Alana B. McCambridge

Auckland University of Technology

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Lynley V. Bradnam

University of Auckland

Arianne P. Verhagen

University of Technology Sydney

Winston D. Byblow

University of Auckland

James W. Stinear

University of Auckland

Peter W. Stubbs

University of Technology Sydney

Anthony Nasser

University of Technology Sydney

Melani J. Boyce

University of Technology Sydney

Poonam Mehta

University of Technology Sydney

James W. Pate

University of Technology Sydney

Camila Quel de Oliveira

University of Sydney

Cooperative Institutions

University of Technology Sydney

University of Auckland

Auckland University of Technology

University of Sydney

University of Otago

UNSW Sydney

Victoria University of Wellington

Westmead Hospital

University of Waikato

Baylor College of Medicine

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Neck rotation modulates motor-evoked potential duration of proximal muscle cortical representations in healthy adults

Experimental Brain Research (2020)

Alana B. McCambridge Kayla Hay Kumbelin Levin Kirsty Philpott Kunal Wood

Neck muscles

Motor area

Evoked potential

10.1007/s00221-020-05887-8

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Citations (5)

Physical Activity, Sedentary Behavior, and Barriers to Exercise in People Living With Dystonia

Frontiers in Neurology (2019)

Alana B. McCambridge Rebecca M. Meiring Lynley V. Bradnam

Background: Dystonia is a neurological movement disorder that presents as sustained or intermittent involuntary muscle contractions causing abnormal postures and movements. Knowledge of dystonia is mostly at the impairment level with minimal understanding of activity and participation limitations. Physical activity (PA) is an important aspect of neurological disease management, with wide-ranging benefits for overall health and quality of life. No studies have quantified PA and sedentary behavior (SB), nor explored barriers to being physically active in people with dystonia. Methods: Participants diagnosed with any form of dystonia completed a mixed-methods anonymous online survey on activity behaviors. The International Physical Activity Questionnaire (IPAQ) and Adult Sedentary Behavior Questionnaire (SBQ) assessed self-reported PA and SB. Barriers to exercise engagement were investigated according to the five-factor social-ecological framework and dystonia-specific questions regarding the impact of exercise on symptoms were included. Results: Two-hundred and sixty-three participants consented to the study (mean (SD) age = 55 (13) years, 76% Female). A large proportion of respondents (40%) reported living with cervical dystonia (CD). Overall, the median (IQR) time spent in walking, moderate, and vigorous activity was 60 (0-120), 120 (15-300), and 0 (0-13) min/day, respectively. SB time during weekdays was 285.0 (157.5-465.0) min/day and 345.0 (195.0-502.5) min/day on weekends. Fifty-five percent of participants were dissatisfied with their current level of PA and 75% reported dystonia had decreased their level of PA. Fifty-seven percent found their symptoms were worsened during exercise though the after-effects on symptoms varied. Fatigue, motor symptoms, pain, and poor balance were commonly cited limiting factors. Qualitative and quantitative data indicated difficulties with more vigorous intensity activity. The common barriers to engagement were personal and governmental factors, such as physical impairments, lack of funding and lack of trained exercise professionals. Conclusion: While more than half of respondents indicated they were not satisfied with their current level of PA, and exercise primarily worsened their dystonia symptoms, most participants were meeting the minimum guidelines. Future studies should incorporate robust objective methods of PA and SB measurement and explore the causal mechanisms underpinning exercise-induced aggravation of dystonic symptoms to further enhance life participation of people living with dystonia.

Cervical dystonia

10.3389/fneur.2019.01121

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Citations (11)

A critical Tiriti analysis of Te Pae Tata: the Interim New Zealand Health Plan

New Zealand medical journal (2023)

Alana B. McCambridge Ngaire Rae Heather Came Leah Bain

The current health reforms in Aotearoa New Zealand are being described as "transformational". Political leaders and Crown officials maintain the reforms embed a commitment to Te Tiriti o Waitangi, address racism and promote health equity. These claims are familiar and have been used to socialise previous health sector reforms. This paper interrogates claims of engagement with Te Tiriti by undertaking a desktop critical Tiriti analysis (CTA) of Te Pae Tata: the Interim New Zealand Health Plan. CTA follows five stages from orientation, close reading, determination, strengthening practice, to the Māori final word. The determination was done individually and a consensus was negotiated from the indicators; silent, poor, fair, good, or excellent. Te Pae Tata proactively engaged with Te Tiriti across the entirety of the plan. The authors assessed Te Tiriti elements of the preamble, kāwanatanga and tino rangatiratanga as "fair", ōritetanga as "good" and wairuatanga as "poor". Engaging more substantively with Te Tiriti requires the Crown to recognise that Māori never ceded sovereignty and treaty principles are not equivalent to the authoritative Māori text. Recommendations of the Waitangi Tribunal WAI 2575 and Haumaru reports need to be explicitly addressed to allow monitoring of progress.

Treaty of Waitangi

Aotearoa

Interim

10.26635/6965.6108

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Citations (4)

Revisiting interhemispheric imbalance in chronic stroke: A tDCS study

Clinical Neurophysiology (2017)

Alana B. McCambridge James W. Stinear Winston D. Byblow

Transcranial Direct Current Stimulation

Corticospinal tract

Pyramidal tracts

Brain stimulation

Stroke

10.1016/j.clinph.2017.10.016

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Citations (55)

‘I-wave’ Recruitment Determines Response to tDCS in the Upper Limb, but Only So Far

Brain stimulation (2015)

Alana B. McCambridge James W. Stinear Winston D. Byblow

10.1016/j.brs.2015.07.027

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Citations (33)

P647: A dissociation between propriospinal facilitation and inhibition after bilateral transcranial direct current stimulation

Clinical Neurophysiology (2014)

Alana B. McCambridge WD Byblow James W. Stinear

Facilitation

Transcranial Direct Current Stimulation

10.1016/s1388-2457(14)50742-0

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Citations (1)

Attitudes towards research in graduate-entry Australian physiotherapy students: a survey

Health Education in Practice Journal of Research for Professional Learning (2024)

Peter W. Stubbs Christopher Altre Arianne P. Verhagen Nicci Bartley Alana B. McCambridge

Purpose: To assess the attitudes towards research in a two-year, graduate-entry Master of Physiotherapy course. Methodology: All students starting (T0) and ending (T1) their degrees in 2020 and 2021 were invited to complete the revised Attitudes Towards Research Questionnaire. This is a three-factor instrument with 13 statements assessing Research Usefulness (four statements, scores ranging from 4 to 28), Research Anxiety (five statements, scores ranging from 5 to 35), and Positive Research Predispositions (four statements, scores ranging from 4 to 28). Each statement was scored using a seven-item Likert scale ranging from ‘Strongly Agree’ (1) to ‘Strongly Disagree’ (7). Student responses between T1 and T0 for factor scores were compared using independent samples t-tests and summarised using mean differences (95% CIs). We defined the minimally important difference as 15% of the scale range. Findings: Ninety-seven percent (n=124/129) of students completed the survey at T0 and 57% (n=79/125) at T1. We found no difference between T0 and T1 in research anxiety (0.2 points, 95% CI: –1.5 to 2.0) and research usefulness (–0.9 points, 95% CI: –1.8 to 0.1), but a significant (although not meaningful) decrease in positive research predispositions between T0 and T1 (–1.7 points, 95% CI –3.2 to –0.2). Research implications: Qualitative research could complement these quantitative findings and provide in-depth reasons for student scores. Practical implications: Educators need more active strategies to improve attitudes and engagement in research-focused subjects to further engage students. Originality/value: This is the first study to document attitudes towards research in an Australian graduate-entry Master of Physiotherapy program. Limitations: There is likely bias (unclear in which direction) at T1 given that 57% of students completed the survey. Surveys were not linked, so group differences were assessed independently. Keywords: Evidence-based practice; research methods; Master of Physiotherapy, UTS Physiotherapy Student surveys (PHYSS) study

10.33966/hepj.7.1.18040

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A dissociation between propriospinal facilitation and inhibition after bilateral transcranial direct current stimulation

Journal of Neurophysiology (2014)

Alana B. McCambridge James W. Stinear Winston D. Byblow

Propriospinal premotoneurons (PN) are essential for accurate control of the upper limb. They receive bilateral input from premotor (PM) and primary motor (M1) cortices. In humans, excitability of PNs can be estimated from motor-evoked potentials (MEPs) by pairing a descending volley using transcranial magnetic stimulation (TMS) to summate with an ascending volley from peripheral nerve stimulation at the C 3 –C 4 level of the spinal cord. Transcranial direct current stimulation (tDCS) alters excitability of cortical and subcortical areas. A recent study demonstrated that cathodal tDCS can suppress facilitatory (FAC) and inhibitory (INH) components of PN excitability, presumably via effects on corticoreticulospinal neurons (Bradnam LV, Stinear CM, Lewis GN, Byblow WD. J Neurophysiol 103: 2382–2389, 2010). The present study investigated the effects of bilateral tDCS with healthy subjects. The cathode was placed over left dorsal PM or M1 and the anode over right M1 in separate sessions (PM-M1, M1-M1, or Sham). TMS of right M1 elicited MEPs in left biceps brachii across a range of TMS intensities chosen to examine PN-mediated FAC and INH. Conditioning was applied using median nerve stimulation with an interstimulus interval that coincided with TMS and peripheral volleys summating at the C 3 –C 4 level. All participants showed FAC at TMS intensities near active motor threshold and INH at slightly higher intensities. After tDCS, FAC was reduced for M1-M1 compared with Sham but not after PM-M1 stimulation. Contrary to an earlier study with cathodal tDCS, INH was unchanged across all sessions. The difference between these and earlier findings may relate to dual- vs. single-hemisphere M1 stimulation. M1-M1 tDCS may be a useful adjuvant to techniques that aim to reduce upper limb impairment after stroke.

Transcranial Direct Current Stimulation

Facilitation

Interstimulus interval

10.1152/jn.00879.2013

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Citations (13)

Botulinum toxin and conservative treatment strategies in people with cervical dystonia: an online survey

Journal of Neural Transmission (2023)

Melani J. Boyce Alana B. McCambridge Lynley V. Bradnam Colleen G. Canning Camila Quel de Oliveira

Abstract Isolated cervical dystonia is a focal, idiopathic dystonia affecting the neck muscles. Treatment usually consists of botulinum neurotoxin (BoNT) injections into the dystonic muscles. Our aim is to investigate the use of BoNT treatment and conservative treatments by people living with cervical dystonia. An online survey in English was conducted between June and August 2022. Participants were eligible to participate if they were living with cervical dystonia, were over 18 years old and could read and understand English. The survey consisted of demographic questions, characteristics of dystonia, questions relating to BoNT use and the perceived utility of conservative treatments. The data were analysed descriptively, and open-ended questions were grouped into similar topics represented by direct quotes. We received 128 responses from people with cervical dystonia, with an average age of 59 years and 77% women. Most participants (52%) described their cervical dystonia as mild to moderate with an average pain score of 5/10. Eighty-two (64%) participants were having regular BoNT injections, with overall positive perceived effects. Common activities reported to improve the symptoms were the use of heat packs, massage, relaxation, physiotherapy and participation in general exercise. Common coping strategies reported were getting sufficient rest, having the support of friends and family, and remaining engaged in enjoyable hobbies. We found that most participants received regular BoNT injections and that heat packs, exercise, massage, physiotherapy and relaxation were mostly perceived as effective in reducing the symptoms of cervical dystonia.

Cervical dystonia

Focal dystonia

10.1007/s00702-023-02707-5

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MPharm students’ views and experiences of the teaching of pharmaceutical calculations and their importance in pharmacy practice

International Journal of Pharmacy Practice (2024)

C. Spence Caren McHenry Martin Alana B. McCambridge Paul McCague

Abstract Introduction Accurately undertaking pharmaceutical calculations is an important professional skill as part of a pharmacist’s role ensuring patient safety1. Effective teaching in this area supports safe, high-quality care from future pharmacists. In the United Kingdom, the need to accurately perform calculations is stipulated in the General Pharmaceutical Council (GPhC) standards for initial education and training of pharmacists2. During a review of teaching in this area, the views and experiences of pharmacy students were sought, in order to inform course design. Aim This project aimed to explore undergraduate MPharm students’ views regarding the importance of pharmaceutical calculations to their future careers, experiences of current calculations teaching, and opinions on improving course design. Methods A questionnaire was developed and distributed to Years 1-4 pharmacy students (n=524) at the School of Pharmacy, Queen’s University Belfast (QUB), in December 2023. The questionnaire consisted of 45 questions, collecting demographic information, as well as students’ views and experiences of pharmaceutical calculations, various teaching methods, and student confidence with calculations. Data was transcribed into Microsoft Excel, followed by analysis using descriptive statistics in IBM SPSS. Ethical approval was received from the QUB Faculty of Medicine, Health & Life Sciences Research Ethics Committee (MHLS23_159). Results A total of 271 students responded to the questionnaire, providing a response rate of 52%. Students felt that being able to perform calculations is important to their future career, with 97% of respondents agreeing or strongly agreeing with this statement. Hospital pharmacy was considered the sector where calculations were most important (96% agree/ strongly agree). Overall, 75% of respondents agreed/ strongly agreed that they were confident in undertaking pharmaceutical calculations. Students felt most competent using provided formula, and with dose and dosage regimen calculations. Conversely, students felt least competent performing displacement value and dilutions questions. With respect to teaching design, students preferred blended-learning to self-directed study or traditional lectures. Eighty-seven percent of respondents reported blended-learning as beneficial/ very beneficial, compared to 57% and 46% for the other approaches. Students reported formative quizzes as the most beneficial activity for learning (92% beneficial/ very beneficial). This was followed by provision of worked examples, with a preference for handwritten solutions. Recommended textbooks and online discussion boards were considered least beneficial. Having dedicated introductory calculations teaching in Year 1, with repeated opportunities for practice and support in subsequent years had the most support for improving teaching, with 87% stating this would be beneficial/ very beneficial. There was also support for the NUMBAS3 e-assessment system for formative examples, along with video or pencasted worked examples, with 80% and 70% of respondents respectively classing these as beneficial/ very beneficial. Discussion / Conclusion QUB MPharm students appreciate the importance of pharmaceutical calculations to their future careers. They prefer a blended-learning approach to teaching, incorporating formative quizzes and worked examples. Dedicated Year 1 teaching, the use of NUMBAS, and pencasting were identified as methods to improve teaching. These findings will aid future course design, with the aim of improving patient safety relating to pharmaceutical calculations. References 1. General Pharmaceutical Council. Standards for pharmacy professionals. 2017. Available from: https://assets.pharmacyregulation.org/files/standards_for_pharmacy_professionals_may_2017_0.pdf?VersionId=C8dRrU1opDLdsuveSss5cKsPSwKObTi2 (date last accessed 03 Jun 2024) 2. General Pharmaceutical Council. Standards for the initial education and training of pharmacists. 2021. Available from: https://assets.pharmacyregulation.org/files/2024-01/Standards%20for%20the%20initial%20education%20and%20training%20of%20pharmacists%20January%202021%20final%20v1.4.pdf (date last accessed 24 May 2024) 3. Lawson-Perfect C, Foster W, Youd A, Graham C, Stagg G. Numbas (Version 6.2). 2022. Available from: https://github.com/numbas/Numbas/ (date last accessed 24 May 2024)

Pharmaceutical Care

10.1093/ijpp/riae058.011

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