Master of Physiotherapy by Research for Prospective Students
Assessment of hand function in stroke patients using the NK Dexterity Board
Contact Person: Ms Kimberly Miller, Prof Mary Galea
The NK Hand Dexterity Test (NKHDT; NK Biotechnical Corp, Minneapolis, MN, Fig. 1) was designed to evaluate gross and fine manual dexterity in individuals with upper limb impairment. The NKHDT consists of a number of objects grouped as small, medium and large object sub-tests.
The sub-tests require participants to pick up objects from individual slots on the customised board, insert, screw and/or assemble objects in corresponding slots on the board, and then remove the objects and replace them in their original places. The sub-tests incorporate a variety of prehensile functions including grasp and release, screwing movements, precision grip, and assembly of pins and washers, thereby providing a more comprehensive appraisal of gross and fine dexterity than any other standardised manual dexterity assessments currently in use in the clinic.
Figure 1. The NK Hand Dexterity Test
Test-retest reliability of the NKHDT has been shown to be fair to excellent in people with no known upper limb impairments, as well as in stroke survivors.
We used the NKHDT as in measure of upper limb recovery in a clinical trial investigating the efficacy of the task-oriented upper limb training in the sub-acute phase following stroke. No previous studies had utilised the NKHDT in a longitudinal investigation of a clinical population where the number of elements of each sub-test completed over time might vary as the manual dexterity capabilities of the participants improved. In the clinical trial, not only did the sub-test completion times for the stroke patients change, but also the number of objects within the sub-tests that they were capable of handling (e.g. a patient might complete more objects and therefore have a longer completion than his/her previous assessment despite being capable of doing ‘more’). As result of these combined changes in performance, meaningful direct comparisons of raw sub-test completion times were not possible.
We aim to develop weighting formulae to adjust the sub-test completion times on the NKHDT for the number and types of sub-test objects executed to permit the pooled analysis of the change in dexterity performance. These formulae can be published so that researchers and clinicians will be able to use the NKHDT to accurately quantify changes in manual dexterity over time in stroke survivors and in other clinical populations.
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A tool for evaluating sensation
Contact person: Ms Kimberly Miller, Prof Mary Galea
Loss of sensation is an important factor contributing to disability in three core clinical conditions: peripheral nerve injuries, peripheral neuropathies related to diagnoses such as diabetes mellitus, and disorders of the central nervous system such as stroke. Accurate and reliable methods to quantify sensation are essential to screen for sensory impairment, and to measure changes in sensation resulting from treatment of these conditions. Most sensation screening devices require time-consuming assessment protocols that are impractical in the clinic,
Our group has devised an instrument, the AsTex®, for screening sensation of the hands and feet. The assessment protocol for the instrument is quick and simple for easy application in variety of clinical settings. We have shown that the AsTex® has high test-retest and inter-rater reliability such that it can be used to track changes in sensation over time or in response to treatment.
Pilot data has been acquired for establishing an age-based normative database for sensation screening (Fig 1). The project involves further testing of healthy adults and children, as well as in people with nervous system injury.
Figure 1. AsTex® thresholds for the index fingers of healthy adults aged from 18 to over 70 years of age.
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The use of accelerometers to measure upper limb use after stroke
Contact Person: Prof Mary Galea, Dr Chris Manzie
The most important outcome for rehabilitation is functional activity in the real-life situation. However, direct, objective, and accurate measures of arm use in the real world are currently not available. Previous attempts to use accelerometry to measure extremity movement have failed because of unacceptable variability.
We are using an accelerometer with Bluetooth wireless technology and a threshold filter to measure arm movements. The project involves the accelerometer being worn by healthy individuals while they carry out their usual activities at home. The accelerometer data will be transformed and the raw value recorded for a given epoch will be set to a constant if it exceeds a low threshold. The aim is to develop threshold-filtered recordings that measure the duration of movement accurately and with very little variability. Programming will be undertaken to permit the identification of specific types of upper limb activity, e.g. bringing food to the mouth, reaching to objects, dressing.
We plan to use threshold-filtered accelerometer recordings for objectively measuring the amount of real-world upper-extremity movement as an index of treatment outcome for stroke patients.
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A model to investigate upper limb movement using 3-D motion analysis
Contact Person: Dr Noel Lythgo, Prof Mary Galea
A 3-D model has been developed, based on recommendations by the International Shoulder Group, to measure upper limb movement. This model can be used to assess movement of any of the joints of the upper limb in a variety of conditions, including stroke.
 
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Ultrasound biofeedback in the management of incontinence after stroke
Contact Person: Prof Mary Galea, Margaret Sherburn
Urinary incontinence is one of Australia’s largest health problems. This condition can affect 40-60% of people admitted to hospital after a stroke, with 25% still having problems on hospital discharge and around 15% remaining incontinent at one year. Physiotherapy intervention, including pelvic floor exercises, has been shown to be an effective treatment for women with incontinence after stroke.
However, assessment of the pelvic floor muscles typically requires an internal (vaginal or rectal) examination, which can be distressing for many people. We have already shown that transabdominal diagnostic ultrasound is a reliable, non-invasive method of visualising action of the pelvic floor muscles in males and females. We have also shown that transabdominal ultrasound is effective as a biofeedback tool for teaching activation of the pelvic floor muscles and improving incontinence in the elderly. In this project we wish to investigate whether ultrasound biofeedback is similarly effective in stroke patients with incontinence. Evidence that this feedback is effective in stroke patients will encourage its adoption in the management of incontinence after stroke in order to improve long-term outcome.
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Clinical and laboratory-based measures of gait performance in people with Multiple Sclerosis.
Contact Person: Dr Clarissa Martin, Prof Mary Galea
Multiple sclerosis (MS) is a chronic progressive disease of the central nervous system. People with MS may experience a variety of symptoms including impaired motor control, co-ordination, sensation, vision and vestibular function, all of which may affect gait and mobility. Despite the fact that up to 85% of people with MS describe reduced mobility as their main problem, the outcome measures currently employed in the clinical management of this patient group demonstrate poor reliability and are insensitive to the changes in gait performance that inevitably accompany disease progression.
A study recently undertaken by our research group has shown that the temporal-spatial parameters of gait, including speed and stride length, provide valid, reliable, and responsive measures of gait performance in people with MS, when evaluated in the laboratory setting using sophisticated movement analysis techniques. While gait speed and stride length may be calculated using data obtained from clinical tests such as the timed 10m walk, it is currently not known whether such clinically derived measures demonstrate the same psychometric properties as the equivalent measures recorded in a laboratory setting. Therefore, in this project we plan to investigate the reliability and responsiveness of clinical measures of gait performance in people with MS, using laboratory-based measures as a comparative “gold standard”. This information may prove invaluable to physiotherapists and neurologists who seek to use psychometrically sound outcome measures in the clinical management of people with MS.
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