Research shaping
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Specialist clinics
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The Perron Institute’s Centre for Restorative Neurology includes Restorative Neurology Research and Clinical Psychology Research.

Restorative Neurology Research

The Centre for Restorative Neurology is a new initiative focusing on research to improve functional recovery of patients after neurological illness or injury including stroke, head injury, Parkinson’s disease and multiple sclerosis. Led by Clinical Professor Soumya Ghosh, this research is multidisciplinary and uses state-of-the-art methodologies, including robotic arm therapy, balance assessment and therapy, cognitive assessment and therapy and non-invasive brain stimulation.

Research Focus

The ultimate goal of the Centre – the first of its kind in Australia – is to develop multidisciplinary programs targeted at promoting recovery and functional improvement neurological patients.

Neurological disorders are one of the leading causes of disability in Australia. In spite of advances in prevention and acute care, a large proportion of patients with cerebrovascular, inflammatory and neurodegenerative disorders are left with significant deficits.

Recovery from neural injury is thought to occur through processes of “relearning” and “neuroplasticity”, and newer techniques such as computer-assisted robotic therapy, cognitive therapy and non-invasive brain stimulation are being increasingly trialed to hasten this relearning process and improve outcomes.

The Centre is active in developing appropriate clinical trials for evaluating newer therapies and understanding mechanisms of neuroplasticity. The Centre also routinely evaluates patients for recruitment into one of these clinical trials.

Members

Achievements

GRANTS

Neurotrauma Research Programme

Augmenting Stroke Rehabilitation with Non-invasive Brain Stimulation
Ghosh S, Thickbroom G and Cooper I ($76,245).

Princess Margaret Hospital Foundation

Understanding brain maturation in premature babies: the use of the standard video EEG to study electrical activity of the brain and neonatal seizures, and predict neurodevelopmental outcomes
Nagarajan L, Ghosh S et al. ($77,000)

MS Research Australia incubator grant

Enhancing balance and gait in patients with Multiple Sclerosis – combined use of balance training (using smart balance master) with non-invasive brain Stimulation
Ghosh S et al. ($25,000)

PUBLICATIONS

  • Lakshmi Nagarajan , Ashleigh Murch, Reimar Junckerstorff, Peter Shipman, Rex Henderson, Soumya Ghosh (2015) Child with a heterozygous deletion of 2 Mb that includes the DAG 1 gene, presenting as developmental delay.  Journal of Pediatric Neurology. (In Press)

Brain Plasticity

The Perron Institute’s Brain Plasticity Research, which includes non-invasive brain stimulation, is now led by Clinical Professor Soumya Ghosh and has been in operation for 25 years.

Brain plasticity refers to the ability of the brain to modify itself in order to respond to new circumstances and to learn new behaviours. The brain has multiple mechanisms that enable it to do this. In neurological disorders, brain plasticity is one of the cardinal methods whereby the brain responds to injury or to progressively developing conditions. An example of brain plasticity is when an uninjured part of the brain takes over a function that used to be performed by a part of the brain that has sustained an injury. For example, the language centres of the brain are normally located in the left hemisphere of the brain in right-handed individuals, but after a stroke that damages that hemisphere, the right hemisphere can acquire language-processing abilities.

Non-invasive brain stimulation is used to up-regulate brain plasticity, to encourage reorganisation in the brain that could lead to some functional improvement in neurological disorders.

The main form of brain stimulation is transcranial magnetic stimulation, which uses electromagnetic induction to stimulate brain cells painlessly and non-invasively using a stimulator coil placed outside the head. The Group has developed stimulation strategies that up-regulate or down-regulate the brain activity underlying the coil, and have shown that under some circumstances, this can lead to improvement in motor performance.

Transcranial direct current stimulation is also a technique used, which passes a very low DC current through the brain that can modulate brain-firing patterns. We are currently trialing this in combination with rehabilitation robotics in stroke, as part of the Restorative Neurology program.

As well as stimulating the brain, we have also recorded function in the brain with functional magnetic resonance imaging (fMRI). This has enabled us to study motor, sensory and language systems, and is used in clinical applications for neurosurgical planning.

Current research involves combining these brain stimulation methods with state-of-the-art rehabilitation tools such as rehabilitation robotics. The institute has acquired the first MIT-MANUS robot in Australia. The device, developed at the Massachusetts Institute of Technology, is used for upper limb rehabilitation after neurological illness or injury. This device has been given Category A approval by the American Heart Association for use in stroke rehabilitation. It will enable the Perron Institute to carry out highly reproducible physical therapy in combination with defined brain stimulation protocols, to endeavour to improve function in neurological disorders.

Clinical Psychology Research

Research in clinical psychology is a developing field of importance to a range of neurological diseases. With research interests in neuroplasticity, neurorehabilitation and the use of holistic biopsychosocial individual and group therapeutic programs, Clinical Psychology Research led by Associate Professor Michelle Byrnes undertakes research on individuals with a range of neurological disorders, including stroke, spinal cord injury, multiple sclerosis and Parkinson’s disease.

Research Focus

Stroke is a leading cause of disease burden in Australia and one of the most disabling chronic medical conditions because its sequelae affect such a wide range of functions, including cognitive capabilities, mood, speech, perception, motor skills, and the capacity to carry out basic and instrumental activities of everyday living. Similarly, spinal cord injury (SCI) – a devastating condition that is most common in younger males and has lifelong implications for both the affected individual and those close to them – is associated with a range of psychosocial symptoms, including depression, anxiety and greater perceived stress. Although the loss of motor function is the most debilitating consequence of SCI, pain is the most disabling health problem precluding participation in daily and social activities. Persistent pain is reported in up to 80% of SCI patients with more than 50% rating their pain as severe or excruciating. Over 50% of people with multiple sclerosis and Parkinson’s disease have difficulty remembering, problem solving and/or paying attention. This difficulty in the way the mind works can have an overwhelming and devastating impact on the individual and their loved ones. It has been common knowledge for more than 20 years that these difficulties in memory, thinking and/or attention exist, and that they impact on the ability of an individual to live a valued and meaningful life.

Clinical Associate Professor Byrnes has developed an integrated cognitive and psychological therapy program called CogACT to assist individuals with neurological disorders experiencing difficulty with remembering, problem solving and/or paying attention. A computerised cognitive retraining program (Cogmed QM) has been specially designed to improve attention by effectively increasing the amount of information that our brain can store and the speed at which we learn this information. The level of difficulty of each training task is automatically adapted to each individual’s performance level. Each person performs the cognitive retraining program on a personal computer at home and attends weekly therapy sessions. The psychological component of the program has been proven to reduce depression, anxiety and stress in individuals with long-term medical and psychological difficulties.

Members

Achievements

GRANTS

MSWA 2016 “Enhancing the Cognitive Functioning of Adults with Multiple Sclerosis: Integrated Cognitive and Psychosocial Therapy”, A/Prof Michelle Byrnes, C/Prof Allan Kermode & Dr Jason Burton.

Neurotrauma Research Program (NRP) 2013 Effectiveness of Cognitive acceptance and commitment therapy (CogACT) for stroke survivors experiencing cognitive impairment: A novel intervention. ($97,000)

Neurotrauma Research Program (NRP) 2011 No Pain, No Gain: RCT of acceptance and commitment therapy for neurotrauma patients experiencing chronic pain. ($173,000)

Neurotrauma Research Program (NRP) 2011-2012 Cortical plasticity after spinal cord injury – measurement & modulation. ($193,184)

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