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Muscle weakness is the main cause of slow walking following stroke and strength training is ‘strongly’ recommended by the recent Stroke Foundation and the US stroke guidelines. It is clear that strength training improves muscle weakness after stroke, however, to date, stronger legs have not translated to greater capacity to walk. Our team has identified why previous strength training trials have failed to improve walking speed. We have developed and tested a new ‘power’ training protocol that 1) targets the main muscle groups responsible for power generation, and 2) reflects how the muscles contract during walking (i.e. quickly or ballistically). Our pilot RCT demonstrated that power training was safe and feasible, and associated in significantly faster walking speeds. Therefore, we propose a Phase III prospective, multi-centre, randomised, single-blind trial of a 6-week program, conducted 3 times per week (a total of 18 sessions) during the sub-acute phase of rehabilitation (< 3 months) which is the optimal period for recovery from stroke. The primary outcome measure is walking speed at Week 26 so we can determine 1) is power training efficacious, and 2) if so, is it maintained.

Even the most functional children with cerebral palsy (CP) who walk unassisted show limitations of high level mobility relative to their peers. Our clinical experience has been that these children articulate self identified goals around aspects of improving their high level mobility in particular running. In clinical reality these more functional children receive fewer services as they are perceived to be able to participate in aspects of recreation and activity that require higher levels of gross motor function. In daily reality, activity and participation restriction in children with CP who are ambulant exists. There are a number of barriers that may contribute to restricted participation including poor physical capacity to undertake high level mobility tasks proficiently, in particular running. Running is the cornerstone for many individual and team sports and recreational activities, and has been reported to be a significant challenge for individuals with neuromotor dysfunction. There is evidence to suggest that children with CP have lower muscle mass, decreased muscle strength and poorer fitness. Two additional factors worth exploring is whether children have learned the motor components of running and whether they have adapted to a non active lifestyle. It may be that individuals with CP avoid or discontinue membership in sports and recreational activities that require speed and agility due to deficits in running ability. Training programs that focus on teaching the components of running skill in children with CP appear to be unreported. Training the components and skill of running in CP is important for a number of reasons. Firstly, like many determinants of motor change and acquisition of skill in CP, therapy and training to achieve the skill is required. Unlike many therapeutic interventions that address the ability to walk, therapists working with CP rarely address the components in running to the same level. Secondly, running is often identified as a goal of intervention for school aged children, particularly as many school activities are focused around running such as school fun runs, lap-a-thons, daily fitness, general sport. Thirdly, although many interventions have been shown to improve muscle strength, anaerobic and aerobic capacity and even walking capacity in CP, few have demonstrated a translation of these gains into higher level mobility and increases in community participation. We propose to run a three month running skill acquisition and training programme to determine its effect on running skill acquisition, improvement in higher level skill improvements in walking and running capacity and engagement into community programmes and participation. This is important because evidence suggests that physically inactive children are more likely to become physically inactive adults and that encouraging positive physical activity habits in children helps establish patterns that continue into adulthood. The running programme will be run through The Centre for Cerebral Palsy (TCCP) at two of their metropolitan sites. In addition to the running training, a lifestyle aspect will be incorporated into the programme. The lifestyle component will focus on strategies to enable the child or young person to adopt an active lifestyle within their family and school context. This component will include cognitive based coaching and motivational interviewing to coach strategies to practice/continue with the activity related training in the daily situation. The programme will be carried out collaboratively by therapists from TCCP and PMH. The Research Coordinator Physiotherapist from PMH was instrumental in initiating the idea of developing a running skills program, researching the ABI running program model and developing the proposal about how it may be best modified to suit children with CP. In addition PMH has physiotherapists involved in exercise lifestyle models in the obesity related programmes and the eating disorders programs. These PMH therapists have the specialised skills to guide the lifestyle intervention aspect of the proposed running model. This aspect of the intervention differs to that run by Williams and other adult facilities and is grounded in the family context of working with children and young people. It was recognized the programme is best implemented in a community based setting by community providers. Physiotherapists at TCCP have extensive experience and knowledge in community based intervention programmes and working with families in the community. The collaboration of PMH with TCCP will bring together the specialist skills of each of these service providers to benefit the formulation and application of programme.

The purpose is to investigate the value of a new mobile therapy for depression using your mobile phone or tablet compared to doing the same therapy program on a computer. We have been modifying an existing internet therapy program for adults with depression and developed a new mobile version. It comprises an illustrated story of someone recovering from depression, take home tasks to facilitate this recovery, and regular clinician advice to improve progress. A username (your email address) and password is required for you to access this mobile therapy application. This is a trial that compares two groups: People who access the course via mobile app and people who access the course via computer. All participants will begin the course at the same time, starting in May.

Traumatic brain injury (TBI) is the leading cause of death and disability amongst adolescents and young adults. The incidence of TBI in Australia is 300 per 100,000, of which 20% are classified moderate to severe. The prevalence of TBI in the community is high because of the survival rate and the demographic groups at most risk are adolescents and young adults. Although a minority of people who sustain a moderate to severe TBI can expect to make a full recovery, over 75% of victims never return to full independence and function. In contrast to the vast literature on neuropsychological impairments following TBI, surprisingly little information is known about the effect of the brain injury on gait. My recent systematic review found the key biomechanical abnormalities of gait were yet to be determined. Further, the key physical impairments contributing to mobility limitations have not been established. Several studies have suggested balance may be primarily responsible. Although balance, spasticity, contracture, muscle weakness and inco-ordination may all contribute to mobility limitations, my research has identified that balance and strength deficits are most prevalent, but the primary cause of mobility limitations was muscle weakness. Physiotherapy is routinely provided to treat the physical impairments that contribute to mobility limitations in order to optimize rehabilitation outcomes for people with TBI. Balance training and muscle strengthening programs are widely used. Strong evidence exists indicating balance training improves balance disorders and strength training improves muscle weakness in neurological populations, yet little evidence exists supporting the impact of either intervention on mobility limitations. Further, a recent international symposium on research priorities for TBI highlighted the urgent need for rehabilitative therapy research as virtually no level 1 evidence exists. The primary aim of this research program is to investigate whether ballistic strength training is more effective than usual carer for improving mobility following TBI. The research program constitutes a randomised controlled trial (RCT) comparing ballistic strength training and usual care for improving mobility following TBI.