Research Themes within the School
Enhancing Upper Limb Recovery After Stroke
Professor Paulette van Vliet and Jodie Marquez
Current rehabilitation, though it can impove outcomes, is insufficient, as 55 - 75% of stroke survivors still have functional limitations months after the infarct. Therefore, there is a need to explore how treatments can be improved.
Treatment for the upper limb following stroke is based on the presenting signs and symptoms, such as muscle weakness, abnormal muscle tone and poor neuromuscular control. As yet there is little utilisation of specific information about the anatomical location of the brain damage, and remaining intact neural tissue and networks, to target treatment to particular lesion types. As a result, most patients receive a generalized intervention common to all stroke patients. Targeting interventions more specifically to individual patients, based on anatomical information, is one way to improve interventions. Another approach is to devise new interventions based on results from laboratory based studies, progressing to explore the effect of these interventions in clinical trials.
Currently in our research group we are using a combination of neuroimaging, biomechanical and clinical measures to investigate mechanisms of recovery and treatment of coordination of the upper limb after stroke. This study is funded by an ARC Future Fellowship awarded to Professor Paulette van Vliet. We are also investigating the potential for using non-invasive cortical stimulation to enhance the effect of physiotherapy intervention for the upper limb in people with stroke. This study is being carried out as part of the doctoral program of Jodie Marquez.
Projects in this theme are carried out within the Centre for Translational Neuroscience and Mental Health at the University of Newcastle.
The group has strong international collaborations in the form of shared externally funded projects investigating visual cue training for walking and turning ability after stroke (funded by the National Institute for Health Research, UK), task specific training of reach-to-grasp at home (funded by the UK Stroke Association) and Functional Strength Training (funded by the Medical Research Council, UK).
The eOSCE: Advancing Technology to Improve Students' Learning and Assessment Reliability
Dr Suzanne Snodgrass, Professor Darren Rivett, Samantha Ashby, Associate Professor Trevor Russell
Assessment of practical skills is essential in the health fields. Objective Structured Clinical Examinations (OSCEs), where examiners assess students performing clinical techniques on simulated patients (actors), are central to the evaluation of practical skills. Traditionally, paper-based OSCEs have been used. These require considerable time-investment to administer, which restricts timely, accurate, individualised and specific student feedback. This research collaboration with the University of Queensland introduced an innovative mechanism for assessing student' practical skills in the health professions.
The 'eOSCE' provides an alternative to paper-based assessment with an electronic marking and feedback system utilising the iPad. The eOSCE is administered using an electronic marking and feedback system (via the iPad) that has specialised software for recording performance and for providing student feedback. An OLT-funded project evaluated the efficacy of the eOSCE for assessing students' practical skills and providing timely individualised feedback to pre-professinal health students. Results of the trial suggest the eOSCE is well-accepted by both students and examiners. Students use the feedback to reflect on their performance and prepare for subsequent examinations. Most examiners find the system easy to use and it reduces administrative burden. A training manual which summarises these results and explains how the system works can be found here. The research team is currently investigating whether the eOSCE is useful in clinical settings.
Best Practice Guidelines for the Nutritional Management of the Elderly
Dr Surinder Baines
Undernourishment is an important condition, which can complicate many chronic conditions associated with ageing. Undetected and untreated under-nutrition can lead to higher mortality rates and poor quality of life, and can extend length of stay in hospital and community nursing through delayed recovery, reduced wound healing, weakness, poor cognitive function, and higher risk of complications. Research has been conducted in collaboration with the Gender and Aging Priority Research Centre. The researchers have been instrumental in developing and validating tools for the identification and management of protein energy malnutrition that is secondary to chronic disease. The research has led to the development of best practice guidelines for use in residential aged care.
Clinical Reasoning Development
Professor Susan Ryan, Professor Darren Rivett
Knowledge about clinical reasoning development, taken from various perspectives, can underpin personal and professional growth, improve practice and service delivery, program and course design, and a greater understanding of interdisciplinary workings. Integrating this knowledge into other bodies of knowledge produces powerful understandings of many practice issues. Research that also combines adult learning theories, models of reflection, and, competency acquisition produces successful and improved outcomes of healthcare. National and international research studies and publications underpin the above work in both occupational therapy and physiotherapy. Current research is developing with other disciplines such as nursing, podiatry and medical radiation science within the University.
Diagnostic Dosimetry and Image Quality Assessment
Associate Professor Helen Warren-Forward, Paul Cardew, Nick Hille
Medical imaging plays an important role in the management of patients for the purposes of diagnosis, screening and guided therapeutic interventions. The ultimate aim of all medical practices is to ensure better patient outcomes. For any specific clinical problem, the questions the clinician should consider include: is the examination necessary at all and, if so, what technique will afford the best patient management in terms of accuracy and safety? This research area focuses primarily on the latter and investigates the assessment of patient doses and image quality and methods that can be used to help in the optimisation of dose.
Improvement of Diagnosis and Treatment for Women with Breast Cancer and At Risk of Breast Cancer
Associate Professor Helen Warren-Forward
One of the group's research themes is the improvement in the early diagnosis and treatment of women at risk of breast cancer and to understand the preventative risk factors and to translate this knowledge into effective strategies for the reduction in the incidence of breast cancer. This area of research has involved multiple collaborations including those involved in the International Breast Cancer Intervention Study I conducted in Australia, New Zealand, the UK and other European countries, the Department of Nuclear Medicine, Waikato Hospital and Waikato Regional Breast Screening Program, and Hunter BreastScreen.
Improving the Efficacy and Safety of Physical Treatments for Musculoskeletal Disorders of the Spine
Professor Darren Rivett, Peter Osmotherly, Sue Reid, Dr Suzanne Snodgrass and Lucy Thomas
This research focuses on understanding risk factors in the physical treatment of spinal disorders, developing effective screening procedures, and translating this knowledge into clinical guidelines. In addition, the force parameters and effectiveness of common interventions for spinal pain and other symptoms are investigated through rigorous evaluation of manual therapy and exercise treatments. This area of research has involved collaboration with the Hunter New England Area Health Service, the Australian Physiotherapy Association, the University of Otago (New Zealand), the New Zealand Society of Physiotherapists, and the Chartered Society of Physiotherapists in the United Kingdom, as well as senior researchers in New Zealand and two other Universities in Australia.
Associate Professor Pauline Chiarelli
Work in collaboration with Gender, Health and Ageing has resulted in improved continence management through the development of effective health education material and other interventions. Research to determine the prevalence and impact of incontinence, and evaluation of existing management strategies, led to the development of interventions, for example, to improve hospital intervention strategies for elderly patients admitted with hip or neck of femur fractures or stroke, and to reduce incontinence following childbirth.
Continence projects by researchers have included the re-writing of Commonwealth Government education resources, and the development of self-help materials and of clinical guidelines. Pauline's work has included the development of educational material about postpartum continence management, a book about continence for women, Waterworks.
The future direction of research is related to bladder and bowel continence promotion aimed at men undergoing radiation therapy for prostate cancer.
Occupational Health and Safety Issues Among NSW Nurses
Dr Maya Guest, Dr Carole James, Professor Darren Rivett, Dr Ashley Kable
Nurses as an occupation group face numerous occupational health and safety hazards. Often they work under highly complex and stressful conditions. In collaboration with the NSW Nurses Association, a number of ongoing separate studies are investigating various health and safety issues.
Dr Maya Guest, Dr Carole James, Professor Darren Rivett, Associate Professor Ashley Kable, Dr Suzanne Snodgrass
The rehabilitation of injured workers is an important process both for the worker and the employer. Often the process is not straight forward or successful. A number of studies are ongoing in a variety of settings to investigate various aspects of the occupational rehabilitation process.
Radiation Therapy Cancer Care
Associate Professor Helen Warren-Forward, Associate Professor Shane Dempsey and Dr Naomi Findlay
Radiation therapy is a dynamic profession associated with increasingly sophisticated technology, that is rapidly implemented into clinical practice, and that forces change to professional standards and practice, and ultimately patient treatment. The main focus of this research has been to encourage and engage the profession, and students in education, to examine emerging technology and advanced practice reforms in terms of their impact of current practice in measurable outcomes. There is on-going collaboration with the Department of Radiation Oncology, Calvary Hospital, Newcastle. Research in this area has been assisted from funding from the NSW Cancer Institute.
The Ageing Workforce
Dr Maya Guest, Dr Janine Duke, Dr May Boggess, Dr Deon Viljoen
Australia's aging population has become a national problem for a number of reasons. Included in these are the shortage of skilled workers, the adjustment of workplaces and working hours to facilitate the older worker and aspects of occupational health and safety.