Stroke and Rehabilitation Research Group

The Stroke and Rehabilitation Research group (SRR) brings together a group of highly skilled researchers working in the area of stroke care and recovery and in rehabilitation more broadly.

The purpose of our group is to foster a collaborative and supportive environment for applied, interdisciplinary research into stroke and rehabilitation.  Our research interests include stroke care, particularly as it relates to allied health interventions across the continuum of acute hospitalisation, rehabilitation care and long term health and well-being of stroke survivors.

From the wider rehabilitation perspectives we also have interest and expertise in driving and dementia, and preventing falls and fall injury.  Because of our research links, we are able to undertake translational and implementation research taking information from the neuroscience bench or the published evidence into the clinical or community setting.  We have specialist knowledge and skills in randomised controlled trials in clinical settings, neurophysiological assessments (including transcranial magnetic stimulation [TMS]]), qualitative research methods and mixed method designs.

We are a dynamic and enthusiastic team of researchers, all with strong clinical backgrounds.  We are passionate about promoting research and evidence generation in both stroke and rehabilitation more broadly, which is relevant and applied to the clinical setting.


People

Research Leaders

Assoc Prof Susan Hillier
Dr Shylie Mackintosh

Postdoctoral Fellows

Dr Coralie English 
Dr Julie Luker
Dr Michelle McDonnell
Dr Susan Thomas 

PhD Candidates

Liz Lynch 
Carolyn Murray

Masters Candidates

Simon Mills

Research Associates

Dr Angela Berndt
Dr Caroline Fryer
Prue Welsh

Honours Students

2014/2015
Marcie Parker - Sitting time, physical activity and fatigue in stroke survivors-an observational cross sectional study.

2013/2014
Laura Hundertmark - Increasing intensity of stroke inpatient rehabilitation: a survey of Australian physiotherapists’ attitudes, perceived barriers and enablers to circuit class therapy and 7-day a week therapy. 

Rebecca Thiele – Community dwellers and health professionals perspectives about falls contingency planning: A descriptive qualitative study.

Katherine Padget - What factors predict falls in clients of ASSIST Disability Services?

2012/2013
Gabrielle Brunner - Therapist-devised exercise programs conducted by family members for inpatients following an acquired brain injury: a pilot RCT.

2011/2012
Leanne Cavanagh - Stroke survivors' perspectives on two novel models of inpatient rehabilitation: seven-day a week therapy or five-day a week circuit class therapy.

Kylie Wall - Screening cognitive skills in early stroke.

2010/2011
Gurpreet Kaur - "Umm, about an hour?" How accurate are physiotherapists at estimating therapy time in rehabilitation after stroke?

Shoshanna Williams - The lived experience of occupational adaptation for people living in the community following stroke.

2009/2010
Laura Fisher - Intra-rater reliability of sonographic measures and early changes in muscle thickness in individuals hospitalised after stroke.

2008/2009
Linda Schouten - Overcoming the long term effects of stroke:  Qualitative perceptions of involvement in a group rehabilitation programme.

2007/2008
Holly McLennan - The reliability and feasibility of using ultrasound to measure skeletal muscle thickness in persons early after stroke.

2006/2007
Tony Elson - An observational analysis of activity levels during group circuit class therapy and individual physiotherapy sessions for stroke survivors receiving inpatient rehabilitation.

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Workshop

Turning up the intensity of physical  rehabilitation

How to improve outcomes for your clients by enhancing your clinical skills

Saturday 13th April and Sunday 5th May

Presenters: Coralie English and Susan Hillier

In this 2-day, practical workshop participants will learn about the ‘whys’, ‘hows’ and ‘what tos’ of implementing intensive practice for people receiving rehabilitation for motor disorders. Participants will be provided with practical strategies to increase intensity of rehabilitation and will be guided through completion of either an audit of clinical practice, or a small implementation project.  The workshop is supported by the National Stroke Foundation, and will have a focus on stroke in particular, but will be relevant to people working with clients with other neurological disabilities.

Following the success of this workshop and due to high demand, it will be offered again later in the year.
Dates TBA - to express interest or reserve a place, please contact coralie.english@unisa.edu.au

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Collaborators 

Some of our key collaborators include:

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Research Highlights 

Key projects and interests

Sitting Time AfteR Stroke.

A phase II safety and feasibility study (STARS-f) How long we sit for each day has detrimental effects on our health, regardless of the time we spend exercising.  Stroke survivors living at home in the community are among the most sedentary members of our community.  This pilot trial is investigating the safety and feasibility of an intervention to encourage stroke survivors to "sit less and move more".  This project is supported by the National Stroke Foundation Nancy and Vic Meyers Prevention Grant 2012.

 

What are the barriers to maintaining or increasing physical activity levels following stroke?

Researchers Michelle McDonnell and Shylie Mackintosh

Increased levels of physical activity has the potential to prevent disability and recurrent strokes. However, a number of issues including physical impairments may limit post-stroke exercise and recovery.  We are investigating attitudes of stroke survivors towards exercising after stroke, in an effort to identify barriers to participation in exercise in people following stroke.  This will help to guide public policy regarding the design and likely success of programs to increase physical activity following stroke.

CIRCIT trial (Circuit class therapy for Increasing Rehabilitation Intensity of Therapy. A pragmatic randomised controlled trial)

Researchers: Susan Hillier, Coralie English, Maria Crotty (Department of Rehabilitation and Aged Care, Flinders University), Leonie Segal (Health Economics and Policy Group, UniSA), Julie Bernhardt (Stroke Division, Florey Neuroscience Institutes), Adrian Esterman (Sansom Research Institute)

For people receiving rehabilitation after stroke, maximizing the amount of physical therapy they receive is vital to maximizing their functional outcomes.  But the most effective and cost-effective way of organizing therapy services to maximize patient therapy input is not known.  This exciting and novel trial is comparing different models of delivering a greater amount of physical therapy (mobility and upper limb related) to people in rehabilitation post-stroke.  These are: Usual care therapy (5 days a week), Usual care therapy provided over 7 days a week and Group circuit class therapy (up to 3 hours day, 5 days a week).  The trial is currently running at three sites in Adelaide, one in Perth and one in Melbourne.

A recently published book chapter lead by Coralie English has been released on open access publisher (see publications list for chapter details and link). 

This book chapter brings together the current evidence for circuit class therapy, and importantly where evidence is lacking.  It also discusses the theoretical underpinnings to circuit class therapy and has a great section on the practicalities of implementation.  The final table includes a comprehensive list of activities and exercises quoted in the literature.  This project was a collaborative effort with Coralie English, Liz Lynch and Ingrid van der Port.  Liz was until recently Principle Physiotherapist, Stroke Rehabilitation Unit at Hampstead Rehab Centre and is a new PhD candidate in iCAHE (Susan Hilier supervisor), and Ingrid is a fellow CCT researcher in the Netherlands.

EPIPS (Exploring Patterns of Inactivity in People after Stroke)

Researchers: Coralie English, Julie Bernhardt (Stroke Division, Florey Neuroscience Institutes), Alison Coates (Nutritional Physiology Research Centre), Tim Olds (Health and Use of Time group)

Sitting time is detrimental to our health, and stroke survivors are among the most sedentary members of society.  This observational study is using state of the art technology to objectively measure patterns of activity and sedentary time as well as energy expenditure and use-of-time in people living in the community with stroke-related disability.

Music therapy in stroke

Researchers: Susan Hillier. Leah Trotta (Hampstead Rehabilitation Centre , Susan Cameron (RAH)

Music therapy can have a positive effect on mood and mental health status.  This pilot RCT is investigating the feasibility and preliminary effectiveness of music therapy on an inpatient stroke rehabilitation ward.  Outcomes of interest are quality of life and mood indicators.

EXSTRaCOG (Exercise to improve cognition following stroke)

Researchers: Michelle McDonnell, Shylie Mackintosh, Susan Hillier, Adrian Esterman, Jon Buckley, Michael Ridding (The University of Adelaide), Robert Penhall (Centre for Physical Activity in Ageing), Bob Barnard (Centre for Physical Activity in Ageing), Janet Bryan (Psychology, UniSA)

Regular physical activity is associated with improved cognitive performance throughout the lifespan, but can it help those 66% of people following stroke who suffer from cognitive impairment?  This randomised controlled trial will investigate the potential benefits of exercise on cognition and the mechanisms involved, including vascular and neuroplastic mechanisms.

PLEX: Plasticity and Exercise

Researchers: Michelle McDonnell, Jon Buckley, Michael Ridding (The University of Adelaide), John Semmler (The University of Adelaide) 

Individuals who regularly undertake large amounts of physical activity have a greater potential for plasticity within the motor areas of the brain, but can one session confer benefits as well?  This study investigates whether a single session of aerobic exercise increases excitability and neuroplasticity in the motor cortex.  A second phase of the study will involve people following stroke to determine whether exercise can promote functionally beneficial plasticity and improve learning post-stroke.

Exploring the implementation of early rehabilitation for patients with acute stroke

Researchers: Julie Luker, Julie Bernhardt (Stroke Division, Florey Neuroscience Institutes (lead organisation))

This is a qualitative sub-study of the multi-centre AVERT Phase III trial which is investigating the effectiveness of providing intensive physical rehabilitation early after stroke onset (VEM). Interviews with the clinicians providing the VEM intervention in acute stroke units in Australia and New Zealand will explore their experience of this clinical practice change to better understand the factors that influence the provision of rehabilitation in acute settings. 

Qualitative sub-study embedded in AREISSA: Altering the Rehabilitation Environment to Improve Stroke Survivor Activity 

Researchers: Julie Luker, Julie Bernhardt (Stroke Division, Florey Neuroscience Institutes), Heidi Jansen & Neil Spratt (Stroke Research Team, Hunter Medical Research Institute (Lead organisation))

The AREISSA project is a cluster randomised Phase II trial that aims to extend our understanding of environmental enrichment (EE), to increase activity levels in stroke survivors undergoing inpatient rehabilitation. Embedded qualitative studies will explore the feasibility of EE through the experiences of stroke participants and the rehabilitation clinicians providing the EE intervention. 

Interventions to promote the uptake of evidence based knowledge in acute stroke settings (Cochrane review)

Researchers: Julie Luker, Elizabeth Lynch, Ian Graham (Ottowa Hospital Research Inst, Canada), Julie Bernhardt (Stroke Division, Florey Neuroscience Institutes), Sandy Middleton (Australian Catholic Uni, Sydney)

This systematic review will examine the effectiveness of professional interventions, directed at health care providers, on the uptake of evidence-based practices in acute stroke units. Secondary objectives are to determine factors that may influence the implementation of evidence in these environments.

Qualitative meta-synthesis: What can we learn about best-practice inpatient rehabilitation from stroke survivors?

Researchers: Julie Luker, Elizabeth Lynch, Leanne Bennett, Susanne Bernhardsson (Linköpings University, Sweden), Julie Bernhardt (Stroke Division, Florey Neuroscience Institutes)

This systematic review aims to better understand how rehabilitation settings can improve physical rehabilitation activity opportunities for stroke survivors. It will synthesise and report existing evidence on the perspectives and preferences of stroke survivors regarding physical rehabilitation or activity in inpatient settings.


Investigating implementation of the Assessment for Rehabilitation Tool (ART): PhD study

Researchers: Elizabeth Lynch, Susan Hillier, Julie Luker, Dominique Cadilhac (Monash University)

This mixed methods study is investigating how people with stroke are assessed for rehabilitation, and is evaluating effectiveness of two interventions to implement use of the Assessment for Rehabilitation Tool. Six hospitals in South Australia and 4 hospitals in New South Wales are participating in the trial.

Contact

Susan Hillier (susan.hillier@unisa.edu.au) or Shylie Mackintosh (shylie.mackintosh@unisa.edu.au)

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Contacts

Dr Shylie Makintosh Shylie.Mackintosh@unisa.edu.au

Assoc. Prof. Susan Hillier Susan.Hillier@unisa.edu.au

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Areas of study and research

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