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This project will evaluate a client-centred motor-training intervention to improve functional outcome after botulinum toxin injection (BoNT-A) for people with a neurological injury (stroke or brain injury). Spasticity is common following stroke and those with greater spasticity typically experience less recovery. Current treatment for spasticity is to provide BoNT-A, an antispasticity drug. Some evidence exists to support the use of BoNT-A, but all studies recommend that BoNT-A be provided in conjunction with physical therapy. However, little direct evidence exists for optimum type, dosage and timing of therapy. Participants will be recruited on a consecutive admission basis from hospital outpatient spasticity clinic and receive an 8-week intervention which will include intensive one-on-one physiotherapy, behavioural strategies to increase patient motivation, and a task-specific home exercise program. A distinguishing feature of the program is that it is tailored to the specific needs of each participant, patients are extended to receive intensive physiotherapy practice, and the content is driven by the Clinical Guidelines for Stroke Management (National Stroke Foundation, 2010). Outcomes will be assessed at baseline, post-intervention, and at 3 months following the conclusion of intervention and will include assessment of functional movement, quality of life, and cost.

The aim of this project is to determine whether therapy using the Nintendo Wii Fit computer game is as effective as practise of more traditional therapy activities for older people in hospital.

Loss of independence is common following stroke, and may lead to reduced quality of life. We will investigate if an increased amount of physical rehabilitation following stroke leads to improvements in walking ability, arm function and independence. Two ways of providing an increased amount of physical rehabilitation will be compared to usual care to find out which leads to improved physical mobility and how they compare economically. The key hypotheses are: 1. Compared to usual care therapy (5 days a week), group circuit class therapy (provided 5 days a week for 3 hours per day) will lead to improvements in walking function and mobility. 2. Compared to usual care therapy (5 days a week) providing physical therapy over 7 days a week will lead to improvements in walking function and mobility. 3. Compared to 7-day a week therapy, group circuit class therapy (5 days a week) will lead to improvements in walking function and mobility. 4. Group circuit class therapy will be more cost-effective than 7-day week therapy.

Shoulder pain is a common and debilitating symptom for a large number of people following a stroke. The cause of shoulder pain is usually related to several factors, including trauma, inflammation and positioning. In cases when shoulder pain is unable to be prevented, current treatment options include arm supports, physiotherapy techniques, and simple analgesic medication. It is commonly observed that shoulder pain persists or is inadequately controlled by these interventions. This research aims to study the effect of an injection that numbs the nerve (Suprascapular Nerve) that supplies pain fibres to the shoulder. The technique has previously been proven safe and effective in the treatment of shoulder pain associated with rheumatoid arthritis and degenerative shoulder conditions.

The anti-inflammatory properties of fish oil are well documented. Hip fracture is common and patients suffer significant unintentional weight and muscle loss leading to poor outcomes. An inflammatory response to the injury is a plausible mechanism for the lack of response observed in these patients when provided with best practice nutrition. This study aims to reduce the weight loss suffered by hip fracture patients by prescribing an intervention of individualised nutrition support and fish oil.

Liquid fish oil is increasingly used in the treatment of a range of inflammatory conditions, however there has not been any work conducted which investigates the acceptability of fish oil to older adults. Considering the evidence that there are numerous factors which affect taste sensitivity in the older population, it may be that fish oil acceptability differs in this group. The aim of the study is to determine the level of acceptability of fish oil to older adults and identify any differences in acceptability between patient groups.

Inflammatory markers have been found to be raised in hip fracture patients. It is plausible that fish oils will counteract production of these chemicals and reduce weight and muscle loss which is experienced in many of these patients. This study will investigate proof of this concept, feasibility of recruitment and adherence to fish oil liquid or capsules.

A comprehensive evidence based approach to transition care: 1. improves patient and carer ratings of the quality of the care transition at 3 months following admission to a residential transition care program, and 2. reduces unplanned days in hospital and residential aged care up to 12 months following study enrolment, when compared to usual care.

In any year, there are approximately 48,000 stroke events amongst Australians. Most patients will experience severe cardiovascular de-conditioning after a stroke and around 21% will experience a decline in mobility which leads to a disruption in usual functioning and may affect social reintegration. For this reason, improving physical fitness may both counteract the deficits frequently resulting from a stroke and play a role in the secondary prevention of cardiovascular disease. While recent Australian clinical guidelines for rehabilitation after stroke have recommended that programmes should include interventions to improve cardiovascular fitness, they provide no information on the components of the most effective programme. Water-based exercise is possible for patients who are non-ambulatory or have balance issues and previous studies have demonstrated high levels of adherence to water-based programmes. The study will compare higher intensity water-based exercise with gym-based exercise of similar intensity for patients within three years of their first stroke. Given the susceptibility of this patient group to functional deterioration, this trial will inform the current debate on the optimal features of programmes designed to improve function and physical fitness following stroke. The current lack of scientifically rigorous research in this area ensures that its results would have immediate application to the content of rehabilitation programmes overall. It is anticipated that the water environment will allow patients to exercise at a higher level than would have been possible on land, translating into greater improvements to function.

Decisions about admission to residential care are being made in the acute hospital and at a time of crisis due to a sudden deterioration in the older person’s ability to self-care and/or the informal care support system becoming overwhelmed. Decisions involving the transition from home to nursing home or hostel accommodation are complex due to the involvement of the patient, their next of kin or family and medical and allied health professionals. There are many factors that contribute to the decision to move and the importance of these factors may differ for each person. This study seeks to explore the issues and tensions around movement into residential care and identify the key factors in the decision, from the perspective of older people admitted to the RGH and their carers. This will be achieved through short, semi-structured interviews with patients, carers and ward staff.