But with the number of people living with stroke expected to almost double by 2032, patient friendly, cost effective treatments are essential to improving quality of life of stroke patients and easing demand on healthcare services.

The team believe that personalising treatments and empowering patients to practice at home may well be the key to improving recovery of upper limb use. As no one treatment will benefit all people, each of the PhD team members is approaching the recovery process from a different angle.

ARM RECOVERY WITH ArMM

Aneel KumarAneel Kumar’s thesis bridges his research career to date in Biomedical Engineering with physiotherapy through his involvement in the development of a portable, wearable device (the ArMM device).

Formerly a biomedical Design Engineer at the National University of Singapore, Aneel brings to the team a wealth of experience in every aspect of design, fabrication and testing of mechanical aides, from orthopedic prosthetics to ophthalmic biomechanics.

The ArMM project, funded by a National Health and Medical Research Council Development Grant, is investigating the efficacy of providing direct feedback to patients regarding their motor control, while they exercise.

Fitted with motion sensors at points between the wrist and hand, the ArMM device allows the recording of acceleration, velocity, and hand position in reach-to-grasp movements to the exact millisecond. Not only can patients track and attempt to improve their deficits, but therapists can also use the feedback from ArMM to draw attention to areas that may need more work.

As well as collecting data on the ArMM device’s reliability and validity, Aneel has undertaken a systematic review of the reliability and effectiveness of all sensor-based assistive technology that currently exists to aid arm recovery in stroke as a means of comparison.

CONSCIOUSNESS AND STROKE REPAIR

GabrielDuring his Bachelor (University of Florida) and Masters (Utrecht University) degrees, Gabriel Axel Montes studied different aspects of neuroscience, including the functional genetics of schizophrenia and neuronal cell culture models of language dysfunction in autism.

Hoping to use his doctoral studies to build on existing evidence that clinical patients, including neurological populations such as stroke victims, stand to benefit from yoga and meditation, Gabriel headed for a visit to the Interacting Minds Centre at Aarhus University (Denmark) to explore possible collaborations.

His time in Denmark inspired him to shift his focus however, and Gabriel is now undertaking study on the cognitive neuroscience of multisensory processing and agency in stroke survivors.

“I decided that it was more important for me as a researcher to take a step back in order to evaluate the cognitive and perceptual constructs that affect stroke recovery,” Gabriel explains.

“At a later stage, I will incorporate the mind-body aspect, as I believe that is worth exploring for its potential benefits to the stroke population.”

AGEING AND FUNCTIONAL LOSSES

The newest addition to the team is Huiqiao Tian, who comes to Newcastle after completing her Bachelor of Biochemical Engineering at Budapest University. Her undergraduate project, using liquid chromatography to analyse human blood serum, ignited an interest in brain changes.

A focus on ageing is parallel to the team’s focus on stroke rehabilitation, as loss of control and function through age can mirror the effects of stroke.

“Aging is usually associated with a decrease in sensorimotor control and functioning as well as cognitive and motor performance,” Huiqiao explains.

“So I want to determine the brain’s structural and functional changes in aged people, with a special focus on reach-to-grasp coordination.”

Huiqiao is observing this age-related difference in neural activity and motor performance during upper limb coordination through the use of Magnetic Resonance Imaging (MRI).

She hopes her contribution can inform further studies on brain pathologies; help to understand the causes of brain shrinkage and its functional losses; and contribute to physiotherapy practice by advising on the most efficacious rehabilitation treatments.

COMBINING MOTOR AND SENSORY TRAINING

Sandhya Urvashy GopaulA professional background in physiotherapy and a research interest in neurorehabilitation have brought Sandhya Urvashy Gopaul to the team via an honours degree in physiotherapy from the University of Mauritius, and a Masters degree in physio rehabilitation from the University of Nottingham in the UK.

Sandhya is looking at the effectiveness of a novel intervention that combines both motor and sensory training to improve arm function after stroke.

Although usual practice is for occupational therapists and physiotherapists to work separately, Sandhya is combining the two disciplines to explore whether a combined sensorimotor training is more likely to further improve arm function than if motor and sensory training were delivered separately.

The combined sensorimotor training aims to synchronously activate the sensory and motor networks of the brain as it would happen while doing any task in everyday life.  Online-feedback is then provided in order to maximize learning amongst stroke survivors.

“The intervention has been pre-tested on 4 stroke survivors and the results look very promising,” Sandhya enthuses.

Although still a PhD student, Sandhya has already lead a successful grant application along with her supervisor and colleagues from the School of Health Sciences. She has also secured a RHD travel scholarship to pursue an experiment in the sensorimotor control lab at the University of McGill, Canada. Most recently, Sandhya has been invited to do an oral presentation describing the novel combined sensorimotor training at the Smart Stroke Conference 2016.

EXERCISE AS MEDICINE

Sarah Valkenborghs Blending her undergraduate base in Medical Science (University of Glamorgan, UK) with exercise science and physiotherapy, Sarah Valkenborghs sees her PhD as a means to explore the efficacy of ‘exercise as medicine’.

Under Professor Van Vliet’s tutelage, along with supervisors Robin Callister and Michael Nilsson, Sarah is undertaking a feasibility study into Aerobic Exercise and Consecutive Task-specific Training for the upper limb after stroke (to be known as the AExacTT Study).

Sarah is investigating whether targeting the brain directly, with aerobic exercise done before practice of arm and hand movements, can enhance the brain’s ability to reorganise and develop new neural connections after stroke.

“We think that the aerobic benefits can enhance the brain’s ability to relearn motor skills which will then flow through to the arms,” Sarah explained.

Winning the Jennie Thomas Medical Research Travel Grant in 2015 allowed Sarah to travel to the US to work with an international collaborator, and to the UK to undertake relevant training courses, attend some conferences and meet up with more collaborators there. She has also co-authored a textbook chapter on Physical Activity after Stroke in Clinical Exercise Science with her UK collaborators.

FIGHTING FOR RECOVERY

The attraction to The University of Newcastle, and the glue that keeps the team together, is their leader, Professor Paulette Van Vliet.

Paulette explains her own focus on the rehabilitation of the upper limb following stroke grew from frustrations during her early career as a young physio in the public health system. Upper limb function was often low on the list of priorities during stroke rehabilitation.

"As therapists, we had to fight to be allowed to treat the arm for as long as we wanted,” Paulette remembers.

“The emphasis was always on getting the patient up and walking, so that they could go home. I felt I had to fight for peoples' arm recovery. "

Fast-forward to 2016, and Paulette and her team are a valued presence within the Hunter Medical Research Institute and the University of Newcastle Priority Research Centre for Stroke and Brain Injury. Paulette’s commitment to this area of research has been rewarded with several millions of dollars in funding.

BETTER TOGETHER

The interdisciplinary nature of the PhD team is reflected in their supervisory team who are themselves masters in varied fields. This spirit of diversity has created an environment where novel ideas and cross-discipline collaboration are encouraged.

“Collaboration and expansion of ideas is one of the exciting things about research. Research need not be only a solo effort; there’s a synergy that emerges when researchers break out of their silos,” asserts Gabriel.

The University of Newcastle’s Professor Michael Nilsson (neuroscience), Dr James Welsh (electrical engineering), Professor Irene Hudson (statistics), Professor Robin Callister (exercise physiology), and Dr Yolanda Surjan (radiation therapy), plus the Florey Institute’s Professor Leanne Carey join Paulette (physiotherapy) to round out an extensive multidisciplinary support and mentoring network for the team.

Huiqiao was drawn to work at HMRI due to the cutting-edge research and collaborations, which lead to funding opportunities and access to advanced laboratory equipment unmatched elsewhere.

“I feel fortunate to be part of the University of Newcastle and HMRI as a PhD student,” Aneel agrees.

“Being part of the University, the PRC and the HMRI, facilitates my research and that of the Stroke Rehabilitation Group through equipment support, infrastructure and research expertise,” Sandhya asserts.

MAKING A DIFFERENCE

Although the scientific advances of the team are a focus, none of the team members have lost sight of the original motivation for their work.

“I have a real passion for about stroke rehabilitation, and helping stroke survivors overcome resultant impairments,” Sandhya says.

“I’m grateful for the opportunity to work towards potentially positively affecting the lives of many chronically disabled stroke patients”, Gabriel echoes.

“A highlight of my research has been getting to know and work with so many lovely stroke survivors whose determination and ambition to recover has been so inspiring,” Sarah says.

With all their superpowers combined and magnified by compassion, surely a stroke rehabilitation revolution or five is coming any day now.

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